HomeMy WebLinkAbout97-00938
,I ;':,, I ,,:, ;'11,1 '''' ) ",:::'j! iI','l ,:lllf['1
, ' "(.t~~7..!l:l1l 'I, I, 'i "I ,: !' I'" i: ,: I "', I'
11\:' ' !"'. . I' :! ,i! 'Iii ,_!: ,I' ! II d!: ;I! I I' ,I' i ,I,
! ~ ! i .1' 'I,ll d : I ,11< " ! : ' I,: i : , : ': I I' ! I ~ i ,I I i I Iii i" "I' ',' II;' i,l' 1,1 i I:" ", J I
:",', '11"i,,,, '1'1 I,'!; ,,'I
" ' 'I;'" I, "" , , ,
, I I ' I ~ ' ; 'I ! II ! I' Ii; , : I , ' , " ' " , : Ii II :, , : I,! ii' 1 1 'I', ' ; I I! 'II I ; , ; I :: :"
,; : - i 1\ : I ,.': : I Il':: I I! ,I I : I I, ! I , ' , I! i I I ~ : ,I i-I ': i, ! I I : \ i i_I j I: I,
. I ' I ,: F' I I I 11 . I ; , I ii' I " ; Ii, I ',I, ' ! ' , ' ! 'I' I' ; , ; ~ I i I ! I I " " i'l
,I' ,dl,j " , 'I Ii' - Iii' "_ " 11_ ,I: I! i I I 'I,
1 ' ' ! II I : I ,: ! I I, 'II i Iii: ',I I ',I 1 r:1 1 I I, i' I, " - - " III! ; : I j i " I ~: , , i' , !!::
:: :1:: :11, lili::I.'I', ":;:1" ,I 1'1:; 1'1'. ':,: ,I;:'::: I:!! 1'1:;: ;::::'1,"111 ii'
'! "I' I I :1,' III: I, il,: :', I';: '" ,,: :1111111 III' I' ;11'
'Idl. ,dil:l: i i i III ,J!I I !:I:' ,! Ii !ii!I,: j! ,":, ','I ,,"Ii, 1,)",11':":11: ~I"I 1,,1,' III I ;,',',','"
1111, !!! 'Ii!, '11-, i; _i' !, II 'iii ii' ",_ _, _ _ _
:d I,':: 1'1' III I" i " , : I:, ',:1 'I' :'11 i 11,,11 f! I) II,:
Ii', '! ':,'1:: 'I' :I! ; ":1 ", ' 'I,: 'i "I,:' :"1,1:1:11111 Iii':
! 1 I ; I ': i 'I 1 III : I ,I :: I 'I' ''': ' , " 'I:"" : I , ~ , ' I' !' i, III I, I I I : I ; I i
ill" 'I "'1'1 ,,", "1, I' , "", I", ," "", , , I' ,I, 1'1, II! I II I i
ijlll:II:::' iil: !!II:::;'C;! ;::'::, 1',11 :::: 1'1: li:':':I::::', ":11':::1 :~:: ::' "I:'::.':' '11:11, !111:lii:II::'illli:i: il: i/!I
i i:i,: i : ;!II: ':1' : 11:1 :!~ '>1 ,I:! :::i 1;:::\':11, ;:,' Iii!: 'i': 'II I: .1 ',': :';1 I T::lllllil,III'" I', 1'1 i ,11',I!1 ,I: ;1
'I' !: III ! I ',I II ' II i,' , ; ; , " , 'I ': I !" I ! I ! II r III II' ,I I! I' , i I I F I! I I) : l", i-I _ I ~ ' : Iii' 'i i I !! I !
I III I" III 'I ' '1111, I ~ I! ;! 'i ' I : ' , , , ! I' I' ",' , 'II' : ! 'II "" I' ,: i I : ! III 'II' 'I! I II: I:: I ' , I 'III [III I: I
I !,! i I i I 'I ii, II I: : ~ ,I ' i , , ' ' i i :,,' !' I, ! I" I , i' I ! I I ,: 'I I : , I ;I ill, I I I : ! I I I I " I, I ", I
I 1'1' I ' '1'1" I""""':' , ,,' 'I' "1'" I, III I' I' , "" .,: I "111',' ,,>, I i II:!:I I, I :~ I I:: I I,: I', II";"
"II 'I! III! I,I I'WI: III', ,: .' 11,1 I" II:, ,II,: 1 ! i ,III :I:III':II'!!:I: 1'111 I II; .... I" IIIII'II';.!
