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PETITION FOR GRANT OJ. LETTERS OF' ADMINISTRATION
Estate ojTI-lJ."M.l\s AI~t'H_~r:AI~~A
also known as
No. ~/-?O-~37
To:
DecellselJ.
Social Security No. I g I -.;; (.. - "''',-L
Rcgislcr of Wills for thc
Coumy of CUMBERLAND in lhc
COlllmollwcalth of Pcnnsylvania
The petilion of thc undcrsigncd rcspcctflllly rcprcscms that:
Your pctilioller(s), who is/arc 18 ycars of agc or oldcr, appl ; ""
for ICllcrs of administralion
on the estatc of
(d.b.n.: pendente lite:; durante ab~cnlia: durante minoril:llc)
the above dcccdenl.
Decendent was domiciled at dcalh in C '"' M." .5..... AN l7 CounlY, Pennsylvania, with
hZs last family or principal rcsidcncc at -T-' c. c~~ K"~.v S7'.
(list MrcCI, number and municipality)
Dcccndent, then -L"l- years of agc, dicd F t:r B ,\... A... Y "I
at j\.i:r bO ,-1!.7:"cX T':'WRS H.r P ~ C "'l\o1:lJ~Il.L..A...vD C n....N~V
,19 go
. Decendent at death owncd propcrty with cstimated values as folllows:
(If domiciled in Pa.) All personal propcrty
(If not domiciled in Pa.) Personal propcrty in Pennsylvania
(If nol domiciled in Pa.) Personal propcrty in Coumy
Value of real estate in Pennsylvania
situatcd as follows: N~ AJ~
$
$
$
$
1,011.+"2...
Petitioner_ after a proper search has...- ascertaincd lhat decedcnt lefl no will and was survived by
the following spousc (if any) and heirs:
Name
PL.""'-/> A. i3...
Rclatiollship
Residence
<'
/bCt)
Ie.. Car.'
M..=o:.II",<; ,1'...
/ "'4.
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THEREFORE, pctitioncr(s) rcspcclfully rcqucst(s) lhe grant of leltcrs of administration in the
appropriale form to the undcrsigned.
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OATH OF PERSONAL REPRESENTATIVE
The petitioner(s) above-named swear(s) or aflirm(s) that the
statements in t:te foregoing petition are true and correct to the best
of the knowledge and belief of petitioncr(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
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COMMONWEALTH OF PENNSYLV ANIA
COUNTY OF CUMBERLAND
Sworn to or affirmed and subscribed
before me this _ 9 -j;I). day of
?lJ g b$~~<I\ 19:.ll<-
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MAR t:;}tEWIS Register
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No. 21 - 80 - 637
Estate of
THOMAS A. BOLLINGER
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW DECEMBER 9, 19~. in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me.
IT IS DECREED that FLOYD A. BOLLINGER
is/are entitled to Letters of Administration. and in accord with such finding, Letters of Administration
are hereby granted to
FLOYD A. BOLLINGER
in the estate of
THOMAS A. BOLLINGER
FEES
Letters of Administration ..... $
Short Certificates( 1) . . . . . . .. ., $
Renunciation ................ $
$
TOTAL _ $ 22.00
Filed .. ..1?~<;:!,.I>,l!3.~~.. 9.,.. A.D. 19..81i--
18.00
? 00
2.00
ATTORNEY (Sup. Ct. 1.0. No.)
ADDRESS
PHONE
21 - 80 - 637
RENUNCIATION
In Re Estate of
'tf;oma.s A. Bol!/I7JI(>~
deccased.
To the Register of Wills of C ,/ m h e j( L a 17 (I
County, Pennsylvania.
The undersigned ,4,.., /J fA IIi\. ,f; c> ! !.,' ny .' /.!. " ,m " i),~ of
the above decedent, hereby renounce{s) the right to administer thc estate and respectfully ask(s) that Lellers
"f .4 r/ ,..",/1 ,... -f P-. t:f + " 0 n
be issued to
FL? 4 .A. 8() / I ,'';},f'/.!.
WITNESS
hand this q ilL day of j)e':(,/?>))P".19~.
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(Signature)
Lf/6 c..oc.j::.L.,'" -S-t,
Mt>,- h(,,,"c.>-b-"~<l) PA I?OSJ
(Address) "7
(Signalure)
(Address)
(Signatun:)
(Addre!is)
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Commonw..lth of PennsVlv.nt..
Dlpartment of Rlvlnu.
Tr.nsfer InhtrU.nc. Ta'IC
A..ldlnt O".'tdant
Re,,~64 EX+ (1.80)
INHERITANCE TAX RETURN
FOR ESTATES WITH GROSS ASSETS
UNDER $10,000.00
Estate of JI+('}."VfA\; A. l~c)~......x:...--I..c,t...:l\:'
1()-(,-fO
.
Dete of Death I~ L" r!, C( '< " ,,'( 9 , I '1 j' 0
.
