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Home My WebLink About95-00517 Oath of Personal Representative Commonwealth of Pennsylvania County of ~ cumberland: The Pelllionerlsl above.namod swoerlsl and alfirmlsllhallho slalDlnonls in Iho lorogolng pollllon ara \rue and correcllO Ihe bOSI 01 Iho knowledge and boliof ot POlillonarlsl and Ihal. as porsonal roprosonlallvolsl of Iho Docodont. Potlllonor(sl will woll ond \ruly adminlstor Ihe aSla~g 10 law. Sworn 10 and affirmod and subscribod " // ~r- bolore me Ihls 10th... day of J),IIV 19li "P(~ c,. ~~. fL. p. B. \J..r DECREE OF REGISTER Deceasod No. 21-95-517 EstalO 01 ANNA 1. BLOSSER also known as 0010 ot Doath: 06-26""1995 Social Securltv No: 11 J -J.1" I ~ >17. AND NOW. JUI,"{ 10 . 19~. in consideralion of Ihe Pelition on Ihe reverse side hereon. satisfectory proof having been presented bafore me. IT IS DECREED that LetterS 0 Testamentary Kl of Administration \0, I". .11.'" I ,I_.~l."'" ~,- ,~",.,'~ ..........,.. "......,.... "..,."., me hereby granted to nnnR1d ~. B1osser. in the above estate and that the instrument(s), If any, dated described in the Petition be admitted to probate and flied of record as the last WlII of Decedent. FEES Lottors........................... $ 80.00 Short Certilicate(sl...lO... $ 30.00 Renunciation................. . $ 5.00 Allidavit ( l................. $ Extra Pages ( I............ $ CodiciL........................ . $ JCP Fee........................ $ 5.00 Inventory & Tax Forms... $ Olhor............................ $ on c~ ::\ ;' . :0 :nIt) I," (~ _ri "n ~.~. ;~:::.:,W'''. e~,~ ~ .\.Jqf~ , 1;';~ I VJ '0 ~ t..J 0- U' . I,:~, .. . -or. ):-::.1 Attorney: R . c. . S f; ;-.:c-er 1.0. No: 0 (, .:z ~ 'f AddtS: "7 ~ J 1'1. '2. d S 1": I 01 r;,<' 6 cM'-t fer. 17 I () '- 7/7- _ 1.1/- 7(. ()'D JULY 10,1995 TOTAL................ $ 120.000 Telephone: DATE FILED: RW-7. 21-95-517 RegIster of Wills of RENUNCIATION E8l8Ie III---A fI fl Cl r. /J /(1 J S e- {' County, PennsylvanIa No. aIIo '"-' u . D_ued Thl undlrslgned, Je d /J e 1-1 & f, Po II \/ \ 0 d UQ h f fA" III (RllatJonahlp) (CIpIClIyY .I 'j 1111 above DlCIdln~ herlby rsnoUf1Cl[a)1111 rfghl lD acImlnllllr 1111 lalaIl and fllpICIlUIly ~Ulal[a)1II111 lIna,. blIsIUld to --f) () tI tl I 01 /J, {J / (J S; S ~ WITNESS .rn d hand Ihls day 01 ~tt 1') ~ . 111 C?'.5. \\.~ C()~rh ( dr...) fSlgnaturl) (Addr"l) (Slgnalure) Swam 10 or affirmed an~bIcrlbad balora e thll .:J 0 - day III 111 95 (Addrl") NOTARIAL SEAL JUDY A IMES. Notary Public Harrisburg, DauphIn County My CommissIon expIres Sept. 8, 1997 NOtE: R.nunclallona Ixacultd outlldllhe 0II1c1 01 Reglallr 01 W1Ua 7 In IOml counll.. Irl rlqulred to be notarized. :J Q,JJ J FClIIIl 1IlW-4 "tpItOd br "'" PonNylvonla Bat AuodalClll lI11n Nallle of Deeedelll: Dale of Dulin Will No.: TO TilE IUi01S'I'llIt: CER'I'JIII<'A'I'ION OJI N()TI<'I~ IINllIm RIIJ.J~ 5,61111 ANNA I. 1Il.0SSER Jlllle 2r" IIJlIS IlJlJS.IIIISI7 e ...;:;.- I eerllfy Ihalllollee or hellellelal huerest re'llIlred hy Itllle S.('(A) or Ihe ~llIi:I" Conrl Itllles Was served 011 ollllalled lolhe followlog hellcllelarlcs or Ihe ahuve.eaJlllolled e5tate 011 IT J ", : . Name IIHl ^ddrc~!'i DONALD A. 1Il.0SSER 1U39 Stale Road Dllllealllloll, J1A 1711211 NIII1IC nnd Address mANNE'l'm I'. POLLY 2411 Exeler Courl Ik:thlehelll. J1A IHII17 Nollee h... 1I0W heell givell tu all J1er5U1l5 elllltled Ihereluullder Rule S.6(a) exeeJlt DaIC~ ROIIERT C. .~. ZEIt, I'.C. ~ (I. SlglIDture NAllle Ruherl C. SJllller 7111 Nnrth SeL1111d Street 1'. O. 1I0x 1211H7 lIarrl5hllrg, I'A 171UH.211H7 TeleJlholle Nu, (717) 231.7fiOIl CAJlAelty: xx J1ersollAI Rellleselllallvc COUIISel rnr J1ersollal ReJlreselltallve <i 00 t5i ::0 c !~ :r.Jm ::J i:' HI n ,,:,.':" ? '.., ==- al I -'" , :~J - ('.J v' j;:~, . , , ., \0 ";. w., ..._ ."''' _..... . , .. ~ - -- -- .._- - ---; ..- '-- --- -- - -.- - -.- --_... .-~ .,-- ~~- ~ -- -- ,.-- .-'-- - '"--- - --- -- - -_. ----- RECEIVED FROM, & ACN ASSESSMENT P:'I CONTROL 1;1 NUMBER AMOUNT SPITZER ROBERT C 701 N. SECOND ST. P.O. BOll 1e9S7 HARRISBURG, PA 1710S-eOS7 Ivl .t:,OY'.Ub j . i l ''''0.",1 I 1 ESTATE INFORMATION, ~ I E MIER III e1-199:5-0:517 EJ NAME Of eECEDENT (LAST) SLOSSER ANNA I II DATE 0 PAYMENT B POSTMARK T COUNTY SSN 171-C?S-1SBe (FIRST) (MI) CUMBERLAND DATE 0 DEATH f I SEAL DONALD A BLOSSER C/O ROBERT C SPITZER PC CHECKtt 109S m TOTAL AMOUNT PAID " ., REMARKS .e,591.06 DO ~ ',1 1 REGISTER OF WI LLS ( . ., ""_1, I 'i' RECEIVED BY 1/<0'1_1 l .' \-'< '." ,.' ."",'V ,;/ S1GN~,,, ~'. j., --" /} ",1,_ MARY C. LEWIS' . ," d'" REGISTER OF WILLS .; -----------~.~~~~-~--------.--~-~-~~ . . . , I . ' ~. i . . -: , . -__ 1 ""4"""'" 1J'- +.......-. , . .- .._- -- ---._-;-:"-----..1_ I ,-' t..- ........