HomeMy WebLinkAbout01-0512
Estate of WILLIAM FIELDING LEWIS
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
Q\ - 0\ - 5t;;;U
No.
To:
-Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. 7 C) S- - / ~ - q J S'I
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 decedent, dated
and codicil(s) dated
October 29
named
1998
, -
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
o Decendent was domiciled at death in Cumberland CountybPennsylvania, with
IS last fa . or principal residence at 1210 Stratford Dnve, CarlIsle, PA 17 13
I l \~ \e.. rD
(list street, number and muncipa1ity)
Decendent, then . . ~ I years of ag~, died May 6 , 2001
at Carlisle, Cumberland County, Pennsylvama
Except as follows, decedent did not marry, was not <;iivorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent 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 $
~alue of real estate in pennSYlvania,.~~ ~ ~ If '- $p:.Ol> 'z (90 /:)
situated as follows: I;} 10 c) OJ' ~ . J 1)/)
, 19
$ ~ as: ~ 0
..
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
I (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
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Ann Lewis Bracken
1213 Pine Drive
, Blacksburg, VA 24060
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ..,..,
fa- ::;~
COUNTY OF Cumberland J
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmc;..QHand subscribed ~'-tok'~~~ '"
before me this -\ OT day of Ann LeWIS Brac en- ~.
y, 2001 a
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No. 21 - 01 - 512
Estate of WILLIAM FIELDING LEWIS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
FEES
Filed
$ 410 . 00
$ 15.00
$
$ 12.00
5.00
TOTAL _ $ 442.00
MAY 30 2001
. . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . .
Probate, Letters, Etc. .........
Short Certificates( 5) . . . . . . . . . .
Renunciation ................
X-Pages
JCP
Called attorney on 5-30-01
James D. Flower, Jr., Esquire
#27742
A TIORNEY (Sup. Ct. I.D. No.)
26 West High Street, Carlisle, P A 17013
ADDRESS
717-243-6222
PHONE
-
~ (\.::;: Qf'I::; ryt:'\' 0'~r...
. This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7298001
No.
~k~
Local Registrar ~
MAY 0 8 Z001
Date
4J Rev 2187
COMMONWEALTH Of PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECOROS
CERTIFICATE OF DEATH
STAlE filE ~A
SOCIAL SECURITY NUM8ER
DATE OF 0EA1H .McnIn. Olr,. ._,
NAME OF DECEDENT If.... r.toddIe. L_,
SEX
2. Male.
UNDER 1 YEAR
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.. 5-6-2001
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DECEDENT'S EDUCRIOH
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MANNER OF DEATH
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1Enst lIIill nub Wtstnnunl
OF
WILLIAM FIELDING LEWIS
I, WILLIAM FIELDING LEWIS, of 1210 Stratford Drive, Carlisle, Cumber.land
County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and
form following:
FIRST:
I hereby expressly rev;oke all Wills and Codicils heretofore made by
me.
SECOND: I hereby direct my Executrix to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicable after my death.
THIRD:
I direct that all taxes which may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid out of my estate as a
part of the administration of my estate.
FOURTH: Upon my death, I direct that my body be cremated and that the ashes
be buried in the graveyard of the Salem Baptist Church in Sparta, Virginia, where stones have
already been set for the purpose of identification.
FIFfH:
I have served in the Armed Forces of the United States. Therefore, I
direct my Executrix to consult the legal assistance office at the nearest military installation to
ascertain if there are any benefits to which my dependents are entitled by virtue of my military
affiliation at the time of my death. Regardless of my military status at the time of my death, I direct
. c:\wp51\Wills\Lewis,William
my Executrix to consult with the nearest Veterans Administration and Social Security
Administration office to ascertain if there are any benefits to which my dependents may be entitled.
SIXTH: I hereby give to my children, ANN LEWIS BRACKEN and
WILLIAM F. LEWIS, JR., all of my personal effects, clothing, furniture, furnishings, jewelry,
automobiles, and any other tangible personal property of every kind and any insurance thereon, in
equal shares, provided they each survive me, and to the survivor if they fail to survive me, to be
divided among them as they may agree, or if they are unable to agree, as my Executrix may decide.
Any items of value not so disposed of shall be sold by my Executrix, and the proceeds added to the
residuary of my Estate.
SEVENTH: It has been my intention and that of my wife ANITA LOVING
LEWIS, that my sister, PATRICIA ROSS LEWIS, of Atlanta, Georgia, be paid the sum of Fifty-
Thousand ($50,000.00) Dollars, provided that she survives us. Since my wife, ANITA LOVING
LEWIS, has made such a provision in her Will, and since that bequest will satisfy our intentions at
my death from proceeds of a Trust which she established, I make no separate bequest to my sister.
EIGHTH: All the rest, residue, and remainder of my estate shall be distributed
as follows:
(A) Two-fifths to my daughter, ANN LEWIS BRACKEN, of213 Pine
Drive, Blacksburg, Virginia 24060; or if she fails to survive me, I give that share of my estate
which my daughter would have received to her children in equal shares, which children are
STEVEN B. LANK, EMILY L. BRACKEN, and WILLIAM M. BRACKEN. By so
2
c:\wp51 \Wills\Lewis,William
specifying these grandchildren, I do not intend to exclude any after born or after adopted children of
my daughter, ANN LEWIS BRACKEN. Said funds shall not be delivered to my grandchildren
directly, but shall be added to those funds held for their benefit in a Trust created through the Will
of my wife, ANITA LOVING LEWIS, and be administered in accordance with the provisions of
that Trust, or if under the terms of that Trust, some or all of the funds have been distributed to them,
any funds passing to them under my Will shall be distributed in the same proportions and the same
manner.
(B) Two-fifths to my daughter, ANN LEWIS BRACKEN, of213 Pine
Drive, Blacksburg, Virginia 24060, IN TRUST, nevertheless, for the benefit of my son,
WILLIAM F. LEWIS, JR., of Glendale, Arizona; the Trustee shall invest such funds in good and
safe securities legal for trust funds in the Commonwealth of Pennsylvania and shall pay the net
income derived therefrom in quarterly installments, or more frequently if convenient, to and for the
use and benefit of the said WILLIAM F. LEWIS, JR. In addition, I hereby authorize and
empower the Trustee to use as much of the principal as she in her sole discretion shall deem
necessary and proper for the personal needs of WILLIAM F. LEWIS, JR., including for his
maintenance, health and general welfare and personal support. This provision is intended to be for
the purpose of necessity only, not convenience. Notwithstanding the foregoing, the said
WILLIAM F. LEWIS, JR. shall have the right exercisable once in any given calendar year to
withdraw 5% of the then principal amount of this Trust, in addition to any income to which he may
be entitled.
3
, c:\wp51\Wills\Lewis,William
(C) Ifmy son, WILLIAM F. LEWIS, JR., fails to survive me by thirty
(30) days, or at his death, the Trustee shall ascertain whether he has any children then living, and if
he has no such children, then I give the share of my estate which was to have been applied for his
benefit under this paragraph to my daughter, ANN LEWIS BRACKEN, or should she fail to
survive me by thirty (30) days, to her children then living in equal shares. Should my son,
WILLIAM F. LEWIS, JR., fail to survive me by thirty (30) days and be survived by one or more
children of his own, or if at his death he is survived by one or more children of his own, I direct the
Trustee to hold and invest the aforesaid funds for his, her, or their benefit, and pay such net income
from the Trust as Trustee deems appropriate for the benefit of said child or children to said child or
children's guardian. In addition, I hereby authorize and empower the Trustee to use as much of the
principal as it in its sole discretion shall deem necessary and proper for the support, maintenance,
health, and general welfare, and education of said child or children, paying to said child or children
his, her or their proportionate share of the principal and any unpaid income of the trust upon
attainment of the age of25.
(D) One-fifth (115) to ANN LEWIS BRACKEN, IN TRUST,
nevertheless, for the benefit of my three grandchildren; STEVEN BURTON LANK, EMILY
LOVING BRACKEN, and WILLIAM MOORE BRACKEN. The Trustee shall invest the
funds in good and safe securities legal for Trust Funds in the Commonwealth of Pennsylvania, and
shall pay such income derived therefrom to or for the benefit of said beneficiaries, as she deems in
her sole discretion to be desirable, taking into account the tax consequences of retention of
4
. c:\wpSl\Wills\Lewis,WilIiam
earnings, and in addition, I hereby authorize and empower the Trustee to use as much of the income
and of the principal as in her sole discretion she shall deem necessary and proper for the support,
maintenance, health, general welfare and education (which education may include graduate or
professional school) without regard to any inequality of said payments for one beneficiary or
another. At such time as the youngest of said beneficiaries attains the age of 25 years, the Trustee
shall divide any remaining principal and all unpaid income into three shares, and shall pay a share
to each of the three beneficiaries, provided that the share of any beneficiary who is deceased at that
time shall be paid to or for the benefit of his or her issue, or in default of same in equal shares to the
remaining beneficiaries.
(E) Should the principal of any trust herein provided for be or become
too small in the TRUSTEE'S discretion so as to make establishment or continuance of the trust
inadvisable or impractical, my TRUSTEE or my executor may make immediate distribution of the
then remaining principal and any accumulated or undistributed income outright to the person or
persons and in the proportions they are then entitled to income. If any such person is then a minor,
distribution may be made to his or her guardian. Upon such termination, the rights of all persons
who might otherwise have an interest as succeeding income beneficiary or in remainder shall cease.
(F) My Trustee, ANN LEWIS BRACKEN, shall have the authority to
delegate some or all of her duties as Trustee to another individual or a professional Trustee,
however, should she fail to do so and for whatever reason become unable to perform her duties,
then my son-in-law, JAMES W. BRACKEN and MICHAEL B. COOKE, CPA, shall jointly
perform the duties of Trustee of any Trust created under this Will.
5
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LASTLY:
I nominate and appoint my daughter, ANN LEWIS BRACKEN, of
213 Pine Drive, Blacksburg, Virginia 24060, as Executrix of this my Last Will and Testament, but
should she fail to qualify or cease to serve in that capacity for any reason, I nominate and appoint as
Substitute Executors, my son-in-law, JAMES W. BRACKEN, and, MICHAEL W. COOKE,
CPA, to serve jointly as Executor. I direct that my personal representative(s) shall not be required
to give bond or security for the performance of his, her or their duties in any jurisdiction.
~ WITNESS WHEREOF, 1 hereunto set my hand and seal this aQ {f.-
daYOf~l1 .1998.
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
2, euJ .
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COMMONWEAL TH OF PENNSYL VANIA
SSe
COUNTY OF CUMBERLAND
I, WILLIAM FIELDING LEWIS, Testator, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by WILLIAM FIELDING
LEWIS, the Testator, this at q th day of r.Q ~ l-o--b.1A _ ' 1998.
e1'~~-~~
William Fielding Lewis,1estator
~~
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. NOtary Public .
NOTARIAL SEAL
MERLENE MARHEVKA, NoWy PublIc:
C8tN.... Cumberland County" PA
My Comml..... ExpIrH June I. 2002
7
. c:\wp51 \ Wills\Lewis, William
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
We, James D. Flower and James D. Flower, Jr. ,
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we are present and saw Testator, WILLIAM FIELDING
LEWIS, sign and execute the instrument as his Last Will, that he signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge
the Testator was at that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower
and JameSQcF;;;;r.
, witnesses this
c;2.Q t,h
day of
, 1998.
~
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Witness .;2
L~~{ld
NOTARlALIIAL
MERLENE MARHEVKA, Nc*ry PubIIe
cwu.... Cumberl8nd County" PA
My CommIuIon ExpIrM ..... .. 2002
8
..
CERTIFICATION OF NOTICE UNDER RULE 5.6~
Name of Decedent:
Date of Death:
Estate No.:
To the Register:
WILLIAM FIELDING LEWIS
May 6, 2001
21 - 01 - 0512
I certify that notice of the beneficial interest estate administration required by Rule
5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries
of the above-captioned estate on June ~ ' 2001.
