HomeMy WebLinkAbout03-0599PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also know'n as ~7~O__y Z.~t.,o,/ ~
Deceased.
Social Security No. / ~c- 7 -' ~.~ ' ~/~.2~
To:
Register of W~ls for/the / 1
County of ~ ~r~t~_e',~t~-/' in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in .~e,n ~/~f7£i .County, Pj~nnsylvania, with
h /.5 last familyorprincipalresidenceat 5'C ~_~_~',~/~,YlyF A~Z?.~P ~'.~,c/~. ~/~7/?013
(list street, number and municipality) '~
Dece~dent, then -~¥- 7~, years of age, died~7'o/~, 9. 2. o~ 3 ,.1-9'-:2 o~9 ~,
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ ,~. ~"O O. c90
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not dGmicfled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Petitioner
the following spouse (if any) and heirs:
Name
after a proper search ha
Relationship
ascertained that decedent left no will and was survived by
Residence
'-i~- '1 ' -
.3)4
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
SS
COUNTY OF
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affi.r~.e.d and subscribed f
bef~q'~me this ~ ~ da of l
! ....
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
t' AND NO.W. , ~(~e __~.__/ ~ ~lO'~in consideration of the petition on
ne reverse sine nere~, satisfacfory proof having beech, resented before me,
IT IS DECREED that .~IzLO~FI ~. tar~ r~'~,sr~ . [ ~t. ol~
is/are entitled to Letters of Administration, and in accor~ ~ith such finding, Letters of Administration
are hereby granted
in the estate of ~-
FEES
Letters of Administration .....
Short Certificates( ) .......... $
nciation ................
$
~ TOTAL __ $
File~.~ ......
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
STATUS REPORT UNDER RULE 6.12
Date of Death: k_J~)'./a,' 9.; ~x.9~ Z
Will No.: ./~_~ 4j////-
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
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. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
b. The separate Orphans' Court No. (if any) for the Personal representative's
account is: '""~'"
c. Did the personal representativ.._e..e sta..J.e an account informally to the parties
in interest? Yes [-1 No l_2.q" ~ _ --~.
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
: ~/,~~:d may be attached to this ~-, .~
Signattuade - .._.
Name --
Telephone No.
Capacity: [-~ersonal Representative
[--1 Counsel for personal representative
~ /~FNOTICE NDERR LES.6 a
Name of
Decedent:
Date of Death:
Will No. ~ Admin. No. > .,~_ [- L9 ~ ~'C~
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the.~rphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Name
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Signature
Name &~ ~ ~e~/
/
Telephon~ / 7 ~ W~ 9570
Capacity: ~ Personal Representative
__Counsel for personal representative
Name of Decedent:
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. ~O /J/// Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Qrphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on~c~ :
Nalne
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
[ c Signat~7'ure~ -
Name
Address
Capacity: ~;sonal Representative
Counsel for personal representative
J 1505607121
REV-1500 EX (06-05) °
OFI
ICIAL USE ONLY
-
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
POBOx2so6o1 INHERITANCE TAX RETURN
Hamsburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 3 0 5 9 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 4 7 4 2 5 3 8 2 0 7 0 9 2 0 0 3 0 2 1 7 1 9 4 9
Decedent's Last Name Suffix Decedent's First Name MI
L E W I S R A Y N O R D
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 1 1. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T,AX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
M U R R E L R W A L T E R S I I I 7 1 7 6 9 7 4 6 5 0
Firm Name (If Applicable)
First line of address
5 4 E A S T M A I N S T R E E T
Second line of address
City or Post Office
M E C H A N I C S B U R G
Correspondent's a-mail address:
State ZIP Code
REGISTER OF WILLS USE ONLY
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI ATURE F PERSO RESPONSIBLE F 1 RE
~,~~, i ~/ J v : ~AT~ U ~'
ADDRESS ~ J,
SARAH M L I ~& Y R LEWIS 74 CHERRY LN ~~ARLISL PA 17013
SIGNATURE O P AR OT R ESENTATIVE
~~J G A 7 "~.~ U S
MURREL R WALTERS, 54 E MAIN STREET MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 ]L505607121
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent's Name: R A Y N O R D• L E W I S :L 4 7 4 2 5 3 8 2
RECAPITULATION
1. Real estate (Schedule A) ..................................... ... 1
2.
