HomeMy WebLinkAbout03-0293Estate of
also known as
Register of Wills of
PETITION
Clarrissa C. Bouldin
Cumberland County, Pennsylvania
FOR GRANT OF LETTERS
No.
, Deceased Social Security No. 19]. - 09-4020
Ann B. Sensenich and Emeline C. Lucas
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut rices named in the last Will of
the Decedent, dated 03/12/1996 and codicil(s) dated None
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
~T/^
B. Grant of Letters of Administration
(c.ta.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
i Name Relationship Residence
(COMPLy- IF- IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at i Alliance Drive, Apt.
Decedent, then 89 years of age, died 03/21/2003
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
202 BT, Borough of Carlisle, Carlisle, PA
(liststreet, number, and municipality)
at Pittsburgh, PA
(Location)
17013
142,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersic~ned:
Si~lnature
Typedorprintednameandresidence
Ann B. Sensenich
17 Hope Drive, Boiling Springs, PA 17007
Emeline C. Lucas
875 Eppley Drive, Mechanicsburg, PA 17055
/ ?
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 0997)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
bef°re me this 28t1~ay°f
FZzzFLMarch , 2003
!- . T For ihe Re~ister '
Donna M. Otto,lst Deputy
Social Security No:
AND NOW,
No.
Estate of Clarrissa C. Bouldin
191- 09-4020 Date of Death: 03/21/2003
April 3rd, ,
21-2003-293
Deceased
2003 , in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary ~ Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minodtate)
are hereby granted to
Ann B. Sensenich and Emeline C. Lucas
in the above estate and that the instrument(s) dated 03/12/1996
Short Certificate(s). ( 6 ).. $
Renunciation ........ $
Affidavits ( ) ....
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
Letters ........... $ 235.00
' ' Register of Wills
18.00 . Donna M.Otto, 1st Deputy
A,orney: James D. Bosar, Esquire
I.D. No: PA 19475
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Extra Pages ( 5 ) .... * 15.00
Codicil ........... $
JCP Fee .......... $ 10. O0
Inventory .......... $
Other ........... $
TOTAL ......... $ 278.00 MAILED LE%~fERS TO.~.ATTORNEY JAMES D. BOGAR ON 4/3/03
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
REGISTER OF WILLS OF c~~ COUNTY
OATH OF SUBSCRIBING WITNESS
James D. Pogar, Esquire
(e~h) a subscribing witness to the wi~ presented herewith, ~ being duly qualified accord/ng to
law, depose(s) and say(s) that he was present and saw
Clarrissa C. Bould in
the testatrix , sign [he same and that he signed as a witness at the
request of testat rix in h er presence and (in the presence of each other) ~
Sworn to or affu'med and subscribed before Jam~s D..Boga_~ff, ~F~_q~_ ~_re
me this 28th day of One W. Main-S~. marne)
~, Marg~ /~1., . /%200_3 Shiremanstown, PA 17011
(Name)
(Address)
21-2003-293
REGISTER OF WILLS OF CLT~mUm-D COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Ann B. Sensenich and Emeline C. Lucas ,
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are fan611= wiuh the signature of Clarrissa C. Bould in ,
testa[rix of _ - the will presented herewith and
codicil
that each believes the signature on the will is in the handwriting of
Clarrissa C. Bouldin
to the best of their knowledge and belief.
Ann B. Senffenlch
f .~me this 2.8.th day of 17 Hope Drive (;~me)
~N ~r~h, , , [~ 2003 Boiling Springs, PA 17007
' '- ' ~ 875 ~pley D~ve i~ame]
Mec~icsBurq, PA 17055
(A ddr~s)
21-2003-293
I,AST WILL AND TESTAMENT
CI~d~R~88A C. BOUnDeN
I, CLARRISSA C. BOULDIN, of Silver Spring Township,
Cumberland County, Pennsylvania, make, publish and declare this
as and for my Last Will and Testament, hereby revoking all other
Wills and Codicils heretofore made by me.
FIRST: I bequeath such of my tangible personal
property as is set forth in a separate dated and signed Memo-
randum, which dated and signed Memorandum shall be placed with or
attached to this, my Last Will and Testament, to the individuals
designated therein. It is my intent that the last dated and
signed Memorandum shall control. If there is no Memorandum, it
is my intent that all of my tangible personal property shall be
and become a part of my residuary estate.
SECOND: I devise and bequeath all the rest, residue
and remainder of my estate of whatever nature and wherever
situate, including any property over which I hold power of
appointment and together with any insurance policies thereon, in
equal shares, to my children, ANN B. SENSENICH, EMELINE C. LUCAS,
and EDWARD J. BOULDIN, JR., provided that should any of my
children predecease me, I give and bequeath such child's share
unto his or her issue per stirpes by representation, and if there
be a failure of same, then I give and bequeath such deceased
child's share to my surviving children as provided herein.
