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HomeMy WebLinkAbout02-22-12 (3) •` Harriebur~l?A 1912t3~0601 RESIDENT DECEDENT ENTER`DECEIfENT INFOI~i1TION BELOW Sodal Security Number Date of Death MdDDYYYY Date Of Birth MMDDYYYY 2 1 4 2 2 9 3 7 5 1 1 2 4 2 0 1 1 0 1 1 8 1 9 2 5 Decedent's. Last Name Suffer Decedents First Name MI L E W I S MAR I ANNA M (If AppNcab?N) Enbsr Surviving Spouse's InfonmatJon Below Spouse's Lest Name Suffix Spouse's First Name MI Spolrae'm Sochi Security Number THIS RETURN MU8T BE FILED IN.DUP. UGATE 1MTH THE - REGISTER OF WILLS FILL IN APPROPRIATE OVAL3 BELOW © 1: Oripirtel Retum ^ 2. Supplemental Retum ^ 3. Remainder R~trm fdMR of dtll>ah .: prior to 12-132) ^ ' 4. LimiEed Estate ^ 4a. Futuro Interest Compromise (date of ^ 5. federal Istabe Tex Retuni Required death after 12-122) [~ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Namberof Serfs Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust) 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Elecxion to,talbc llrlder Sec. 9143(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TNIB SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFDENTfAi. TAX IN~ORMATf~1 gFiOi~.if ~ T0: Name Daytime Tebphotre Number M A R C U S A- M c K N I G H T III 7 1? 2 4 9 2 3 5 3 f ,. ._ .,,.;:: 1505610140 V-1.500 ~` ~~,-,~, PA of Revenue ~~ u3E ONLY Burosu afJhdivlduatTaxes INHERITANCE TAX RETURN ~~Code Year File Number Po sox 2fiD601 2 1 1 1 1 3 0 5 ~,m ~. First line of address ~ ~ .: ~ h3 r IRWIN & McK N IG HT P C ~~ ^~ Second line of address a ~' ~ _ :r c ` - .--, , 6 0 W E S T P O M F R E T S T R E E T ~ w . City or Post Office State ZIP Code ~~ ~ '!`+ C A R L I S L E P A 1 7 D 1 3 Con+ssporrdsrtt~': e-mail address: under pmel~sa of perjury, I declare that 1 nave examh-ed thls rswm, inducting aocompenyhq sdbdube and statemeMa, and m the hest o1 my krwiMerfge and beNer, k is.t+as.. end oorr~plste. of preparer other thar- the personal represenre is based on all inforrrrepon d rrhict-,prsparsr tuts any kopwNlppe. SKiNA RE L~FOR FILING RETURN p ~~~/1 i z,/ zl ~~1 v DATE PLEASE USE ORIGINAL FORM ONLY Side 1 ~- 1505610140 1505610140 I l~t~(/ J 1505610240 a REV-1500 EX DecxdsnYs Social Security Number oeoedent's Name: M A R I A N N A M• L EW I& 2 1 4 2 2 9 3 7 5 RECAPITULATION ~ '` '' 1. Real Estate (Schedule A) ........................................... 1. • 2. stocks and sonde (schedule a) ...................................... 2. 1 4 1. 3 4 3. Closely Held Corporation, Partnership arScle-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) ............ ........... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 2 4 7 2 3 . 0 2 6. Jointly Ownsd Property_ {Schedule ~ ^ Separate Ruling Requested ....... ti. 1 3 4 ' S . 2 2 7. Inter-Vivos firanstl~rs "b Mispellaneous Propertjf 8. (Sr~redub G) rate BiNing Requested ....... TQtd Grass Assets (total Lines 1 through 7) ............................ 7. 8. 2 2 4 6 0 6 7 9 0 1 2. 6 ~ 2...: ~ 7 5 . 9. Funeral ,F.xpenses,and Administrative Costs (Schedule M) .................. 9. 1 6 8 8 2. 7 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. ~ 3 3 ~ . 9 7 11. ,Total: L1eduWora (total Lines 9 and 10) ............................... 11. 1 9 2 1 ,b`. 7 3 12 t~Yalw of Estes (Line 8 minus Line 1.1> ..................... .... 12. 2 4 .7. 6 9 .5 .~ ~ ,~ 13. C.harttabb and Govenunental Beque~sta/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 1 0 0 (] . 