HomeMy WebLinkAbout02-0464
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
" .
It
Estate of Velva ~ BollinQer
also known as
No.
21-02-464
Velva B BollinQer
Jere ~ BollinQer
Peijtjoner(s), who is/are 18 years of age or older, apply(ies) for:
, Deceased
Social Security No. 189090486
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or
Decedent, dated 06/05/2000 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, ate
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate: was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 415 E Coover Street, MechanicsburQ, PA 17055
(list streel. number and municipality)
Decedent, then 89 years of age, died April 16 ,2002 ,at Holy Spirit Hospital
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PAl All personal property ......................................... $
(if not domiciled in PAl Personal property in Pennsylvania .................... $
(If not domiciled in PAl Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ............................. ............ ............................................................................ $
gO()[)
/0.1000
'fll()(}O
./
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Typed or printed name and residence
er
RW-7 1/- b3-~
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent,
Petitioner(s) will well and truly administer the est~n7if ':r!12
Sworn to and affirmed and subscribed f ll~ - ~
tFere l/i'Bollinger
before me this 13th day of
MAY 2002
~/ '6j" "< ~h /.IC'/ /LJ"'-7/
DECREE OF REGISTER
Estate of velv!iisollinaer
also known as
Deceased
21-02-464
No.
Social Security No: 189090486
Date of Death: 04/16/2002
AND NOW, MAY 13 2002 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary (J of Administration
are hereby granted to Jere L BollinQer
(c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minorilate)
in the above estate and that the instrument(s), if any, dated June 5, 2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters .................................... $
Short Certificate(s) .......tP......
$
$
$
$
$
$
Inventory & Tax Forms............. $
$
Renunciation ..........................
Affidavit (
) .......................
)..............
Extra Pages (
Codicil .................................
JCP Fee .................................
Other ........... ...... ...... ........ .... ...
TOTAL .............................$
RW-7A
235.00
· 7'''{<f2]jm:!.....uJl.tH),M1!
Regl er of Wills
18.00
12.00
5.00
Attorney: Marielle F Hazen
1.0. No: 68003
Address: 845 Sir Thomas Court Suite 12
HarrisburQ
Telephone: 717-541-5550
DATE FILED:
PA 17109
270.00
1"(\",,<,1''' 1!."\' <}/',(,
This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~~~
l..- Local Regi ~
Fee for this certificate, $2.00
p
8329473
APR 18 2002
Date
21-02-464
HIOS;~R...21S1
COMMONWEALTH OF PENNSYLVANIA. DEPA.RTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
rYlO(JlO,"IolT
"
J'[I'lIolAIolEHT
IILACI( 11011(
N1o.ME0f'DEC[O€NTl~..~_l_1
...
n.. 'Y HU-"i
SOCI"'~ 3lCVAlTY HV/IIUJlt
~
@
~
o
~
~
z
VHOl!I'l , Yv.A
- ..,.
Velva
"'OE(\.a"~
B.
t. Female ,. 189 - 09 - 0486
~OI'DEAr')I~...,."...__..-..on_-'
""""'"
I.......)zl. t:~O
89
COVNTY.,.IXR"H
=,
... Cumberland
QECEOENT'S lJIUAA.. 0CCUl"JQ'l0N
~-=:~,,==;r
. 11 Housewife ",.
OECEOEHrS loIA'I.INQ AI)OM" (SiIr...~. "'.llpc-l
White
-"""'"
"'......,...--
-
-,
PA 1701
..Gi
'j,
".,
,-
;irII__
:---
:
"""": ~"""""""''''''''''._.tIoUI
-.............~---..""'"".
,J
.-"
TIMIOI'IfoUUfI"(
~IflWOAK1 OI!ICAI8IEHOW'lH.IUIWOCClJAfIIED
..'.J
~c...
..... 0 ,.0
.J
~
v
:iJ
lOCR1ClNlSha~. ...
LAST WILL AND TESTAMENT
OF
VEL VA BOLLINGER
I, VEL V A BOLLINGER, now domiciled in Cumberland County, Pennsylvania, declare this
to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously
made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my two children, JERE BOLLINGER, of Cumberland
County, Pennsylvania, and BETTEANN M. STAMBAUGH of Cumberland County, Pennsylvania,
in shares such that JERE BOLLINGER shall receive Eight Thousand Five Hundred Dollars
($8,500.00) more than BETTEANN M. STAMBAUGH. However, if a beneficiary does not
survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those
descendants shall receive, per stirpes, the share the beneficiary would have received had he or she
survived me by thirty (30) days.
Article V
I nominate, constitute, and appoint my son, JERE BOLLINGER, of Cumberland County,
Pennsylvania as Executor of my Last Will and Testament. In the event ofthe renunciation, death, or
inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my
daughter, BETTEANN M. STAMBAUGH as successor Executrix of my Last Will and Testament.
I direct that my Executor or successor Executrix be permitted to serve without bond and in addition
to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike
shares and to file any qualified disclaimer I could have filed if living. My Executor or successor
Executrix shall receive reasonable compensation for services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executor and successor Executrix,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest In all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
( e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
- 3 -
-
(j) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, VEL VA BOLLINGER, hereby set my hand to this my Last
WH! m>d T"tao"",t, 00 ;)(</J<~ S, 2000, at Hom,bUQl, Ponn,ylvonia
71
In our presence, the above-named VEL V A BOLLINGER signed this and declared this to be
her Last Will and Testament and now at her request, in her presence, and in the presence of each
other, we sign as witnesses.
Name
Address
XL[,") ~1hfJ}1{~~ t( Hhf!J. ))~D/09
~J..dMJ fA), ,~~.A/JMLUV
8t/.&; Ai, 'f),rrtYJr> /I (' -1 ~) f7/l I 710 ,
- 4-
I, VEL V A BOLLINGER, Testatrix, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed this instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
VEL VA BOLLINGER, the Testatrix
on r../ S 2000.
~~
ot Pu lie I
~fr!i- 0.,~
VELV A BOLLINGER
Notarial Seal
Marielle F. Hazen, Notary Public
Lower Paxton Twp., Dauphin County
My Commission Expires Sept. 23, 2002
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by If,~'n J,v, &-/('~
'nd"'''''"/1..~ -. _
wItnesses, on .s
~--
Not Public ~
~L/ii-~) t{J, /juAtMtLl/J{/
Itness
,2000.
~('j1 ~ . -I--kl~~ QLJq
tness
Notarial Seal
Marielle F. Hazen, Notar~ Public
Lower Paxton Twp., Dauphin County
My Commission Expires Sept. 23, 2002
- 5 -
,~,
--..Y
BEFORE THE REGISTER OF WillS, CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Velva Bollinaer
Date of Death: 04/16/2002
Will No. 2002-00464
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on OS/28/2002
Name
Address
Betteann M Stambaugh
408 Cocklin Street
Mechanicsbura
1107 Granada lane
Mechanicsbura
PA 17055
PA 17055
Jere Bollinger
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: OS/28/2002
~A{i$IJ
Signature Marielle F Hazen, Esquire
-
Name: Jan l Brown & Associates
Address: 845 Sir Thomas Court Suite 12
Harrisbura PA 17109
i l~J
")
Telephone(717) 541- 5550
6Z I
7r:
',..~.l.
Capacity:
x
Personal Representative
Counsel for Personal
Representative
Jan L. Brown, Esquire
ADMITTED IN PA AND DISTRICT OF COLUMBIA
JAN L BROWN & ASSOCIATES
ATTORNEY AND COUNSELOR AT LAW
OLDE ENGLISH GAP
845 SIR THOMAs COURT
SUITE 12
HARRISBURG, PA 17109
Email: jlbassoc@ptd.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
Jessica A. Holland, Legal Assistant
Brenda F. Kephart, Legal Assistant
Kelley M. O'Brien, Legal Assistant
March 17, 2003
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Velva Bollinger
Social Security No. 189-09-0486
File No. 2002-00464
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
I. Family Settlement Agreement together with Check 1044 in the amount of $17 to cover
the filing fee.
2. Status Report Under Rule 6.12 stating that estate administration is complete.
Please time stamp and return our file copies of these documents. A return envelope is
provided.
If you have any questions, feel free to contact this office.
Sincerely,
=1~
Legal Assistant
bfk
Enclosure
STATUS REPORT UNDER RULE 6.12
v
c,
a~
Name of Decedent: Velva Bollinaer a/k/a Velva B Bollinaer
Date of Death: 04/16/2002
Will No. 2002-00464
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans I
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 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:
a.
account with the Court?
Did the personal representative file a final
Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative I s account is:
c . Did the personal representative state an
account informally to the parties in interest ? Yes X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date: 03/17/2003
~}3 -Pf; A_
Jere Bollinaer
Name (Please type or print)
408 Cocklin Street
Mechanicsbura PA 17055
Address
(717) -6972810
Tel .No.
Capacity :
X
Personal Representative
Counsel for personal
representative
F AMIL Y SETTLEMENT AGREEMENT AND FINAL RELEASE
IN
ESTATE OF VELVA B. BOLLINGER, DECEASED
KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, VEL VA B.
BOLLINGER, late of Mechanicsburg Borough, Cumberland County, Pennsylvania, deceased,
died testate on April 16, 2002, having first made her Last Will and Testament, which was dated
June 5, 2000, and is duly recorded in Cumberland County Courthouse, Register of Wills, File
No. 2002-00464;
WHEREAS, the said VELV A B. BOLLINGER, by the aforesaid Last Will and
Testament, named JERE BOLLINGER as Executor of said Last Will and Testament;
WHEREAS, Letters Testamentary on the estate of said decedent were duly issued by the
Register of Wills of Cumberland County, and Letters were granted to JERE BOLLINGER,
hereinafter called Personal Representative;
WHEREAS, the said Personal Representative has gathered the assets of the estate of the
said decedent, and the assets consisted of real property and personal property to a total value of
$124,433.55 as set forth in Exhibit A, which is a statement of account of the said Personal
Representative, and which is attached hereto and made a part hereof and marked Exhibit A;
WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A
has been reduced to cash and will be distributed as herein indicated in accordance with the terms
ofthe Last Will and Testament of the said decedent;
NOW, THEREFORE, KNOW YE, that we, JERE BOLLINGER and BETTEANN M.
STAMBAUGH, being all of the beneficiaries of the said decedent and heirs under the Last Will
- 1 -
and Testament of the said decedent, and being those persons entitled to inherit under said Last
Will and Testament, do hereby, each of us, acknowledge that we have this day had and received
from the aforesaid Personal Representative, in full satisfaction and payment, all sum or sums of
money, legacies, bequests and devices as are given, devised and bequeathed to each of us
respectively by the said Last Will and Testament, which amounts we have received this day, and
which amounts are in the amount set opposite our respective names in the table and schedule of
distribution in said statement attached hereto and marked Exhibit A;
AND, each of us does hereby stipulate that in order to avoid the expense and time
involved in the filing of a formal account and schedule of distribution, we each agree that no
account is necessary, and we do hereby agree that we do consent to distribution being made
without the filing of an account and schedule of distribution, the same to be with the same force
and effect as ifit had been filed and confirmed by the Orphans' Court Division of the Court of
Common Pleas, Cumberland County Branch.
THEREFORE, we and each of us do hereby remise, release, quit claim and forever
discharge the said Personal Representative, JERE BOLLINGER, his heirs, executors,
administrators and assigns, JAN L. BROWN & ASSOCIATES, attorneys at law, and JAN L.
BROWN, ESQUIRE of and from the said estate and from all actions, suits, payments, accounts,
reckoning, claims and demands whatsoever for or by reason thereof, or for any other use, matter,
cause or thing whatsoever touching upon the estate of the said decedent, and each of us do further
hereby covenant and agree that should any liability come due to the estate of the said decedent
after the signing of this agreement, each of us do hereby covenant and agree with each other and
the aforesaid Personal Representative that we will contribute pro rata our share ofthe estate to
- 2 -
satisfy any and all claims, demands, suits or causes of action which may be successfully
prosecuted against the said estate or the aforesaid Personal Representative after the signing,
sealing and delivery of this Family Settlement Agreement and Final Release.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this 17th day of
March, 2003.
~(/ldll t~/()/ul;
Witness
tJ;/~ t Iir/14
Witness
L_~~
()ERE BOLLIN
16JfL~ ')n_~
BETTEANN M. STAMBAUGH
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
On this the 17th day of March, 2003 before me, a Notary Public, the undersigned officer,
personally appeared JERE BOLLINGER and BETTEANN M. STAMBAUGH, 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.
NOTARiAl SEAL
JESSlCAA. HOUAND. NOTARY PUBLIC
CITY Of HARRISBURG, DAUPHIN COUNTY
MY OMMIS ION EXPIRES MAR H 2006
~ro,/:A-- 'dMo.ra
rot Public
. \
''--)
- 3 -
STATEMENT OF ACCOUNT OF THE ESTATE OF VELV A B. BOLLINGER
Real Property
415 E Coover St, Mechanicsburg $108,000.00
Personal Property (using date of death values)
Allfirst Bank Checking 0016378822
Federated Investors Inc 11015913
Cash
Household goods, auction proceeds
Reimbursements/refunds
Income Earned After Death
Allfirst Bank Checking 0016378822
Federated Investors Inc 11015913
Life Insurance Proceeds
The Paul Revere Life Insurance Company
Total Assets
Expenses
Funeral
Legal fee; Jan L Brown
Administrative costs
Debts of decedent
Inheritance Tax
Inheritance Tax refund
Total Expenses
Net Assets Available for Distribution
$7,250.33
$1,035.63
$213.00
$5,676.75
$2,257.84
$2.27
$2.23
$5,117.50
-$8,012.00
-$4,335.00
-$10,635.42
-$1,844.15
-$4,488.21
$5.90
DISTRIBUTION TO BENEFICIARIES
ACCORDING TO TERMS OF WILL
Jere Bollinger
One-half life insurance proceeds
Cash distribution residuary estate
Cash distribution residuary estate
Betteann M. Stambaugh
One-half life insurance proceeds
Cash distribution residuary estate
Total Distribution
$2,558.75
$8,500.00
$43,314.58
$2,558.75
$43,314.59
$129,555.55
-$29,308.88
$100,246.67
$100,246.67
· Actual cash distribution may be increased or decreased based on interest accrued, market value
of assets. presentation of an obligation and/or payment of additional charges.
03/1 1/2003
Exhibit A
/
v-/
Jan L. Brown, Esquire
ADMITTED IN PA AND DISTRICT OF COLUMBIA
lAN L BROWN & ASSOCIATES
ATTORNEY AND COUNSELOR AT LAW
OLOE ENGLISH GAP
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
Email: jlbassoc@ptd.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
Jessica A. Holland, Legal Assistant
Kelley M. O'Brien, Legal Assistant
Brenda F. Kephart, Legal Assistant
January 13, 2003
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Vel va B. Bollinger
Social Security No. 189-09-0486
File No. 2002-00464
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. Inventory.
2. An original and one copy of the Inheritance Tax Return together with Check 1043 in the
amount of $4,488.21 to cover the tax shown to be due.
3. Check 1040 in the amount of $25 to cover the filing fees.
Please time stamp and return our file copies of these documents. A return envelope is
provided.
If you have any questions, feel free to contact this office.
Sincerely,
J,.'~) /
':i1.U//CtCL 1- J<~(2J:;
Brenda F. Kephart
Legal Assistant
bfk
Enclosure
BEFORE THE REGISTER OF WillS, CUMBERLAND COUNTY
(/
INVENTORY
, Deceased
No. 2002 00464
Date of Death 04/16/2002
Social Security No. 189090486
Estate of Bollinqer, Velva B
also known as
Velva B Bollinqer
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate 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 Decedent's death, and that Decedent owned no
real estate outside 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 made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jan l Brown
Jere Bollinqer
I.D. No.: 67993
Address: 845 Sir Thomas Court Suite 12
Harrisburq
Telephone: 717-541-5550
Dated 1/13/03
PA 17109
Description
Value
Allfirst Bank
Checking Account 0016378822
7,250.33
Federated Investors Inc.
Account 11015913
1,035.63
Cash
213.00
Capital Blue Cross; medical claim reimbs
559.50
Household goods; auction proceeds
5,676.75
Tax rebate
448.37
Total
123,851.30
(Attach Additional Sheets If necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
Include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HAZEN MARIELLE F
845 SIR THOMAS COURT
HARRISBURG, PA 17109
n~U~~_ fold
ESTATE INFORMATION: SSN: 189-09-0486
FILE NUMBER: 2102-0464
DECEDENT NAME: BOLLINGER VELVA
DATE OF PAYMENT: 01/14/2003
POSTMARK DATE: 01/13/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 04/16/2002
NO. CD 002042
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,488.21
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,488.21
REMARKS:
CHECK#1043
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
\{?-6.:3.~
BURE~ DF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
DEPT. 280601
HARRIS8URG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NDTICE DF INHERITANCE TAX
APPRAISEMENT, ALLDWANCE DR DISALLDWANCE
DF DEDUCTIONS AND ASSESSMENT OF TAX
JAN
JAN
845
HBG
L BROWN
L BROWN & ASSOCS
SIR THOMAS CT 12
PA 17109
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-10-2003
BOLLINGER
04-16-2002
21 02-0464
CUMBERLAND
101
'*
REY-lli'i7EXAFPUll-l5)
VELVA
B
Allount Rellitted
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 ~
REv:i54j-Ex--"FP--(OFii3rNcfficE--oF-YNHEii'i;:ANcE-TA)n~-PPRAiSEMENY-,--"ii.-OWA'ifcroi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOLLINGER VELVA B FILE NO. 21 02-0464 ACN 101 DATE 03-10-2003
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Dwned Property (Schedule F)
7. Transfers (Schedule G)
B. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
108,000.00
.00
.00
.00
16,433.55
.00
.00
(B)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expensas/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Raturn
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
22,982.42
1.844.15
(11)
(12)
(13)
(14)
NDTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
124,433.55
;;04.8;;06 57
99,606.98
.00
99,606.98
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: I~ an assessment was issued previously, lines
r~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
lB. Allount of Line 14 taxable at Collateral/Class B rate (lB)
19. Principal Tax Due
.00 X 00 =
99,606.98 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
.00
4,482.31
.00
.00
4,482.31
TAX CREDITS:
"""".LrI ,+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-13-2003 CDo02042 .00 4,488.21
TOTAL TAX CREDIT 4,488.21
BALANCE OF TAX DUE 5.9oCR
INTEREST AND PEN. .00
TOTAL DUE 5.9oCR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATIDN DF ADDITIDNAL INTEREST.
IF TDTAL DUE IS LESS THAN $1, ND PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRM FDR INSTRUCTIONS.)
REIJ,o;!470 EX (6-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
Velva B Bollinger
REVIEWED BY
Deborah Washington
ITEM
SCHEDULE NO.
INHERITANCE TAX
EXPLANATION
OF CHANGES
EXPLANATION OF CHANGES
E&H
Made changes per your correspondence dated 2-24-2003.
ROW
FILE NUMBER
ACN
2102-0464
101
Page 1
'"' .1<
REV-1SlO EX. (8-00)
:
\", ",_..' ~.,
~,^I '-- ," 'l..J..\-
r. >-=-:',Ii\.'
,,.,.~"i'c<r"':
, .'(J. ~/.').''''I
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
Q
W
o
W
Q
w
..
,,:Sco
,,""
w~g
"'.....
08:lD
C
OECEDENT'S NAIE (lAST. FIRST, AND "'DOLE INITVIL)
Bollin er Velva B
DATE OF DEATH (MM-D[)'Ye..)
DATE OF BIRTH (MM-DD-Y...)
C/
OFACIAL USE eN. y
/7- 62>' d-
FILE NUMBER
21-020464
""'COOHiY"COOE -YEAR- --NliWiiER--
SOCIAL SECURJTY NUMBER
1 89- 0 9 - 0 4 8 6
TIllS RETlJRN MUST BE RLED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCVIL SECURJTY NUMBER
o 3. Remainder Retum (daDldlleathpriorb12-13-821
o 5. Federal Estate Tax Retum Required
_ B. TotalNumberofSaleDepos~Boxes
o 11.ElecIiontotaxunderSec.9113(A)_"'01
z
o
5
::I
l-
ii:
0(
o
W
0::
z
o
~
::I
ll..
::i!
o
o
S
04/16/2002 10/19/1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, RRST, AND MIDDLE INITIAl)
00 1. Original Retum
o 4. Lim~ Estate
00 6. DeoedentDiedTestate l_copyofWl)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale d death .12-12-82)
o 7. Dooedenl Maintained a Living Trusl_" """ ofTMIJ
D 10. Spousal Poverty Credit (dale ofdaalh between 12-31--111 and 1-1-95)
..
z
w
Q
Z
Q
0-
co
W
..
..
o
"
Harrisbur
845 Sir Thomas Court Suite 12
PA 17109
20.
108:,000.00
OFFICIAL USE ONLY
NAME
Jan L Brown
FIRM NAME (W Applicable)
Jan L Brown & Associates
TELEPHONE NUMBER
717-541-5550
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. C~ Held Corporation, Partnership or Sole-ProprietOlShip
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposi1s & Miscellaneous Personal Properly
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
7. Inter-VIVOS TransfelS & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
B. Total Gross Allots (total Lines 1-7)
9. Funeral Expenses & Admin~lralive Costs (Schedule H) (9)
10. Debts of Deoedent Mortgage Liabili1ies, & Liens (Schedule I) (10)
11. Total Deductionl (total Lines 9 & 10)
12. Net Value of Eltate (Line B minus Line 11)
13. Charitable and Govemmental BequeslslSec 9113 Trusts for which an eleclion to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FORAPPUCABLE RATES
15. Amounl 01 Line 14 taxable at the spousal tax
rate, or IranstelS underSec. 9116 (a)(1.2)
X _(15)
99,737.98 X .045 (16)
X .12 (17)
X .15 (lB)
(19)
15,851.30
(B)
1?3,8!i1.30
16. Amounl 01 Line 14 taxable al6neal rate
17. Amount of Line 14 taxable alsibling rate
lB. Amounl 0' Line 14 taxable alcollateral rate
19. Tax DlIO
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
22,269.17
1,844.15
(II)
(12)
(13)
24,113.32
99,737.98
(14)
99,737.98
4,488.21
4,488.21
Decedent's Com lete Address:
STREET ADDRESS
415 East Coover Street
CITY
Mechanicsbur
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Pnor Payments
C. Discount
(1)
4.488.21
3. Interest/Penalty ff applicable
D. Interest
E. Penalty
Total Credits (A +8 +C) (2)
T otallnteresUPenalty ( D + E ) (3)
4. If Line 2 is 9reater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4.488.21
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 +5A. This is the BALANCE DUE. (58) 4.488.21
Make Check Payable to: REGISTER OF WILLS, AGENT
IIltlll!!l!li,lljJj[ .1~i!lbr'J!l.li[MI ' '1l~''''''''~~''j::llU '!
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN 'X. IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 IZI
b. retain the nght to designate who shall use the properly transferred or its income; ........................................ 0 IZI
c. retain a reversionary interest; or ...................................................................................................... 0 IZI
d. receive the promise for Iffe of either payments, benefrts or care? ............................................................. 0 IZI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
WIThout receiving adequate consideration?.............................................................................................. 0 IZI
3. Did decedent own an 'in trustfo~ or payable upon death bank account or secunty at his or her death? ................. 0 IZI
4. Did decedent own an Indlviduai Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 IZI
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 Ihat! have examined this retum, includ~ acoom!BlYing schedules aw:l statements, and to the besl of my knowledge and belief, it is true, correct
and cc:mplele.
Decla'u r:i prepnr other than the personal representative is based on all information of which preparer has any knc:1vr1edge.
SIG TURE Of PERSON RESPONS LE FOR FILING RETURN DATE
c;r!?
01/1312003
RESENTATlVE
PA 17055
DATE
01/13/2003
ADDRESS 6 Sir Thomas Court Suite 12
''HaQ'isburQ PA 17109
,..., ," .........,Iif...... "=.- .=. m__ii5iii' ""-"",, . ....""'_...
i~1;~r1$illlmfu*;mg m; 'Hll~ jgm;:J~:&IE0llJ!1.m%llifiif;'ili;;;r~~J~~.
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 statute does no! exemo! a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the surviving spouse is the oniy 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 decedenfs Iineai beneficianes 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(aX1.3)]. 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.
,
~'002EX'(',".
COMMONWEAlTH OF PENNSYLVANIA
INHERlTANCE TAX RETURN
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Bollinaer Vp.lva B 21 02 0464
All real property owned s.lely or as a lanant In c.....n must be repo!\ad at fair mamet value. Fa~ maI'Ket value is defined as the price at which property w.uld be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the releYant racls. Roa' property wflich is jointly-owned _
right.f
surviv.rshlp must be dlscl.sed.n Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
415 E Coover Street, Borough of Mechanicsburg, Cumberland County, PA
See attached page 1 of Agreement for Sale.
Property is scheduled to be sold on 1/28/03.
VALUE AT DATE
OF DEAn"
108,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
108000.00
.
~'~~:('~ '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Bollinaer Velva B
FILE NUMBER
21 02
0464
lodude the prooeeds of litigation and the date the proceeds were received by the _. All property jolntJy-owned with the right of survivorship musl be disclosed on Schedule F.
ITEM VALUE AT OATE
NUMBER DESCRIPTION OF DEATH
1. Allfirst Bank 7,250.33
Checking Account 0016378822
2 Federated Investors Inc. 1,035.63
Account 11015913
3 Cash 213.00
4 Capital Blue Cross; medical claim reimbs 559.50
5 Household goods; auction proceeds 5,676.75
6 Tax rebate 448.37
7 MRP insurance refund 660.00
8 Verizon refund 7.72
TOTAL (Also enleron line 5, Recapitulation) $
(If more spaoe is needed, insert additional sheets of the same size)
15851.30
.
""''''''''(1-97)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
21 02
0464
Bollinaer Velva B
Debts of decedent must be reported on Schedule I
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cocklin Funeral Home 7,932.00
2 James Gingrich Memorials 80.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personel Represenlative (5)
Social Security Numbe~s) I EIN Number of Personal Represenlalive(s)
Street Address
City Slate Zip
Yea~s) Commission Pa~:
2. Attomey Fees Jan L Brown & Associates 4,335.00
3. Femi~ Exemption: (If decedenls eddress ~ not the same as claimanls, attach explanation)
Claimanl
Streel Address
City Slate Zip
Relationship of Claimanl to Deoedent
4. Probate Fees Register of Wills, Cumberland Co 270.00
5. Accountants Fees
6. Tax Return Prepare(s Fees
7. Cumberland Law Journal, legal advertising 75.00
8 The Sentinel, legal advertising 97.07
9 Estate check su pply 19.34
10 Borough of Mechanicsburg; sewer/refuse 65.20
11 PPL Electric Utilities; electric 192.08
12 UGI Corporation; gas 113.55
13 United Water PA; water 44.55
14 Verizon; telephone 74.01
15 Rusty Campbell; house repairs 150.00
16 Cloverleaf Service Company; hot water heater repair 92.'37
17 The Wiley Group; legal fees; real estate matters 500.00
18 Westfield Group; homeowner's insurance 75.00
TOTAL (Also enler on line 9, Recapitulation) $ 22269.17
(If more space is needed, insert additional sheets of the same size)
.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Bollinger, Velva B
21
02
0464
Paae 1
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
19
20
21
22
Real estate closing costs; see attached realtor estimate
Register of Wills, Cumberland Co; filing fee Inventory
Register of Wills, Cumberland Co; filing fee Inheritance Tax Retum
Register of Wills. Cumberland Co; filing fee Family Selllement Agmt
8.112.00
10.00
15.00
17.00
SUBTOTAL SCHEDULE H.B7
8,154.00
.
REV."""':"..,,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Bollinaer Valva B
FILE NUMBER
21 02
0464
Include unreimbulTled medical expellee..
ITEM
NUMBER
DESCRIPTION
AMOUNT
1. Allfirst Check 3853 cashed after death
2 Borough of Mechanicsburg
outstanding sewer/refuse bill
3 Comcast Cable
outstanding cable bill
4 PPL Electric Utilities
outstanding electric bill
5 UGI Corporation
outstanding gas bill
6 United Water PA
outstanding water bill
7 Verizon
outstanding telephone bill
8 Holy Spirit Hospital
outstanding medical bill
9 Barry L Heckard Sr, Tax Collector
outstanding real estate tax bill
22.92
65.20
25.50
92.33
128.60
13.40
71.24
162.72
1,262.24
TOTAL (Also enteron line 10, Recapitulation) $
(" more space is needed, insert additional sheets of the same size)
1 844.15
.
REV-,513.EX.'.
COMMONWEALTH OF PENNSYlVAN(A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
\/"Iv" R ?1 O? 04R4
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS pnctude O~ht ~usal distributions, and transfers under
See. 9116 (a (t )]
1. Jere Bollinger son $8,500.00
408 Cocklin Street, Mechanicsburg PA 17055
2 Jere Bollinger son 50% residue
408 Cocklin Street, Mechanicsburg PA 17055
3 Betteann M Stambaugh daughter 50% residue
1107 Granada Lane, Mechanicsburg PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
.
StANDARD '~GREEMENT FOR Till! SALE OF REAL ESTATE
~lrH'lllr~~~,jf<<o""'Ol'f~."b)o, .a:t'4t-"",otlllll'alllly~..... . ~"'I~UA&.:I'OMS.~
r-.... SELLER'
I BROKER. (C~fWl1J
l.WON.l;:"~. _
, aRaKER 15 'IBIl "Ga"... J'OR SI!l.l.n.1ko;patcd ......~.)..., SeIItr,
I OR
1 Thole...- ~ ~OT tLH .~"'t:lt lor Sell.., And it ~aIl.l 0 .'\G.!m' fOI.): .
A/So1K
I ",.""" IAlOUlt :
: nROK~1l(c...9"') '. PBOh"E~._.
! .o\.OiJRP.SS. PAX
i :RTt()f\F.R IS TSE At'iEN" FOR BU\U. Daicnatcd ~"t(!IJ r, if appfk~:.. . i
I OR I
:ft",lIUrkNOO"mcApltIQtJ'l.lty.erudll.nm: QAa&"-TfOJt.SEJ,..LI;R C~('.t:N1'rOali1ALD D_nANlAr..'"t1ON~
: -. I
l'nn tbr:i.. thke SI.~ll.tIorSdtu _1.tM[ klt.~ Jltobrir II ~A""AI.r1kc~ tc.Hcaan::"15t) Dual ~tlM.ISIll
,--,,-~......', r..._..a~t~.. 't.-._...t"'.........D.,.......'--..Dn~A...L
! ~~~cem~nl, ~WJ7 '_ ,0_
LI__
:5 Fi /.. Sf-, meet, J2L
:1- PRoPERrY (1-N)SeiJlrbu8)'aerec:.s loacD1lIJIi,,*,~ eo Bc;rcr....m hettIlo!..,... "'PP~
ALL~~~'1:;g"ft;.~b~~'.J~~/n.tJt-~~~
~....~., C/, "",p.. .. I ..~.1o...~_oIp-/~~1..,A<r .....
J. :R::~"'" ;::;~~~.u~ :;-. ~R:::i;h.1L _ '-'Aul
(~I turci-Prm l...:./f it:. ' If.l{~re/l r~'l ($~CUI/<(
.-. -.-
Btj1:'ER(~): -.-.-
---: J 1;,
.
,
"
,.
"
"
"
"
"
"
11
"
"
"
"
"
wtIIcI:I ..;)t bit ,paid 10 Wilt bJ l'D}1:It II.'\: r6Ouwt.;
J,("..:I.$IIGf'~ittipillttl\:\~t~
2. t~ilShorcbeck"'tI\irI_._dly!Mtl:w:c:ttClltct\"fltrio;~
,.
-1 Ctsh.ca.:sI:ritlr.~Clto,:;"1ificdcbe.::ltM;cm>&,,,~
.,.._.callad"Stlltt.'O.
......
.
.
~
;\..--
._o~HBd,lttoff
u,s,Dalbrs
. /~r1
$ "
-~~
"
"
II
"
"
..
(G) A.lWut ::4.....~ t"'- rc)lJo.~ 1o'i!.l.bc~pv-~l:lll.aJWrl)u;i;~kycclDlSs.n-, ~Ml.mflPl'1t=a1l;;tuc.s 3t
(:lI::cInfOiID!ltioq R.p'dWgT~ProMi~,;!eI\l:t., \........~!lNftp..~~ ooa~l&Ia fu::ad ~ ~1IalfcCl,J.1 :g
Ml.,~ "tl'.~.-!,lg[" il(;'Ne;t fees. if rGY, ~ wilb ~y alber licr..llIJiI! ItllI cbtCOI ate tel be ~ ~()(' the poticW(J) :II
oo'/end:. '."". ,lIt~lli~~taA-'ldind'" emends 1Iil1 dX)'I ~UAbI.~~ II
~. _ - l!!:lLl1 ~ . I :lI
"
..
..
..
..
..
a
..
.,
.
..
"
(B) Dr-9Q5itopilid~acooIIDtof~~..,m~b:::i:tcIdb,..~fotSc.lk:t.
"
"
"
"
"
"
"
"
..
(Cl Seller'J",'ril1lioqpro
(D}~lObc.OJl
(HI C~"'ey,lDl;' &uta Sell
lI&.-r:d m:
or WotI' if kya: liIXI $c~~.
(F:, hymcDt ut 1tadfcc tala .m 1,l.. t5~dId. tqU&Jly bcrwaeo. Du.
'.u.tw.i:lcatmdba:R:___.
"
"
"
"
"
"
.~
..
..
..
..
"
..
,1
~. I7tXl'L1CES'& PERSONAL ...IMonR'IY (1-00)
(A) INC:.tJ"DEDiIll!\;~~akabd~priqar.:dl~it:mJ .flccofu.-.iudlld.i.llQ:~.
lIc&og; 1iJbiaE l\xlull:il (i.llcludiq; d\a.,illr.l ahd ~ fw;: w.w.f aDd 'Ill ~ ~ door opa:rm
lAd ClIUlIlitla\O:; lalIvjaiOll ~; ~n.~buy. ~ tGd UllJlO!Iat -.. IllY r-wRtY4s bedaJ llDd eookUIQ t.da .tICRd CD thl!
~.t ttMr,.,.o{ u:ltlemerst. w~1 to ....aU eatpctiD&; 'Irindo... L:o~bISd~.IIh.d." btidli tMlloin lirCDl41iCDmi t,Mol.[t.oln
spp~il"":~~vea~t,~~.AJloint'lllllw:l:
ffi'! L'EAS!.D i,tImI! (not owned bot ~r...):
ie) BXCLl.iDBO fi:INrtI ad illl!9d'
~ .
" S. D4.T.tS(1'&\(E IS OT 11JP; Ii:..U!NCE (1.Q2) .
~o ':A) TIw~juefor$eull!lMtIland.aJOlherd:1lz5il111i~3tdmedLUfutd:le~;&ngtotatlJ'riW:dtIlptioQllo!tb.ia~t&tC 91
S1 ;tat'L'c4t.lbeofttNl~oflbU~t:md~.~. Sf
51 .:B) P<<1bcp~ot~A.-~1I'~0:4d<ll'i.'d'~~ltedftml.Ilw4Cr1czcet.'Iti~,bjluch%.fiDCtlMcbylhiJ~tCIDClIt... Q
n ~:atl.aclG_thltl...diyf)ftbctimtpen<ld.. 53
.. ie) Thed.lillQraut1e.mcachl\OC.extcadcdbyaJl.3,()ttetpro\l!sio.l!;?f~^~AD(tI:ftilJ'onJ.ybccurmdedb)'Ul;I;I:1i.II.W'IitreQ~ot 54
IS o-pdltl. is
Sll (7)) C:.wo.tilmperiDlkOlNpte-ptill.:C(lint1tj~Azr-iJlell~ItI<<>!:l...:a..;lrllr:';ClothelNy.-3Ud.SoDcr,Atlyp~1imeperi(lltliltt~lI K.
: 1Ddma;~~.~l!IOttbP.,,(:_ICdtt:;J\~rl.Usaen:JD.calti!'m<lmcpetiod~lOlllputi~a :
ijI .1IY...ldWI~~ AISo1Khpl",S ScDa-ln ~_ Sf
gJ. ~-U'IIIIIN" COJ'\':If(:MTI'I!:NlUn.V,lNI.4AiliO o,~~>>r.
lfEAL1Ci?S'I ;)lfl1l
.-......---
;:oo~
,U1V:il1:l rvJl::iI1:I
,
.
.
7
.
.
"
II
"
..
"
1S
"
"
..
"
( {JJvf
, ~~ 'v
joh\
8~~
l?
~ "lJr{
~,
~ ~ l'--
~ J , 1'7 r;!;,q;.6f'-
I<.J"'I J:.I '"
1.(111I-
V ,..nW
1b\~ -
.~
feOM~
Ljd~ ,
1V(,V'JOIJ
gel! !CL l!L rvd 6!:~l NOt COO~/C!/10
.
STATEMENT OF ESTIMATED SELLER'S COST
DATE PREPARED
i
i .I
/.} r ..' -,
/i-..../ J tr', .,) /~..
.
SALE PRICE
/0 gClJO
PREPARED BY
1\ ,
i , ;.-j..( ,I ~f I,
r ..(.1 _-Jt)./ :
,II
,.
v
, ./
:/.<;:}/'
SELLER
,
/.j;. /1/
... '/'-{' ;i.
l- "._~'t
~.."~~,
"\,(.-.11//
. I
,.,\_/..," ,
r:/ / (:.;~ , '" _,'~',~--I 1.. (L( ,./
- "
PROPERTY
,'. "yll
, .' , ,",
..:, if- /!i , \.....
.
The following estimate, showing the amounts to be paid, supersedes all previous agreements, oral or written, and is provided so that the
Sellers will understand what costs will be deducted for the Gross Sale Price at the time of settlement.
./ ')(> 11J7~ / (/e.:- ,) r3f-"
1. Broker's Commission 01 % of $ / (. /5 ;~.. i C/ ....................................................... $:.i r() (. ~
,'7 '..- 6)-;'7-'-"" , /1 "'-''') '.
2. Transfer Tax % of $ /, J r1' /,// . .0.7'.................................................... $ / l/(,' "
3. Deed Preparation ...............................................................;............................................................................... $ 100.00
4. Transaction Fee .................................................................:............................................................................... $
5. Notary Fees ........... ......... .............................................. .............. ........... ................... ......... ....... .... ....... .............. $
6. . Overnight Mail Fee ........................................................................................................................................... $
7. Domestic Relations Lein Search (use $20./person) .......................................................................................... $
8. Buyers settlement costs ..................................................................................................................................... $
9. FRAN A Seller Fees ......................................................................................................................................... $
10. Home Warranty Plan ......................................................................................................................................... $
12500
12.00
.,!4.66
~~:~-',);;~'~',~,
Inspections/Certifications
11. Wood lofestation luspection ............................................................................................................................. $
12. Private Ou-Iot Sewage System Pumpinglluspection ......................................................................................... $
13. Well Water Analysis ......................................................................................................................................... $
14. Radon Test..... ............ ..... ............... ...... ............ ..... ...... ............................. ................. ....... ............................ ...... $
15. Roof Certification......... ................................ ............................. ....................... ................ ............... .................. $
16.
17.
18.
Home lnspection ......... ....... .......... ................. ......... .............. .............. ............. ............... ....... ............. ............... $
Other /?aA 6,p, J (1 flf/j f'. hb1/1../ / b.rYlId ,i1.f/~........................................... $
- I
....................................................... $
'700
Other
TOTAL ESTIMATED SELLING EXPENSES ............................................................................ $
9 II :)..
These are approximate figures. Exact figures will be provided at the time of settlement
Based on the above figures, Sellers hereby fully understand that they will net approximately $ i 0(, ).'/' ,/. from which deduction will
be made or credit given. as the case may be, for payment of existing moi'lgages, judgments, satisfaction fees, escrow adjustments, and any
other liens or encumbrances, lax or insurance adjustments, sewer, water, 'or rent adjustments, and any other items to which the parties agreed
in their contract.
YWe hereby acknowledge receipt of a copy of this Statement of Estimated Seller's Settlement Costs and approve the above charges.
Fax Statement: This Document and any amendments thereto, may be executed in multiple counterparts by the parties and delivered by way
of transmission through a facsimile (FAX) machine and such counterparts shall have the same legal enforceability and binding effect as
though it were signed by all parties in original form. ^
" , II
'I, ij" ,:U f {-:h "'----'J' \\ i? 'Ji'
WITNESS ::. vb::x~-""'r-(;.j/L--/ SELLER i '. N<~ I)~ ~lJ.0...-1 , _
WITNESS/ SELLER 0 {/
DATE:
f'd./I'f/O-::J....
! I
DATE:
.
LAST WILL AND TESTAMENT
OF
VEL VA BOLLINGER
I, VEL VA BOLLINGER, now domiciled in Cumberland County, Pennsylvania, declare this
to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously
made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
,
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
.
.
,
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my two children, JERE BOLLINGER, of Cumberland
County, Pennsylvania, and BETIEANN M. STAMBAUGH of Cumberland County, Pennsylvania,
in shares such that JERE BOLLINGER shall receive Eight Thousand Five Hundred Dollars
($8,500.00) more than BETTEANN M. STAMBAUGH. However, if a beneficiary does not
survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those
descendants shall receive, per stirpes, ~e share the beneficiary would have received had he or she
survived me by thirty (30) days.
Artic1eV
I nominate, constitute, and appoint my son, JERE BOLLINGER, of Cumberland County,
Pennsylvania as Executor of my Last Will and Testament. In the event of the renunciation, death, or
,
inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my
daughter, BETTEANN M. STAMBAUGH as successor Executrix of my Last Will and Testament.
I direct that my Executor or successor Executrix be permitted to serve without bond and in addition
.
to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike
shares and to file any qualified disclaimer I could have filed if living. My Executor or successor
Executrix shall receive reasonable compensation for services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executor and successor Executrix,
in hisJher absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
,,(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
- 3 -
.
(j) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, VEL VA BOLLINGER, hereby set my hand to this my Last
W~ll and Testament, on ?(,AU :J, 2000, at Harrisburg, Pennsylvania.
~0~N
VEL VA BOLLINGER
In our presence, the above-named VEL VA BOLLINGER signed this and declared this to be
her Last Will and Testament and now at her request, in her presence, and in the presence of each
other, we sign as witnesses.
Name
Address
. XI.{)' .Ju~1ivmt~~ (If. /-.fhfJ. t-fJ/7/09'
J )
~,.iiM) U). ,A'LOI,A.--.,
li'K.Ai! '1J,"""""A ('~ ~ I /'/l 1710'j _
'.
-4-
WHEREAS, on the 13th
dated June 5th 2000
was admitted to probate as the last will of BOLLINGER VELVA
(LA~l, rlK~l, MluuL~j
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2002-00464 PA No. 21-02-0464
ESTATE OF BOLLINGER VELVA
(LA~l. rlK~l. M1UUL~j
a/k/a
Late of
BOLLINGER VELVA B
MECHANICS BURG BOROUGH
CUM~~K~U CUU~lYJ
Deceased
Social
day
Security
of May
2002 an instrument
No. 189-09-0486
a/k/a BOLLINGER VELVA B
late of MECHANICSBURG BOROUGH CUMBERLAND County, who died on the
16th day of April 2002 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to BOLLINGER JERE
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 13th day of May 2002.
?'yrJ ~i:';'Jift!M-"Y
* *NOTE* * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
I, VEL V A BOLLINGER, Testatrix, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed this instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
VE.LV A BOLLINGER, the Testatrix
on: "lL/.rt../ ,<) 2000.
cf?}~~
7/,},H- -6~
VEL V A BOLLINGER
Notarial Seal
Marielle F. Hazen, Notary Public
Lower Paxton Twp., OauIlhin County
My Commission Expires Sept 23, 2002
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
.. purposes therein expressed; that each ofus in her sight andhear.ing signed the WiIJas'Yitnesses, al!d
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by
andu;!
witnesses, on
~;:;/;;,) (,o,/3w.AflAUJ/x)
ItnesS
,2000.
cr:~.tdJ . f/o. ~ f afI(j
tness
/dJ~
---
Notarial Seal
Manelle F. Hazen, Notary Public
Lower Paxton Twp_. Dauphin County
My Commission Expires Sept. 23. 2002
- 5 -