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Home My WebLink About03-0855PETITION FOR PROBATE and GRANT OF LETTERS Estate of~ ~VIRGINIA M. GELBAUGH No. ~l 'O.~ --"~-~ also known a~,~VIARY VIRGINIA BOLLINGER, To: -- - also known a~I. VIRGINIA BOLLINGER, Deceased. County of Cumberland in the Register of Wills for the Social Security No. 179-12-4105 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner are 18 years of age or older and the Executors named in the last will of the above decedent, dated July 31, 1978, and codicil(s) dated [none]. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 828 Forge Road, Carlisle, South Middleton Township. Decedent, then 88 years of age, died October 10, 2003, at 828 Forge Road, Carlisle, Pennsylvania. Except .as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: 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: None $ unestimated $ $ WHEREFORE, petitioners respectfully requests the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. Velma JeanCt~ohn 10 Raylen Drive Boiling Springs, PA 17007 (717) 258-3839 William I. B. Evans 828 Forge Road Carlisle, PA 17013 (717) 243-7256 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioners above-named swear or affirm that the statements in the foregoing petition are tree and correct to the best cf the knowledge and belief of petitioners and that as personal representatives of the above decedent, petitioners will well and truly administer the estate according to law. Sworn to or affin, ned and subscribed before me this \ L0TM day of ',3 Velma Jean ~6hn William I. B. Evans Estate of VIRGINIA M. GELBAUGH a/k/a MARY VIRGINIA BOLLINGER, a/k/a M. VIRGINIA GELBAUGH, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, 0LtFoLt~_ 20, ~z)o~:~ , 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 July 31, 1978, described therein be admitted to probate and <v filed of record as the last will of irginia Gelbaugh a/k/a Mary Virginia Bollinger and Letters Testamentary are hereby granted to Ve]n~a Jean Bohn and William I. B. Evans. -,,, c~ ~ ....... ~x~ Will Book Page FEES Probate, Letters, Etc. Short Certificates( ) TOTAL ' R~st~r of~rWill_s_.~ ~c '~ ATTORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 Filed F:~FILES~DATAFILE~ESTATES~6099-5.1¢tt~i~.tcs 105.805 REX" 9/g6 This is to certify that the information here given is correctly copied from an original certificate of' death duly filed with mc as Local Registrar. The original certificate will be £onvarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8749603 No. /Local Registrar OCT 1 4 2003 Date NENT m0s.~q a~,. ~7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ',. M. ~'~rginia Gelbaugh J Yemale I l?O ~ ..... Io ~o~_~.,~.~,., · G£(t-"~8~YI ..~a,v~ ~",D~ 0*TaO~a,m.~ ,~.~~~ -- ~,. October 10, 2003 ~1 Cumberl~d p. Middleton Twp. I 828 Forge Road o~r~m"s M.,.,NG ~ss (s,,.,,. o,~,.., s,,,., a,c~ i&C~C<NT,s PA Widow ,,. 828 Forge Road ~c~ at~xsc~ ~ -..~ ~.~ S. Middle,on Twp. Carlisle PA 17013 ~ 't ~ Cumberland ,,. Irvin Rotz ,, Bertha Can Syoe William Evans [] 14, 2003 Valley Mem. Garde 013144 L ~ ~0o~ 'MO PA 17013 Carlisle PA 17013 )me ksle PA 17013 LAW OFFICES WILLIAM F. MARTSON, P,C. LAST WILL AND TESTAMENT I, MARY VIRGINIA BOLLINGER, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral and testamentary expenses shall be paid as soon after my death as possible from the residuary of my estate. 2. I give the sum of One Thousand Dollars ($1,000.00) unto GRACE UNITED METHODIST CHURCH, Pomfret and West Streets, Carlisle, Pa, bequeathed in memory of George E. Bollinger. 3. I give unto each of my husband's nephews, LARRY BOLLINGER, GERALD BOLLINGER, JAY BOLLINGER, and DUANE BOLLINGER, the sum of One Thousand Dollars ($1,000.00). 4. Ail the rest, residue and remainder of my estate, both real and personal property, I give, devise and bequeath in equal shares unto my children, VELMA JEAN BOHN and WILLIAM I. B. EVANS, absolutely. Should any of said children predecease me, then I give, devise and bequeath his or her share in equal shares to his or her children living at the time of my death. 