0 0 14. Nelt Vatur subJect~ to Tax (Line 12 minus Line 13) ...................... 14. 2 4 6 6 9 5. 5 2 ~' -SAX ~BULATIOiiI-., INSTRUCTIONS FOR APPLICABLE RATES `f5. Art~int of Line'1~4-taxable at tt~l ~x'rate, or treN~rs updsrSec. 9116 16. Anmunt of,line 14 taxable at Ibal rate X .045 2 7 6 6 9 5. 5 2 1 s. 17. Amount of Line 14 taxable w ~ , at;s~ng ;~ }t~ 0 . 0 0 17. 18: Artr4unt ofi Line 14 taxable at ooNatsral rate X .15 0 • 0 _- 0 18. 19. TAX DUE ......................................................19. 20. FILi tN THE OVAL 1F YOU. ARE REQUESnNG A REFUND OF AN OVERPAYMENT p : ,. 1505610240 Side 2 0. 0` 0 1 2 4 5 1. '3 0 0. 0 0 0.: 0 0 1 2 4 5 1. 3 0 0 REV 150 EX Pape 3 Decedent's Coimplete Address: Fih Number 21 11 1305 DECEDENT'S NAME MARIANNA M. LEWIS STREETADDRESS 210 BIG SPRING ROAD CITY NEVWILLE STATE PA ZIP 17241 Tax Paylments wind Credits: 1. Tax Due (Page 2, Line 19) (1) 12.451.30 2. CreditslPaymerds A. Prior Payments s. Disoourtt 622.57 Total Credits (A + B) (2) 622.57 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, sober the dfference. This is the ONERPAYN~frT. (3) Fig M oval on Ppa Z. Line ZD b reque~ a refund. (4) 0.00 5. ff Una 1 + Line 3 is greater than Line 2, enbar the difference. This is the TAX DUE. (5) 11.828.73 Make check payable to: REGISTER OF WILLS,. AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AP~tOPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or irxxxne of the Property transferred; ...................................................................... ^ b. retain the right to designate who shall use the property transferred a its irxxxne; ............................... ^ c. retain a reversionary infest; or ................................................................................................ ^ d. receive the promise for Iffe of either payments, benefits a care? ....................................................... ^ 2. ff death ocarmed after December 12,1962, did decedent transfer property within one year of death without receiving adequab rxxtsiderefiorr? ......................................................... 3. Did decedent own an'in trust for• or payal~e-upon-death bank account ar security at his or her death? ......... 4. Did decedent own an individual retirement accarnt, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ® ~ ^ IF THE ANSMIER TO ANY OF THE ABOVE QUESTIONS 18 YE8~ YOU MUST COMPLETE 8CHEDULE G AND FILE For da6es of d~tr on or after July 1,1994, and before Jan. 1, 1995, the tax Hate imposed on the net v~ue of tran~ers b or for the use of ills surviving.spouse is 3 percent (72P.S. §9116 (a) (1.1) (i11. For dates of death on or aAer Jana 1,1995, the tax refs imposed on the net value of tr~sfers to or for the use of the surviv~g spouse is 0 percent p2 P.S §9118 (a)`{1.1) (11)]. The ~atute does not exempt a transfer fp a surviving spouse from tax, and the statybory requlremertts for disclosure of assets alnd filing a tax radon are stlN appfiCable every if the surviving spouse is the only benefiaary. For dates ~ dea~.on of otter Juty 1,2000: • The tax rate ~rlposed tz{t ~ net value of trartsfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, err adoptive parent or a steppareltt of the child is 0 percent (72 P.S. §9116(a)(1.2)]. • The tax rate impo®ed on'tlte net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72P.S. §9116(aK1)]. • The ~x rate imposed on Ute net vale of tr~sfers b or for the use of the deoedenYs siblings is 12 peroerrt p2 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individu~ who has at least one parent in common witl~ the decedent, whether by Mood or adoption. REV-1503 EX + (6-98) SCHEDULE B ~ CQAwONWEALTH of PENNSYLVANIA STOCKS ~ BONDS INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FEE til1MBER MARIANNA M. LEWIS 21 11 1305 AN propeAr joMgaownetl wNh rlpM of wrvhorship must be dreclaed w ticheduN F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF pEATH 1. 