HomeMy WebLinkAboutOC1971-0467 - ESTATE OF LEWISF~RM 67
REV.1-50
~3-7.J
REG.WILLS
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heirs by adoption)are as follows.
i\ppliratiun fur 14ttttrli uf i\~minilitratiun un tqt
Estate of .,RQ.X A..t....•~w.J.s...~g.L.lsL.!i!RQ.x ~WJs..
late of.........Ma.r.ia.nna..,.....Was.hington...c.o.unt)l'.,.....P..e.nna.......,Deceased.
Before the Register of Wills of Washington County
personally appeared PQ.NA~P.G...,~W~~D.g J.Q.ijN F.!!~W.~s...
who,being duly sworn deposes and says that..RQ.Y.A..~J~~W~..
age §.~.,having..h.!.~last family or principal residence at .
(Street and Number)
.......~!'..!~P:P.-.~~.2!'.9.!:-?:gh ,Washington County,Pennsylvania,died intestate
(City.Borough,Township)•
at..W.9.§.b.Jp.,g.1;.QD..~r.~mD.~..Y.J.Y..9.D.t.g.,on the LJ...day of Ap.J.:.i.l..
A.D.,19 1.1..,3!t..l ..:..QO A M.,possessed of personal estate to the estimated value
$.1.6 Q.00 00,and of real estate in the Commonwealth of Pennsylvania to the estimated value of
$~2P.:~,situate in ..
The names and addresses of the decedent's surviving spouse (if any)and other heirs (including
>;
RELATIONsmp RESIDENCE'
p..9.n~Jg G..~1.~w..t~:p..r..9..1;:.b.~.r.R.!'.P.~.4..,.w.~§.hJD.g~.9.P.."r..~.D.P..?..t .
.J.gh~¥...~~.~.~.~.~!?!'.9..~h~!:B.Qx 2.3.8..,Mat'..i.g.nn9 p.e..nna .
G.J.~;mP..1gw.t.§."J.J.:.t JJ,g.p'b.~w.W.ar.r.en.,.Ohio .
(sole heir of brother,Gl nn Lewis ho died in 1962)
[~1~~~~:f:~i~:~:~:;~::.:::~~:~:~~~~:~:::::::~~~:~gi~~::::~i~~:~=~:~~~::::~:~:~~:~:~:~~:~~:~:~i.::::~959 :
G.~..;y ~~~.~~n~ph~w 1J.P..kn.9:W.:n ..
.J.9.~P.:~~~.~~p..~ph~~~.p},lsD.9.WD..
D.es.a.les Leyl.is :niec.e unknO¥1n ..
Donna Lewis niece unknown
That deponent is over 21 years of age,resides at...R..t P.t 4..,Wg§.htD.g~.9.D."r..~.OO.~.~
~.~.9.~.2~~~.~."~E.~~.~P.:~..L g~P.:P.-.~.y!y.~.~J~.".!'.~§.P.~g..1;:JY..~Jy..~..
is a citizen of the United States and a resident of Pennsylvania,and respectfully applies for Letters of
Administration upon the Estate of said decedent,no letters having been previously issued thereon.
Sworn and subscribed before me this 2.8 .
day of..Ap:r..i.l ,A.D.,19..1..1 ..
.....................~.~.
REGISTER
COMMONWEALTH OF PENNSYLVANIA}SS.
WASHINGTON COUNTY,.
And now Ap.r.J.l 2JL ,19 7..1..,comes p..9.n~Jg G..!'.J:!~w.J§9..gQ J..9.h:n ¥.·Lewis
who being duly sworn doth depose and say that..th~y..........will well and truly administer the goods and
chattels,rights and credits of RO.y A.LEWrs..,.a,fkja .ROy LE.W.IS..,.,deceased,
to the best oLtheiEkill and judgment in strict compliance with the laws of this Commonwealth,mind-
ful of the laws relatin!?;to inheritance taxes.
Sworn and subscribed before me this :?.§..
day of..Apr..il ,A.D.,19 ..7..1 .
::::::::::::::::::~:::::~::::::::
REGISTER
APPLICATION FOR
Letters of Administration
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Letters....1 :..
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Certificates\\$.
....~.QX...4..~.....~~.!2 ..t....:N..~/~.....~g!....~~.IS
Renunciations .'\"'..:/$::::..
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Frank C.Carroll.......................................................................................................
Attorney
~2
~tJo",·•
(ltnmmnumtalt4 nf 'tuunyluauia,t ss.
IIItts4ittgtl1tt Q!l1Utttg.\
,
I,Russell Marino ,Register for the Probate of Wills and Granting
Letters of Administration in and for the County of Washington,in the Commonwealth of Pennsylvania,
to Donalg.G.Lewis and John F.Lewis
administrators of all and singular the goods and chattels,rights,and
cl'edits,whi,ch were of Roy A.Lewis a/k/a Roy Lewis late of Washington County,deceased,
GREETING:
WHEREAS,the said Roy A.Lewis a/k/a Roy Lewis late of
Marianna in the county aforesa~d,lately died intestate
I .
<.'.
(as is affirmed),possessed of divers goods and chattels,rights and credits,within the said County,
Russell Marino
by r,eason whereof the power of granting administration thereof doth belong ,to me;I therefore,confiding
in your fidelity,do by ,these presents gl1ant unto you these LETTERS OF ADMINISTRATION,here-
by commitlJing unto you full power to administer the goods and chattels,rights and credits,which were
of said deceased within this Commonwealth,you having taken ,and subscribed the oath of office pre-
scribed by law;~equiring you to well and truly administer the goods and chattels,rights and credits,
which were of said deceased,and to exhibit a true and perfect inventory thereof into the Register's
office,at Washington,within ninety days,,and to render a just 'and true account of your administration
at ,the expiration of six months from the date hereof,and to regard and comply with the provisions of
the laws relating to ihheritance taxes.
IN TESTIMONY WHEREOF,I have hereunto set my hand and
caused the seal of said Office to be affixed this 28
day of April in the year of our Lord one thousand
nine hundred and sevent y-one
.......~~.
RUSSELL MARINO,Register.
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Estate of ~gy.A.!~~.~.~.~}
M ia No 79.9 of 19 .
late of ........El.r.......!1!1~.............,Deceased
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KNOW ALL MEN BY THESE PRESENTS,
That we,p..().rl.s:.1.~...cr..~....:L.€l'Al.~.~...~.~~..J.()?n...~.~~E3.v~.~.~~s..~:r.~.nc:.~p.E\.~.~~.l1:~Uni~~.??tate s
........}~.~~.~..1.~.~}..~.l1:~..cx.l:l(i.:r.El.!l.~.~c..O'.~~.~.~.t~Irl()r..~.'.~~.~~~.r..~.~.y..
.Ill of Washington County,Pennsylvania,are held and firmly bound unto the Commonwealth of Pennsyl-
vania,for the use of those interested in the estate,in the sum of ....~"~r..~~.e.!l:...:r.l?:().1l.~~.11~......Dollars,to
be paid to the said Commonwealth,to which payment,well and truly to be made,we do bind ourselves,
jointiy and severally,for and in the whole,our heirs,executors,administrators,successors and assigns,and
each and every of them,firmly by these presents.Sealed with our seals and dated the ?E3~!l.day of
...............~p;r.~J A.D.,one thousand nine hundred and ~.EJ.y.EJ!l.ty..9.l,l€l .
THE CONDITION OF THIS OBLIGATION.IS,That if the above bounden
Donald G.Lewis and John F.Lewis....,,.
Administrator s...or any of them,shall well and truly administer
the estate according to law,this obligation shall be void as to those who shall so administer the estate;but
otherwise,it shall remain in force.
Sealed and delivered in the presence of:
B~.......At·torn eY'.l:.ll/4'-'a..ld'
t'tattuttnt of ~urtttl
I•........._.....__..__...__. ...----------•surety in the sum of $on the
administration bond in the estate of :--------------.--------------------------------. ,say that I reside at
-..---_~-.-----.--------.-.---------------.Washington County.Pennsylvania;that I am the owner of real estate the,..
title to which is in my own name and duly recorded.situated in ______._,
Washington County.Pennsylvania.worth above all encumbrances $--.. .. ..;and that I am worth the
amount expressed in said bond.over and above my just debts and liabilities.
