HomeMy WebLinkAbout04-0595PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
, Deceased.
Social Security No. I ~,1 - :~,,t - / ~ ~_,~
Register of Wills for the
County of
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executr-i ~
in the last will of the above decedent, dated Prg ~-; / ~ '~, ~--',-/
and codicil(s) dated ~
in the
named
,19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~/- e~b ~ o~ County, Pennsylvania, with
h ~-~ last family or principal residence at 6t
(list street, number and muncipality)
Decendent, then 4 2. years of age, died
at
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:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the pr~ba et,~o.f the last will
presented herewith and the grant of letters '~ (- ,-, a ~ ~ t-t. ~3 to .~.~ff~:.--
and codicil(s)
(testamentary; administration cma.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA q.
COUNTY OF CLk3,y[~d-~Lt~x/D f 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affiLme/d and subscribed ~- --~C~. ~ ~.~e~ ~ ca
before me this Z,'I day of_,[ __ ~'
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having be~ pr~,~t¢ b~fore me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to proba__te and filed of record as the last will of
and Letters
are hereby granted to~[0/J[ C ~/~)'~'~-~
, in consideration of the petition on
Register of ' { ' ~ ~
FEES
Probate, Letters, Etc ..........
Short Certificates(
TOTAL
Filed ...................................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
595
No. ~ Date
H05143 Rev. 2/87
f
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH ° VITAL RECORDS
OF
DEATH s,.,, F,~,.~.
"*ME °~ DEcEDENT,F"', '~'", L.s,, CERTIFICATE I-'E× SOC,AL SECUR,TY NUMAR .' I D^TE OF DEAT.,.onth, D.y, y.er,
~. Hartin L. Blosser iz ~le I=. 161 -34 . 1320 ?}14. Jlln~
AGE (Last a~y) IUN~R 1 YEAR I UNDER 10AY I DATE ~ BIRTH
State ~ F~gn C~I~) ~1~: I O~R.
cou.T~ o~ O~T. I C,~. m.O.~ O~ ~T. I~C'r'T~ I""' I "--
~ME (If ~t ~sM~i~, ~ SE~I and n~) JW~ECEDENT OF HISPANIC ~tGIN? IRACE - Amed~n I~ian, Bla~. ~ite,
~., Le~non I~.ne~non ~ J,, VA M¢ical Center I.oD ,-m,,ea,,~o~an
I ~, I ~".
DECEDENT'S USUAL OCCUPATIONr KIND OF BUSINESS I INDUSTRY ~NAS DECEDENT EVER IN~em.~of~ ~ ~.~ DECEDENT'S EDUCATION I MARITAL STATUS. Marded, I SURVIVING SPOUSE
o ~ if,; do ~et u,e re,'ed)C~S I US./~ED FORCES? I (S~aff ~nlf NC~est ~ido ¢~mCe~d) I Never Mamed. Wi(lowed. (if ~a. ~ve m~i~n
/ v..l~ .~ ~l I Elemema~/se~ondory College I Divorcl~l (Spec~J) . __
DECEDE_NT~S MAILING .ADDR Fr~ S (StreW, City/Town, State, Zip Code) I DECEDENI'S
4705 B Charles Road I^CTUAL "". S~,. Pa. ad ~r,. E] Yea,~..~,,,~i.
Mechanicsburg, Pa. 17055 IREs~rmNcE
{sea ~m~, Cumberland "~ ~°" No. de~.nt,~
15. I on ot~ side) l?b. County
FATH~R~ NAME (First. Mid,e. Leal) ~ MOTHER'S NAME (First. Midde. Maiden Surname)
~,. Harry W. Blosser ~,. Sarah Marlin
INFORMANT'S kb~ME (Type/Print) ~ INFORMSN/'S ~JLI~ AD[DRESS (SirDar. C~ly/To~ State. Tip C.4;de) ~ ~
~,. Patricia A. Blosser ~,~ 1923 DabBre~k Czrcl~ Harrisburg, va.
' METHOD OF DISPO.~IIQN I DATE OF DISPOSITION ~ PLACE OF DISPOSITION- Name of Cemeta~A Cmmathr~ ~ LOCATI~.-,C,~/I~n. ~ale. Z~ Cede ~ _
~,,. ./o~(s~} ,/ , E]lt~ti 6-21-2004 I~1~ Shoop's Cemetery ',d Harrisburo Pa
S'ONAT~'R$~f/;,W~CS~R~CE~Cr"~SE~O~ERSONACT'NGASSUCH lUCENSENUMBER ' %AMEANDAOORESSOFFAC,UTY ' ' ]33~'N '~nd St
IMMEDBTE CAUSE (Fin~ ', onset a~ ~ath
~ ..... ~ Metastatic ~us Cell Carcin~
reducing in dea~) ~ a.
Seq~eofla~ llst conditions b.
if any, leading to immediate ~'
cause. Enter UNDERLYING
CAUSE (Disease o~ inlu~j c.,
resulting on death ) I~ST cl.
ESJ~ TO (OFt AS A CONSEQUENCE OF):
DU~ TO (OR AS A CONSEQUENCE OF):
DU~ TO (OR AS A CONSEQUENCE OF):
WAS AN AUTOPSY I WERE AUTOPSY FINDINGS I MANNER OF DEATH
PERFORMED? I AVAILABLE PRIOR TO
COMPL T,O. OFC E
I°Fo-TH? ,INat"A en, M[] "®'"-
! Pending InvBsbgapon
Yes [] No [] I Yes [] No [] I Suicide [] Could not be determined
Z8a. j' 2~b.~.
I PLACE OF INJURY - At home, farm, slreat,-.f~, ~ fLOCATION (Strset, City/Town, State)
JgT."'~'~, j~,.
CERTIFIER (Check only one)
.*I~oER.~TI_F~_N.G_ I~ HY ~ICIA .N ( .Physi.cla 9. car tif ythg cause of death when another phys~an has pronounced death and comCeted item 23)
me ~es[ mmy[now~e~ge, eeato occurred due to the coueas(i) end manner aa allied. ......................................................... ....... []
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both p~oUnC4ng death and ca~ti~ing to cause Of death) ~
To the beat of my knowledge, death o¢cun-e~ et the time, date, and place, and due to the cauea~(~,) end manner aa etatod ...................... ~,J
*MEDICAL EX~MINER/CORONER
On the basle Of' exemlnaUnn and/or Investigation, In my opinion, death occurred at the time, date, and place, and due to the ceuesE(a) and
manner aa Mated ............................................................................................................................................................ []
31a. ..,..
,,. - b4/ ,/41
SIGNATURE AND I'ITLE OF CERTtFIF~
LICENSE NUMBER DATE SIGNED (Month, Day, Year)
*~. [VID 034~)Q2-E ~. June 17 t 2004
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type or Pdnt Michael T. Baer~ MD
VA Medical Center, Lebanon, Pa 17042
$2.
DATE FILED (Month. Day, Year)
THE LAW OFFICE
off
JAMES M. BACH
Attorney-At-L~w
352 S. Sporting Hill Road
Mechanicsburg, PA 17050
737-2033
LAST WILL AND TESTAMENT
FOR
MARLIN L. BLOSSER
C
LAST WILL AND TESTAMENT OF
MARLIN L. BLOSSER
I, MARLIN L. BLOSSER, of the TOWNSHIP OF HAMPDEN, COUNTY OF
CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good bodily health and of
sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue
influence of any person whomsoever, merely calling to mind the frailty of human life, and being
desirous of disposing my worldly goods while I have the strength and capacity so to do, I do make,
publish and declare this my LAST WILL AND TESTAMENT. I hereby revoke, cancel and
annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and
declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS
LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1.
I direct that my Executrix hereinafter named, pay and discharge all of my just debts,
funeral and testamentary expenses.
ITEM 2.
I order and direct that I be buried in a lot which I own situate at Shoops Cemetery,
Harrisburg, Pennsylvania.
ITEM 3.
I hereby convey and grant to TEDDY L. SHEIBLEY, the right to live in myhome
free from rent for a period not to exceed 120 days following my death. My home is
known and numbered as 4705-B Charles Road, Mechanicsburg, Pennsylvania.
TEDDY L. SHEIBLEY may depart sooner, if he finds another place, but in any
event, not later than 120 days following my death.
ITEM 4.
All the rest, residue and remainder of my entire estate, wheresoever situate, and
whatsoever it may consist of, I give, devise, and beq~ath, absolutely, and in fee, to
KENNETH GOODHART, ~.}, LYNNE S~)~LL and RICHARD C.
BLOSSER, III, share and share alike, per stirpes. '~
ITEM 5.
I nominate and appoint PATRICIA C. BLOSSER, as Executrix of this my LAST
WILL AND TESTAMENT. Should the Executrix named fail to qualify or cease
to act as Executrix, then I appoint TEDDY L. SHEIBLEY as Executor in her
stead.
MARLIN L. BLOSSER ~
ITEM 6.
I direct that my personal representatives, as well as their successors shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
ITEM 7.
ITEM 8.
I direct that all estate, succession, legacy, inheritance or other transfer taxes, however
designated that shall become payable by reason of my death in respect of all property
comprising my gross estate for tax purposes, whether or not such property passes
under this LAST WILL, shall be paid by my Executor out of my residuary estate.
ITEM 9.
I grant to my personal representatives herein named, in addition to, but not in
limitation of those powers vested by law, to be exercised without prior application to
or approval of any court, the power and authority to retain indefinitely any property,
to invest and reinvest any assets or the proceeds derived from the sale of assets,
although said investments may not be of the character prescribed by hw, to sell,
convey, assign, transfer and encumber any property, to pay, set'de or compromise all
claims, to make distribution or divisiom in cash or in kind, and in general to exercise
all powers in the management of any property hereunder which any individual could
exercise in the management of similar property owned in her own right, and to
execute and deliver any and all instrmnents and to do all acts, which may be deemed
necessary and proper.
MARLIN L. BLOSSER ~
................................................... END- ..................................................
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
ss
I, MARLIN L. BLOSSER, the TESTATOR, whose name is signed to the attached or foregoing
instmmem, having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act
for the purpose therein expressed.
Sworn to or affirmed and acknowledged before me, by: the TESTATOR this 27th dayof Aprik 2004.
MARLIN L. BLOSSER
ARY PUBLIC
The preceding instrument comisting of this and two (2) other typewritten pages, identified by the
signature of the TESTATOR, was on the date thereof signed, published and declared byMARLIN L.
BLOSSER, the TESTATOR therein named as and for his LAST WILL AND TESTAMENT.
WITNESS
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
)
COUNTY OF CUMBERLAND )
We, (WITN£SS)and 0 , - twiTN£SS),
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and saythat we were present and saw the TESTATOR sign and execute the instrument as
his LAST WILL; that the TESTATOR signed k willingly and that he executed k as his free and voluntary
act for the purpose therein expressed; that each witness in the hearing and sight of the TESTATOR signed
the WILL 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.
Sworn to.,Or affirmed and acknowledged before me, by:r~/& ~'. ¥%'rx-~S (WITNESS)
and ~'0~-x~.~t,l. r~. gO(:~ o-o~fI. TNESS), witnesses, this 27th dayof April, 2004.
Al
[ulenla 13. Krlder, Notary Public I
Olty Of Lebanon, Lebanon County I
My Com',m!ssion Expires Sept. [9, 20051
NOTa VtmLXC
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Marlin L. Blosser
Date of Death: June 17, 2004
Will No. 2004-00595
To the Register:
I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
July 23, 2004.
Name
Richard C. Blosser, II/
Lynne Sowell
Kenneth Goodhart
Address
333 South 2nd Street
Steelton, PA 17113
4178 Green Road
Springfield, TN 37172
4313 Tennessee Court
Harrisburg PA 17112
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A
Dante: July _~'5
,2004
Dav'~W ReageXr, Esquire
Reager & Adler, PC
2331 Market Street
Camp Hill, PA 17011
(717) 763-1383
Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLA/M
In Re: The Estate of:
Court File No: 2104595
MARLIN L BLOSSER
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.SA S3532(b)(2).
,)
Claimant's name: ECAST SETTLEMENT CORP
c/o NCO Fh,ancial Systems, Inc
Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
Creditor listed below is the owner and holder of a claim in the amount of
$11,576.36 Acct# 6011002756501532
The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
2)
3)
4)
5)
6)
7)
Decedent's address: 4705 B CHARLES RD, MECHANICSBURG PA 17050-7050
Date of Death: UNKNOWN
That the claim arose prior to the death of the decedent on or about
8)
That the claim is secured by
On behalf of the claimant, I do solemnly decl
perjury that they Information and representat
to the best of my knowledge, information a
alties of
nd correct
and affirm under the
ns ma heJ1.. are tr
lief.
.' bSi-U
Claimant 511056
Written notice of claim was given to Personal Representative and/or hisl~er couns!:il
as stated below: C: :
JAMES M BACH .
Name
352 S SPORTING HILL RD
Address
MECHANICSBURG P A 17050
City/State/Zip
MAY 12, 2005
Date notice mailed
Dated: May 12, 2005
,AGENT
-.. '
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Register
Bill To:
REAGER & ADLER P
2331 MARKETST
CAMP HILL, PA 17011
Total:
Marjorie A. Wevodau
First Deputy
Kirk S. SOhQnage, Esq
Soliqitor
f Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
380
5/31/2005
MARUN L. BLOSSER
21-2004-0595
n
1
Fee Descn tion
Additional Probate
Fee
Total
$35.00
35.00
$35.00
Checks shoul be made payable to the Register of Wills. Tenns: Net 30.
Please return ne copy of this invoice with your payment. Thank you.
REV-1500EX + (6-00)
~
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'?'f.:'~L~;~' ~
'tr.1" \!.~,
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITI L)
BLOSSER MARLIN L.
DATE OF DEATH (MM-DD-V...)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
FILE NUMBER
2 1 -0 4 0 5 9 5
""OOiitfly'COOf - - - - iiii:iiiER--
SOCAL SECURITY N MBER
DATE OF BIRTH (MM-O[)"Year)
1 6 1 - 4 - 1 3 2 0
THIS RETURN MU T BE FILED IN DUPLICATE WITH THE
RE ISlER OF WILLS
06/17/2004 12/30/1941
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST, AND MIDDLE INITiAl)
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1. Real Estate (Schedule A)
2, Stocks and Bonds (Schedule B)
3. CIose~ Held Corporation, Pamership or So Proprielorship
4. Mor1gages & Notes Receivable (Schedule D)
5. Cash, Bank Deposils & Miscellaneous Perso al Property
(Schedule E)
8. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-VIVOS Transfers & Miscellaneous Non-
(Schedule G or L)
8. Total Gross Assets (Iota[ Lines 1-7)
9, Funeral Expenses & Adminis1ra1ive Costs (
10. Debls of Deoedent Mor1gage Liabilffies, & L' ns (Schedule I)
11. Total Deductions (Iotal Lines 9 & 10)
12. NelValue 01 Estate (Line 8 minus Line 11)
13. Charitable and Govemmental BequeslslSee 113 Trusls for which an election 10 tax has not bean
made (Schedule J)
00 1. Original Retum
o 4. Limned Estate
00 6. Decedent Died Testate (A!lachcopyofWiHI
o 9. Litigation Proceeds Received
THSEC'llON,l\Il.I$lIlIi!CQMr>LE'l'E
NAME
DAVID W. REAGER
FIRM NAME (II Ap~k:aI;,)
REAGER & ADLER P,C,
TELEPHONE NUMBER
717-763-1383
SOCAL SECURITY N MBER
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death aft8r 12-12-82)
o 7. Decedent Maintained a Living Trust (Abch copyofTrust)
o 10. Spousal Poverty Credit (date ofdeath between 12-31-91 and 1-1.95)
o 3. Remain erRetum (dale of death priortl 12-13-82)
o 5. Federal Estate Tax Retum Required
o 8. Total N moor 01 Safe Depos~ Boxes
o 11.EI . 10 tax underSec. 9113(A)_hSohOI
LL CORRESPONDENCE ANI) CONFIIlENTlAL TAX INFORMATION SH ULD BE DIRECTED 1'0:
COMPLETE MAILING ADDRESS
2331 MARKET STREET
CAMP HILL
PA 17011
OFFICIAL USE ONLY
l
I
I
(1)
(2)
(3)
(4)
(5)
118,900.00
r-.,
,
4,219,29
,. "'
(6)
~,..
(7)
8,155.00 .
,
.-1
~---~
-.;
(8)
131 274.29
(9)
(10)
32,179.14
103,548,27
(11)
(12)
(13)
135727.41
-4453.12
14. NelVelue Subject to Tax (Line 12 minus Li e 13)
SEE INSTRUCTIONS ON REVERSE IDE FOR APPLICABLE RATES
(14)
-4453,12
Z 15. Amount of Line 14 taxable al the spousal tax
0 rate, or transfers under See, 9116 (a)(l.2) 0,00 X _(15) 0.00
i=
~ 16. Amount of Line 14 taxable at lineal rate 0.00 X _(16) 0,00
:J 0.00
D. 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00
::i!
0 18, Amounl 01 Line 14 taxable at collateral rale 0.00 X .15 (18) 0.00
0
>< 19. Tax Due (19) 0.00
~
20, ~
<<
Decedent's Com lete Address:
STREET ADDRESS
4705 B Charles Road
CITY
Mechanicsburg
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Pove~ Credit
B. Prior Payments
C. Discount
Total Credits (A + B +C)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Une 1 + Une 3, enter th difference, This Is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter th difference. This is the TAX DUE, (5)
A, Enter the interest on the tax due, (5A)
B, Enter the total of Une 5 + 5A. This is the B NCE DUE. (5B)
Mak Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOlL ING QUESTIONS BY PLACING AN "X. IN THE APPROPRIATE
1. Did decedent make a transfer and: Ye
a, retain the use or income of the prope~ transferred; """............".""""""""""""............""""""......
b, retain the right to designate w shall use the prDpe~ transferred or its income; """,,,,,,,,,.....,,,,,,,,,,,,,,,.....
c. retain a reversionary interest; ......................................................................................................
d, receive the promise for life of ther payments, benefits or care? ........."..."""""""".............""""""......
2. If death occurred after December 2,1982, did deeedent transfer prope~ within one year of death
without receiving adequate consid ration?""" """,,,,,,,,,,,,,,,,,,.... ...................."""", """"".........,,, """",.
3. Did decedent own an 'in trustfo~ r payable upon death bank account or seeurity at his or her death? ".........."",
4. Did decedent own an Individual R irement Account, annuity, or other non-probate prope~ which
contains a beneficiary designation ",,,,,,,,,,,,,,,,,,.,,.......................,,,,,,,,,,,,,,,,,,,,,,,,,,,........,,.",,,,,,,,,,,......
(1)
(2)
ZIP
17050
0.00
0.00
0.00
0.00
0.00
0.00
lOCKS
No
00
IX]
IX]
00
IX]
IX]
D
IF THE ANSWER TO ANY OF THE ABOVE QU STIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A PART OF THE RETURN.
ADDRESS
Under penalties of perjUfY, I declatllhat I have exanined this retum, i ing ac:compMying schedules and statements, and to !he besl of my knowledge ald belief, it is true,
Declaaon of preparer other lIlal the personal representative is bas on all information of which preparer has any knowledge.
SIGNATURE OF ERSON RESPONSIBLE FOR FILING R TURN
ADDRESS
/923
SIGNATURE OF PREPARE
fJ If 110
/YJ
and complete.
DATE
'" g4d"'S-
DATE
Z7~
For dates 01 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 the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1,1995, the t rate imposed 00 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 exemot a transfer to a surviving pouse from tax, and the statutory requirements for disclosure of assets and filing at retum are still applicable even ~
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 fro a deceased child twenty-one years of age or younger at death to or for the use of a atural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1 )].
The lax rate imposed on the net value of transfers to r lor the use of the decedent's lineal beneficiaries is4.5%, except as noted in 72 P.S ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed 00 the net value of transfers to r for the use 01 the decedent's siblings is 12% [72 P.S. ~9116(a)(1,3)]. A sibling is de ned, under Section 9102, as an
individual who has at least one parent in common wit the decedent, whether by blood or adoption.
REV-1502 EX. (6-98)
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
RI
FILE NUMBER
21 nil
All real property owned solely or as a tenant In com on must be reported at fair market value. Fair martc.et value is defined as the price at which roperty would be
exchanged between a willing buyer a~d a.~ ling seller. neither being ~pelled to buy or sell, both having reasonable knowledge of the re vant facts.
Real oionenv wI1. h is inintlv-owned with nahl 01 sUIYivorshio must be disclosed on Schedule F.
..001 ,., I
n"a"
ITEM
NUMBER
1.
DESCRIPTION
4705 B Charles Road, M chanicsburg, PA 17055
VALUE AT DATE
OF DEATH
118,900.00
TOTAL (Aiso enter on line 1, Recapitulation
(If more space is needed. insert additional sheets of the same size)
$
118900.00
REV-1508 EX . [6-98)
.. SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
D' MARLIN L ~1 04 O!';Q!';
Includ the proceeds of litigation and the date the proceeds were received by the estate.
All pro, rty jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T ACCOUNT 4,219.29
checking account
TOTAL (Also enter on line 5, Recapitulation $ 4219.29
(If more space is needed, insert additional sheets of the same size) !
,
REV-1510 EX + [6-98)
* SCHEDULE G
INTER.VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA MISC. NON.PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BLO!':!':ER MARliN L '1 04 n!'>ll!'>
This schedule must be completed a filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COY R SHEET ~ yes.
DESCRIPTION l PROPERTY
ITEM INCtUCETHENAMEOI'THETRANSfEREE,T ~~ RB..ATlONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACHACO OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE
(IFAPPUCHlLE)
1. ANNUITY - EQUITABLE INSUF ~NCE COMPANY 8,155.00 100. 8,155.00
PATRICIA BLOSSER, BENEFI IARY
TOTAL (Also enteron line 7 Recapitulation) . 8155.00
(If more space is needed, insert additional sheets of the same size) I
I
REV-1511 EX + (12-99)
... SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
'" MARliN I 21 fl.<I 0595
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Neumyer Funeral Home 7,279.62
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Co rmissions
Name of Personal Rep sentative (s) PATRICIA A. BLOSSER 6,155.00
Social Security Number VEIN Number of Personal Representative{s)
Street Address 192 DAYBREAK CIRCLE
City HARRISBUF G Stale PA Zip 17110
Year(s) Commission Pa : 2005
2. Attorney Fees REAGER 8 ADLER, P.C. 2,500.00
3. Family Exemption: (If decedenfs ddress is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claiman to Decedent
4. Probate Fees CUMBERU ND COUNTY REGISTER OF WILLS 200.00
5. Accountants Fees
6. Tax Return Preparer's Fees
7. CUMBERLAND LAW OURNAL 75.00
8. THE SENTINEL 95.27
9. REAL ESTATE COM~ ISSION - ERA/NRT 7,134.00
10. TRANSACTION FEE ERA/NRT 125.00
11. OVERNIGHT DELlVE ~Y FEE 15.00
12. 1 % TRANSFER TAX 1,189.00
13. MORTGAGE SATISF CTION FEE 27.00
14. TAX CERTIFICATION 3.00
15. PATRICIA A. BLOSSE R - HOME REPAIRS - SEE ATTACHED 4,815.70
16. REPAIR CREDIT TO ELLER 850.00
17. TROUTMAN'S FLOOI ING 1,645.37
18. DUTY'S LOCK & KEY SERVICE 70.18
TOTAL (Also enter on line 9, Recapitulation) $ 32179.14
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
* SCHEDULE.
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES. & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BLnC::C::ER MARl IN I 71 f\<I n"o"
Include unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRiPTION OF DEATH
1. MORTGAGE PAYOFF' P VALLEY NATIONAL BANK 56,667.10
2. VALLEY NATIONAL BA K - MONTHLY MORTGAGE PAYMENTS 3,870.93
July - January including jnonths in arrears
3. ST. MARKS HOMEOWt ER'S ASSN 480.00
July - January
4. AT&T - final phone bills 24.09
5. COMCAST - final bill 2.29
6. PP&L - final bills 534.93
July - January
7. PENNSYLVANIA AMER CAN WATER COMPANY 129.37
July-January
8. HAMPDEN TWP - SEW R & TRASH 115.00
October - December
9. SHERMAN ACQUISITIC N LIMITED - COLLECTION AGENT 6,743.43
See attached claim form
10. CREDIT FIRST NATION f.L ASSOCIATION 602.13
11. NEW CUMBERLAND FE DERAL CREDIT UNION - PERSONAL LOAN 6,500.00
12. DISCOVER CREDIT CA ~D 14,828.00
13. FLEET CREDIT CARD 1 ERVICES 11,078.00
14. NEW CUMBERLAND FE DERAL CREDIT UNION 1,973.00
TOTAL (Also enter on line 10, Recapltulatic ) $ 103 548.27
If more space is needed, insert additional sheets of the same size)
REV.,513EX'I*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
01 "AOI '.11
NUMBER
I.
II.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
71 n4
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NAME AND AOORESS OF P RSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [indude 0 !right spousal distributions, and transfers under
Sec.911 (a)(1.2)]
1.
Richard C. Blosser, III
333 South 2nd Street
Steelton, PA 17113
Lynn Sowell
4178 Green Road
Springfield, TN 37172
Kenneth Goodhart
4313 Tennessee Court
Harrisburg, PA 17112
2.
3.
Collateral
Collateral
Collateral
n<;Q<;
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DI1n-RIBUTiONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, eN REV.1500 COVER SHEET
NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1.
B. CHARITABLE AND GOVERNMEN AL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOT L NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
If more space is needed, insert additional sheets of the same size)
- FormA""m d CNBNo. 2502_0265
A U.S. DEPARTMENT Of HOU51NGA DlJf<llJ\NDEllElOPMENT B TYPE OF lOAN
SETTLEMENT STAT- ~ENT ,. D FHA 2 o FMHA '.W ONV. UNINS.
Affiliated Settlement Sevic s Group, LLC 4. D VA 5. 0 CONY. INS
3912 Market Street 6, ESCROW FILE NUMBER: 7.LC N NUMBER:
00052864-001 NJT 647 19168
Camp Hill, PA 17011 e, MORTGAGE INSURANCE CASE NUMBER:
(717) 975.7839
FINAL
G. NOTE: - ....This form ;s fumished to ive)Ou a statement ofaclual sellfement costs. Amountspaid to and by the settlement agent ar, shown.
Items msrked ~(p.O.c.r ~re paid outside the closing; they are shown here for informations{ purposes snd are not includ d in the totals.
D. NAME OF BORR9WER: Harry E. Koester and Irene Koester
ADDRESS OF BORROWER: 7 South point Drive
Mechanicsbura. PA 17055
E. NAME OF SELLER: Estate of Marlin L. Blosser
ADDRESS OF SELLER"
F. NAME OF LENDER: iABN AMRO Mortoaqe Group Inc.
ADDRESS OF LENDER: 2600 West Big Beaver Road
"'"roy, MI 48084
G. PROPERTY LOCATION' 14705 B Charles Road
IMechanicsburg, PA 17050
k:;umberland County 10-21-D279-382.U4
Unit 4, of S1. Mark's Place, Plan Book 58, PaQe 108
H. SETTLEMENT AGENT: ~ffiJiated Settlement Sevices Group, LLC
PLACE OF SETTLEMENT B912 Market Street, Camp Hill, PA 17011
I. SETTlEMENT DATE: 1128 005 PRORATION DATE' 1/28/2005 DISBURSEMENT DATE: 1/2812005
J. SUMMARY OF BORROWER' TRANSACTION IK SUMMARY OF SELLER'S TRANSACTION
10 "'GR 's' 'M "Due'FR' BvmOOER::;- '4QO.GROSS AMOUNT DUETO SELLER:';' <'>.-> " ""',"1
101. Contract Sales Price 118,900.00 40L Contract Sales Price 118,900.00
102 Personal Property 402. Personal Property
103 Settlement charges to Borrow r(line 1400) 4,086_01 403
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY Ell.ER IN ADVANCE' ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVAN E
106. CityITown Taxes 406 CilvlTownTaxes I
107. Counly Taxes 407. CounlvTaxes i
'08 Assessments 408. Assessments I
109. School Tax 01/28/05 to 06/30/05 395.47 409 School Tax 01128/05 10 06/30/05 395.47
110. Sewer 01128/05 to 03/31/05 80.50 410 ~Sewer 01/28/05 10 03131105 80.50
111. JanuarvHOA 01/28/05 to 01/31/05 8.50 4" JanualVHOA 01/28/05 to 01/31/05 8.50
112. 412. !
113 413 i
"4 414
115. 415
120. GROSS AMOUNT DUE FROM BO ROWER: 123,470.48 420. GROSS AMOUNT DUE TO SELLER: 119,384.47
I 20o;i.../itC)Urn~PA!Oi!re!l!l"~ael-fA RiOF,:BOf~~OWER:;;ii~::Zi!,Y" "W~;';:i":;,;':'i,'i,>:500:;REOUC110NS IN-AMOUNT DUE TO .sELLER: '<i" ,/,.,,"/!" 1
201_ . Deposit or earnest money 1,000.00 501. Excess deposit (see instructions)
202, Principal amount of new loan(s 95,120.00 502. Settlement charges to Seller (line 1400) 20,997.32
203-. Existing loan{s) taken subject t 503. Existing loan(s) taken subject to
204. 504 Payoff of 1st mtg. loan to VALLEY NATIONAL B 56,667.10
205. 505 Payoff of second mortgage loan
206. CofTwp Tax (1/1/05-1/28/05) 17.92 506. CofTwp Tax (1/1/05-1/28/05) 17.92
207: RepairCredil 850.00 507 Repair Credit 850.00
208. . 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID YSEllER' ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. CityfTownTaxes 510. CitvlTownTaxes
211. County Taxes 511. CounlyTaxes
'.212. Assessments 512. Assessments
213.', ' .' 513.
214. .' 514
215. . 515.
216_ 516
217. 517.
218. 518.
219. . 519.
220. TOTAL PND BVFOR BORROWE , 96,987.92 520 TOTAL REDUCTIONS IN AMOUNT DUE SELLER: 78,532.34
1::3pll.l;.C.A5W~~$'E:lTfEMONTiI'l!P '~~O!V:~:t'~,'~:~'\';);:..\.:!st ;.~1f:,'d'j;g;ti;:\"'1~t600: CASH A T.5ETTLEMEtffi TOlFRal,f~El.LER:/ ;'n' .0" ,.'C....
301. Gross amount due from Borrow r(line 120) 123,470.48 601 Gross amount due 10 Seller (line 420\ 119,384.47
302. Less amount paid by/for Borrm r(line220) 96,987.92 602 less reduction in amount due Seller (line 520) 78,532.34
303. CASH I 00 FROM) ( 0 TO)B RROWER: 26,482.56 603. CASH (0 FROM 1 (1iiI TO) SELLER: 40,852.13
~
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Escrow Nurnb!lr: 00052864-001 N T
BF.2AKOOWN OF PAYOFF N HUD LINE 504
VALLEY NATIONAL BANK
1460 VALLEY ROAD
WAYNE, NJ 07470
Loan # 17246754
Total as shown on HUD line 504.
Description
Principal Balance
Interest
Statement Fees
PER DIEM INTEREST
Total Payoff
56,667.10
Amount
56,636.11
-34.85
20.00
45.84
56,667.10
~
JAMES M. BACH
Attorney at Law
352 S. Sporting Hill Ru., Mechanicsburg, PA 17050, Tel: (717) 737-2033
~
HE LAW OFFICE "
of:
J ES M. BACH
Att0111cy-At-Law
352 S. Sporting Hill Road
Mechanicsburg, PA 17050
737-2033
LAST WILL AND TESTAMENT
FOR
MARLIN L. BLOSSER
t
f'"J
'"
','.1
f-...',
"-....
WILL AND TESTAMENT OF
MARLIN L. BLOSSER
I, IN L. BLOSSER, of the TOWNSHIP OF HAMPDEN, CO OF
CUMBE , COMMONWEALTI-1 of PENNSYLVANIA, being in good bodily heal'
sound. and disp ing mind and memOlY, and not acting under duress, menace, fraud, 0
influence of any pmon whomsoever, merely calling to mind the frailty 01 human life,
desirous of disp sing my worldly goods while I have the strength and capacity so to do, I
publish and dec are this my LAST WILL AND TESTAMENT. I hereby revoke, c
annul all my fo er Wills and Testaments, including codicils thereto, by me at any time
declare this a10n to be my LAST WILL AND TESTAMENT.
AS TO SUCH . STATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH I THIS
LIFETIME, I ISPOSE OF THE SAME AS FOLLOWS, VIZ:
I1EMl.
11EM 2.
11EM3.
11EM4.
11EM5.
direct that my Executrix hereinafter named, pay and discharge all of my j t debts,
uneral and test.-1ment.-uy expenses.
order and dir~ct that I be buried in a lot which I own situate at Shoops metety,
Ii'arrisburg, Pennsylvania.
I hereby convey and grant to TEDD):"L. SHElBLEY, the light to live . myhome
free from rent for a period not to exceed 120 days following my death. y home is
known and numbered as 470S.B Charles Road, Mechanicsburg, Pe sylvania.
TEDDY L. SHEIBLEY may depart sooner, if he finds another place, ut in any
event, not later than 120 days following my death.
All the rest, residue and remainder of my entire estate, wheresoever
whatsoever it may consist of, I ~. -'ve, devise, <],94 begueath, absolutely,
~1 ~ S'-"I?~.'L"~
KENNETH GOODHART, fR, LYNNE 50Wt;LL and RI
BLOSSER, III, share and share alike, per stirpes. '-
tuate, and
in fee, to
c.
I nominate and appoint PATRICIA C. BLOSSER, as Executrix of . my LAST
WILL AND TESTAMENT. Should the Executrix named fail to q or cease
to act as Executrix, then I appoint TEDDY L. SHEIBLEY as Exe utor in her
stead.
1
~.
I1EM7.
I1EM8.
ITEM 9.
............
I direct that my personal representatives, as well as their successors s not be
required to give bond for the faithful performance of their duties in any j . diction.
~ 0
r
.Q C c.' ~
/
e e aI
1 direct that all estate, succession, legacy, inheritance or other transfer tax s, however
designated that shall become payablc by reason of my death in respect of
comprising my gross estate for tax purposes, whether or not such pro
undcr this LAST WILL, shall be paid by my Executor out of my resid
I gram to my personal representatives herein named, in addition to, ut not in
funitauon of those powers vested by law, to be exercised without prior ap licatian to
or approval of any court, the power and authority to retain indefinitely an property,
to invest and reinvest any assets or the proceeds derived from the sa! of assets,
although said investments may not be of the character prescribed by I :w, to sell,
convey, assign, tranSfer and encumber any property, to pay, settle or com romise all
claims, to rnalre distribution or divisions in cash or in kind, and in general 0 exercise
all powCt> in the management of any property hereunder which any indiv ual could
exercise in the management of similar property owned in her own ri ~ and to
execute and deliver any and all instruments and to do all aCts, which may e deemed
necessary and proper.
f"!"l\(~j, 'J'?
MARLIN L. BLOSSER
____m__.________________._________._END_________._________________..__---..---....-------
2
.........
ACKNOWLEDGMENT
ALTH OF PENNSYLVANIA
ERLAND
55
. E.~ 1 ~ . T , whose name is signed to the attached foregoing
g been duly qualifled according to law, do heeeby acknowledge that I signed d executed
my LAST WILL; that I signed it willingly; and that I signed it as my free and v lootacy act
therein expressed.
ed and acknowledged before me, by: the TESTATOR tIlls llili day of .e.p,j),
d"lc\ ~ f ~" 1-. d:?J~
MARLIN L. BLOSSER
?>A~U.:~ l&.. ~ lJ-,
~OT Y PUBLIC
The ttceding instrument consisting of this and two (2) other typewritten pages, iden . ied by the
signature of e TESTATOR, _ on the date thereof signed, published and declaced by
BLOSSER, he TESTATOR therein named as and foe his S
..eb~?'I.\
~
Residing at
V* Ibv."f,c.J
L L. NI::0> ktQ
Residing at 00:. rt1 e,d-.;;Ct>-L
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t
AFFIDAVIT
ALTH OF PENNSYLVANIA
OF CUMBERLAND
)
)
)
55
e, Rc-r<J. .J,;-vJiJ (WITNESS) and /(...,... ll., L, lAJ
the witn es whose names are signed to the attaChed or foregoing instrument, being duly q
to law, do depose and say that we 'Were present and saw the TESTATOR sign and execute
his WILL; that the TESTATOR signed it willingly and that he executed it as his f
act for th purpose therein expressed; that each witness in the hearing and sjght of the TE
the 'WI as witnesses; and that, to the best of our knowledge, the TESTATOR 'WaS,
of age. of sound mind and under no COIlStrnint or undue influence.
r:r r-- ,
e affirmed and acknowledged before me, by: "l< . V ONJ
c. - IUo.", , witnesses, this 27th clay of A!>riI,
. red accQckg
e instrument as
e and volUJltaIy
ATOR signed
the time, 18 or
~
~~~
NOTARIAL SEAL
E lI.nla,O. Krider. Notary Public
CI y of I.4blnon, Lebanon County
M)I C mmisslon Expires Sept. ~9. 2.005
~l^~<~ V0J\ let"
01' PUBLIC
3
UNITED STATES BANKRUPTCY COURT
MIDDLE DlSTRlCI' OF PENNSYLVANIA
INRE:
MARLIN L. BL SER
CASE NO. 1-01-03436
CHAPTE 13
Debtor(s)
ORDER DISMISSING CASE
NOW, this '2: .J1- day of APRIL, 2004,
Upon consid . on of Debtor's Motion to Dismiss Case (and hearing if . ate), and
it having been determin that this esse should be dismissed, it is
ORDERED th the esse of the above-named debtor(s) be and it hereby s dismissed and
it is further
ORDERED t thetrusteeherebyis discbargcdfrom furthcrresponsibili in this case, and
it is further
any outstanding fees are immediately due and p Ie to the U.S.
ORDERED th all pending adversary proceedings in this case be and they hereby are
dismissed, and it is
Bankruptcy Court.
JW THE COURT:
~
c()~ />t7M IS d d().L h
due dell-j~ It! h1/t'Yf- fv
I /A/II/JW~ .
f1;Iee r M MM ;xA/1L .
APR 2 7 2004
1>>7920
!
In rc MARLIN L. BLOSSER Case No.
,
Debtor
'SCHEDULE F. CRE DITORS HOLDING UNSECURED NONPRIORJ TY CLAIMS
State the name, mailing address, includi g zip code, and account number, if any. of all entities holding unsecured laim s without priority against lh~
debtor or the property of the debtor, as of tI e date of filing of the petition. Do not include claims listed in Schedules [ and E. If all creditors will not fi"
on this page, use the continuation sheet pr vidcd.
If any entity other than a spouse in a joi t case may be jointly liable on a claim, place an "XU in the column labeled "C odcbtor," include the entity or
the appropriate schedule of creditors, and c mpletc Schedule H - Codebtors. If a joint petition is filed, state whether h sba nd. wife, both of them, or the
marjtaJ community may be liable on each laim by placing an "H)" "W," "J," or "C" in the column labeled "Husband Wi fe, Joint, or Community."
If the claim is contingent, place an ") " in the column labeled "Contingent." If the claim is unliquidated, pla( an "X" in the column labclec
"Unliquidated." If the claim is disputed, pia e an "X" in the column labeled "Disputed." (You may need to place an ") " in marc than one of thesc three
columns.)
Report total of all claims listcd on this: hedulc in the box labeled "Total" on the last shcet of the completed sche ule . Report this total also on the
Summary of Schedules.
o Check this box if debtor has no credito holding unsecured nonpriority claims to report all this Schedule F.
C Husband Wire Joint or Communilv C U 0
0 0 N I
CREDITOR'S NAME AND MAIL!~ G 0 H DATE CLAIM WAS INCURRED AND N l S
E W T I P
" CONSIDERATION FOR CLAIM. IF CLAIM I 0 u
ADDRESS INCLUDING ZIP CODE T J IS SUBJECT TO SETOFF, SO STATE. N u T AMOUNT OF CLAIM
0 e G 1 E
R E 0 0
N A
Account No. 513928394 1997-2002 T T
CONSUMER DEBT E
0
CFNA
P.O. BOX 81344 -
Cleveland, OH 44188-0344
v 704.00
Account No. 4820 9955 0002 5094 1997-2002
CONSUMER DEBT
CUSTOMER SERVICE
PO BOX 30495 -
Tampa, FL 33630
1,973.00
Account No. 6011 0027 5650 1532 1997-2002 .
CONSUMER DEBT
DISCOVER
C/O KNUPP, KODAK & IMBLUM -
PO BOX 11848
Harrisburg, PA 17108-1848
1/" 14,828.00
Account No. 4305 5000 0920 8896 1997-2002 ,
CONSUMER DEBT
FLEET CREDIT CARD SVCS
P.O. Box 15368 -
Wilmington, DE 19886-5368
/
V 11,078.00
,
continuation sheers attached : ubtotal 28,583.00
1 (Total oft is pa ge)
Copyright (c) 1996.2000. Best Case Solutions. Inc. . Evan on, ll- (800J 492-8037 SJN:21074 Best Case Bankruptcy
In re MARLIN L. BLOSSER Case No.
,
....'.- Debtor
SCHEDULE F. CRE PITORS HOLDING UNSECURED NONPRIORJ TY CLAIMS
(Continuation Sheet)
e Husband Wile Joinl or Communl1v U 0
0 n I
0 H s
CREDITOR'S NAME AND MAIL1~ G E w DATE CLAIM WAS INCURRED AND I p
B CONSIDERATION FOR CLAIM. IF CLAIM ~ P u
ADDRESS INCLUDING ZIP CODE T J T AMOUNT OF CLAIM
0 e IS SUBJECT TO SETOFF, SO STATE. E
R ~ ~ 0
Account No. 1997-2002 E
PERSONAL LOAN 0
NCFCU
P.O. BOX 658 -
New Cumberland, PA 17070
,/ /
6,500.00
Account No. 5409-8422-0110-4222 1997-2002
CONSUMER DEBT
PROVIDIAN
POBOX 660737 .
Dallas, TX 75266-0737
. f.-./ 6,786.00
Account No.
Account No. -
Account No. ,
Sheet no. -L of ...1- sheets attached to ehedulc of ~u biotal
Creditors Holding Unsecured Nonpriority CI ims (Total oft is page) 13,286.00
Total
(Report on Summary ofSc e dules) 41,869.00
COp)'l'lghl (Cl19~2000 - Best Case Solutions, Inc. - Evan t on, IL . (BOO) 492-8037 Besl Case Bankruplcy
COMMONWEA TH OF PENNSYLVANIA
COURT OF COM
OF CUMBERLAND
ORPHANS' COUR
ON PLEAS
COUNTY
DIVISION
NOT/CE OF CLA/M
In Re: The Est
MARLIN L BLO
Deceased
Court File No: 2104595
TO: THE CLER OF THE ORPHANS' COURT DIVISION Notice of cl im by
creditor, Pursua t to Section 3532(b)(2) of the Probate, Estates, and Fidu aries
Code, 20 PA.C. .A. ~3532(b)(2).
1 ) Claimant' name:
2) Claimant' address:
3)
ECAST SETTLEMENT CORP
c/o NeO Financial Systems, Inc
Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
Creditor I sted below is the owner and holder of a claim in the amo nt of
$11,576.3 Acct# 6011002756501532
4)
The facts upon which this claim is based is a credit agreement betw en
Creditor nd Decedent, identified as account number which is evid nced by
the attac ed affidavit of account stated.
Decedent s address: 4705 B CHARLES RD, MECHANICSBURG PA 17050-7 50
5)
6)
7)
Date of ath: UNKNOWN
That the laim arose prior to the death of the decedent on or about
8)
That the laim is secured by
On behalf of the claimant, I do solemnly decl e and affirmrrer the Ities of
perjury that they Information and representa ons m e he are t a correct
to the best of m knowledge, information .
Dated:May 12, 20 5 ,AGENT
Claimant 811056
Written notice of claim was given to Personal Representative and/or his/he counsel
as stated below:
JAMES M BACH
Name
352 S SPORTING L RD
Address
MECHANICSB
City/State/Zip
MAY 12, 2005
Date notice mai ed
THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYL ANIA
ESTATE OF
MARLIN L BLOSSER
, Deceased
No. 21-04-595
of 2003
To the Clerk of the Orphans' Curt:
Enter the claim of ERMAN ACQUISITION LIMITED
P RTNERSHIP
Accl. 51 4450140048863
In the amount of
$6,743.4
, against the above entitled estate.
The decedent, who res ded at 4705 CHARLES RD # B MECHANICSBURG PA 17 0
died on
06/171 004
. Written notice of sai claim was given
to PATRICIA BLOLLER
,if known to clai ant, at
(Personal R presentative or counsel)
1923 DAYBREAK CIRCLE, H RRISBURG, PA 17110
on
November 9, 2004
(Date)
Address:
5330 East Main St eet, Suite 200
Columbus, Ohio 213
Claimant's Counsel
Address
ORIGINAL
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Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A, Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
380
5/31/2005
MARLIN L. BLOSSER
21-2004-0595
REAGER & ADLER PC
2331 MARKETST
"
CAMP HILL, PA 17011
Qty
1
Fee Description
Additional Probate
Fee Total
35.00 $35.00
Total:
Po\. .; 71= 1'11' L/ 25
$35.00
. --~.-
.,1
J\lt-l ,?.rJ(J~
------
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Ci
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
\.)--
08-15-2005
BLOSSER
06-17-2004
21 04-0595
CUMBERLAND
101
APPEAL DATE: 10-14-2005
( See reverse side under Objections)
Amoun't Rem:l.'t'tedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER Of WILLS
CUMBERLAND CO COURT HOUSE~
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REy:is4;-Ex"AFP"io3:osj-NoTIcE-OF-INHERITANCE-TAX-APPRAiSEMENT~-ALLONANCE-OR----"-----"----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MARLIN L FILE NO. 21 04-0595 ACN 101
p::r,nq\\c)i n~F)(:~ rr
BUREAU OF INDIVIDIIAt:,:i;1xtS:~ .:: ,~,' ,:
INHERITANCE TAX PIVISJDtt','-,.-,"':' -.-, ," ',-' (_~
PO BDX 280681 ' --' '.. ,- -
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCIIDNS AND ASSESSHENT OF TAX
2'lnc: .1!\l0 I?
lJ ,~:) :'-j ~,' '.J 1 '-
i: 05
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
lJ1_J
r;,
err'
1'-<.-
r
r.,
DAVID WREAGER
REAGER & ADLER
2331 MARKET ST
CAMP HILL
PA 17011
ESTATE OF
BLOSSER
*'
REV-15~7 EX AFP (06-051
MARLIN
L
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
DATE 08-15-2005
I~ an assess.en't was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflec't ~igur8s 'tha't include 'the total o~ ALL returns assessed 'to da'te>
ASSESSMENT OF TAX:
15. A-ount of Line 14 .t Spousal rat. (IS)
16. Amount of Line 14 taxable .t Lineal/Class A rat. (16)
17. Aooount of Lina 14 at Sibling NOt. (17)
18. Amount of Line 14 taxable at Collateral/Class Brat. (18)
19. PrinciPIII Tax Du.
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule Al
2. Stocks and Bonds ISchedul. B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Marto-ges/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule GJ
8. Total Assets
11)
(2)
(3)
(4)
IS)
(6)
(7)
118,900.00
.00
.00
.00
4.219.29
.00
8.155.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of rax Return
13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule ~)
14. Net Value of Est.t. Subject to rax
(9)
lID)
32,179.14
103.548 27
NOTE:
.00 X
.00 X
.00 X
.00 X
NOTE: To insure prope"
credit to your account,
~it the Upper portion
of this fo'" with your
tax pay..nt.
131,274.29
Ill)
(12)
(13)
(14)
1~S; 727 41
4,453.12-
.00
4,453.12-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(19)=
TAX CREDITS:
,>J AHDUNT PAID
DATIO NUI1BER INTEREST/PEN PAID 1-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). YDU HAY BE DUE o'
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTTnN~ 1 _<C~
-
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH
REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED,
FILE a 6.12 FORM YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Marlin L. Blosser
Date of Death: 6/1712004
Will No.:
2004-00595
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion ofthe administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X
No
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No. I is yes, state the following:
A. Did the personal representative file a final account with the court?
Yes
No
B. The separate Orphans' Court No. (if any) for the personal representative's
account is:
en
L'
C. Did the personal representative state an account informally to the parties in
interest? Yes No X
Estate is insolvent.
D.
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
,,~
David W. Reager, Esquire
Reager & Adler, P.C.
2331 Market Street
Camp Hill, P A 17011
(717) 763-1383
Counsel for Personal Representative
C
I
c~
L
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( l
Date~.',
<1/ a31d.- CO!:>
IIFPO 1 luserssflLSh arpelZERCH ER. monica. dlBlosser. Marlin. Estatelstatusreport. form. wpd
LC,-
eumberland County Register of illS
INVENTORY
Estate of BLOSSER MARLIN L
No.21
04
595
, Deceased
Date of Death 6/17/2004
Social Security No. 161 1320
also known as
Personal Representative(s) of the above Estate. deceased, verify that the items appearing in the following inventory in ude all of the
personal assets wherever situate and all f the real estate in the Commonwealth of Pennsylvania of said Decedent, th the valuation
placed opposite each item of sajd invent ry represents its fair value as of the date of the Decedenfs death, and that 0 cedent owned no
real estate outside the Commonwealth 0 Pennsylvania except that which appears in a memorandum at the end of this nventory. I/We
verify that the statements made in this in entory are true and correct. r/We understand that false statements herein m e are subject to the
penalties of 18 Pa. C.S. Section 4904 rei ling to unswom falsification to authorities.
Personal Representative:
Name of
Attorney: DAVID W. REAGER
1.0. No.: 20868
Address: 2331 MARKET STREE
~
Dated
CAMP HILL
PA 17011
Telephone: 717-763-1383
Description
4705 B. Charles Road, Mechanic burg, PA
M&T Checking Account
Total
(Attach Additional Sheets if necessary)
Val
~
118,900.00
4,219.29
r--)
5
(:.),
C)
N
-'
123,119.29
NOTE: The Memorandum of real estate 0 tside the Commonwealth of Pennsylvania may, at the election of the persona representative,
include the value of each item, but such fi ures should not be extended into the total of the Inventory.
RW-4