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Home My WebLink About04-0937 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills for the 209_36_86~sDeceased.~ County of Cumberland in the Social Security No. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execuP r s named in the last will of the above decedent, dated Apr £ 1 26. ,19. 69 and codicil(s) dated (state relevant circumstances, ecg. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 215 South York Street~ Boroul~h of Mechanic sburg~ Mechanic sburg: PA 17055 (list street, number and muncipality) Decendent, tixet) 92 years of age, died September 6, ,X1-'9_~2004 at Green Rxdgel-W~LTg~ Nursing Home, West Pennsboro Twp., Cumberland ~-~un'ty, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: a,~-~ ~ ~t~6't0t< ~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herZ~ith and ~he grant of letters . · . '~ (testame y; administration c.t.a.; administration d.b.n.c.t.a.) theron, c~ - Thomas E. Blosser 4834 E~t~ Trindle Road, Amt.'~2 Mechan~sbur~.~PA 17055 Jac'~. b&bsser, ~00 va±ley view Road Newl~umDerlan(1, PA I /O/O SalIy A. Blosser York, PA 17402 ~~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CW~RLAND Thc 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,nd truly admi~ter t~e estate according to law. worn to or af[ ,d and subscrie .,before me this I~'~'~' day of { T,h, omaq/E. Blosser ~ ' October ~_ 2004 J ' \/Q ~'"'~-x /~-~"-~' ~ ~ No.~-oq Estate df VIOLET C. BLOSSER ., Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW F, ap4~aer (Z)C-'Vo~:~_~-- \o~ ~ 2004, 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 26, 1969 described therein be admitted to probate and filed of record as the last will of Violet C. Blosser .; and Letters Testamentary are hereby granted to Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser FEES Probate, Letters, Etc .......... Short Certificates( ) .......... $ ~-. ,A p0 $ TOTAL $,..~(~ ~, Filed ~.0.~. {~.~ .~ ..................... SNELBAKER, BRENNEMAN & SPARE, P.C. ' ~ By: Fhili~ H. Spu~ ~ 652~0 ATTORNEY(Sup. Ct. I.D. No.) 44 West Main Street ADDRESS (717) 697-8528 PHONE WILLS OF~ COUNTY ( ) a subscribing witness to t~l presented herewith, (each'~ng duly qualifieff a law, depose(s) and say(s) that ~ x.~ present and saw"~ ~ , sign the same and that ~"~_ signe-"~s a witness at th~ request of tes~ in h-~ presence and (in the~nce of each other) (in the~ence of thc ~ t:~ins~ s~ii~ifn~~ed b e for e ~ ~ me tffis._ ~ of '~ame) (Name) (.4 ddress) REGISTER OF WILLS OF CUMBERLAND . COU~'~fY OATH OF NON-SUBSCRIBING WITNESS ~-~ Thomas E. Blosser and Jack S. Blosser (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that each is familiar with the signature of Violet C. Blosser testat rix of ('&i~x~ltxtWex~.olt~gc~xK~/t:g~g$~xro~ the will presented herewith and that each believes the signature on the will is in the handwriting of Violet C. Blosser J% to the best of their knowledge and belief./' ~ Sworn to or affirmed and subscribed beforel/z~h o~as~.:j me this 10~%'x''- day of October ~ 2004 ~ C~-~..~o~. $C~o~Register 4834 East Triar~:rni~oad, Apt. #2 Mechanicsburm. PA 1705j 100!~lley. VieW'oeCd, New Cumberland, PA 17070 (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee tbr this certificate, $2.00 P 10530920 ~ .m,.fiEP 1 ~ 2004 No. ' 'Local ~[egi~trar COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~'-.---. - ..... I~.~est P~nn~boro ~.Creen Ridge Vtll~ge Hechanicsbur ........ [ RESI~N~(B. in--mi ~m~' dack~ms~m~Blosser [lm' 100 Valley Vier Road ~ ~erl~ma PA 17070 LAST WILL AND TESTAMENT I, VIOLET C. BLOSSER, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Ex~tor~ case may be, hereinafter named, as soon as convenie~3~ly may be done after my decease. ~ SECOND. I give, devise and bequeath all the r~t, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated unto my husband, DERBIN S. BLOSSER, absolutely and in fee simple, if he survives me. THIRD. If my husband, DERBIN S. BLOSSER, does not survive me, then and in that event, I give, devise and bequeath my said entire residuary Estate in equal shares unto my three (3) children, namely, THOMAS E. BLOSSER, JACK S. BLOSSER and SALLY A. BLOSSER, share and share alike, absolutely and in fee simple. Should any of my said children predecease me and leave lawful issue to survive me, I order and direct that such issue of any deceased child or children shall be substituted herein for their deceased ancestor or ancestors, said issue to receive their deceased ancestor's or ancestors' share herein per stirpes by representation and not per capita. LASTLY. I nominate, constitute and appoint my husband, DERBIN S. BLOSSER, to be the Executor of this, my Last Will and Testament, but if, for any reason, he should fail to qualify as such Executor or cease so to serve, then I nominate, constitute and appoint my three (3) children, namely, THOMAS E. BLOSSER, JACK S. BLOSSER and SALLY A. BLOSSER, to be the Executors hereof, all to serve without bond. affixed my signature this ~ ~ Thousand Nine Hundred Sixty-nine IN WITNESS WHEREOF, I, VIOLET C. BLOSSER, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have day of April, A. D., One (1969). (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by VIOLET C. BLOSSER, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our~witnessesnal hereto. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: No. 2004-00937 Violet C. Blosser, Deceased September 6, 2004 PA No. 21-04-0937 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about October 20, 2004: Name Thomas E. Blosser Jack S. Blosser Address 4834 East Trindle Road, Apt. #2 Mechanicsburg, PA 17055 100 Valley View Road New Cumberland, PA 17070 150 South Royal Street York, PA 17402 Sally A. Blosser Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: October 20, 2004 Philip H. Spare, Esquire 44 West Main Street Mechanicsburg, PA 17055-0318 (717) 697-8528 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 REV-1162 EX(11 96) NO. CD 004699 SPARE PHILIP H 44 W MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 209 36-8688 FILE NUMBER: 2104-0937 DECEDENT NAME: BLOSSER VIOLET C DATE OF PAYMENT: 12/06/2004 POSTMARK DATE: 1 210612004 COUNTY: CUMBERLAND DATE OF DEATH: 09/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,000.00 TOTAL AMOUNT PAID: $4,000.00 REMARKS: SEAL CHECK#94 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500EX\6-OO) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FilE NUMBER 21 04 0937 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, fIRST, AND MIDDLE INITIAL) ~ Blosser Violet ~ DATE OF DEATH (MM-OO. YEAR) DATI: OF BIRTH (MM-DD-YEAR) ~ 9/6/2004 2/2/1912 W (IF APPLICABLE) SURVNlNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C C SOCIAL SECURITY NUMBER 209-36-8688 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :r::.~U') u"'''' w"-u ,,00 u"''''' "-'" "- ... 00, 04 006 09 Limited Estate D 2. Supplemental Return 0 3 Remainder Return (date of death prior to 12-13-82) o 48. Future Interest Compromise (date of death after 12-12-82) 0 5 Federal Estate Tax Return Required D 7, Decedent Maintained a living Trust (Mach copy of Trust) L B. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit Idate 01 death between 12_31_91 and 1.1-951 0 11 Election to tax under Sec. 9113(A}(,o,\\act1S<.hO\ Original Return Decedent Died Testate (Attac.11 c.cpy 01 WIll} Litigation Proceeds Received ~ z "' a z a .. U> "' 0: 0: a " THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Richard C. Snelbaker 44 West Main Street FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. Mechanicsburg, PA 17055 1ElEPHONE NUMBER 717-697-8528 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Receivable (Schedule OJ (4) 5. Cash, Bank Deposits & Miscellaneous Personsl Property (Sd1edule E) (5) Z 6 Jointly O'Mled Property (Schedule F) (6) 0 o Separate Billing Requested j:: :5 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) => (Schedule G or L) l- ii: 8 Total Gross Assets (total lines 1-7) <I: U W 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 0:: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Sdledule I) (1D) 11. Total Deductions (total lines 9 & 10) 12 Net Value of Estate (line B minus Line 11) ':......'." 84,000.00 2,498.08 0.00 0.00 10,998.01 8,466.90 OFFOAL Usa ONl '< (",,) 7,124.00 113,086.99 (8) 11,142.79 379.14 13 Charitable and Governmental Bequests/Sec 9113 Trusts for wtlich an election to tax has not been made (Schedule J) (13) 11,521. 93 101,565.06 0.00 (11) (12) 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 0.00 Z rate, or transfers under Sec. 9116 (a)(1,2) 0 ;:: 16 Amount of Line 14 taxable at lineal rate 101,565.06 < l- => 0.00 "- 17 Amount of Line 1 4 taxable at Sibling rate '" 0 0.00 U 18 Amount of Line 14 taxable at collateral rate >< ... T ax Due I- 19. (141 101,565.06 , 0 ~(15) , .0 ~(16) ,12 (17) ,15 (18) (19) 0.00 4,570.43 0.00 0.00 4,570.43 20 ~ CHECK HEREIF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W46451000 )- Decedent's Complete Address: STREET ADDRESS 215 South York Street, Bore of Mechanicsburg Cumberland County CITY I STATE I ZJP Mechanicsburg PA 17055- Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,570.43 0.00 4,000.00 200.00 Total Credits (A + B + C) (2) 4,200.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + line 3 is 9reater than line 2, enter the difference This is the TAX DUE. (5) 370.43 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the lotai of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to. REGISTER OF WILLS, AGENT (56) 370.43 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 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 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 propert'l within one 'leaf of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ 3. Did decedent own an "in trust for" or payable upon death bank account or securily at his or her death? 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designalion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D []g IF THE ANSWER TO ANY OF THE ABOVE UESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No D D D D ~ ~ og og D ~ Under penalties of pequry. I declare that I have eJ<amlned \t\i re , inducing accompal1ying scheaules and statements. and to tI'1e best of my knowledge and belief, it is true, correct arHl camp,ete eclaralion of preparer other than the personal resentati based on all inforrnatlon ofwn,ch preparerhas any knowledge SIG~R ~1MER 1MANREPRESENTAl1VE ~rJ'~1~ ~- ADO 44 West Main Street OAT:::. ../)/.1( , Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and before January 1. 