3.773 SHARES OF CONSTELLATION ENERGY GROUP STOCK 141.34 3.773 SHARES X $37.4600 PER SHARE _ $141.34 TOTAL (Also enter on line 2, Recapitulation) ~ $ 141. (If more sp6oe is needed, Bert additlonel sheets of the same size) REV-1808 EX+ (11-10) ~nnsylvania SCHEDULE E v+s DEPARTI~N7OFREVENUE CASH, BANK DEP031TS, 8i MISC. ~sio ~r~cT~~r~ir~~~ PERSONAL PROPERTY MARIANNA M. LEWIS 21 11 1305 Include Cie of 6~fon and the dale the proof were reoeNed by Cie.estals. AM pron«b owned wNh right of wryhronbia nwst be dNdowd on tidw~duk F. ITEM VALUE AT DATE NUMBER DESCRIPTION AF DEATH 1. SOVEREIGN BANK -MONEY MARKET #3381127756 24.723.02 TOTAL (Also enter on Line 5, Recepitul~ion) ~ f C more s~ce is needed, insert additlonal sheets of paper of Cre same sim REV-1509 EX+ (Ot-10) ~i Pennsylvania ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY c~ r nr c vr: F~.E NUIf~ER: MARIANNA M. LEWIS 21 11 1305 ~ an aslssWt wa made jointly owned wMhin one year of the decederlt'e date of dsMh, it neat be rePorbd on Sdaduk G. SURVMNG JOINT TENANT(S) NAME(S) ADDRESS DECEDENT A. JOHN M. s. c. JOINTLY~4MIMED PROPERTY: NDER SPRING PA 17015 ITEM NUMBER TENANT MAD JOINT INCLUDE NAME OF FMIAN(~AL~NS~TITUT~IO~N AND B~AM(aC.COUNT NUMBER OR siMILAR iDENiiFYING NUMBER. ATTACH DEED FOR JgNTLY-HELD REAL ESTATE. DATE DF DEATH VALUE OF ASSET % of DECEDEM'S INTEREST DATE OF DEATH VAI.(~E OF DEC~ENT'S titTERESI 1. A. SOVEREIGN BANK 1,450.92 50. 725.46 CHECKING ACCOUNT #2891028848 2. A. SOVEREIGN BANK 1,239.51 50. 819.76 CHECKING ACCOUNT #2891028856 TOTAL (Also enter an Line 6, Recapitulation) I S 1345 22 ff more space is needed, use additional streets of paper of the same size. REY-1510 EX+ (08.09) ii Pennsylvania ~ DEPARTMENT OF REVENUE INHERfrANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY C>, IAI C OF FILE tR1MBER MARIANNA M. LEWIS 21 11 1305 This schedule nwst be oomplaied and tiled if the ar~wer>p any of queatlor~s 1 through 4 an papa tluee of the REV-1500 is yes. REM NUMBER DESCRIPTION OF PROPERTY INauoE THE Naa: of THE TitANB~ff, Tt[~Mt RELATIONSF~ To DECS~ear A40 Ttf0U1TE0PTRN. ATTACHACOPYOFTHEDffDFORRENL~TATE DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION ~~vaic~a.q TAXABLE VALUE 1. . SOVEREIGN BANK - IRA #33880488997 5,195.37 100.00 5,195.37 CONTINGENT BENEFICIARIES: JOHN M. LEWIS WILLIAM B. LEWIS DAVID S. LEWIS 2. WESTERN NATIONAL LIFE INSURANCE COMPANY 172,921.25 100.00 172,921.25 ANNUITY #tW219750 BENEFICIARIES: JOHN M. LEWIS WILLIAM B. LEWIS DAVID S. LEWIS 3. SUN LIFE FINANCIAL 62,586.05 100.00 62,586.05 ANNUITY #KA12899029-01 BENEFICIARIES: JOHN M. LEWIS WILLIAM B. LEWIS DAVID. S. LEWIS TOTAL (Also enter on line 7, Recapitulation) ~ s 240 702 67 If more space is needed, use additional sheets of paper of the same sine. RE1/-151 ~C+ (10-09) ~, Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARIANNA M. LEWIS 21 11 1305 Decedents debts must be reported on ScMdule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 8,784.00 2. WESTMINSTER CEMETERY -INSCRIPTION 500.00 3. WESTMINSTER CEMETERY -INTERMENT/ENGRAVING 1,930.00 4. FUNERAL LUNCHEON 512.72 5. HOFFMAN-ROTH FUNERAL HOME -ADDITIONAL DEATH CERTIFICATES 60.