HomeMy WebLinkAbout01-0270
REV-1500EX(5-DO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
w
,..,
~~CI)
u"'>:
w..u
",00
u"'-'
..<II
..
'"
I-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
LYONS, JR. RALPH
DATE OF DEATH (MM-DD-YEAR)
1& <)./0:;> - io
REV-1500
OFFICIAL USE ONLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~ L - -0-'-
COUNTY CODE YEAR
,;),70
NUMBER
SOCIAL SECURITY NUMBER
L.
DATE OF BIRTH (MM-DD-YEAR)
174
1131
- 20
02/14/2001 11/06/26
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
LYONS
ROSEMARY
K.
[]I 1. Original Return
o 4. Limited Estate
[]g 6. Decedent Died Testate (Atlach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-1H2)
o 7. Decedent Maintained a Living Trust (AtlachcopyofTrusl)
o 10. Spousal Poverty Credit (dale of dealh between 12.31-91 and 1+95)
o 3. Remainder Return (date ofdealh priOf to 12-13-82)
o 5. Federal Estate Tax Return Required
-l 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AtlachSch0)
,..,
z
w
c
z
o
..
'"
w
'"
'"
o
u
'TIlIS'SEC1'Il)' -1.\ ,S ,13EC()MPI.ETED;'ALLCORRESPONDENCE'ANDCONFIDENtIAI.TAXINFORM...tIOI($
NAME COMPLETE MAILING ADDRESS
William A. Yocum Es uire 3001 Market Street
FIRMNAMEIIfAppli~bl'l Camp Hill, PA 17011
TELEPHONE NUMBER
717-761-5041
:J:\l;bIRI:CtEO ,TO!
(I)
(2)
(3)
(4)
(5)
(6)
(7) 5,439.34
(8)
(9) 10,785.30
(10) R,SOO 00
OFFICIAL USE ONLY
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G orL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
z
o
!ci:
...J
::l
l-
e:
<C
u
w
0::
5.419_14
(11)
(12)
(13)
19,285.30
00.00
(14)
00.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
z
o
~
I-'
::l
Q.
:iE
o
u
X
~
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rale
19. Tax Due
x.O_ (IS)
x.O_ (16)
x .12 (17)
x.15 (18) 00.00
(19) OP,N
i'-
~ . "
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20,0
/,:^,"W:"'1,.,> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <<-"''''f '.,'
Decedent's Complete Address:
STREET tB~E61d Mill Drive
CITY Camp Hill TSTATE I ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
00.00
Total Credits (A + 8 + C ) (2)
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenal1y ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the inlerest on the tax due.
(5)
(SA)
00.00
00100
8. Enter Ihe lotal of Line 5 + SA. This is the 8ALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
00.00
~. .,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedenl make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
o. retain a reversionary interest; or.......................................................................................................................... 0
d. receive Ihe promise for life of either payments. benefils or care? ...................................................................... 0
2. If death occurred. after December 12. 1982. did decedent transfer property within one year of death
without receiving adequate consideralion? .............................................................................................................. 0
3. Did decedenl own an "in trusl for' or payable upon dealh bank account or securily al his or her death? .............. 0
4. Did decedenl own an Individual Relirement Account. annuily, or olher non-probate property which
contains a beneficiary designation? .......................................................................... .............................................. IXJ
No
IKI
IX]
IX]
IX]
IX]
IX]
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under perlallies of perjury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best or my knowledge and belief, it is true, correct
and complete.
Declaralionofpreparerolherlhan the personal represenlalive isb ased on all informalion of which preparer has any knowledge.
SIGNATURE OF PER~ RESPONSIBLE FOR FILING RETURN "
,
.J
DATE
0'"
;} 7\
~.
ADDRESS
108 Old Mill
SIGNATURE OF PRER
17011
ADDRESS I
3001 Market Street, Camp Hill, PA 17011
~aum:l!-,,,- ~~~~.:wz?,I'j'J'"'~~i1l:~q~'O'!1i.'tf!',~.lfll,""ln"""'"...,-,, """~,'!~~~I!.r.I'7~..~UI\':li"j.~",,,,,~..~~.~,~ _ ~, ._. ,._"",,,pll~;+lt1;~(,i,qJ~m;t
For dales of death on or after July I, 1994 and before January I, 1995, Ihe lax rate imposed on Ihe net value of Iransfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)J.
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 0% (72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemol a transfer to a surviving spouse from lax, and the statutory requirements 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 I, 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 stepparenl 01 the child is 0% [72 P.S. 99116(a)(I.2)].
The tax rate imposed on the nel value oftranslers to or for Ihe use of Ihe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The lax rale imposed on Ihe nel value 01 Iransfers to or for the use of the decedent's siblings is 12% 172 P.S. 99116(a)(1.3)]. A sibling is defined, under Seclion 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
''''~'''m''''''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
ESTATE OF
RALPH L. LYONS, JR.
