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M'AYANENT
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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
Date
AuG ~ s. 2001
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLWNIA • OEPAR'TMENT OF HEALTH • VRAL RECORDS
CERTIFICATE OF DEATH
~02~71
NAMECF oECEDExr tFn<Mleu.. w sacw sEClRVrr ~w„aEn oFOEATNIwrI. Dir. •Awh
+• Martha A. Blessing a 2~emale a 208 - 38 - 7341 .. ~ ({ ( s
ADE M1i+eYiYrR uNDa„reAa uNOE111 ~v DATEasawm wnr,wACrs ICM,re MAC[as DFRNKlwJl a+ymi-sirr Aorrmdbl ltly
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• Hommaker „ domestic , , ~~ n~i«s., , Widavled ,
DECmENT•swuwoAODRESarsi.r.c~/e,.e.ar..ns,ceaN a ,a sld.~gn~ylVania Da ,TmC$w.
a.e.ris.rlti East PennSboro
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7 Hunter Lane e.,,,,,, ^~
,a Catg Hell, PA 17011 m ~ r 17-. C~erlClnC~ Mme? ,H^ ~MRaebYidYd
aNAME 1F.a Miafi, taq
John D. Hatfield MOflER'SNAME (~ x raw. l+.e.,sv,.iy
,a Mary C. Arnold
wsonwwraNAMERVOw.Yq
Doris J. Blessing
-enaoasoelrowraN D`oeos Dls-CwrIDN MAawaADDRE9a19itl,CidWias,Ib, Cee1J
7 Hunter Lane, Camp Fii~l, PA 17011
MACEaroemoslnw-NrrdCarrXC,aeru, ~of.ioIDN-CMw4we.sbb.mc«r
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D+rm•.w. ^ January 28, 1995 Ro
g Green Memorial Park Lower Allen 4Wp. , PA 17011
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mi.p.0. Box 431 New Cumberland PA 170'0
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NAME ANDAODRE990F VEASON WHO COW~ETED CAUSE OF D&VN
•~DICAL EIUAWa:R/COgpNER (Item 2Y) Typi «PAM
on eb bWi d uullY,itle„ and/or Mreityalbe, b my •olnlon, dell, oavniE it tlb Ume, aNi, e„U plxi, altl dw 1e 1M twr(i) rA Peter M. Brier, MD
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"` ,z 108 Lflwther St., Lemoyne
PA 17043
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S SIDNRURE ANO NUMBER ~ , S ORE FlLED (MaMn.OW. Werl ~}
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~ETIT~ON FOR PROBATE aa~d GRANT OF LETTERS
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F,.state ~(!~J~7NtA f}• ~3~~(",l4 No. a~ I - ~~"C>DD % 7 •
also known as _ To: ~~" -/~`~ ~-- '~
____ Register of Wills for the G ,
Deceased. County of Cu~+r~ t~4~11~ in the
,S'ecial."ert:rit}~ ^'o. ~Q~ ' ~ ° ~_7~''~1 - Commonwealth of Pennsylvania
"the petition of the unclersic,ned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut _ named
in the last tail) of the abo~~e decedent, dater. _~, /~~~et5'y" -, 19~+_
and coclicil(s) dated _ - `
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ ~rr~~R~a~D County, Pennsylvania, with
h last family or arincipal residence at 7 N~aXTf~Q 1,~N~ , CRjy1 ? N!L L AA
(list street, number and muncipality)
Decendent, then L(-_ years of age, died u1R~V~e-~}~2-y a-~-, 19~,
at H ~ t_;/ S~'!£t ~ ~~~ypl7'/rL-
~~MP l-F/`4 ,PA-
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Except as follews, decedent did not marry, was not divorced and did not have a child born or adopted
after execution ol'the will offered for probate; was not the victim of a killing and was never adjudicated
ircornpetent:
_
Decendent at death owned property with estimated values as follows:
(I f domiciled in Pa.) All personal property $ ~~,• o o ~
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Valve of real estate in Pennsylvania $ i
situated as follotts: i
l
~
-----
«'HEREFORE, etitioner s res ectfull ~ re uest s the robate of the last will and codicils
P () P y 4
() P ()
,
presented herewith and the grant of letters ~ .~ 'S7'RMENTi1-Ky
(testamentary; administration e.t.a.; administration d.b.n.c.t.a.)
tl:eron.
