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Home My WebLink About03-11-10._...~ REV-1500 Ex (os-o5> 15 0 5 6 0 4115 8 PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 0 9 0 56 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201-18-6461 05272009 08231917 Decedent's Last Name BOBB Suffix Decedent's First Name PAULINE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - REGISTER OF WILLS REGISTER S USE O~ - ~ n ~+ om, ~ rn ~,:~ , ~ rte, ~~~ £. Y _ , N ~-- .~'. 4 `7 DATE FILED v FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of d prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) ^ 7. eath after 12-12-82) Decedent Maintained a Living Trust (Attach Copy of Trust) ~ 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTWN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CRAIG A. HATCH, ESQUI RE 717-731-9f~0 Firm Name (If Applicable) C.n o GATES, HALBRUNER, HATCH & GUISE, P.C. First line of address 1013 MUMMA ROAD, SUITE 100 Second line of address City or Post Office LEMOYNE State ZIP Code PA 17043 MI F MI Correspondent's e-mail address: C• H A T C H a G A T E S L A W F I R M- C O M Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING R ~~N Jo ce A. Rehm, Co-Ex. ~,`~'~,y-Y4i Brenda D. Orr, Co-Ex. d~U ADDRESS 0 d Gettysb g 05 nd St. Mechanicsbur PA 17 East Pennsboro, PA 17025 SIGNATURE OF PREPARER OTHER THAN REPRESENT/~TIVE DATE CRAIG A. HATCH, ESQUIRE// ~ - ~~~y/~~~~ /iUUKtSS PLEASE USE ORIGINAL FORM ONL 15056041158 Side 1 6M4647 3.000 15056041158 J~ J 15056042159 REV-1500 EX Decedent's Social Security Number decedent's Name$ O B B 2 01-18 - 6 4 61 PA II TN1= F RECAPITULATION 1. Real estate (Schedule A) 1. 88942.42 2. Stocks and Bonds (Schedule B) . 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. 0.00 4. Mortgages & Notes Receivable (Schedule D). 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 360.57 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 4 3 6 81 • 9 $ (Schedule G) ~ Separate Billing Requested 7. 0.00 8. Total Gross Assets (total Lines 1-7). 8. ], 8 4 7 9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 2 9 8 8 5.71 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule f). 10. 3332 • 23 11. Total Deductions (total Lines 9 & 10) . 11. 33217.94 12. Net Value of Estate (Line 8 minus Line 11) . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 9 9 7 6 7 • 0 3 an election to tax has not been made (Schedule J) . 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. _ _ _ _ _ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0~ 0 , 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .015 9 9 7 6 7. 0 2 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 0 - 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 - 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042159 15056042159 6M4648 2.000 ~ ~ o r• U 0.00- 4489.52 o•oo 0.00 4489.52 e~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0 , 0 B. Prior Payments 7 5 0 0 0 0 C. Discount ~ , ~ ~ 3. Interest/Penalty if applicable D. Interest 0 ~ ~ E. Penalty ~ - ~ ~ (1> 4489.52 Total CredRs (A + g + C) (2) '7 5 O 0 - O 0 Total Interest/PenaRy (D + E) (3) O - 0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) _ 3 0 ~ 0 4 8 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 - 0 0 A. Enter the interest on the tax due. (5A) 0 • 0 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0 - 0 0 Make Check Payable to: REC~STER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ye s ,,,_ a. retain the use or income of the property transferred; ^ ,~~J b. retain the right to designate who shall use the property transferred or its income ^ : c. retain a reversionary interest; or . . ^ d. receive the promise for life of either payments, benefits or care? ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . ^ 3. Did decedent own an "in trust for" or payable upon death bank account or securit t hi h ^ y a s or er death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ^ 4~-~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)J. The statute d c not x mot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S.>j9116(1.2) [72 P.S.§9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 39116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6M4671 1.000 REV-1500 EX Page 3 File Numhnr REV-1502 EX + (~ ~-08) Pennsylvania SCHEDULE A DEPAR'nr£NiOF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENiDECEDENT ESTATE OF FILE NUMBER Pauline F. Bobb 21 09 0568 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value 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. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owened as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Two-story, single-family dwelling located at 3812 Seneca Avenue, Camp Sill, Cumberland County, Pennsylvania; being Tax Parcel No. 13-23-0553-021; $88,942.42 transferred to Glenn I. Bobb, Sr., and Pauline F. Bobb, husband and wife, by deed recorded in the Cumberland County Recorder of Deeds Office at Book B, Volume 18, Page 431. Value is net sales price. TOTAL (Also enter on Line 1 Recapitulation) I; $88, 942 42 awasss z.ooo If more space is needed, insert additional sheets of the same size. REV-1503 EX + (698) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT Al t Ut FILE NUMBER Pauline F. Bobb 21 09 0568 All property jointly-owned with right of survivorship must be disclosed on Schedule F. awasss i.ooo (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E CONNv10NWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Pauline F. Sobb 21 09 0568 Include the proceeds of litigation and the date the proceeds were received by the estate. 