HomeMy WebLinkAbout01-03-79 (2)
RCC..3 (4-73)
APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of May 28, 1956, P.L. 1757, and Act of June 15,1961,
P.L. 373, as amended)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Application is hereby filed for the approval
of an exemption from Pennsylvania Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau Fi Ie #
;( /.... ,., J - ~ ~ 0
2. Date of Death ~:~-8-
3. Date of Approval -l1~~\D I 3._
J9 7 {
4. Name of Decedent
.TnHa B. Rebuck
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 4nn nn
(Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of
the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift
or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases
enter such fractional or percentage amount above).
6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless
such material has been previously filed.
WILL ff/;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME
Grace united Church of Christ of Shippensburq
ADDRESS Corner of Qranqe and prince streets, Shippensburg, pennsylvania 17257
o See listing on reverse side for additional charitable organizations covered.
8. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct.
Signature of Appl icant
() ~ )l.QJ~,d-r
~~. B.p\..H~~
Address of Applicant
R. D i3. Shiooensburg. pennsylvania 17257
Official Title
Executors
Date December 15, 1978
This farm must be completed in triplicate and all three copies delivered to the Register of Wills far the County in which the decedent
resided, or in which letters were iSlued for a non_resident decedent's estate. If the decedent was a non_resident of Pennsylvania and
letters were not issued by 0 Pennsylvania Register of Wills, deliver 011 three copies to the Director, BureaU of County Collections,
Penna. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po.
00 not write below this line. For Official Use Onl
APPROVED: For the Secretary of Revenue
REFER RED to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denied* 0
(Signature of Register of Wi
~ICH^RO 'I!. Al'IDmtGll
ReGiSTER OF WILLS
"-nl1\J~U \;uu,rUr;
(c..~
!'lAy
(Date of A roval) I
(Initials of Register of Wills)
(Authori zed Si gnature)
(County)
(Title)
(9?f
(Date of Referral)
(Date of Action)
* See reverse side for reasons
MUST BE FILED IN TRIPLICATE
lication for exem tion has been denied.
Date:
The application for exemption contained on the face of this form has been denied because
Note: Any party in interest, including the Commonwealth, aggrieved by this action may within sixty (60) days after
the date of this notice exercise their rights of Protest, Notice, or Appeal in accordance with the provisions of applicable
Pennsylvania Inheritance and Estate Tax Acts.
-:; ~ .