5. In the event any issue of my children shall be entitled to share in my estate and they shall not have attained the age of twenty-five (25) years at the time of distribution, I give Mary ~r~ini ,~.~Bollinger.~ '~ f -1- LAW OFFICES WILLIAM Fo MARTSON, P.C. and devise such share unto FARMERS TRUST COMPANY, Carlisle, Pa., in trust, to hold, manage, invest and reinvest the same and to use and apply the income and so much of the principal as my Trustee shall deem necessary in its sole discretion for the support, maintenance and education of such issue. All income shall be distributed by my Trustee to said issue upon attaining the age of eighteen (18) years. Any principal and income not distributed shall be distributed to such issue when he or she attains the age of twenty-five (25) years, and if he or she dies before attaining the age of twenty-five (25) years, the trust shall terminate and such share shall be distributed to his or her personal representative. 6. I hereby appoint VELMA JEAN BOHN and WILLIAM I. B. EVANS as Executors of my estate and I direct that my personal representatives shall employ the firm of WILLIAM F. MARTSON as attorneys in the settlement of my estate. IN WITNESS ~IEREOF, I have hereunto set my hand and seal this .{ i day of ~ , 1978. -J~bqr ~f~w~ ~A~o.(SEAL) Mary ~J. rginih~Bo 11 inger ~ SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, I~RY VIRGINIA BOLLINGER, as and for her Last Will and Testament, in the presence of us, who, at her request, have hereunto subscribed our names as witnesses thereto, in the presence of said Testatrix and of each other.~ / -2- LAW OFFICES WILLIAM F, MART$ON, COMI,{0~-~,~EALTH OF PENNSYLVANIA ) SS COUNTY OF CUPEBERLAND .... ) I, Mary Virginia Bollinger, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to Mary~iniaof Bo~linger1978. y ~iCgin~a BolIinger ~ and ackn~wledg~ before me b~ ~ , the Testatrix, this ~/~ day Nota~ CorJisie, Curnberjoncl Co., PA COMMO~g~EALTH OF PENHSYLVANIASS ) ~ ~ ~ ~ ~, t~ COMITY OF CbR~ER~ND .... ) the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Mary Virginia Bollinger , Testatrix, sign and execute the instrument as her Last Will; that Mary Virginia Bollinger signed willingly and that Mary Virginia Bollinger executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of Mary Virginia Bollinger , Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~ ! / , Add;ess /~ ~7'~ ~~-- Sworn or affirmed to and subscribed before me, by MARY VIRGINIA BOLLINGER LAW OFFICES HENDERSON BLOCK TEN EAST HIGH STREET CARLISLE, PENNSYLVANIA 17013 F:\FILES\DATA FILE\ESTATES\6099-5.notice.cert CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mary Virginia Bollinger a/k/a Virginia M. Gelbaugh Date of Death: October 10, 2003 File No. 21-03-0855 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 or about October 28, 2003. Grace United Methodist Church 45 South West Street Carlisle, PA 17013 Mr. Larry Bollinger 5731 Clearview Road Dover, PA 17315 Mr. Jay Bollinger 5711 Clearview Road Dover, PA 17315 Mr. Duane Bollinger 5670 Clearview Road Dover, PA 17315 Mrs. Velma Jean Bohn 10 Raylen Drive Boiling Springs, PA 17007 Mr. William I.B. Evans 828 Forge Road Carlisle, PA 17013 Mr. Gerald Bollinger 5741 Clearview Road Dover, PA 17315 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: October 28, 2003 Signature ::.- Name Edward L. Schorpp, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003384 SCHORPP EDWARD L 10 EAST HIGH STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 179-12-4105 FILE NUMBER: 2103-0855 DECEDENT NAME: BOLLINGER MARY VIRGINIA DATE OF PAYMENT: 12/29/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 O/10/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,230.37 TOTAL AMOUNT PAID: $1,230.37 REMARKS: VELMAJEAN BOHN C/O EDWARD L SCHORPP ESQUIRE SEAL CHECK# 102 INITIALS' JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 179-12-4105 00855 NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GELBAUGH, Virginia M. DATE OF DEATH (M~DD-yEARi r DATE C)~ BIRTH (MM~DD-YEAR) THIs RETURN MUST BE FILED IN DUPLICATE WITH THE 10/10/2003 09/20/1915 REGISTER OF WILLS (IF APPLK~ABLE) SURVIVING SPou~;S NAME( LAS~', FIRSTAND ~16DLE'ifii'rlALi - ' ' SoCiAL SEcuriTY N~JMBER [] 1. Original Return [~ 2. S~pplementat Return ~ [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) ~ [] 6 DecedentDiedTestate(Attachcopy [] 7. DecedentMaintainedaLivingTrust(Attach of Will) copy of Trust) < [] 9 Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between ] 3. Remainder Return (date of death prior to 12-13-82) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) .... ]THIS SECTIONMUST BE COMPLETED. ALL COR~tESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Edward L. Schorpp, Esquire FIRM NAME (If applicable) Martson Deardorff Williams & Otto Ten East High Street Carlisle, PA 17013 TELEPHONE NUMBER 717/243-3341 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation. Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (1) None (2) 9,680.99 (3) None (4) None (5) 25,513.96 (6) None (7) -0- (9) 13,478.97 (10) 1,268.64 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 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 INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate 4,000.00 x .15 19. Tax Due 15,447.34 x .045 20. [] (8) 35,194.95 (11) 14,747.61 (12) (13) 20,447.34 1,000.00 (14) 19,447.34 (15) (16) (17) 695.13 (18) 600.00 (19) 1,295.13 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: I STREET ADDRESS · 828 Forge Road CITY Carlisle sTAVE i PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount InterestJPenalty if applicable D. Interest E. Penalty 64.76 Total Credits (A + B + C) (2) Total InterestJPenalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (1) 1,295.13 64.76 0.00 1,230.37 1,230.37 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; ............................................................................. [] [] b. retain the right to designate who shall use the property transferred or its income; ......... : ...................... c. retain a reversionary interest; or ............................................................................................................ d. receive the promise for life of either payments, benefits or care? ........................................................... [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Velma Jean Bohn ~ //~ _ Z5~ 10 Raylen Drive 2~/'~~"~:ae~.,_ /__,~-'"z~-~ Boiling Springs, PA 17007 SI~'NATURE OF PERS(~J~I~ESPONSIBLE FOR FILING RETURN ADDRESS ~Ailliam I.B. Eves ~A~ '~------~ ~ 828 Forge Road Carlisle, PA 17013 SI OF PREPARE*R'DTHER THAN REPRESENTATIVE ADDRE%S Edward L. Ten East High Street Carlisle, PA 17013 DATE DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempt 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, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANtA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GELBAUGH, Virginia M. FILE NUMBER 21 - 03- 00855 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM i VALUE AT DATE OF NUMBER ~ DESCRIPTION J UNIT VALUE . DEATH 1 1719.537 shares, Dryden High Yield FD Class A 5.63 9,680.99 Cusip # 74435F106, held in Prudential Securties Account #03800506479 TOTAL (Also enter on line 2, Recapitulation) 9,680.99 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GELBAUGH, Virginia M. FILE NUMBER 21 - 03 - 00855 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 DESCRIPTION M&T Bank CD# 31003910440278 M&T Bank CD# 31003910489565 M&T Bank checking account # 1240013 M&T Bank savings account # 15004200117867 Prudential Securities, dividend from Dryden High Yield Fd Class A Comcast, refund Elwood Gardens, refund Medicare, reimbursement Sprint, refund Dehart's Auction Services, sale of personal property Dan Shunk, sale of personal property TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 7,304.77 13,321.62 2,431.06 1,262.85 57~75 18.21 584.00 25.20 9.22 314.28 185.00 25,513.96 ,~ SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOSTRANSFERS & 'N.ER,TANCE X RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GELBAUGH, Virginia M. 21 - 03 - 00855 This schedule must be completed and filed if the answer~to any of questions I through 4 on page 2 is yes. DESCRIPTION OF PROPERTY I ' ITEM Include the name of the transferee, their relationship to decedent and the date of transfer DATE OF DEATH % OF NUMBER FVALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate. (IF APPLICABLE) INTEREST 1 1988 Mercury Station Wagon, title ~ransfered to william 1,000.00~ 100% 3,000.00i 0.00 I.B. Evans (son) 9/17/2003 TOTAL (Also enter on line 7, Recapitulation) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /~OMINISlRATIVE COSTS RESIDENT DECEDENT ESTATE OF GELBAUGH, Virginia M. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FILE NUMBER 21 - 03 - 00855 AMOUNT FUNERAl_ EXp~NSEs: ~ Hoffman-Roth Funeral Home 6,850.00 2 Grace United Methodist church, funeral reception, minister 235.00 3 Funeral flowers 185.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Martson Deardorff Williams & Otto (estimated) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant William I.B. Evans Street Address 828 Forge Road City Carlisle State PA Relationship of Claimant to Decedent Son Probate Fees Cumberland County Register of Will Zip 17013 2,400.00 3,500.00 72.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Other Administrative Costs Certified mailing, Department of Public Welfare Register of Wills, short certificates 4.42 6.00 Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 226.55 13,478.97 ,~ ,?x::hedl~ H COMMO.~,EA,TH OF PEN.S~,¥^N,^ Funa~ ~ & INHERITANCE T~ RETURN ~~ ~ ~n~ RESIDENT DECEDENT ESTATE OF GELBAUGH, Virginia M. 3 EVP, stock valuation FILE NUMBER 2] 03- 00855 1.55 Register of Wills, filing fee, Inheritance Tax Register of Wills, filing fee, Inventory Reserved for additional probate and miscellaneous expenses 15.00 10.00 200.00 Page 2 of Schedule H .~ SCHEDULE I i DEBTS OF DECEDENT, MORTGAGE CO""ONWEAL*.O~PENNS¥,VA.,A LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GELBAUGH, Virginia M. Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 DESCRIPTION oUtstanding cheCks °n~&T Bank a~couni #1 ~400 ~ ~ on date of death Chapel Pointe, balance due Margaret's Tree Care. balance due FILE NUMBER 21 - 03- OO855 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 1,088.28 105.00 75.36 1,268.64 REV-1~513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF NUMBER 1. SCHEDULE J BENEFICIARIES RESIDENT DECEDENT GELBAUGH, Virginia M. ;FILE NUMBER ' 21 - 03- 00855 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Larry Bollinger 5713 Clearview Road Dover, PA 17315 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Step-nephew AMOUNT OR SHARE OF ESTATE 1,000.00 Gerald Bollinger 5711 Clearview Road Dover, PA 17315 Jay Bollinger 5711 Clearview Road Dover, PA 17315 Step-nephew Step-nephew 1,000.00 1,000.00 II. Duane Bollinger 5670 Clearview Road Dover, PA 17315 Step-nephew See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet i NON-TAXABLE DISTRIBUTIONS: 1,000.00 iA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE i B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Grace United Methodist Church 45 South West Street, Carlisle, PA 17013 1,000.00 TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE]' 1~000.00 "~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN I RESIDENT DECEDENT~' ESTATE OF : FILE NUMBER NUMBER I. GELBAUGH, Virginia M. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and ~ransfers under Sec. 9116(a)(1.2)] Velma Jean Bohn 10 Raylen Drive Boiling Springs, PA 17007 21-03-00855 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE DoNotLIstTrustee(s) OF ESTATE Daughter i 1/2 of estate residue William I.B. Evans 828 Forge Road Carlisle, PA 17013 Son 1/2 of estate residue Page 2 of Schedule J Estate Valuation Date of Death: 10/10/2003 Valuation Date: 10/10/2003 Processing Date: 10/16/2003 Shares Security or Par Description High/Ask Low/Bid 1) 1719.537 DRYDEN HIGH YIELD FD INC (74435F106; PBHAX) CL A NASDAQ 10/10/2003 5.63000 Bid Estate of: Virginia M. Gelbaugh Report Type: Date of Death Number of Securities: 1 File ID: 6099.5 Mean and/or Div and Iht Security Adjustments Accruals Value 5.630000 9,680.99 Total Value: Total Accrual: Total: $9,680.99 $0.00 $9,680.99 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. please contact EVP Systems at (818) 313-6300. (Revision 6.4.1) If you have questions, Prudential Mutual Fund Services LLC P.O. Box 7387 Philadelphia, PA 19101-7387 Prudential Financial Page I of 2 A Consolidated Overview Of Your Investments This is your Prudential Mutual Fund Statement for the period July 1,2003 to September 30, 2003 The recent restructuring of product lines by Prudential Financial into JennisonDryden and Strategic Partners mutual funds adds new flexibility to your long-term investment strategy. Read Making Advised Choices to learn more. Mail to: VIRGINIA M GELBAUGH 513 B S WEST ST CARLISLE PA 17013-0000 h,,llh,,llh,,,,,Ih,lhlh,,Ih,,Ih,,Ih,,Ih,,Ih,,h,hl Your Account Summary Your SSN/TIN#: ON FILE VIRGINIA M GELBAUGH ::::::::::::: :::::: ::::::::: :::::: ::':::::::::: :::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::: ::: :;::::::::::: :::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: $180.13 $0.00 $0.00 0.000 1,719.537 1,719.537 $5.59 $9,612.21 Features & Services: Representative: Dividends: Cash Capital Gains: Cash Telephone Exchange Robert P Yockin Lutcf (717) 975-8150 Detailed Transaction Activity Gross Sham Number of Shams Sales Charges and/or Net Amount Total Shams Date Description Amount Price Purchased or Sold Taxes Withheld Owned 07/01103 Opening Sham Balance 1,719.537 07/21/03 Dividend-Cash $57.75 $57.75 1,719.537 08/21/03 Dividend-Cash $61.45 $61.45 1,719.537 09/19/03 Dividend-Cash $60.93 $60.93 1,719.537 09/30/03 Closing Sham Balance 1,719.537 While we make every attempt to ensure that your statement is accurate, errors may inadvertently occur. Please review your statement thoroughly and contact us if you find any information you believe to be inaccurate, If we do not hear from you in 30 days, we will assume that all information is correct. Prudential Financial is a service mark of Prudential, Newark NJ, and its affiliates. If required by your state, Prudential Mutual Fund Services LLC will be supplying this information to the appropriate state agency. November 10, 2003 Martson, Deardorff, Williams & Otto Ten East High Street Carlisle, PA 17013 499 Mitchell Street, Millsboro, DE 19966 Estate of Virginia Gelbaugh Date of Death: October 10, 2003 Social Security Number: 179-12-4105 Dear Ms. Otto: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Certificate of Deposit Account Number. ...................... 31003910440278 Ownership (Names of) .............. Virginia M. Gelbaugh Opening Date ........................... 09/29/99 (account closed 10/28/03) Balance on Date of Death. ......... $7,300.00 Accrued Interest $ 4.77 Total. ...................................... $7,304.77 Account 7~Jpe ........................... Certificate of Deposit Account Number. ...................... 31003910489565 Ownership (Names of) .............. Virginia M. Gelbaugh Opening Date ........................... 10/20/99 (account closed 10/28/03) Balance on Date of Deattt ......... $13,300.00 Accrued Interest $ 21.62 Total ...................................... $13,321.62 · Page 2 November 10, 2003 Account Type ........................... Checking Account Account Number. ...................... 1240013 Ownership (Names of) .............. Virginia M. Gelbaugh Opening Date ........................... 04/08/95 (account closed 10/28/03) Balance on Date of Deattt ......... $2,430.93 Accrued Interest $ O. 13 Total. ...................................... $2,431.06 Account Type ........................... Savings Account Account Number. ...................... 15004200117867 Ownership (Names of) .............. Virginia M. Gelbaugh Opening Date ........................... 04/08/95 (account closed 10/28/03) Balance on Date of Deattt ......... $1,262.73 Accrued Interest $ O. 12 Total. ...................................... $1,262.85 Sincerely, Charlene Wardn~on, Associate I (302) 934-2722 LAST WILL AND TESTAMENT LAW OFFICES WILLIAM F, MARTSON, I, ~RY VIRGINIA BOLLINGER, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral and testamentary expenses shall be paid as soon after my death as possible from the residuary of my estate. 2. I give the sum of One Thousand Dollars ($1,000.00) unto GRACE UNITED METHODIST CHURCH, Pomfret and West Streets, Carlisle, Pa, bequeathed in memory of George E. Bollinger. 3. I give unto each of my husband's nephews, LARRY BOLLINGER, GERALD BOLLINGER, JAY BOLLINGER, and DUANE BOLLINGER, the sum of One Thousand Dollars ($1,000.00). 4. All the rest, residue and remainder of my estate, both real and personal property, I give, devise and bequeath in equal shares unto my children, VELMA JEAN BOHN and WILLIAM I. B. EVANS, absolutely. Should any of said children predecease me, then I give, devise and bequeath his or her share in equal shares to his or her children living at the time of my death. 5. In the event any issue of my children shall be entitled to share in my estate and they shall not have attained the age of twenty-five (25) years at the time of distribution, I give ~ary ~irg~n~a,~Bollinger -1- LAW OFFICES WILL]A~I F. M^RTSON, and devise such share unto FARMERS TRUST COMPANY, Carlisie, Pa., in trust, to hold, manage, invest and reinvest the same and to use and apply the income and so much of the principal as my Trustee shall deem necessary in its sole discretion for the support, maintenance and education of such issue. All income shall be distributed by my Trustee to said issue upon attaining the age of eighteen (18) years. Any principal and income not distributed shall be distributed to such issue when he or she attains the age of twenty-five (25) years, and if he or she dies before attaining the age of twenty-five (25) years, the trust shall terminate and such share shall be distributed to his or her personal representative. 6. I hereby appoint VELMA JEAN BOHN and WILLIAM I. B. EVANS as Executors of my estate and I direct that my personal representatives shall employ the firm of WILLIAM F. MARTSON as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal mary ~irginia?Bollinger SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, MARY VIRGINIA BOLLINGER, as and for her Last Will and Testament, in the presence of us, who, at her request, have hereunto subscribed our names as witnesses thereto, in the presence of said Testatrix and of each other.~ -2- LAW OFFICES WILLIAM F. MART$ON, COMI,¢Oi-E4EALTH OF PENNSYLVANIA ) SS COUNTY OF CU~,iBEPJ~AND .... ) I, Mary Virginia Bollinger, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that i signed it as my free and voluntary act for the purposes therein expressed. Mary ,,~i~g±n~ Boliinger Sworn or affirmed to and ackn~g~ledge,8 before me bM" Mary ~Virginia Bollinger , the Testatrix, this jL,,~:/~ day of );~iI , 1978. ~rlisJe, Cum~nd ~., PA CO~O~K~ALTH OF PENI']SYLVANIASS ) COMITY OF CL!{BER~ND .... ) We ,'Z~ .~.~ ....... ;¢2 /' ~ ~ ~_.~ .... ~ .... ~.7~..~,-~ ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were ~resent and saw Mary VirAinia Bollinger , Testatrix, sign and execute the instrument as her Last Will; that Mary Virginia Bolli~ger signed willingly and that Mary Virginia Bollinger executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of Mary Virginia Bollinger , Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influenge. --/ ~ ' / ~ ~ ~" X '- Sworn or affirmed to and subscribed before me, by this .::.-d' day of ~:.~..L./~. , 1978. ~, ~ ~., PA Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of G_ E.!~BAUGH, ¥irgi~nia M._ also known as Mary Virginia Bollinger; M. Virginia Bollinger , Deceased No. 21 - 03 - 00855 Date of Death 10/10/2003 Social Security No. 179-12-4105 Velma Jean Bohn William I.B. Evans The Personal Representative(s) of the above Estate, dece~d, ~erify that ~he items aPpearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedenrs death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/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. Attorney: Edward L. Schorpp, Esquire I.D. No.: 17495 Address: Telephone: Representative Signature: V~lma J~aja B~6hn Signature: ~;;~~,~ William I.B. Evans Signature: Ten East High Street Carlisle, PA 17013 Address: 10 Raylen Drive Boiling Springs, PA 17007 717/243-3341 Telephone: (717) 258-3839 Dated: Personal Property 1719.537 shares, Dryden High Yield FD Class A Cusip # 74435F106, held in Prudential Securties Account #03800506479 M&T Bank CD# 31003910440278 M&T Bank CD# 31003910489565 M&T Bank checking account # 1240013 M&T Bank savings account # 15004200117867 Prudential Securities, dividend from Dryden High Yield Fd Class A Comcast, refund :, Elwood Gardens, refund Medicare, reimbursement 9,680.99 7,304.77 13,321.62 2,431.06 1,262.85 57.75 18.21 584.00 25.20 (Attach additional sheets if necessary) Total Personal Property and Real Estate $41,615.62 Estate of also known as Register of Wills of Cumberland County, Pennsylvania INVENTORY continued GELBAUGH, Virginia M. No. 21 - 03 - 00855 Mary Virginia Bollinger; M. Virginia Date of Death 10/10/2003 Bollinger , Deceased Social Security No. 179-12-4105 Sprint, refund Dehart's Auction Services, sale of personal property Dan Evans, sale of personal property Prudential Financial Life Insurance Policy # M09478823, proceeds payable to the estate Prudential Financial Life Insurance Policy # 474206542, proceeds payable to the estate Prudential Financial Life Insurance Policy # M53657601, proceeds payable tothe estate 9.22 314.28 185.00 3,087.71 1,576.67 1,756.29 Total Personal Property $41,615.62 2 REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: Date of Death: File No.' Social Security No.: Virginia M. Gelbaugh 10/10/03 21-03-0855 179-12-4105 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the follo~v~ng with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: ao Did the personal representative file a final account with the Court? Yes No X The separate Orphans' Court No. (if any)for the personal representative's account is: Co Did the personal representative state an account informally to the parties in interest? Yes X No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans'Court and may be attached to this report. September 14, 2004 Signature :,.~i~~ffi~'~~,,~~ ame: Edward E. Sc~torpp, l~squire Address: MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Counsel for personal representative F \FlLES\DATAF1LE\ESTATES\6099-5 step BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DZV/$/ON DEPT. 28n601 HARRTSBURG, PA 17128-060! EDWARD L SCHORPP ESQ MARTSON ETAL 10 E HIGH ST CARLISLE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX .... ~ATE .: . ? \~/ilIsESTATE OF DATE OF DEATH FILE NUMBER '04 FEB 27 P 1 .~qUNTY ACN PA 17015CUm~o~'i~i}~ Co., PA REV-15q7 EX &FP 02-26-200q GELBAUGH L. VIRGINIA M 10-10-2005 21 03-0855 CUMBERLAND101 Amoun~ Rami**ad MAKE CHECK PAYA]ILE AND REMTT PAYMENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LTNE ~ RETATN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHER/TANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GELBAUGH VIRGINIA N FILE NO. 21 03-0855 ACN 101 DATE O2-Zq-2OOq TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATTON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership In~ares* (Schedule C) ($) ~. Mortgages/No,as Receivable (Schedule D) (~) 5. Cash/Bank Daposi~s/Hisc. Personal Propar~y (Schedule E) 6. Jointly O~ned Propar~y (Schedule F) (6) 7. Transfors (Schedule G) (7) 8. To*el Assa~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expansas/Adm. Costs/Misc. Expenses (Schedule H) 10. Dab,s/Hot,gage LiabiZi~ias/Lians (Schedule I) (10) 11. To,al Deductions 12. No~ Value of Tax Re~urn 9~680.99 25~513.96 .00 .00 NOTE: To insure proper cradi~ ~o your account, .00 submi~ ~he upper portion .00 of ~his form ~i~h your ~ax payment. .00 (8) 15,q78.97 $5,19q.95 1,268.6q (11) lq .7~7 .&l (12) 20,qq7.$q 15. 1,000.00 1~. 19,qq7.3q NOTE: 18 and 19 #ill reflect ~igurss that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e (1~) .00 X O0 = .00 16. Amoun~ of Line 1~ ~axabla a~ Lineal/Class A ra~o (16) 15,qq7.$q X Oq5 = 695.13 17. Amoun~ of Line lfi a~ Sibling ra~a (17) .00 x 12 = .00 18. Amoun~ of Line lq ~axablo a~ Collateral/Class B ra*a (18) q,O00.O0 X 15 = 600.00 Charitable/Governmental Baquas*s; Non-elected 9115 Trus*s (Schedule J) (15) No~ Value of Es~m*e Subjec~ ~o Tax Z~ an assessment ~as issued previously, 11nas 14, 15 and/or 16, 17, 19. Principal Tax Due TAX CREDITS: PAYMENT DATE 12-29-2005 RECETpT NUMBER CE00$$Sq DI$COUNT (+) INTEREST/PEN PAID (-) 6q.76 IF PAID AFTER DATE L FOR CALCULATION OF ADDITIONAL INTEREST. (19)= 1,295.13 AMOUNT PAID 1,230.37 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,295.15 o00 .00 .00 IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REGUIRED. ..j'l~'~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)