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NO. 21-80 3.U
PETITION FOR LETTERS OF ADMINISTRATION
IN Tin: ES'rA'rl~ OF ..,..~,~f!!!~Y..}......~.9)),~,!!g~.r.............,....,...... IlECEASED,
Hary C. Lewis
To "...,..".,....,..",..,..""""""",...."",.".,.,',..,"...",....,.....,."..,...",."....".,",.,",."...,..,,.,
HegiHtel' of WiIIH 1'01' the Couuty of Cumherlaud, in t he Commonwealth of l'ennHylvauia.
The Peti t ion 0 I' ",....",..."....",..," ~~IY... ~.".~,~y.".,...,..,.....,..."....,..,."",...".."..""...,......"...""""""""""''''''''''''
".."",......,....", ""..,...,...,."""..,.."",.,' t'eHllectflllly Hhowet h thut .,Sidney,...l.".S.c.heaff.er".."" "..."."",.,.."..,..
'~I!ltWJM
WIIH II reRident of ........Sh;lppeUJl,hurg........,..............JjOI.OI;gh ,Cumherland County, State of PennHyl.
vania, Ilnd II Citizen of United StllteH, and depllI'ted thiH life inteHtllte in the County of ................,...........
.."....,.I!",r.l\n~,U,I1..,..,',...., anll State of ".J>.\\nn~y,~)(f!n.t(l,.,' ....,... .,..,..", ,...,. ..". """" ... ,....,......., ,.."..." ,....,.. "...".."",
on ..,..~~,';\:.~~,~,L..,......,.., the ,..y.~~........,........,....,... day of ..~p.,:.g.............,......,.......,........ A. D.. In...~Q.."
lit the Ilge of ......A~,.... yeat'H.
That the Haid ,~,~~~~1.,J~,..,S,?~~~,f.f,~~....,..,...............,........... deceaHed, left Htll'viving the following
lIamed widow ot' husband, heirH IInd next to kin, to wit:
Nllme HelationHhip Hesidence
..Qh,(lI~!\~..,!;l, l;!l!}.\l,f. f.!} "S..",." ,...",.,."..... .." ~.r.R ~!l~.r..",......,...",....", )l.",. ,p", , ,.Ill.,.. Sl:\j,p.p.~J),(I,b.lI);g....rll.... ,l7 2 5 7
......................."......................................, ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ........................................... ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
That those above named includc all of the next of kin, so far as known,
The sllid decedent was possesHed of personal property to the estimated value of $..,..L>..9.Q,:,O''O......
and of Real Estate, less incumbrance, to the eHtimated value of $....,;,,"',,=.7."'............. ''" near as clln be
ascertained,
That the said Real Estate in so far as iH known iH located in ...................,.....,............................,.........
...............................................................................................",......................................,...............................................
Therefore, yotlr petitioner(H) respectfully IIpply(ies) for LetterH of AdminiHtratlon in the above
named estate,
Dated .........~,~y...n..,......,.............,.. A. u.. HI$.!?....
/)3
\"""" :~1. .~':: ;,\:..., ."!..... :::.~:.'.:::,j.'''''''''''''''''''''' ....... ,....,...."
l' (I '
Mary Busey
Signature and AddreHs
of Petilioner(s)
........................................................................................
..................,.....................................................................
119 Apple Avenue
Shippensburg, Pa. 17257
........................................................................................
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLANi)
1
~ ss:
.......'"....." "....."..,...,.....,..",..,. ...,... ....,..., ....... .....,... ,~\l:!:y',.~.I,\~!lY..............", ,.. .."..........." ....... ..... ,.............."... named
in the above application being duly ,................,....e.WQrn............,.. accol'lling to law, Sill' that the facts set
forth in the above application lire true to the best of ..hat:....... knowledge and helief.
'b"e"f'o"r"e" "m" 'e"," ...~W!?r.\\. Y?..,.............. and su bscrihed 1 ...... /;',......,.........., .j.....;......'.............................'........".....
-i~ ;,1 '-\.-'1 .1 /1_L.'-l._:y'
.\........'.......'{".................j...................................