FILE NUMBER
2001-00270
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM l~jCLUDE THE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DAlE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATT/lCfI A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET IFAPPLlCABlEI
NUMBER INTEREST
1, Mellon Bank, NA - IRA 5,439.34 100 5,439.34
"Beneficiary was spouse, Rosemary K. Lyons
TOTAL (Also enteron line 7, Recapitulation) $ 5,439.34
(If more space IS needed, Insert additional sheels of the same size)
REV.1511EX.ll-91j
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RALPH L. LYONS, JR
FILE NUMBER
2001-00270
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Funeral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,843.00
Cemetery Plot................................................... . 700.00
Internment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800.00
Flowers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217.30
Lunchemn........................................................ . 570.00
B. ADMINISTRATIVE COSTS:
1. Perwnal Representative's Commissions
Name of Personal Representative (s)
Social Secunty Numbe<<s) I EIN Number 01 Personal Represenlative(s)
Street Address
City Slate Zip
Yea~s) Commission Paid:
2. Attorney Fees ........................................................ 500.00
3. Family Exemption: (Ifdecedent's address is not the same as claimant's, attach explanaUon)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees ........................................................ BO.OO
5. Accountant's Fees
6. Tax Retum Preparers Fees ................................................. 75.00
7.
TOTAL (Also enter on line 9, Recapitulalion) $ 10,785.30
(If more space is needed, insert additional sheets 01 the same size)
''''."'',,.,''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
RALPH L. LYONS. JR
FILE NUMBER
7001-00710
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1. Home Equity Loan to pay for decedent's Bereiatric hospital bed... 8,500.00
TOTAL (Also enter on line 10, Recapitulation) $ 8,500.00
(If more space IS needed, insert additional sheets of the same size)
~
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DiSTRIBUTIONS (include outright spousal distributions)
FILE NUMBER
2001-00270
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
ESTATE OF
RALPH L. LYONS, JR.
1. Rosemary K. Lyons
108 Old Mill Drive
Camp Hill, PA 17011
Spouse
Entire
REV-1513EX+ (1-9l)
'*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RALPH L. LYONS, JR.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I . TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Rosemary K. Lyons
108 Old Mill Drive
Camp Hill, PA 17011
FILE NUMBER
2001-00270
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spouse
AMOUNT OR SHARE
OF ESTATE
Entire
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
,
@
Mellon
I R {1/5
f~1'i
Mellon Bank, N.A.
Retirement Plans Center
P.O. Box 41520
Philadelphia, PA 19101-1520
MAY 07, 2001
Rosemary K Lyons
108 Old Mill Rd
Camp Hill PA 17011-8201
Dear Client (s): MRS. R. LYONS RE:TD#1179079/#1179082/SA#0355-258014
As per your request, we have completed the following transaction (6)
for the above referenced account (s).
(Xl
DECEDENT
WITHDRAWAL
INTEREST WITHDRAWAL/DECREASE
ACCOUNT CLOSING
PARTIAL REDEMPTION
[Xl
Your check number 0258171561 for $5,459.34
is enclosed.
Your Tra~sfer Authorization\Direct Rollover Request is
enclosed.
Your certificate receipt is enclosed.
Your passbook is enclosed.
If you have any questions, please telephone us at the number listed
below.
Thank you for banking with Mellon Bank.
l1ttr1tlY,
~B~NEY/bmcd
Retirement Plans Representative
(215) 553-8080
(800) 552-2621
I tV <2D 11;( ~
TA~
f.U
3F
l' ff - (.Je/.-.JJ Uf tts ..51 (I 37
C A{LE'i)
.5- ({-or
--
;!:o5 II-.fll-
Exh~b,f.A,
~ I
,-.
EQUIPMENT DELIVERY RECEIPT
DELIVERED TO:
/) () j)
FACILITY NAME KO ~ f\V\ (~.Cf'r1LL),---,
I1i' /"\ .
JGB ( ~fd f: J )J f ),,)1 i.A/( ,
e a /1/)\,/0 ~-l( j /tr'A I 7)1 /
TELEPHONE NUMBER (j -/ r7 -r-Y7 //J?V
r\ (. t \1,,(\ Y\ S
j
ADDRESS
RESIDENT NAME
;:\-~ .,,' \",.f'.
