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IJETITION FOR PRODA TE and GRANT 01<' LETTERS
Ellall' of ____ffl..Yj:l1R-L!\lQ~?QL______ No, ~l=2-L - R /
also kllowlI as .__________________________,_ To:
_________h_____n_____._.__ Regi<ter of Wills for the
___m________. /)I'('ea.\('II. County of C\JmlxJrlund In the
Social Security No, .204-01 -S 110 _____ Commouwe<llth of Pennsylvania
The petition of the undersigned respectfully represents thllt:
Your petllloncr(s), who is/<lre 18 yellrs of IIge or older IIn the executor
lu the IlIst will of the IIbove decedent, dllted _____J.Yl--Y..2l
~I .._________.__
named
, 19.!U-
(\IAIC rCIC\'illll drt.:lllll'iIIlI\CC\, l'.K, rCI1Undllliull, ~kalh or l''(Ccutor, CIC,)
Decendent WIIS domiciled lit dellth In ____cuml.xl1:1YllL_ .__ County, I'en~~~~afto..wlth
h.llL_-:-- IlIst flll~~~~inclp~~~sldence 1I~=l~QW~f2~ttf&tTwt~ I Lo I 3
(Ihl mCl'I, Ilumher ill1d l1IundrlllilYI
Decendent, then __aL_ yellrs of IIge, died __Januur.~2~___ 0 19...9.!L_,
IIt~B S. 26th St. .-..llarrisill!l;u.YJL<lLt~I1Qll"Q._of her grunddaughter. CeOO,rah Stulx1r
Except liS follows, decedent did notmllrry, WIIS not divorced IInd did nol hllve a child horn or adopted
after execution of the will offered for probllte; WIIS notthc victim of II killing and was never adjudicated
incompetent: ___n .______
Decendentat death owned property with estimllted values :IS follows:
(If domiciled In Pa,) All personal property $_..QQ....OOO. no
(If not domiciled In I'a,) Persolllll property Inl'eilnsylvllnlll $
(If not domiciled In Pa,) Personal property in County $
Value of real estate in PtIlnsylvllnia $
situated as follows:
WHEREFORE, petllioner(s) respectfully request(s) the probate of the last will and codlcll(s)
presented herewith and the grant of lellers 'jh"tmrpnti'\ql-
(ICSllllllcnllu)'; udminlstratlon c.t.n,j lldmlnl51rallon d,b,n,c,t.a.)
theron.
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Car 1i slo..-J.'A.
(717) ?49-?'\<;'\
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSVLV ANIA } l:lS
COUNTY or' CumlXlrlunc1
The petllil1ner(s) abov~.namcd swellr(s) or nffirm(s) Ihntlhe statements In lhe foregoing petition are
Irue und Cl1rrectlO the be:;1 of the knowledge und helieI' of elltioner(s) and that as personal represen.
tative(ro) of the above decedent petitloner(s) 11'111 IVell and_~~Y)~n.lir 'ster the eslate according to law,
Sw," " " .m",w, l'l1 ,,,.wd.,, d-,t:c ;,/,,'~4. .
before me Ihls ____.__:.___u__:.__~---- (.lIlY 01 .t ~c;U!u\,- Kn.i t. II ~
~~~~=~::/'::I'r ~u:_:~~-=~~~.~.:.~:_ ~ ____ !
II) - ( ,( t.- ,(,.
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1flCt$t ~il1 nM ~tatCtttttut
I, EDYTH S. BLOSSER, of South Middleton TOIInship,
Cumberland County, Pennsylvania, being of sound mind and under no
legal disability, declare this instrument to be my Last Will and
Testament, hereby express ly revok iny all Wills and Codicils
heretofore made by me.
ONE: direct my Executor to pay all of my debts,
funeral and administr'ative expenses as soon as may be done
conveniently after my decease.
TWO: I specifically give, devise, and bequeath the sum of
One Thousand and no ($1,000.00) Dollars to my son,' Leon F.
Blosser in consideration of the extrodinary help he has been, to
me these past several years.
THREE: I specifically give, devise, Clnd bequeath to my
grandchildren the following:
a. 10 Deborah Stuber . . . . . . . . . . $ 1 ;000 .00 i
b. To Timothy Blosser. . . . . . . . . . $ 1,,000.00 i
c. To Phoebe Bookamer . . . . . . . . . $ I,OOO.OOi
d. To Jonathan Blosser . . . " . . . . . $ I,OOO.OOi
.e. To Julie Graves . . . . . . . . . $ 1,000.00.
FOU~l All the rest, residue, and remainder of my estate of
every nature and wherever' situate I give, devise and bequeath to
my sons, Leon F. Blosser and Earl G. Blosser, in equal shares,
. "
I.
per stirpes. If one of my sons has predeceased me, then his
share will be divided equally by his issue who survive me. If
one of my sons dies without living issue, then the share of said
,predeceased son will be distributed to my son who survives me.
E!.fu I appoint, Marcus A. McKnight, Ill, Esquire, to serve
as Executor of this my Last Will.
llXl My Executor may . at his discretion, compromise
c1'a ims, borrow money, retain property for such length of time as
he may deem proper; lease and sell property for such prices,
on such tel'ms as he in his sole discretion deems proper, and
invest estate property and income without restriction to legal
investments.
SEVEN: I direct that my Executo" will not be required to
post bond or enter security in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set ,my hand and seal
2
flu,
[,
CERTIFICATION OF NonCE UNDER RULE 5.61 a \
.=-::..L '9~ F[lJ..'~ 1'1:53
Name of Decedent I EDYTH S. BLOSSER Clu!
Date of Death, 01-23-94 CUrl,:, "
Will No. Admin. No, 21-94- fl
To the Registerl
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
,
Name
Address
-,--
JONA'~ BLOSSER
JULIE GRAVES
LEON F. BLOSSER
DEBORAH STUBER
TIMOTHY BLOSSER
PHOEBE BOOKAMER
EARL G. BLOSSER
1129 STATE STRE!T. DUNCANNON, PA 17020
7113 WINDlIAVEN RD., NO. RICRI.AND IIILLS, TX 76180
P. O. BOX I, MANAMA BAHRAIN. ARABIAN GULF
708 S. 26TII STREET, HARRISBURG. PA 17111
1669 QUAIl. DRIVE, CARLISI.E, PA 17013
515 S. SPRING GARDEN STREET, CARLISLE, PA 17013
801 BROADWAY. EUl,ESS. TX 76040
Notice has now been given to all persons entitled thereto under
Rule 5~6(a) except
Date I Oa.- 03 - cl Y
ES UIRE
Address 60 WEST POHFRET STREET
CARLISLE, PA 17013
TelephoneJ717) 249-2353
Capacity, X
X
Personal Representative
Counsel for personal
representaU ve
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COMMONWEALTH Of PENNSYLVANIA
COUNTY Of CUMBERLAND
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._~_.----_---_-___u_!'l.arcus A. ,,!~j{.!}ill!!!:J III
being duly sworn ____ eccordlng 10 lew, depolu end IeYI thel he is the executor
___--------.----------- 01 Ihe Eltelo 01 Edvth S. Blosser
lele 01 _._~9;:t!LJlidd~~t.o-'L:rOWl!!lh!P-u .,__.__ .___-, Cumberlend County. Pe., dec....d end thai the
wllhln II en Inventory mede by __._~a;:.cuB_A..'._ McKnigh~L}g_ __-, the uld executor
01 the onllro ulete oluld decedenl, conlllllng 01 ell the personel prop.rty end rill ulete, except real utele outside
Ihe Commonw..llh 01 Pennlylvenle, end thel Ihe Ilgurel oppollle IIch Item 01 the Inventory roprillent It'l lelr value
II 01 the dele 01 decedonl'l deelh.
.--
Sworn
and lublcrlbed beloro me,
_1994
Add"..
Dele 01 Ollth
23
DIY
01
Month
94
v..,
INSTRUCTIONS
I, An Inventory must be lIIed wllhln three monlhl elter appolnlmenl 01 perlonal reprllentatlve.
2. A lupplement Invenlory mUll be lIIed within Ihlrty deYI of dllcovery 01 additional ....+s.
3. Addlllonal Iheets mey be alleched II to per~onelty or really
4. See Arllcle IV, Flduclerln Acl 011949.
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RECEIVED FROM,
&
ACI~
ASSESSMENT I!'
CONTROL IilI
NUMBER
AMOUNT
Me; KNIGHT MARCUS A III
bO W POMFRET ElTRfiET
101
'!'I,471?1!I!'1
CARLI SLI:: PA 1 "/013
lOIP Hut lOtO HIU
ESTATE INFORMATION,
B ER
I]
II
m
e 1,,1 99It"O(lfJ 1
ME OF DECEDENT (LAST)
f.lL,OSS[m V:OYTH S
I F PAYMENT
BSN 2(l4-()H51 SO
IFlR$T) 7lM
':1" J.JU.+-
u Y
ClIMBEIlL AND
ATH
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RECEIVED BY~' . .!, i.." \!' / ,;~ ,;J I
. ,i SIGNATURE {, '
, '/ -rr I
MARY C. LEWIB " ,,' , '.; ,./d//,I
Rr.GISTF.R or: WILI.S . I If' I
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I
m TOTAL AMOUNT PAID
, /94
.~. '(Ie. 85
REMARKS
IRWIN, IRWIN & MCI(NlC:lHT
SEAL
CHliCK4I 7"/81
___ -, ~-- -,... .-,.. --.. ...,..., ...... ___. ....._ __ ,..._. ___. ...,.... ....'__ u',,_ '._n_ ...... _..,
/ie'1
ReGISTER OF WILLS
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1111.1500 fit. 12,"1
JJ~Q INHERITANCE TAX RETURN
,~;;!' RESIDENT DECEDENT 21 _
COMMONWIA'l11 OIIl"I/IYlVANIA lTO BE FILED IN DUPLICATE
or'....:lM!N101Ilh'lNUI
'011 O"'CI'O' Ill/ WITH REGISTER OF WILLSl COUNTY COD!
HAIIRI$tUIlCo PA 1710~ RJH
--~_.- -~:~~::r~;~;~n:~N~~'IIN-'-'lAii-" _'n -- _-__-- - - -1- i~:~NH:IT~i~;~bf~~i3
a ~OEiirSfCURrIYNUMln-----rDAfr 01 tHA'fu lOAff 0' eMIt ·
lrl CUMBERLAND
Q 204-01-5130 01-23-9/, 11-05-1907 c....
.--------- - -=---
~ RJlI. Original ReI"n 0 2, Suppl.m.nlol R.lum 03,
l'i"L~
ll: 0 4, limi,.d f.,o'. 040, Fulure Inlll..t Compromil. 05,
i5~il (la, dolll a' deolh oller 12,12.B21
L 0 6. Dec.denl Died T..,o'o 0 7, Decedenl Moin,ointd 0 li,ing Trull
It (AII_och copy of Will) (Alloch cOEl 01 T,.u.'1
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD IE DIRECTED TO,
NA;:;;IN. IRWIN, & HC KNIGHT I:~o :~~-:-~ STREET
!!I1'"0Nl NUMIlA -- CARLISLE. PA 17013
llLJ~.". ?'l~'l C'_' _ g _
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94 -
0081
_!!~R
NUMBER
._=
R.molnder R.lu,n
Ifor do'e.,o' deo,h prior to 12.13,82)
Foderol E"ol. To.
Relu,n R.quired
_ 8, Tolol Number a' Safe D.po,1I 10...
2,629.17
16)
17)
1,632.18
1. Real Ellol. ISch.dul. A) I I) _.n
2, Slack. and Bond. (Sch.dul. B) ( 21 _.._..!Qh~07 . 73
3, Cloltly Held S'ocklPortntllhip In'e,e.' ISch.dule C) I 3)
4, Mortgogll and Naill Recei,oble ISch.dule D) I 4)
5, Co.h, Bonk D.po.lI. & MllCelloneoUl p.rtonol P'ope~yl 5)
ISch.dule E)
6, Join'ly Owned Prop.~y (Sch.dule FI
7. T,on"'"ISchedul. GIISch.dule l)
8, T 0'01 Uroll Aile" Ilolollin.. 1.7)
9, Funeral E.pln.e., Admlnl.trotl,e Co.II, MitcelloneoUl ( 9)
E 'penll' (Sch.dul. H)
10, Deb,., Mortgage liobiliti.., Lie" ISch.dule I)
11. To'ol D.ductio" 1'0'01 line. 9 & 10)
12, Nel Value 0' Ello'elllne S mlnu. line 1'1
13, Chori'obl. and Go,ernmen'ol Beque," ISch.dul. J)
14, Net Value Sub Ie" to Tax (line 12 mlnUlline 13)
15, Amounl of line 14 toxobl. at 6% roll
(Include ,olue. ',om Sch.dule K or Sch.dul. M,)
16, Amounl a' line 14 to.oble at 15% role
Ilnclude ,01uII from Schedule K or Sch.dul. M,)
17, Principal '0. dUlIAdd 10. f,om line 15 and ',om line 16,)
18. Crfldill Prior Poymenh Dllcoun!
+ 5%
19, If line IS it greolll than line 17, .n111 ,h. d,lIe,el1ct on lint 19, Thil" the OVERPAYMENT,
a=:J
20, If line 17 it greolll Ihon lint lB, en'" ,h. dille'lnct on line 20, Thit i.th. TAX DUE,
A. EnlII the Inle'II' on the balance due on line 20A,
8, Entll ,he '0'01 of line 20 and 20A on line 20B, Thl. i. Ih. IALANCE DUE.
Make Check Povoble 'a, Regl.te,.f Will., Agent
L - _BE-SUP.E TO ANSWER ALL QUESnONS ON IIlVllSIlIDI AND TO IIECHIC<< MATH..
Under p.nallifl plrjury, I dlclare lhall have 'ltomin;d lhil "Iurn, Including Qccompanyir\g Ich,dull. and "all minh, and 10 thl bill of my .nowltdgt and belllf,
bl'" 'dtl'" corr I and campl," I declar. Ihol all ,101 tUal. hOI bun nporl,d allrul marhl vollJl, Oeclarallon of p"portr oth., Ihan thl plr.onal "pf.Nnla,IYe I.
Olt on a 0' allan Oof leh P' or" hot an)' .nowlfdgt,
I NA . N IlL 117t .~~.N ADO_EU DAU
'/)4 (j v"'A (,7'"._ \ -,- 04-25-94
60 West P~mfret Street, Carlisle, PA 17013
N Nm1Alfi,'5ffif DATI
1l
( 8) .
10,237.00
(l0!_ 4,317.02
(15) .
96,015.06
(11)
(12)
(13)
(14)
K ,06.
(16)
K ,15.
(17) __
Inle,,,,
(18)
(19)
C"ec~ h"e If you are rrqut'ltinO (I refund of your ovtrpnvmeonl,
(20)
(20A)
120B)
'.,1
110.569.08
14.554.02
96.015.06
96.015.06
5,760.90
288.05
5.472.85
5. 472. 85
-'O-WS1'~TI1"~. C~1I11!ll", PI 17n1)
04-25-94
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (",.) IN THE
APPROPRIATE BLOCKS.. . .
I N
1. Old decedent make a transfer and:
a. retain the us~ or Income of the property transferrerl, lOIIIIII....,,,..,"I'ltI"..,,..,,,...
I
I
b, retain the right to designate who shall use the property transferred or its Income,
I
c. retain a reversionary Interest or 11""ltlllIl".'I"III'O'IIIIIII.'.II"""IIII'I.I""II'.'tll.'"
d. receive the promise for life of either payments, bonefits or careL......................
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without recoiving adoquate conslderatlon9 If death
occurred after December 12, 1982, did decedent transfer property within one year of
death without rocelvlng adequate consideratlon9 ......".....................".............,....
3. J>ld decedent own an 'In trust for' bank account at his or her death".....................
I
I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
I'
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CO,",ONWI~I1N Of 'INNIYIY~N'~
,. INHIlI1ANCI lA_ 1/1UItN
III'DI"' DICID ",
ISTATE OF .
SCHEDULE B J
STOCKS AND BONOS
fiLE NUMBER
Edyth S. Blosser
21-94-0081
(All p,oporty ,olnlly-ownod wllh Righi of S~",IYo"hlp m~11 bo dllll...d on Schodulo F.)
ITEM
NUMBER DESCRIPTION
VALUE AT DAlE
Of DEATH
1. Edward D. Jones - Account #377-01760 opened 09-02-92 -
Fund, Inc. :. ,
American Mutual Date of Death Value. . . . 16,926.83
Colonial Mutual Funds - Date of Death Value . . . . . 15,393.35
New Perspective Fund, Inc, - Date of Death Value. . . . . 6,128.40
2. Legg Mason -
Fund Sha res Price Per Share
Lord Abbett 12,489.744 $ 2.98 . . 37,219.44
Van Kampen Merritt 1,376.878 15.68 . . . 21,589.45
152662
Van Kampen Merritt 867.714 10.43 . . 9,050.26
'OlAIIAho 001" 0.'1.0 2. "..oplluloUo.)
(""',, lflll' ....d.d, 1<...11 odd",on.' .".." 01 ..... ,",,/
S 106,307.73
R1V.IlO'llh (1,111
"
COMMOUWULTH 0' 'INNS'f'lYAtol,A
INHUITANCr UK .,'UI:N
'Il'DI~f DreIDIN!
SCHEDULE "F" I
JOINTLY.OWNED PItOPERTYJ___
------ -----FfLE-NUMBER--
.STATE o'
Edyth S. Blosser
21-94-0081
Join' 'onan'llll
NA~
A. Leon F. Blosser
ADORnS
RELATIONS~IP TO DECEDENT
Son
P. O. Box 1
Manama Bahrain, Arabian Gulf
..
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Jo'ntlv..wnod proportyl
ITEM LmER DATE
'OR DESCRIPTION 0' PROPERTY TOTAL VALUE DICD'S DOLLAN VALUE 0'
NUMBE JOltU MADI 0' ASSET ~INT. DICEDENT'S INTlRIST
TINA T JOINT
-
1. A 09-01-67 Farmers True t Company
Checking Account #4-03830 3.264.35 50% 1,632.18
"
,
.
.
TOTAL (AI.. on'.. on Iino 6, Rtcapll,'allan) I S 1,632.18
I" mort 'pact I, nHdod Inltrl oddiliona',h.." 0' ,omo lilt)
1IV11111"1"'~1 ~ :J
COMMONWfAl; 0' PfNNSYlVANIA
INIURI1ANCE TAX RnURN
'fSIP!NT OtCfO!NT ..
SCHEDULE H 1
. FUNERAL EXPENSES,
ADMINISTRATI.VE COSTS AND
MISCELLANEOUS EXPENSES
P~.a.. Print or !,Y.e!..
ESTATE OF
ITEM
NUMBER
A,
B.
2,
3.
4,
c.
Edyth S. Blosser
---1 FILE NUMBER
21-94-0061
DESCRIPTION
AMOUNT
1.
2.
3.
4.
Funeral bp.nl'"
Hoffman-Roth Funeral Home.
Phone Callse . . . . . . .
Thank You Notes and Stamps
Luncheon . , . . . . . . .
. . .
, . . . . .
. . .
. . .
. I ...
. . , I .
. . .
4,103.00
50.00
25.00
100.00
. . .
. .
. . .
. . .
. . .
. . . . .
. . . '. .
. . .
1.
Admlnlltratlve Co.1I1
Perlonal Reprllentatlve Commllllonl
Social Security Number of Perianal Representative:
Year Cummllllons paid
Allorney Fees - Irwin, Irwin & McKnight . . . . . . .
5,525.00
. . . , ,', . .
Family Exemption
Claimant
Addrell 01 Claimant at decedent's death
Slreet Addrell
Relationship
City..
State
Zip Code
Probato FCles - Letters Testamentary. I . . . . , t . . . . . . . .
147 . 00
1.
Mllcellan,oul bp.n"I'
Register of Will - Filing Fee . . . . . .
Clothes donsted to Goodwill Industries.
, . . . I . . .
. . .
. . . . . . . .
'. . .
25.00
225.00
15.00
10.00
12.00
2.
3.
4.
5.
Farmers Trust - Lost Ssfe Deposit Key
. . I , . . . .
. . .
Po'stage Expense . . . .
Roger B. Irwin - Notary
. . . .. .
. . .
. t . .
. . . . .
Fees.
. . .
. . . . . .
, . . . .
. . .
TOTAL (Also enter on line 9, Recapltulatlonl
$
10,237.00
(If "OIl'PO" II ."dod, In"~ oddltlo.ollht'I' 01....0 .1.0)
REI/.UU EX' (7oI3l
SCHEDULE "1"
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
COMMClNWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
Spahr's Antiques - Apprsisal Fee. . . . . . . . . .
Carlisle Suburban Authority - Water .......
Thomas P. Hilterman - Rent. .' ....
--
Edyth S. Blosser
DESCRIPTION
FILE: NUMBER
. . .
" , ,
, . . . . .
. . . . . . . . . .
PP&L (89.11 and 23.eS) I . . . . . t . . . . . . . . . . . .
United of PA (717-258-6564) . . . . . . . . . .
TV Cable of Carlisle - Account No. 0495916. . . . .
balance , . . . , . . . . . .
. . . .
Kelly Assisted Living. . . . . . . . . . .
. . . . . , .
. . . . . .
. . .
. , . . . . .
Allstate Insursnce Company - Policy No. 028610141 ...
J. P. Mascaro I. Sons - Trash Removal Nov 93 to Jan 911 . .
PA Department of Revenue - 1993 Income. .
Cumberland Crossings Retirement Community
FarmerR Trust - Checks clesred after date
01-25-94
01-28-94
Check 0303
Check 1/301
$80.00. .
54.00. .
. . .
. . .
10. Colonial Mutual Fund - Withdrawal - Loss from date of death
11.
12.
13.
14.
. . . . . . . . . . .
. . . . . . .. ..
- Final Payment . .
of death -
I . . . . . , . , . .
. , . . . . t , . . .
Patricia A. Rosendale - Fiduciary Return and 1994 Income Tax
Preparation Fee . I . , . I . . . . . . . . . . . . . . . I .
TOTAL !AIIO anter on IIna 10, Recapitulation)
Hf mort tfMIc.11 n..dld In"rt .ddltlan.llhMlI of Mml,l.t)
21-94-0081
AMOUNT
65.00
86.63
384. 37
112.96
309.81
11. 84
38.00
203.40
35.62
270. 19
171.20
2,294.00
80.00
54.00
200.00
. 4317.02
-
, --' .'. ." ~.' ....... '
I REV-1547 EX AFP 110-93*
CotlltOHllEAl TH Of Pt!NHSYlYAHIl
OEPARTHEHT Of REVEHUE
8UREAU OF INDIVIDUAL TAMES
OEPT, 280601
HARRllaUllG. PA 11128'0601
~
ACN 101
NOTICE OF INNERITANCE TAM
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS. AND ASSESSHENT OF TAM
DATE 08-22-94
FILl! NO.
DATE OF DEATH 01-23-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREOIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
IRIHN ETAL
60 W POMFRET ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
cunt Ro.ittod J
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
R i V: ifli.-j'ix' -A Fin lO"-93"i -NOT i CE- -oF" i"N'Hiifii' ANC! 'TAX - 'liP' pitA"i sEifiilr;-A r. rOWAN'C! -iili-- -.-..- --." - -"..
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT ~F TAX
e:STATE OF BLOSSER EDYTH S FILE NO.21 94-0081 ACN 101 DATE 08-22-94
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funorol E.ponloo/Ao.iniotrotivo Cootol
HilooUonoouo E.penuo (Sohedule HII'I 10 , 237 , 00
10. Dobto/Hortgogo Liobil1U.o/Liono (Sohodulo II (10)- 4,317,02
11. Totol Doductiono Ill)
12. Net Voluo of r.. Roturn (2)
15. Choritoblo/Govorn.ontol Boquo.to (Sohodulo J) (15)
14. Net Voluo of E.toto Subjoot to To. (141
If .n ......m.nt w.. i"u.d prlviou.ly, linel 14, 15 and/or 16 and 17 will
rlfl.ct figurel that inolud. thl total of ~ returnl allell.d to d.t..
ASSESSMENT OF TAX:
15. A.ount of Line 14 to.oblo ot 6X rote
16. Aoount of Lino 14 to.oble ot liX rote
17. Prinoipol To. Due
TAX CREDITS:
PAYHENT
DATE
TAM RETURN WAS. (X) ACCEPTEO AS FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rool Eltote lSohedule Al
2. Stook. ond Bondo (Sohedule Bl
5. Clouh Held Stook/Portno".hip Intero.t I Soh.dulo C)
4. Hortgogo./Not.. Rocoivoblo (Sohodule D)
5. Co.h/Bonk Dopa.it./Hi.o. Por.onol Prop.rty (Sohodulo EI
6. Jointly Dwnod Property ISoh.dulo FI
7. Tron.foro (Sohedule GI
I. Totol A...to
NOTE:
RECEIPT
NUHBER
OISCOUNT (+)
INTEREST (-)
04-23-94
885995
288,04
PAYMENT MUST 8E MADE BY 10"23-94ll.
I I CHANOED
11)_
(2)
(5l
14)
(SI
(61
(7l
,00
106.307,73
.00
.00
2,629.17
1.632.18
.00
III
110,569.08
14,554.02
96,015.06
.00
96.015.06
(5)
(6)
96,015,06 M.06.
,00 M.15 .
(17)
5,760.90
.00
5,760.90
AHaUNT PAID
5,472,85
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
5,760.89
.01
.00
.01
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN fl/ NO PAYHENT IS RE~IRED.
IF TOTAL DUE 11 REFLECTED AS A "CREOn" lCRl, YOU HAY IE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION I
PUAflOSEIII'
NOTlCEI
PAVII!NTI
REFlINO (CRll
OIJEClIlINS'
AOI1IN
ISTPATlVE
CDfIItI!CTlONS I
DISCOUNT I
INTEREITI
, , .,! ,
" ,
I"
"
\'1
'~,l " .,
f',-t ,. i, ,
, , ",
, "
':,1\ ',I ~j , "
I,!~ (..)t.)
",
Elbtll of dtctdtnt. ~ylng on or blfor. Dlc',b,r 12. 1982 u If any future lnterut In tM ,ltat' 11 tr""f.rr.d
in po.....lon or Injoyunt to ell... . (coUet.raU bln,flahrl" of thl dlcldent .ftlr the '1lCplnUon of IInY IIt.t. for
I1f. or for y..r.~ the COIWO"M,.lth h.r.by .lepr...ly r...rYI. the right to .ppr,I.. and 11'1" tran.f.r Inheritance TIIC.'
It thl lawful el,.. . (ooUat,rl1) rate on MY luch future 1ntlr..t.
Tn fulfill thl raqulrlHnh of Stotlon 2lftO of thl Inherltancl and E.ttltl TIX Aot, Aot 22 of 1991. 72 P,S.
Soollon Zl~O,
Detlch thl top portion of thh Hotice and :tub, it with your pIV.."t to thl Rlgl.t,r of N11l1 printed on thl r.vlr" .Ide.
""H.., ,hock or oono. erdor p,voblo tCI REGISTER GF MI~~S, AGENT
All PIVltnt. rlc,lvad Ihlll fir.t bt IPPUld to any Jntlrut whlcn ..y b. duti wUh any r...Jnder epPUld to thl tax.
. r.fun(l of . tl)( cr.dit, whJch Wit not r.qu..t.d on the TeIC R.turn, 8ay b. requutld by co.phUng an "AppUcatJon
for R.fund of PIM.ylvanl. Jnh.rltanc. and Eltit. Tele" (REV. nUl. Appllcatlon. .r. e...aUebl' at the OffiCI
of the Rlght.r of NiUI, 80y of thl 25 RI",lnUI District OffiCII. or by c.Uing the ,plolal 24ehour
tn....rlng 'Irvic. nutlblr. for fcr.' ordlringl In P.nn.yl.......I. 1-800-U2e2050, outddl P.nnlyl...anie and
within loc.l H.rrllburg ar.. (717) 787e8094. TOOl (717) 77Z-2252 (H.arlng lapllrld Onh),
Any ptrtv In lntlrut not ..tI.fI.d with the apprals...nt, allowancl or dlsallowanc. of deduotlon., or 1l....0Hnt
of tu (lnt-ludlng dllcount or Int.rll1) II .hown on this Hotle. 1\.IIt obJ.ot within .hcty (60J day I of r.cIJpt of
thh NotlCI bYI
uwrltt.n protut to the PA O.partllnt of R.....nu., Board of Appuall, DEPT. Z81021, Harrisburg, PA 11128el021, OR
UII.otJon to ha.... the .Itter d.t.r.lntct at audit of the IlCCO\l1t of the per.onel rtpr...ntaU...I, OR
.utppt.1 to the Orphan,' Court.
FlCltuel errorl dllo~vertd on thl. a.......nt ,hould bt addr....d In writing tOI PA Dtperteent of Rlvanul,
Sur.1Y of Individual TIIC", ~TTHI Po.t .......ent RIVllw Unit, DEPT. 280601, Harrl.burg, PA 17128-0601
Phone (117) 7&7e6S0S, Sit paal ! of the bookl.t "Inltruotlon. for Inherltano. T.II' R.turn for I Rttld.nt
Dto.dtnt" (REV-150l) for In IxplanaUon of adalrllstr.tly.h corraoteblt Irrort.
If any tax due I. p.ld within thrH (!) calondar aonth. afttr the dec~t'. dlath, a five perctnt (SlO dhcount of
the tax plld I. .110wed.
Int.rllt Is chlrtte1 b.alMlnl with tint d.y of dlUnquenclV, or nln. (9) aonth. and 001 (ll day froe the d,t. of
dl.th, to the date of pIVHnt. TalCII whJch blc", dollnq\lt1lt blforl January 1, 1982 bltr Int.rut at the rat. of
'Ix U:O percent plr IfV'lW c.leulated at . dal1y retl of ,000164. All tu.. which bUill dllinquent on and .fter
Jenuary 1, 191Z wl11 bl.r Int.rl.t at a rat. which will vary froe ce11ndar Ylar to calandar y,lr Wllh th.t r.t.
lMOlWICled by the P. DlptrtHnt of Rlvlnue, Th. appl!cabl1 interl.t rllt.. for 1912 through 1994 IIr.,
'!!!r Int.rllt Ret. DillY Int.r..t Faotor :!!!.r Intlr..t Rate OallY Int.rllt Fletor
1911 lOX .ooml 191' lOX .000,7~
1913 16X ,00ml 1917 9X ,0001~7
19" m ,DOOm 1911"1991 IIX ,000301
1911 ux ,000356 1991 9X ,0001~7
1993"199~ 7X ,000191
....Int.rllt I. cllcul.tad a, followlI
INTEREt' . IA~ANCE OF TAX UNPAIO X HUHIER GF OAYS DE~INQUENT X DAILY INTEREtT FACTGR
....AnY MoUc. lI.ued .fter the tlX becall dlllnquent will rlfllct In Interllt calcul.tlon to fifteen (15) d.y,
bt~ond the dat. of thQ .........,t, If peytlf1t Is eade Ift.r the Inter..t cOt;)Ut,tlon d.tt .hoNn on the
Notlo., IdcUtlDnlI Int.rllt I'JIt be c.lculetlel,
"
v .
(!.,
Rece",'! ;, L , .' 01
RI::II", '. .!,lIn
STATUS REPORT UNDER RULE 6.12
'95 I'II\R 13 P 1 :34
Name of Decedent I 2~ 3 , &~j..s..c..r
Date of Deathl D/' .:23. 9</
I,;IU\I.
Cumbll ,.
. ",I\Ht
,".,,, PA
Will No.
Admin. No. ~/"'1I./- ODSI
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 estatel
1. State whether administr.ation of the estate is complete 1
Yes)( No
2. If the answer is No, state when the personal
representati VB reasonably believes that the administra t Ion will be
complete 1___.___
3. If the answer to No.1 is Yes, state the following I
a. Did the personal representative file a final
account with the Court? Yes __ No X
b. The separa te Orphans' Court No. (if any) for
the personal representative's account iSI
c. Did the personal representative state an
acoount informally to the parties in interest? Yes)( No
d. Copies of teceipts, releases, joinders /lncl
approvals of formal or informal accounts may be filed with tho
Cerk of the Orphans' Court and may be attached to this report,
Dot" D~.~y.qL j1;?;J. ,(, fl1.'__
~-it re .
CU'1, . <.lkfl i Ili:l-'J//-:,. ..,
Name (P, ase type r Jrlntl
l&.~_dt._~~q~~ I f\ I') 01 '3
Address
DDJ 6- L(ct_} :'~'::5 .
Tel. No.
CapacitYl -x-'Personal HOpl.'l1RIJlltllt.iVfl
A-counsel fot' perRollal
repreaentll tJ vo
(MAH lI:'mf/ AM3 )