HomeMy WebLinkAbout04-0664Estate of
also known as
Register of Wills Cumberland county, pennsylvania
PETITION FOR GRANT OF LETTERS
Robert E. Bollinger No.
, Deceased ~2cial Security No. 195-26-9025
Lorraine E. Bollinger and Tammy Jo.Bollinger n/k/a Tammy Jo May
(COMPLETE "A" OR "B" BELOW:) ~
A. Probate and Grant of Letters and aver that Petitioner(s)'is/are the executrices named in the Last Will of the
[~ Decedent, dated November 28, 2003 and codicil(s) dated n/a
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if anY) and heirs:
Name Relationship Residence I
(COMPLI: I1:: IN ALL CASES:) Attach additional heats if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 120 CME, Newville, Lower Mifflin Township. Cumberland County_. Pennsylvania 17241
Decedent, then 7z~ years of age, died . July 7 ,20 04, at Chapel Pointe at Carlisle
Carlisle, Cu~'~l~erland County, Pennsylvania
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property .............................. $ ..... 10,000.00
(If not domiciled in PA) Personal property in Pennsylvania ...................... $ 0.00
(If not domiciled in PA) Personal property in County .......................... $ 0.00
Value of real estate in Pennsylvania ............................................... $ 0.00
Total .............................................................. $ 10~000.00
Real Estate situated as follows: n/a
Wherefore, Petitioner(s) respectfully .request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature Typed or printed name and residence
Lorraine E. Bollir~ger
164 Fryt°wn Road,, Carlisle, PA 17013
Tammy Jo Bollinger n/k/a Tamm¥ Jo May
509 Baltimore Pike, Mt. Holly Springs, PA 17065
Oath
Commonwealth of Pennsylvania
County of Cumberland
of Personal
Representative
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
~orrect to the best of.the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this I~T~ dayof ' vq ,
~J!~ ._.,., ~.-,I ,. ~ , ~ ~.. .~ .~orraineE. Bollinger ~
~ ~ J ~~~ / -. Tam~joOollinger n,a~am~ Jo May~ :- ~
DECREE OF REGISTER
Estate of Robe~ E. Bollinger Deceased No. ~l-O '~ ~ ~ ~
also known as
Social Security No: 195-26-9025 Date of Death: JUly 7, 200~;
AND NOW. --~[~'~ , 20 0, in consideration of tl~.~ Petition
on the reverse side hereon, satisfactory proof having been presented before me, r -
IT IS DECREED that Letters [] Testamentary [] of Administration
are hereby granted to
Lorraine E. Bollinger and Tamm¥ Jo Bollinger n/k/a Tammy Jo May ':
in the above estate and that the instrument(s), if any, dated November 28, 2003 '
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........................... $ 4~ 0,00
Short Certificate(s)...6. ...... $ [~ '0 0
Renunciation ..................
Affidavit ( ) .................
Extra Pages ( ) ............
Codicil .... ' ......................
JCP Fee ........................
Inventory & Tax Forms...
Other ............................
(o O0
P~I-Ta
Regi~lter of Wills
Attorney:. Lowell R. Gates, Esquire
I.D. No: 46779 ·
Address: Gates, Halbruner & Hatch, P.C.
1013 Mumma Road, Suite 100, Lemoyne, PA 17043
717-731-9600
DATE FILED:
his is to certify that the information here given is correctly copied from an original certificale .ff ~ic; ~ d~ ~, ! .l ..;itt :,~
Local Registrar. The original certificate will be forwarded to the State Vital Records Office fi,r ~ern~ em : 1 ~
WARNING: It is illegal to duplicate this copy by photostat or photoilra3~3
Fee for this certificate, $2.00
No.
JUL 8 2Cl0;
H 105.143 Rev. 2~87
4ANENT
CKINK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS "'~
"
CERTIFICATE OF DEATH
NAME OF DECEDENT (Fi~L Middle, Lest) STATE $1t.E
SEX [ SOCIAL SECURITY NUMBER [ DATE OF DEATH tM~tlh ~ Year
AGE (Las1 S~hday) MU_N~DER, 1 Y_EAR "~UNDE.R 1 DAY I DATE OF BIRm I a RmPLADE (City and IPLACE OF DEATH ~Check --'- --
~. I o~ms I u~y~I Ho~s [Minutes I (Month. Day, Year) [ SiataorFa,.al~nCountm ~Hn*~,rr~.. ~e~e-s~emstmctlo~s~oth~-slde)
cou,~o~o~,r. I c~ ..... L: .... ~" I"". I ~ ~ =~.-~ ~ ~
DEC~DENTS USUAL ~CUPATION ]KIND OF BUS NESS I INOU~y ~8 DECEDENT ~R IN DECE~EgT~ ED~T~
~.rs a~f (T~¢ ps. Dora
20.. Loaaa~n~ BO~inno* INF~TS~LING~DRESS(~ ~S~ Z~
...... · ~i.:::~-~7~ ......... ' "' .~2~'m'~/~/v /- ~U ~L ~-~
] ]~.nt O P.dinglnve,..~ OI J J *-O ~D I
...............................................................
LI~ ~UMB~. ~, ,/ DATf SIGNED ~.
LAST WILL AND TESTAMENT
I, ROBERT E. BOLLINGER, of Newville, 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 Executrices to pay all of my debts, funeral and administrati~e expenses as
soon as may be done conveniently after my decease. ~ ·
2. I authorize and empower my Executrices 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.
3. I devise and bequeath all of my estate of every nature and wherever situate to my four
(4) children, share and share alike, but if any of my children owe me any money, such amounts
shall be considered and deducted from any final distribution of my estate.
4. I nominate and appoint LORRAINE E. BOLLINGER and TAMMY JO BOLLINGER
to be the Executrices of this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representatives retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of
November, 2003.
Signed, sealed, published and declared by ROBERT E. BOLLINGER, 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 wimesses
hereto.
2
A CKNOWLEDGEMENTAND AFFIDAVIT
WE, ROBERT E. BOLLINGER, SHARON L. SCHWALM and MARTHA L.
NOEL, the testator and wimesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that thc
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 thc Will as a wimess 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.
ROBERT E. BOLLINGER--c---~
SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by ROBERT E. BOLLINGER, the
testator, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA
L. NOEL, wimesses, this 28th day of November, 2003.
ry Public
No~arial Seal
Roller B. Irwin, Notary Public
Catlike Bom, Cumberland County
My Com~'dssion Expires Oct. 3, 2004
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
No. 2004-00644
David P. Brackbill, Deceased
July 6, 2004
PA No. 2104-0644
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 or
about July 14, 2004:
Same
LaRue C. Wagner
James L. Bailey
Address
Sherwood Drive
Carlisle, PA 17013
710 Mountain Road
Newville, PA 17241
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE.
Date: July 14, 2004
~uire
44 West Main Street
Mechanicsburg, PA 17055-0318
(717) 697-8528
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Robert E. Bollinger
Date of Death: July 7, 2004
File No.: 21-2004-0664
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
October 4, 2004.
Name Address
Tammy Jo May
509 Baltimore Pike, Mt. Holly Springs, PA 17065
Lorraine E. Bollinger
164 Frytown Road, Carlisle, PA 17013
Brenda K. Kuhn
202 Garfield Drive, Carlisle, PA 17013
Robert L. Bollinger
321 Mountain Road, Newville, PA 17241
Notice has now been given to all persons entitled ~ere/o 1 nde~ Rule 5.6(a).
Il
//
Counsel [or Personal Representative
GATES, ~HALBRUNER & HATCH, P.C.
1013 Mt~nma Road, Suite 100
Lemoyne, PA 17043
(717) 731-9600
Dated: October ~___, 2004
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
I '
To the Register:
I certify that notice of (beneficial interest) ~tg t~Oministrafion 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 :
Name Address
S ~,/A,~z,, /o,./£.,,~ f4~, ?,t~/,~,~, ,~,~ / 70/$
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Address /~,.I~
.X"_~,,Z,.,:
Telephone CO?)
Capacity: __ Personal Representative
~'/Counsel for personal representative
CERTIFICATION OF NOTICE UNDER RULE 5.6(al
N.eo, ceaent: / 08e 7
To the Register:
I certify that notice of (beneficial interest) ' ' rio 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 :
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
: ,. .r'¥ i?
Signature
Name Jl~/~l)~__ ~'~ ~//t'~l~ ~
Address /~¢ &~--.~tl ~
Telephone
Capacity: Personal Representative
~Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
GATES LOWELL R ESQ
1013 MUMMA RD
SUITE 100
LEMOYNE, PA 17043-1144
RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS, COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 10/25/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Personal Representative(s)
Judge
Sincerely,
GLENDA FARNER
Clerk of the Orphans' Court
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
~OLLINGER LORRAINE E
164 FRYTOWN ROAD
CARLISLE, PA 17013
RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS, COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans, Court his/her Certification of Notice.
This filing will become delinquent on 10/25/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
Sincerely,
Clerk of the Orphans' Court
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
BOLLINGER TAMMY JO
509 BALTIMORE PIKE
MT HOLLY SPRINGS, PA 17065
RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans. Court his/her Certification of Notice.
This filing will become delinquent on 10/25/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
Sincerely,
GLENDA FARNER S~
Clerk of the Orphans' Court
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717)240-6345
Date: 10/05/2004
NKA MAY TAMMY JO
RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS, COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 10/25/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
Sincerely,
GLENDA FARNER ST~
Clerk of the Orphans, Court
LAW OFFICES OF
GATES, HALBRUNER &-HATCH, P.C.
1013 MUMMA ROAD. SUITE 100. LEMOYNE, PENNSYLVANIA 17043
(717) 731-9600. FAX: (717) 731-9627
LOWELL R. GATES, LL. M.
LLM.inTaxalion
Also Admitted to Massachusetts Bar
MARK E. HALBRUNER
Also Admitted to New Jersey Bar
CRAIG A. HATCH, CELA
Certified as an Elder Law Attorney by
the National Elder Law Foundation
CORY J. SNOOK
ALBERT N. PETERLlN
Also Admitted to Maryland Bar
CLIFTON R. GUISE
Also Admitted to practice before the
U.S. Patent & Trademark Office
BRANCH OFFICE:
3 WEST MONUMENT SQUARE, SUITE 304
LEWISTOWN, PA 17044
(717)248-6909
WEB SITE:
WNW.GateslawFlrm.com
CORRESPONDENCE ADDRESS:
Lemoyne Office
STACEY L NACE
Paralegal/Office Manager
TRACI L. SEPKOVIC
Paralegal
VALERIE LONG
Paralegal
April 5, 2005
Cumberland County Courthouse
Office of the Register of Wills
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Robert E. Bollinger
Estate No. 21-04-00664
',:1
co
Dear Register of Wills:
Enclosed for filing are the Pennsylvania inheritance tax return (in duplicate), Inventory
and Status Report for the Estate of Robert E. Bollinger. A check in the amount of$I,315.90 is
enclosed as payment of the inheritance tax. Please time-stamp the additional photocopy of each
document and return them to our office in the enclosed envelope. If there are any additional fees
owed with the filing of the enclosed, please send your invoice also to our office with the return of
the time-stamped documents.
Please contact Attorney Lowell R. Gates or myself if you need any additional
information.
Sincerely,
--U a u;! ~~0 / -",
Traci L. Sepkovic
Paralegal
Enclosures
cc: Lorraine E. Bollinger, Co-Executrix (wi enclosures)
Tammy Jo May, Co-Executrix (wi enclosures)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GATES LOWELL R ESQ
1013 MUMMA RD
SUITE 100
LEMOYNE, PA 17043-1144
---- fold
ESTATE INFORMATION: SSN: 195-26-9025
FILE NUMBER: 2104-0664
DECEDENT NAME: BOLLINGER ROBERT E
DATE OF PAYMENT: 04/06/2005
POSTMARK DATE: 04/05/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/07/2004
NO. CD 005167
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,315.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 124
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$1,315.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GATES LOWELL R ESQ
1013 MUMMA RD
SUITE 100
LEMOYNE, PA 17043-1144
__u____ fold
ESTATE INFORMATION: SSN: , 95~26~9025
FILE NUMBER: 2104-0664
DECEDENT NAME: BOLLINGER ROBERT E
DATE OF PAYMENT: 04/06/2005
POSTMARK DATE: 04/05/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/07/2004
NO. CD 005172
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $.90
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#124
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$.90
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
Register of Wills Cumberland
County, Pennsylvania
INVENTORY
Estate of
Robert E. Bollinqer
No. 21-04-00664
also known as
Date of Death July 7, 2004
, Deceased
Social Security No. 195-26-9025
Lorraine E. Bollinger and Tammmy Jo Mav,
Personal Representativo{sl of the above Estate, deceased. verify that the items appearing in the following inventory include ail
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Oecedent. 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 foal estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. l/We verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S, Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney:
Lowell R. Gates, Esqui~
~-~
Dated -3 f:J ~OS
I.D, No.~
46779
Gates, Halbruner & Hatch, P.C.
Addre5s~
1013 Mumma Rd., Ste. 100. LemQyne~ 17043
Telephone, (717) 731-9600
Description
Value
Lot & mobile home located at
120 Conodoguinet Mobile Estates
$ 13,081.36
10,150.37
6,750.36
6,517.11
330.31
1,500.00
214.95
Members 1st Federal Credit Union; CD#193904-42
Members 1st Federal Credit Union; Savings Acct. #193904- 5
Members 1st Federal Credit Union; Checking Acct. #196904- 11
Members 1st Federal Credit Union; Savings Acct. #193904-0
Miscellaneous Personal Property
United American Insurance Company - refund of premium
To.al: $35,544.46
(Attach Additional Sheets if ne ($ar'l
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsvlvania may. at the election of the personal representative. inclllde
the value of each item. but such figures should not be extended into the total of the Inventory.
RW-B
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j \(w_ ~
'pel L10.
COMMONWEALTH OF
PENNSYLVANIA
DEPARThlENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
<1
\:), :P,I) ?:j).O
it
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500 EX (6-(0)
OFFCIAL..USEONlY
FILE OOM6ER
~L
COLMY CODE
04
YEAR
MJMBER
00664
-----
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DECEDEN'T'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BOllinger Robert
DATE OF DEATH (MM-OO-YEAA) DATE OF BIRTH (MM-DD-YEAR)
7/7/2004 5/2/1930
(IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
E
SOCIAL SECURIlY NUMBER
195-26-9025
illS RETUfIo.I MUST BE FILED IN DUPLICATE WmI THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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00 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return D 3. Remainder Return (dale of dElath priorta 12-'3-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a LMng Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (dale Of deathbetwe9<l12.31.91 ard \.1.95\ D 11. Election to tax under Sec. 9113{A)\.e.'tlachScl10)
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THIS SECTION MllST BE COMPlETEO. ALL CORRESPONDENCE ANO CONFIDENTIAL TAX INFORMATION SHOULD lie DIRECTEO TO:
NAME COMPLElE MAILING ADDRESS
Lowell R. Gates, Esquire 1013 MUmma Road, Suite 100
FIRM NAME (It Applicable)
Gates, Halbruner & Hatch, P.C. Lemoyne, PA 17043
TELEPHONE NUMBER
717-731-9600
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Propelt'J
(Schedule E) (5)
Z 6. JO Owned Property (Schedule F) (6)
0
j:: Separate Billing Requested
:s 7. Inter-Vivos Transfers 8. Miscellaneous Non-Probate Property (7)
~ (Schedule G or L)
l-
ii: 8. Total Gross Assets (total Lines 1-7)
<C
(J
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
II:
10. Debts of Decedent, Mortgage Liabilil:les, & liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
$13,081.36
$0.00
$0.00
$0.00
$25,463.10
$0.00
OFFCIPL USE ~y
$0.00
\.0
$38,544.46
(8)
$8,403.28
$898.90
3W46451.000
(11)
$9,302.18
$29,242.28
$0.00
(12)
(13)
12. Net Value of Estate (L.ine 8 minus Une 11)
13. Charitable and Governmental BequestS/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRLJCnONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax:
rate, or transfers under Sec. 9116 (a)(1.2)
'.0 !!...- (15)
,.0 ~(16)
(14)
$29,242.28
$0.00
$29,242.28
$0.00
$0.00
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
}( .12 (17)
(19)
$0.00
$1,315.90
$0.00
$0.00
$1,315.90
x .15 (18)
18, Amount of Line 14 taxable atoollateral rate
19. Tax Due
20 0
CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUES1IONS ON FlEllEASE SIDE AND RECHECK MATH < <
.,J-.
Decedent's ComDlete Address:
SlREET ADDRESS
120 CMB
Cumberland
CIlY I STATE I ~p
Newville PA 17241-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credn
B. Prior Payments
C. Discount
(1)
$0.00
$0.00
$0.00
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
$0.00
$0.00
TotallnteresVPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page' 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.
(5A)
B. Enter the total of Line 5 + 5A. This is the BAl..ANCE DUE.
Make Check Pa able to: REGISTER OF WILLS, AGENT
(5B)
$1,315.90
$0.00
$0.00
$0.00
$1,315.90
$0.00
$1,315.90
PLEASE ANSWER THE FOLLOWING QUESTlONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D
b. retain the right to designate who shall use the property transferred Of its income; . D
c. retain a reversionary interest; or " . . . . . . . . . . . . . . . . . . . . . . D
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D
2. It death occurred after December 12, 1962, did decedent transfer property within one year at death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0
3. Did decedent own an -in trust tor. or payable upon death bank account or security at his or her death? 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 []I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Undel penalties 01 perjury, I declare lhatl have examined this ratum, including accompanying schedules and statements, and to the best 01 my knowledge and baliel, it Is true, correct
and complete.
Declaration 01 pre parer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGN E OF P';RSON RESPO~r6LE.t~1 FlUNG RETURN
f1.l'lf, /::J{:ec I\.
RES
No
og
og
og
og
og
QlI
101 Mumma Road, Suite 100
Lemoyne, PA 17043
DATE
3 -61r-os-
PA
For tes of death on or after July 1, 1994 ami belore Ja.nuary 1, 1995, the tax rate imposed on the net value of transfers to or tor the use of the surviving spouse is 3%
[72 P.S. 9 9916 (ai (1.1) (i))
For dates of death on or after January 1, 1995, the tax rate imposed 00 the net value at transfers to or for the use of the SUNMng spouse is 0% [72 P.S. f3 9116 (a) (1.1) (]i))
The statute does not exemot 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 the use of a natural parent, an adoptive parent,
Of a stepparent of the child is 0% In 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 beneficlaties is 4.5%, except as noted in 72 P .S. g9116(1.2) [72 P.S. g9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedenfs 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.
3W46461.000
REV-1503 EX + (6098)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Robert E. Bollinger
21 04 00664
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPllON
VAlUE AT DATE
OF DEATH
3W46961.000
TOTAL (Also enter on line 2, Recapitulation) $
(It more space is needed, insert additional sheets of the same size)
$0.00
REV.1508 EX + (6-98)
COMMONWEAL lH OF PENNSYLVANIA
INHERITANCE TAX RE1URN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONALPROPERTV
ESTATE OF
Robert E. Bollinger
FILE NUMBER
21 04 00664
(oelude the proceeds of litigation and the date \he proceeds were received by the estate.
All proper1V 10lntlv-OWll8d with the rlaht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 Members 1st Pederal Credit
Union
Interest accrued to 7/7/2004
Certificate of Deposit
11193904-42
2 Members 1st Pederal Credit
Union
Interest accrued to 7/7/2004
Savings Acct. 11193904-05
3 Members 1st Pederal Credit
Union
Interest accrued to 7/7/2004
Checking Acct. 11193904-11
4 Members Pirst Pederal Credit
Union
Interest accrued to 7/7/2004
Savings Acct. 11193904-00
5 Miscellaneous Personal
Property
6 united American Insurance
Company
refund of insurance premium on
policy 11574418620
VALUE AT DATE
OF DEATH
$10,147.24
$3.13
$6,749.16
$1.20
$6,516.83
$0.28
$329.81
$0.50
$1,500.00
$214.95
3W46AO 1.000
TOTAL (Also enter on line 5 Recarlitulation\ It
(If more space is needed, insert additional sheets of the same size)
$25,463.10
REV.1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERlTM(;E TAX RETURN
AESlDENTDECEOENT
ESTATE OF
Robert E. Bollinger
SCHEDULE F
J~NTL~OWNEDPROPERTV
FILE NUMBER
21 04 00664
If an asset was made Joint within one year of the decedent's date of death, II must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
,6D[)RESS
RELATIONSHIP TO DECEDENT
A.
B.
c.
JOINTL V-OWNED PROPERTY:
""'" DATE DESCRtPOON OF PROPER1Y %OF DATE OF DEATH
ITEM FORJOI~ MADE INCLUDE NlWE OF FINANCIAL INSTITUTION AflD BAN< ACCOLNT DATE OF DEATH DECD'S VALUE OF
NUMBER JOINT N..MBEA0Fl SIMILAR IDENTIFYING M..NBER ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
T""'" ..()INTlY+ELD~ESTATE.
1. A.
TOTAL fAlso enter on line 6 Rer'.Aoitulation\ S $0.00
3W46AE1.000
(It more space is needed, insert additional sheets of the same size)
AEV-1510 EX + (&-ge)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX AE11JRN
RESIDENT DECEDENT
ESTATE OF
Robert E. Bollinger
FILE NUMBER
04 :11 00664
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.
DESCRIP1lON OF PROPERiY
ITEM N;tiOE TtE tw.E OF TtE mANSFEREE, THEIR REU< T10NSHP TO DEClODENT AJID DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBE' TtEDATEOFl1'WS'ER. ATT;\O-IACOPV OF T!-I: DEED FOR REAL ESTATE VALUE OF ASSET INTEREST '.I>I'l'UCMlLE' VALUE
1.
TOTAL (Also enter on line 7, Recapitulation) $ $0.00
(If more space is needed, insertaddltional sheetS of the same size)
aW46AF1.000
REV 1511 6X + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert E. Bollinger
FILE NUMBER
21 04 00664
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions $2,000.00
Name of Personal Representative(s) Lorraine E. Bollinger, Co-Executrix
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address and Tammy Jo May, Co-Executrix
City State Zip
Year(s) Commission Paid: 2005
2. Attorney Fees $4,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees $74.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1 Adams Electric Coop., Inc.
electric utility service $86.04
2 Cumberland Law Journal
estate notice publication fee $75.00
Total from continuation pages $1,668.24
TOTAL (Also enter on line 9. Recapitulation) $ $8,403.28
3W46AG1_000
(If more space is needed, insert additional sheets of the same size)
Estate of: Robert E. Bollinger
J:tem
No.
3
4
5
6
7
8
9
10
Description
Hollinger Funeral Home <<
Crematory, :Inc.
fee for additional death
certificates
Kloughls Oil Service
gas utility service
Miscellaneous Administrative
Expenses
photocopies, postage, etc.
Mobile Home Lot Rent
October - November 2004
Mobile Home Permdt Fee
Shelby L. Winter, tax
collector
2004 real estate/school tax
The patriot-News Co.
estate notice publication fee
The Sentinel
advertising fee for sale of
mobile home
Total (Carry forward to main schedule)
Schedule H part 2 (Page 2)
Amount
$24.00
$167.79
$23.45
$822.00
$2.00
$168.93
$297.07
$163.00
$1,668.24
REV-1512 EX + (609B)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert E. Bollinger
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILmES, & LIENS
FILE NUMBER
04 21 00664
Include unrelmbursed medical expenses.
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1. Adams El.ectric Coop., :Inc.
electric utility service
2
Chapel Point
nursing home charge not paid
by Medicare
3
Gates, Halbruner & Hatch, p.e.
legal fees owed at death for
estate planning matter
4
Metro Mad Services
emergency transport
5 Newville Community Ambulance
Service
emergency transport
6
Sprint
phone service
$19.16
$42.00
$617.52
$127.50
$53.11
$39.61
3W46AH 1,QQQ
TOTAL (Afso enter on line 10, Recaoitulation) $
(It more space is needed, insert additional sheets of the same size)
$898.90
AEV-1513 ~+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Robert E. Sollinaer
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a' (1.2)]
1
Lorraine E. Bollinger
164 Frytown Road
Carlisle, PA 17013
2
Robert L. Bollinger
321 Mountain Road
Newville, PA 17241
3
Brenda K. Kuhn
202 Garfield Drive
Carlisle, PA 17013
4
T_ Jo May
509 Baltimore Pike
Mt. Holly Springs, PA 17065
FILE NUMBER
21 04 00664
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter
Son
Daughter
Daughter
$7,310.57
$7,310.57
$7,310.57
$7,310.57
ENTER DOLLAR AMOUNTS FOR DISTIlIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTIlIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46Ar1.000
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTIlIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$
(\1 more space IS needed, Insert additional sheets of the same sIze)
$0.00
'5 ~()5 REV 9iS(>
This is to certify ti>at 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.
No.
~~.~~~
Local Registrar
Pee for this certificate, $2.00
p
10589251
JUl 2 220M
Date
H'05.143Rev.2J87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
/PRINT
"
'ANENT
:KINK
74 Yrs.
';l 3.195
BIRTHPl.'ICE (CIty and P
Stale or FO<<Ilgn Caunlly) HOSPIT.ol.:
etty.bukg, PA ....-0 ._0
7. a..
FACILITY NAME (If /101 insUMion, Illve sl_t and number)
ST^TEFlLENUMBER
NAME Of' DECEDENT (Firs~ MiQdla. LnI)
..
AGE (LufllO<thday) N
....,
SOCIAL SECURITY NUMBER
26 - 9025
DATE OF DEATH (Mc:>nlh. Oay. Year)
.Ju~ 7 2004
..
COUNTY OF OEA TH
~o
=fyl D
RACE. AmericIIn Indian. Black. White.el
"-Whae
".
o~l
...
eumbe<~and
eM~'u'~e
k.
DECEDENT'S USUAL OCCUPATION
(d":::~'::''':'~='
11&. Laboltelt
DECEDE/Ilrs MAILING ADDRESS (Slre91. City
J 20 eME
KINO Of BUSINESS/INDUSTRY
MARJTALSTA11JS-Menied,
NIlII<<Uutk<I.W\dQIfoad,
DIvorced(SpecIly)
14. w-idowed
SURVIVING SPOUSE
\~-....-........)
11.{;on~tJw.c.t,ion CO.
own. S1a1tl. Zip Code) DECEDENrS
>.0"'''-
RESIDENCE
(S....I...lructlcnt
onO\tler,lde)
17a. Stale VII",,,, ~'JP""oq i"
""
decedent
~~~P7 Hd.O ~hi~~:rn::;:oI
MOTHER'S NAME (Flrs~ Mlddla. Maid..., Sumame)
'l~. Do a . I{
INFORMANT'S IJ.All..lNG ,.,OORESS \SIftIQI. Cltf1:own, SbllIl. Zip Code)
1Ob.164 Fk town Rd. eMa.~e PA 17013
Pl.'ICE Of' DISPOSITION. Name ofCa.....tery. CremBlory LOCATION _ Cily/Town, Stale. Zip Code
~OtherPlace
He. 00 Yal,decedentll:vedln
IflWPh /Jio6pil'l
..,
Hb.Co<m
_.
'SMAN. (F< IIIoddle.LIS\)
ek
..
23b. 23c.
WAS CASE REFERRED TO A EDICAL EXAMINER IC RONE
26. Ya'D NoD
: Appro'dmeta PART II; Qlher signifICant condition, contr1bulinll to dhlh. bIlt
. in\eIV,1belwee noIresulling in lhe undertying cause IlNeo In PAAT I.
: onlO1laoo<kIath
...
27. PAIlf I, [_....~...._.~...___O......lllO...llo, DOA'hm..lho"od.oto~IAg.. h....nll. "'...plnlo""IT..~.I>o.k"'h..rtl.II"...
u.. "",,0"'_"OA_II....
$equenUlilyblcondlllons b
II Iny.l..dlngtaimme<1iaw
ClU". E~terUNOERLY1NG t'
CAUSE (Olsaae or In/Ury c.
lhllllnitlolled......1lII
~ondea\t1Iu.sT d.
WERE AUTOPSY FINDINGS
....V....ILABLE PRIOR TO
COMPLETION OF CAJJSE.
OF DEA TH7
'"
MANNER OF DEATH
',0
,.....
_00'
Suicide
~
o
Homldde
Pendinl!ln\l9lllllalion
CouklnQtbQda~
D^TEOFINJURY
(toIonO'l,O.y.voo.)
o
o
D~EOf"INJURY
"'-"'dInv,~c.(Spoclly>
30..
TlMEOFINJURY
INJURY AT WORK7 DESCRIBE HOW INJURY OCCURRED.
Y..o No.
y"O
"b.
YelD NoD
M. 30e.
At home. rarm, su.el. rectof)'. omce
....
LOCATION (SltHt. CltyfTown, State)
301.
SIGNA~RE '*'0 T~"TYfOf CERTIFIER
(XI"b.,~O.
LICENSE NUMBER DATE SIGNEiD (MorIth, Oay, Year\
.0 31e. 31d. ::fJ( ~ 'LO()
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUS OF'DEATH
(Ilem 27) Type Or Print
/vVf)
21&. 2.b.
CERTIFIER(Cllec:kootyQnll)
l~~~:for~'(S~PJ';,~~re:f:~a~:(:r~3'..r.~8~,h:,~r.rr?~;:r:~.~~~.~.~~,~~~~.~~.~~.)...".
...
'PTR"o~~~~Gm~~~~~:'~~~~i~~~~~~~~~,~~~hd'~:~8.;Zi~:U~.C:;~i~<f'::~!..ru .lal.d,."",......
"MEDICAl. EXAMINERrCORONER
=b::~~~~.I.~~,I~~. .~~~~~.:~~~~~,~~~~;,l~.~~. ~~I~~~:.~~~~.~~~:~.~.~.l. ~~.~.~I~~: .~,~~~:,~.~~.~~~~:. ~.~~,~~. ~~. ~~~~.~~~,~~.. 0
3h.
REGISTRAR'S SIGNAT\JRE AND NUMBER
~. ~eu.~~
iaJ 11d!\ In
OON.l.LDJ.I\OV~S.MD
....lIowllreichl!SFami!yPoadicll~.r
32. lJ5S LlUlO..., Rd., Boing Spriogs. AA 17001.
:TEFILED(MOnll>ds~.er)<? ~oot
LAST WILL AND TESTAMENT
OF
ROBERT E. BOLLINGER
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 15th day of July, Two Thousand and Four,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of BOLLINGER ROBERT E , late of LOWER MIFFLIN TOWNSHIP
{Last, First, MiddleJ
in said county, deceased, to BOLLINGER LORRAINE E
and
(Last, First, Middle)
BOLLINGER TAMMY JO
and NKA MA Y TAMMY JO
(Last First, Middle!
(Last, First, Middle!
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this ~5th day of July
Two Thousand and Four.
File No. 2004-00664
PA File No. 21-04-0664
Date of Death 7/07/2004
S. S. # 195-26-9025
CL~ctJJtW . . ^
~vm .~
~
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
COpy
LAST WILL AND TESTAMENT
I, ROBERT E. BOLLINGER, of Newville, Cumberland County, Pennsylvania, declare
this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and
Codicils heretofore made by me.
I. I direct my Executrices 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 Executrices 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 if1iving.
3. I devise and bequeath all of my estate of every nature and wherever situate to my four
(4) children, share and share alike, but if any of my children owe me any money, such amounts
shall be considered and deducted from any final distribution of my estate.
4. I nominate and appoint LORRAINE E. BOLLINGER and TAMMY JO BOLLINGER
to be the Executrices of this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representatives retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of
November, 2003.
/P 6'()~t (~orbt6ER 7'-;'CI-(SEAL)
Signed, sealed, published and declared by ROBERT E. BOLLINGER, 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.
.,1 . J' ,
(\:Yd~/>,(/'7C ,Jr !:::tA"ula/~/j
. ,
#~lt61/
2
ACKNOWLEDGEMENT AND AFFIDA VIT
WE, ROBERT E. BOLLINGER, SHARON L. SCHWALM 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, si!;ouedthe 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.
IV cr-[-O,-t I;; ItJ /.,,-1107-< .tt~
ROBERT E. BOLLING
\(;12/:-,./ /).( ,y' k::;::j/.i.rl!~>-Lj
SHARON L. SCHWALM
~JY.f4~ i(fffi-
MA HA .N. EL
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by ROBERT E. BOLLINGER, the
testator, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA
L. NOEL, witnesses, this 28th day of November, 2003.
Notarial Seal
Rogt:r B, Irwin. Notary Public
CarliSle Bore. Cumberland County
My' Comml..lon Expires Oct. 3, 2004
Mernber, Pilnnsy~'.nIaAs..ocIatiOl1 of Notaries
3
L Settlement Charnes
700. lotal Ssle&lB"iokers Commluion: (based on price)
,
Oi'fflton 01 CommissIon (line 700) as follows:
Errorl@
Bookmark not
defined.
701.
702.
70:3. Commission paid al Settlement 10 Sallhamet real Estnte
704.
6 . 1tem!l Payable In Connection w th Loan
BOt. loan Origlnstion Fee %
802. loan Discount '3J!.
803. Appraisal Fee
804. Credij R"enort
005. lemler's InspectIon Fee
BOO. MOrtgS!-l6 IMufance. Application r ell
Bal.
Boa. Shelby L. Winter, Tax Collector $2.0(1 PemLit F~
809. _ Commonwealth of PA
810. SollenburgerS Pee
811.
812.
813. SculcUlcnl fee, Smlha.lllcr Re..11 Esk11C
814.
QOa.1tema Required by lender to Be Psld In Advance
901. Intarest from \0
902 MortgaQe Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves Deooelted wit" lender
1001. Hazard Insurance
1002. Mortoaoe Insurance
1003. Cl ro taxes
1OQ4.Cou~onertvtaxes
1005. Annual assessments
1006:-1
1007.
1008
1009.
1100,1Itle<;:I\': es
1101. Settlementfcloslng fee
1102. Abstracl/l:ltre search
1103. Tille examination
1104. Title insurance binder
1105. Document f~ BfBtkm
1100. Nolary tees
1107,AUorne 's lees
includes above ilem numbers
1106. Tille !nsuranr:&
(Includes above Item numbers
1109. Lender's covera-;;e
1110. Owner's coveraCle
1111.
1112.
1113.
1200. Government Recording and Transfer ChlfgeS
1201. Recording fees; Deed Mllrt a e
1202. Citv/oounf'J taX/stam s: Deed
1203 Slate lax/stamps; Deed
1204.
1205.
1206. . . -
1300. Additional Settlement Ctlargea
1301. Surveil
1302. Pest Itl'Specti'Jn
1303.
1304..
1305.
1308:
1307:'
1308.
1400. Total Settlement Char eti: This Number Transoor. to Llne'lS 103 & SOl Above
P.o.c.
P,o.c.
P.O.C.
'15.00
per ay
months $
montt\sft s-
monlhs ftI $
mtmlhs
llonlhs III $
1\tmlhs
perrnonlh
per month
ermooth
nermonlh
er morill1
ar month
.
'.
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Release
Morj;:.ane
Morl"'ane
.
'.
.
,,-
.
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.
. .
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2,0 .00
_ S,,1Ie1
To the best of my knowledge 'he HUn-' Selllemenl Statement which I have prepared 19 ttue and
have been or Will be disbursed by the uncler81gned U jlatl of ttwl se\\\l'lmen\ 01 thl9lranl5actlon.
Selllement Alieni
Dale
lOlf&I 1502-0165l
u.s. DEPARTMENT or HOUSING IIND llRBIIN f1EVELOrHENl'
A. HUO:t UNII=ORM SEITL!;:MENT STATEMENT
B. Type of. Loin
1. FH~,2.FmHA 3. Con.... Uni'ns. . File Number: osn urn er: ,or gage nsuraoCQ 3s'! um er:
4.0 VA:S.:' OCGfW. Ins.
. : IS orm urms, es a s a emen a se emen cos . moun s pal 0 an y e lie emen agen are s own, ems ma e
~.....were paid oulslde the closIng; they are shown for informationsl purposes and are ~)til1clutled m the totals.
U. I sme II Address of BOlTClwer: E. Name, Address & TIN of SeUer: f. Name S. Address of Len~er:
David R. & Cheryl J. Ocker
789 OeUmt Rd. Estate of Robert Bollinger .
Gala"{ Va. 24333 lzO ConodoDuincl Mobile Eslalcs
G. Pro ert Location: TlNllfSeller: H.SefllementAgenl:
Place ofSeUlemenl
120 Conodoguinet Mobile Eslales 494 E.,sl KingS!. Sailluuuer ~I Estate, Inc
New....ille,Pn.IIHl Shi"""'lSbur2, Pa. 17257 1. SelllementDale: I
J. Summary ot Borrower I! "Transaction Summary of Seller s I ransacUon
100. Ora.s Amount Due tram Borro~t 400. rOil ml)unl Due let Sellet:
101. Contract sales price IS.UOU.l){} WI. .....Of\'TaC'Saes Imce J 5,000.00
102, Personal Property 402. PtHsooal Pft)p(lrly
103. Borrower's settl~menl charges (line 1400) ,uo
104. ~V4 .
105. 405.
Adjustments fur item. paid by seller tn advance AdJu.tments Tor .t.me plld by .,III'er In Idvlnoe . .
106. Cllyftown taxes l t12JIZU04 10 %f30ntmS" 10).94 14Ua. Llty/lown laxes 11/231200<1- 100<i/J01201Jo 103.94
107.,Counlylaxes 11/2312004 10IUl!nO()4 3.42 40f. county-texes 11123/20(l4 101213112004 J.42
10B. Assessmenls 10 i4<JB. A$$essmen\s 10
109. PalkRent 11/2312004 101113012004 49JKJ 409. Park Rent lllBno04 to 11/3012004 49.00
110. 410. .
111 11.
112. 412.
113. 413.
120. Ora.s Amount Due trom Borrower 15,156.)6 20. GtOIl Amoun.~ Dus to S.II., 15,156.J6
200. Amounts Paid by or In Behalf of Borro"".er: 1111. R.duotionsln Amount Du. to Sell.r:
201. Deposits or earnest money 200.00 01. Ell,~ess cnposl\ ISB'e inslructions)
202. prlnc1pelatnOuMl ot new loan(s) 02. Settlement ct\8fQ6S (1) seller lUne 14(0) 2,075.00
203. Existing loan(s) taken subject to 03. E)(i5tin~ loan(sllakef\ subject to
204 04. Payoff of firsl morlgage
205. 05. Payoff of second morlgage
.~Q6~ .--;;;; 06
'201. 7.
208. "'B.
209. 509.
AdJu.tmentlllor Uems unpaid by seller Ad ustmanls for Utml unDltd bv ...II.t
210. Cit'1ItOWI1 tSl<.SS 10 10. Clty/lownlll:xes 10
211. COUl1tytUElS 10 11. County laxes 10
212. Assessments 10 12. Assessments 10
213. 10 513. 10
214, 14.
215. 15.
216. ,.
217. 517.
216. "
219. .,. 19.
220, Total Psld Sylfer Borrower lQO.OO 2\). Toul RedllotiDn Amounf Ou. Sellsr 2,075.00
300. Calh at Settlement Fromlfo Borrower \]'3. Ca.h at Setttement To/from Seller
301. Gross amount due from borrower (line 120) ]5,156.36' Ot, Gross 3\lli)\m\ due to seller {lIne 420 15,156036
3U2, Less amounts paid bvlfor borrower (line 220) 200.00 02. less reductions In amOUnt due sellel (line 520 2,U'75.00
303. Ca.h l)('1'rom -r-Ito Borrower 14,956,]6 03.Cuh IXI to I I from Seller l3,mll.36
\/
/
Substitute Form 1099 SeUer Statement
The information In Blocks E, G, H, I & Iine4Q1 (or. jf line 4011$ uterisked,l\ne 4U3 and 404) 1s Importan! tax informatIon and Is being
t\lmlshe-d \0 'the Internal Revenue Service. If you are required 10 file II return, a sanction will be Imposed on you If thIs Item I~ required to tIS
reported and the IRS determInes that It has not been reported, If this real estate Is your principal residence, file Form 2119. Sale Of
Exchange of PrfHcip81 ResldiJhce. fat ~ny gain. with your Income tal<. returri-. 'or other transactions, complete the applicable pints of !=orm
4197, Form 6252 endlor Schedule D (Form 1040). You Bre requlrtld to provIde the Settl~mel'\t Agent \hamed above) wllh your correct
tax.payer ldentificat\oT' number. If you do not provide the Settlement Agent wllh your taxpayer Id"mtlfication number, you may be subjecl to
civil or crlt!l'nal pensltles Imposed by law. Under p~na\t\es 01 perjury, I certify that the number llhown on thl,s .stilter:nenI19 my torrect
taxpayer fdenUncatlon number. . ,
(Sener's Signature)
(Seller's SlynalUie)
PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
tv 1~
MEMBERS 1st
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/2004 to Date of Death
Name of Previous Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/2004 to Date of Death
Name of Previous Joint Owner
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/2004 to Date of Death
Name of Previous Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/2004 to Date of Death
Forfeitures
Narne of Previous Joint Owner
193904 -00
OS/24/2000
$329.81
$.05
$329.86
$3.21
Tammy Jo May - removed 06/23/2004
193904 -11
OS/24/2000
$6,516.83
$.28
$6,517.11
$586
Tammy Jo May - removed 06/23/2004
193904 -05
05124/2000
$6,749.16
$1.20
$6,750.36
$173.22
Tammy Jo May - removed 06/23/2004
193904 -42
09/27/2003
$10,144.11
$3.13
$10,147.24
$185.50
$91 .44
Tammy Jo Bollinger - removed 06/23/2004
MM~RS 1ST FEDE~~L CREDIT UNION
~~td( d ~~
Denise A. Wolfe I ~
Insurance Services Supervisor
November 9, 2004
Estate of: ROBERT E. BOLLINGER
Date of Death: 07/07/2004
Social Security Number: 195-26-9025
,
I
I
v
5000 Louise Drive' PO. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org
united american;ns~nce company
08/31/04
Estate or Robert 801.1 inger
154 Fry town Rd
Carlisle PA 17013
Policy S74418&20
Irlsllred~ Robert E Bollinger
Dear Sir or Madam:
The recent refllnd was processed based on the paid to date of the
polley_
We are now j,nformed by our Accounting Department that
renewal payment was returned unpaid by the bank. As a
an over refund in the amount of $214.95 was made.
the last
result
Please submit your personal check or money order
return envelope to my attention to insure proper
in the enclosed
handling.
Thank you In advance for giving this matter your prompt attention.
Sincerely,
Angela Perkins
Policy Service Department
Enclosure
-~
I
,
POST OFFICE BOX 8080 . MCKINNEY, TEXAS 75070-8080 . (972) 529-5085
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
-------------------
-------------------
RECEIPT FOR PAYMENT
cumberland County - Register Of Wills
Hanover and High StreeE
Carlisle, PA 17013
BOLLINGER ROBERT E
Estate File No. :
Paid By Remarks:
2004-00664
T J MAY
VZ
Fee/Tax Description
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Check# 93
Total Received.........
Recetpt Date:
Rece~pt Time:
Receipt No. :
7/15/2004
14:56:39
1037217
Amount
Distribution ------------------------
Receipt
Payment
40.00
6.00
18.00
10.00
----------------
$74.00
$74.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
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. ............... ........,......" ."... ...~v..<.; PV1 UV" ~I""" . <.;.UI" ..,Uj }Iv.... p....y"'o.;,,.
Account If: 205411'2001 Motor TypojProvious Ad' P~osenl Rd 1- Multiplier I KWH Used I R~ad~g I
Name: ROBERT E BOLLINGER EST --- yp
KWH 61940 62050 1 110 Actual
Reading Dales: 10;07/2:004 TO 11/06/2004-
Rate: RESOl RESIDENTIAL
Service Loc: CME-SBG LOT 120
-- ---'---"---.--- ..__'.'_n_____"
BILLING DETAILS
BASIC CHARGES NON-BASIC CHARGES
Energy supply prices and charges are set
by your electric generation supplier.
Adams Electric Cooperative Inc. (888) 232-6732 <<
1338 Biglerville Road
Gettysburg. PA 17325-1055 ~ \\ ~
ENERGY SUPPLY:
Energy charge 110kwh@ .04074 4.48 ~J
TOTAL ENERGY SUPPLY 4.48
DISTRIBUTION:
Service char~e 13.00
Distribution c arge 110kwh@ .02926 3.22
TOTAL DISTRIBUTION 16.22
ACCOUNT SUMMARY
Rev Month NOV 2004 Previous Balance: -16.20
Payments Received: 0.00
Total yearly Balance Forward: -16.20
KWH for 3030 Total Basic: 22.69
FCR CHARGE 110kwh@ .01805 1.99 past 12
months Total Non-Basic: 0.00
f-.-.--- Sales Tax: 0.00
TOTAL BASIC CHARGES: 22.69 Average
monthly 252"- ACCOUNT BALANCE 6.49
KWH
for past 12
months
PAYMENT DUE 12/15/2004 (6.49 )
'- ./
r
I
;
~
Account #: 2054112001
Name: HOBf:tfl E dOLLINGeR I:.~T
Meter Type
KWH
Read ing Dates: 07 {7 /2004 TO 08108/2004
Rate: RESOl RESIDENTIAL
Service Loc: CME-SSG LOT 120
61770
61840
70
BilLING DETAilS
BASIC CHARGES
Energy supply prices and charges are set
by your electnc generation supplier.
Adams Electric Cooperative Inc. (888) 232-6732
1338 Biglerville Road
Gettysburg, PA 17325-1055
ENERGY SUPPLY:
Energy charge
70kwh@ .04074
2.85
TOTAL ENERGY SUPPLY
2.85
DISTRIBUTION:
SerJice charge
Distribution charge
70 kwh @ .02926
1'3.00
2.05
TOTAL DISTRIBUTION
15,05
FCR CHARGE
70 kwh @ .01805
1.26
TOTAL BASIC CHARGES:
19.16
NON-BASIC CHARGES
Glqqo
~-\y~
WSO
'0'6'
u I '
'tf q --'10.07
EBILL IS HERE! VIEW YOUR ELECTRIC BILL ONLINE NOW!
VISIT HTTP://EBILL.ADAMSEC.COM FOR ACCOUNT
IN~vRMA"10N.
Rev Month AUG 2004
Previous Balance:
Payments Received:
Balance Forward:
Total Basic:
Total Non-Basic:
Sales Tax:
ACCOUNT BALANCE
Total yearly
KWH lor 3590
past 12
months
Average
monthly 299
KWH
for past 12
months
29.75
-29.75
0.00
19.16
0.00
0.00
19.16
"
\
..---i
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, P A 17013
NOVEMBER 12, 2004
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Lowell R. Gates, ESQUIRE
RE:
Robert E. Bollinger, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------------------------------------------------------
---------------------------------------------------------------------
Advertisement inserted on following dates:
October 29, November 5,12, 2004
Advertising Cost
Proof of Publication
Second Proof Request
Payment Received
Total Amount Due
Payment received October 26. 2004
by Beckv H. Morgenthal/Executive Director
$ 75.00
$ 0.00
$ 0.00
$ 75.00
$
0.00
---------
---------
/
..(
\}
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16,1929), P. L.1784
STATE OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND :
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2,1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
VIZ:
OCTOBER 29, NOVEMBER 5, 12,2004
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Bollinger. Robert E., dec'd.
Late of Lower Mifflin TOWnship.
Co-Executrices: Tammy Jo May,
509 Baltimore Pike. Mt. HoUy
Sprtngs. PA 17065 and Lorraine
E. BoIUnger. 164 Frytown Road,
Carlisle, PA 17013.
Attorneys: Lowell R. Gates, Es-
quire. Gates. Halbruner & Hatch,
P.C.. 1013 Mumma Road, Suite
100. Lemoyne. PA 17043.
, Editor
S RN TO AND SUBSCRIBED before me this
12 day of NOVEMBER 2004
NOTA l SEAL
LOIS E. SNYDER, Notary Public
CHilisle Boro, Cumberland Counly
My Commission Expires March 5, 2005
I"
.. .. .....
~
...-
-
HoIIin~er Funeral Home & Crematory, Ine.
Eric L. HolIinlier, Supervisor
July 26, 2004
Mrs, Lorraine Bollinger
J 64 Fry town Road
Carlisle, PA 17013
Dear Lorraine:
On behalf of everyone at Hollinger Funeral Home & Crematory, Inc, we're
honored you selected us to handle your loved one's arrangements. We want
to thankyoufor trusting us with this very important service.
We'd like to once again express our condolences, We hope we were able to
ease your mind and provide some comfort to you in this most difficult time.
I have enclosed the 12 additional Death Certificates that you requested...
ecertificate costs $2.00@I 2 additional that is a total owed to us of
$24, OO~ you are interested in the additional obituary cards, please
nt.act-n:~, .
Sincerely,
~~.J~.
Eric L. Hollinger
Supervisor
501 NORTH BALTIMORE AVENUE. MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 . (717)486-3433 . FAX (717)
www.hollin~erfuneraIhome.com
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W' ESTATE OF ROBERT E. BOLLINGER
~ st
MEMBERS I"
FEDERAL CREDIT UNION
~'1I.17m
b~._benil'l.lIIJ
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CORRECTED fir checked\
~ame. street add'ess. city. state. liP code. and telephone no. Payer's RTN (optional) OMB No. 1545-01' 2
ORNERSTONE FEDERAL C.U.
T .GATE DRIVE ~@O4 Interest Income
~ B<)K' nn
" . LISLE PA 17013
/
(7Jj7) 249-1661 Form 1099-INT
+--PA~R'S Federal identification number I RECIPIENT'S identjfrcation number 1 Interest ir\COI"lre not included in box 3 Copy B
? -1948719 175-48-5135 $ For Recipient
J;!:ECIPIENT'S name, address. and ZIP code 2 Early withdrawal penalty 3 Interest on U.S. Savings This is important tax
/ Bonds and Treas. obligations information and is
I LORRAINE E BOLLINGER $ $ 1792 .40 being furnished to We
Internal Revenue
164 FRYTOWN RD 4 Federal income talC withheld 5 Investment expenses Service. If you an.!
CARLISLE PA 17013 $ $ required to file a return,
a negligence penalty or
6 Foreign tax paid 1 F"oreign coufltry or U.S. other sanction may be
possession imposed on you if this
income is taxable and
Account number (optional) the IRS determines that
it has not been
0 $ reporter!
\J-
Fmm 1099-INT
* Printed on Recycled Paper
(keep for your records)
Department of the Treasury - Internal Revenue Service
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Receipt
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'Y 0--:>+0_
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Is any Portion of this Sale a Charitao
DYes
Tax Deduction?
)lSt'NO
If ~Yes," the fair market value of the postage portion of the foregoi
First-Class postage rate.
By (SignatU(~. Tit1~ I Date
L-,--c: ~ of;~~
PS Fonn 1096, April 1998
c
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;20
CONODOGUINET MOBILE ESTATES
Lease Agreement "Renewal"
This agreement, made and entered into in d~plicate on
thi\ FIRST____ day of SEPTEMBER, 2004, by and between
(Lessor) and
MOBILE
/J
-,.1,,.', ; I ..~..
,":___/~J--"..../I ---<Lv'I'U!......
ESTATES herein after called
13<1-.!.l!..-"7_< (>,'..~
/
called Resident (Lessee).
the Management
CONODOGUINET
herein after
WITNESSETH: That the Management (Lessor) does hereby rent
(Lease) to the Resident (Lessee) the following described
premises, to wit: Lot #
/:26
for the term of ONE YEAR
commencing on SEPTEMBER 1, 2004, and ending on AUGUST 31, 2005
for the following monthly sum:
Basic site rental
,1'1 /\ (; vo
.d- U (j'
so.
Additional residents
Pets
Storage fees
Others
Total Monthly Rent
,r, 0' 'I, " "
,j ,J.
This tenancy is not transferable.
Signedr;:!1f,f4""J 1_'{!0.,.--</~t/ SS No
r;/
DOB
Signed SS No
DOB
Signed
SS NO
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/<..._)./',<./--(/(:_-_-1--1 ;; ,1/.<1./-.,/" ...J
f
(Management)
DOB
In the presence of management
,
Date ~' -' 17' D <I
f)()cI~' /011<.611
r- DATE
0. RECEIVED FROM
-
UJ
No. 7814896
1$2?8A> I
DOLLARS
U OFOR RENT
OFOR
UJ ACCOUNT
~ PAYMENT
""'- BAL. DUE
OCASH J#m
~ECK.r(
OMONEY li BY
ORDER I
, ......2701
~ DATE No. 784949
a. RECEIVED FROM 1$~-t6 I
LU DOLLARS
U OFORRENT c(-
o FOR
OCASH #J~r ..:.
LU ACCOUNT
~
~ 'PAYMENT ~ECK ~
BAL. DUE OMONEY j BY
ORDER -.2701
(
J
t-
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Uj RE;;;':
U 8~~~RENT !&J--f#I/t:J-~--f-
LLJ ACCOUNT OCASH
AJ PAYMENT Q9.CHEC
""" BAL. DUE . OMONEY
No. 784897
I $~,{~Ch I
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Now you know
Order Confirmation
Paver
Paver Account Number
11885
Sales
Order Taker
Order Source
0001211942
rholton
rholton
Fax
Customer
GATES, HALBRUNER & HATCH, P.C
Orderer Account Number
11885
Ad Order
Soecial Pricinq None
GATES, HALBRUNER & HATCH, P.C
ATTN: TRACI L. SEPKOVIC, 1013 MUMMA ROAD,
SUITE 100
LEMOYNE PA 17043 USA
PO Number
Ordered BV
Customer Fax
ESTATE OF BOLLINGER
TRACI
Customer EMail
Customer Phone 717-731-9600
Paver Phone 717-731-9600
Tear Sheets
o
Proofs
o
Affidavits
1
Blind Box
Promo Tvpe
<NONE>
Invoice Text
Ad Order Notes
Materials
Total Ad Cost
$297.07
Payment Amount
$0.00
Payment Method
Amount Due
$297.07
Ad Number Ad Tvpe
0001211942-0' Legal liners
Ad Size
: 1.0 X 24 li
Color
<NONE>
Production Method Production Notes
Ad Booker
Product Information
Classification
# Inserts
Run Dates
PNCO: :Full Run
806-Estate Notices
3
11/3/2004, 11/10/2004, 11/17/2004
Run Schedule Invoice Text
LETTERS TESTAMENTARY for the Estate of Robert E. Bollinger, dec
11/17/2004 9: 11 :06AM
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THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Michael Morrow, being duly sworn according to law, deposes and says:
That he is the Controller of The Patriot News Co., a corporation organized and existing under the laws of
the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in
the City of Harrisburg, County of Dauprun, State of Pennsylvania, owner and publisher of The Patriot-News and The
Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the
City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th,
1854, and September 18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared on the 3rd, 10th and 17th day(s) of November
2004. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and
that all of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
COpy
Swo
PUBLICATION
GATES, HALBRUNER & HATCH, P.C.
ATTN: TRACl L. SEPKOVIC
1013 MUMMA ROAD
LEMOYNE, PA. 17043
Statement of Advertising Costs
LoweU'R'~Gaht.. Esquire
Ga"~:,f;falbrun.r&Hatch, P.C.
1013 'MummaROCId. Sultf'OO
L.emo:viie,"PA'l7043
To THE PATRlOT-NEWS CO.
For publishing the notice or publication attached
hereto on the above stated dates
297.07
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have
been duly paid.
By....................................................................
RETAIN THIS PORTION FOR YOUR RECORDS
m~~~~L I B!LL TO
P.O. BOX 130 CARLISLE PA 17013 LORRAINE BOLLINGER
AD NUMBER I CLASS SALESPERSON BJlllNG DATE LINES
269272 760 MOBILE HOMES 28 08/25/04 5
AD DESCRIPTION START DATE STOP DATE
NEWVILLE, 14X70 IN NICE PARK. 2 BED 07/23/04 08/21/04
PUBLICA liON INSERTIONS RATE NET AMOUNT GROSS AMOUNT
THE SENTINEL 30 OPN 162.0(
TOTAL AD CHARGE 11-/ (}j/ 162.0(
1 HANDLING 01HAN 1. or
8' :.5~ 01
DAYS RUN
PURCHASE ORDER PAY THIS AMOUNT 163.00 195.60*
. AFTER 09/09/04
MESSAGE:
SENTINEL CLASSIFIEDS - direct 240-7130 or dial 243-2611, 697-4611,
582-0100, 530-0155. FAX your ad to 243-3754.
You can also email youradto:c1assified@cumber1ink.com
Be sure to include your name, mailing address and a phone number
we can reach you at to verify your ad.
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PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
50
Account #: 2054112001
Name: ROBERT E BOLLINGER EST
Reading Dates: 08/8/2004 TO 09/10/2004
BILLING DETAILS
BASIC CHARGES
Energy supply prices and charges are set
by your electnc generation supplier.
Adams Eleclric Cooperative Inc. (888) 232-6732
1338 Biglerville Road
Gellysburg, PA 17325-1055
ENERGY SUPPLY
NON-BASIC CHARGES
~40
C. ~~~
Q ~:;CJ
:;.
Energy charge
WPCA
50 kwh @ .04074
50 kwh @ .00500
2.04
0.25
TOTAL ENERGY SUPPLY
2.29
DISTRIBUTlbN:
Service charge
Distribution charge
Deposit
Deposit interest
50 kwh @ .02926
13.00
1.46
50.00-
1.25-
TOTAL DISTRIBUTION
ACCOUNT SUMMARY
Rev Month SEP 2004
Previous Balance:
Payments Received:
Balance Forward:
T olal Basic:
Total Non-Basic:
Sales Tax:
ACCOUNT BALANCE
19.16
-19.16
0,00
-33.60
0.00
0.00
-33.60
ClJ-'l[\ \
~tv
36,79-
FCR CHARGE
50 kwh @ .01805
Total yearly
KWH for 3400
past 12
months
0.90
TOTAL BASIC CHARGES:
33.60-
Average
m~W~IY 283
for past 12
months
CREDIT BILL
DO NOT PAY
-33.60
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Chanel
Pointe
STATEMENT
a/Carlisle
eo /1211 /2121e1L,
770 S. HANOVER ST.
CARLISLE, PA 17013
(717) 249-1363
TOTAL'AMT. DUE
5,591. Q.'0
ROBERT L BOLLINGEH
LORRAINE BOLLINGER
164 FRYTO\>JN RD.
CRRLISLE, PR 1712113
For: ROBERT E. BOU_INGER
12116--~,
- DETACH AND RETURN UPPER PORTION WITH REMITTANCE-
DATE
DESCRIPTION
DEBIT
CREDIT
16/23/~~IZIlZlLt PRES;3-0N NAI'r'JE TAPES
10121 NAME TAPES
7/1211-1217/31 SEMI-PRIVATE ROOM @ $179.121121
L~ ~~" IZI'~
"l-i:!..QI11.1
5, 5L~9. tZlQ\
5,591.00
?d CJ~ut :itQS
'l~l0 -tr--t
dp-t;;1 CO U
y l1lrc ~ 54q ctl UYJ)) fu:/ ~ ffiv
0A0 clLCBlr ~t\h-l.J2& Ja; ~
For: ROBERT E. BOLLINGEH
12116-1)
120 DAYS
.0121
90 DAYS
.1210
60 DAYS
.0121
30 DAYS
.1Z\0
5,5'..11.00
TOTAL
DUE
~
5,591.1210
...... !
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Metro Med Services
P.O. Box 726, New Cumberland, PA 17070-0726
717214-6018 Toll Free 877 214-6018
.
Patient name: BOLLINGER, ROBERT E.
ROBERT E. BOLLINGER
120 CME
NEWVILLE, PA 17241
Patient SSN: 195-26-9025
Run number: 04-24271
Date of call: 6/22/2004
Time of call: 13:04
Caller: Melinda
From: CARLISLE REGIONAL MEDICAL CENT
To: CHAPEL POINTE AT CARLISLE
Primary payor: Bill Patient
Secondary payor:
Description
Amount
Stretcher Van
Mileage/Stretcher Van
Oxygen
Check #
Quantity
Unit price Payment date
1
2
1
80.00
1.25
45.00
a~ ~~ -OY
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80.00
2.50
45.00
/
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$127.50
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NEWVILLE COMM. AMBULANCE C/O PROM ED SERVICES, INC.
4807 JONESTOWN ROAD SUITE 247
HARRISBURG, PA 17109
1-866-678-6855
Patient Bill
ROBERT BOLLINGER
164 FRYTOWN RD
CARLISLE, PA 17013
Page: 1
Printed: 12/13/04 07:05
10: Newv-564
DOB: OS/20/1930
line Dale Range Prv Procedure DxRef POS Charge Unt Apprv'd PI Pd Ins Pd Adjusted PI Due Balance
Patient: ROBERT BOLLINGER
Claim Number: 47400590Diagnosis 1) E888 2) 780.4
Ins: 1) MC/Asgn 195269025A
0106/15-06/15/04 010 A0429RH 12 A 375.00
Procedure: BLS EMERGENCY SERVICE
Date first billed: 12/06/04
0206/15-06/15/04 010 A0425RH 12 A 104.00
Procedure: MILEAGE
Date first billed: 12/06/04
Patient Totals: 479.00
10: 564 OOB: OS/20/1930
3) 4)
1 208.99 167.19 0.00 41.80 41.BO
13 56.55 45.24 0.00 11.31 11.31
265.54 0.00 212.43 0.00 53.11 53.11
I Total Amount Due By Guarantor: 53.111
vvvvvv DETACH HERE wvwv
PLEASE MAKE CHECKS PAYABLE TO NEWVILLE COMM AMBULANCA
Prov Codes: 01 O=Newville Ambuiance
.. ~ - - .. - - - - -. - - ~ - - - - To insure pro er credit, please clip and mail this section for each pa e and include with a ment - - - - - ~ - - - - - - - - --
Guar: ROBERT BOLLINGER #: Newv-564 elms: 47400590
?a e 1 Amt Due for this a e: 53.11
Total Due: 53.11
,/
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Sprint@
Monthly statement: July 4, 2004
10f 6
Customer service
1-800-829-8009
Internet address
sprint.com/local
Customer number
717-776-4966-796
Summary of Current Charges
local long Distance Total
Monthly Service Charges 18.86 .00 18.86
Partial Month Charges -.05 .00 -.05
Other Charges and Usage .07 14.66 14.73
Taxes and Surcharges 6.07 .00 6.07
Previous cha rges
Payment June 24 - Thank you!
Balance
39.43
-39.43
.00
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Glenda Farner Strasbaugh
Register of Wilis
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:
295
4/7/2005
ROBERTE BOLLINGER
21-2004-0664
LOWELL R. GA 1ES, ESQUIRE
1013 MUMMA RD, SUI1E 100
JA
LEMOYNE, PA 17043
Qty
1
Fee Description
Additional Probate
Fee Total
30.00 $30.00
Total:
$30.00
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.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY
UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.:
Robert E. Bollinger
July 7, 2004
21-04-00664
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: No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: August 2005
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a final account with the court? nia
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: nia
C. Did the personal representative state an account informally to the parties in
interest? nia
D. Copies of receipts, releases, joinders and appro als f formal or informal
accounts may be filed with the Clerk of Orp s' ourt and may be attached to
this report.
owe R. Gates, Esquire
PA 1. . # 46779
GAT S, HALBRUNER & HATCH, P.C.
101 Mumma Road, Suite 100
Le oyne, P A 17043
(717) 731-9600
Date: AprilS, 2005
J : \
Capacity: Counsel for Personal Representative
J
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:
LOWELL R. GA1ES, ESQUIRE
1013 MUMMA RD, SUI1E 100
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
295
4/7/2005
ROBERT E BOLLINGER
21-2004-0664
JA
LEMOYNE, P A 17043
Qty
1
Fee Description
Additional Probate
Fee Total
30.00 $30.00
Total:
$30.00
Second Request
***********
Please pay promptly,
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.
r ...
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
LOWELL R GATES, ESQUIRE
1013 MUMMA RD, SUITE 100
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
295
4/7/2005
ROBERT E BOLLINGER
21-2004-0664
Bill To:
JA
LEMOYNE, PA 17043
Qty
1
Fee Description
Additional Probate
Fee Total
30.00 $30.00
Total: 'PC\ J Lo L~ y<(
$30.00
Second Request
***********
Please pay promptly.
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
06-27-2005
BOLLINGER
07-07-2004
21 04-0664
CUMBERLAND
101
APPEAL DATE: 08-26-2005
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _
REY:is4;-Ex-AFP-io3:osi-NOTICE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLowANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ROBERT E FILE NO. 21 04-0664 ACN 101
BUREAU OF INDIVIDUAf.tAXE$
INIERITANCE TAX DIVISION . ,
PO BOX 280601 -
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
H"l
,-. ')!I
~~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
,j;'
(l~
LOWELL R~.GArES
GATES ETIIL
1013 MUMMA
LEMOYNE
ESQ
RD STE 100
PA 17043
ESTATE OF
BOLLINGER
*'
REV-1547 EX AFP (06-05)
ROBERT
E
TAX RETURN WAS: (X I ACCEPTED AS FILED
I CHANGED
DATE 06-27-2005
I~ an assess.ent was issued previOUSly, lines 14, IS and'or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. AIIount of Line 14 at Spousal rat. (IS)
16. Anount of Line 14 taxable at Lineal/Cless A rate (16)
17. AItount of Line 14 at Sibling ..t. 117 I
18. Anount of Line 14 taxable .t Collateral/Class Brat. (18)
19. Principal Tax Due
TAX C
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estat. (Schedule A)
2. stocks and Bonds (Schedule B)
3. Closely "-ld stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedul. D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule EJ
6. Jointly Owned Property ISchedul. FI
7. Transfers (Schedule S)
8. Totel Assets
(11
(21
131
141
(51
(61
(71
13,081. 36
.00
.00
.00
25.463.10
.00
.00
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule Hl
10. Debts/Hort~ge Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax R.turn
13. Ch.ritable/Govenn.antal Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estat. Subiect to Tax
(91
1101
8,403.28
898.90
1111
1121
1131
1141
NOTE:
.00
29,242.28
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
.
INTEREST/PEN PAID (-I
.00
.00
AHOUNT PAID
1,315.00
.90
DATE
04-05-2005
04-05-2005
NUNDER
CD005167
CD005172
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
1191=
NOTE: To insure proper
credit to your account,
~lt the upper portion
of this fora with your
tax pBYllent.
38,544.46
I) .3D? 18
29,242.28
.00
29,242.28
.00
1,315.90
.00
.00
1,315.90
1,315.90
.00
.00
.00
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE DF THIS FOHN FOR INSTRUCTIONS.I
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 6/22/2007
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GATES LOWELL R
1013 MUMMA RD STE 100
LEMOYNE, PA 17043
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RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
7/07/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Si~,~. ~
, ~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
cJ
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 6/22/2007
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509 BALTIMORE PIKE
MT HOLLY SPRINGS, PA 17065
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RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
7/07/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
J
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 6/22/2007
164 FRYTOWNROAD
CARLISLE, PA 17013
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BOLLINGER LORRAINE E
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RE: Estate of BOLLINGER ROBERT E
File Number: 2004-00664
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by:
7/07/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
J
Pa, O,C, Ru.le 6,12 STATUS REPORT
REGISTER OF WILLS OF 0MhelllAnL COT.JNTY, PENNSYLVAN1A
Name ofDecedent~ e R. t. E 130 ,,} (\3 -Gr
Date of Death ;X It 0'7 - Jay/ File Number: :J I -01 - 0661
Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration or
the above-captioned estate: .
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . ., ~Y es D No
2. lfthe answeris No, state when the personal representative
reasonably believes that the adri1inistration will be complete:
3. lfthe answer to No.1 is YES, state the following:'
a. Did the personal representative file a fina1"account with the Court? . . . .., DYes
DNo r/Uol
. " SqR.t..-
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
dO(VT K.(lJOU-
#
c. Did the personal representative state an account
infoID1ally to the parties in interest? ..............,................ mYes DNo
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.
Dale
O(jJ(LL, ?Ol i)007
/
Capacity: OPersonal Representative D Counsel
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Pa, 0,(:, Rule 6,12 STATUS REPORT
REGlSTEROFWILLSOF tJJmPdJllfind C01JNTY,PEN~SYLVA:N1A
NameofDecedeut ]2obeflf [ !1f2}JIr)(r'
Date of Death: 7 - '7 - ()4 File Number: ::J/ -{)L! -~ ~ (j
Pursuant to Pa. O.C. Rule 6.12, I report the follmving with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . .~ Yes 0 No
2. lfthe answeris No, state when the personal representative
reasonably believes thatthe adrmnistration will be complete:
3. lfthe answer to No.1 is YES, state the following:'
a. Did the personal representative file a fina1'account with the Court? . . . .., DYes
?
DNo
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
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c. ~id the personal repr~se~ta~ve sta~e an account ~
mformally to the partIes m mterest. ..............,................ ~'i. es 0 No
d. Copies of receipts, releases, joinders and approvals of fonnal orinfonnal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this repOlt.
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