HomeMy WebLinkAbout03-0109 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Larry R. Zimmerman No. ~'~- O~-- ~(~:~_
also known as To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 193 - 36- 3889 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, apply for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cumber land County, Pennsylvania, with
his last family or principal residence at 116 S. Frederick St.,Mechanicsbur. g,PA
(list street, number and municipality)
Decendent, then 56 years of age, died January 29, ,19 2003 ,
at Holy Spirit Hospital, East Pennsboro Township
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 2 5,0 0 0 o 0 0
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Petitioners after a proper search have ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
See At~ach~d Sh~.
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
Ada J. Lynn Ronald L, ~Zimmerman
1~ South Hi,Ih Street 287 Lost Hollow Road
Mechanicsbur~ Dillsbur~, PA 17019
STATUS REPORT UNDER RULE 6.12
DateofDeath: January 29, 2003
Will No.: Admin. No.: 21-03-0109
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
follo~dng with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes [] 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. Did the personal representative file a final account with the Court?
Yes x_ No ~]
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes [-] No []
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Cleric of the Orphans' Court
and may be attached to this~ ~
Date: 12/6/04
Signature ~' h~y,
Andrew C. S Esquire
127 South Market Street
P.O. Box 95
,<: Mechanicsbur,~, PA 17055
1
~__~ Address
(717) 697-7050
. .~-~:- Telephone No.
C~¢acity: [--] Personal Representative
IX] Counsel for personal representative
OATH OF PERSONAL REPRESENTATIVE,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s)that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
before me this 5th day of
_ ~l~R~llfi~v 9Nn~ ~.,~.~.
No. Sk%-O~- ~q
Estate of Larry R. Zimmerman
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW FEB~IIA~¥ 6 ~ ?NN2 19 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Ada J. Lynn and Ronald L. ~Zimmerman
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Ada J. Lynn and RonaZd L. Zimmerman
in the estate of Larry R- ~mm~rmnn
FEES ~ndrow C. ShoolT, 62469
Letters of A~inistration ..... $ (~. OO
Sho~ Certificates(~) .......... $~ ~o~ (Sup. ct. Lb. No.)
Renunciation ................ $~.O~ 127 S. Market St.,P.O. 95
ADDRESS
TOTAL__ $~ Mechanicsburg, PA 17055
Fi~cd~:.%r.~ ......... A.D. ~ (717) 697-70~0
PHONE
This is to certi~ that the information here given is correctly copied fi'om an original certificate of death duly filed with me as
Local Registrar. The original certificate will be fbrwarded to the State \:ital Records Office for permanent "fiJin~.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
tllu~ 143 He~ 2~67 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
~ ..,.~ CERTIFICATE OF DEATH
'"*':~"~ ,. Larrv R Zlmmerman' ~ Male ~ 193 -- 36 -- 3889 ~: ~,. A ,7' ~;.
56 v~. ; ~ Nov 29, 1946 ~ Mechanicsburg, Pa. ~'~ ~ ~ ~ ~ ~ ~ D ~ ~ ~ ~o, ~
.... Dispatcher 1 .... ~ ' ~ I'~ I*' (~m 121 ( ...... I" Never Married
116 South Frederick Street .~E
Mechanicsburg, Pa. 17055 ~,..,~)
,~. ~.~..~ Cumberland ~.~ ...~
Oeome Zimmerman
· ~. ~ I,~ Florence Swanger
INF~M~S N~ Cy~pf~) ~ /.n~ ~I~M~'S ~ ~ ~. C~, ~, ~ ~}
~. ~= ~'"' =~ 16 South High Street Mechanicsburg, Pa. 17055
~; ~S~S~T~ ~ ~ I~E~ms~smoN ;~~.-N~=C~ C~ IL~-Cq~, Sm.. ~
~=~,~0 ..... ~ ~ O[ Feb 3 2003 ~ Mechanicsburg Cemetery ~ Mechanicsburg Pennsylvania
.... ~~~ I .....FD-012755-L I~. ~,.~u..,. Home, lnc. 37 East Main Street Mechan csburg, Pa17055
~U~(~ ~ C~S~QUE ~E O~: J -7~ ~ '
............................................................ .., ......................................... U,. __1
RENUNCIATION
In Re Estate of Larry R. Zimmerman deceased.
To the Register of Wills of C umber 1 and County, Pennsylvania.
The undersigned W i 11 i am L. Z i mme r ma n of
the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to Ada J. Lynn and Ronald L. Zimmerman
WITNESS ;'~'y hand this /5~- day of ~'"~'~ ,~o~.
(Address)
(Signature)
(Address)
(Signature)
RENUNCIATION
- _ loci
In Re Estate of Larry R. Zimmerman deceased.
To the Register of Wills of C umbe r 1 and County, Pennsylvania.
The undersigned Betty L. Huey of
the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters
of Administration
beissucdto Ada J. Lynn and Ronald L. Zimmerman
WITNESS AA ~ hand this__/Si- day of ~-/'~c~et] , ~9-~0o~ .
/
(Signature)~
(Address)
(Signature)
(Address)
(Signature)
... ' (Address)
RENUNCIATION
In Re Estate of Larry R. Zimmerman deceased.
To the Register of Wills of Cumber land County, Pennsylvania.
Theundersigned L~roy H. Zimm~rman of
~eabovedecedent, herebyrenounc~s) thefi~ttoadmi~sterthecstate ~drespect~lly ~k(s) thatLetters
of Administration
beissu~to Ada J. Lynn and Ronald L. Zimmerman
WITNESS ,~ )' hand this i ~'1- day of ]~ 5c~ ~ .4~c~o-~..
(Signature)
(Address)
(Signat~e)
(Address)
(Signature)
(Address)
RENUNCIATION
In ReEstate of Larry R. Zimmerman deceased.
To the Register of Wills of Cumber 1 and County, Pennsylvania.
The undersigned Robert H. Zimmerman of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to Ada J. Lynn and Ronald L. Zimmerman
WITNESS /~X y hand this / 5 F day of ~c 5- ,, ~c~3.
(Signature)
(Address)
(Signature)
(Address)
Attachment to Petition for Grant of Letters Of Administration
ESTATE OF LARRY R. ZIMMERMAN
Petitioners after a proper search has ascertained that decedent left
no will and was survived by the following heirs (continued from
original sheet)
Robert H. Zimmerman - Brother- 112 GrissomRoad
Manchester, CT 06040
William L. Zimmermann- Brother- 852 E. Lottery Street
Carlisle, PA 1 7013
Leroy H. Zimmerman - Brother - 553 Petersburg Road
Carlisle, PA 1701 3
Ada J. Lynn- Sister 16 South High Street
Carlisle, PA 1701 3
Betty L. Huey - Sister - 119 West Fouth Street
Lewistown, PA 1 7044
Ronald L. Zimmerman - Brother - 287 Lost Hollow Road
Dillsburg, PA 1 701 9
Donald E. Zimmerman, - Brother - last known address:
Deceased 1 7 West Locust Stree. t
Date of Death- 10/2.5/99 Mechanicsburg, PA 17055
Harold W. Powell, Brother - last known address:
Deceased Spring Garden Street
Date of Death - 8/24/96 Carlisle, PA 1701 3
CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ~
NAME OF DECEDENT: Larry R. Zimmerman
Date of Death: January 29, 2003
Will No. NONE Estate No. 21-03-0109
To the Register:
I hereby certify that Notice of Beneficial Interest required
by Rule 5.6(a) of the Orphans Court Rules was served or mailed to
the following beneficiaries of the above-captioned Estate on
February 25, 2003.
Robert H. Zimmerman Brother 122 Grissom Road
Manchester, CT 06040
William L. Zimmerman Brother 852 E. Louther Street
Carlisle, PA 17013
Leroy H. Zimmerman Brother 553 Petersburg Road
Carlisle, PA 17013
Ada J. Lynn Sister 16 S. High Street
Mechanicsburg, PA 17055
Betty L. Huey Sister 119 W. Fourth Street
Lewistown, PA 17044
Ronald L. Zimmerman Brother 287 Lost Hollow Road
Dillsburg, PA 17019
Donald Zimmerman Nephew 4148 Nantucket Beufont Square
Mechanicsburg, PA 17055
Denise Patrick Niece 17 W. Locust Street
Mechanicsburg, PA 17055
David Zimmerman Nephew 17902 Bimini Isle Court
Tampa, FL 33647
Deb Means Niece 20 W. Locust Street
Mechanicsburg, PA 17055
Dee Luzier Niece 1004 E. Coover Street
Mechanicsburg, PA 17055
Steve Powell Nephew 415 Run Road
Carlisle, PA 17013
March 4, 2003
Page 2
Certification of Notice
Dave Powell Nephew 3614 Franklin Avenue
Mechanicsburg, PA 17055
Jim Powell Nephew 24 W. Coover Street
Mechanicsburg, PA 17055
Bob Powell Nephew 6419 Union Deposit Road
Harrisburg, PA 17111
Sharon Smith Niece 5201 Stage Road
Benson, VT 05743
Notice has now been given to all persons entitled thereto under Rule
5.6(a) except: NONE
PA ID NO 62469
P.O. Box 95
127 S. Market Street
Mechanicsburg, PA 17055
717-697-7050
Counsel for Personal Representative,
Ronald L. Zimmerman, Administrator
Ada J. Lynn, Administratrix
Estate of Larry R. Zimmerman
COMMONWEALTH OF PENNSYLVANZA
COURT OF COMMON PLEAS
OF CUMBERLAND ,COUNTY
ORPHANS' COURT D:[VIS[ON
NO TICE OF CLAII~
~n Re: The Estate of: Court File No: 21-03-109
LARRY R ZIMMERMAN
Deceased
TO: THE CLERK OF THE ORPHANS' COURT D:[V:[S~ON:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2).
:[) Claimant's name: SEARS, ROEBUCK AND CO.
CIO BALOGH BECKER LTD, 4150 OLSON MEMORIAL
2) Claimant's address: HWY #200
MINNEAPOLIS, MN 55422
8887629997
3) Creditor listed below is the owner and holder of a claim in the amount of
$. 536.43
4) The facts upon which this claim is based is an account for credit evidenced by the
attached Affidavit of Account Stated.
5) Decedent's address: 116 S FREDERICK ST MECHANICSBU, PA 17055
6) Date of Death: 01/29/03
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by.
On behalf of the claimant, ! do solemnly declare and affirm under the penalties of
perjury that they ]:nformation and representations made herein are true and correct
to the best of my, knowledge, information and belief.
Dated: ~"-'/~/~/ ~
~' ! Chelsea A. Jagusch/Angela~H~;~, Attorney
Written notice of claim was given to Personal Representative and]or his/her counsel
as stated below: ~:: :i ~ ¥' ~LLI~
ANDREW SHEELY Sears, Roebuck and Co,, f~f-lit?~e'~J and as
Name servicing agent for any entity having an
PO BOX 95 interest in the receivable evidenced by this
Address Clain~jL: L[',~' g- J'lJ"JJ" ~0.
MECHANICSBURG, PA 17055
City/State/Zip ';i ;~i~1-3~
Date notice mailed ?" : :; ~:?K::;Sj:I
IN RE ESTATE OF: LARRY R ZIMMERMAN
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of her duties.
3. The Decedent purchased merchandise in the amount of $ 536.43 evidenced by
account number 0362225074032
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney' s fees.
Further your affiant sayeth not
BALOGH BECKER, LTD.
By: ~
One of its attorneys: ~
Chelsea A. Jagusch__ Angela M. Horr~
Michael D. Johnson __ Cyrenthia D. Jordan __
Mary Ellen Weeman __ Thersia O. Lee __
Chad J. Bolinske Eve C. Zamora
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4804
Subscribed and sworn before me
This~"J~dayof ~P~0~k~ ,2003.
(~ · . ~ Utnnesota ~
1MY ~SmmiSS~on Expfres ,J~nu~ry 3~1. 2007t
Notary Pilhlic' ~ - TM ~ ~
COIvlMONVVEALTH OF
I~l...V I ~Jl~.;~,~r
~ PENNSYLVANIA
~~~, DEPARTMENT OF REVENUE
DEPT. 28060 INHERITANCE TAX RETURN F,.E"UMBE.-
PA ?:28-060 RESIDENT DECEDENT 21 _ 03 0109
COUNTY ~ YE'C, NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-' ZIMMERMAN, LARRY R.
Z 193-36-3889
t't DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
LU 01/29/03 11/29/46 REGISTER OF WILLS
iii (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[u [] 1. Original Return [] 2. Supplemental Return [] 3. Rernmnder Return ,,'date of ~eati' p~ior ~o ~2-~3.~2)
3:O0
n, .~ [] 6. Decedent Died Testate (Attach copy of Will) [] 7. Decedent Maintained a Living Trust (Amch copy of Tms~) 8. Total Number of Safe Deposit Boxes
'< [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit
"' NAME COMPLETE MAILING ADDRESS
oz Andrew C. Sheely, Attorney Andrew C. Sheely, Attorney
~. FIRM NAME (if Applicable)
,~ 127 South Market Street, P.O. Box 95
"' Andrew C. Sheely, Attorney at Law
~' Mechanicsburg, PA 17055
n, TELEPHONE NUMBER
O
~ (717) 697-7050
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) 61 1.34
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Beposits & Miscellaneous Personal Property (5) 8,603.17
(Sciledule E)
6. Jointty Owned Property (Schedule F) (6)
]Separate Billing Requested
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
~ (Schedule G or L)
[ l~~
¢~ 8. Total Gross Assets (total Lines 1-7) (8) --, 9,214.51
III 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 16,026.79
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 24,763.09
11. Total Deductions (total Lines 9 & 10) (11) 40,790.69
12. Net Value of Estate (Line 8 minus Line 11) (12) 0.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 0.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
~ rate, or transfers under Sec. 9116 (a)(t.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)
O
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) 0.00
Decedent's Complete Address:
t STREET ADDRESS
1 16 South Frederick Street
clTYMechanicsburg IsTATEPA I zip 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (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.
Check box on Page 1 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) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
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; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. tf death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for'' or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................
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 penall~es of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal rapresenta~ve is based on all information of which preparer has any knowledge.
DATE
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) ti)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 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 surv~ving 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 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 decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on tile net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3}]. A sibling is defined, under Section 9~02, as at~
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-~03 E×+ C6-98,~ SCHEDULE B
OO~ON~EA~_'~ O~ ~EN~S¥~_VAN~A STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LARRY R. ZIMMERMAN FILENUMB~i-03-0109
All properly jointly-owned with right of su~ivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Larry R. Zimmerman died on Wednesday, January
29, 2003, at the Holy Spirit Hospital in Camp
Hill, Pennsylvania. Stock values are listed
as the mean between the high and low on
January 29, 2003. Values based upon informatiol
provided by Met Life.
Stock
1. MetLife $26.58 $611.34
(23 shares)
Cusip 59156R10
$611.3,~
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
MetLJfd Your Check is Enclo-__ _ cl
Have you updated your account to reflect your social security number?.
To provide you with the best possible customer service, we need to be sure that each account has been updated
to reflect a correct social security number. Please take a minute to update your account by calling 1-800-649-3593
and accessing the automated telephone system. Or, Jf you have already established a PIN, you may access your
account on the Intemet at httos://vault.melloninvastor, com/isd and enter the information electronically. You may
access the automated telephone system and the Intemet site 24 hours a day, 7 days a week.
As always, please remember that this check does not affect any existing MetLife policy you may have. It is
the distribution of a dividend for MatLife, Inc. common stock and is not a policy dividend.
THIS IS NOT A BILL
· 0102003 G1
MetLife° POLICYHOLDER TRUST STATEMENT RETAIN FOR YOUR RECORDS
The enclosed check represents a distribution on your Trust Interests payable December 13, 2002 to holders of record on
November 8, 2002. The aggregate amount paid to all Trust Beneflolarle~ In this distribution Is $83,475,059.85.
THIS DOES NOT AFFECT YOUR POUCY IN ANY WAY.
MARKET CLOSING PRICE ESTIMATED MARKET
INVESTOR ID REGISTRATION AS OF RECORD DATE VALUE
8066 1442 9258 LARRY R ZIMMERMAN $27.100 $623.30
NUMBER OF TRUST RATE PER CURRENT NET PRIOR YEAR
INTERESTS INTEREST DISTRIBUTION TAX WITHHELD DISTRIBUTION DISTRIBUTION
23.0000 $0.21 $4.83 $0.00 $4.83 $4.60
You may purchase or sell shares of MetLife, Inc. common stock An annual shareholders' meeting to elect members of the Board of
through the Trust, free of any commissions or other fees, under the Directors of MetLife, Inc. and for transaction of other business is
MetLife Purchase and Sale Program, as amended. A copy of the expected to be held on April 22, 2003. The deadline for submitting
brochure describing the program is available on the Internet at shareholder proposals for consideration at this meeting was
www.metlife.com, by selecting Investor Relations and then the November 25, 2002. A copy of MetLife, Inc.'s annual report and
Shareholder Services Information page, or by calling the number proxy statement will be available free of charge on or before March
listed below. You are permitted to transfer your Trust Interests in 31,2003, along with other MetLife, Inc. and Policyholder Trust filings
only the circumstances described in the brochure. You may also under federal securities laws, (i) on the Internet at www.metlife.com,
instruct that all (but not less than all) of your shares of MetLife, Inc. (ii) by writing to MetLife, Inc. Investor Relations, One Madison
common stock held by the Trust be withdrawn. Information regarding Avenue, Area 22a, New York, NY 10010 or (iii) by calling the number
your withdrawal rights may be found in the Purchase and Sale listed below. These and other securities filings by MetLife and the
Brochure or by calling the number listed below. Pdlicyholder Trust are also available on the Intemet atwww.sec.gov
For inquiries about your account, the status of your Trust Interests, or discrepancies or errors in this statement, contact information is
listed below:
General Mail: Transfers Only:
Phone 1-800-649-3593 MetLife MetLife
Email metlife@melloninvestor, com c/o Mellon Investor Services c/o Mellon Investor Services
Internet https://vault.melloninvestor, com/isd P.O. Box 4412 P.O. Box 4447
South Hackensack, NJ 07606-2012 South Hackensack, NJ 07606-2047
P,a:,aso ,Note: Your Sale Proceeds Check is Attached
I~ROKER'S Nalne, Address, ZIP Code. Federal
l,le,ilificalion Number and Telephone Number: Form l 099-B Proceeds From Broker and Barter
COPY B FOR RECIPIENT Exchange Transactions
kK:lh-m tnvestor Services ***IMPORTANTTAX INFORMATION*** U.b. lIN l*Ol~i~lA 1 10~
OMB NO.
83 (ihalloll§er Road This is important tax information and is being furnished to RETURN FOR 2003
Ridgefield Park, NJ 07660 the Internal Revenue Service. If you are required to file a 1545-0715
22-i~367522 return, a negligence penalty or other saoction may be la DateofSale lb CUSIP Number
imposed on you if this income is taxable and the 1RS
i SOO ii 1U-3593 determines that it has not been reported. 03/28/2003 59156R11}
TO WHOM PAID 2. Stocks, Boods, etc. 3. Bartering
Ronald L. Zinunennan & Ada J. $614.52
Ls~m Ex. Est. Larry R Zimmerman ,t FEDERAL INCOME TAX WITHHELD
C/O Andrew C Sheely
P.O. Box 95 $0.00
127 S. Market St. EEl
Mechanicsburg, PA 17055-6328 REPORTED } and optlom premiun~
TO IRS [--I Gros~proceeds
5. Description
Metlife, Inc.
Investor ID I Recipients ldentificatiofi Number on FILe
_.. 8065 4367 9112I 25-6833827
· IMPORTANT TAX RETURN DOCUMENT ATTACHED ·
Date Description Shares Sold Sale Price Gross Proceeds Tax Withheld Net Proceeds
($) ($) ($) ($) Trust Interest Balance
Balance 23.0000
04/02/2003 Shares Sold 23.0000 26.7182000 614.52 0.00 614.52 0.0000
YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK
REPRESENTS THE FULL VALUE OF YOUR ACCOUNT.
Retain this number for future reference:
Investor ID: 8065 4367 9112
For information concerning this statement, call MetLife, Inc.'s Transfer Agent,
Mellon Investor Services toll free at 1-800-649-3593
SFULL (01-03) PLEASE DETACH ALONG THE PERFORATION }" 0401
I H~ FACE OF Il-tiS DOCUMEIql PlA5 A BLUE B,~\(. }(.('dq(.)Ul~D Ol~t VVtIItE P,o,I-'EFI I-IqE bqAGt'( OF '[FIIS DOCUbIENI CON IAINS AN ARI'IFICIAL WA'I EHMAHK HOLD Al-ANGLE IL) VIEW
Description: Sale Proceeds Check No. 00404066 50-937
213
Check Date Investor ID Pay
04/0210~ 8065 4567 9112 ****$614.52 .
Pa)' to The Payable at
Order of: Ronald L. Zimmerman & Ada J.
Lynn Ex. Est. Larry R Zimmerman Chase Manhattan Bank, Syracuse, NY or '
C/O Andrew C Sheely The Chase Manhattan Bank, New York
P.O. Box 95
127 S. Market St.
Mechanicsburg, PA 17055-6328 t~~/t~
Authorized Officer Signature
,'OOt, OhOg~=,' ,:081,~,OC~,?cil: r~O~,SciBOOC~,'
Transfer Transaction Advice
Ronald L. Zimmcrman & Ada J. Please be sure the correct address appears
L2~va~ Ex. Est. LarD. R Zhnmerman in the window of the envelope if you are sub.
C/O Andrew C Sheely miffing a Purchase or Sale Instruction. The
P.O. Box 95 attached instruction card identifies the
127 S. Market St. correct address for each type of transaction.
Mechamcsburg, PA 17055
The following shares have been recorded on the records of the Company in book-entry form.
Beneficiary of: Metlife Policyholder Trust CUSIP Number: 59156R10
Issue: Trust Interests Transaction Bate: 03/26/2003
Interests: 23.0000 Transaction Advice Number: IRO 757337
Registration: Ronald L. Zimmcrman & Ada J. Investor II): 8065 4367 9112
Transfer Agent: Mellon Investor Sen,ices
This Transaction Advice is your record of the indicated Trust Interests being credited to an account on the books of the referenced
transfer agent. The Transaction Advice should be kept with your important documents as a record of your ownership of these
securities. These Trust Interests are transferable only as permitted under the MetLife Policyholder Trust.
PLEASE READ THE IMPORTANT INFORMATION ON THE BACK OF THIS FORM AND IN THE PURCHASE AND SALE BROCHURE
BCR (0%02)
C 0327 0000398
Use ONLY if a transaction is requested. Unless you wish to initiate a transaction, no action is required.
PURCHASE INSTRUCTION Change of address:
'&~,~ ~,,~:;~ :.ich ~o $~-~ui 8065 4367 9112
Ronald L. Zimmerman & Ada J.
Signature: Jif address beina chanaed)
Mellon Investor Services Make check, in U.S. dollars, payable to:
PO Box 382200 MetLife Purchase Program
Pittsburgh PA 15250-8200
Amount Enclosed
I,,,11,1,1,,,I,1,1,1,11,,,I,,I,,,I,II1,,,11,,,11,,,11,,,I,,,11 Minimum investment $250.00 (except as
,04 Please be sure this address appears in the described in the purchase and sale brochure)
envelope window for PURCHASES ONLYI
Please see the enclosed Brochm-e
for important mt'onnation on your
0 0 0 0101 10 2 8 0 6 S 4 3 6 ? 9112 8 right to xvithdraw from file Trust.
,~ SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LARRY R. ZIMMERMAN 21-03-0109
Include the proceeds of litigation and the date the proceeds were received by the estate,
All property jointly-owned with right of survivorship must be disclosed on Schedule E
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. L996 Lincoln Towncar S/N 1LNLM81WXTY679800 $ 3,500.00
2. PNC Checking Account - %5070017708 $ 1,717.20
3. Decedent's Personal Property - per Bricker Sale $ 350.00
4. Pennsylvania Employees Benefit Trust Fund $ 684.48
Reimbursement
5. Decedent's final accrued benefits from Commonwealth
of Pennslyvania $ 2,316.49
6. 2000 Eagle Coin, painted silver $ 35.00
TOTAL (Also enter on line 5, Recapitulation) $ 8,60 3 . 17
(If more space is needed, insert additional sheets of the same size)
~"o~';:::~ L.B. Smith Ford, Inc.
of Sales 1100 Market Street · Lemoyne, Pennsylvania 17043
and Service Phone: (717) 761-6700 or (800) 422-3673 · FAX: (717} 761-3951
E-mail: fords~lbsmith.com
July 28, 2003
TO WHOM IT MAY CONCERN:
It is my opinion that the approximate actual
cash value is $3500.00 for the 1996 Lilcoln Towncar,
S/N 1LNLM81WXTY679800, with 68,100 miles on the odometer.
Information from Kelly Blue Book was used for this appraisal.
Homer S Hetrick,
General Manager
Regular Checking Account Statement
PNc Bank PNCBAN(
Primary account number: 50-7001-7708
Page I of 2
For the period Oll28/2003 to 02/24/2003 Number of enclosures: 1
x
Y LARRY R ZIHNERNAN '~ For 24-hour customer service or
116 S FREDERTCK ST current rates:Call 1-888-PNC-BANK
NECHANICSBURG PA 17055-6:507 Movinl;? Please contact usat l*888-PNC-BANK
E~ Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
j~, Visit us at
www. pncbank,cem
~TDD terminal: 1-800~531-1648
For hearing impa/red clients only
Get a 15% Discount off the TurboTax® for the Web(sM) Regular Prices
Save time and money on your taxes! Do you]' taxes online with the TurboTax for the Web service. Visit pncbank, com to find out
how you can save 15% off the regular price when you prepare and file your federal and state taxes with the TurboTax for the Web
service.
Regular Checking AcCount Summary ~ Larry R Zimmerman
Account number: 50-7001-7708 Account Link ® number: 0193363889
Balance Summary Please see the Activity Detail section for
Beginning Deposits and Checks and other Ending additional information.
balance other additions deductions balance
611.67 1,481.00 2,092.67 .00
Average monthly Charges
balance and fees
653.82 .00
Transaction Summary
Checks paid/ Bank card/POS Account Information Teller
withdrawals transactions assistance calls transactions
2 0 0 1
Total ATM PNC Bank MAC Other MAC ATM Other ATM
transactions ATM transactions transactions transactions
0 0 0 0
Activity Detail
Deposits and Other Additions There was 1 Deposit or Other Addition
Date Amount Description totaling $1.481.OO.
01/31 1,481.00 Direct Deposit - Tax Refund
US Treasury 220 193363889
Checks
Check Date Reference
number Amount paid number
1578 375.47 01/31 029167427
There is 1 check listed totaling $375,47.
Online and Electronic Banking Deductions There was 1 Online or Electronic Banking
Date Amount Description Deduction totaling $1OO.OO.
02/03 100.00 Direct Payment - Payment
Federalbond 4482A00036271
FORM953R
Regulbx Checking Account Statement
~ For the period 0112812003 to 02/2412003
For 24-hour customer service: LARRY R ZIMMERMAN
Call: 1-888-PNC-BANK Primary account number: 50-7001-7708
Account nmnber: 50-7001-7708 - continued Page 2 of 2
Other Deductions There were 2 Other Deductions totaling
Date Amount Description $1,617.20.
02/07 .00 Outstanding Item Close
02/10 1,617.20 Withdrawal Tel 0400004113 0033
Daily Balance Detail
Date Balance Date Balance Date Balance
01/28 611.67 02/03 1,617.20 02/10 .00
01/31 1,717.20 02/07 1,617.20
Important benefit information for all PNC Bank VISA Gold Check Cardholders
A VISA Gold Check Card provides you with even more great benefits. For example, when you use your PNC Bank VISA Gold
Check Card to make non-PIN purchases you have the added benefits of:
Purchase Security* - 90 day theft or damage protection on most card purchases.
Warranty Manager* - Doubles the manufacturer's written U.S. warranty up to one year on warranties of three years or less.
Register your purchases by phone or online.
*Certain restrictions and conditions apply.
For complete benefit information, go to www.visa.com/benefits or call 1-800-595-9928.
If you don't already have a PNC Bank VISA Gold Check Card, ask us how you can get one today! Simply stop by your nearest
PNC Bank branch, call 1-888-PNC-BANK or visit pncbank.com for details.
BRICKERS AUCTION
Complete Auction Service
Auction- Wednesday Evenings
766-5785
Chuck Bricker, Auctioneer
TOTAL SALE
COMM.
~0,oo
BRICKERS AUCTION
Complete Auction Service
Auction- Wednesday Evenings
766-5785
Chuck Bricker, Auctioneer
TOTAL SALE
COMM.
~ ..... -'~' BRICKERS AUCTION 831 "~'~
'~' '~':' MECHANICS
~a P~ ' Plan
REV-1351 EX (6-98) TO BE USED IN CON.IUNSTION W!TH REV~485
~ STOCKS/BONDS ESTATEOF L~-~,7 /~. Z,~.~f-¢~-..-,
COMMONWEALTH OF PENNSYLVANIA INVENTORY FILE NUMBER ~ / -- 0 5 -- 0 ~O ~
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-~01 SOCIAL SECURITY NUMBER l~ ~ -- ~ ~ ~ ~
NO. SHARES/ STOCKS/BONDS
DENOMINATION C~SS/SERIES COMPANY NAME CERTIFICAT~ BOND NUMBER DATE OF ISSUE
REGISTERED IN NAME(S) OF
..c SA.K,".A. ~' 059661
BUREAU OF COMMONWEALTH PAYROLL OPERATIONS PI'Iq'SBURGH, PA
SALARY/TRAVEL ADVANCEMENTS 8-9/430
817
P.O. BOX 8007 00059661
HARRISBURG, PA 17105-8006
cHECK AMT.
DATE VT. NO.
05/0~-/~003 $25~.
PaY TO THE ORDER OF:
p VOID AFTER 60 DAYS
Estate of:
Larry Zimmerman
SAL / PEMA
,,0 5 elF=r=
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
30 NORTH THIRD STREET - P.O. BOX 1147
HARRISBURG, PENNSYLVANIA 17108-1147
TOLLFREE: 1-800-633-5461
www.sers.state.pa.us
April 18, 2003
L R ZIMMERMAN & ADA J LYNN EXECS
LARRY R ZIMMERMAN ESTATE
ANDREW C SHEELY ATTORNEY AT LAW
PO BOX 95
MECHANCISBURG PA 17055
RE: LARRY R ZIMMERMAN
S.S. #193-36-3889
We are in receipt of the short certificate you submitted to this office for the Estate of Larry R.
Zimmerman, the named beneficiary in the above referenced account, thank you.
In order that we can voucher a check in the final settlement of this account, the enclosed Release
and Indemnification Affidavit must be completed, notarized, and returned to this System at the
address shown above as soon as possible.
The following information is being provided:
Death benefit payable to you: $157,294.57
Taxable Portion: $157,294.57
Non Taxable Portion: $0.00
If you have any questions or need assistance, please contact the field office nearest you at 1-800-
633-5461.
Sincerely,
Linda M. Miller, Director
Disability & Death Benefits Section
Benefits Determination Division
Enclosures
BEN63^ I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
REV- I E×+ SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LARRY R. ZIMMERMAN 21-03-0109
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1
MYERS FUNERAL HOME $ 7,271.00
GRAVE OPENING 1,160.00
GINGRICH MEMORIALS 1,200.00
B. ADMINISTRATIVE COSTS:
1. Personam Representative's Commissions
Name of Personal Representative(s) Ronald L. Zimmerman, Co-Administrator $1,200.00
Ada J. Lynn, Co-Administrator $1,200.00
Social Security Number(s)/EIN Number of Personal Representa~ve(s)
Street Address 287 Lost Hollow Rd.
City Dillsburg State PAZip 17019
Year(s) Commission Paid:
2. Att0rneyFees ANDREW C. SHEELY, ESQUIRE, PER AGREEMENT $ 5,405.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State __ Zip
Relationship of Claimant to Decedent
4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS $ 105.00
CUMBERLAND COUNTY REGISTER OF WILLS 9.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. ,EGAL ADVERTISING: CUMBERLAND COUNTY LAW JOURNAL $ 75.00
THE PATRIOT NEWS CO. 99.79
[EIMBURSEMENTS - RONALD L. ZIMMERMAN, ADMINISTRATOR
DECEDENT'S VEHICLE EXPENSES 102.00
Reserves to conclude administration of Estate, including
filing of PA Inheritance Tax Return, Inventory, First and
Final Accounting, preparation/mailing and copy charges of
necessary Fiduciary Returns $ 600.00
16,026.79
TOTAL (Aisc enter on line 9, Recapitulation) $
(if more space is needed, insed additional sheets of the same size)
Myers Funeral Home, Inc.
37 East Main Street
Mechanicsburg, Pa. 17055
Boyd L. Myers Jr., Supervisor
(717) 766-3421
A STANDARD OF EXCELLENCE SINCE 1910
Wednesday, February 19, 2003
Mr. Andrew Sheely
127 South Market Street
Mechanicsburg, Pa. 17055
Dear Mr. Sheely,
Thank you for selecting our funeral home to provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the services for:
Larry R. Zimmerman
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED $8,911.00
LESS: Credits granted 1,640.00
LESS: Total Payments 0.00
CURRENT BALANCE $7',271.00
Credits Granted: $1,640.0 Package Price Discount
Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days.
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
James P. Fickes
Funeral Director
James R. Ack. #
' RIALS Date Rec'd
"A Tribute to Life"
Found. ordered Complete __
5243 Simpson Fen~ Road, Mechanicsburg, PA 17055 · (717,) 766-5622
~ . ,~. ,~,,.. ~::~ ~>Mt',, Position verified
S, OLD TO: ~-,'"-:'~'~ ~.~,",,¥~',~-~' r~, .t~q "~""".~'~ ' Date of Order ~- fL~-.
IO ~l~rt~' L. ',t',<~v ~X.[,,,. ~;~f~ ~.<',~' rr~:" Cemetery .}.[~,'~x,,~c~,',,~..;/..~ , ~
~ ........... ~ Center Over Graves Lot ¢
Phone ~) ~c~,,., ,
b "~ ~ ~ t~'~c" (W) Approx. Date of Completion ~¢ i'~
Lettering
Type of Memorial :~ ~' ~, i Material h~' ~ "~
Size ~- 0 X~5· ,~ X ~'. -",~ 'Finish ~ .
Base ~-'~: X i" 'J; X{.)' ~' Finish t:~ ~ ~'
Misc.
Design 0 (~",', ~ C'~' ,"~
Location:
~ Vase ~ Corner Posts
Ag~,.m..~: A ~0% d~,o~i~ *~ ,,q,i~.~ ,,io, ~ oo~m.,o.m.,~ ~ ,o~k. P rice $
by cuslomer unless agreed by bolh petites. The adicle herein mentioned shall remain the properly o~ ~mes R. 61ngrlch ~emorials until paid in full and
lhey rescue Ihe right to remove the same is not paid as slated.
I agree Io carefully proolread atl names and dates for accuracy and accept tull responsibility lot any errors or omissions. TH E RE WILL BE AN ADDITIONAL
CHARGE FOR ANY LEVERING ADDED TO TH S MEMORIAL A~ER ERECTED ON THE CEMETERY.
TOTAL
I fudher agree ~o pay the balance stated for (he work pedormed under Ibis conlract within thi~y (30) days of receipl of the final invoice and ~udher agree
that interest shall accrue at the rate of one and one-hall percenl (1 ~%) per month on Ihe unpaid balance owed to James R. Gingrich Memorials nol paid D E POS IT $ -~"
wilhin Ihi~y (30) days of Ihe invoice dale. In addition Iherelo, I agree if it becomes necessary for James R Gingrich 1o institute legal proceeding to collect
any ~nds due lrom me lot my account being past due thidy (30) days, 1o pay afl coud costs and altomeys lees incurred by James R Gingrich Memorials Balance Due
~ .,~ ~ ,~ ~ .... ~, Upon Completion $
Dealer *% (?~'* '~[~ ~,)~-~ ...... ~" ' , ustomer k:" / ,- :* '-., :,'- . ·
(I fudher agree that the above names, spelling, and dates are correct)
Salesman Type of Sale Date Entered
WHITE/Office YELLOW/Production PtNWCustomer GOLDENROD/Branch ; ;/
In Agreement With: ....~....~./.~.~.... ..'~....~.....~...~ .........
Street ...../.~ ..... ...~..: ...... ~2:.~...~ ...................................................
Ci~
For Cemete~ Lot No.~(~.C..~'.~... Section ...... ~ ...... Graves ..... .~ ........
I agree to pay lhe sum of $ ............... ~. ................. in the manner specified
hereinafter:
Cash in 30 days $ ....................
The said Cemetery Lot with title thereto and right of possession thereof,
shall remain the property of' the Mechanicsburg Cemetery until paid for in
full. In default of any payment hereunder, I license the Mechanicsburg
Cemetery to repossess without guilt or other wrong, and authorize and em-
power the Mechanicsburg Cemetery in my name and on my behalf, to repossess
same, without being answerable to me for it or for any proceeds therefrom.
Signed:
(Purchaser) ............................................................
Mechanicsburg Cemetery Assn.