Last Address
+1[, C"'io; L. :rN ST,
Social Security # J "if I - ""-" ., .$" ,-. Go 2..
Mc,:CNA"I;t::(~ e'/t{(., . PA
(
(Cltv) (Scace)
Bureau File # 0 /'3 'i 0 '11~
17(J~;-;;-
fZip)
County File # .;J/- flo.t,.3 7
1. Decedent died;
(51l Intestate (without a will)
o Testate (leaving a last will - copy attachedl
2.
o Executor/Executrix
13l Administrator/Administratrix
Name r- L oY L":> /t. 'is ,., ~ C :r' N r:, <: t~
Address 4-/1D C,,-...i" L.~N s,.;-:
/trt i.,...:e-..i ^ M r c \ 1->, ~ t?c,
IClIv)
F/~.
(Stote)
;7 CJ S" S""
(Zip)
!
3. All correspondence should be mailed to 0 Attorney (2;I Fiduciary.
4. If an attorney is representing the estate, indicate:
Name
Address
ICilV)
(State)
(Zip)
REAL PROPERTY - Idemifv real property located in Pennsylvania by lot nnd block number, street address and
include iJ statement of mortgage encumbrances as of the date of death.
Estimated
Market Value
N""",iE
Total
//-/3.2-1
Department Valuation
(Official Use Onlv)
N.,.,!.&
DEBTS AND DEDUCTIONS
Dlte
Nama of Paveo
Nature of Debt
Amour,
=
MA,:c.:,.1
It..,
l(l~O
;'::~N~:'ltA'" 14u~v''-:J X;(jc:..,
I.$C.UAIII rC\.;1 '-4 ~r. i~.r
Funeral expenses paid
t: ~O
:1."1 <.. "l. -
Family cKcmption (wil: nOl be allowed unless dcc~dcnl died
r..>siding with a parent. SI)Quse or chlldren.l
Admini..tration Expenses
Counsel Fees
Fiduciarv Commission
(Other Debts and Claimsl
Total
It
.~ '1'2....
so
Under penalties of perjury, I declare that I have examined this return, and 10 the best of my knowledge and belief, it is true, correct and complete.
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U Signature of Fiduciarv q
~~~
Dale
I do hereby certify that 1 have appraised the assets contained herein in conformity with Pennsylvania law.
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Appraiser Date I I
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
f'6te on any such future interest.
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~isterofWills
Debts and deductions are allowed in the sum of $
percent.
/..'2 - 1"- J?)
O.ate
,,'Mel ^q alqeJlJ^O:llJJ aJe 1unowe a>l!l JO slqap se anua^al:;l JO 1uawucdaa il41 ^q paJiMO:laJ aq 01 Jassal a41 S! JaAa4:>!4M
000' 1$ JO anp aq 01 punoJ Alale"'!lln xel aliI JO %9l10 Alleu.el e 01 . . . alqe!l Alleuosmd aq lIe'ls . . . W!lI 10 p.J!nbaJ )Joel.J J.'IIO
JO UJOlaJ e al!1 01 sl!eJ AllnJll!M OllM uosJad Aile' . '" le'll sap!^oJd alnlelS 1961 alii jO 16L UO!lOas - NIln.L31l 3'1~ O.L 3Iln'IV~
'popad 41uow.au!u a41 U!41!M anua^al:;l JO AJe1aJ:>as 941 ^q
palUeJ6 pue JOI pa!ldde uaaq sell 6u!!!1 JOj UO!SUaIXa ue "alun ''Ileap s,lu.pa..p a'll JalJe slIlUOW au!u .np S! umlaJ a'l.L - ~NI1I~ 1l0:l 3WlJ.
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AEY.4U EX+ (M01
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0637
~ Original
o Supplemental
o Remainder
File Number
Estate Name
BOLLINGER, Thomas A.
Date af Death
02/09/80
Sacial Securi ty Number
181-56-5662
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I nave appraised the real and personal property as reported In the foregoing
retum at the values set forth opposite each Item In the last column to the right in Schedules "A", "8", lie", and "E"
Dated:
December 4, 1980
$1 "''' f,} J 1P/~J9 'l.. "i )
INHERITANCE TA,X APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schedule 8)
Joint-Held Property (Schedule E)
Transfers (Schedule C)
$
None oa+
1,011 42 la+
None 20+
Kone 30'"
1,011 42
40-
93-
92+
TOT AL GROSS ASSETS
less D.bts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONL Y
Tax on $
CODE
COMPUTATION OF TAX
S
S
S
S
6"
"
Tax on $
15%
Tax on S
Tax on $
Tax on $
s
Exemptions
Total Estoto
TOTAL TAX
INTEREST FROM
BALANCE
s
s
s
TO
Less Credits
DA TE OF PAYMENT
INTEREST
DISCOUNT
TAX CREDIT
AMOUNT PAlO
S
+ $
S
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INTEREST FROM
BALANCE OUE
BALANCE
TO
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