.
-'
Co.
Street •
&tattuttnt of ~urdt!
P.O.
I.:__....----....--..-------------.surety in the sum of $.......on the
administration bond in the estate of --------..-------------..------..----.---------..--------------..-..----..-------------------..__....•say that I reside at
_.__..~.:.......:•Washington County.Pennsylvania;that I am the owner of real estate the..
title to which is in my own name and duly recorded.situated in __.
Washington County,Pennsylvania.worth above all encumbrances $-----..-----..----;and that I am worth the
amount expressed in said bond.over and above my just debts and liabilities.
COMMONWEALTH OF PENNSYLVANIA.}SS:WASHINGTON COUNTY.
Street P.O.
And now ,..............................19 __......•comes __.
who being duly sworn.says that he is acquainted with the financial standing of the securities to the within bond;that
the said obligors have each executed the said bond and that the sureties thereto are the owners of real estate in their
own right of value more than the penal sum of said bond over and above all incumbrances and exemptions.
Sworn and subscribed before me this ..------------------------------
day of .................A.D.19..._
~--_._----------------.-.-------------------...-----------.-----_._.-------------.-.._----.-------_.-----------
,.
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L,3-7/-L/~7
No ~.9.9 .
!\~miui!ltrutinu 1Bnub
IN THE ESTATE OF
._R9.Y-..A.!L~.wJ~__._._._.
And now .A.pr.il 2:fL ,19l.1._
Bond approved and Letters issued to
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)Bond Book
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Page 153
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BADZIK PRINTING ~9 DONORA
/009'/t.:5~7J-#-~7
i\ffi~uuit QDf 1fxrrutnr (@r i\~miuilitrutnr
i;tatr of 'rtiusyluauia,~ss:
C!1nuuty of 1IIl1as~iu!ltau \
Personally before me,the undersigned authority,a ~Q.t~.!:y.f.!-!Q.!..!.~in and for said
County and State,appeared J.Qhp.f.~!:!~:w..!1L who,being duly
sworn according-to law,deposes and says that he is th~~administrator of the estate of
..................RQY.8.~!:!~w..;W...1 deceased,that the foregoing schedules constitute a
complete inventory and appraisement of the real and personal estate of...RQX f.\..,~J;;w.,1;~..~,
deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite each item
of real and personal estate in the foregoing schedules are determined and stated by the undersigned to
be the fair value of said items as of the date of the decedent's death,based upon a just appraisement of each
item made by the above name<b6lxxiXlltOl'X Administrator.
Sworn and ,.bmibed before me th;,_..~..?_)/J.-/?'washi~~~;~~~:i~~~~~dlo~ll1jTRUC:I~:····..~~·······-
1.An inventory must be filed within three months after appointment of personal representative.
2.A supplemental inventory must be filed within thirty days of discovery of additional assets.
3.1 Original and 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Copies and 2 RCRI-SS,
Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-SS,Over $50,000,in-
cluding Copy of Will and copy of Federal Estate Tax Return.
REFERENCE FOR ADDITIONAL COPY
Act of 1947 P.L.51S Sec.5.2,72 P.S.4844.2
lJuututnry aub 1\ppraiatmtttt of the goods and chattels,rights and credits which
were of ~Q¥.A...~~w:.!§late of ~.!:.~~.~~~..t .
Washington County,Pa.,taken and made in conformity with the above affidavit.
/-
REALTY:
PERSONALTY:
NONE
DOLLARS
NONE
CENTS
1970 Ford 500 Ga1axie hardtop automobile
Checking Account #0300425200 in the name of Roy
Lewis in First National Bank &Trust Co.,Washington,
Penna.
2,000
955
00
24
Savings Account 1646 in First National Bank &Trust
Company,Wash~ngton,Pa."
Total personalty----------------------------------
REALTY
Personalty
Tota1 Es tate
3.457 03
li6 412 27
None
6 412 27
6.412 27
STATE OF PENNSYLVANIA,
WASHINGTON COUNTY,~55:
The wirhin named Accountant being duly SWorn according to law,depose and say that the above account
as stated is true'and correct as he daes verily believe,
1l-...£l ·
.................................~.....
John F.Lewis
Sworn and subscribed before me this !..<:': .
daYOf --_-->~
Notary Public
Washington,Washington County,Pennsylvania
My commission expires Feb.20,1975
Walshington County,ss:I do certify that I have given legal notice 'to all persons
concerned of the filing of the within account in the manner
prescribed by Statute and Rule of Court,as evidenced by proofs
"h3 _.'le1-/thereof filed to No .
Witness my hand and official 'seal thiS ~..~.
daYOL~::~~?:
Register of Wills
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Washington Coun~Reports.
Washington,Pennsylvania
(PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16,1929,P.L.1784 Sec.3,paragraphs (3)and (25).
COUNTY OF WASHINGTON}88.
STATE OF PENNSYLVANIA
Personally appeared before me,a Notary Public in and for said County
and Commonwealth,CHARLES C.KELLER,who,being duly sworn,deposes
and says:that he is the Editor of the WASHINGTON COUNTY REPORTS,
the officilll1 legal periodical for said Washington County,published weekly
having its place of business at Washington,Washington County,Pennsylvania,
and is acting as its agent in this behalf;that the said WASHINGTONCOUNTYREPORTSwasestablishedonMarch31,1920,and was designated
as the official legal publication for Washington County,Pennsylvania,by order
of the several courts of said County,dated November 11,1920;that the printed
notice or advertisement attached hereto is a copy of a notice or advertisement,
exactly as printed or published,which appeared in the said legal periodical in
its regular issues on the following dates:
...........~y.~.I.~.~.t ?Q.p.~;,??.~uo.
..Estate NeS
The Register of wms has granted
letters,testamentary or of administration,
in the following estates.Notice is hereby
given to all persons indebted thereto to
make payment without delay and to those
having claims or demands to present
them for settlement to the Executors or
Administrators or their Attorneys.
• ••• •• •••• •••• • ••
LEWIS.ROY A.,a/k/a ROY LEWIS,1
Dec'd.h'Late of Marianna Borough,Was mg-
ton County,Penna.. RAdministrators:Donald G,Le"\yls,'D 4 Washington,PennsylvamaJohnF,Lewis,Box 238,Marlanna,
Pennsylvama II 33 WAttorney'Frank C.Carro , .Beau Street,Washington.Pennsyl-
vania
that the affiant or the corporation in behalf of which he is acting is not
interested in the subject matter of said notice or advertising and that all of the
allegations of this affidavit as to the /)~ce,and ~haracter of the publication
M'_.-~---.l!1--4i:tIv~
Sworn to and subscribed before ~~
.....?Q!~~day Of ~~,19 .?.;.
~-..27P-~~
JOSEPH:IIE T.SC!AMI\NNA
Notary Public,Vh,ilin,~ton,Washington Co.
My Commission Expires July 1.1974
Sworn to and
-.
"
l
.bserver -Reporter "
WASHINGTON,PENNSYLVANIA
PROOF OF PUBLICATION
In compliance with the News,paper Advertising Act of 16 May,1929,
P,L.1784,as amended.
Commonwealth of Pennsylvania,County of Washington,SS:""...,•..,
Pe,rsonally appear,ed before me,a Notary Public in and for said County
and State,Ri.~.h.~.r.q ~.~G9.W.~.~,who being duly s,worn
according to law,deposes and says that he is the Yic.e..~.P.r..eJ~iQe.nJ
of the Obs,erver Publishing Company,a Pennsylvania corporation,and its
agent in this behalf;that the said Company is,the owner and publh,her of
the Observer-Reporter,succ'essor to The Washington Observer,established
September 18,1871,and The Washington Reporter,established August 15,
1808,a daily news!pap'er of general circulation,printed and published and
having its place of busines's at Washington,Washington County,Pennsyl·
vania,where it or its predecessors have been established and published
continuousIy for more than six months'prior to the publication of the notice
hereto aHached;tha;t the pr.inted notice or advertisement hereto attached
is a copy of an official advertisement,official notice,legal notice or legal
advertis,ement,exactly as printed or published in the Obslerver·Reporter in
its regular editions on the following date or dates;__..
______.____..__~y.--3..L..1Q ~n9.J.7...1 J9..7..!____..
that neithe,r the affiant nor the Observer PUblishing Company is interested
in the subject matter of said notice or advertising and that all of the allega·
tions'of this affidavit as to the time,plaC~d characte-r ,&ubliCatiOn
are true..C~<i.l ~~r:z:-:~.~
subscribed before me this...J7...day of...M~Y....l9..7.J...~~,~;~~
WASH!.~I ••,';;ASHII'lGTON COUNTY
MY COMMISSION EXPIRES MAY 6.1972
J ..
The First and Final Account of John F.Lewis,surviving
Administrator of the Estate of Roy A.Lewis,Deceased,late resi-
dent of Marianna,Washington County,Pennsylvania.
,,
PER INVENTORY AND APPRA !SEMENT
Interest from Savings Account in First
National Bank &Trust Co.
TOTAL AMOUNT OF ASSETS
TOTAL AMOUNT OF CRED ITS CLA lMED
BALANCE DUE
16,412.27
581.63
16,993.90
-3,525.40
$13,468.50
The Accountant claims credits out of said estate as
follows:
PAYEE
Internal Revenue Service
Washington Hospital
REMARKS
1970 Income Tax
Blood
AMOUNT
176.00
60.00
Russell Marino Inheritance Tax on Account 1,000.00
John Shrontz Funeral expense
Estate of Donald G.Lewis Share of Administrator's
commission
John F.Lewis Administrator's Commission
Frank C.Carroll Attorney's Fee
Frank C.Carroll Reimbursement of follow-
ing costs advanced
432.00
250.00
599.70
849.70
158.00
Russell Marino Letters &3 S.C.21.00
Observer Publishing Co.Adv.Letters 14.00
Washington County Reports "14.00
F.J.Buckley Agency
Russell Marino
Russell Marino
Mar ie Gu idos
Bond premium
Filing Account
Filing Inventory
Notary Fees
85.00
16.00
3.00
5.00
Total amount of credits claimed $3,525.40
"t-.
~lt tijr Qtnurt nf (ltnmmnu .'lr~s nf Ifallijiugtnu_(ltnuuty
@rpijaull ~(ltnurt minillinu
In the matter of the Audit of Account in
)1
Estate of Roy A.Lewis,a/k/a
~oy Lewis,deceased
TO THE AUDITING JUDGE:
Enter__-'_o_u_r .appearance for
of Dopald G.-Lewis
I
I
/
467 of 1971No.__--=---_--=---::-._
. I
Sylvia R.Lewis,Executrix of the Estate
N.B.-Counsel sh1all,by separrute pape,r,present a concise statement of each
claim,w.ith supporting calculation of any interest claimed.Objections
to an account as filed,shall be concisely stated in a separate paper.
Council suggesting proper distribution shall file a separate conc1se state-
ment in that regrurd.
&BLOOM
Partner
,19~
No.467 of 1971
==================
In ra Audit of Account in EstaJte of
ROy A.Lewis,a/k/a Roy Lewis,
deceased.
AUDIT
'rn~tip~fnr i\pP~ttraUtr
FOR
Sylvia R.Lewis,Executrix of
the Estate of Donald G.Lewis,
-L.n
oU).......,....~.f _-....
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)BLOOM,BLOOM,ROSENBERG &BLOOM
Attorney
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~lt tijr aJ:nurt nf <trnutmnu IUras nf lIasijiugtnn <trnuuty
(@rpijaus"<trnurt ilinisinu
In the m3itter of the Audit of Account in
J
Estate of__--.:R_O--=Y_A_.=--LE_.;..:.W_IS~,~{
a/k/a ROY LEWIS,DECEASED.
TO THE AUDITING JUDGE:
467 of 1971No.__---.:..~~=-=:_..::=_=_..:...::=___
Enter m:::...LV --'appearance for John F .Lewis ,surviving Adminis,trator
of the above-captioned estate.
N.B.-Counsel shall,by separa:te paper,present a concise statement of each
claim,with supporting calculation of any interest claimed.Objections
to an account as filed,shall be concisely stated in a separate paper.
Council suggesting proper distribution shall file a separate concise state-
ment in that regard.
J
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t7Z FIPR 6 PI1 3 25
RUS S;:d.:.~~.,IdO
HE GIS TEF:0F \'11 LLS
V/ASHIN(:TON GO ..Pf\.
No.467 of 1971
In re Audit of Account in EstaJte of
ROY A.LEWIS ,a Ik/a
ROY LEWIS,deceased.
AUDIT
Jrartipr fnr i\ppraraurr
FOR
John F.Lewis,surviving
Administrator.
Frank C.Carroll
Attorney
~2
---------------~-------------------------------_._--------~-------
(Form where decedent died intestate)
lJu tl1r (@rpl1uun'QInurt nf DIIusl1tugtnu <tInunty
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ESTATE OF No.467 of 1971 xx~xlX)ix ,A.A.
ROY A.LEWIS,a/k/a
············R6Y"···i.E·wfS··~·················································D~·~~~~~d
In the audit of the Firs t and Final
Account of John F.Lewis,
Surviving Adminis trator.
State (l)whether de-
cedent was married or
unmarried;(2)if mar-
ried,whether a husband
or wife survived and
his or her name;(3)
whether or not there
was any marriage settle-
ment;(4)whether or
not family relation was
maintained until deced-
ent's death;and (5)
whether the decedent
left children or issue of
deceased children•.
The petition of.J.~h~f...~~.~.~.~~-..
(Narne of Petitioner)
respectfully represents:_ .
(a)The decedent died ,AP..t:JJ l...3.."l9...7J ,intestate and
(Date)
letters of administration on........h.is.......estate were granted..........Ap:r..il....2.8.~.....l9..7.l,
(Date)
as per record thereof appearing in Administration and Bond Book No .
at page ..was unmarr1ed andDecedent/was survived by
Donald G.Lewis brother
John F.Lewis brother
Glenn Lewis,Jr.:nephew
(s9l~.heir of brother,Glenn Lewis who died in 1962)
Following Heirs of brother Stanley Lewis,who died approximately
1959:Stanley Lewis nephew
Gary Lew~s nephew
John Lewis nephew
Desales Lewis Harris niece
Donna Lewis Gray niece within
(b)At the time of death,the decedent's domicile was ~ld1acx.the Com-
monwealth of Pennsylvania,to-wit,at.....MaX.i9.p.p..~..~....W.~.~.bJ.~g~9.n ....~.Q1J:DJ;;Y,Pa.
(Town or Township,State and Nation)
and residence was atMg.~J~.~P.:~..L ..w:?§J:~J~K~gP.:....G~~.~.~.Y...L ..~.~.t:t.~§.y..!Y..~.~.!.~...
(Town or Township,State and Nation)
(c)The names of all persons having any interest as heirs or next of kin
with the names of their deceased parents,to show relationship if they take by
representation are as follows:
NAMES
..
Relationship Interest
Of age,sui-
juris,or not,
(write yes or
no).
Name of Guardian,Trustee or Committee,if
any,or beneficiary,manp..er and place of
record of appointment and is bound suffi-
cient to cover and protect share.
Estate of Donald G.Lewis brother 174 yes
John F.Lewis brother 1/4 yes
Glenn Lewis,Jr.";nephew 1/4 yes
(Sole Heir of brother,G enn Lewis,who lied in
Following He irs of brother ~tanley LeV<i is,w10 died
Stanley Lewis,Jr.nephew 1/yes
Gary Lewis nephew ~/9 yes
John Lewis nephew i/9 yes
Desales Lewis Harris niece l~~J yes
Donna Lewis Gray niece l/~yes
1962)
approximately 1959:
State exceptions,if any,
giving names and dates
of death and the names
of their executors or
administrators,or the
names of their issue as
the same may be mater-
ial.
Describe type of notice.
All of said parties in interest are living,except Dona ld G.Lew is,who
died testate on August 20,1971,and Letters Testamentaf~
were granted to Sylvia Lewis,'his wife,on August 25,1971
written
(d)All parties having any interest have had ./.notice of the filing
of the account by letter of March 6,1972.
(e)Balance for distribution per Account
(f)Additional debits,not shown by Account
(Itemize)
$..J ..~.-,..4.Q.6...~.5 0
$~?~:.