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-__------__OAT~I OF PERSONAL REPRESENTATIVE
COMMON~VEALTI~ OF PENNSYLVANIA
ss j
(:OUNT~' OF I
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
sworn to or aCftrmed and subscribed ~ -s-,•-.~~~ t~_
befog: rte this ~~„~ dam ~f ~ ~'
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,~ ~ ~~ ~ Register -~
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~~. 21-95-0097_
~~~>~'~ ~~ MARTHA A. BLESSING ,Deceased
DL+CREE OF PROBATE AND GRANT OF LE'T'TERS
AND NOW F~~bruar~ 7th 19 95 , in consideration of the petition on
t;i~ reverse side hereof, satisfactory proof having been presented before me,
1 i I5 DF_C;Ri/EL? that the instrument(s) dated August 1984
describe~.l ;herein be admitted to probate and filed of record as the las, will of
and Letters ~ey~~t~m~nt~rv
are hereby granted to George B. Blessing Jr.
FEES
Probate, Letters, Etc.......... $ 115 .0 0
Short Certificates( .......... $ 18.00
Renunciation ................ $
MCP $~~ 00
TOTP.L _$ 2 3 8. 0 0
Filed ,ret~ruary,.7,.1995....,._,.._
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L~S~ Register f Wills
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE.
~.~;GISTER OF WILLS OF COUNTY
'®~T~I OF SUBSCRIBING WITNESS
codicil /
(each) a subscribing witness to the will presented herewith, {eac~~eing duly qualified according to
law, depose(sl and say(s) that ~ present and saw
'~.
the testat _~, sign the same and that _`
request of testat . in h presence
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
i
me this !day of
i 19
Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
O~TI-I OF NON-SUBSCRIBING WITNESS
r
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
y~Ll ~f'E familiar with the signature of /~11~/2TN~9 ~: ~L~_._551~4/~-,
codicil
testate of (one of the subscribing witnesses to) the will presented herewith and
codicil
that _ ~~ ~~~ _ believes the signature on the will is in the handwriting of
to the best of = ~~ E~ ~'~ Knowledge and belief.
Sworn to or affirmed and subscribed before
me this _~ day of
~~~tJLI~}f~ 19~
~/ ~~ '~ ~ ~~~ Register
~~ ~,
/ ,
~ signed as a witness at the
the presence of each other) (in the presence of the
~ ~- ~ ~_
(Name)
~2zS fV ~~~Ol/~ ll.~Z" ,~~ -~ G~7~'st~ i
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!"{+~~ ~•, I ~ ~ ~ e ~ sus ~ ~ POVERTY CREDIT IS CLAIMED I_J
~I COMMONWEALTH OF PENf:ISY~VANIA I FILE NUMBER
th./l DEPARTMENT OF REVENUE ~TO ~ r11.CY IIY wr~11c.ATE
DEPT. 280601 WI H REGISTER OF WILLS] 21 95 0097
HARRISBU G, Pq 17129.0601
OECEDE 'S NAME (U,ST, FIRST, AND MI LE INITIAL) - COUNTY CODE YEAR NUM
B e S I n g, Martha A. DECEDENT'S COMPLETE ADDRESS
= IAL URITY NUMBER 7 Hunter Lane
~ DAT ATH GATE OF BIRTH Camp H11~1 , PA 17011
W 8-38-7341 /24/95 8/25/03 Cumberland
O •+FLIG~LE) SuRVtwniG SIpUSE'S N,v~E MSi, N~iST Ip Ceue
SOCIAL SECURITY NUMBER ...n.~.~..~~....-- .--- .-.-_-.. --
~
ss 6 y 1. Original Return ^ 2. Supplemental Return
^ 3. Remainder Return
W ~~
~dm ^ 4. Limited Estate
^ 4a. Future Interest Compromise (for dates of death prior to 12.13
^ 5
F
d
l E
(for dotes of death offer 12-12-82) .
e
era
state Tox Return Require
c 6. Decedent Died Testate
(Attach copy of Will) ^ 7. Decedent Maintained o Livin Trust
(Attach copy of Trust) g
-8. Total Number of Safe Deposit Bo:
011 f Dtaeeers.rr.~....~
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-- ~-•-•---• - -~-~~ •+sa+ wrvrsuenngL IAJC INFORMATION SHOULD BE DIRECTED TO:
NAMbr
harles F. Sullivan CPA CFP 1513 Cedar Cliff Drive
HONE NUMBER
717 ~ 737-5466 Camp Hill, PA 17011
1. Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule B) ( b 9 , 9 2 2. 7 4
3. Closely Held Stock/Partnership Interest (Schedule C) (3 )
d. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits 8 Miscellaneous Personal Property
(Sched
l
E ( 200.00
u
e
)
6. Jointly Owned Property (Schedule F) ( 1 , U b $ - $ ,5
7. Transfers (Schedule G) (Schedule L) (~ )
8. Total Gross Assets (total lines 1-~
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses(Schadule H) (Q~ 4 s 85 9 - 13
10. Debts, Mortgage liabilities, liens (Schedule I) (10)
1 1. Total Deductions (total Lines 9 8 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Ga~ernmental Bequests (Schedule J)
14. Ner Value Subject to Tax (Line 12 minus Line 13)
15. Spousal Transfers (for dates of death after 6
30
94
-
-
)
See I t f
ns rucirons or Applicable Percentage on Reverse (15)
Side. (Include values from Schedule K or Schedule M.) x' -_
16. Amount of line 14 roxable of 694 rats (16) 6 6 , 3 3 2.4 6 Oe 3 , 9 7 9.3 5
(Include values from Schedule K or Schedule M.) -
17. Amount of line 14 roxable at 15°14 rote (1~)
(Include values From Schedule K or Schedule M.) x .15 =
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) 3, 979.35
19 Credits Spousal Poverty Credit Prior Payments Discount
Interest
21. IF Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21 A.
8 Enter the total of Lins 21 and 21A on line 218. This is the BALANCE DUE.
Make Check Poyoble to: Register of Wills, ARenf
~ ~ BE SURE T
+ + _
20. tf Lins 19 is greater than Lina 18, enter the differences on Line 20. This is the OVERPAYMENT.
O ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~
Under penalties of penury, 1 declare char I have examined this return, including accompanying schedules and statements, and ra the best of my knowledge and E
it is true, correct and complete. I declare that all real estate has been reported a- true market value. Declaration of prsporer other than the personal represenra
based n all information of which pr arsr has any knowledge.
Sr E Oi -ERSON - I E FOq FgING R qN ADDRESS
L532 A eve Lane, Green Valley AZ 85614 ~ ~`
SiG RE iA f E E r r E ADDRESS
r r e o•r_ ~ ,~~-r t
. ar es _ u _ n __ C P L513 Cedar C1ifE Dr., Camp Hill, PA 170[1 o.re
(g) 71,191.59
(tt) 4,859.13
(lz) 66,332.46
(13)
(ta) 66 , 332.46
(19)
(201
(2t) 3.979.35
(2 I A)
(2te) 3,979.35
Ad #48 e# 1994 p-ovides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of tine spouse. ?he rotes as prescribed by the statute will be:
• 3°16 (.i~. wiN be applicable for estates of decedents dying on or after 7/1/94 end before 1/1/96
• 2°/6 (.#!) will be applicable for estates of decedents dying on or after 111/96 and before 1/1/97
• 1% (.O1) wiN be applicoble for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Sp«rs~l t•ansfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, .. .....................................................
b. retain the right to designate who shall use the property tronsferred or its income, . ..............
c. retoin a reversionary interest; or ...................................................................................
d. receive the promise for life of either payments, benefits or care? .......................................
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate considerations If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate considerations ...................................................................................................
3. Did decedent own an 'in trust for' bank account at his or her death$ ......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN.
_ REY-1503 EX+ (4-86)
COMMONWEALTH OF~PENNSYLVANIA
INHERI7AN[F Ter oon~eu
SCHEDULE B
STOCKS AND BONDS
carhrc yr FILE NUMBER
Martha A. Blessing 21 95 0097
(All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER DESCRIPTION VALUE AT DATE
Of DEATH
~• IDS Selective Fund
Acct. No. 0010-5482-2464 4204.587 Sh.@ 8.482 35,663.31
Accrued Dividend 173.18
2. IDS Bond Fund
Acct. No. 0011-2482-2464 6,668.592 Sh.@ 4,625 30,842.24
Accrued Dividend 194.39
3. IDS Federal Income Fund 635.517 Sh.@ 4.776
3,035.23
Accrued Dividend 14.39
TOTAL (Also enter on line 2, Recopitulafion) $ 6 9 , 9 2 . 7 4
(-f more space is needed, insert addi~iona! sheets of soma size.)
~,
REKISOB EX+ (2.87i
SCHEDULE E
CASH, BANK DEPOSITS AND
1LTN OF PENNSYLVANIA MISCELLANEOUS
1NCE TAX REruRN PERSONAL PROPERTY
~EPIT DECEDEM
Kartha A. Blessing
(Ali property jointlyowned with the Right of survivonhlp must be disclosed en schedule F)
ITEM
NUMBER DESCRIPTION
1. I Miscellaneous Personal Property
Please Print or Type
JMBER
21 95 0097
VALUE AT
DATE OF DEATH
$ 200.00
TOTAL (Also enter on line 5, Rsca itulation) $ 200 00
(Anach additional 8'/a" x 11" •hsets if more ~pacs is needed.)
REV•I509 EJ(r ~12.88i
""~-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mart
Joint tenant(s):
A. Blessin
NAME ADDRESS
A• Doris Jean Blessing 7 Hunter Lane
Camp Hill, PA 17011
B.
C.
Jointly-owned property:
ITEM LFORR DATE
)MBE JOINT MADE DESCRIPTION OF PROPERTY
TENANT JO
~• A- /1/65 PAIC Bank
Checking Acct.
#5140005033
SCHEDULE F
JOINTLY-OWNED PROPERTY
LE NUMBER
21 95 0097
RELATIONSHIP TO DECEDENT
Daughter
TOTAL VALUE I DECD'S I DOLLAR VALUE OF
OF ASSET °h INT. DECEDENT'S INTEREST
1,068.85
TOTAL (Also enter on line 6, Recapitulation) $ 1 O!i . $ 5
s
(If more space is needed insert addifionol sheets of tame size)
PNC Bank, N. ~,.
' '. ~lY4Y (:arlisle Pike
Camp Hill, P:a 17011
May 22, 1995
Charles F. Sullivan, CPA CFP
1513 Cedar Cliff Drive
Camp Hill, PA 17011
RE: Martha A. Blessing
Date of Death: January 24, 1995
Social Security No. 208-38-7341
PNC 1~~~T 1~
Dear Mr. Sullivan:
As per your request for information on accounts the above
referenced decedent held with us,~~yythe information is as follows:
-Checking Account No. 5140005033 opened 06/01/65 in the name of
Dor' Jean Blessing, Martha A. B 'ng. Balance at date of death:
,135.20. Accrued interest• 2.49
If I can be of any further assistance, please feel free to contact
me at (717) 730-2321.
Sincerely,
~c~~ ~~~'
Edith Tancil
Miscellaneous Services Supervisor
Bank Operations
ET/mky
~~ ~ SCHEDULE H
~
~
~
PENSES,
• COhIMONWlA1TM u
NSYLVANIA ADMIN STRATIVE
INNERtTANCE TAX RETURN
C
D
RESIDENT DECEDENT
MISCELLANEOUS
EXI'ENSES
Please print or T pe
Nartha A. Blessing
21 95 0097
ITEM
NUMBER ~ DESCRIPTION
AMOUNT
A• Funeral Expenswa:
I• Gilbert W. Parthemore Funeral Home, Inc.
$ 2
30.00
6• Administrative Costs:
1. Personal ReprosetHativa Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2• ~BrH$r~$i Professional Fees:
Preparation of PA Inheritance Tao Return
3. Family Exemption 1,400.00
Uaimant Dorris J. Blessing Relationship DAughter
Address of Claimant at decedent's death
Street A~d~e9y°i ":~ n t e r Lane ""'°"".,~...~.,~..~._ °'""°"°..°„°--W~..-
Camp Hill,
"-
, S
PA ~'~
~
tate
~
~
Zip Code 17011 2 , 000.00
4. Probate Fees $13 8.0 0 + 15.0 0 + 10.0 0
Legal Advertising (Patriot-News $44.56 + Cumb. Law J. 40.00
) 163.00
C• Miscellaneous Expenses; 84.56
~- Checks written by decedent clearing after 1/24/95
2 146.38
• ~ PNC Check Printing Fee
3• Nessiah Village - Elder DAy Care - Jan. 1995 21.00
4• PA Dept. of Revenue - 1994 PA Income Tas 462.00
5• EKG Associates - Medical 195.82
6. PA Neurological Assoc.- Nedical 4.50
~
7. A.Z. Ritzman Assoc. - Nedical 35.69
i 28.16
8. 'Internists of Central PA - Nedical (138.28 - 50.26)
88.02
TOTAL (Also enter on line 9, Recapitulation} $ 4 , 8 9.13
Ilf moro space is needed, insert additional sheets of same size.}
COMMONWEALTH OF PENNSYLVANIA
INNERttANCETAX RETURN
REf10ENT DECEDENT
CJI AIC pF
lYiartha A. Blessing
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
I' Kara K. Wolf
6300 W. liichigan Ave. Apt. E13
Lansing Iiichigan 48915
2. Debra S. ilolf
R. D. #2, Bog 42
Newport, PA 17074
3. Glenn D. Walf
Nome Alaska 99762
4. Richard Blessing
7 Hunter Lane
Camp Hill, PA 17011
5- Steven B. Blessing
767 Greenspring 8oad
Newville, PA 17241
6- Michael D. Blessing
425 N. Hanover St. Apt. 2
Carlisle, PA 17013
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
FItE NUMBER
21 95 0097
RELATIONSHIP ,,, AMOUNT OR
randchild $ 200.00
randchild 200.00
randchild 200.00
randchild 200.0 0
randchild I 200.00
randchild I 200.00
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more spoee is Deeded, insert odditionol :heett of same size)
PAGE 1
SCHEDULE J
BENEFICIARIES
AMOUNT OR
SHARE OF ESTATE
5
REV-1513 EX+ ~2'B7i
Page 2
• COMMONWEALTNSYLVANI SCHEDULE J
INNERrtANCETAxRETURN A BENEFICIARIES
REEIDENT DEatDENt
ESTATE OF
Martha A. Blessing
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
T~- Kenneth Blessing
203 ~'ranklintown Road
Dillsburg, PA 17019
8- John M. Blessing Jr.
1202 Highlander Way
Mechanicsburg, PA 17055
9. Mary Ellen Wolf
121 Cherry Lane
Dillsburg, PA 17019
10. John M. Blessing
33 Woodridge Circle
Shermansdale, PA 17090
11. George B. Blessing Jr.
1532 Agave 8oad
GreenValley AZ 85614
12. Doris J. Blessing
7 Hunter Lane
Camp Hill, PA 17011
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
FILE NUMBER
21 95 0097
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
andchild ~ 200.00
randchild ~ 200.00
Daughter I25Z Remainder
Son I25Z Remainder
Son I25x Remainder
Daughter 25Z Remainder
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
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' °~ C!AUP~TY OF CUMBERLAND
1~ '~:
George B. Blessing, Jr.
being duly _ auuointed according to law, deposes and says that he is the
Eaecutor
of the Estate of Martha A. Blessing
late of the Township of East Pe_nnsbora
within is an inventory made by -.George B. Blessings Jr _ Cumberland County Pa., deceased and that the
of the entire estate of said decedent, consisting of~all the personal property and real estate se ceps teat a ate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death .
~~Or"` and subscribed before me,
/' ~ ~ _
f
/~ !~ ~ `
&aeulor . Administrat
~~
~4 z gS~ ~
Address
Date of Death 24 January
• pay 19 9 S
Monfb 7aar
INSTRUCTIONS
~. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may bs attached as to personalty or realty
4. See Article IV, Fiduciaries AN of ! 949.
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liartha A. Blessing deceased
1.
2.
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4.
IDS Selective Fund $.35,836 9
IDS Bond Fund 31,036 3
IDS Federal Income Fund 3,049 2
irliscellaneous Personal Property 200 0
0,122