Name
Ann Lewis Bracken
Ann Lewis Bracken,
In Trust For the Benefit of
William F. Lewis, Jr.
Ann Lewis Bracken
In Trust For the Benefit of
Steven Burton Lank, Emily
Loving Bracken and
William Moore Bracken
Address
213 Pine Drive, Blacksburg, VA 24060
213 Pine Drive, Blacksburg, VA 24060
213 Pine Drive, Blacksburg, VA 24060
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: June
t
,2001
.capacity:
Name James D. Flower, Jr.
Address 26 West High Street
Carlisle, PA 17013
Telephone (717) 243-6222
_ Personal Representative
~ Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FLOWER JAMES D JR
26 WEST HIGH STREET
CARLISLE, PA 17013
__nnn fold
ESTATE INFORMATION: SSN: 705-14-9181
FILE NUMBER: 21-2001- 0512
DECEDENT NAME: LEWIS WILLIAM FIELDING
DA TE OF PAYMENT: 08/03/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 05/06/2001
NO. CD 000116
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $27,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: ANN LEWIS BRACKEN
C/O JAMES D FLOWER ESQUIRE
CHECK# 95131
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
$27,500.00
MARY C. LEWIS
REGISTER OF WILLS
\ /{;-G2~33 - /
~~BUREKb OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Rr:;C
;DATE
ESTATE OF
DATE OF DEATH
DI'-IttEl NUMBER
COUNTY
ACN
.02
f-\PR -1
JAMES D FLOWER
SAIDIS ETAL
26 W HIGH ST
CARLISLE
CiS'
CurnL
PA 17013
03-25-2002
LEWIS
05-06-2001
21 01-0512
CUMBERLAND
101
'*
REV-1547 EX AFP (01-02)
WILLIAM F
Allount Rellitted
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
26.597.48
.00
245.544.44
105.119.44
.00
.00
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-Y=is4-f-i3f-AFP--fl'-f:ozj--NC)y-ici--OF-'rtitiiififANCE-T-A)rA-PPRA-isiifENT~--AiioWAifcE-ifi------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEWIS WILLIAM F FILE NO. 21 01-0512 ACN 101 DATE 03-25-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
22,113.48
7.899.59
ll1)
(12)
ll3)
(14)
(9)
nO)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(8)
377,261.36
30.013 07
347,248.29
.00
347,248.29
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. AMount of Line 14 at Sibling rate
18. AMount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
llS) .00 X 00 = .00
(6) 347,248.29 X 045 = 15,626.18
(7) .00 X 12 = .00
ll8) .00 X 15 = .00
ll9)= 15,626.18
TAX CREDITS:
.-...n..n. K~l;~~rl II 1+ J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO116 781.31 27,500.00
TOTAL TAX CREDIT 28,281.31
BALANCE OF TAX DUE 12,655.13CR
INTEREST AND PEN. .00
TOTAL DUE 12,655.13CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
... - .
~
REV-1470 EX (6-88)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
FILE NUMBER
William Fielding Lewis
REVIEWED BY
ACN
2101-0512
101
Sandra J Eslinger
ITEM
SCHEDULE NO.
E 8
EXPLANATION OF CHANGES
The value of this item has been suspended from the appraisement of the return until. the
final value can be determined. A supplemental return must be filed when the value of the
suspended item is determined.
The value of this item has been suspended from the appraisement of the return until the
final value can be determined. A supplemental return must be filed when the value of
the suspended item is determined.
A 1
ROW
Page 1
/1: -,Q$ 3 - -Y'
~BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
JAMES D FLOWER
SAIDIS ETAL
26 W HIGH ST
CARLISLE
"Ol
;,~3
'1 t.::'
" j ..J
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-22-2002
LEWIS
05-06-2001
21 01-0512
CUMBERLAND
101
*'
REY-1547 EX iFP (01-02>
WILLIAM
F
Allount Rellitted
r~~7013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R'Ev=is4j-EX--AFP--co1-:02i--NCificE-OF-'rNHEififiifci-TAX-A-PPRAisEirENT~--AL1-owiNci-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEWIS WILLIAM F FILE NO. 21 01-0512 ACN 101 DATE 07-22-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
205.000.00
.00
.00
.00
11.810.56
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage 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)
151141.99
351.77
Ul)
(2)
(3)
(4)
NOTE: To insure proper
credit to your accountl
subllit the upper portion
of this forll with your
tax paYllent.
2161810.56
11;.493 76
2011316.80
.00
5481565.09
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(5) .00 X 00 = .00
(6) 5481565.09 X 045 = 241685.44
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(9)= 241685.44
. "'. ....... . K~~~~I"'I II {+J AHOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO116 11234.27 271500.00
TOTAL TAX CREDIT 281734.27
BALANCE OF TAX DUE 41048.83CR
INTEREST AND PEN. .00
TOTAL DUE 41048.83CR
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR) 1 YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
VI
oK
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
WILLIM~ FIELDING LEWIS
Date of Death:
May 6, 2001
Will No.
Admin. No. 21-01-0512
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:
Yes XX No
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? Yes No XX .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes XX No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 02/12/03
,Gl~ rE;L\,',
~ sJignature ~ \
.' James D. Flower, Jr.
Name (Please type or print)
26 West High Street
Carlisle. PA 17013
Address
( 717) 243-6222
Tel. No.
Capacity:
Personal Representative
XX Counsel for personal
representative
(MAH:rmf/AM3)
//:rc2Sg~6./
\\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG I PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1607 EX AFP 101-05)
JAMES D FLOWER
SAIDIS ETAL
26 W HIGH ST
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-10-2003
LEWIS
05-06-2001
21 01-0512
CUMBERLAND
101
WILLIAM
F
Allount Rellitted
PA 1.7013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V =ii;ifj-i3c--AFP--fol-:oil-------...--fNifERii'-ANc'E--TAX--SyjffEM'E-tiT-ifF-ACCouiff--.-..---------------- - - ---
ESTATE OF LEWIS WILLIAM F FILE NO.21 01-0512 ACN 101 DATE 02-10-2003
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYMENTS~ THE CURRENT BALANCE~ AND~ IF APPLICABLE~
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2003
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
24~825.41
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-03-2001 CDOOO116 1~241.27 27~500.00
01-23-2003 REFUND .00 3~915.86-
TOTAL TAX CREDIT 24~825.41
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $l~
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
RfV.1500EX(&DO)
, *1-. COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 171211.0601
REV-1500
ILv~~33-Lf
FILE NUMBER
c
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 - 01
05 12
YEAR
NUMBER
COUNTY CODE
DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL)
I-
Z
LlJ
o
LlJ
()
LlJ
o
LEWIS, WILLIAM FIELDING
OATE Of OEATH MM-OO-YEAR}
SOCIAL SECURITY NUMBER
705
- 9181
14
DATE OF BIRTH (MM-OD-'fEAR)
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
05/06/2001 07/19/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
o 2.Supple.me.ntal Return
o 4a. Future Interest Compromise Idal~ordaathafter12-12-621
D7.DecedentMaintainedaLivingTrustattachaooPyofTrUst)
o 1 O. Spousal Poverty Cred'll (dale otduth between 12-31-91 and j.I_95)
o 3. Remainder Return (dale 01 deatn pnorto 12-13-82)
D 5, Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D11,Electiontotaxundersec.9113(A}attachschoO
W
f-
<:1''' -
w!!:o
I~O
,,0"
~ .
~
<
/A
~1 Original Return
D4.LirnitedEstate
C8J 6, Decedent Died Testate (Attach copy 01 Wm)
Ds.uligalionProceedsRecei'led
r
z
W
Q
Z
Q
.
.
W
.
.
o
o
THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONflDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO
NAME COMPLETE MAILING ADDRESS
James D. Flower, Jr..
s~fJ1.~,A~Mir,"rj6wer & Lindsay
TELEPHONE NUMBER
717-243-6222 26 West Hi h Street, Carlisle, PA:1j7 13
1_ Real Estate ($cheduleA)
2, Slocks and Bonds (Schedule B)
(1) $ 204,600.00 ::$ .~ c5 ::tJ
rr N '~1)
26,597.48 ~")
(1) -,-,
rr"
(3) 0 cci
I
1'1 245,544.44 U1
(5) 115,119.44 ..'"
.:.,.",
0.00 ~
(61 0
(7) 0.00
4. Mortga.ges & Nates 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)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
z
o
i=
~
:>
f-
0-
0{
U
ill
0:
6, Total Gross Assets (total Lines 1-7)
(81 591,861.36
(9) 22,113.48
(101 7,899.59
9_ Funeral Expenses & Administralive Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule 1)
(111 30,013.07
(12) 561,848.29
(13) 0.00
(14) 561,848.29
13. Charilable and Governmental Bequests/Sec S113 Trusts for which an election to tax has not been
made (Schedule J)
z
o
f-
<(
f-
:>
a.
~
o
u
X
<(
f-
15. Amount of line 14 taxable atthe spousal tax
rate, or transfers under Sec, 9116 (a)(1,2)
16, Amounl of Line 14 taxabJe al lineal rate
17. Amoun~ of line 14 taxable at sibling rate
18. Amount of line 141axable at collateral rate
19. Tax Due
11. Total Deductions (total Lines 9 & 10)
12, Net Value of Estate (Line 8 minus Line 11)
14. Net Value Subject to Tax (Line 12 minus Line 13)
see INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x.o_ (15)
x.o 45 (16) 25,283.17
)( .12 (17)
x,15 (16)
(19) 25,283.17
561,848.29
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20~
> > B SURE TO ANSWER ALL Q ESTI NS ON REVERSE SIDE AN
Decedent's Complete Address:
STR"ETADDRESS 1210 S f d D .
trat or rIve
CITYCr1 I STATE PA I ZIP 17013
ar IS e
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credil
B. Prior Payments
C. Discount
(1) 25,283.17
$ 27,500.00
1,447.33
Total Credits (A' B , C) (2) $ 28,947.33
3. Interest/Penalty If applicable
D.lnleresl
E. Penalty
TotallnteresUPenally ( D , E ) (3) 0.00
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) 3,664.16
5. If Une I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the lax due, (SA) 0.00
B. Enterthe total of Line S' SA. This is the BALANCE DUE. (513} 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
. Did decedent make a transfer and: Yes No
a. relain the use or income of the property transferred; - - - - - - - - - - - - - - - - - - - - - - - - - - - 8 18I
b, retain the right to desIgnate who shall use the property transferred or its income; _ _ - - _ - - - - - - - - - - ~
c, retain a reversionary Interest; or_ - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - B
d. receive the promise for life of either payments, benefits or care? _ _ _ - _ _ _ - - - - - - - ~ - - - - - - - - - -
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - 6 18I
3. Did decedent own an "in trust for"c9ayable upon death bank account Of security at his or her death? _ 181
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ - - . 0 I8J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Und.r plnalties of perjury, I declar. that I hay. .umlntd this return, Including accompanying schtdules and statlm.nll, and to th. b"t 01 my know1edv.' and btlitf, ltls. trl.l9, COH~t
1M ~pIn.
D.cla,ationofpr.par.roth.rthanth.pefsonalr.pr.stnlatlv.isbasedonaII Inlolmation ofwhloh pr.par.r has any knowl.dge.
DATE
-s-
,2002
SIGNA
DATE
,2002
Street, Carlisle, PA 17013
es 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 to the use of the surviving spQuse is 3%
[72 P.S. 99116 (a) (1.1) (I)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value oitransfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, 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 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at dealh to or for Ihe use of a natural parent, an adoptive parent,
ora stepparent of the child is 0% 172 RS. 99116(a)(I.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. 99116(1.2) [72 RS. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% {n P .S. ~9116{a){1.3)l. A sibling 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.,mFX-11-9iJ{lJ~_
' ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Lewis, William Fielding 21-01-0512
AI) real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property whicl'J is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
I.