1995, the tax rate imposed an the net value of uan:s.fers to or for the use of the surviving spouse IS 3% [72 P,S. 9 9916 (a) (1.1) {il]' 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 sulVivif'l The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets G the surviving spouse is the only beneficiary NAPD 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 tI or a stepparent of the child ls 0% {72 P ,So S S 116(a)(1 ,2)J The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4,5%, except as noted i 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. S9116(a)(1.:3)] A s ~. individual who has atleasl one parent In common 'Mth the decedent. whether by blood or adoption V - 3'N4646 lOCO COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE REV-1502 EX+ (6-98) ESTATE OF FILE NUMBER Violet C. Blosser 21 04 0937 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 betweelt a willing buyer and a willing seUer, neither being compelled 10 buy or sell, both having reasonable knowtedge of the relevant facts Real property wl1ich is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Property known and numbered as 215 South York Street, Mechanicsburg, FA 17055 84,000.00 sale value(copy of settlement sheet attached) TOTAL (Also enter on line 1. Recapitulation) $ 84,000.00 3W469S 1 000 (If more space is needed, insert additional sheets of the same size) A.,,--- u.s. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT SETTLEMENT STATEMENT CORNERSTONE LAND TRANSFER, INC. OMS No. 2502-0265 TlTLEPRO Laserprinl B. TYPE OF LOAN 4705 East Trindle Road Mechanicsburg, PA 17050 Phone: (717) 730-9664 Fax: (717) 730-9665 1. [ ] FHA 4. [ JVA 6. FILE NUMBER; 40464 2. [ ] FMHA 3. [ ] CONV. UN INS. 5. [ J CONV..INS. 17. LOAN NUMBER; 9503317br 8. MORT. INS. CASE NO.; C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the selllemenl agent are shown. Items marked '(p.D.C.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER; E. NAME AND ADDRESS OF SELLER; F NAME AND ADDRESS OF LENDER; Thomas M. Devlin Thomas E. Blosser,Jack S. The Washington Savings Ba Blosser & Sally A.Blosser nk, FSB Executors G. PROPERTY LDCATION; Mechanicsburg, PA 17055 215 S. York Street Mechanicsburg Borough Cumberland County H. SETTLEMENT AGENT; L SETTLEMENT DATE; Cornerstone Land Transfer, Inc. PLACE OF SETTLEMENT; 4705 E. Trindle Road, Mechanicsburg, PA J. SUMMARY OF BORROWER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 101 Contract sales price 84000 . 00 102. Personal property 103. Settlement charQes to borrower (line 1400) 4029 . 97 104. 105 Adjustments for items paid by seller in advance 106. CilyfTown tax 107. County tax lOB. Assessments 109. SCHOOL '0 11 /22 /04'0 12/31/04 '0 11/22/04'006/30/05 45.48 716.51 110 to 111 Swr/Ref: $109. 22/qend12/31 46.55 112 120. GROSS AMOUNT DUE FROM BORROWER 88838.51 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 201. Deposit or earnest money 202. Principal amount of new loan(s) 203. Existina loan(s) taken subject to 204. 10000.00 74000.00 205 206. 207. 20B. 209. Adjustments for items unpaid by seller 210. CityfTown tax to 211. County tax 10 212. Assessments to 213. SCHOOL 214. 215. 216 217. 218 219. to 220, TOTAL PAID BY/FOR BORROWER 300, CASH AT SETTLEMENT FROM OR TO BORROWER 301. Gross amount due from borrower (line 120) 302. Less amount paid bY/for borrower (line 220) :. 303. CASH ([)i FROM) ([ ] TO) BORROWER 84000.00 88838.51 84000.00 4838.51 Cl /..1 / ..-' ---.. .-'" I.)J. Buyer or Borrower's Signature 11/22/04 K. SUMMARY OF SELLER'S TRANSACTION; 400. GROSS AMOUNT DUE TO SELLER 401.Contract sales price 402,Personal properlv 403, 404. 405. 84000.00 Adjustments for items paid by seller in advance 406.CityfTown tax 10 407.County'ax 11/22/04'012/31/04 40B.Assessments to 409. SCHOOL 11/22/04'006/30/05 45.48 716.51 410. '0 411. Swr/Ref: $109. 22/qend12/31 46.55 412. 420. GROSS AMOUNT DUE TO SELLER 84808.54 500. REDUCTIONS IN AMOUNT DUE TO SELLER 50l.Excess deposit (see instructions) 502.Settlement charges to seller (line 1400) 503.Existina loan(s) taken subject 10 504.Payoff of First Mortgage Loan 10000.00 2280.35 50S. Payoff of Second Mortgage Loan 506. 507. 508. 509. 510. CllyfT own tax 511,Countytax 512,Assessments 513 SCHOOL 514. 515. 516. 517. 518. 519. Adjustments for items unpaid by seller to to to '0 520.TOTAL REDUCTION AMOUNT DUE SELLER 12280.35 600. CASH AT SETTLEMENT TO OR FROM SELLER 601.Gross amount due to seller (line 420) 602.Less reduction amount due seller (line 520) 503fAS,H ([ XTO) ([ ~M~I}LER \()v"A -""Y. I..<..L 'e "'(l) ~ S,ejJJ>r's,$jg~ '~'e /1 /' 6 ){~lJ~ rAL //~ZL 84808.54 12280.35 72528.19 , J /.2::;/ 0 Lj II, I ,- '2 ~ - u '-t II (22JJfJ.,'-(,e, 5/86 " U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT OMS No. 2502-026E Pag e .I.EMENT CHARGES 40464 PAID FROM PAID FROM lorAL SALES/BROKER'S COMMISSION based on price $ 84000. 00 BORROWER'S SELLER'S FUNDS AT FUNDS AT / Division of Commission (line 700) as follows: Total : $0 .00 SEITLEME:NT SETTLEMENT 701. $ . to ltlllllllrfJ1!1.' Iti~i~lr~lli!II!I~illil:III,1 702. $ to 703. Commission paid al Settlement 704. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN B01. Loan Origination J:ee % 802. loan Discount % 803. Appraisal Fee to Appr.Express $250 POC (L) 804. Credit Raporl to MCR $17 POC (L) a05. lenders Inspection Fee 806. Mortgage Insurance Application Fee to 807. Assumption Fee 808. Tax Srv. BBSeT 85 00 809. Flood Cert GeoTract 22 00 810. Doc Prep The Washinotan Savinos 295. 00 811. Undrwr Fee The Washinqton Savinos 75 00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 11/22/04 to11/30/04 @$ Iday 116 .28 902. Mortgage Insurance Premium for mo. to 903. Hazard Insurance Premium tor lyrs. to Nationwide Ins. $419 POC 904. Courier yrs. to Federal Express 30 00 905. ApDlicat. The Washinqtan Savinos 350. 00 1000. 1001. 1002. 1003. 1004. 1005. 1006. 1007. 1008. A 1100. TITLE CHARGES 1101. Settlement or closing fee to 1102. Abstract or Wle search to 1103. Title examination to 1104. Tille insurance binder 10 1105. Document preparation to 1106. Notary fees 10 1107. Allorney's fees to (includes above ilems No.:) f 108. Title Insurance to (includes above items No :) 1109. Lender's coverage $ 1110. Owner's coverage $ 1111. Endors. 1112. C.S.Letter 1113. Courier 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Oeed $ 38 . 50 Mortgage $ 76 . 50 1202. Citylcounty tax/stamps: Deed $ 84 0 . 00 Mortgege $ 1203. State tax/stamps: Deed $ 840 . 00 Mortgage $ 1204. 1205. 300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pesllnspectlon 10 1303. Swr Re OND Mechanicsbur 1304. 04 Sch Tax Barr Heckard 1305. Tax Cert Barr Heckard 1400. TOTAL SETTLEMENT CHARGES (enler on Jines 103 and 502, See lions J and K) RESERVES DEPOSITED WITH LENDER FOR Hazard Insurance 9 mo. @ $ Mortgage Insurance 2 mo. @ $ CityfTown tax mo. @ $ County tex 11 mo. @$ Assessments mo. @ $ School Tax 7 mo. @$ mo.@$ mO.@$ 34.92 55.50 Imo. Imo. Imo. Imo. Imo. Imo. Imo. Imo. 314.28 .'<<.... 111. 00 35.57 391.27 99.33 695.31 -381.92 Notar Public 14.00 6.00 Cornerstone Land Transfe Fidelit National Title Cornerstone Land Transfe 1102 74 84 Cornerstone Land Transfe 1104 1103 000 000 Misc. $ 115.00 840.00 840.0( Bora 4029.97 120.1 1311.2 3.0 2280.3 Parties agree thai no liability is assumed by Settlement Agenllor Ihe accuracy 01 Informallon lurnished by others as shown on the HUD-1 Seltlement SIatement. Settlement Agenl hereby e~1 reserves the light 10 deposil any amolm/s collac/ed lor dJsbursemenl In an in/arest bearing account in 8 Federally Insured inslilutlon and to credit any interest so earned 10 ils own account as ad compensalionlorilsservlcesinlhislransacllon. HUD CERTIFICAtION OF BUYERS AND SELLERS I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a tr. ;;;de ::;-r;.:b$~ ~tion. I ("rther eertHy that I have received a copy at the HU -1 SetUeme ~ Buyer or Borrower's Signature 8uye,'sAddress & Phone: d accurate slatement of all receipls and disburse! nt. "&'" ~"";' ~ ^ ,A- ~hn'S~wc:,(d'ar~s"~PhJ(e: -I ~s Q true and accurate account Dr this transaction. I have caused Of wiff cause the funds to be disbursed In accordance wilh lhis sla/em / /-;)~ -of REV-150J EX+ (S.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Violet C. Blosser 21 04 0937 All property jointly-owned with r'ight of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. Prudential Financial Stock DESCRIPTION VALUE AT DATE OF DEATH 2,498.08 52 shares of common stock valued at $48.04 per share TOTAL (Also enter on line 2, Recapitulation) $ 2,498.08 3W46961.000 (If more space is needed, insert additional sheets of the same size) REV-1509 EX" (6-98) COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Violet C. Blosser SCHEDULE F JOINTL V-OWNED PROPERTY FILE NUMBER 21 04 0937 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Blosser, Jack S ADDRESS RELATIONSHIP TO DECEDENT 100 Valley View Cumberland, PA Road, New 17070 Son B. Blosser, Sally A 150 South Royal Street, York, PA 17402 Daughter c. Blosser, Thomas E 4834 East Trind1e Road, Apt. # 2, Mechanisburg, PA 17055 Son JOINTLY-OWNED PROPERTY: <EmR DATE DESCRIPTION OF PROPERTY %QF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE WlME OF FINANCIAL INSTITUTION ANJ BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF N...MBER OR SIMIlAR IDENTIFYING MJMBfF<. ATTACH DEED PDR NUMBER TENANT JOINT -DINTlI'-I-ELDREALESTATE VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1 A 3/25/2000 Commerce Bank 1,890.53 50.000 945.26 checking account number #513173559 2 A 3/25/2000 Commerce Bank 5,014.80 50.000 2,507.40 savings account #616126349 3 B 3/28/2000 Commerce Bank 5,014.02 50.000 2,507.01 savings account #616126358 4 C 3/28/2000 Commerce Bank 5,014.47 50.000 2,507.23 savings account #616126366 TOTAL (Also enter on line 6, Recaoitulationl $ 8,466.90 3W46AE 1 COO {If more space is neetled, insert addiflonal sheets of the same size) REV-1510EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Violet C. Blosser FILE NUMBER 04210937 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPllON OF PROPERTY ITEM I~LLCE Tf-E!'>\ME OF TI-€ TRANSFEREE_ THEIR RELATiONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUM8Ef; n-EDATEOFTRAI\6FER A.TT/lCHACOPV OF THE DEED FOR REA.L ESTIITE VALUE OF ASSET INTEREST IFAPPlICABLEI VALUE 1. Commerce Bank 10,124.00 100.000 3,000.00 7,124.00 account #801163 opened 1/23/2004, joint with Jack S. Blosser TOTAL (Also enter on line 7, RecapitulatIon) $ 7,124.00 (If more space is needed, insert additional sheets of the same size) 3W46Af' 1 000 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Violet C. Blosser SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 04 0937 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAl EXPENSES: 1. Auer Memorial Home & Cremation Services, Inc. funeral services 4,004.34 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) f EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees 1,125.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 260.00 5. Accountant's Pees 6. Tax Return Preparer's Fees 7. 1 Bricker's Auction commission on sale of household goods 2,200.00 Total from continuation pages 3,553.45 TOTAL (Also enter on line 9, Recapitulation) $ 11,142.79 ?,W46AG '000 (If more space is needed, insert additional sheets of the same size) Estate of: Violet C. Blosser Item No. 2 3 4 5 6 Description Charges associated with the sale of the Real Estate: A. Notary fees - $6.00 B. Transfer Tax - $840.00 c. Sewer/refuse - $120.14 D. 2004 School Tax- $1,311.21 E. Tax Certification - $3.00 Cumberland Law Journal advertising Executors notice Patriot News advertising Executors notice Register of Wills filing fee for Inheritance Tax Return Reserve for accounting fees, filing fees and other costs associated with the administation of Decedents estate Schedule H part 2 (Page 2) Amount 2,280.35 75.00 183.10 15.00 1,000.00 Total (Carrv forward to main schedule) 3.553.45 REV~ 1512 EX + (12~03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE1URN RESIOENT DECEDENT ESTATE OF Violet C. Blosser SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBIiR 04210937 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Barry L. Heckard, Tax Collector personal taxes 2004-2005 11.00 2 Continuing Care RX perscription expenses 275.41 3 PPL Electric final electric service 82.15 4 United Water Pennsylvania final water service 10.58 3W46AH 2000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same siz.e) 379.14 REV-1513 EX... (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE fAX RETURN RESIDENT DECEDENT ESTATE OF Violet C. Blosser SCHEDULE J BENEFICIARIES F]LE NUMBER 21 04 0937 NUMBER NAME AND ADDRESS OF PERSON(SI RECE]V]NG PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 911610111.2)] RELATIONSH]P TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 Jack S. Blosser 100 Valley View Road New Cumberland, PA 17070 Commerce Bank Inventory Value: 945.26 Commerce Bank Inventory Value: 2,507.40 Commerce Bank Inventory Value: 7,124.00 33.333333% Residue: 2B,658.05 Son 39,234.71 Total from continuation pages 62,330.34 ENTER DOLLAR AMOUNTS FOR D]STR]BUT]ONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPR]ATE. ON REV-1500 COVER SHEET II NON-TAXABLE D]STR]BUT]ONS A. SPOUSAL D]STR]BUT]ONS UNDER SECTION 9113 FOR WHICH AN ELECT]ON TO TAX ]S NOT BE]NG MADE B. CHAR]TABLEAND GOVERNMENTAL D]STR]BUT]ONS 3W46All,OOO TOTAL OF PART II- ENTER TOTAL NON-TAXABLE D]STR]BUT]ONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same sIze) $ 0.00 Estate of: Violet C. Blosser Item No. Description 2 Sally A. Blosser 150 South Royal Street York, PA 17402 Commerce Bank Inventory Value: 2,507.01 33.333333% Residue: 28,658.05 3 Thomas E. Blosser 4834 East Trindle Road Apt. 11 2 Mechanisburg, FA 17055 Commerce Bank Inventory Value: 2,507.23 33.333333% Residue: 28,658.05 Total (Carry forward to main schedule) Schedule J part 1 (Page 2) Relation Amount Daughter 31,165.06 Son 31,165.28 62,330.34 IART60N & SNELDAKER ATTORNEYS AT LAW LAST WILL AND TESTAMENT I, VIOLET C. BLOSSER, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding,' do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Executors, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated unto my husband, DERBIN S. BLOSSER, absolutely and in fee simple, if he survives me. THIRD. If my husband, DERBIN S. BLOSSER, does not survive me, then and in that event, I give, devise and bequeath my said entire residuary Estate in equal shares unto my three (3) children, namely, THOMAS E. BLOSSER, JACK S. BLOSSER and SALLY A. BLOSSER, share and share alike, absolutely and in fee simple. Should any of my said children predecease me and leave lawful issue to survive me, I order and direct that such issue of any deceased child or children shall be substituted herein for their deceased ancestor or ancestors, said issue to receive their deceased ancestor's or ancestors' share herein per stirpes by representation and not per capita. LASTLY. I nominate, constitute and appoint my husband, DERBIN S. BLOSSER, to be the Executor of this, my Last Will and Testament, but if, for any reason, he should fail to qualify as such Executor or cease so to serve, then I nominate, constitute and appoint my three (3) children, namely, THOMAS E. BLOSSER, JACK S. BLOSSER and SALLY A. BLOSSER, to be the Executors hereof, all to serve without bond. IN WITNESS WHEREOF, I, VIOLET C. BLOSSER, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have ~ affixed my signature this ;l' day of April, A. D., One Thousand Nine Hundred Sixty-nine (1969). ~ ~. ~fa-.::r -e"'-' (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by VIOLET C. BLOSSER, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed ~ MARTSON tic SNELlJAKEfl C~l'.ifd~a ct: yd..,~~n~ ATTORNEYS AT LAW COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-060'1 REV-1162 EX(11"96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SPARE PHILIP H 44 W MAIN STREET MECHANICSBURG, PA 17055 _uu___ fold EST A TE INFORMATION: SSN: 209-36-8688 FILE NUMBER: 2104-0937 DECEDENT NAME: BLOSSER VIOLET C DATE OF PAYMENT: 06/06/2005 POSTMARK DATE: 06/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/06/2004 NO. CD 005390 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $370.43 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#102 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $370.43 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Register of Wills of Cumberland County I /: STATUS REPORT UNDER RULE 6.12 Name of Decedent: Violet C. Blosser Date of Death: September 6, 2004 Estate No.: 21-04-0937 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 0 No fikx 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Approxima tel y 9 man ths 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 0 No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Cler 0 the Orphans' Court and may be attached to this report. Date: 6/6/05 ~---- Sit:> ture Richard C. Snelbaker Snelua1(er & Brenneman, P.C. Name 44 West Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. Capaciry: 0 Personal Representative lK1clCounsel for personal representative vi () l' , ',- -.--.-- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIvIouAlJEm~ED OFFICE Cc APPRAIS:~~~~~ ~~L~::~~T~:C~I~:~LOlIANCE INHERITANCE TAX DI'ISIlIII " C, OF DEDUCTIONS AND ASSESSHENT OF TAX PO BOX Z8D6Dl HARRISBURG PA 171Z8-0601 08-22-2005 BLOSSER 09-06-2004 21 04-0937 CUMBERLAND 101 APPEAL DATE: 10-21-2005 (See reverse side under Objections) Amoun1: Rl!lIIittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS +- REy:is47-EX-AFP-io3:0Sj-NOyiCE-OF-iNHERiYANCE-YAX-APPRAiSEKENY:-ALLOWANCE-oi--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX VIOLET C FILE NO. 21 04-0937 ACN 101 2~n, 'Ii': 10 f",/,' II: 25 Ue.l,; ""-"..,f <--' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CtEr:,_\ Ci~~->" :,:.' ,:'~~ ,"'-',' RICHARD e\SNELBAKER SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 ESTATE OF BLOSSER *' REY-1547 E~ AFP (06-05) VIOLET C TAX RETURN WAS: I X I ACCEPTED AS FILED DATE 08-22-2005 I I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. ISch8dul. Al 2. Stocks 81><1 Bonds (Schedul. B I 3. Closely Held Stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposlts/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule FJ 7. Tr8l'\sfe...s (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdII. Costs/Hisc. ExPenses (Schedule H) 10. D.bts/Hortgeg8 Liob11iti.s/Li.ns ISch.dul. II 11. Total D8ductions 12. Net Value of Tax Return 13. Charlt8bl./Govern.ental Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax 191 1101 III 121 131 (41 (5) 161 (7) 84,000.00 2.498.08 .00 .00 10 .998.01 8.466.90 7,124.00 181 11,142.79 If an assessment was issued previously, lines 14, 15 and,or 16, 17, 18 and 19 will reflect figures that include the 'total D'I' ALL returns assessed to date. ASSESSMENT OF TAX: IS. AItount of Line 14 .t Spousal rat. (15) 16. Aaount of Line 14 taxable .t Lineal/Class A rat. (16) 17. A.ount of Lins 14 at Sibling rat. (17) 18. AMOUnt of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Du. X NOTE: . INTEREST/PEN PAID I-I 210.53 .00 .00 DATE 12-06-2004 06-06-2005 08-15-2005 NUMBER CD004699 CD005390 REFUND ISchedule .II 379.14 1111 1121 1131 1141 .00 X 101.565.06 X .00 X .00 X AMOUNT PAID 4,000.00 370.43 10.53- , TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 00 = 045 = 12 = 15 = 1191= NOTE: To insure proper credit to your account, sub.it the upper portion of this for_ with your tax pay...,t. 113,086.99 11,1i?1 93 101,565.06 .00 101,565.06 .00 4,570.43 .00 .00 4,570.43 4,570.43 .00 .00 .00 I IF TOTAL OUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A "CREDIr' ICRI, YOU KAY BE DUE A REFUND. SEE REVERSE SrDIE OF TIITOIt I:'n" II:'''D T......TIM."'""".._._ , RECEIPT AND RELEASE ~'-(j4 -6q31 WHEREAS, Violet C. Blosser, late of Mechanicsburg Borough, County of Cumberland and Commonwealth of Pennsylvania, died on September 6, 2004, having first made her Last will and Testament in writing probated before the Register of Wills of said Cumberland County on October 19, 2004, and Letters Testamentary were issued on the same date to Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, the Executor's named in the Last Will and Testament of said Decedent; and WHEREAS, said Executor's has entered upon and completed their administration of said Decedent's Estate as set forth in their First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the persons named in the Statement of Proposed Distribution also attached hereto, both of said documents being incorporated herein by reference thereto; and NOW KNOW ALL MEN BY THESE PRESENTS, that we, Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, being the principal legatees and distributees named in the Will of said 1..'.._ (--~-, ~ " Decedent and the persons entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare 10.-' C ~, C\:.. L'__ t' ( >, F:, . c::.) LAW~ici.s c.:> (.':; SNEU3A1<!ER: & '-, BRENNml>.k'P.c. ~:. anusay that we, and each of us, have examined the attached Cn"; "---' 1 C .-j <-l <....; Account and Statement of Proposed Distribution, and find the same to be true and correct, and in strict accordance with the terms and provisions of said Will, and we do hereby acknowledge that we, and each of us, this day have, had and received of and from Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, Executor's of the Estate of Violet C. Blosser, the cash, personalty and/or real estate set opposite our names in the above Statement of Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purports and dividends which were due, owing and payable and belonging to us, and each of us, by any means whatsoever, for or on account of our full share, part or dividend of the Estate of Violet C. Blosser, Deceased. NOW, THEREFORE, we, and each of us, the said Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, do by these presents, remise, release, quit-claim and forever discharge the said Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, their heirs, executors and administrators, of and from our said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing the foregoing Account of said LAW OFFICES SNELBAKER & BRENNEMAN. P.C. 2 administration in the Office of the Register of Wills of said Cumberland County and by having the balance in the hands of the Executor's, as shown by said Account, distributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, we, and each of us, do hereby agree that the foregoing Account and Statement concerning the matter of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported upon by said Court, in a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that we, and each of us, the said Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, do hereby agree that if any legitimate debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that we, and each of us, will return to the said Executor's such amounts thereof as may be necessary to pay such debts or demands. LAW OFFICES SNELBAKER & BRENNEMAN, P.C. 3 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 7th day of September 2005. WITNESSED BY: /~ &--- Thomas E. Blosser (SEAL) ..!~ JaJ S. Blosser <. U ..-J~ ;/-1-;) (..,_~ Sally 1\. Blosser (SEAL) (SEAL) 4 LAW OFFIC~S SNEL8AKER & BRENNEMAN. P .C. COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) On this the 7th day of September 2005, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~Chd^oK~ Notary Public COMMONWEALTH OF PENNSYLVANIA Notalial5eal Sandra K. Showers. Notary Public Mechanicsburg Born. Cumberland County My CanmissIOIl Expires Nov. 22. 2007 Membar, Pennsylvania A,;;sociation Of Notaries 5 ESTATE NO. 21-04-0937 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY THOMAS E. BLOSSER, JACK S. BLOSSER AND SALLY A. BLOSSER, EXECUTOR'S OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF VIOLET C. BLOSSER, DECEASED, LATE OF MECHANICSBURG BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, Executor's as aforesaid and the Accountants herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: September 6, 2004 October 19, 2004 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal Patriot-News October 29, November 5, 12,2004 November 23, 30, December 7, 2004 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. Prudential Financial Stock, 52 shares of common stock valued at $48.04 per share 2. Commonwealth of Pennsylvania, 2003 property tax rebate 3. Nationwide Mutual Fire Insurance Co.. refund unused premium policy #5837MP030180 4. Presbyterian Homes, refund on resident care 5. Household goods, sold via public auction 6. Commerce Bank, Certificate of Deposit #801163 Goint with Jack S. Blosser) 7. Commerce Bank, checking account #513173559, remaining balance after estate expenses Goint with Jack S. Blosser) 8. Audiologic Consultants Inc., refund on medical services 9. Jack S. Blosser, overpayment from net proceeds of household goods 10. Gain from sale of Prudential Common Stock TOTAL. PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER & BRENNEMAN, P.C. The Accountants claim credit for the payment of the following items from Decedent's Personalty Account: 1. Register of Wills, estimated Inheritance Tax payment 2. Continuing Care RX, prescription expenses 3. Barry L. Heckard, Sr., personal taxes 2004-05 Page 1 $ 2,498.08 338.56 166.00 493.20 10,000.25 10,199.82 11.51 15.00 16.75 760.95 $ 24,500.12 $ 4,000.00 275.41 11.00 4. Register of Wills, filing fee for Inheritance Tax Return 5. Register of Wills, Agent, Inheritance Tax 6. Bricker's Auction, commission/expenses associated with sale of household goods 7. Auer Memorial Home & Cremation Services, Inc., funeral services 8. Snelbaker & Brenneman, P.C., attorney services 9. Snelbaker & Brenneman, P.C., costs advanced: a. Cumberland Law Journal, advertising Executo~s Notice b. Patriot-News, advertising Executor's Notice c. Register of Wills, probate fees 10. Reserve for filing fees, accounting fees and other miscellaneous costs associated with the administration of Decedent's estate TOTAL, PERSONAL TV, PRINCIPAL ACCOUNT, CREDITS: PERSONAL TV - INCOME ACCOUNT DEBITS The Accountants charge themselves with the receipt of the following income from the investment of Personalty Principal: 1 . Orrstown Bank, interest on estate checking account 2. Prudential Financial, dividend TOTAL, PERSONAL TV, INCOME ACCOUNT, DEBITS: PERSONALTY - INCOME ACCOUNT CREDITS The Accountants claim credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONAL TV, INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of Decedent's Real Estate as follows: 1 . Proceeds from sale of property located at 215 South York Street Mechanicsburg Borough, Cumberland County, Mechanicsburg, PA 2. Adjustments made at settlement for County Taxes, School taxes and Sewer TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE. PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER & BRENNEMAN, P.C. The Accountants claim credit for the payment of the following items from Real Estate Principal Account: 1. Settlement charges associated with the sale of property located at 215 South York Street, Mechanicsburg, PA a. Notary fees b. Transfer Tax Page 2 75.00 183.10 260.00 6.00 840.00 1500 370.43 2,200.00 4,004.34 1,125.00 518.10 3,259.03 $ 15,778.31 $ 87.87 32.50 120.37 $ $ NONE $ NONE $ 84,000.00 808.54 $ 84,808.54 $ 2,280.35 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. c. Sewer adjustment d. School Taxes 2004 e. Tax certification 2. United Water Pennsylvania, water service 3. PPL Electric, electric service TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: REAL ESTATE -INCOME ACCOUNT DEBITS The Accountants charge themselves with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: REAL ESTATE -INCOME ACCOUNT CREDITS The Accountants claim credit for the payment of the following items from the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: Page 3 120.14 1,311.21 3.00 10.58 82.15 $ 2,373.08 $ NONE $ NONE $ NONE $ NONE PERSONALTY: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION: LAW OFFICES SNELBAKER & BRENNEMAN, P.C. RECAPITULA liON Page 4 $ 24,500.12 $ 15,778.31 $ 120.37 $ NONE $ 84,808.54 $ 2,373.08 $ NONE $ NONE $ 8,721.81 $ NONE $ 120.37 $ 82,435.46 $ 8,842.18 $ 82,435.46 $ 91,277.64 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. STATEMENT OF PROPOSED DISTRIBUTION Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, Executor's and Accountants herein, proposes to distribute the balance of the Estate of Violet C. Blosser, Deceased, to wit: $ 91,277.64 in accordance with the Last Will and Testament of said Decedent as follows: 1. Thomas E. Blosser 1/3 of residue as per Item Third of Will $ 30,425.88 2. Jack S. Blosser 1/3 of residue as per Item Third of Will 30,425.88 3. Sally A. Blosser 1/3 of residue as per Item Third of Will 30,425.88 TOTAL FOR DISTRIBUTION: $ 91,277.64 Page 5 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser, being duly sworn according to law deposes and says: that they are the Executor's of the Estate and under the Last Will and Testament of Violet C. Blosser. Deceased, and the Accountants herein; that there are no unpaid creditors or claimants of said Estate; that there are no persons interested in the distribution of said Estate other than as stated in the foregoing Statement of Proposed Distribution; and that the facts set forth in the foreqoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of their knowledge. information and belief. -- /oh-, {3~ Thomas E. Blosser Executor and Accountant \; v l Jack S. Blosser Executor and Accountant ~oJ]J /4- b~ Sally A. Blosser Executrix and Accountant Sworn to and subscribed before me this 7th day of September 2005 ~~O-K~ Nota ublic COMMONWEALTH C:' PENNSYLVANIA Nolanal Selll Sandra K. ShoweIS. NoIa<y PubliC Med1anicsburg BolO, Cumbet1and CoOn4' My Co.....'..lo" EX1l'.... Nov. 22, 2007 Member, Pennsylvania ASSOCiation Of Notaries Page 6 Inventory of the real and personal estate of VIOLET C. BLOSSER, Deceased PERSONAL TV: 1. Prudential Financial Stock, 52 shares of common stock valued at $48.04 per share 2. Commonwealth of Pennsylvania, 2003 property lax rebate 3. Nationwide Mutual Fire Insurance Co., refund unused premium policy #5837MP030180 4. Presbyterian Homes, refund on resident care 5. Household goods, sold via public auction TOTAL PERSONALTY: REAL ESTATE: 1 Property known and numbered as 215 South York Street Mechanicsburg Borough, Cumberland County, Mechanicsburg, PA TOTAL PERSONAL TV AND REAL ESTATE: L.I", Or:./~, t...LJ . C) LL LL' . c-=:) -: q L...1 Cl cc: C~ C.) L11 c- (V) a... w VJ en = "'-'" <--0 lJ") C> co . f---'-' ~~': .' ~ ~ ~k::~"; '-.1(- - '-/ fr~ -, U~t 5~, u Page 1 $ 2,498.08 338.56 166.00 493.20 10,000.25 $ 13,496.09 $ 84,000.00 $ 97,496.09 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND \ J 55: Thomas E. Blosser, Jack S. Blosser and Sally A. Blosser according to law, deposes and says that lhey are the Executor's of the Estate of Violet C. Blosser I t f Mechanicsbur" Borou"h C bid C ty P d d d h h a e 0 ____._.:....=..S2-______D.:._ f urn er an aun I a'l ecease an t at t e . .. . Thomas E, Blosser, Jack S. Blosser and . Executor's Wlfhln IS an Inventory made by ~.qT Y A 'R1QC"'iQr _ , the said of the entire estate of said decedent, consisting of all the personal prop.rty and real estate. except real estate outside Ihe Commonwealth of Pennsylvania, and that the figures opposite eaff",.jtem of the Inventory represent it's fair value as of the date of decedent's death. ';/[0 ~ Sworn ~ ~ and subscribed before me, ~c4 ,A rfCe:rvt-.. l~XX 2005 Thomas E. Blcf~r.Jjtt". 7 58 Allenvi"" Ddv'e Mechanicsburg. FA 170" being duly sworn A~-:..idr..a..... Sally A. Blosser 150 South Royal ~o~k, PL^'" 1 :~192 Street September 7th ~clw/K~~k Jack S. Blosser '00 'i7All~:T Vi<i'dl New Cumberland, RQa4 PAA1<w,0 Date of Death COMMONWEALTH OF PENNSYLVANIA NoIariaI Seal Sandra K ShoweIs, NoIalY Public Me<:hanicSburg BolD. CunberIand County My c....,1issIon ExpI18S Nov. 22.2f1JT Member P an,s Association OfNotar1e Day eptember Month 2004 Y..r INSTRUCTIONS I. 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 be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. .<: OJ) ::l 0 >- ... "'0 0 ., 0- W '" ~ r- '" I- .. ... 0') ~ w 0( OJ) " '" a.. 0- u G-" 0"> 0 ... ... " 0 0 w Vl '" ::l Cl ",,,, ... '" w ...c G I :I: <Jl .c .... ..... a.. <Jl <Jl a...... 0:: I- -' U. .. <lJ ~ 0 Z 0( 0 0 u a.. " 0 I u.. -' .... ..-< :l: .... UJ 0 <( W ",' " ,;. UJ 0( N > Z '" '" - . Z 0 .c c '-' Cl '-' u " ci Vl Z ~ 0 '" ..... 0 "" Z w 0( - ... a.. <lJ "'0 '" .... c .<: 0 .. u ..-< - -;: ..-< :>- 0 " '" -" "'C ~ " E 0 - ~ .. " 0 -' 0 u: '" BUREAU OF INDIVIDUAL-TAKES .~. -- "'.- , INHERITANCE TAX DIVISION ' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP 103-05J ,'.., DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-29-2005 BLOSSER 09-06-2004 21 04-0937 CUMBERLAND 101 VIOLET C ".) RICHARD C SNELBAKER SNElBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 Amount Remitted 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, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF BLOSSER VIOLET C FILE NO.21 04-0937 ACN 101 DATE 08-29-2005 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 PRDJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-15-2005 PRINCIPAL TAX DUE: 4,570.43 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-06-2004 CD004699 210.53 4,000.00 06-06-2005 ~ CD005390 .00 370.43 08-15-2005 REFUND .00 10.53- TOTAL TAX CREDIT 4,570.43 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 .. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J Rf. I L. c) ," l.L! C.~ Ci. ~ L'_. I (-~,' (-=-' , t '. ,'. (~--~~ ("!- c) C" tL. Date: ~'-~~ C"") Q- w..1 (,., ) L~ C::.. c.: _~J <"-J I /; Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: VIOLET C. BLOSSER Date of Death: September 6, 2004 Estate No.: 21-04-0937 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 0. 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 the personal representative file a final account with the Court? Yes 0 No & 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 rn No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Cle e 0 h ' ourt and may be attached to this report. 9/7/05 tr.> C':) co Sign ture Richard C. Sne1baker Snelua~er & Brenneman, P.C. Name 44 West Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. Capacity: 0 Personal Representative Ncounsel for personal representative G~