(g)Additional credits,not shown by Account
(Itemize)
Pa.Department of Revenue -1971 State Income
Tax--------------------------------------$13.38
$ .
$..J).J.4.~.?..~J 2
Insert word "not"where I (h)Claim for exemption has been made,and has na.t been paid.
necessary.
(i)The estate is subject to the payment of inheritance tax to the
State of Pennsylvania,and $1,000.00 has been pa id on accoun~.
If taxable state wheth-I (j)The estate is P.-.Q.t subject to the payment of the county 4 mills
er tax has been paid.
tax.
(k)The estate is P.-.9..t subject to the payment of Federal inheritance
tax.
;.......
if too many for the
space,annex a list there-
of;if no such claims,
insert the word "none."
If any creditor or other
claimant has not re-
ceived actual notice,that
fact must be stated.
Indicate such claims as
may be secured or en-
titled to a preference,
and give detailed infor-
mation concerning such
security or preference.
Here insert a reference
to all questions requir-
ing adjudication,and a
statement of any mater-
ial facts not already
given.If none insert the
word "none."
If any share has been
assigned or attached
that fact should also be
stated here.
State kind,form and
character of property
composing the balance
for distribution.and if
any part thereof is not
cash,whether or not I
there has been any elec-
tion to take sucb part
in kind.
(1)All creditors"(and other persons who have complied with Rule II,..
Sec.9),of whose claims the accountant _..h~H3.notice or knowledge,have
........................received actual notice of this audit;the amounts of their claims and
whether·or not they are admitted to be correct are as follows:
NONE
(m)
NONE
(n)The balance for distribution consists of property in kind,form and
character,as follows:
Cash----------------------------------------$13,455.12
Are there any advance-
ments by decedent to be
consideren on distribu-
tion and has any distri-
bution on account been
made by accountant to
any distributtee?
(p)Donald G.Lewis,Automobile and
Cash (See Receipt attached hereto)$2,137.00
(q)Give brief location of any real estate sold.
NONE
Wherefore your petitioner asks that distribution of principal and income
be awarded to the persons thereunto entitled and suggests that the balance of
principal and income should be awarded respectively as follows (shares being
stated in proportions but not in amounts):-
res idue
residue
residue
res idue
res idue
res idue
res idue
res idue
And your petitioner will,etc.,
Lewis brother
brother
nephew
nephew
nephew
nephew
niece
niece
Estate of Donald G.
John F.Lewis
Glenn Lewis,Jr.
Stanley Lewis,Jr.
Gary Lewis
John Lewis
Desales Lewis Harris
Donna Lewis Gray
NONE
If prior accounts have
heen filed,list number (r)
and term.
County of Washington,ss.
The above named petitioner being duly
Sworn doth depose and say that the
facts set forth in the foregoing petition are true
to the best of ~....his....knowledge and belief.
Sworn to and subscribed before me this
I ~day of...__..M~u;:::~.h ..,19...1..7...
~d -;
------------_..--.-----._----..----_--..--/~----.Notary Public
Washington,Washington County,Pennsylvania
~••••~•••••J.o..........................•••••••••••••••~••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
My commission expires Feb.20,1975
;--1'\
("!t~>H.4 .--1
~
J
FORM IN CASES OF INTESTACY
No...4.6..7.....Q.f 1.9..7.1 ~JQXlKXX A. A.
IN THE
F II;.:-..
'7Z [,PR h..PH 3 25
ORPHANS'COURT
WASHINGTON COUNTY,PA.
Estate of RQX A...,J,J.';WIs..~a./k..lg .ROY LEWIS,.Deceased.
Sur account of John Lewis-_...~_..-----_..__..,.....__._.._._-_._----~._--_.._..._-----_._---......
....~.~.~y..~y..!.~K ..~.4.~,!.~~.~.~~.~..~g.~.~.
PETITION SUR AUDIT
In Conformity with Court Rule III,
Sec.5 (B)
COUNSEL FOR THE ACCOUNTANT WILL
SUBMIT HEREWITH
1.The letters of administration.
2.A copy of the inventory and appraisement.
3.Proof of advertisement of the grant of letters,
if not filed with accountant.
4.An appearance for those represented.
5.Inheritance tax receipts,if any.
6.Certificate of liens in case any of the funds fo.r
distribution are derived from the sale of real estate.
7.Copy of Federal Estate tax return,if estate is
subject thereto.
8.Signed elections to take in kind,if any.
.......f1;.~A~G..~9.~.~;:~.!~.___.
Attorney for kccourrtant.
....2
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-,,.
....'
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f d:.:j~0
REG 1ST Ef<J F \';'1 LLS
\'f ASH IN;:T0.'~CO.,PA.
...'.
LAW OFFICES
McILVAINE &CARROLL
WASHINGTON,PENNSYLVANIA
15301
ALEXANDER McILVAINE
FRANK C.CARROLL 33 WEST BEAU STREET
March 6,1972
AREA CODE 412
223-9930
IN RE:ESTATE OF )No.467 of 1971,in the
)Orphans'Court Divis ion of
ROY A.LEWIS,)Washington County Court of
)Common Pleas.
Deceased.)
NOT ICE
Please be advised that the First and Final Account in
the above-entitled estate has been filed,and the Court has set
Thursday,March 23,1972,at 10:00 o'clock a.m.E1S.T.in the
Washington County Court House,Washington,Pennsylvania,as the
time and place for the audit of the same,at which time you may
attend,however,it is not necessary that you appear.
Very truly yours,
Frank C.Carroll
FCC:mg
Copies mailed to:
Donald G.Lew±s Estate,c/o I.C.Bloom,Esq.
John F.Lewis,Box 238 Marianna,Pennsylvania
Glenn Lewis,Jr.867 Hunter,N.W.,Warren,Ohio 39289
Stanley Lewis,Jr.220-1/2 E.Watertown Ave.Rapid City,S.Dakota
Gary Lewis,510 Cliffside Drive,Apt 70,Pittsburgh,Penna.15202
Desales Lewis Harris,1639 London Circle,Sparks,Nevada 89431
John Lewis-B-37-l8-49,U.S.F.Hunley (A.S.-31)Div,E.c/o
San Francisco,California 96601
Donna Gray,950 Grant Road,Titusville,Florida
",,
J
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENN •
ORPHANS'COURT DNISION
IN RE:
Estate of
ROY A.~EWIS,a/k/a
ROY LEWIS,
Deceased.
(
)
(
)
(
)
(
)
(
No.467 of 1971
BEFORE:
APPEARANCES:
TIME:
THE COURT:
HEARING ON ADD IT
The Honorable P.VINCENT MARINO,Judge of the
said Court.
FRANK C.CARROLL,Esq.,of W?-shington,Pa.,
representing the Accountant.
Thursday,March 23,1972,at 10:00 A.M.,EST
Number 467 of 1971,the estate of Roy A.
Lewis,deceased.The Administrator is John F.Lewis and the
attorney is Frank C.Carroll.Mr.Carroll?
MR.CARROLL:I have all of the papers here,Your Honor.The e .
are no problems in the estate.Just for the explanation of the Cour
John F.Lewis and Donald G.Lewis were brothers who took out
Letters together.in this particular estate and Donald G.died
subsequent thereto.And his interest will go to his wife as Executr'
of his estate.And that's the explanation for the surviving administ ator.
;
We have paid $1,000 on account for the inheritance tax and there
will be a balanc.e due on that.All of the pa rties have been notified
and there's no outstanding claims.
2
Court.
THE COURT:
decedent's estate?
:!~THE COUBT:..>-enzz .
IIIII.
ioI-"ZXen~
Is there anyone else in Court interested in this
(NO RESPONSE)
The audit of this account is ordered closed by t e
(A UDIT CLOSED )
f
I t-=u~!!!
Q..0(
§I hereby certify that the proceedinqs and evidence are
Q::l.,
~eontatned fully and accurately in the notes taken by rne on the hearing of
t'C
~the above e~use,and that this copy is a correct transcript of the same.~II:oLIIIII:
l-ll:::JoU...0(o
ii:II.o
The foregoing record of the proceedings upon the
heartnq of the above cause Is hereby approved and dh'ected to be filed.