CLASSIFIED
ADVERTISING BILLING DATE
INVOICE
.uesdons regarding this invoice call (717) 255-8338 To Piece your ad Call Ciassillad (717) 255-8121
Tearsheel Request call ('717) 25584]7
iNVOiCE NO. CLASS START DATE STOP DATE TIMES SIZE AD AMOUNT
BOX CHARGE
~ P 0 I~ 6J)( ~? ~) A~ENTION GE~ER
DEBIT MEMO
CREDIT MEMO
DISCOUNTS
ADVANCE PAYMENT
ACCOUNT NO. ACCOUNT NAME
PLEASE DETACH AND RETURN'WITH I~AYMENT
~ ~:l:r[i3d;- .~£~:[~ O.~r. WE ACCEPT CHECK; MONEY ORDER VISA MASTERCARD, AMERICAN EXPRESS AND DISCOVE
ACCOUNTiNG'DEpARTMENT _ ACCOUNT NAME
HARRISBURG, PA 17106-0367 ACCOUNT NUMBER EXP. DA'
FED. ID':23'13O4402 ~ ACCOUNTNO 1&'~77050AND AMOUNTPAID
CUMBERLAND LAW JOURNAL
2 LIBERTY AVENUE
CARLISLE, PA 17013
March 7, 2003
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Andrew C. Sheely, ESQUIRE
RE:
Larry R. Zimmerman, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
FEBRUARY 21, 28, MARCH 7, 2003
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment Received $ 75.00
Total Amount Due $ 0.00
Payment received MARCH 4, 2003
by Becky H. Morgenthal/Executive Director
RECEIPT FOR PAYMENT
Cumberland County - Reqister Of Wills Receipt Date 2/06/2003
Hanover and Hiqh Street Receipt Time 11:53:51
Carlisle, PA 17013 Receipt No. 1031876
ZIMMERMAN LARRY R
File Number 2003-00109
Remarks ANDREW SHEELY ESQ
JA
........................ Distribution Of Receipt ........................
Transaction Description Payment Amount Payee Name
PETITION FOR PROBA 60.00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION HEIRS 20.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 15.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D
Check# 3393 ~105.00
Total Received ......... 105 00
REV-1512 EX.- (6-98) I
,,~ SCHEDULE I
I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAXRETUR. MORTGAGE LIABILITIES, & LIENS
RES' DENT DECEDENT
ESTATE OF FILE NUMBER
LARRY R. ZIMMERMAN 21-03-0109
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t Ritter's TrueValue - final bill $ 49.81
2. AmeriCredit $ 11,802.21
3. UGI - final bill $ 498.41
4. Postmaster - Certified Mail, AmeriCredit $ 4.42
5. Consolidated Collection Services, Inc. - United Water, final bill $ 51.41
6. Powell, Rogers & Speaks - PP&L, final bill $ 247.04
7. Verizon - final bill $ 85.98
8. Sears, Roebuck & Co. - final bill $ 536.43
9. AT&T Wireless - final bill $ 186.07
10. HealthSouth - final bill $ 491.66
11. National Revenue Corporation - Lloyd Silber Orthopedics, final bill $ 114.89
12. West Shore Emergency Medical Services $ 855.59
13. Family/Internal Medicine Associates $ 215.00
14. Edward Batista, PhD. $ 10.00
15. PSECU Loan $ 4,859.10
16. Beneficial - Acct. #711714-00-539063 $ 4,266.12
17. Factory Finance Co. - Acct. #6798000 $ 348.47
18. American Collection Consnltants - Alamo Rental-Acct.62298 $ 141.29
$24,763.-90
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
..,,~,,~,,~v..~ v,., State t
25 W Main Street men
Mechanicsburg, PA 17055
of Account
LARRY R. ZIMMERMAN STATEMENT DATE
116 S FREDERICK STREET 02/28/03
MECHANICSBURG PA 17055
ACCOUNT NO.
FinChg Prior Finance Charges 6.00 0.00 6.00 6.00
Bal/Fwd Balance Forward 42.81 0.00 42.81 48.81
FinChg Current, 1.5% / Month 1.00 0.00 1.00 49.81
CALL US NOW TO SAVE YOUR CREDIT RATING!
0.00 0.00 0.00 0.00 42.81 TOTAL 49.81
[;u~ar Ous(omer:
'T '~e cu~ent balance on your a~ount wlth Amer~C~d t F'. nancial Se~ ces, Inc, as of the date sho~
:;H:,ove Is $ t~{~,.~¢~ . Your r,e)~ payment is due on, or he, re,
..... ~~. TPe pa~"am3unt s ~ [X.~~~, whlab is good
II".'ough D. ~3. This ~mount i~ sul:)jec~ to chan~ ~ additiom~l paymen~ am made or it the
p{~yoff is r~ed after the Goo ~ THROUGH date.
8'muld you have any qu~tio ~s rega~3ing ~is ;aoco'jni, please, conl~ Arner~redit et tine number
sl',own below.
12125 HerbertWayne Court, Suite 100
Hun[ersvllle, NC 28078
1-800-325-3930
Past Bill Information - UGI Utility ~:' i~:?:~F.:'~:~:'"'i~ii ........ ~ :~'"~ ~
The account balance on your lastbill was $ 493.84 i!~.~ ..~
0,00 ~ 219725870541
Payments ............................................................................ -128.61
~ ~ ~ ~ ~ ~ ~: ~ Adjustments ...................................................................... 4.57
,,,.,
LARR~ZIMMERMAN EST Your
116 S FREDERICK ST
MECHANICSBURG PA 17055
Rate Classification:
Residential Heating Current Bill Information - UGI Utility
Customer Charge .............................................................. 6.27
Billing Period: Commodity Charge ( 130 CCF at $0.60292) ............ 78.38
01/07/2003 to 01/29/2003 (22 days) Distribution Charges ........................................................ 44.17
Final Read PA State Tax Surcharge .................................................. -0.21
To _ , ,, ... · $ 498.41
Que~ions? tal Current Chames - UGI Utility ........................
Call 1-800-276-2722 or write to UGI at UGI UtiliW charges owed thru bill
PO BOX 13009 ~o~1 Amount Bue~ Please Pay by Bue Bate (03/24/2003) ..................................... $ 498.41
Reading, PA 19612-3009
· Your current UGI charges include
State taxes totaling $ 4.14.
CPT 219 725 8705 41 1
Meter Reading Information
7.401_ Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used
6.66_ 1235960 7012 (estimated) 7142 (final) ~ 30
5.92 Messages from UGI
5.18 · Your current price to compare is $ 0.60293/CCF.
4.44
3.70 · Your total annual usage is 1,018 CCF. Your average monthly usage is 84 CCF.
2.96 · Please pay your bills promptly or your credit history may be affected.
2.22
1.48 · Help prevent pipeline damage, accidents and service disruptions. If you see someone
0.74 digging near your home please call UGI.
0.00
FMAMJ JASONDJ F
2002 Months 2003
· = Estimated Usage
Last This
Average Year Year
CCF/day 5.91
Daily temperature 23OF If you pay at a payment agent please take your entire bill. Make check payable to UGI.
Keep this part for your records. Important information is on the back of this bill.
Please pay by the due date
~ UGI Utilities, inc. to avoid the late charge.
~i~lr. gl~ Post Office Box 13009 Please return this portion
Reading, PA 19612-3009 with your paymenL
CPT 219 725 8705 41 1 RH
l ~ March 24, 2003
,,, I,,,111,,,111,,,,I,1,,I,1,,11,,,,11,11,,,I,,,I,,,11,11,,I,1,,I
m~m~m~AUTOmm $-DTGIT 170 $498.41
LARRY ZINMERMAN EST
270
219725870541032402000498410006170000000000000000000004
** FINAL BILL
........... BILLING SUMMARY ......
PRIOR BILL AMOUNT
PAYMENTS THRU 02/20/05 ~0.00
BALANCE FORWARD ~48.29
REGISTER ANY QUESTIONS OR CURRENT BILL CHARGES:
COMPLAINTS ABOUT THIS BILL
PRIOR TO THE DUE DATE TO:
UNITED WATER PENNSYLVANIA SERVICE CHARGE $$.03
$0.15
4211E PARK CIRCLE DSIC SURCHG $$.18
PO BOX 4151
HARRISBURG, PA 17111-0151 TOTAL CURRENT CHARGES
PHONE: 717-564-$662 $O.O~CR
TOLL FREE: 1-888-299-8972 STAS SURCHG
METER READINGS TOTAL AMOUNT DUE $51.41
02/04/03 0264
02/18/03 0264
CONSUMPTION 0 MGL
$0.14
APPROXIMATE STATE TAX INCLUDED IN THIS BILL ,,,~:,.,..~,me
02/20/03 116 S FREDERICK ST 00200999566497 51.41
0020099956649700000005141000000004
02/20/0-3 0.3/12/2003
--- UNITED WATER PENNSYLVANIA51.
PO BOX 371.385
PITTSBURGH~ PA 15250-7~85
i,,,llh,,llh,,,I,l,,I,l,,Ih,,,ll,ll,,,h,,I,,'ll'll"l'h'l
116 S FREDERICK ST
MECHANICSBURG PA
116 S FREDERICK ST 00200999566497 51.41
POWELL, ROGERS & SPEAKS, INC.
P.O. Box 61 '107
Harrisbur9, Pennsylvania '17'106-1 '107
(7'17) 896-2850
NATIONWIDe:
(800) 762-4697
Aprll 24, 2003
G60576-017 147398 33375
I.,,lll,,,llh..hl,,I,l,,Ih,,,ll,,I,,ll,,I,,,,ll,ll,.I,,ll
Larry R Zimmerman-Estate CASE #: G60576
16 S High St
Mechanicsburg PA 17055-6348
Creditor Account # Regarding Amt Owed
Ppl Electric Utilities 8560125008 116 S Frederick S 247.04
Total Due: $247.04
Dear Larry R Zimmerman-Estate:
Please be advised that the above claim has been referred to this office for
collection in full. The delinquent balance appearing above is listed against you,
and our client states is just and due.
This notice to you is our formal demand that you pay this office the account
in full.
A pre-addressed envelope is provided for your return check or money order.
Please include your CASE #G60576 on your payment.
Pursuant to 15 U.S.C. sec: 1692g, unless within 30 days after receipt of this
letter you dispute the validity of the debt, or any portion thereof, this office
will assume this debt is valid. If you notify this office in writing within the 30
day period that the debt, or any portion thereof, is disputed, this office will
obtain verification of the debt, or if applicable, a copy of a judgment against you
and mail you a copy of such verification or judgment. Upon your written request
within the 30 day period, this office will provide you with the name and address of
the original creditor, if different from the current creditor.
Sincerely,
Powell, Rogers & Speaks
This is an attempt to collect a debt by a debt collector and any information
obtained will be used for that purpose.
~I)I~RSPI()I 7
Office Hours: Monday - Thursday 8:00 AM - 9:00 PM · Friday 8:00 AM - 5:00 PM · Saturday 9:00 AM - 12:00 PM Eastern Time
01105--6
N
V~ 3194.T.1016613(,16~)011.ERa eSI CollecUon ~r~lces,
200 ~ ~EC~I~DR ~RD FL PO BOX 933 ~ ~77~84-774~
BRO~ELD WI
CRED~OR:
I ffil llffi lml[ lllllHll llllIHmU lllmllllllmlilflllUl[l R[zo
ACCOUNT~:
101~13
I,,,111.,111,,,,1,1.1,1.11,,,,11,11,,,I.,I.,11,11,,1,1,,I D*TE:
~Y ZlMME~ NO~MBE~ 15~ 2002
116 8 FREDERICK ST AMOUNT:
MECH~ICSBURG PA 1705~307 $85.98
INTEREST:
$o.oo
TOTAL DUE:
res.ce
Notice Date: Client Ref No:
11115/02 7176915784523
TOTAL AMOUNT DUE: $85.98
verl?Oll Amount
Enclosed[ r
vPole.ase m_eke you.r check pey.ab~ to
nzon c;ommunlcetlons in(] wr~o
your account number on check.
LARRY ZIMMERMAN
118 S FREDERICK ST I,,,lll,,I,II,,,ll,,,,,I,II,,I,II,,,ll,,,,,I,II,l,,I
MECHANICSBURG PA 17055-630?
VERIZON
PO BOX 28002
LEHIGH VALLEY PA 18002-8002
11771706915784523002h00002000001000000859850000008
JAMES A. BALOGH - MN ARIZONA OFFICE:
CARvW. BECKE -DC, MN, BALOGH BECKER, LTD. 7702 EAsT DOUBLEFREE
*CREDITOR'S RIGHTS SPECIALIST RANCH ROAD
AMERICAN BOARD OF CERTIFICATION ATTORNEYS ATLAW SU,TE 300
.............................................. SCOTTSDALE, AZ 85258
CHELSEA A. JAGUSCH - MN, WI SEND ALL WRITTEN REPLIES TO: DIANA THEOS - AZ, CO
ANGELA M. HORN- MN
MICHAEL D. JOHNSON - MN 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 OF COUNSEL:
CYRENTHIA D. JORDAN - MN MINNEAPOLIS, MINNESOTA 55422-4804
MARY ELLEN WEEMAN - MN, MO LITOW LAW OFFICES, P.C.
THERSIA O. LEE- MN TELEPHONE 763-852-8449 (IOWA)
CHADJ. BOLINSKE - MN FAX 763-852-8499 LUSTIG, C~LASER & WILSON, P.C.
APRIL M. LII~LE- MN TOLL-FREE 877-76.8-4494 (MASSACHUSETTS)
EVE C. ZAI~ORA- MN
April 18, 2003
Re: Our Client: Sears Roebuck And Co.
Account No: 0362225074032
Unpaid Balance Due: $536.43
Balogh Becket Account No.' 486163
Dear Sir or Madam:
Our law firm represents Sears Roebuck And Co. whenever an account holder has passed away. Please accept
condolences from our Client and our firm for your loss.
As indicated above, there is an unpaid balance on this account. Sears Roebuck And Co. has asked us to explore
resolving this matter and we are asking for your assistance. You, of course, are not personally liable for the balance.
However, if you have information about the estate, please contact us toll free at 1-877-768-4494.
Again, we are sincerely sorry for your loss.
(~ordially,
8alogh Becker Ltd.
Attorneys at Law
IMPORTANT NOTICE
Unless you notify this office within thirty (30) days after receiving this notice that you dispute the validity of the debt,
or any portion thereof, this office will assume the debt is valid. If you notify this office in writing within thirty days from
receiving this notice, this office will obtain verification of the debt or a copy of a judgment against you, and a copy
of such verification or judgment will be mailed to you by this office. Upon your written request within the thirty-day
period, this office will provide you with the name and address of the original creditor, if different from the current
creditor. This is an attempt to collect a debt and any information obtained wiJl be used for that purpose. This
communication is from a debt collector. ~)b,,n~.~j ~-/[ ~/~--~
:~.',:~ .:,'~ ',-' /~;f';~ ,,>'c'....:.,. ,,-,. ~
.~/ ~ /,~..,~..? '"':' ,,."~. ,/ ~ , .,. ,_..
!~>;i ESTATE OF LARRY R ZIMMERMAN
~i,'~'~''~'~ RONALD L ZAIDAMMERMAN ADMINISTRATOR
i ~ J LYNN ADMINISTRATRIX 5 1 2
127 S MARKET STREET ~"
MECHANICSBURG, PA 17055 ...~ ,'~ ,'2 '-'l.._.(/~(~-,,J'. ~ q"~,'/' r'~--,
-Pa~' to t.he ,7~'7- 'J- / ~.L. fl ,... ,( _.~),. ,p
Oraer or. ) ' ":¢ ,,.=, c- c.
J~J:/) (:: 7,/ lC':.:: -Dollars
e~,~ CITIZENS BANK
Pennsylvania /~-)G_/¢ .~ ~.'.~7,.~ g '7'
,"OOO 5 i, ~," ':O :~ BO ? E, ], 50~: r-, 80 t, :,O L, F=,'S l,,' ,'"OOOOO ;I,P, BO ?,,'
: ., .. :,. _.f.:..~.~&~,.:. ~,4~ ~, i,', ~: ,~ ~" ,:,,'.i.,,, ~', ":~3' ;~-; (~'~;~-!Y~'~;:'~"~ ' ;::;t~?:'~: ~¢'d,:~,~.'.*'h'~ , '~ :' :.,':~,-". ~> ~'.'r.,'~%?, ~ ....... -: ,~ . ,~,
Dear Larry Zimmerman: '/~-f/~' y~ -~'7:g7~C"35/
/ ?:5.
In an effort to assist you ~n resolving your account, we
have been authorized by our client to present you w~th a
offer to satisfy your account at a substantial sav~ngs.
This means ~nstead of paySng the full balance due on your
account, you can pay 65 ~ of the total amount due
and the above mentioned client will consi, der th~s accoun~
settled.
This is a grea~ opportunity to fSnally take care of this
long overdue account. If you w~sh to take advantage of th~s
offer, contact our off&ce at (604) 633-1~59 or ma~l your
rem&trance, &n th~_~_~,of a cashier's check or money order,
~n the amount of~186.077 If the settlement amount '
is not received ~'h'~n'""~ourteen (14) days of the date of
th~s letter th~s offer u&ll become nuIl and vo&d. Please
note that th~s letter does not reduce your ~&ghrs as stated
on the reverse side of this letter.
GC Se~&ces does not report any ~nformat&on to any
bureaus or agencies.
~e are being as fIex&ble as possible with you so call us
today and let us help you resolve this overdue account.
However, 5f you d~spute th~s account or any port~on thereof,
please refer to the reverse s2de of this letter for an
explanation of your rSghts. For proper credSt to your
account, please return t~&s not&ce ~t~ payment.
IHPORTA~T: This offer only pertains to b~e above mentioned
account of t~e above named client for the above l~sted
balance. ¢. ~&lliams
BSL-ATT~ Account Representative
Rehabilitation of i'.4echanics~Jrg
DATE A~oril 14, 2003
Street '116:3 ¢:rederick Street ir we dO nor h~r
within 10 daya, thi! account
Cily, State bter. l~anicsbur(,h PA 1705f
__ could be turned ov!~. I0 our
coll~tio~ egenc~y.
PATIENT NAM E L.n, RRY R ZlfvlI~EF:MAN
PATIENT ACO'F. ¢.~ 855539
DATES Ol~ St:;l:~',/CE ~¢17/02.1 '1/Z',',/02
PREVIOUS BAL 22', 13
PAYMENT RECEIVED 0.00
CURRENT AMT DUE
ACCT, BALANCE DUE 22'1.13
The balance s,~ o',n above iS now your r~sponsi:dlit't (se~ reason checked I~low), and i~ due and
payable within 15 days of the date of thi~ notice
Thank you for ?our prompt ~=Jttentk]n,
[] II%%~ranoe Denial
[] In.,;.urance Terminab:'~d
[2 Coordination of Benefits not retJmed
t,3 Insurance Company
r-1 C o-P ay/D cd,.~..~tible
~ O'I-HER: MEDICAL SIJPPLIE3
Patient Account!~ Represen :ative E'ic~ .--~'/~47. '/.
For your conv~r'ience, we now ac:copt VISA, M~[S'FERCARD, AMERICAN EXPRESS and DISCOVER
CARDS Youl bill is payable at our Rehab Hospit8.1, Spemal Sea:roes, or ~ ny cfi our Outpatient
175 Lancaster Blvd..,, Me¢:haniCsbUf[l. PA 17055 - 717 691.3700 - Fax 717 697-5879
HEAL Ti-iSOU' ':t
RehabilitatPn of Mechani=sbur!; ....
DATE t2-Nov-02
Name L.&RRY R. 71MMERMAN 3RD REQUEST
Street 116 S, FREDERICK S'[ REET DUE! NOW
City, State ~/IECHANICSBURG, P~,. 17055
PATIENT ACCT, # 663:!04
DATES OF SiL:RVICE 7/17 -9/3/)2
PREVIOUS BAL 27'0.53 -
PAYMENT.~ P,L:CEIVEr)
CURRENT AMI' DUE
ACCT. BALJq,JCE DUE 270.53
The balance ,,;hewn abow is now yo~. r respo'~s~bilit7 ~see re, asc,n checb,d below), and is due and
payable within 15 days of the d..:lte of [his noti::e.
Thank you for your prompt at[e-~tion
C Insurance Denial
[-' Insurance "'ermir ~ted
F Coordinaticn of B~.,nefits not returned
IZ to)Insuranc~ Cornpany
1": Co-Pay/D,~.ductib a Du,!
J[.. OTHER: HBDIC..&~L
Patient Account Represe qtative CAROl. YN RL=GAN
PHONE .~.}:1_..7.}...790'86Z5' .............
For your convenience, we now accept VISA, IvlASTE;:~¢;ARD, AMERIC/.N EXPRESS and DISCOVEF
CA~D.5. Vol J[ [)ill iS pay.~ole at oul Ruhab "tL:spilal, Spe~i~¢ 5er¥ices, or any o!: o~r Outpatient ~ites.
· l'r!~ I_.ancaster Eflvd. -. Mechanicsb,jri~, PA 1T055 - 717 091.3700 - Fax 717 097-652,1
BiI,LI.N(J .DE'. AI:'JI ME. fl'
PO BOX 670I 5
HARI;[ISBI/R(I, ]!'A. 17'1.06
['-800u360-.299g 717-5:[0~7624 X3'.31.4
FAJi 717-541-2654
~)F ?^GUS O.NCL'trDm, 3 COV~) .~
FROM: J~z,,),. ~ ,,A RIVERA
II-liS '.I:RANSMI'I-I?AL IS I(ECEIAfBD I[~;)ORbY r,.)~. I. t4COJY~?.: .El-ELY, FL,'~>t,SE CA.;~.
'P[.,~A.~ NOTE: ~[,~; ME,q: ;AOE Lg IN'TEND.liD OlsI.,T FOR. TI:~, U8~5; (DF ~B .4-'E, INDB.qiY,?2. OR.
ENITFY TO WHICH ]'I' WA..'i ADDF05S$~D AC, ID M~.'Y C(')NTAI/q I~I,tl*O1R.N[/ql] ON "Dt,%,T [.S
'F~?,IVll'.P..GED, COI~}[I'j~JN~i ~ A4~I'I)' E>:I3MFI' FR.CIM :TL.qCLOSU]~! IJNT"I-2R. APPLI(L~k]3: ,E LAW,
YOU }-i<VE RECEi'Vb_I') ['IRIS COMMU]qlO~.TIC/S[
[IV~ltSI).I A',Ftz~¥ l:'.--TI'I trr ~: ACSIIvlll~, £)!~. TE£,h'I>iq £)N E. TI-1A>~K YOU.
PLEASE HELP
FINAL NOTICE
Your insurance company has
not paid. Please call and If we do not hear from you
encourage them to pay today, within 10 days, this
It is your responsibility to see account will be turned over
that they pay on time. to our collection agenoy.
~- .......... -~ L ......
INVOICE WEST SHORE
PATIENT NA~K: ~ "~'~'"'"'
CALL NUMBER:
INSURANCE: r~ i r ~:'~[; [ c ': ':k ::Rc'c ..........
~* ...... - ~'=, DATE OF CALL:
r"-~PFr~ ~ ~ C:~OSS ?~;i
............... ~'~'~ ........ : TIME OF CALL:
CALLER:
~ ~ ~ FROM:_
A-f'ii'~ Al TOFt~4EY A r~O~-~E't;t: S;*~EELY FOR ,~ .......... .......
,~ ...... ~ .~ ~-.~,Ur~,~ P~ '~70~ TRANSPORT
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
gF'! ""'v'~ :'i~0~ "-0TM
~,~,. .... ~ i .O 4.22
' fi,.3-i-T TU Eli id (~; &'[J3~4 '{ .0 7.5~;
..... t'-.~,:, ~_'~_-,~. ~n (i4-24) .,~ O?~. ,~O ~-'~ ~:' -' 4 75
~3 _U C:OSE BL'OC. D A. 0394 i Q 5.54
E!.--:(~ ~i ~C"i"~?Z:,DE8 .~:.039~; i 0 4.02 4.r02
G ;, U Z E PA Z:*c:O .A c'd 3 8 2 i ~3 1.? 9 i.7
ii'.aFEC:TiC:,iq c"?",i'.imN,~, c-~ ~c,u, ~.
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
PLEASE PAY THIS AMOUNT --~
Continued on Next Page
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
PATIENT NAME: 7iM['dC-RMA['-..i ~e-,' ~ ,- i .,.. :,.~,,~ CALL NUMBER --' -~ ......... - AMOUNT $
PATIENT NUMBER: 4900 BILLING DATE: fio..i, ce ~c,.:, ENCLOSED
VISA
rio F'A'¥'it;iFii¥ H~F_; ~EEN F;ECEiVi::D ON 'i'~iiS r.:- :., ,:~ *
.. ,_*L:~n~,. PLEASE CONTAC-F AND
[~ASTEFI CARD
ACCEPTED
FAMILY/INTERNAL FiEDICINE ASSOC., p. C. STATEFiENT
6 MARKET PLAZA WAY
~ECHANICSBURG, PA 17055 Patient: ZI~VlERMAN, LARRY
Tel: 71 7/766-0228 Tax I.D. 232488934
ZI~RMAN, LARRY R STATEFiENT DATE PAGE
11 6 S FREDERICK ST 01/03/03 1
MECHANI CSBURG , PA 1 7055 ACCOUNT NUFIBER
1001143 - 1 / BS
INDICATE
AMOUNT PAID $. ~/~ 0 0
Place Codes: IH=In Patient OH=Out Patient ER=Emergency Room
AMOUNT
07/12/02 ..... I_ I Balance forward last statement
I? 1199213 INTE mDI TE VISIT 50.00
55. O0
08/27/02 ~u. uu [0 [] 99213 INTERIV!EDIATE VISIT 55. O0
09/16/02 719.46 ~ l199213 INTERIVlEDIATE VISIT 55. O0
ESTATE OF LARRY R ZIMMERMAN
RONALD L ZIMMERMAN ADMINISTRATOR 518
ADA J LYNN ADMINISTRATRIX
127 S MARKET STREET
MECHANICSBURG, PA 17055 3-76t5/360
29!
Paytothe /..~.~/.-;.--/i/l /~/'~(/~C/ /)/t~;//~/:/O(~...' /~j.~d::~,}/--~.. I$
Order of . . - "
~ CITIZENS BANK
,'0005 I, t5,' i:o%r=o?r= ~,5o~: r= ;~OL,~,OL, r=5 ~
CURRENT AMOUNT PAST DUE AMOUNT PLEASE PAY
$ O. O0 $ 215. O0 THIS AMOUNT $ 215. O0
BALANCE DUE UPON RECEIPT OF STATEIKENT.
PLEASE REMIT PAY~IENT.
THANK YOU. ~
EDWARD BATISTA, PHD
LICENSED PSYCHOLOGIST
3812 MARKET STREET
CAMP HILL, PA 17011-4327
(717) 737-7332
Bill To:
LARRY ZIMMERMAN
116 S FREDERICK ST
MECHANICSBURG, PA 17055 Bill For:
LARRY ZIMMERMAN
Bill as of: Feb 1,2003
Date Transaction Check No. Session Charge Total Amounts Total Owed
Previous Balance $0.00 $0.00
01/07/2003 Individual Psychotherapy $90.00 $90.00 $10.00
01/31/2003 Payment- UBH CLAIMS 428929 ($60.00) $0.00
01/31/2003 Adjustment- UBH CLAIMS ($20.00) $0.00
$90.00 $10.00 $10.00
Please PaY this Amount:! $10.001
ESTATE OF LARRY R ZIMMERMAN
RONALD L ZIMMERMAN ADMINISTRATOR
ADA J LYNN ADMINISTRATRIX 51 9
u C N Sau.G, p^
3-761§/350 291
Date
Order of__ ,
~-~~ Dotlars
~ CITIZENS B~K
Pe~ylv~ia
.
PSEC
the financial linkm
Ill I February 07, 2003
Illlll I
Mr. Andrew Sheely, Esquire
P.O. Box 95
Mechnicsburg, Pa. 17055
RE: Larry R. Zimmennan
SS # 193363889
Dear Mr. Sheely:
Per your request Feb. 06, 2003, the following is the Date of Death Balance's for Larry
Zimmerman's account with PSECU:
Account Date of Death
Balance
Savings (SI) $0.01
Moneyhandler (S4) $.00
Personal Loan (L1) $4,859.10
If the estate has sufficient funds to payoff the above loans, please remit a check, made
payable to PSECU, in the amount of $4,859.10. If there is not sufficient funds to payoff
the loans, please provide PSECU with a letter stating this fact.
If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-
7328, then press 6, extension 3120.
Sincerely,
Bonnie Berkoski
PSECU
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: I Credit Union Place, Harrisburg, PA 17110-2990 · (717) 234-8484 · (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TDD) · (800) 472-1967 (TDD)
Web Address: www. psecu.com
II
Savings federally insured up to $100,000 by the National Credit Union Administration.
/03 ?R.[ 16:29 FAX 17177310~$5 18ENEF]CI{I.
' Me~sbu~8, ~A I7o5o
~,,,~' 193-36-3889
~IS LETTER ~S TO '~RIF~ '.~HAT T'~E PA~0FF 3N ACCOUNT 711714-00-539063
,266;12 AS O~'31/29/03(DOD), '[ ~%VE ,~ENI A LIFE INSU~C]g CLA~ .,.(
'..~2,~~,'SO T~T."WE"WI~L 3E fi~l~ TO PR)CESS RIS LIFE
~'.~%3~:.~ FURTRER QIIESTIONS, F~A:~B CONTACT T~E (,FFICE AT (717)-76L--8200, ~: '**
CA.LISLE P=KE ' ' r - ' Beneficiar
Statement of Your Account
SUITE 104 ATP,~[')ITION OF CALLING.
MECHANICSBURG PA 170~0 ACOMh, tITMENT To You.
Payment ~ccoum Number New Ualance Closing uam ~'aymem uue UaTe Minimum Amounl Due
Coupon 711714-00-539063-4 6,568.65 01-28-2003 03-22-2003 199.05
00120024338
I,,,lll,,,llh,,,hl,,I,h,,hll Mai~ Payment To:
LARRY R ZZ..E..AN '"'"' "' "' '"'"'"" ' '"',''~ ",,~m,',m,,m,,",~,,h","',V',",,',,'"",',".,",,"'
1[6 S FREDERICK ST
HECHANI'CSBURG PA ].7055 BENEFICIAL
POST OFF,CE BOX 4153-K
CAROL STREAM IL 60197-4153
hll,,ll,,,,,,lll,h,h,,hh,l,,,Ihhh,,Ih,h,II
0 1000199057117140053906340006568650
FOR ASSISTANCE: ACCOUNT SUMMARY
4910 CARLISLE PIKE
SUITE 104
MECHANICSBURG PA 17050
717-761-8200
Account Number Closing Date Payment Due Dale Standard Payment Amount Past Due Minimum Amount Due
, 711714-00-539063-4 01-28-2003 03-22-2003 199.05 .00 199.05
Account Detail Since Last Statement
Inlerest and Amount Applied
Date Transaction Description Amount Other Charges To Balance *New Balance
12-28-2002 Starting Balance 6,767.70
01-15-2003 Payment 199.05 .00 199.05 6,568.65
Your payment will be electronically debited from your designated
bank account with the frequency and for the amount selected on
your EZPay Plus enrollment form. If you have any questions,
please call your local branch or customer service representative
at the number listed above.
To evaluate and maintain the quality of our service to you, you
permit us to listen to and/or record telephone calls between you
and our representative.
TO ENSURE PROPER AND PROMPT CREDIT IS APPLIED TO YOUR ACCOUNT,
ALWAYS RETURN THE TOP PORTION OF YOUR BILLING STATEMENT WITH
YOUR PAYMENT. IF YOUR NAME OR ADDRESS APPEARS INCORRECT, PLEASE
LET US KNOW. WE TAKE PRIDE IN ADDRESSING OUR CUSTOMERS PROPERLY.
Sign up today for convenience and speed! Log on to
BENEFICIAL.COM to manage your account and make payments online.
BENEFICIAL. COM - help is always in site.
* * * DELINQUENCY CHARGES ACCRUE AFTER 10 DAYS * * *
Page 1 of 1
*Your payoff' amount may (~ifter from your balance as shown on Ibis stalement. If you would like to delermine your payoff balance or if you
have questions on this billing, please call Customer Service at 717-761-8200. Address wrilten inquiries and all nonpayment correspondence
to Beneficial Customer Service. 4910 CARLISLE PIKE. SUITE 104, MECHANICSBURG PA 17050. Mail payment to: BENEFICIAL. POST
OFFICE BOX 4153-K, CAROL STREAM IL 60197.
STMT12013 (01/03)
FACTORY FINANCE CO~, !NC.
701 EAST LOCUST STREET
MECHANICSBURG, PA 17055
z~/o5/o2
LARRY R ZIMMERMAN
116 S~ WREDERICK ST
MECHANICSBURG, PA. 17055
THIS IS JUST A FRIENDLY LETTER TO LET YOU KNOW AT PRESENT YOU HAVE A
SMALL BALANCE ON YOUR ACCOUNT IN THE AMOUNT o? e 348.47. YOU MAY
AT THIS TIME CONTINUE PAYMENTS OR MAKE ONE PAYMENT IN THE AMOUNT OF
THE BALANCE T~DIC~TED ABOVE.
THIS LETTER IS AN ATTEMPT BY A DEBT COLLECTOR TO COLLECT A DEBT~
AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
SINCERELY
· ' :~'~',C: :.:, %; "' : '~'C
........ ,. ~o?k: (., . ~, . .-, ..... F'iL~e¥: OFF
. .. :~u , z.l. (~ 5G
'"Pi:ES IS g~ DZP ~:.~CC:OLJN'f
r 'O,"2L/O:Z' 46. ~c,S. 0 ,,00 0.00 0 ~ O0 34 .22 _-_*~ .33 348 .
: 08:'/2(~/02 4.6.55 0 ,, O0 0 . (>O 0 ,, O'D 40 ,, 22 G, ,. 3:2: ~:02.
; C7,'3L/02 ,¢6.._.~': 0.00 .0.00 O,O:D 4. L .4.7 .~.OS 422.
;' 7:7L 2 Pt:,'rt~S: :~lSE,, 20 0¥' ig: 12 I ni'tJa'!: 0,00
; :30: C, Othe¥'; O.DO ~u.!l: :3 Days Of: 0
:' ";:~u~ ,. !1 -- P~'.~P {:>~d¥, Recall P/"inb Fi]'~..':~r' On,/Of'f
PO Box 1536
Chula Vista, CA 91912 AN~aR/CANCOfI~C//ONCONSULTANTS
Return Service Requested 303 H ST STE 320
CHULA VISTA, CA 91910-0000
619-946-5600
May 5, 2003 AMOUNT DUE: $141.29
RE: ALAMO RENTAL CAR-INSURANC 141.29
OUR ACCOUNT #: 62298 ~
CLIENT ACCOUNT #: 59383862
LARRY ZIMMERMAN 62298 - 6
16 S HIGH ST
MECHANI CSBURG PA 17055-6348
You have already received at least one notice from our company advising you of
your indebtedness to our client.
This debt is not going to just go away.
(((( BE ADVISED ))))
The only way this account is going to go away is when it is paid in full.
If you cannot liquidate the balance of $141.29 immediately - call our office
now to discuss payment arrangements.
Sincerely,
MARIA DURAN
888-883-2580
Ext. 2063
This is an attempt to collect a debt. Any information obtained will be used
for that purpose.
Amount Due: $141.29 Acct #: 62298
Amount enclosed:
If your address has changed, please fill out the following:
Street Address:
City: State: Zip:
New home phone: New work phone:
AMERICAN COLLECTION CONSULTANTS LARRY ZIMMERMAN
PO Box 1536 16 S HIGH ST
Chula Vista, CA 91912 MECHANICSBURG PA 17055-6348
ACL6-502A300293~J X03-3 861
.~.~3~×.~.97, ~ SCHEDULE J
CO.MONVVEA'TH OF PE.NS~'VAN,A BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTAIE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outdght spousal distributions)
/~.Y~¢..~ ~'~ ~t~~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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)
~//~-//~-// CON.ON#EALTH OF PENNSYLVANIA
BUREAU OF ZNDZVZDUAL TAXES DEPARTNENT OF REVENUE
ZNHERZTANCE TAX DZVZSZON
DEPT. Z8060!
HARRISBURO, PA 17128-0601 NOTICE OF ZNHERZTANCE TAX
APPRAZSEMENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1;47EXAFP(01-05)
DATE 11-17-2003
ESTATE OF ZIMMERMAN LARRY R
DATE OF DEATH 01-29-2003
FILE NUMBER 21 05-0109
- *" _7 ~COUNTY CUMBERLAND
ANDREN C SHEELY ATTY ~ ~ '~ACN' 101
127 S MARKET ST
PO BOX 95 I Amount Remitted
MECHANZCSBURG PA 17055 , ~.
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LINE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ZIMMERMAN LARRY R FILE NO. 21 03-0109 ACN 101 DATE 11-17-2003
TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 611.3q credit to your account,
$. CloseZy Held Stock/Partnership Interest (Schedule C) ($) .00 submit the upper portion
q. Mortgages/Notes Receivable (Schedule D) (q) .00 of this form with your
$. Cesh/Bank Deposits/Misc. Personal Property (Schedule E) ($) 81603.17 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 9,21q.51
APPROVED DEDUCTIONS AND EXEMPTIONS: 16 026 79
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) ' '
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 2q,763.09
11. Total Deductions (11)
12. Net Value of Tax Return (12) 31,575.37-
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
lq. Net Value of Estate Subject to Tax (lq) 31,575.37-
NOTE: Z~ an assessment .as issued previously, 1/nas 1~, 15 and/er 16, 17, 18 and 19
reflect figures that include the tote! of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rata (16) .00 X 00 = .00
16. Amount of Line lq taxable at Lineal~Class A rate (16) .00 X Oq5 = .00
17. Amount of Line lq at Sibling rata (17) .00 X 12 = .00
18. Aeount of Line lq taxable at Collateral/Class B rata (18) .00 X 15 = .00
19, Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT I .00 I
BALANCE OF TAX DUE . 00
INTEREST AND PEN. .00
TOTAL DUE . O0
ZF pATD AFTER DATE ZNDZCATED~ SEE REVERSE ( TF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REI~UZRED.
FOR CALCULATION OF ADDZTZONAL ZNTEREST. TF TOTAL DUE 1'S REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THTS FORM FOR TNSTRUCTZONS.)
RESERVATION: Estates of decedents dying on or before December 1Z, 19BI -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collataral} beneficiaries of the decedent after the expiration of any estate for
life or for years, tho Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To ~ulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (TZ P.S.
Section 9140).
PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF N/LES, AGENT
REFUND (CR): A refund of a tax credit, #hich was not requested off the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at tho Office
of tho Register of Hills, any of the Z3 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-eOO-36Z-ZOSO; services for taxpayers ~ith special hearing and / or
speaking needs: 1-BOO-447-30ZO (TT only).
OBJECTIONS: Any party in interest not satisfied ~ith the appraisement, allowance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. zeloz1, Harrisburg, PA 17lie-lOll, OR
--election to have the matter determined at audit of the account of tho personal representative, OR
--appeal to tho Orphans' Court.
ADHIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due Is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is allowed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of tho tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from tho date of
death, to the date of paywent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (SI) percent per annum calculated et a daily rate of .00016~. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by tho PA Department of Revenue. The applicable interest rates for 198Z through ZOO3 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .000S48 1987 9Z .000Z47 1999 7Z .OOOlgZ
1983 16Z .000~38 1988-1991 Ill .000301 ZOOO 8Z .OOOZX9
1984 llZ .000301 199Z 9Z .000247 2001 9Z .O00Z~7
1985 Z3Z .000356 1993-1994 7Z .00019Z ZOOZ 6Z .000164
1986 ZOZ .O00ZT~ 1995-1998 9Z .000247 2003 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DEL/NQUENT X DAILY iNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond tho date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
IN THE CIRCUIT COURT IN COUNTY AND FOR PROBATE DIVISION
IN RE: LARRY R ZIMMERMAN
Our Client: Sears, Roebuck and Co.
Account No: 0362225074032
Court File No:
SATISFACTION AND RELEASE OF CLAIM
The above named Claimant has received the sum of $536.43 in settlement payment of the claim
made against the Estate. This Satisfaction and Release of Claim is executed to acknowledge
payment and discharge of claim and to release thc Estate and personal representative from all
further liability with respect thereto.
Executed this~"~ day of q\_l%~..k. ,20 ~.
By: ~ /N~
One of its attorneys:
Chelsea A. Jagusch __ Angela M. Horn
Michael D. Johnson Cyrenthia D. Jordan/
Mary Ellen Weeman Thersia O. Lee ~
Eve C. Zamora
Attorneys and Agents for Claimant
4150 Olson Memorial Highway, Suite 200
Minneapolis, Minnesota 55422-4804
877-768-4494
Su?lr~d and swo~ to me this
day of (JOt~°~ , 20
N~o't~arv~bli) '~/~
!li~k~1[~J NOTARY PUBLIC - MINNESOTA
FIRST AND FINAL ACCOUNTING AND STATEMENT OF
DISTRIBUTION FOR THE ESTATE OF LARRY R. ZIMMERMAN
LATE OF BOROUGH OF MECHANICSBURG, CUMBERLAND COUNTY
RONALD L. ZIMMERMAN CO-ADMINISTRATOR
ADA J. LYNN CO-ADMINISTRATRIX
ESTATE NO. 21-03-0109, ORPHAN'S COURT DIVISION
CUMBERLAND COUNTY, PENNSYLVANIA
Date of Death: January 29, 2003
Date of Co-Administrator Appointment: February 6, 2003
Accounting for the Period: January 29, 2003 to
May 18, 2004
Legal Advertisement:
Patriot News: February 18, 2003, February 25, 2003, March 4, 2003
Cumb. Law Journal: February 21, 2003, February 28, 2003, March 7, 2003
Purpose of Account: Ronald L. Zimmerman, Co-Administrator, and Ada J.
Lynn, Co-Administratrix, offer this first and final
accounting to acquaint beneficiaries and interested
parties with the transactions that have occurred
during the administration of the Estate of Larry R.
Zimmerman. This accounting does not address
payments made for expenses of the Estate of Larry R.
Zimmerman prior to February 6, 2003. This accounting
also indicates proposed remaining distributions from
the Estate of Larry R. Zimmerman to the beneficiaries.
It is important that the account be carefully examined. Requests
for additional information or questions or objections can be
discussed with:
Andrew C. Sheely, Esquire
127 S. Market St., P. O. Box 95
Mechanicsburg, PA 1705 $
(717) 697-7050
SUMMARY OF ACCOUNT
RECEIPTS OF PRINCIPAL & INCOME
Receipts of Principal $ 5,581.72
Receipts of Misc. Assets 2,875.41
Receipts of Income 159,611.06
Total Receipts of Principal, Misc. Assets and Income $168,068.19
DISBURSEMENTS OF PRINCIPAL AND INCOME AS OF MAY 18, 2004
Debts of Decedent $ 20,729.71
Funeral expenses 9,631.00
Administration expenses 4,502.63
Taxes 37,688.00
Total Disbursements of Principal, Misc. Assets and Income $ 72,551.34
ESTATE ACCOUNT BALANCE AS OF MAY 18, 2004 $ 95,516.85
CHECKING ACCOUNT BALANCE AS OF MAY 18, 2004 $ 95,516.85
LESS: AMOUNTS REMAINING TO BE PAID
Andrew C. Sheely, Esq. (Attorney fees)-balance due $ 2,705.00
Ronald L. Zimmerman, Advance Fees-balance due $ 600.00
Ada J. Lynn, Advance Fees-balance due $ 600.00
AMOUNTS TO BE HELD IN RESERVE $ 800.00
CASH AMOUNT AVAILABLE FOR DISTRIBUTION $ 90,81 1.85
RECEIPTS OF PRINCIPAL
1) PNC Bank- checking account #5070017708 $1,617.20
2) Sale of personal property 35(i).00
3) MetLife Stock 614.52
4) Sale of Vehicle 3,000.00
TOTAL OF RECEIPTS OF PRINCIPAL $ 5,581.72
RECEIPTS OF MISC. ASSETS
1) Decedent's 2002 Internal Revenue Service Tax Refund $ 29.00
2) MetLife Insurance Death Claim 1,764.35
3) Pennsylvania Employees Benefit Trust Fund-reimbursement 684.48
4) Capital Blue Cross-reimbursement 22.58
5) Cumberland County Clerk of Courts 140.00
6) Cumberland County Clerk of Courts 235.00
TOTAL RECEIPTS OF MISC. ASSETS $2,875.41
RECEIPTS OF INCOME
1) Final Employer Income - Commonwealth of Pennsylvania $ 2,063.88
2) Payroll Deposit - final pay period 252.61
3) State Employees Retirement Service Benefit 157,294.57
TOTAL RECEIPTS OF INCOME $159,611.06
TOTAL RECEIPTS OF PRINCIPAL, MISC. ASSETS
AND INCOME $168,068.19
3
DISBURSEMENT OF PRINCIPAL
DEBTS OF DECEDENT
1) Ritter's True Value 5/14/03 ~502 $ 49.81
2) AmeriCredit 5/14/03 //504 11,802.21
3) UGI-final bill 5/16/03 #506 498.41
4) United Water-final bill 5/19/03 #508 51.41
5) PP & L-final bill 5/19/03 #509 247.04
6) Verizon-final bill 5/19/03 #510 85.98
7) Sears Roebuck &Co. 5/19/03 #511 536.43
8) AT & T Wireless 5/28/03 #512 186.07
9)HealthSouth 5/28/03 #513 491.66
10) Reimbursement-Ronald Zimmerman-disposal fee 5/29/03 #514 102.00
11) Lloyd Silber Orthopedic 6/26/03#515 114.89
12) West Shore EMS 8/11/03 #517 855.59
13) Family/Internal Medicine 9/24/03 #518 215.00
14) Edward Batista, Ph.D 9/24/03 #519 10.00
15) PSECU-loan payoff 9/24/03 #521 4,859.10
16) Factory Finance Co.-loan payoff 9/24/03 #523 348.47
17) Alamo Car Rental - outstanding bill 9/24/03 #524 141.29
18) CAC Financial Corporation 9/24/03 #530 134.35
TOTAL DEBTS OF DECEDENT $20,729.71
FUNERAL EXPENSES
1) Myers Funeral Home 5/8/03,5/14/03 (#501 and #503) $7,271.00
2) Grave Opening 2/12/03 # 93 1,160.00
3) Gi'ngrich Memorials 5/16/03 #505 1,200.00
TOTAL FUNERAL EXPENSES OF DECEDENT $ 9,631.00
ADMINISTRATION EXPENSES
1) Cumberland County Register of Wills (Probate) 2/12/03 /? 95 $ 105.00
2) Postmaster 2/25/03 - 5/16/O3 #507 8.84
3) Register of Wills 8/7/03, 9/26/03 (#516, #528) 19.00
4) Legal Advertisement - Patriot News 3/17/03 - #97 99.79
5) Legal Advertisement - Cumberland County Law Journal 75.00
6) Boreman & Babb - Accounting Fees, Personal taxes 3/22/04, # 532 140.00
7) Attorney's Fees (Partial Payment) 9/26/03, #529 2,700.00
8) Boreman & Babb - Accounting Fees, Estate Taxes 3/22/04, #534 155.00
9) Executor's Commission-partial payments 9/26/03, #526, #527 1,200.00
TOTAL ADMINISTRATIVE EXPENSES $4,502.63
4
FEDERAL AND STATE INCOME TAXES (PERSON/ESTATE)
1) IRS-Federal 1040- Personal tax due 3/22/04 #531 $ 37,617.00
2) PA Dept. of Revenue Estate tax due 3/22/04 #533 71.00
TOTAL $ 37,688.00
TOTAL DISBURSEMENTS OF PRINCIPAL and INCOME $ 72,551.34
PROPOSED
DISTRIBUTION TO BENEFICIARIES
REMAINING ESTATE ACCOUNT
NAME OF DESCRIPTION AMOUNT OF
B ENEF IC IARY DISTRIBUTION
1)Robert H. Zimmerman 1/8 $11,351.49
122 Grissom Road
Manchester, CT 06040
2) William L. Zimmerman 1/8 $11,351.49
852 E. Louther Street
Carlisle, PA 17013
3) Leroy H. Zimmerman 1/8 $11,351.49
553 Petersburg Road
Carlisle, PA 17013
4) Ada J. Lynn 1/8 $11,351.49
16 S. High Street
Mechanicsburg, PA 17055
5) Betty L. Huey 1/8 $11,351.49
119 W. Fourth Street
Lewistown, PA 17044
6) Ronald L. Zimmerman 1/8 $11,351.49
287 Lost Hollow Road
Dillsburg, PA 17019
7) Donald Zimmerman 1/40 $ 2,270.29
4148 Nantucket Beufont Square
Mechanicsburg, PA 17055
8) Denise Patrick 1/40 $ 2,270.29
17 West Locust Street
Mechanicsburg, PA 17055
6
9) David Zimmerman 1/40 $ 2,270.29
7902 Bimini Isle Court
Tampa, Florida 33647
10) Deb Means 1/40 $ 2,270.29
20 West Locust Street
Mechanicsburg, PA 17055
11) Dee Luzier 1/40 $ 2,270.29
1004 East Coover St.
Mechanicsburg, PA 17055
12) Steve Powell 1/40 $ 2,270.29
415 Run Road
Carlisle, PA 17013
13) Dave Powell 1/40 $ 2,270.29
3614 Franklin Avenue
Mechanicsburg, PA 17055
14) Jim Powell 1/40 $ 2,270.29
24 West Coover St.
Mechanicsburg, PA 17055
15) Bob Powell 1/40 $ 2,270.29
6491 Union Deposit Rd.
Harrisburg, PA 17111
16) Sharon Smith 1/40 $ 2,270.29
23 South Spring Garden Street
Carlisle, PA 17013
7
VERIFICATION OF ACCOUNT BY ADMINISTRATORS
Ronald L. Zimmerman, Co-Administrator, and Ada J. Lynn,
Co-Administratrix, of the Estate of Larry R. Zimmerman, deceased, hereby
declare under oath that they have fully and faithfully discharged the duties of
their office; that the foregoing First and Final Account is true and correct and
fully discloses all the significant transactions occurring during the accounting
period; that all known claims against the Estate have been paid in full; that, to
their knowledge, there are no claims now outstanding against the Estate; and
that all taxes presently due from the Estate have been paid.
Date: May/?, 2004 /'j~_~.ff~ / ~
R~)nald L~Z~mmerman, C o-Adminis trator
Ada ]. Lyffn, Co'f-A~lministratrix
Andrew C. Sheely, Esquire
127 S. Market Street
P.O. Box 95
Mechanicsburg, PA 17055
PA ID NO. 62469
717-697-7050 (Phone)
717-697-7065 (Fax)
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND,
PENNSYLVANIA
ESTATE OF LARRY R. ZIMMERMAN
BOROUGN OF MECHANICSBURG, CUMBERLAND COUNTY
RONALD L. ZIMMERMAN, CO-ADMINISTRATOR
ADA J. LYNN, CO-ADMINISTRATRIX
ESTATE NO. 21-03-0109
CUMBERLAND COUNTY, PENNSYLVANIA
AFFIDAVIT OF SERVICE OF FIRST AND FINAL ACCOUNT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND :
ANDREW C. SHEELY, being duly sworn according to law, deposes
and says that he caused a true and correct copy of the First and
Final Account of the Estate of Larry R. Zimmerman, upon Ronald L.
Zimmerman, Ada J, Lynn, William L. Zimmerman, Dave Powell, Jim
Powell, Steve Powell, Bob Powell, Sharon Smith, David Zin~nerman,
Donald Zimmerman, Denise Patrick, Dee Luzier, Betty L. Huey, Leroy
H. Zimmerman, Robert H. Zimmerman and Deb Means, by Certified
Mail, Return Receipt Requested, as indicated by the attached
receipt cards, on the dates therecn indicated.
SWORN to and subscribed before me
this /5~day of June, 2004.
Notarf 'Public
My Commission Ex i~s:
I I
· Complete items 1,2, and 3. Aisc complete A. j~a,[ture '
item 4 if Restricted Delivery is desired. ~-'~ I ~ ~"~1 [ /v*. ~ ~1 ~ [] Agent
· Print your name and address on the reverse X ~.~j,K,.~,~,..,/k, [9 ~,1 { ~-~ ~' [] Addressee
so thatwecan return thecard to you. B. Received by(PdntedName) ~C. Dare, lO, very
· Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from~item 17 [] Y~s
Dee T,U ~, i e r If YES, enter delivery address bel~
1004 East Coover Street I~l j~!Y ~.
Mechanicsburg, pA 17055
3. Service Type ~,,~'~'~ ,'"~.,~. ~_~C)~- -~'~ '
J~' Certified Mail [] Express Mail~05~).~?.~
[] Registered [] Return Receipt for~ndise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3247
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
· Corn. plate items 1, 2, and 3. Aisc complete A. Signature
iterT~ 4 if Restricted Delivery is desired. X~ '"'" ''~
Agent
· Prir~ your name and address on the reverse
[] Addressee
So ~at we can return the card to you. B. Received/by (Printed Name.) ~[~C. Date .of/Deliv)ery
· Attach this card to the back of the mailpiece,
orl3n the front if space permits. _
1. Article Addressed to: D Is delivery address different from item 17 [~Ye~/
If YES, enter delivery address below: [] No
Betty L. Huey
119 West Fourth Street
Lewistown, PA 17044
3. S~rvice Type
[~'Certified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3308
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
· Complete items 1, 2, and 3. Aisc complete A. Signature __
item 4 if Restricted Delivery is desired. X ~,~;~--~'~ D[~Agent
· Print your name and address on the reverse ~-~ Addressee
~3 that we can return the card to you. Re~'ei_v~4--F~ted Name) C. Date of Delivery
· ~,ttach this card tOspacethe back of the mailpiece, B. t 5~
/~or on the front if permits. (~'E~/~ ~'~'~'" ' ~
/;" D. Is delivery address different from item 1 ? [] Yes
1. Article Addressed to: If YES, enter delivery address below: [] No
Leroy H. Zimmerman
553 Petersburg Road.
Carlisle, PA 17013
3. Service Type
~i~"Certified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
7001 2510 0000 3029 3322
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-u-2569
item 4 if Restricted Delivery is desired. V~ y ~, ~.//// _.. 9;~-Agent
· Print your name and address on the reverse ~ ' ~r~/~' ,~',,¢~,~,1/~ Address~
v r -~; J~ D~of
So that we can return the card to you. B. R~eiv~by ( d Name) Delive~
m Attach this card to the back of the mailpiece,
or on the front if space permits.
1. A~icle Addressed to: D. Is deliv~ add~ diffe~nt f~m item 17 ~ Yes
If YES, ente~delive~ address below: ~ No
David Zimmerman '~~
6 l'wombly Lane
Hadison, NJ 07940 3.
,ecei.
4. Restricted Deliver? (Ext~ F~) ~ Yes
2. A~icle Number
~ransferfromse~icelabel) 7001 2510 0000 3029 3186
P~ FO?~ ~8~ ~, Augu~ 2009 Domestic ~e~urn ~e~p~ ~o25~5-o1-~-25o~
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse [] Addressee
so that we can return the card to you. B. Received by
· Attach this card to the back of the mailpiece,
o.r on the front if space permits.
1. ~'rticle Addressed to: D. Is delivery address different from item
;o
If YES, enter delivery address
nald Zimmerman
4148 Nantucket Beufont Sq ~re
Mechanicsburg, PA 17055
3. Service Type
~ Certified Mail [] Express~
[] Registered [] Return
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3285
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
· Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse []
so that we can return the card to you. B. Received by (Printed Date of Delivery
· Attach this card to the back of the mailpiece, ~,Y 2 2 200~
o,~on the front if space permits.
1. ,~[rticle Addressed to: D. Is delivery address different [] Yes
If YES, enter delivery address below
Denise Patrick
17 Nest Locust Street
Mechanicsburg, PA 17055,
3. Service Type
~J~'Certified Mail [] Express Mail
[] Registered [] Return Receipt for Memhandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3278
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
· Complete items 1, 2, and 3. Also complete A. Si ature .
item 4 if Restricted Delivery is desired. ~u~,~, I-I Agent
· Print your name and address on the reverse X
[] Addressee
SO that we can return the card to you.
' Attach this card to the back of the mailpiece, B.R~/ame) / C. Date of Delivery
or on the front if space permits.
D. ,{~'d/elivery address diffe~eht~f~~ Yes
1. Article Addressed to: I~-~E~aeCt~lr~el~ll~ address bel~w_i__..~ No
Dave Powell
3614 Franklin Avenue
Mechanicsburg, PA 17055
3. Service Type
I~' Certified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3223
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M~2509
· Complete items 1, 2, and 3. Also complete ;ignature
:
ite~4 if Restricted Delivery is desired. ~~'[] Agent
Pr~ht your name and address on the reverse [] Addressee
S~ that we can return the card to you. Received by ( Printed Name) I C. Date of DeliverN
Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 17 [] Yes
If YES, enter delivery address below: [] No
Bob Po~ell
6491 Union Deposit Rd.
Harrisburg-, PA 17111
3. Service Type
'J~rcertified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
'" [] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3209
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
· CDmplete items 1, 2, and 3. Also complete II~t/Jd"~-/"~~m A. Signa~re -- ~ [] Agent
item 4 if Restricted Delivery is desired.
· P{int your name and address on the reverse I ' - ... , [] Addressee
s~that we can return the card to you. ~ I B. Received by (Printed Name) C. Date of Delivery
· A~tach this card to the back of the mailpiece, / I
or on the front if space permits.
~ ] D~ew addre~~ ' ~ Yes
If YES enter d~[v~dre~~"X ~ No
1. A~icle Address~ to: /I,,
Sharon Smith
23 S. Spring Garden St.
Carlisle, PA 17013
~~Se~ice Type
~Ce~ifi~ Mail ~ Express Mail
~ Registered ~ Return Receipt for Merchandise
~ Insured Mail ~ C.O.D.
Restricted Delivew? (~tra Fee) ~ Yes
2. A~icle Number
~ransferfromse~icelabel, 7001 2510 0000 3029 3193
PS Form 381 1 August 2001 ~mestic Return R~eipt lO2595-o1-M-25e~
,
· Complete items 1, 2, and 3. Aisc complete
item 4 if Restricted Delivery is desired. Agent
· Print your name and address on the reverse [] Addressee
SO that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery
· Attach this card to the baqk of the mailpiece,
or on the front if space peh~its. ·
D. Is delivery address different from item 17 [] Yes
1. Article Addressed to: If YES, enter delivery address below: [] No
Steve Pow'ell
415 Run Road ~ ~._,
Carlisle,, PA
'~ / 3. Service Type
J~ Certified Mail [] Express Mail
'" · [] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Ar1
PS F( 102595-01-M-250§
· Complete items 1 2, and 3. Aisc complete A. Signature
, Agent
item 4 if Restricted Delivery is desired. X [] Addressee
· P~int your name and address on the reverse
s~ that we can return the card to you. B. I~eceived by ( Pre,ted Name) I C. Date of Delivery
· ~tach this card to the back of the mailpiece,
-'- on the front if space permits. Jo~/b' [ 0 a~]~/--~--I SLI~
D. Is delivery address different from item 17 [J Y(~s
1. Article Addressed to: If YES, enter delivery address below: [] No
Jim Powell
24 ~est Coover Street
Mechanicsburg, PA 17055
,l~ Certified Mail [] Expr .-....__ .
[] Registered [] Return R~ ~h~se
[],nsured Mai, [] o.e.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number 7001 2510 0000 3029 3216
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-250u
· Complete items 1,2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. /~
X~ [] Agent
· Print your name and address on the reverse ' / ./~./~ ;~ ./~; ~ [] Addressee
sothat we can return the card to you. B. B~ed by ( Printed Name) lC. Date of [~eliv ry
· Attach this card to the back of the mailpiece, ~,-~3 ~ '~'~'~/c4 ~
or on the front if space permits. .~ 0 /~'~/~i~ ,~,//g/7 ~
1. Article Addressed to: ~. I~-delivery address'dif~e-re~t from item 1 ? I [] ~'es
If YES, enter delivery address below: [] No
William L. Zimmerman
852 E. Louther Street
Carlisle, PA 17013
3. Service Type
J~"Certified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transfer from service label) 7001 2510 0000 3029 3339
PS Form 3811, August 2001 Domestic I~e{urn R~::~ipt 102595-01-M-2509
- · Complete items 1, 2, and 3. Aisc complete
item 4 if Restricted Delivery is desired. [] Agent
· Print your name and address on the reverse [] Addressee
SO that we can return the card to you.
· Attach this card to the back of the mailpiece,
or on the front if space permits.
s different from item 17 [] Yes
1. Article Addressed to: If YES, enter delivery address below: [] No
Robert H. Zimmerman
122 Grissom Road
Manchester, CT 06040
3. Service Type
j~ Certified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number 7001 2510 0000 3029 3346
(Transfer from service label) ~
PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509
A. Signature
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delive~ is desired.
a Print your name and address on the reverse X
ddmssee
so that we can return the card to you. B. R~eiv~ by (Printed Name) C. Date of Delive~
· A~h this card to the back of the mailpieCe,or~ the front if space permits.
1. A~cle~ Addressed to: D. Is delive~ add~ different ~m item 17 ~ Yes
If YES~ address below: _ ~o
20 West Locust Street
Mechanicsbur~, PA 17055
~ Reg~ Return R~eipt for Memhandise
~ Insur~ Mail ~ C.O.D.
4. Restricted Deliveu? (Extra F~) ~ Yes
2. A~icle Numar
~m.sferfromse~icela~l) 7001 2510 0000 3029 3254
PS Form 381 1, August 2001 Domestic Return Receipt 102595-0~-M-2509
FIRST AND FINAL ACCOUNTING ~
OF RONALD L. Z IMMERMAN, -_ ~ ~
CO-ADMINISTRATOR, AND ~
ADA J. LYNN, CO-ADMINISTRATRIX,
OF THE ESTATE OF
LARRY R. ZIMMERMAN, LATE OF ~. 5'~
THE BOROUGH OF MECHANICSBURG ·-~
CUMBERLAND COUNTY, = ~
PENNSYLVANIA ~ ?
ESTATE NUMBER 21-03-0109
LETTERS ISSUED 02-06-2003 theCourtfor~a~d~lhel0~ds~,~oflle
ESTATE ADVERTISED snd to e~ry o~er person kr~wn
THE PATRIOT NEWS CO. have or claim an ~nte~est in the estate ~ emd~o;
2/18/03, 2/25/03, 3/4/03 ben~ar~,heiro~nex~ofkin.
CUMBERLAND COUNTY LAW JOURNAL A copy of said Statement w~s included with the rrot~ce.
2/21/03, 2/28/03, 3/7/03
ATTORNEY FOR ESTATE
~DREW C. SHEELY, ESQUI~
7 SOUTH ~ET ST~ET
P. 0. BOX 95
;ecti~s to ~ ~ '~ '" "
MECH~ISBURG, PA 17055
717 - 697 - 7050 , ~ory un~ ~ ~ ~ ~ ~)th~ per~
~nown tO ~ ~ ~ ~e n,; claim an
~, neneficiaW,
CERTIFIED BY: .merest in ~ ~ ~ -
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
SHEELY ANDREW C ESQ
PO BOX 95
MECHANICSBURG, PA 17055
RE: Estate of ZIMMERMAN LARRY R
File Number: 2003-00109
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/21/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge