HomeMy WebLinkAbout04-0142PETITION FOR PROBATE and GRANT OF LETTERS
rstate of' C-D 6,.C'e. e. No.
also known as To:
Deceased.
Social Security No. _lq[a- [tq _ ~ q c~k q
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age o~ 91der an tl~e execut ~', I ~
in the last will of the above decedent, dated I k_;[3klT rcX~.~ [i~..
and codicil(s) dated
Register of Wills for the
County of
Commonwealth of Pennsylvania
in the
named
,19. ~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
was domiciled at death in (,..} %:¥~]P~("x,.\(_A.~(}~.. County, ~ennsylvania, with
Decendent
~lastt, ~ t~9,~ --.3...Ifamily[~o or principal residence at
(list street, number and muncipality)
Decer{qentt, the. gl-~.~_2 :, years,of a. ge, died ~)<~Ce ,h'XCq f~. \c~ ,+9~,
Except as follow~, decedent did hot marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters.
theron.
request(s) the probate of the last will and codicil(s)
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF j~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well apd truly administer the estate according to law.
Sworn to or affirmed and subscribed
b.~jore me this /~ day of [
, ~-~ -I,
No.
Estate Of ~(~,~ ~ce~ ~ '~to~sa~- , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~-~a~-~ I~ ~/, in consideration of the petitionon
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
and Letters -- 1 F_~-F~ r,~.,~--~3~
are hereby granted tO k/~C ~, ~ ~k]~
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ..........
enunciation ................
'-'-~
Filed
TOTAL $~
.~,~.~¥.. ~ .... ~.~. .......
A'FrORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
zo:ta £1.113J ~.
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9812228
No.
Date
~3Rev 2/87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (F
- Grace C. Blosser
COUNTY OF DEATH
Cumberland
ISEX SOCIAL SECURIT~ NUMBER
2.Female ~.196 -- 14 -- 3427
,. 3-13-24 ,.Lewistown, PA ,~ EFI~
..E~ Pennsboro ... ~OLy -~Ol~tT ~O~PIT~ ~ I,~~'~ ....
~' 12
~CEOENT'S USUAL OCCUP~'rloN I KINO OF BUSINESS/INDUStRY
Technz;cz;an ,1..~ e,~l Telephone
309 College Hggg Road ,,..m,. PA ~ ,,,.D~.~,~ E~g Penn, bore,
~_Eno/a,~ PA 17025 [~
~' ~' Cumberland
Corbe~t ,~ Ma~gha Weave~
~. wc,~ o. wa~e~ I~ 309 Co~ege H~ Road Eno~a PA 17025
~m,~ ..... ~Ja~. 12-Z2~ ~a~,. PA C~ema~o~q ' ~a,~ Har~sbu~o, PA 17100
'MEDICAL EXAMINER/CORONER
LAST WILL AND TESTAMENT
of
GRACE C. BLOSSER
I, GRACE C. BLOSSER, single woman, of Enola, East Pennsboro
Township, Cumberland County, Pennsylvania, being of sound and dis-
i~posing mind, memory and understanding, do hereby make, publish and
i declare this to be my, Last Will and Testament, hereby revoking
and all Wills and Codicils previously made by me at any time here-
tofore.
FIRST: I hereby direct my personal representative,
hereinafter named, to pay all my just debts, funeral and testa-
~mentary expenses as soon after my demise as may be practicable.
SECOND: Ail the rest, residue and remainder of my
estate, I hereby give, devise and bequeath to my daughter, VICKI B
!iWAGNER, should she survive me by thirty (30) days.
THIRD: In the event that my daughter, VICKI B. WAGNER,
predeceases me, dies on or before the thirtieth (30th) day following
my death, or should we die simultaneously, I hereby give, devise
and bequeath, all the rest, residue and remainder of my estate
to my grandson, CARL WAGNER.
FOURTH: I hereby nominate, constiute and appoint MARTHA
SOUDER as Guardian of the Estate of such assets that pass to CARL
WAGNER and vest in her complete discretion to convert any real
estate into cash as may be appropriate by sale or mortgage.
FIFTH: Should I, at the time of my demise, be acting as
Guardian of the Person of CARL WAGNER, as provided for in my
daughter's, VICKI B. WAGNER, Will of this same date, I hereby
~nominate, consitute and appoint my ex-husband, CHARLES BLOSSER,
as Guardian fo the Person of CARL WAGNER. CHARLES BLOSSER shall
be entitled to compensation in the amount not to exceed four (4%)
'per cent per annum of the balance of the cash assets being managed
i!by the Guardian of the Estate.
SIXTH: In the event that my daughter, VICKI WAGNER, and
!imy Grandson, CARL WAGNER, both predecease me, fail to survive me
~' hereby
~'~by thirty (30) days or all three of us die simultaneously, I
igiYe, devise and bequeath all the rest, residue and remainder of
;Imy estate to MARTHA SOUl)ER, of Harrisburg, Pennsylvania, and.
!iKENNETH CORBETT of North Vernon, Indiana, equally and per capita.
SEVENTH: I hereby nominate, constitute and. appoint my
!!daughter, VICKI B. WAGNER, as Executrix of this my, Last Will and
!?estament. In the event that my daughter, VICKI, predeceases me,
iifails to qualify, ceases to act, or for some reason is incapable of
llperforming such task, I hereby nominate, constitute and appoint
iiMARTHA SOUDER of Harrisburg, Pennsylvania, as alternate Executrix
ilof this my Bast Will and Testament
EIGHTH: None of the abovenamed persons shall be required
to post bond or surety in this or any other jurisdiction for faith-
ful compliance of the office of Executrix, Guardian of the Person
and/or Guardian of the Estate.
IN WITNESS WHEREOF, I hereunto set my hand and seal, to this
and two (2) other typewritten pages, identified~by my signature,
dated, this ay of 19
~~f ~SEAL)
GRACE C. BLOSSER
The preceding instrument, consisting of this and two (2) other
typewritten pages, identified by the signature of the Testatrix,
GRACE C. BLOSSER, as and for her Last Will and Testament, who in
her presence, and at her request, and in the presence of each
bther, subscribed our names as Witnesses hereto.
REIDING AT ~~ ~
iCOMMONWEALTH OF PENNSYLVANIA )
) ss.:
I, GRACE C. BLOSSER, Single woman, Testatrix, whose name is
signed to the attached and foregoing instrument, having been duly
!iqualified and sworn according to law, do hereby acknowledge that I
~ signed and executed the instrument as my, Last Will and Testament,
iiand that I signed it willingly; and that I signed it as my free and
~!voluntary act for the purpose therein expressed.
SWORN or AFFIRMED to and ACKNOWLEDGED before me, a notary publi
by the Testatrix, GRAC~ C. BLOSSER,_~oj~--this the
' My Commission Expires, ~,~/~/.,;~
COMMONWEALTH 0F PENNSYLVANIA )
) ss.:
COUNTY OF ~~C~.~ )
~IT~ESSES, ~oae n~mes a~ sSgned
instrument, being duly qualified according to law, do depose and s~y
that they were present and saw the Testatrix, GRACE C. BLOSSER,
sign and execute the instrument as her Last Will; that GRACE C.
BLOSSER signed it willingly; and that GRACE C. BLOSSER executed
it as her free and voluntary act for the purposes therein expressed ;
that each of us in the hearing and sight of each other and of the
Testatrix, signed the Will as Witnesses; and to the best of our
knowledge and sight, the Testatrix, GRACE C. BLOSSER, was at
the time eighteen (18) or more years of age, and under no constrair.t
or undue influence.
SWORN or AFFIRMED to and SUBSCRIBED to before~e.
public, by the WITNESSES ~,'~
this the )~day of ~ , 19
ary Public
LAST
WILL AND
OF
GRACE C.
TESTAMENT
BLOSSER
COUNSELOR-AT*LAW
105 MT V~£w Dw.
ENOLA. PA. 17025
PHON~ (717! 732-3552
~EV-1500 EX (6-00) ·
' ~ COMMONWEALTH OF
~ PENNSYLVANIA
.m~~~:~. DEPARTMENT OF REVENUE
r~~~l~ ~ DEPT. 280601
~HARRISBURG, PA 17128-0601
Z
UJ
C~
UJ
UJ
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DM-YEAR) ) DATE OF BIRTH (MM-DD-YE/~R)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[~1. Original Return [] 2. Supplemental Return
[~] 4. Limited Estate [] 4a. Futura Interast Compromise (date of death after 12-12-82)
[] 6. Decedent Died Testate (Attach copy of wiu) [--~ 7. Decedent Maintained a Living Trust (Attach copy of Trusl)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Cradit (date of death between 12-31-91 and 1-1-95)
FIRM NAME (If Applicable) J
I
14.