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Sheet Address CHy State ZIP Y~r(s) Commission Paid: 2. Attorney Fees: IRWIN 8 McKNIGHT, P.C. 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant _- Street Address City State ZIP Relationship of Claimant to Decedent 4. ~ Primate Fees: REGISTER OF WILLS 5. Aoca~rdarrt Fees: ti. Tax Return PreparerFees: PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. SOVEREIGN BANK -DATE OF DEATH VALUATION 9. THE SENTINEL -ESTATE NOTICE 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 11. NOARY FEES 4,250.00 141.50 375.00 30.00 20.00 189.54 75.00 15.00 TOTAL (Also enter on Line 9, Recapitulation) I = 76 ff more space is needed, use additional sheets of paper of the same size. REV-1 ~12 EX+ (12-06) Pennsylvania ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS esrATE vF - FILE NUMBER MARIANNA M. LEWIS 21 11 1305 Report debts Mcurred by the decedent prbr to detlh tlrat rernainad unpaid at the dab of death, IncludMg unrein~ursed medical eorpergee. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. DELAWARE PUBLIC EMPLOYEES' RETIREMENT SYSTEM 100.00 REIMBURSEMENT OF PENSION 2. CHASE -CREDIT CARD 28 44 3. GREEN RIDGE VILLAGE -NURSING 1,607.06 4. MILLENNIUM PHYS SYSTEMS -MEDICAL 319.84 5. UGI -UTILITY 37.57 6. CENTURYLINK -TELEPHONE 38 46 7. HOMESTEAD SENIOR CARE -NURSING 87.00 8. MET-ED -ELECTRIC 74.31 9. ALPHA DIAGNOSTICS -MEDICAL 41.28 TOTAL (Also enter on Line 10, Recapitulation) I ; H nare space is needed, ir~ert additional sheets of the same sine. REV 1513 EX+ (01-10) ~~ Pennsylvania ti DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES MARIAN NA M. LEWIS 21 11 1305 RELATIONSHIP TO DECEDENT AMOUNT OR SWORE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lbt Tnatee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pndude autrfaM spousal d~ibudore and trars~ers under Sec. 91 6 a) 1.2.E 1. WENDY LYNNE LEWIS Lineal 5,000.00 2120 WILLOW WAY WILMINGTON DE .19810 2. ELIZABETH LAUREN LEWIS Lineal 5,000.00 305 PARK CIRCLE ' ELKTON, MD 21921 3. MORGAN ANNA LEWIS Lineal 3,000.00 305 PARK CIRCLE ELKTON, MD 21921 4. CHASE WILLIAM LEWIS ( Lineal 3,Opp,00 305 PARK CIRCLE ELKTON, MD 21921 5. CAITLYN BRIANN LEWIS Lineal 3,000.00 14 iMONTERRY DRIVE NEWARK, DE 19713 6. CHRISTOPHER J. LEWIS Lineal 5,000.00 881 ALEXANDER SPRING ROAD CARLISLE, PA 17015 7. TREVOR MOORE Lineal 3,000.00 15 JONATHON DRIVE NEWARK, DE 19702 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, A3 APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: t B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. ST. PAUL'S LUTHERAN CHURCH 1,000.00 201 VV. LOUTHER STREET CARLISLE, PA 17013 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. i 1 000.00 ff more space is Headed, use additional sheets of paper of the sane size. -_ vvnunuapOn OT IttV-7500 Inheritance Tax Return Resident Decedent ~, MARIANNA M. LEVVIS 21 11 .1305 DecedeM'a Name Pape 1 F(b Number Schedule J - Beeeflciariee -1 NUMBER NAME AND ADDRESS OF S RECEIVING PROPERTI( RELATIONSHIP TO DECEDENT Do fiot LJatT AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUT'~NS S 1 i ~ .2). ec. 91 6 (a ( 918 8. WILMA WORTHINGTON Lineal 3,000.00 367 OLD STATE ROAD GARDNERS, PA 17324 9. JOHN M. LEWIS Lineal 881 ALEXANDER SPR{NG ROAD 4096 REMAINDER CARLISLE, PA 17015 10. WILLIAM B. LEWIS Lineal 11 NEWGATE CT. ~ 3096 REMAINDER NEWARK, DE 19713 11. DAVID S. LEWIS Lineal 305 PARK CIRCLE 3096 REMAINDER ELKTON, MD 21921 r ,~ `4 I MARIANNA M. LEWIS, of Dickinson Township, Cumberland County, Pennsylvania, declaze this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor from my estate, and that none of the aforesaid taxes shall be prorated among those persons or entities named herein or otherwise beneficiaries hereunder. TWO. My Executor may, at his discretion, compromise claims, borrow money, retain property for such length of time as he may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor is authorized and empowered to engage in any business in which I may be engaged at my death, for such period. of time after my death as seems expedient to said Executor. r ,,. a~ THREE: I specifically give, devise, and bequeath my personal property as follows: a. WILLIAM B. LEWIS ....................... Walnut Comer Cupboard b. DAVID S. LEWIS ................................... Grandfather Clock c. JOHN M. LEWIS ..... Pie Crust Table and Small Drop Leaf Table FOUR: I specifically give, devise, and bequeath to the following: a. WENDY LYNNE LE~'VIS ........................... $5,000.00/ b. ELIZABETH LAUREN LEWIS .................... $5,000.00 c. MORGAN ANNA LEWIS ........................... $3,000.00 ~/ d. CHASE WILLL~IVI LEWIS .......................... $3,000.00 ,~ e. CAITLYN BRIANN LEWIS ....................... $3.,000.00 f. ST. PAUL'S LUTHERAN CHURCH .............. $1,000.00 g. CHRISTOPHER J. LEWIS .......................... $5,000.00 h. TREVOR MOORE ...................................................$3,000.00 i. WILMA WORTHINGTON ............................:........$3,000.00 If any of the above have predeceased me their share will be distributed pursuant to paragraph five (5) of this my Last Will and Testament. FIVE: I give, devise, and bequeath all of the rest, residue and remainder of my estate of every nature and wherever situate, to the following: a. JOHN M. LEWIS ......:...................................... 40 ~ b. WILLIAM B. LEWIS ........................................ 30% c. DAVID S. LEWIS ............................................ 30% 2 a +~ .., SIX: I appoint my son, JOHN M. LEWIS, to serve as Executor of this my Last Will. If he has predeceased me, failed to qualify, or ceased to serve as Executor, I appoint my sons WILLIAM B. LEWIS and DAVID S. LEWIS, to be the Co-Executors of this my Last Will. SEVEN: No Executor, acting hereunder shall be required to post bond or enter security in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of October 2011. ~~~~- ~ _ ~ ' (SEAL) MARIANNA M. LEWIS Signed, sealed, published and declazed by MARIANNA M. LEWIS, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other have subscribed our names as~ witnesses hereto. 3 Y •-~ •. ACKNOWLEDGMENT AND AFFIDAVIT WE, MARIANNA M. LEWIS, MARTHA L. NOEL, and KAREN S. NOEL, the testatrix and witnesses respectively, whose names are signed. to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MARIANNA M. LEWIS, the testator herein, and subscribed and sworn to before me by MA THA L. N Land KAREN S. NOEL witnesses, this ~~day of October 2011. O ~ ~___.- ~~ a aunt t wry waK MARIANNA M. LEWIS * «~~~~ ~~ ~reielcAn~ PO BOX 922 WALL STREET STA71aN NEW YORK, NY 10289-0860 INTERNET WEBSITE: ` WWW.AMSTOg000M TELEPHONE~ N~~~IItABER: 880p4- <: • {IItI'I~I'It11I'Iilllll'II'II'I'l'II'I!"IIIIIIIIII'IIIIINIIp6 ~ 9coaoeaeoe 111005.0109.2~l98.01.01 ' 09/12/2011 !O-RI711Oi11 LENIS . 102 !~ DRIVS 10/03/2011 CARLISLE, PA 17015-7622 .240000 13.06 .000 51.000 3.431 .00 .Ob 12.24 .87 33.06 01/01/2011 B ALANCE FOR WARD ~"~~' 2.289 at PNorthrn 01/03/2011 60 12.79 .26 30.9850 0.404 2.693 ~ ~"~ 01 ~ 04/01/2011 60 12.89 .26 31.2200 0.405 3.098 07/01/2011 60 12.98 .26 38. 0.333 6'1 ~ purahaaad~Wd-ap0onal 10/03/2011 60 13.06 .26 .4600 0.342 3.773 ~ caah dlaoolNR " K lhuas ~oalwd ~ iTOCK OMDEND tT!Oiit 66 O ~~ r EP tb >i1Nns fb-. 67 aMeN 0@08tl~1 Yy NAIG ar . T~ W Mlt TMiM~ ~ U \ a~4aola 70 ARTML WIt1M~l ' hauad far whale `wv/~~` \ 71 PARiMt.WfTiB'lIlA1NAL-whoN shares sold r! PAR'flALWtMDRAWAL- Mntad /or ~irhois rhwsc kacMon • solo 7S PARTW.YYttlB)RAWAL-~hMSs aokip slwrholds-rrtanlsr Nt pWl ~ PLAM TlRIMIATtON • aarwllalls lewd tar vdlols ~~ ksoYan soldt 01 PLAN TERYM11Ti011 • aM shoes sold a ah.n. iglu our as spans DEBIT adJuswam 71s a roau].t o! the ENrgaacy Ecoaooia Stabilisation 11ct of 2006, the IRS raquiraa sAarahoidira to raimrlist s aiaitna- of 10+1 of their share balance arch sahadulad disburssasint data. If your account fella baloM the 104 aaadatory tArasAold, you Mill ba~sant a aotification outliainq your altarnatiws for dividend rai>xvast>Aar-t. a _ 2,051.80 .000 5,.000 3.773 54.773 .00 .00 51.72 00 00 ~ $25 1Q2i $100 , 000 DfA7C Bo~ereigr~ w~u[ ui'aereo Processing ~ Decedents - MAl-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 December 15, 2011 Marcus A. McKnight, III Irwin & McKnight 60 West Pomfret Street Carlisle, PA 1701.3-3222 RE: Estate of Marianna M. Lewis Date of Death: 11/24/2011 Dear Marcus A. McKnight, III: ~~~~~ '~~~ l ~ 2()€~~ iliWll~ ~ ~cKNit~H? ~~iY~ OFFiCFc Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, Ni le o Specialist 617-514-5189 ,.. S~overeigrt Bank ESTATE OF Marianna M. Lewis SOCIAL SECURITY #: 214-22-9375 DATE OF DEATH: November 24, 2011 Account #: 2891028848 Type: Checking Open date: 4/12/1985 In the panne af: Marianna Lewis or Sohn M Lewis. Date of Death Balance: $1,450.92 Int.(YTD) from 1/1/2011 to 11/23/2011 $0.11 Accrued interest to date of death: $0.00 Other info: Account #: 2891028856 Type: Checking Open date: 4/19/1985 In the name of: Marianna Lewis or John M Lewis Date of Death. Balance: $1,239.51 Int.('YTD) from 1/1/2011 to 11/23/2011 $0.94 Acerued interest to date of death: $0.00 Other Info: Account #: 3381127756 Type: Money Market Open date: 8/17/1999 In the name of: Marianna Lewis Date of Death Balswce: $24,723.02 Int.('Y'I'D) from 1/1!2011 to 10/31/2011 $135.48 Accrued interest to date of death: $12.89 Other info: Account #: 3388048997 Type: 1RA Open date: 12/8/2000 Ln the name of: Marianna Lewis Date of Death Balance: $5,195.37 Int.(YTD) from 1/1/2011 to 10/31!2411 $174.96 Accrued interest to date of death: $14.66 Other Info: Beneficiary information: Harold Lewis -spouse. Page 1 of 1 .~ ~. January 6, 2011 Life Insurance C o m p a n y P.Q Box 871 Arnarillo,Texas 79105-0871 1.800.424.4990 IRWIN & MCKNIGAT WEST POMFRET PROFESSIONAL BUII.,DING 60 WEST POMFRET ST CARLISLE PA 17013 RE: Policy Number: W219750 Deceased: Marianna M Lewis Dear Mr. McKnight: WESTERN ~ NATIONAL ~~CEIVED JAId 13 2012. iRi1Ni~ McKNIGHl' lAW OFl~CES Thank you for your recent inquiry regarding the referenced annuity contract. It is our pleasure to be of service to you. We would like to take this opportunity to respond to your letter dated December 19, 2011. ' If you have any questions please contact our customer service representatives, at 1-800-424-4990. We appreciate this opportunity to serve you. ' cerely, ~~~~~~ Celia Martinez Claims 1 a 3 j ~ ~~~~~. Sun Life Assurance Company of Canada (U.S.) ~~` r Sun ~; P.O. Box 9133 - Life Financial ® Te111800 5272 6A 02481-9133 Fax: 781-304-5383 December 28, 2011 Marcus A. McKnight III Law Offices of Irwin & McKnight PC West Pomfret Professional Building 60 W Pomfret St Carlisle PA 17013-3222 RE: Contract values and history. Contract number: KA12899029-01 Owner(s): Marianna Lewis (Deceased) Dear Mr. McKnight, Thank you for writing to us about this Sun Life Financial annuity. ~~~iv~~ ~~ IAiN OFf1CES The information below is provided in the same order as the questions on your original request. 1. The registered owner of this contract is Marianna Lewis. Our records also show the following beneficiaries for this Sun Life Financial annuity. This information is up to date as of November 24, 2011. Primary Beneficiaries: John M. Lewis William B. Lewis David S. Lewis Contingent Beneficiaries: None listed 2. This contract was issued on August 16, 2006. 3. There were no ownership or registration changes for this contract within one year prior to November 24, 2011. 4. There were no other contracts owned by Marianna Lewis closed within one year prior to November 24, 2011. Sun Life Assurance Company of Canada (U.S.) is a member of the Sun Life Financial group of companies. www.sunlife.com w 5. The contract value of this annuity as of November 24, 2011 includes all interest .. ~ earned. 6. As of November 24, 2011 the contract value of this annuity was $62,586.05. Please know that on December 27, 2011 we also mailed claim packages to each of the beneficiaries for this contract. If you have any questions, please ca11 our Customer Service Center at 800-752-7216. Sincerely, Elizabeth Matisz Annuity Operations & Customer Service 23326429 Sun Life Assurance Company of Canada (U.S.) is a member of the Sun Life Financial group of companies. www.sunlife.com ti S FUNERAL HOME ~ CREMATORY, INC. John M. Lewis 881 Alexander Spring Road Carlisle, PA 17015 219 North FbnoverStreet Ca~sle, Perx 17013 717.243.4511 toll tree 1.Bb6.451.4511 fcnc 717.243.3723 wwwmm December 6, 2011 Statement of Funeral Expenses for. Marianna Lewis Dalbe of Death: November 24, 2011 Account Id: 16382-252 PACKAGE:. Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,650.00 Sub Total: : 4,650.00 MERCHANDISE: Casket Portland $ 2,345.00 Outer Container. Monarch -Concrete Vault $ 1,420.00 Sub Total: ; 3,766A0 .._.. TOTAL FUNERAL HOME CHARGES: = g,41~pQ CASH ADVANCES: 10 Certified Death Certificates at $ 6.00 each $ 60.00 Clergy $ 100.00 Fk~Nrers $ 159.00 Hairdresser ~ $ 50.00 Sub. Toml: s SAO Total Funerai Exoerxe: ! 8.784.b0 Balance: ;a soo u~+ TAx - == ~ S' 1 . f ft~~'~ r \ i~ ~~ ~ / ., ,~,_ % 111 t,~~'. *~~ ' /"I ,gam ~,~~E~. X~ .~~~ '_ ~~~ ~~ w~N M~ ~ o~ ;; ~b l~bd ~~`1 ~~~ a~ • ~~ ~, ~~ ~y w ~ ~~ ~~ ~+ ~ 3 t.~A __ ~~ ~_~ ~ . ~ r` es ~ " `s ~~ r ,- ~ ~ ~ ~' .x ~ C~o~ h ~ ~, J ~~ $~Q ~G'gv9 ~ r ~~141. 1 ~F • egn s9 'y'r '~'' y v! S"' y~~, t37 ~.~ ~ yy ~ yes pa ~ ~ f ~ y ~ ~Z 1 ~ '~ CJ' ~ ~ ~ J .. l W v ~ -~.,. ~~ ~ ~ ~ yr ~ ~ N ~ ~ ~~ ~~ W ~ ~` ~~ '~ ;.~ ~~~~o Fay o~ -+Q ~ of v ~ v .~' ~..rt ~ ~ f ~ ~ ~ ~ ,~' ~ ~-: ,~ ~ ~ ~ ~ o a ~.~ ~. ~ ~~ ~ ~ ~ ~ ~ .~_ ~~ ~ ~ ~ ~ ~. 1 J U ,~ f` x ~ .~~ Z ~ 1 ~' ~' '~ O ~ ~ ~ ~ ~ ~ "" ~ ~ ~ ~ ~ .,a ~, E: %: ~ ~~ a: ~ ~ `3 p ~~ ~, '~' • ~ I~j o~ ~ ~~ ~. ~ .~ .~ ~ 4 ~~~~~,~ «-. N ~ . .+~ !L' r ~~ • ~~ 0025 Server: DEBRA C (#20) 11j29/11 1fi:36, Swiped RUSTIC TAVERN 823 NE4~VILLE ROAD CARLISLE, PA 17013 (717)245-2999 -1~ERgiANT # : Rec: 13 T: 15 Term: 3 CARD TYPE ACCOUNT NUMBER MASTER CARD XXXXXXXXXXXX9298 Nave: JOfIN M LEp~IS ~ TRANSACTION APPROVED AUTHORIZATION #: R08~53 Reference: AUI1088113 TRANS TYPE: Credit Card SALE CHECK: TT- . ADDL. TIP: TOTAL: 437 . #~' 74.8: ~~ .7 2 x PHONE: ( ) - CAROHOLDER I~ILI PAY CARD ISSUER A80VE AMOUNT PURSUANT TO CARDHOLDER AGREEMENT Sign One Copy & Keep a Copy far Your Records ~- ~, ~.~ CLLT•t0.8,1 Doss-it~s,r .uo~.,,a„~;uosJ ,,,p,c,~~ ~ _,~. ~~ . ____---- .LSf12Fi3J,y15~ _--- _.._ -.~ Q; ,~, = M ® !V OC O ... G ../MV .. M 4' ... j WW.tib ~ ~ w ~' o ~iH•y .. « ~ 4 V7 4 fy j Y ~ ~~ ~.. 2 Of Y ~ D H 7K Z,~ ..may '~ ~ o t ~'d. oau w.o. v ~ aC ° ~"~ ac ~ g°. ~- a ... ~.... .~ ~o __ 9 _ e ~~~ ,_, o :~~R'.7a~a..w......._...V.~__.._.._..._~C1.1l~ru~ __ ._....._.__..........__..._...._... _.....__...__....____.~.___~_... _.~_....___._._... - ORKiiNAL 2~1 ACCT.1~. ~v/ B7y~ ~.~.d w v Fur wit ~«~d..d IVerne oioece~esd. o._. -~~ d ~,.~. ^ OTHER ~.aa! f~~r ~+ " 1 ~ ~ LAST eauwcE s -~-"'' +uu CREDffS i LESS P4YMENT ~' ~ ` _ ~~ _____ . raw staL~ce s x;6742 -- -~...rQ..~--~~r~ii3a G ,• •' ~ c• SW13't 'w 1~ .wno~~v jsnw.~vy~ ~a'~tnn~w ~ NU~~ ~~ STATB OF DBLAWARB BXECUTIYE. DBPARTMENT OFFICE OF MANAGEMENT AND B.YDGET February 6, 2012 John M. Lewis Estate of Marianna Lewis 881 Alexander Spriflg Rd. Carlisle, PA 17015 Dear Mr. Lewis:. RE: Estate of Marianna Lewis Pension Employee ID# 143203S01 The Office:of Pensions received notification of the death of pensioner Marianna Lewis who died on November 24, 20Y 1. As Ms. Lewis died in the month of November 2011, she was entitled to her pension benefits through that month. Ms. Lewis was not entitled to receive pension benefits far the month of December 2011. Funds in the amount of $826.84 were distributed on December 23, 2011. The State of Delaware was able to retrieve the net .distribution of $726.84 from Ms. Lewis's account. The remaining $100 was paid into her Federal Incomes Taxes, because the taxes have already been paid in and reported to the IRS, the Estate of Marianna Lewis owes the Delaware Public Employees' Retirement System the overpaid amount of $100.00 for the month of December. Please submit a check in the amount of 51011.00, made payable to the "Delaware Public Employees' Retirement System" and forward to: W5585 State of Delaware P.O. Box 7777 Philadelphia, PA 19175-5585 OR ' ~ fr ~ .. . 1.i• OFFICE OF PENSIONS 880 SILVER LAKE BLVD. SUITE 1 • MCARDLE BUILDING • DOVER. DE 19904 PHONE: (302)739-4208 • TOLL FREE: (800) 722-7300 • FAX: (302) 739-8129 • WWW.oMS.DELAwwRE.GOY t ~ ~ DETAILED ICE Service For . Mariana Lewis**(1) Baled To : Mrs. Marianna Lewis Invoice #: 1489-1111-2 Invoice Date :11/30/2011 Service Period :Nov 16, 2011- Nov 30, 2011 J~~1~11, • Zo uf, ~tf pertoaa~' 5002 Lenker Street Mechanicslxng, PA 17050 (717)731-9984 vwvw+.Honaelnsbead.c:om 11/16 IO:OOam 6:OOpm 11:30am 7:30pm Nomiai ~ Smith-Dccloar, Jane White,l3es~a Rise-N Shine Shift Tuck In Shift 1.00 1.00 s43.S0 543.50 ~ 543.50 $43.50 1Nites: 0.00 ~ 50.59 - 50.00 MiecdLneoos - 50.00 a~aamon.t cn~~croa~~: - SO.AO Servicx Deposit App&ed: - f 0.00 Current Invoice Totsl: 587.00 Total Amount Dne: Sg'1.QQ Dne Date : Dne ~ apt •~n overdue ..~ Sobj«x ro ~ ~s%Asswl seevioe Cesre