--. , l \. . R[V~ 1&00 [lit 11-g4' DECEDENT CHECK APPRO- PRIATE aLOCKS CORRES- PONDENT RECAPIT - ULATION TAX COMPUTA- TION . I!>- .y;J - q INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGIS1 i-R OF WILLS) 21950517 NUMBER CO~MONW["'l Tli OF PENNSYLVANIA D[PAfH~4[NTm Il[V[NU[ DLPT.noeOl HARRISBURG. PA 11111.01101 FOR DATES OF DEATH AFTER 12131/91 CHECK HERE IF A SPOUSAL POVERTY CREDIT IS CLAIMED FILE NUMBER 1995 COUNTY COOE YEAR DECEDENrs COMPLETE ADDRESS 403 5'IH srnEE:r Sl..M>1ERClALE, PA., 17093 4 24 1935 Counl cu.1BERll\ND SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) BLC\SSER ANNA I. SOCIAL SECURITY NUMBER 171-28-1882 VilIS' i~D M~D l[ INlfllALI U 1, OllglnaJ Roturn 3. Romalndor Ralurn If Of dltual dulh pllOI tD 11-13-121 o 6. Fodoral Estato Tax Aulurn Roquirod . o 4. Umilod Estalo 0 40. Futuro Inl01091 Compromiso (lor dalos 01 doalh ollar 12-12-02) J O. Oocodont Dlod Tostolo 0 7. Docodonl Molntalnod 0 Uvlng Trust (AIIach copy 01 Will) (AIIach copy 01 Tluot) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAIUNG ADDRESS ROBERT C. SPITlER PCP 0 BOX 12087 TELEPHONE NUMBER HARRISBURG 717-231-7600 PA. 17108 1, Roal EOlalo (Schodulo A) ( 1 ) 35 ,999.00 2. Slocko ond Bond. lSchodulo B) ( 2 ) 3. Cloooly Hold Slock/Portnolohlp Inlolool (Sch. C) ( 3 ) 4, Mortgogoo and NalDo RocDlvablo (Schodulo D) ( 4 ) 5. Cash. Bank Doposils & Mlscollanoous Po,sonal ( 5 ) Proporty (Schodulo E) a. JolnUy Ownod Proporty (Schodulo F) 7, Tran.lo,o(Schodulo G) (Schodulo Ll a. Total Glo.a Arlaola (10101 UnDo 1-7) 9. Funerol Expansos, AdmlnlSlraUve Costs, Miscellaneous Expenses (Schedulo H) 10. Dobla, Mongago Uablllllos, Uona(Schodulo I) 11, Total Doducllon. (Iotol UnDo a & 10) 12. Not Valuo 01 Eslalo (Uno a mlnua Uno 11) 13. Charltablo and Govornmontal Boquosta(Schodulo J) ...Q.. a. TOlal Numbo, 01 Solo Dopoall Bo.oa , i 35,824.43 ( 0) ( 7) (0 ) 71,823.43 ( 0) 7 ,681. 73 (10) 20.957.45 28,639.18 43.184.25 (11) (12) (13) (14) 43,184.25 14. 15. spou..' TI.n.I.'.I'ol d.lu 01 dllltl.l1.r 8-30-114). s.. In.trucllon.lot Appllcabl. P.rcenlaga on Page 2.(Inclu(l. ....lu..fromSch.dll'.K.or Sch.dllt.M.1 16. Amount ot Uno 14 takablo 016% fato (lncludo values from Schedulo K or Schedulo M.) 17. Amount 01 Uno 14 takoble 0115% rolo (Include valuos from Schedulo K or Schodulo M.) la. P,lnclpallax duo (Add tax I/om UnDo 15, 10 ond 17,) 10. Crodits spou..' Po....,ty C,.dll Prior Payments 0.00+ + 20. II LinD 1910 roolor Ihan Uno la, onlor tho dllloronco on Uno 20. Thlola tho OYER PAYMENT. A. Ch..k h... n OIl ar... llUIfn I ..lund 01 our ovo .Ilt. 21. If Uno 10 is grooler than Uno 19. ontor tho difforonco on Line 21. This Is tho TAX DUE. A, EnlDr tho Inlorost on tho balonco duo on Uno 21A. B. Enta, tho 10101 01 Uno 21 and 21A on Uno 21B. Tlllala tho BALANCE DUE. Make Chick Pa able to: Ro Ister of Wills, A ent (10 ,'. . . . 110) 43 ,184.25. ,00 . 2.591. 06 0.00 (17) o . 00. ,10 . (10) 2,591. 06 0.00 Olncounl Intoresl (19) (20) (21) (21A) 121B) 2,591.06 0.00 2,591. 06 . .. .;,,'. "".. ".'".'"",.".....",,,...... BE SURE TO ANSWER ALL QUESTlONS ON PAGE 2AND.TO RECHECK MATH ..... ....,,, .." .. '. ....,'. . . . Under ponaltles 01 perjury. I doclmo that I havo oxomlned 1hls return. Includmg accompanying schedules and Blatomonts, and to the bost 01 rpy knowledge and bellol, It Is truD. corrael and complelo. I declare lhat all roal ostolo h09 boOn reportod at (rue morket valUQ, Declarotlon 01 proparor other thao the personal ro rosentallvo Is basod on a1llnlormotlon 01 whl:h proparor 1109 any knowlod,18. 51 AT nE OF PEn N P SIDLE Fan FILING nETunN AoonES5 See Schedule attached TATIVE DATE 3/20/9-11' O~TY", 2/9(, Copyughl Forma :lollw.,. Only, IlIa4 N.lco, lnl;, Na4PA001 ~. I' _1995-21950517 Estate of I ANNl\ I. BtalSER ,. (' stM-lAR'l OF ALLOCATICNS '10 BJ;llEF1CIARlFS Class A raw.n A. J3LQ9SE1l .:JEl\NNE:l'l'E F, roLLy 21,592.12 21,592.13 43,184.25 . " Estate of I J\NNlI. I. BLOSSER -1995-21950517 'Il1e following persons are signing the retum as representatives of the estate: o:::NAI.D A, BLOSSER 1039 STATE ROAD IXJNCJ\Nl'OI, PA 17020 'j , I" :;:-r I': REV-l&02 EX + 1'2-~\ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ANNA I. BLOSSER _1995-21950517 (Property 10lnUv-ownld with RighI 01 Survlvollhlp mUll be dllClolld on Schedull Fl AU ,..I ..1111 Ihould bl ,eported II lit, ml"'"I vllul whIch II dlftned IIthl prtCI II which p,oporty would bl I.chlnged belw..n I willing buy" Ind I willing IIUII, nllth.. bllng cornpoUtd 10 b 0' ..U, both havln ,..oonobll know! olthl IIllvlnllacll. ITEM NO. VALUE AT DATE OF DEATH DESCRIPTION 1 sIN3lE FAMILY 0'IELLIN3 I..OCA'IED AT 403 5'lll srnEEl' stM-lERD!\LE, EASl' PENISJ3ORO TCMNSHIP, aM3ERIJIND o:xJNl"{, ~VAN1A, TAX MAP tl), 09-113005-050, o::NSISTINJ OF .14 ACm'S, ASSESSED VAUJE $2,700., TIMES cnM:N I.EIIEL RATIO FACIOR OF 13.333, VAUlED AT 35,999.00 35 999.00 TOTAL Also ente' on IIno I, Roce ItulaUon (II moro spaco Is neeclod, Inson edditlonBlshoola of sarno Blze.) $ PAI5021 NTF 1211 CopyriGht Form. SoU.," Only, 111M Nelto, Inc. NMPA021 ,,.