1. Real Estate (Schedule A) ~q ~ C~
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) \ (:~'~"~
r-'-~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) /'~ c~' ('~
11. Total Deductions (totat Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
FILE NUMBER
OFFICIAL USE ONLY
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOC~[~SEIU~j~NUMBER _
[~3. Remainder Return (date of death prior to 12-13-82)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
]11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
'' ~FIC~L =,USE
,~ : ONLY
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate ~'~ Q[, ["D9~'~ ~ ~"~,-.~ ~/~ x.O {1~)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
Decedent's Complete Address:
STREETADDRESS ..~(,.~(~ C(3LL-~J~ ~J~::~::g-J~.-
CITY ~ ~OL~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments r(r~
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
STATE
Total Credits ( A + B + C )
Total Interest/Penalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(1)
(2)
(3)
(4)
(5)
(5A)
(SB)
!
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; .......................................................................................... [] ~,~
b. retain the right to designate who shall use the property transferred or its income; ............................................ []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] r~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 information of which preparer has any knowledge,
SlGNA,~UR~OF I~E,RSON RE,~:~ONSlBLE FOR FILING RETURN
SiGNATURE~ 1R~ARER OTHER THAN REPRESENTATIVE
DATE
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 3%
[72 RS. §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 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the 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 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(12) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX ~: (1~7) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~'y jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation), $ L~j ~.~
#
(If more space is needed, insert additional sheets of the same size)
SCHEDULE F
JOINTLY. OWNED PROPERTY
R~-~EX.(~-9~ ~
COMMONWEALTH OF PENNS~ LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
If an asset was made joint within one year of the decedent's date of dea~, it must be reported on Schedule G,
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
JOINTLY-OWNED PROPERTY:
Lb I I~-~ DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include nan'e of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
/ J
(3 o - ,
TOTAL (Also enter on line 6, Recapitulation) $ I I C~ ,~q
(If more space is needed, insert additional sheets of the same size)
flU!S.~.~eApV ON
REV-1,~11 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A.
1.
5.
6.
7.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions ~
Name of Personal Representative(s) ~~ ~
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
Attorney Fees
State
Zip
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ",~ ~ ~__.l~_...~._ ~ ',,,,,,~ ~::~ ~... ~,~ ~____. ,~,.
Street Address ~¢~ ~~ ~¢LL
City ~ ~ State ¢~
Relationship of Claimant to Decedent ~6~~
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Aisc enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY
PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF
GRACE C BLOSSER
) Register' s
Deceased)
CLAIM
To the Clerk of the Orphans' Court Division :
Index and make proper entry in your official records of the
claim of CITIBANK (SOUTH DAKOTA) NA in the amount of
2,401.50 against the estate of the above-named decedent. This
claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S.
ss. 3532 (b) (2) .
The said decedent, whose last known residence was at
309 COLLEGE HILL RD ENOLA, PA 17025
Written notice of this claim was given to VICKI B WAGNER
309 COLLEGE HILL RD ENOLA, PA 17025
on March 29, 2004
(Claimant)
SHAWN HARMER,manager of Citicorp Credit
Services, Inc. USA under limited power
of attorney for CITIBANK (SOUTH DAKOTA)
NA
7930 NW 110TM ST
KANSAS CITY, MO 64153
(Claimant's Address)
Account #(s) 5491130356843532
Universal Cash Rewards Card
December 11 - January 12, 2004
Page 1 of 3
GRACE C BLOSSER
Accoun[ 5491 1303 5684 3532
Calling Card 9631917788 + PIN
How To Reach Us
Account Online: www.universalcard.com
Customer Service: 1 800 423-4343 or write
Cardmember Services, PO Box 44167
Jacksonville, FL 32231-4167
Minimum Payment Due ........................................... $50.00
Due Date· ............................................... February 6, 2004
· Payment must be received by 1:n0 pm local time on the payment due date.
Credit Line .......................................................... $8,000.00
Available Credit .................................................... $5,598.00
Cash Advance Limit ......................................... $2,400.00
Ava ab e Cash Advance Limit ............................. $2,400.00
FREE SERVICES FOR AT&T
UNIVERSAL CARD MEMBERS
Receive your statement online only when
you enroll in our Ali-Electronic program
when you register for account online. Also,
manage your account, pay bills and more!
