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Home My WebLink About04-16-08 (2) -I 15056051058 REV-1500 EX (0fH)5) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year ~\ 01 File Number O(P~ Date of Birth 088-30-0715 03/10/2007 04/03/1938 ~lCedent's Last Name Suffix ~nt's First Name MI E'olella Barbara c (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FIILL IN APPROPRiATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CIORRESPONDENT - THIS SECTION MUST BE COMPLETED. AU CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ", (J = (201) 841-12$20 :3.5 c :.r~TID ~ .>'-- ~ ,c-[T', .-.c :TJ U):;.." ~JO ~:,2 -h ~ :ii ---; j;2 4. Limited Estate . 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes VVilliam L. Bolella Firm Name (If Applicable) en Fiirst line of address '124 Wolfpit Rd :> ::II: ~; I:~ -n ("'5 '-TI Second line of address .r::- eo City or Post Office Sussex State ZIP Code NJ 07461-3900 C~rrespondent's e-mail address:WBolella@aol.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. SIG~Rr, RE~ILlNG RETURN 4;~L~~ i ADDRESS -.:124 W~lfpit Rd., Wantage, NJ 07461 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---l ~~ --' 15056052059 REV-1500 EX Decedent's Name: RtECAPITULATION Barbara C Bolella 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. B. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 1'1. Total Deductions (total Lines 9 & 10). . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15,. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate x.045 120,147.90 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . .. . .. .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 088-30-0715 Decedent's Social Security Number 47,684.67 718.36 113,363.20 161,766.23 19,019.95 22,598.38 41,618.33 120,147.90 120,417.90 5,406.66 5,406.66 15056052059 .-J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Barbaral C Bolella -- --- STREET ADDRESS 6343 Cl'eekview Rd File Number DECEDENTS SOCIAL SECURITY NUMBER 088-30-0715 -- f---------- - CITY Mechanicsburg I STATE PA ~----Tiip I 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CredilslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,406.66 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penany 134.75 TotallnterestlPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Une 20 to request a refund. (4) 134.75 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter Ilhe interest on the tax due. (SA) B. Enter Ilhe total of Line 5 + SA. This is the BALANCE DUE. (58) 5,406.66 134.75 5,541.41 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) pE!rcent [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) Oi)]. The staMe does not exempt a transfer to a surviving spouse from tax, and the staMory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs tineal beneficiaries is four and one-half (4.5) percen~ except as noted in 72 P.S. ~911€i(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value oftransfers to orforthe use ofthe decedenfs siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the deceden~ whether by blood or adoption. REV-Hi08 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Barbara Coles Bolella FIl.E NUEER 2107-0669 Indude the prac;eeds of IIIgalIon and the dale the proceeds were received by the estate. AI pnIpIfty ~.. with rigIlt of lIIIIVMnIllp IIllISt be dilcloMd on ScMd.!de F. ITEM NUMBER DESCRIPTION VAlUE AT DATE OF DEATH 1 Total Control Account Met Life - TeA Money Market Option 404-4029203 2 Toyota Avalon - 2001 XLS - Fair Condition - not I'lIMing - 44,390 miles value per Kelly Blue book II 38,769.67 8,915.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert addilionaI sheets of !he same size) 47,684.67 Total Control Account~ March 2007 Account No. 404-4029203 Statement Period From 3/01/07 To 3/31/07 Page 1 of 1 AH.l6767D- TCA1PB11 BAIRBARA C BOLELLA 6343 CREEKVIEW ROAD MEiCHANICSBURG Your Representative: HINZ MARCUS J PA 11050 Branch servicing your account: ATLANTIC CST FI GP 168 FRANKLIN CORNER RD 2FL BLD 1 LAWRENCEVllLE NJ 08648 (609) 896-0013 (800) 638-7283 Telephone: Customer Service: If you want to write to the Total Control Account department, please write to us at: MetLife and Affiliates, Total Control Account, 485 E US Highway 1 FL 4. P.O. Box 4121, Iselin. NJ 08830-4121. Please remember to sign and include your account number in your correspondence. TeA MONEY MARKET OPTION (MMO) Ef(~(;JI~f;. fJ.,nrwal 'field 4.10% as of 03/31/07 Account Summary BeginningB.:llan;e . $38,769.67 $132.57 interest Ending Balance $38,902.24 $394.11 $0.00 Year To DatE! Interest Year To DatE! Federal TaxWUhhel-dHH Transaction Details Trans Oate Date Written .-.. -.... ---. .--.... --- . .- - --. .. -- --.. - -,. -- .'" --- .",.. .ActiVIDt. '.' .. "CbeCkNo.,'X:J~~F:l'iptiOA Interest Amount ::;'31 $132.57 III1IIIIIIII 'Cl1921l3I)W. Kelley Blue Book - Trade-In Pricing Report - Toyota, Avalon Kelley Blqe Boe~ THE TRUSTED ItE50UICf .:.C'.>:.rtisem'.:::-::: $~,OO@ TOTAl. CASH BACK .03 Chevy fqlbtG;l r-- New Cars Used Cars Research & ExDJore News a Reviews Oassifieds Auto Loans &. Insurance Compare Vehides I Perfea Car Ander I Most Reseatcbed Used Vebfdes Honle. Used Car Values Classitieds 1 Certified Pre-Owned -,...