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Jlennsylttnnin,(@rp!Jnns'Olnnd llittiswn
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ESTATE OF
Roy A.Lewis,a!k!a
Roy Lewis
deceased
No.63 ...71-467
In the matter of the:_~F=i.::.r.::.s-=t--=a==n=d~F=i==n=a~l,---
Account of·_--::J~o~h~n~F~.!-...:L~e::.!w!.::!i:..!:s~_
Surviving Administrator
ADJUDICATION AND DECREE
And now April .(.19E-,this matter came on for hearing,
audit and distribution at this session and testimony taken;'and thereupon,upon due consideration
thereof theJ>~!anc;.e for distribution in the hands of the Accountant.is detern:i~ed to be
$13,~25..1~and the account is accord ingIy confirmed;and It IS ordered,
adjudged and decreed that the said balance be paid out by the Accountant in accordance with ,the
schedule of distribution hereto attached and made a part hereof,unless exceptions hereto be filed
sec.reg.or an appeal be token herefrom sec.leg.
SCHEDULE OF DISTRIBUTION
Balance per account _
Additional crf.'lditasked at audit
Balonce 1 $13,455.12
$13,418.62
619.69
619.68
619.68
No balance
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
IN RE:ESTATE OF )
)
)No,.
ROY A.LEWIS,DECEASED)
)
467 of 19i.!-..,A. A.
R E C E I P T
Dollars,in accord with the distribution of the Adjudication and
Six Hundred Nineteen and 68/100------------------($619.68
__R_o"""y_A_~_L_e_w_i_s_"',Deceased,the sum of
J&day of ~.~19 I~I-"-';=...:.0:=-__"........,..-v-~-------'-'I
II,
AND NOW,this,I
I,
I
I,the unders igned,hereby acknowledge to have received from
John F.Lewis ,Administrator,of the Estate of
I
II
Decree of the Orphan's Coutt of Washington County,Pennsylvania.
WITNESS my hand and seal the .s£L4t day of ?2zagc
19B-.
Witness:
.Lot.6~;';~(SEAL)
Desa1es Lew~Harris
,
I
III,
.:-..J:'""~rv;-.;:::u:D-r'!c-(f)<.:>c:~(nen,..,?-=:,..Jrl~-.)-1 --.
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c:-,
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,.
IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
IN RE:ESTATE OF )
)
)No..467 of 19i.L-,A.A.
ROY A.LEWIS,DECEASED )
)
I
I .
I
from
Glenn Lewis,
R E C E I PT·
,,.~;~AND NOW~this ~day of 0I,the undersigned,hereby acknowledge receivedtohave
_______J_o_h_n__F~.__Le~w~is~,Administrator,of the Estate of
II IRoyA.:~~,~is'Deceased,the sum of I
I ~~~~'~re~e~~~'~~~~s~j~n~d~N~1~'n~e~t~y_-~E~i~gh~t~a~n~d~4~2~/_1~00~-_-_-_-_-_-_-_-_-~~($3,098.42 )'
I I
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I"Dollars.in accord with the distribution of the Adjudication and !
Decree of the Orphan's Coutt of Washington County,Pennsylvania.:
II WITNESS my hand and seal the {;day Ofr-.:,
I19.1L.'i
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
I,the undersigned,hereby acknowledge to have received from
R E C E I P T
ROY A.LEWIS,DECEASED I .
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__...4.:.,::6:..&,7__0 f 19l1..-,A. A.No .•
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AND NOW,this
ESTATE OFINRE:
I
r
John F.Lewis
__~R~o~y~A~.~L~e~w~i~s_',Deceased,the sum of
Six Hundred Nineteen and 69/100------------------~($619.69 )
Dollars,in accord with the distribution of the Adjudication and
Decree of the Orphan's Coutt of Washington County,Pennsylvania.
WITNESS my hand and seal the 2'7 r l/day of /'14-Y "!
I
19..l.L..'
I .Witness:
II ~iP7 ciuu~"'-l~t~~~~~~~_'_---(SEAL)IG~WLewtS
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
IN RE:ESTATE OF )
)
)No,.
ROY A.LEWIS 2 DECEASED ,)
)
_4_6.._7____0 f 19i.L..,A.A.
, I
!
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R E C E I P T
_____R_o~y_A_'_:"_L_e_w_~_·s ,Deceased,the sum of
AND NOW;this :2ee day of ;~'
I,the unders igned,hereby acknowledge to ha:=ived
I
I1972.I,~'I
from I
I
John F.Lewis ,Administrator,of the Estate of I----~--~----------II
II
Nine Hundred Sixty-One and 43/100----------------.,.($961.43 )1
Dollars,in accord with the distribution of the Adjudication and
I Decree of the Orphan's Coutt of Washington County,Pennsylvania.
,I WITNESS my hand and seal the '7..t<day of ~
1'19R-.,"
,;.
II~I~EAL)';
Bloom,Bloom,Rosenberg &I
Bloom I
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I IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
I
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IN RE:ESTATE OF
ROY A..LEWIS,DECEAS ED
)
)
)
)
)
No .•_4..;..6;;..;7~_of 19l!..-,A.A.
R E C E I P T
Decree of the Orphan's Coutt of Washington County,Pennsylvania.
Dollars,in accord with the distribution of the Adjudication and
($619.69
Iday0f....M~ap9l--,1
Deceased,the sum of
..;
AND NOW,this
WITNESS my hand and seal the .30th
Roy A.Lewis
Six Hundred Nineteen and 69/100-------------------
--",".-{",,'....0.::...-__day 0 f ..;..;~-r~r"':"""=:1:;";;'-r----.19l.L.I
I I,the unders igned,hereby acknowledge to have received from I
I --=oJ_o.:.;h~n:....::..F..:........;Le.;;;.w;;.._,;is~,Adminis trator,of the Es tate of i·
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19.1.L.•..'
Rapid City,
ISo.Dak.I
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~~~b)::~~-P:-::z......_-'(SEAL)
Witness:
Subscribed and sworn before me this 'JOth day of MaY 1972
I
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
ROY A.LEWIS.DECEASED
t!II
II
I IN RE:
I
I
I
ESTATE OF
•
)
)
)
)
)
No .._..:.46~7~_0 f 19.iL-,A.A.
R E C E I P T
.Six Hundred Nineteen and 68/100-----------------~($619.68
______=J~o=hn=-F~._Le~w~i=s ,Administrator,of the Estate of
y
I
I
,19l..L,!AND NOW~this
___R_o....y__A......__Le_w",,-i_s_·_..._~.,..--,Dec eas ed,the sum 0 f
I"I,the unders igned,hereby acknowledge to have received from
I
IiI,
WITNESS my hand and seal the ,:Y,d·
Decree of the Orphan's Court of Washington County,Pennsylvania.
]
day Of~~/
Dollars,in 'accord with the distribution of·the Adjudication and
I
IIi
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19.1L..
Witness:
i ~IJIAl)Jn.Ji·ltl&~t ~<-'-.Lu L/<SEAL)·I
Donna Lewis Gray/I
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,.IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
IN RE:ESTATE OF )
)
)No,.467 of 19.i!..-,A.A.
ROY A.LEWIS,DECEASED )
)
R E C E I P T II
I
..,'IANDNOW~this 30th day of I May ,19.1L,!
Six Hundred and Nineteen and 68/100----------------($619.68
Dollars,in accord with the distribution of the Adjudication and
y
I
Deceased,the sum ofRoyA.Lew is
'I
II
II
II I,the undersigned,hereby acknowledge to have received from
II .....;;J....o__h....n~F__._L__e...;.;w_i__s ,Admin is tra tor,0 f the Es tate 0 f
II
II
Decree of the Orphan's Coutt of Washington County,Pennsylvania.
4-T-'_,~--=-_L.-.......~""""",,,,__'_''(SEAL)
/fdhn Lewis
19,1L.,,'
WITNESS my hand and seal the'30th day of _Ma~Y '1
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
_..;.46;:;..7~_of 19i.L,A. A.No.
ESTATE OF )
)
)
ROY A.LEWIS,DECEASED )
)
I
:1
!,
II IN RE:
One Thousand Seven and 70/100----------------------($
_____day of -'--....,--,19l1.-"
i
I
R E C E I P T
AND NOW~this
John F.Lewis
!
,Adminis trator,of the Es ta te of II'
____·_R_o""'y_A_~·_'·_L_ew_is ,Deceased,the sum of I
I•I
1,007.70 ):
II
II
II
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I I,the unders igned,hereby acknowledge to have received from
I
II
Decree of the Orphan's Coutt of Washington County,Pennsylvania.
,,,-_~--:=,--=--=-(S EAL)
WITNESS my hand and seal the
Witness:
Dollars,in accord with the distribution of the Adjudication and I
I
Idayof'1
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19--ZL•.
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-,:-..J:.;::.J ['-"rl'l :::0en0C·c....-r (/;(=(,..~', 1 '-
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IN THE ORPHAN'S COURT OF WASHINGTON COUNTY,PENNSYLVANIA
I:
{~1
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I IN RE:ESTATE OF )
)
)No .•
ROY A.LEWIS,DECEASED)
)
_4.....6-..7__0 f 19l!.-,A.A.
I
I
I
I
I
l
I_____day of _.'--.,...,19l1.-,j
I
AND NOW~this
R E C E I P T
I .I I,the undersigned,hereby acknowledge to have received from I!
i.
John F.Lewis
__R_o~y_A_._L_ew_i_s·,Deceased,the sum of
Three Thousand Ninety-Eight and 42/l00---------~-($3,098.42
Dollars,in accord with the distribution of the Adjudication and
WITNESS my hand and seal the ..,....day of ,j
I Decree of the Orphan's Court of Washington County,Pennsylvania.
II119-E.-.;...
·1 /Witness:If}.1I~{;,'~~I;
II
II
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(f)OC":::r -,~-en ~.
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1 6 412 2 7
1641227~~-:
~~~~&~~~~.~.+A•••••.....tt"f..o'OtO"OOOOOM
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Form RCC-33
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF W.~.s..h.j,ng:t.9.D..
IMPORTANT:This return must be completed in detail and filed in duplicate,with will attached,with the'
Register of Wills of the County where decedent 'resided;Return is due within one year after
date of death,unless an extension is granted by the Secretary of Revenue.(Section 703 of
_~th~_Inl:lerit{l.nce__{l.n!l.E_!:!tateTa!C A,ct of lQ!Jl.)
of the estate 0(the above-named decedent being duly sworn,depose S and say SAdministrator
IN THE MATTER OF THE'ESTATE OF }AFFIDAVIT OF
-........................R9..¥·~..i~t~~~·~:..~f·d~~~~t)·..·":.................~~X
Late of W~..~..hing.t.Q:n..."County ADMINISTRATOR
:.:.~~::~~~;::~~~::::=:=}'"
--_J.Q.h1.1.f...~I&,w.J~_ .
Decedent'died A:p.:t,;'J1J.~.J....,1911J teJD(lK~CX¢«C~C~lCCtoo;XQK&>X<C«C:lOO~}
(Month)(Ilay}(Yt1lr)Lintestate..
otherN::t:::i:::r:::r:fse:tttao:~::~:}'.."',--;ja.:k~.Ca~rOll _.......
whom all correspondence should be ~_.aU __treet ..._ .
mailed.Adminl.s tratorWashington,Penns ylvania
That as such ~~~"deponent is familiar with the affairs of said estate and the property con-
(Ex"c"tor·Admini~trator)
stituting the assets thereof and their fair mar~et value.
That at the time of death there was no safe deposit box registered in decedent's individual name,or jointly
with,or as agent or deputy of another,or in decedent's individual name,with right of access by another as agent
or deputy,with the exception of the following:-
NAME AND ADDRESS OF BANK'OR OTHE~INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
None
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO_DECEDENT
That the contents of said safe d~posit box or boxes are itemized under Schedules of this
'return,with the exception of tpe following,for the reasons hereinafter set forth:
That Schedule A atta~hed hereto a.nd made part hereof sets forth fullv and in"detail all the
real property in the Commonwealth of PennsYlvania of which decedent died having an interest therein.It
also sets forth the mortgage encumbrances upon each parcel of real property at the date of death,giving
the amount still due at death,name of mortgagee,date,rate of interest,and book and page of record
thereof.It also sets forth in the columns provided therefore the assessed valuation of each of said
parcels,the estimated market value thereof as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal
property wheresover situated own!'!d by the decedent at the tim!'!of death;all moneys left by the decedent
at the time of death,whether in decedent's immediate possession,standing to decedent's credit in banks
of deposit,savings banks,trust con~anies,or other institutions,whether individually,or in trust for
any other person or persons giving also separately the accrued interest thereon,if any,down to the last
interest day prior to decedent's death in the case of savings banks,and to the date of decedent's death
in all other cases;all bonds,postal saVings,treasury certificates or notes and other evidence of in-
debtedness of the United States to the decedent;all obligations,whether by statute or agreement they
are designated as tax free,of tpe United States,or any state,or political subdivision thereof,or of
any foreign country;which are owned at the time of death;all wearing apparel,jewelry,silverware,'pic-.-...
tures,books,works of art,household furniture,horses,carriages,automobiles,boats,and any and all
other 'personal chattels of whatsoever kind Or nature,left bydecedent,together with the"fairly estimated
market value thereof;all bonds and mortglll';es held by decedent and of all claims due and owing decedent
at the time of death,and all Promissory notes or other instruments in writing for the payment of money
of which decedent died possessed,of whatsoever nature,with interest thereon,if any,giving the face
value and estimated fair market vallIe thereof,and .if s.uch estimated fair market value be less than the
face value,it sets forth briefly the reasons for such depreciation-as to each item;all moneys payable
to the estate from life insurance polici-es carried by decedent;all annuity and endowment contracts the
proceeds of which were payable upon the death of the decedent;and all the corporate stocks and dividends
due thereon and unpaid as of the date of death,bonds and accrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent at the time of death,with the market
value thereof at such time.
In the case of securities of close or family corporations,the values reported are as far as
possible substantiated by financial statements of the corporations,showing the assets and liabilities
thereof as of the'date of death.The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business,and in support of the value of such interest there is annexed to
said schedule,financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement,(if oral,a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business,its location,and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted.,It should also set forth in itemized form,together with the fair market value
thereof,any other property owned or bequeathed by the decedent at the time of death•.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers ofproperty,real or personal,within two years of decedent's
death,in contemplation of decedent's death,or intended to take effect in possession or enjoyment at or
after death,said schedule sets forth the nature and value of such property,to whom transferred,the
relationship of the transferees to the decedent,the proportionate share received by each transfe~ee and
all other facts of a pertinent nature regarding said transfers.In the case of transfers intended to
take effect in possession or enjoyment at or after death,there is also attached to the schedule a copy
of the deed,trust agreement or other instrument creating the trust.Ther,~is also set forth in said
schedule a list of all property,real and personal,with its value,which pa£ses at decedent's death by
virtue of the exercise by decedent,either individually,or jointly with another,or any power of appoint-
ment vested in decedent,either individually or jointly,~y the Will,deed,or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death,the nature of their res-
pective interests,their relationship,if any,to the decedent,together with the ages at the time of
decedent's death of all minors,annuitants and beneficiaries for life under decedent's Will.It also
contains a statement showing which of the beneficiaries named in the decedent's will,if any,died prior
to decedent,the dates of their death,their issue,andthe relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property,real and per-
sonal,owned by the decedent jointly with another or others,including intangible,standing in the name
of the decedent and others,plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty,plus the name,address and relationship,if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate,including funeral expenses paid;
family exemption,where applicable;costs of administration of this estate;counsel fees and fudiciary's
commissions paid or to be paid;cost expended for burial trusts,tombstones or gravemarkers,and reli-
gious services,in consequence of the death of the decedent;debts and claims owing and unpaid at time of..',death;taxes accrued chargeable for period prior to decedent's death (except.those allowed under Section
651 of the Inheritance and Estate Tax Act);together with a statement of collateral pledged for obliga-
tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the
estimated amount claiming and allowed,that the same will be reported to the Register of Wills,and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A","B", "C","E",and "F"as directed therein"
have been carried forward and properly registered in the Summary•
.
.........................s~~s..,.,~,~..,~..be:",..,a.nd s..;,..a.Oy.,,~..O,~,fft.,O,..~b.e,..fo..,..r,,~me ,.~~.:.::.:.::.!~.~.~:.:.:.:.:.:.:.:.:.:.:.::.m -(~~;,it;~5c_~--,./.!.,~~.,..",....,..",Box 2.3.8 _.._..
Notary Public (Street Number)
Washington,Washington County,Pennsylvania ,..,~.!:.!.~.~!}.?..L R~.nn~.y!.Y..~pJ.~.
My commission expires Feb.20,1975 (City or Town and State)
NOTE:Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None",and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business,that the
data and statements required under the paragraph above relating to Schedule "B"are attached.Also make
certain that column #1 in the "Summary"has been properly completed as above-directed.
..
RCC-34 (I-U)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE •
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece-
dent.Where property held as joint tenant or tenancy by entireties,report on Schedule "E".Property held by
the decedent as tenant in common with another or others,should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pennsylvania should be (1)(2)(3)
described by lot and block number,street and street number,together wi th DEPARTMENTageneraldescriptionoftheproperty,with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title;if a farm state number of a-FOR YEAR OF ESTIMATED CAUTIONcres;also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writeofdecedent.Taxes,assessments,accrued Interest on mortgages,etc.,are DEATH In this space)to be listed on Schedule "F"and must not be deducted from this schedule.
NONE NONE
Insert this total opposite "real property",Schedule "A"in the X X X X X
"As Reported"column on the last page of this return.
NONE
RCC-35
COMMONWEALTH QF PEN~SYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.-.i"
SCHEDULE "n"
PERSONAL PROPERTY
INSTRUCTIONS:This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent,at the time of his death.Property owned by the decedent jointly with another or others
must be listed under Schedule "E".Inta~gible personal property,titled in the name of the decedent,but
payable at death to another or others,including but not limited to P.O.D.U.S.Savings Bonds and tenta-
tive trust accounts,must be listed,despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g.jewelry,wearing apparel,household
goods,and fUrnishings,books,paintings,automobiles,boats,etc.)
Intangible personal property,such as bonds,treasury certificates,cash on hand and in bank,
•>stocks,'mortgages,notes,together with accrued interest or dividends,salaries or wages,insurance pay-
able to the estate or fiduciary in said capacity,partnership interests,interest in anyundistributed
estate or or income from any property held in trust under the will or agreement of another,even though
located outside of the State,at the time of death,should be listed in this schedule.--..,..-_.,-..;,.-----------------.......--.......-----~-------
Item
No.
1
2
ITEM
List and describe fUlly
1970 Ford 500 Galagie hardtop automobile
Check ing Account 410300425200 in the name
Roy Lewis in First National Bank &Trust
Co.,Washington,Penna.
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKEl'VALUE (Do not write in
this space)
'tr2,000.00 dO()O.OOI
of
~
955.24 C;S-S &A Y
3 Savings Account 1646 in First National Bc:nk
&Trust Company,Washington,Pa.13,457.03
Insert this total opposite "Personal Property",Schedule "B"in
the "As Reported"column on the last page of this return.
x X 16,412.27 i b ¥I ~0<7
J(),/(':or I.
..
RCC-3D
rOmmN'\'EALTH OF PENNSYLVANIA
TIUNSFER INHERITANCE TAX
~SSIDENT DECEDENT
SCHEDULE "c"
T RA.N SFEItS
(1)Did decedent,within two years of death,make any transfer of any material part of his estate,without
receiVing a valuable and adequate consideration therefor?(Answer yes or no)no
(2)Did decedent,within two years of death,transfer property from himself to himself and another or
others (including a spouse)in joint ownership?(Answer yes or no)no
(3)If the answer to (1)or (2)above is in the affirmative state:
(a)Age of decedent at time of transfer _
(b)State of decedent's health at time of making the transfer.(Note 1).
(c)Cause of decedent's death.(Note 1).
(4)Did decedent,in his lifetime,make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)no
(a)Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition?(Answer yes or no)no
(b)What was the transferee's age at time of decedent's death?not appIl.cable
(5)Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a)The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no)no
(b)The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom?(Answer yes or no)__n~O~_
(6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent
alone or others ----:-_
(7)Did decedent in his lifetime make a transfer,the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor?(Answer yes or no)no
(8)Did decedent,at any time,transfer property,the beneficial enjoyment of which was sUbject to change,
because of a reserved power to alter,amend,or revoke,or which could revert to decedent under terms
of transfer or by operation of law?(Answer yes or no)no
(9)If the answer to (8)above is in the affirmative,was the power to alter,amend,or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)_
NOTE 1:The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2:If answer to any of the above questions is yes,set forth below a description of the property
transferred,it's fair market value at date of death,dates of transfers and to whom transferred,with
relationship of transferees to decedent,if any.Submit copy of any trust deed or instrument,if trans-
fers are claimed to be non-taxable,also submit detailed statement of facts on which said claim is based.
NOTE 3:List applicable property below in manner in which provided in Schedules A,B,or E.
ITEM DESCRIPTION
NONE
MARKET VALOE
(Estlmated)
NONE
DEPT.VALUATION
(Dept.Only)
Insert this total opposite "Transfers",Schedule "C"in the
"As Reported"column on the last page of this return.NONE
SCHEDULE "E"
JOINTLY OWNED PROPERTY
ReC-38
CaMMONWE~LTH OF PENNSYLVANIA
TRANSFER INHERIT~NCE TAX
RESIDENT DECEDENT
,-.-,
INSTRUCTIONS:This schedule must disclose all property,real and personal,owned by the decedent jointly
with another or others,including intangibles,standing in the name of the decedent and others.List
real estate first,as entireties,or joint tenants,giving brief description,as indicated under Schedule
"A",plus the date and place of record of instrument effecting vestiture,but do not include entireties
or out of state real estate value in estate valuation column.Personal property should be listed as in
Schedule "B",plus date of acquisition,and the name,address and relationship (if any)of co-owners to
the decedent.
DescriP.tion of Property,Date of Acquisition,Name I unit
Address and Relationship of Co-Owners,and Place Value
of Record of Instrument,where Real Estate.!
NONE
percentage
Share
Estate
Valuation
NONE
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
Insert this total opposite "Jointly Owned Property",Schedule "E"
in the "As Reported"column on the last page of this return.
RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
•
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OF(State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
have an interest,vested,contingent or other-are involved,set STATE YES IN ESTATE
wise,in estate)forth this fact.)OR NO BIRTH
Donald G.Lewis brother yes 1/4 residue
(Died on August 20,1971,tes tate;Lett~rs Teste mentary we re granted to
Sy!vl.a LeWl.S on August 2.,197!.)
John F.Lewis brother yes 1/4 residue
Box 238,Marianna,PennsyJ vania
Glenn Lewis Jr.neohew ves 1/4 residue
(sole heir of brother,G1E nn Lewis,who died in 1962)
FOLLOWING HE IRS OF BROTHEE STANLEY LEVJ IS who c ied aoorox imate1v 1959:
Stanley Lewis,Jr.nephew yes 1/20 residue
Address unknown
Garv Lewis neohew ves 1/20 residue
Address unknown
.John T.~T.7;~.1-ves 1/20 residue
Address unknown
n~~~l~~T_~t'..1;~n;pC'p vp~1/20 res idue
"'Address unknown
Donna Lewis niece ves 1/20 res idue
Address unknown
,
,
,
J .:~-!
"
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Donald G.Lewis August 20,1971 R.D.4,Was hl.ngton,J:'enna.
---------
.Vd •.(}:)N;]J :'NIH SV't,\
c:11 '.~',.1 (I JI :.'I 0.I f.\3".......L,.-,~.1',~-\J..J,!.~V 0
oN\~,'.;-I '13 S'3 nH
I ,"i1r 2J"I'~i 1~IJ _,.,
:....
:0\>::Sio ::S'"o:~0 ~::s ;....::s ~::::
(l)N (l)"g -
:."""I
N c:t~'-J ~
£0 01 ;"iII'~
:(I '~';rl
",,1.,.1 i .~J
:....:
~O\
10:~:....:N:.:N::'-J :
~~~:f":
~:--....:
~
:~
~
-OO~~~
~.:.
:~:~:
.~
:.........