Register now at www.universalcard.com
Previous Balance 2:601
Payments and Adjustments -200.0F)
Master Card~ Ac(ivitv 0.SN
Total AT&T Services' 0.0~3
New Balance $2,402.00
Note: Detailed activity starts on page 3.
Cash Rewards Dollars
Total current month Dollars ............................................ 0,00
Payment Record Amount Paid: Date Paid: Check Number:
Please fellow payment instructions outlined in the "Important Instructions for Making Payments" section of the statement.
OA'raT
Y~ur A¢c~at Numar
05491130356843532240200050000003 I 5491 1303 5684 3532
Pleise Enter Amount of P~yment E~clos~l
FEB 06 2004 m sz4oz.oo $5o.ooll5
I&S MC OO A I ARTOSDSgi4
I,,,llh,,llh,,,,hhhh,,hh,,Ih,,Ihlh,lh,,hh,,Ih,I
GRACE C BLOSSER
309 COLLEGE HILL RD
ENOLA PA 17025-2116
II1,,,I,,,I,I1,,11 .... Ih,h,h,,hllh,,h,,hh,II
AT&T UNIVERSAL CARD
PO BOX 8207
SOUTH HACKENSACK NJ 07606-8207
Ihhh,lllllh,,llh,lhllh,lh,lllh,hlhlhhlll.lllh,I
GRACE C BLOSSER
Account 5491 1303 5084 3532
December 11 - January 12, 2004
Page 3 of 3
AT&T
Tran s Post Descri pti on
12/22 PAYMENT THANK YOU
Total Payments and Adjustments
66414763
Amount
200.OOCR
$200.00CR
Purchases ........................................................................................................................................................ 0.00
Cash Advances and Checks .......................................................................................................................... 0.00
Finance Charges ............................................................................................................................................. 0.50
Total MasterCard Activity ........................................................................................................................... $0.50
Total MasterCard Purchases ............................................. $0.00
Cash Advance Limit ............................. $2,400.00* *This represents a portion of your total credit line.
Finance Charge Information
I
Days in Balance Periodic Transaction ANNUAL'
Nominar Pedodic x Billing x Subject to = FINANGE + Fee/FINANCE PERCENTAGE
APR Rate Period Finance Charcje GHAR(~E CHARE;E RATE
PURCHASES
Standard Purch 9.990%
Offer4 0.~0%
CASH ADVANCES
Standard Adv 19.990%
.02737%(D) x 32 x $16.10 = (*) + $0.00 9.990%
.00000%(D) x 32 x $2,447.96 = $.00 + $0.00 0000%
.05477%(D) x 32 x $0.00 = $.00 + $0.00 19.990%
One minimum FINANCE CHARGE of $050 was imposed.
Total FINANCE CHARGE = $0.50
AT&T Universal Calling Card Calls ......................................................................................................... $0.00
CASH REWARDS DOLLARS as of JANUARY 12, 2004:
Previous Cash Rewards Dollars ..................................................................................................................... 0.12
New Cash Rewards Dollars .... . .............................. 0.00
Paid Cash Rewards Dollars ............................................................................................................................ 0.00
Adjustments ...................................................................................................................................................... 0.00
Total Cash Rewards Dollars ...................................................................................... 0 12
Citicorp Credit Services, Inc. USA
A Subsidiary of Citicorp
Kansas City Regional Center
7920 N. W. 110t~ St
Kansas City MO 64153
Citicorp Credit Services, Inc. USA
CUMBERLAND CO CLERK
1 COURTHOUSE SQ
ROOM 102
CARLISLE, PA 17013
March 30, 2004
RE: The Estate of GRACE C BLOSSER
File Number: 2104142
Dear Sir/Madam,
Please find enclosed our claim against the above mentioned estate.
return a FILED stamped copy in the enclosed envelope.
Thank you for your attention to this matter.
Please
Sincerely,
SHAWN HAP. MER
Manager, of Citicorp Credit Services,
Inc. USA under limited power of attorney for
Citibank (South Dakota) N.A.