lil;i!'II'I'III'" "II' I,; "I 11""1 i 'II'! I' !','I 'I" ' ': "1" ,I" 1111"1' ,"I I I' 1'1 '111"; 'I' ,
' I : I : II : ' 1I11 ' I Ii' ,III I ' :: i ! I ~ I II' , ,I ~ I ,I I ! : I 1'1 I L ii' ,I ,I 'I , I ~ II i I I: I:: Ii!, I !, 1,1", 'I I, 'III ; I,
1111" "111'" I" 'III i,:' ',," 'I I "I ':' :11:111'1" 'I 11'1" '" "', "1'111 'II'
II' '1:1',;;1 ,1,li, :11' ':il ill;i :": I, I :,' , , ;, ' 'I " "I il: ',I' I" 1111, ,i III ii' 1'1 :'! I I! I' I,: I,' 'II: ,Ii,
,,;I,!: ! :I:I:'! :;, I 1'1 "II' 'I "" II I ,"II: III, ' ,':' 'I II '",::f 'I 'I ,I" Iii I: I "1'1"1
!;I:i:i!~ ,! li!ll! ! ! !: : liI::1 ....:! \i:?:' 11:11 I,,'!, :11 . 1:1: ::: I : !III',i ! :;1 I:; :liI11111:! \ I,' ':1 '!: II::, i
' I ! I" : I I' ", I I , I " , I, ' !",,' : ~ 1 I II :, I ,I : I I ' ! ' I I I ' : I II ,,' 'I : . ! III" I I 'I ' 1111 I : II : I . , I ! Ii I :
111111 : 'Ii Iii 'I ! I' 'I ! ; i ': I " :' ,I I' , I ;, ' ii' :, I " "':' II 1 ~ 'Ii I I ! i I I ," 11111, "II "I'
111'11 ii", ,I, I' I"~ ,I' I"" II'" 1'1 'I II, :"'1 ',II' "I' ,i II'" 'I ;'11'" I " , I'll'
I !'i I:', II" i, '1'1 ,:'; 1"'1'" I':"~ ; ': I ;::, "I ': 'I',',! ;','11, 'i"1 'II " " 11111' 'I' '" " ,I II'
I ' 'I II'" i' !' "I ' , I, 'I " ,'" ~"', :",' ,I I"~ I', " '" ','I':' "I "1:' I"',,, I " I " " , ' ' I, 'I" 'I I,: I"", I Ii, : : ,I : " ' "I '
, ,! , ,j , 'I'" I" , : ,I, '~ I Ii' I " :, :,' I , '" 'I' I I , I
! 111'1' , !iI' "Ii I h 'I:' 'I,'II,~ :1". : 'I!I'IJI.I ,,!" '11.1'1 !'I'I'I !,I I' ':' :,'11,11' I ,: "'I: Ii ",
! 1;,1,1'1: I:, :1: I: '1"": ..',,', 'I 1,,1 " "I" II I' Iii '" 1 111'111 " I :,i 1'1 ,I'
I,!;! :!:,I:: I' il,!, il i!II'> '';II:\)::;i,{ ;:1:; ::':,,:! I:;: III ;:1;1: i 1::1: 1:11 Ili'.'11 ~IIII' 1" I", I \ I II~, II"
I Ii:' I!'lilll:: III!IIII" i 1.111 II"" ,I 'I"'!";' , ':1' 11,1 'I ',I I ",1'1 I ,'11"11'11'1' I 1"1' II'" I'
Illl i I j I ' 'i , I : 'I'" I' i I' , " ': I " , ",'" ',' , , " !' II " I I I :" :: ,', I' ", I 'I' '\- _ ! I ~ I,! i _ : I I ' , I "
l'd'!111 .:1' I::, II: :1,1':1' ", I, ,:', ,!:I: I ',I' Ii: I! !;,;'I' 'I I,. II! '11'1:11'11' ':,; ,
iii:![lll!!::,il "I,i i'i,!li:::'" lIi':'iii',,!,,:"i;:II;,!,i;!li::I,'1::j::,:i;,;IIIIII:ii,IliWlli: I';, 1,:,lli"
III'I! ;',,!, :1, ,"'!I; "'II' i"ill:I' '11,111 ;1 II I 1:11 'I!I'I' , II', 'I 'I 11'1' 11"1'11111 '1'1 :'1 : I:'
' 'I ,I,i"! Ii :"" " ' I i,':,',' , I,' I"', 1"1'; , ',I', ~ ", ,Ii II" Ii (I'I I; '; i:
'IIII!I 'I!I" I" I'" ' ,I I:" 'I' I';, ,II", : : ";,,,' ,: ' , ! 1:1 I " ",I I ,', II' I' I
"I ,,1;1 Iii' d!l: :"111" ,! ," 1',1','111,,::1,1:, I, .:'1:' :1,':1; ~ I!," I 'I':: 'ii!"1 : !!I !,I 'I;:W I!, 'I :1,1 i,ill
i I'III,!! 11"11,: il:i' I II ",' illl 'I" ""!' ,", ',' 'I """ I1II I" I I'
! I,':' "1'1, I'" I' ,! 'II I, I"" . ",I" 'I, ' :,:1",,1,1; I" : :,::, !,,' " '1"1,,, 1,1 11,1, ;1" I"~, ,,1,: ,,', I
:\ 1;11: : I ' !! 11 "!I'II " ::,:1;, I' "" II :! ,I:': ,: I" II ,i i: ,II" '1'1 i' 'i: I ,i II III! 11111:1 11I1 :,": I!I :,:'
',""'" ,', ,I I 'ii", II '" , I"" Ii", '::: I' II 1,1; i
'ill' (,:,' ;';!',II":' " 'I;, ,,' I'! '!I,:',"" '" :",,:;,,:1" "1111:1: 11'1111 ":111:: I 'I
Id I !! II: i! ! I :;! ' ! -~ I ~ ! ; \ '_ II I i I i-I, . I I I' !' I !': I Ij j '; I , : I '; -, I' I '; I ~_ I I '
,,1,11,1 ,,! 'I" 1,':1,,1" ',::1' 1,11'1 . :,' :,,!I, i':': ,1,:1:";:: ' ':il' 111':1111 ': IIIII'!II"
!:; i::l: I: "II I:: '" ;" " ",: : ii' i Ii: : "'" 'I I ""I!' "
! ;':'::;;, ";:,, "" ' I,' II" ,I' 1,;1 : ;;':: ! ,I'I II 'Ill:! III: I
i "'.' i!:1 II" " )'" " ::\i; I; 1II1I 1111:,1111 il'; III'
"
I'd
, ,
I ~ ~ 11" f'
lY.1 lij ~ ,~
~. t ~ ~ g
U ~ tf..
[:1,1 ~ n~l
~ I ~
I i! h
-...