< ~-~~~.',"-"'-.;h.,.~",!'t~'k.~U.~'~""''''-~'''-''' .......4...., < ."......<r,"'--~ ;' ,::~;~-;";~.,,- 3117 m.MI!RTlIN oIVI!N1ffi IIo1RRISIIIIHlI.1'.\ \710'1.11.I1 I'IIUNI; 717"'1-1111 r,\.'\ 717.J41.1)4.... .... August 19, 1995 Robert Spitzer, Esquire Robert Spitzer, PC p, O. Box 12087 Harrisburg, PA 17108-2087 RE: Estate 01 Anna I. Blosser Dear Mr, Spitzer: In accordance with your request, I have appraised the personal property of Anna I. Blosser, Deceased. The proparty Is located at 403 5th Streot, Summerdale, PA 17093. The values shown have been arrived at after a careful study of the property. believe it to reflect a true measure of Its fair market value as of July 25, 1995. Fair market value is defined as being the most reasonable or probable price in terms of money that real or personal property will bring In an open and competitive market under all conditions requisite to a fair sale, the buyer and seller each acting prudently and knowledgeably, and assuming the price is not affected by undue stimulus. Taking Into account all of the factors set forth in the pages that follow, it is the opinion of the undersigned that the fair market value of the personal property Is Six Hundred Four Dollars ($604.00,1 Employment In and compensation for making this appraisal are in no manner contingent upon the value reported and I certify that I have no financial Interest In the property appraised, present or contemplated. Very truly yours, John S. Ensminger . ESTATE OF ANNA BLOSSER END TABLE $ 5.00 LAMP'" -. -~."--" '$_~__._m-~2,OO' SOT:j\'G-REEN"' -_._~-' ---. ...- _...-~._---_._-- - >$-_._"'~--- --"--25.00 SOFA~G-c5LO ._~.,,"-------------- -S-~---25.oif LAMP----' --- - .-----.--.---- $----- ---. 4.00 MISC-:RITCHEN .-- -. d. -$ .-..' 5.00 KITCHENTiiifCe -'- -.- --' --.. --- .---- -$--" ---.5'-00 BOOK SH-ELF- --- ..- ..-' - -----. $""- ."----.25:0'0 SANYO.STEREO .----- --- ..._n_ ..-. S--' ."-40.00 3 PC. 'BC6ND-BEDR06~nmiT-'. - ---.-.... ---.. $-"."---...75..00 MISC~LINENS~--" ..'_.. ----.. ,...-----..-...,..-----. $----------.. ..... 10.00' MISC-:CHRfsTMAS--- _u"._' - $ 5.00 MISC. CRAFTS --.. ---- ---..--------- $"-- 15.00 END TABLE .-- .--..------------- $---' 5.00 MISC. BEDROOM $ 50.00 MISC. BLANKETS--"'-- --- $ 1Q.iiO 2LAM~---" --. $ 8.00 OLD BUReAU .. ~~_:==~~==~~.::....~~-..- -r- 5,00 DOUBLE BED $ 10.00 GE MICROWAVe------------ $ 25.00 MISC. KITCHEN $ 35.00 GE REFRIGERATOR . $ 50.00 MAYTAG WASHER $ 50.00 ELECTROLUX VACUUM $ 10.00 TV STAND $ 5.00 2 END TABLES & COFFEE TABLE $ 15,00 HAMPER $ 5.00 6 CHAIRS $ 10.00 MISC. BOOKS 1$ 10.00 WHIRPOOL DEHUMIDIFIER $ 40.00 6 PLASTIC PORCH CHAIRS -, $ 20.00 TOW $ 604.00 Page 1 REV-Ian txtt1-UI SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Plus. P~nl or 'TYP. FILE NUMBER -1995-21950517 COMMONWEAL TH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ANNA I. BLOSSER ITEM NO. A. Fun.ra' &pen..a: DESCRIPTION AMOUNT 1 ROLLlID GREEN MI;loORIAL CEMEIERY. BURIAL WI' 1,839.95 2,838.50 2 SULLIVAN FUNERAL HO>1E, EmLA, PA. B. AdmlnlstraUv. Costs: 0.00 1. Personal Reprosontadve COmmla.lons Social Security Number 01 Personal ReprosenlsUvo: Ve", COmmission. paid 2. Attorney Foes ~ S fl' t ~ e.('") f. c, 2,000,00 0.00 3. FomIlvexemptlon Clalmsnt Address 01 Claimant .t decedont'. dealh SUoelAddross RolaUonahlp City Slale Zip COdo 0.00 4. Probata Foes c. Miscellaneous Expenses: 1 APPRAISAL FEE FOR TAJIOIBLE PE:R.9:W\L PROPERTY 'IO ROBERT ENSIIIN3ER APPRAISERS 2 ADVERl'ISlID AND FILlID FEE'S 'IO aM3ERI>>ID c:cxJNl'Y CXXJRT AND NEl'ISPAPERS 3 FAST PENNSBORO 'lWP. SEWER AND WATER 4 USF&G ~ IN.SURANCE FOR REAL ESTATE 5 PP AND L ELECIRIC a:::MPANY FOR ELECIRIC SERVlCE'S AT REAL ESTATE 90.00 102.71 87.75 176.90 38.13 6 ALICIA srINE, TAX COLLECTOR FOR FAST PENNSBORO 'I'CWNSHIP, REAL ESTATE TAXE'S 'IO c:cxJNl'Y, 'TCMNSHIP AND SQICOL DIsrRIcr 507.79 TOTAL Also entor on IIno 0, Rec lIuladon S (II mora space Is needed, InHrt addlUona' .hs.ts 01 um. ellS.) 7 681. 73 PAiS111 NTF UII COPWOflght Forml 5oltw&" Only, 11184 N,ltO, Inc. N84PA111 RllV-lII1EX+llIU) SCHEDULE I DEBTS 'eF DECEDENT. MORTGAGE LIABILITIES AND LIENS . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEN'DECEDEN' ESTATE OF ANNA I. Bu:ssER Pl.... Prlnl or FILE NUMSER -1995-21950517 AMOUNT ITEM NO. OESCRIPTION 15.90 1 P P & L ELECIRIC a::t>1PAN'i BAlANCE FOR SERVICE 2 BELL ATUINl'lC FOR TELEPH<M: SERVICE Bl\LI\NCE 3 DANBURY MINl'- Bl\LI\NCE 0'lED 4 A T & T Bl\LI\NCE roE 5 I T T Hl\RI'FORD INSURANCE a::t>1PAN'i, AtJI(M)BIlE INSURANCE, BAlANCE 6 FIRSI' NATIOOAL BANK OF MARYSVlLLE, toOR1'3!