- ZIP Code 170551 Chong<; Home > used, Cars > 200) > TQyot.! > Av~ > 4-doot XL5 5ed.-:II 4D Recently Viewed You Might Also Like Free Dealer Price Quote 204)1 Toyota Avalon XLS Sedan 4D T'.ade-In Value Private Party Value Suggested Retail Value Photo Gallery CClmpare Vehicles li~~~f! RE:!view CClnsumer Ratings Find Your Next Car Spedficatlons ,~ Shopping Tools Fr~e CARFAX Record Check Auto loan from 5.74% AM compare lnsu,.ance Rates Pa,.ment Calculator SHllOtiR USED m on Blue Book Oassifieds- Reach millions. of shoppers Of) kbb.com. AutoTrader.com, and other popular stl:es. toln" Out more, Clldt. 6Ui' ~. Ij Sfl; (t.~ on IItue Boote Classlfieds'" JToy(lta fA~~n ~Ijles or less . ..::J ZIP Code fl70S5 To View Ads, Click liNE) IHf 'tIGhl CAR ComJ.are Used YS. New 1 $5,000 to 510,000 ..::.J fBOtil New and used ~ ~~ To Vi'l:w List" Click VIP:' MOTHER HHI(lf fScled:~ ~~._; 8f eliM1'ij1,"l1f't'8ag'Y BLUE BOOK TRADE-Hi VALUE _~"'_ f _ "-"_,--.~~.; ..,,:~1IIIlQ More Photos NEXT STEPS: SearCh Local LIStings: ~ View Toyota Avalon Sea<<:h aR aasstfieds tn 17055 Most ReseafChed Sedans Condition Finance &. Insurance Value ~---.-.; r'" E}:ceHeii.~ Get a New Car loan from, 5.74% APR Get a Pre-Owned loan from 6.09% AM $1.0,700 G-Ood $10,050 \A'air $8,915 You,. Credit Score for Free Get Pricing on New Vehicles Sell Your Sedan Get a free lnsucance Quote ,"1(.VCi-tlSefl'l.2,nt Average Consumer Rating (77 Reviews) Read Revtews 200S Ford Taurus ~~ Photos I'rif;jng Similar New Vehicles ..:.i ..:.i 2008 Toyota Avalon ~]= More Results >> Check Out Our 10 Most Researc:bed Sedans 2009 Toyota Camry 2009 Toyota CoroUa 2008 Merc:edes-Benz C-Class 20GB ~n"" CTS 2008 Toyota A'falon Check out New Vehides From Toyota http://www.kbb.comIKBBlUsedCarslPricingReport.aspx?Manufacturerld=49&Yearld=20... 2008 Honda Accord 2QQ8. t\oncIe. Cloric. 2008 Nissan Alttma ZOOS _MAZDA3 200__ n Vehicle HigtHigh~ Mileage: 44,390 Page 1 of3 Pnnt Emall 212012008 KeUev Blue Book - Trade-In Pricing Report - Toyo~ Avalon Engine: v6 3.0 Uter Transmission: Automatic Drivetrain: FWt- Selected Equipment -- ,oJrCo__ Power steerinO Power Wlndows Power Door loclts TlItW_ Change EquIpment ervlSe Contn>I AM/fM Stereo <=- """'............- Fnlnt Side ..... _ ADS (4.W""el) Dual Power seats _WheelS 0ptt0nIII HuRl eo_ 0I0c: ......- _Roar BlUe BOOk TraCle-.lft Value Trad:e~ln Value is what consumers can expect to receive from a deafer fOr a trade-in vehk:Je aSSUming an accurate appraisal 01 condition. This value wilt likely be less than the Private Party Value because the reselling dealer incurs the cost of safety Inspections. reconditioning and other costs of doing business. vehIcle Condition Ratings Check Vehicle Title History Excellent SHt700 Q looks fI<:\'" }$ in (;-.'\c~Hen: fH~-,dl;jilll:,~1 {.(~"'lit;QiI ,"'.J,t l!tcds n'.; r€COf~ct:ftionin~_ )"eVer Ilao .:3nV paliH or WiG)' ;,'ion: .'tHO' IS tr,~", Dr rw;(. Clean title history anti W11J p"ss <;> snujq a.:'J Siirety if\5Vt:\:.t:;;;:i. ::I Engln...: Cnil1pa~tment 15 d<e~ln, ,."th 110 ttuicl le~f:5 dfhl 15 ;1'(;;>0 ;)t dUt \'iei:n (,.r \!lsihi~ de(t.."ns, <;. _._Qmplet.;' ann v~rih.ab\~ 5er"rlre rct!u:,1s.. ~':"s:." than ~';c of i:iiJ usee veliiC~s ~z-H into this ~.ah::{jG-11, (jOod $ l.{}rOSQ C> fr'~e 01 <oliY fll~Jl,). tldt:cts ::.- LJ~l1n UUe history, m-e !}amts, Way, el/}u lntcia;.'f he';...: '}.Iih: minor {If any) blemish~s._ af>-d there are an ma;or Ir;€ctlamc,]l probtems " UU!.,~ or no rust CI) thi'S ...eWcie. (:< j IH~5 nwtcn ana fkf\fe 5uUSoltiHtk11 tn:ati WEdf ie~t So j:.. "g':1cd" ~etHc!e ..-/m nee<t <;.Orne rf'!:CiJn~li;jo['.lng to t'l:" ",,'\k,i <11 '~.'!~li ~.l<-'5t consumer own~d '1~hjc1-<:-s rt::/.l intD !his C:.:::fltgcr,' Fair $8,915 . Some mechanical or cosmetic defects and needs setvlctng but is sUU In reasonable fUnning condition. . t...tean tloe fUStOry. me parm:. DOdy afld/Ot' It'Itenor need work performed by a prof6sional. Tires may IIeeIl to be replaced. There may be some repairable rust damage. Poor Nff1 {:> ~;e'/e,e OlCCi"lrtllit;di dl;d/o.- (<::l:>.:netlc 'J~kcts "pH1 ;.0; :p 1"~'J1 .<.:nql~'} ~(lmj;bO"n. !'-lay n<>ve ~obkms th~t cannot t~ t'~,,:.d<jy ti;;r;f-;d sud; as ~ dlltn:;t'lt:'O frame cr iJ rust~d -through Ol->G}', " ~ Rrdn,l~d tiHe (5~h.'il"ge, nO()d, etC} or Ufi5uhs!<m::ak~ mi~6.q~ r:.ei!(oj' 6lue SOO~ does:mt attempt to [cL-ort .a ,,'aitlt' on a ~p.:wr' ve;,;,..::e teCdas.>: :he Vd!l;e of the:;-e: \'eh~tes vancs 9FCiltfy _ A vetJ;;cj~ ;:. 1.1::::0. c-:>rH:titkJn may re.-:atir~ ill.. iUdepentie:i! ap;:i~ili$,'! 1.0 ~!:erm;n.;:;: it,; "'az~. .. PennSYlvania 2119/2008 Accurate Condition Appraisal Change Condition Accurately appraistng the condition of a vehicle Is an important aspect in determining Its. BltJe Book value.. Taking our 16 question condition quiz will ensure you know the correct conditiOn ratlf\g~ ..- rV {.{.,,(S /,4 t 11/( Y I ! J 11.t). t /, 77 1~ t .", " . I ,,, ,"".' fi.> "- .~ l1-- 1_;" ;-:,.. l'-,.;--;.~, ,- L /ll t--/( t It.1 ./ ""-7/ .--1 '. L.~'t/.. '1 _-';- P..H..