N ~
~ 1',,1 . <
.. I ;- ,',
. '
,;~
PA REV-11lOO EX (1-D7)
..Q.!2 . t'I Co
. flTREI!T ADDRESS
Messiah Villa B
Pago a
0, IntereaUPenally II epplloeblo
0, Inloreat
E, penall'f
4,
TolllllnloroaVPonollY (0 + E)
11 line a la grealer Ihan line 1 + IIno G, enlar Iho dlfferonoo, Thla la Iho oveRPAVMENT,
OhICk ~x on PIU' I Une " 10 requ..' I relund
If IIno 1Hlne 0 la gruater Ihln line a, enler Ihe dlfferonou, Thla Is Ihe TAX DUe,
A, Enter the Intetual on Ihe lax due,
p, Enlor Ihe 10101 ul Une D + GA, Thla la lho IIALANCe DUll.
MaJ<~ChllC~~ay~blelo:~EQI8TBR .oF\V'.~8.,.AQIINT. .
(0) . 0.00
(4) 133.22
(8)
(GA)
(8B)
8,
""W' .",
~<:~;~?lW{:W}'-'; ",".,-. ,,' .,' - -"'-.." ,
"M')!""\"""""',"r"'i,,\";ii;ii#C~~~A~'iW~~tH~~6Lt'()WINQQO~sYibNIi; '.,.. . ..' . .....,
BY PLACINOAN ")<" IN THE APPROPRIATE Bl.OCKS
1, Old dOClldenl malee a Iranaler and:
a. relllJn the use or Income of the property tranat8rredl ' , , , , , , , I , It' ; , t. , , , I , , , , t , , , , , , , , , , , , , ,
b, re101n Iho rlghllo dealgnale who aholl uae lhe properlY Iranslorrud or Ita Inoomel, , , , , , , , . . , , , , , , , ,
o. retlJn a r~Vef'8IQnary lntetalt; or. I I , ., ! I I ; ,t, , , , , " " '" , I , , . , '" " " t " , , "" , . , ,,; . , , ,
d, reoelvQ the promlee ror Ino 01 eIther pAvment8, benefits or 0810? . , , , '" I " '! . I , , '" j t j , '" I ,', ,
a, If lleath occurred on or before December 1a, iDea, did detlildenl wllhln two yeara
pi_ding death Irenafer properlY without receiving adoquale oonalderullon? If dealh ooourrod
aller DOClImber 19, 1D82, did dllQedont tranaler properlY within one year of dualh wllhoUI
",-",,,--,,,,,,
,.,.'.,.'-',.,'.,
,:,.::,-,-:,,::./-.-:.:"''-''::'''''-'-'
,--"C,-"",,,,,,,,,,,,,,,,.
i I
reoolvlng adequato aonBlderaUon?, , I . , , . I , I t t , , . , . , , , ,', ' , , . . , , . , , , t , , , , , . , , I I I , I , , , , . , ~ It' ,
Q, Old dOClldenl own an 'In IrUBt lo~' or payeblu upon dealh bank account or 80CUrllY
o H @
at,hlsorher-daath? It.,., It'. I ,.,'", "1 ,'", ,t, \" It' "." ""'" ,-", I' "" .,. It., ,", , !."
B I
4, bid dOClldenlown an Indlvlduol rellroment accounl, annull'f, or olhor non-probale proporIY?, , , , , , , . , , , ,
IF THEANBWEA TO ANV OF THE ABOVE QUEBTIONS 1$ YES, '
YOU MUST COMPLETS BOHEDULe Q ANt) FIl.E IT AS PART OF THli RETURN
7a p,a, 8G1181a) (1,1) (I) provided for the reduOllo.n of Ihe lax .rale Imposud on Ihe nel vlllue of Iranslere 10 or tor thu usu of Ihe aurvlvlng ,spoLii18 from 8% 10
0% for datee 0 dealll on or a"er July 1, lDD4 and before January 1, I~D8,
7~, P,S, 18118 (a) (1.1) (II) proVldod for ,horeduollon ol'lhe rale ImpollQd on IhO nal valuo of transfero to or lor the use of Iho aurvlvlng spoutIllrom 0% 10 0%
for datu of dealh on or a"or January 1, 1DDD, The elatulo doos not oxemot alranafor 10 a oU,rvlvlng spouae from lax, and the atalulory requlremenla for
dlscloaure of _to and IIl1ng a tall return are 01111 appltoable even If theaurvlvlng spouse Ie Ihe only benellolary,
POR DATeS OF OBAniON OR AJlTBA .JANUA/lV I, IIGa -. PloUQ anowor Iho following quostlOn by pllOlng an 'lC" In Ihe epproprtat.epace,
Old 1I1e dtotdtnl or.... alnlll or 8lmlllr arranu.menl whloh Ie aollly for 1I1e lurvlvlng apoult'a blneffl for hie or her enlirl 1Illlima?
. '1..0 No~ '
"
II you answered yes 10 fhe above qU8l1l0n, Ihe lall onlhe trull! or all11llar arrangelllllntla poatponed untlllha death ollho second spouse, all'(hloh lime It Will
be fUIlV laxablu allhe rale(e) eppltoable 10 Ihe temolnder beneflolary(los), Enla/lhe value of Ihalnlal on Sohedule J, Par1I1,ln ordOlto removo II from the
oalculaUon of Ihelall due In Ihl. 88llle, 'Iou may wish 10 flID Sohedule 0 In order tu malee Ihe 018OIIon avollablo under section D110, If Ihe elecllon II mldo,
Ihe trual or ell11llar errahgemen, la lallud In tha ealale of lhe Iltal dllQedent apouae, Ihe poJ1lon of lho truel or almllar arrangemenl Whloh beneft1a Iho lLirvlvlng .
apouse Ie laxud at Iho zero lall rale. and Ihe remalnder Is taxed allho rate(o) applloablo 10 Iho remalnder benellclary(lea), If you 011001lO to malee Ihe elecUon,
you muel attaoh Sohedule 0 10 allmefy-llled lax relurn, alOng wllh SohedUle(s) K and/or M In order to ahow the epportlonment 01 the trual or all11ilar
arrangemenl between the lurvlYlng spouse and lhe remalnder benallolary(18I), '
7 PA1100a NTP 10110
Copyrlgh1 Forma 8oflwAr' O"ly, 1101 N"OClj Inc,
"';'4U IX. II-'n!