..............,..,~~.Y....~,~.....,..........,......... A, D., 19.~.~,... I
....q;i~..,,~,:..,..~t-~.........,:..,....,.,
I (/11 Rell'lHter
........................................................................................
........................................................................................
I~(;
(over)
.....}HW:/........(]..,..hl.(If..(.f.....(,~ So Q_
/I;; Eli 57 I( II<<- sl. F/.:- j.J
Stl/f'(''E/f/513uflCr, f'A. n> f l C)-tf.
Filed; ....!~!.':X......n~.....},?.~9..........,....,............. Attorney:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO:
"j ~'1 "
"x - /, -,") ,;/ /
,.' ---:- / , ~)":;('I
OATE <;;'. (, //""'.{' H:.,./ A < / /,
,./,. . ,"/ //,/
ESTATE -:""'(d.":/, > ". , --""I/.,/v-
.,;'){/~,~ -;." ///
FILE NO. . .7 1 ,~/i - .n11
TO:
.~ ~..
.- .' ( ~' " , ,r _ /-' / ,~_, __
. ......~f>;: i."..;;
-rj: v / ,~
/, ~gt!'/ " , 'dO;l (,"','(
.", j 'i - ~ ,.. ~
I ,-
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17/" ?
COUNTY
"" // / IC
I'//())) '/17'''' " ./( ,-Yr"",.,;"
- ,-
DATE OF DEATH
/
. {/,.
/
// /;/ /'iV)
, "
Appraised Value of Estate:
Real Estate
$
Personal Property
+
"
.,
.~.! ./,/
,
,p
/,
Jointly Held PropertylTransfers
+ ---..-------
Total Gross Estate
$ -;,:) '/;;
/
i :-;
I~
Total Approved Deductions
.. / I/.,.. /; /
,"; /~ /, /,- 'l
$
Clear Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$ :~'7-& h?
Amount Taxable @ 6% Rate
$
tax due
s
Amount Taxable @ 15% Rale
;;..'/.-;
...., ) j (/..
1;-7
tax due
~ " ",')
.,' .:.; , ;-()
TOTAL PENNSYLVANIA INHERITANCE TAX DUE S
.. .. * .. .. .. A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
+ S
$
= S
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
,'()
:," "l:~',/ i- /,"(:'~!i'..".(""'"
,.' '/
A.....edby: /, .' . '1' ,',..
See Information on Reverse Side Ag.ntlo, I~ commo",wlIllh " '
, i/ ....-- I
" j .../ ~ ..' II t..J
,
,
I
/
,.
iiil
INFORMATION
To insure proper credit to your account, tho name of the estate and file number should be clearly print.
ad on the chock or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961172 P,S, ~ 2485.708).
To the extent that inheritance tax is paid within three (3) months after the death of the decedent. a
discount of five IS) percent is ellowed 172 P.S. ~ 2485.7' C'
Inheritance Tax. other than tax on a future interest, is due at the date of the decedent's death and becomes
delinquent at the expiration of nine 19) months after the decedent's death (72 P.S. ~ 2485.711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 9 2485.7121. Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
-~-----_...-..._- --------- ---...------ --- ------------- -... ---- --- ---------- -- -- - ----
1 month ,005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months .055
3 months .015 6 months .030 9 months .045 12 months .060
1 days .00017 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00065 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 deys .00135 18 days .00301 28 days .00471
9 days ,00152 19 days .00318 29 days .00488
10days .00169 20 days .00335 30 days .00500
-------------------...- --------- --- -------- - -----.----- -- - -...------- ------
Any party in interest. including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (601 days after receipt of this Notice as provided by Section
1001 of the Inheritence and Estate Tax Act of 1961 172 P.S. 9 2485.1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
COMMONWEALTH OF PENNSYLVANIA
OEPARlMENl OF REVENUE
BUREAU OF EXAMINATION
COUNTY FILE NO:
8.-. ( -6 () -
Appraised Value of Estate:
Real Estate
Personal Property
Jointly Held PropartylTransfers
Tatal Gross Estate
lotel Approved Deductions
Claar Value of Estate
Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
Amount Taxable @ 6% Rat.
Amaunt Taxable @ 16% Rate
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
DATE
ESTATE
FILE NO,
COUNTY
DATE OF DEATH
$
+
+
$
s
s
$
tax due
$
tax due
tlOTAL PENNSYLVANIA INHEI1ITANCE TAX DUE )$
_ ,."("'r\ I-I '7- ITk --Lo 1- t .6"~
C. olor.u .
A five percent discount totaling $
Inheritance Tal( is paid by
5 :, , SO
3.00
5' 0, 5'd
(,~~
.*.***
will be granted if the
leSS Credits:
DATE OF PAYMENT
AMOUNT PAID
J-X'-R'~
/ - )1 - 1(,).
$ ):),,3 .Sf)
3.0U
DISCOUNT J!!li~ TAX CREDIT
+ $ - $ = $ 5.3. 5 V
+ = ...;3,00 \
\
+ = i
I
I
,
,
Interest accrues at the :rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment, Interest due if paid by is - 01 ~::-:L., ~ ,I
BALANCE OF PENNSYLVANIA INHERITANCE TAX OU~,/ L-1L.1@. ~,~
../j I I, J. II , ',/ (.' 0,4:;/'
Assessed by: / I. 'u:..u-
See Information on Reverse Side AgenlfortheComml?"
rH..:GISTER OF \\'IL.LS
INFORMATION
To insure proper credit to your account, the name of the estate and file number should be clearly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 (72 P.S. 92485.7081.
To the extent that inheritance tax is paid within three (3) months aftor the death of the decedent, a
discount of five (5) percent is allawed (72 P,S. 9 2485.7161.
Inheritance Tax, other than tax on a future interest. is due at the date of the decedent's death and becomes
delinquent at the eKpiration of nine (91 months after the dec..edent's death (72 P,S. S 2485-711). Inheritance
Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. 5 2485-712), Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
--------------------- ---------- --- ---- --------- - - - -- - --- ---------- -- -- - -- --
1 monlh .005 4 months .020 7 months .035 10 months .050
2 months .010 5 months .025 8 months .040 11 months ,055
3 months ,015 6 months .030 9 months .045 12 months ,080
1 days .00017 11 days .00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 deys .00051 13 days .00220 23 days .00386
4 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days ,00420
6 deys ,00101 16 days .0~267 26 deys .00437
7 days ,00118 17 days .00284 27 days ,00454
. 8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days .00318 29 days .00488
10 days. .00169 20 days .00335 30 days .00500
--- -------- ---------- --- ------ --- ---- ---- --- --_._--- - -- - --------- ------
Any party in interest, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (601 days after receipt of this Notice as provided bV Section
1001 af the Inherilance and Estate Tax Act of 1961 (72 P.S. 9 2485.10011.
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES ONLY
OF RESIDENT DECEDENTS
*'
RCC.\03 \:J.73)
COUNTY OF CUMBERLAND
Thll return must be completed In detail and flied In duplicatc, with tho Rogistur of Wills in tho County whoro tho docodent residod withIn nino
month. after doto of doath, union an oxton.ion is granted by tho Socrotory of Rovonue.
~~I~n. No~\-8t\-3..\h9_ I, Marv Busey
lNAMEI
of 119 Annie Avenue
(ADDRESSl
Mise,
being duly sworn according III law, deposes and s;ays IhutEhc is the -A.dmini~trntl"i'l(
(EXEC., ADM., LEGATEE. ETC.l
of Ihe cslnlc of Sidney_.J._ ~h(~.i1..ffe..!:_._.___ lille of-~~AA~%\JR8J~%:\;PMlmll,\\fg
deceased, and thallhc whole of the estate or said decedent. whll died Oil 4p~ill7_,._l9JlQ_______._~_____
lOA T E)
consisted of Ihe Ilssets listed below il11d that allow;lh1c debts :llllllleductiol1s exceeded the fair market value or lhe tlssets anll
no Pcnnsylvania Trnl1~rcr Inherillllwe Tax is lIue.
