HomeMy WebLinkAbout02-0802
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Samuel
also known as
D.
Blevins
No. 21-02-802
To
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No.
213-14-9017
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the executor
in the last will of the above decedent, dated April 29, 1981
and codicil(s) dated N/A C/,h~A-~, ~!'3>{!!!t/h'tLS
named
L~/ ~An".u// ~ o?e-oR.
tz
(state relevenat circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
his last family or principal residence at
748 Meadow Drive, East Pennsboro Township, Cumberland County, Camp Hill
(list street, number and municipality)
Decedent, then 82 years of age, died February 3,2002
at Manor Care Health Services, North Cornwell Township, Lebanon County
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: No Exceptions
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ unestimated
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
thereon.
Kenneth David Blevins
2608 Curry Comb Court
Virginia Beach V A 23456
~~~
L nn 0 nna mIt .
15 Hill Street, P.O. Box 68
Railroad P A 17355
OATH O}'rpERSONAL llliPRS~NTA'nVE
COMMONWEA TLH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~
before me this 14th day of
May, 2002
~/.>7 OtPJ, t<<.acZ
ary . eWIS ~"n j ;}_ J Register
~ ~ .A.~Lo/
No. 21-02-802
Estate of Samuel
D.
Blevins
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW SEPT. 6, 2002 in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated_ April 29, 1981
described therein be admitted to probate and filed of record as the last will of
Samuel D. Blevins
and Letters Testamentary
are hereby granted to Kenneth David Blevins and Lynn JoAnna Smith
FEES
Probate, Letters, Etc. $ 235.00
Short l'ertificates(l) $ 6. HH
x-pages 6 --
Renunciation $
JCP $ 5.00
Total_ $ 252.00
Filed.... .~.~.~.?:~~~~...??. ~~~ ~
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~iS~l~~I~.V7 ;flU
Stephen D. Tiley 32318
ATTORNEY (Sup. Ct. J.D. No.)
5 South Hanover Street
Carlisle, Pennsylvania 17013
ADDRESS
(717) 243-5838
PHONE
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PETITIO~ FOR PROBATE and GRA~T OF LETTERS
Estate of Samuel
also known as
D.
Blevins
No. 21.02-802
To
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
213.14.9017
Social Security No.
The petition of the undersigned respectfully represents that:
Your petitionerCs), who is/are 18 years of age or older and the executor
in the last will of the above decedent, dated April 29, 1981
and codicil(s) dated N/A
named
Cstate relevenat circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County., Pennsylvania, with
his last family or principal residence at
748 Meadow Drive, East Pennsboro Township, Cumberland County, Camp Hill
(list street, number and municipality)
Decedent, then 82 years of age, died February 3,2002
at Manor Care Health Services, North Cornwell Township, Lebanon County
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: No Exceptions
Decedent at death owned property with estimated values as follows:
CIf domiciled in Pa.) All personal property
CIf not domiciled in Pa.) Personal property in Pennsylvania
CIf not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ unestimated
$
$
$
WHEREFORE, petitionerCs) respectfully requestCs) the probate of the last will and codicilCs)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
there~~.tI~ if~
K~LJ. [J~
Renneth David Blevins
2.608 Curry Comb Court
Virginia Beach VA 23456
Lynn JoAnna Smith
15 Hill Street, P.O. Box 68
Railroad P A 17355
OATH O}' PERSONAL REPRSENTATIVE
COMMONWEA TLH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The petitionerCs) above-named swearCs) or affirmCs) that the statement in the foregoing peition'are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
:ative(s) of the above decedent petitionerCs) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
)efore me this 4~ day of
~lA~t~2002
'. :J"~Ctu.~~-hj t-\lf\<-
J "" 0./ _ -,
~~tfJ.ll~
~ LJ~t<LI7~
Register
No. 21-02-802
Estate of Samuel
D.
Blevins
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW SEPT. 6 2002 in consideration of the petition on
the reverse side hereof, satisfacrory proof having been presented before me,
IT IS DECREED that the instrument(s) dated_ April 29, 1981
described therein be admitted to probate and filed of record as the last will of
Samuel D. Blevins
and Letters Testamentary
are hereby granted to Kenneth David Blevins and Lynn JoAnna Smith
JCP
FEES
$
$
$
$ 5.00
Total_ $ 252.00
Filed....... .~.~~.~.~~~.. .~.!.. .?~~ 2
235.00
6.00
6.00
~ /T} ~J /4tl'. ,Q4<'Y
RegisterofWills~ ~~
Stephen D. THey 32318
ATTORNEY (Sup. Ct. LD. No.)
5 South Hanover Street
Carlisle, Pennsylvania 17013
ADDRESS
(717) 243-5838
PHONE
Probate, Letters, Etc.
Short Certificates ( 1 )
x-pag~s .
RenUnCIatIOn
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21-02-802
REGISTER OF WILLS OF CUMBERLAND
OATH OF SUBSCRIBING WITNE
X:UcXIX
(each) a subscribing wit ss to the will
law, depose(s) and say(s) tha
Samuel D'-Blevins
the testat or , sign the same
request of testat or
other subscribing witne es)).
.if''''"''''
Register
d and subscribed before
day of
XN ?oo?
herewith,-. (each) being duly qualified according to
present and saw
signed as a witness at the
'n the presence of each otl?,.er) (in the presence of the
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Tp.J'oy !'lmith
(each) a subscriber hereto, (each) being duly- qualified according to law, depose(s) and say(s) that
he was familiar with the signature of Samuel D. Blevins
\,- codicil
of (one of the subscribing witnesses to) the will
testat or
that
he
Samuel D. Blevins
presented herewith and
- ~KiXi.K
believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
his
Sworn to or affirmed and subscribed before
me this 14th day of
~ X~~
J~_ 1Jt-..6~ /Ld J~~U
Mary C. Lewis ~~ Reg "Ster
~
L~~/l4.~
Leroy Smith (Name)
15 Hill Street, P. O. Box 68 Railroad, FA 17355
(Address)
(Name)
(Address)
21-02-802
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUBSCRIBING WITNESS
RT1'v1T 1NT) ~ MVl<'pS
DIltixX
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that he was present and saw
Samuel D. Blevins
the testat or , sign the same and that h~ signed as a witness at the
reqUest of testat or in h is presence and ~ ~(in the presence of the
other subscribing witness(es)).
~~e)
P .0. Box 109, IBnoyne,
(Address)
PA 17043
Sworn to or affirmed and subscribed before
me this 6th day of
_AUGUST 2002
"- h-..,---J /J? /JrLJ, U;r J L{~"" Y
'~AU~
(Name)
(Address)
REGISTER OF WILLS OF ClMBERIAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
RALPH H. WRIGHT, JR.
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
he is familiar with the signature of Samuel D. Blevins
codicil
will
test at or
of (
presented herewith and
~
believes the signature on the will is in the handwriting of
the
that
he
Samuel D. Blevins
to the best of his knowledge and belief. ~
Sworn to or affinned and subscribed before ~ 0 \
6th ,. Ra P H. l.ght~ JJ;.
me this day of 7Name)
AUGUST ..2llil2.... P.O. Box 109, Lemoyne,
~Jm~~)/7}O~~) ~ 4<7
~ A-u 4ey Register
PA 17043
(Address)
(Name)
(Address)
H105.112 REV. 8/88
(FEE FOR THIS
CERTIFICATE $200)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5112 791
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Date of Issue 0' This CertificatIOn
21-02-802
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First Middle [_jS!
Sex "-Yfl/.14, Social Security No. ;[/3 J J.j- tfJ d I 7 Date of Death~ ~IJ~~~_
Date of Birth Jf)U,<. F, I'} 1'1 Birthplace c.,l.pL-e.-l, ~ __ ___ ___ ___
Place of Dea~Ii..~I1.kA;wlu.AK.t!.4A" ytJ .k4l.tIHl.) ~'d /#~~ ,,~g__~_-.Eennsyl~n~i~
FaClhly Name . . ~~4 ~f80'o"g,;t-: Tow"',,,o ~
Race tA~-j;2 Occupation 7~---'- VL/~JJ Armed Forces? (Yes:r NO)_~___~___n~__~_
. \. Decedent's n1'J II. /p '" I 1\
Mantal Status I~d~ Mailing Address "1-!'rlrN<d~4~p.t-~YLa~ ~/!::./J~ JaL-'-1'?Lfn~--
Informan~"lf .,d-PL,:d Funeral Director _~_~_ __ ___
~~::':;af~~t~bli~~~ent ~}->>~~.i:,.(~ .z/J,~ -i.~ IL-
I Interval Between
Onset and Death
Name of Decedent
Part I:
Immediate Cause
(a) ./1,A.t I-fl.4~'
(b)
I
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(c)
(d)_
Part II: Other Significant Conditions
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Manner of Death
Describe how injury occurred:
Natural k8r
Accident D
Suicide
Homicide
Pending Investigation
Could not be Determined
D
D
D
D
Address
~~o~k~~ Id
(M.D., D.O.. Coroner, ME)
Name and Title of Certfier
This 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 fili~
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21-02-802
iEasl Mill &.ttb illtslamttd
I, SAMUEL D. BLEVINS, of the Borough of Camp Hill,
Cumberland County, Pennsylvania, do hereby make, publish and
declare this as and for my Last will and Testament, hereby
revoking all other Wills and Codicils heretofore made by me.
I.
I direct that my just debts and funeral expenses, including
my gravemarker and expenses of my last illness, shall be paid by
my Executrix hereinafter named, as soon as practicable after my
decease as a part of the expense of the administration of my
estate. I authorize my Executrix to execute a contract for
perpetual care, using therefor funds from my estate, in such
amount as she shall consider necessary and desirable for the care
and maintenance of a cemetery lot.
II.
I give to my beloved wife, ODESSA R. BLEVINS, if she survives
me by thirty (30) days, my motor vehicles and insurance thereon,
my household goods, any stocks or bonds owned by me at my death
and other items of tangible personal property. In the event that
she fails to survive me by thirty (30) days, I give the said
tangible personal property to my issue, per stirpes, living on
the thirty-first (31st) day following my death.
III.
All the residue of my estate of whatsoever nature and
wheresoever situate, I give and devise to my wife, ODESSA R.
BLEVINS, if she shall survive me by thirty (30) days. In the
event that she fails to survive me by thirty (30) days, I give
and devise all the residue of my estate of whatsoever nature and
wheresoever situate to my issue, per stirpes, living on the
thirty-first (31st) day following my death.
IV.
I appoint my wife, ODESSA R. BLEVINS, to be the Executrix of
this, my Will. If my wife fails to survive me or fails for any
reason to complete the administration hereof, I appoint my children,
KENNETH DAVID BLEVINS and LYNN JOANNA SMITH, to be the Executors
in her stead.
V.
I direct that my Executrix or her successor shall not be
required to give bond for the faithful performance of her duties
in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
A,1~day of ./!jJr;/ , 1981, to this, my Last Will and
this
Testament, consisting of two typewritten pages, the first page of
which bears my signature in the margin for purposes of identifi-
cation.
L-L;I--~ L/ &;,__~.4- (SEAL)
Samuel D. Blevins
- 2 -
Signed, sealed, published and declared by 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 hereunto
sUbscri~ur names as wit~esses.
/O~
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--....-
{;Jlt~ G I~
JERRY R. DUFFIE
RICHARD W STEWART
C. ROY WEIDNER., JR.
EDMUND G. MYERS
DAVID W DELUCE
RALPH H. WRIGID, JR.
DAVID J. LANZA
MARJ( C. DUFFIE
MELISSA PEEL GREEVY
MICHAEL J. CASSIDY
ROBERT M. WALKER
LAW OFFICES
JOHNSON, DUFFIE, STEWART & WEIDNER
A Professional Corporation
301 MARKET STREET
P. O. BOX 109
LEMOYNE. PENNSYLVANIA 17043-0109
WEBSITE: www.jdsw.com
HORACE A. JOHNSON
CoUNSEL TO mE FIRM
KEIRSTEN WALSH DAVIDSON
OF COUNSEL
TELEPHONE 717-761-4540
FACSIMILE 717-761-3015
E-MAIL mail@jdsw.com
WRITER'S EXT. NO. 24
E-MAIL rhw@jdsw.com
':~
August 2. 2002
Tracey Entwisle, Assistant Chief Deputy
Office of the Clerk of Court
Judicial Center, Building 10B
2425 Nimmo Parkway
Virginia Beach, VA 23456
RE: Petition for Probate and Grant of Letters
Estate of Samuel D. Blevins
Oath of Personal Representative
Dear Ms. Entwisle:
,~, .!i
This letter accompanies the authorization from the Office of the Register of Wills of
Cumberland County, Pennsylvania, to your office to administer the Oath of Personal
Representative to Kenneth D. Blevins, one of the Co-Executors of the above-referenced estate.
Enclosed with this letter is a pre-paid, Federal Express envelope, whereby the Petition
for Probate and Grant of Letters may be returned to the Register of Wills of Cumberland County
after Mr. Blevins has been given his Oath and signed the Petition. Please do not hesitate to call
if you have any questions, and we appreciate your assistance with this matter.
Very truly yours,
RHW:lar:161275
Enclosure
MARY C. LEWIS
Register of Wills &
Clerk of the Orphans' Court
JERRY R. DUFFIE, ESQ.
Solicitor
One Courthouse Square
Carlisle, Pa 17013
(717) 240-6345
FAX (717) 240-7797
OFFICES OF
3R~gist~r of Dills an~ OIl~rh of t4~ QI}rp4ans' OIour!
<llountu of <llumhtrmnb
August 2, 2002
Tracey Entwisle, Assistant Chief Deputy
Office of the Clerk of Court
Judicial Center, Building lOB
2425 Nimmo Parkway
Virginia Beach V A 23456
RE: Petition for Probate and Grant of Letters
Estate of Samuel D Blevins
Oath of Personal Representative
Dear Ms Entwisle:
This office has received a Petition for Probate and Grant of Letters in the above
referenced estate, and one of the named co-executors, Kenneth David Blevins, resides in
Virginia Beach. It is necessary under Pennsylvania Probate Law for an Oath to be given
by the public officer of another jurisdiction having duties similar to those ofthe Register
of Wills is permitted to administer the Oath. Accordingly, you or any of your duly
authorized Deputies, are hereby authorized to administer the Oath of Personal
Representative to Kenneth Blevins.
Very truly yours. _ "" )
CJl?d~5r (1 . o/u~
Mary C L/~is
Register of Wills
~/?-P7- //
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTIONl:i J AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AF'P <01-02)
1(\
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DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-07-2002
WAMPLER
05-25-2002
21 02-0822
CUMBERLAND
230-38-8290
02135947
THELMA
D
RUSSELL L WAMPLER
1532 SHEEPFORD RD
MECHANICSBURG PA 17.~55
", ,\'~
Amount Remitted
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 ~
RE-Y=is4ii-E)f-AFP--coi-:02j------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-07-2002
ESTATE OF WAMPLER
THELMA
D DATE OF DEATH 05-25-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0822
TAX RETURN WAS:
S.S/D.C. NO. 230-38-8290
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
02135947
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
203664-40
TYPE OF ACCOUNT:
DATE ESTABLISHED
( ) SAVINGS ( ) CHECKING ( ) TRUST (X> TIME CERTIFICATE
04-04-2001
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
10,721.78
0.083
893.45
.00
893.45
.00
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
Sl;~ R~Vi:'DC:C' ~TnC' n~ TU'I'ro ,..,.......... ___ _...___..____H
JRD, 'me 30, 1992/17858
In Re: Estate of SAMUEL D BLEVINS
Late of EAST PENNSBORO TOWNSHIP
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-02-802
NO. 21-02-802
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: KENNETH DAVID BLEVINS AND LYNN JOANNA SMITH
Counsel for Personal Representative: STEPHEN D TILEY
Date of Grant of Original Letters: 09-06-2002
Date of Delinquency Notice: 12-06-2002
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on DECEMBER 06,2002, and that
the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule
5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
Date: 01-02-2003
~~r,\-~~~
If_J C. 1._.. in, Register of I
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for ..J -If.( -CJ 3 at 9-.3~..?-1I1n Courtroom No.3. If the
Certification of Notice is filed prior to the hearing date, the he w'll ut matically be
cancelled.
V'a
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: SAMUEL D. BLEVINS
Date of Death: February 2, 2002
Will No.
Admin.No. 21-02-0802
To the Register:
I certify that notice of (beneficial Interest) 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: February 13, 2003
Name Address
Lynn Joanna Smith 15 Hill St., P.O. Box 68, Railroad PA 17355
Kenneth David Blevins 2608 Curry Comb Court, Virginia Beach VA 23456
Notice has now been given to all persons entitled thereto under Rule 5.6)a)
except NO EXCEPTIONS
Date: February 13, 2003
Name:
Address:
s~ -;;t}, ?"~
Stephen D. Tiley
5 South Hanover Street
Carlisle. Pennsylvania 17013
Capacity:_Personal Representative
-.XCounsel for Personal Representative
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: SAMUEL D. BLEVINS
Date of Death: FEBRUARY 3. 2002
Will No.
Admin. No. 21-02-0802
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:
Yes ( ) No (X )
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: 2004
3. If the answer to No. 1 is Yes, state the following:
(a) Did the personal representative file a final account with the Court?
Yes () No (X).
(b) The separate Orphans' Court no. (if any) for the personal
representative's account is:
(c) Did the personal representative state an account informally to the
parties in interest? Yes (X) No ( )
(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.
Date: FEBRUARY 19, 2004
b'~ ;;f) I~
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Stephen D. Tiley
Name (Please type or print)
..-
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-
5 South Hanover Street
Carlisle. Pa 17013
Address
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Capacity:
(717) 243-5838
Telephone No.
( ) Personal Representative
( X) Counsel for personal representative
FREY & TILEY
ATTORNEYS-AT-LAW
5 SOUTH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
ROBERT M. FREY
OF COUNSEL
TELEPHONE (717) 243-5838
STEPHEN D. TILEY
FACSIMILE (717) 243.6441
ROBERT G. FREY
August 31,2004
Commonwealth of Pennsylvania
Department of Revenue
Department 280601
Harrisburg, PA 17128-0601
Attn.: Inheritance Tax Division
Re: Estate of Samuel D. Blevins, Deceased
File No. 21-02-0~
~O~
Dear Sir or Madam:
Enclosed please find an inheritance tax return for the above referenced estate.
The filing of this return, and the administration of this estate, has been delayed because
of significant difficulties which exist between the Co-Executors, who are also the co-
beneficiaries of the estate. I represent Lynn Joanna Smith and Attorney Ralph Wright
here in Cumberland County represents Kenneth David Blevins. You may correspond
directly with me, as Attorney Wright and I are able to cooperate and coordinate our
efforts on behalf of our clients.
The inheritance tax return included an interest calculation through July 31, 2004.
Because of the situation between the parties, and the long distance communications
necessary, I have not amended the return, but have filed it as is with the estate check
for inheritance tax and interest due as previously prepared. You will also find enclosed
my law firm's check in the amount of $31.67, representing additional interest through
August 31,2004.
You will note that the inheritance tax return indicates that the decedent had one
(1) safe deposit box. That safe deposit box was inventoried this morning. Nothing of
monetary value was found in the safe deposit box. Attorney Wright will be sending the
safe deposit inventory to you.
We hope that these checks will satisfy the estate's obligation to the Inheritance
Tax Division. The enclosed inheritance tax return is the subject of much negotiation
between the parties. My client expended significant efforts in maintaining, and in fact
\)-..
Frey & Tiley
Attorneys-At-Law
Commonwealth of Pennsylvania
Attn.: Inheritance Tax Division
Re: Estate of Samuel D. Blevins, Deceased
File No. 21-02-0820
August 31. 2004
Page 2
improving, the real estate so that it could be sold at a high value. My client maintains
that she, or her husband, are entitled to additional payments and reimbursements for
their efforts, but we have declined to include them as a deduction on the inheritance tax
return as the negotiations with the other Co-Executor and beneficiary have resulted in
an agreement only to pay those items listed on the return.
Should you have any questions concerning this return, please do not hesitate to
contact me.
Sincerely yours,
.#~' '7.-4j
Stephen D. Tiley
SDT/t1
Encl.
cc: Ralph H. Wright, Jr., Esquire
Ms. Lynn Joanna Smith
", I
REV-150Q EX (6.QO) COMMONWEALTH OF REV-1500 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN 21-02-0820
DEPT. 280601 FILE NUMBER
HARRISBURG, PA 17128.0601 RESIDENT DECEDENT - "
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- Slevins Samuel D. 21-02-0802
z DATE OF DEATH (MM.DD-YEAR) rATE OF BIRTH (MM-DD- YEAR)
w THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
Q
W 2/3/2002 12118/1919 REGISTER OF WILLS
"
w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) socrAL SECURITY NUMBER .
Q
w [R] 1. Original Return o 2. Supplemental Retum D 3. RemainderRelum(daleofdealh prior 10 12-13-82)
...
"'~~ D 4. limited Estate 04a. Future Interest Compromise (date of death after 12-12-62) 05. Federal Estate Tax Return Required
ug:~
wOO o 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
""'~ -1.. 8. Total Number of Safe Deposit Boxes
Utm
< D 9. litigation Proceeds Received 010. SlKlusal PovertyCredft Cdalll of death blllween 12<31-91 and 1.1-9.5) 011. Election to tax under Sec. 9113(A) (Attach 5ch 0)
I- tffl~~~TIQIl!M~mlqpM~$I!!l##~!!R~N!iiI1!@\Iij!:l..!:1!!~ll!lmtiNiit~!!'!!!P!lM~1@!liI~!199~!lI~g'!!l~!;]gpt9i}
z NAME COMPLETE MAILING ADDRESS
w
Q 5 South Hanover Street
z Stephen D. Tilev
~ FIRM NAME (If Applicable) Carlisle, PA 17013
en
w Frev and TiI~
'"
'"
0 TELEPHONE NUMBER
"
717-243-5838
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) 178,280
2. Stocks and Bonds (Schedule B) (2) NONE
(3) NONE ::J0 i€t?
3. Closely Held Corporation, Partnership or Sole-Proprietorship - (~ g
::s 7'
4. Mortgages & Notes Receivable (Schedule 0) (4) NONE cr' ';'.
5. Cash, Bank Deposits & Miscellaneous Personal Property q; ""
(Schedule E) (5) 911:511 c:: "
en
(6) NONE 6, w
6. Jointly Owned Property (Schedule F) . -
Z DSeparate Billing Requested "
0 C'1 -0
~ ..'
~ 7. Inter-VIvos Transfer & Miscellaneous Non.Probate Property ,- N
::l (Schedule G or L) (7) NONE y, .. " I" :~
I- 0
it
-0: 8. TOTAL GROSS ASSETS (total Lines 1-7) (8) 277,791
lrl
'" 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 70,502
.
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) ;10) NONE
11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 70,502
12. NET VALUE OF ESTATE (Une 8 minus Une 11) (12) 207,289
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J) (13)
14. Net Value SUbject to Tax (Line 12 minus Line 13) (14) 207,289
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate ,or transfers under Sec.9116 (a)(1.2) x ,0 - (15)
Z
0
~ 16. Amount of Line 14 taxable at lineal rate 207 ,289 x ,045 (16) 9,328
-0:
I- -
::l
..
::E 17. Amount of Line 14 taxable at sibling rate x .12 (17)
0
"
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
I-
19. Tax Due (19) 9,328
200 1.~M..'rl."illi"'"_ifl!ll'1
i, ::. . .: ' " . .~. .':j .... :': '0, .,: '." . ' . '. . : .,: '. .', . :. . ~ :.. .!:" . " .: ;:: . : ': .::~
''". n___. - "_._I:l:i: _.. ." n. ._._.. I , .. ,., lIt. . ... tI
............. .........................!!!!iIii!IlQmiiit!:lAN$.Wlii.!l9!UliiQQ!l1lil1!PNllqN."Ii!VI;ll'lll1<mPihlliNPIlliC!ilI;PIlMATfli';$}................... .
217 Blevins, Samuel D, 21-02-0802
Decedent's ComDlete Address:
STREET ADDRESS
748 Meadow Drive
..
CITY I~TATE '~IP
CamD Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 9,328
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty jf applicable
D. Interest 770
E. Penalty
TotallnteresVPenalty ( 0 + E ) (3) 770
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5, If line 1 + line 3 Is greater than line 2. enter the difference. This is the TAX DUE. (5) 10,098
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 10,098
:::::::::::,:::':;::':':'{.::"":':n':::;:':"',,':n:;::qi?i?f''':':::;::::;;'::'::':'H':I:~Th~~I;~~~;~~;ik~%Th~'iII~;ir~0,g~~k~~"ighI:i,i~b~;:g'~~:0IlI;mmIl'iH:;:II'BIitI:IIIttP""""''''''''''''''''
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1, Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; 0 0
b. retain the right to designate who shall use the property transferred or its Income; 0 0
c, retain a reversionary interest; or .. .. 0 0
d. receive the promise for fife of either payments, benefits or care? 0 0
2, If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 0
4. Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation? . . . . . . . 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE rr AS PART OF THE RETURN,
Under penalties of perjury, I cIecIare thai I have examined this return, Including accompanying schedules and statements, and 10 the best of my knowledge and belief, Ills true, ~
.nd ete. OecIaratlonof retolherthanthe rsonal re resentalive Is based on all information of which rer has an knowled e.
SIGNATURE OF PE ON RESPONSIBLE FOR FILING RETURN
-J
ADDRESS
Kenneth David Blevins, 2608 Curry Comb Court, Virginia Beach, VA 23456// Lvnn JoAnna Smith, 15 Hill Street. Railroad, PA 17355
SIGNATURE OF P ARE HER THAN REPRESE~ATIVE DATE
/b.r 7/
-
ADDRESS
Ste hen D, Tile 5 South Hanover Street Carlisle PA 17013
For dales at death on 0{ after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value at transfers to Of for the use of the surviving spouse is 3%
(72 P.S. Section 9116 (aX1.1)(i)J.
FO{dales of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use otthe survivlng spouse is 0% 172 P.S. Section 9116 (a){1.1)(H)).
The statute does nol exempt a transfer to a survivlng spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the survlvlng spouse Is the only beneficiary.
For dates of death on or after July 1, 2000;
The tax rale imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death 10 or for the use of a natural parent, an adoptive parent,
Of a stepparent oflhe child Is 0%[72 P.S. Section 9116(a)(1.2)J.
The tax rate imposed on the net value of transfers 10 or for the use of the decedent's lineal beneficiaries Is 4.5%, except as noted In 72 P.S. Section 9116(1.2) 172 P.S. Section 9116(a){1)].
The lax rale imposed on the net value of ltansfers to Of fO{ the use of the decedent's siblings Is 12% [72 P.S. Section 9116(a)(1.311A sibling Is defined, under Section 9102, as an
indivldual who has alleasl one parent In corrmon with the decedent, whether by blood or adoption.
AT I
REV-1S02 EX + (1-9?) (f)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Blevins, Samuel D, 21-02-0802
ALL REAL PROPERTY OWNED SOLELY OR AS A TENANT IN COMMON MUST BE REPORTED AT FAIR MARKET VALUE. Fair market value is defined as the price at
which property would be exchanged between a willing buyer and a wiJllng seller, neither being compelled 10 buy or sell, both having reasonable knowledge of the relevant facts. REAL
PROPERTY WHICH IS JOINTLY-OWNED WITH RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 748 Meadow Drive, Camp Hili, PA 17011
(See settlement sheet attached, Selling price, line 401, minus lines 506,703, 704,
1202 & 1307,) 178,280
.
TOT AL-LAlso enter on line 1 Recapitulation $ 178 280
(If more space is needed, insert additional sheets of the same size)
F",,,, App'''....d OMeN... 2!02..Q21!!
A. ." .--:.=...!.!.S.D~"ARnl~"rOFMOUSJNGAljOUlleglpEVHOPMENT 8. .' _, F LOAN
SEmEl\.lENT STATEME t(J:s~ 1. 2. r ~ 3. OCONV. UNrNS.
Abstract Land Associates, I 4. 00 VA 5. 0 Cl,.. ....'i:~.?s.
3912 Market Street 6. ow I NUM 7. AN NUMB R:
0001515B-001 NJT 0046601744
Camp Hill, PA 17011
(717) 763.1450 " e. MORTr;;AGE INSURANCE CASE NUMBER:
FINAL 10-10-6-0580740
C. NOTIO Tf,;s (onn;s (um;S('ed 10 g;'e yOU a SI,lament ofaduat se{(lamenl cOsfs, Amounls pa;d 10 and by tha salttamanl aganl a" sf>own.
Itams macked -(P.O.Cr Wa~ pa;d oulskie the clostng; Ihey a~ shown hm ro'mlonna"one! PU'POses and a" noUnctudad m ",. lola/s.
. NA W Ie ar asser r. an ane asser
ADDRESS OF BORROWER: 1717 Creek Vista DrIve
New Cumberland, PA 17070
E. NMIE OF SELLER: Estate of Samuel D. BlevinS
ADDRESS OF SELLER:
F. NAME OF LENDER; orporalJon
ADDRESS OF LENDER: 1555 W. Walnut Hill Lane, Ste
Irving, TX 7503B
G. PROPERTVLOCATIO\l; f4H Meadow Unve
Camp Hill, PA 17011
Cumberland County 09-18-1304-0B3
. se EMENr A ENT; Abstract Land Associates, Inc.
P!..ACEOF SEITlEMENT: 3912 Market Street, Camp Hill, PA 17011
,. SelTLeMENT DATe, 4/20/2004 PRORATION CATE, C'SBURSEMENT CATE, 4120/2004
--'f" SUMMARY OF BORROWER~ TRANSACTION K SUMMARY OF SELLER'S TRANSACTION
t:'OO"GRO"'AMOU""'OUEFROM BaRR OWE"'., . "~"'. _. ..400".GR"SS'''MOUNr.:CUEi,T'''SE'''",,, .." '-,.. , """
101. Conlr.oct Sal" P"ca 199,999,00 401. ConOact Sal" Prica 199,999.00
102. Personal Property 402. Personal Property
103. Settlement charges to Borrower (line 1400) 11,735.16 403.
104. 404.
105. 405.
ADJUSTMENTS FOR rTEMS PAID BY SelLER IN AOVANCE: ADJUSTMENTS FOR ITEMS PAlO BY SELLER IN ADVANCE:
106. CflYlTown Taxes 406. CltylTown Taxes
107. CO,"ly To<" 04/20104 Ic 121'1/04 374.79 407. Counly T",s 04120104 10 121J1t04 374.79
108. Assessments 408. Assessment.!l
109, School To< 04120104 io 061'0104 'B9,70 409. School Tax 04120104 10 OBIJ0J04 'B9,70
110. SeW"fT""h 04/20/04 '0 061'0104 74.67 410. SeW"fT'''h 04/201C4 to 061'0104 74,67
111. 411.
112. 412.
113. 413.
114. 414.
115. 415. ~
120. GROSS AMOUNT CUE FROM BORROWER, 212,573,'2 420, DROSS AMOUN7 CUETO SELCER, .1 200,638,16
82iiOilCAMOUR""i:.ijjo'.~di'!'i~5EiE""'j;f,[Oil<~)'ijj,!lR.. .~, ~ . "~~~~i!!@~~~ .."".,
201. Deposit or earnest money 501. Excessde~InSlruCtlons) ~
~ -"nn",!,-, amo,"t ~ new oanes) .0 502. SeWement cha",.. 10 Sell" (line 1400) ...::z .:.::
~~. ~~g loan(s} laken s~ect to 503. Existing lcan(s) laken subJecllo
~. ~om~r ~ 504. Payoff of lrstmortgageloan
~ 505. Payoff of second mortgage loan
.::::". ~,-",-onc.."oo ~ S06. Sell" Concession ~ .:.::
~. ~r
~Ug. 50a.
~ 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER.
210. Cily/Town Taxes 510. CilylTown Taxes
211. CounlyTaxes 511. County Taxes
212. Assessments 512. Assessmenls
213. 513.
214. 514.
215. 515.
218. 51a
217. -"',.
218. I~
219. . _.~.
220. TOTAL PAlC BY/FOR BORROWER, 212,533,00 52. TOTAL RECUCTlONSIN AMOUNTOUE SELLER, 25,177.09
L300,"C,i(Sij'l\tSED:q;"E~',M,,~q:~qi'!~R,\\!E~> " ." ~~t;~~~~!'T:1i~l'i.NmOir;~q~~EtL" ,.. ""._. .,....,'
'01 Gcos",mouoldue lcom Bonow" ( Un"20) 212,573"2 601. Gmss amounldu_ 10 Sell" IUn"20) 200,6'6.16
'02. L"s amouot paid byllo, Bonow" (lina 220) 212,533.00 602. Less "ducllon lnemounl lIue S_rra'illne 520) 25,177.09
'CJ CASHt~FROM' I 0 TO 'BORROWER' 40.32 60'. CASH 10 FROM) lli!l TO)SELLER, 175,661.07
c;.,.....,..v.. rll..!: '~UI\tll;lt;:R' 00015158.001 NJT
';:Si6'6;~~~~~.C.q"!M!esr0"'~!:;';~':,f~lt""m",,':~;y,~!~;;;W3'i!?J,t(:Y['?:"":Ci,",,,,,,,,""''''~;~~~t1!;;r~1i!E';;,~~~e''1,,",;1
UN OF COMMISSION (LINE 10aJAS MS. AT'~i,";1.~~OS i:J~~R~~
11,499.00 to Re/Max Really, ,o(essionals SETTLEMENT
S 10 Re/Max Realty Professionals
J. Camm',,'oo p," ,t ,.rrr.m.nl " .' 11,999.00
.04. ",n"'lion F."o Ra/M" R..lty P''''''''ooal, 125,00 125,00
I80D"i"EMs'e"XA~""'1N:t~~~"c",qN)~t1'!,~Q.~i~i1!'(\1'",j"1!!!1ii'~f~,Ii;j~ ''''.~ " 4-.,,,, 1. " ..'.", ,,,,,,,,,~''Y'.'g
801. Loan Origination Fee
, 802. Loan Discount fee.
80J. Appraisal Fee 10 Terry Edward Freeman 300.00
804. Credil Report _
a05. Lenders InspecUon Fee
806. Mortgage Insurance Application Fee
B07. Assumption Fee
a08. Underwriling Fee 10 FHHLC (Paid By BrOker) 250.00
809. Tax Service Fee 10 FHHLC (Paid By Broker) 90.00
810. VA Funding Fee 10 VAAdminislrallOll 4,799.98
811. HSeaaltached for breakdown 219.00
1..")Q"ITEMS'REg~'.~~O.8.Y,;!"'NOERST9'.8";r~,!,;II'tM,\{'-l!!<;"{I.i~il>~'!1<';~~,~"""i,!!lirlll.~i'lf~9,g" . ...",.". "J;I,\lI'~~lI!""""~.~""~~'IJ,,'il
_"'" Inl'n!'-'ccom 04l20t04l0 06/01104. (l!J_W.3"01d,y % (11_ aey,) 3UO:,<,
902. Mortgage Insurance Premium for Month{s) 10
903. Hazard Insurance Premium for 1 Years(511o Erie Insurance (488.001
904. Yield Spread Prem Pd by FHH 10 A-1 Financial Mortgage Services (2,303.98)
905.
["'OODe'RESERVESDEPOSITEO !V1'h"'Le~OERi~'<;i.'!1;1!.'l\t~""':l':"\~~~~',"",!i~l" ... ,..."'i~~"ffin~\!!l!i'""...r~~l,",~"r,,,,,
1001. Hazard Insurance 3 mQ'llhs@s 40.67 permonlh 122.01
1vu..:;. Mortgage Insurance maTlhllQ S permonlh
~ ~l_I~"'ropert~laxes mQ'llh.Os plrmonlh
1[1[14. (;ountYProperty axes J maun.Os -4J.!ilO permonlh 131.70
~. AnnualASSessments mQ'llh.os pllrmo~
~ti. ~~OOlTax ~1 mQ'llhsOS ~Ul perm~l11 1,837.11
10U7. malln.os permonlh
1uuG. AggregaleAccl Adj. mQ'lln. GIs permonlh --338.26
1'''"a.!;I.titi:'';c.iiA.iib,,~.. " ~ .1flii< '" ,'.. " ,~. ',..,. _.iii'" _... '., c" . d."""
1101. SelUement or closing fee
1102. Abstract or tlUe search
_ I ~U..1. _ IIUe examinallon
__' ru<+. lIue Insurance b~nlJer
I IV;;!. _ l.IOcumenl preparation
1106. ~"'Olary rees
1107. AUorneY!Fees
(includiiiabov8Ilem!lnUmblr!l: J
1108. TIlle Insurance 10 ADSl1acl ~nd AssoClales, Inc. '.'t, ~";;J
(inClucllllSilboveilemllnumbeflJ: )
1109. lenders coverage $ 204.798.00
,1110. Owner's caverage .$ l::1::1,::I~!l.uu
1111. "nd""men~ luO-'OO",1.71010 Ab5U'" L'nd ""OC;aI.., Inc. 2."',00
1112.
1113.
tf1200j'GOV"';;MEN~(jEt.ORbiN""A'NO'r;;~N~F.~L.~A~~E '.., " .. ., ..,.,'.... .". ,. -:P'li '~~~ ,.,...,," .;',.l1';Wi',fl"
1201. Recarding Fees: Deed $ 38.50 Mortgage $ 70.50 Release.$ 109.00
1202. C;ty/CounlY''''''lam", Dead $ 1,999.99 Mortg'ga $ 1,999,99,
1203. Slate Iax/Slamps Deed $ 1,999.99 Mortgage $ 1,999.99
1<04. .'
,.u,.
L;joo;'AOO;r'ON.!-C'Set,n;EMEJoticij;\RGES; "'.', ''''.. ".. "". ...., .:.,....
1301. Survey
'..1UO::. r-eSl mspecllon
'..1U". msurea l..oslng rolscuon 1..U" (a uuaramee Hue 6. lrusl 1.,;0. 35.00
...':"'. -"~"'-"'-"'P.'":"U",J 0 _,",~nn con"m''.''",ca, 96,00
~... w~u~._"aallax IO_I.,;U~Oerland(;ounly la~L:lal~t:lureau 2,635.30
~UQ. ~uu't-=-oun.y, wp_rax 10_ ...,Ioa l.I_~ .;;June 526.80
~Uf. . .;lee alta"",ed lor l:lre~"uown 115.00 395.00
1400. 'O"L ..m'M'"'C"'RG'5'E"'.,~,,". '''.5'0","'..",.,.. "',5,0""Ki '~. 17,977.09
' ".~ ='." ..- ,". "".,., ..,.._", 5.'._", ~"... ..... "" ",~..,. .", b."., I, .."' .", .,,"... ..,,_", m.. _01'0 .", """"._",, m",," m, .",,",
~"'-'".""""~~''''''''''~"''.'''.'''''O'.'''''''''''",H'''''''~.m."''''"m.",. ~~ -.I': - 7
~ n'=9:= Z~;:;,,-,~~~~_~.__
~. ." J/"f:-. ~ ./ /' . .
'ch 'd e4,os,a, J". E"ala or Samua' D. 8Ia,;n,
Ul CNllL /fu,'/f}i7~vd,~:.
orroweri!l !. . Sellers
J h..... CIIUUd ",wll I;au Ih.luf'dl 10 b. dlsbu","" I~ G~f~anCII wilh this
~./ /:'/lr /).' /
/~i//t/'Ly Oale
WARNING: n h. ."'Ime I" II:nO....."lll't m... 1.11.. slal....nls 10 II'. Unll"d Sal.s On Ihis or ."y 'mUD' ronn. pen.tlos "pon aonvi::lkm e." Inch.a." an. .n<llmprison....nt. .....a.l... ..., Tld.
l1U.S. Coil. s.edOlllOOl 'ndS~bn 10tO.
-- -~".~,
. 'DETAILED BREI 'OWN OF ITEMS PAYABLE IN CONNEC- WITH LOAN
Jescriptlon Buyer
Amount
Fundin9 Fee 10 FHHLC (Paid By Broker) 45.00 ..
.3. Flood CerUficalion Fee to Federal Flood " 24.00
d14, Commilmenl Fee 10 FHHLC (Paid By Broker) 150,00
Total as shown on HUn page 2 Line #811 219.00
,
HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES
Buyer Seller
Am ount Amount
1202, City & County TaxlStamps
City TaxlSlamps: Deed $1,999,99
Total as shown on HUD page 2 Line #1202 1,999,99
Buyer t Seller
Amount Amount
1.203. State TaxlSfamps
Slale TaxlSlamps: Deed $1,999,99
Total as shown on HUe page 2line #1203 1,999,99
HUD 1307 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES
Buyer Seller
Description AmOunt Amount
1308. Home Warranty 10 American Home Shield Corporation 395,00
1309. Collecl/on Account (lot #925) 10 Lake Wynonah Municipal Authority 115,00
Total as shown on HUe page 2 Line #1307 115.00 395,00
.
.
,
I
j
I ,
AT
REV-150a EX + {1-97} (I)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. "
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Blevins Samuel D, 21-02-0802
InchJCle the proteedl cf litigation and tile dale the PI'lX:~ were received IJy the "late. ALL PROPERTY JOINTL Y.OWNED WITH THE RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F.
ITEM VALUE AT DATE
NUMBER DESCRiPTION OF DEATH
1. Fulton Bank Account No. 0100-83588 95,720
Accrued Interest to d,o,d, 25
(See Schedule "H" items A1 and B7, These amounts, totaling $25,000, were withdrawn
Friday, February 1, 2002, but not charged to the account until Monday, February 4, 2002,
Decedent died Sunday, February 3, 2002.
2, Liberty Mutual 1 New Penn Motor Express, Inc, Workman's Compensation repiacement
checks received after death, 2,142
3. Three retirement benefits checks received after death from Central Pennsylvania Teamsters
Pension Fund, 1,230
4, GE Financial, premium reimbursement. Long term care Insurance, 266
5, Comcast, refund, 16
6, Capital Blue Cross, refund 112
,,'
TOTAL (Also enter on line 5 Recaoltulation $ 99511
(If more space is needed, Insert additional sheets of the same size)
Fulton Bank
CAPITAL DIVISION . LANCASTER/CHESTER DIVISION
DROVERS BANK DIVISION . GREAT VALLEY DIVISION
(717) 291-2437
April 30, 2004
Frey & Tiley
5 South Hanover Street
Carlisle, Pennsylvania 17013
Dear Mr. Tiley:
RE: Samuel D, Blevins, deceased February 3, 2002
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Money Market # 0100-83588, open 1129/2001, balance $95,719,91 and
accrued interest $25,20, joint with Odessa R. Blevins,
If you should have any further questions, please do not hesitate to contact me,
VelY tmly yours,
/ ~ ~ c..o.J
~Go~ " G
Karen D, Hillegas
Credit Inquiry Processor
..
"
CONFIDENTIAL
i I '$ina.ll''' C~t
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" reo po".., III . b"'ct to change Withal" .'
'~\L, OOlnion herein expressed IS su j..-. ,
POBox 4887 Loncaster, PA 17604
fullonbonk.com ]-800-FULTON-4
217
REV-1511 EX + (12-99)
SCHEDULE H "
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FilE NUMBER
Blevins, Samuel D, 21-02-0802
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
" J.J, Hartenstein Mortuary, Inc. 575
J,J. Hartenstein Mortuary, Inc, 6,302
B, ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Number(s) I EIN Number of Personal Representatlve(s)
Street Address
City State :zip
Year(s) Commission Paid;
2, Attorney Fees 11,422
3, Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
City Stale Zip
Relationship of Claimant to Decedent
4, Probate Fees 252
. .
5, Accountant's Fees
6, Tax Return Preparer's Fees
7, February 4,2002, $25,000 withdrawn from Fulton Bank account no, 0100-83588 (Sch E,
item 1) To reimburse Lynn J, Smith for care and expenses of decedent and decedent's wife
who died January 2,2002, less funeral expenses reported at item A1 above, See Exhibit "A." 18,123
8, Reimburse Lynn J, Smith for out of pocket expenses to third parties for repairs, renovations and
maintenance of residence 3/30/2002 to 2/27/2004, See Exhibit "B," 10,750
9. Millage to Leroy Smith and Lynn J. Smith re repairs and malntainance of home, See Exhibit "C," 9,484
... ADDITIONAL EXPENSES FROM CONTiNUATION SHEET, 13,594
TOTAL IAlso enter on line 9 Recapitulation $ 70,502
(If more space is needed, insert additional sheets of the same size)
SCHEDULE "H"
- CONTINUATION SHEET ..
ESTATE OF: Blevins, Samuel D, FILE NUMBER: 21-02-0802
10 Maintenance and repair fees to Leroy Smith for work
on residence from February 3, 2002 through sale
on April 20, 2004, See Exhibit "D," $ 8,990,00
11 September 19, 2002, Cumberland Law Journal,
Advertising Letters (Reimburse Frey & Tiley,) 75,00
12 October 15, 2002, The Sentinel, Advertising Letters
(Reimburse Frey & Tiley,) 97,07
13 October 15, 2002, S & W Petroleum Services, Inc,
Tank Removal. (Reimburse Frey & Tiley,) 1,400,00
14 April 20, 2004, Register of Wills for Short Certificate
(Reimburse Frey & Tiley,) 3,00
15 Taxes paid at sale of 748 Meadow Drive, (Settlement
sheet follow Schedule A. Items 1305 and 1306 less
items 407 and 409,) 2,597,61
16 Sewer and trash fees paid at sale of 748 Meadow Drive,
(Settlement sheet follows Schedule A. Item 1304 less
item 410,) 21,33
17 PP&L for final electric bill
748 Meadow Drive 64.96
18 Pennsylyania American Water, for final bill "
748 Meadow Drive 24',54
"
19 Keystone Oil for final bill
748 Meadow Drive 320,76
*** TOTAL ADDITIONAL EXPENSES TO SCHEDULE H: 13,594,27
",
REV-1513 EX 01- (9.00)
SCHEDULE J .. ..
COMMONWEALTH OF PENNSYlVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT ,
ESTATE OF FILE NUMBER
Blevins Samuel D, 21-02-0802
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY Do Not List Trustee(sl OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec, 9116 (a) (1,2)J
1, Kenneth David Blevins
2608 Curry Comb Court
Virginia Beach, VA 23456 Son 50%
2, Lynn JoAnna Smith
15 Hill Street
Railroad, PA 17355 Daughter 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II, NON~ TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1, "
"
"
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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~
~. I, SAMUEL D. BLEVINS, of the Borough of Camp Hill,
Cumberland County, Pennsylvania, do hereby make, publish and
t declare this as and for my Last will and Testament, hereby
\,
r,\,
\\\ revoking all other Wills and Codicils heretofore made by me.
i
~ I.
'..J I direct that my just debts and funeral expenses, including
'~ my gravemarker and expenses of my last illness, shall be paid by
, '
~\ my Executrix hereinafter named, as soon as practicable after my
"
\. '\
~ decease as a part of the expense of the administration of my
~
\ I authorize my Executrix to execute a contract for
~ estate.
perpetual care, using therefor funds from my estate, in such
amount as she shall consider necessary and desirable for the care
and maintenance of a cemetery lot.
II.
I give to my beloved wife, ODESSA R. BLEVINS, if she survives
me by thirty (30) days, my motor vehicles and insurance thereon, i
,
my household goods, any stocks or bonds owned by me at my death
and other items of tangible personal property. In the event that
she fails to survive me by thirty (30) days, I give the said
tangible personal property to my issue, per stirpes, living on
, the thirty-first (31st) day following my death.
!
EXHIBIT "E"
- I --
I
i
III.
All the residue of my estate of whatsoever nature and
wheresoever situate, I give and devise to my wife, ODESSA R.
BLEVINS, if she shall survive me by thirty (3D) days. In the
event that she fails to survive me by thirty (3D) days, I give
and devise all the residue of my estate of whatsoever nature and
wheresoever situate to my issue, per stirpes, living on the
thirty-first (31st) day following my death.
IV.
I appoint my wife, ODESSA R. BLEVINS, to be the Executrix of
this, my Will. If my wife fails to survive me or fails for any
reason to complete the administration hereof, I appoint my children,
KENNETH DAVID BLEVINS and LYNN JOANNA SMITH, to be the Executors
in her stead.
V.
I direct that my Executrix or her successor shall not be
required to give bond for the faithful performance of her duties
in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ' '/ I/, ,/1/1/"'/'/ 1981, to this, my Last Will and
A. day of ,
Testament, consisting of two typewritten pages, the first page of
which bears my signature in the margin for purposes of identifi-
cation.
I L.<Lh~L/,j; ~~e~..''''- (SEAL)
Samuel D. Blevins
I
EXHIBIT "E"
- 2 -
I . I
Signed, sealed, published and declared by 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 hereunto sUbscri~ur nam~s as witnesses.
/~'i~~
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COMMONWEALTH OF PENNSYLVANIA REV-1 162 EX{1 1~96}
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004327
TILEY STEPHEN D
5 S HANOVER STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
__n_~__ lold .~n~n~n nndU
101 I $10,098,00
ESTATE INFORMATION: SSN: 213-14-9017 I
FILE NUMBER: 2102-0802 I
DECEDENT NAME: BLEVINS SAMUEL D I
DATE OF PAYMENT: 08/31/2004 I
POSTMARK DATE: 08/31/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/03/2002 I
I
TOTAL AMOUNT PAID: $10,098,00
REMARKS:
CHECK# 0566
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004328
TILEY STEPHEN D
5 S HANOVER STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
nn____ fold ..._____n unun
101 I $31,67
ESTATE INFORMATION: SSN: 213-14-9017 I
FILE NUMBER: 2102-0802 I
DECEDENT NAME: BLEVINS SAMUEL D I
DATE OF PAYMENT: 08/31/2004 I
POSTMARK DATE: 08/31/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/03/2002 I
I
TOTAL AMOUNT PAID: $31,67
REMARKS:
CHECK# 5346
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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cILFT,2806:)1
HARO,:ISt3:J'1Ci FA 1 r 23 ::lee)1
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO, CD 004679
TILEY STEPHEN D
5 S HANOVER STREET
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
",1<1 ______u__
101 I $3,87
ESTATE INFORMATION SSN: 213.14-9017 I
FILE NUMBER: 2102-0802 I
DECEDENT NAME: BLEVINS SAMUEL D I
DA TE OF PAYMENT: 11/30/2004 I
POSTMARK DATE: 11/30/2004 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/03/2002 I
I
TOTAL AMOUNT PAID: $3,87
REMARKS: FREY ET AL
CHECK# 5536
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA '*
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX
INHERITANCE TAX DIVISIDN STATEMENT OF ACCOUNT
PO BOX Z80601
HARRISBURG PA 171Z8-0601 REY-!U7 EX AFP 112-D41
DATE 12-27-2004
ESTATE OF BLEVINS SAMUEL D
DATE OF DEATH 02-03-2002
FILE NUMBER 21 02-0802
COUNTY CUMBERLAND
STEPHEN D TILEY ACN 101
5 S HANOVER ST I Allount Rellitted I
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~~:r~~".!5r.A~~..rGl~.~~'........;...fA~!~e1r.fA5r.~tA;rIAlnrf.b~.l~c:oO~...j(..........._..........
ESTATE OF BLEVINS SAMUEL D FILE NO.21 02-0802 ACN 101 DATE 12-27-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 1l-01-2004
PRINCIPAL TAX DUE:. ...IIIIIIIII...R...........III...................IIIIIIIIIIIIIIIIIIIIIIIII11I11I11I11I111I11I..... 9,328.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-31-2004 CD004327 770.00- 10,098.00 "'"
08-31-2004 CD004328 31. 67- 31.67 ("') =
<::::> :::0
11-30-2004 CD004679 3.87- 3.87 ~ <:.n n',
~ C)
cD :I> c:::>
,11 ("') % f~~~~
:'2,- .Fn - I i'j
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?' C')
0 :;> --1l
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(nO
CO -'n
-
TOTAL TAX CREDIT 9,328.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IE IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
JRD/June 30, 1992/17858
Date: January 10,2005 ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
BLEVINS KENNETH PENNSYLVANIA
RE: Estate of BLEVINS SAMUEL D
File Number: 2002-0802
Dear Sir/Madam:
It has come to my attention that you have not filed the Status Report by Personal
Representative (Rule 6.12) 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 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 will become delinquent on: 02/03/2005
Your prompt attention to this matter will be appreciated.
Thank you.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Personal Representative (s)
Judge
STATUS REPORT UNDER RULE 6,12
. --::> . ....5::9-..n?~:& d /'J,
Name of Decedent: ~~~
---- ~ o2p.o:2
Date of Death: 7?"A-e....-;/
Will No,: ....../'€/O-<. _0:;'&2 Admin, No,: OZ&,/J.2 -C'??&;;;L
Pursuant to Rule 6,12 of the Supreme Court Orphans' COUl-t 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:
Yes D No ff
2, lfthe answer is No, state when the person~resentative reasonably believes
that the administration will be complete: ,..,... C ...?~ ,,?p, er-
3, If the answer to No, 1 is Yes, state the following:
a, Did the personal representative file a final account with the Court?
Yes - NoD
b, The separate Orphans' Court No, (if any) for the personal representative's
account is: -
c, Did the personal representative state an account informally to the parties
in interest? Yes D No D
c, Copies of receipts, releases, joinders and approval offormal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report,
Date: #"$>,,.- ~A ,--Z~
Signature
~,.,.z"'A /.-v 22 ..,/>~v
Name ./ ,/
M fA-~ #~~--- 5?:
u. rn
Oc.':, .. >- Address . ~ /A'- /747/ Y
LLl-' - to: .........-.. ,(';r; 7'
C_)
CT.: c;: t, ;:-- 7/"7 ~ ,;z"Y7- 5~:n
U,_ II o?:,:,
Cl '~-.~
C:IO" M e~~~. Telephone No,
LU_' - LW"'~o
c=) -...i........
CC '""".- o~. Capacity: n Personal Representative
C) ...:::: L.:
c..:> -") c:.:
LLl ..,.., 0 @'Counsel for personal representative
0:: =
=
"""
vJ
FIRST AND FINAL ACCOUNT OF KENNETH DAVID BLEVINS AND LYNN JoANNA SMITH,
CO-EXECUTORS OF THE LAST WILL AND TEST AMENT OF SAMUEL D, BLEVINS,
LATE OF 748 MEADOW DRIVE, CAMP HILL,
CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED
DATE OF DEATH: LETTERS TESTAMENTARY ADVERTISED:
Feb. 3,2002 CUMBERLAND LAW JOURNAL
Sept. 28, Oct. 4 & II, 2002
THE SENTINEL
Sept. 23 & 30, Oct. 7, 2002
PRINCIPAL RECEIVED
Accountants charge themselves with the following principal amounts received:
Date
2002
2-Feb See Fulton Bank Account described at March 23, 2004 entry,
2003
2004
23-Mar Fulton Bank Money Market Acct. #0100-83588, date of death Bal. 95,719,91
Accrued interest to date of death 25,20
March 23, 2004 is date of closing of Fulton Bank Account
Less amount deducted from Account 2/3/2002 for funeral
($6,877.00) and care expenses set forth on Exhibit "A" to
Inheritance Tax Return, (See Schedule "H," items A,I and B,7) (25,000,00)
70,745,11
20-Apr Net Proceeds from Sale of Real Estate at 748 Meadow Drive,
Camp Hill, Pennsylvania 170 II 175,661.07
30-Apr Central Pennsylyania Teamsters Penson Fund - Outstanding
Retirement Benefits 1,230,00
15-Jun Death Benefits from Chauffeurs, Teamsters and Helpers Local
Union No, 776 - Drivers Welfare Fund 2,000,00
Page I
26-Jun Liberty Mutual/New Penn Motor Express, Inc, Workman's
Compensation replacement checks receiyed after death 2,142,00
26-Jun Capital Blue Cross - Refund 112.45
26-J un Comcast, Refund 15,52
26-Jun State Farm Insurance - Returned Premium 551.23
TOTAL PRINCIPAL RECEIVED 252,457.38
INCOME RECEIVED
Accountants charge themselves with the following income amounts received:
Date
2002
31-Dec Fulton Bank, Year 2002 interest, $1,195,85 from Form 1099,
less $25.20 acrued interest to date of death shown as Principal,
less $141.93 of January 2002 interest accrued to principal prior to
death, to balance with funds received, 1,028,72
2003
31-Dec Fulton Bank, Year 2003 interest from Form 1099 730,95
2004
23-Mar Accrued interest of 2004, to date Fulton Bank account closed 158,92
30-Apr Commerce Bank credit as an accomodation for initally failing to
deposit the Fulton Bank check, then correcting its error. 10.00
13-May Interest on Estate Checking Account - Commerce Bank 21.43
14-Jun Interest on Estate Checking Account - Commerce Bank 32,73
15-Jul Interest on Estate Checking Account - Commerce Bank 32,18
13-Aug Interest on Estate Checking Account - Commerce Bank 17.38
16-Sep Interest on Estate Checking Account - Commerce Bank 9,72
Page 2
15-0ct Interest on Estate Checking Account - Commerce Bank 7.48
15-Nov Interest on Estate Checking Account - Commerce Bank 8,00
14-Dec Interest on Estate Checking Account - Commerce Bank 7.48
2005
13-Jan Interest on Estate Checking Account - Commerce Bank 7,75
TOTAL INCOME RECEIVED 2,072.74
DISBURSEMENTS
Accoutants claim credit for the following amounts paid:
Date
2002
4-Feb Note $25,000 withdraw from money market account charged
to account on February 4,2002, for funeral expenses ($6,877,00)
for decedent, Samuel D, Blevins, as set forth on Schedule "H,"
Item A,I, of Inheritance Tax Return, and for funeral and care
expenses for Odessa R. Blevins, set forth in Exhibit "A" to
Inheritance Tax Return. (See Schedule "H," Item B,7,)
2003
2004
26-Jun Check No, 563 - Lynn J, Smith, for items lised on Schedule "H,"
Item 8.8, and Exhibit "B," of Inheritance Tax Return 10,750,00
26- J un Check No, 564 - Leroy Smith and Lynn J, Smith, for items listed
on Schedule "H," Item B,9, and Exhibit "C," of Inheritance Tax
Return 9,484,00
26- J un Check No, 565 - Leroy Smith, for items lised on Schedule "H,"
Item B,I 0, and Exhibit "D," of Inheritance Tax Return 8,990,00
26-Jun Check No. 99 - Frey and Tiley, for items lised on Schedule "H,"
Page 3
Item 8.4 and Items 8.11-14, of Inheritance Tax Return 1,827,07
28-J un Check No, 96 - PP&L 64,96
28-Jun Check No, 97 - Pennsylvania American Water 24.54
28-Jun Check No, 98 - Keystone Oil 320,76
28-Jun Check No. 566 - Register of Wills, Agent, for payment on
account of Inheritance Tax 10,098,00
28-J un Check No, 567 - Register of Wills, filing fee for Inheritance
Tax Return 15,00
2005
12-Jan Check No, 568 - Frey & Tiley for additional Inheritance Tax 31,67
12-Jan Check No, 570 - Frey & Tiley for additional Inheritance Tax 3.87
12-Jan Check No, 571 - U,S. Treasury for 2002 Fiduciary Income Tax 80,00
12-Jan Check No, 572 - PA Dept. of Rev, for 2002 Fiduciary Income Tax 37,70
12-Jan Check No, 573 - U,S, Treasury for 2003 Fiduciary Income Tax 25,00
12-J an Check No, 574 - PA Dept. of Rev, for 2003 Fiduciary Income Tax 26,00
I3-Jan Check No,': .X - Reserve for 2004 Federal Fiduciary Income Tax 25.00
I3-Jan Check No,,'~- - Reserve for 2004 Penna, Fiduciary Income Tax 15.00
13-Jan Check No,"" , - Register of Wills - For filing Account 230,00
I3-Jan Check No, ~- Frey & Tiley for attorney's fees 5,661.86
13-Jan Check No, yi'f'- Johnson Duffie Stewart & Weidner for 5,661.86
attorney's fees
TOTAL DISBURSEMENTS 53,372.29
Page 4
RECAPITULATION
Total Principal Received 252,457,38
Total Income Received 2,072.74
Total Receipts 254,530,12
Less Total Disbursements (53,372.29)
Balance for Distribution 201,157,83
PROPOSED
SCHEDULE OF DISTRIBUTION
1 Kenneth David Blevins
2608 Curry Comb Court
Virginia Beach, V A 23456
1/2 Residuary: 100,578,92
Less Partial Distribution by check No, 93: (75,000,00)
Net Distribution upon Confirmation of Account: 25,578,92
2 Lynn JoAnna Smith
15 Hill Street
Railroad, PA 17355
1/2 Residuary: 100,578.91
Less Partial Distribution by check No, 94: (75,000,00)
Net Distribution upon Confirmation of Account: 25,578,91
Summary:
Total Distributions: 201,157,83
Total Net Distributions upon Confirmation of Account: 51,157,83
Page 5
j./ Z /:..r;. ~.. /'./;:_1
COMMONWEALTH OF P~NSYLVANtA
,",'':'-j:C7_'-'''J'fI ls~/c// SS,:
COUNTY OF C-YMBERALND
Before me, the undersigned officer, personally appeared Kenneth Dayid Blevins, one of the
Co-Executors of the Last Will and Testament of Samuel D, Blevins, Deceased, who, being duly sworn
according to law, desposes and says that the foregoing First and Final Account and Proposed Schedule
are true and correct to the best of his knowledge, information and belief,
/' t /l ' /It \
(" .J. .' C _. . \
.--t!...VI<.--f-/ 1,/../ ....t.;,,"q , -:"v~"-<"--"'>
Kenneth David Blevins
Sworn to and subscribed before me
this.:l6day of.Jh-.JU".a.y I '2 ()o 5
~h V&
COMMONWEALTH OF PENNSYLVANIA
: SS,:
COUNTY OF CUMBERALND
Before me, the undersigned officer, personally appeared Lynn JoAnna Smith, one of the
Co-Executors of the Last Will and Testament of Samuel D, Blevins, Deceased, who, being duly sworn
according to law, desposes and says that the foregoing First and Final Account and Proposed Schedule
are true and correct to the best of his knowledge, information and belief.
.I (L .h. 1-.L
7;'~'1 (
\,..t.-,.{ L---', ' ,,,--t./
, Lynn JoAnna Smith
,
Sworn to and subscribed before me
..,L -- /
this,)Sdayof j-"l"'ltl~ c::L<,x-.n ~/
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NOTARIAL SEAL
TRISHA A lIESS, NOTARY PUBLIC
BOROUGH OF CARLISLE. CUMBERLAND ce,. PI.
MY COMMISSIO~.EXPIRES MAY 7.0. 200e, Page 6
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Cumberland County - Register Of Wills
One Courthouse Square
Carlislel PA 17013
Phone: (717) 240-6345
Date: 1/04/2006
TILEY STEPHEN D
5 S HANOVER STREET
CARLISLE, PA 17013
RE: Estate of BLEVINS SAMUEL D
File Number: 2002-00802
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsell 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:
2/03/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~AJ~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
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STATUS REPORTlHIDERRULE 6.12
Name of Decedent: 5/J-/lfpL.e-.(~. Zkt/~'-N-f
D t fD h .- / "::7 -?..nL1 ........
a e 0 eat _: '/---C b,e.-..(~/ ~ / ~17__
Estate No.: d? / - 2.CJ c? :;:::t - CJ 8' CJ :;z...
.
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 whCjil1er administration of the estate is complete:
Yes I:!2r No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did ~ ~rsonal representative file a final account with 'the CoUrt?
Yes M No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state at'"1 account informally to the pa.."iies in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: ~k..7 ~~6
, /
~H
l!Y0:AJ, 7 A
Si a e
--Z/" 777
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Name /
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Telephone No.
Capaciti:
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~el for personal representative
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