-' , ._ )-1', l.r li.,)(;jV, !\.. ~.; ',~; .. 71 I'J. .i~ ,) ! '--. U .-1". ';}~/,- ';j- ? .------- http://www.kbb.comIKBBlUsedCarslPricingReport.aspx?Manufacturerld=49&Yearld=20... Page 2 of3 /( L-j I '..~ 212012008 REV-1!109 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLy-oWNED PROPERTY - ESTATE OF FILE NUMBER Barbara Coles BoIeIIa 2107-0669 If an aut _ made joint wItIIIn one ,.., of the dececIenfa ..... of .......It ... be ,.,ortlId CMI SchIduIe Go SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kalhleen B. Daniels 6343 Creekview Rd. MechanicsbulQ, PA 17050-2038 Daughter B. C. JOINTLY-owNED PROPERTY: 2. LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH FOR JOINT MAIlE INClUDE NAME OF FINNICIAI.lNSITTl1TION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VAlUE OF t TENANT JOINT IOENT1FYING NUMBEft ATTACH DEED FOR JOlNTlY-HElD REAL ESTATE. VAlUE OF ASSET INTEREST DECEDENTS INTEREST A. 10101103 Joint Account - Sovereign Bank Checking -1681733188 1,411.68 50% 705.84 A 10101103 Joint Account - Sovereign Bank Savings - 1681733935 25.03 50% 12.52 TOTAL (Also enter on line 6, Recapitulation) $ 718.36 (If I1lOI8 space Is needed, insert additional sheets of \he same size) ITEM NUMBEF 1. 'ff- Sovereign BanK '"'..... .".,F' .",.. ""'>F j"",-""" -<, :::.' ! A. ; b MEN; t.} ,~\CL.( "U~'<J ; :::: pagid 0/6 1681733188 ~~-~ go'~r~lgD. B~l]M S '}~=Ei'~2Ei\j? ()~ ,~CC:()UNTS 1-877-S0V-BANK (1~877;'768-2265) www.sovereignbank.coni statement PeriOd 03/01/07 TO 03/31/07 PREr.ljli:R flflONEY I'JlARKET SAVINOS a ~ ~ i ~ ~ ~ ~ ~ ~. < "~ ~ ~~j_01 '"J:pI;f~~ I5MIER MONEY MARKET SA,nNGS "Statement periofl 03Ze1'1'[01' -, Gl3~~iiiZ€J~t , '- . ~. ~.... ~ -,,'~~ :,."" Account/1681733935 BJ.lRBARA COLES BOLEllA KATHLEEN 8 DAN/as Esalances E~itl[liTJ9B~I~Ii~i, ........ .. Deposits/Credits VVithtfraw?I$!Debits- . . ,..... <\$~Q{03 '. +$0.01 ....Gl.Ji"l'~TrtBaI~n~ '. AverageDaily Balance $25:04 $25.03 ~ - .' <,:'~:$O.OO'. - - --,.--- = ~ ,'P'ald.'Yei:lr-"T04:>c:ltE!t .' ". '-'__>"_ ',_'C__.., -, -"-~-;'-->'-.---'-~- . '. '->$,~.01'-'. $ 0.01 ',_ .....$0.03.... .....:.............................-................'......._....:....-.................-.......-...................._._.r._:......_..'.....:.....'...__...._._.._'...'.._:.._ :_Jm......i......nu................a.......IP....,~I)~gey~~gE~rn.. .e.:I. i.. ',." .... ..<-:-7_.'-',.',.::.<__.,:.'''':''O._C_''__,:_,-",: _.n__ .'_',_..' .'-_.' ".. .. Paid Last Year . . IL47:% $0.11 ~ - - - ~ Interest .fi~id..1.tli~p~~ijdtFi Eamedthis Period '<-:.::'>:.-',..','-.-'. -, - ~ ~ ~ - "The interest eamedandtheinterestpaidmaydifferdependingon when interest is credited to your account. Service Fees J~6N]'"H,-yijAi~CE,fEg/~;' FEES WAIVED Total - - - Date # Transactions.. -.--FS9... Total- $10.00- - $10.00 $0.00 ~ """'"= ~ = ~ - . , - .,.'..-u.--.-..___'.__._.__.. ,___ ___ _ 63i3d/oi>i 03130/07 '.'.,,--;>:-:--'-:-,.-. t 1 . 1 (JeOO -10.00 Account . Activity D~!te DesCription . OJ;..01 Beginning Balance di~~~o "'-,~t;~$+r~~~[)rrg 03-31 Ending Balance Additions Subtractions Balance $25.03 ~g$,P4 $25.04 ..$0.01.'. ,- -~.;::--"'--'-:.,-:::;:-- --~'~'=-'-=-.=c------=-=_~~,,,.~-,,,=,,-,,,,:_..,.,::......_.,_~--=~~ page 3 of3 1681733935 REV-15110 EX+ (6-98* COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTA1E OF Barbara Coles BoIeIla FILE N.-eR 2107-0669 This lICI1eGlIe mu&t be compIeIed and filed if the answer to any of queslions 1 ftIrough 4 on the RMIIllll side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DAlE OF DEAlli % OF OECO'S EXClUSION TAXABLE N:t.lIlE llE NMIE OF llE 1IWlSFEREE 1IEIl1BATlllNSltP1O IlECEIl9If NIl NUMBEI llE llIiIE OF TIWISfat A1TACHAlXlPYOFllE IlEEIl FOR REM. ESWE. VALUE OF ASSET INTEREST IF API'Ul:AIIlEI VALUE 1. Fidelity IRA - beneficiary designations - children - WHam, Joseph, Edmund, 101,865.40 100 101,865.40 Kalhleen, 8a'bara II 2 TIM Cref IRA - beneficiary designations - chidren - William, Joseph, 11,497.80 100 11,497.80 Edmund, Kathleen, 8a'bara . TOTAL (Also enter on fine 7 Recapitulalion) $ 113,363.20 (If IIlOI'8 space is needed, i1sert additional sheets of the same size) .. .. o Q. CD II: .. C CD E, ;: CD > C "- e e N ~ C"l .c ~ 11l :;: "- e e N .c o Ui :2 E III U) ill o > n: ill U) t- Z &Ill ':E III a: - t- 1&1 ex: o 1&1 ex: rr w iI. iIi.i r: Q. >- I [.1..0 fa il- fj en i! ::::> Ill: l- I- 2 UJ ::;E UJ 1.1....1.... ~ "2 .<f: 1::;E [>- tl- fJ ill ,0 I 'j~ 1<( jCI: '--1 /'<( II~ .j~ l~ ,i 0: "l- . ~:5 '--1 Jw j--1 '0 ro aZ <(:5 0:0 <(0 rol- CI:W <(::> roo It) C'? <D ,... N 0') ..:. o:r ~ rtl ;bt =0 \'ij 1: ,0 """ ,:";d <"'" ,,~ (ij ;;", f= t~ .. - If ''''. ~ J ;~,; ~_.= :'i ~ -;t,.~_ Ii"'" o C>I g C? ! cD m en C>I ci o T"'" o EN :>~ ~e <C"l "<t o ~ :?: u <( E II> E u; Q) > c '0 lij (5 .0 c: ;;J .2 U) Cl "~ .5 1; '0 .. c: .3 w o 0 g "<t ~ui mCO ~ ..- o T"'" U) c C\/ :> (l) o d ~ C"l "'" {13. '" ~ Q) '" ~ ..c:: '" III o ~ ~ i1:: lD E o cg .S - ~E <( ~ g>t:2 c-Q)~ .2 c: E Q) 'Q.CQ')o'" ii"o,CllO " lD :> .3m-S - C = o (,) (,) <E 10 !1oo '0 f.) ;:: :J e D- o .!! Q. ~ E .. :> o '0 <D > 'CD o Q) ... c:'U o c ~~ ~ ~~ .30 ~ "S :;:: () ~ - i S CI) ~ S Zoo (J)w <(> on: >-w I-OO ~ ::i n:UJ -.:w ~ 0 .. - mLL E .. ~ e ;0 C"l .. -- mo C') - .... "C " ~$.,"~: -~ :?j~;~~~Jf~:~J2 EN :> Q) o d ~C"l c "<t .2U) U .. .. c: l! >- (j) ~ Q) (j) ~ ..c:: (j) III o ~ Ii) :s! lL CI) c::: o :;:: () e .... -g CI) b ~ ~ .S! ~ 't:s q: >.. ~ --.. (,.? ] <;; '"5 ~ .... ~ Cii ::J 1:1 .~ -S "~ ~ c: -E ~ III .~ ::J ~ ~ 1:1 ~ 's e Q. .!!! g> '~ .Q ~ Cll -S "- e III ..c:: '" in Q. o u c .. . m E :> o E <I: - ~ @J .. ;; o ON gC"l '" . ~~ N N o ~ {13. ~~ ~d <en v {13. o en !(fj o ~i j II <, .. ;; o -~ ~ <= _t::J C\; ~ .~ ~ (() iU III <0 .C: "- ~ 1l:0,,:, -~~ ~&,~ .2:6 g ~ en <;.. C1) . o ~ ~ ,g ..c:: ;.., ~.~ -~ .- ~-.;; -gs:~ o -G:: ()~Ol to (Y) .c: .0 ci ::s ~ ~ ~ c: -::.- G:~.Q -0 ~ (j) -.- {) .....~o ij; "- 0 E 0 c: !!l~lii <u '- ..... iI5 ~ 5i lD ..... E .c: Cll ::J .... c: 0 E:1::J.g o III ~ -c:: ~~ C:0:S .,g -.J '0 '1l-.l E '" is: '"- Q) 0 ..e .~ 0 .~ ~ <IS :Iii ~,~ uQ).:! ~ g>-g ~Q)C: .S ~ ~ ~Q'i5 ~ .~~ ~~lO SiJ::~ e_C) QO~ .2~o) "'t~~ (Y)::Et;() ~Ctf~ "- c: O'1lE C5CJ)c: <<:It.Cll ID<:E g, <ri ~ r.:: a.s .:::~o- ~ ~ Lu;;E '" ::J ~ Q) E '- .Q '- ~ E .~ ~ ~ E Cl)Q)~ Q) Q ';;; -S;:1:1 E::-:..8l 1:1(1)~ (I) l.1. Cll ~ E,1:1 ~Oc: Cll-.llll '"--.I '" .!!!E ~~ o o o o M (') o r-- o ::.. C <'J C <C -,:- o L() (') (j) """ o <D It? (') C\/ r-:> i"~ A ~, ~ ~ E k o ~ c -- CU C o TIAA CHEF FINANCIAL SERV'ICES FOR THE GREATER GOOD~ www.tiaa-cref.o!l;1 April 2, 2007 William L Bolella 124 W olfpit Rd Sussex, NJ 07461 Re: TIM No. CREF No. C3862129 U3862127 Dear Mr. Bolella: We have received notification of the death of Barbara C Bolella and you are listed as the beneficiary of her TIAA-eREF fixed andlor variable annuity contracts. The following lists the total TIAA-CREF retirement annuity accumulation for which you have been named beneficiary as of the participant's date of death. Value as of 03/20/2007 TIM Traditional Account $2,299.56 TIAA-CREF Variable Accounts $0.00 TOTAL $2,299.56 )" 1. ,(- i17h. I V ~ (c/Q. h,-,::> J -; il, if 'f 7. '6 V Please keep in mind that the Internal Revenue Service does have certain regulations about the time period during which benefits must be paid (or a 50% excise tax could apply). We have enclosed the following information to help answer any questions you may have: . Single Sum Payment ... At a Glance, which provides answers to frequently asked questions about your payment. . TIAA-CREF Quarterly Performance card . After the Death of a Loved One, which describes the important steps you may need to take after the death of a family member or friend. For your convenience, we have listed the materials you will need to provide to receive your benefits: . Request for a Single Sum Payment form TlAA-CREF Individual & Institutional Services, LLC Member NASD. SIPC. Headquarters: 730 Third Avenue. New York. New York 10017-3206 Tel: 212-490-9000 8500 Andrew Carnegie Blvd, Charlotte, NC 28262 REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINIS1IATIVE COSTS - ESTATE OF Barbara Coles BoIeIIa ALE NUMBER 2107..Q699 DebIs of decedlInt must be ....... on ScIIeduIII L DESCRIPTION AMOUNT m,M NUMBER A. FUNERAL EXPENSES: Bronson & Guthlein - Funeral Home Sir John's - Funeral luncheon Flowers Headstone Fees 1. 2. 3. 4. B. ADMINISTRATIVE COSTS: 1 . Personal RepIesenIaIive's CommissionS Name rI Personal Representative{s) Social Security Number{s)IEIN NtIJ1ber of Personal Representative{s) Street Address City Year(s) CormIission Paid: Slate Zip 2. Atlomey Fees 3. Family Exemption: (If decedenl's address is not the same as claimant's, atIach expIanalion) Claimant Kathleen B. Daniels StreetAddress 6343 Creekview Blvd City Mechanicsburg Relationship of Claimant 10 Decedent Daughter Slate NJ .ZIp 17055 4. Probate Fees 5. AccountanI's Fees 6. Tax Return Preparer's Fees 7. Postage Costs 8. Mileage - RIT Wantage, NJ to Cumberland County Register of WtIIs (420 miles) .9. Mileage ~ RIT Wantage, NJ to Penndotl AM Saanton (110 miles) 10. Vehicle Title and Document Service 11. Tolls and Parking 12 Verizon - Phone until June 15 11,456.00 1,327.27 630.00 1,250.00 3,500.00 155.00 150.00 53.05 203.70 55.55 60.50 2.00 175.98 $ 19,019.05 TOTAL (Also enter on line 9, Recapitutation) (II more space is needed, insert addiIionaI sheets of lite same size) REV-1512 EX+ (12-03) . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS EST A 11: OF FILE NUMBER Barbc:lra Coles Bolella 2107-0669 Report debts lneumd by the decedent prior to death which remained unpaid _ of the cIate of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. American Express 158.74 2. Avenue 117.94 3. OCM Services Bank of America 633.84 4. Heritage medical Group 52.24 5. Personal Loan Joseph A. Bolella 500.00 6. ERI- Boscovs 417.14 7. E-Z pass Close Out Expense 9.94 8. Office of Aging 63.55 9. Sears Mastercard 49.99 10. U.S. Treasury 20,595.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 22,598.38 i;.iJ::,::~d$~i ...~~r.~~~~~pai<lin ~~~t~~!lt~ip9~~~difl9' .. enior Member tatement of Account - :>repared For BARBARA C BOLEUA AaxJuriI Ntmber 3710-716263-61002 Claoing Dale 03112/07 Page 1 of 10 PrevIOUS BaJance $ 328.74] 1 Payment Aclivily $ -328.7411 New AdMly $ re Adjusa'nenIB +158.741 New Balance $ Please Pay By 03127/07 Please refer to page 3 for important information regardng your account 158.74 See Page 7 For A Notice Of Changes To Your Agreement ._.._..~._-"... See Page 8 F=or A Notice Of Changes To Your Membership Rewards Program Account See Page 9 For An Important Privacy Notice To manage your Card account online or to pay your bill,. please visit us at www.americanexpress.com. You can also pay your bill by calling 1-800-I-PAY-AXP (1-800-472-9297). --.-.- --~-- Activity . Indicates posting dale 02/24107;~a~MI1~~2R'<IIl~X~ .. .... .......<< . Due in Full Acl:ivlty for BARBARA C BOLELLA C31d XXXX-XXXXX3-61002 03/02107 AOL 8ERVICE 800-827-6364 NY ONLINE TWX"AOL SERVICE 0307 ROC No. 0080742723 03/11/07 Qve ,<600-367-9444 WEST CHESTER PA REF# 3334177305, 3 OF 3 ROC No. 33341n305 Total Due in Full Activity Amount $ ~328:14 ... Amount S 25:90 132.84 158.74 l.--l \\ + Please fold on the perforation below, dela:h and .......h with your pll}Ol1eI1I . Continued on Page 3 Please Pay By: Please enter account 03127/07 number on all checks and correspondence. Make check payable to American Express. Payment Coupon Account Ntn1bef 371 0-716263-61 002 BARBARA C BOLELLA 6343 CREEKVIEW RD MECHANICSBURG PA 17050-2038 Total Amount Due $158.74 See Finance Charges section on reverse side for a description of when additional Finance Charges are not assessed on Features. I,,, 11\" ,1It1ll' 1,1,11'11I,1 .1It. III ,11.1,,1,,1. ,I"n.I".n Mail Payment to: II. I .111.1...11111,1",11111,,1.11,11.11.11..11I.1.1. .11I.1,11 AMERICAN EXPRESS P.O. BOX 2855 NEW YORK NY 10116-2855 I,. ,11\1. III" II,,, II. II ",,1.11. ,I 111,1,,1,1,1,1..1,1 III ,11.1 Check here if address or telephone number has changed. Please note changes on reverse side. \~ t' ~ \)J~ n 0000371071626361002 000015874000015874 10 rl ~ II I .. Our Spring collection has arrived! Our zip hoodie is available in an assortment of solid colors and embroidery. Also, check out our Signature Chino Collection the all season long as we w!" be introducing zip hoodie new lengths and silhouettes. Stay tuned to Avenue, your fashion source for Spring! This Month's .Activity: Trans Referelll:lt Credit Transaction Date Number. . PIanISeq DescrfpIIon 02101107 81n901 001 AVENUE PURCHASE M DEN". KNIT BOTTOMS. KNIT TOPS . WOVEN TOPS, SWEATERS Special Offer ,ot the Month An additional 20% off coupon is endosed. Give it to a friend OR treat yourself to something extra! ~\" ;~U l;.-"" .f il&.-' \. \ , \J O\J\ ,.' \ ~\ ~ ;'1 ~ ~ \ \ \V \ \ '\1 \ C)~/ Statement Summary: Account: 146-001-771 Payment Due Date: 03/18/2007 Credn Limn $850.00 Average Daily Balance $0.00 Previous Balance $0.00 Available Credit $;732.. OAll Y Periodic Rate O~ + New Charges $117.94 Closing Date 02J21f2fM11 Corresponding ANNUAL - Paymen~redils $0.00 Days in Billing Periodl 30 PERCENTAGE RATE 22.BOOO'lIt + FINANCE CHARGES $0.00 Scheduled to Pay $10.00 = New Balance $117.94 Past Due $0.00 ANNUAL PERCENTAGE RATE 22.~ Minimum Payment $10.00 Minimum FINANCE (:ttARGE $0.00 NOTICE: Sf1e TflIHKSB side for Important ;~0f!!'B1ion _=_. Bank of America .. www.bankofamerica.com BARBARA C BOLELLA 6~143 CREEKVIEW RD MECHANICSBURG PA 17050-203843 January 19, 2008 Account No.: 4500660999458670 Dear Barbara C Bolella, Thank you for your final payment toward the settlement of $633.84. This pa.yment serves as the full settlement of the above-referenced account, and your account will be reported to the consumer reporting agencies (Experian, TransUnion, and Equifax) as a settled account, legally paid in full for less than the full balance. Any future credit balances on the account will be the property of Quantum. Although this account is now closed, please note that any new or third-party charges posted to this account will be your responsibility. If this account is linked to any new charges or preauthorized third party fees or services (such as internet services or gym memberships), other charges may still post to the account. It will be your responsibility to cancel any third party services that mayor may not require authorization to charge the account. If the remaining amount is equal to or greater than $600.00, we are required by federaT-law.-{IRS-section-6050PJto-repott thi.s amount. You will be receiving a Form 1099-C from Quantum no later than next January 31st. If you have any questions regarding your personal taxes, we recommend that you consul t a certi fied "ubI ic accountant or other tax professional. If you have any questions, please call 1-800-242-3328, Monday through Thursday from 8 a.m. to 10 p.m., Friday, 8 to 8, or Saturday, 9 to 2 (Eastern time). If you prefer, you may write to Quantum at P.O. Box 15971, Wilmington, DE 19850-5971. Our knowledgeable Account Managers are ready to assist you. Sincerely, Brian Kilpatrick Customer Assistance department lIBMBL14 1.1 US-EN 01 of 01 08.020-00149 - 324 - - - = - - - - = - - - = - - - r-" , I I._oJ - ;;;; ;;;; - = ;; i :!:! r-., , , I._oJ ;;; !:! ;;; . ;; . ;; - . ;;;; r-" - I I I._oJ - - - ~ ;; ;;;; - - ~ - - Heritage Medical Group, LLP HERTAGE