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IN RE: GUARDIANSmP OF
ROBERT L. BLOSSER, JR.
IN THE COURT OF COMMON PLEAS o~PR 11 Z001 f17
CUMBERLAND COUNTY, PENNSYL VANIA
. ORPHANS' COURT DIVISION
: NO. .21- 01 - 3~s
h ~O
AND NOW, this ~ day of .J.J..Q'^ , 2001, upon consideration
of the attached Petition filed, pursuant to 20 Pa.C.S. ~5513, it is hereby ORDERED AND
DECREED that, based on a finding that Robert Leon Blosser Jr. suffers from impaired
ability to reason and physically care for himself as a result of organic brain syndrome due
to possibly Korsakoff's Psychosis or Wernicke's Encephalopathy, and is so severely
mentally and physically impaired that he is unable to make, communicate or participate in
any decisions relating to his estate or person, Robert L. Blosser, Jr., is adjudged totally
incapacitated. Bobbi J. Blosser is appointed Emergency Temporary Guardian of the
person and estate of Robert Leon Blosser, Jr., and is appointed to manage and handle all
aspects of the alleged incapacitated person's estate, specifically including, but not limited
to: all issues relating to the operation and maintenance of his home at 730 Hillside Drive,
Carlisle, Cumberland C~unl?" Pennsylvania, and payment of debts on that home; all issues
relating to payment of routine bills and other banking and savings account needs; the
operation of his portion ofGC Blosser Beverage Distributors, Inc., where he is a one-third
(1/3) owner and employed as the manager; the maintenance, operation and control of his
stocks and bonds; the maintenance of his life and other insurance of which he is an owner
or beneficiary; his entitlement to any governmental or non-governmental benefit plans;
preparation and filing of federal, state, and local taxes; claims made or to be made on
behalf of him or against him; the execution of documents, entry into contracts affecting
him and the payment of reasonable compensation or costs to provide services for him,
including medical services. In addition, the Emergency Temporary Guardian is appointed
to handle all issues relating to the person of the alleged incapacitated person, specifically
including, but not limited to: his living arrangements, his medical and psychiatric care, the
administration of medication to him, and the employment and discharge of physicians,
psychiatrist, dentists, nurses, therapists, and other professionals for his physical and mental
treatment and care.
This Order shall expire 72 hours from today's date unless extended pursuant to the
provisions opO pa~ ~5{'} _
~ ~ Esquire, is appointed as counsel for the
incapacitated person, Robert Leon Blosser, Jr., and shall be given notice of all future
proceedings in this matter.
J.
IN RE: GUARDIANSIllP OF
ROBERT L. BLOSSER, JR.
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYL VANIA
: ORPHANS' COURT DMSION
: NO. .,2/- (j / _c ()3? s
STATEMENT OF RIGHTS
AN ORDER HAS BEEN ENTERED WHEREBY YOU HAVE BEEN
ADJUDICATED A TOTALLY INCAPACITATED PERSON AND UNABLE TO
CARE FOR YOURSELF AND/OR MANAGE YOUR PERSONAL AND FINANCIAL
AFFAIRS. YOU HAVE THE RIGHT TO FILE EXCEPTIONS TO THE COURT'S
DECISION WITIllN TWENTY (20) DAYS OF THE DATE OF THE COURT'S
ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL BECOME
FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS, THE ORDER WILL
BECOME FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS AND THEY
ARE DENIED, YOU HAVE A RIGHT TO FILE AN APPEAL TO THE SUPERIOR
COURT WITIllN THIRTY (30) DAYS OF THE DATE OF THE DENIAL OF THE
EXCEPTIONS.
IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME
TO MODIFY OR TO TERMINATE THE PLENARY GUARDIANSIllP IF THERE IS
A SIGNIFICANT CHANGE IN YOUR CAPACITY OR IF YOUR PLENARY
GUARDIAN FAILS TO PERFORM mS/HER DUTIES IN ACCORDANCE WITH
THE COURT'S ORDER.
IF YOU WISH TO FILE EXCEPTIONS TO OR FURTHER APPEAL THE
ORDER OR TO PETITION THE COURT TO MODIFY OR TERMINATE THE
PLENARY GUARDIANSIllP, YOU MAY BE REPRESENTED BY AN ATTORNEY.
IF YOU DO NOT HAVE AN ATTORNEY, YOU MAY REQUEST THAT THE
COURT APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN
ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY
APPOINT WILL BE PROVIDED AT NO COST TO YOU.
IN RE: GUARDIANSIllP OF
ROBERT L. BLOSSER, JR.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
. NO ']/ .. / ;2'/':-
. '.y - c)- <;JJ
PETITION FOR ADJUDICATION OF INCAPACITY AND
APPOINTMENT OF AN EMERGENCY GUARDIAN
AND NOW, comes Robert L. Blosser, Sr. and Jane Blosser, by and through their
counsel of record, Bradley L. Griffie, Esquire, and petitions the Court as follows:
1. Your Petitioners are Robert L. Blosser, Sr. and Jane Blosser, adult individuals
currently residing at 583 E Street, Carlisle, Cumberland County, Pennsylvania.
2. The alleged incapacitated person was born on May 2, 1959 and is 41 years of age, is
single, and resides at 703 Hillside Drive, Carlisle, Cumberland County, Pennsylvania.
3. The following persons are to the best of Petitioners' knowledge, information and
belief, the next-of-kin of the alleged incapacitated person: Robert L. Blosser, Sr.
[Father] and Jane Blosser [Mother] of 583 E Street, Carlisle, Cumberland County,
Pennsylvania.
4. To the extent known by Petitioners, the assets of the alleged incapacitated person
include: (1) a one-third (1/3) ownership interest is GC Blosser Beverage Distributors,
Inc., 222 East High Street, Carlisle, Cumberland County, Pennsylvania, value
unknown; (2) real estate at 730 Hillside Drive, Carlisle, Cumberland County,
Pennsylvania, value approximately $200,000.00; (3) checking and savings account at
M&T Bank at One West High Street, Carlisle, Cumberland County, Pennsylvania,
balances unknown.
5. Petitioners estimate the alleged incapacitated person's annual income to be
$31,200.00.
6. The alleged incapacitate person is not a member of the armed services of the United
States and is not receiving benefits from the United States Veterans' Administration.
7. The alleged incapacitated person is incapacitated due to Organic Brain Syndrome due
to possibly Korsakoff's Psychosis or Wernicke's Encephalopathy. Correspondence
from the alleged incapacitated person's treating physician is attached hereto and
incorporated herein by reference as Exhibit "A".
8. Because of Robert L. Blosser, Jr.'s present medical condition, he suffers from
impaired ability to reason and physically care for himself
9. Because of his mental/physical condition, the alleged incapacitated person is totally
unable to manage his financial affairs, property and business and to make and
communicate responsible decisions relating thereto, including the ability to
communicate his need for assistance in these areas.
10. The severity of the alleged incapacitated person's mental and physical condition and
the lack of viable, less restrictive alternatives necessitate that a Emergency Temporary
Guardian of his estate be appointed to manage and handle all aspects of the alleged
incapacitated person's estate, specifically including, but not limited to: all issues
relating to the operation and maintenance of his home at 730 Hillside Drive, Carlisle,
Cumberland County, Pennsylvania, and paYment of debts on that home; all issues
relating to paYment of routine bills and other banking and savings account needs; the
operation of his portion of GC Blosser Beverage Distributors, Inc., where he is a one-
third (1/3) owner and employed as the manager; the maintenance, operation and
control of his stocks and bonds; the maintenance of his life and other insurance of
which he is an owner or beneficiary; his entitlement to any governmental or non-
governmental benefit plans, federal, state, and local taxes; claims made or to be made
on behalf of him or against him; the execution of documents, entry into contracts
affecting him and the payment of reasonable compensation or costs to provide services
for him, including medical services.
11. The severity of the alleged incapacitated person's mental and physical condition and
the lack of viable, less restrictive alternatives necessitate that a Emergency Temporary
Guardian of his person be appointed to handle all issues relating to the person of the
alleged incapacitated person, specifically including, but not limited to: his living
arrangements, his medical and psychiatric care, the administration of medication to
him, and the employment and discharge of physicians, psychiatrist, dentists, nurses,
therapists, and other professionals for his physical and mental treatment and care.
12. Petitioners are not aware that the alleged incapacitated person signed any power of
attorney or advance health care directives or in any other way designated anyone to
serve as his agent over any of his personal or financial affairs or as his surrogate over
his medical care, or that he designated in writing his wishes with regard to health care,
including the use or refusal of life-sustaining treatment.
13. Petitioners, Robert L. Blosser, Sr. and Jane Blosser, are the natural parents of Robert
L. Blosser, Jr. and his next of kin; however, Petitioners were at their temporary
residence in the State of Florida at the time of the alleged incapacitated person's
medical emergency and are unable to remain in Cumberland County, Pennsylvania, for
an extended period of time as of the date of filing of this Petition.
14. The alleged incapacitated person has siblings, one of whom, Bobbi 1. Blosser, of 583
E Street, Carlisle, Cumberland County, Pennsylvania, has agreed to serve as Guardian
and is the choice of your Petitioners' to serve as Guardian; therefore, the proposed
Emergency Temporary Guardian of the person of the alleged incapacitated person is
Bobbi 1. Blosser, of 583 E Street, Carlisle, Cumberland County, Pennsylvania.
15. The proposed Emergency Temporary Guardian has no interest adverse to the alleged
incapacitated person.
16. The consent of the proposed Emergency Temporary Guardian is attached as Exhibit
"B" .
17. As indicated in the treating physician's report, the alleged incapacitated person has
been unable to communicate for over three and one-half (3~) weeks and, due to the
fact that his illness has not yet been determined and the cause of his medical difficulties
has not yet been located, there is no means to determine when the alleged
incapacitated person may be in a position to handle his own affairs.
18. It is the position of your Petitioners and the proposed Emergency Temporary
Guardian to have the within guardianship appointment approved on an emergency
basis, to be extended as permitted by law by further Petition, if necessary, and
ultimately, to be entered as a plenary guardian following hearing, ifnecessary.
19. Delinquencies developing in the alleged incapacitated person's financial affairs at home
and at his business, as well as the need to make medical decisions and decisions on the
day-to-day care of the alleged incapacitated person necessitate the entry of an Order
providing for an Emergency Temporary Guardian.
20. The appointment of an Emergency Temporary Guardian is the least restrictive
alternative available in this case, particularly in light of the inability for the medical care
providers to give an exact diagnosis and an exact prognosis.
WHEREFORE, Petitioners request your Honorable Court to enter an Order
adjudging Robert L. Blosser, Jr. to be incapacitated and appointing Bobbi J. Blosser
Emergency Temporary Guardian of the person and estate of the said Robert L. Blosser, Jr.
Respectfully submitted,
. e, Esquire
At or Petitioners
200 North Hanover Street
Carlisle, P A 17013
(717) 243-5551
(800) 347-5552
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
DATE:
rfj/tJ 10 /
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/// ':---' / ./, ,"
#~46~-/~ ~,
Robert L. Blosser, Sr.
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
DATE:
"'11/0 )rJ /
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J ' losser
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BELVEDERE MEDICAL CORPORAnON
860 WALNUT BOTTOM ROAD
CAf:\LlSLE. PA 17013
Internal MedicUtf
J.CRAlG JURGENSEN, M.o.- NEUROlOGY
STEVEN L. HATlEBERG. M.D.
DAVID P.ALBRIGH~ M.D.
SEVDAUNA V. BOSHNAKOV. M.D.
SERGE N. KOlE'J. M.o.. DERMATOLOGY
717~243-3944
FAX 717-243-7225
April 9, 2001
Bradley L. Griffie, Esquire
Griffie & Associates
200 N. Hanover Street
Carlisle, PA 11013
RE: Robert L. Blosser, Jr.
DOB: 05/02/1959
Dear Mr. Griffie:
As per your letter from March 26, 2001. you are requesting a detailed description of your
client's, Mr. Robert Blossert present condition. My understanding is that Mrs. Blossert his mother)
is applying for a medical and legal power of attorney.
As you know, Robert Blosser was admitted to the hospital on March 17 with acute delirium.
This was thought to be related to alcohol use and chronic liver disease. Unfortunately, his condition
required mechanical suppon and intubation for the first eight days of his admission. Also, he
required heavy sedation. His three weeks of hospitalization could be described as a gradual, but very
slow improvement of his mental status. At this point, though he is able to communicate with mostly
'yes' and 'no' and follow partial commands, he is not able to feed himself. nor he is able to yet
ambulate. He is somnolent and at times quite confused. He needs a hundred percent assistance with
his activities of daily living as washing. dressing, feeding; and his cooperation due to his mental
status is very minimum. Again, he follows partially oommands but he is not able to perform more .
complex tasks. Physical therapy and occupational therapy and speech therapy have been evaluating
him. Though all the studies have not shown us any particular reasons as stroke or infection involving
the brain, his diagnosis is organic brain syndrome due to possibly Korsakoff's psychOSis or
Wernicke's encephalopathy.
Mr. Blosser currently still is in Carlisle Hospital. He is under 24.hour supervision with a sitter
and assistant.
At this point~ I do not believe that Mr. Blosser is able to make any rational decisions, and I do _
not believe he is able to write or read comprehensively. There is still a detailed evaluation pending;
however, this process is going to probably be long and his recovery is probably expected to some
degree the next two to three months.
Exhibit "A"
Z 'd
SlZLEtl 'ON XV d
a3W lYNH31NIld3G NY 8E:ll Hill IO-OI-HdV
Page 2
April 9, 2001
RE: Robert L. Blosser. Jr.
I will be glad to assist you with any further information in regards of your client. If you need
any specific information. please let me know. Do not hesitate to call me.
Sincerely,
d:i~ak, -h.J:J
Sevdalina V. Boshnakov. M.D.
SVB/gmj
E 'J
SZZLftZ 'ON XV ~
a~N lVN~31NIJd~a NV 6E:l1 anJ 10-01-~JV
CONSENT OF GUARDIAN OF mE PERSON AND ESTATE
I, Bobbi J. Blosser, hereby consent to act as the Guardian of the Person and Estate
of Robert Leon Blosser, Jr.
I reside at 583 E Street, Carlisle, Cumberland County, Pennsylvania.
I am a citizen of the United States of America and can speak, read, and write the
English language.
I have no interest adverse to Robert Leon Blosser, Jr., the alleged incapacitated
person.
/7 /'''7
~ /,?;;.a ~;7.3/~
BOBBI J. BL6SSER
COMMONWEALTH OF PENNSYL VANIA
COUNTYOF Llt~~
On this the 10 t:h day of ~
, 2001, before me, the undersigned
officer, personally appeared Bobbi 1. Blosser, known to me (or satisfactorily proven) to be
the person whose name is subscribed to the within Agreement and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~~1 LlN-I-~
Notarial Seal
Robin J. Goshorn, Notary Public
Carfisle Boro, Cumberfand County
My Commission Expims Apr, 17, 2003
Exhibit "B"
. I
"
IN RE: GUARDIANSIllP OF
ROBERT L. BLOSSER, JR.
APR 1 G ZJJJf:J
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
: NO. 21-01-375
ORDER OF COURT AND RULE
TO SHOW CAUSE
AND NOW, this ~ day of /Ar/ ' 200~, upon presentation and
consideration of the within Petition for Adjudication of Incapacity and Appointment of
Permanent Guardian, a Rule is hereby issued upon Robert L. Blosser, Jr. to show cause, if
any he has, as to why he should not be found to be an incapacitated person.
Rule returnable at a hearing to be held on 7x /J~. , the :J J1.M of
A. ( JJ /? ..' ) ,) . 3
c::!7~ ' 2001 at ;:L 2JL o'clock, JLm., 10 Courtroom No. , of
the Cumberland County Courthouse, Carlisle, Pennsylvania.
Order of Court and Rule to Show Cause shall be served upon Robert L. Blosser,
Jr. by serving his attorney of record, Michael A. Scherer, Esquire.
BY THE COURT,
. J.
cc: Bradley L. Griffie, Esquire
Attorney for Petitioners
Michael A. Scherer, Esquire
Attorney for Robert L. Blosser, Jr.
r,
....
. .
IN RE: GUARDIANSlllP OF
ROBERT L. BLOSSER, JR.
IN THE COURT OF COMM:ON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
: NO. 21-01-375
IMPORTANT NOTICE
TO: ROBERT L. BLOSSER, JR.
c/o MICHAEL 1. SCHERER, ESQUIRE
A petition has been tiled with this Court to have you declared an
Incapacitated Person. If the Court finds you to be an Incapacitated Person, your
rights will be affected, including your right to manage money and property and to
make decisions. A copy of the Petition which has been filed by Robert L. Blosser, Sr.
and Jane Blosser is attached.
You are hereby ordered to appear at a hearing to be held in Courtroom #_,
of the Cumberland County Courthouse, Carlisle, Pennsylvania, on
the day of , 2001, at o'clock, _.m., to
tell the court why it should not find you to be an Incapacitated Person and appoint a
Guardian to act on your behalf
To be an Incapacitated Person means that you are not able to receive and
effectively evaluate information and communicate decisions and that you are unable to
manage your money and/or other property, or to make necessary decisions about where
you will live, what medical care you will get, or how your money will be spent.
At the hearing, you have the right to appear, to be represented by an attorney, and
to request a jury trial. If you do not have an attorney, you have the right to request the
Court to appoint an attorney to represent you and to have the attorney's fees paid for you
if you cannot afford to pay them yourself You also have the right to request that the
court order that an independent evaluation be conducted as to your alleged incapacity.
If the Court decides that you are an Incapacitated Person, the Court may
appoint a Guardian for you, based on the nature of any condition or disability and your
capacity to make and communicate decisions. The Guardian will be of your person and/or
your money and other property and will have either limited or full powers to act for you.
If the Court tinds you are totally incapacitated, your legal rights will be
affected and you will not be able to make a contract or gift of your money or other
property. If the Court finds that you are partially incapacitated, your legal rights will also
be limited as directed by the Court.
\
If you do not appear at the hearing (either in person or by an attorney representing
you), the Court will still hold the hearing in your absence and may appoint the Guardian
requested.
PENDING the hearing in this matter, our Order of April 11, 2001, naming BOBBI
J. BLOSSER as Emergency Temporary Guardian is extended for an additional twenty
(20) days pursuant to 20 Pa.C.S. ~5513.
BY THE COURT,
Date:
Clerk, Orphans' Court
IN RE: GUARDIANSHIP OF
ROBERT L. BLOSSER, JR.
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. 21-01-375
STATEMENT OF RIGHTS
AN ORDER HAS BEEN ENTERED WHEREBY YOU HAVE BEEN
ADJUDICATED A TOTALLY INCAPACITATED PERSON AND UNABLE TO
CARE FOR YOURSELF AND/OR MANAGE YOUR PERSONAL AND FINANCIAL
AFFAIRS. YOU HAVE THE RIGHT TO FILE EXCEPTIONS TO THE COURT'S
DECISION WITHIN TWENTY (20) DAYS OF THE DATE OF THE COURT'S
ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL BECOME
FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS, THE ORDER WILL
BECOME FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS AND THEY
ARE DENIED, YOU HAVE A RIGHT TO FILE AN APPEAL TO THE SUPERIOR
COURT WITHIN THIRTY (30) DAYS OF THE DATE OF THE DENIAL OF THE
EXCEPTIONS.
IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME
TO MODIFY OR TO TERMINATE THE PLENARY GUARDIANSIllP IF THERE IS
A SIGNIFICANT CHANGE IN YOUR CAPACITY OR IF YOUR PLENARY
GUARDIAN FAILS TO PERFORM mSIHER DUTIES IN ACCORDANCE WITH
THE COURT'S ORDER.
IF YOU WISH TO FILE EXCEPTIONS TO OR FURTHER APPEAL THE
ORDER OR TO PETITION THE COURT TO MODIFY OR TERMINATE THE
PLENARY GUARDIANSIllP, YOU MAY BE REPRESENTED BY AN ATTORNEY.
IF YOU DO NOT HAVE AN ATTORNEY, YOU MAY REQUEST THAT THE
COURT APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN
ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY
APPOINT WILL BE PROVIDED AT NO COST TO YOU.
DATE:
Clerk, Orphans Court
IN RE: GUARDIANSHIP OF
ROBERT L. BLOSSER, JR.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
: NO. 21-01-375
PETITION FOR ADJUDICATION OF
INCAPACITY AND APPOINTMENT OF
PERMANENT GUARDIAN
AND NOW, comes Robert L. Blosser, Sr. and Jane Blosser, by and through their
counsel of record, Bradley L. Griffie, Esquire, and petitions the Court as follows:
1. Your Petitioners are Robert L. Blosser, Sr. and Jane Blosser, adult individuals
currently residing at 583 E Street, Carlisle, Cumberland County, Pennsylvania.
2. The alleged incapacitated person, Robert L. Blosser, Jr., was born May 2, 1959 and is
41 years of age, is single, and resides at 703 Hillside Drive, Carlisle, Cumberland
County, Pennsylvania.
3. The following persons are, to the best of Petitioners' knowledge, information and
belief, the next of kin of the alleged incapacitated person: Robert L. Blosser, Sr.
[Father] and Jane Blosser [Mother], of 583 E Street, Carlisle, Cumberland County,
Pennsylvania.
4. An Emergency Temporary Order was entered on April 11, 200 1 based upon a Petition
for Emergency Guardianship, a copy of said Decree and Petition being attached hereto
and incorporated herein by reference as Exhibit" A".
5. The alleged incapacitated person has been in-patient at the Carlisle Hospital since
March 17, 2001 and has been under 24-hour supervision since that time with a sitter
and an assistant.
6. The report of Dr. Sevdalina V. Boshnakov, dated April 9, 2001, was provided to
support Petitioners' prior Petition to secure an emergency temporary guardianship
Decree.
7. In the past 72 hours, the alleged incapacitated person's medical condition has not
changed from that outlined in the letter of April 9, 2001, a copy of said letter being
attached hereto and incorporated herein by reference as Exhibit "B".
8. Pursuant to 21 Pa.C.S. ~5513, an extension of the 72-hour emergency Order is
necessary for an additional 20-day period in order to allow for the Emergency
Temporary Guardian to maintain the personal and financial needs of the alleged
incapacitated person.
9. Based upon the medical recommendation, Petitioners request that a permanent
guardian be named and that a hearing be scheduled for purposes of taking testimony, if
necessary, in order to allow for the naming of a permanent guardian.
10. The Court has appointed Michael A. Scherer, Esquire as counsel for the alleged
incapacitated person, Robert L. Blosser, Jr.
11. The facts recited in Petitioners' initial Petition for Adjudication of Incapacity and
Appointment of An Emergency Guardian remain as set forth in that Petitioner, which
is attached hereto as Exhibit "A".
I,
WHEREFORE, Petitioners request your Honorable Court to extend the 72-hour
emergency temporary guardianship naming and appointing Bobbi J. Blosser as said
guardian for an additional 20-day period and to schedule a hearing in this matter to
determine the appropriateness of naming of a permanent guardian.
Respectfully submitted,
GRIFFIE & ASSOCIATES
L. Griffie, Esquire
omey for Petitioners
200 North Hanover Street
Carlisle, P A 17013
(717) 243-5551
(800) 347-5552
VERIFICATION
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section
4904, relating to unsworn falsifications to authorities.
DATE: '-{ I I ~ I 0 I
( I
---
VERIFICATION
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section
4904, relating to unsworn falsifications to authorities.
DATE: f. ///7- //J /
1/'
~
~~?/J;/ /'. .~ .~
ROBERT L. BLOSSER, SR.
IN RE: GUARDIANSHIP OF
ROBERT L. BLOSSE~ JR.
IN THE COURT OF COM::M:ON PLEAS OF
CillvffiERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. OIL -OJ -a15
DECREE
AND NOW, this I'.l.l day of 2001, upon consideration
of the attached Petition filed, pursuant to 20 Pa.C.S. 95513, it is hereby ORDERED AND
DECREED that, based on a finding that Robert Leon Blosser Jr. suffers from impaired
ability to reason and physically care for himself as a result of organic brain syndrome due
to possibly Korsakoff's Psychosis or Wernicke's Encephalopathy, and is so severely
mentally and physically impaired that he is unable to make, communicate or participate in
any decisions relating to his estate or person, Robert L. Blosser, Jr., is adjudged totally
incapacitated. Bobbi J. Blosser is appointed Emergency Temporary Guardian of the
person and estate of Robert Leon Blosser, Jr., and is appointed to manage and handle all
aspects of the alleged incapacitated person's estate, specifically including, but not limited
to: all issues relating to the operation and maintenance of his home at 730 Hillside Drive,
Carlisle, Cumberland County, Pennsylvania, and payment of debts on that home; all issues
relating to payment of routine bills and other banking and savings account needs; the
operation of his portion of GC Blosser Beverage Distributors, Inc., where he is a one-third
(1/3) owner and employed as the manager; the maintenance, operation and control of his
stocks and bonds; the maintenance of his life and other insurance of which he is an owner
or beneficiary; his entitlement to any governmental or non-governmental benefit plans;
preparation and filing of federal, state, and local taxes; claims made or to be made on
behalf of him or against him; the execution of documents, entry into contracts affecting
Exhibit "A"
him and the payment of reasonable compensation or costs to provide services for him,
including medical services. In addition, the Emergency Temporary Guardian is appointed
to handle all issues relating to the person of the alleged incapacitated person, specifically
including, but not limited to: his living arrangements, his medical and psychiatric care, the
administration of medication to him, and the employment and discharge of physicians,
psychiatrist, dentists, nurses, therapists, and other professionals for his physical and mental
treatment and care.
This Order shall expire 72 hours from today's date unless extended pursuant to the
provisions of20 Pa.C.S. ~5513.
~L~ &k..~
. Esquire, is appointed as counsel for the
incapacitated person, Robert Leon Blosser, Jr., and shall be given notice of all future
proceedings in this matter.
BY THE COURT,
JSI ~~C~ E. J:J~
P. 1.
A TRUE COPY FROM RECORD
'n Testimony wheref, I hereunto set my hand
and the seal of said Court at Carlisle I P A
This tl day of 20QL
., .
I.
IN RE: GUARDIANSHIP OF
ROBERT L. BLOSSE~ JR.
: IN THE COURT OF COM:M:ON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
: NO.
STATEMENT OF RIGHTS
AN ORDER HAS BEEN ENTERED WHEREBY YOU HAVE BEEN
ADJUDICATED A TOTALLY INCAPACITATED PERSON AND UNABLE TO
CARE FOR YOURSELF AND/OR MANAGE YOUR PERSONAL AND FINANCIAL
AFFAIRS. YOU HAVE THE RIGHT TO FILE EXCEPTIONS TO THE COURT'S
DECISION WITIllN TWENTY (20) DAYS OF THE DATE OF THE COURT'S
ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL BECO~
FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS, THE ORDER WILL
BECO~ FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS AND THEY
ARE DENIED, YOU HAVE A RIGHT TO FILE AN APPEAL TO THE SUPERIOR
COURT WITHIN TIllRTY (30) DAYS OF THE DATE OF THE DENIAL OF THE
EXCEPTIONS.
IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME
TO MODIFY OR TO TERMINATE THE PLENARY GUARDIANSHIP IF THERE IS
A SIGNIFICANT CHANGE IN YOUR CAPACITY OR IF YOUR PLENARY
GUARDIAN FAILS TO PERFORM mS/HER DUTIES IN ACCORDANCE WITH
THE COURT'S ORDER.
IF YOU WISH TO FILE EXCEPTIONS TO OR FURTHER APPEAL THE
ORDER OR TO PETITION THE COURT TO MODIFY OR TERMINATE THE
PLENARY GUARDIANSHIP, YOU MAY BE REPRESENTED BY AN ATTORNEY.
IF YOU DO NOT HAVE AN ATTORNEY, YOU MAY REQUEST THAT THE
COURT APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN
ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY
APPOINT WILL BE PROVIDED AT NO COST TO YOU.
"
IN RE: GUARDIANSHIP OF
ROBERT L. BLOSSER JR.
IN THE COURT OF COMrvION PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
. ORPHANS' COURT DIVISION
: NO. :2.' - 6 \ - 315"
PETITION FOR ADJUDICATION OF INCAPACITY AND
APPOINTMENT OF AN EMERGENCY GUARDIAN
AND NOW, comes Robert L. Blosser, Sr. and Jane Blosser, by and through their
counsel of record, Bradley L. Griffie, Esquire, and petitions the Court as follows:
1. Your Petitioners are Robert L. Blosser, Sr. and Jane Blosser, adult individuals
currently residing at 583 E Street, Carlisle, Cumberland County, Pennsylvania.
2. The alleged incapacitated person was born on May 2, 1959 and is 41 years of age, is
single, and resides at 703 Hillside Drive, Carlisle, Cumberland County, Pennsylvania.
3. The following persons are to the best of Petitioners' knowledge, information and
belief, the next-of-kin of the alleged incapacitated person: Robert L. Blosser, Sr.
[Father] and Jane Blosser (Mother] of 583 E Street, Carlisle, Cumberland County,
Pennsylvania.
4. To the extent known by Petitioners, the assets of the alleged incapacitated person
include: (1) a one-third (1/3) ownership interest is GC Blosser Beverage Distributors,
Inc., 222 East High Street, Carlisle, Cumberland County, Pennsylvania, value
unknown; (2) real estate at 730 Hillside Drive, Carlisle, Cumberland County,
Pennsylvania, value approximately $200,000.00; (3) checking and savings account at
M&T Bank at One West High Street, Carlisle, Cumberland County, Pennsylvania,
balances unknown.
"
5. Petitioners estimate the alleged incapacitated person's annual income to be
$31,200.00.
6. The alleged incapacitate person is not a member of the armed services of the United
States and is not receiving benefits from the United States Veterans' Administration.
7. The alleged incapacitated person is incapacitated due to Organic Brain Syndrome due
to possibly Korsakoff's Psychosis or Wernicke's Encephalopathy. Correspondence
from the alleged incapacitated person's treating physician is attached hereto and
incorporated herein by reference as Exhibit "A".
8. Because of Robert L. Blosser, Jr.'s present medical condition, he suffers from
impaired ability to reason and physically care for himself
9. Because of his mental/physical condition, the alleged incapacitated person is totally
unable to manage his financial affairs, property and business and to make and
communicate responsible decisions relating thereto, including the ability to
communicate his need for assistance in these areas.
10. The severity of the alleged incapacitated person's mental and physical condition and
the lack of viable, less restrictive alternatives necessitate that a Emergency Temporary
Guardian of his estate be appointed to manage and handle all aspects of the alleged
incapacitated person's estate, specifically including, but not limited to: all issues
relating to the operation and maintenance of his home at 730 Hillside Drive, Carlisle,
Cumberland County, Pennsylvania, and payment of debts on that home; all issues
relating to payment of routine bills and other banking and savings account needs; the
operation of his portion of GC Blosser Beverage Distributors, Inc., where he is a one-
third (1/3) owner and employed as the manager; the maintenance, operation and
,J.
control of his stocks and bonds; the maintenance of his life and other insurance of
which he is an owner or beneficiary; his entitlement to any governmental or non-
governmental benefit plans, federal, state, and local taxes; claims made or to be made
on behalf of him or against him; the execution of documents, entry into contracts
affecting him and the payment of reasonable compensation or costs to provide services
for hi~ including medical services.
11. The severity of the alleged incapacitated person's mental and physical condition and
the lack of viable, less restrictive alternatives necessitate that a Emergency Temporary
Guardian of his person be appointed to handle all issues relating to the person of the
alleged incapacitated person, specifically including, but not limited to: his living
arrangements, his medical and psychiatric care, the administration of medication to
him, and the employment and discharge of physicians, psychiatrist, dentists, nurses,
therapists, and other professionals for his physical and mental treatment and care.
12. Petitioners are not aware that the alleged incapacitated person signed any power of
attorney or advance health care directives or in any other way designated anyone to
serve as his agent over any of his personal or financial affairs or as his surrogate over
his medical care, or that he designated in writing his wishes with regard to health care,
including the use or refusal of life-sustaining treatment.
13. Petitioners, Robert L. Blosser, Sr. and Jane Blosser, are the natural parents of Robert
L. Blosser, Jr. and his next of kin; however, Petitioners were at their temporary
residence in the State of Florida at the time of the alleged incapacitated person's
medical emergency and are unable to remain in Cumberland County, Pennsylvani~ for
an extended period of time as of the date of filing of this Petition.
,-
14. The alleged incapacitated person has siblings, one of whom, Bobbi 1. Blosser, of 583
E Street, Carlisle, Cumberland County, Pennsylvania, has agreed to serve as Guardian
and is the choice of your Petitioners' to serve as Guardian; therefore, the proposed
Emergency Temporary Guardian of the person of the alleged incapacitated person is
Bobbi 1. Blosser, of 583 E Street, Carlisle, Cumberland County, Pennsylvania.
15. The proposed Emergency Temporary Guardian has no interest adverse to the alleged
incapacitated person.
16. The consent of the proposed Emergency Temporary Guardian is attached as Exhibit
"B" .
17. As indicated in the treating physician's report, the alleged incapacitated person has
been unable to communicate for over three and one-half (3 Y2) weeks and, due to the
fact that his illness has not yet been determined and the cause of his medical difficulties
has not yet been located, there is no means to determine when the alleged
incapacitated person may be in a position to handle his own affairs.
18. It is the position of your Petitioners and the proposed Emergency Temporary
Guardian to have the within guardianship appointment approved on an emergency
basis, to be extended as permitted by law by further Petition, if necessary, and
ultimately, to be entered as a plenary guardian following hearing, if necessary.
19. Delinquencies developing in the alleged incapacitated person's financial affairs at home
and at his business, as well as the need to make medical decisions and decisions on the
day-to-day care of the alleged incapacitated person necessitate the entry of an Order
providing for an Emergency Temporary Guardian.
.'
20. The appointment of an Emergency Temporary Guardian is the least restrictive
alternative available in this case, particularly in light of the inability for the medical care
providers to give an exact diagnosis and an exact prognosis.
WHEREFORE, Petitioners request your Honorable Court to enter an Order
adjudging Robert L. Blosser, Ir. to be incapacitated and appointing Bobbi 1. Blosser
Emergency Temporary Guardian of the person and estate of the said Robert L. Blosser, Jr.
Respectfully submitted,
. e, Esquire
A or Petitioners
200 North Hanover Street
Carlisle, P A 17013
(717) 243-5551
(800) 347-5552
, '
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
DATE: i /,; /0 /
I! /
I
/
/
I
//';
/~~' /j/. ~/;~/ .'
'-, f~u-1 / /' J//' // /';'.,; L/t')',.
;/ ~ ;,~' ,-_.-<..'-/~... ' ~.
Robert L. Blosser, Sr.
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
DATE:
q<-J)Jo )tJ /
I '
'0av 1
JtBlosser
c,
'&. M i/. 2,~ /
I I .
,I .J.
, ,
BELVEDERE MEDICAL CORPORATION
850 WALNUT BOTTOM ROAD
CARLISLE. PA 17013
/ntemIJl ,~edicil'lt
J.CRAlG JURGENSEN, M.D.- NEUROLOGY
STEVEN L.HATLEBERG. M.D.
DAVID P.ALBRIGHT, M.D.
SEVOAUNA V. BOSHNAKOV, M.D.
SERGE N. J<OLE'J, M.o. ~ DERMMOLOGY
717-243-39~
FAX 717-243-7225
April 9, 2001
Bradley L. Griffie, Esquire
Griffie & Associates
200 N. Hanover Street
Carlisle, PA 17013
RE: Robert L. Blosser, Jr.
DOB: 0510211959
Dear Mr. Griffie:
As per your letter from March 26, 2001, you are requesting a detailed description of your
client's, Mr. Robert Blosser, present condition. My understanding is that Mrs. Blosser, his mother,
is applying for a medical and legal power of attorney.
As you know, Robert Blosser was admined to the hospital on March 17 with acute delirium.
This was thought to be related to alcohol use and chronic liver disease. Unfortunately. his condition
required mechanical support and intubation for the first eight days of his admission. Also, he
required heavy sedation. His three weeks of hospitaHzatioo oould be described as a gradual, but very
slow improvement afhis mental status. At this point, though he is able to communicate with mostly
~yes' and 'no' and follow partial ctlmmands, he is not able to feed b.i.msel~ nor he is able to yet
ambulate. He is somnolent and at times quite confused. He needs a hundred percent assistance with
his activities of daily living as \VS.41hing, dressin~ feeding; and his cooperation due to his mental
status is very minimum. Againt he follows partially commands but he is not able to perform more .
complex tasks. Physical therapy and occupational therapy and speech therapy have been evaluating
him. Though all the studies have not shown us any particular reasons as stroke or infection involving
the brain, his diagnosis is organic brain syndrome due to possibly Korsakoff' 5 psychosis or
Wernick.e's encephalopathy.
~1r. Blosser currently still is in Carlisle Hospital. He is under 24.hour supervision with a sitter
and assistant.
At this point, I do not believe that Mr. Blosser is able to make any rational decisions, and I do .
not believe he is able to write or read comprehensively. There is still a detaiJed evaluation pending;
however, this process is going to probably be long and his recovery Is probably expected to some
degree the next two to three months.
Exhibit "A"
tJ . d
~ZZLEtz 'OllXYi
caw 1VNE~lNlld3a NY 8S:I1 121 ro-or-~dV
I I
,1 .I
Page 2
April 9, 2001
RE: Robert L. Blosser, Jr.
I will be glad to assist you with any further information in regards of your client. If you need
any specific informationt please let me know. Do not hesitate to call me.
Sincerely,
c5-wLa.k _ pJ:>
Sevdalina V. Boshnakovt M.D.
SVB/gmj
E 'J
~ZZLfvZ 'ON XV~
tJEW lYN~11NIJdja XV BE: II j111 IO-Ol-~ti
I I .
.. ,I
CONSENT OF GUARDIAN OF THE PERSON AND ESTATE
I, Bobbi J. Blosser, hereby consent to act as the Guardian of the Person and Estate
of Robert Leon Blosser, Jr.
I reside at 583 E Street, Carlisle, Cumberland County, Pennsylvania.
I am a citizen of the United States of America and can speak, read, and write the
English language.
I have no interest adverse to Robert Leon Blosser, Jr., the alleged incapacitated
person.
,..<.:~..." //'J /<7
'-->::~ ,/ /7.Y~'
BOBBI J. B~ER
COMM:ONWEAL TH OF PENNSYL VANIA :
COUNTY OF L It r\\...b,vJ. ~
On this the J 0 th day of ~"<L
, 2001, before me, the undersigned
officer, personally appeared Bobbi J. Blosser, known to me (or satisfactorily proven) to be
the person whose name is subscribed to the within Agreement and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~ ~,;.1 d ~~~-
NotariaJ Seal
Ro~in J. Goshorn, Notary Public
Cartlsle Bore. Cumberland County
My Commission Expi~s Apr. 17. 2003
Exhibit "B"
. I 11
.. " t
BELVEDERE MEDICAL CORPORATION
SSO WALNUT BOTTOM ROAD
CARLISLE. PA 17013
Internal Medicin~
J. CRAlG JURGENSEN, M.o. - NEUROLOGY
STEVEN LHATlEBERG. M.D.
OAVlO P.AlBRIGHT: M.D.
SEVDALINA V. BOSHNAXOV, M. D.
SERGE N. KOLE'I. M.o. - DERMATOLOGY
717-243-39<<
FAX 717-243-72?S
Apri19,2001
Bradley L. Griffie, Esquire
Griffie & Associates
200 N. Hanover Street
Carlisle, PA 17013
RE: Robert L. Blosser~ Jr.
ooB: 05/0211959
Dear Mr. Griffie:
As per your letter from March 26, 2001, you are requesting a detailed description of your
clientts, Mr. Robert Blosser, present condition. My understanding is that Mrs. Blosser, hi! mother,
is applying for a medical and legal power of attorney.
As you know, Robert Blosser was admitted to the hospital 0Jl March 17 with acute delirium.
This was thought to be related to al~hol use and cl1ronic liver disease. Unfortunately, his condition
required mechanical support and intubation for the first eight days of his admission. Also, he
required heavy sedation. His three weeks ofhospitalizatioo could be described as a gradual, but very
slow improvement ofms mental status. At this point, though he is able to communicate with mostly
~yes' and ~no 1 and follow partial commands, he is not able to feed himself: nor he is able to yet
ambulate. He is somnolent and at times quite COJ1fuscd. He needs a hundred percent assistance with
his activities of daily living as W3-4lhing, dressing. feeding; and his cooperation due to his mental
status is very minimUllL .~ he follows partially commands but he is not able (0 perform more .
complex tasks. Physical therapy and occupational therapy and speech therapy have been evaluating
him. Though all the studies have not shown us any particular reasons as stroke or in.te.::tion involving
the brain., his diagnosis is organic brain syndrome due to possibly Korsakoff' 5 psychosis or
Wernicke's encephalopathy.
l\-1r. Blosser currently still is in Carlisle Hospital. He is under 24.hour supervision with a sitter
and assistant.
At this point, I do not believe that Mr. Blosser is able to make any rational dc:cisions, and I do .
not believe he is able to write or read comprehensively. There is still a detailed evaluation pending;
however, this process is going to probably be long and his recovery is probably expected to some
degree the next two to three months.
Exhibit "B"
., ~
. .
. ' I
. .' ,
Page 2
April 9, 2001
RE: Robert L. Blossert Jr.
I will be glad to assist you with any further information in regards of your client. If you need
any specific informatioD~ please let me know. Do not hesitate to call me.
Sincerely,
.5~ak, P.J:J
Sevdalina V. Boshnakov, M.D.
SVB/gmj
IN RE:
IN THE COURT OF COMMON PLEAS OF
GUARDIANSHI:P OF
ROBERT L. BLOSSER, JR.
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-2001-0375
RULE
WE COMMAND, you that laying aside all business and excuses whatsoever,
you hp and appear in your proper person before the Honorable Judges of the
Cornmon pleas Court, Orphans' Court Division at a session of the said Court,
there to be held, for the County of CUmberland to show cause why, if any he
has, as to why he should not be found to be an incapacitated person.
Rule returnable at a hearing to be held on Monday, the 23rd day of
April, 2001 at 9:30 o'clock, A.M., in Courtroom No.3, of the Cumberland
County courthouse, Carlisle, P ~nsylvania. Order of Court and Rule to Show
Cause shall be served upon Robert L. Blosser, Jr. by serving his attorney of
record, Michael A. Scherer, Esquire.
witness my hand and off ical seal of office at carlisle, pennsylvania,
this 17th day of April, 2001.
MMfLI . ~ ~) G( iJYf]UtLctipJvl'-'
Mary C. Lewis, Clerk of Orphans'
Court Division, Cumberland County,
Carlisle, pennsylvania. My Cornm.
Exp. 1st Mon. January 2001.
'J
.
Estate oj Robert L. Blosser, Jr.
also known as
PETITION F'()R PI~OBATE and GRANT OF LETTERS
c:J1.LJ /- &~
Deceased.
No.
To:
Register of Wills for the
County of Cumber land in the
Commonwealth of Pennsylvania
Social Security No. 1 99- 5 2- 6 2 7 3
The petition of the undersigned respectfully represents that:
y our petitioner~), who is/are 18 years of age or older an the execut r i x
in the last will of the above decedent, dated May 1 5, 2 0 0 1
and codicil(s) dated ( None )
named
, X9L--
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
his last family or principal residence at 730 Hi lIs ide Drive, Car Ii s Ie, PA
(Borough of Carlisle)
(list street, number and muncipality)
Decendent, then 45 years of age, died May 20, 2004
at r~rli~lA Region~] MAni~~l rAntAr
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 married Peti tioner after execution of the
Decendent at ~~~ t,~ned p;~perty 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: 730 Hillside Drive, Carl i slAt
,XI
$1,000.00
$ 0.00
$ 0,00
PA$'~~81~OO_OO
WHEREFORE, petitionerOO respectfully request(s) the probate of the last will )lKQ{X~Q(I.~X
presented herewith and the grant of letters tes tamen tarv
theron.
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
v>
llJ
U
r::
ll.l
~3
ll.l ...
o::u
s:::
-00
c.=
=r'=
3~
u.....
30
'as
c
1>0
Ci5
stacy Teats Blosser
730 Hillside Drive
r~rli~lp, p~ 17011
~~
- - n_ J, - -- ~~
OATH OF" PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF C9MBERLAND .
The petitioner(s) a.bove-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and SUbscribe~.
_~met~ ~.
~ ~ .' ~~A
~ ~~~g~ter &I~~4~_
~<y ,
V:l
c;Q'
~
~
.....
s::
~
~
~
,
No. ~/-CJ/-E?~-"
Estate of Robert L. Blosser, Jr.
, Deceased
DECREE OF PROBA~rE ANI) GRANT OF LE1"'TERS
AND NOW .Tllnp- L/ 2004 __Xwx.....-, in consideration of the petition on
the reverse side hereof, satisfactory proof haying been prc3ented. before me,
IT IS DECREED that the instrument(s) dated May 1 5 , 200'1
described therein be admitted to probate and filed of record as the last will of
Robert L. Blosser, Jr.
and Letters Testamentarv
are hereby granted to stacy Teats BIos ser
FEES
Probate, Letters, Etc. .........
.II. -,4.!,.~
Shott Certificates( )..........
Renunciation ................
C)ey:;
A ITORNEY (Sup. Ct.. LD. NQ.}
200 N. Hanover street
Car .11 S .1 e , p.& 0 RklsD 1 ::3
717-243-5551
PHONE.
\( I";;
This IS to ccrtifv that the information here given is correctly copied from an original certificate of death dulr filed with me as
Local Re!!istrar~ The original certificate will be forwarded to the State Vital Records Office for permanent fIlmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $2.00
~=\
-1 n'-lrj!
~,) ,,~~'J ~
E
No.
'ii-~.~~~
Local Registrar
'....~....i i - !.~
MAY 2 2 200~
Date
H105.144 Rev. 1/91
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
!/PRINT
IN
'ANENT
C1( INt(
SEX
2.
Male
Blosser,
DATE OF BIRTH
(Month, Day, Year)
L
Jr.
Robert
UNDER 1 VEAR
Months Days
STATE FILE NUMBER
SOCIAL SECURITV NUMBER
199-52-6273
May 20, 2004
3.
BIRTHPLACE (City and
Slate or Foreign Country)
PLACE OF DEATH (Check. only one see inS'IUC!IQns on othe' Side)
HOSPITAL
Carlisle / PA InpalienlD
7 81.
FACILITY NAME (If nol institution, give slreet and number)
~=ity)O
Did
decedent
live ina
Cumberland township? 17dl(] ~~h~e;~t~~~~i~~~OI Carlisle
MOTHER'S NAME (F".t. Mddle, Ma,den Surname) Jane SWOpe
19.
INFmTA~~r~iDd~Sffil":'.,cot~'ti"tSii~,e) PA 17013
20b.
PLACE OF DISPOSITION. Name 01 Cemetery. Cremalory
or Other Place .
Cumberland Valley Memor1al
21C:--'Garaens
NAME AND ADDRESS OF FACILlTV Ho man-
22c. 219 N. Hanover St. /
LICENSE NUMBER
UNDER 1 DAV
Hours Minutes
. CI
~,
Cumberland
8c.
lb.
WAS DECEDENT EVER IN
US ARMED FORCES?
vesO NO~
KIND OF BUSINESSIINDUSTRV
Beverage
III. Owner -0 rator l1b Distributor
DECEDENT'S MAILING ADDRESS (SIr..t, CitylTown, State, Zip Code) DECEDENT'S
730 Hillside Dr. ~~1~;iNCE
Carlisle / PA 17013 ~~t~:,r~~'f's
<2.
17a. State
PA
17b. Count
Robert L. Blosser/ Sr.
Stacy Jo Blosser
2004
DATE PRONOUNCED DEAD (Monlh. Day. Year)
24. a. M. 25. May 20, 2004
27. PART I: Enter the diseases. Injuries or complications whlct'l caused the death, Do not enter the mode of dying, such as cardiac Of re'5pifa\Ofy anest, shock or hean tailure,
List onty one cause on each line
Acute Hepatic Failure
DUE TO (OR AS A CONSEOUENCE OF).
~ Hepatic Encephalopathy
DUE TO (OR AS A CONSEOUENCE OF):
DUE TO (OR AS A CONSE~UENCE OF)
d.
WERE AUTOPSV FINDINGS
AVAILABLE PRIOR TO
COMPLETiON OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURV
(Monlh, Day. Year)
&
o
o
RACE. American Indiln. Black. White, ote
(Specify)
'0.
White
MARITAL STATUS. Married
Never Married. Widowed,
Di....orced (Specify)
Married
SURVIVING SPOUSE
(II W<<e. give malOefl flame)
Stacy Jo Teats
He.D Ves. decedenllJved in
twp
citylboro
LOCATION. CilylTown. State. Zip Code
nc
23b. 23c.
WAS CASE REFERRED TO MEDSL EXAMINER/CORONER?
Yes )1S\ No 0
2&.
I Approximale PART II: Other significanl conditions contributing to death, but
: interval between not resulting in the undertying cause given in PART I.
! onset and death
o
TIME OF INJURV
INJURY AT WORK?
No 0
Accident
Pending I. ,r'slig9Iion
o
o 30a. JOb.
o ~';:d~nEg~;~~(~~~;!~)A! hnrfle. farm, street, factory, office
JOe.
M. JOe.
Natural
HorTHCldr'
Yes 0 No rj.. Ves 0
280. 28b.
CERTIFIER (Check only one)
. CERTIFYING PHYSICIAN (Pr,YSlC1an certifying cause of death when anothef phySICI8f\ has pr00(Ju'
To the best of my knowledge. death occurred due to the cluse(l) and m.nne, .s.tlted. .
COUld nOI
Suicide
29.
\I:~n\h ",nd comp\e\eO \\p.m 23)
'PRONOUNCING AND CERTiFYING PHYSICIAN (Physician both pronouncing dealh and cert,ly'ng I luse 01 death)
To the best of my knowledge, death OC:C:Ufntd at the time, date, Ind placet Ind due to the causejs) Ind mlnner.1 .tated.. .
.MEDICAl EXAMINER/CORONER
On th. bull of ...mlnallon and/or Inve8llgallon, In my opinion, death oocurred "' the time. dlte, and place, and due to the cauee(s) and
mann.r u atated.. . . . . . . . . . . . . . . . . . .. .. .. . .. , . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .
3ta.
REGISTRAR'S SIGNATURE AND NUMB~ _ C"
33. ~ ~. ~~'t'"~~~ ~
~ud
Yes
Coroner
DATE SIGNED (Month, Day, yeerb
o 31c. 3td. May 21, 2 04
~\~~E2~K~~~~~~~,oF P}110~h~~cfML~TE~c~~~ i ;~Co r one r
kt 6375 Basehore Road, Suite HI
~ ~ Mechanicsburg, Pa. 17050
34.
'.
~/-OI-~7S-
1East lIIill attb Qrtsbtttttut
OF
ROBERT L. BLOSSER, JR.
I, ROBERT L. BLOSSER, JR., of 730 Hillside Drive, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding, do
make, publish and declare this to be my Last Will and Testament, hereby revoking and
making void all previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my Executor hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death as is reasonably possible. However, my Executor need not
accelerate and pay those unmatured obligations which, in his, her or its opinion, it might
be proper and more advantageous to retain or renew and pay as they become due and
payable. If I do not own a burial plot or a grave marker at the time of my death, I
authorize my Executor/Executrix, in his, her or its sole discretion, to purchase a burial plot
and to erect a suitable grave marker at my grave, and to expend sums from my estate for
this purpose.
G'RIFFIE & ASSOCIATES
ATTORNEYS.AT-LAW
200 NORTH HANOVER STREE,Page 1 of 11
CARLISLE, PENNSYLVANIA 17013 CHAMBERSBURG PENNSYLVANIA
\
SECOND
I give, devise and bequeath all of my interest of whatsoever nature in Blosser
Beverage Distributors, Inc. equally to my siblings, ELIZABETH OILER and BOBDI
BLOSSER, per capita, together with all insurance proceeds and assets associated
therewith.
THIRD
I give, devise and bequeath all of my intangible personal property, including, but
not limited to, all of my checking and savings accounts, as well as other investments that
do not otherwise have a designated beneficiary, in trust for the benefit of my dear and
close friend, STACY TEATS. Upon my death under these circumstances, a trust shall be
established with COMMERCE BANK through the assistance and at the direction of my
legal counsel, Bradley L. Griffie, Esquire, or the firm of Griffie & Associates, with the
Trust being for the benefit of Stacy Teats. It is my intention that the said Stacy Teats shall
be permitted under the terms of the Trust to receive all routine income, interest or
dividends from said Trust account, so as to use those funds for her routine care and
maintenance. Stacy Teats shall not be permitted to invade the principal of the Trust for
any purposes except for her medical emergencies or for purposes of assisting her children, ~
Kaitlin Teats and William Teats, in their educational needs or for their medical
emergencies, which use of principal must be approved by the Trustee. Upon the death of
Stacy Teats, William Teats and Kaitlin Teats shall immediately become the beneficiaries of
the Trust fund. Kaitlin and William Teats shall be permitted under the Trust to receive
routine income, interest and dividends from the trust account for their routine maintenance
and care, but shall not be permitted to invade the principal of the Trust except for
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 2 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersburg, PA 17201
purposes of medical emergencies or their education. However, upon the first of the two
named children to reach the age of 25, that child shall be entitled to receive a disbursement
of twenty-five (25%) percent of the principal of the aforesaid Trust without further
consequence and shall thereafter no longer be a beneficiary of the said Trust. When the
second child reaches the age of 25, he/she shall receive thirty-three and one-third (33
1/3%) percent or one-third (1/3) of the principal of the Trust without further consequence
and shall thereafter no longer be a beneficiary of the said Trust.
At the time when the youngest child reaches the age of 25 and the disbursements
are made as set forth above, the balance of the Trust funds shall then be converted to a
new Trust to be managed and administered by COMMERCE BANK for the purpose of
distributing funds for educational scholarships for qualified seniors at Carlisle High School
who intend to advance their post-secondary education following graduation. I give the
express authority to Commerce Bank and my legal counsel, Bradley L. Griffie, and the law
firm of Griffie & Associates to establish the terms of the Trust for the disbursement of
scholarship benefits with the following directions:
1. The scholarship trust established under these terms shall designate from one to
five scholarships each year to a worthy Carlisle High School senior for
purposes of assisting them with the cost of their post-secondary education;
2. The qualifications to receive scholarship funds may include financial need,
academic excellence, involvement in extracurricular activities, as well as
involvement in social or humanitarian endeavors; and
3. At no time shall the Trust fund be depleted, but rather, the scholarship amounts
and the number of students receiving scholarships shall be determined by the
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 3 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersbllrg, PA 17201
'i
Trustee and my legal counsel in a manner so as to preserve the Trust and allow
for ongoing disbursement of Trust funds for these purposes in perpetuity.
FOURTH
Should my beloved friend, STACY TEATS, predecease me or die on or before
the sixtieth (60) day following my death, then I give, devise and bequeath all of my
intangible personal property, including, but not limited to, all of my checking and savings
accounts, as well as other investments that are not otherwise designated on such
investments to be distributed to other individuals, to be held in Trust by COMMERCE
BANK to the benefit of the children of Stacy Teats, Kaitlin Teats and William Teats,
per capita. Kaitlin and William Teats shall be permitted under the Trust to receive routine
income, interest. and dividends from the trust account for their routine maintenance and
care, but shall not be permitted to invade the principal of the Trust except for purposes of
medical emergencies or their education. However, upon the first of the two named
children to reach the age of 25, that child shall be entitled to receive a disbursement of
twenty-five (25%) percent of the principal of the aforesaid Trust without further
consequence and shall thereafter no longer be a beneficiary of the said Trust. When the
second child reaches the age of 25, he/she shall receive thirty-three and one-third (33
1/3%) percent or one-third (1/3) of the principal of the Trust without further consequence
and shall thereafter no longer be a beneficiary of the said Trust.
At the time when the youngest child reaches the age of 25 and the disbursements
are made as set forth above, the balance of the Trust funds shall then be converted to a
new Trust to be managed and administered by COMMERCE BANK for the purpose of
distributing funds for educational scholarships for qualified seniors at Carlisle High School
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 4 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersbllrg, PA 17201
~
who intend to advance their post-secondary education following graduation. I give the
express authority to Commerce Bank and my legal counsel, Bradley L. Griffie, and the law
firm of Griffie & Associates to establish the terms of the Trust for the disbursement of
scholarship benefits with the following directions:
1. The scholarship trust established under these terms shall designate from one to
five scholarships each year to a worthy Carlisle High School senior for
purposes of assisting them with the cost of their post-secondary education;
2. The qualifications to receive scholarship funds may include financial need,
academic excellence, involvement in extracurricular activities, as well as
involvement in social or humanitarian endeavors; and
3. At no time shall the Trust fund be depleted, but rather, the scholarship amounts
and the number of students receiving scholarships shall be determined by the
Trustee and my legal counsel in a manner so as to preserve the Trust and allow
for ongoing disbursement of Trust funds for these purposes in perpetuity.
FIFTH
I give, devise and bequeath the rest, residue and remainder of my estate to my dear ~
and beloved friend, STACY TEATS, under circumstances where she survives me by at
least sixty (60) days. If Stacy Teats predeceases me or dies on or before sixty (60) days
following my death, then I give, devise and bequeath the rest, residue and remainder of my
estate in Trust as hereinbefore referenced to be established with Commerce Bank to the
benefit of Kaitlin Teats and William Teats, as well as the establishment of a scholarship
fund as described above. Any real estate or tangible personal property in existence at the
time of my death and under circumstances where Stacy Teats has predeceased me or dies
GRIFFIE & ASSOCIATES
Anorneys At Law
Page 5 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersbllrg, PA 17201
~
on or before sixty (60) days following my death, shall be liquidated so as to provide
proceeds to be deposited in Trust as hereindescribed for the benefit of Kaitlin Teats,
Williams Teats and the scholarship fund established by this my Last Will & Testatment.
SIXTH
I direct my ExecutorlExecutrix to divide among such beneficiaries all personal
property of a sentimental or family nature (excluding cash, stocks, bonds and the like),
including but not limited to jewelry, household goods, antiques, furniture and memorabilia,
in accordance with a separate memorandum which I may place with my Will or deposit
with my attorney. In the absence of such disposition by memorandum, I direct that the
said tangible personal property be divided between my residual beneficiaries with due
regard for their personal preferences in as nearly equal shares as practical, with the value
of such dispositions being credited to the share of each respective recipient. If the said
beneficiaries do not agree to the division of the personal property provided for hereunder,
the decision of my ExecutorlExecutrix, including the decision to sell the property at public
or private sale and distribute the proceeds therefrom as provided hereinafter, shall be final
and conclusive on all parties.
SEVENTH
I grant my ExecutorlExecutrix the following powers in addition to and not in
limitation of such powers as my ExecutorlExecutrix shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger, reorganization
or voting trust plan; to delegate authority with respect thereto; to deposit
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 6 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersbllrg, PA 17201
investments under agreements and pay assessments; and generally to exercise
all rights of investors, including but not limited to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my Executor/Executrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the paYment of taxes or for any other proper purposes in ~
the administration of my estate, and to mortgage or pledge estate assets as
security .
(h) To compromise claims without court approval including, but not limited to,
any controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 7 of 11
38 N. Main Street
Chambersburg, PA 17201
(i) To distribute in cash or in kind upon any division or distribution of my estate.
G) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management of
the settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
EIGHTH
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary .
NINTH
I nominate, constitute and appoint my beloved friend, STACY TEATS, as
Executrix of this my Last Will and Testament. In the event Stacy Teats is deceased,
unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I
nominate, constitute and appoint my parents, ROBERT L. BLOSSE~ SR. and JEAN
BLOSSE~ to serve jointly, or their survivor, as Co-Executors of this my Last Will and
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 8 of 11
200 N. Hanover Street
Carlisle, PA 17013
38 N. Main Street
Chambersburg, PA 17201
~
..
Testament. I direct that my Executor/Executrix shall not be required to give or post bond
for the faithful performance of his, her or its duties in this or any other jurisdiction.
TENTH
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable knowledge
of my affairs, views and wishes respecting any matters that may arise at the probate of this
instrument, the administration of my estate, and the execution of the powers herein
mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of eleven (11) typewritten pages, the first eight (8) of
which bear my signature on the side margin, for purpose of identification, this
/5 ffi
day of /ll '6'
. 2001.
y~/ ~G/~ J
ROBERT L. BLOS ER, JR.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 9 of 11
38 N. Main Street
Chambersbllrg, PA 17201
..
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND
I, ROBERT L. BLOSSER, JR., the Testator whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
~o-eJ :tg4<~ J-
ROBERT L. LOSSER, JR.
Sworn or affirmed and acknowledged before me by ROBERT L. BLOSSER, JR.
the Testator this Ie{ i:/J
.
dayof I ~/
. 2001.
/;:;?~~ if d~'UV
, (1
Notarial Seal
Robin J. Goshorn. Notary Public
Carlisle Born, Cumberland County
My Commission Expires Apr. 17. 2003
100 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 10 of 11
38 N. Main Street
Chambersbllrg, PA 17101
'..
AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA:
: ss.
COUNTY OF CUMBERLAND
WE, c~[Uil-f(J L 61' .rf{e and K an H Ii ,--{Lvc ~
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will and Testament; that he signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testator signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testator was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
~
and
Sworn or affirmed .and subscribed before me by '~o.i4,1 60 ~
). .' C~
1:::-12,-15 d- () it i/~Ci'1A- this /<) !:!J. day of / '-'
I U
. 200 1.
(--Kr&~ {] ddH'L-
Notary Publi~
Notarial Seal
Ro~in J. Goshorn, Notary Public
Carlisle Bore, Cumberland County
My Commission Expires Apr. 17, 2003
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 11 of 11
38 N. Main Street
Chambersburg, PA 17201
CERTIFICATE OF NOTICE UNDER RULE 5.6{a)
Name of Decedent: Robert L. Blosser, Jr.
Date of Death: May 20, 2004
Will No. 2001-00375
Admin. No. 21-01-0375
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules
was mailed to the following beneficiaries of the above-captioned estate on June ~ , 2004.
NAME ADDRESS
Kaitlin Teats
c/o Stacy J. Blosser
730 Hillside Drive
Carlisle, PA 17013
Williams Teats
Carlisle Area School District
c/o Stacy J. Blosser
730 Hillside Drive
Carlisle, PA 17013
c/o Mary K. Durham
District Administration Office
623 West Penn Street
Carlisle, PA 17013
Stacy J. Blosser
730 Hillside Drive
Carlisle, PA 17013
Notice has now been given to all personal entitled thereto under Rule 5.6(a) except: Bobbi
Blosser and Elizabeth Oiler
~;i;;sentatives
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717)243-5551
(800) 347-5552
CERTIFICATE OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Robert L. Blosser, Jr.
Date of Death: May 20, 2004
WillNo. 2001-00375 Admin. No. 21-01-0375
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Corot Rules
was mailed to the following beneficiaries of the above-captioned estate on October 13, 2004.
NAME
Bobbi Jane Blosser
Elizabeth Ann Oyler
ADDRESS
583 "E"Street
Carlisle, PA 17013
317 Walnut Street
P.O. Box 478
Boiling Springs, PA 17007
Notice has now been given to all personal entitled thereto under Rule 5.6(a) except: Bobbi
Blosser and Elizabeth Oiler
DATE:
Cc:
Rquire
epresentatives
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
Robert R. Black, Esquire (For informational purposes)
NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In RE: Estate of Robert L. Blosser, Jr.
No. 2001-00375
TO: Bobbi JaneBlosser
583 "E" Street
Carlisle, PA 17013
Please take notice of the death of decedent and the grant of letters to the personal
representative named below. You may have a beneficial interest in the estate as follows:
A 50% interest in decedent's share of G.C. Blosser, Inc.
Name of Descendent: Robert L. Blosser, Jr.
Last known address of decedent: 730 Hillside Drive, Carlisle, PA 17013
Date of Death: May 20, 2004
Place of death: Carlisle Regional Medical Center, Carlisle, Cumberland County, Pennsylvania
County of grant of original letters: Cumberland County
Descendent died: testate
A copy of will is attached.
Name, address, and telephone number of personal representatives appointed:
.NAME ADDRESS
Staey J. Blosser 730 Hillside Drive
Carlisle, PA 17013
Name, address, and telephone number of counsel.
NAME ADDRESS
Bradley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013
Additional information may be obtained from the undersigned.
DATE: /Z~,~ ~! 0'1 ~r',-~e
o~uns~l~or~ers p '
sentatwe
TELEPHONE #
(717) 218-5038
TELEPHONE #
(717) 243-5551
(800) 347-5552
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In RE: Estate of Robert L. Blosser, Jr.
No. 2001-00375
TO: Elizabeth Ann Oyler
317 Walnut Street
P.O. Box 478
Boiling Springs, PA 17007
Please take notice of the death of decedent and the grant of letters to the personal
representative named below. You may have a beneficial interest in the estate as follows:
A 50% interest in decedent's share of G.C. Blosser, Inc.
Name of Descendent: Robert L. Blosser, Jr.
Last known address of decedent: 730 Hillside Drive, Carlisle, PA 17013
Date of Death: May 20, 2004
Place of death: Carlisle Regional Medical Center, Carlisle, Cumberland County, Pennsylvania
County of grant of original letters: Cumberland County
Descendent died: testate
A copy of will is attached.
Name, address, and telephone number of personal representatives appointed:
NAME ADDRESS
Staey J. Blosser 730 Hillside Drive
Carlisle, PA 17013
Name, address, and telephone number of counsel.
NAME ADDRESS
Bradley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013
Additional information may be obtained from/,~~
DATE: L, / ~-3 / ~ ~
Dld~[~i£fie, ~quire
~~ s~o~n/a~l~e~esentative
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
TELEPHONE #
(717) 218-5038
TELEPHONE #
(717) 243-5551
(800) 347-5552
IN THE MATFER OF
ESTATE OF:
ROBERT L. BLOSSER
A/IdA ROBERT L. BLOSSER, JR. '04
STATE OF PENNSYLVANIA
INTHE ORPHANS COURT
OF CUMBERLAND COUNTY
ESTATE #: 2101-375
ilO!/ 15 I~ ~ :F~I
STATEMENT OF CIdLIM
1. ERI Financial Services, the creditor, cerfities fl~at fl~ere is due va~d owing by
ROBERT L. BLOSSER deceased, fl~e mnount of TWO THOUSAND ONE HUNDRED
EIGHTY NINE DOLLARS AND TVVENTY-FIVE CENTS. ($2,189.25).
2. The nature of the claim is a Bowtlex account nuinber 0151691100644551.
3. The name and address of the creditor is: ERI Financial Services, P.O. Box 3542,
Baltimore, Maryland 21214.
4. Tiffs claim is not based on any one instrmnent. The balance has accrued since die
account was established.
I do solemnly declare m~d affirm under the penalties of perjury fl~at fl~e inforn~afion in the
fbregoh~g clahn is true and con'ect to the best of my knowledge, information and belief. I bave made
diligent inquiry and examination, and I believe fl~e claim is just and all legal offsets, payments, and
credits made known to fl~e affiant have been allowed.
SHANNON EWING
ERI Financial Services
P. O. Box 3542
Baltimore, Maryland 21214
(410) 444-8022
State of Maryland, County of Balfixnore:
IN WITNESS WHEREOF, I hereunto set my band and Notarial Seal this 10th day of October,
2004.
My Commission Exp~8.
1N RE:
ESTATE OF:
ROBERT L. BLOSSER
DECEASED.