,I
,a:1b
COMMONWI'".1l 0' 'UmmVAMIA
OIPAI Mtur 0' UV'NUI
'"HUI'''H!;' 'A)( OIYltlON
'--0'" "*1
II"UIIIU1U, 'A 111U.0601
SAPI DIPOSIT BOX
INVINTORY
(LA!T, IUT, ""PP II
Webste~ Monroe Lewis
ADDRIIS 0' D ~ DINT IITR1IT) IC'TVI
Messiah Village, 100 Mt. Allen Drive, Mechanicsburg, PA
NAMI AND ADD Rill 0' ,IR.oN RIQUIITING THI OPINING 0' THI .API DIPOSIT BOX
~t~2~ney David H. St.one
IITRIIT AODReIlI I,ITYI
414 Bridge Street New Cumberland
NAMI, ADDRU' AND ReLATlONIHIP (I' ANV) To DICIDINT, 0' PIR'ONItl PRUlNT AT THI BOX OPINING
a. INA"'", ' IRI\ATION!HIPI
Patricia A. Walter Trust Officer
IITRIlT ADD~IIII IClTYI
349 Union Street Millersburg
b, INAMII " IRHAlION!HIPJ
Att.orney David H. Stono Administrator
IIT~1lT ADDRlUI ICITYI
414 Bridge St~eet New Cumberl~nd
., INAMII 1!l\,qloN~HlrJ
1l~11~97
17055
IITRIlT ADD~U!I
t\::lTYj
IIIAIII IZIP ,0011
IIIAlIl IZIP CODII
PA 17070
,-
IITAlIl IZIP CODII
PA 17061
II1AlIl IZIP CODII
PA 17070
IIIAlII ' IZI~ CODII
NAMI AND ADDRlI' 0' fiNANCIAL INITITUTION WHIRl THI SAn DIPOSIT BOX II LOCATIO
INAMII
Mid Penn Bank
1$T~1lT ADDAlSl1 I~'!VI IITAlIl IZIP CODEI
349 Union St.L-eet Millersburg PA 17063.
NAMI 0' PIR.ON MAKING LA'T INTRV DATI AND TIMI 0' LAST INTRV
pat.ricia A. Walter December 4, 1996
OAT OP CONTRACT TO RINT BOX NUMUR 0' BOX TITLI UNDIR WHICH BOX IS RIOISTIRID
December 4, 1996 26 Webster M. Lewis
NAMI AND.ADDRIII 0' PIRIONII) HAVING ACCIII TO BOX
a. (NAM I b. INA"'II
Stephanie Lewis
IITRIlT ADq~UII lTReeT ADDAII"
Flat 9 Cleasby Grange, 8 Wollestonecroft oad
Bo~d'1JnWe Manor BH5~JQ Bourne~~~h IZIP roODII ICITYI IIIAIII IZIP CODer-
NAMI AND T\TLI 0' IMPLOVl TAKI 0 T IINVINTORV
patricia 'A. Walter/Trust Officer
WAI A WILL IN THI BOX? eVil IONO If V.., a, Da,..f willi
b, Nam. a"d add,... of p.,.."al top,...h,a'IVI, If "am'" '" 'h. will
INAMII '
IITRIlT ADDUnl
ICITYI
I. Nom. and aadr... .f aue;n.." If al"V
INAMII
IIT~IIT ADD~1I11
ICIIYI
IIIAIlI IZIP ,0011
IITAIlI IZIP CODII
ACCOUNT # a10~07~Q00
TRANS.
DATE DI!SCiUPT It:IN OF TRANSACTION
WEBSTER M. LEWIS, TRUST UIA
.
TRANSACTION HISTORY
FROM 1/01/S7 TO 1!/10/97
INCOME
CASH
J:'A13~
PRINCIPAL
CASH
6
BOOK VAl.UE
I NVI;;STMENT
~~____________.__"_______________"____.________________~_______________'_'______M'__~_
6/06/9"1 I NTJ::RI!ElT ON eTF. OF DEP.
FIDELITY FEDERAL ElAVINrss BANI~
CTP OF DEP 6..30M OF 09-0&-97
G/ilI9n7 ASSETS SOLD
COMMUNITY BANK CTF or DEP
6.G~Yo OF 0G-09~97
6/09/97 ASSETS PURCHASED
COMMUNITY BANK CTF OF DEP
6.00% OF 0g-0a~g7
6/11197 ASSETS PURCHASED
MID PENN SANK SWEEP ACCT
6/11/';17 ASSETS r:'UI~CHASED
MID PENN BANK SWEEP ACCT
6/tU97 ASSETS .SOLD
MI~ PENN ~nNK SWEEP ACCT
&/li2/S7 LIVING EXPENSE
&/1S/'n INT.ERE8T ON crF. OF DEP.
KEY BANK CTP OF DEP
3.60% OF 08-14-97
6/13/97 ASSETS ~URCHABED
REVERSAL TRANSACTION
MID PENN DANK SWEEP AeCT
6/a0/91 MISC. INCOME OISBURSED
DOCTOR'S VISIT
fi/~4/97 ASSETG SOLD
MID PENN BANK SWEEP ACCT
S/~4/97 TRRNS PRIN CRSH TO INC CRBH
~/a6/97 CRSH ADDITIDN
PI(OCEEDS Ff'lOM J:'NC CI\l'3 ACCT
G/30/97 INTEREST ON eTF. OF DEP.
QIJI:E::NS r.C'IJN1'Y f3AV \ NtiS Bf~NK
err DF o~p B.!3Yo DUE 04-16-99
3e.~1'l
38eil5.47-
36. lit
10::. 10-
'::347. 16
!54,GG
S"\~,
31000.00
~7300.iZI0-
146a.e6-
148e.<::6-
e3c:0.53
llla~. a:a
2e~g.4J
e34"7.13-
- 11-
6331.'~O::
t'.. 3 .
:J 3 I ,~,)..
6:'130121. 12I1~
2320.63
3S2'3.43
1'1.
, ,
WESSTER M. ~EWla, TRU~T UIA
;4 1
TRANDACTION HTSTORY
I!'nl1l~ \1'Z\,.,97 TI?\i'i:I\il1/97
"
~C~OUNT # 2J$~~?'~~0
C'A I':; !!
II
TIlJ.iNa.
ORT~ UE9CA~PTION O~ TRANSACTION
I Nl:ClME
, CmJH
t:'!UNCI~'f'il..
r.:A~l"1
IlO(ll< lJl~l.lJL\
I 1\I\llt:rrl~L':1 J1'
.. ... - - -'" -..... ---.. --.,.......- ....- -...-_.~ .......--...... .-.. ...,...- -.. - -.... ....-.... -.,. ............. "'" -...~,._--- -... -- ~..-... - -.... --.... ...-....- - ,........,..... .....
1\Zl/JII'iJ7 I1~c.;('JI~l~ OgF'OS. IrED ii;a~.>.l4
TRu,AaURY ANNUITY
H!l/J 1!'1>'7 tNt;or~J.Z Ot~r:oos I TED 9/1, l~ilI
~IA 8ENriP I T
liZlI3t/'-H INCOME OEPOS ~ Tt!l). ae. I . ~~0
SOI=II~L SliOUR ITV -0-
i 10/~1I97 r NTF.RE'S'r ON SHORT TERM lNVEtH. <.:i...a
' J IJ 51 Tlmf.)eUAV CA13H Ri::Se:RVEEl
VAIHABLE Rrm::
10/3J /"17, INTEml;:S'f ON eTF. OF ocr~.
QUE.Etm COUNTY SAV I N13S f)AI'IK
CTF OF DIU:' 6. ~l:lll OlJE 04'-0~-<1'J
sr,. t..n
11/~1/97 TRUSTEE'S PEE
11/11/W7 TRUSTEE'S FEE
ASSET MANA~EM~NT FEE
11/07/~7 INTEREST ON CT~, OF DEP.
REO I ONfl BANI'. Cl''RTI I" Ir~"'Tg OF
OgPOSIT, .B. 10M, DUE 9/7/90
11/~B/97 INr~REST ON C~F. OFDEP,
' SttCURrTY STATr:: MNK CiiF 01" Dl!P
SCOT~CITY AZ, ~.9~., DUE 3/81
,,' 98 '
Z6/" till--
1 ~:; (.. .~~....
I.:.l,."" 51~~
117. 7~)
III 11/'.:17 ASS1HS SOL,D
U 13 TR[;ASUr~Y C:ASH Rii:agRVES
VAH t ABI..E: RATE:
11/11/97 TRANS PRJN CARH TD INC CABH
,. ,f ,. 1:7S
11/lq/17 ~IUING EXPENSg
~11!r,a I AH V t l.LAt3e.
:a.H. a'U
::,~: t, h':'
..-....~...;
:ml.Ml-
_..........~..
,'i;,,~'l. 8':1--
. (I'
,11/J0/~7 ~gYETS 'SOlD
U $ TR~AmUAY CRSH RES!RVBS
1,IRrir'~I:\I.a: RnTE:
1.1. I Ja ,1:.~
1 :.J.l:. ;.2,,:,
_ (111)~1 I ~
('.> , ~ :, ~
... ~.
COMMONWIALTH O' PINHIYLVANIA
COUNTY O' CUMIIRLAND
}
..,
DaviO BoO StcnG
belnv d~ly , ;10'01:>> . looordlnvlo law, de po... Ind "YI Ihit ho h' A~m1Rh~lIIl~~ Q. T. A.
0' Ihe Bllolo 0' I'/ebstar M. LeW.ts ...
11'0 0' __,~.1lP.j;l.IU,_Aillil.n,j.'WiL----. , O~mb.,lond Oo~nty, Po., d.o....d Ind.thot the
within II In Invonlory m.ode by . O'l"i n ll... .Sl-t')n~ ' , ._ _ " tho ,,1~<:1'llj nlll-rator I"TA
o".ho onllro "I~'I. 0' "Id doc.denl, oonlllllnll of IlIlho porlonol prolldrly .nd .r..1 ..hto, lKoopt ro.1 '11010 outtldo
tho OO/1lmonweollh 0' Fennlylvlnll, Ind Ihlllhe f111~r" oppollte ..oh lIem 0' Iho Inventory ropro..nllt'l ,.Ir v.l~e
II 0' Ih,dllo 0' dmdenl'l :::I:~blorlbed be'oro me, (,\, / ~l .
Oa V id HS-~;;;.{1f: M;ln'Itrlter eTA
19__ . Stone
4l~ Bridae ~treat
NAW ~nmhAY'l Ann r 131\ 17n70
Md,...
'Dol. 0' boolh
11
Dlv
11
Month
1997
v..,
"
INSTRUCTIONS
I. Anlnvonlory rn~lt be med within Ih,et monthl .fte, Ippolnlmenlo'p."onelrep,..enl.tJvo.
2. A I~pplomenllnvenlo'y mUll be riled within Ihlrty dlYI 0' dltoovtry 0' additIonal Utoli.
3. Addltlonallho.olt m'y be a!laohed ..to pmonelty 0' "ully
4. S.. A,tlol, IV. Fld~ollrl.. Aol 0'1949,
I i ~ III ]
~ !~ 'M
~ ~ I I
~ i.
~I~~ .
ill j
~
~. .,.
~
~ :I
HAKI CHICK PAVAI~I AN~ RIHIT PAVHINT TOl
REGISTER OF WI~~S
,CUMBER~AND CO COURT HOUSE
CAR~I&LE, PA 17015
CUT AI.ONG THU ~INI.. .. RITAIN 1.01lllR PORTION POR YOUR RICORDa ~
ftW:iiW"I~"~~'Ji"r&':f.. 'j""AFlYflll""d'''."W. All(ff~'I{d'I"VA~".A'li~ftAlili(fNt"""~t'L"oQ~'I{oi"b1t'...""--"_-.."m""
DI8A~1.0IlANCI CP DIDUOTloNa AND AaalaaHINT OP TA~
laTATI OP LEWIS WEBSTER M PIl.I NO. l!l 97-0958 ACN 101 DATI 09-18"1998
TAX RBTURN WAI I I X I ACCEPTED AS FI~EC I ) DIlANGED
RIIIRVATION OCNOIRNtRo'PUTURI INTIRlaT " III RIVIRBI
APPRAIslD VAI.UI OP RITURN IA81D ONI ORXGINA~ RETURN
1. R.al Eetate ISohadule A)
e, Itooko llI1d 80ndel80hedulo II)
a, Dloeel~ Held 8took/Portnerehip Intereet ISoheciule pI
~, Hort.e.e'/Notoe Rloliylblo (Soh.dule pI
J, Coeh/llank Depoolte/Hi.o. Per.onal Propert~ (aohedule E)
6, Jointl~ OWned Propert~l'oh.dule P)
7, Tronefer' (Sohedule 0)
8. Tot.l A..et.
APPROVID DIDUCTIONa AND IXIHPTI~N81
9, Funeral EMpene.e/Aa., Coete/Hleo, EMpen.e. ISohedule H) 191
10. Debt.tHcirtG'.e UlbUUitl/Liene (8ohedull I)' UO) S .aF, 6~
11, Tot.l hduoUone (11) IA.A41.7Q
18, Net V.l\11 of TIM Return (18) 29,588,48
la, Ch.rAtable/Gover".entellequeete, Non..l.oted 9118 Tru.t, ISohedule Jl (18) ',~~
l~, Net V.lue of IItah Subj.ot to TIM (l~) 29, SS8. ~~
NOTll If.n ......MlnttW.. i*'~'d.pr'Viou,~Y, ~in.. 14, 11 .nd/or 16, 17 .nd 18 will
rlfl.ot figural h.t inolud. th. tot.l Df ~ raturn. .......d to d.t..
AS81a8HINT OP TAXI
1&, Alountof Line l~ .t Spou..l rata Ill) ,'OOX"OO.
16, A.ount of Line 1~ hMtble lit Llne.l/Dl... A rate (16) 29,588 , 48 K' 06.
17., AlOunt of Line 14teMeble at Colleter.l/Cle.. I rate 1171 ,00 X .1~.
11, Prinoipal TeM OUe (181
TAX CRIDITal
PAVHENT
DATE
(:; ,)I'~ to
lURE AU DP IHDIVIDUAL TAXEI
IHlttMIlAHct lAM "IYIIIPH
1110"1', /80601
IIA'"l181I111Q, I'A 11118'0601
OOHHONIIIAI.TH op PINNaV~VANIA
DIPARTHINT OP RIVINUI
NDnCE DF INHIRITANCE TAM
APPRAIIIHENT, ALLOWANCE DR DISALLOWANCE
OP DEDUCTIONS AND AIIESIHENT DF TAM
c...
DAVID H'.TONH HSQ
414 BRIDGE ST
NEW CUMBERLAND PA 17070
DATI
.ISTATI OP
DAT. OP DIATH
PIl.I NUHIIR
COUNTY
ACN
09-15-1998
~EWI8
11-11-1997
21 97-0958
CUMBI!UAND
101
A.o\lllt ~e.iHed
(11
Ie)
(SI
(4)
(II
(6)
171
.00
.00
,'00
.00
48,200.27
.00
.00
leI
13,004.16
RECBXPT
HUI1IER
DI8COUNT It)
INTERI8T IPIN .PAID 1.1
AHDUHT PAID
TOTA~ TAX ORIDIT
IAI.ANCI OP TAX DUI
INTIAIST AND PIN.
TOTAl. DUI
*'
U,.ltH .. m \It.",
IIEBSTER
M
NOTII To,in.ure proper
oredit to ~our .ooount,
e~it th. upper portion
of thie forM with ~our
t.M p'~...nt.
98,200,~7
,00
1,761.81
,00
1,761.81
1,888,08
126,87CR
,00
126,87CR
. IP PAID APTER DATE INOICATID, SIE RIVERSE
FOR CALCU~ATIDH D~ ADDITIDNAL INTIREST,
I ~F TOTAL DUE IS LEaS THAN fl, NO PAYHENT IS REQUIRID,
IF TOTAL DUE IS REFLECTlD AS A "CREDn" ICRI, VDU HAY 81 DUE
A RBFUHD. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIDHS. I
1:1"
Ii
:\)11 ''II' 11, I J ,.' : 1 ..'