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+(g-g8) SCHEDULE F corvlNloNwEALTH OF PENNSYLVANw JOINTLY OWNED PROPERTY INHfftfTA NCE TA X RETURN RESDBVT DECEDENT ESTATE OF FILE NUMBER Pauline F. Bobb 21 09 0568 ff an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVNNG JONTTENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Rehm, Joyce A 935 Gettysburg Pike, Mechanicsburg, PA 17055 Daughter JOINTLY-0WNED PROPERTY: TEEM NUMBER LErrER FOR JOIN TENANT DATE MADE JOR~TT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JoINrLV•HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S NT9ZEST DATE OF DEATH VALUE OF DECEDBVTS NTEREST 1 A 6/1/1976 PNC Baak Checking Acct. No. 51-4025-3475 $22,332.54 50.0000 $11,166.27 Interest accrued to 5/27/2009 $0.79 50.0000 $0.40 2 A 4/26/1988 PNC Bank Savings Account Acct. No. 51-3021-2557 $65,024.81 50.0000 $32,512.41 Interest accrued to 5/27/2009 $5.79 50.0000 $2.90 TOTAL (Aisoenteron line 6. Recaojtufation) I $ $43, 681.98 (If more space is needed, insert adddanal sheets of the same size) 3W48AE 1.000 REV-1510 EX + (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Pauline F. Bobb __ 21 09 0568 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLIAETFENNv£OFTHETRANSFEREE,THEIRREIATIONSHIPTODECEDENiAND THE DATE ~ TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S THEREBY EXCLUSION IF APPLICABLE TAXABLE VALUE ~ • None TOTAL (Also enter on line 7, Recapitulation) ~ $ 0.00 (If more space is needed, insert add'Aional sheets of the same size) 3W46AF 1.000 REV-1511 EX+(~0-06) CONRdONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS Pauline F. Bobb 21 09 0568 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. St. John Cemetery gravesite $600.00 Total from continuation schedules . B. 1 2 3 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant $7,156.87 $10,000.00 $10,000.00 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees $260.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Leon D. (3arlach, Appraiser real estate appraisal $325.00 2 Musselman Funeral Home death certificate $9.00 Total from continuation schedules $1,534.84 TOTAL (Also enter on line 9, Recapitulation) ~ $ $29, 885 71 ~wasn~ i.ooo (If more space is needed, insert additional sheets of the same size) Estate of: Pauline F. Bobb Schedule H Part 1 (Page 2) Item No. Description 2 Baughman Memorial Works, Iac. engraving 3 Musselman Funeral Home, Inc. funeral goods & services 21 09 0568 Amount $215.00 $6,941.87 Total (Carry forward to main schedule) $7,156.87 Estate of: Pauline F. Bobb 21 09 0568 Schedule H Part 7 (Page 2) 3 Postage $85.28 4 Cumberland Law Journal publication fee $75.00 5 Patriot-News publication fee $245.57 6 Bonnie K. Miller, Tax Collector school tax bill $769.44 7 $rwin Insurance Agency homeowaer~s insurance premium $198.35 8 Patriot-News ad for sale of real estate $161.20 Total (Carry forward to main schedule) $1,534.84 REV-1512 EX+(12-08) Pennsylvania SCHEDULE I DEPARTA~ENTOF REVENUE DEBTS OF DECEDENT, HJHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Pauline F. Bobb 21 09 0568 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. awasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+(11-08) SCHEDULE J Pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER rautine r~. esoaa 21 09 0568 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees} OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 2116 (a) (1.2).] 1, Joyce A. Rehm 935 Gettysburg Pike Mechanicsburg, PA 17055 PNC Bank Checking Acct. No. 51-4025-3475 Inventory Value: $11,166.27 Accrued: $0.40 PNC Bank Savings Account Acct. No. 51-3021-2557 Inventory Value: $32,512.41 Accrued: $2.90 20~ of Residue: $11,217.01 Daughter $54,898.98 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. ([ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S $ 0.0 0 If more space is needed, Insert additional sheets of the same size. 8W 46AI 2.000 Bstate of: Pauline F. Bobb Schedule J Part 1 (Page 2) Item No. Description 2 Brenda D. Orr 205 2nd Street Bast Pennsboro, PA 17025 20~ of Residue: $11,217.01 3 Glean I. Bobb, Jr. 3814 Seneca Avenue Camp Hill, PA 17011 20~ of Residue: $11,217.01 4 Dennis 8. Bobb 5480 Boany Rigg Court Mechanicsburg, PA 17050 20$ of Residue: $11,217.01 5 Barry W. Bobb 5262 Terrace Road Mechancisburg, PA 17050 20$ of Residue: $11,217.01 Relation Daughter Son Son Son 21 09 0568 Amouat $11,217.01 $11,217.01 $11,217.01 $11,217.01 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ;e for this certificate, $6.00 ~ 15'189858 Certification Number This is to certify .that the information. here given is coiTectly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be. forwarded to the State Vital Records Office for permanent filing L~~m., ~ / Q ~IAY 3 0 2009 Local Registrar Date Issued __ _ _ _ ___ _ __ _ REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRIM IN (ANENT ,K INN (See tnsERTonsCand exOamplDes on reverse) 1. Name a Decedent (Flr>t, midde, less, audq Y. Sex 3. SacMl Secudy Number y ~ ^, ` I , V m y. Dale dl Death (Month, day, year) female 201 -18 6461 a 27 2009 5. Age (last Birmtlay) UMar 1 year Under 1 tley 6. Dale d Binh (Month, day, er) 7. Blrmplau (Gty antl stale a I count) &a. PMMd Deem (Check only ou) 91 ""°~" °i" "°"` """""" Aug. 23,1917 Summerdale,PA "oealak O1~` Assisted Living Y rs. ^ InpeUenl ^ ER / Outpatient ^ DOA ^ Hurting Hans ^ Resitlence Olhar ~ Spedry: M. County of Deem &. City, Boro, Twp. of Death Xd, Fadlsy Name (II nor mslXUlbn, gNe street aM number) 9. Wu Decetlenl dl Hispanic Ongin7 Na ^Ves 10. Rata: Ameriun kNMn, Black, Wnite, etc. Cumberland Silver Spring Bridges at Bent Creek ("~'°o°ary~l'~^' ~ sM ~ M.xican, Puend Rhin, alt.) e 11. DecaMnl's Usual lion KM d work done most of work' tile. Do not stale relir 12. Was Decedent war M the 13. Decedent's Etluulion (Spealy onry highest grade urlkpbled) td. MarXal Status: Martied, Never Marred, 15. Surviving Spouse (II wde give maiden name) , Kind d WaN Klnd a Busine" /Industry U.S. Amred Forrces? Elementary / Secondary (0-12) CoXega (1-1 or 5.) ~~~~ Daaced (Speary) food servic Food ^Ves Lprlo 8 idowed 18. Decedent's MalMkg Adtlresa (Street, city / Wvm, Male, xb rode) Decedent's Did Decedent Actual Resltlena t7e. Stale PA t.Ne m a 17c. Yes. Deudant LNed in 935 Gettysburg Pike T ; Twp ~ ~ua• Si r-i A p~ b? . . g 1>b.~unry Cumberland ,7d.^~.ILlvedw6hM Mechanicsbur PA 17055 AcNaI LimAe pl ciry/Bat 16. FaOar'a Name (FkM, mMie, MM, xdfiz) 1S. Mdher'g Name (Fha1,mMdM, nltiden aunleme) Harry M. Wright Elizabeth Shelly zM. Idamanl'e Nerve (Type I Pnnl) 20b. Inlormenl's MaXNp Adiess (Street dry / lavn, slate, 2b taGel Joyce A. Rehm 935 Gettysburg Pike Mechanicsburg, PA 17055 21a. Method d DiepoeNbn i ^ Cremadak ^ Donation ~ l BuMI ^ Removal lrom Stole 21 b. Dale d DMpuNMn (MOnM, day, ymr) 2tc. Place of DlsposXlm (Name d canMery, aematary a dher place) ' 21 d. Caption (CXy /lawn, slate, lip code) y u ;Wag Cramatlon or Donalbn AUlMnzetl ^ Other - Specily.~ Medkal Examiner I Coroner? ^ Yes ^ No June 1 , 2009 St. John s Cemetery Camp Hill, PA 22a. Sign lure F Service Lice~aee (a irp as such) C 22b. License Nwriber 22c. Nerve aM Adtlress of Faakly ~ (~J 011248 L usselman FH&CS Inc. 324 Hummel Ave.Lemoyne,PA Campele Hems 23a-c ody when unNyMg dryticMn M nd waNede at lime of deem m 23a. To are t of my knowdedga, death eaurred al the lime, dale antl place shred (Slgrkamre and line) 23b. Uunse Number 23c. Dale S red y ) Ig (Month, tla ,year cMily uuw of Melh. Items 2426 muss bs cam led pre W person who pronounces Math 2a. Time of Deam ^ t( ` , ~ P 26. Dale Pronounced Dead Month, M , ear 1 Y Y I LA f~ x1 26. Was Case Relerted to Medkel Examiner /Coroner la a Reason Olner Than Cremalbn or ponalion? . M. , ~ ~ O ~ ~ •j ^Ves ®Na CAUSE OF DEATH (See Inshuttlans and examples) I Approxknale Inlerrel: Item 27. Pan l: Enter the chain d events - iseases, irpuMS, a complications - Ihal dreclry uused the tlealh. DO NOT solar lenninal wants such as cardiac artest I Angel 1o Deelh reaprala arteal a veadclNar ObnlMBan wI1h 1 l i th ai l Li t Pen Il: Enter olMr ~ionT *nl m•!nmrt<mn ,a„ qg 1o tlealh, but not resoing M the underlying uuae given in Pan L gflDM Tobacco Use CanlAlwle to Death? Y ^ e s ^ Prabaay y , ww ng W S o ogy. e s arty one CaUSe on each Xne. ~ ~- - ~ dAMEp1ATE CAUSE~inal diseases /~yy_n n rjl ^ ^ ) yJ / I _ WG ^o ^ Unklgwm ) Q S ~I ~ mMilxn resoling n elh) ~~ a. ~ W 1 ~ (/TT 1LJJ ICY ,(,/'T") ~ y ~a.At„t S ~ I 'l ~ ~. ~, Q' ~ ~~~ S 2q. II Famde: Due 10 (a as a LpnSBQUente 0~: j Segrenlialry list toMilans, a arty, b ~ ~q Ne'M.y ~"~ ~2,y ~ t S (~-~ ~. ~ H y ^ Nel pregnant within peal ear ^ P . Madrq la ma pose Xeled an Xne a. }~ regnam al lime o1 Maln Enlx the UNDERLYING CAUSE Due to (a as a cansepuance oQ: I ^ ^ Nat pregnant, but pregMnl wimp /2 tlay5 (dgease or injury met nNMMtl me t. k wenle ~aNgg n deem) u6T. , D - , ~ M ~ f J . X 1 y ~ d tleath ue to (a as a consepuence d) r ^ Nd pregnant, but pregnant d3 tlays to I year d. I I ~1 _ R"~~ ~ ~ ~~ u~) )~ bNae Mam ^ Unkrgwn X pregnant wimM the peal year 308. Was an Aaopsy Penomked? 3W. Ware AWa(uy FkkMgs Avaeade PMr to CanpMlMn 31. Manner d Death 32a. Dale d In"ryry (Manlh, day, year) 326. Deserve How Iryury Ocwrted 32c. Pfau d I ~ Home, Farm, Slred. Faa 'I'u ry ~. a cause a Dam? n ~~I ^ Hamkido V"°""" OXka Bul d~r g, arc. lSpstB)'! ^ yes Q,Nd ^ Ye5 ^ No ^ AcGdenl ^ Perking Invealigatian 32d. Tone d Irqury 32e. Inryry al Work? 321. II TnmpMaXm Injay (Spedry) 32g. Caution d Irpury (Street, city /town, sMlel ^ Suidde ^ Could Nol be Determined ^Ves ^ No ^ Dmrer / Operalw ^ Passenger ^PBdealMn M Oaker Spetity. 33a. Cenifrer (Cned1 ady anal 33b. Slglature end rata a Cenirler • CenNyhkg pnyakden (Physiden pnnyk,g uuse d Mato when anomer phyairien has praaakced death aM completed IMm 23) To the heal d my NnoMedga, Malh ocarred dw to the peN(a) and manror as aMled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ P ~ v. ~/J 1 •' • `~ - • ronoorkolnq and terlllying phyaklM (Physiierk bdh prakarrlnq d9aln aM cenirying to pose d death) To IM bell a my knowledge, Mam aumd al fM tlms, dale, and place, end due to iM puee(s) end manner as sMted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. l NkaNMr 33d. Dols $Ignetl pIMOnm, My, yeah ~~~ ~ ~~ • Medlin Exemkkx I Caron" ~ 26 O~ On the haste a examinetlon and I a I n ve ellgelfon, M my oplnbn, death acurred al Iha Ilme, date, and gate, and due to iha causale) and mann" as stelae- ^ ~ Name antl AM rn E a Pa ra an Nlg Conlp Ml ed Ceugaa 1 n p l em 2]) T / P ri nt /Dog ~ ~ / Regislrer'6 ~ ore end Di61 ~ /T ~ I / I l I / I / I ( ar ` ' ~~/ ~ ~ . /~ ~ [~ y~ //.., ~~~ff ~ a ~ ~ , l n ~ ~~. ~~ ,, : N ~ I! ~ v I ~ T'~/X~'X V .rl I7 R tG~l ~~ ~~) ~~ ~rC ' w ~ y] v OMpotition Permll No. l J 3~ ~ V G ~ , LAST WILL AND TESTAMENT OF PAULINE F. BOBB REGISTER OF ~!l/ILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2009- 00568 PA No . 21- 09- 0568 Estate Of : PAULINE F BOBB (first, Middle, Lastl Late Of : UPPER ALLEN TOWNSHIP. CUMBERLAND COUNTY Deceased Social Security No : 201-18-6461 WHEREAS, on the 18th day of June 2009 an instrument dated June 24th 2003 was admitted to probate as the last will of PAUL/NE F BOBB (First, Middle, Lastl late of UPPER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 27th day of May 2009 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: JOYCE A REHM and BRENDA D ORR who have duly qualified as EXECUTOR(R/XJ and have agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 18th day of June 2009. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TES'TAME'NT DF N n Q PA ULINE F. BOBS '= ~ `° ~ `, `~~~' _ ~ ~- ~ , ~. , ,. -.:;;T ~ I PAULINE F. BOBB of the Township of Lower Allen Count of Cumb' id a e i ~' , , , y nt ~ ~~ v-;,--- ~.j ~ ,~, State of Pennsylvania, being of sound and disposing mind, memory and unders~c~ing, d~, ;: make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. I direct the payment of all my just debts and fiineral expenses as soon after my decease as the same can be conveniently done, including the payment out of the principal of my general estate, of all inheritance, estate and succession taxes which may be assessed in consequence of my death. 