>'"o(1:~
(tt-v'"'-2.::sr::c..
•
RCC-Bl (6-71)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
(~~UAdmini strator)
j
IN YOUR REPLY PLEASE
REFER TO UNX 38-168-4
Inheritance Tax Division
In Re:Estate of _-=R:..:.co::....:Y=--.=A;:..:.'----=L=EW::..:.:..:::I=s'----=a:.Ll....:::k:.Ll..=a:.------:-_
Washington Coun ty - FileNo._----"<.6""-3--'--7-'--'1"'--_4.!...6"'-.7.!....-_
Dear Mr.Lewis:
You are he re by noti fied that the_~:__'o"-'r~i~g~i~n~a~l~-:--7---------
appraisement in the estate of Roy A.Lewis a/k/a
has been filed in the office of the Register of Wills of liashington
County on January 18 ,19l1,Said appraisement reflects the following
valuations:
Real Estate _
PersonaI Property__--=l=-6~,4--=-=1.=2'-".-=2'-'7 _
Transfers _
J0 intIy Own ed -----=-;;---~;;-=--=__=_----
Total =.1.::-6.L,4--=..:1=-2=-=-.2=-7~_
As to such tax that is paid within three months from date of death,a five (5%)
percent discount is allowable.As to any tax that remains unpaid after nine (9)months
(fifteen months when death occurred from December 22,1965 to June 16,1971,inclusive;
and tWelve months when death occurred prior to December 22,1965)from date of death,
interest at the rate of six (6%)percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may appeal therefrom
as provided by law.
Date _~J~a~n~u~a~ry~1=-8"4_,~1~9.L7~2__Signed _~F~R~A~N=C~E~S~LE=O~_
Title CHIEF APPRAISER
DATE OF DEATH:April 13,1971
Note:This is not a bill.
RCC-39"(~66),.
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.~.........•
DATE OF DEATH \.4':::l3-71:::;:"PILE NO.63-71-467EstateofLE\'lIS,
(Last Name)
ROY
(First Name)
A.
(Initial)
SUMMARY
REPORT OF INHERITANCE TAX APPRAISER
I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washington
Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set fotth opposite each item iu the last column to the dght in Schedules "A","B","~
Dated,January 18.1972 ";~.-.u..~L ~iJ~
INHERITANCE TAX APPRAISER /
REPORT OF THE REGISTER OF WILLS
I,the undersigned duly elected Register of Wills in and for County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent,except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F",which greater or lesser amount represents the sum
allowed as a deduction.
Dated:_
REGISTER OF WILLS
16 412 27
16.412 27
None
16,412 27
$
, 6 412 27
16.412 27
None
16,412 27
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$$-------+--
CLEAR VALUE OF ESTATE
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint -Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
Valuation of life estates or -t=
FOR USE OF REGISTER ONLY
Tax on $-+__
Tax on $-+_--(
Tax on $---------+--Tax on $-+__
Tax on $-+__
Exemptions===========1~=Total Estate -1-__
TOTAL TAX
2%
6%
o
10%
15%
*
COMPUTATION OF TAX
$--------+---
$--------+--
$--------+--
$--------1---
$-------f---
$---JL....-_
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death ::::::::::::::t===
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%fro~_____to $------
AMOUNT OF ESTATE TAX ASSESSED $L-
Estate tax paid $l-
BALANCE DUE $-----,-
Add interest at rate of 6%from t=
------lto-----$-----~,
TOTAL TAX BALANCE $------1
PAID $-J
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:WherJ:subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
Will IN
Administration ~o.
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
I{OJ f!+.•.~E;\\TI.S.Cl./}{!a
Deceased
Late of .
County of
MARIANNA
WASHINGTON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
*
l""onn F~CC-2
DEPARTME1\~T OF REVENUE
.."1 r +~
BUREAU OF COUNTY COLLECTIONS;-;
HARRISBURG.PENNA.17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE J..anuary l.8..,1.9.72 .
COUNTY W.~.~.4J.l.l:.g.tQ.P.:.
FILE NO•........~..~.:..?~.:::.4..~.?..
Whereas..R9..y.@:A.t.1.~.w..i..$.~I.k/.~late of Ma.ria.nna .
in the County of .w.~.$..b.i.ngt..Q.n :.:.:;Commonwealth of Pennsylvania.having died on
the +.~t..h day of :-.,.Ap.r..iJ 19 71..seized and possessed of an estatej
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore.I•...........F..ra.n.C.~.$.....L.e..Q.............................................................................•an appraiser duly appointed according to law.
having been designated to make a fair and conscionable appraisement of the said estate.and to assess and fix
the cash value of all annuities and life estates growing out of said estate.hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit AppraisementDescriptionofAssetValuesMadeforInheritance
Tax Purpoles
$
PERSONALTY:
See COny of Schedule B attached to annr;:l;S 16.412 27
Total 16.412 27
Having been duly sworn accordin~.I do hereby r ify that the above appraisement is made in con-
formity with law on this /£:.day of ;;:;7"'...... . .~......................19.Z-<
V/.······················~······~····~··A~~
~.
1 .~(l'Iu r and Str~~t)
.................~_..........................................................•Penna.
(Poat O!llee)
'vASHINGTON County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
ROY A.LEWIS
Deceased.
Late of
MARIANNA
Date of DeatJ;.....:Apri1 13 1971:'L .
Appraisemeilt Docket Vol.,3.8..; .
Page,16.8~.4 No..6.3.~.71.~.4.6.7 .
Filed in Register's 0 jJice,J.a.n l-8.,19..7.2
Amount of tax due,$.
.DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.ut Appraisement,.
Appeal f,.om Appraisement,.
Entered and charged,.
I,
1.
!
DEDUCTIONS ALLOWED IN
"STATEMENT'OF DEBTS
AND DEDUCTIONS
~.@ /S"o Register of Will.,Age"1
REGISTER OF WILLS
•OFFICE OF TME
ESTATE OF __Ro----'y:'--A_._Le_w_is---=-._D_e_c_e_a_se~ATEOF Marianna,Was h1ngton County,Penna.
AND AGENT OF TME CO~MONWEALTH
OF _---:..W:....a_8_h~1n___"g!!=!....._tO..:..._n_COUNTY
Form RC C,lO
DATE OF FILING APPRAISEMENT DATIi OF DEATH A...p_r_i_l_l_3,;....:'--1_9_·.;..7_1 _
DATE NO.OF NAM"OF PAYEE REMARKSVOUCH""AMOUNT
Internal Revenue Service 1970 Income Tax 176.PO
Washington Hospital Blood 60.PO
Russell Marino Inher1tance Tax """PasonAccount,,-1,000.
John Shrontz Funeral Expense 432.00-..
Estate of DonaldG.Lew1s Share of Adm1n1Strata~vsJ 250.btl
John F.Lewis Administrator's Commission 699.70
Frank C.carroll Attorney's Fee 849.70
Frank C.Carroll Reimbursement of follow..
l.ng COSl;S 8QVanCea 2l.0(
...,:)0.IUU
Russell Marino Letters &3 S.C.
Observer Pub.Co.Adv.Letters l4.0(
Wasb.Co.Reports Adv.Letters l4.0(I
F.J.Buckley Agency Bond premium as.O(
Russell Marino Filing Account l6.0(
Russell Mar1no Filing Inventory 3.0l
Marie Guidos Notary Fees S.Ol
('.11 A A A j-(\~",'11;.,~rA..A AA"A.J&1'0I./V'~""TA
.
~----
I ~J52S 407
COMMONWEALTH OF PENNSYLVANIA }
Washington S8:COUNTY OF ----,;;--"1,.....--_......-_
JobD F.LewisI,---.:=..:::=:.-=~-===-_HEREBY CERTIFY,THAT.TO THE BUT OF
MY kNOWLEDGE AND BELIEF,THE FOREGOING IS AJUST lltiYrRAl~SI".~.T OF DEBTS,.n -....W40 FUNERAL EXPENSES AND EXPENSES OP'
ADMINISTRATION SUBMITTED TO THE ESTATE OF -------~,......,,:---f--r----=-
INHERITANCE TAX PURPOSES.
-....,",",",-,--_DAY OF
Washington.Washington County.Peonsylvania
My commisLon expires Feb.20,1975