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HomeMy WebLinkAbout03-0162 PETITION FOR PROBATE aug GRANT OF r. E12'iiltS F__ztate of John Kenneth Zimmerman Ne. __ ~/- ~ _/'~ ~ also known as John K. Zimmerman To: Regist~. of Wills for the Deceased. Count7 of Ctmtberland in the Socta/Security No. 174-05-1 zt{~7 Commonwealth of Pennsylvania The petition of the undersigned r~pectfully repr~nts that: Your petitioner(s), who islam: 18 years of age or older an the ~xecutor named in the last will of the above decedent, dated June 11 19 80 and codicil(s) dated (state ret-warn arcnmstanc~. ~.g. rentmvia,!on, daath of ~r. Decendent w~ domiciled at death in ~rl~fl ~o~nty, Pennsylv~ia, with h is _ l~t family or principa r=idence at 6~ 7 N. ~st St., ~1xsl~ ~roush (l~z ~r~, n~b~r ~d m~p~ty} Decendent, then 80 y~s of age, ~ ~rna~ 12, 2003 at Carlisle Reqio~] M~i~] Center. o~]~ ~ ' Except ~ follows, dec:d:nI did not ma~, w~ not ~d~ ~d ~d ,ot have a c~Id bom or adopted after execution of ~he will offer~ for probate; w~ not the ~ ora ~g ~d w~ n~ver adiudicaIed incompetent: -- ' Decendem al death owned pro~e~y ~th e~timated ~u~ ~ fo~ows: (If domiciled in Pa.) ~I u:rsonal ~roU:~Y $ 15.000,Q0 (If not domiciled in Pa.) P:rsonal prope~y ia P~nsylv~a $ (If not domiciled in Pa.) Person~ prop:~y in Co~ty V~ue of real estate in P:nnsylv~a $ 125,0Q0.00 situated ~ follows: 617 Nor~ East S~eet, ~r]i~]~ ~rou~h, ~rl~d ~tyt PA WHEREFORE, petifioner[s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentar_v theron. , (testamentary;, administration c..t.a.; administration d.b.n.c.~.a.) -? sth .~ New OJ. ml~.r,J,.~d~ pg. '17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTI-/OF PENNSYLVANIA 3. COUNTY OF ct~~,~n £ The Petitioner(s) at)ove~aamed .'.wear(s) or affirm(s) that the statements in thc foregoing petition are true and correc: to the best of tl~e knowledge and belief of Petitioner(s) and that as personal represen- tativels) of ~he above decefient phil:loner(s) will well and truly admirfister the~tatc according to law. IN RE ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN K ZIMMERMAN ORPHANS' COURT DNISION C) r':o - _,:n . -~.; () DECEASED NO. TERM .:21 -02>-ILoJ- iT1 --=-_'J PETITION FOR CITATION ~..., ',--/ -0 . , --,- TO THE HONORABLE THE JUDGES OF SAID COURT: ::~] w _-:) --i AND NOW, this 2A. <r- -..l , ~~~ t day of ~o...~"-"" comes the Commonwealth of Pennsylvania, by Robert Freedenberg, Esquire, Deputy Secretary for Taxation, for Thomas W. Wolf, Acting Secretary of Revenue, who avers: 1. That John K. Zimmerman, deceased, (hereinafter referred to as "the Decedent") died on February 12, 2004. 2. That the Decedent left personal property in the form of a bank account in the names of the Decedent and Transferee, (hereinafter referred to as "the Transferee. ") Said account was established on January 1,2003, and valued as of the date of the Decedent's death at $37,431.87. 3. That the Pennsylvania Department of Revenue did cause to have entered an appraisement of said bank account and an "Official Notice of Inheritance Tax Appraisement and Assessment of Assets Not Subject to Administration," was mailed to the Transferee on February 7,2005. Attached hereto and made a part hereof is a copy of said Notice of Appraisement and Assessment marked Exhibit "A." v ~-, c-:;:.)- .:,.:;;;::) --.I :::.~ :":~\" :;"'0 r'V N .r.:- 4. That Inheritance Tax due in the estate of the Decedent is $5,614.78, plus interest at the applicable statutory rates from November 13,2003 until the date of payment. 5. That the Transferee is liable for the payment of Inheritance Tax due. 6. That on September 26, 2006, a certified demand letter was sent to the Transferee outlining the nature and amount of tax due and the consequences if not paid. A receipt for said letter was signed and returned to the Department of Revenue. Attached hereto and made a part hereof is a copy of said letter and receipt marked Exhibit "B." 7. That under Section 2176 of the Act of August 4, 1991, P.L. 97, No. 22, (72 P .S. S 9176), the Secretary of Revenue is authorized to request the Court to issue a Citation directed to those subject to any duty imposed by the aforesaid Act, commanding such persons to appear and show cause why the requirements of this Act should not be met. WHEREFORE, your Petitioner prays your Honorable Court to issue a Citation upon the Transferee directing the Transferee to appear and show cause why said Inheritance Tax in the estate of the Decedent should not be paid as required by law; and to further direct that the costs of this action shall be borne by the Transferee. COMMa BY FOR: Thomas W. Wolf Acting Secretary of Revenue COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF DAUPHIN Robert Freedenberg, Esquire, Deputy Secretary for Taxation, for Thomas W. Wolf, Acting Secretary of Revenue, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct to t is knowledge, information and belief. For: Thomas W. Wolf Acting Secretary of Revenue Sworn to and Subscribed before me this )01 a day of /~ ClDO) ~./,~ (;~MfOi)NlIIli~ru, iiiii ~lilliilllWl,I;6NI. NOTARIAL seAL JOAN M. PETfRS. NOTARY PUBLIC CITY OF HARRI88URoG. DAUPHIN COUNTY MY COMMISStON EXPIRES APRil 07. 2008 . '. , 1 N ~/-O.:5- /6~ o. Estate of John Kenneth Zi.rrmennan, a/k/a John K. Zirnnennan . DeceaSed DECREE OF PROBATE AND GRANT OF LETTERS AND NOW h~AAY O).,s- ~~~ I in consideration of the petition on the reverse side hereof. satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ,June 11. 1980 described therein be admitted to probate and filed of record as the last will of John K. zimmerman - and Letters Testamentarv are hereby granted [0 J~ William Zimmerman .......- FEES Probate. Letters. Etc. ......... S 02a~ l"'.2::J ~~t Cenificates( ).......... S /~/'J6 "\.-r'Atfc&S .. ~;;~ ct:uion ................ S .tt:Ja ,-- S ~/'J. ~ TOTAL _ SQ2~~o Fiied ~~.~~~ .~~....... .O~-...~a.~ /.o~, 4H:7i~ . j ~'- Rf:r1stCf ofWi~ ~ CQ~~~#39785 AlTORNE1 (Sup. Ct. !.D. No.) 414 Bridge St., New CUmberland, PA 17070 ADDRESS (717) 774-7435 PHONE -~ .. ~ - --- rr:....l..~~J.Ul" .1'Vn. rnUDn...J,;. 0.&&&" _.L~'.1 ur .1J.L.......~lo.U Brare 0; John Kenneth Zimmennan . also kno'wn as John K. Zimmerman No. To: Register of Wills for the Deceased. County of Cl.lmber land in the SOCIal Securiry No. 174-05-1467 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents dult: Your petitioner(s), who iShDc 18 years of age or alder an the execulOr in the last will of the above decedent, dated June 11 and cOdicil(s) dated ,.:)/-0.0-/ A~/' named .19 80 (state relevant circlllnstanccs. e.g. renunciation. death of OJecmor. cu:.) Decendem was domiciled at death in ~lann C;ounty, Pennsylvania. with h is last family or principal residence at 7 N. East st., Car.lJ.sleBorough, PA (list street. number aDd mUDCipaUlY) Decendent, then at isle Re ia E.'tcept as fallows, decedent did not marry, was not divorced and did not have a child born or a opted ~fter execution of the wiII offered for probate; was not the victim of a killing and was never adjud cated Incompetent: . Decendent at death awned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not d~miciled in Pa.) P&;rsonal property in PennsylVania (If not domiciled'in Pa.) Personal propcny in County Value of real estate in Pennsylvania situated as foHows: 617 North East street Cumber land Count PA Fphrll;:lry 12. 2003 ~ 15 s s s S 125,000.00 theron. ,. OATH OF PERSONAL REPRESENTATIVE COMMON\VEALT.H OF PENNSYLVANIA } as COUNTY OF ~}l.Nn '" The petidoner(s) at;ove~I1amed ~wear(s) or affirm(s) that the statements in the foregoing petition re true and <::'Or-rect to the best of tbe knowledge and belief of petitioncr(s) and that as personal represe - tative(s) of the above decedent pl:tidoner(s) wiII well and tmIy administer th e according to la Sworn to or affirmed and subscribed ~ r c., before me this 0;'$/7,-'/ day of . €' ~~~~~;/~, 4:;%r , i ~ /?/~-7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN PO BOX Za06Dl HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE >~'."<'-:T, CC'mi.J:tC€':OF INHERITANCE TAX ."-'., ... ,.AP.PRA1SEKENT~ ALLOKANCE OR DISALLOKANCE OF DEDUCTIONa~. AND ASSESSKENT OF TAX ON 'JOINTLY nELD OR TRUST ASSETS *' REV'15~1 EX AFP 112.D~1 " I?:: 28 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY 02-07-2005 ZIMMERMAN 02-12-2003 21 03-0162 CUMBERLAND 174 05 1467 JOHN K SSN/DC - - JENNETTE NEEL Y ACN 04001795 59 NORTH EAST STREET I AlIOUnt R..i Heel I CARLISLE PA 17013 ~KE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ..... -------------------------------------------------------------------------------------------------------- ------- REV-1S48 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-07-2005 ESTATE OF ZIMMERMAN JOHN K DATE OF DEATH 02-12-2003 COUNTY CUMBERL ~ND FILE NO. 21 03-0162 S.S/D.C. NO. 174-05-1467 ACN 0400 795 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: AMERICAN INVESTORS LIFE ACCOUNT NO. 405948 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 01-01-2003 Account Balance 37.431.87 NOTE: TO INSURE PROPER CREDI TO Percent Taxable X 1.000 YOUR ACCOUNT. SUBMIT T E Amount Subject to Tax 37.431.87 UPPER PORTION OF THIS OnCE Debts and Deductions - .00 WITH YOUR TAX PAYMENT o THE Taxable Amount 37.431.87 REGISTER OF WILLS AT TI E Tax Rate X .15 ABOVE ADDRESS. MAKE I HECK Tax Due 5.614.78 DR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AG NT ." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 02-15-2005 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 5.61 ~.78 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 29 ~.13 ,,~: TOTAL DUE 5.91:5.91 · IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1. NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) ~~ . HARRISBURG DISTRICT OFFICE STRAWBERRY SO 4TH &: WALNUT STS HARRISBURG, PA 17128-0101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . I I i i JENNETTE NEELY 59 NORTH EAST STREET CARLISLE, PA 17013 DATE: Estate of: 9/26/2006 JOHN K ZIMMERMAN Date of Death: 2/12/2003 File Number: 2 1 0 3 - 0 162 A C N(s): (See Reverse Side) De& JENNETTE NEELY: (Certified Mail-Return Receipt Re uested) This is to again advise you that the above estate is in a delinquent status. According to Department records, the estate still is not settled. As of this date, you have failed to respond to prior contacts to resolve this matter. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by the personal representative, transferee, or beneficiary of the estate within nine months of the decedent's death. The Department's records show that tIlls estate remains open because: CURRENT TAX LIABILITY OF S 6476.23 INCLUDING INTEREST CALCULATEDTO 10/21/2006 HAS NOT BEEN PAID. Accordingly, you &e directed to pay all tax due including interest within thirty days from the date of this letter. If you fail to comply with this directive, your case will be referred for local enforcement and may result in the filing of a citation by this Depmment with the Orphans' Court Division of the Court of Common Pleas, requiring you to appe& in court to show cause for your failure to comply with the law. In order to protect the Commonwealth's interest, the Department of Revenue may also file a lien in Cumberland County. Under Act 40 of 2005, additional collection costs including but not limited to fees of up to twenty-nine percent (29%) of the amount due, and attorney fees incurred in securing payment, may be imposed on any liability not paid prior to referral to a collection agency or contract counsel. MAKE CHECKS PAYABLE TO: REGISTER OF WILLS. AGENT Any questions regarding the tax liability of this estate, please CONTACT: HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH & WALNUT STS HARRISBURG, PA 17128-0101 TDD# 1-800-447-3020 (Services for taxpayers with special hearing and/or speaking needs) Sincerely, JOSEPH ROMANELLI (717)787-9869 cc: EXHIBIT C s . Complete Items 1, 2, and 3. Also complete Item 4 If Restricted Delivery Is desired. . Print your name and address on the reverse so that we can retum the card to you. . Attach this card to the back of the mallplece, or on the front If space permits. 1. Article Addressed to: JENNET'li:-~NEEL y 59 NORTH EAST STREET CARLISLE PA 17013 21 03-0162 ROMANELLI 3. ServIce Type o Certified Mall [] Express Mall o Registered [] Retum Receipt for Merchandise o Insured Mall [] C.O;O. 4. RestrIcted Delivery? (Exf18 Fee) D Yes 2. Article Number ! f"ansferfrom service label) i PS Form 3811. February 2004 7003 1680 0000 9629 68.47 Domestic Return Receipt 102595-02-M-1640 I UNITED STATES POSTAL SERVICE 111111 First,Class Mail Postage & Fees Paid USPS p, .~ rmlt No. G-10 '"'I. · Sender: Please print your name, address, and ZI +4 in this box · 1'(l.. /;~ GCI 02 a Harrisburg District Office ~~'R7-t~i7f'i';.:JL; PA Department of Revenue rS8{jRG%Of.-,~ . tob~y, Strawberry Square TRier ~f Harrisburg, PA ~7128-0101 r-.... .... ''V, ~ ) ~'-""'I r i_II.._ iJ'f,mnrltl,H f,I,.h,i,I,h,JullU, IIUwi.,i-,lllt".i,,1 H EXHIBIT C No. ~/-o,5-/~ Estate of John Kenneth Zi~m~erman, a/k/a John K. Zimmerman , Deceased DECREE OF PROBATE AND GliNT OF LETTERS AND NOW /~r.,~,~e,9, ,,a,5-- '~[:~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 11. 1980 described therein be admitted to probate and filed of record aa the last will of John K. Zimmerman and Letters Testamentary are hereby granted to J, William Zinm~erman Probate, Letters, Ere .......... $--q-~ Short Certificates( ) .......... $ /,.~..,")d> AI'rORN~y (Sup. Ct.. I.D. No.) :at:on ................ $ 4a 4 Bridge St. ~ New ~rZ~d~ PA ~ 7070 TOTAL (717) 774-7435 Flied ~~.~fi<. ~~ ....... , PHO~ his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be. forwarded to the State Vital Records Ofrice fbr permanent, filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9 0 414 3 4 ~---~,~,~-':;'~ FEB 1 ~ 200,.-1 No. Date z,a? COMMONWEALTN OF PENNSYLVANIA · OEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ,. John Kenneth Zimmerman ,.Male ~ 174 -- 05 --1467 ,. February 12, 2003  .w~. I . ~ I 1,. ]7. ~ I ~r~zsze ~rlzsle R~ional M~ical Center ~ ~-"~"' ~ - · ~_,~ [ ,.,.o~ ,us,~s~.ous,.v I ~qE~t~ E~"'" I ~=~.vS~m ~ ~ :~--'~'' Brl~e Contractor ~ ~ E~~ ,~ m~ ..... ~' 617 North ~st St. ~u~ .... ~.. PA ~ ~,~rlisle, Pa 17013 ~ ~rl~d ~,,. Hegif~ L. Zippi ~,,. Mi~ie I. Fi~e~inder ~ John W. Zi~n '"~*J~~.~.~ ' m. ~8 Fifteenth St., New ~rland, PA 17070 Q,,,. Feb. 19, 2~2 ,,~orkt~e Cremtion Se~. [,,,. York, PA 174~ ~~~~~~" [~, 01~19 L ]mo~ ~ u ....... Hoff~n-Roth ~eral H~ '~ '1~ ~IAN (~ ~ ~ ~ d ~m ~ a~ ~ ~ ~ ~am ~ c~ ~N~ ~ ~ CERT~iER - .... ~ ........... _, ............................... ~, ' ; *~"'~'~" ~*~'"""' .... ~"~" ~"~'~" ........... '~ ..................... "'T'~"""~ ............................... * * " ..... ~'~'~ LAST WILL AND TESTAMENT OF JOHN K. ZIM_~ERMAN I, JOHN K. ZIMMERMAN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form following: 1. I hereby expressly revoke all Wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. 3. Should my wife, Grace E. Zimmerman, survive me for a period of thirty days following my death, I devise and bequeath the remainder of my estate to Grace E. Zimmerman. 4. Should my wife, Grace E. Zimmerman, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the remainder of my estate in equal shares to my son, J. William Zimmerman, and my daughter, Becky J. Witter; and to the issue, per stirpes, of either who is then deceased. 5. I nominate and appoint CCNB Bank, N.A., New Cumberland, Pennsylvania, Trustee of the share of any beneficiary who may be a minor. The income and/or principal of said trust may be accumu- lated or expended for the maintenance, education and support of such beneficiary as my Trustee in its sole discretion may determin~ and my Trustee, in the expenditure of income and/or principal for such purposes, may, at its discretion, apply the same directly without the intervention of a guardian or pay the same to any person having the care or control of said beneficiary or with whom the beneficiary resides, without duty on the part of the Trustee to supervise or inquire into the application of the funds by any person to whom any payment is so made. The balance of such income/ and/or principal shall be paid to such beneficiary upon reachingf/ majority, or to such beneficiary's estate in the event of death prior thereto. - 1 - 6. I nominate and appoint my son, J. William Zimmerman, as Executor of this my Last Will and Testament; and as substitute Executor I nominate and appoint CCNB Bank, N.A., New Cumberland, Pennsylvania. 7. I direct that my personal representative and Trustee, as well as their successors, shall not be required to file bond or any jurisdiction. security in IN WITNESS ~EREOF, I have hereunto set my hand and seal this II~ day of June, 1980. COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : I, John K. Zimmerman, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willing.y; and that I signed it as my free and voluntary act for the pur- poses therein expressed. Sworn or affirmed to and acknowledged before me, by John K. Zimmerman, Testator, this I~ ~ of June, 1980. ////~/~t a to ?~/ JAN CF. E. ~.-.~ER'r)'~ .-.~ ~ ,,~-~-, ~¥ P1181.1C ............ ~,.sslon ~)q:)i~es 3enue~y 27, ]983 - 2 - COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, Roger M. Morgenthal and Tom H. Bietsch, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, John K. Zimmerman, sign and execute the instrument as his Last Will; that he signed will- ingly and that he executed it as his free and voluntary act for the purposes therein expressed; that both of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or mor~ years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by Roger M. Morgenthal and Tom H. Bietsch, witnesses, this ~/~ day of June 1980. , ......... ~' / '/-'¢'r'i~l'" P,A Expires 3anuo. ry 27, 1983 - 3 - OF JOHN K. ZIM34ERMAN STONE, LAFAVER ~ SHEKLETSKI A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 41 ~STREET NEW GIJMBERLAND, PA 17070 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JOHN K. ZIHHERHAN, a/k/a JOHN KENNETH ZIHMERHAN Date of Death: February 12, 2003 Will No. 2003-00162 To the Register: I certify that notice ef beneficial interest required by Rule 5.6(a) ef the Orphans' Court rules was served on or mailed to the fellowing beneficiaries ef the above captioned estate en Harch 10, 2003. J. William Zimmerman 408 15~:~ Street New Cumberland, PA 17070 Notice has now been given to all persens entitled thereto under Rule 5.6(a) . / / Date: 3 DAV-IE>'t~./ STONE, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-1435 Capacity: Personal Representative Ceunsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002537 STONE DAVID HEAN ESQUIRE 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... - ....... 101 I $7,000.00 ESTATE INFORMATION: SSN: 174-05-1467 FILE NUMBER: 2103-01 62 DECEDENT NAME: ZIMMERMAN JOHN K DATE OF PAYMENT: 05/08/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/12/2003 TOTAL AMOUNT PAID: $7,000.00 REMARKS: DAVID H STONE ESQUIRE CHECK# 1008 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003230 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... _ ....... 101 $960.76 ESTATE INFORMATION: SSN: 174-05-1467 FILE NUMBER: 2103-01 62 DECEDENT NAME: ZIMMERMAN JOHN K DATE OF PAYMENT: I 1/14/2003 POSTMARK DATE: 1 1/1 4/2003 COUNTY: CUMBERLAND DATE OF DEATH: 02/12/2003 TOTAL AMOUNT PAID: $960.76 REMARKS: JOHN WILLIAMZIMMERMAN EXEC. C/O DAVID H STONE ESQUIRE CHECK# 1044 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS RE- 1500 EX (6-00) OFFICIAL USE ONLY ' COMMONWEALTH OF REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN F,LENUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 2003 0162 COUNT'~ CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND M~DL~ INITIAL), SOCIAL SECURITY NUMBER Z~ Zimmerman, John K a/K/a donn Kenneth 174-05-1467 olLI DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE PILED IN DUPLICATE WITH THE LU 02/12/2003 07/3.6/1922 REGISTER OF WILLS O LM (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER U.I ~ ~-J 2. Supplemental Return I-- 1. Original Return [--'-] 3. Remainder Return (date of death pdor to 12-13-82) L___J 4. Limited Estate I I 4a. Future Interest Compromise (date of death after 12-12-82} II 5. Federal Estate Tax Return Required ~' ~ 6. Decedent Died Testate (Attach copy of W~II) ~ ] 7. Decedent Maintained a Living Trust (Attach copy of Trust) i 8. Total Number of Safe Deposit Boxes <a' ~ 9. Litigation Proceeds Received ~ 10. Spousal Povarty Credit (date o, deamb ....... 2-3~-9~ ...... 95) ~ 11. Election to tax under Sec. 9113(A)(^tt~chSc,O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z NAME COMPLETE MAILING ADDRESS LU ~ David H Stone· Esquire Z · o 414 Bridge Street . FIRM NAME (If Applicable) ,,m, New Cumberland, PA 17070 ~ Stone LaFaver & Shekletskl O TELEPHONE NUMBER 717-774 -7435 1. Real Estate (Schedule A) (1) 148,237.25 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 0. 00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0. O0 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 18,704.66 - Z 6. Jointly Owned Property (Schedule F) 0.00 O (6) ~--- ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 34,7 2 7.18 ::~ (Schedule G or L) ~ 201,669.09 <~ 8 Total Gross Assets (total Lines 1-7) (8) O LM 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 16 · 5 7 6 . 18 10. Debts of Decedent, Mortgage Liabilities, & Liens (Sdaedule I) (10) 0. 0 0 11. Total Deductions (total Lines 9 & 10) (11 ) 1 6 / 5'7 6.18 12. Net Value of Estate (Line 8 minus Line 11) (12) 1 8 5,0 92.91 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 0 . 00 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 185,092.91 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (a)(1.2) 0. O0 x .00__ (15) 0 , 00 O ~- 185,092 91 8,329 18 ~ 16. Amount of Line 14 taxable at lineal rate ' x .045 (16) · I- ~ 0. O0 0 00 a. 17. Amount of Line 14 taxable at sibling rate x.12 (17) O (J 18. Amount of Line 14 taxable at collateral rate 0 o O0 x .15 (18) 0. 00 X I- 19. Tax Due (19) 8,329.3.8 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < 2W4645 1.000 Decedent's Complete Address: STREET,ADDRESS 617 ~orth East Street CITY STATE ZiP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 8r329.18 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 7 r 000.00 C. Discount 368.42 Total Credits (A + B + C) (2) 7,368.42 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.0 0 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) 960.7 6 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 960.7 6 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; ....................... ['~ r~ b. retain the right to designate who shall use the property transferred or its income; ......... [~ ~ c. retain a reversionary interest; or ................................ r~ ~ d. receive the promise for life of either payments, benefits or care? ................. ~ ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ E~ ['~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ r~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ r~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, 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 rspreser~tative is based on all information of which preparer has any knowledge. SIGNATUREQF PERSON RESPONSlBL~E FOR FILING ~ffJJJEbl___ DATE AD~'S~'408' i~h Str'e~9~~ .... / New Cumberl~n.~l~A 17070 ,,,% t 7. New C'~u~:~er'land, PA. 17070 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nat value of transfers to or for the use of the surviving spouse is 3% [72 P.S. § 9916 (a) (1.1) (i)]. For dates of death on or after Jan uary 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 surviving spouse is the only beneficiary. For dates of death on or after ,July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 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"/0, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whather by blood or adoption. 2w4646 1.000 · REv-~o2*~x + (~-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Zimmerman, John K a/k/a John Kenneth 21-2003-0162 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Property located at 48 N. East St., Carlisle, Cumberland 44,712.25 County, PA balance due on a sales agreement dated February 12, 1998 with Larry E. Gossard and Sheri L. Gossard, his wife 2 Property located at 617 N. East St., Carlisle, Cumberland 103,525.00 County, PA at assessed value $102,500 times CLR (1.01) TOTAL (Also enter on line 1, Recapitulation) $ 148,23?. 25 2w4695 2.000 (If more space is needed, insert additional sheets of the same size) REV-150~J EX+ (1-97) ' SCHEDULE E ~OMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Zimmerman, John K a/k/a John Kenneth 21-2003-0162 Include the ~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. American Investors-monthly checks 380.48 2 Leglonaire Insurance Trust-monthly checks 52.61 3 PNC Bank-Checking Acct. #5140194559, Princ. $9,515.89, Int. 9,516.89 $1.oo 4 PNC Bank-Checking Acct. #5140424633 2,206.71 5 1977 Bonneville sold to Jim Doyle 5,500.00 6 Erie Insurance Group-refund on homeowners insurance 68.00 7 Highmark, Inc.-refund 59.97 8 Net proceeds on household goods sold at auction by Chuck 230.00 Bricker 9 1992 GMC Sahara Minivan at Kelly Bluebook value 690.00 TOTAL (Also enter on line 5, Recapitulation) $ 1 8,7 0 4.6 6 2W46AD 2.000 (if more space is needed, insert additional sheets of the same size) REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Zimmerman, John K a/k/a John Kenneth 21-2003-0162 This schedule must be completed and filed if the answer to any of questions I bhrough 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DATE OF DEATH DECD'S EXCLUSION DECEDENTANO THE DATE OF TRANSFER. ATTACH A COPY OF THE TAXABLE VALUE NUMBEIq DEED FOR REAL ESTATE. VALUE OF ASSET IN'rEREST (IF APPLICABLE) 1. American Investors Life 34,727.18 100.00 0.00 34,727.18 Insurance Company-Policy No. 409376-beneficiary is J. William Zimmerman 2.*~American Investors Life- 37,431.87 100.00 37,431.87 Policy No. 405948, benef. is Jennette Neely **~ FOR INFORMATIONAL PURP()SES AND TS NOT INCLUDED ON FRON~.~ PAGE UNDER SCHEDULE "G' . A SEPARATE BILLISG IS REQUES~.?ED FOR BENEFICIARY TO PAY TOTAL (Also enter on line 7, Recapitulation) $ 34,727.18 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 REV-1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN AD M IN ISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Zimmerman, John K a/k/a John Kenneth 21-2003-0162 Debts of decedent must be reported on Schedule I. ITEM NUMB ER DESCRIPTION AM O UNT A. FUNERAL EXPENSES: Hoffman-Roth Funeral Home-funeral expenses 1,500.00 t. 2 The Patriot News Co.-advertising 14.00 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.0 0 Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: 2. Attorney Fees Name : David H. Stone 10,083.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0. O 0 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 2 6 9.0 0 5. Accountant's Fees 0.0 0 6. Tax Return Preparer's Fees 0.0 0 7. The Cumberland Law Journal-advertising grant of 75.00 letters 8 The Patriot News Co.-advertising grant of letters 105.73 9 Duty's Lock-rekeying at property 67.56 10 Erie Insurance-insurance on car 80.00 11 PA Dept. of Transportation-duplicate certificate of 45.00 title on car Tot~ 1 from continuation pages .... 4,336.89 TOTAL (Also enter on line 9, Recapitulation) $ 16,576.18 2W46AG 2,000 (If more space is needed, insert additional sheets of same size) Page 2 Estat~ of: Zimmerman, John K a/k/a John Kenneth 21-2003-0162 Schedule H, Part B -- Administrative Costs I tern No. Description Araoun t 12 PA Dept. of Transportation-duplicate registration 9.00 card 13 Kelley Kimbach-van inspection and oil change 46.64 14 PNC Bank-check printing fee 48.80 15 Drilling lock box (110), gas for van (26) and copies 138.00 (2) 16 PNC Bank-Interest Withholding 0.59 17 UGI-gas service at property 619.34 18 PPL Electric Utilities-electric service at property 170.42 19 UGI-service agreement for gas at property 185.00 20 Comcast-cable service at property 16.89 21 Darlene Moyer-taxes for property 522.11 22 Erie Insurance-homeowners insurance 83.00 23 Sentinel newspaper ad, car wash, gas for van 196.41 24 PPL Electric Utilities-electric service at property 31.84 25 Sprint-telephone service at property 27.09 26 UGI-gas service at property 75.13 27 UGI Utilities, Inc.-air conditioning checkup 85.00 28 Callen Kihback, Inc.-air condition dialysis 175.12 29 Paint for property 268.00 30 UGI-gas at property 33.41 TOTAL. (Carry forward to main schedule) ...... 2,731.79 Page 3 .Estate of: Zimmerman, John K a/k/a John Kenneth 21-2003-0162 Schedule H, Part B -- Administrative Costs Item No. Description A~ount 31 PPL Electric Utilities-electric at property 23.02 32 Paint and curtains for property 325.00 33 Carpet Mart-carpet for property 177.02 34 Duty Lock Service-dead bolt for garage 82.00 35 PPL Electric Utility-electric service at property 23.37 36 Kelley Kimbach-to fix flat tire on van 30.21 37 PNC Bank-Check printing fee 48.80 38 Co~onwealth of PA-registration on van 36.00 39 The Patriot News Co.-ad for Bonneville 18.00 40 BM Transmission Service-transmission service on car 95.40 41 UGI-gas service at property 16.54 42 PPL Electric Utilities-electric service at property 74.40 43 Erie Insurance Group-insurance on van 53.00 44 Kelley Kimbach-services for fixing flat tire on van 94.54 45 Cohlck & Assoc.-income tax preparation for decedent's 200.00 final return 46 PNC Bank-check printing fee 48.80 47 Erie Insurance Group-insurance on van 59.00 48 Reserve for closing expenses 200.00 TOTAL. (Carry forward to main schedule) ...... 1,605.10 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Zimmerman, John K a/k/a John Kenneth 21-2003-0162 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE D ISTRIB UT IO N S [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Zimmerman, J. William son 185,092.91 408 15th Street New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 2W46AI 1.ooo (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF JOHN K. ZI~MERMAN I, JOHN K. ZIMMERMAN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form following: 1. I hereby expressly revoke all Wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. 3. Should my wife, Grace E. Zimmerman, survive me for a period of thirty days following my death, I devise and bequeath the remainder of my estate to Grace E. Zimmerman. 4. Should my wife, Grace E. Zimmerman, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the remainder of my estate in equal shares to my son, J. William Zimmerman, and my daughter, Becky J. Witter; and to the issue, per stirpes, of either who is then deceased. 5. I nominate and appoint CCNB Bank, N.A., New Cumberland, Pennsylvania, Trustee of the share of any beneficiary who may be a minor. The income and/or principal of said trust may be accumu- lated or expended for the maintenance, education and support of such beneficiary as my Trustee in its sole discretion may determine~ and my Trustee, in the expenditure of income and/or principal for such purposes, may, at its discretion, apply the same directly without the intervention of a guardian or pay the same to any person having the care or control of said beneficiary or with whom the beneficiary resides, without duty on the part of the Trustee to supervise or inquire into the application of the funds by any person to whom any payment is so made. The balance of such incomei and/or principal shall be paid to such beneficiary upon reaching majority, or to such beneficiary's estate in the event of ~eath prior thereto. - 1 - 6. I nominate and appoint my son, j. ~iY~iam zi~erman, as Executor of this my Last Will and Testament; and as substitute Executor I nominate and appoint CCNB Bank, N.A., New Cu~erland, Pennsylvania. 7. I direct that my personal representative and Trustee, as well as their successors, shall not be required to file bond or security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~l~ day of June, 1980. ~ohn Kyerman WITNESS: /~ ' cOMMONWEALTH OF PENNSYLVANIA : · SS. cOUNTY OF cuMBERLAND : I, John K. zimmerman, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the pur- poses therein expressed· Sworn or affirmed to and acknowledged before me, by John K. zimmerman, Testator, this I~ ~ of June, 198~0. oC - JANICE E. FIFIRT71 ER, I',]OT/',RY PI.IBL. IC C[:;n~Serlend Co~:nt,/ Ccirli~sle, PA ;My Cornmission Expires January 27, 1983 - 2 - COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, Roger M. Morgenthal and Tom H. Bietsch, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, John K. Zimmerman, sign and execute the instrument as his Last Will; that he signed will- ingly and that he executed it as his free and voluntary act for the purposes therein expressed; that both of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by Roger M. Morgenthal and Tom H. Bietsch, witnesses, this I/~L day of June, 1980. - 3 - STONE LAFAVER 8c SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E OF COUNSEL GERALD J. SHEKLETSKI NEW CUMBERLAND. PA 17070 CHARLES H. STONE ELIZABETH B. STONE www. stonelaw, net JON F. LAFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-31~69 March 11, 2003 PA Department of Revenue Harrisburg District Office Attn: Sarah Husser Lebby, Strawberry Square Harrisburg, PA 17128-0101 RE: Estate of John Kenneth Zimmerman, deceased Late of Borough of Carlisle, Cumberland County, PA Date of Death: February 12, 2003 Social Security No. 174-05-1467 File No. 2003-00162 Greetings: I enclose a Safe Deposit Box Inventory, Form REV-485, in the above captioned estate. Do not hesitate to call me should you have any questions regarding the above. Very truly yours, STONE LaFA.V~R & SHEKLETSKI David 'H'{ Istone DHS/krl Enclosure R~'¢-485 EX+ (9-00) SAFE DEPOSIT BOX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INVENTORY INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS ~ DECEDENT'S NAME (LAST, FIRST, MIDDLE) ~ DATE OF DEATH ~Zl~e~ma~, 2oh~ Fen~e~h J ~eb~ua~y ~2, 2003 ADDRESS OF DECEDENT (STREET) (CITY) (STATE) (ZIP CODE) 17 No~h gas~ S~eet, Ca~llsle, ~A 17013 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) D~vl~ H. S~one, Esquire (STREET NAME) (CITY) (STATE) (ZiP CODE) 414 ~dge S~ee~, New Cumberland, ~A ~7070 ~ NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) 408 15:h St~ee:, New Cumberland, ~A 17070 b. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) ~ NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) ~ & · ~a~A (STREET NAME) (CITY) (STATE) (ZIP CODE) O~e Wes~ ~igh St~eeE, Ca~lisle, ~A 17013 ~ NAME OF PERSON MAKING LAST ENTRY ~ DATE AND TIME OF LAST ENTRY 2oh~ ~ DATE OF CONTACT TO RENT aOX ~ NUMBER OF BOX ~ TITLE UNDER WHICH BOX IS REQUESTED ~aa. 31, 1978 ~ 2265 15o~n ~. Z~mme~a~ ~1 NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) b. (NAME) 2oh~ ~. Z~e~maa ~ie ~. Z~e~ma~ (~eceased) (STREET ADDRESS) (STREET ADDRESS) 617 N. East St~ee~ 617 N. gas~ S~ee~ (CITY) (STATE) (ZIP CODE) (CITY) (STATE) (ZIP CODE) Ca~lisle, ~A 17013 Carlisle, ~A 17013 ~ NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS A WILL IN THE BOX? [] YES [] NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) Dav±d ti. Stone (STREET NAME) (CITY) (STATE) (ZIP CODE) 414 Bridge Street, New Cumberland, PA 17070 REV-1381 EX (6-98) ~age 2 of 2 To BE USED IN CONJUNCTION WITH REV-485 STOCKS/BONDS ESTAIEOF John Kenneth Zimmerman COMMONWEALTH OF PENNSYLVANIA INVENTORY FJLE NUMBER 2003--00 ]_ 62 DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 SOCIAL SECURITY NUMBER 174-05-1467 NO. SHARES/ DENOMINATION CLASS/SERIES COMPANY NAME CERTIFICATE/BOND NUMBER DATE OF ISSUE STOCKS/BONDS REGISTERED IN NAME(S) OF 100 [ Capta±n Internat±onal Industr±e~ 43326 05/04/70 John K. Z±mmerman Inc. 100 }r~ 0 43327 John K. Z±mmerman 100 ~/ " 43328 John K. Zimmerman 50 i~z~ /~ /West Shore Times 11 09/20/62 John K. Zimmerman · Form .View - public tax file 3-31-2003.fp5 Page 1 of 1 Form View public tax file 3-31-2003.fp5 .ome [ .e~p Search Table View Viewing: 1 of District_Number 02 Parcel_Identifier 02-20-1800-130 Map_Suffix_Number House_Number (~17 Direction N Street EAST STREET Owner_Name_l ZIMMERMAN, JOHN K Owner_Name_2 Land Use Code Property_Description Living_Area 153 Current_Land_Value 15000 Current_Improvement_Value 87500 Current_Total_Value 102500 Current_Preferred_Value Acreage .19 CleanGreen_Status Taxable or Exempt 1 Sale_Amount 93000 Sale_Month 10 Sale_Day 02 Sale_Century 19 Sale_Year 95 Deed_Book_and_Page 00129-00076 Year_Built 1928 http://205.247.227.59:591/FMRes/FMPro?-db=public%20tax%20file%203_3 l_2003.fp5&_o... 5/7/2003 ~/~/ _ ' AGREEMENT OF SALE / FOR REAL ESTATE THIS AGREEMENT is made this ~ [- tE'day of February, 1998, by and between JOHN K. ZlMMERMAN, of Carlisle, Cumberland Count,/, Pennsylvania, hereinafter, whether one or more, called SELLER, and LARRY E. GOSSARD and SHERI L. GOSSARD, husband and wife, of Carlisle, Cumberland County, Pennsylvania, hereinafter, whether one or more, called PURCHASER. WlTNESSETH: 1. SELLER agrees to sell and convey to PURCHASER, and PURCHASER agrees to purchase and accept the conveyance of 48 North East Street, Borough of Carlisle, Cumberland County, Pennsylvania. 2. PURCHASER agrees to pay the sum of Fifty Five Thousand and 00/100 ($55, 000. 00) Dollars for said property as follows: Three Thousand and 00/100 ($3,000. 00) Dollars at the time of the signing of this Agreement, receipt of which is hereby acknowledged by SELLER; and the balance of Fifty Two Thousand and 00/1 O0 ($52,000. 00) Dollars in initial monthly installments of Four Hundred Fifty and 00/100 ($450.00) Dollars; allpayments include interest at the rate of eight (8%) percent per annum, with the first such installment due as of Marcb 12, 1998, and continuing on the same day each month thereafter, for a total of Two Hundred Twenty Two (222). PURCHASER may prepay the principal balance due at any time, in whole or in part, without pena/ty. At the time that payment of all princJpal and accrued interest has been made in full, settlement as herein provided for shall be held. An amortization schedule containing the payment terms as herein set forth is attached hereto and made a part hereof, and the parties agree that principal and interest amounts as set forth in said schedule shall be used for tax calculation purposes as required for by either party. If any principal is prepaid by PURCHASER, the parties shall cooperate to adjust the interest amounts reportable for tax purposes with reference to said schedule. - 3. At final settlement, SELLER shall convey title in fee simple by special warranty deed, free and clear of all encumbrances except easements and restrictions visible or of record. 4. At settlement, all realty transfer taxes, if any, shall be divided equally between the parties; except that the obligation of the SELLER shall not exceed one (1%) percent of the purchase price as stated in this Agreement, to wit: Five Hundred Fifty and 00/100 ($550.00) Dollars. 5. Possession of said property has been delivered to PURCHASER as of the time of the execution of this Agreement, and PURCHASER agrees that they have accepted the said property in its present condition, as is. 6. Real estate taxes shall be prorated to the date of delivery of possession to PURCHASER as follows: all subsequent taxes beginning with the 1998 County/Borough/Library taxes to be paid by PURCHASER. 7. As of the date of delivery of possession of said premises to PURCHASER, PURCHASER agrees to keep all improvements on the premises insured against fire with extended coverage, in a company reasonably agreeable to SELLER, for a sufficie,-~t sum to at all times cover the unpaid balance of the purchase price, said insurance to be carried in the names of the parties as their interests may appear, and to be further endorsed to protect any mortgagee of SELLER for said premises. In addition to such insurance, PURCHASER agrees to hold harmless and indemnify SELLER against any claims, suits or losses resulting from PURCHASER's occupancy or use of the said premises, including reasonable attorneys' fees for defense against such claims, suits or losses. 8. After delivery of possession of said premises to PURCHASER, PURCHASER agrees to keep the premises in a good state of repair, including the cutting of grass and other vegetation to a height at least as required by the regulations or ordinances of boro/township -, and to make no substantial alterations or construct any improvements on the said premises, without the prior written consent of the SELLER, which will not be unreasonably withheld. 9. Any municipal assessments or charges against said premises made subsequently to the date of this Agreement shall be the sole obligation of PURCHASER, who will hold SELLER harmless against the same. 10. On default in the payment of any installment of principal and/or interest for a period of thirty (30) days or more, or failure to correct the breach of any other obligation under this Agreement within thirty (30) days after written notice from the SELLER thereof, SELLER may declare this Agreement to be ended, retaining all payments made to that time as liquidated damages; and in such event, the Prothonot.ary or any attorney of any court of record in Cumberland County is hereby authorized to appear for and to confess judgment in an amicable action of ejectment against PURCHASER, their/his/her heirs, executors, administrators, successors, assigns or lessees, and in favor of SELLER, their/his/her heirs, executors, administrators, successors, or assigns, for the premises herein described, and to direct the immediate issuance'of a Writ of Possession with Writ of Execution for costs without notice and without asking leave of Court, and with One Thousand ($1,000.00) Dollars added as a reasonable attorney fee, or, at the option of SELLER, said Prothonotary or attorney is authorized to confess judgment against the PURCHASER and in favor of the SELLER for the unpaid balance of the purchase price and costs, interest, insurance, etc., with fifteen (15%) percent added as a collection fee. In addition, if this Agreement has been recorded in Cumberland County or elsewhere, said Prothonotary or attorney is authorized to appear for and to execute, acknowledge and record such documents as are deemed necessary by SELLER's counsel to void such Agreement as of record so that it shall not constitute an objection or cloud on the title of said premises. 1 1. The interest of the PURCHASER in this Agreement shall not be assignable in whole or in part without the prior written consent of the SELLER, and if such assignment is attempted, it shall constitute a default hereunder and the rights stipulated in the preceding paragraph shall accrue to the SELLER. 12. The PURCHASER has inspected the premises and, as set forth above, accepts this conveyance in an "as is" condition, including matters of survey and amount of acreage, and they have not relied upon any representations by either SELLER or SELLER's counsel as to the condition of the premises or the state of the title thereto. 13. If the subject property is a residenti~d dwelling, this contract is contingent upon a risk assessment or inspection of the property f(,r ~.he presence of lead-based paint and/or lead- based paint hazards at the Purchaser's expense~' until 9 p.m. on the tenth calendar da'~' ,,:ter ratification (insert date 10 days after contract ratification or a date mutually agreed u,.,on). (Intact lead-based paint that is in good condi::, :: is not necessarily a hazard. See the EPA pamphlet Protect Your Family From Lead in Yoc .... ~e for more information). This continjcncy will terminate at the above predetermined dead:!: J unless the Purchaser (or Purchaser's a,jent) delivers to the Seller (or Seller's agent) a written: _,~tract addendum listing the specific e;:!uting deficiencies and corrections needed, togethei' with a.copy of ~e inspection and/o; risk assessment repo[t. The Seller may, at the Seller's option, within day.' after delivery of the addendum, elect in writing whether to correct the condition(s) pr~r to settlement. If the Seller will correct the condition, the Seller shall furnish the Purchaser with certification from a risk assessor or inspector demonstrating that the condition has been remedied before the date of the settlement. If the Seller does not elect to make the repairs, or if the Seller makes a counter-offer, the Purchaser shall have days to respond to the counter-offer or remove this contingency and take the property in "as is" condition or this contract shall becomev~id. ThePurchaser may remove this contingency at any time without WITNESS WHEREOF, the arties have here~nto set their IN ~ ~rti hands and seals the day and date first above written. Witness: J.~N K. ZlM~ERMAN, ~eller  f LARRY E. GOS~ARD, Purchaser ' SHERI L. GOSSARD, Purchasa~ COMMONWEALTH OF PENNSYLVANIA : :SS. COUNTY OF CUMBERLAND : ON this, the day of February, 1998, before me, a notary public, the undersigned officer, personally appeared JOHN K. ZlMMERMAN, known to me (or satisfactorily pioven) to be the person whose name is subscribed to the within instrument, and acknowledge that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunt.; set my hand and official seal. .. ,.q-..-.:::..- :.... · '.; .~;," OF ;;!!;,:f: ii.' Notary Public ~) -' .. c'" I NOTARIAL SEAL ' ;, '..' '.'3 ~ ~ ~-" ~ PATR~ D. ~Y~ ~ ~lc "-,,,' ~'/~ ~;'~[," Ha~T~.,~d~, PA My O~ ~ ~ust 27. COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND : ~ :'." ON this, the ~ , day of February, 1998, before me, a notary ~bblic, the undersigned officer, personally appeared LARRY E. GOSSARD and 8HERI L. GOSSARD, husband and wife, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledge that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. .' ',., ~, -~.:'~ ~ " NOTARIAL S~L J ~icl ,0/200,3 STONE LaFAVER & SHEKLETSKi Mortgage Amortiza~icn Page Jan 1/2003 Go Dec 1/20,33 /21~ ed [or: ZIMMERM~ Re: GOSSARD Years : 0.00 Principal: 52000.00 Payment : 450.00 Rate: 9.0009 Payment Frequency: Monthly C~mpcundei: 12 Interesl Factor 1.006666667 Payment Tozal interest Principal Balance Total llt ~'ate Number Paymenn Paymen~ Payment Loan Per Year Per Diem Dec 31/1993 Sub-Tonal 26,94.82 3ec ....... Sub-Tonal 4634.23 3e~ 31/2203 Sub-Tonal 3920.85 Dec 31/2731 Sub-Tokai 3~°°/~.!0 Dec 3-'2332 Sub-Tonal !665.16 Jan -2/23{1 5~ 4i9.~d0 299.09 150.91 44712.25 299.09 Feb 12/2023 59 453.30 298.08 151.92 4ii~}i } ~ 59S.~? 9.~S ?{?r 12,'23,3.3 61 450.,30 297.07 152.93 444;}7.40 894.24 Ac~ 12/2313 5! 45,3.00 296.05 153.9~ 44253.45 1199.29 ~.74 Hay i2/2523 82 459.00 295.02 154.98 44098.47 1485.31 9.7} Jun 12/23,13 63 450.00 293.99 156.01 43942.46 1779.30 9.67 Jul 12,'233.3 6'4 45~.:90 292.95 157.05 43785.41 20i2.25 9.64 A'lg 12/2303 68 453.00 291.90 158.10 43627.31 2364.15 9.63 SoD 12,'23,03 66 450.00 293.85 159.15 43468.16 2655.,33 9.57 Oc~ 12./2}.73 6! 450.00 289.79 160.21 43307.95 2944.79 9.53 Ncr 12/2303 68 459.00 28~.72 161.28 43146.67 1233.5! 