...............................
Stocks and Bonds (Schedule B)
...
2~ •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages & Notes Receivable (Schedule D) ..................... ... 4.
7 ~ ~ ' ~ ~
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .... ... 7.
8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 7 ~ ~ • ~ ~
9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 5 1 3 0 . 0 D
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... ... 10.
11. Total Deductions (total Lines 9 8 10) ........................ ... 11. 5 1 3 0• 0 0
12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. - 4 4 3 0 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... ... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............... ... 14. - 4 4 3 0 . 0 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.0 _ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ............................................ ....19. •
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 03 05!x9
DECEDENT'S NAME
RAYNOR D. LEWIS
STREET ADDRESS
5C CREEKSIDE LANE
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1• Tax Due (Page 2 Line 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + ~~) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : .......................................................... ............ ^ X^
b. retain the right to designate who shall use the property transferred or its income; ................... ............ ^ ^X
c. retain a reversionary interest; or .................................................................................... ............ ^ ^X
d. receive the promise for life of either payments, benefits or care? .......................................... ............ ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .......................................................................... ............ ^ Q
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................... ............ ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ,4ND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirE;ments for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
RAYNOR D. LEWIS 21 03 0599
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1984 CADILLAC 150.00
SALE PRICE
2. 1964 CHEVROLET NOVA 500.00
3. ALLFIRST BANK 50.00
CHECKING ACCOUNT
TOTAL (Also enter on line .5, Recapitulation) I $ 700.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILI=NUMBER
RAYNOR D. LEWIS 21 03 0599
Debts of decedent must be reported on Schedule t.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME 4,855.00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
2. Attorney Fees MURREL R. WALTERS, Itl, ESQUIRE
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City State _
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY
5 Accountant's Fees
6. Tax Return Preparer's Fees
7.
Zip
225.00
50.00
TOTAL (Also enter on line S3, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~. ~~ ~~~~
RAYNOR D. LEWIS "" """"
RELATIONSHIP TO DECEDENT
AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
I Sec. 9116 (a) (1.2)]
1. RAYNOR LEWIS Lineal
74 CHERRY LANE
CARLISLE, PA 17015
2. SARAH M. LEWIS Lineal
74 CHERRY LANE
CARLISLE, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CC)VER SHEET $
(If more space is needed, insert additional sheets of the same size)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APRRrM~~SFsl~ENT,r•°~1,EOWJINCE OR DISALLOWANCE
• OR DEIyllET_BONS~'AND ASSESSMENT OF TAX
~.1 _. .. ~, _ .._
REY-1547 EX AFP (01-09)
DATE 03-30-2009
~~?~g ~~~~~ 3 ~ P~ ~~,~'; , STATE OF LEWIS RAYNOR D
DATE OF DEATH 07-09-2003
~ n~ ,.~~-. FILE NUMBER 21 03-0599
;~.
,~~.,~,;,,, ~,~~, ~T COUNTY CUMBERLAND
MURREL R WALTERS III ~~~~ `~~' •) -'J ~~ ACN 101
54 E MAIN ST C~ ``fl'fl ~' ~r~-, APPEAL DATE: 05-29-2009
MECHANICSBURG PA 17055 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
--------------------------------------------------------------------------
REV-1547 EX AFP (01-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEWIS RAYNOR D FILE N0. 21 03-0599 ACN 101 ---
---
OR
DATE -----------
3-30-2009
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: T o insure proper
2. Stocks and Bonds (Schedule B) (2) .00
credit
to your account,
00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax pay ment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 700.00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
e. Total Assets (g) 700.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
5,130 .00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
L0. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00
11. Total Deductions C11) x.130.00
12. Net Value of Tax Return C12) 4,430.00-
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule „I) (13) .00
14. Net Value of Estate Subject to Tax C14) 4,430.00-
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assess ed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) •00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) •00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 _ .00
19. Principal Tax Due (19)= .00
TAY C:QCTITTC •
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)