ROOM NO. ' I~,' ') \U \,' , ,( e
FACILITY ACKNOWLEDGES THE DELIVERY OF EQUIPMENT AS REQUESTED:
MANUFACTURER & MODEL OF EQUIPMENT
'-18/1 P \, T'/ ~<:"d
J! . /
SERIAL NO. 0.70 Go q (/7
, /J
SIGNATURI(0 ;f...,. v
[,uY\
-Ji(///9C
r-
", '\e (' \ " If
~_/ -"" '--- \) _ ('--/.j
N3oel,') )
'. .eO (':7<-,~/
(i
"
POSITION
DATE 1:1 I u I()C)
BY ERGO SCIENCES me. ~"-l1.{~O r )-1Yf_
rA iJ. I h fj i I
( f1 r( 14/ 2Jg'Q 3735 y)
E.x hl))/ 'j-, 13
5064 West Chester Pike. Edgemont, PA 19028
Phone 800-898-4311 . Fax 610,353-7209
,.---'
(
,./ .\
~
------..
'~ --
"'
/
)
'\
/
\
4-
----..
'\.
1
j
...~
'.,
i
j/
/
.\-.
~
"
. I
-"....:
,
I
I
j
/
,
"
t-- J;~
,
..
r
o
-<l
d~ a::
~ffi 9
'~c. 0
OW
.. ;~
03..'
1]',Ij
.il
'!ta
~,-.
"':~:,i.
,Ii
.,. "~
~,',
~
<if
'"
3
ii'
~
-........ --
"--- .-./'
,I
,
-~
,
,
,,",,
~
El'
i
o
~
!'f
ru
....
OJ
OJ
....
-<l
"....
L/'1
OJ
-<l
..
. ',."
.:\
"
'\
-,
Ex hi t/J- C
Parthemore Funeral Home & Cremation Services, Inc.
1303 Bridge St.-P.O. Box 431
New Cumberland, P A 17070-0431
(717)774-7721
Mrs. Rosemary Kumpf Lyons
108 Old Mill Drive
Camp Hill, PA 17011
Exh;6t}- j)
For receipt on the account of: Mr. Ralph L. Lyons, Jr. Jr.
Date ofpayment: 0311512001
Cash/Check #: 132-R Lyons
Service Number:2001013.0
Balance: $
Payment Amount: $
Balance: $
\L.\
7843.00 VcY- .
-7843.00 -y- ~
0.00
I UI"iL REFERENCE ITEM AMOUNT DEUSVC TAX TOTAL TOTAL DUE
~"._".~-"
2/19/01 000006001 FUNERAL ARRANGEMENT, CASKET $205.00 $0.00 $12.30 $217.30 $217.30
Occasion: Miscellaneous
RALPH LYONS
(f~/1/ 61
/
'f
r
.",jl,.:" ACCOUNT NUMBER+"";',"
0000002162
CURRENT
$217.30
30+ DAYS
$0.00
60+ DAYS
$0.00
90+ DAYS :- "120+ DAYS'
$0.00
$0.00
$217.30
MARCH SPECIAL - ONE DOZEN CARNATIONS IN A VASE (NATURAL COLORS) WITH
ACCENT FLOWERS, FERN AND A DECORATIVE RIBBON - $20.00 WITH A FREE MYLAR
BALLOON - CASH AND CARRY - DELIVERY $4.00 EXTRA - THINK SPRING! IT'S RIGHT
AROUND THE CORNER!
,EY/;,h/)- E
PAl})
31 L - 01
&J Office of Catholic Cemeteries
Diocese of Harrisburg
PO Box 3651
Harrisburg, Pennsylvania 17105
Phone (717) 657-4804
Invoice No. 12-0785
INVOICE """'"
---
Customer
"'
"'
Name
Address
City
Phone
ROSEMARY LYONS
108 OLD MILL DR
CAMP HILL State PA
ZIP 17011
Date
Order No.
Rep
Terms
2/22/2001
12-0785
GATE OF HEAVEN
90 DAYS
Date Description TOTAL
- -._-~ ---~800.0i:i
02119/01 INTERMENT FOR RALPH L. LYONS, JR.
~ D\
( V \\0 I 'br
~ lp
) ~/ J
*
. ~;
SubTotal $800.00
$0.00
TOTAL $800.00
Please return one copy of invoice with your payment. If not paid within 90
days, a finance charge of 6% will be added.
[;()7/ )/If F
&J Office of CaTholic CemeTeries
DIocese of Harrls.burg
PO Box 3651
Hafrisbur-g. Pennsylvania 17105
Phone (717) 657-4804
Invoice No. C2-2899
INVOICE """'"
Customer
Name
Address
City
Phone
ROSEMARY LYONS
108 OLD MILL DR
CAMP HILL
State P A
ZIP 1701
I'
Date
Order No.
Rep
,Terms
2122/2001
C2-2899
GATE OF HEAVEN
90 DAYS
Qty Description Unit Price TOTAL
2 - INTERMENT SPACES $700.00 $1,400.00
2 INTERMENT SPACES $350.00 $700.00
SubTotal $2,100.00
Downpayment $700.00
TOTAL $1,400.00
If/6:J.,-7 C0_tJ~
~_n
Rif
16J Ji~ f}L-
Please return one copy of invoice with your payment. If not paid within 90
days, a finance charge of 6% will be added.
c- X)I/ j / J- C,
RECEIPT FOR PAYMENT
----------------~--
-------------------
Cumberland County - Reqister Of Wills
Hanover and Hiqh Street
Carlisle, PA 17013
Receipt Date
Receipt Time
Receipt No.
3/12/2001
11:3.3:42
1 O:\,~ '.17:
LYONS RALPH L JR
File Number 2001-00270
Remarks ROSEMARY K LYONS
DO
------------------------
Distribution Of Receipt ------------------
Payment Amount Payee Name
60.00 CUMBERLAND COUNTY GENERH
6.00 CUMBERLAND COuNTY GENER.
9.00 CUMBERLAND COUNTY GENERA.
5.00 BUREAU OF RECEIPTS & CNl'L
Transaction Description
PETITION FOR PROBA
SHORT CERTIFICATE
EXTRA PAGES
JCP FEE
Check# 3676
Total Received.........
$80.00
$80.00
EA'~/j;).. )f
PETITION Ii'OI{ !l!{OBATE and GI{ANT Ol~ LETTEItS
::2\- 0\ - ;;:)iD
Ralph L. Lyons, Jr.
No.
To:
Estate of
also kno wn as
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 174-20-11 31 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executrix
in the last will of the above decedcnt, datcd All 811 Q t 4 J
and codicil(s) dated
named
, 19-9L-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 108 01 d Mi 11 Drive. Lower Allen Township
(list street, numuer, 'l'wp. or Boro.)
Decedent. I hen 74 years of age, died
at Lower Allen Township (home)
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of t.lle will offered for probate; was not the victim of a kilting and was never adjudicated
incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
February 14,
,+~ 2001 ,
$ 21.000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s}
presented herewith and the grant of letters Te 51 t amen t 1;l ry
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
~
u
u
c
u
:g3
u ...
o::u
C
-00
c';::
rj'~
3~
v.....
~ 0
~
C
l:lIl
Vi
~",,#A??r I: ir~
~t~?i~! ~~fr
OATH OF PEI{SONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA }
ss
COUNTY OF Cumberland
The petitioner(s) above-named swcar(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 represen-
tative(s) of the above decedent pctitioner(s) will well al truly administer the estate according to law.
:/
affirmed and
8TH
MAR
llo-~IW-)O
~-
V)
~.
::s
C:l
-
;::
~
~
No. /1 - 01 - ?70
Estate of
RALPH L. LYONS, JR.
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 1 ~, X~ 2Q01, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated AUGUST 4 t 1997
described therein be admitted to probate and filed of record as the last will of Ralph L. Lyons. Jr.
and Letters Testamentary
are hereby granted to RosemClry K. Lyons
'-
FEES
Probate, Letters, Etc. .........
Short Certificates( 2) . . . . . . . . . .
Renunciation ................
X~PAGES
JCP
$ 60.00
$ I) OF)
$
$ 9.00
/,5. 00
.TOTAL _ $ AO 00
. . . . .M~~CH .1? ". .?'QO.1. . . . . . . . . . . . . .
William A. Yocum, 06263
ATTORNEY (Sup. Ct. 1.0. No.)
3001 Market Street
Crimp Hi 11 ~ "PA' 17011
ADDRESS
(717) 761-5041
Filed
PHONE
Mailed letters to Executrix on 3-12-01
'Co h h . t' m"t'lon here given is correcrlv copied from an original certificate of death duly filed with me as
h ' is to certll j t at t e m or <1. " , .., . '1'
I. )'.; i Registrar. The original certificate will be forwarded to the State Vital Records othce tor permanent h mg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
~-,-Iijjfi1ii;;;-;;/"";;;,~
1.\I~(~\.}~OJ-1{fj~~
!..,".;;:.'tt;'/' ''-:.'If'L~,
I,' ~/ _ ',,-:?-: ~
it"""'! tIUr. '?":;.
/ ~ ~I __ --'?!'~ \"p ~
I~C); - :-~_. ~~~
\: c-1 "'l',h '~ ~,I;b.. ~
.... " - . ....~ '. " :\
',...1
\~-" /~/
,- ~" / ~,\\'I
\':~:-~:ft9hi~-- - .(~\; Itl.~
~"~,, EN1 \\ 1'1'111
~O/II,'IJ
p 7176910
No.
~J
","
f.A.,.4'G/.!C/
":;{.1? ?~'2.,~. , Y T'" 'Y
Local Registr~r" "..-li/
U
C'
t-'
7QQ1
1 t_'
Date
COMMONWEALTH Of PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
e. 2187
NAME Of DECEDENT tF',;SI Mod.Jie~- ---.--- .
SEX
a. male
1.