OESCRIPTION
ALL THAT certain tract ofland situate in the Borough of Carlisle, Cumberland County,
Pennsylvania, more particularly known and numbered as 1210 Stratford Drive,
Carlisle, Pennsylvania 17013. Estimated sale price of $220,000.00, less 7% realtor's
conunission and transfer tax. Please suspend review pending actual sale, at which
time we will file an amended/supplemental return
VALUE AT DATE
OF DEATH
$ 204,600.00
TOTAL (Also enter on line 1, Recapitulation) :Ie 204,600.00
(If more space IS needed, Insert additional sheets of the same sIze)
"""""',1''''''1*
COMMONWEAL 1\1 OF PENNS'IlIJAN1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
Lewis, William Fielding
FILE NUMBER
21-01-0512
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
I
DESCRIPTION
332 sh. American Industrial Properties Reit, cammon stock, @ $ 12.89/share
VALUE AT DATE
OF DEATH
$ 4,279.48
2.
Adarus Electric Cooperative, Inc., patronage capital stock, account #5292016. See
attached letter
736.84
3.
Johu Hancock Financial Services, Account #1200-000158027,596 shares of
demutalization compensation@ $36.21/share
21,581.16
TOTAL (Also enter on line 2, Recapitulation) s 26,597.48
(If more space is needed, inse- additional sheets of the same size)
"".""";-,,.,,"".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Lewis, William Fielding
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-01-0512
ITEM
NUMBER
I.
Coal Bank Hollow, principal loan. See attached letter
VALUE AT DATE
OF DEATH
245,000.00
Unpaid interest accrued to date of death
544.44
TOTAL (Also enter on line 4, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
. 245,544.44
""""""1:"11'1*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lewis, William Fielding
FILE NUMBER
21-01-0512
ITEM
NUMBER
Include the proceeds of litigation and the dale the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
6.
7.
8.
9.
10.
II.
12.
13.
14.
15.
16.
17.
DESCRIPTION
Checking Account No. 182-452-5826, M & T Bank. See attached letter
VALUE AT DATE
OF DEATH
$ 11,274.30
2 Subscriber Savings Account No. 00004-10-31, USAA Investment Management Company.
See attached statement 1,420.39
3. Investment Account #44-44901004063, USAA Investment Management Company,
199.056 shares @ $12.95/share 2,577.89
4. Fidelity Investments Fund/Account #003-0667887269, Mutual Fund #Tl53806168.
See attached statement 3,471.63
5. Scudder Investments, IRA Account #00086515981-1, consisting of the following, as per
attached statement: 69,041.22
654.203 sh. Scudder Large Company Value @$27.13/share
1,329.241 sh. Global Fund@$25.11/share
817.348 sh. Global Bond Fund@ $9.09/share
427.3020 sh. Growth and Income Fund@ $23.14/share
666.419 sh. Development Fund @ $27.53/share
$ 17,748.53
33,377.24
7,429.69
9,887.77
18,346.52
Personal property as per appraisal of Benny E. Rowe, Auctioneer, attached
7,783.00
1989 Cadillac Sevillewith 62,000 miles as per attached appraisal of Graham Motor
Company
2,000.00
1992 Ford Van. Estimated sale price. Please suspend review pending actual sale, at
which time we will file an amended/supplemental return
10,000.00
Armed Forces Insurance Exchange (AIFE) Subscriber Capital Account #0062861. See
attached statement
447.32
John Hancock, Long Term Care Insurance Payment
3,150.00
Penn State, Insurance Refund
6.00
Penn State, Plan A Refund
619.16
County of Cumberland, burial allowance
100.00
Commonwealth of Pennsylvania, Revenue Refund
182.60
U. S. Treasury, IRS Tax Relief Refund
300.00
U. S. Treasury, Retired Pay, Defense Finance
4.43
Uniformed Services Benefit Assoc., refund of prepaid premium
16.50
TOTAL (Also enter on line 5, Recapitulation) $ CONTINUED
(If more space IS needed, Insert addItional sheets of the same size)
SCHEDULE E - CONTINUED
CASH, BANK DEPOSITS AND
MISCELLANEOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Lewis, William Fielding
21-01-0512
ITEM
NUMBER
DESCRIPTION
AMOUNT
18.
John Hancock Life Insurance Company, life insurance
benefits on the life of Anita Loving Lewis
$ 2,200.00
19.
John Hancock Financial Services, reimbursement for
nursing home expenses
525.00
TOTAL $115,119.44
"'''''':'1''''11''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R~SIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Lewis, William Fielding
FilE NUMBER
21-01- 0512
ESTATE OF
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES: $ 647.25
1. Storke Funeral Home, Inc., funeral
St John's Church, church services 500.00
Charles Ferris 125.00
Richard Ward 30.00
Father Mark Scheneman 300.00
Salem Baptist Church, Reverend MacMarshall 125.00
B. ADMINISTRATIVE COSTS:
I Personal Representative s Commissions
Name of Personal Representative (s)
Social Security Number(s) ! EIN Number of Personal Representatlvels)
Street Address
City Slate Zip
Year(s) Commission Paid
2. MlorneyFees !Saidis, Shuff, Flower & Lindsay I 16,837.08
3. Family Exemption: (if decedents address is nollhe same as claimant 5, allach explanation)
Claimant n1a
SIreelAdelre55
City State Zip
Relalionship of Claimanl 10 Decedent
4. Probate Fees
442.00
5. Accounlant s Fees
6. Tax Return preparers Fees
Cumberland Law Journal, advertising Estate Notice 75.00
7.
The Sentinel, advertising Estate Notice 84.11
Roanoke Times, obituary notice 94.50
Rowe's Antiques, personal property appraisal 85.00
Register of Wills, 2 short certificates 6.00
Richmond Times Dispatch, obituary notice 363.32
TOTAL (Also enter on line 9, Recapitulation) I CONTINUED
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H - CONTINUED
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Lewis, William Fielding
FILE NUMBER
21-01-1512
ESTATE OF
ITEM
NUMBER DESCRIPTION
AMOUNT
1. Patriot News, obituary notice
325.50
2. John Hancock, fee for sale of shares
10.00
3.
State Employees Retirement System, refund of payment
406.81
5.
Register of Wills, 9 short certificates
1,469.87
27.00
4.
William F. Lewis, Jr., reimburse costs to transport car
6.
M & T Bank, check printing charge
25.08
7.
8..
M & T Bank, check printing charge
Allowance for closing costs
35.96
100.00
TOTAL $ 22,113.48
SCHEDULE I-CONTINUED
Page 2
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES ADN LIENS
ESTATE OF
Lewis, Williarn Fielding
FILE NUMBER
21-01-1512
ITEM
NUMBER
DESCRIPTION
AMOUNT
$ 29.99
36.80
763.20
51.21
8.03
36.80
44.22
44.49
29.99
47.70
29.66
34.51
36.80
29.99
32.67
28.08
24.41
29.99
24. ADT Security Services, account
25. Corncast Cable, account
26. Rynard's Lawn Service, lawn service
27. P. P. & L., account
28. Borough of Carlisle, water/sewer account
29. Corncast Cable, account
30. P. P. & L., account
31. Sprint, account
32. ADT Security Services, account
33. Rynard's Lawn Service, account
34. Sprint, account
35. P. P. & L., account
36. Corncast Cable, account
37. ADT Security Services, account
38. Sprint, account
39. P. P. & L., account
40. Borough of Carlisle, water/sewer account
41. ADT Security Services, account
SCHEDULE I - CONTINUED
Page 3
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES ADN LIENS
FILE NUMBER
ESTATE OF
Lewis, William Fielding
21-01-1512
ITEM
NUMBER
DESCRIPTION
AMOUNT
$ 13.49
73.60
29.20
1 06.44
59.98
73.60
13.84
34.69
25.55
31.52
111.30
25.55
79.50
42. Borough of Carlisle, water/sewer account
43. Comcast Cable, account
44. Sprint, account
45. P. P. & L. Co., account
46. ADT Security Services, account
47. Comcast Cable, account
48. Borough of Carlisle, water/sewer account
49. Comcast Cable, account
50. Sprint, account
51. P. P. & L. Co., account
52. Rynard's Lawn Service, account
53. Sprint, account
54. Sandra Hockensmith, reimburse costs for service to van
TOTAL $ 7,899.59
"".,,''':.,,.,,"''.
COMMONWE;"l TH OF ?ENNS'flV!\N1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
LEWIS, WILLIAM FIELDING
21-01-0512
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
$ 32.28
27.58
82.37
21.52
34.69
59.98
1,174.55
774.55
143.36
19.29
190.80
275.00
3.50
13.49
86.26
44.49
406.81
2,218.74
119.02
32.91
13.49
73.60
24.51
. CONTINUED
1
Sprint, account
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18
19.
20.
21.
22.
23.
Sprint, account
P. P. & L., account
Borough of Carlisle, water/sewer account
Corneast Cable, account
ADT Security Services, 2 months' service
United Church of Christ Home, nursing home care
Pharmerica, account
BETRA In Home Care, van transport and van service
Belvedere Medical Corp., account
Rynards Lawn Service, lawn services
Michael B. Cooke, CPA, preparation of2000 tax retums
USAA, auto insurance
Borough of Carlisle, water/sewer account
Sprint, account
P. P. & L., account
State Employee's Retirement System, refund of May retirement payment
Darlene L. Moyer, Tax Collector, 2001-02 School Real Estate Taxes
P. P. & L., account
Sprint, account
Borough of Carlisle, water/sewer account
Corneast Cable, account
Sprint, account
TOTAL (Also enter on line 10, Recapitulation)
(If more space IS needed, Insert additIOnal sheets of the same size)
'"."":',,.,,"".
COMMONWEAL T\-\ Or PENNSYlVAl~IA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Ann Lewis Bracken Daughter 1/2 of personal effects,
213 Pine Drive and 2/5 ofresiduary
Blacksburg, VA 24060 estate individually
2/5 of residuary estate as Trustee in Trust for
William F. Lewis, Jr.
1/5 of residuary estate as Trustee in Trust for grandchildren,
Steve Burton Lank, Emily Loving Bracken and William
~oore Bracken
William F. Lewis, Jf. Son 112 of personal effects,
1188 West Salmon Court and 2/5 of residuary
Gilbert, Arizona 85233-6749 estate as beneficiary
under Trust
Steve Burton Lank Grandson 1/5 of residuary estate
Emily Loving Bracken Granddaughter . ointly as beneficiaries
William Moore Bracken Grandson
all of 213 Pine Drive
Blacksburg, VA 24060
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
\1. NON.TAXABlE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
1 None
B CHARITABLE AND GOVERNMENTAL DISTRiBUTIONS
1 None
TOTAL OF PART 11 - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS DN LINE 13 OF REV 1500 COVER SHEET $ 0.00
Lewis, William Fielding
FilE NUMBER
21-01-0512
ESTATE OF
(if more space is needed, insert additional sheets of the same size)
c:\wp; I \WiUs\lewis. William
FILE COPl
I
"
L~ ~o"gllJaI_
!7IYlP 1-.. 0~ (j~ LnJI ~
3East JlIill atWQf~stcttlUtd
OF
WILLIAM FIELDING LEWIS
I, WILLIAM FIELDING LEWIS, of 1210 Stratford Drive, Carlisle, Cumberland
County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and
form following:
FIRST:
I hereby expressly revoke all Wills and Codicils heretofore made by
me.
SECOND: I hereby direct my Executrix to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicable after my death.
TIDRD:
I direct that all taxes which may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid out 'of my estate as a
part ofthe administration of my estate.
FOURTH: Upon my death, I direct that my body be cremated and that the ashes
be buried in the graveyard of the Salem Baptist Church in Sparta, Virginia, where stones have
already been set for the purpose of identification.
FIFTH:
I have served in the Armed Forces of the United States. Therefore, I
direct my Executrix to consult the legal assistance office at the nearest military installation to
ascertain if there are any benefits to which my dependents are entitled by virtue of my military
affiliation at the time of my death. Regardless of my military status at the time of my death, I direct
I
I
,
I
I
i
c:\wp5l\Wills\Lcwis. WiltLam
my Executrix to consult with the nearest Veterans Administration and Social Security
Administration office to ascertain jf there are any benefits to which my dependents may be entitled.
SIXTH: I hereby give to my children, ANN LEWIS BRACKEN and
WILLIAM F. LEWIS, JR., all of my personal effects, clothing, furniture, furnishings, jewelry,
automobiles, and any other tangible personal property of every kind and any insurance thereon, in
equal shares, provided they each survive me, and to the survivor if they fail to survive me, to be
divided among them as they may agree, or if they are unable to agree, as my Executrix may decide.
Any items of value not so disposed of shall be sold by my Executrix, and the proceeds added to the
residuary of my Estate.
SEVENTH: It has been my intention and that of my wife ANITA LOVING
LEWIS, that my sister, PATRICIA ROSS LEWIS, of Atlanta, Georgia, be paid the sum of Fifty-
Thousand ($50,000.00) Dollars, provided that she survives us. Since my wife, ANITA LOVING
LEWIS, has made such a provision in her Will, and since that bequest will satisfy. our intentions at
my death from proceeds of a Trust which she established, I make no separate bequest to my sister.
EIGHTH: All the rest, residue, and remainder of my estate shall be distributed
as follows:
(A) Two-fifths to my daughter, ANN LEWIS BRACKEN, of213 Pine
Drive, Blacksburg, Virginia 24060; or if she fails to survive me, I give that share of my estate
which my daughter would have received to her children in equal shares, which children are
STEVEN B. LANK. EMILY L. BRACKEN, and WILLIAM M. BRACKEN. By so
2
c:\wpS I\WiIIs\Lcwis. William
specifYing these grandchildren. I do not intend to exclude any after born or after adopted children of
my daughter, ANN LEWIS BRACKEN. Said funds shaIl not be delivered to my grandchildren
directly, but shaIl be added to those funds held for their benefit in a Trust created through the Will
of my wife, ANITA LOVING LEWIS, and be administered in accordance with the provisions of
that Trust, or ifunder the terms oftbat Trust, some or all of the funds have been distributed to them,
any funds passing to them under my Will shaIl be distributed in the same proportions and the same
manner.
(B) Two-fifths to my daughter, ANN LEWIS BRACKEN, of213 Pine
Drive, Blacksburg, Virginia 24060, IN TRUST, nevertheless, for the benefit of my son,
WILLIAM F. LEWIS, JR., of Glendale, Arizona; the Trustee shaIl invest such funds in good and
safe securities legal for trust funds in the Commonwealth of Pennsylvania and shall pay the net
income derived therefrom in quarterly installments, or more frequently if convenient, to and for the
use and benefit of the said WILLIAM F. LEWIS, JR. In addition, I hereby authorize and
empower the Trustee to use as much of the principal as she in her sole discretion shall deem
necessary and proper for the personal needs of WILLIAM F. LEWIS, JR., including for his
maintenance, health and general welfare and personal support. This provision is intended to be for
the purpose of necessity only, not convenience. Notwithstanding the foregoing, the said
WILLIAM F. LEWIS, JR. shall have the right exercisable once in any given calendar year to
withdraw 5% of the then principal amount of this Trust, in addition to any income to which he may
be entitled.
3
c:\wp51\Wilt.s\Lcwis. William
(C) Ifmy son, WILLIAM F. LEWIS, JR., 1iIils to survive me by thirty
(30) days, or at his death, the Trustee shall ascertain whether he has any children then living, and if
he has no such children, then I give the share of my estate which was to have been.applied for his
benefit under this paragraph to my daughter, ANN LEWIS BRACKEN, or should she fail to
survive me by thirty (30) days, to her children then living in equal shares. Should my son,
WILLIAM F. LEWIS, JR., fail to survive me by thirty (30) days and be survived by one or more
children of his own, or if at his death he is survived by one or more children of his own, I direct the
Trustee to hold and invest the aforesaid funds for his, her, or their benefit, and pay such nct income
from the Trust as Trustee deems appropriate for the benefit of said child or children to said child or
children's guardian. In addition, I hereby authorize and empower the Trustee to use as much of the
principal as it in its sole discretion shall deem necessary and proper for the support, maintenance,
health, and general welfare, and education of said child or children, paying to said child or children
his, her or their proportionate share of the principal and any unpaid income of the trust upon
attainment ofthe age of25.
(D) One-fifth (l15) to ANN LEWIS BRACKEN, IN TRUST,
nevertheless, for the benefit of my three grandchildren, STEVEN BURTON LANK, EMILY
LOVING BRACKEN, and WILLIAM MOORE BRACKEN. The Trustee shall invest the
funds in good and safe securities legal for Trust Funds in the Commonwealth of Pennsylvania, and
shall pay such income derived therefrom to or for the benefit of said beneficiaries, as she deems in
her sole discretion to be desirable, taking into account the tax consequences of retention of
4
c:\wp51 \WilIs\Lcwis. William
earnings, and in addition, I hereby authorize and empower the Trustee to use as much of the income
and of the principal as in her sole discretion she shall deem necessary and proper for the support,
maintenance, health, general welfare and education (which education may include graduate or
professional school) without regard to any inequality of said payments for one. beneficiary or
another. At such time as the youngest of said beneficiaries attains the age of 25 years, the Trustee
shall divide any remaining principal and all unpaid income into three shares, and shall pay a share
to each of the three beneficiaries, provided that the share of any beneficiary who is deceased at that
time shall be paid to or for the benefit of his or her issue, or in default of same in equal shares to the
remaining beneficiaries.
(E) Should the principal of any trust herein provided for be or become
too small in the lRUSTEE'S discretion so as to make establishment or continuance of the trust
inadvisable or impractical, my lRUSTEE or my executor may make immediate distribution of the
then remaining principal and any accumulated or undistributed income outright to the person or
persons and in the proportions they are then entitled to income. If any such person is then a minor,
distribution may be made to his or her guardian. Upon such termination, the rights of all persons
who might otherwise have an interest as succeeding income beneficiary or in remainder shall cease.
(F) My Trustee, ANN LEWIS BRACKEN, shall have the authority to
delegate some or all of her duties as Trustee to another individual or a professional Trustee,
however, should she fail to do so and for whatever reason become unable to perform her duties,
then my son-in-law, JAMES W. BRACKEN and MICHAEL B. COOKE, CPA, shall jointly
perform the duties of Trustee of any Trust created under this Will.
5
c:\wpSI\Wi1Is\Lewis. William
LASTLY: I nominate and appoint my daughter, ANN LEWIS BRACKEN, of
213 Pine Drive, Blacksburg, Virginia 24060, as Executrix of this my Last Will and Testament, but
should she fail to qualify or cease to serve in that capacity for any reason, I nominate. and appoint as
Substitute Executors, my son-in-law, JAMES W. BRACKEN, and, MICHAEL W. COOKE,
CPA, to serve jointly as Executor. I direct that my personal representative(s) shall not be required
to give bond or security for the performance of his, her or their duties in any jurisdiction.
~ WITNESS WHEREOF, I h""""" .. my ""'" "" "'" "'" .019 {r-
day of /'. n') , 1998.
I)
,,-,<:I
William Fielding Lewis
{~
L,f2U]
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
( It".. .~.
, vv.J.Y...~. '
6
c::\wpSI\Wills\LewiS. wiUimI
COMMONWEALTH OF PENNSYL VANIA
ss.
COUNTY OF CUMBERLAND
We, James D. Flower and James D. Flower, Jr.
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we are present and saw Testator, WILLIAM FIELDING
LEWIS, sign and execute the instrument as his Last Will, that he signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge
the Testator was at that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower
and
James('rF;;z:r.
, witnesses this
-;2CJ -f.),
day of
,1998.
/
(
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Witness
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WItnesS
l_LltlUL"~~~d
No ublic
"""
NCJrAlllAL SEAL
Ml!A1ZN1! 1oWIHEVKA. __
ConIoIe. eum...._ eoo.ntv. PA
Uy~ ExpIIOO....... 2002
8
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3'~
Tax Parcel No.: 04-22-0479-034
DEED
MADE THE
of Our Lord
s-T
/~ day of
one thousand nine
,,4?e/<9VS" T
hundred ninety-four
, in the year
(1994)
BETWEEN EDWARD L. SCHORPP and JANICE F. SCHORPP, husband and
wife, of 35 South Thrush Drive, Carlisle, Pennsylvania,
GRANTORS,
and WILLIAM F. LEWIS and ANITA L. LEWIS, husband and wife, of
1210 Stratford Drive, Carlisle, Pennsylvania,
GRANTEES
WITNESSETH, that in consideration of One and no/lOO ($1.00)
Dollar in hand paid, the receipt whereof is hereby acknowledged,
the said Grantors do hereby grant and convey unto the said
Grantees, their heirs and assigns, as tenants by the entirety.
ALL THAT CERTAIN tract of land situate in the Third Ward of
the Borough of Carlisle, Cumberland County, Pennsylvania, bounded
and described as follows:
BEGINNING at a point on the southern side of Stratford Drive
at corner of Lot No. 22 on the hereinafter mentioned Plan of
Lots; thence along Lot No. 22, South 20 degrees 34 minutes East
114.43 feet to a common point of Lot Nos. 20, 21, 22 and 23;
thence along Lot No. 20, South 69 degrees 26 minutes West 140.00
feet to a point on the eastern line of Wellington Drive; thence
along the eastern line of Wellington Drive, North 20 degrees 34
minutes West 91.19 feet to a point; thence by a curve to the
right having a radius of 20.0 feet and an arc length of 32.21
feet to a point in Stratford Drive; thence along Stratford Drive,
North 71 degrees 42 minutes 38 seconds East 119.19 feet to a
point, the Place of BEGINNING.
BEING Lot No. 21 on the Plan of Lots known as Nottingham,
Section 2, as recorded in the Office of the Recorder of Deeds for
Cumberland County in Plan Book 23, Page 02, and having thereon
erected a brick ranch-style dwelling house known as and numbered
1210 Stratford Drive.
BEING the same premises which Eugene S. Schlosnagle and
Ethel S. Schlosnagle, husband and wife, by their deed dated June
18, 1984, and recorded in the Office of the Recorder of Deeds in
and for Cumberland County in Deed Book "8", Volume 30, Page 1144,
e2C~ 109 ?,\GE 464
granted and conveyed unto Edward L. Schorpp and Janice F.
Schorpp, husband and wife, grantors herein.
SUBJECT, HOWEVER, to any building and use restrictions and
easements of record.
AND the said Grantors hereby covenant and agree that they
and each of them will warrant SPECIALLY the property hereby
conveyed.
IN WITNESS WHEREOF, said Grantors have hereunto set their
hands and seals the day and year first above written.
signed, sealed and delivered
in the presence of
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Edward L. Schor p
~~~LL/ (SEAL)
J ice F. Sch rpp / (
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
. S-r
On this, the I - day of P"'-1"--~'t , 1994,
before me, the undersigned officer, personally appeared Edward L.
Schorpp and Janice F. Schorpp, known to me (or satisfactorily
proven) to be the persons whose names are subscribed to the
within instrument, and acknowledged that they executed the same
for the purposes therein contained.
....
NoIarialSoal
lawrence D.IQser, NoIaIy Public
CalIsIe Boro. CumbeItand County
My CommiSSion EJcpiresJune 2. 1 'i1il7
Member. . AssociaIion of Notaries
official ,1::1'11/111' .,
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IN WITNESS WHEREOF, I hereunto set my hand and
seal.
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I do hereby certify that the precise residence and complete
post office address of the within named Grantee is 1210 Stratford
Drive, Carlisle, pennsylvania 17013.
Ql~1
. 1994
l
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
Recorded on this \ day
in the Recorder's Offi~~f the
Volume - . page _.
Given under my hand and seal of the said office, the date
above written.
55.
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said C nty,
in
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Adams Electric
Cooperative, Inc.
