Loading...
HomeMy WebLinkAbout04-0551PETITION FOR PROBATE & GRANT OF LETTERS Estate of JOHN W. BOLDOSSER also known as Social Security No. 174-05-3418 , deceased. NO. 21-04- TO: Register of Wills for the County of Cumber/and Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Co-Executors named in the Last Will of the above decedent dated June 25, 1998 , and codicils dated none . The Executor named none died Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at Chapel Pointe at Carlisle, 770 S. Hanover Street, Carlisle Borouqh, Pennsylvania Decedent, then 84 years of age, died June 2 , 2004, at Chapel Pointe at Carlisle. 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: N/A Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: $80,000.00 $ $. WHEREFORE, Petitioners respectfully requests the probate of the Last Will and herewith and the grant of letters testamentary thereon. Signature(s) and Residence(s) of Petitioner(s): vvilliam A. B(~ldosser 1146 Petersburg Road Boiling Springs, PA 17007 (717) 258-3471 Codicil(s) presented OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~,O/~_Z,~ /'~ /~~_j_~,.~/~ before me this. It~r~ day of William A. Boldosser June ,2004. No. 21-04- Estate of JOHN W. BOLDOSSER, deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, June ~ ,2004, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 25, 1998 described therein be admitted to probate and filed of record as the Last Will of John W. Boldosser ; and Letters Testamentary are hereby granted to William A. Boldosser FEES Probate, Letters, Etc ........ $ 200.00 Short Certificates(-2-) ...... $ 6.00 Renunciation(s) ........... $ JCP .......... .......... $ 10.00 Other Will PaRes (-2-) .... $ 6.00 TOTAL: .... $.222.00 Filed...~.'..~!: .~ ................ Register of Wi s c~ C- /I~IVV~IN & j~cKN~HT Roqer B. I .r.r.r~,~Esquire (06282) ATTORNEY. J,.Sa15. Ct. I.D. No.) 60 West Pomfret St., Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filcJ ix itl ~, Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filin,, WARNING: It is illegal to duplicate this cop}, blt photostat or photograph. Fee for this certificate. $2.00 No. COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH , 30111'1 IR BOiI~.~.~ '~Ex Isoo*tsEcun,rv.u.s~n ' o^~Eo~o~. ...... " · ' ,. Hale .... ,. O~e 2, 2~ C~rland I ~.;..~ I ...... ' ...... ~ L ~'~ j~na~& Folnce ag ~rI~ie I~ ~.~. i~ · ' I ~ ~ ~ I ',~ Ce~nt ~ "~ ~nst~c~ion I,. [. ~,n ~ ~ ~:~,~=s ~ ~ ~ ~ ~, ' · ,4. Wid~ ,,. ~1 ~nt~ :nat ~rlisle ~ .... .E~ PA Harry A. Boldosser William Boldosser :. LAST WILL AND TESTAMENT C_. I, JOHN W. BOLDOSSER, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereSy~i expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executor to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executor to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. o follows: Boldosser, I give, devise and bequeath all of my estate of every nature and wherever situate as (a) (b) (c) My wife's jewelry to Kay Burton. My wife's sewing machine to JoAnn Boldosser, My hunting and fishing equipment including guns and rods to William A. (d) My real estate located at 105 Woodlawn Lane, Carlisle, South Middleton Township, to William A. Boldosser, (e) Any Certificates of Deposit to be divided equally between Kay Burton, Craig Boldosser and John Boldoser, and (f') All the rest, residue and remainder to my two children, Kay Burton and William A. Boldosser, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint William A. Boldosser to be the executor of this my Last Will and Testament; he is to serve as such without bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint Kay Burton, as substitute executrix, also to serve as such without bond, with the same powers as are given herein to my executor. 5. I hereby suggest that my personal representative McKnight & Hughes, as attomeys in the settlement of my estate. 1998. retain the services of Irwin, IN WITNESS WHEREOF, I have hereunto set my hand and seal this 25TH day of:kr}y;, j ~'.~'//~ ~~ ~EAL) 'J6ugw. Signed, sealed, published and declared by JOHN W. BOLDOSSER, the above named testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, JOHN W. BOLDOSSER, CHERYL L. CLELAND and MARTHA L. NOEL, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will, and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. CHER~ L. CLELAND THA L. NOEL COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by JOHN W. BOLDOSSER, the testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this 25TH day of June, 1998. otary Public Notarial Seal Roger B. Irwin, Notary Public Carlisle Bore, Cumberland County My Commission Expires Oct. 3, 2000 Member Pennsy~var~,a Association of Notaries CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: John W. Boldosser June 2, 2004 21-04~00551 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 11, 2004. Name Address William A. Boldosser Kay Burton 1146 Petersburg Road, Carlisle, PA 17013 P.O. Box 640526, E1 Paso, TX 79904 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none . Date: 06-11-04 Signatur/~ .%. ~ IRWIN & McK~-IG~T Name Roger B. Irwin, Esquire Address 60 West Pomfret Street Carlisle, PA 17013 Telephone (717) 249-2353 Capacity: __ Personal Representative __ Counsel for Personal Representative REV- 1500 EX * (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. ?80601 HARRISBURG, PA 17128-0601 REV-1500 D E C E D E N T cAPB HpRL EpIO cRAC Co. E S T R E C A P I T U L A T I O N C O M T I O INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Boldosser John W. DATE OF BERTH (MM-DD-YEAR) I 06/02/2004 OFFICIAL USE ONLY FILE NUMBER 21-04-00551 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 174-05-3418 DATE OF DEATH (MM-DD-YEAR) THIS RE'TURN MUST BE FILED IN DUPUCATEWlTH THE 04/29/1920 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER  1. Original Return ~ 24~! Supplemental Return 4. Limited Estate · FuturelnterestCompromise(dateofdeathafter17-12-87) 6. Decedent Died Testate Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) r---] 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between 17-31-91 and 1-1-95) (date of death 3. Remainder Return prior to 12-13-82) 5. Federal EstateTax Return Required 8. Total Number of Safe Deposit Boxes ~ 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Roger B. Irwin Esq. FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717,/249-2353 COMPLETEMAILINGADDRESS 60 West Pomfret Street' West Pomfret Professional Bldg. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole -Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. 14. Carlisle, PA 17013 .'.7~ ,i" [~ne None None None 79,859.56 None 14,037.82 15,333.20 2,025.10 OFFICIAL USE ONLY Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) 93,897.38 (11) 17,358.30 (12) 76,539.08 (13) (14) 76,539.08 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 76,539.08 X .0 0 X .0 45 X .12 X .15 (15) 0.00 (16) 3,444,26 (17) O. O0 (18) O. 00 (19) 3,444.26 Copyright (c) ;~000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS Chapel Pointe at Carlisle 770 S. Hanover Street CITY Carlisle STATE ?A ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 172.21 Total Credits ( A + B + C ) (2) 3,444.26 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No :. retain the use or income of the property transferred; '. ........................ ~ ~ · retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................... ................ d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. ~ ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ [--'] [--~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 172.21 0.00 0.00 3,272.05 0.00 3,272.05 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN William A. Boldosser DATE , -~ , ,/7 ~ ~ /~ /1146 Petersburg Rd. ~AT~E~FPREPAREROTHER~ANR~PRESENTATIVE IRWIN & Mc~IGHT DATE  ~ 60 West Pomfret Street 7 ~ 0 surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after Januau 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutou 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 twen~-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aXl)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a~1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV- 1508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John W. Boldosser SS~t 174-05-3418 06/02/2004 21-04-00551 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Gibb Financial Services - Charles Schwab One Account (Money Market & Misc. Funds) M & T Bank - Checking Account 2673004020 TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 73,112.33 6,747.23 $ 79,859.56 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV- 1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John W. Boldosser SS~/ SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 174-05-3418 06/02/2004 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. FILE NUMBER 21-04-00551 (If more space is needed, insert additional sheets of the same raze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1~97) DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. NUMBER ATTACH ACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 Western-Southern Life - 14,037.82 14,037.82 Annuity W0020126488 TOTAL (Also enter on line 7, Recapitulation) $ 14,03 7.82 REV- 1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John W. Boldosser SS# SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 174-05-3418 Debts of decedent must be reported on Schedule I. ITEM NUMBER 2 3 4 1 2 06/02/2004 FILE NUMBER 21-04-00551 DESCRIPTION FUNERAL EXPENSES: Hoffman-Roth Funeral Home Trinity United Methodist Church ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street'Address City State Year(s) Commission Paid: Zip Attorney's Fees IRWIN & McKNIGHT Family Exemption: (If decedent's address is not the same as claimant's, attach ~xplanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Register of Wills Tax Return Preparer's Fees OtherAdministrativeCosts Cumberland Law Journal Estate Notice Register of Wills - Filing Fee The Sentinel - Estate Notice The Sentinel - Classified TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 8,830.90 400.00 5,400.00 222.00 250.00 75.00 25.00 125.00 5.3O $ 15,333.20 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-151Z EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John W. Boldosser SS# SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 174-05-3418 06/02/2004 Include unreimbursed medical expenses. DESCRIPTION ITEM NUMBER 1 2 3 4 FILE NUMBER Appalachian Orthopedic Center, Ltd. - Medical Chapel Pointe at Carlisle - Medical Millennium Pharmacy Sprint Telephone (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 10, Recapitulation) $ 21-04-00551 AMOUNT 59.78 1,940.90 18.61 5.81 2,025.10 Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1512 EX (Rev. 1-97) REV- 1~ 13 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John W. Boldosser SS# 174-05-3418 SCHEDULE J BENEFICIARIES 06/02/2004 NUMBER '11. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spou~l distributions, and transfers under Sec. 9116{a)(1.2)] William A. Boldosser 1146 Petersburg Road Boiling Springs, PA 17007 Kay Burton P.O. Box 640526 E1 Paso, TX 79904 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) $ on Stepchild FILE NUMBER 21-04-00551 AMOUNT OR SHARE OF ESTATE 50% of Remainder 50% of Remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SH~bi NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 0.00 Copyright (c) ?000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00) LAST }FILL AND TESTA IENT I, JOHN W. BOLDOSSER, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executor to pay all of my'debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empo~ver my executor to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sate, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) (b) (c) My wife's jewelry to Kay Burton. - Given July, 2002. My wife's sewing machine to JoAnn Boldosser, - Sold July, 2002. My hunting and fishing equipment including guns and rods to William A. Boldosser, - Sold July, 2002. (d) My real estate located at 105 Woodlawn Lane, Carlisle, South Middleton Township, to William A. Boldosser, - SOLD. (e) Any Ce~ificates of Deposit to be divided equally between Kay Burton, Craig Boldosser and John Boldoser, and (f't All the rest, residue ,-md remainder to my two children, Kay Burton and William A. Boldosser, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. [ nominate and appoint William A. Boldosser to be the executor of this my Last Will and Testament; he is to serce as such without bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint Kay Burton, as substitute executrix, also to serve as such without bond, with the same powers as are given herein to my executor. 5. I hereby suggest that my personal representative retain the McKnight & Hughes, as attorneys in the settlement of my estate. 1998. services of hxvin, IN WITNESS WHEREOF, I have hereunto set my hand and seal this 25TH day of J'trt7; i/' - JOHff w. BG£D6gSi~R Signed, sealed, published and declared by JOHN W. BOLDOSSER, the above named testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. 2 ACK~NOWLEDGMENT AND AFFIDAVIT WE, JOHN W. BOLDOSSER, CHERYL L. CLELAND and MARTHA L. NOEL, the testator and witnesses respectively, whose names are signed to the fbregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will, and that he had signed willingly, and that he executed it as his fi'ee and volunta~- act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their know'ledge the testator was, at that time, eighteen years of age or older, of' sound mind and under no constraint or undue influence. ~.'j.'.,, 7:',. '/,.~ ~," ~,'~.,...,,..z.~ .~,' CHER,I/L L. CLELAND COSIMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by JOHN W. BOLDOSSER, the testator herekq, and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L, NOEL, witnesses, this 25TH day' of June, 1998. / ~otary Public Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2000 Weslern-Soulhern Life' June 21, 2004 IRWIN & MCKNIGHT ROGER IRWIN WEST POMFRET PROFF BLDG 60 W PROMFRET ST CARLISLE PA 17013 2004 RWI'N & McKNIGHT RE: Contract W0020126488 Dear Mr. Irwin' Thank you for contacting Western-Southern Life. As requested, we have calculated the .date of death value for the above contract. As of June 1, 2004 the date of death value was estimated to be $14,037.82. The beneficiary named on this contract was William Boldosser. He has already sent in the necessary paperwork to have the funds paid in a lump sum and the funds were mailed today. He also sent a certified copy of the death certificate, so I am returning one back to you. If you should have any questions, please contact your sales representative or the Annuity Operations Department at 1-800-926-1702. A representative will be happy to assist you. Sinc~erely, , Lois J Craft Annuity Administrator Annuity Operations Department Annuity Operations Group · P.O. Box 2918 ° Cincinnati, OH ° 45201-2918 Mag?Bank June 10,2004 Law Offices Irwin & McKnight West Pomfret Street Carlisle, PA 17013-3222 499 Mitchell Street, Millsboro, DE 19966 .,R viN & , ,.cKNtGHT Estate of John W. Boldosser Date of Death: June 2, 2004 Social Security Number: 174-05-3418 Dear Mr. Irwin: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Checking Account (Non Interest Bearing) Account Number. ...................... 2673004020 Ownership {Names oj9 ..............John W. Boldosser Opening Date ........................... 09 / 01 / 67 Balance on Date of Deatlz .........$6,747.23 Accrued Interest $ 0.00 Total ...................................... $6,747.23 Sincerely, Charlene Warrington, Records Management 1-888-502-4349 GIBB FINANCIAL SERVICES, INC. 16 West Pomfret Street, Carlisle, PA 17013 (717) 249-3737 FAX (717) 249-8010 June 24, 2004 Roger B. Irwin Irwin & McKnight 60 W Pomfret Street Carlisle PA 17013-3222 IRWIN & McKNIOHT RE: Estate of John W. Boldosser Dear Mr. Irwin, As you requested, following is the information for the account Mr. Boldosser held at Gibb Financial Services. John W. Boldosser (Individual Registration) Charles Schwab (TIMS 4159-3925) Date of Death Value: Market Value 6/2/2004 $73,112.33 This is the only account Mr. Boldosser held with our firm. If we can be of further assistance please do not hesitate to contact us. Sincerely, Lisa Riggleman Registered Sales Assistant Branch Office: Cadaret, Grant & Co., Inc., Member, NASD and SIPC Hoffman-Roth Funeral Home, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 June 14, 2004 Irwin & McKnight Law Offices 60 West Pomfret St. Carlisle, PA 17013-3222 The Funeral Service for John W. Boldosser 14299~ 112 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND bvlERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package $3590.00 t:NERaLUO eSERViCi;ChAkdEd i i i i i 'i i i i i $3s9o.oo SELECTED MERCHANDISE: Livingston Casket ........................ $2195.00 Venetian Interment Receptacle THE COST OF OUR S~R'VI~E~ I~OI~'IP'MI~N+ J~NI~~iE~C~A~D'~Sd '' $1640.00 THAT YOU HAVE SELECTED' ' ............... $7425.00 Cash Advances Openirig Grave ................. · ........ $995.00 Newspaper Obituary Notice-Patriot News Clergy Offering · ' ................ $154.40 Certified Copies of Death Certificates $ I00.00 Flowers .................. $24.00 ........................... $132.50 TOTAL CASH ADVANCES AND SPECL~L CHARGES ........ $1405.90 Please Total Total Cost $8830.90 TOTAL AMOUNT DUE $8830.90 This statement is net and payable in full within 30 days of receipt, Please return this portion with your Remittance $ Amount Enclosed Service ID # 14299-112 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND William A. Boldosser being duly sworn according +o law, deposes and says that he is the Executor of the Estate ol~ John W. Boldosser ~afe o{ t_h_e. _Bqro_ug~h _o_f_ C_arlisle .......... . Cumberland County, Pa., deceased and that the w~th;n ~s an ~nventor¥ made by William A. Boldosse~__ --, the sa;d Executor Of the entire estate of ~.~d deceden,~ consisting o{ aH ~'he personaJ ptope~-ty and rea~ estate, excep~ reaJ estate outside the Commonwealth o{ Pennsv~van;a, and fhaf the f;gures o~os;fe each item of fha Inventory represent it's fair value as of the date o~ decedent? death. ~' Sworn this and subscribed before me, day of July, _]9 2004 ~ J~ Roger B. Irwin, Notary Public ~1' Carlisle Bom, Cumberland County [ My Commission Expires Oct. 3, 2004 Merreer,~~o.~an% Date oF Dea+h ....... Q_~ ...... Oa-y 06 · · dof~r,~-gx-ecutor 1146 Petersbu_rg Road B°ilin_~..in~s, PA 17007 Address 2004 Month INSTRUCTIONS I. An inventory must be fi]ed within three months after appointment o( personal represenfaHve. 2. A supplement inventory must be Filed within thirty days of discovery of addlfional assets. 3. Additional sheets may be attached es ~o personalty or realty ~-__'~;:' 4. See Article iV, Fiduciaries Act oF 1949. ' Inventory of the real and personal estate of JOHN W. BOLDOSSER deceased Gibb Financial Services - Charles Schwab One Account (Money Market and Miscellaneous Funds) .......................... 2. M&T Bank - Checking Account #2673004020 ................ TOTAL .................. 73,112 6,747 79,859 33 23 56 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004148 IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 174-05-3418 FILE NUMBER: 2104-0551 DECEDENT NAME: BOLDOSSER JOHN W DATE OF PAYMENT: 07/09/2004 POSTMARK DATE: 07/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/02/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,272.05 REMARKS: TOTAL AMOUNT PAID: $3,272.05 SEAL CHECK# 021319 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.1~ Name of Decedent: JOHN W. BOLDOSSER Date of Death: JUNE 2, 2004 No. 21-04-0551 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: X Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? ~ Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: d. Copies of receipts, releases, joinders and approvals of fOrmal o~nformal accounts may be filed with the Clerk of Orphan's Court an~.~nay be attached to this report. Did the personal representative state an account infor~y to thee parties in interest? X Yes~ No :~-'~ ~.' ~ .. IRWIN & McKNIGHT Roger B. Irwin, Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle, PA 17013 City, State, Zip (717) 249-2353 Telephone Number Date: 09/21/2004 Capacity: X . Personal Representative Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVIS/ON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-1547 EX AFP C01-05) ROGER B IRWIN ESQ IRWIN B HCKNIGHT 60 W PONFRET ST CARLISLE PA 17015 DATE 09-06-2004 ESTATE OF BOLDOSSER DATE OF DEATH 06-02-Z004 FILE NUNDER 21 04-0551 COUNTY ACH 10 JOHN HAKE CHECK PAYADL~,ArND R~T pAYHENT TO: REGISTER OF WILLS CUH~ERLAND COCOURT H"'~USE CARLISLE, PA 11:7015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF BOLDOSSER JOHN W FILE NO. 21 04-0551 ACN 101 DATE 09-06-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVAT/ON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE APPRA/SED VALUE OF RETURN EASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule 3. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Hortgeges/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (-~) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G} (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Cos~s/N/sc. Expenses (Schedule H) (9) 10. Dmbts/Hortgage Liabilities/Lions (Schedule T) (10) 11. Total Deduct/OhS 12. Not Value of Tax Return 79/859.56 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper port/on .00 of this form with your tax payment. 14/057.8Z 15,353.Z0 13. 1~. NOTE: 2/025.10 (11) Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Not Value of Estate Subject to Tax (1~) ]:f an assess, ent .as issued prev/ously, lines 14, :15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. UISCOUNT INTEREST/PEN PAID (-) 172.21 9:5,897 .$8 ]7.358.30 76,539.08 ASSESSNENT OF TAX: 15. Amount of Line lq a~ Spousal rate 16. Amount of L/nB lq taxable a~ Lineal/Class A rate 17. Amount of Line lq at Sibling rate 18. Amount of Line lq taxable a~ Collateral/Class B rate 19. Princ/pal Tax Due TAX CRED]:TS: I PAYMENT RECETpT DATE NUHBER 07-09-~004 CD004148 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 76,539.08 18 and 19 will (15) .00 x 00 : .00 (;.6) 76,539.08 x 0q5: $,4q4.26 (~7) .00 x 12 = .00 (i8), .00 x 15 = .00 (~9)= 3,q44.26 AHOUNT PAID 3,272.05 TOTAL TAX CREDIT I 3,444.26 DALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates af decedents dying on or before December 12, 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class S (colLateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-1313). Applications are available et the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ensnaring service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty [60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 2BlOZ1, Harrisburg, PA 171ID-lOll, OR --eLection to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is altowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 19BZ will bear interest at a rate which will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 ZOZ .0005q8 T~'~'8-1991 ZXZ .000301 ~ 1983 16Z .000438 1992 9Z .000247 ZOOZ 1984 llZ .000301 199S- 1994 72 .000192 ZOO3 1985 132 .000356 1995-1998 9Z .000Z47 Z004 1986 102 ,000274 1999 7Z .000192 1987 XOZ .000274 ZOO0 72 .000192 --Interest is calculated as foZioNs: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Interest Daily Rate Factor 92 .000247 62 .000164 52 .000137 42 .000110 --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.