ESTATE NO. 2101-375
SATISFACTION AND RELEASE OF CLAIM
The undersigned, Kathy M Peyton, Agent for ERI FINANCIAL SERVICES, has accepted
a settlement in the amount of $1,600.00 equal to 73%, satisfying the claim filed in this
proceeding on behalf of the Creditor. This satisfaction and Release of Claim is executed to
acknowledge discharge of the claim and to release the estate and personal representative fi'om all
further liability in respect to the date of death liability on account number 0151691100644551.
Executed this December 6, 2004.
ERI FINANCIAL SERVICES
Claiman)
By: )K~/th~ M~ e~oo n~, [A~g~-~
Estate Recoveries, Inc.
P.O. Box 24566
Baltimore, MD 21214
Estate of Robert L. Blosser, Jr.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
WILL NO. 2001-00375
ADMIN. NO. 21-01-0375
INRE:
PETITION TO WITHDRAW AS COUNSEL
AND NOW, comes Petitioner, Bradley L. Griffie, Esquire, and the law firm of
Griffie & Associates and petitions the Court as follows:
1. Your Petitioner is counsel of record for the above-captioned estate.
2. The Executrix appointed in this matter is Stacy Teats Blosser, formerly known
as Stacy Teats of730 Hillside Drive, Carlisle, PA 17013.
3. The said Stacy Teats Blosser was appointed as Executrix of the Estate of
Robert L. Blosser, Jr. by Certificate of Grant of Letters dated June 4, 2004.
4. Since the appointment of the Executrix, your Petitioner has made repeated and
ongoing efforts to gain the cooperation of the Executrix to process the estate
and make appropriate distributions and payment of appropriate debts.
5. Despite repeated and ongoing attempts to gain the cooperation of the
Executrix, your Petitioner has been unable to gain a response from her and is
unable to proceed with the complete and final probating of the estate in this
matter.
6. Petitioner has no further means of advancing this case on behalf of the
Executrix who retained Petitioner in this matter.
c
I'."'
,',-I
',<--
"",":'::>
WHEREFORE, Petitioner requests your Honorable Court to enter a Rule upon
Respondent, Stacy Teats Blosser, to show cause, if any she has, as to why Petitioner
should not be permitted to withdraw as counsel in this estate.
Respectfully submitted,
L(/lI/o:r
Date
y . riffie, Esquire
IF & ASSOCIATES
200 orth Hanover Street
Carlisle, P A 17013
(717) 243-5551
(800) 347-5552
VERIFICATION
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsifications to authorities.
DATE: '1/11 /05
,
RIFFIE, ESQUIRE
INRE:
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: WILL NO. 2001-00375
: ADMIN. NO. 21-01-0375
Estate of Robert L. Blosser, Jr.
CERTIFICATE OF SERVICE
p...
I, Bradley L. Griffie, Esquire, hereby certify that I did, the ~ day of April,
2005, cause a copy of Petitioner's Petition to Withdraw as Counsel to be served upon
Respondent by first-class mail, postage prepaid at the following addresses:
Stacy Teats Blosser
730 Hillside Drive
Carlisle, PA 17013
DATE: Y/I.J-/o5
RECEIVED APR 192005 j./}
INRE:
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: WILL NO. 2001-00375
: ADMIN. NO. 21-01-0375
Estate of Robert L. Blosser, Jr.
ORDER OF COURT
AND RULE TO SHOW CAUSE
AND NOW, this .u;!" day of
,2005, upon presentation
and consideration of the within Petition, a Rule is hereby issued upon the Respondent,
Stacy Teats Blosser, to show cause, if any she has, as to why Bradley L. Griffie, Esquire
and the law firm of Griffie & Associates should not be permitted to withdraw as counsel
for the above-referenced estate.
Rule returnable 2 e> days after service by first-class mail, postage prepaid.
By the Court,
I .
l .
......~ '
41905 ~L~l(Y
~RL\DLEY G~PFic,EsQ .
STf.\Oi TEATS bLD~E:K.
V lit LlSf6 Vf., ,
'-'
C".~j
Irt
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/29/2006
GRIFFIE BRADLEY L
200 N HANOVER STREET
CARLISLE, PA 17013
RE: Estate of BLOSSER ROBERT L JR
File Number: 2001-00375
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/20/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~ kIJ;;/~u~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/29/2006
TEATS STACY
NKA
730 HILLSIDE DRIVE
CARLISLE, PA 17013
RE: Estate of BLOSSER ROBERT L JR
File Number: 2001-00375
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/20/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
Cumberland County - RegisteruI Wl.L.LS
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/29/2006
BLOSSER STACY TEATS
RE: Estate of BLOSSER ROBERT L JR
File Number: 2001-00375
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/20/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TEATS STACY NKA
730 HILLSIDE DRIVE
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 199-52-6273
FILE NUMBER: 2101-0375
DECEDENT NAME: BLOSSER ROBERT L JR
DATE OF PAYMENT: 04/28/2006
POSTMARK DATE: 04/28/2006
COUNTY: CUMBERLAND
DATE OF DEATH: OS/20/2004
NO. CD 006626
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,377.36
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TOTAL AMOUNT PAID:
$1,377.36
REMARKS:
CHECK# 98
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
=E/-' 500 E~ .t.:~,
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REV-1500
*""-~ COMMONWEALTH OF
} _.' PENNSYLVANIA
.' . -~ ..' \ . DEPARTMENT OF REVENUE
. . c'.' DEPT 280601
" .' HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS ,f.,JAME (LAST, FIRST, AND MIDDLE INITIAL)
Blosser Robert L
DATE OF DEP.JH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
5 20 04 5 2 59
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Blosser
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Q 1. Onglnal Return
D 4. Limltea Estate
[] 6. Decedent Died Testate (Attach copy of Will)
D 9. LitlgatJon Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date oj death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy oITrust)
D 10. Spousal Poverty Cre'dit (dateofaeatn'belWeen 12-31-91 anc '-1-951
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COMPLETE MAILING ADDRESS
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FIRM NAME (H Applicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2, Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
(1) 1 59, 000 00
(2) . 0 0
(3) 1 1 , 4 7 7 .i 9 9
(4) 3 , 536 . 72
(5) 1 , 6 7 8 . 32
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7) . 0 0
(6) . 0 0
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(9) 6 f 7 7 8 _ 4 7
(10) 3 , 342 . 44
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has net been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
154,094.13
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
11,477.99
18. Amount of Line 14 taxable at collateral rate
1 Q T~y nlU:l
FILE NUMBER
21 -JLL LJLL1-2
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
199 27
i THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I REGISTER OF WILLS
SOCIAL SECURITY NUMBER
208
56
3505
D 3. Remainder Return (date of aeam pnorto 12-~3-82)
D 5. Federal Estate Tax Return Required
--9- 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (A~Cl1 5ch 0\
)
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-9FFICIAL USE ONLX')
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(8) 1 7 5 , 6 9 3 . 0 3
(11 ) 10,120.91
(12) 165,572.12
(13) 0.00
(14) 165,572.12
X.O_ (15) 0.00
x.O_ (16) 0.00
x .12 (17) 1, 3 7 7 . 3 6 .6&
x .15 (18) 0.00
(19) 0.00
Decedent's Complete Address:
I. STREET ADDRESS
clrr :;:l~:::Side Drivo
I STATE
PA
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
1,377.36
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( D + E)
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
(3) 0.00
(4) 0.00
(5) 1,377.36
(SA) 0.00
(58) 1,377.36
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
@~2if,A,;;'~0f;~-~, ~_:: 1"..:'S:~-~'~":".l:;,,;~i:::~,~i~.~~.,:.:.i.i~ ~,.~',~~i.~~;i;~:"'f~-;--' .....~.,~~:"~'.:~.2~:-l;:Z;'~:}_ - ',?,'/.."j '~'~~:_::. ''':' .~: -,', ,_ ...:-:" '. ;::;-:' - - <:.- :"",: ~_:'-' '. '.:':.'-' _' .~. __~:,:~'*
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 ~
b. retain the right to designate who shall u~e the property transferred or its income; ............................................ D GI
c. retain a reversionary interest; or.......................................................................................................................... 0' [Xl
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...... .......... ...................... ... ....... ...... ............. ..... ...................................... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? .... ..........." .................... ...................... ......... ........................................ ............ 0 [KJ
IF THE ANSWER TO ANY OF THE ABOVE QUEsTION~ I~ vct' \J,.... - - 1ST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
( r'i ements. and to the best of my knowledge and belief, it is true. correct a~ complete.
.C:;:j? i1Y knowledge,
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0~.;Yo '...(" ats Bloss~r
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For dates of death on or after July 1, 1994 and before Januar J I I I ;:7::10, me tax rate imposed on the net value of transfers to or for the use of the su:, !'1ing spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)J.
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Under penalties of perjury, I declare that I have examined this return.
Decl ti of preparer other than the personal representative is base
Lt-41~O Co
DA-=
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For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sur/iving spouse is C:'., [72 P.S. 99116 (a) (1.1) (ii)],
The statute does not exempt a transfer to a sUlViving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax ~=:um 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 na::_-31 parent, an adoptive parent.
or a stepparent of the child is 0% [72 P,S. 39116(a)(1.2)j_
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. 99116(' 2i [72 P.S. 39116(a)( 1)J.
_f "__.1-__ ,. -- t__ ,....- "M ~~ Ih~ ~"MrlMl'" ,,;hlir1r1C' i~ 1?O/~ f7? D~ &Q11R(:::\\(11\! A ~ihlin(] is defirrS<!. under Section 9102. as an
REV.1502'~ (12-85) .-
. COMMONWEALTH OF PENNSYlVANI-A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Robert L. Blosser, Jr.
21-04-00375
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
730 Hillside Drive, Carlisle, PA
(Appraisal attached)
159,000.00
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
$ 159.000.00
.
.
APPRAISAL REPORT
730 HaLSIDE DRIVE
CARLISLE, PENNS\'LV ANIA
PREPARED FOR
THE ESTATE OF ROBERT L. BLOSSER, JR.
BY
LARRY E. FOOTE
DIVERSIFIED APPRAISAL SERVICES
35 EAST IDGH STREET, SUITE 101
CARLISLE, PENNSYLVANIA
17013-3052
(717) 249-2758
~
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SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS
LOCATION: 730 Hillside Drive
Carlisle, Pennsylvania
TAX PARCEL NUMBER: 04-21-0322-367
llv1PROVEMENTS: Two-story detached single-family dwelling.
PROPERTY RIGHTS: Fee simple interest.
OWNERSHIP mSTORY: The subject property is owned by Robert L. Blosser, Jr.
The property was purchased on May 14, 1997 for a
reported consideration of $1.00 and ovvnership transferred
on Deed Book 158, Page 198.
SCOPE OF THE ASSIGNMENT: The scope of the assignment included an analysis of the
subject's area, an inspection of the subject property, an
estimation of the property's highest and best use,
consideration of all three approaches to value, and the
application of those relevant to the valuation of the
subject.
OBJECTIVE: To estimate the market value of the subject property as
unencumbered.
EFFECTIVE DATE: May 20, 2004.
IDGHEST AND BEST USE: Continued use as a single-family residence.
COST APPROACH: N.A.
SALES APPROACH: $159,000
INCOl\.1E APPROACH: N.A
FINAL VALUE CONCLUSION: $159,000
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APPRAISAL CERTIFICATION
I hereby certify that upon application for valuation by:
THE ESTATE OF ROBERT L. BLOSSER, JR.
the undersigned personally inspected the following described property:
All that certain piece or parcel of land, with the improvements thereon erected, situate
in the Borough of Carlisle, Cumberland County, Pennsylvania, bounded and described as
follows:
Beginning at a point on the South side of Hillside Drive, which point is in the line
dividing Lots Nos. 128 and 129 on the hereinafter referred to Plan of Lots; thence along
Hillside Drive South 87 degrees 56 minutes East 110 feet to a point in the line dividing Lot
Nos. 129 and 130 on said PI~ thence along said dividing line South 13 degrees 41 minutes 20
seconds West 156.82 feet to a point common to Lot Nos. 125, 126, 129 and 130; thence along
the line dividing Lot Nos. 126 and 129 South 76 degrees 23 minutes West 83.53 feet to a point;
thence by the line dividing Lot Nos. 128 and 129 North 02 degrees 51 minutes East 175.78 feet
to the place of beginning.
The above described lot being No. 129 as shown on the Plan of Section "A'J' of
Heatherlands recorded in Plan Book 11, Page 20.
To the best of my knowledge and belief the statements contained in this report are true
and correct, and that neither the employment to make this appraisal nor the compensation is
contingent upon the value reported, and that in my opinion the Market Value as of May 20,
2004 is:
ONE HUNDRED FIFTY-NINE THOUSAND DOLLARS
$159,000
The property was appraised as a whole, subject to the contingent and limiting conditions
outlined herein.
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PURPOSE OF THE APPRAISAL
The purpose of this appraisal is to estimate the Market Value of the subject property as
of May 20, 2004.
Market Value, as defined by the courts, is the most probable price estimated in terms of
money which a property will bring if exposed for sale in the open market, allowing a
reasonable time finding a purchaser who buys with knowledge of all the uses to which it is
adapted and for which it is capable of being used.
Frequently, it is referred to as the price at which a willing seller would sell and a 'Willing
buyer would buy, neither being under abnormal pressure.
. EUGBEST ~ BEST USE
Highest and Best Use is defined by the Appraisal Terminology and Handbook,
published by the Appraisal Institute, as "the most profitable likely use to which a property can
be put". The opinion of such use may be based on the highest and most profitable continuous
use to which the property is adapted and needed, or likely to be in demand, in the reasonable
near future.
However, elements affecting value that depend upon events or a combination of
occurrences which, while within the realm of possibility, are not fairly shown to be reasonably
probable, should be excluded from consideration. Also, if the intended use is dependent on an
uncertain act of another person, the intention cannot be considered.
Based on the above definition and after seeing the site, neighborhood, and area, it is my
opinion that the present use of the subject is its Highest and Best Use.
4
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ADDRESS:
BOROUGH:
COUNTY:
STATE:
LOT SIZE:
SEWERS:
WATER:
ELECTRICITY:
LANDSCAPING:
730 Hillside Drive
Carlisle
Cumberland
Pennsylvania
110' x 156'
Public utility.
Public utility.
PP&L
SITE DATA
Typical for the area, with a sodded lawn, trees and shrubs.
DETRIMENTAL INFLUENCES
None. Pride of ownership is evident throughout the neighborhood.
DESCRIPTION OF IMPROVEMENTS
GENERAL DESCRIPTION: One-story detached single-family dwelling containing 1,522
square feet of gross living area above grade and an attached two-car garage.
CONDITION:
ROOMS:
EXTERIOR:
Exterior: Good
Interior: Average
First Floor:
Basement:
Foundation:
Walls:
Sash:
Gutters:
Roof:
Storm units:
Living room, kitchen, dining room, family room, three
bedrooms and one and one-halfbathrooms.
Full, with a family room and sauna room.
Concrete block.
Brick and aluminum siding.
Vinyl-clad thermopanes.
Aluminum, painted.
Fiberglass shingles.
Combination throughout.
5
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INTERIOR, PRINCIP At ROOMS: Flooring:
Walls:
Ceilings:
Trim;
KITCHEN:
Cabinets:
Counters:
Walls:
Flooring:
Sink:
BATHROOM:
Flooring:
Walls:
Bathtub:
Lavatory:
Water closet:
CONSTRUCTION:
Joists:
Beams:
Columns:
Plumbing:
HEATING:
Hardwood
Drywall
Drywall
Wood, painted.
Wood, painted.
Formica
Drywall, painted.
Vinyl
Double-bowl, Corian.
Vinyl
Drywall, papered.
Built-in, with shower.
Pedestal sink.
Two-piece.
Wood
Wood
Steel
Copper
Oil-fired hot water.
COOLlNG:
Central air conditioning.
HOT WATER:
Electric, 80-gallon. .
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ELECTRlC:
Circuit breaker system, 200-ampere.
OTHER: There is a brick fireplace in the living room and a brick fireplace in the
family room. Attached to the front of the dwelling is a small porch and attached to the rear of
the dwelling is a concrete patio. Located in the rear yard is an inground swimming pool.
GENERAL CONDITION: All improvements are considered to be in good condition on the
exterior and average condition on the interior, with the exception of hardwood floors that are in
need of refinishing and the fact that there are no doors on the closets. Mechanical systems
appeari to be adequate and functioning properly.
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THE APPRAISAL PROCESS
Three approaches to value are generally included in an appraisal report. These
techniques include the cost approach, sales cOlnparison approach, and income approach to
value.
The cost approach to value is based on the assumption that the reproduction cost of a
building plus land value, tends to set the upper limit to value. A key assumption is that a newly
constructed building would have advantages over the existing building, therefore an evaluation
focuses upon disadvantages or deficiencies ( depreciation) of the existing building compared to
a new facility. Due to the age of the subject improvements, the cost approach is considered to
be inappropriate and has, therefore, not been included in the development of this appraisal
report.
The sales comparison approach to value assumes that under normal conditions, a given
number of parties acting intelligently and voluntarily, tend to set a pattern from which value
can be estimated. Application of this approach relies on a comparison of the subject with a
sufficient number of recent transactions of comparable properties in the market, based on a
common unit, such as price per square foot of building area.
The income approach concerns itself with present worth of the future potential benefits
of a property. The initial estimate involves the net income, which a fully informed person is
justified in assuming the property will produce during its remaining usefullif~. This estimated
net income is then capitalized into a value estimate, based upon the level of risk as compared
with that of a similar type and class. Since homes silnilar to the subject are not typically
utilized as income-producing investment properties, the income approach to value is considered
to be inappropriate and has, therefore, not been included in the development of this appraisal
report.
7
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SALES COMPARISON APPROACH
In arriving at this conclusion of the value of the subject property, the appraiser made a
survey of properties that have sold in the area of the subject property.
Consideration was given and adjustments were made on each comparable sale as to
time of sale, size, location, as well as all other factors that might affect value. A resume of
some of the sales considered by the appraiser is as follows:
SALE NO.1:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
SALE NO.2:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
SALE NO.3:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
61 Hillside Drive, Carlisle.
Apri129,2003.
$166,500
1,610 square feet.
$103.42 per square foot.
53 Hillside Drive, Carlisle.
July 18, 2003.
$152,000
1,198 square feet.
$126.88 per square foot.
653 Belvedere Street, Carlisle.
March 7, 2003.
$166,000
1,748 square feet.
$94.97 per square foot.
The appraiser, in addition to the sales listed, also considered several additional sales in
arriving at his final opinion of value. On the Sales Comparison Analysis form that follows this
page are dollar adjustments reflecting market reaction to those items of significant variation
between the subject and comparable properties. If a significant item in the comparable
property is superior to, or more favorable than, the subject property, a minus (-) adjustment is
made, thus reducing the indicated value of the subject; if a significant item in the comparable is
inferior to, or less favorable than, the subject property, a plus (+) adjustment is made, thus
increasing the indicated value of the subj ect.
After making all of the necessary adjustments, it is the appraiser's considered opinion
that the indicated value of the subject property by the Sales Comparison Approach is $159,000.
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SALES COMPARISON ANALYSIS
ITEM
Address
Proximity to Subject
Sale Price
Price / Sq. Ft. GLA
Data Source
ADJUSTMENTS
Sales or Financing
Concessions
Date of Sale / Time
Location
Site / View
Design and Appeal
Construction
kee
Condition
Above Grade
Room Count
Gross Living Area
Basement &Finished
Rooms Below Grade
I
SUBJECT
730 Hillside Drive
Carlisle
COMPARABLE #1
61 Hillside Drive
Carlisle
COJVIP ARABLE #2
53 Hillside Drive
Carlisle
CO:MP ARABLE #3
653 Belvedere Street
Carlisle
Inspeotion
DESCRll'TION
., .
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As of 5-20-04
Average
110' x 156'
One-story detached
Brick & aluminum
40 years
Average
Tot.
Courthouse & Central Penn MLS
DESCRIPTION
$ Adjust
None
DESCRll'TION
Courthouse & Central Penn MLS
$ Adjust
None
DESCRIPTION
Courthouse & Central Penn MLS
$ Adjust.
None
4-28-03
Similar
124' x 132'
Similar
Brick
-10,000
7-18-03
Similar
82' x 136'
Similar
Aluminum siding
47 years
Superior
Tot.
Bath
+1,000
-5,000
3-7-03
Similar
110' x 135'
Similar
Brick
Bath
-10,000
-5,000
7
2
-1,000
-6,800
1,522 square feet
Full basement, with
family rm. & sauna.
-5,000
Bath
3
-3,000
-2,600
6
1,198 square feet
Full basement, 100
percent finished.
Similar
Similar
1-car built-in ara e
Porch, enel. porch,
wood deck.
2
+1,000
+9,700
7
1,748 square feet
Full basement, with
family room.
Similar
Similar
Similar
Porch, patio, storage
bui1din .
+ 1,000
+9,000
I
1,610 square feet
Full basement, with
family room.
Similar
Similar
Similar
+ 1,000
Similar
None
-2,000
+5,000
+8,000
+2,000
Similar
2 fir laces
I Net Adj. (total)
Indicated Value
of Subject
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Built-ins.
Porch, atio.
+10,000
Similar
None
+2,000
Similar
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t - --I ~ .
+19,700
171,700
FINAL INDICATED VALUE OF SUBJECT PROPERTY: $159,000
I
Similar
I
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i
-7,600
158,900
9
Similar
~>:~ - ' ;--. ...
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-12,800
153,200
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CORRELATION
Correlation may be defmed as "the bringing together of parts in a proper relationship."
The parts of this appraisal report are the following approaches to value your appraiser used:
Value Indicated by Cost Approach
Value Indicated by Sales Comparison Approach
Value Indicated by Income Approach
N.A.
$159,000
N.A.
These approaches are representative of the market value of the subj ect property. I have
carefully reexamined each step in each method, and I believe the conclusions accurately reflect
the attitude of typical purchasers of this type property in this neighborhood. It is my belief that
this reexamination has confirmed the original conclusions.
The Cost Approach will result in an excellent estimate if all elements are figured
accurately, because no prudent person will pay more for a property than the cost to produce a
substitute property with equal desirability and utility. Purchasers of the type of dwelling
typical of the subj ect property are more concerned with amenities than with hypothetical
replacement of the property. Due to the age of the subject improvements, the Cost Approach is
considered to be inappropriate and has not been included in this appraisal report.
The Sales Comparison Approach was based on several recent sales of properties similar
to that of the subject, all of which are located in the same general area. The adjusted sales
prices are most consistent under comparison. This approach is the most reliable because it
reflects the reactions of typical buyers and sellers in the market.
The Income Approach is most applicable to income producing properties or properties
that are primarily utilized for income producing purposes. Purchasers of income producing
properties are willing to pay no more for a particular property than the net operating income
will support. Since the majority of properties similar to the subj ect are not utilized for income
producing purposes, this approach to value has not been included in this appraisal report.
Therefore, as a result of this appraisal and analysis, it is this appraiser's considered
judgment and opinion that the Market Value of the subject property, as of May 20,2004, is:
.;!
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!:
ONE HUNDRED FIFTY-NlNE THOUSAND DOLLARS
$159,000
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UNDERL\'lNG ASSUMPTIONS AND LIMITING
CONDITIONS SUBJECT TO TillS APPRAISAL
1. I assume no responsibility for matters legal in nature, nor do I render any opinion as to
the title, which is assumed to be marketable. The property is appraised as though under
responsible ownership.
2. The legal description used herein is correct.
3. I have made no survey of the property, and the boundaries are taken from records
believed to be reliable.
4. I assume that there are no hidden or unapparent conditions of the property, subsoil or
structures which would render it more or less valuable. I assume no responsibility for
such conditions or for engineering which might be required to discover such factors.
5. The information, estimates, and opinions furnished to Iue and contained in this report
were obtained from sources considered. reliable and believed to be true and correct.
However, no responsibility for accuracy can be assumed by me.
6. This report is to be used in its entirety and only for the purpose for which it was
rendered.
7. Neither all nor any part of the contents of this report (especially any conclusions as to
value, the identity of the appraiser or the fmn "With which he is connected) shall be
reproduced, published, or disseminated to the public through advertising media, public
relations media, news media, sales media, or any other public means of communication,
without the prior written consent and approval of the appraiser.
8. This appraisal was prepared for the exclusive use of the client identified in this appraisal
report. The information and opinions contained in this appraisal set forth the
appraiser's best judgment in light of the information available at the time of the
preparation of this report. Any use of this appraisal by any other person or entity, or
any reliance or decisions based on this appraisal are the sole responsibility and at the
sole risk of the third party. The appraiser accepts no responsibility for damages
suffered by any third party as a result of reliance on or decisions made or actions taken
based on this report.
11
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CERTIFICATE OF APPRAISAL
Your appraiser hereby certifies that:
1. The statements of fact contained in this report are true and correct.
2. The reported analyses, opinions, and conclusions are limited only by the reported
assumptions and limiting conditions, and are my personal, impartial, and unbiased
professional analyses, opinions, and conclusions.
3. I have no present of prospective interest in the property that is the subject of this report,
and no personal interest with respect to the parties involved.
4. I have no bias with respect to the property that is the subj ect of this report or to the
parties involved with this assignment.
5. My engagement in this assignment was not contingent upon developing or reporting
predetermined results.
6. My compensation for completing this assignment is not contingent upon the
development or reporting of a predetermined value or direction in value that favors the
cause of the client, the amount of the value opinion, the attainment of a stipulated result~
or the occurrence of a subsequent event directly related to the intended use of this
appraisal.
7. To the best of my knowledge and belief~ the statements of fact contained in this
appraisal report, upon which the analyses, opinions, and conclusions expressed herein
are based, are true and correct.
8. This appraisal report sets forth all of the limiting conditions (imposed by the terms of
my assignment or by the undersigned) affecting the analyses, opinions, and conclusions
contained in this report.
9. This appraisal report has been made in conformity with the Uniform Standards of
Professional Appraisal Practice adopted by the Appraisal Standards Board of the
Appraisal Foundation, and is subject to the requirements of the Code of Professional
Ethics and Standards of Professional Conduct of the National Association of Realtors
Appraisal Section.
r-
12
10. No one other than the undersigned prepared the analyses, conclusions, and
opinions concerning real estate that are set forth in this appraisal report.
Larry E. Foote
Certified General Appraiser
GA-000014-L
13
~ - -:-..- <,
PRIVACY NOTICE
Pursuant to the Gramm-Leach-Billey Act of 1999, effective July 1, 2001, appraisers,
along with all providers of personal financial services are now required by federal law to
inform their clients of the policies of the firm with regard to the privacy of client nonpublic
personal information. As professionals, we understand that your privacy is very important to
you and are pleased to provide you with this information.
In the course of performing appraisals, we may collect what is known as ~'nonpublic
personal information" about you. This information is used to facilitate the services that we
provide to you and may include the information provided to us by you directly or received by
us from others with your authorization.
We do not disclose any nonpublic personal information obtained in the course of our
engagement with our clients to nonaffiliated third parties, except as necessary or as required by
law. By way of example, a necessary disclosure would be to our independent contractors, and
in certain situations, to unrelated third party consultants who need to know that information to
assist us in providing appraisal services to you. All of our independent contractors and any
third party consultants we engage are informed that any information they see as part of an
appraisal assignment is to be maintained in strict confidence within the fmn. A disclosure
required by law would be a disclosure by us that is ordered by a court of competent jurisdiction
with regard to a legal action to which you are a party.
We will retain records relating to professional services that we have provided to you for
a reasonable tilne so that we are better able to assist you with your needs. In order to protect
your nonpublic personal information from unauthorized access by third parties, we maintain
physical, electronic and procedural safeguards that comply with our professional standards to
insure the security and integrity of your information.
14
LARRY E. FOOTE
REAL ESTATE APPRAISER
EXPERIENCE:
1979-Present: Chief Appraiser, Diversified Appraisal Services, Carlisle, Pa.
Principal Broker, LaRue Development Company, Carlisle, Pa.
1976-1979: Associate Broker, Colonial Realty, Carlisle, Pa.
1972-1976: Realtor Associate, Jack Gaughen Realtor, Carlisle, Pa.
Appraisal experience included undeveloped land, farms, building lots, single-family dwellings, mobile
home parks, Inedical centers, nursing homes, motels, apartment buildings and complexes, office
buildings, service stations, veterinary clinics, rehabilitation centers, retail buildings, daycare centers,
warehouses, and manufacturing facilities.
EDUCATION:
Bachelor of Business Administration, Pennsylvania State University, 1976.
Associate Bachelor of Business Administration, Harrisburg Area Community
College, 1974.
Diploma, Carlisle Senior High School, 1965.
Certificate, Pennsylvania Realtors Institute, GRI I, GRI II, GRl m.
Certificate, Realtors National Marketing Institute, CI 101, CI 102, CI 103, CI 104,
CI105.
Standards of Professional Practice, American Institute of Real Estate Appraisers.
Real Estate Appraisal Principles, American Institute of Real Estate Appraisers.
Residential Valuation, American Institute of Real Estate Appraisers.
Appraisal Procedures, Appraisal Institute.
Principles of Income Property Appraising, Appraisal Institute.
Case Studies in Real Estate Valuation, Appraisal Institute.
Report Writing and Valuation Analysis, Appraisal Institute.
PROFESSIONAL LICENSES:
General Appraiser #GA-OOOO 14-L, Commonwealth of Pennsylvania.
Real Estate Broker #RB-029729- A, Commonwealth of Pennsylvania
PROFESSIONAL DESIGNATIONS:
GRI: Graduate of the Pennsylvania Realtors Institute, awarded by the Pennsyl-
. vania Association of Realtors.
CRS: Certified Residential Specialist, awarded by the Realtors National Market-
ing Institute of the National Association of Realtors.
CCIM: Certified Commercial Investment Member, awarded by the Realtors
National Marketing Institute of the National Association of Realtors.
PROFESSIONAL ORGANIZATION AFFILIATIONS:
National Association of Realtors Appraisal Section.
Carlisle Association of Realtors.
Pennsylvania Association of Realtors.
National Association of Realtors.
Realtors National Marketing Institute.
15
PAST CLIENTS:
Borough of Carlisle
Keystone Financial Mortgage
Cornerstone Federal Credit Union
Pennsylvania State Bank
Commerce Bank
Cumberland-Perry Association for Retarded Citizens
Carlisle Suburban Authority
Members 1 st Federal Credit Union
Pennsylvania National Bank
Evans Financial Corporation
Greenawalt & Company, CPA
Smith's Transfer Corporation
Carlisle Department of Parks and Recreation
Executive Relocation Services
Carlisle Area School District
Messiah Homes, Incorporated
ERA Eastern Regional Services
Pennsylvania Turnpike Commission
Chase Home Mortgage Corporation
Defense Activities Federal Credit Union
Pennsylvania State Employees Credit Union
PNC Mortgage Corporation
F&M Trust Company
National City Mortgage Corporation
Washington Mutual Home Loans, Inc.
Prudential Relocation Services
Lender's Choice
Market Intelligence, Incorporated
United Telephone Employees Federal Credit Union
Cumberland County Commissioners
Allstate Enterprises Mortgage Corporation
Dickinson College
PPG Industries, Incorporated
Gettysburg College
Redevelopment Authority of Cumberland County
Record Data Appraisal Semces, Incorporated
First United Federal Savings Association
Fulton Bank
United States Marshall Service
GMAC Mortgage Corporation
Orrstown Bank
Letterkenny Federal Credit Union
BancPlus Mortgage Corporation
Coldwell Banker Relocation Services, Incorporated
Central Pennsylvania Savings Bank
Mellon Bank
Provident Home Mortgage Corporation
Drovers Bank
16
American Home Bank
Trans Union
M&T Mortgage Corporation
Cody Financial Mortgage Services
WaypointBank
Northwest Savings Bank
Blue Ball National Bank
Adams County N ationaI Bank
Countrywide Home Loans
Aarrow Mortgage
VariOllS law firms and individuals
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17
PHOTOGRAPHS OF THE SUBJECT IMPROVEMENTS
'~'5<U EX+ {>-921 ..
COMMONWEA11H OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
Please Print or Type
FILE NUMBER
21-0400375
Robert L. Blosser, Jr.
Schedule C-1 or C-2 must be attached for each business interest of the decedent, other than a proprietorship.
ITEM
NUMBER
DESCRIPTION
VAWE AT
DATE OF DEATH
1.
43 Shares Common stock
G.C. Blosser, Inc.
(Valuation Report attached)
11,477.99
TOTAL (Also enter on line 3, Recapitulation) S 11 , 477 . 99
(If more space is needed, insert additional sheets of same size.)
{C(gfY
G. C. Blosser, Inc.
Valuation Report
Prepared by:
Rob Wintz, CPA. MBA
5583 Wagner Road
Coopersburg, PA 18036
(ft;Jff{
'ivvf J
Date
Robin S. Wintz, CPA
1
G. C. Blosser, Inc. Valuation Draft Report
December 22, 2003
Contents
Table of Valuation Exhibits
Description of the Business Interest
Purpose, Standard and Premise of Value
G. C. Blosser Inc.
General Economic Outlook
Book Value and Financial Condition
Earning Capacity
Goodwill
Depreciation
Valuation Approaches
Selection of Valuation Approach
Operating Value
Discount for Lack of Control
Marketability Discount
Application of Discounts
Reasonableness Check
Conclusion of Value
Limiting Conditions
Qualifications
3
4
4
4
5
5
6
7
7
7
8
8
10
10
10
11
11
12
13
2
G. c. Blosser, Inc. Valuation Draft Report
December 22. 2003
Table of Valuation Exhibits
Exhibit 1: Comparative Balance Sheets
Exhibit 2: Comparative Profit Statements
Exhibit 3: Normalized Common Size Profit Statements
Exhibit 4: Guideline Company Comparison
Exhibit 5: Common Size Guideline Company Comparison
Exhibit 6: Valuation Indicators from Guideline Companies
Exhibit 7: Application of Value Indicators and Debt Adjustment
Exhibit 8: Reconciliation of T atal to Minority Non-marketable Value
5
6
7
B
9
9
9
10
3
G. C. Blosser, Inc. Valuation Draft. Report
December 22, 2003
Description of the Business Interest
The business interest being valued is the total equity of G.C. Blosser, Inc., (the Company), on a oon-
control basis. The valuation date is November 301 2003. The Company is a closely-held Pennsylvania
corporation. Control of the corporation resides in a 69.291339 percent interest held by Robert L. Blosser
Sr. Each of three children owns a non-controlling interest of 10.236220 percent The Company has
elected to be taxed as an S Corporation.
The Company is in the retail beverage (beer and soda) distribution business.
Purpose, Standard and Premise of Value
The purpose of this valuation is to provide a record of value for gift tax and estate planning purposes1 and
to accompany any related tax filings. The standard of value for this purpose is fair market value (FMV).
FMV is defined in IRS Revenue Ruling 59 - 60 as "the price at which the property would change hands
between a willing buyer and a willing seller, when the former ;s not under any compulsion to buy. and the
Jatter is not under any compulsion to sell, both parties having reasonable knowledge of relevant facts." In
accordance with this, the IRS states that the following factors should be considered:
a) Nature of the business and the history of the enterprise
b) The economic outlook in general and the condition and outlook of the specific industry in
particular
c) The book value of the interest to be valued and the financial condition of the business
d) The earning capacity of the enterprise
e) The dividend paying capacity of the enterprise
f} Whether or not the enterprise has goodwill or other intangible value
g) Sales of interests and the size of the block of interest to be valued
h) The market price of interests of enterprises engaged in the same or a simDar line of business
having interests actively traded in a free and open market
These factors have been considered in this valuation.
The premise of value is that the Company is a going concern that will continue to operate as a retail
beverage distributor. While a 100 percent interest is controlling, the intent is to gift ownership blocks that
represent less than a controlling interest The premise is that none, of the recipients of a gifted interest
will enjoy a controlling interest after the gifting. The allowance of a minority discount in this situation
follows Revenue Ruling 93-12.
G. C. Blosser, Inc.
The Company was incorporated in 1963. It operates as a drive-through retail distribution outlet for beer.
soda and miscellaneous snacks.
During calendar year 1999, reported Company sales were in excess of $4 million_ In May of 2000, the
Company sold its exclusivity franchise for Budweiser and other Annheiser -Busch products. Sales
dropped as a result, and the Company reported sales of $521 thousand for calendar year 2001. This
change presents a significant valuation issue. The emphasis on this valuation is recent earnings.
Operating performance prior to year 2001 does not support current estimates of FMV.
The Company is located in Carlisle, Pennsylvania. a small college town in the south central region of the
state. The region has a long stable history and is the home of Dickenson College, a liberal arts institution,
and the U.S. Army War College. It is also several miles from the Carlisle Fair Grounds. the host of about
a dozen 3-day nationally known auto shows and similar large venue events.
4
G. C. Blosser, Inc. Valuation Draft Report
December 22, 2003
General Economic Outlook
The FMV of an investment is influenced by current economic conditions and general economic outlook.
In the aggregate, at any given time, investment dollars flow to investments that provide the highest risk
adjusted return. When the economy is exhibiting instability and slow growth, investors react by moving
funds into less risky securities such as government and corporate bonds. In periods of sustained growth,
equity markets become more attractive.
The U.S. economy is in the process of making a strong recovery from the shock created by the u9111l
WTC attack. The uncertainties surrounding the war with Iraq have been mostly resolved. Interest rates
are at historic lows. Leading economic indicators are pointing favorably toward growth.
In November 2003, the Federal Open Market Committee made the decision to keep the federal funds rate
at 1 percent This can be interpreted as a cautious move. Their decision shows concern that the
anticipated growth is too uncertain to risk dampening effects from a rate increase.
In terms of valuation adjustments. it makes sense to expect modest growth.
Book Value and Financial Condition
Exhibit 1 is the balance sheet for Blosser as of December 31, 2002) its fiscal year-end, presented in
dollars and percent of total assets. The source is Schedule L of the Company's 2002 Form 11208. Also
included is comparison data collected by Robert Morris Associates, Inc. (RMA), based on a 101 company
comparison group reporting sales between $1 million and $3 million.
Exhibit 1: Comparative Balance Sheets
Blosser RMA
Assets
Cash $ 1,325 1.1% 11.8%
Accounts receivable 0.0% 2.1%
Inventories 27.362 232% 48.4%
cnhercurrentasse~ 4..914 4.2% 0.9%
T olal current assets 33,601 28.5% 63.2%
Net fixed assets 7E.184 66.4% 16.0%
Jntangible assets 0.0% 15.4%
Other assets 5,980 5.1% 5.4%
Total Assets 117,765 . 100~OOk 100.0%
Current liabilities
Notes payable - short term 0.0% 7.7%
Accounts payable I trade 12.030 10.2% 19.7%
Current portion of L TO 49,991 42.4% 2.9%
Other currentliabilities 29 I 111 24.7% 13.7%
Total. current liabilities 91,132 77.4% 44 .0%
Loans from shareholders 126,164 107.1 % 0.0%
Long term. debt 0.0% 21 .9%
All other non-current 0.0% 8.8%
Total liabilities 217.296 184.5% 74.7%
Capital stock 30.100 25.6% NA
Retained earnings 410,006 348.2% NA
Less cost of treasury stock . . (539,637) -458.2% NA
Total shareholders' equity (99.531) -84 .5% 25,3%
T otalliabilities. and
shareholders. equity. 111,765 100.0% 100..0%
NA = Not available
5
G. c. Blosser, Inc. Valuation Draft Report
December 22, 2003
The Company presents a very different structure from the RMA comparison group. It is holding
significantly less in current assets relative to total assets. and has a current ratio of 0.37 versus the RMA
average of 1.44. Fixed assets include leasehold improvements, office equipment, materials handling
equipment. and delivery vehicles. There is no real estate.
Debt exceeds the value of the total assets resulting in a negative shareholders' equity. The largest part of
the debt has been financed by a shareholder loan.
Net working capital is barely sufficient to sustain normal operations. On a book value basis. the Company
has no value.
Earning Capacity
Exhibit 2 presents comparative earnings statement for the Company.
Exhibit 2: Comparative Profit Statements
1998 1999 2000 2001 2002
Net sales $ 3,928,261 $ 4,051,170 $ 3.470,786 $ 521 ,672 $ 983,516
Cost of sales 3,041,620 3.127,719 2,697.799 474,366 821,37'1
Gross profit 886,641 923,451 772,9B7 47,306 162,145
Rent 49,600 57,000 55,000 55,000 55,000
Ownersl.compensation 94,278 97,228 83,299 12,520 23 ;604
Other'operating' expenses 603,338' 513,796 560,279 272,200 223,998
T eta I operating expenses 747.216 668,024 698,578 339.720 . 302,602
Normalized operating profits 139.425 255,427 74,409 (292,414) (140.457)
Other income 11,381 1 ,272 64 ,040
Normalized profits (S-Corp) 150,B06 256,699 138,449 (292,414) (140.457)
Source: Company tax filings on Form 11208 for the years listed.
The term normalized refers to adjusting operating expenses to reflect the normal operating structure of a
business of this type. For example, the Company is currently not paying rent Anyone buying the
business will factor in a normal rent payment before estimating earnings potentiaL
Pre-2001 sales and profits are substantially higher than the most recent two years. The drop is the result
of selling the exclusMty franchise previously mentioned. Sales from 2001 to 2002 show growth of almost
89 percent Although 2002 shows a loss, the loss is half that of 2001. In terms of valuation, the
Company still has no earnings. and there is no solid basis for predicting earnings. There is historic
evidence that the facility can handle a sales volume of at least $4 million and generate a profit The
business might attract a buyer, but the price would be discounted.
6
G. C. Blosser. Inc. Valuation Draft Report
December 22. 2003
Exhibit 3 presents the same information as Exhibit 2 on a percentage-ta-sales basis.
Exhibit 3: Normalized Common Sized Profit Statements
Blosser Cornman Sized P & L
1998 .1999 2000 2001 2002 RMA
Net sales 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Cost of sales 77.4% 77.2% 77.7% 90.9% 83.5% 74.2%
Gross profit 22~6% 22.8% 22.3% 9.1% 16.5% 25.8%
Selling and. delivery exps 1.3% 1.4% 1.6% 10.5% 5.6% NA
General and admin exps 19.0% 16.5% 20.1% B5.1 % -30.8% NA
Operating income 3.5% B .3% 2.1% -56.1 % -14.3% 1.4%
Other income 0.3% 0.0% 1.8% 0.0% 0.0% 0.5%
Income before tax 3.8% 6.3% 3.9% -56.1% - 14.3% 0.9%
Sales for 2002 generated a gross profit that was two-thirds that of the RMA comparison group. From
1998 through 2000, sales were generating a gross profit that was a third larger than the 2002 gross profit,
and in line with RMA Even if Company sales return to pre-2001 levelsJ it will need to return to a 22
percent gross profit to achieve previous levels of income. From a valuation standpoint. it will be
necessary to adjust value indicators that are based on sales to reflect the reduced performance.
Goodwill
Goodwill is an amount that a buyer will pay for a business that is above the value of the identifiable
assets. In financial theory, it represents earnings that are above normal returns on business operations.
The analysis of earnings for Blosser shows that excess earnings do not exist There is no .basis for
recognizing value related to goodwill.
Depreciation
Depreciation expense for the Company is not material to the determination of income. Most of the assets
are old and have previously been written off. No valuation adjustment is required.
Valuation Approaches
Three approaches are considered when valuing a business interest the income approach, the net asset
(cost) approach and the market approach. Each emphasizes different aspects of a business interest. and
the selection of one approach over another is determined by the characteristics of the underlying
business. Each approach can be applied using one or more methodsJ and selection of the most
appropriate method within an approach is made in light of the availability of reliable data.
The income approach recognizes that the value of an operating business arises from the expectation of
future discretionary cash flow; the owners of the interest expect to receive IldividendsJl over Mure years.
Value is estimated through financial computations that equate future net cash flows to a present value
through financial discounting, at a rate that reflects the value placed on the cash flows by the market,
factoring in relative risks and economic factoTS.
In recent years, the Company has not reported earnings and there is no basis for computing prospective
earnings. This method is not available.
The cost approach focuses on the balance sheet and emphasizes asset cost analysis. This method is
most suitable for asset based businesses such as investment companies. Since generally accepted
accounting principles are based on historic cost, the balance sheet for most other companies doesn't
reflect market value. In a products based company such as Blosser, the method is useful for
7
G. C. Blosser, Inc. Valuation Draft Report
December 22. 2003
determination of liquidation valueJ but an earnings or market based approach should be used when the
premise of value is going concern.
The market approach involves searching the marketplace to find value indicators that can be applied to
the company being valued. There are two methods generally used. The market transaction method
involves analysis of individual business sale transactions. An alternative market approach involves
obtaining security price multiples from public securities market data. A factor considered in the selection
of these methods is the availability of comparable data.
Selection of Valuation Approach
The market transaction method was selected for this valuation. Comparable transaction data was
available from several subscription databases.
Data from public securities markets was not used. Importantly, there are significant size and structural
differences between public companies and Blosser. such that any comparison would be meaningless.
Operating Value
Exhibit 4 presents a computation of a 2002 profit and loss statement Blosser along with three Guideline
company results. A guideline company is one that is similar to the subject company and has been
recently sold. After adjustment, a guideline company provides a basis for price comparison to a company
being valued, through a process analogous to a real estate appraisal.
Exhibit 4; Guideline Company Comparisons
Net sales
Cost of sales
Gross profit
Rent
Owners' compensation
Other operating expenses
Total-operating. expenses
Operating. profit
Blosser
983.516
821,371
162.145
55,000
23,604
223.998
302,602
$ (140,457) $
PS1
818,852
628,548
190,304-
51 ,535
69,181
110,466 .
231 ,1 82
(40,878) $
PS #: Guideline data from Pratrs Slats transaction reports
Be 1: Guideline data from Business Valuation Resources Biz Camps
NA : Data not available
8
PS.2
926;696
679,557
247,139
172.841 .
172.841
74.29B
BC1
4BO ,ODD
NA
NA
NA
NA
NA
NA
NA
G. C. Blosser, Inc. Valuation Draft Report
December 22, 2003
Exhibit 5: Common Size Guideline Company Comparisons
Exhibit 5 presents the guideline data as a percentage to Net Sales. It also presents the statistic of Sales
to total assets and Sellers Discretionary Earnings.
Blosser PS1 PS2 BC1
Net sales 100.0% 1 00.0% 100.0% 100.0%
Cost of sales 83.5% 76.8% 73_3% NA
Gross profit 16.5% 23.2% 26.7% NA
Rent 5.6% 6.3% 0.0% NA
Owners. compensation 2.4% 8.4% 0.0% NA
Other operating "expenses 22.8% 13.5% 1 B. 7% NA
Total operating expenses 30.8% 28.2% 18.7% NA
Operating profit - 14 .3% -5.0% 8.0% NA
Sales I total assets 8.352 13.127 5.486 NA
Sellers discretionary earnings $ (47,B45) NA NA $ 82,000
The common sized statements provide a basis for adjusting available transaction price-to net sales ratios
to factor in the differences in gross profit between Blosser and the guideline companies. The adjustment
recognizes that a dollar of sales at a gross profit of 16.5 percent generates only 71.1 percent of the cash
flow that is available from a guideline company generating a gross profit of 23.2 percent
Exhibit 6: Valuation Indicators from Guideline Companies -
Transaction price I net sales
Adjusted-price-I net sales
PS 1
0.366
0.260
PS2
0.140
0.087
BC1
0.250
0.250.
0.252
0.1 99
Average
Due to the absence of eamings~ guideline indicators based on earnings could not be applied. Indicators
based on sales were available. but had to be adjusted to factor in differences in gross profit percents.
Exhibit 7: Application of Value Indicators and Debt Adjusbnent
Exhibit 7 presents a two step computation to determine enterprise value. First. sales were multiplied by
the average guideline price indicator. The resulting value represents operational value for the Company.
Normally this would represent the value of the equity on a controlling interest basis. On the balance
sheet, the Company shows negative equity. with assets being financed by a shareholder loan. For
valuation purposes, this loan must be subtracted out to get an indicated enterprise value.
Sales
Price indicators
$ 983,516
0.199
195,720
" (126,164)
$ 69,556
Less: Shareholder-loan
Indicated" enterprise value"
The indicated enterprise value includes a control value.
9
G. C. Blosser, Inc. Valuation Draft Report
December 22. 2003
Discount for Lack of Control
Control of the Company rests with the majority stockholder. Market research has consistently shown that
an equity interest lacking control will sell at a discount from the value of the net assets. Data from
numerous studies has shown premiums with a wide range of means. One notable study. the Mergerstat
Review published by Applied Financial Information LP shows an industry wide mean average of 57.2
percent and a median average of 40.5 percent This translates to a minority discount averages of 36
percent and 29 percent respectively. A discount of 35 percent was selected for this valuation.
Marketability Discount
Studies have demonstrated that investors will pay a premium for an investment traded in an active and
organized public market over its closely-held counterpart. In IRS Revenue Ruling 77-287. section 6.041
the IRS states uSecurities traded on a public market generally are worth more to investors than those that
are not traded on a public market D
The subject stock is unregistered and cannot be offered for sale through an exchange. The stockholder
seeking to sell their interest will find it difficult to do so relative to a similar investment for which there is an
organized market A rational investor will offer a price that is less than the underlying value of the
Company determined through comparative analysis of publicly traded securities. or through the
evaluation of yields from similar investments that are publicly traded. An investor will apply a discount.
Mean discounts for lack of marketability have clustered around 35 percent The value indications used in
this study were derived from company sales data. Sale of a company requires time on market and
typically a broker's fee is involved. This makes the Company less marketable than shares of publicly
traded stock, but more liquid than a partial closely held interest A 25 percent discount was considered
appropriate.
Application of Discounts
Exhibit 8 shows the application of discounts for lack of control and lack of marketability.
Exhibit 8: Reconciliation of Total to Minority Non-marketable Value
Indicated enterprise value $ 69.556
Less: Discount for lack of control .35.0% (24.345)
Minority, marketable value 45.211
Less discount for lack of marketability 25.0% (11,303)
Minority. non-marketable value $ 33,90B
Discounts are applied separately in a chained fashion. They are not additive numbers. A 35 percent
control discount plus a 25 percent market discount produces a total percent discount that is less than 60
percent The first discount is applied to the indicated enterprise value. and the second discount is applied
to that discounted result.
The minority, non-marketable value represents the value of the equity on a non-controlling basis.
10
G. C. Blosser, Inc. Valuation Draft Report
December 22, 2003
Reasonableness Check
It is important that the reasonableness of the indicated value be considered. The question to be
answered is whether it is reasonable to expect that the parties to a buy I sell transaction would agree to
the estimated FMV. For $34 thousand, a buyer obtains an illiquid non-controlling block of common stock
of the Company_ Based on historic earnings, the "buyer is looking at the prospect of zero earnings unless
a significant increase in sales can be achieved, along with a higher gross profit margin. There is
evidence of businesses being purchased despite current losses. In this case the Company has the
capacity to achieve a level of sales that should generate profits. The value is somewhat speculative.
Conclusion of Value
Based on this analysis) my estimate of the value of the total common stock of Blosser Company, on a
minority interest basis in the hands of a minority stockholder is $33,900.
Thirty-three Thousand Nine-hundred Dollars
11
G. C. Blosser, Inc. Valuation Draft Report
December 22, 2003
Qualifications for Robin S. Wintz CPA
Academic and Professional Credentials
Masters of Business Administration, Accounting/Finance, Drexel University
Bachelor of Arts, Gettysburg College
Certified Public Accountant, Pennsylvania Lic~nse CA-015057-L
Position and Experience
Principal, RSW Consulting
Director of Consulting Services, Semaphore, Inc.
Senior Analyst, Southeastern RnanciaJ Valuations
Senior Auditor, Coopers & Lybrand
Adjunct Faculty, Trinity College, Hartford. Connecticut
Memberships and Affiliations
American Institute of Certified Public Accountants
13
~
_'~'11~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMA rlON REPORT
ESTATE OF
FILE NUMBER
Robert L. Blosser, Jr.
1. Name of Corporation G. C. BIos ser, Inc.
Address 222 East High Street
City Carlisle State PA
2. Federal Employer 1.0. Number 23- 1 63 1 38 1
3. Type of Business Retail Beverage Dist.
21-04-00375
State of Incorporation P A
Date of Incorporation 1 963
Zip Code 1 7 0 1 3 Total Number of Shareholders 6 0 0
Business Reporting Year Calendar
ProductJService Bee ran d S ad a
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VAWEOFTHE
STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK
Common Voting 88 $100.00 43 $ 11,477.99
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? ex Yes 0 No
If yes, Position Manager Annual Salary $
Time Devoted to Business 4 0 h r s / w k
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
~ Yes 0 No
$3,536.72
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes KJ No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes []l No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
Consideration $
Date
9. Was there a written shareholders agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
o Yes 0 No
10. Was the decedent's stock sold?
DYes Kl No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes fJ No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? 0 Yes KJ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. Ust those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
m.~~.:,~, '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Robert L. Blosser, Jr.
FILE NUMBER 2 1 - 0 4 0 - 0 0 3 7 5
All property jointJy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
3,536.72
G.e. Blosser, Inc.
Note Receivable
'-
TOTAL (Also enter on line 4, Recapitulation) $ 3, 536 . 72
(If more space is needed, insert additional sheets of the same size)
_.'''.~.~~ .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert L. Blosser,
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Jr.
FILE NUMBER 2 1 _ 0 4 - 0 0 3 7 5
Indude the proceeds of litigation and the date the prcceeds were received by the estate. All property jointty-owned 'Nith the right of survivorship must be disclosed on Schedu~ F.
ITEM
NUMBER
1.
DESCRIPTION
Members 1st Federal Credit Union
Regular Savings Acct. No.,239155-00
VALUE AT DATE
OF DE~TH
1,331.21
2.
Members 1st, Federal Credit Union
Checking Acct. No. 239155-11
347.11
TOTAL (Also enter on line 5. Recapitulation) I $
1.678.37
~
tv 1st
MEMBERS 1st
FEDERAL CREDIT UNION
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
239155 -aD
12/29/2003
$1,330.57
$.64
$1,331.21
None
CHECKING 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
239155 -11
12/29/2003
$347.11
$.00
$347.11
None
~B~RS 1s>>D~RA..L CREDITUNION
;{kddc U~
Denise A. Wolfe /--
Insurance Supervisor
June 9, 2004
Estate of: ROBERT L. BLOSSER, JR.
Date of Death: OS/20/2004
Social Security Number: 199-52-6273
5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · wwvv.memberslst.org
REV-fS1,ex.{1-97) ~
,,~
~OMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Robert L. Blosser, Jr.
FILE NUMBER
21-04-00375
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
Il.MOUNT
FUNERAL EXPENSES:
1.
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Yea~s) CommISSion Paid:
2.
3.
Attorney Fees
Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
c~~m stacy Teats Blosser
Street Address 7 3 0 hilI sid e Dr i ve
City Car 1 is Ie State PA
Relationship of Claimant to Decedent S po use
2,500.00
3,500.00
Zip 1 7 0 1 3
4.
Pro~reF~s Register of Wills
314.00
5.
Accountants Fees
6.
Tax Retum Preparers Fees
7.
Real Estate Appraisal to diversified Appraisal Services
275.00
8.
Advertising to Cumberland Law Journal
60.00
9.
Advertising to The Sentinel
129.47
TOTAL (Also enter on line 9, Recapitulation) $ 6, 778 . 47
(If more space is needed, insert additional sheets of the same size)
REV.1512 E\-+- '~Jl.. .
\ . ~ .
.-. ~.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE liABiliTIES AND LIENS
COMMONWEAlTH OF PENNSytvANIA
INHERITANCE TAX RETURN
RESlOENT DECEDENT
Robert L. Blosser, Jr.
Please Print or Type
FILE NUMBER
21-04-00375
ESTATE OF
ITEM
NUMBER DESCRIPTION
AMOUNT
1. Quest Diagnostic (medical)
2. West Shore EMS (ambulance)
3. Exxon Mobil (gas card)
4. Borough of Carlisle (water & sewer)
5. Citgo
6. Dauphin Oil Company (heating fuel)
7. Keystone Pool & Spa (supplies)
8. Estate Recoveries, Inc. (for Household Bank (SB)N.A.)
(compromise of claim)
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of some size.)
35.42
643.24
232.95
35.64
204.17
237.46
353.56
1,600.00
I
I
I
IS
! 3,342.44
REV-1513EX. +(1-; .... ..
1. ..
...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J I
BENEFICIARIES
n ~IP~~ 1_ Blosser Jr.
FILE NUMBER
21-04-00375
ESTATE OF
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1. stacy Jo Teats Blosser
730 Hillside Drive
Carlisle, PA 17013
2. Elizabeth Oiler
317 Walnut street
P.O. Box 478
Boiling Springs, PA 17007
3. Bobbi Blosser
583 E street
Carlisle, PA 17013
* Intangible personal property bequest in third paragraph ~f Wil~-could not
be accomplished because debts exceeded the value of the intanglble
personal property and the named trusted in Will does not have a Trust
Department (see attached correspondence) - ---
Wife
159,194.13
Sibling
5,739.00
( 1 /2 value of st oc
5,739.00
:( 1 /2 value of st oc
Sibling
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $ 0 00
(If more space is needed. insert additionaL sheets of the same size)
..,
l
w
Commerce
.BankNA
N ovenlber 16, 2004
Griffie & Associates
Attorneys and Counselors at Law
200 North Hanover Street
Carlisle P A 17013
Re: Estate of Robert L Blosser, Jr
S.S. No. 199-52-6273
Dear Sir or Madam,
We received your request for Commerce Bailie to act as trustee for the Estate of Robert L
Blosser. At this time we are unable to act as trustee due to the fact that we do not have a
trust department to handle this matter. I have enclosed the original documents to you
with this letter.
If you have any additional questions, please contact me at 717-240-2665.
rJ@-.
Tra T M rin
Assistant Branch Manager
Commerce Bank / Harrisburg, N.A.
P.O. Box 8599
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'\Rfirn i\CCl0C ('[NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXESEEO,j; U;:L) \'..h~~SEHENT I ALLOWANCE OR DISALLOWANCE
INtERITANCE TAX DIVISION r[ '.,'.OF 'DEDUCTIONS AND ASSESSHENT OF TAX
PO BOX 280601 _.." '._.
HARRISBURG PA 17128-0601
07-10-2006
BLOSSER JR
05-20-2004
21 01-0375
CUMBERLAND
101
APPEAL DATE: 09-08-2006
( See reverse side under Objections)
~ount R..ittedJ I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
~~!_~~g~~_!~~~-~~~~------~--_!~!!!!_~P~~!_fP!!!P!_EP!_!PY!_!~~P!P!__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ROBERT L FILE NO. 21 01-0375 ACN 101
20GS JUL 17 Mj \!: 38
STACY J BLOSSERru'
730 HILLSIDE DR~
CARLISLE
PA 17013
ESTATE OF BLOSSER JR
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
*'
REV-I547 EX AFP (06-0S)
ROBERT
L
DATE 07-10-2006
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fw.r.l Expenses/AcIII. Costs/H1sc. Expenses (Schedule H)
10. Debts/Hortg8g8 Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued preViously, lines 14, 15 and/or 16, 17, 18 and
reflect ~igures that include the tatal ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. A.ount of Line 14 at Spousal rate (IS)
16. Aaount of Line 14 taxable at Lineal/Class A rate (16)
17. AlIOUnt of Line 14 at Sibling rat. (17)
18. A~unt of Line 14 taxable et Collateral/Class B rate (18)
19. Principal Tax Due
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Totel Assets
NOTE:
:
DATE
04-28-2006
fUlBER
CD006626
INTEREST/PEN PAID (-)
.00
( ) CItANf;ED
(1)
(2)
(3)
(4)
(S)
(6)
(7)
159..000.00
.00
11.477.99
3..536.72
1.678.32
.00
.00
(8)
(9)
(10)
61778.47
3.342.44
(Ill
(12)
(13)
(14)
1541094.13 X
.00 X
111477.99 X
.00 X
00 =
045 =
12 =
15 =
(19)=
AtIDUNT PAID
11377.36
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-29-2006 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER DATE INDICATED I SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To Insur. proper
credit to your account I
__i t the upper portion
of this for. with your
tax pay~t.
1751693.03
10.1?O Ql
1651572.12
.00
1651572.12
19 will
.00
.00
11377.36
.00
11377.36
11377.36
.00
90.46
90.46
'&
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
.
J
INRE:
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: WILL NO. 2001-00375
: ADMIN. NO. 21-01-0375
Estate of Robert L. Blosser, Jr.
AFFIDAVIT OF SERVICE
I, Bradley L. Griffie, Esquire, counsel of record for Plaintiff, and states that a true and
attested copy of a Petition to Withdraw as Counsel and an Order of Court dated April 21, 2005
was sent to Executrix, Stacy J. Blosser at her address of 730 Hillside Drive, Carlisle,
Pennsylvania, by certified mail, restricted delivery. A copy of said receipt is attached hereto
indicating service was made on September 20, 2006.
Vd "O:J iJ.fI1dJ8V\:';:J
Itln08 S,N'ifH&IC
:10 >ltl3l8
NOTARiAl SEAl
R0811I. GOSHORN, NOTARY PUBlIC
CARLISLE BORO.. CUMBERlAND COUNTY
MY COMMJSSION PIRES APRlll 2007
I i :6 ~;!~ 62 d3S 9002
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U.S. Postal Servlc(~
CERTIFIED MAIL RECEIPT
(Domestic Mdtl Only. No Insurance Coverage Provided)
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Certified Fe.
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INRE:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Robert L. Blosser, Jr.
ORPHANS' COURT DIVISION
WILL NO. 2001-00375
ADMIN. NO. 21-01-0375
PETITION TO MAKE RULE ABSOLUTE
AND NOW comes Petitioner, Bradley L. Griffie, Esquire, and the law firm of
Griffie and Associates and petitions the Court as follows:
1. Petitioner filed a Petition to Withdraw as counsel in the above captioned
action on April 19, 2005.
2. The Court issued an Order of Court and Rule to Show Cause dated April 21,
2005 obligating the Respondent, Stacy Teats Blosser, to show cause as to why
Petitioner should not be permitted to withdraw as counsel in the above
captioned matter, with the Rule returnable twenty (20) days after service.
3. Upon entry of the aforementioned Order, Petitioner was able to gain limited
cooperation from Respondent, Stacy Teats Blosser and performed additional
services on behalf of the Estate of Robert L. Blosser, Jr.
4. Petitioner advised Respondent that he was assisting to bring the estate to a
proper conclusion, but would terminate services in the event that Respondent
once again failed to cooperate in concluding the estate.
5.
Despite repeated requests, Respondent has once agam failed to maintai~'
contact with Petitioner and has failed to cooperate in taking action to conclude:)
this estate.
. )
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6. Although service of the Petition to withdraw as counsel was made by first-
class mail postage prepaid in 2005, Petitioner provided additional service of
the aforesaid Order by certified mail restricted delivery upon the Respondent
which was received on September 20, 2006.
7. More than twenty (20) days has passed since the service of the aforesaid
Order and no response to the Petition to Withdraw as Counsel has been filed.
WHEREFORE, Petitioner requests your Honorable Court to authorizing
Petitioner to withdraw as counsel in the above captioned action.
ztion
GRIFFtE & ASSOCIATES
200 North Hanover Street
Carlisle,PA 17013
(717) 243-5551
(800) 347-5552
VERIFICATION
I verify that the statements made in the foregoing document are true and correct.
understand that false statements herein are made subject to the penallties of 18 Pa.C.S
Section 4904, relating to unsworn falsifications to authorities.
DATE: '6\.LA) ( () {;;>
FIE, ESQUIRE
[NRE:
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
WILL NO. 2001-00375
ADMIN. NO. 21-01-0375
Estate of Robert L. Blosser, Jr.
CERTIFICATE OF SERVICE
I, Bradley L. Griffie, Esquire, hereby certify that I did, the
'f^..
J-o day of
October, 2006, cause a copy of Petition to Make Rule Absolute to be served upon
Respondent by serving her by first-class mail, postage prepaid at the following addresses:
Stacy J. Blosser
730 Hillside Drive
Carlisle, P A 17013
DATE:~
//
/
/ r
C / FIE & ASSOCIATES
/ 00 North Hanover Street
Carlisle, PAl 70 13
(717)243-5551
(800)347-5552
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INRE:
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: WILL NO. 2001-00375
: ADMIN. NO. 21-01-0375
Estate of Robert L. Blosser, Jr.
PRAECIPE
TO THE REGISTER OF WILLS:
WITHDRAWAL OF APPEARANCE
Pursuant to Order of Court of November 7, 2006, please note my Withdrawal as legal
counsel for the Estate in the above captioned matter.
Date: }} ,// Lf 10 "
Respectfully submitted,
~~Uire
Griffie & Associates
200 North Hanover Street
Carlisle, P A 17013
(717) 243-5551
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Cumberland County - Register Ot Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/14/2007
TEATS STACY
NKA
730 HILLSIDE DRIVE
CARLISLE, PA 17013
RE: Estate of BLOSSER ROBERT L JR
File Number: 2001-00375
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
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 11 1992, the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/20/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
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Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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In Re: Estate of
BLOSSER ROBERT L JR
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2001-00375
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: BLOSSER STACY TEATS
Counsel for Personal Representative:
Date of Decedent's Death: 5/20/2004
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
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Date:
5/22/2007
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Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
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Pa. a.e. Rule 6.12 STATUS REPORT
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Name of Decedent: . L . \
Date of Death: .5 ~ dO -' C~y-\
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COUNTY, PENNSYLVANIA
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REGISTER OF WILLS OF
File Number:
Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . '.' . . . . . . . . . . . ~es DNo
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. Did the personal representative file a finaI'account with the Court? . . . . .. ~es DNo
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? ..............,................. DYes DNo
Capacity:
o Counsel
Name of Person Filing this Form
Address
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Form RW-JO rev, IO.J3,06
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-16~7 EX AFP (03-05)
STACY J BLOSSER
730 HILLSIDE DR
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-04-2007
BLOSSER JR
05-20-2004
21 01-0375
CUMBERLAND
101
ROBERT
L
Amount Remitted
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PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - - - - - -
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF BLOSSER JR
ROBERT
L FILE NO. 21 01-0375
ACN 101
DATE 06-04-2007
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE, AND. IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-06-2006
PRINCIPAL TAX DUE: ___________~L,377.36
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (- )
04-28-2006 CD006626 .00 1,377.36
05-14-2007 CD008166 90.46- 90.46
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE
1,377.36
.00
.00
.00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR).
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
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COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
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NOTICE OF CLAIM ~ ;
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IN RE: The Estate of: PA Estate File No: 21 ~ 5 r ~~~' ,Yl
ROBERT L. BLOSSER, JR., Deceased "' _~. `-l
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TO: THE CLERK OF THE ORPHANS' COURT DIVISION: 0~ N -Y" Y ~,
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Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, an~1''
Fiduciaries Code, 20 PA.C.S.A. Section 3532(b)(2).
1. Claimant's name: GRIFFIE & ASSOCIATES
2. Claimant's address: 200 N. Hanover Street, Carlisle, PA 17013
3. Creditor listed below is the owner and holder of a claim in the amount of $1,882.46.
4. The facts upon which this claim is based:
Legal services provided to the estate for which payment was not made despite
demand
5. Decedent's address: 730 Hillside Drive, Carlisle, PA 17013.
6. Date of Death: May 20, 2004.
7. That the claim arose during the administration of the estate.
On behalf of the claimant, I do solemnly declare and affirm under the penalties of perjury
that the information and representations made herein are true and correct to the best of
my knowledge, information and belief.
DATED:_
e ~ ~ ~riffie, Esquire
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Written notice of claim was given to Personal Representative and/or his/her counsel as
stated below:
Stacy J. Blosser
730 Hillside Drive
Carlisle, PA 17013
Date notice mailed:
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