OI~lr
GUIld
,\I
1'/\
RnJRYATlDttI UI.I.. .f d...d.nh dylnf .n .r b.f.r. n....bor Il, 1982 _. If ony fUlUro Inl.".1 In Ih. ..1.1. It lron.for"d
In,pa.....lonor .n~o~..nt to el... . (Goll.tira1) blntflo1,rl..'Qf thi dlOldlnt ,ftlr thl .xplr.tl~n of .nv ..tlt. for
11'. or fOr v..rt; thl Qoaaanw'llth hlr.bv ,"pr..,IV rOI.rv., 'hI right to IPprt'" .nd...... trln,flr 1"",rlt,nol taM..
tt the lawful Cll'. . (ooll1tll'l1) rate on tnv '\loh futurl Int.r..t.
P\IllPOla Of'
ItOTlCl;.
P~YttI!HTI
RIFUHn lOR) I
OIJl!CTlIlHII
~OH1H
nTRATI\'Il
OlHlRIOTlDttl1
DIIcOUHTI
I>I!HALTYI
tHTlptlaTl
To ''''lfill thl roqulr..Jntl of aloUon 2140 of thl Inhlrltamlli and htate TIM Aot" Act U of 199&. (72 p.a.
sloUon'140),
Uttftoh thl tqp par. UOM of thh Hotlol and tUbll.t with vour p.~..nt to thl Rlaht,r of WUh printed onthl river" ,Ide;
.-H"'" oh.ok .r ..n.y ordor p.y.bl. 10' RBO~STBR OP "%~~B I ~UBHT
A'rlfund'of" tilt ar.dlt, ~h'oh w.. not r.qullt.d on the TIW Rlturn, .IV bl r'qlIllt,d bY oo.pl,tt"' an "ApplloaUon
for ~efllnd .f P~",,'YIY'nl.tnhtrlt.no' .nd ~.I.I. TIN" IR~Y.lSn)., ~~pll06110n..re 'Y'II.blt .1 Ih.' Of II..
.f tho Regltltr of Will., .ny 01 Ih' II RoY6nu. nltlrl.\ Offlo'" or by ..Ulno Ih. .p.o .1 14.h.llr
an,wlrlnD ,.rvlo. nuab.r. for for."nrdtrlngl In p.nn.~ly.nl. 1~.OO.S62~aOI0, out.ld.,P.nn.ylv"nl. and
Hlthln 1.0.1 ,H.rrlt~uro .re. (717) 711~lm. Tn06 1717l 772-1112 lII..rlno t.p.lr.d OnlY)'
Any pftrt~ I" Intert.t not I.tllfled with the .ppr.I....nt,.llow.n~. or dl..llowanql of d.~otlonl, or .....'..nt
of taw tlnatudlng dllClaunt ar Intlrllt1 I' .hoW" on thit HaUal au.t ObJlct within .IKt~ (60J d.v. ofr.ollpt of
thlt, Hott.. bYI
....."IU," protutta thl PA Olp.rt.."t of Rlv,nul, Board of App.lh, DIPt. eal0n, HarrhburD, 'PA17U'''lOU,
....I.oUon ta havI th."'I\tI~ dtt.rllln.d at audit of thl"ooauot ofthl ptrlem.t r'pr...nt.U".' ,OR
~.app..l,tq th' ~rPh'".'courtl
OR
Flotu.l Irrorl dlscov.red on thlt allon,.nt "hauld bl .ddr.....d ,In wrlUng toi PA alpart,'n'\: ~f Rlv.nu",
IUro.u .f !ndIYldu.1 ToM", ~TTH' P..I I.......nl R.yl.. Unit, n.pl, 1I0~ol, t1orrltburt, P~ 17128-0601
Phont (711) 76'....01, .1. PlOt & of thl boo~l.t "Instruotlonl for Inhlrlt.nOI TI)( Atturn f9r a Rtsld1nt
Ola.dtnt" (REV..laOll for an ."planatl," of .d.lniQtr~tly.IV aorr.otlbi. Irror..
If any tlH dU' 1t,p.id ,wlthln three (I) oel.ndlr Month. after thl dICldlnt'. dllth(. flyt plrolnt (aU) dllCiO\ll'lt of
Ih, I" p.ld I. .11.H.d.
Tho IIX I'M .....Iy non-p.r~I.lp.tl.n p.n.lly I. ..'Pul.d on Ih. l.t.1 .f tho 16M .nd Inl.r..1 .......d, ond hOt
p,id b.foreJanui..Y la, 1996, ,tht Utlt day aHer th.end elf the tlX e."..W plrlod. Thh non"plrUolp"Uon
penlltY 11 IPP.Ilabltln the .... .anner Ind In th. the 'I.~ tl.1 plrlod "' yoU WOUld ,applll thl tlW and,ln,.....t
thit' hllbll" .......d .. lndloated' on thit noUo., '
tnhr..j It ."orf.d b.ol""lno Hlth flrel d...f d.lIn,,".n... .r nln' 191 ..nlh...nd on. <11 d.yfro. th.d.to.f
de.th, to the datt of pl~..nt, '.WI' whloh bIOI._ dt'lnquent b_fort January 1, 19at baar inter..t'lt thl rat. of
..~ (6X) perolnt PI" annUl olloul.ted It a dll1~ ra'lof ,000164. 411 t.~.. whlah blo...,dlllnqUlnt on end Ifter
January'l, 1962 will bt.r lntlrt.t it . rat. whioh ~ltl yarv fro. oallnder Vllr to oiilnder Ylar with thet rite
announold by thl PA Dlpart.."t of RtVlnul, lh. eppl10Bbll intlrllt rit.. for 1982 t~rouah 1991 Br.i
'tW ItHlrid 'lI.h b..1v lnt.r..t ~Iotar xur Inter..t Rit. 011111 Interl.t Flotor
1"2 20X .OOOI~8 1917 .X ,00OR47 '
I'U 16X . ooo~sa 1911'1991 llX ,OOOSOl
191~ llX ,00OSOI 1991 .X .OOOI~7
, 1.11 ISX ,OOO.I~ 19.I'I"~ 7X ,0001.2
1986 IOK .oOOI7~ 199,-1991 9K .G00247
~~tnt.r..t II olloul.t.d .. fOl10H'I
%HTBRSlT . .A~AH~B OF TAX UNPAID X HUHBBR QP DAY9 DS~%HqUBHT X DA%~Y %HTBRBBt FACTOR
--AnY HoUel luuMl Ifttrtht taM btoo... dtUnq....nt will refhot In intlrllt ollloullUon tekf!ftt.n (16) da~.
