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RCC-314-73)'
APPLlCA nON FOR CHARIT ABL E 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)
COMMONWEAL TH 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 File #
~. ,.' f.-~"'-.r
,y/-//- ,
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2. Date of Death
October 1,~78
a>f"30,l l?r,?
3. Da te of Approva I
4. Name of Decedent Dessie E. Skell
100fll
5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ /{fJ..S r ~C{L-
(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 percenta~ 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 0.;
DEED 0;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHER 0;
(If other, explain)
7. Correct Business Name and Address of Charitable Organization receiving property:
NAME
Visiting Nurses' Association
ADDRESS c/o Carlisle Hospital, Carlisle, Pa. 17013
[X] See listing on reverse side for additional charitable organizations covered.
8. I certify that the information contained her ' ~in to the best,of fY knowledge and belief, true and correct.
Signature of Appl icant r'SZi--"-n [/ L ~ ~<
G. Irvin Van Scyoc, E cutor
Estate of Dessie E. Skelly
Address of Applicant c/O John H. Brouios, Esquire
4 North Hanover Street
Carlisle, Pa. 17013
Official Title Executor Date
/1- .J. ~ - '/ ~
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, Harrisburg, Pa.
Do not write below this line - For Official Use Only
APPROVED: For the Secretary of Revenue REFERRED to Bureau Headquarters
Approved 0
For Secretary of Revenue
Denled* 0
,~
(Initials of Register of Wills)
(Authorized Signature)
(County)
(Title)
(Date of Referral)
(Date of Action)
* See reverse side for reasons
MUST BE FILED IN TRIPt.ttA Tf
~~~
This section will be compl 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.
2. The First Lutheran Church
Carlisle, Pa. 17013
1/ ~ J/fi,01
'/
3. Carlisle Hospital
Carlisle, Pa. 17013
~ ~j iff 1', () 7
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