Ralph
UNDER 1 YEAR
~ Oays
BIRTHPLACE (CAy;ond
Slal. Of fCleogt1 Counlryl
PU\CE Of DE,(J"H /CI>eck llflly f)fle - __ "'Slrucl""'" on omel _,
HOSPITAl'
Massillon, OH Inpali.nl 0 E~I1.nt 0
7. ...
FACILITY NAME (II 1lllI1nSI'1UllOl\, 91'18 ~lleeI ..-cIl\llI'I\llef.
OOAO
:=dy)O
L.
AGE (laSl BonIlOay)
74
VIS.
'-5.
_ COUNTY OF OE1JH
..
!!
~..
Lower Allen Twp.
ec. ....
KINO Of BUSlNESSllNOUS1RY
Cumberland
DECEDENT'S USUAl OCCUPRIOM
(an.. tund d WOfk oone dulltlQ most
... oI.....king ..; do noI use le\lfelll
O"l1L Carpenter Ilia. Construction
. DECEDENT'S MAIlING AOOAESS (SlI... CllyflOwn, S\aIe. Zip Code) DECEDENT'S
108 Old Mill Drive ~~~~
Camp Hill, PA 17011 ~~~~~
11.. Slat.
STAlE FILE NUMBER
SOCIAL SECURITY NUMBER
DATE OF DEATH ,MCNII. Oa~.""")
~ February 14, 2001
3. 174
20
1131
RACE. Ameocan IncHn. Blac:k. WhiI.. etc.
(SpIlClly)
MARITAl ST,(J"US . Matriecl
N._ Married. W_.
OMlrced (SpectIy)
14. married
17c.1il v... ~nllMod in
white
SURVIVING SPOUSE
\11 ..... \II" ma.aen name)
11. Rosemary Kumpf
Lower Allen
1 lb. Coun
Did
dec;edenl
Iiwo .. .
Cumberland 1oWnSllip1 17d.O :':::::'~0I
MOTHER'S NAME ,F.sl. Mod<Je, Maoden Surname)
Eva Eshenour
CIly/boRl
la.
FATHER'S NAME (FilS!. MIOdIe. laSl)
II, Ralph L. Lyons
INFORMANT'S NAME (T ypelPnnQ
He. Rosemary Kumpf Lyons
METHOD Of OlSPOSlTIOM
8uriaI1iO Crernal"'" 0 AMnovaI bom Sial. 0
~ D Other (Speedyl
21L
SlGHAJURE OF F
lWp.
11.
INFORMANT'S MAILING ADDRESS (SIr... C.lylTown. SlaI4l. lip Code)
108 Old Mill Drive, Camp Hill, PA 17011
PlACE OF DISPOSITION, Name of ~.ry. C,.malOlY LOCAflON. CityI1Own. Stal.. Z"lI>Code
(W Other Place
Gate of Heaven Cemetery
ale.
2001
22a.
ComPel. ._ 23a-i: n ce
p/Iyslaan . noI available al I,m. 01 dea'"to
c:endy ~ 01 death.
LICENSE NUMBER
a2b. FD 013 340 L
the beSI of my know'-<lge. death occurred a'lhe "me. dale and plac. slaled
(Signature and Tille)
I.... 24.2e _ be compleled by
per--. wno pronouncee deal".
:I3L
TIME Of DEATH
D,(J"E PRONOUNCED DEAD (M",,"'. Day, Veal)
'2-\4...0\
24. 7: J 5 M. 25.
27. I'lUn I: En..rlhe diMases, iojurieSor complK:allOflS which caused Ihe dealh Do nol enl.rlh. mode ot dyi"ll. such a. ca.Oiac or respllalory arreSl, shock or h.art lailur.
LIIl 0I'lly one cause on each_
....OIATE CAUSE (FUlaI
~ 01 Con<ldlOn
,..-ng", 0Mlh)-
L' A'K. i:) 10 }A-l.J 0 r AT\4 \../
~ DUE 10 lOR AS A CONSEOUENCE Of):
I.) I A ~b;T6 S
DUE 10(00 AS A CONSEQUENCE Of):
t.DP-C>~A~1 1\1-2--1f:::..;2.y
DUE 10 (00 AS A CONSEQUE NeE OF)'
DIseASb"
Sequentially !ill condoIions
~ an,. IMdinQ 10 1IIIIMdIa1.
_. Enter UNDVIt.YINO
CAUSE (Oosease 01 "'PMY
lNt~e_
r..-ng '" <leelt\llAST
d
Wo\S AN AU10PSV WERE AUlOPSY FINDINGS
PERFORMED? _\.ABlE PRIOR 10
COMP\.ETION OF CAUSE
OF DEATH?