blyond the dlti of t~ ..~'ls'lnt.tf Ply,tnt 1. .idi after the lntlr.st aOlputlt19";dlt. .hO"h on 'hi
NOtlo., ~dltlonal lnt.r..t .u.t be aalaul.tad,
, PAVItIHT,
Detloh thl top portion of thll NoUol Ind IUtNIlt with your p.~..nt ..d, p.~abh to thl n..,' and Iddr...
printed on thl rlv.r.. .ide.
.. If RlIIIH!HT lH!e!D!HT .akt ohlok or .0ntV order PIVlbh 101 RHGISTlN OF HILLS, AGHNT,
.- If HOH-R!IID!HT D!C!IH!HT ,"k" ohlok or .0nlV ordor PIYlb11 10' COHHOHlfHALTH OF pHNNSVLVANIA.
RI~UNO eCA)1 A r.fund of . tlH ar.dlt, whioh WI' not r.quI.tld on tht 'aM R,turn, I'Y be rlqUlltad bV'GoIPI,tlng an
."APPlloltlon for R,fund of P,nnlvlvlnll Jnh.rlt~o. end elttt. '1M" (REY~lS1S), Applloatlon, ar. .y.ll~l. It
tht OfflO' of thl Rtglit't of WIlli, 80Y of thl IS RtV'nue Plltrlot Off10,. or fr~ thl D,part.,nt'. 14.hour
""....rt'" ..rvlol flUIbtr. for for.. ordtrln'lI In Ptnn.vhtnlt 1-100"162-20&0, outlldl Penn,yly,,"11
end ~llhln 10011 Hlrrl,burl Irll (7171 717-1094, TOOl (7171 77e-eeBe (HI.rlno IIp.lrld onlyl,
Rt!P~V TO'
OU..Uonl r,glrdlng .rror. Gontl,tnld on t"lI notlo. 'hould b. .ddr....d tal PA D.pert.,nt of R.venu., Burtau
of IndividuI' TIMII, ATTN. po.t' A.......nt Rlvilw Unlt,,',Olpt. 280601, Hlrrhburg, PA 17128-0601, phon.,
(717) 717-650B.
DIICDUIIT'
If .nv tlM due i. Plid within thrl. (5) alllnder lonth' Iftlr the deold.nt'l de.th, . fly. plra.nt (aX) dl.aount
of the taM PIld 1. Illowed.
PlHA~ TV,
ThI .IX tlM .-n'lty non-Plrtioip.tlon p.nlltv 1. GOIPut.d on the totll of the tlX and lnt.r..t .......d, .nd not
p.ld b.for, J.nulry 18, 1996, the flrlt dav Ift.r the .nd of the tlx Ilnltty plrlod.
I
IHT!MIIT,
Inter..t ltch,rgld bog Inning with firtt dl~ of delinqulnay, or'".nl (9) lonth' and 01'11,(1) day fro. thl dltl of
de.th, to thl dltl of pIY~lnt, TeMI' whiah blo... d.llnqulnt befarl Jenulrv 1, 1982 be.r Int.r..t at thl r.t. of
.1K (6X) p.rolnt plr ennuI o.loul.t.d,.~ I dIllY rate of .000164. All tIK.' whlah beo... d.llnqu,nt on Ind "ft.r
Janua~y .,1'82 will be.r intlr..t It . rati whloh will verv fro. ael.nder Vllr to oll.ndat'~I.r with thlt rltl
Innouno.d by thl PA Depart..nt of R'YenuI, Thl .pplioabll lnt.r..t ratl' for 1.82 through 1..8 Ir'l
Vllr Int.rt.t Rlt. Ollly Int.r..t Flotor V,lr
Intlrllt Rltt Dlih Interllt Feator
-
-
1981 10~ .00mB 1917 9~ .00OR47
1985 16~ ,000458 1981-1991 II~ ,00010'
1914 II~ .000101 1991 9X .000147
198& 1&~ ,0001&6 1995'1994 7X .00B1ge
1986 tole .aOOR74 199&-1990 9~ .00OR47
.wlnttr..t 1. a,laullt.d I' follow..
INTBRBlT . BALANCB OP TAX UNpAID X NUHSSR OP DAYS OBLINQUBNT X DAILY INTIRSST FAQTOR
"-Any' MoUoI ,t..ued .ftlr thl tl/C 'bloon. d.Unqu.nt will rlUlat en int,rut ollou"Uon to fUteen n.) dlyi
~yond the dlt. of the I......."t. If pIYlent il lad, Ifter thl lnter..t OOiputltlon date .hown on thl
Not'OI, tddlt'onll tntere.t iu.t bl alloUllt'd.
'I: