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RCC.3 (4~73)
APPLICATION FOR CHARITABLE EXEMPTION
FROM PENNSYLVANIA TRANSFER INHERITANCE TAX
(Act of Moy 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 opproval
of an exemption from Pennsylvonia Transfer
Inheritance Tax on the transfer of the property
described below:
1. Bureau File# at-rJJ"- 'fof
2. Date of Death July 18, 1978
3. Date of Approval ~Q/L fI/ {9 t'Jr
4. Name of Decedent Lula Grace Varner
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 500.00
(Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value af
the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift
or bequest represents a stoted 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 a;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTH ER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME Messiah United Methodist Church
ADDRESS Shippensburg, Pennsylvania
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 Applicant 7~ /~
Harry Varner
Address of Applicant 121 West King Street
Shippenshurg, Penn"yl1Tallia 17257
Official Title Executor. Estate of Lull) (:;rl)l'e V",'Y'TlP" Date March 2, 1979
This form must be completed In triplicate and all three copies delivered to the Register of Wills for the County in which the decedent
resided, or in which letters were issued for a non_resident decedent's estate. If the decedent was a non-resident of Pennsylvania and
letters were not issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of County Collections,
Penna. Department of Revenue, 26 S. 4th Street, Horrisburg, Po.
Do not write below this line. For Official Use Onl
APPROVED: For the Secretary of Revenue REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denied* 0
(Signature of Register of Wil
RfC Jj.\RD I!. ANDERSllll
JH~~I<::Trfl n1: Will'
cu'~e~\fWMOUri1t
"nan ~ /~ '71
(Date of Approval)
(Initials of Register of Wills)
(Authorized Signature)
(County)
(Title)
(Date of Referral)
(Date of Action)
* See reverse side for reasons
MUST BE FILED IN TRIPLICATE
This section will be campi eted by Bureau Headquarters only when the application for exemption 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.