A Touchstone Energy-.Cooperative ~
-
1338 Biglerville Road
Gettysburg, PA 17325-1055
Telephone: 717/334-9211
Fax: 717/334-3980
Web Site: www.adamsec.com
July 19,2001
SAIDlS, SHUFF, FLOWER & LIND SA Y
26 WEST HIGH ST
CARLISLE PA 17013
RE: WILLIAM F. LEWIS
PATRONAGE # 52920169
DEAR ATTORNEY FLOWER:
This letter is regarding the above estate and the status of patronage capital derived during the year(s)
in which electric service was received from Adams Electric Cooperative, Inc.
As a non-profit utility, Adams Electric Cooperative annually allocates patronage capital to its
member-consumers based on their electric usage or patronage. Each member's annual patronage
capital allocation is added to any prior year allocation and becomes subject to cash retirement as
financial conditions permit. Patronage capital is required by cooperatives for working capital and
equity purposes to secure long-term loans necessary to construct reliable electric facilities to serve
member-consumers.
For the past 23 years, the Cooperative has made special retirements of patronage capital to estates on
a discounted lump sum basis. Both the general and special retirements are subject to annual
authorization by the Cooperative's Board of Directors.
The special lump sum early retirement of an estate's patronage capital discounts the unretired
patronage capital for each year that such amounts are paid in advance. Applying the process to this
estate's patronage capital yields an approximate lump sum amount of $736,84,
1. Complete the endosed Legal Statement
2. Sign the Legal Statement in the presence of a Notary Public
3. Return the Legal Statement in the enclosed postage-paid envelope by November 15, 2001.
After return of the completed Legal Statement I will include the estate's patronage for consideration
of a special discounted retirement tentatively set for December 2001.
Sincerely, "
~~A~>~
Joanne B. May, Patronage
Capital Representative
Enclosure
cc: Ann Bracken
~ EQUISERVE
STATEMENT OF HOLDINGS
Pasl Office Box 842009, 80slon. MA 02284-2009 www.EquiServe.com
Comnanv Name
JOHN HANCOCK FINANCIAL SVCS
1200-10
ANN LEWIS BRACKEN
EST WILLIAM F LEWIS
C/O JAMES D FLOWER JR
26 WEST HIGH ST
CARLISLE PA 17013-2922
Account Number
4115-5990
PLEA5fOf'liMiiiER TO THE REVERSE SIDE OF
THIS STATEMENT FOR AN EXPLANATION OF
TERMS AND FOR INFORMATION REGARDING
THE SALE OF STOCK AND THE ISSUANCE OF
A CERTIFICATE
Statement Date I
09/21/011
16-01/0102001 XR M083794
SHARE BALANCE AS OF:
9/21/01
Shares Held By You
Shares Held By The Agent
Total Shares
Year.To-Oate Activitv
. ransaction i
Date t
Transaction Description
$ S?~ce $ Net Amount Invested $ Price Per Share Transaction Shares
$ Tax Basis
Per Share
Total Shares Held
by Agent
9/14ITRANSFER IN
9/21 IllSALE OF SHARES 'r 1 O. 00 21,463.34
CHK SENT SEPARATe 21,463.34
,
596.0000
36.0291 -596.0000
596.0000
I
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Cunent Value
Market Price Market Value
IMPORTANT
ALL REQUIRED INFORMATION REGARDING THE SALE OF
SHARES IS BEING FURNISHED TO THE INTERNAL REVENUE
SERVICE. RETAIN THIS STATEMENT FOR YOUR INVESTMENT
AND TAX RECORDS.
34.440 0.00
.'," 0
.,1: .iOi
April 20, 2001
This promissory note is to record a loan for $245,000,00 ($218.816.86 + 26,183.14) made to Coal
Bank Hollow, Inc. by William F. Lewis this 20" day of April 2001. This refinances a previous loan plus an
additional $22,000. It is understood that the loan has been made at a rate of 5% with monthly payments of
$1020.83 (interest only) to begin on May 20, 2001.
Borrower:
Coal Bank Hollow, Inc.
Q~~~)
~O~i:)w.f=: ~
Maker:
Coal Bank Hollo\.... Inc.
Post Office Box 11115 . Blacksburg, V A 24062 . (340) 552-4244 . Fax (540) 552-4024
, rm'M&rBank
August I, 2001
RE:
Estate Search
The Estate of:
Date of Death (D.O.D.)
WILLIAM F LEWIS, SR
5/6/2001
To Whom It May Concern;
Identified below is the account information requested.
I. M&T Bank accounts in which the decedent's name appears:
Account Account Number
Type
Account Title
Opening Branch
D,O,D, Accrued Interest
Balances
(Includes Accr.
Int.)
$11274.30 $0
CHECKING 424714
WILLIAM F LEWIS
4319
2, Loans, Mortgages, or other obligations titled in the decedent's name
Account Number
Amount Owed
Account Description
A Safe Deposit Box titled in the Decedent's name existed at our HIGH STREET CARLISLE. The Safe Deposit Box Number is
000058 I.
If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724-
2440 outside of the Buffalo, NY calling area. Thank you,
Sincerely,
M&T BANK CORPORATION
~;JA~ V f1
Authorized Signature
BY:
1 Jff'iiJ
DATE:
>1- /-d(1f) J
,
Manufacturers and Traders Trust Company. 1100 Wehrle Drive, PO, Box 761, Buffalo, NY 14240-0767
~
USM~
Check Date
USAA Number
Check Number
Amount Paid
: 02-19-2001
: 00004 10
: 620538
: $157.82
9800 Fredericksburg Road
San Antonio, Texas 78288
Visit us at usaa.com
10
38787
For automated information about
your SSA. call (800) 531-6095 and
press 1 on your touch-tone phone.
WILLIAM F LEWIS
COL USA RET
213 PINE DR
BLACKS BURG VA 24060-1808
****SSA SENIOR BONUS CHECK***
SUBSCRIBER'S SAVINGS ACCOUNT (SSA) ACTIVITY
I PRIOR SSA BALANCE
2 LESS YOUR SENIOR BONUS CHECK
$
$
1,578.21
157.82
3 NEW SUBSCRIBER'S SAVINGS ACCOUNT (SSA) BALANCE
$
1,420.39
As you requested, here is your Subscriber's Savings Account (SSA) Bonus check. It is 10 percent of your
prior account balance, as shown on line I above.
When our association's financial results allow us to distribule the bonus in future years, we will automatically
send you a check because that is the option you selecled. If you would rather apply your senior bonus to
your P&C premium balance or leave your SSA balance intact, please call us at (800) 531-6095.
Thank you for your many years of loyalty to USAA. We will continue to work hard to give you superior
service that is unmatched in the industry.
Income Tax lmpication: The Internal Revenue Service does not consider SSA disrribueions taxable unless JOlt deduct .\.Our
Insurance premIum as a bUSiness e:q:ense. Please consult .wur lax advisor i f:wu have an:1/ questions.
DM13685
*** PLEASE DETACH BEFORE DEPOSITING CHECK ***
~
~
-
-
-
.~~'
~~
LJSM l!Il",'Ii.\.-\ C\\TST...IE."T 'L\~AGE\IE!'\T CO\1PA:\T
9~WO Frt'dt'dd\.~ burg Road San Antunio. TX 78288
Page 1 of3
INVESTMENT ACCOUNT STATEl\IENT
Statement Period: 01/01/2001 - 03/31/2001
Customer Sen"ice
TouchLinl,@
Websrrc---
1-800-531-8448
1-800-531-8777
www.usaa.com
000775 00] 5..+9
USAA NUMBER:
000041031
WILLIAM F LEWIS
213 PINE DR
BLACKSBURG VA 24060
TOTAL ACCOUNT VALUE:
$2,593.86
How did )'our portfolio do in 2000? If you !'lade a big bet.on tecb stocks, it prohably suffered. Di,'ersification
between stocks and bonds may belp you wltb )'our financml $oals. USAA Investment Management Company bas a vast
array of s.tock and. bond funds, from consen'ath-e to aggresSlw, tbat may fit )'our needs. Call 1-800-531-8448
for more ,"formatIOn and a prospectus.
USAA Tax Exempt
Intennediale-Term Fund
$2.593,86
$2,536,28 Tax-Exempt
Tii~'~~Qu.igs ,
$34,02
,\:S34.{}~.;.;:
$34,02
:, S#;9~
Total Account Value
.. ,', ". "$2 "93 ..., ,.; .. ".. UJ:: ~"
:'~ "., ',.""",,,,'/r' "C', ::._";"~'''''
USAA Tax Exempt
Intermediate4 Term Fund
44-44901004063 USATX
100,00
I
I
I
198,156
Total
100.00 I
r, .,"
.', S2,593,!l~~
" ,"",', ">".:.'
~~
GLS,A~
to, .:2DO\ t2aQ.
SC 5 Sl:."T] NVYN - 000775 - OI~9. INP.JIN458FS.PAGE2.NOOOOOI ur0331 1854:20
6f\.~
~AI\~
111~~~~I~I~OOI~~~~mm~lm~IW~
Fidelity n Investments.
August 1,2001
JAMES FLOWER
26 WEST HIGH STREET
CARLISLE PA 17013
Dear Mr. Flower:
Thank you for your letter requesting information about William Lewis' accounts at
Fidelity. The tables below list the average account values based on the closing prices as
of Friday 05/04, and Monday 05/07/01.
Mutual Fund account, T153806168: Individual Registration
Fund/Account Quantity 05/04 05/07 Average
Unit Value Unit Value Market Value
003/0667887269 108.016 $32.17 $32.11 $3,471.63
Total Value $3,471.63
To transfer the ownership of the account, simply complete the transfer form I am
enclosing. Please note the additional documentation requirements in section two. I am
enclosing a return envelope that you may use to return the documents to our Dallas
office.
I hope this information is helpful to you. If you have any questions, please call
800-762-9621 between 9:00 a.m. and 5:00 p.m. Eastern time or visit our website at
www.fidelitv.com..
Sincerely,
~YOO~~
Wanda Ford
Legal Transfer Department
Our file: W05424-27JULOI
Fidelity Account T153806168
::\.-:.c~r2g,~ 5er,'.:,>,
;:,jel,ty Brckero';'2 _~",
Mer:~ber NYSr:; '': ~" =-,<
-".:,-"iJ! funds (k~~li:.
:',~i~:ilty lJist,"i::;;1:.::'s _.. -~_
Fidelity Service Company, Inc.
P,O. 80x 650276
Dalias, TX 75265-0276
SCUDDER
INVESTMENTS
P.O. Box 219669
Kansas City MO 64121-9669
1-800-728-3337
July 25,2001
James D Flower Jr
26 W High St
Carlisle P A 17013-2922
Inquiry #:
Fund:
Account #:
20203608
Global Fund-Class S
00086515981
Dear James D. Flower:
We are writing in response to your request for information regarding the value of William F.
Lewis account. The information below is only for the date you requested, May 6,2001:
FUND NAME(S) NUMBER OF SHARE ACCOUNT
SHARES PRICE BALANCE
Scudder Large Company Value 654.203 $27.13 $17,748.53
Global Fund 1,329.241 $25.11 $33,377.24
Global Bond Fund 817.348 $9.09 $7,429.69
Growth and Income Fund 427 .3020 $23.14 $9,887.77
Development Fund 666.419 $27.53 $18,346.52
According to IRS regulations, the beneficiary can only receive distributions from an IRA without
a premature distribution penalty upon the death of the owner. The only beneficiary on this
account is Anita 1. Lewis.
There are other options available for taking distributions. First, you may choose to redeem the
account. In order to redeem the account, please complete the enclosed W-9 form. We also
require a certified copy ofthe death certificate and a letter of instruction signed by the primary
beneficiary in his/her capacity with a signature guarantee.
A Signature Guarantee will protect the account by assuring us that the person(s) signing
the request is authorized to do so. Before you sign the letter of instruction or form, take it
to a local bank, credit union, or broker and ask them for a "Signature Guarantee." A
representative will verifY your identity, witness your signature, stamp the letter, and sign
his/her name and title. It is important to remember that a "Signature Guarantee" is
different from a Notary Public's stamp.