MANNER Of DEATH
_urat if Horn'<"de 0
Acclden. 0 Pandt"llln_igalion 0
Suicide 0 Could noI be delermlned 0
DATE OF INJURY
(Monll1. Day. ~arl
Upper Allen Twp., PA 17055
21d.
IWAEANOADDRESSOfFAClllTY Parthemore F. H. & C. S., rne.
Uc.P. O. Box 431 New Cumberland. PA 17070-0431
LICENSE NUMBER ORE SIGNED
(Month. Day. _I
23b. 231:,
WAS CASE REFERRED TO MEDICAL EXAMINEAlCORONER1
Yea 0 No k\I
at.
I Approxlmal.
:=.=:
I
I
,
PART II: 0IMt sogtlillcanl condiIions contributing 10 dealh. but
noI ruuIling in the ~ ~ given in PART I.
TIME OF INJURY
INJURV AT WORK? DESCRIBE HOW INJURY OCCURRED.
v.. 0 NoD
M. :JOe.
zt.
3011. 3011.
PLACE Of INJURY. AI horn.. tarm. Slr..l, fac\ory.offic.
buildinQ. elc. ISpec,r.)
3011.
....0
V" D
NoD
No
Be. 21la.
CERTIFIER {Check oniy one\
'CERTIFYING PHYSICIAN (Phys.c...n c",..tyonq e<>u5e 01 <leattl whe" a"OIn.. ph"""", has pronounceo aealh ana comple1ed nem 231
To _ _lot my know-.... death oc<:unotd _ \0 the ceuae($) and mann., a. staled. . . . . . . . . . . . . . . . . . . .
'PRONOUNCING AND CERTIfYING PHVSICIAN (PhySIC",n 00111 ~'onouroC,n9 <.Iedlh and Ce''''V''''llocause 01 aealn\
To"" Mat 01 my know....9ft. death QCcurred allhe time. dal.. and place. and due \0 lhe cause(.) and manner .. .'aled. ,
/"
/ ,/
."t.;."..
'MEDICAL EXAMINER/CORONER
On the ba.i. ot...minal/on and/or investigation, in my opinion. de.lh occurred al Ihe tlm., dal.. and place, and due 10 the cause(al.nd
manne, as slaled.. . . . . . . . . . . . . , . .. ..........,...........,............,..........,................................
31a.
33 R~~N~
\2/I~/11
....Q -.,
ICE R D,(J"E S1GNEOtMonln, Day, ~ar)
o 31C.o SOD ~ 44 <;;:E 31d. z..{ll.I/O /
NAME AND ADDRESS Of PERSON WHO COMPLETED CAUSE OF DEATH
lllem 27) g'ECi{\~ ~ 14 ,L C. /i\ u..;LU\ 't~
COLoMp 1-+-'; 1\ pA
o
32.
OATE FILED (Monlh Oav. Vear)
,.. U /,.
-
o? l?a /
b-
-
CEH'rIFICATION or NOTICE UNDEH nUJJE 5. G (a)
. Name 01 Decedent:
RALPH.L. LYONS, JR.
Date of Death:
February 14, 2001
Will No. 21....2001-270
l\clmln. No.
To the Register:
I certify that notice of beneficial interest required by
Rule 5.G(a} of the Orphans' Court :Hules was served on 'or mailed to
.the [allowing beneficiaries u[ the above-cuptlonecl estate on
May ,2001
Name
Address
1. Rosemary K. Lyons
108 Old Mill Drive, Camp Hill, PA 17011
2. Linda Louise Cover
101 Rosedale Avenue, Middletown, PA 17057
3. Lynn Eileen DeMart~n
1059B York Road, Dillsburg, PA 17019
4. . Kathleen Ann Harney,
17 Squire Avenue, Mansfield, MA 02048
CONTINUED ON REAR
Notice has now been gIven to all peJ:sons entitled thereto under
I\ule 5.G(a) except No Exceptions
May 7 ' 2001
'1
~~(~/
,.., t ~
01g11rl . ure./
I !
V
J/ ~.
1\. ~~;v{'&~
Date:
Name Rosemary K. Lyons
Address 108 Old Mill Drive
Camp Hill. PA 17011
'felephone (717) 737-1688
Capacity:
x
Personal n~presentatlve
Counsel [or personal
representa Li va
r.F.'RTTFTr.ATTON OF NOTTr.F. TTNDF.'R 'R"lp l) n(;:!) r.nnrim'pr1_._.____~__
Ralph L. Lyons, Jr., Estate
5. Ted Gerard Lyons 9 Cedar Road, Mechanicsburg, PA 17055
6. Patricia Rose Lyons P.O. Box 597, Barre, MA 01005
7. Laura Lee Rhodes 3266 Fulling Mill Road, Middletown, PA 17057
8. Becky Ellen Burks 652 Copper Circle, Lewisberry, PA 17339
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
l
J
55:
Rosemary K. Lyons
being duly
according to law, deposes and says that she is the Executrix
of the Estate of Ralph L. Lyons, Jr.
late of --Lo.wer--Allen-Township_________ I Cumberland County, Pa., deceased and that the
within is an inventory made by her ___ ----I the said Executrix
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
sworn
N#{lfAhPl t;
~~j~~ t).~~
}{i2001
,
/ t /
I: (:,7'; /,"'-( ~ i. ...~ ./
\ , xeeutor . Adm~J,( rator
Sworn
and subscribed before me,
108 Old Mill Drive
i-__-G-;T;~:x e ,;;;;:_. "'OIIJ
> . t ,,__. j !
,
Camp Hill, (Lower Allen Township) PA 17011
Address
Date of Death
14th
Day
February
Month
2001
Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory mus"t be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV. Fiduciaries Act of 1949.
. -0
>- I-l en
.- w IJ lit
>- 0:: .- to S
0 w < Q)
" ~ 0.. .- (f) u U
N 0 0 V) Q Q) en 0
0 w e:::: w 0 C t7' :;>-4 >0-
J I to en
.-- 0.. 0.. r::
.-f Z .- -J u.. H to ....
0 u.. -J < 0 . ! 0.. <:: 0
I UJ 0 < w J >. :s:
.-f > e:::: ~ s<
N II z .... m
Z 0 c:
C ::l 'r-!
0 V) Z 0 r-l
0:: U r-l
Z I UJ < vt- 'r-!
a.. " :?:
c:
to
I ! ..... "'i:
0 Q)
..a ~
Q) E "
.... en 0
I to ::l 0
-I U u: ~
Inventory of the real and personal estate of
RALPH L. LYONS, JR
deceased
1.
IRA - retirement account in decedent's name payable to surviving
spouse in Mellon Bank, NA..........................................
5,439 34
TD/11179079
1179082
SA1t0355-258014
TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 5 , 439 4
~ /t-,::j/6--/(i
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Reco! c
Rep'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-31-2001
LYONS
02-14-2001
21 01-0270
CUMBERLAND
101
j...-..d
"--'I
WILLIAM A YOCUM iQi
3001 MARKET ST
CAMP HILL
JAN -4 P12 :05
*
REV-15~7 EX AFP 02-0D)
RALPH
L
Allount Rellitted
Ci~~_17011
Cilt,nb....,, '-;<'
.. ~~ f" .-","~ ~ - ~-_
, PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V-: i54j-Ex--AFP--rr~f:ool--No~"-icE--oF-i:NHEifiTAirci-~"-Ax-A-PPRAisEiwfiNi':--Aii-oWAN-ci-o-i------------ - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LYONS RALPH L FILE NO. 21 01-0270 ACN 101 DATE 12-31-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
.00
5,439.34
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
10,785.30
8.500.00
NOTE: To insure proper
credit to your account 1
subllit the upper portion
of this forll with your
tax paYllent.
5,439.34
(11)
(2)
(3)
(4)
19.:;>>81] 30
13,845.96-
.00
13,845.96-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 =
.00 X 045=
.00 X 12 =
.00 X 15 =
(9)=
.00
.00
.00
.00
.00
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
c
PLEASE 1i'ILE TIllS REPORT "VITIIIN T'VO YEARS OF DATE OF DEATH REGARDLESS Oli'
TIlE STATUS OF TIlE ESTATE. IF ESTATE lS NOT COlVIPLETED, 1i'ILE a 6.121i'ORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER I~ULE 6.12
NallleofDecedent: RALPH L. LYONS. JR.
Date of Death:
February 12, 2001
Will No.: 2001-00270
Admin. No.: 21-01-0270
Pursuant to Rule 6.12 of the Suprenle Court Orphans' Court Rules, I report the following with respect
to comp~qtion of the ad.ministration of the above-captioned cstate:
1. State whethcr adnunistration of the estate is complete:
Yes X
No
2. If the answer is No, state when the personal represcntative reasonably believes
that the adil1inistration will be complete:
3. If the answer to No.1 is yes, state the following:
A. Did the personal represcntative file a final account with the court?
Yes No X
B. The separate Orphans' Court No. (if any) for the personal representative's accounl
. .. .
IS:
C. Did the personal representative stale an account informally to the parties in
interest? Yes X No
D. Copies of receipts, releases, joindcrs and approvals of fonnal or informal accounts
may be filed with thc Clerk of the Orphans' Courl and may be attached to this
report.
Date:
November 7, 2001
7
Kr.<< 12W- '''~ /:!
Signaturc (/',
'---'" '
v!L71fh<:l-/
(//
Rosemary K. Lyons
Namc (Please type or print)
108 Old Mill Drive
Camp Hill (L6wer Allen Twp.), PA. 17011
^ddrc~s
(MAH:rmllAM3)
717-737-1688
Telepholle No.
Capacity:
x
Personal Representative
R.W. - 27
Counsel for Personal Representative
.
.
~..
LAST WILL AND TESTAMENT
OF
RALPH L. LYONS, JR.
I, RALPH L. LYONS, JR., of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament hereby revoking
and making void any and all other Wills by me at any time heretofore made.
1.
I direct that my Executrix, hereinafter named, shall pay all my just
debts and funeral expenses as soon as conveniently may be done after my decease.
II.
All the rest, residue and remainder of my estate, whether real, personal
or mixed, and wheresoever situate, I hereby give, devise and bequeath unto
my wife, ROSEMARY, K. LYONS, if she survives me by a period of thirty (30) days.
If she does not survive me by a period of thirty (30) days, then this gift to
her shall be divested and I then give, devise and bequeath my entire estate,
whether real, personal or mixed, and wheresoever situate in the following
manner:
I direct that my residence located at 108 Old Mill Drive, Lower Allen
Township, Cumberland County, Pennsylvania be appraised and if any of my children
desire to purchase said house, that child shall be given the opportunity to do
so, at the appraised value of the residence. If more than one child desires
to purchase the house, those children desiring to do so shall determine the
purchaser by utilizing by any method acceptable to all of those who desire to
, -
purchase said house. If no purchaser can be determined then the house shall
be placed on the open market for sale at its appraised value or it shall be
sold at the best price obtainable on the open market. The net proceeds
derived therefrom shall be placed in the residue of my estate.
III.
I give and bequeath all the rest, residue and remainder of my estate
whether reals personal or mixed and wheresoever situate, in equal shares, to
my six (6) children, LINDA LOUISE COVER, LYNN EILEEN DeMARTYN, KATHLEEN ANN
_Yi'!aiHARNEY, TED GERARD LYONS, PATRICIA ROSE LYONS and LAURA LEE RHODES, per stirpes.
Those items that are not bequeathed in kind, shall be sold and the net proceeds
divided accordingly among my aforesaid six (6) children.
IV.
I direct that my fiduciaries, herein named, shall not have to post
bond for the faithful performance of their duties.
V.
I hereby nominate, constitute and appoint my wife, ROSEMARY K. LYONS,
as Executrix of this, my Last Will and Testament. If my said wife should
predecease me, not qualify or not accept the position of Executrix, then I
hereby nominate, constitute and appoint my son and daughter, TED GERARD LYONS
and LINDA LOUISE COVER, as Co-Executors.
IN WITNESS WHEREOF, I, RALPH L. LYONS, JR., the Testator, have unto
this my Last Will and Testament, set my hand and seal this ~t~ day of
/J4<;1l ~J
, 1997.
~}~yo_~~)
/- /
Page Two of Four Pages
.......,.
PUBLISHED and DECLARED by RALPH L. LYONS, JR., the
above-named Testator, as and for his Last Will and Testament in the presence of
us who have hereunto subscribed our names as witnesses at his request, in the
presence of the said Testator and of each other.
~-<t~; 1~
<< (,'0 \# \ '\. '. 'C'N~' \. \
~".""._."
~~("'_~'_"~"'~'i~~ifj>;?'<~:'-
ACKNOWLEDGMENT AND AFFIDAVIT
STATE OF PENNSYLVANIA
)
) SS.
)
COUNTY OF CUMBERLAND
We, RALPH L. LYONS, JR., J;;'-"fS J. )JJ,/It'L and Lt'H' A. tJ~jp,,//
the Testator, and the witnesses, respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testator signed and executed the instrument as his
Last Will and that he executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of
the Testator signed the Will as witness and that to the best of their knowledge
the Testator was at that time eighteen years of age or older, of sound mind and
~~~ under no constraint or undue influence.
i-;!;/T7(L<J.- J. Ar:!'l-... (SEAL)
~ ess (/
1:".:\ \.. 0 . (, ".~ ,,,,,', \. ~iSEAL)
Witness
Page Three of Four Pages
r
-
and
LOrl/}.
and acknowledged before me by RALPH L. LYONS, JR.,
and sworn to before me by )01'>'1'5 J. 11;,/~,,-
C J jrj/hl'/J , witnesses, this q t!' day of At, S l. 5}
, .
1997.
2/r.JJ2t:dh'
Notary Public
(),. &a-:'A
:Y "'
'~"~'., :1",:~"';1~\\::;~t':';"';'0;' ",
NOTARlAl SEAl
WilLIAM A. YOCUM, I~otary Public
Camp Hili Bora, Cumbsrlanu Counly
My Commission Expireo JW18 <7, 2000
."""''''J,'',''
.. ',.,...~~,~._",.,..:,_!,
"'. ." ;J;", "-~ .. ..
Page Four of Four Pages