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Estate! of (/J '~L ,. I( .!
a/so known as
PETITION I-OH PHOnATE IInd C,HANT OJ.' LETI'EHS
)1 J b.,.uJ._ No, ____OIJ_-=-gto - q Il
_. _______,__ To:
,_,______ _,~_ Register of \~I~S ,for lite
. [)"c'l'a,H'd, County of , ...../,~ -"-in lite
Socio/5<'curily No, dt'~_t" oS !..Ld!....,___ COll1l11onweallh of Pennsylvania
Tlte petilion of the undersigned ecspeelfully represents lhat:
Your pelilioner(s), who is/arc IH years of age or older anlhe exeeUIb'L'
In Ihe lasl will of tlte above decedenl, dated _ JllL Y 8.
and codicil(s) dated .1JIr1
named
,19.JllL
(\I<ue rclevanl ciU:llm\lanCC\, t.~. rr:nundatioll, dr:alh of e\r:,utor, tiC.)
Decendelll was domiciled al dealh in (!" "" ILd {" ~,,L. Counly, Pennsylvania, wilh
It I " , last family or principal residence ~l "///L .'.L t.f' .t.1 <-- /.ru U ^- J.: ,<" N 4)
hie 'II/filled ,/<, 1'".. ".i!J.~1 I. I ~c" (.(;5,.'t,-",')"') ,
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(Ii\1 metl, number ami Olundpalil)')
Decendenl,lhen ff .5 years of age, died
at '<hI. IlL tt' '" L.__ /(.(~L'-TIc., J.l \..(."",~'-
Except as follows, decedelll didnolll1arry, was nol divorced and did not have a child born oe ado pled
after execulion of the will offeeed for pcobale; was netlhe viclim of a killing and was never adjudiealed
incompelent: ~/fl
Decendent al death owned propeclY wilh eslimaled values as follows:
(If domiciled In Pa,) All personal properlY
(If nol domiciled in Pa,) Peesonal peoperlY in Pennsylvania
(If not domiciled In Pa,) Personal properlY in County
Value of real eslale in Pennsvlvania
siluaeed as follows: 1// i/
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,19 'h.
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WHEREFORE, pelilioner(s) respeclfully request(s) the probate of the lase will and codicil(s)
per<ellled herewilh and the geant of lellers /'.: ,. "" k I., hf
tl~stamCnl3r)'; fdmini\lraliol1 c.t,a.; administration d.b,n.c.l.a.)
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OATH OF PEHSONAL HEPHESENTATIVE
COMMONWEALTH OF I'ENNSYLVANIA 1 ..
COUNTY OF CUMBERLAND J :::;>;
The petilioner(s) above.named sweae(,) or affinll(s) Ihallhe slatements inlhe foregoing petilion arc
Irue and eorrecl 10 Ihe besl of the knowledge and belief of petilioner(s) andlhat as personal represen'
tative(s) of Ihe above decedenl pelilioner(s) will well aodlruly adminisler lhe estate accocding to law,
Swom to or affie"}1'~ and subscribed ~ ;G~, /: -,- ..,.... _:: ~;4"> ,-........".... '"
before me lhis ct.ay of ,/ ~'
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No. 71-90-911
Estute of
AURALlA M LEWI S
, I>eceused
I>ECREE 01: PRonATE ANI> GRANT OF LETTERS
AND NO"V NOVEMBER 11, 19 96, '," r I ' ,
, __. III con"uecatton 0 t Ie pellllon on
Ihe rever'e ,ide heceor. s;lIi,raelury pcoor having been IICesenled herore lIIe.
IT IS DECREED Ihal the inSlrulllenl(s) dmed JUL Y 8, 1988
de,eribed therein be adlllilled to pcobale and riled or cecord as Ihe la,,: will or
AURALlA M LEWIS
TESTAMENTARY
RICHARD J LEWIS
and Lellers
arc hereby grnnled to
7}Jt1^<S( ~;.{)w~o r~ (JmC'/:tfJ a...,.
...... Regi\lcr of WiII\ ' tJ(f
MARY C. LEWIS
FEES
Probate, Lellers. Etc. """." $
Short Certilicate'(~) ,,',""" $
Renunciation """',',""" $
X-Pages $ 6 .00
JCP 5.00
TOTAL _ $ 7n nn
Filed .., ..~OY,~~6~R. n., ,m,6,........,
'i0.00
9.00
^ nClKNH (Sup, Ct. I.D, No,)
ADIlKESS
PHONE
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Mailed letters and order to Executor on 11-13-9~.
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3879918
NCl-f u;, 1996
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COllllONWEALTH OF PENNSYLVANIA' OEPARTllENT OF HEALTH' VITAL RECOROS
CERTIFICATE OF DEATH
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I, Female 1,204 - 03 - 1721
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L Novenber 2 1996
Jan 3,13 Steelton Pa
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a.mberland
C<.... oca.m>o
..:::=:.'=' ':::.J:r
Clerk De t of Trans
~'YAUClADONlIlSnIl~""lWeo:s.!
1700 Market Street
Cat;:1 Hill, Pa 170 II
Hill
Manorcare Health Services
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Richard J. Lewis
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fartuni.. Biasi
915 West faxcroft Drive
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Cam Ilill
lCll'QSI'OIlllOH
Wlnr\o.,,__,
o , Noverrber 5, 1996
Oflf'lNClilACTNlAlIUCtI UClkKHUUeU'l
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Resurrection Cerretery
I'WII AHa ADOAl.. Of" MClUh
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UCIHK HUt4lA
Harrisburg, Pa
903 net S
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a. Edio D. L.~wiH, Jr. - an unrlivirlo!d ow.-third
(11 l/n);
b. Hicharrl J. 1,.~wiH - an undivirl,,!rl on.!-thirr!
(11 1/1~);
c. Donald l'iHh.!r, St"v'!Il l'iHI\O,!r, and Cath'~rin'~
r.aflp,_,r - an undivirl.'rl on.~-third (11 1/1'1.) '~ach.
ITEM 4. I nominatu and appoint EDIO D. LEWIS as
Ex.,cutor of thifl my Last Wi 11. Should th', i-:x.'rutor nam..d fail
to qualify or c'~os" to act as Ex'~cutor, th'~n I appoint RICHARD
J. LEWIS as Exucutor in his stead.
ITEM 5. I dir'~ct that my perflonal r'~pres<:lntatives,
as w<:lll as their succeflsors, shall not be required to give bond
for the faithful performance of their duties in any jurifldiction.
ITEM 6. 1 dir.~ct that all '~state, succession, legacy,
inheri tance or oth'~r transfer taX'~fl, how,~v'~r designated that
sha 11 becom<:l payable by reaflon of my rI',ath in reRpect of all
prop'~rty comprising my groRs '~stat.~ for d'~ath tax pUrpOR<:lS,
whether or not Ruch prop'~rty paRses under this Last Will, Rhall
be pairl by my Ex'~cutor out of my r'~Rirluary '~Rtat.~.
ITEM 7. I grant to my personal representative h<:lrein
namerl in addition to, but not in limitation of those powers veRted
by law, to be exerciserl without prior application to or approval
of any court, the pow<:lr and authority to retain ind'~finitely
any property, to inveRt and reinv'~st any aSS<:ltR or th.~ proceerls
derived from the sale of assets, although sairl investments may
not be of th'~ charact'~r prescribed by law, to Rell, convey,
assign, transfer, and encumber any property, to pay, RettIe,
or compromisc all claims, to make rliRtribution or diviRions in
cash or in kind, anrl in gcneral to exercise all powers in the
manag'~ment of any prop(~rty h"r'!unrl'~r which any inrlivirlua 1
could .~xercise in th'~ managr,m"nt of similar prop',rty owned in
hiR own right, anrl to ,~x.'cut,~ and rI",liv"r any anrl all inRtrum'~nts
and to rlo all actR which may b'~ rI.,'~m,~rI n.,cr,~ssary and proper.
, '
{ (, l'lll,l\.d ) ),.
AURALlA M. LEWIS
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CO""CN\.mAI:I'1I OF I'ENNSYI,VANIA
f ; ~ :
COUN'l'V or CUMIlElU lIND
I, AUIlJ\I,lh M. I,I::WIS , 'I'I':::'I'J\'IT!IX, ~:ly,:'" !i,l"" t" ''1'1,'''d
to the attad1ed 'lr f~lr,xpi"'ll""t.nll\""t., 11i1vill'lI>"'!i duly '1"..1l11'''d
aecxJrding I'D law, eh hereby ilc~.lnwl"d'J" 1.I>i1t: I l:iqll.'<I i)'ld "X,o"l1v<I Ill"
inRtrunnnt nfl my lJlS'I' WII.I,; I.h.]t I ,dq!i','d it. wi \ I illqly; dnd 111;'1. I i'tql:"ll
it aR my free <1I~l \f.lllJlltary ",;1: f'lr t.h" pm!, ,"" Ib<'I"in ":1.1'1"'1''''''1.
SW:lllt or ilfrLrn,;d ID .1IId ,lCklflWkd'I,'d Iy,r,>l'" ",~, by I\UHALIlL.
M. 1,EWIS
, the'IT:S'I'N1'IlIX, Lhis _~.::,~_ day 'If__.Jlj}2'________, l'lIlO,
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W"::hillli';,'burq, PAl
~ly C:'>ll11ni""i'l!l 1':Xpir';',: 4/) 5/91
The precedillg i.r,slXUl\"lcllL cnllsistillq ')f t.\1I" n!l<l L~'" 12) ,,1.11"1:
typewritten pages, idelltified by the Si'lllo1LIJl" '>1' 1:1,(' 'I'I':S'I'A'I'HIX, Wil': '111
the date therrYlf siglled, publishcd olld 0""1aro,<I by AUIlALIA M. LEWIS
the TFSTATIUX thereill lIonncJ os illld hr he,!: IJl5'1' WII,!. NIl) 1'1:"S'I'fI/olI::N'I'.
\,.
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JAMES M. BJ\CII
I
Residing at 352 S. Sfnrtillq lIill RJad
r+~Chillli<;sbu!:g, 1'1\ 17055
7f4'()~ l=l~' Q,;f"
PAULA D. POTTEIGER '
R<'~si.ding al: 352 S. S[:nrting lIill R:Jao
Mr:chanicsburg, 1'1\ 17055
A I' riD A V 1 'I'
CCJMt.ONWEI\I,TIt OF PENNSVI.VlINI A
ss
COUNTY OF CUMBERIAND
We, JAMFS M. BACH and PAULA D. POTTEIGER the witnesses WlYlSr.
nares are signed tD the attached or forecping instrunnnt, being duly
qualified acalrding tD law, eID dep:lflr. and say that we were present and
saw TFSTATRIX sign and executr. the instrunnnt as her IJlST WT)'I.; that sh"
signed willingly and that she r.xecutr.d it as her fre" and IT.llunt.ary a':t
for the purp:lse therein exprr.ssed; that each nf us ill the 11'~ari!:g a!',d sight
of the TFSTATRIX signed the W1I,1, as wi.t.llesses; ar:d tha!: I~l tl1e' oos!: ')f ~'ur
krt)Wledge the TESTA'l'RI X wos at the tin., 10 '>r ffiJrC y"arlC '.11' a<J", 'Jf l"J\J[;d
mind and und"r !n ennstrain!: 'll: undue inflll',ri':'"
Svnrn nr affirllrd tn and subscrily'd tfl lY,r'lr" 1\"1: by ,Jrll-ll:~'; r,l.
BACH and
PAULA D. POTTEIGER
8th
day "r
Wi.trlCf:S(~S ,
this
July
1~ B~
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NO'I'ARY PUBI,I(~
W,d1aL ksburg, ,I'
~'y '-:',mnlSS1'11l 1':Xpi 1:,",":
4/1 5/91
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CERTIFICATION OF NO'l'IeE 1l1l~!!_"'llJL~; 5. 6lJ!1
Name of Decedent: ;/u...-!r!'-IA II/. L EuJt S
Date of Death: 11-;),-</ t:..
W1.'ll N ~ <'>
O. I i";', ,en III
Admin, llo,
To the RegisLer:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the orphans' COlJrt Rules was served on or mailed to
the following beneficiaries of the above-capLioned estate on
:
~
Address
I0cJUIAb J. La..)i.5 ,sf!. 9/~-U.1 Fox.cfl.o F1 DtI., (i"nll) /-(", :?,q /70 I I
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tA..Io LCt.Ji 5 ~, ), II u..J~ ,r ,k' '..' (('...y
7)o,v,t.fl-:D ~,.she4. "lo:;J. 1~""!.H',rICN1 1<., t.,TITz.,
r ~ ' ,
('..n,I'''-'''''' en"""''' "/.~ /.J,/Icl,Fr-7)1o! :)I,,-<'h",LI"C~~<lII.{.., 1'.4 17oS'S-
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,sr.'v(,cJ r-,5h....~ ;j';;;)') J)115~,~,.J t-,>raTf~ 'D,.z" ~1.:"',T"',lJ 7X,77{)S.3
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Date: 1/ ,.}.) ,')10
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ignature
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Name A I (: flr;(' d (,T l.c tP IJ
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Address ?I,~ I~~ ;:&,rc/C ~ I....;;~~
('/r.'" ~ I/' f t i::~, I 7c /
7C..'5 '7cllf.5 '
Telephone (7,i')
Capacity: v Personal Representative
counsel for personai
representaLive
STA'I:.lJS Jl~XQ~l':!:_J!~!)ER_-B-UJ'~; 6. 12
Name of Decedent:~uf'4 J. 119 /P~ L/3' w / J'
Date of Death: tV,j t/L-.:L-L2.1t'
Will No,
LI- 'fl..
Admin, llo.
'ill
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administraLion of the a~ove-captioned esLate:
1. State wheLhcr administration of the estate is complete:
Yes~ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. I is Yes, state the foilowing:
a, Did the personal representative file a final
account with the Court? yes_____ No,~
b, The sepal'il t e Oq)hilns' C"lI rt No. (i f any) for
the personal representative's accollnt is:
c, Did t,he personal representative state an
account informally to the parties in interpst? Yes'')o(. No
d, Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
"
Date:
r;'-( J -ij
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LA
19na Lure I
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llame (Please type or print)
9/,5--!p hyc,l('c;'r/ v/?
Address
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(7/11 ? tf .f ;?..:7 C/J-
Tel, No,
Capacity: ~personal Representative
Counsel for personal
representative
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(MAH: rmf /J\M3)
COMMONWEAL'" OF PENNSYlVANIA
DEPAIHMWT or IlEVENUE
BUREAU OF INDIVIDUAL TAXES
otPT 280601
HARRISBURG. pA 17128.0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
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NO.AA211411 "LV".''''''''''
RECEIVED FROM:
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ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
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RICHARD J LEWIS sn
915 WEST FOXCROFT DR
CAMP HILL, PA 17011
101
",5 11
fOlDH[JlE -
fOlD HlIll
ESTATE INFORMATION:
FilE NUMBER
" I - 1 Q.2bd)!ll1 SSlILZ0I=03=-l..2Z 1
NAME or DECEDENT ILAST) (FIRST)
_LEW.lS-IIUEllU-UI M
DAlE or PAYMENT
i-.~/cn
POSTMARK DATE
Olnnlnn
COUN1Y
IMII
TOTAL AMOUNT PAID
sS.ll
--'--cUl'lBERLAr,m
DAlE or DEATH
-l-.LO
REMARKS R I CHARD J LEW I S SR
SEAL CHECK II 113
~ ~ I I .,' ~ '. \' ~ I
RECEIVED BV Whfi.. t. \ , ,
MArlY c. "WIS .5.J{:,./A..J~.I'-.J
REGISTER OF WILLS ~
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COMMONWIA1II401 ,'NW"HV..."IA
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Dr" 110601
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OlUOltl \ ",1."'1 11,1.\ IUt. "'II) M!Orlll lPilltAU
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fOA OATIS Of DIATH Ann 12/31/91 CHICK HIAI
If A SPOUSAL
POVIATY CAlDIT IS CLAIMID IJ
.~ "---.------- ---------.
fill NUMIIA
:!J%-u~ll
COUNty CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
NUMBE~
llICllllt,l.,tOI,ll'tllI Allll'l\\
J~2~ :;(~l)t('~i~X..!r
(':<11111' lIilL, PI,
Ilt-iv"
17Ull-:,\J63
II 2
CO""'( Ctu:UlerLlIld
. "I,IOUfl(I(Cll'o'lO-ISlIltISlltuClIOHSI
-~- - - - -- ------.-
[J J, Remainder Relurn
(lor dole. of dealh prior to 12.13.821
[15. Federal Eltole Tall Relurn Required
5upplemenlul Relurn
bel ,. Original R.turn
[] 4. Limited Ellate [] 40. Fulure Inlerllll Camp rami III
l'ar datel 01 dllalh alter 12.12.82)
[] 6. Detedenl Died Tellale [] 7. Dlltedenl Moinlained 0 living TrUll
IAllath tOpy 01 Will) IAuath tOpy 01 Trull}
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOI
t~AMf COM'lfTlI,II....lllNG ADO'f!)~
Rich;:rrd J. J..c\'lis ___ ~15 Fm:croft Drive ,
""'HO..' "UMI!' CiJJi1[J lIill, P,\ 17011-lU4~
[717 763-~2r.5
. ':- 8. TOlol Number ~r~ole Deposit Ball..
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1. R.al Ella.e (S,hedute AI
2, Sla,h and Band. IS,hedule B)
3. Closely Hold Stotk/Parlnenhip Interest (Schedule C)
4. Mortgages and Noles Retoivable 15thedule 01
5. COlh, Bonk Deposils & MistellaneouI Penonal Properly
(S,hedule EI
6. Joinlly Owned Properly (5thedule FI
7, Tranlie" (S,hedule 0) (S,hedule LI
8. T alai Gran Anel' (lolelline' 1.71
9. Funeral E.pensel, Adminhtrolive Cas", Minellaneous
Expenuu (5thedule H)
10, Debll. Morlgoge liabilities, lie", (5thedule II
11. Tolal Deductions Ilotallino, 9 & 101
12. Net Value of Ellole (line 8 minu. line 11)
1 J. Charitable and Governmenlol Beque'" 15thedule J)
( 11 ,_, _~n
(2)_,U7,046.!.l4 ,~~~~~-.--
(31~~'n_____ ,--------
(J) _~__ ___n~n______ ,__
(5I,_3.1,59!.l.;i.'L.-----
(61-,----
171 ____u__ -
(B I .J,2l,646.4U ___
(ql___9,2IG.17_u_
(to) _______,______'___
~_276.17
112, 370.31
(11)
(121
(131
(U)
112,370.31
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IA. Net Value Subjetllo Toll. (line 12 minus line 13)
15. Spousol Transfeu (for dalos of dealh cher 6-30.94)
See '",tructions for Ar,plicoble Pertenloge on Revene
Side. (Include value. rom Schedule K or 5thedule M.}
16. Amount 01 line 14 IOlloblo at 6% rote
(Include yolue. from Schedule K or Schedule M.)
17. Amount olUne 14 taxable 01 15% role
Ilndude value I from Sthedule K or Sthedule M.)
18. Prindpol tax due (Add tall from lines IS, 16 and 17.)
19. Credils Spousal Poverty Credil Prior Paymenll
______ + ~,'lOO~_ +
(lql
(20)
115)
~_____~________.~_x._=
1161______________~_,__" ,06 = ~L742.22
(171________,___" ,15 =
In Ie rest
(1BI __6.,,242.2:1
6,737.11
Distount
337.11
20. II line 19 is greater than line 18. enler Ihe differente on line 20. Thi. is the OVERPAYMENT.
Ii! 0
Check horo if you oro roquesting a rolund of your ovorpaymonl.
(2t)
(21AI
(2IB)
5.11
21. 11 line 18 is greater than line 19, enler Ihe differente on linll 21. This i. the TAX DUE.
A. Enler Ihe interesl on the balance due on line 21 A.
B. Enler Ihe lotol 01 line 21 and 21A on line 218. This is the BALANCE DUE.
Mah Check Payabll to: Rlgllter of Willi, Aglnt
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON AEVERSE SIDE AND TO RECHECK MATH -c:-c:
lInder penalties of perjury. I dedare Ihol I hove ellamined this relurn. induding attomponying sthedules and ,lolements. and 10 the bell 01 my knowledge and belief,
I is Irue. corretl and complete. I dedore Ihal 011 real eslole has belln reporled at true markel valulI. Oedaration 01 preporer olhllr Ihan the personal reprelenlative is
bo..d. till information of whith prepa r has any knowledge.
\1~UR(O'P~NRU'O~l\l.~j GRllURN.... DDIlI!lS DAn /. C' .~...
fJ..,! bt'(c:(:.~ , ~,"" 15J:Q;,cJ.:ol..L.DnY>.l.,_<":"1l\4J Iii] L, p:, 17ll] ] -] g.19- f/ - /,- / ?
JiGifAIURE 0' PRlPAll(ll OlHl III UfNIAlIVl ADDIlU!l DAn
IIV,1l0)"'IU.'
~1~9.
.ff1tf
COMMOHW.AWt Of 'WU'Yl~AUIA
IHllIln"'U(f IA..llOlH
l"IOIUI 1Jt( 1111 141
iiTAl. 'O~",''''~~ ''''''o.'';,.'
SCHEDULE B
STOCKS AND BONDS
.'_.FIU(NUMBER'C''-
^lll'lIl1a II. 1l,Jl./iu ;!l96-U~l1
--_._.,_.~~--,. .-. -~-_..__._",. .~----_._~-- _.- ,,-"~.-.- ._~-"------'-'-.-_.--------'- ---- -,-,---,---
tAUpl!!'!~'.v,I..,I~..!!t..~..nld~~h..!l,I..th! ., Su'..I.."~!P mu~~~~..c1......d .~ Sch.dul. !~
IlEM
NUMaER DESCRIPTION
VALUE AT DATE
OF DEATH
\,
4UU ::h.1fUU \.l 23.UO
UtiI Corporation C:U~IP ~02GU(j 9,227.61
2.
11 J:.j Bond 1'\1ncl
^cct. No. 0011-2489-J1313-5 77,UI9.JJ
TOTAL (Also enter on Iino 2. Recopilulation)
(II more space is needod, insert additional sheeh of same size,)
S 87,046.94
.
U'\ll$OIII+ 12-111
-Ij\'J\t:9C\
~
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Prlnl or T~ e
FILE NUMBER
2196-0911
COMMONWEALfH Of PENNnLVANIA.
INH(lnANCI fAX .nUIN
IUIDINT DlcrDINr
ESTATE OF
Aura1ia M. Lewis
(All prop.rtv lolntlv.owned with the Right of Survlvonhlp mutt b. dl.do..d on Schedule '1
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
P.N.C. Bank
Savings Acct. U513010663l
3,491.46
2.
P.N.C. Bank
Qlecking Acct. U5140381266
l'/estern National Life
Annunity #BA036786
Oppenheimer Strategic Fund B
Acct. #231-2312152898
6,984.08
3.
15,000.00
4.
7,123.98
5.
Personal items - Clothing & Furniture
Given A\~ay
.00
TOTAL (Also enler on line 5, Reea ilulatian) S
34 599.54
(Alloch odditionoISY," x 11" iheets if more 'POCI is needed,)
"'tUIlII. Jl"l
,,~1,~9~
-'1'~jlJ"
UlMMQl4WI Atltt Of rrW"UYlYANIA
IWIUltAmr tAl IflulI'4
_UlIlI fH ell n OUB
ilYAlro.,-
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
3, Family Exemption
Claimant
Address of Claimanl at decedent's death
stroel Address
City
ITEM
NUMBER
A,
1.
8,
I.
2,
4,
C.
I.
2,
3,
4,
5,
6,
7,
8,
9.
Pl.... Prinl arTypo
FILE NUMBER
2196-0911
6,1l61.00
1\1I1'i11Ia 1\. l.lJwin
DESCRIPTION
Fun.,al Exp.nulI
1'lyurn-lIarnur Funoral llano, IlIc.
1')03 llilrkot :Jt., Camp 11111, PA 17011
! Admlnlllratlv. Call..
Personal Roprosentative Commissions
Social Security Number of Personal Roprosentative:
Yoar Commissions paid
Attoilillj<-.:looFccs
Relationship
State
Zip Code
Probata Fees Hc<.Jister of mlls - Cumbcrloml County
Mlscellaneoul Exp.nl8l1
Grove DigginS! - Diocese or IInrrisburg
Knights of Columbus - Reception
Bell Telephone
Clunber1and ApotJtecilI)'
l'lilnor Care
Postage
The Potriot News COII~Jill1Y
'l'clephone
Incane 'faxes Fed
e
TOTAL (Also enter an line 9, Recapitulation)
(II mar. Ipac. II needed, Inlert addlllanallheeh of lame Ilze.)
175.00
73.00
500.00
660.88
13.31
90.58
527.00
19.20
95.20
20.00
~OL_
S 9,276.17
I(Y.I)1) lit tU1j
J'J~:91'
--~
COMMONWf"ltH 01 ,rlm~ll\."tlI"
IHHlln...NCI'..... IIIUIH
InlOIHIOICIDIHI
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21%-0!.l1l
ESTATE OF
Auralia 1-1. LeHin
-~-_._----~- ._-,--- ---
. --~._----- - --.-.----
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
:3on 33 1/2 II
Son 33 l/2 %
Grandson 11\\
Grandson 11%
A. Taxable Deque,":
1. Hichard J. WHis
915 Foxcroft IJr., Cillllp Hill, Ph 17011
2. &Jio D. LeI/is, Jr.
141 WillO\~ ct., Cleveland, GA 3052U
3. Donald Fishcr
702 ROSGlont Dr., Lititz, PA l7543
4. stcven Fisher
11222 l-lission Estnten Dr.,
Houston, TeY~s 770U3-5376
5.
Cathcrinc Cas[JCr
913 \'llllc1iff Dr., llcch., Ph 17055
Granddaughter
11%
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmenlal Beques":
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aho enter on line 13, Recopilulotion) S
(If more spac. Is n..d,d, insert addltlonalsh.ets af sam. sill)
II(V I~OOr.. I!V"I
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I lOA OA11501 OIAIHAnlA 12/31191 CttlCK HIAl
1/ A SPOUSAL I
POVIAlY CAlOIlIS ClAIMIO I I
/lU NUMIIA
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(OMMONWUlltt Of p(Nu!.nVAt~IA
O(PA"TM(tH Of A(V(UU(
DfPT now!
HARAI~I_l!.~~G,_~A:,,1 ~l ?B_ObO I
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
2196-0911
COUNty CODE
YEAR
NUM8ER
lHCIt)t,.! \ COMPUII AOOIU!.
3525 September Drivo
Camp 11111, PA 17011-5063
OlClO(ut!. t'AMI IIA!.l. fll!.t. MfO MIOOII l'mlAl1
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Lewis Auralia M.
'0(1A;~~~~~~;;;-1-~ -- - __n r'~!:~~~~6 _ _ r~~:~;:'13 -
I" ...,<."" """"" "DUll' ".., ,,," '''' ..". ':'~:'~'~_Joc:_:~~~,"M'I~_u
XX 1. Original Return Lj 2. Supplemental Re!urn
o 4. limited E'tale [] 40. Fulure Intere,' Compromi,e
Ifar dole' of deolh alter 12.12.82}
06. Decedenl Died Teslate 0 7. Decedenl Mainlained 0 living Tru,1
(Allach copy of Willi IAlloch copy of Tru't)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOl
NAME COMPLEtE MAIlING AOOIl[!l!l
,CO."t~~''''-''''iC'',ji''T--'
[] 3. Remainder Return
lfor dotes of death prior 10 12.13.82)
rJ 5. Federal Estole Toll, Return Required
_ 8. Talal Number 01 Safe Depolit Baus
Richard J. Lewis
915 Foxcroft Drive
Camp Hill, PA 17011-1849
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1, Real Ellale (Schedule A)
2. SIoch and BondI (Schedule B)
3. Clolely Held Slack/Partnership Inleresl (Schedule q
4. Marlgages ond Notes Receivable ISchedule 01
5. Cash, Bonk Depasih & Miscellaneous Personal Property
(Schedule EI
6. Jointly Owned Properly (Schedl'le F)
7, T,an,fe.. (Schedute G) (Schedule l)
8. Tolal Gran Anets (total lines 1.7)
9. Funeral Expenses, Administralive Co"s, Miscellaneou,
Expenses ISchedule H)
10. Debts, Mortgage Liabilities, Lien, (Schedule I)
11. Total Deductions (tolollines 9 & 10)
12. Nel Value of E,tate (line 8 minus line 111
13. Charilable and Governmental Bequesh (Schedule J)
14. Net Value Subject to Tall, (line 12 minus line 13)
(1)____
(21 9,227.61
(31
(4 )
(5 ) __19,529..54
(6)
(7) --92,819.33
IQI_~,276.17
(10) .00
181
121,646.48
(II) 9,276.17
(12) 112,370.31
(13)
(141 112,370.31
(15) x._=
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IS. Spousal Tran,fers (for dotes of dealh after 6.30.94)
See Instructions for Ar,plicoble Percentage on Revene
Side. (Include volues rom Schedule K or Schedule M.)
16. Amounl of Line 14 lall,oble at 6% rate
(Include values from Schedule K ar Schedule M.)
17. Amaunt of line 14 tallable at 15% role
(Include value, from Schedule K or Schedule M.I
18. Principal tOll, due (Add 10K from lines 15. 16 and 17.)
19. Credih Spousol Poverty Credit Prior Payments
____~ + ~,~JlO.Q(;L +_
(lQ)
120)
(l61___112,370.3Ln____" ,06 = __~, 742.22
(l71..__._______..____,___x ,15 =
Inlere,1
(10) __Ei_,H2._22
6,737.11
Discount
337.11
20. If line 19 is greater than line 18, enler the difference on Line 20. This is Ihe OVERPAYMENT.
ao
Check hero if you are requesting a r.fund of your overpayment.
5.11
(211
(2tA)
(2t8)
21. If line 18 i, greater Ihon line 19, enter Ihe difference on line 21. Thi, is Ihe TAX DUE.
A. Enter Ihe inlerest on Ihe balance due on lino 21A.
B. Enter Ihe lotal of line 21 and 21A on line 218. Th;, is the BALANCE DUE.
Malee Check Payable to: Regllter of \y1lI1, Agent
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Under penaltie, af perjury. I declare that I hove e...omlned Ihl' relurn. Including accamponYlng "hodule, and ,'olements, and to Ihe be,' of my knowledge and belief,
II i, true, correct and complete I declare that 011 real ostolo ho, been reported at true market value Declaration of prepaUlr olher Ihan Ihe per~1 rep",e,ali~s-,
baled on all infor lion of which preparer ha, any kno*dge . / - -L_I_--LJ
!l'G~AtUJtlO'P%DNJt(!lPO~!tjNG~f,~/- 0'- --- -- ~ ~ ----'7- - --- --- ----- ------ fiA:ff:-;-7- -
~cC..:"""'_ _~~_...:_ '/ ..//../<-~*--t. _ ____ - -2..t..- f'?
SIGNAtUJtf 'P (PAI("OtHfltH...,~"(PII!.('lTAtIV( ~~_. r DAH
.
I' ~ "ll fl' I'"
ES"rATE OF
I Ploa.o Print or Typo
~, FllfNUMDER
121.96-091lm~
~'\'~) ~n
I'!.,\..,'
. f!.""
COM""otlW( AI1I4 01 '(NN~H"AH!A
IWHAIIAH(( lAX A(lIJAN
.1~llHul OE((OlNI
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
--__._~_ ___.__H_,. _____________. _ ... ...._____
Auralia M. Lewis
-----.------r. .
ITEM I
NUMBER
DESCRIPTION
A, Funorol Expon.o"
B,
2,
1.
1.
Myers-llarner Funeral !lane, Inc.
1903 Market street, CaIrp Hill, PA 17011
i Admlni'lrotivo Co.ls:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid _____~._..___
Attorney Fees
legal Fees
3, Family exemption
4,
C.
1.
2,
3.
4,
5,
6,
7,
8,
ll.
Claimant
Addro" of Claimant 01 decedent'. death
Rolatianship
Streot Addre"
Cily
Stato _,_ Zip Code
Probate Feos
Register of Wills - Cumberland County
MI.cellaneou. Expen.es:
Grave Digging - Diocese of Harrisburg
Knights of Columbus - Reception
Bell Telephone
CUlrberland Apothecary
Manor Care
Postage
'ltIe Patriot News Canpany
Telephone
,~,Fedaral-and state, ~__ ~~_
TOTAL (Also ontor on lino 9, Recapitulation)
(If maro .pace I. needod, In.orl additional .h.." of .amo 1110.)
AMOUNT
6,861.00
175.00
73.00
500.00
660.88
13.31
90.58
527.00
19.20
95.20
20.00
~O--
S 9,276.17
" .
11\1 !)I)f.. tllff
ESTATE OF
ITEM
NUMBER
1.
2.
3.
4.
5.
ITEM
NUMBER
1.
J:'~l"~(\
-.m;.!
(O......Otrft!.llu(l. """\'1""""''''
INHUUANCI 'AI tllUIN
'"IOINIDICIOIN'
SCHEDULE J
BENEFICIARIES
Auralia M. LeWis
NAME AND ADDRESS OF BENEfiCIARY
A. Ta.able Bequcnh:
Richard J. LeWis
915 Foxcroft Dr., Camp Hill, PA 17011
El:Uo D. LeWis, Jr.
l41 Willow ct., ClevelaOO, GA 30528
rxma1d Fisher
702 RoseIront Dr., Lititz, PA 17543
steven Fisher
8222 MissionEstates Drive
HOuston, Texas 77063-5376
Catherine Casper
913 Wi11cliff Drive, Mech., PA 17055
NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Beque'h:
FILE NUMBER
2196-0911
___ .___m~____~____.___
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
Son
33-1/2 %
Son
33-1/2 %
Grandson
11%
Grandson
11%
Granddaughter
11%
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAI.o enler on I;.e 13, RecopHulo.;on) S
IIf mar. space is needed, insert additional shilts of same sill)
\.
6
COMMONWEALTH Of PENNSYLVANIA
COUNTY Of CUMBERLAND
i
f
IS:
llichard J. l.ewin
bolng duly s~lOrn according to law, doposos end seys that ho _ l1icharu J. 1.<)\,/i;L, --, -
Executor of tho Estato of Aurulia II. 1..:.'Win
leto of -..JS,S,. :;.cl)tOlJlbccDr., ,Ca:lIlL lIiU"J'I)___, Cumborland County, Pa., decoolOd end that the
within is an invontory mado by llicllLlnl J. & Ec.lio 0. lJ::!\'/i;;_~r~__, tha soid Executors
of the entiro estete of seid docodent, consisting of ell tho personel propdrty end r.al osteto, exc.pt rool ostalo outside
tho Commonwoelth of Pennsylvanie, and that tho flguros opposita oach itam of tho Invontory roprosont it's fair valuo
u of tho dalo of docodont's doath,
"
j ttJtJRtJ end subscrlbod boforo mo,
~'d! &. i, ~ql
':4ti _J,r~_
L OT^.":', or.,!.
FR/.I -: J. ~' ',' r .,1-";: :,\:
H"'IISllU,, I, : II'I! I OUI '
My Colllnol>".-O EX.llP" ..Jr., 5, J(i1
-.-.-..--......-... -.,.
Ca:.!!l.) Hill, PA 17011-1849
Add,oll
Date of Death
02
Ooy
110vell1!Jcr
Month
199G
Yur
INSTRUCTIONS
I. An inventory must be fll.d within three months after eppointment of personel representetive.
2. A supplement inventory must be filed within thirty deys of discovery of edditional ellets,
3. Additionel sheets may be etteched as to personelty or realty
4. See Article IV, Fiduciaries Act of 1949.
~
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en W 0 -< '... i- -<
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j
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
(:
~~l\~~
Ilt,.l~
BUREAU OF INDIVIDUAL TAXES
INII[N1UHCl tAlt DiViSION
DlP'. :aDbOI
IlAARISlURG, 51' 1I1l1"ObOl
NDTlCE or INIIERI1 ANCE 1 AX
APPRAISEHENT. ALLOWANCE OR DISAlLOWANCl
OF DEDUCTIONS AND ASSESSHEN1 OF TAX
t",a.' II ". III'"
RICHARD J LEWIS
915 FOXCROFT DR
CAMP HILL PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-29-91
LEWIS
11-02'96
21 96,0911
CUMBERLAUD
101
AURALl A
M
\~_,~_~.."~unt~~!,t toll.
MAKE CHECK PAYABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAUD CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiEV:i54'rEX-AFP-fo;F9:;T"NoYiCE--oTYtiHERii'ANCE-YAx-jiPPRjiisEHENT-,--ALLowANCE-oli-------m-------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEWIS AURALlA M FILE NO. 21 96-0911 ACN 101 DATE 09-29-97
TAX RETURN WAS: ( I ACCEPTED AS FILED
( XI CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGIUAL AND SUPPLEMENTAL
1. R..I Estat. (Schedule A) 11)
2. stocks and Bonds (Schedule 81 (2)
3. Closely Hald stock/Partnership Intarast (Schedule C) (31
4. Mortgages/Note. Raceivable {Schedule OJ (4)
S. Cash/Bank Deposits/Hlsc. Parsonal Property (Schedule E) 15)
6. Jointly Owned Property (Schedule F) 1&)
7. Tranlfers (Schedule G) (7)
8. Total Assets
RETURU NO, 01
.00 HOTE: To insure prop."
9 .227.61 cradit to your account,
.00 sub..it tha uppar portion
.00 of this for.. with your
19 ,599,54 tax poyftont,
,00
92.819,33
181 121.646,48
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ad... Costs/Hisc. Expansas (Schedule H) (9)
10. Dabts/Hortgage Liabilities/liens (Schedule I) (10)
11. Total Daductions
12. Net Valua of Tax Raturn
13. Charitabla/Govern..antal aequests (Schadula J)
14. Nat Value of Estata Subject to Tax
9.276,17
,00
(Ill
lIZI
lI31
lI41
Q.?7;; 17
112.370,31
,00
112.370,31
If an assessment was issued previouslY, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rat. 11S)
16. A.ount of Lina 14 taxable at Lineal/Cles5 A rate 1161
17. Amount of Lina 14 taxabla at Collataral/Class a rata (17)
18. PrincIpal tax Dua
NOTE:
,00 X ,00=
112,370,31 X ,06=
,00 X ,15=
lIBI
,00
6.742,22
,00
6.742,22
TAX CREDITS:
PAYHENT
DATE
01-23-97
06-13-97
DISCOUNT 1+1
INTEREST/PEN PAID ('I
336.84
,00
AHOUNT PAID
6.400,00
5,11
RECEIPT
NUHBER
AA185107
AA211411
TOTAL TAX CREDIT
BALANCE OF TAX DUEi
INTEREST AND PEN.
TOTAL DUE
6.741.95
,27
,00
,27
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
( IF TOTAL DUE IS LESS THAN Ii. NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS,)
_.......--~....... .
ltfV~.lOul.....i
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVtDUAL TAXES
DEPT,280001
HARRISBURG PA '1128.000'
DECEDENrS NAME
FILE NUMBER
2196'()911
101
Auralla M. Lewis
ACN
REVIEWED BY
Donna Tobias
SCHEDULE ITEM
NO,
EXPLANATION OF CHANGES
Combined original and supplemental returns.
o
'_..:,.1
ROW
Page 1