A mnnbn tJf 8 Zurkh SauJMr Inwstmmts
A third option is to transfer the money into your own IRA account. The money would not be
subject to your IRA rules. In order to do this we would require the same information as
referenced in the previous situations, as well as a completed IRA transfer form which I have
enclosed.
There are other options available if you wish to leave the assets in an IRA for the tax deferred
status. We suggest that you contact a tax advisor for assistance in determining which option
would best suit your financial needs.
Please contact me in the Transaction Processing Department at (800) 844-5584, extension 43082,
if! may be of further assistance.
Sincerely,
~~
Carrie Atkins
Service Specialist I
Enclosure(s): Scudder Return Form
No-Fee IRA New Account Form
Postage-paid envelope
Inherited IRA Distribution Information
Inherited IRA Distribution Request Form
Scudder Privacy Statement (dtd32701)
IRS Form W-9
D~ ROWE:~~l:t
.DOB . AU 2276L
R. D. 4, Box 353 . Carlisle, P A
249-2677 249-1978
Auction Is Action Call "ROWE"Por Satisfaction
May 29, 2001
TO: Ann Bracken
Executrix
213 Pine Drive
Blackburg, VA 24060
(888) 343-4244
COPY: James Flower
Attorney
26 West High Street
Carlisle, Pa. 17013
FROM: Benny E. Rowe
Auctioneer/Appraiser
2505 Ritner Highway
Carlisle, Pa. 17013
(717) 249-2677
REF: William Lewis estate, 1210 Stratford Drive, Carlisle,
Pa., Personal property Appraisal at current Auction
Market Value.
PAGE 2
LIVING ROOMN
8 ~ lQ Brown Background Rug
6 X 9 Karastan rug
4 X 6 Area Rug
3 Cushion Overstuffed Sofa
(2) Blue Upholstered Chairs
$ 75.00
85.00
35.00
175.00
80.00
DINING gQQJ:'!
7 Pes. Mahogany Dining Room suite
Pine Dry Sink
2 Pes. PA House Hutch Cupboard
(2) Tapestry Chairs
4 Chippendale Style Chairs
Victorian Marble top Stand
Slag Glass table Light
Linens
9 Pictures/Prints
Glass
China
Decorators
275.00
120.00
285.00
110.00
360.00
350 .00
350.00
20.00
65.00
175.00
225.00
85.00
LIVING ROOM
Mahogany Game table
Mahogany Coffee table
(2) Oak End Stands
Mahogany One Drw Stand
1930's Mahogany Empire Desk
8 Pictures/Prints
Mahogany Wall Table
(2) Brass Table Lights
(2) Barrel back Chairs
Mirror
Decorators/Accessories
150.00
60.00
60.00
45.00
265.00
80.00
65.00
40.00
20.00
15.00
30.00
')
PAGE 3
BEDROOM !.l
2 Single beds
2 Maple Chest of Drawers
Table Lights
Misc.
$ 11 0 . 00
160.00
6.00
12.00
BEDROOM #2
Desk w/Swivel Chair
Rocking Chair
Misc. Office
Typewriter w/Stand
2 Drw File Cabinet
2 Table Lights
Books
Mahogany Lamp Stand
35.00
25.00
30.00
5.00
5.00
6.00
3.00
55.00
BEDROOM ftl
Chippendale Style Bed
Chippendale Style vanity w/mirror
2 Table Lights
Victorian Marble Top Stand
Quil track
Marble Top Stand
RCA Color T V
6 Drw Mahogany Chest
Mahogany Lamp Stand
Bedding
185.00
215.00
30.00
375.00
20.00
75.00
65.00
165.00
25.00
10.00
DEN
Entertainment Center
Stereo Cabinet
Emperor Carriage Clock
OaK Lamp Stand
Coffee Table
3 Cushion sofa
Table Light
(2) Plaid Wing Chairs
Books/Records
Accessories/Decorators
Wing Chair- Covered
Plank Chair
165.00
N/V
75.00
20.00
8.00
110.00
5.00
160.00
8.00
30.00
5.00
15.00
'"
'~
.',
,~
,
PAGE 4
PATIO
Tubular furniture
tHsc.
$ 145.00
8.00
KITCHEN
Oak Trestle table
4 Plank Chairs
Pots- Pans- Baking
Small electrical Appliances
pictures/Prints
Glass/China
Small Kitchen Accesories
Refrigerator
65.00
75.00
65.00
50.00
15.00
70.00
35.00
225.00
LAUNDRY ROOM
Whirlpool washer & Dryer
Misc.
210.00
15.00
BASEMENT
Invalid Helpers
Exercise Cycle
Fan
2 Maple beds
Corner desk
Kerosene Heater
Card Tables
Games
Shop vac
Golf Clubs
Sleds
Books
~"ood Shelving
Dehumidifier
Metal Shelving
Decorators
His<::. Household
Weights
12.00
5.00
2.00
70.00
20.00
8.00
20.00
12.00
8.00
5.00
20.00
10.00
35.00
40.00
60.00
25.00
55.00
5.00
^
~~
~ ,
PAGE 5
GARAGE
Mahogany Chest of Drawers
Mahogany Lamp Stand
Small Hand tools
Small Electrical tools
Work Bench
Lawn Cart
Hose
Deep Freezer
Long Handle tools
Misc. Garage
Step Ladder
Luggage
Seasonal Decorations
$ 125.00
25.00
45.00
30..00
25.00
60.00
5.00
65.00
15.00
45.00
8.00
2.00
25.00
TOTAL $7685.00
--'-;'Z:::
~~
Benny E. Rowe
Graham
Motor Compa"y, Inc.
YI
PONTIAC.
To Whan it May Concern:
The value of one 1989 Cadillac Seville with
I.
VIN *1G6KS5158KU801512 and mileage of 62,000
would be $2000.00.
ou",lObIe
I
I
@
BUICK
d~~
An~ J Conley
Sales Manager
Graham Motor Co Inc
~
~..
'Ht1!tfVI1C
lE
TRUCKS
_1402 Holly Pike, Cadisle, pennsyl",...ia 17013 . Telephone 717-243-3066 . FAX 717-249-7998-
E-mail
service@afi.org
ARMED FORCES INSURANCE EXCHANGE
P.O. BOX G, FORT LEAVENWORTH, KS 66027-0428
For Billing Service, Call Toll Free: 1-800-524-9325
World Wide Web
www.afi.org
STATUS REPORT OF SUBSCRIBER CAPITAL ACCOUNT
ACCOUNT NO. 0062661
JULY 18. 2001
ESTATE OF WILLIAM F LEWIS
C/O ANN BRACKEN. EXEC
213 PINE DR
BLACKSBURG VA 24060
INFORMATION ONLY. DO NOT PAY - THIS IS NOT A BILL.
BEGINNING
BALANCE
ADDITIONS
TO ACCOUNT
AMOUNT
PAID TO YOU
ENDING
BALANCE
5447.32
s.oo
$.00
$447.32
In accordance with the bylaws of Armed Forces Insurance Exchange, a non-Interest bearing Subscriber
Capital Account is established in your name. The capital account is one of the ways Armed Forces
Insurance distributes earnings. These accounts provide operating capital to support stability and growth.
Investment income earned by funds in capital accounts is applied against operating expenses, including
claims, to help keep the premium for insurance at the lowest level possible.
Funds in a capital account represent your affiliation share in Armed Forces Insurance. These funds
cannot be withdrawn to payor reduce a premium due balance. If your Subscriber Capital Account
exceeds 180% of your annual premium, a check for the excess is Included with this remittance.
Sincerely.
~~#"~I
Stephen J. Kempf
President
--
INFORMATION ONLY. DO NOT PAY - THIS IS NOT A BILL.
~f'J.1SOOUr'OOI
5I4pplelW\~,,+..l
REV-1500
*' COMMONWEALTH OF
PENNSY1..VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I (o-,X63- Y
c...
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 - 01
05 12
COUlirvCOO!O
"!OAR
NUMBER
DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL)
I-
Z
UJ
Q
UJ
U
UJ
Q
LEWIS, WlLLIAM FIELDING
DATE OF DEATH MM-OD--YEAR)
SOCIAL SECURITY NUMBER
705 -
14
- 9181
DATE OF BIRTH (MM.OO.YEARI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
SOCIAL SECURITY NUMBER
05/06/2001 07/19/1919
(IF APPLICABLE) SUR\lI\lI~G SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
UJ
f-
ue~-
w.u
".0
u~iii
.
.
<
~,.originaIReturn
D4.LimiledEstale
~6.DecedenIDiedTestate(Att'd'lcOPvotWilll
09, Litigation Proceeds Received
/A
~2.SuPPlementaIRetllrn
D4a.FuturelnterestComprOmiSe(d,llotdulh,fter12-12.82J
o 7. Decedent Maintained a Living Trusl allach I cop~ at Trusll
o t 0, Spousal Po,;erty Credit\dllttal~n\hbl\Wttn12.31-il anOl.'.95)
o 3, Remainder Return \dW. OIllQ1ll prlllflo 12-\)..82)
D5.FederalEstateTaxRetllrnReQlJired
8. Total Number of Safe Deposit Boxes
o 11,Eleclion 10 tax under Sec. 9113(A) allach ScIlOO
THIS SECTION MUS, BE COMPLE,ED ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULO BE DIRECTED ,0
NAME COMPLETE MAILING ADDRESS
James D. Flower, Jr..
s~fjl~,A~h~W,"J'!i;jwer & Lindsay
TElEPHONE NUMBER
717-243-6222 26 West Hi Street, Carlisle, PA 17013
(1) $ 205,000.00
(1) 0
(3) 0
('I 0
>-
z
w
o
z
o
.
.
w
.
.
o
u
1, Real Estate (Schedule A)
2. Stocks and Bonds (Schedule Bl
c~
l',-"
1. Closely Held Corporation, PartnerShip orSola-Proprietorship
4, Mortgages & Noles Receivable (SChedule D)
(5) 11,810.56
5. Cash, Bank Deposits & Miscellaneous Personal Property
(ScheDule E)
z
o
j:
~
..J
::J
f-
a.
~
()
UJ
0:
6. Jointly Owned Property (Schedule Fl
DseparateBillingReqUesteo
f'-'
(6) 0.00
(7) 0.00
7, Inter-VIvos Transfers & Miscellaneous Non-Probate property
(SChedule G orL)
(8) $ 216,810.56
(9) 15,141.99
(to) 351.77
9, Funeral Expenses 8. Administrative Cosls (Schedule H)
10, Debts of Decedent, Mortgage Liabililies, & Liens (Schedule t)
z
o
f-
..;
f-
:;)
a.
:;;
o
l)
X
..;
f-
15, Amount ottine 14 taxable at \M spousal tax
rate, orlransfers under Sec. 9116 (a)(1.2)
16. Amounl of line 14 taxable al lineal rate
11. Amouni 01 line 141axable al sibling rate
18. Amount of line t 4 taxable at ccllateral rate
19. Tax Due
201:8:1
(11) 15.493.76
(11) 201,316.80
(13) 0.00
(14) 201,316.80
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election 10 lax has not been
made (SChedule J)
8. Total Gross Assets (tolallines 1-7)
11, Total Oeductions (lotal Lines 9 & 10)
12, Net Value of Estate (Line 8 minus Line 11)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RA TES
x.O_ (15)
X.o 45, (16) 9,059.26
x.12 (17)
x ,15 (18)
(19) 9,059.26
201,316.80
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
HECK MATH < <
Oecedent's Complete Address:
STREETADDRESS 210 S ~ d D .
1 trat or nve
CITY C r I I STATE PA I ZIP 17013
ar IS e
Tax Payments and Credits:
,. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. SjX)usal POlJerty Credit
B. Prior Payments
C. Discount
Prior Tax Due
$ 15,626.18
(11 9,059.26
$ 24,685.44
Total Tax Due
$ 27,500.00
781.31
Total Credits (A+ B + C I (21 28,281.31
3. InterestJPenalty if applicable
D.lnleres!
E. Penalty
TotallnteresUPenalty ( 0 + E I (ll
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 I + Une 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5)
0.00
3,595.87
0.00
A. Enter the interest on the lax due, (SA)
0.00
B. Enter the total of Line S + SA. This is the BALANCE DUE. (5Il)
0.00
Make Check Payable to,' REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
. Did decedent 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
c. retain a rel/ersionary interest or - - - - - - - - - - - - - - - - - - - - - - - - - - - - " - . - - ~ ~ - - ~ ~ - - " . - B
d. receil/e the promise for fife of either payments, benefits or care? " _ _ _ _ _ _ _ _ ~ _ _ _ _ ~ _ _ _ " _ _ _ " _ _
2. If death occurred after December 12.1982, did decedent transfer property within one year of death
without receiving adequate consideration? _ _ _ _ _ _ _ ~ _ _ ~ _ _ _ ~ _ ~ _ ~ _ ~ _ _ _ " . _ _ _ . _ _ _ _ _ _ _ ~ _ _ bJ
3. Did decedent own an ""In lrust for"d?ayable upon death banI< account or security at his or her death? _ U
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property wlllch
contains a beneficiary designation? ~ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ " _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ 0
No
~
~
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SIG
Under ptn,lll" 01 iM'j~ry, I dtcf~re tll~11 h~ve enminltd Illis rtt~rn, inlll~din; allllompanyinll schfd~l.. and statem.nt!l, and to Ill. btStol my ~(\(l'll!ed~. 10M ~~, \t \s lIlli,
COJl~ and complelt.
Ooelaralion of preparer oltl.. lllln Ih, person,l repr...ntalive is buill on ,II inform'tion 01 Which prep.,,, Ilu ~ny ~nowlldge.
D~TE
June 3
RE DF PERSON RESPONSIBLE F
'-€... .
,2002
ADDRESS
213 Pine Drive, Blacksburg, V A 24060
SIGN TURE OF PREP~RER OTHER TH N REPRESENTATIVE
,,' . IJ-
,
DATE
June
i I
,2002
FOldates of death an or after July 1, 1994 and Before January 1, 1995, the tax rate imposed 00 the net value of transfers to or to the use of Ihe surviving spouse is 3%
j72 PS, S9116 (al (1.1) (II],
For dates of death on or after January 1, 1995, the tax rate imposed on Ihe net value of lransfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)J.
The statute does nol exemot a transfer to a surviving spouse from tax, 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 1, 2000:
The tax rate Imposed on the net value of transfers from a deceased child lwenly-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 cI1ild is 0% 172 RS. 19116(a){1.211.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. ~9116(1.2) [72 RS. ~9116(a)(1)J,
The tax rale imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [12 P.S. 99116{a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
",....".".,,"'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Lewis, William Fielding 21-01-0512
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant faels. Real property whid\ is jOin~wned with right
of
SUNivOTShi mu, be disclo"ed on Schedule F.
ITEM
NUMBER
I.
DESCRIPTION
ALL THAT certain tract ofland situate in the Borough of Carlisle, Cumberland County,
Pennsylvania, more particularly known and numbered as 1210 Stratford Drive,
Carlisle, Pennsylvania 17013. Actual Sale Price. Copy ofHUD-l attached
VALUE AT DATE
OF DEATH
$ 205,000.00
TOTAL (Also enter on line 1. Recapitulation) . 205,000.00
(If more space is needed, insert additional sheets of the same size)
,,,.,,oex"""'I"w
COMMONWEALTH OF PE.NNSYLYANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lewis, William Fielding
FilE NUMBER
21-01-0512
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F.
ITEM
. NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1992 Ford Van, as appraised by Newberry Ford-Mercury. See attached appraisal
$ 10,000.00
2.
County/Township Real Estate Tax Proration 4/12/02 to 12/31/02
750.07
3.
School Real Estate Tax Proration 4/12/02 to 6/30/02
480.22
4.
Comcast, refund
90.95
5.
Sprint, refund
24.89
6.
USAA, refund
17.11
7.
Armed Services Insurance Exchange, refund
447.32
TOTAL (Also enter on line 5, Recapitulation) $ 11,810.56
(If more space is needed, Insert additional sheets of the same size)
'~.."ex.I'.""'I.
COMMONWEALTH OF PENNSYLVANIA
IHHERIT-'NCe TAX RETURN
RESIOENTDECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lewis, William Fielding
FilE NUMBER
21-01- 0512
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative s Commissions
Name ofPersOIlal Representative (s)
Social Security Numbe!(s) I ElN NumMr of Pers.ona\ Represenla\i'll!{s)
SIreelAddreS5
City State Zip
Year(s) Commission Paid:
,. Attorney Fees I I
3. Family Exemption: (if decedents address is nollhe same as claimant s. attach explanation)
Claimant nJa
S\reetMdress
City State Zill
Relationship ofClaiman! to Decedent
4. Probate Fees
5. Accountant s Fees
6. Tax Return Preparers Fees
Sollenbergers Messenger Service, transfer title to Van 48.00
1. George L. Ebener & Associates, Realtor's Commission on sale of house 11,300.00
lNotary Fees, on sale of real estate 10.00
2002 County/ Township Real Estate Taxes r ,040.97
I % Transfer Tax 2,050.00
Kuhn's Carpet, cleaning carpet 260.34
Carlisle Borough, water/sewer account through 4/11/02 42.68
'\merican Radon Services, radon mitigation 375.00
,,-egister of Wills, File Supplementallnheritance Tax Renun , 15.00
TOTAL (Also enter on line 9, Recapitulation) I 15,141.99
(If more space is needed, insert additional sheets af the same size)
..,.,""x.".,"".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
21-01-0512
LEWIS, WILLIAM FIELDING
FilE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
OESCRIPTION
AMOUNT
$ 58.62
92.44
0.66
13.49
86.82
63.60
36.14
2.
3.
4.
5.
6.
7.
I.
Sprint, account
Sprint, final bill
~orough of Carlisle, water/sewer account
P. P. & L., Co., account
Rynard's Lawn Service, mowing
P. P. & L. Co., account
P. P. & L., Co., account
TOTAL (Also enteron line 10, Recapitulation) s 351.77
(If more space IS needed, Insert addItional sheets of the same size)
""'''''''''''"11''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
FILE NUMBER
21-01-0512
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
ESTATE OF
Lewis, Wllliam Fielding
1. TAXABLE DISTRIBUTIONS (include outnght spousal distnbutions)
Ann Lewis Bracken
213 Pine Drive
IBlacksburg, VA 24060
Daughter
1/2 of personal effects,
and 215 of residuary
estate individually
2/5 of residuary estate as Trustee in Trust for
~illiam F. Lewis, Jr.
1/5 of residuary estate as Trustee in Trust for grandchildren,
Steve Burton Lank, Emily Loving Bracken and William
Moore Bracken
William F. Lewis, Jr.
1188 West Salmon Court
Gilbert, Arizona 85233-6749
Son
1/2 of personal effects,
and 2/5 of residuary
estate as beneficiary
under Trust
,teve Burton Lank
Emily Loving Bracken
William Moore Bracken
all of213 Pine Drive
Blacksburg, V A 24060
Grandson
Granddaughter
Grandson
1/5 of residuary estate
jointly as beneficiaries
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL OISTRIBUTIONS UNDER SECTION g, t 3 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1, None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None
TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00
(If more space IS needed, insert additional sheets of the same size)
A. Settlement Statement
u.s. Department of Housing
and Urban Development
OMB No. 2S02~265
B. Type or Loan
I. D FHA 2.DFmHA 3.IXJConv. Unins.
4. D VA 5. DConv. Ins.
6. File Number
7. Loan Number
8. Mortgage Ins. Case Number
2002-0033REP
4924112
C. This form is furnished as 8 statement of aclmd seltlemenl costs. Amounts paid to and by the settlement agent are shown. Hems mark.ed
(p.o.c) were paid outside the c1o~ing; they are shown for informational purposes and are not included in tolals.
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address or Lender
Anthony R. Williams Countrywide Home loans Inc
Barbara M. Williams William Lewis Estate
424 Walnut Street
Carlisle. PA 17103 -
G. Properly Location H, Settlement Agent law Offices of
1210 Stratford Drive. Carlisle Borough. Cumberland County, James A_ Mi 11 er
Place of Settlement I. Settlement Date
Car1isle. Pennsylvania 17103
2010 Market Street 04/12/2002
Parcel No. :04-22-0479-034 Camp Hill. PA 17011
I. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. . GROSS AMOUNT DUE TO SELLER
101. Contract ~a1es price 205.000.00 401. Contract sales price 205.000.00
102. Personal property 402. Personal property
103. Seltlemenl charges to borrower(line 1400) 10.554.45 403.
104. Overnight PacKage to Countrywide 25.00 404.
105. Wire fee from lender 25.00 405.
AdjU,'i;lmenls for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes 10 406. CitY/lown taxes 10
101. Count)' ta"es 04/1212001b 12/31/2002 750.07 407. County faxes 04/12/200li> 12/31/2002 750.07
lOX. A...~cssmenl~ 04112/200a, 06/30/2002 480.22 408. As~c~smcllts 04/121200a, 06/30/2002 480.22
109. 409.
110. 410.
III. 411.
112 412
120. GROSS AMOUNT DUE FROM BORROWER 216.834.74 420. GROSS AMOUNT DUE TO SELLER 206.230.29
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnesl money 5.000.00 501. Excess dcposil(see Instructions)
202. Principal amount of new loall(s) 105.000.00 502. Selllemcnt charges to scllcr(line 14(0) 15.078.99
203. Existing ItJan(~) k'lken subject 10 503. Existing 10Iln(s) taken subjecf to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
109. 509. ,
Adjuslments for ilems unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes 10 510. City/town taxel; to ,
::>'11. Coun!y taxes 10 511. County laxes \0
212. Assessmenls \0 512. Assessmenls \0 ,
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 5\9.
-----~
220. TOTAL PAID llY/FOR BORROWER I 110.000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 15.078.99
300. CASH AT SETTLEMENT FROM/TO BORROWER 600. CASH AT SETTLEMENT TO/FROM SELLER
30\. Gross amount due from borrower(line ] 20) 216.834.74 601. Gross amount due to seller(line 420) 206.230.29
302. Less amount paid hy/fllr horrower(line 220) 110.000_00) 602. Less reduction al1lount due s.cllc:r(!ine 520) ( 15.078.99)
303. CASIl([!] FROM)(DTO) BORROWER 106.834.74 603. CASH(IXI TO)(D FROM) SELLER 191.151. 30
The inf<lfInalinn conl.1.ined in Blocks E. G. H and I rind on line 401 or. i.f line 401 is astcri~ked.
lines 403 and 404 is importanl tax infurm:llion and is heing furnished to the Internal Revenue Service. If yoP are required to file a return. a negligence
penally or olher sanction will be imposed on you ir this item is required 10 he reported and the IRS determines that it ha.s not heen repoTted.
~UD-l SETTLEMfNT STATEMENT
~ Bmtnstorm Software 1 ~540-665-o800
~
SETTLEMENT STATEMENT
PAGE 2
WARNING: It is a crime to knowingly make false Slalements to (he United Slates
on this or any other similar form. Penalties upcn conviction can include a fine
and imprisonment. For deUlils see: Tille 18 U.S. Code $eclionlO()! & 1010.
