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Home My WebLink About04-0374 PETITION FOR PROBATE and GRANT OF LE~TTEIRS No. l-Oq-- Estate of CAROLE M. BOLLINGER To: also known as · Deceased. Social Security No. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the execut or in the last will of the above decedent, dated SEPTEMBER 23, 1997 and codicil(s) dated Register of Wills for the County of CUMBERLAND Commonwealth of Pennsylvania _ in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in CUMBERLAND County, pennsylvania, with h~ last family or principal residence at 48 SCARSDALE DRIVE (L~WER ALLEN TOWNSHIP~ ~UNTY PENNSYLVANIA 1701 (list street, number and municipality) Decedent, then 69 years of age, died 3/24/2004 ' ' at SELECT SPECIALTY HOSPITAL CAMP HILL PA 17011 Except as follows, decedent did not 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: Decedent 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: $ $ $ $ 3,000-00 3,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamenta~; administration c.t.a.; administration d.b.n.c.t.a.) thereon. 2466 MERCER STREI~ ;'%' HARRISBURG PA 17~4- ' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF (;;UMBERLAND The petitioner(s) above-named swear(s) or aff'u'm(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 a~ trolly ad~?inister the e~tat/e~c~0~ding to law. ..... Sworn to or affn-med ano sunscnoea · j - ' before me this I~-t-v~ . day of / APRIL. 2004. [ ~ , .~ r'~C'~"~ ~~ster ~.~ k~ No. ~21 - Oq- ~qq Estate of CAROLE M. 8OLLINGER ~ Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ , in consideration of the petition on 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 flied of record as the last will of ~:AROLE M. BOLLINGER and Letters TESTAMENTARY are hereby granted to ARLENE S. KOHR FEES Probate, Letters, Etc ......... Short Certificates ( ~ ...... TOT~_ 2_0920 ..... ATTORNEY (Sup Ct I D No ) 64 SOUTH PITT STREET CARLISLE PA 17013 ADDRESS _717-243-6090 PHONE 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 No. Local Registrar g 9 2004 '~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECOR~:)S ~4..v. ~, CERTIFICATE OF DEATH (Coroner) · ST~ FIE NU~ER ~29-230 IsEx I~'AL ~CUR'~ NUU~R ~C~m(F..,.~,L.) I,. Female ['- 184-26-44[[.,,, '' I" M~r~ 24, 2004 ,. Carole M Bollin ~.~[ ~ ~. (Ch~ ~ ~-- ~ i.=~,~ ~ ~) 69 ~' 19, 1935 ~g. ~ PA ,..,~ ~mo~.. ~ ~e C,j~herland East Pennsboro Select Specialty Hospital ~x~.P~,~c. ~ DECEDE~ E~R~N DECE~NT*S ED~ U.S. ~MED F~ES ~ ~ ~i~) .m~.c~m~ ~t. z,~ la ~ ~,.~ ~.~--~ ~wer Allen 48 Scarsdale Drive aES,~m~ ~p Hill, PA 17011 '~'~ ,m.~C~berland '~** ~,,.~ ~,.s~¢,~.u~.~ John W. Stauffer ~> Arlene Kohr ~ 2466 Mercer St., Harrisburgz PA 17104 ' IL~ - C~, S~lth j(M~. ~Y. ~) ~P~CE OF OlSPOSmON - N~ ~ ~,,,~;~,f. C~,mmo~ ~D c,~ ~,,~s,,t,~ ~l,lb.l 3-29-04 ~°'~'~' J Harrisburg, PA ...... _.~ ~ ~*. ~st Harrisburg C~. SUCH mE~ ~ M a ~,,,.Myers-Harner ~, 1903 ~t St, ~, PA 17011 IL~ENSE NUUSE. IO~E ~NE~ ~ ~ ~ I~t~e and T~) m 2~ [TIM~ OF DE~H IDlE PR~NCED DEAD (M~. ~y, Y~r) ~ l~S CA~ REP~H~ED ~cA~¢~ I Decubitus ulcer ~ Sepsis r~ ~ ~) ~ ~ ~E ~ (~ AS A C~ENCE ~: ~ Morbid obesity ~m~ b. Urinary Tract Infection DA~ ~ m ~ry c r~)~T ~fl~RMED? ~E ~1~ ~ I ~,,.1~.., -ay, , I IDATE SIGNED (Iv~3o~. Day. Year) [] ,,=. 'l,,d March 28, 2004 NAME AND ADDRESS O~ PER WHO COMP ETED CAU OF i~em27)Typ~orPdnt To~"e~)N Ce Ec~enro~T~E~ '~ch~ .l)epl,~oroner 6375 Basehore Rd., Suite ft ~8[ Mechanicsburg, Pa. 17050 12. DATE FILED (Month, Day, ~r~ar) LAST WILL AND TESTAMENT I, CAROLE M. BOLLINGER, of 48 Scarsdale Drive, Camp Hill, Cumberland County, Pennsylvania 17011, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my daughter, Arlene S. Kohr, or if she be deceased, then to her children, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living. 4. I nominate and appoint Arlene S. Kohr to be the personal representative of ~ estate} t6 serve without bond. If she cannot or does not serve, then I appoint ,John A. Bollinger to be ~ subs~ute personal representative, also without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~,~r'z day of September, 1997. CAROLE M. BOLI.:IN~;ER (SEAL) Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. .4 CKNOWLEDGMENT AND .4FFIDA FIT WE, CAROLE M. BOLLINGER, JOY S. ZERANCE and GAY L. IRWIN, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. CAR/~.E M. BOLLINGE¢- COMMONWEALTH OF PENNSYLVANIA · :SS.' COUNTY OF CUMBERLAND · Subscribed, sworn to and acknowledged before me by CAROLE M. BOLLINGER, the testatrix herein, and subscri~d and sworn to before me by JOY S. ZERANCE and GAY L. IRWl N, witnesses, this '~ ~ day of September, 1997. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 07/01/2004 IRWIN HAROLD S III 64 SOUTH PITT STREET CARLISLE, PA 17013 RE: Estate of BOLLINGER CAROLE M File Number: 2004-00374 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 07/30/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, ~EeNr~Ao[At~EeRoSr~hans' Cour~ Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 07/01/2004 KOHR ARLENE S 2462 MERCER STREET HARRISBURG, PA 17104 RE: Estate of BOLLINGER CAROLE M File Number: 2004-00374 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 07/30/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, Clerk of the Orphans' Co~t cc: File Counsel Judge TO THE REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: CAROLE M. BOLLINGER Date of Death: 3/24/2004 Will No. 2004-00374 Admin. No. 21 - 04 - 00374 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 7/12/2004 . Name Address ARLENE S. KOHR JOHN A. BOLLINGER 2466 MERCER STREET HARRISBURG PA 17104 48 SCARSDALE DRIVE CAMP HILL PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: 7/12/2004 Signature Name: HAROLD $, IR, WIN,'~ft+.-.~ Address: 64 SOUTH PITT STREET Telephone(717) - 2436090 Capaci~: . × Personal Representative Counsel for Personal Representative REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of CAROLE M. BOLLINGER also known as , Deceased No. 21 04 00374 Date of Death 3/24/2004 Social Security No. Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: HAROLD S. IRWIN, III 29920 64 SOUTH PITT STREET CARLISLE PA 17013 Personal Representative: ARLENE S. KOHR Dated JULY ,2004 Telephone: 717-243-6090 Description MANOR CARE NURSING HOME Residential Trust Fund Balance MEMBERS FIRST FEDERAL CREDIT UNION 50% Interest in Regular Savings Account No. 23719 - 00 Owned Jointly with John A. Bollinger MEMBERS FIRST FEDERAL CREDIT UNION 50% Interest in Regular Savings Account No. 120063 - 00 Owned Joinly with John A. Bollinger MEMBERS FIRST FEDERAL CREDIT UNION 50% Interest in Regular Savings Account No. 140517 - 00 Owned Jointly with John A. Bollinger MEMBERS FIRST FEDERAL CREDIT UNION 50% Interest in Regular Checking Account No. 120063 - 11 Owned Jointly with John A. Bollinger MEMBERS FRIST FEDERAL CREDIT UNION 50% Interrest in Regular Checking Account No. 140517 - 11 Own ed Jointly with John A. Bollinger (Attach Additional Sheets if necessary) Value 83.32 13.64 121.32 644.70 1,080.25 149.35 Total 2,092.58 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW -4 Z U~ LU ILl [~ Z Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA t 7128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFF[CIA[ USE ONLY FiLE NUMBER 2 1 -0 4 0 0 3 7 4 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INiTiAL SOCIAL SECURITY NUMBER BOLLINGER, CAROLEM. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM DD Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 03/24/2004 01/19/1935 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMRBR [] 1. Original Return [] 2. Supplemental Retum [] 3. Remainder Return (date of death p.orto 12-13-82) [] 4, Limited Estate [] 4a, Futura Interest Compromise Idate of dea~ a~e~242-82) [] 5. Federal Estate Tax Return Required I-~6. Decedent Died Testate iAItach copy of Will) [] 7. Decedent Maintained a Living Trust (A~tach copy of Trusl) -- 8. Total Number of Safe Deposit Boxes [] 9. Litigation Proceeds Received [] 10. Spousal Povedy Credit (date of death between 12-31 91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (A~a¢ Sc, OI THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS HAROLD S. IRWIN, III 64 SOUTH PITT STREET FIRM NAME (If Applicable) IRWIN LAW OFFICE TELEPHONE NUMBER 717-243-6090 CARLISLE PA 17013 1. Real Estate (Schedule A) (1) 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 Proparb/(Schedule F) (6) ] 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) (t 0) 11. Total Deductions (total 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) I 0.00 ] 0.00 0.00 83.32 2,009.26 O.00 OFFICIAL USE ONLY (8) 2,501.00 1,904.O7 (it) ' .:,' 2~092.58 4,405.07 (12) -2~312.49 0.00 (14) -2~312.49 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) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxabIe at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 X __, (15) 0.00 X __ (t6) 0.00 X .12 (17) 0.00 X .15 (18) (19) 0.00 0.00 0.00 0.00 0.00 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH Decedent's Complete Address: STREET ADDRESS 48 SCARSDALE DRIVE CITY CAMP HILL I STATE PA I zip 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A, Spousal Povedy Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. 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 (4) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due, (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 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 properly transferred; ........................................................................... [] [] b. retain the right to designate who shall use the properly transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 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 penury, 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 ~nd complete. Declaration of preparer other than the person¢ representative is based on all information of which preparer has any knowledge. 0.00 0.00 0.00 0.00 0.00 0.00 SIG~TURE OF PERSON ,~ES/PO?S?~LE FOR FILING RETURN ADDRESS ~-466 MERCER STREET /~HARRISBURG PA 171¢4 .____ SIGNATUFj, B~ PREPARER OTH ER~TH,,AN R~NTATIVE ADCRESS ~ SdUTH PIT~ STREE~ CARLISLE PA ~013 / DATE 7/i~2004 DATE 7/~/2004 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 P.S. §9116 (a)(1.1) (i)]. For dates of death on or after January 1, t 995, 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 tineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [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-1502 EX + (6-98) ~ f COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATEOF FILENUMBER BOLLINGER. CAROLE M. 21 04 00374 ITEM NUMBER All real property owned solely or as a tenant in common must be reposed at fair market value. Fair market value is defined as the price at which proper would be exchanged be~een a willing buyer and a willing seller, neither being compelled to buy or sell. bo~ having reasonable knowledge of the relevant facts. VALUE AT DATE OF DEATH NONE Real property which is iointly-owned with ri,qht of survivorship must be disclosed on Schedule F. DESCRIPTION 0.00 TOTAL (Aisc enter on line 1, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV 1503 EX + (6 98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESfDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER BOLLINGER. CAROLE M. 21 04 00374 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL (Also enter on line 2, Recapitulation) $ 0.00 (If more space is needed, insed additional sheets of the same size) REV-1504 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES[DENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER BOLLINGER, CAROLE M. 21 04 00374 Schedule C-1 or C-2 (including afl supporting information) must be attached for each closely-held corporation/pa rthership interest of the decedent, other than a sore-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. iTEM NUMBER 1. NONE DESCRIPTION VALUEAT DATE OF DEATH 0.00 TOTAL (Also enter on line 3, Recapitulation) $ 0.O0 (If more space is needed, insert adddional sheets of the same size) REV 1507 EX + (6 98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER BOLLINGER. CAROLE M. 21 04 00374 All property jointly-owned with the right of survivorship must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 NONE 0.00 TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) F~EV-1508 EX + (6 98) COMMONWEALTH OF PENNSYLVANfA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER BOLLINGER. CAROLE M. 21 04 00374 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION MANOR CARE Residential Trust Fund Balance See Exhibit "B" VALUE AT DATE OF DEATH 83.32 TOTAL (Also enter on line 5, Recapitulation) $ 83.32 (If more space is needed, insed additional sheets of the same size) l~bV 1~U9 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER BOLLINGER, CAROLE M. 21 04 00374 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JQHN A. BOLLINGER 48 SCARSDALE DRIVE SON CAMP HILL PA 17011 C JOINTLY-OWNED PROPERTY: LET-ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND RANK ACCOUNT NUMBER OR SIMII~.R DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER AT-ACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENTS INTERE~ 1, A. 2/28/80 MEMBERS FIRST FEDERAL CREDIT UNION 27.27 50. 13,6L Regular Savings Account No. 23719 - 00 :See Exhibit "C" 2. & 4/22/91 MEMBERS FIRST FEDERAL CREDIT UNION 242,64 50. 121,3~ Regular Savings Account No. 120063 - 00 See Exhibit "C" 3. A 5/26/94 MEMBERS FIRST FEDERAL CREDIT UNION 1,289.40 50. 644.7C Regular Savings Account No. 140517 - 00 See Exhibit "C" 4, A 4/23/91 MEMBERS FIRST FEDERAL CREDIT UNION 2,160.50 50. 1,080.25 Regular Checking Account No. 120063 - 11 See Exhibit "C" 5. A ~/9/94 MEMBERS FIRST FEDERAL CREDIT UNION 298.7( 50. 149,35 Regular Checking Account No. 140517 - 11 See Exhibit "C" TOTAL (Also enter on line 6, Recapitulation) $ 2.009.2(; (if more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF = FILE NUMBER BOLLINGER, CAROLE M. 21 04 00374 This schedule must be completed and filed Jf the answer to any of questions 1 throu( q 4 on the reverse side of the REV-1500 COVER SHEET is, DESCRIPTION OF PROPERTY ITEM ;NCLUDE THE NAM~ OF THE TRANSFEREE THEIR ~£L~TIONSHI~ TO DECE[~EN~ AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE O~ TRANSFER A%'AC'~ A COPY OF THE DEED FOR REAL ESTATE 1. NONE VALUE OF ASSET rNTEREST (~F,~PUC,~BU VALUE 0.0~ O.0C TOTAL (Also enter on line 7 Recapitulation) $ insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER BOLLINGER1 CAROLE M. 21 04 00374 Debts of decedent mast be reported on Schedule 1. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: MYERS - HARNER FUNERAL HOME ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of PersonaJ Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees IRWIN LAW OFFICE Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address city Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS Accountan['s Fees Tax Return Preparer's Fees Sla~e Zip. AMOUNT 1,945.00 500.00 56.00 TOTAL (Aisc enter on line 9, Recapitulation) $ 2,501.0(~ (If more space [s needed, insert additional sheets of the same size) REV-1512 EX+ (6 98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FiLE NUMBER E~OLLINGER, CAROLE M. 21 04 00374 Includeunreimbursed medicalexpenses. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1,904.07 MANOR CARE NURSING HOME Final Bill for Nursing Care TOTAL (Also enter on line 10, Recapitulation) $ 1.904.07 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BOLLINGER, NUMBER L 1I. 1. CAROLE M. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY FILE NUMBBR 21 04 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Sec 9116 (a)(1.2)] ARLENE S. KOHR 2466 Mercer Street Harrisburg, PA 17104 JOHN A. BOLLINGER 48 Scarsdale Drive Camp Hill, PA 17011 Lineal Lineal 00374 AMOUNTOR SHARE OFESTATE 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 NONE B. CRARITABLE AND GOVERNMENTAL DISTRIBUTIONS NONE TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 0.00 0.00 (If more space is needed, insert additional sheets of the same size) lAST WILL AND TESTAMENT I, CAROLE M. BOLLINGER, of 48 Scarsdale Drive, Camp Hill, Cumberland County, Pennsylvania 17011, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my daughter, Arlene S. Kohr, or if she be deceased, then to her children, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living. 4. I nominate and appoint Arlene S. Kohr to be the personal representative of my estate, to serve without bond. If she cannot or does not serve, then I appoint John A. Bollinger to be the substitute personal representative, also without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, Ill, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this'"~'/.,z?~'~ day of September, 1997. CAROLE M. BOLI_IN~ER (SEAL) Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. A CKliIOWLEDGM£NT AND AFFIDAVIT WE, CAROLE M. BOLLINGER, JOY S. ZERANCE and GAY L. IRWIN, the testatrix and witnesses respectively, whose names am signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. CARO~_E M. BOLLINGEI~ ~Y.~ ZEI~CAN,~;~- - COMMONWEALTH OF PENNSYLVANIA : :SS.' COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by CAROLE M. BOLLINGER, the testatrix herein, and subs_.cribe, d and sworn to before me by JOY S. ZERANCE and GAY L. IRWIN, w~tnesses, th~s ,-; day of September, 1997. st MEMBERS 1't FEDERAL CREDIT UNION May 25, 2004 Harold S. Lrwin, III Irwin Law Office 64 S. Pitt Street Carlisle, PA 17013 RE: Estate of Carole M. Bollinger SSIN Dear Mr. Irwin, Enclosed is the information requested in your letter dated May 6, 2004 regarding thc accounts held with Members 1st by Carole Bollinger. All our accounts are established with fight of survivorship. Therefore, the account funds become the property of the named joint owner. Likewise, the accounts listing Carole as joint remain the property of the primary owner. Please do not hesitate to contact me at 795-5131 should you have any questions or require additional information. V~'~?ruly you~ Denise A. Wolfe // h~surance Services Shpervisor Enclosure 5000 Louise Drive · EO. Box 40 · Mechanicsburg, Pclmsylvania 17055 · (717) 697-1161 · www. memberslst.org st MEMBERS 1't FEDERAL CREDI F UNION Primary Owner: REGULARSAVINGSACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Primary Owner: REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of: Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Carole M. Bollinger 23719 -00 02/28/1980 $27.27 $.oo $27.27 John A. Bollinger 02/28/1980 John Bollinger John Bollinger 120063 -00 140517 -00 04/22/1991 05/26/1994 $242.49 $1,288.71 $.15 $.69 $242.64 $1,289.40 Carole Bollinger Carole Bollinger 04/22/1991 05/26/1994 120063 -11 140517 -11 04/23/1991 06/09/1994 $2,160.50 $298.70 $.0o $.oo $2,160.50 $298.70 Carole Bollinger Carole Bollinger 04/23/1991 06/09/1994 MECM~ERS 1sT FEDERAL CREDIT UNION D~nise A. Wolfe Insurance Supervisor / May 25, 2004 Estate of: CAROLE M. BOLLINGER Date of Death: 03/24/2004 Social Security Number: 5000 Louise Drive · PO. Box 40 · Mechanicsburg, Pcnnsylvania 17055 · (717) 697-i161 · wvc~,tmcmbcrslst.org The Managing Trustees HCR ManorCare Resident Personal Trust Fund 5th floor Resident Trust Statement 01/01/20II4 Through 03/31/2004 05/04/2004 10: ] 8 AM Legal Representative Bollinger, Carole M Date Description Check# 02/29/2004 Interest Earned Pagc 1 Resident # 23021 Bollmgcr, Carolc M 48 Scarsdale Drive Camp Hill PA 17011 Bank: M & T Bank Acct #: 3740881531 Admit: 2/10/2003 2:00:00 PM Disch: 2/19/2004 12:25:00 P Bt'ginning Balance , Withdrawals Deposits Bal;mce Trans ID $0 01 $83.32 10616 Ending Bahmce $83 32~ This is not a Ifill M & T Bamk 37408815~, l BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 HAROLD S IR~IH III IRWIN LAW ~FICE 6q S PITT ST CARL/SEE ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I;~7 EX AFP (01-03) DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 09-27-200q BOLLINGER 03-Zq-ZOOq 21 0~-037q CUMBERLAND 101 Amount CAROLE M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAHD CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS *~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF BOLLINGER CAROLE M FZLE NO. 21 0~-037q ACN 101 DATE 09-27-200~ TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) S. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgage L/eb/1/~/as/L/ans (Schedule I) (10) 11. Total Deductions 12. Na~ Value of Tax Return O0 83 32 2z009 26 .00 O0 NOTE: To insure proper O0 cred/t to your account, O0 sube/t the upper port/on of this for. w/th your tax payment. (8) 2,092.58 2,501.00 1,90~.07 (11) ~.~05.07 (12) 2,312.~9- 15. NOTE: Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Sub~ect to Tax (lq) If an assessment vas issued previously, lines 14, 15 and/or 16, 17, 18 and reflect f/gures that include the total of ALL returns assessed to date. .00 2,312.~9- 19 will TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. J TOTAL DUE I IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REg)UZRED. ,,,,/~ ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DU A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ASSESSMENT OF TAX: 15. Amount of L/ne lq at Spousal rata 16. Amount of L/ne lq taxable a~ L/neel/Class A rata 17. Amount of L/ne lq at Sibl/ng rate 18. Aeoun~ of L/ne lq taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECEZP1 DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAZD (15) .00 x O0 = .00 (16) .00 x Oq5: .00 (17) . O0 x 12 = . O0 (lB) .00 x 15 = .00 (19)= . O0 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 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 lifo or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafu! Class D (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ES of ZOOO. (TZ P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NXLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ars available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special ge-hour answering service for forms ordering: 1-800-36Z-Z050; services For taxpayers with special hearing and / or speaking needs: 1-800-4~7-30Z0 (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 sheen on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, Harrisburg, PA 17128-1021, 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 writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg~ PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOi) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty ls 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, ar nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 198Z will bear lntersst at s 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 198Z through 200~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548 ~'~"~'&-1991 11Z .OD0301 ~ 9Z .OOOZ47 1983 162 .000458 1992 9Z .000247 200Z 62 .00016~ lgBq llZ .000301 1993-1994 72 ,OOO19Z 2003 52 .000137 1985 132 .000356 1995-1998 92 .O00Z~7 2004 42 .000110 1986 lOZ .000274 1999 72 .O0019Z 1987 lOZ .000274 ZOO0 72 .O0019Z --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNpATD X NUNBER OF DAYS DELTN~IUENT X DALLY TNTEREST 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 date shown on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: CAROLE M BOLLINGER Date of Death: 3/24/2004 Will No. 21 - 04 - 0374 Admin. No. 2104 - 0374 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 X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No x . b . The separate Orphans' Court No. (if any) for the personal representative' s account is: N/A c . Did the personal representative state an account informally to the parties in interest? Yes X 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 is re rt. Date: 2/3/2005 1...0 o HAROLD S. IRWIN III Name (Please type or print 64 SOUTH PITT STREET CARLISLE PA 17013 Address ( 717 ) - 2436090 Tel.No. Capacity : Personal Representative X Counsel for personal representative ~