THIRD: Should any of my grandchildren or great-grand-
children not have attained the age of twenty-one (21) years at
the time for distribution to him or her, I give, devise and
bequeath the share of each such grandchild or great-grandchild to
my hereinafter named Trustee or Trustees, IN SEPARATE TRUSTS, to
hold, manage, invest and reinvest the shares so received, and to
use and apply from time to time such portion of income and
principal for the said grandchild's or great-grandchild's educa-
tion (including college, trade school or other similar training
or education), support and welfare as my Trustee or Trustees, in
their sole discretion, deem advisable. My Trustee or Trustees
may make the payments for the support and maintenance of my
grandchildren or great-grandchildren directly to said grandchild-
ren or great-grandchildren or to their parents as required. Any
payments made by my Trustee or Trustees pursuant hereto shall be
made without further responsibility to the said grandchildren or
great-grandchildren, or their parents, or to any person taking
care of my grandchildren or great-grandchildren. The Trustee or
Trustees, in exercising their discretionary authority with
respect to the payment of income or principal of the within Trust
to my grandchildren or great-grandchildren, shall take into
consideration any income or other resources available to my
grandchildren or great-grandchildren from sources outside this
Trust. In addition, my hereinafter named Trustee or Trustees
shall have the right, in their sole discretion, to purchase and
pay for out of the principal, as well as income, such insurance
policies as will provide for the grandchild's or great-grand-
child's medical care.
Any income or principal not so applied shall be dis-
tributed to each grandchild or great-grandchild when he or she
attains the age of twenty-one (21) years. In the event any of my
grandchildren or great-grandchildren predeceases me or dies prior
to the termination of this Trust, the interest of said grandchild
or great-grandchild in said Trust shall cease with any income and
principal being divided evenly between or among my other grand-
children or great-grandchildren or the separate trusts
established hereunder for their benefit. If, however, said
grandchild or great-grandchild is survived by any children, my
Trustee or Trustees shall pay net income of the Trust to or apply
the same for the benefit of such children of my deceased grand-
child or great-grandchild, in such amount or amounts as my
Trustee or Trustees, in their sole discretion, deem advisable for
2
the support, welfare and maintenance of said children. Any
income or principal not so applied shall be distributed when such
children of my deceased grandchild or great-grandchild attain the
age of twenty-one (21) years.
FOURTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any' property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
3
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FIFTH: I nominate and appoint WILLIAM E. LUCAS,
husband of EMELINE C. LUCAS, of 875 Eppley Drive, Mechanicsburg,
Pennsylvania, as Trustee of the hereinabove described trusts for
my grandchildren. I direct that my Trustee shall serve without
bond and shall receive fair and reasonable compensation.
SIXTH: I nominate and appoint ANN B. SENSENICH and
EMELINE C. LUCAS, as Co-Trustees of the hereinabove described
trusts for my great-grandchildren. I direct that my Co-Trustees
shall serve without bond and shall receive fair and reasonable
compensation.
SEVENTH: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
EIGHTH: I nominate and appoint ANN B. SENSENICH and
EMELINE C. LUCAS, Co-Executrixes of this, my Last Will and
Testament. I direct that my Co-Executrixes, and their succes-
sors, shall not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
4
seal to this, my Last Will and Testament, this \ ~ day of
~~o , 1996.
CLARRISSA C. BOULDIN
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
5
MEMORANDUM
In accordance with the provisions of Clause FIRST of my
Last Will and Testament, dated ~~ i~ , 1996, I direct
that the following described personal property be given outright
to those individuals so designated:
I have prepared and maintained a small notebook for
each of my children. Each notebook contains a specific list of
items of personal property, furniture and contents of my home.
Said list will govern the distribution of all property so listed.
Date
CLARRISSA C. BOULDIN
(SEAL)
OF
CLARRISSA C. BOULDIN
JAMES D. BOGAR LAW OFFICES
JAMES D. BOGAR, ESQUIRE
ANDREW C. SI~IEELY. ESQUIRE
I W£ST MAIN STREET
SHIREMANSTOWN, PENNSYLVANIA 17011
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Clarrissa C. Bouldin
Date of Death: March 21, 2003
Will No. 21-03-0293 Admin. No.
To the Register:
I certify that notice of estate administration required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
April 4, 2003:
Name Address
Ann B. Sensenich
Emeline C. Lucas
Edward J. Bouldin, Jr.
17 Hope Drive
Boiling Springs, PA 17007
875 Eppley Drive
Mechancisburg, PA
17055
421 Main Street
Irwin, PA 15642
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date: 4/19/03
~e~e~[ ~r~ t~ire
Shiremansto~, PA 17011
(717) 737-8761
Capacity: Personal Representative
X Counsel for Personal
Representative
JAMES D. BOGAR
JENNIFER B. HIPP*
*Also admitted to New Jersey Bar
JA~F~S D. B OGAR
ATTORNEY AT LAW
ONE WEST MAIN STREET
SHIREMANSTOWN, PENNSYLVANIA 17011
e-marl mafl@bogarlaw.com
June 18, 2003
TELEPHONE
(717) 737-8761
FACSIMILE
(717) 737-2086
Direct e-mall jbogar@bogarlaw, com
VIA HAND DELIVERY
Donna Otto
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE:
The Estate of Clarrissa C. Bouldin
No. 21-03-0293
Date of Death: March 21, 2003
Dear Ms. Otto:
I represent the Estate of Clarrissa C. Bouldin. Enclosed is
a check made payable to the Register of Wills in the amount of
$5,472.00, same constituting a prepayment at discount on account
of Pennsylvania inheritance taxes in the above-captioned estate.
The prepayment is determined as follows: $128,000.00 multiplied
by 4.5% or $5,760.00, less discount in the amount of 5% or
$288.00, resulting in payment of $5,472.00. Please provide me
with the appropriate receipt in this matter.
Your time and consideration in this matter are greatly
appreciated.
JDB/leb
Enclosure
CC:
Very truly yours,
JAMES D. ~AR
Ann B. Sensenich, Co-Executrix
Emeline C. Lucas, Co-Executrix
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 00270O
BOGAR JAMES D ESQUIRE
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
........ fold
ESTATE INFORMATION: SSN: 191-09-4020
FILE NUMBER: 2103-0293
DECEDENT NAME: BOULDIN CLARRISSA C
DATE OF PAYMENT: 06/18/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/21/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,472.00
TOTAL AMOUNT PAID:
$5,472.00
REMARKS: EMELINEC LUCAS
C/O JAMES D BOGAR ESQUIRE
SEAL
CHECK# OO95
INITIALS: SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
THHERTTANCE TAX DZVZSTON
DEPT. 18060!
HARRTSBURG, PA 17128-0601
JAMES D BOGAR ESQ
I W MAIN ST
SHIREMANSTOWN PA 17011
CONNONk/EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE 11-17-2005
ESTATE OF BOULDIN
DATE OF DEATH 03-21-2003
FILE NUMBER 21 03-0293
COUNTY CUMBERLAND
ACN 101
Aeount Remitted
REV-16,~? EX AFP c01-05)
CLARRISSA C
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF k/ILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THTS LZNE ~ RETAIN LOk/ER PORTION FOR YOUR RECORDS -~(
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEIdENT, ALLOk/ANCE OR
DZSALLOk/ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF BOULDZN CLARRZSSA C FILE NO. 21 03-0293 ACN 101 DATE 11-17-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks end Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Rece/vable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Tote1 Deductions
12. Net Value of Tax Return
15.
14.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Net Value of Estate Subject to Tax
36~172.15
.00
111;153.19
.00
.00 NOTE: To insure proper
credit to your account,
submit the upper portion
.00 of this fore with your
tax payment.
.00
(8)
17,218.36
.0O
NOTE:
147,~15.3~
(11) 17.218.36
(12) 130,206.98
(15) . O0
(14) 130,206.98
Zf an assessment ~as issued prev/ously, lines 1~, 15 and/or 16, 17,
reflect figures that /nclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
1.6. Amount of L/ne 14 at Spouse1 re~e (1.6)
16. Aeount of Line 14 taxable at Lineal/Class A rate (16).
17. Amount of Line 14 et Sibling rate (17).
18. Amount of Line 14 taxable et Collateral/Class B rate (18).
19. Principal Tax Due
RECEIPI
NUNBER
D/SCOUNT
INTEREST/PEN PAID (-)
288. O0
.00
18 and 19 ~111
ANOUNT PAID
5,~72.00
99.31
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
06-18-2003
10-01-Z005
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
5,859.31
.00
.00
.00
( IF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS RE{IUTRED.
ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
TAX CREDITS:
PAYII~NT
DATE
CDOOZ700
CD003072
.00 X O0 = .00
130,206.98 x 0~5= 5,859.31
.00 x 12 = .00
.00 x 15 = .00
(~9)= 5,859.31
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collatara1) beneficiaries of the decedent after the expiration of any estate far
life or far years, tho Coamonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B [collateral) rate on any such future interest.
To full111 the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILES, AGENT
A refund of a tax credit, which was not requested on the Tax Raturn~ amy bo requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications era available at the Office
of the Register of Nails, any of the Z$ Revenue District Offices, or by calling the special 24-hour
ansaaring service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-4q7-30Z0 (TT only).
Any party in interest not satisfied aith the appraisement, alloaance, or disalloeance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17118-1011, OR
--election to have the matter determined et 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 Indivldual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) 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 (SI) discount of
the tax paid is alloaed.
The 151 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 ties 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, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .OO016q. All taxes which became delinquent on and after
January 1, 1981 will bear interest at a rate ahich will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 ara:
Interest Dally Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .000548 1987 9Z .000247 1999 7Z .000191
1983 161 .000438 198B-1991 llX .000501 ZOO0 8Z .000119
1984 111 .000301 1991 92 .000247 2001 91 .000247
1985 13Z .000356 1993-1994 7Z .OO019Z 2002 6Z .000164
1986 101 .000174 1995-1998 9Z .000247 2003 51 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (1S) days
beyond the date of the assessment. If payment is sade after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Clarrissa C. Bouldin
Date of Death: ~arch 21, 2003
Wi 11 No. 21-03-0293
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
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. ! is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
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 X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
James D. Bogar, Esquire
Name (Please type or print)
One West Main St.
Shiremanstown, PA 17011
Address
{717 ) 737-8761
Tel. No.
Capacity:
__Personal Representative
(MAH:rmf/AM3)
X
__Counsel for personal
representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003072
BOGAR JAMES D ESQUIRE
1 W MAIN STREET
SHIREMANSTOWN, PA 17011
fold
ESTATE INFORMATION: SSN: 191-09-4020
FILE NUMBER: 2103-0293
DECEDENT NAME: BOULDIN CLARRISSA C
DATE OF PAYMENT: 10/01/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 03/21/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $99.31
TOTAL AMOUNT PAID:
$99.31
REMARKS: EMELINEC LUCAS
C/O JAMES BOGAR ESQUIRE
SEAL
CHECK# 109
INITIALS: DO
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-I$00
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-03-0293
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Bouldin Clarrissa C.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
03/21/2003 01/11/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
cAPB
HpRL
EpIO
AC
~TK
Co.
R
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C
A
P
I
T
U
L
A
T
I
O
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C
0
M
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I
0
SOCIAL SECURITY NUMBER
191-09-4020
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return ~ 247! Supplemental Return
4. Limited Estate . Future Interest Compromise (date of death after 12-12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
I I 9. Litigatio. Proceeds Received II 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1-1-95)
U (date of death .A.
3. Remainder Return prior to 12-13-~.')
5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
~'] . Election to tax under Sec. 9113(A)
1
I
(Attach Sch O)
NAME
James D. Bo~ar Esquire
FIRM NAME (if Applicable)
TELEPHONE NUMBER
717,/737-8761
COMPLETE MAILING ADDRESS
One West Main Street
Shiremanstown, PA 17011
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (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) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14,
None
36,272.15
None
None
111,153.19
None
None
17,218.36
None
OFFICIAL uSE ONLY
(8) 147,425.34
(11) 17,218.36
(12) 130,206.98
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13).
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13) (14)
130,206.98
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 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
130,206.98
X .0 0 (15) 0.00
X .0 45 (16) 5,859.31
X .12 (17) 0.00
X .15 (18). O. O0
19. Tax Due (19) 5,859.31
Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
1 Alliance Drive
Apt. 202 BT
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
Z. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 5,472.00
C. Discount 288.00
5,859.31
Total Credits ( A + B + C ) (2)
5,760.00
3. interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) 0.00
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) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 99.31
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 99.31
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. retaintheuseorincomeofthepropertytransferred; .........................
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? ................................ [-'"-1
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? ..............................................
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Ann B · Sens enich DATE
~ ~, ,,~~~ __~7___H_o_p__e__D_~__i_v_e_Boilin~; SprinF~s, .................................. PA 17007 ~Z~'
SiGNATURE OF PREPARER OTHER THAN REPRESENTATIVE JE~ltes D. Bogar Esqt. lire DATE
\ ^ [ , . One West Main Stree~
For daie~ of death ~r~ or af~'er' J~liy il i'~9~ 'and' ~f0re' ~ua'~ 'i 'i 995~' ~e'~a~ rate'i~s;d' ~' [~ ~'e~ val'~ 'of tr~n~fe;~ to or 'fo~ t~e'u~e 0f ~he
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after Janua~ 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 statuto~ requirements for disclosure of assets
and filin~ a tax return are still applicable even if the su~iving spouse is the only beneficial.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twen~-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(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.
Copyright (c) ~000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
ADDITIONAL Personal Representatives
Estate of Clarrissa C. Bouldin SS# 191-09-4020 03/21/2003
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Marne
Address Line 1
Address Line 2
City, State, Zip
Date
Emeline C. Lucas
875 Eppley Drive
Mechanicsburg, PA
17055
REV- 1503 EX * (1-97)
COMMONWEALTHOFPENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
Clarrissa C. Bouldin $S# 191-09-4020 '03/21/2003
AIIpropertyjointly-owned withrightofsurvivorship mustbedisclosedonScheduleF.
FILE NUMBER
21-03 -0293
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE
OF DEATH
1 787.89522 shares PNC Investments Securities 44.73 35,242.55
Investment Account No. 17236824
2 33 Prudential Securities Inc. CUSIP 744320102 31.20 1,029.60
TOTAL (Also enter on line 2, Recapitulation) 36,272.15
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. [nc. Form REV-1503 EX (Rev. 1-97)
PNC INVESTMENTS
~ dixdsion ofJ.J.B. Hi~liard, W ~ L?h~ lm member N'tSF ,!hi:
May 13, 2003
James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, PA 17011
Re: Estate of Clarrissa C. Bouldin
The actual date the account was opened was 11/01/1995. The account was titled
Clarrissa C. Bouldin (individual account).
The items needed to distribute the assets among the beneficiaries are as follows:
Letter Of Authorization Stating:
-Names of Beneficiaries
-Address of Beneficiaries
-Social Security Numbers
-D.O.B's (if beneficiary is a minor, custodian info needed)
-Number of Shares of each position for each beneficiary.
The letter of authorization needs to be signed by the Executor of the Estate.
If you have any questions, please feel free to contact me at 800-762-0123.
Sincerely,
( J?finine M. Koepke
"S'ales Assistant to
Regis T. Sulkowski
Financial Advisor
A member of The PNC Financial Services Group
Two PNC Plaza 620 Libcrty Avenue Pil!sburgh ?ennsv~vrm,~ 15222
www. pncinvestments.com
Important Investor Information:
Dare ot Death: 03/21/2003
valuatiOn Da:e: 03/21/2003
processing Da:e: 04/15/2003
s~ares Securi:y
or Par Descrip:ion
787.89522 PNC FINL SVCS GROUP INC (6934751053
03/21/2003
Total value:
Total Accrual:
Total: $35,242.55
~state valua%ion
High/Ask
{5.60000
Low/Bid
Es:a:e of: CLAI~I$SA C. BOULDIN
Accoun:: 17236824
~epor: Ty~e: Date of Dea~
Number of SecuIities: 1
File 1D: BouLDIN,CLA~RI$SA
Me~ ~d/ar Div ~ ~t Seedily
A~jus~e:~S AcceSS Value
43.86000 H/L
44.730000
$0.00
35,2¢2.55
$35,2¢2.55
Page 1
was Oroduced wi:h gs:a:e~al, a ~roduc: o~ ~s:a:e yaluations & Pricing Systems,
.... ~ ~,a~ams a: (8181 313-6300. (Revision 6-¢.031
you have
The Estate of Clarissa C. Bouldin
Date of Death' March 21, 2003
Company Cusip Symbol
Prudential
Total Sales
Value a/o DOD Price Per
Quantity 03/21/03 Value Share
Commission
744320102 PRU
33 $31.20 $1,029.60 $36.14
$65.00
Net
Proceeds
$1,127.56
/MI quotations have been ~ frozn lhe
hisloricat ','~;?abase and oilier applicable research
sources. '~, ese quoiatioris have been carefully
checked btl; ,lieir accuracy is not
Ali capilal c!~a~fles ~nay nol be reflecled in lhe
~l)ove vaJualiorl.
REV- 1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clarrissa C. Bouldin SS# 191-09-4020 03/21/2003 21-03-0293
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Chapel Point - Entrance Fee Refund
1
2
4
8
9
10
11
12
13
PNC Bank, N.A. - Certificate of Deposit, Account No. 31000211402
date of death balance $5,000.00, accrued interest $10.94
PNC Bank, N.A. - Checking Account, Account No. 5140180958, date
of death balance $973.00, accrued interest $0.00
PNC Bank, N.A. - Savings Account, Account No. 5000679183, date o:
death balance $9,211.54, accrued interest $2.58
Smith Barney Citigroup
724-21316-18 008
Smith Barney Citigroup
724-21316-18 008
Smith Barney Citigroup
724-21316-18 008
Cash and Money Market Funds, Account No
Discover Bank CD, Account No.
Huntington National Bank CD, Account No
Sprint - Telephone-Refund of Credit Balance
The Sentinel - Refund
USAA - Refund of Automobile Insurance Policy
USAA Refund Automobile and Tenant Insurance
1993 Buick Park Avenue, VIN 1G4CW53LXP1637296
Personal Property Sold at Private Sale
TOTAL (Also enter on line 5, Recapitulation)
66,250.00
5,010.94
973.00
9,412.12
10.63
20,211.60
5,201.60
5.07
25.96
145.88
656.39
2,500.00
750.00
$ 111,153.19
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, [nc. Form REV-1508 EX (Rev. 1-97)
'"
Ch_aRe
t'Otnt¢
at Carlisle
770 South Hanover Street
Carlisle. PA 17013
April 14, 2003
Telephone: 717-249-1363
Fax: 717-249-951 I
Website: www.chapelpointe.com
Mr. James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, PA 17011
Dear Mr. Bogar:
I am responding to your March 31, 2003, letter to Linda Amsley inquiring about the
refundable apartment entrance fee due to the estate of Clarrissa C. Bouldin and the
policies relating to such refunds.
I have attached a spreadsheet that shows the calculation of the $66,250 refund.
According to Mrs. Bouldin's residency agreement (copy enclosed), the refund will be
paid within 30 days after the apartment has been reoccupied by a new resident and the
entrance fee for the reoccupied apartment has been paid in full. If the apartment is not
reoccupied within six months of the surrender date, 50% of the refund due will be paid on
the six-month anniversary of the surrender date. If the apartment is not reoccupied by the
one-year anniversary of the surrender date, the remaining 50% of the refund will be paid.
We have no way of knowing when the apartment will be reoccupied. We certainly hope
that it will be before October 1, 2003, which will be the six-month anniversary of the
surrender date.
If you have any questions, please contact me.
Sincerely,
Richard A. Lehmann
Director of Financial Services
CC: Linda Amsley
retirement community of The Christian and Missionary Alliance
PNCBAN<
April28,203
James D. Bogar
One West Main Street
Shiremanstown, PA 17011
Estate of Clarissa C. Bouldin, deceased
SSN; 191-09-4020
DOD: 3/21/2003
In response to your request for Date of Death ba!~uces for the customer noted above, our
records show the following:
Certificate of Deposit
Account #31000211402
CLARRI$SA C BOULDIN
DOD balance: $5,000.00 + $10.94 accrued interest
Established 03/21/2003
Account #5140180958
CLARRI$SA C BOULDI2q
DOD balance: $973.00 + $0.00 accrued interest
~;tabl/~hed 08101/1967
Savings Account
AccounI #5000679 lg3
CLARRISSA C BOULDIN
DOD balance: $9,211.54 + $2.58 accrued interest
Established 04/19/1996
For Brokerage information, please call 1-800-762-6111. ~ #17236824
Page 1 of 2
Please note that this office only provides date of d~ath balances for d~msit accounts
(IKAs, CDs, Ch~-g and Savings accounts). We do not process ~ny financial
transactions or provide statements. If you nccd assistance wi~ any of these items,
please call 1-8$8-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
Rachelle Wells
1-800-762-1775
P7-PFSC..04-F
500 fi~s~ Ave.
Pi~burgh PA 15219
Page 2 of 2
M~mber FDIC
SMITH BARNEY
c t groupJ
April l 1, 2003
James D. Bogar
Attorney At Law
One West Main Street
Shiremanstown, PA 17011
Dear James:
Listed below, please find the date of death values for the account of Clarfissa C. Bouldin.
call me if you have any questions.
Please
Security
Cash and Money Market Funds
Discover Bank CD
Huntington Nat'l Bank CD
Total Account Value
Clarrissa C. Bouldin
Value of Account on
March 21, 2003
Quantity
10.63
20,000
5,000
Bid
1.00
101.06
104.03
Ask
1.00
101.06
104.03
Value
$10.63
$20,211.60
$5.201.60
$2£423.83
Sincerely,
~M. Becker
Registered Sales Assistant to
Robert Beard
Vice President - Investments
Financial Consultant
The information herein has been obtained from sources' we believe to be reliable, but do not guarantee it's accuracy or completeness.
Citigroup Global Market~ }nc. I ! North 3rd Street, 2nd Floor Harrisburg. PA 17101 Tel 717 780 1'~00 Fax '1? 233 2090 Toil-r?ee 800 23- 1-00
CHEVROLET, INC.
3400 Hartzdale Drive at Capital City Mall Drive · Camp Hill, PA 17011 · Phone (717'~ 761-0600
4/22/03
Owner of Vehicle: Clarrissa C. Bouldin
Vehicle Identification Number: 1G4CW53LXP 163 7296
Year/Make/Model: 1993 Buick Park Avenue
Fair Market Value as of 03/21/2003: $2500.00
Above Information Provided By:
(Title)
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clarrissa C. Bouldin SS~/
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
191-09-4020 03/21/2003
FILENUMBER
21-03-0293
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
1
2
3
4
2
3
4
DESCRIPTION
FUNERALEXPENSES:
Anthony Hoke - Funeral Services-Clean-up
Deb Brandburg - Funeral Services-Clean-up
Dr. Gilchrist Eulogy
Ewing Brothers Funeral Home - Funeral/Burial
Total of Continuation Schedule(s)
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees James D. Bogar Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Legg Mason Wood Walker, Inc. -
Stock
State Zip
Commission for Sale of Prudential
Register of Wills Short Certificates
RESERVES: Costs to conclude administration of Estate including
filing fee for PA Inheritance Tax Return, Inventory and First &
Final Account; preparation of Personal and Fiduciary Income Tax
Returns
Sprint - Telephone Bill-Final
AMOUNT
25.00
25.00
100.00
9,456.60
1,371.52
4,812.50
278.00
65.00
9.00
850.00
43.90
Total of Continuation Schedule (s) 181.84
TOTAL (Also enter on line 9, Recapitulation) 17,218.36
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
Estate of: Clarrissa C. Bouldin
Soc Sec #: 191-09-4020
Date of Death: 03/21/2003
Continuation of Schedule H-A
(Funeral Expenses)
Item Description
Amount
5 Innovative Graphic Funeral Announcements
6 Susan Yingst - Funeral Luncheon
7 Wayne Noss Flowers Funeral Flowers
8 Westminster Cemetery - Grave Opening
26.75
362.67
37.10
945.00
1,371.52
Estate of: Clarrissa C. Bouldin
Soc Sec #: 191-09-4020
Date of Death: 03/21/2003
Continuation of Schedule H-B7
(Other Administrative Costs)
Item Description
Amount
5 U.S. Postal Service - Certified Mail to EquiServe
6 USAA - Automobile Insurance
7 USAA - Automobile Insurance
4.42
61.72
115.70
181.84
REV- 1513 EX * (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clarrissa C. Bouldin SS~/ 191-09-4020 03/21/2003 21-03-0293
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING pROpERTY Do Not List Trustee(s) OF ESTATE
II.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1
Edward J. Bouldin, Jr.
421 Main Street
Irwin, PA 15642
Emeline C. Lucas
875 Eppley Drive
Mechanicsburg, PA
17055
Ann B. Sensenich
17 Hope Drive
Boiling Springs, PA
17007
Son
Daughter
Daughter
One third
(1/3) of rest,
residue and
remainder
One third
(1/3) of rest,
residue and
remainder
One third
(1/3) of rest,
residue and
remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) ;)000 form software only The Lackner Group. Inc. Form REV-1513 EX (Rev. 9-00)
I,AST WILL AND TESTAMENT
OP
CLARRISSA C. BOULDIN
I, CLARRISSA C. BOULDIN, of Silver Spring Township,
Cumberland County, Pennsylvania, make, publish and declare this
as and for my Last Will and Testament, hereby revoking all other
Wills and Codicils heretofore made by me.
FIRST: I bequeath such of my tangible personal
property as is set forth in a separate dated and signed Memo-
randum, which dated and signed Memorandum shall be placed with or
attached to this, my Last Will and Testament, to the individuals
designated therein. It is my intent that the last dated and
signed Memorandum shall control. If there is no Memorandum, it
is my intent that all of my tangible personal property shall be
and become a part of my residuary estate.
SECOND: I devise and bequeath all the rest, residue
and remainder of my estate of whatever nature and wherever
situate, including any property over which I hold power of
appointment and together with any insurance policies thereon, in
equal shares, to my children, ANN B. SENSENICH, EMELINE C. LUCAS,
and EDWARD J. BOULDIN, JR., provided that should any of my
children predecease me, I give and bequeath such child's share
unto his or her issue per stirpes by representation, and if there
be a failure of same, then I give and bequeath such deceased
child's share to my surviving children as provided herein.
THIRD: Should any of my grandchildren or great-grand-
children not have attained the age of twenty-one (21) years at
the time for distribution to him or her, I give, devise and
bequeath the share of each such grandchild or great-grandchild to
my hereinafter named Trustee or Trustees, IN SEPARATE TRUSTS, to
hold, manage, invest and reinvest the shares so received, and to
use and apply from time to time such portion of income and
principal for the said grandchild's or great-grandchild's educa-
tion (including college, trade school or other similar training
or education), support and welfare as my Trustee or Trustees, in
their sole discretion, deem advisable. My Trustee or Trustees
may make the payments for the support and maintenance of my
grandchildren or great-grandchildren directly to said grandchild-
ren or great-grandchildren or to their parents as required. Any
payments made by my Trustee or Trustees pursuant hereto shall be
made without further responsibility to the said grandchildren or
great-grandchildren, or their parents, or to any person taking
care of my grandchildren or great-grandchildren. The Trustee or
Trustees, in exercising their discretionary authority with
respect to the payment of income or principal of the within Trust
to my grandchildren or great-grandchildren, shall take into
consideration any income or other resources available to my
grandchildren or great-grandchildren from sources outside this
Trust. In addition, my hereinafter named Trustee or Trustees
shall have the right, in their sole discretion, to purchase and
pay for out of the principal, as well as income, such insurance
policies as will provide for the grandchild's or great-grand-
child's medical care.
Any income or principal not so applied shall be dis-
tributed to each grandchild or great-grandchild when he or she
attains the age of twenty-one (21) years. In the event any of my
grandchildren or great-grandchildren predeceases me or dies prior
to the termination of this Trust, the interest of said grandchild
or great-grandchild in said Trust shall cease with any income and
principal being divided evenly between or among my other grand-
children or great-grandchildren or the separate trusts
established hereunder for their benefit. If, however, said
grandchild or great-grandchild is survived by any children, my
Trustee or Trustees shall pay net income of the Trust to or apply
the same for the benefit of such children of my deceased grand-
child or great-grandchild, in such amount or amounts as my
Trustee or Trustees, in their sole discretion, deem advisable for
the support, welfare and maintenance of said children. Any
income or principal not so applied shall be distributed when such
children of my deceased grandchild or great-grandchild attain the
age of twenty-one (21) years.
~OUR~: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
3
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FIFTH: I nominate and appoint WILLIAM E. LUCAS,
husband of EMELINE C. LUCAS, of 875 Eppley Drive, Mechanicsburg,
Pennsylvania, as Trustee of the hereinabove described trusts for
my grandchildren. I direct that my Trustee shall serve without
bond and shall receive fair and reasonable compensation.
SIXTH: I nominate and appoint ANN B. SENSENICH and
EMELINE C. LUCAS, as Co-Trustees of the hereinabove described
trusts for my great-grandchildren. I direct that my Co-Trustees
shall serve without bond and shall receive fair and reasonable
compensation.
SEVENTH: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
EIGHTH: I nominate and appoint ANN B. SENSENICH and
EMELINE C. LUCAS, Co-Executrixes of this, my Last Will and
Testament. I direct that my Co-Executrixes, and their succes-
sors, shall not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
4
seal to this, my Last Will and Testament, this \ ~ day of
CLARRISSA C. BOULDIN
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
5
MEMORANDUM
In accordance with the provisions of Clause FIRST of my
Last Will and Testament, dated ~'~/~c~ i~ , 1996, I direct
that the following described personal property be given outright
to those individuals so designated:
I have prepared and maintained a small notebook for
each of my children. Each notebook contains a specific list of
items of personal property, furniture and contents of my home.
Said list will govern the distribution of all property so listed.
Date :~ ~.k ~ ~ % ~k-~.:~~ (i~ ~: ~2t~-~ ~ (SEAL)
CLARRISSA C. BOULDIN
E
Register of Wills of
Estate of Clarrissa C. Bouldin
also known as
CUMBERLAND
INVENTORY
County, Pennsylvania
. Deceased
No. 21-03-0293
Date of Death 03/21/2003
Social Security No. 191~09-4020
Ann B. Sensenich and Emeline C. Lucas,
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 of 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
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative
Name of
Attorney: James D. Bo~ar Esquire S,gnature: A/jD.~. ,~/~ ~,~/C=nseni~'~.~~
Address: One West Main Street Address: 17 Hope Drive
Shiremanstown, PA 17011 Boilin~ Sprinss, PA 17007
Telephone: 717/737-8761 Telephone: 717/258-6544
Dated:
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Value
Total: 147,425.34
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.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form t~IRW-7 (1997)
Estate of:
Date of Death:
County:
INVENTORY
Clarrissa C. Bouldin
03/21/2003
Cumberland
CASH:
Chapel Point
Refund
Entrance Fee
PNC Bank, N.A. Certificate
of Deposit, Account No.
31000211402, date of death
balance $5,000.00, accrued
interest $10.94
PNC Bank, N.A. Checking
Account, Account No.
5140180958, date of death
balance $973.00, accrued
interest $0.00
PNC Bank, N.A. Savings
Account, Account No.
5000679183, date of death
balance $9,211.54, accrued
interest $2.58
Smith Barney Citigroup Cash
and Money Market Funds,
Account No. 724-21316-18 008
Smith Barney Citigroup
Discover Bank CD, Account
No. 724-21316-18 008
Smith Barney Citigroup
Huntington National Bank CD,
Account No. 724-21316-18 008
Sprint - Telephone-Refund of
Credit Balance
66,250.00
5,010.94
973.00
9,412.12
10.63
20,211.60
5,201.60
5.07
-1-
The Sentinel Refund
USAA Refund of Automobile
Insurance Policy
USAA Refund Automobile and
Tenant Insurance
25.96
145.88
656.39
PERSONAL PROPERTY:
1993 Buick Park Avenue, VIN
1G4CW53LXP1637296
Personal Property Sold at
Private Sale
2,500.00
750.00
STOCKS/LISTED:
787.89522 shares PNC Investments -
Securities Investment
Account No. 17236824
33 Prudential Securities Inc.
CUSIP 744320102
35,242.55
1,029.60
TOTAL RECEIPTS OF PRINCIPAL ...............
107,903.19
3,250.00
36,272.15
147,425.34
-2-