L. SETTLEMENT CHARGES PAID FROM PAlD FROM
700. TOTAL SALES/BROKER'S COMMISSION based 011 price $ 205.000.00 @ 6.0 % - $ 12.300.00 BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS AT
701. S 11.300.00 to George L. Ebener & Associates Realtors SETTLEMENT SETTLEMENT
702. $ 10 ($12300 less $1000 . agent credit)
703. Commission paid at Settlement 11,300.00
70'.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Originafion Fee ~
801. Loan Discount 2 .8750 ~ CHLI 3,018.75
803. Appraisal Fee 10
1lQ4. Credit Report 25.00 10 CHLI 25.00
805. Lender's Inspection Fee ,
1lQ6. Mortgage Insurance Applicali<m Fee 10
807. Assumption Fee
ROB. Landsafe Flood . flood cert 25.00
809. Countrywide Tax Service . tax service 90.00
810. Document Prep fee 350.00
811. CHLI . property valuation fee . 50.00
900. ITEMS REQUIRED BY LENDER TO BE PAlD IN ADVANCE
901. Inlc:rc:slfrom 04/12/200210 05/01/2002 @$ 12.590000 Iday 239.21
902. MOrlgage Insurance Premium for mofllhs 10
903. Hazard Insurance P,emlum for 1 years to CAI 364.00
904.
'105.
WOO. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance 3 months @ S 30.33 per month 90.99
1002. Mongage insurance months @ $ rcr month
1003. City properlY taxes months @ $ per month
1004. County proper{y laX(:S 4 months @ S 86.75 per monlh 347.00
1005. Annual assessments 12 mOnlhs @ S 184.90 per month 2.218.80
I(106. months @ S per mOnlh
I<X)7. months @ $ rer Illollth
1()()8. Aggregate Adjustment ..438.05
1100. TITLE CHARGES
1101. Senlement or closing fee 10 law Offices of James A. Hi 11er
1102. Abslrac( or title search 10 Ionni Abstract
1103. Tille examination 10 Law Offices of James A. Hi 11 er
1104. Tille in.~UTance binder 10 lonn; Abstract
1105. Document preparation 10 Law Offices of James A. Hi 11 er
1106. N DIary fees 10 Cash 10.00 10.00
1107. Attorney's fees to Law Offices of James A. Hi 11er 1.383.75
(includes ahove items Numbers: 01 throu9h 08 )
I lOR. Tille insurance 10 Stewart Title Guar~nty
(includes above ilems Numbers: )
1109. Lender's coverage S Countrywide
1110. Owner's coverage S
1111. Endorsements 100. 300. 8.1. ARM ($200); clos prot ltr ($35) 235.00
1112.
1113. 2002 county taxes 1.040.97
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed S 35.00 ;Morlgage $ 85.00 ;Releases $ 1,20.00
L102. City/county tax./stamps: Deed S 2.050.00 ;Morlgage $ 2.050.00
1203. State laxJstamps: Deed S 2.050.00 ;Mortgage $ 2.050.00
\20..
1205.
1300. ADDITIONAL SETTLEMENT CHARGES -
1301. Survey 10
- DOL. Pest inspcdioll .
10
1303. Kuhn's Carpet cleaning 260.34
1304. Carlisle Bor . water/sewer (through 4/11/02) . acct 6124.A 42.68
1305. ESCROW . radon mitigation. American Radon Services 375.00 375.00
1400. TOTAL SETTLEMENT CHARGES (enler on line 103. Section J and line 502. Section K) 10,554 .45 15.078.99
CERTIFICATION
0- L Seltlement Statemenl and to Ihe hest of my knowledge and belief. it is a lrue and accurale statement of all receipts and
nl o~,~}:' me in ihis Iransaclion. I further cerlify that I have received a copy of the HUD-) Selllement Statement.
( Antny R. Wi lYani~
. .t,"JU-"J lH (/(".4 -
orrowers ar ara H. Wi iams
The HUD-t Settlement Statement which 1 have rrepared is a lrue and
in accordance with Ihis slalemen!.
"',,-", ^"C 'N~;.
ate
will cause Ihe funds 10 be disbursed
April 12, 2002
Date
. Bi0>l"_i_m
~;. ;jil::l$im.w~.
SMIIJ '. .'iaith%$ml~.
MERCURY
cNau6~
Drawer I 0 794 N. Main Street
Pearisburg, Virginia 24134
(540)921-1531 o Fax: (540)921-2818
April 17, 2002
Mrs. Ann Bracken
213 Pine Drive
Blacksburg Va. 24060
Dear Mrs. Bracken;
After inspecting the 1992 Ford Van with VIN number listed
lFDEE14N8NHB01424, it is my opinion that the fair retail
market value would be approximately $10,000.00.
Steve New
Newberry
,
"'."0"".".""".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lewis, William Fielding
FILE NUMBER
21-01-0512
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
$ 3,432.00
2001 Federal Income Tax Refund
2.
200 I Pennsylvania Income Tax Refund
93.00
3.
Sprint, refund
0.66
TOTAL (Also enter on line 5, Recapitulation) $ 3,525.66
(If more space is needed, insert additional sheets of the same size)
REV_1500EJl(IDDI
Second
Supp 1-erY\.t\~GU.
REV-1500 /~- ;;1."33 V
IV
'* COMMONWE:;ALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 - 01
05 12
COUNTY CODE
YEAR
NUMBER
DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
I-
Z
W
Cl
w
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w
Cl
14
- 9181
705 -
LEWIS, WILLIAM FIELDING
DATE OF OEATH MM--DD-YEI\R)
DA1E OF BlR1H (MM-DD-'fEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
, REGISTER OF WILLS
SOCIAL SECURI1Y NUMBER
05/06/2001 07119/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
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o 1. Original Return
D4.LimitedEstate
~6.DecedentDiedTestate(Att3ch"OPYOfWjll)
o e,Litigati<ll1PrQceecsReceWed
~2.,SI1PPleme(\taIRe\Um
D4a. Future Interest Compromise (d3IeofdealhanerI2-12-S2)
07. Decedent Maintained a Living Trust aUach a copyofHusl)
o 1 C. Spousal P<lver\y Credit (dste ofde31h betwe~n 12.31_91 and 1_1_95)
D 3. Remainder Return (dale ofdeath prior to 12-13-S2)
DS,FederalEstateTaxReturnRequired
8. T<ltal Number of Safe Deposit Boxes
o 11. Election to tax underSec, 9113(A) attach SchOO
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THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO
NAME COMPLETE MAILING ADDRESS
James D. Flower, Jr..
F1~M NAME (" "'''"'i') .
Saldls, ,shun, Y. ower & Lmdsay
TElEPHONE NUMBER
717-243-6222 26 West Hi h Street, Carlisle, PA 17013
1, Real Estate ($cheduleA)
2.. Stocks and Bonds (Schedule B)
(1) $ 0
Il) 0
(3) 0
(4) 0 r_
(5) 3,525.66
(S) 0.00
(7) 0.00
(S) $ 3,525.66
('I $ 689.83
(10) 0
J, Closely Held Corporalion, Parlnership or Sole-Proprietorship
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4, Mortgages & Notes Receivable (Schedule D)
S, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
1. Inter-Vivos 1ranslers & Miscenaneous Non-Probate Property
(Schedule G orL)
8. Total Gross Assets (total Lines 1-7)
9, FI.ll'\er~1 ExpiHlWi. & Administralive Costs (Schedule H)
10. Debts ~r Decedent, Mortgage Liabilities, & Liens (Schedule 1)
11. Total Deductions (tolal Lines e & 10)
(11) 689.83
(12) 2,835.83
(13) 0.00
12.. Net Value of Estale (Line 8 minus Line 11)
13. ClIari\able al'lll Governmental Beques\s/Sec 91131rus\s forwh.lcn an election to lax has not been
made (ScheduleJ)
14. Net Value Subject to Tax (line 12. minus Line 13)
(14) $ 2,835.83
seE INSTRUCTIONS ON REVERSE sIDe FOR APPLICABLE RA rES
z
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x
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1S. Amounl of line 14 taxable atthe spousal tax
rate, or transfers underSec, 9116 (a)(1.2)
x.o_ 115)
'.0 45 (16) $ 127.61
x .12 (HI
x ,15 (18)
(") $ 127.61
$2,835.83
Hi. Amoun\ of Line 14 laxable at lineal rale
17. Amount of Line 14 taxable at sibling rate
18, AmountofLine 14laxable at collateral rate
19. Tax Due
20~
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
> > 8 SUR T ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MAT < <
Decedent's Complete Address:
STREETADDRESS 1210S ~ dD.
trat or rIve
CITYCr1 I STATE PA I ZIP 17013
ar IS e
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
$ 24,685.44
(I) 127.61
$ 24,813.05
Prior Tax Due
Total Tax Due
$ 27,500.00
781.31
Total Credits (A+ B + C ) (2) 28,281.31
3. In1erestJPenalW if applicable
D.lnleresl
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the diUerence. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If line I + 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)
0.00
3,468.26
0.00
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (513)
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "x" IN THE APPROPRIATE BLOCKS
Yes
-8
. Did decedent make a transfer and:
a. retain the use or income of the property transferred; _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
b, retain the right to designate who shall use the property transferred or its income; _ _ _ _ ~ _ _ _ _
c. retain a reversionary interest oc - - - - - - - - - - - - - - - - - ~ - - B
d, receive the promise for life of either payments, benefits or care? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. If death occurred after December 12, 1982, did decedent transier property wilhin one year of death
without receiving adequate consideration? - - - - - ~ - - - ~ - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - B
3. Did decedent own an "in trust for"d?ayable upon death bank account or security at his or her death? _
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
No
I
181
181
181
IF THE ANSWER TO ANY OF THE ABOVE QUESTiONS is YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Uncle' penaltiu of perjury, I declarelhall have examined lhis return, Including accompanying achecluJes and slal,ments, and to lhe but of my knowledge and belier, It is !fue, correcland
complete.
Deoltratlon of pr'll'-r~ otM( tlIar. \M ~t.onal f'p1nll'ltrlt~. is based on all information 01 which pr'parer has any knowledge.
,
.2002
S] URE OF ~~ H~S~ONSIBLE :
ADDRESS
213 Pine Drive, Blacksburg, VA 24060
]G TURE OF PREPARER OlliE THAN REPRESENTATIVE
I
17013
DATE
S tember ~
DATE
S, t,mb" !J-
,2002
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 to the use of the sUNiving spouse is 3%
[72 P.S. ~91 t6 la) (1.1) (])].
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 survilJing spouse is 0% [72 P .5. ~9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the sUlViving 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 o( for the use a~ a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 RS. ~9t 16(a)(1.2)].
The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. ~9116{1.2) (72 RS. ~9116(a)(1)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common wit'n Ihe decedent, whelher by brood or adoption.
"'''''''"1'"''11'1.
COMMONWEAlTH OF PENNSYlV{l.NIl\
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC"
PERSONAL PROPERTY
ESTATE OF
Lewis, William Fielding
FILE NUMBER
21-01-0512
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
OESCRIPTION
VALUE AT DATE
OF DEATH
$ 3,432.00
2001 Federal Income Tax Refund
2.
200 I Pennsylvania Income Tax Refund
93.00
3.
Sprint, refund
0.66
TOTAL (Also enter on line 5, Recapitulation) $ 3,525.66
(If more space ($ needed, Insert additIonal sheets of the same size)
"",,,,,.,,.0'1(".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lewis, William Fielding
FILE NUMBER
21-01- 0512
Debts of decedent must be reported on Schedule 1
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I.
B. ADMINISTRATIVE COSTS:
I. Personal Representative s Commissions
Name of Personal Representative ($)
Social Security Number(s) I EIN Number of Personal Repre$enta\i'le(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees I I
3. Family Exemption: (if decedents address is not the same as claimant $, attach explanation)
Claimant n/a
Street Mdress
City Slale Zip
Relationship afClaimant to Decedent
4. Probate Fees
5 Accountant s Fees
6. Tax Return Preparers Fees
Register of Wills, File 2nd Supplemental Inheritance Tax Return 15.00
7.
Pa. Department of Revenue, fiduciary income tax 274.83
Michael B. Cooke, C.P.A., 2001 Tax Return Preparation 300.00
TOTAL (Also enter on line 9, Recapitulation) I 689.83
(If more space is needed, insert additional sheets of the same size)