2. In the event that I have not already done so during my lifetime, I make the following bequests, to wit: (a) I give and bequeath my Marble Top Stand to my daughter, BRENDA D. ORR. (b) I give and bequeath my Bookcase to my daughter, JOYCE A. REHIVI. (c) I give and bequeath my Desk to my daughter, BRENDA D. ORR -1- 3. I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same my be situate, to my .five (5) children, to wit., GLENN I. BOBB, JR., DENNIS E. BOBB, BARRY W. BOBB, JOYCE A. REHM AND BRENDA D. ORR, share and share alike, per stirpes. 4. For the purpose of facilitating the settlement and distribution of my estate, I authorize and empower my executrices, hereinafter named, to sell any and all real estate which I may own at the time of my decease, as well as my personal property, at either public or private sale or sales. LASTLY, I nominate, constitute and appoint my daughters, the aforementioned, JOYCE A. REHM and BRENDA D. ORR, Co-Executrices of this my Last Will and Testament and direct that they be excused from posting bond or other security for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set m hand and seal this ~` ~ y <~ day of June, A. D. ?003. :~ '~ ~ ~ ~ (SEAL) Pauline F. Bobb -~- cr~rlrlr~ra}-~Enr,'rn or 1'ENNSl'L.vANll~ CUlIN'1'Y 0[' CUMi31?RLANll ss. I. ''.'.lTr~I~11?, I~ ~ T~~`,~,T-j _ _ tyre testatl'1.~'. a whose Hanle i.s signed to the aCtac~lted or foregoing instrument, having been du.1y yualified accorcli.ng Co 1.aw, do hereby acl<nowledge 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 volun- Cary acL and. deed, for the l~ur.poses Cherein contained. Sworn and affirmed to and acknowledged before me by; ?~ / r r -- , -~n T.~ n n ,..~ r .~:1,i?::...~r~ w., . t~Or:P, the testat y; a'. ~'°.:c:a this ~ y '; '(( P~,z~. ~. z~~ fr . T o '~ 4`hlotary Public NOTARIAL SEAL CUAIMUNWEALTH OF L'ENNSYLVANIA ) MAURA A, ,IF.NKINS; tdciary °ublic SS. Mechat~iCSburG horn, C'umberlar7tf County CUUNTY OF CUMI3ERLANll ) My Comnjissirr, E:r.;.,ire~s P~1nve;rr;t+e ?Q, 2Q03 We, the undersigned, ~T. TiUi~3 ~T L~illi;t''F'EFi and IiEIT)I 1~';. NI~LSOT'•i the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified accnrdi_ng to Law, depose and say that we were present and sa.w the testatr_i_ -'~'.IT~I;<-~:~~ '' ?~G~ sign anal exe- cute the instrument as ~G~-./her I_,ast Will and 'T'estament; that the said testat''':i~•; _, ! E. .. 1`.=~ ~-~- -~-~ __ executed it as C~T`e~/her tree ar.~d voluntary ac L- fur the purposes therein expressed; that each of us, in the he2r.i.ng and sight of tlrP testat":i._; , siQnecl the Will as witnesses; and that to the best oC our knowledge, the testat,~:~.:: was, at the time, eighteen (1.8) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribed to befo~'e m~_this '~' ` ~- day ^o f^^ , LO.J~- --, /`' ji ~~ i~ / j! i` , ,- r /, ~~ }, J f l /, f .'®~j rlarARlAI_ sE~aL MAURA ~ Jr (N;(•,S, tdotary s3ubl~c Mechanirsbu,r, hint ` nml;erlarid County ~,~,~ ~ My Com;ris,ic„ [x~rrc dc3}+e;nl:4cr IU, 2003 s r -, - -- ' t'~~~" 1 ' U '' ~„ ,~ ~^r'~. ! Gam. ~'~ ~ ~ __ ~{{, ~~QK~ ~~ PAt;C `~'J~ FHH-SIMPLE D6E~-Typewri~rr ~ ~ ^ ~ i~ ~Yt~~l~t~tx~, ~t~~e ~~~e 3rd day of ~-~1~'~+'~ in the ,year of our Lord One T houaand Nine Hundred and P i f t y- S e V e A, ~Pt1UPP11 WALTER L. DARBROW and MILDRBD A. DARBROW, bia wife, of Lower Allen Township, Cumberland County, Pennsylvania, parties of '~ the first part, Grantors, A N D GLENN I. BOBS, and PAULINE F. BOBS, his wife, of the City of Harrisburg, Dauphin County, Pennsylvania, parties of the second part, Grantees, I 7 of the second part, 3~1t~nQ$sP#l~ That the said part iesf the first part, for and in consideration r of the sum of } Thirty-five Hundred ($3500.00) Dollars, lawful money of the United States of America, well and truly paid by the said park@e~f !ht steosd part to the said partie8of the first part, at and before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged, have granted, bargaiwed, sold, aliened, enfeof fed, released, conveyed, and confirmed and by these prtaenta do gran!, bargain, aeU, alien, en f eo f f, release, convey, and confirm unto the said parti @ g o f the second part their heirs and assigns, ,~~i That certain lot of land situate in the Township of Lower Allen, County of Cumberland and State of Peansylvania, more particularly bounded and described as follows, to wits BEGINNING at a point at the northwest corner of Dickinson Avenue and Orchard Avenue (both 30 feet wide); thence nozth 27 degrees 42 minutes west along the western side of Orchard Avenue 216 feet, sore or less, to the southerly side o,f Irving Avenue; thence by the latter south S8 degrees 20 minutes west 174 feet to a point; thence south- wardlT along the easterly line of Lots Nos. 13, 12 and 9 on the here- iaafter aentioned Plan of Lots, 222.9 feet, aore or less, to the northern line of Dickinson Avenue; thence by the latter, north S6 degrees east 174 feet to the place of Beginning. BBING Lois Nos. 10, 11 and 14 as shown on the Plan of Rana Villa Garden, said Plan being recorded in Plan Book 2, Page 47, Cumberland County Records. Having thereon erected a single txo story frame house. BEING part of the preaises which Carlisle Trust Coapany, by Deed dated Pebruary 10, 1939, and recorded in the Office aforesaid in Deed Boole "Y", Vol. 11, Psge 138, granted and conveyed unto halter L. Darbsow and Mildred A. Darbrow, his wife, Grantors herein. ,. ~' 'w..;;. ,, _ . . BOON 1~. 1H NAGE~~~ ~~~p~(Ypr' with all and aingulat, the ttntmenta, hereditamenta and appu:~tenaneea to the acme belowg- ing or in anywise appertaining, and the reversion and rrversiona, remainder and remainders, rents, iatuea awd profits thereof; ~~~18D all the estate, right, title, interest, property, claim and demand mhatwever, both in law and equity, of the said part ie S of the first part, of, in, to or out of the Laid premiaea, and every part and paretl thereof ~II ~ttUp ttri~ Ln II1~ the avid premirrs, with all and singular the dppurtenancea, onto the said parties of the second part, their heir{ dnd assigns, to and for the only proper uat and behoof of the said part ie~ of the second part, their heirs and aaaignr forever, ~~~ THE SAID parties of the first part, for triemselves, their heirs, executors and administrators, do by these presents, covenant, grant and agree to and with the their heirs and assigns, that said part 18 s of the second part, they, the said parties of the first part, and their heirs all and singular the hereditamenta and premiaea hereinabove described 'and granted or mentioned, and in- their htira tended so to be, with appurtenances, unto the said earl i6s of the seoond part, and assigns, against the said part le S of the f irat part and t he i i heirs and against all and every other person or prrsons zvhomsoever' lahallland lwill, by these prescntse IVARRANTpANDt FOREVER DEFEND ~ri i~rip~~ ~p~pII~ the said part Se S of the first part have ~ hereunto set their hands and seals the day and ,year first above written. O _. _ ( EAL) _ __. (SEAL) `~ ~- __ ._._ _ ' ed, Sealed and Delivered / ~J.- '`''~~"~'!~' (SEAL) ~~ ~ _ ,,,=--;` ~ ..',-1C ^;``in he Presence o _ _. ;. =,C' ~, .. ........~. ' ~ v -0 _ __ • h ~~y•. - ~~~-•~ ....._.... .__ ....................................... ..__... .. .. .. .... .. ....... ... . ,~ •~:.~~ ~.~'.. .•>: J01Y GOM SION EXPIRES I _._ _. ............. ' 0~,~.......• ~. R Y .... ~.,:.~.'..`` .................'.°..P_ IL 2. ~ 8x9 •''~~,~ ,,,,:•,.,, YORK, YORK t;b ............ .... .... __... _ STATE OF PENNSYLVANIA C O IINTY --O.F..-Y.O.RK ............ .. _ . _ _ .............................. On this, the ~ day of ~ 1957, before me, a Notarx ~~ti4; signed...o.f..f.i.o.e.r..,._..p.,ers.aaally.....a.p.p.e.a.re M•i1•dre•d •J4......La.F.brox,kaa~~~~b~~ ily proven) to be the person rrhose~name is subscribed to t~ rr~~1~5~' ','.... ~~ and acknowledged _that she executed the s2r;i~e ft5r` th'tl~ parp~'~f~s.: IN WITNESS WHEREOF, I hereunto et„my. hand anc~i,`~f•icia~~s~. 1.M,,,.+ O (SEAL) (SEAL) (SEEAL) (SEAL) (SEAL) (SEAL) i~., the under- $~~tisfactor- ~'' rument stained. ~~ i My coM~n'Ss~o~'s'~xgF~3~' APRIL''2.>a~~~ •ln YORK, YORK 'COUNTY, P.~. ~.,: _ ~. ~tECORDED•OffICF Of THE P CLERK OF COURTS REORDER OF DEEDS ,;~: 3 9P~ ;tIMBERIAND COUNTC ~ENNSYEVANIA Boob ~ 10 f'AGr~~~3 ' COMMONWEALTH OF PENNSYLVANIA SS: •. GOUK,7'Y OF'...........iu.~T.M~~.A.~RII.~? ............................................_.. lOYVER ~t4~N TG"h~liSiii? S~~~:~~~ OISTftlC1 REAL ESTATE TF-i.4itISFER ~~ AX »~~•. .. _ AGENT Octo.b.er...._ ............:........................., 19 .~..~._...., before me On this, the .......,~..~'.d .............. day of .............................................. _. . outs , Pub1iC ................................._.........................., the undersigned ...................................................................... _._~ .........................Y................._...... WA , E R L DA R B RO M1 , ....._...:..._......._........._ ............................................................................ officer, personally appeared .........................................~............................ .. ~., .~~~' iF. j GY *~ .•,,,, `j~i.jk~'` 1~lrttt~(or. satisfactorily proven) to be the person .. • ••.••••.•~•••••••••• whose name ..........x..13....... tubacn'bed to the i ,,•.. executed the same for the purpoat !herein cor-la:ne . ..~ :~, ~31'ie•ii4 ;and aeknozoledged that ............... he .......... . ~ •~ ~:: , g~~ Wyk. •'• ~ n, Si ~'~N ~$'f~{ y~HEREOF, I hereunto set my hand and official seal. • .',,~,5. ' a ~. Y `d F. ~ \~'P~'~ ~ .. . ~ ..............._.'........ ~ .. ~J~• 'aa •. /'~ ~ ~," ~ 1 ,,-' M commaaaon es fires :............1YJ.y..Ga:rr". ~a..E.,.~ E a;t.t3 i .. ~.4.~..__.......... I hereby certify that the Precise Residence of the Grantee, an the it~itn Deed, ia ...................................._.................. 625 DelaKare Street..x.....Harri.s.bur.S.~......Pen.na.,. ......................................................................................... .......................................................................................... . ~~~~ ................ ~ti.. _ . _. _. Attorne f rrantee. Y . -; _. - 1 d °' ~ ~ ~ a a ~ H H ~ ~ °a ~ a a. s O ~ d ~ ,~ '.. . '8 '~ as - M ~ a ~ ~, ~9 F a ~ ., a ~ a d ~ Jh ~ q F ~ - •O ~ x ~ a• ~ ~ ~, ~- `~ ~ p z a Y w s w w v N a y d o ', rh ca ~ b ~ 0 ~ ~ ~ ~ ~ rl 3 u w ° ~ y W ~ U x ~ o ~I Q W II t ° ' a Q U 0.'i u V x OMMONWLALIH OF PE~.NSYL~'A~IA SS: ' COUNTY, In the Office for Recording of De ~1F1~ ~ eds, D'Iortgages, etc. in and for the County cc / Pt //~~ in Deed Book..lc'J... .... Vol..:......... _~a......_. ...... , Page ...'t.3..l.. ... .... . of ....... ... ~ M ~ Hand and Seal of Office, this ~it11P8B S ......... ....................................~...~ ........................... da y of ............................................. Anno D ~ omini 1~~ , ...... /. p ~ /" s Gates, Halbruner, Hatch Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 1 FHA & Guise, 1 • v • 2 FmHA C Unins C E. Seller F. Lender: G. Property Adc 3 onv. i statement o actua sett ement costs. mounts pai to an y t e sett ement agent are s own. they are shown here for informational purposes and are not included in the totals. Glenn I. Bobb Jr. Gerlinde T. Bobb 3814 Seneca Avenue, Cam Hill, PA 17011 Estate of Pauline F. Bobb 935 Gettysburg Pike Mechanicsburg PA 17055 ress: 3812 Seneca Drive Township/Municipality: Lower Allen Township Coun Cumberland Cam Hill, PA 17011 Gates,L moyne rPA 97043 (717) 731 9600 Fax: (717)R 31d9627e 100, H Settlement Agent: Clifton R. Guise Esq. Attorne 's Name. I. Settlement Date 12/16/09 J. Summa of Borrower's Transactions too Gross Amount Due From Borrower 101 Contract Sales Price $ 102 Personal Pro e $ 103 Settlement Char es $ 104 $ ]OS ,d'ustment for Items Paid b Seller in Advance 106 Township Taxes from 12/16/09 to 12/31/09 $ 107 Coun Taxes from 12/16/09 to 12/31/09 $ 108 Assessment from 12/16/09 to 12/31/09 $ tog School Taxes from 12/16/09 to 06/30/10 $ Ito Sewer from 12/16/09 to 12/31/09 $ 11 1 ]12 113 114 1 zo Gross Amount Due From Borrower ~ $ zoo Amounts Paid b or in Behalf of Borrower 201 De osits $ 202 Princi al Amount of New Loan $ 203 Existin Loans Taken Sub'ect to $ 2oa Check from Borrower $ 2os $ 206 207 $ 208 Ad'ustments for Items Un aid b Seller 21o Ci Taxes from 01/01/09 to 12/16/09 $ 2t 1 Coun Taxes from 01/01/09 to 12/16/09 $ 212 Assessment from 01/01/09 to 12/16/09 $ 2t3 School Taxes from 07/01/09 to 12/]6/09 $ $ 214 $ 215 $ 216 $ 217 22o Total Paid by/for Borrower 30o Cash at Settlement From/To Borrower Sot Gross Amount Due From Borrower $ 302 Less Amount Paid b /for Borrower $ 303 Cash from Borrower $ K. Summa of Seller's-Transactions 40o Gross Amount Due To Seller 500.00 aot Contract Sales Price $ - 402 Personal Pro e $ 727,00 403 $ - 404 $ - 405 ng 88,500.00 Ad'ustment for Items Paid b Seller in Advance 31 406 Townshi Taxes from 12/16/09 to 12/31/09 8 $ 8.31 . 7.69 ao7 Coun Taxes from 12/16/09 to 12/31/09 $ 7.69 - aos Assessment from 12/]6/09 to 12/31/09 $ - 90 ao9 School Taxes from 12/16/09 to 06/30/10 412 $ 412.90 . 13.52 4to Sewer from 12/16/09 to 12/31/09 $ 13.52 $ - - an $ - - ate - $ 413 - $ 414 - 89,669.42 ago Gross Amount Due to Seller $ 88,942.42 50o Reductions in Amount Due to Seller 700.00 sot De osit Held b Seller 17 $ - , - sot Settlement Char es to Seller $ 5,010.00 - 503 Existin Loans Taken Sub'ect to $ - - 504 ] st Mort a e - $ - Sos 2nd Mort a e - $ - 506 $ - 507 - $ - 508 - Ad'ustments for Items Un aid b Seller _- - 51o Ci Taxes from 01/01/09 to 12/16/09 $ - - st t Coun Taxes from 01/01/09 to 12/16/09 $ - - 512 Assessment from 01/01/09 to 12/16/09 $ - - 513 School Taxes from 07/01/09 to 12/16/09 $ - $ - 514 $ - 515 $ - 516 $ - 517 17,700.00 520 Total Reductions in Amount Due to Seller $ 5,010.00 60o Cash at Settlement To/From Seller 669.42 601 Gross Amount Due to Seller 89 $ 88,942.42 , 17,700.00 602 Less Reductions in Amount Due to Seller $ 5,010.00 71,969.42 603 Cash to Seller $ 83,932.4= 4 VA 5 Conv. Ins. X OMB-No. 2502-0265 I-IUD-1 (Rev. 3/86) L. SETTLEMENT CHARGES Paid from Paid from 700 Total SalesBroker's Commission 500.00 O.Oo/u = $ _ $ 88 Borrowers Seller's Funds , Based on Price Division of Commission (Line 700) as follows: Funds at Settlement at Settlement 701 $0.00 to 702 $0.00 to $ _ $ - 703 Commission Paid at Settlement $ _ $ _ so0 Items Pa able in Connection with Loan $ _ $ _ sot Loan Ori ination at 0.00% to $ _ $ _ 8oz Loan Discount at 0% to $ _ $ - 803 A sisal to $ _ $ - so4 Credit Re ort to $ _ $ - 805 Loan Processin Fee to $ _ $ - 806 to $ - $ - 807 tO $ - $ - 808 to $ - $ - 809 to $ - $ - 810 to $ - $ - 811 to $ - $ - 812 t~ $ - $ 813 tO 900 Items Re uire b Lender to be Paid in Adva a~e er da $ ~ $ $ _ got Interest from 12/16/09 to $ _ $ - 902 Mort a e Insurance Premium to $ _ $ - 903 Hazard Insurance Premium for to $ _ $ _ 904 $ - $ 905 tooo Reserves De osited with Lender for: er month $ ~ $ toot Hazard Insurance months $ - er month $ _ $ - months 1002 Mort a e Insurance er month $ - $ $ _ too3 Ci Pro ert Taxes months $ - er month $ _ $ - months tooa Cn Pro a Taxes $ _ er month $ $ - loos School Taxes months $ _ $ - l006 A e ate Anal sis Ad'ustment $ - $ - 110o Title Char es $ $ t tot Settlement or Closin Fee to $ 125.00 $ - t toe Abstract or Title Search to Ionni Abstract $ _ $ - l to3 Title Examination to Hatch & Guise, P.C. lbruner H $ 550.00 $ - _ , a t loa Attorne 's Fees to Gates, $ - $ I tos Deed Pre aration to $ - $ - I t o6 Nota Fees to $ - $ t to7 Attorne 's Certificate of Title: to includes items No.: to to Stewart Title Guarant Com an $ - $ 1 tos Title Insurance includes items No.: $ _ ItogLender'sCovera e $ _ $ t t to Owner's Covera e - to Stewart Title Guarant Com an $ _ $ _ t t t l Endorsements to Stewart Title Guarant Com an $ $ _ _ $ I t t z Closin Service Letter to to t t 13 Commitment Fee s Ch $ - ar e 1200 Government Recordin and Transfer $ _ $ 52.00 52.00 Mort a e: t2ot Recordin Fees: Deed: $ 885 00 Mort a e: $ - $ - $ - . t2o2 Ci /Coun Stam s Deed: $ Deed: $ 885.00 Mort a e: $ $ _ _ $ - 1203 State Tax/stam s $ _ tzoa Recordin Fees: $ t zos 1300 Additional Settlement Char es Hatch & Guise, P. lbruner H $ $ 5,000.00 - $ 10.00 , a t Sot 2nd Installment Le al Fees to Gates, Bonnie Miller, Tax Collector $ $ - $ _ 1302 Tax Certification to $ to $ - 1303 to $ _ $ 1304 to $ _ $ 1305 t0 $ _ $ 1306 to $ - $ 1307 t0 $ $ t 308 to $ 727.00 $ 5,010..00 1309 1400 TOTAL SETTLEMENT CHARGES it is a true and accu lief b rate statement of all receipts and disbursement ma e , e i have carefully reviewed the HIJD-1 Settlement State and totlh? bra of my knowledge and v received a copy of the HUD-1 Settlement Stat ement. on my account or by me in this transaction. t further certify Borrower: Borrower: Date _,_______ Date: Glenn I. Bobb Jr. Seller: Seller: Gerlinde T. Bobb Date ___._- Date: Estate of Pauline F. Bobb e HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. t have caused or will cause the funDate a disbursed m Th ----- accordance with this statement Clifton R. Guise, Esq. Settlement Agent: Warning: it is a crime to knowingly make false stateeC~onol00t and Sectaons1010.is or any other similar form. Penalties upon conviction include a fine an imprisonment. For details see: Title 18 U.S. Code S PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY Solutions ci-I~,cK nn~rE: o9n8/2o09 'nt1LINE 801313 CI~:CK NUMBER: 0000279032 VENDOR NUMBER: 108817 1NV()lc(: NUMBF'iZ < n1~"I 1; I)ESCRtP11()N n1v1[7IN"I~ '> €?L?N'[' P/tik~ 1I NMR013087 09/15/2009 REFUND 16.82 ~_ ic) rnt.s I I ~ [ 6.~2 I ',sec 1 uC 2 QPNCBANK 040 UPPER ALLEN (112) 127 KIM ACRES DRIVE UPPER ALLEN PA 17055 Gashbox 02 AM * Deposit Check 10:24 AUG 4 2009 XXXXXX9821 Account Number $g,60 Tran Amount W/S ID W4~JSH1123 Sequence Number 00059 Batch 401 This devasit ar vavnent is ecceDted subiect to verification and to the rules and regulations of this bank. Devasits nav not be available for in~lediete uithdrauel. Receivt should be held until verified with your stetenent. CAMP HILL EMERGENCY PHYSICIANS (HYP) PROVIDER SERVICES REFUND ACCOUNT HOLY SPIRIT HOSPITAL 800-355-2470 PAYEE NAME & ADDRESS PAULINE F. BOBB 935 GETTYSBURG PIKE MECHANICSBURG, PA 17055 PATIENT: pAULINE F. BOBB REFUND CHECK DATE REFUND AMOUNT 07/21/09 $8.60 ACCOUiv T NUMBER 29467578 PLEASE DETACH AT PERF LINE T SERVICE DATE 03/02/07 REASON FOR REFUND INSURANCE PAID & PAT 091826102740010 PC~ICY NUMBER 1253420 62140 07/09 /, PA REV-1500 SCHEDULE F JOINTLY OV'VNED PROPERTY ~~ . i.EAitl~lG Tt#~+IIfAY July $, 2009 Traci L Sepkovic Paralegal Gates Halbruner Hatch & Guise P.C. 1013 Mumma Rd Ste 100 Lemoyne, PA 17043 - RE: Pauline F Bobb SSN: 201-18-6461 DOD: OS-27-2009 Dear Sir/Madam: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checlang Account Account # 514023475 PA,U,[,INE BpBB JOYCE REFI.M DOD balance: $ 22,332.54 + 0.79 accrued interest Interest paid O 1-01-2009 thru 05-27-2009 $10.75 YTD Savings Account Account # 5130212557 PAULINI/ BOBB JOYCE REHM DOD balance: $ 65,024.81 + 5.79 accrued interest Interest paid 41-01-2009 thru OS-27-2009 $ 94.75 YTD Established: 06-O1-1976 Established: 04-26-198 8 Please note that this office pxovides date of death balances for deposit accounts (ZRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-I?NC-BANK (i-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 2 \ - PA REV-lsoo SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS Invoice BAUGHMAN MEMORIAL WORKS, INC. CEMETERY MEMORIALS 23-25 S. MAIN STREET DOVER, PA 17315 PHONE: (717) 292-2621 ' FAX: (717) 292-7936 BILL TO: JOYCE REHM 935 GETTySBURG PIKE MECHANICSBURG, PA 17055 ~~ ~ 10/ 15/2009 17080 -• Net 1 ~ LETTERING COMPLETED ON 10/10/09 FOR PAULINE BOBB IN ST JOHNS CEMETERY (MAY 27, 2009) 215.00 215.04 w ,b r~ ~~ ~'~ o~ .~ ~ All work is complete! TOTAL $21 s.oo ;75053 ! t !(i9 ~ Cotal Banking Statement For 24-hour information, sign on to PNC Bank Online Banking on pnc.com. PNCBANK For the period 05/15/2009 to 06/75/2009 PAULINE BOBB Primary account number. 51-4025-3475 Page3of3 :heck Images saa PAU4NE BOBS sm s. mN cr. u -umn K -16-05 n a i eiuwrau.FA +,on~ ~ F"'°'w`~: D 71~nn 4z '~ ~`Gf ~ 3 35R.1D L o~. d ~r~ p e.. ®_._ -~---- ~PNCBA :: „ °° ~ p ~ ~:03i312738~: 5 140 25 347 5°' 0644 r'00000359t0.~' 644 $359.10 05/'LY/•cuvy fi48 -s .. __ . __- _- - __ _. _.. ~ s,mqu u Wm b--~-04 w a~~~Q »rdx,.~C.a.~ JI` ~ $y~,a~.w .ur~-~te2h ..v~v/_./Jif,. ~~..+~/c~X~~D -~b.n... fi a ~pNCBANK " ~ mca.r<ra .. - ". •M r`~` -.-- Fw ~VV.. __.. .__ __. ~:03 13 1 2 738~: 5140253ti75a' 648 .x'0000324800." 648 $3,248.00 oti/uis/zuva say PAUUNE BOB9 w~ 1,-1-04 "'ow'l C: ~ ~ _ a~~.-,~~cTifP~wn_ - v~ non.. 6 c.:_ ~~w a:03 i3 i 2738: 5140253475x4? 647 $600.00 06/04{2009 649 _ _ PAULMEBO@6.______ .___- _.. _. _.._ -... __ ___ ~r~a~a oa. ~_H_ay °1tOa° Fo.o a~` ~,.orr r:Bnrltee. ,..6 ~ 75.63 o.~.« ata - - oer.. ®~.. ~ NK ~~~ Fw ~w~"IY.-_ .. ~ -. r ~:03i3i2738N. 5140d53475r 649 649 $75.63 06/09/2009 Jith PNC Online Banking, you can view, print and save up to the most recent 90 days of your canceled checks -front and back -FREE of harge. Please contact us for additional options. Leon D. Gerlach, Appraiser Commercial, Industrial 8~ Residential 305 West Shady Lane Enola, PA 17025-2240 Phone 717-732-5052 Fax 717-732-6646 BILL TO Brenda or Joyce BOBB Pauline F. Estate 3812 Senica Avenue Camp Hill, PA 17011 ~~' I~L INVOICE "Forward to Accounts Payable REFERENCE Invoice #: Invoice Date: Order Date: Appr. File #: Case #: Client File #: PO #: Tracking #: BOBB-3812 Seneca Ave 06/24/2009 06/15/2009 H09060776 BOBB-3812 Seneca Ave BOBB-3812 Seneca Ave H0906077B a3 DESCRIPTION b J2~1 ~~ Property Address: 3812 Seneca Avenue Camp Hill, PA 17011 BILLING AMOUNT $ 325.00 ---------------------------------------------------------------------------------------------- Total $ 325.00 Payment 1 Check #: Date: ~ ) Terms: Balance due upon receipt of invoice Balance Due $ 325.00 Federal I aX ~f: ~5- iou4u~iisp PLEASE SEND A COPY OF INVOICE OR INCLUDE FILE No. WITH PAYMENT FOR CORRECT CREDIT ALL ADDITIONAL WORK WILL BE BILLED AT A RATE OF $ 150.00 PER HOUR RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 6/18/2009 Cumberland County - Register Of Wills Receipt Time: 09:03:13 One Courthouse Sc{uare Receipt No.: 1057187 Carlisle, PA 17613 BOBB PAULINE F Estate File No.: 2009- 00568 ~CE Paid By Remarks: J REHM A ------------------------ Receipt Distribution ----- -------- -------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 210.00 00 15 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN WILL SHORT CERTIFICATE . 20.00 00 10 CUMBERLAND BUREAU OF COUNTY RECEIPTS GENERAL & CNTR FUN M.D JCP FEE AUTOMATION FEE . 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN Check# 650. Total Received......... $260.00 $260.00 /~ V ~~~~~ ~~ MUSS~LMAN :^ ;~ FUNERAL HOME &~ CREMATION SERVICES, INC. <~- ~ . 1vlusselman Funeral Home & Cremation Services, Inc. 324 Hummel Avenue P.O. Box 137 Lemoynef PA 17043-0137 ~;~ /.~\\.~} ,/~\ /' v ~L~,Z~C~t~~ l~K. J P (1 Rnx 1~7 ~ X74 HnmmPl QpPn11P ~ T Pmn~mv PA 17C1d~,(1127 ~ (7171 7(.2,7dd(1 ~ >~~~• (7171 7~n_07c~Q PA REV-1500 SCHEDULE I DEBTS QF DECEDENT MURTGAGE LIABILITIE S and LIENS G18TCE01 01001001UDtOtBR001'TCE' CAMP HILL EMERGENCY PHYSICIA PO BOX 13693 PHILADELPHIA, PA 19101-3693 ~nr~~~u~~~~uu~r~n~r~u~r~m~~uN~i~t~n~n~~u~N~r,~~m~ D82516-0000029467578-06 #BWNJFDB #OOOOOOOHYP536675# STATEMENT OF ACCOUNT (1) Statement Date: May 30, 2008 ACCOUNT NUMBER: HYP29467578 _ Patient Name: PAULINE F BOBB Tax ID #: 20-4667340 Account Balance: $8.60 Amount Pending insurance: $0.00 Amount DLIe From Patient (Current): $8.60 Amount Due From Patient (Past Due): $0.00 Pay This Amount: 58.61 PAULINE F BOBB ~ Gj 935 GETTYSBURG PIKE ,~ MECHANICSBURG PA 17055-5324 PLEASE REMIT PAYMENT BY "PAYMENT DUE BY" DATE. THANK YOI Please refer to coupon below for paymel instructions. Account Detail ~`~'~/ Date # Description Charge Paid By First Ins. Paid By Other Ins. Paid By Patient Amount Ad'usted Due From Insurance PATIENT BALANCE 03102107 1 99284 EMERGENCY EVAL 8 MGMT $541.00 (LVL 4) DX:788.52 DR. OLSONJHOLY SPIRIT HOSPITAL 05107/08 MEDICARE CONTRACTUAL ALLOWANCE $-433.53 05107/08 MEDICARE TIME LIMIT ADJUSTMENT $-8.60 05K37:C9 A'EDICAR[PAYM[NT - - $~%%.351 05124/08 BLUE SHIELD PAYMENT f $-12.89 $8.60 TOTALS. $541.00 $-77.38 $-12.89 ~ $0.00 $-442.13 $0.00 $8.60 Important Messages: This statement is for the direct treatment and/or supervision of care you recently received from an Emergency Physician at Holy Spirit Hospital. The tees for this private physician are biNed separately from any hospital charges or other professbnal Fees for which you may also be responsible. Therefore, should you receive a bill from the hospital or other physicians for charges in connection wdh this visN, it will not include the items listed ar this statement. "Payment Plans" Accepted Questions about this statement? / Llame de Lunes a Viernes? Call 1-800-355-2470 Monday through Friday 9:30AM - 4:OOPM. Your automated system access code is 801-29467578, or you can send email to billing_questionst~emcare.com. Please detach and return bottom portion with your remittance. Date Procedure Description Diagnosis Charge Credit Balance Code 03/03/09 99214 OFFICE VISITESTMOD25 428.0 155.00 79.37 75.63 \~~ ~ ~\ ~~ ~~ ~S~` MEDIGAP BLUE PLAN B DOES NOT COVER THE MEDICARE DEDUCTIBLE, PLEASE SUBMIT PAYMENT. Total Current 31-60 Days 61-90 Days 91-120 Days Over 120 Days pm0uot Due: $75.63 Insarance Balance ASSOCIATED CARDIOLOGISTS __ Patient Balance $ .00 $ 75.63 $ .00 $ .00 $ 00 856 CENTURY DRIVE PA 17055 MECHANICSBURG , Account Balance $ 75.63 All billing questions can be made between L. Bruce Althouse, M.D., FACC (1941-1998) Donald C. Durbeck, M.D., FACC Jeffrey S. Fugate, D.O., FACC Stuart B. Pink,M.D., FACC, FSCAI Kenneth J. May; Jr, M.D.; FACC Robert A. Skotnicki, D.O., FACC David L. Scher, M:D., FACF, FACC J4y,C. L. Corion, M.D., FACC Ira Sackmah, M.D., FACC Robert D. AronoB, M.D., FACC. David C. Man, M.D., FACC Edward C. Brennan, D.O., FACG Andreas U. Wali, M.D., FACC Michael D. Bosak, M.D., FACC Lerike Erki, M.D. Rajesh M. Dave, M.D. Sang Kim, M.D. the hours of 9[30 AM antl 4:W h'M. For Billing Questions Call: (717) 591-7122 For Toll Free Call: 1-800-845-1742 Patient Name: PAULINE BOBB STATEMENT I~~~II~~~I~ ~~I~I~ SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION o122-1a7 i~J~tt~r .~t'~„~'ta~+t.~G~t~tporatio~' :' HCR ManorCare MANORCARE HEALTH SERVICES -CAMP HILL 1700 MARKET STREET CAMP HILL, PA 17011 (717)737-8551 Joyce Rehm 935 Gettysburg Pike Mechanicsburg, PA 17050 Pauline Bobb # 2339 05/03/09 Medicare A Co-insurance 5/3-5/26/09 @ $133.50/day $3,204.00 04/24/09 Beauty and Barber $28.00 05/12/09 Beauty and Barber $16.00 V'~ ~ J~ rn~ ~ PAYMENT DUE UPON RECEIPT $3,248.00 $ AMOUNT DUE $3,248.00 v INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA ~ SS 2109-0568 COUNTY OF CUMBERLAND File Number JOYCE A. REHM and BRENDA D. ORR, Personal Representative(s) of the Estate of PAULINE F. BOBB deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. -. ~ I verify that the statements made in this Inven- ~~~-t.•l ~'rIM tory are true and correct. I understand that false state- w ments herein are made subject to the penalties of ~~~ tlJ) ~,~- 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Craig A. Hatch, Esquire (Supreme Court I.D. No.) 76361 Attorney -- (Name) (Address) Gates, Halbruner, Hatch & Guise, P.C., 1013 Mumma Road, Suite 100, Lemoyne, PA 17043 (Telephone) 717-731-9600 DATE OF DEATH LAST RESIDENCE May 27, 2009 3812 Seneca Avenue, Camp Hill, PA 17011 DEGtUtrvlS suc. atm. rvU. 201-18-6461 FIGURES MUST BE TOTALED Real estate located at 3812 Seneca Avenue, Camp Hill, Cumberland County, Pennsylvania 88,942.42 Cash 250.00 Camp Hill Emergency Physicians -refund 8.60 Rx Solutions -refund 16.82 Homeowner's insurance premium refund 85.15 f+J Gi O _ X1 Q ...4. , 3 ..~ ~ ~' y' ~ a ' ~ „ ~_.t ....} ~ '~ ' ~ ~. y ~ ~~ C . a^ t , ?"i tv ~"' ?n ~.•~ ,~ r -.~ i,4naeh additional sheets as needed) TOTAL: ~ 89,302.99 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ,¢ 3301(6)) Form RW'-09 rev. lo.13.116 LAW OFFICES OF GATES HALBRUNER &. HATCH P.C. 1013 MUMMA ROAD • SUITE 100 • LEMOYNE, PENNSYLVANIA 17043 (717) 731-9600 • FAX: (717) 731-9627 BRANCH OFFICE: LOWELL R. GATES, LL. M. 3 WEST MONUMENT SQUARE, SU ITE 304 LL. M. in Taxation Also Admitted to Massachusetts Bar LEWISTOWN, PA 17044 (717) 248-6909 MARK E. HALBRUNER WEB SITE: CRAIG A. HATCH, CELA Certified as an Elder Law Attorney by www.GatesLawFirm.com the National Elder Law Foundation CORRESPONDENCE ADDRESS: CLIFTON R. GUISE Lemoyne Office Also Admitted to practice before the STACEY L. NACE U.S. Patent 8 Trademark Office McCARROLL SARAH E Paralegal/Office Manager . TRACI L. SEPKOVIC Paralegal VALERIE LONG Paralegal March 8, 2010 o Cumberland County Courthouse ~~ 3 ~.~ ~'~~ ~:~'y; Office of the Register of Wills ~~ ~ r ' One Courthouse Square :~ ~ ~ ~ r r r Carlisle, PA 17013 ~ ~ - ~ ~-~ ~ ~ "' - RE: Estate of Pauline F. Bobb _ ~,--+ !y =~ ~ 5 .- I-r, 2109-0568 File No ~' ~' `~'' `- F . ~ ., Dear Register of Wills: Enclosed for filing (in duplicate) are the Pennsylvania inheritance tax return and Inventory for the Estate of Pauline F. Bobb. I am also enclosing a check in the amount of $30.00 as the filing fee for both documents. Please time-stamp the additional copy of each form and return them to our office in the enclosed envelope. Thank you for your assistance in this matter. Sincerely, ~~ ~ ,tom ~--- C/C- G~~~'-~ Traci L. Sepkovic Paralegal Enclosures cc: Joyce A. Rehm, Co-Executor Brenda D. Orr, Co-Executor