\GE BAIJ\NCE CN AC<XXJNl' #218021 7 Acx:RIlED nm;:RE'SI' roE CN PiOOVE ~ 29.95 16.45 9.64 43.00 20,828.20 14.31 TOTAL Also onlor on Ilno 10. Roc itulaUon (II ""ro spsco Is noodod, Insorlsddlllonol shoots 01 same slzo,) s 20 957.45 PA15121 NTF :a1l0 ~ -==- '\ REGISTER 01' WILLS 01' CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY ESlate of ANNA I. BLOSSER No. ~ 1-"1 :')- 5/1'1 also known as Date or Death 6/26/95 Deceased Social Seeurlly No. 171-28-1882 Personal Representative(s) of Ihe above Estate. deceased, verify thatthc lIems appearing In the following Inventory inclode all of Ihe personal assels wherever slluate nnd all of Ihe real estate in the Commonwea\lh of Pennsylvania of said Decedent. Ihat the valuation placed opposhe each ilem of said Inventory represents lis fair valoe as of the date of Ihe Decedenl's dealh, and Ihat Decedenl owned no real estate outside of the Commonweallh of Pennsylvania except Ihat which appears In a memorandom at the end of this inveOlory. IIWe verify Ihat Ihe statemeals made In this Inventory are true and correct. IIWe undersland that false statements herein are made subjecllo Ihe penalties of 18 Pa. C.S. Seclion 4904 relallng 10 unsworn falsineation to authorities. Name of Allomey: Personal Representative: {kJ~r-= DONALD BLOSSER ROBERT C, SPITZER. ESQUIRE 1.0. No.: 06264 JJl6 /?6 / DATED: Address: 701 NORTH SECOND STREET. P. 0, BOX 12087 HARRISBURG. PA 17108-2087 Telephone: 717/231- 7600 Description Real Estate at 403 Fifth Street, Summerdale, PA. single family dwelling, assessed valoe $2.700: Valued at Cash at Residence Balance in Checking Account at First National Bank of Marysville. #34-378-1 (not interest bearing) Balance in Savings-Passbook Account at First National Bank of Marysville. Account #2086800 Interest on Savings-Passbook Account Balance In Christmas Club Account at First National Bank of Marysville. Account #7015232 Value 35,999.00 4.50 1,193.84 109.93 4.30 260,00 , -' IN Till! COURT or' COMMON PLEAS OF CUM8ERLAND COUNTY. PENNSYLVANIA IN RE: IlSTATE OF ANNA I. BLOSSER DIlCE,\SIlI) ORPIIANS' COURT DIVISION NI,. OF VERIFICATION FOR fNVENTORY 1 hereby verll'y Ihat I am Ihe Execulor or Ihe Eslate or Anna I. Blosser. deceased, Md Ihallhe rorgolng sehedolC5 conslllute a complele Inventory Md appraisement or Ihe real and personal eSlate or AMa I. Blosser, deceased. excepl real eslate oOlslde or Ihe Commonweallh or PennsylvMla, Md lhatthe "gures opposlle each lIem or real Md personal. propcny In Ihese schedules an: Ihe ralr markel valoes or said lIems as or lhe date or Ihe dealh or Ihe decedenlto Ihe bcJl or my knowledge. Inrormallon Md beller. I undersland Ihat raise statemenls herein are SObJCCllO Ihe penallles or 18 Pa. C,S.A, Secllon 4904 relallng 10 unsworn ralslncatlon to aUlhorlltes. ~~ Date: .3)')..z./~( , J /5 j 3 -lfJ REV-1547 EX AFP 112-95* COHHONWEAlTH Of PENNSYLVANIA OEPAATHEHT Of REY[NU[ BUREAU OF IHDIVIDUAl TAMES DEP'. 210601 nARRISlUAG, PA 171,..0601 C. L/ ACN 101 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE 07-08-96 FILE NO. DATE OF DEATH 06-26-95 COUNTY CUMBERLAND NOTE I TO INSURE PRDPER CREDIT TO YDUR ACCOUNT, SUBHIT THE UPPER PORTIDN OF THIS FORM WITH YOUR TAX PAYMENT TD THE REGISTER DF WILLS. MAKE CHECK PAYABLE TG "REGISTER OF WILLS. AGENT" REMIT PAYMENT TO: ROBERT C SPITZER PO BOX 12087 HBG PA 17108 REGISTER OF WILLS CUMBERLAND CO counT HOUSE CARLISLE, PA 17013 Allcunt R.Mitt.d CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifi\i:is4i-EX-AP'p--iiz-:9SY-NOi''iCE--.iF""iNHEiffi'ANCE-YAX-iiPPRiifsEH€ii'r-;-ALrciwA;fcE-iiJi--------mmm DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BLOSSER ANNA I FILE NO. 21 95-0517 ACN 101 DATE 07-08-96 TAX RETURN WAS I eX) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Eat.ol. (Schedule Al 11) 2. Stock. and Bond. (Sch,dull BJ 12) 3. Cloa.ly Hald stock/Partnerahip Int.r..t (Schedula C) (5) 4. Hortg'a..IHot.. Receivabl. (Schedula DJ (4) S. C..h/Bank Dlpolltl'Hilo. Plrlon.l Property (Schedula E) IS) 6. Jointly Ownad Property (Schedule FJ (6) 7. Tranlf.r. (Schadula OJ (7) 8. Tat.l A...t. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Fun.ral Expan.../Ada. Co.t./Hi.c. Expansa. (Schedula H) (9) 10. Dabts/Hortuaua Li.bilitia./Lian. CSchedula I) Cia) 11. Total Daductions 12. Het Value of Tax Raturn 15. Charitabla/Govarn.ant.l aequ.at. (Schadul. J) 14. Hat Value of E.t.t. Subject to T.M If an assessment was issued previOUSly, lines reflect figures that include the total of ALL ASSESSMENT OF TAXI 15. Anount of Lina 14 at Spous.l 16. Anount of Lina 14 taxable at 17. Anount of Lin. 14 taxabl. at 18. Principal TaM Du. TAX CREDITS: PAYMENT DATE 03-26-96 NOTE: r.t. Lin..l/CI... A r.t. Coll.t.ral/Cl... a r.t. US) U6) U7l RECEIPT NUMBER AA1l2665 DISCOUNT INTEREST It) C-) .00 I CHANGED 35,999.00 .00 .00 .00 35,824.43 .00 .00 IS) 71.823.43 7.681.73 20,957.45 Ill) U2) U5) U4) ;>8 .