BUREAU OF INDIVTDUAL TAXES
INHERITANCE TAX DTVTSION
DEPT. 280601
HARRTSBURG, PA 17128-0601
VICKI B NAGNER
$09 COLLEGE HILL RD
ENOLA
CONNONNEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
'.'PA 17025-2116
DATE
ESTATE OF
DATE OF DEATH
FZLE NUNBER
COUNTY
ACN
REV-1647 EX AFP (01-03)
04-26-200~
BLOSSER
12-19-2005
21 0~-0142
CUMBERLAND
101
Amount Remitted I
GRACE C
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF gILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03} NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF BLOSSER GRACE C FZLE NO. 21 04-01~2 ACN 101 DATE 04-26-2004
TAX RETURN NAS: (X} ACCEPTED AS FILED ( ) CHANGED
RESERVATZON CONCERNING FUTURE ZNTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate {Schedule A) (1)
2. Stocks and Bonds (Schedule
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
~. Hortgages/Notes Receivable (Schedule D) (~)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E} ($)
6. Jointly Owned Property (Schedule F) {6}
7. Transfers (Schedule G) (7)
B. Total Assets
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funaral Expanses/Adm. Costs/Nisc. Expenses (Schedule H) (9)
10. Dabts/Hortgage Liabilitias/Lians (Schedule Z) (10)
11. Total Daductions
12. Net Value of Tax Re~urn
R/501.00
1;957.00
.00
.00 NOTE: To insure proper
.00 credit to your account,
· O0 submit the upper portion
.00 of this form with your
tax payaent.
(8)
5,Zlq. O0
15.
1~.
NOTE:
ASSESSHENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amoun~ of Line 1~ taxabla at Lineal/Class A rata
17. Amount of Line 1~ at Sibling rata
18. Amount of Line lq taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDZTS:
PAYHENT KECETp1 DISCOUNT
DATE NUHBER ~NTEREST/PEN PA~D
4 a284. O0
(11)
(12)
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15)
Net Value of Estate Sub~ect to Tax (14)
Xf an assessment ~as issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
6,458. O0
9.498-00
$,060.00-
.O0
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
5,060.00-
18 and 19 #ill
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.)
.00
.00
.00
.00
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
ANOUNT PAID
(1.;), .00 X O0 = .00
(16) .00 X 045= .00
(17) . O0 X 12 = . O0
(18) .00 x 15 = .00
(19)= . O0
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CA):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December ZZ, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, tho Commonuaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfil! the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (TZ P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLSj AGENT
A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Nills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Zl, Harrisburg, PA 17128-lOZ1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. gB060I, Harrisburg, PA 171ZD-060!
Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decadent's death, a Five percent (SI) discount of
the tax paid is a11owed.
The 15X tax amnesty non-participation penalty is computed on the total oF the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (SI) percent per annum calculated at a daily rate of .000164. A11 taxes which became delinquent on and after
January I, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19DZ through Z004 are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor
19az lOX .000S48 1'~'~'8-1991 llZ .000301
1985 IGZ .00043B 1992 9Z .000247
1984 112 .000501 1995-1994 7Z .00019Z
1985 13g .000556 1995-1998 9Z .000Z47
1986 lOX .000274 1999 7Z .000192
1987 lOZ .000Z74 ZOO0 7Z .00019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Daily
Year Rate Factor
~-~ 9Z .000Z47
ZOOZ 6Z .000164
2005 5Z .000137
ZOO4 4Z .00011g
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation data shown on the
Notice, additional interest must be calculated.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of t4he O0phans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on [~-~[ [~ I,:~k.~ :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name
~.?..~,~,~ t~t~. qtq ~ 6- 5'~ sci
Capacity: /Personal Representative
Counsel for personal representative
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
GRACE C. BLOSSER
Date of Death:
12.- t9-2CXB
Estate No.:
.21-()4-0l,~2
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes IB No 0
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 0 No I:B.
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 0 No [![
c. Copies of receipts, releases, joinders and approval of fonnal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. \
Dateo 11-21-2005 /~i~ \D(~
('1 VICKI H. WAGlIDt
Name
309 COLLEGE HILL RD
ENOLA PA 17025-2116
<.
Address
717-215-6706 (cell)
717-732-1070 (home) 717-605-5784 (work)
Telephone No.
(', )
Capacity: D. Personal Representative
o Counsel for personal representative
~z
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, 2A 17013
Phone: (717) 240-6345
Date: 11/15/2005
WAGNER VICKI B
309 COLLEGE HILL ROAD
ENOLA, PA 17025-2116
RE: Estate of BLOSSER GRACE C
File Number: 2004-00142
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/19/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~.~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge