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PLEASE USE ORIGINAL FORM ONLY
Side 1
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX2806~1 INHERITANCE TAX RETURN 2 1 0 6 0 8 7 0
h'arrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 4 2 0 6 0 6 1 0 7 2 0 2 0 0 6 0 8 2 7 1 9 2 7
J 15056041125
Decedent's Last Name
Z I M M E R L Y
Suffix Decedent's First Name
E V E L Y N
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
C
MI
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J U D Y J W I L L I A M S 7 1 7 ~ 4 1 1~-~, 4 6
-.
Firm Name (If Applicable) __..
REGISTEE~ Q~ILLS USBa@NLY
_~c ~ ~~
- . r--
~'- s7~ t j
First line of address ~ •_- _ - Ln l
3 7 4 0 S P R I N G R O A D ~ ~ :~-~
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Second line of address ~ ~~-U
_C7--i ,,
C :'3
r
DATE FILED ~'"'J
City or Post Office State ZIP Code ~ -_ _ _ __ ____ _ _ -___ ______~
C A R L I S L E
Correspondent's e-mail address
P A 1 7 0 1 3
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it true, correct and c mpl te. D laration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
S NAT OF E SO f~ONSIBLE FOR FILING RETURN E ,. r
ADDRESS
3740 S_RING ROAD CARLISLE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
PA 17013
DATE
ADDRESS
15056041125
15056041125 J
1,50560421,26
REV-1500 EX
Decedent's Social Security Num ber
~ecedenrs Name: EVELYN C. ZIMMERLY 1 7 4 2 0 6 0 6 1
RECAPITULATION
1. Real estate (Schedule A) ..................................... ... 1.
2. Stocks and Bonds (Schedule B) ........................ ... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages & Notes Receivable (Schedule D) ................... ... 4. •
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . ... 5. 1 0 0 0 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested .... ... 7.
S. Total Gross Assets (total Lines 1-7) ........................ ... 8. 1 0 0 , 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 4 3 2 8 , 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ... 10.
11. Total Deductions (total Lines 9 & 10) .................... ... 11. 4 3 2 8 , 0 0
12. Net Value of Estate (Line 8 minus Line 11) ................. ... 12. - 4 2 2 8 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... ... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
..............
...14. - 4 2 2 8 0 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.0 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18. •
19. Tax Due ........................................... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1,5056042126 150560421,26 J
dEV-1500 EX Page 3
Decedent's Complete Address:
File Number
2~t o6 og~o
DECEDENT'S NAME I
LY'ELl'\ C. ZIMiV1ERLY
- - --
STREETADDRESS
i-1 FOB LA'~E
CITY i STATE i ZIP
\E~V~'1LLE ', PA ~ 17241
Tax Payments and Credits:
Tax Due (Page 2 Line 19j (1)
2. Credits%Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest,Penalty if applicable
D Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5g)
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did deceden~ make a transfer and'. Yes No
a. retain the use or income of the property transferred : ................................................................. ..... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ X^
c. retain a reversionary interest; or ........................................................................................... ..... ^
d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ ^X
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................. ..... ^ X^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .... ..... ^ X^
4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................. ..... ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3} percent [72 P.S. §9116 (a) (1.1) (i)],
For dales 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 zero (0) percent
(~ 2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)j.
The tax rate Imposed on the net value cf transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(11]
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
RE~J-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
EVELYN C ZIMMERL~' 21 06 0870
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must 6e disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 1990 Che~,rolet Sedan 100.00
VIN: 1G 1 JC4G3LJ274803
TOTAL (Also enter on line 5, Recapitulation) ~ $ 100 00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
'~
SCHEDULE H
COMf~10NWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EVELY~ C ZIMMERL~' 21 06 0870
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. Richardsou's Funeral Home 4,328.00
B
2.
3.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Sorial Security Number(s)/EIN Number of Personal Representative(s) _
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5 Accountant's Fees
6. Tax Return Preparer's Fees
!,
Zip
Zip
TOTAL (Also enter on line 9, Recapitulation) ~ $ 4,328.00
(If more space is needed, insert additional sheets of the same size)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FVFI.I"ti C_LI!VIMLRLY 21 O6 0870
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AfJD ADDRESS OF PERSON(S) RECEIVING PROPERTY Da Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 lusolvent Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1~', AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS.
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
ZIMMERLY.WILL
~_.,
LAST WILL AND TESTAMENT ~?°-
~- ~ G=; -
__~ _c~ ~.•~~
EVELYN C. ZIMMERLY --'.-'---. ~-'~~ -- _
I, EVELYN C. ZIMMERLY, presently residing at 1Q_1~'41~=~. 2-3rd`~-= ;'
Street, Harrisburg, Dauphin County, Pennsylvania 171Q~=~ dec`T:are -- ~!--~'
,5
this to be my Last Will and revoke any Wills previously made by me.
ITEM I: I direct that all my just debts and funeral
expenses, including the cost of a suitable gravemarker and
perpetual care for my burial plot, shall be paid from the assets of
my estate as soon as practicable after my decease.
ITEM II: I give all automobiles and all other articles
of personal or household use, together with all insurance relating
thereto, to my children, DEAN A. JACOBS, FRANK W. JACOBS, III,
DONNA L. STONER, DEBRA D. STURGIL and FREDA L. SMITH, in equal
shares, per stirpes, to be divided among them as they may agree or,
in the absence of agreement, as my Executrix may think appropriate;
provided that articles which my Executrix considers unsuitable for
my children may be sold and that proceeds thereof added to my
residuary estate.
ITEM III: I give, devise and bequeath all the rest,
xesidue and remainder of my estate, real, personal and mixed,
wheresoever situated, to my children, Dean A. Jacobs, Frank W.
Jacobs, III, Donna L. Stoner, Debra D. Sturgil and Freda L. Smith,
provided that the share of any child who predeceases me or dies on
1
_ .. _ ~t
or before the thirtieth (30th) day following my death shall be
distributed to his or her issue, per stirpes, living on the thirty-
first (31st) day following my death and in default of any such then
living issue such shares shall be added to the share or shares for
my other children.
ITEM IV: No interest in income or principal shall be
assignable by, or available to anyone having a claim against a
l~~neficiary before actual payment to the beneficiary.
ITEM V: All federal, state, and other death taxes
payable on the property forming my gross estate for tax purposes,
whether or not it passed under this Will, shall be paid out of the
principal of my residuary estate just as if they were my debts, and
none of those taxes shall be charged against. any beneficiary.
ITEM VI: I authorize my Executrix:
(a) to retain and to invest in all forms of
real and personal property, regardless of (i) any limitations
imposed by law on investments by executrices or trustees, (ii) any
principle or law concerning delegation of investment responsibility
by executrices or trustees, or (iii) any principle of law
concerning investment diversification;
(b) to compromise claims and to abandon any
property which, in my Executrix's opinion, is of little or no
value; to borrow from, and to sell property to others, and to
2
pledge property as security for repayment of any funds borrowed;
(c) to sell at public or private sale, to
exchange or to lease for any period of time any real or personal
property, and to give options for sales or :leases;
(d) to join in any merger, reorganization,
voting-trust plan or other concerted action of security holders,
and to delegate discretionary duties with respect thereto;
(e) to use administrative or other expenses of
my estate as income or estate tax deductions and to value my estate
for tax purposes by any optional method permitted by the law in
force when S die, without requiring adjustments between income and
principal for any resulting effect on income yr estate taxes; and
(f) to distribute in kind and to allocate
specific assets among-the beneficiaries in such proportions as my
Executrix may think best, so long as the total market value of any
beneficiary's share is not effected by such allocation.
These authorities shall extend to all real and
personal property at any time held by my Executrix and shall
continue in full force until the actual distribution of all such
property.
All powers, authorities, and discretion granted
by this Will shall be in addition to those granted by law and shall
re exercisable without leave of court.
ITEM VII: I appoint JUDY JACOBS-WILLZAMS of 536 Salmon
3
^•
Road, Mechanicsburg, Pennsylvania 17055, Executrix under this Will.
I direct that any fiduciary acting hereunder shall not be required
to enter bond or other security in any Court or jurisdiction in
which said fiduciary may be called upon to act. I specifically
direct that said Judy Jacobs-Williams shall :be entitled to a fee in
the amount of five (50) per cent of the value of my probate estate
for acting as Executrix.
IN WITNESS WHEREOF, I have hereunto set my hand and seal and
caused this my Last Will and Testament, consisting of four (4)
pages, to each of which I have affixed my signature, this ~/-~~~
day of November, One Thousand Nine Hundred and Ninety-five (1995).
~ ~ `- 7
,~' . ~~~~I~-~ ~ ~i~~-~~-_~4.G~ (SEAL)
Evelyn C. Zimmerly
Signed, sealed, published a:~d declared by Evelyn C. Zimmerly, the
above-named Testatrix, 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, all being present at the same time,
have subscribed our names as witnesses.
? ~ ,(~ ~% ,
/~ !/~',~%z~:~..,~ ~f' ~i,,.%~c.~ n~a~.,.~,~~y~.;~ Residence: 2915 Brookwood Street
J Harrisburg, PA 17111
~,
E ~ ,,
l '~ ~ i.
. ~.~ ~'~"~`ti~~'/t~~.~~•c,.~.-~-r,:> '°'" Residence: 2916 Brookwood Street
Harrisburg, PA 17111
4
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
CO~~'l~10N~~'E,~LTH OF PENNSYLVANIA ~ SS
COL~~~TY OF CUMBERLAND ~
06 Ob70
Persona] Representative(s) of the Estate of Evelyn C. Zirnrnerly
deceased. depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the Leal estate in the Conullonwealth of Pemisylvania of said Decedent, that the valuation placed opposite each item of said
inventorv Lepresents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memc~randlim at the er~d of this inventorx
l ~ erifv that the statements made in this Inven-
tory are nue and correct. I understand that false state-
ments herein are made subject to the penalties of
I ~ Pa. CS. y-1904 relating to rmswom falsification to
authorities.
-~~w r~
Judy J. Williar
Attorne~~ -- (Nrmte) _ (Sul~remc Court LD. No.)
lAddres~sl
(Telephattc>1
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
74 Fox Lane
7120.-06 Newville PA 17241 174-20-6061
FIGURES MUST BE TOTALED
Cash. Banl: Deposits, & Misc. Personal Property
1990 Chevrolet Sedan
V1N: IG1lC=4G~LJ274~0~
100.00
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(.-ittrn~h udrlitirtna! s/rec~ts u.~ needed)
ToT.~~,: ~ loo.oo
\~~ I I I l he itiirnn~ruxium ~~I real Cslate nutsi~le the Comm~>n~ccallh i~l Prnnsyl~;u~ia may- ~~ the elec~inn i~L the personal repruenrative include the value of each
ilrm. hw ,uch li Puri; ;h~wl~l n~~l h~ e~IcntleJ into the total i~l the Im~inlurv. (J'r<~ ?0 Pu. (-J'- >~ ; ;U/(bll
l~olur /ill-U'/ ;,~~~ fU lj. U(~
COUNTY, PENNSYLVANIA
File Number 21