~:oIq 18 43.18(1.25 .00 43.184.25 14, 15 and/or 16, 17 and 18 will returns assessed to date, .00 X .00. 43.184.25 X .06. .00 X .15. UB) .00 2.591.06 .00 2.591.06 AMOUNT PAID 2.591.06 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 2,591.06 .00 .00 .00 . IF PAID AFTER DATE INDICATEO, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN 'i. ND PAYMENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICR). YOU MAY aE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) o:t ~~ - <~I t\.. '15 .. ell 00 " " - a: .1 ,''':::; , .) '1' '. :1 '- ,:t .~. 1 ,. ~ " ,j') ',;, , ~ \5 " ."8 uel ~ ili roo.: G a: RESERVATIDN. Eltet.. of d~adent. d~lno on or blfar. D'c'~.r 12, 1911 -- If ~v lutur. lnt.r..t In thl ..t.t. I, tr~.f"r.d In po.....lon or .nJaVlent to C1... . (call.t."l) bln.flcl"l.. of thl dlcedent .,t.r thl IxplrtlJon of eny ..,.t. for 11f. or for y..r., the Co..onw..lth hlr.by I.pr..llv r...rv., thl right to IPpr.I.. ~ ...... t'ln,'.r Inherlt~c. TI... It thl Slwful el... . (co11".,.1) r.t. on any such lutur. Jnt.r..t. PURPOSE OF NOUCE. To'fulflll thl r.quln..ntt of S.cUon ZIlla of thl Inh,rUMe. end flbt, Tu Act, Aat Zl of 1991. 7r P.S. lactlon 2140. PAYMENT I Dttlch thl top portion of thl, Hotlel and tubtlt with your p.y..nt to thl Algl,te, 0' Will' printed onths rlVlr.. ,Ide. --H,h check Q~ lIonay o~da~ payabla tal REGISTER OF MILLS, AOENT All paw-ant. ~acalvad .hall fl~.t ba appll.d to any Inta~..t whIch a.y b. dua wIth anv ~...Inda~ appll.d to th. t... REFUND (CA)I A r.fund of at.. cradlt, which w.. not raqu..t.d on tha T.. A.turn, .ay b. r.qu..t.d by co~latlnD an "Appllc.tlon fo~ A.fund of P.nn'vlvanl' Inh.~ltanc. and E.tat. Ta." (AEY-1JIJ). Application. ara av.llabla at th. Offlca of th. A.gl.t.r of Will., any of th. 2J A.v.nu. al.t~lct Offlc.., or by c.lllng th. .p.clal 2~-hour en.w.~lng ..~vlcl nutbar. fo~ for.. ord.rlnDI In penn.vlvanla 1-8aO-S62-Z050. out. Ida Plnn.ylvanla and within local Harrl.burg ar.. (717) 7'7-8094. TOOl (717) 772-2252 CH..~lnD lap.lrad Onlv). OIJECTIONSI Any party In Intar..t not .atl'flad with tha .pp~.I"''"t. .Ilowlnc. o~ dl..llowlncl of d.ductlon.. o~ .......ant of t.x (Including dl.count o~ Intar..t) a. .hown on thl. Hotlc. .u.t obJ.ct within .I.tv (60) d.v. of ~'cllpt of thl. Hotlc. bVI --w~ltt'" prata.t to th. PA O.p.~tlant of R.v.nu.. Bo.~d of App..I.. D.pt. 281021, Ho~rl.burg. PA 17128-10ZI. OR u.l.ctlon to hav. th. ..tt.r d.t.r.ln.d at audit of thl account of th. p'~.on.1 ~.pr...nt.tlv.. OR --appa.l to thl O~phan.' Court. ADHIH ISTAAlIVE CORRECTIONS I Factual .r~or. dl.cov.r.d on thl. ........nt .hould b. .dd~....d In w~ltlna tal PA D.p.rtaant of RIVenu., Bu~.au of Indlvldu.l T..... ATTHI po.t A......ant R.vl.w Unit, D.pt. 280601, H.~rl.burg, PA 11121-0601 Phon. (111) 111-6505. S'I p.a. 3 of th. baokllt "In.tructlon. for Inhlrltanc. T.. R.turn far I R..ldlnt Olc.dant" (REY-lSOl) fa~ an ..planatlon of aa.lnl.t~.tlv.ly ca~r'otabla .rra~., tf any ta. due 1. paid within thr.a (J) o.llnd.r lanth' a,t.r thl dlc.dlnt'. dlath. . flv. pa~c'nt (SX) dl.count of tha ta. p.ld I. allow.d. Tha ISX ta. .~.ty non-participation pan.lty I. co.putad on th. tat.1 of tha t.. and Int.r..t .......d. and not p.ld b.for. Janu.~y 18. 1996. th. flr.t day .ftar tha Ind of th. ta. aan..ty p.~IOd. Thl. non-p.~tlalpltlon pan.lty I. .pp..labla In tha .... .annar .nd In th. th. .... tll' p.rlad a. vou would app.al th. t.x and Intar..t thlt h.. ba.n .......d .. Indlc.t.d on thl. notlc.. DISCOUNT I PENAL TV I INTEREST I Int.r..t I. ch.~g'd b.glnnlng with flr.t d.V of d.llnqu.ncv, o~ nln. (,) lonth. and on. (I) d.y frol th. d.t. of d..th. to th. data of p.y.ant. T.... which bac... dallnqu.nt blfara Januarv I, 1982 ba.~ lnt.r.,t .t thl r.t. of .1. (6X) p.roant p.r annua calcul.tad .t I d.lly r.t. of .000164. All ta.a, which bac... d.llnquent on and .ft.~ January I. 198Z will b.ar lntar..t at . r.t. which will va~y froa c.land.r y~'r to c.l.ndar yair with th.t rlt. announcld by th. PA alpart_ant 0' R.v.nu.. Th. IPpllcabl. Int.ra.t r.t.. for 1982 through 1996 ar.1 '!!!! tntar..t A.t. D.lly [ntarut Facto~ :!!!! [ntarut Rat. D.lly [ntarut F.ctor 1982 'OX .ooasu 1981 .~ ,oaazu 1983 16~ . ooa~3I 1'86"1991 11;( .000101 198~ IU .00asOI 1992 .~ .0002U 1915 U~ .00as56 1995-1994 n .0ODI92 1986 lOX .aaDZ1~ 1995-1996 OX .GoaZU "Int.~..t II calculatld a. follow'l INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Hotlo. I.suad aftar tha tax b.eol.. d.llnquent will r.fl.ct an Int.r..t calculation to flftaan CIS) d.v. b.yond thl data of tha .......ant. If plYlant I. .ad. .ft.r th. Int.r..t coaput.tlon dlt. .hown on tha Hotlc., addltlon.l Int.r..t au,t b. calcul.tad. .._..1;~~,,">"'~ -- JRD/June 30, 1992/17858 REGISTER OF WILLS Cumberlnnd County Courthouse One Courthouse Square Carlisle, PA 17013 NOTICE PURSUANT TO RULE 6.12 PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULES To: personal Representative Counsel: ROBER'l' C. SPl'l'ZER, ESQ., RE: Estate of ANNA I. BLOSSER , Deceased, Late of EAST PENNSBORO TWP Estate No,: 21_1995-0517 Date of Decedent's Death: JUNE 26, 1995 Pursuant to Rule 6.12, the above named personal representative or the above na",ed attorney. If applicable, within two (2) years of the decedent's death, and annually thereafter until adminIstration Is completed, Is required to file with the Reglsler of Wills a SlalUS Report as requIred by Rule 6.12, In subslantlally the prescribed form, showing the dale by which Ihe personal represenlatlve, or attorney. as applicable, reasonably believes administration will be completed. The purpose of this NOllce Is to advise you that unless the requisite Status Report is flied with the Register of Wills or Clerk of the Orphans' Court, as appropriate, wIthin ten (l0) calendar days after the dale of this NOllce that the Register of Wills Is required to notify the Orphans' Court Division, Court of Common Pleas of such delinquency and to request that said Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent penooal representative and the delinquent personal representative's counsel, If any. Accordingly. If the requisite Status Report Is not filed by AIlGtlS'l' 6 , 1921, you are hereby advised that a request will be submitted to the Court In accordance wilh Rule 6.12. ,-\f\ ClJU (i.' . Date: JUI,Y 23, 1997 Disuibutloa to Estate File , . . ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent I ;+1\ Itt.( .r: f3! 0 >5e-f Date of , Deathl C /..C /75 '2/1/ f5 Admin. No, 0517 Will No, , Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estatel 1. State whether administration of the estate is complete I Yes No t.- 2, If the answer is No, state when the personal representative reasonably ~lieves tha~ the ~dministr4tjon will be complete I U f) r.. e.r f'tt i 'r G 1\ VlI. dJ 1?'1I1 ell'; or" fr u tr~ ~ ~ J, If the answer to No. 1 is Yes, state the followingl a, Did the personal representative file a final account with the Court? Yes No 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 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 att ed to this ort, Datel rz/Z.?/97 P') , p.: :( r.J ,": ' '~ t_~. ,-) 1'1 RJ ~ HJ b ek I- C. \' t .z:t...f Name (Please type or pint) J? 'If 120~7 II trY- I ~. r1/()8 Adtlress I [717, ::z.'3/-;;r.0lJ. Tel. No. ,-, :" til.L a: r- P' _~5 uc.; Capacity: Personal Representative Counsel for personal representative (HAH:rmf/AHJ) .. -. ~.:-._.... - .~~,-.-.. .~- ,.......~,~"'...,~., "-'-,-~,",-"",,,, 81' A TU8 REPORT UNDER RULE 6.12 Name of Occcdcnt: ANNA I, nLOSSER Will No. Date of Death: June 26. 1995 Admin. No.21-1995-0517 l'orsuanlto Rule 6.12 orthe SuprC01e Court Orphans' Court Rules. I reporllhe following with respect 10 complc\lon oflhe administration oflhe above-captioned eslate: I. Slale whc\her admlnlslrallon orthe eslate Is complete: Yes_ No.1L 2. Irthe answer Is No. slate when Ihe personal reprcscnlallvc reasonably believes Ihal the admlnlstrallon will be complc\e: ONE YEAR Yes 3. Iflhe answer 10 No. I Is Yes, state Ihe following: a. Old the personal represcnlallve me annal accounl with Ihe Court? Yes _ No b. The scparale Orphans' Court No. (If any) for Ihe personal reprcscnlallve's accounlls: e. No_ Old the personal reprcsenlallve slale an accountlnfonnally 10 Ihe parties In Inleresl: d, Copies ofrccelpls, relcases, joinders and approvals orronnal or Infonnal nccounls may be med with Ihe Clerk orthe Orphans' Court and may be allnched 10 Ihls report. Dole: JULY i1. 1998 O,!!1 tJJC: :' ;::' , *.. 0 '-J io :Ij u!r1 ~.~ a: a: ny (. ROBERT C. SP fZER 407 North I'ronl Street P. O. nOK 12087 llarrlsburg,PA 17108-2087 7171231-7600 f"'l N o E:;: 131f r,'t ) cja !.~ Capacity: _Personal Reprcscntatlve ....x.. Counsel for Personal Reprcscolntlvo o N " ~ ~ u 01 .~ .0 .~ ~ do STATUS REPORT UNDER RULE 6.12 Name of Dcccdcnt: ANNA I, BLOSSER Date ofDcath: lune 26. 1995 Wlll No. AdmIn. No,21.1995-o517 , Pursuant to Rule 6.12 oflhe Supreme Coun Orphans' Coun Rules, I repon the following with respect 10 completion of the adminlstratJan ofthe abo\'e-caplloncd eSlale: I. Slate whether administrallon of the eslate is complele: Ycs_ No.1L 2. If the 8flSlVCr is No. Slale when the pcBOnal rcprcscnlall\'e reasonably believes that the adminlS\rallon will be complele: ONE YEAR 3. Ifthe 8flSlVCr to No. I is Yes, slate the follo"ing: 8. Old the pcBOnal reprcscnlatl\'C flIe a final account "ilh Ihe Coan? Ycs _ No_ The separate Orphans' Coun No, (if any) for Ihe JlClSOnal rcprcscnlallvc's account is: Old the pcBOnal rcprcscnlatJ\'e Slate an account informally 10 Ihe panics in intercsl: b, c, Ycs_ No_ d Coplcs of receipts, releases, joinders and appro\'als of formal or informal accounts may be flied with the Cleric of the Orphans' Coun and may be atlachcd to tWs rcpan, Dale: Mav 6. 1999 BY ROBERT C, SPITZE 407 Nonh Front Slreet P. O. Box 12087 Harrisburg, P A 17108-2087 717/231-7600 Capacity: _ PcBOnal Rcp=i\'e -ll Counsel for.". I Reprcscnla~1'C:r) .: I!:; i:',~ ~ - o ~.:f ~.-, (J\ .:, 1....1 C/ Name of Deccdenl: ANNA I. m.OSSER Date of Death: June 26.1995 Will No. Admin. No.21-1995-0S 17 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the tollowing with rcspect to complction of the administration ofthe above-captioned estate: I. State whether administration of the estate is complete: Yes_ No.JL 2. Ifthe answer is No. state when the personal reprcsentative reasonably believes that the administration will be complctc: ONE YEAR 3. If the answer to No. I is Ycs, statc the following: a. Did the pcrsonal rcpresentativc filc a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the pcrsonal rcprescntative state an account infonnally to the parties in intcrest: Yes_ No_ d, Copics ofrcceipts, relcascs,joinders and approvals oflormal or infonnal accounts may be filed with the Clcrk of thc Orphans' Court and may bc attached to this report. o. 'I) '(5 tr: - ~~ ~ ~ Date: ~ay 8. 2000 . SPITZER, P.C. i~, ~ :2:';' o -..:.! i!ll~ 0:0: ~ :'1.- BY C ROBE T C. SPIT . 407 North Front Strect P. O. Box 12087 Harrisburg, PA 17108-2087 717/231.7600 ,~ .D ;:;c..: ~5 uu !3 Capacity: _ Pcrsonal Reprcscntatiyc -X. Counsel tor Pcrsonal Rcpresentative , . . . u~ . Poslal Scrvicc CERTIFIED MAIL RECEIPT {f)/I"'f'~tll: M.1I1 Dilly, No "t'HII,IIICI' Covvr,lf/o Ptovll/m/} 'ITI .... e a- :r a- LI1 .... iLl1 ,MJ ;e . e Po,lag_ , ClttlfoedF.. PotlltlAfk tl.,. "etum AK!lipt f.. (tndotHtMnl Requndl RMtnetedOlltveryF.. ~R~ed1 1 CJ ToW po.leg' & r... $ Ie i ~ .:~~:: . ~f11.JT.rsrr::..:=.................... i ~ .; ~l. ~jr.A'~~P.",~,r.................................,.............. , ..,.,..'......""'_."''"...c'~'''''''''~....''~.;'ffP .___.._____----...~-_..~.._n_~~. _ , ! I , . Complele"ems 1, 2, and 3. Aloo complete "em 4 " Realrlcted Delivery II dlllred. . PrInl your name and add.... on the rev,"" 10 lhal WI can return the catd 10 you. . Attach thll catd to Iha back of the mall piece, or on the fronl " Ipace pemlltl. 1. __to: 1?D5f4rr C.~P,T~~. 1DI:~. 7J!1) -s r rt .MI)BlARq -fA ./1IOK 31:0l\'PO I C<<tlflod Moll [] Ex,.... Mall I Roglalarod [] Return RocoIpt 101 MllId1andl.. I [] Inautod Moll [] 0.0.0. 4. RoIlrictod Oollvory'l {&Ira Foe) [] V.. , ... . \1~~~q4--q()l3- I lie Relum Roc:olpl ,,<_,,,,-"~,..~.._~_~.-.... .. ".." - ,'~_" .. '.'. '. ._. '_~""_'_'"_'_''_''' ,..-..".-0....- ",_,,_, .. 102$05-.....1710 _.~~._.~_.........'""_., l , .... , h ..~' ':\ . . t , ~ "- \' \. ',' " , "j .. , () STATUS REPORT UNDER RULE 6.12 Date of Death: June 26. 1995 Name of Decedent: ANNA I. BLOSSER Will No, Admin, No.21-1995-0517 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration offhe above-captioned estate: 1. State whether administration of the estatc is complcte: Yes No .2L 2, If the answer is No. state whcn the personal rcpresentative reasonably believes that the administration will be complete: ONE YEAR .~, (. '. BY ROBERT C. SPIT E 407 N0I1h Front Strcet P. O. Box 12087 Harrisburg, P A 17108-2087 717/231-7600 3. If the answer to No.1 is Yes, state the following: a. Did the personal reprcsentative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account infonnally to the parties in intercst: Yes No d. Copies of receipts, releases, joinders and approvals of fonnal or infonnal accounts may be filed with the Clerk of the Oll1hans' COlll1 and may be attached to this report. Date: July ]3.2001 r"'J - ,- >._- .:J Capacity: _ Personal Representative -X. Counsel for Pcrsonal Representative , C/ ~ 12 Name of Decedent: ANNA I. BLOSSER Date of Death: June 26. 1995 Will No. Admin, No,21-199S-0SI7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report "he following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes-X... No_ 2. Ifthe answer is No. state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes _ NOlL- b. The separate Orphans' Court No. (if any) for the personal representative's account is: e. Did the personal representative state an account informally to the parties in interest: Yes..lL No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. See Attached Family Settlement Agreement. N ".' ':J ", : ;{ . .J,~ Date: Fe1)ruary 20: 2002 o N .' .. tt! ,j .> .J R 'i;ij <lJ -~ .Q ~ ~ l= ID(C ~ a: OJ= "'(3 '...J ROBERT C. SPIT ER, P.C, t:L;' / - 2- BY Ii '( . ROBERT C. SPI 407 North Front Street P. O. Box 12087 Harrisburg, P A 17108-2087 717/231-7600 Capacity: _ Personal Representative --2L Counsel for Personal Representative ~ -' . . FAMILY ESTATE SETTLEMENT AGREEMENT AND NOW Ihis :::Ji., day or 01C.l..,.\ c:.fi.... , 1996. DONALD A. BLOSSER. 'Blosser' or 1039 Slote Road. Doncannon, PA 17020. an aduh individual, and JEANNETTE F. POLLY. 'Polly', of 2411 wIer Coun. Belhlehem. PA 18017. an aduh individual. hereby enter Into Ihls Family Eslale SeUlemenl Agr...JllCllt. I. BACKGROUND: Blosser and Polly arc the only sorviving childr,~n of Anna J. Blosser, deceased. No olher Issue or Anna I. Blosser an: noW surviving. AMa I. Blosser died on Jone 26. 1995. InteSlale. and Blosser has been appointed as Adminimalorof her Estale. Blosser has engosed Roben C. Spilzer. P.C., 'Spitzer" to reprosenl him as personal rcprcscnlatlve of the Eslale. and Blosser and Polly have been advised of Iheir righls 10 obtain independent counsel In connection with entering inlo lhis Agreemenl. Blosser and Polly confirm Ihat Ihey have direcled Spitzer to provide this Family Eslate SCltlemenl Agreement whereby the following undemandings they have reached would be memorialized. CJ!L C1lossex- First, Polly will receive one.half of a Keogh Plan balan~ :hich she Is entitled In the sum of approximately Fifl<l:n Thousand Dollars ($15.000.00); second. ill be respoasible for OAI halfef the Pennsylvania Transfer Inheritance Taxes incurred by the Eslale: Ihird. Polly will be rcspoasible for ORI hall' .1' V~ Ihe legal fees incurred by lhe Estate: founh. Blosser will have responsibility as personal represenwlve 10 administer and settle the Estate. and shall be entitled to one-half of the Keogh Plan balance. as well as all of the other nel assels of the Eslale. Blosser and Polly acknowledge that Spitzer has advised each of them Ihatll is premalure 10 enter into such an Agreemenl. bcca1Se the extent of asselS and lIablllties owned by the decedenl arc nOI yet clearly known and Iherefore this understanding could be 'unfair' to one or the olher. because of future circumsl"ccs thai an: unknown. Blosser and Polly have reached Ihis Agreement as to Ihe lerms and conditions onder which the Eslate of AMa I. Blosser would be adminislered and divided and paid and dlmiboled on the basis of the uoderstandlng each has or Ihe goals and objeclives and lnlenlloas of Anna J. Blosser. II. AGREEMENT: In consideration or the premises, the mutual promises conlained herein. and Inlending to be legally boond he~by. Blosser and Polly agree as follows: I. Blosser shall administer Ihe Eslale in accordance with law. and shall be enlitled ID all of Ihe nel asselS or Ihe Eslale clcepllng only ror an approxima:e Fifteen Thousand Dollar (515,000,00) balance due and payable IU Polly uoder a Keogb Plan owned by Ih. leceased. ~.\~ \ .~:C':.f..-.,q.-H........,,,,,,,-",,,,.,,.....~_o*_......"~...___,...,,.,,'_;i"'."_. . ... ;, , 2, All Olher lISKlI, and relpnnsibllhy for payinll all olher bllll (except as expn,nly lei fonh herein) shall be Ihe rapoOllblll1y of BluS5~r, (3/. S-Se<" 3. Pellrallrces 10 be relponslble for 8110 1I.1r .f Ihe Pennsylvania Transfer Inherilance Tlltes due and payable by vlnue of lhe dealh of Ihe dcccdcnl; Ilk~wlse, Polly allrc~s to be responsible ror I or r the Ic.1I fees incurred by Blauer In canncclion Wllh Ihe udMlnlSlfallon or Ihe Eslale. (" ~ (TO tJ . ') INTENDING 10 be Icplly bound h~rcby, Ihe I'ani~s herelO have scllheir hands and seals the day and yell nrst above wnnCft, ~:b <JI-:2~tf/ ~ ~~~ - DONALD A. BLOSSER (SEAL) ~~ (SEAL) '. ~- ~ .' ~ '. COMMONWEALTIl OF PENNSYLVANIA: 55: COUNTY OF DAUPlIlN: On Ihis Ihe d (0 r} d~y of "JrlI'J.lA It , 199.k.., before me. A NOlary Public In and for said Commonwellth lIll~ County. Ihe undersigned officer. penonlllyappeared DONALD A. BLOSSER, known 10 IIIC (or ullsfaclory proven), 10 be Ihe person whose nlme Is subscribed 10 Ihe whhln Insuwnenl, lIlld acknowledged Ihlt hclshe exccoled Ihe SAme for Ihe purposes Ihereln coRlalncd, lIlld desired Ihe same 10 be recorded IS such, IN WITNESS WHEREOF, I have hereunlo SOl my hand an~ NOlarlal Seal. NOTAq\Al SEAL JUDY ~ I~~ES, r;LI'If'/ p"~'IC Ilarn~b"rll, Oa"ah."~ t,",Jr.ty ~97 M1 Comm;~s!on Exan.> "to\. 8. I COMMONWEALTH OF PENNSYLVANIA: COUNTY OF /)~ .~ 211 1. . On lhis Ihe d ~ day of CUA'. . 199~. before me, a NOlary Public In lIlld (or said Commonwealth lIlld County, the undersigned officer, personally appcand IEANNETIE F. POLLY. known 10 me (or salls(IClory proven), 10 be Ihe person whose name is subJcrlbed 10 the whhln Insuumenl, lIlld aclcnowledged thaI he/she execuled the same (or Ihe purposcs lhereln coRlllncd. lIlld desired Ihe ume 10 be recorded as soch. IN WITNESS WHEREOF. I have hereuRlo sel my hand and Notarial Seal. NOTARIAL SEAL mission Expl s: JUDY A. IMES, NOl3ry Public Hafflsburg, Dauphin County My Commission expires Sept. 8, 1997 ,.~ ,~