Sworn and IlJbscdbed bofore me
the ,;1') ~ day o,r-f"-""o )
1912-
"Jr;
{s1::~
Administratrix
{ TITLE}
Type of ASlet:
Real Estate, Pen.
Property, Jointly
Held Prop. or
Tranders
ASSETS
(Attach additional shaets If nocessary)
Description of Asset
Estimated
Markot
Value
Dapertmant
Valuation
CAUTION
(Do nat write
in this sea)
Old Republic Life Ins.- Death Proceeds
Borough of Shippensburg- Payroll 4/24/78
Commonwealth National Bank- Christmas Club
Borough of Shippensburg- Payroll and vacation
pay 4/27/78
Appleby Camper, 1972- Sale proceeds
1970 Pontiac Catalina Stationwagon
U. S. Treasury-Refund of Income tax
$ 399.80
367.89
50.00
381. 33
150.00
350.00
598.16
TOTALS
2,297.18 ,c2.J .z 91/ $
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the above County do respectfully report that I have
apprais, ed the real and personal property as reported in the fore oing .s 'hedule ~the values set forth oppositc each item in
Ihe Ins I column 10 Ihe righl. /~. . r:t::r:t'
Dated: ,f-old"KI (1NHERlTANCE x APPRA ER)
Nama of Payae
DEBTS AND DEDUCTIONS
Nature af Clolm
Amount
Claimed
Amount Approved
by Rogista,
Register of Wills, Cumb.Co
Lett2rs of Administration,one short
certificate, Renunciation
Advertising Letters
Advertising Letters
Funeral Service
1980 Per Capita Tax
Attorneys' Fee
Administratrix's Cc."mission
Filing Insolvent Return
Notary Fee
Family EHem~ti8R
15.00
15.00
18.00
1,722.82
15.69
75.00 I
75.00 I
3.00
1.00
2,800.QO-
News-Chronicle Co.
Cumberland Law Journal
Mervin O. Fogelsanger
Frederick A. Reddig
Mark & Weigle
Mary Busey
Register of Wills, Cumb.Co
Shirley A. Marburger
lI....J.:J B...3~Y-
TOTALS
+3,9~5 .51:
REPORT OF TilE REGISTER OF WILLS
I,thc undersigned duly elected Register of Wills in and for the above County. do respectfully repurt that I havc allowed
dcduc:tiuns in the amounts set forth in the above sehcdule as claimed, excepl wherc I have set forth:t grcalcr nr lesser amount
'" ,,. ,," ",'~. "~..,. ""io" ~.'"' " ,,, '" ""'""' '".""'" ",.. . ",.., .. · ,,'"' ","
Dnlc nf Approvnl: ;J;;m h..J;{~ If,f/ a.
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Ne"s-Chronicle Company- AdvertisIng Letters
Cumberland Lm, Journal- Advertising Letters
Mervin 0, Fogelsanger, Funeral Director-Funeral Service
Frederick A. Reddig, Tax Collec:tor- 1980 Per Capltll TIIX
Mark & \veigle- Attorneys' Fee
Mary Busey- AdministratrIx's Commission
Register of lVills, Cumberland County- Filing Insolvent Return
Register of Wills, Cumberland County- Filing First and Final
Shirley A. Marburger- Notary Fee
Register of lVills, Cumberland County- Pennsylvania Inheritance
Tax
Mark & \1eigle- Reimbursement for balance paid to Pennsylvania
Inheritance Tax
TOTAL CREDITS
TIllS ESTATE BEING INSOLVENT. NO SCHEDULE OF DISTRIIlUTlON \VILL BE FILED.
l i:'l."~ _l.\! I.. r,,~\:
~ . -,
'"' "I;""
MARK a. WEIGLE' ATTORNEYS AT LAW - t 1] EAST KING STREET. SHIPPENSBURG, PENNA. t72!>1
15,00
18,00
1,722.82
15.69
86.09
86.08
3.00
25.00
3.00
53.50
3.00
$2 047,18