DIAGNOSTIC CENTER 3 Walnut Street, Suite 206 Lemoyne, PA 17043 Ple21se check if address or insurance information is incorrect and complete form on back. 111.111111111... .1.1.11.. '111.111.. '1111.1. .1. .11111111.1.. .11 ::W's***u*******5-DIGIT 17050 BARBARA J BOLELLA 6343 CREEKVIEW RD MECHANICSBURG PA 1705~2038 Check Card Used and Fill in Below to Pay by Credit Card o MasterCard o Visa o Discover ay IS mount $6.34 SHOW AMOUNT $ PAID HERE HERITAGE MEDICAL GROUP, LLP PO Box 70850 Philadelphia, PA 19176-5850 0007668900002747310000000634 4 OHeritage Medical Gronp,lLP CONNER RICH ASSOCIATES 207 House Avenue Suite 101 Camp Hill. PA 17011 Pleas;e check if address or insurance informatiOn is incorrect and complete form on baCk. I ,..111...111....1.1.11.....1.1111111111.1..1..1..1..11.111111 ::;{;i**u*******5-DIGIT 17050 BARBARA J BOLELLA f.343 CREEKVIEW RD MECHANICSBURG PA 17050-2038 Chec:It Card Used and F'III in BeloW to Pay by credit Card o MasterCard o Visa o Discover ay IS $37.16 SHOW AMOUNT PAID HERE '" .. '" .. ... ~ ... $ HERITAGE MEDICAL GROUP, LLP PO Box 70850 Philadelphia. PA 19176-5850 0000A17700002747310000003716 5 -- _.........._:._-.,-".-.- '"~ \Heritage Medical Group, liP SHEPHERDSTOWN FAMILY PRACTICE 2140 Fisher Road Mechanicsburg, PA 17055 Plea,se check if address or Insurance information is incorrect and complete form on back. I.. .111...111. ...1.1.11. ... .1.111.... .11.1. .1. .1. .11111.1.. .11 m94'r************3-DIGIT 170 BARBARA J BOLELLA 6343 CREEKVIEW RD MECHAN!CSBURG PA 1705~2038 Chectc. Card Used and Fill in Below to Pay by Credit Card o MasterCard o Visa o Discover mount Exp. ate ay IS mount Account $8.74 274731 SHOW AMOUNT $ PAID HERE HERITAGE MEDICAL GROUP I LlP PO Box 70850 Philadelphia, PA 19176-5850 0011730700002747310000000874 6 BOWfvJANSDALE FAMILY PRA 1 KACEY CT MECHANICSBURG, PA 17055 03/31/2008 Merchant ID: Terminal 10: 235021905999 14:59:21 000000000453822 01051984 CREDIT CARD MC SALE CARD # INVOICE Batch #: Approval Code: Entry Method: Approved: Avs Code: yy, ~0399 0016 000210 076236 Manual Online SALE AMOUNT $52,24 CUSTOMER COPY APR-07-2008 16:25 FROM:THE STONE CENTER 973 972 2851 TO: 973 9999999 .-/ . ,.. ''. {'.l . .. 1= it-"" L- 0 .'>;- '" .. . " "/J - A . " .j~)C/ ! /f-,pni;Ll,r "I. l lfjiJ ..,...............- III~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Department # 6129 P.O. Box 1259 Oaks. PA 19456 5418-2038 IDENTIFYING INFORMATION ERI File Number: ERIHOOOO041120 Creditor Account Number: 0000000 105139535 Creditor: ERI Financial Services Estate of: BARBARA J BOLELLA . -_._--- . --- ._~--------~._.- -- - -.-. ..--.-. ---..----- ---- -. --..-.-..---.. . . --~.- ACCOUNT BALANCE: Office Hours (Eastern Time) M - Th: 9:00am - 9:00pm - Fri: 9am - 5pm 1-800-229-8472 Ext 694 Fax: 410-426-4051 Estate Of Barbara J Bolelfa c/o William Bolella 124 Wolfpit Sussex, NJ 07461 September 26. 2007 Dedf Sir/Madam: This letter is to serve as a receipt and to verify satisfaction of the debt in the name of tbe decedent with regard to the recent settlement. The specifics regarding your payment are listed below. Payment Amount: Date of Payment: Account Number: $417.14 09/07/2007 000000010513 95 3 5 If you have any questions or require additional infonnation, please do not hesitate to contact this otlice at 1-800-229- 8472 Ext. 694. Sincerely. Estate Recoveries, Inc. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION 9 5418 - 2038 QTumbtrlanll illuunty OOffice of Aging & Qtommunitu ~eruice!i 16 West High Street, Carlisle, PA 17013 240-6110 or 1-888-697-0371, Ext. 6110 Fax: 240-6118 website: www.ccpa.net/aging e-mail: aging@ccpa.net HUW\N SERVICES BUILOING I INVOICE FOR SERVICES Barbara Bolella 6343 Creekview Rd Mechanicsburg, PA 17055 Brm:c BarcLn ("/JUlnl1(j'it G"rv Eichelb"r"cr Vice Cl1mniitJJI Invoice Number: February-07-14 Invoice Date: April 5, 2007 Richard L. ~o\'egllo .\ecrefan rern L, bark'\ - f):rc'c!u"r SERVICE PROVIDED: Personal Care MONTH OF SERVICE: February, 2007. ACTUAL COST PER Hour l 16.3 I YOUR REDUCED SLIDING FEE SCALE RATE PER Hour I 3.1 I TOTAL Hour(s) OF SERVICE YOU RECEIVED I 20.5 I PLEASE PAY THIS AMOUNT I 63.55 I Payment Due Upon Receipt of Invoice. Payment Is Delinquent if not paid by Apri130, 2007. Contact CCOA if any issues. Make Checks Payable To: CUMBERLAND COUNTY OFFICE OF AGING Please keep this copy for your records -- - - -.- - - -'--- -'-'-.-.-.-.-.-.-.-.---.-.- -'-'- -'-'-'-'-'- _.- - -.- _.- - - -.- - - - -.- _.- -.-.- - - - - - - - - . Sears Gold MasterCar<f' Call us at 1-800-669-8488 Go to www.searscard.com Write to us at PO Box 6922 The Lakes, NV 88901-6922 ',~--_;:'i- -." ~:~,: ;; {;,'" BARBARA BOlELLA Account Number. 5121 G717 9194 6837 Page 1 of2 L PaYll1entDullDate 03/28/07 ) y our Al~count Summary Billing Cycle Closing Date Amount Over Credit Line Amount Past Due Current Minimum Due Total Minimum Due 02128/07 $0.00 $10.00 $42.66 $52.66 Manage your account online-it's FREE Pay your bilL..track purchases.uset email alerts... even request a credit line increase-do it all online at SearsCard.com. It's a great way to stay on top of your account. -- - - - Your Credit SUmmary Total Credit Line Available Credit Line Cash Access line Available Cash $~:ft Jlm'~ - it ~~ $7,500.00 ~ $7,379.00 $1,500.00 $1,500.00 Register today at SearsCard.com. It's free, and you won't believe how much time you can save. See for yourself at SearsCard.com. Previous Balance Payments & Credits purchases & Debits Other Charges FINANCE CHARGES Account Balance - - - - - - - == Activi~, Sale Date Post Date Descriptiott Amount 01/30/07 01/31107 02/19107 02119107 SUPER SHOE #7MECHANICSBURG PA LATE PAYMENT FEE 49.99 4:- ,,39.00 - - - == -- -- !!!!!!!!!!!!!! - - - !!!!!!!!!!!!!! - - THE AMOUNT DUE SHOWN ABOVE INCLUDES A PAST DUE AMOUNrr. YOU SHOULD SEND THE ENTIRE AMOUNT DUE NOW. IF PAYMENT HAS BEEN MADE RECENTLY. THANK YOU. r "\ I I.- ~~ ~r 1 - 0 L,S7~ 1-1. })., lV\ .~ Ii'" ---- if /'J ;) - - = ;;;;;;;;;;;;;; ;;;;;;;;;;;;;; !Vl ~ ..- .CJ ;;;;;;;;;;;;;; !!!!!!!!!!!!!! Sears Gold MasterCar~ Account Number: 512107179194 6837 ,1111,11,.,111111111,111_11111 " III~ Account Ilalance L $120.19 ) ( Payment Due Date Total Minimum Due )( $52.66 J ~ Amount Enclosed J 03/28/07 Dln167 D ZO A 07059 1 TXS503 fVG 0.1 7 N 1111111'11111"1.1.1.11111..1.1111'1..11.1111..1..1..11.1,"II BAFiBARA BOLELLA 6343 CREEKVIEW RD MECHANICSBURG PA 17050-2038 1.1..1..11...1.111.111..1'1.11.11'111111...1.11111...1.11.1..1 Make check paynble to SEARS CREDIT CARDS PO BOX 183082 COLUMBUS, OH 43218-3082 Please make address corrections abOve. 100 5121071791946837 0012019 0005266 0000000 2017 "_ .___ .__....~__ ._ _~.__.._._. '__. '__.' ___.. .~. _-"'''.''-:--_''' -'~--c:""'-::~'-.'. .,.,... ..........., ,,--," Total ControlAccount~ -MetUfe :STATE OFBARBARi\ C eplELLA V1LLlAM LElOLELLAEXEC ULWT - 24WOLFPrfRO iUSSEXNJ 07461 ~etrop<ltillln I.tfe InsUl1lll<': <,:"",pany 0094 . Date.. r/ i"! OJ ." n.'~~ j%~~ 6~e (/ S. l/..f1-:sl/Jt/'- - 1$ Jo,srf =1 A"'f' /C. Jj fiJf-,., 1- I J - Ist~. X)f , . ....~::.:::~':;~ . f' v~ ~~..;M <t...l.v."'flb.t~ .;: DolIar3 ry~ ~::O~- .10.- 071S' .signaturedv..dtJ.~ . 'J....()(J' r"""J t:.> - - pLc f .f-JIr V '-. . .:0 :l . .00 .511: I.0:l 5 2 (;0 I.G boa . 00 ql. ~.-.-_..c....--,,-_.____~.~_:..:.:.:..:.c.c.;_._~,.~....-...__.._c..._.___-"---.:..~-,.,.:..-._---_._...------_..._-_...:.-.--.-..._-'--'.~.__.._.--,--.~_..,"" REV-151:1 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER 2107 -0669 ESTATE OF Sarb~lra Coles SoleUa 5. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERlY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] William L. BoleUa -124 Wolfpit Rd., Wantage, NJ 07461 Son 20% Joseph A. BoleUa - 200 Lewis St., Apt. 309 Rahway, NJ 07065 Son 20% Edmund F. BoleUa - 2024 Hone Ave Bronx, NY 10461 Son 20% Kathleen B. Daniels - 6343 Creekview rd Mechanicsburg, PA 17055 Daughter 20% Barbara J. BoleUa - 17 Herbert Ave. Milltown, NJ 08850 Daughter 20% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of lhe same size) NUMB I 1. 2. 3. 4. = n REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2007-00669 PA No. 21-07-0669 Es ta te Of: BARBARA COLES BOLELLA (First. Middle. Last} a/k/a: Late Of: BARBARA BOLELLA HAMPDEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 088-30-0715 WHEREAS, on the 16th day of July 2007 an instrument dated October 19th 1999 was admitted to probate as the last will of BARBARA COLES BOLELLA (First. Middle. Last) a/k/ a BARBARA BOLELLA la te o;f HAMPDEN TOWNSHIP, CUMBERLAND County, who died on the 10th day of March 2007 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUl"fBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: WIL.LlAM L BOLELLA who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLlSL.E, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 16th day of July 2007. , &tLkjbl</UC Jfr,{y tatf-O ~a "9;;)~~ · Deputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) r::::5 IATE~v1ENl OF BARBARA COLES BOLELLA I, BARBARA COLES BOLELLA, of the Township of Hamilton in the County of Mercer and State of New Jersey, being of sound and disposing mind and memory, and not acting under undue influence of any person whomsoever, do make, publish and declare this instrument to be my last will and testament, hereby revoking all former wills and codicils made by me. FIRST: I direct that all my just debts, expenses of my last illness and funeral expenses be paid as soon as conveniently may be done after my decease. I direct that all estate, transfer, succession, inheritance, legacy and similar taxes, including interest and penalties thereon, if any, upon or with respect to any property required to be included in my gross estate under the provisions of any tax law, and whether or not passing hereunder, or upon or \vith respect to any bequest or devise herein made, or upon or with respect to any person with respect to any such property, including any tax resulting from inclusion of any amounts in the computation of the tax under any tax law, shall be paid out of my residuary estate as an expense in the settlement of my estate. and there shall be no proration of any such taxes. SECOND: I reserve the right at any time in the future, without any formal Codicil to this Will, to make a separate \vritten list (either in my own handwriting or by a writing signed by me) of items of tangible personal property, and my Executor, hereinafter named, shall deliver the items of tangible personal property therein described to the person or persons therein designated to receive the same as if herein originally set forth. THIRD: All th.e rest, residue and remainder of my estate, real, personal and mixed. wheresoever situate, and any property over which I may have a power of testamentary jJif3 PAGEIOF5 to my beloved husband, AUGUSTINE BOLELLA, absolutely. FOURTH: In the event my said husband, AUGUSTINE BOLELLA, should not survive me or if we should die in a common accident, then I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, of whatsoever kind and nature and wheresoever situate, of which I may die seized or possessed, or to which I may be entitled at the time of my death, to my beloved children \V1LLIAM BOLELLA, JOSEPH BOLELLA, EDIvIUND BOLELLA, KATHLEEN BOLELLA AND BARBARA JEN BOLELLA, share and share alike. In the event that any child of mine shall predecease me leaving issue surviving, then 1 give, devise and bequeath his, her or their share to his, her or their issue, per stirpes. In the event that any child of mine shall predecease me leaving no issue surviving, then I direct that his, her or their share be distributed evenly among my surviving children. FIFTH: I nominate, constitute and appoint my beloved husband, AUGUSTINE BOLELLA, as Executor hereof and direct that he be permitted to serve without bond or other security for the faithful performance of his duties in this or any other jurisdiction. In the event my said husband shall not survive me, or having survived me shall for any reason fail to qualify, or having qualified, shall for any reason cease to act, then I nominate, constitute and appoint my beloved son, WILLIAM BOLELLA, substitute Executor hereof, likewise without bond or other security. LASTL Y: For the purposes of settling my estate and carrying out the provisions of this will and testament, I hereby authorize and empower my Executors and substitute Executor, hereinbefore named, to sell and convey any part or all of my estate, at public auction or' private sale, without court order, and on such terms as my Executor, in his uncontrolled discretIon, may Bcfj PAGE20F5 deem advisable, tor the best imer:?5tS :0 execute such ins~runler"',~ I.. ~":~::V be necessary and proper to effectuate such purposes and to otherwise have all the express and implied powers granted to Executors by the laws of the State of New Jersey. of Od~~( IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ,If day , in the year of our Lord, One Thousand Nine Hundred and Ninety- Nine. fj2J~ U 4U4 BARBARA COLES BOLELLA (L.S.) Il\r THE PRESENCE OF: ~ /0) , . 1- }Ii ~v--I' -' i1[.IL;f; 1u ) I" fl _ ku!^-..- I \ . lJ--{} ru / residing at 1l~1) " ,.' .. .# '-?J/l. , 4""/>,0/ .'-'u/..A ;:."/:," \... t';"U.. v ~ /.eA- ..;.- .I' /" {;../ residing at (Jcg PAGE30F5 The above and foregoing instrument, consisting of three (3) typewritten pages besides this, was, on the date thereof, subscribed by BARBARA COLES BOLELLA, the Testatrix named therein, and declared by her to be her Last Will and Testament, in our presence and in the presence of each of us, we all being present at the same time; and we, at her request, in her presence and in the presence of each other, have hereunto signed our names as attesting witnesses. /' ~'7 / .. ) " t/J!tlM/ A,L~t) Lll. - f/ 'f\ /i I fAAu1\ I l' U l.J.frtLf! / residing at ~/f a/::::;) " ,"" / ",/'/../ /~ Z,.I '/!tt/Ud/~U?;G 7~ f ~ - ~ ....11 I I \t.LiJ'\ /!y...JJAlJlJrU~~J 7JfJ '--.j residing at residing at I, BARABARA COLES BOLELLA, the TestatrLx, sign my name to this Instrument this 19 day of t7(-r;/j-l.f--6t , 1999, and being first duly sworn, do hereby declare to 'the undersigned authority that I sign and execute this Instrument as my Last Will and Testament and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. &-i---- C;U~ lUL4 BARBARA COLES BOLELLA /V\ /1 ~ r ::Do it) PrTD , ~1AR1A N. Abud-f' and , the witnesses, being fIrst duly sworn, do each hereby declare to the undersigned that the Testatrix signs and executes this Instrument as her Last Will and Testament and that she signs it willingly and that each of us states that in the presence and hearing ofthe Testatrix, we hereby sign this Will as witnesses to the Testatrix's signing, and to the best of our knowledge the Testatrix is 18 years of age or older, of sound mind and under no constraint or undue influence. -witness 1la~i~ 71- (J));~ / -witness -witness PAGE 4 OF 5 ) SS. Of !Jjcz-/(r::-!; ~ ) Suhscribed, sworn to and acknowledged before me by BARBARA COLES BOLELLA, the Testatrix, and subscribed and sworn to before me by -.111 fll<f 0(/ {..1ft TO ' /ll1l~/4 1/ 1l~()Llf and , witnesses, this /9 Day of p{':Ifrrf-er ,1999. Arz1tU.:.r JJJ AtY/la- Notary Public lCrrIN'" P.- ~ *-y NIle Of NeW Jtttcy It1C<l1MiMioo E$ 11/1_,,?t.? c/ PAGE 5 OF 5 .-- t .' c;;; ii, ~ CiS' =:;: --. 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