9.59 Final Pa'./menz 43146.67 Principal Paii so Eahe 8803.33 inzeress Paid co 8ate 21746.67 ?ctal Paid zo Date 30600.00 ~. ~ O.S. REPORT SELECTIONS Report: Mortgage Amortization Layou[ Temp!aze: Ail Requested by: ADMIN Finished: Thursday, October 30, 2003 at 02:50:41 PM Date Range: Jan 1/2003 to Dec 1/2003 Name: ZIMMERMAN Re: GOSSARD Principal: 52000.00 Rate: 8.00 Payment: 450.00 Ver: 6.10b PNCBAN< May 1, 2003 David H. Stone ,[14 Bridge Street P.O Box E Ne~, Cumberland, PA 17070 R.E: Estate of John K. Zimmerman, deceased SSN: 174-05-1467 DOD: 2/12/2003 Dea: Mr. Stone: ]'n response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Accounts Acc runt #5140194559 Established 03/01 / 1974 JOHN K ZIMM~ IX)D balance: $9,515.89 + $1.00 seemed interest Acc ~unt #5140424633 Established 03/01 / 1980 JOHN K ZIMMERMAN DOD balance: $2,206.71 (non-interest bearing) Please note that this office only provides date of death bal_a._n, ees for doposit accounts (!R~s, CDs, Checking and Savings accounts). We do not proceu any finnncinl ~ra~,~saetlons or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Raehelle Wells 1.-800-762-1775 P7-PFSC-04-F ::00 first Ave. Pittsburgh PA 15219 Member I~DIC TOTAL P.01 · Kelley Blue B.ook Used Car Values Page 1 of 2 Kelley Blue Book '.,[ tsou.c[ MARKET WATCH. Enter emai, address kbbxom ue~,c'.~pr~cmg Blue Book Trade-ln Report Build a Car Incentives Pennsylvania · November 12, 2003 Quality Ratings Ownership Cost 1992 GMC Safari Minivan My Car's Value Used Car Retail Free Price Quote Buy a Used Car Sell Your Car ~4oto rcycles Financing Insurance Engine: V6 4.3 Liter Lemon Check Trans: Automatic Warranties Drive: Rear Wheel Drive Car Reviews Mileage: 100,000 Car Previews Decision Guides Equipment Advice 5 Passenger Power Steering Free Newsletter SLX AM/FM Stereo Air Conditioning ABS (4-Wheel) About kbb Home Shop over 50 Consumer Rated Condition: Fair models from "Fair" condition means that the vehicle probably has some 7 gr~t brands mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a Body Style professional in order to be sold. The tires need to be replaced. There may be some repairable rust damage. The value of cars in this Zip Code ~ category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. t~y~l~a, er Trade-In Value $690 Trade-in value represents what you might expect to receive from a '~ ...... ~"~k°~ .....~' dealer for this consumer owned vehicle. Keep in mind that the dealer ~'~,:?'~:~'~:~,~'. must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Get a Private Party Value Get Invoice & MSRP on New Cars http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;881314;PA041 & 17013;van+t;&278;GM... 11/12/2003 AmerUs Annuity Group Co. 555 South Kansas Ave Topeka. KS 66603 800/ANNUITY 888/ANNUITY ,ccs~lr~ str~ ICE, March 6, 2003 A~uity David Stone 414 Bridge St New Cumberland PA 17070 Re: American Investors Life Insurance Company Policy Number - 409376 Annuitant - John Zimmerman (Deceased) Dear Mr Stone: We were sorry to learn of the death of John Zimmerman and offer our deepest sympathy to his family and friends. Please read the enclosed General Instructions for Completion of the Annuity Death Claim Form. The instructions list the documents required to process the claim on policy ¢f-409376. Our records indicate the beneficiary designation is John Zimmerman. The Death Benefit provided by this policy is the Accumulated Value ($34,727.18) applied under a fixed period equal to five years or longer. We have enclosed an illustration of a five-year payout with monthly benefits for your review. Annual, semi-annual and quarterly payouts may also be chosen. We will be pleased to provide illustrations of alternative payout options for your review. In lieu of the Accumulated Value under a fixed period, the Beneficiary may elect to receive a lump sum payment of ($33,282.78) which is the larger of the Cash Surrender Value or the total Premiums paid under this policy less any Withdrawals. The death benefit will be paid with interest from the date of death to the date of payment or other settlement at the same rate that the Company would have credited if the Annuitant had not died. The credited rate is currently 7 percent. If you should have any questions or need illustrations of alternative payment options, please do not hesitate to contact our Customer Service Department at 1-888-ANNUITY. ~ ?.~9~ ~-,/" cc: Rocco Capuano A~y Iq/erriCton Claims S~ecialist Enclosures AMERICAN ~'NVESTORS LIFE DELTA LIFE & ANNUITY FINANCIAL BENEFIT LIFE IL ANNUITY -. AMERICAN INVESTORS LIFE INSURANCE CO., INC. March 6, 2003 SPECIAL DEATH BENEFIT PROVISION (5 YEARS) Zimmerman Policy Number 409376 Account Value $34,727.18 Payment $607.38 PER MONTH First Payment 3/6/2003 Last Payment 2/6/2008 Total Payments $36,442.70 Principal $34,650.03 Exclusion Ratio 0.00% Interest Rate 2.00% -. AmerUs Annuity Group Co. 555 South Kansas Ave Topeka, KS 66603 800/ANNUITY 888/ANNUITY ~Ct'SIOMER SER\'ICk,, March 6, 2003 ~_]~j~-/,~, Annuity Group David Stone 414 Bridge St New Cumberland PA 17070 Re: American Investors Life Insurance Company Policy Number - 405948 Annuitant - John Zimmerman (Deceased) Dear Mr Stone: We were sorry to learn of the death of John Zimmerman and offer our deepest sympathy to his family and friends. Please read the enclosed General Instructions for Completion of the Annuity Death Claim Form. The instructions list the documents required to process the claim on policy #405948. Our records indicate the beneficiary designation is Jennette Neely. The Death Benefit provided by this policy is the Accumulated Value ($37,431.87) appJied under a fixed period equal to five years or longer. We have enclosed an illustration of a five-year payout with monthly benefits for your review. Annual, semi-annual and quarterly payouts may also be chosen. We will be pleased to provide illustrations of alternative payout options for your review. In lieu of the Accumulated Value under a fixed period, the Beneficiary may elect to receive the Cash Surrender Value ($33,543.03) in a lump sum. The death benefit will be paid with interest from the date of death to the date of payment or other settlement at the same rate that the Company would have credited if the Annuitant had not died. The credited rate is currently 5 percent. If you should have any questions or need additional assistance, please do not hesitate to contact our Customer Service Department at 1-888-ANNUITY. ,~'~rely, ; ,/'~--v"t"/Ar~'/C'~//c-~ngt°n cc: Rooco Capuano 'Claims ?ecialist Enclosure AMERICAN INVESTORS LIFE DELTA LIFE & ANNUITY FINANCIAL BENEFIT LIFE IL ANNUITY .. AMERICAN INVESTORS LIFE INSURANCE CO., INC. March 6, 2003 SPECIAL DEATH BENEFIT PROVISION (5 YEARS) Zimmerman Policy Number 405948 Account Value $37,431.87 Payment $654.68 PER MONTH First Payment 3/6/2003 Last Payment 2/6/2008 Total Payments $39,281.00 Principal $37,431.87 Exclusion Ratio 95.29% Interest Rate 2.00% 2. Street Add e .. ,.. '~' ~ P.O, Box 2039, Topeka, KS 66601-2039 z,,co,, [?__._Ol.,~ -~£,~--~ ~; Typ'---~ofAn~uity: Source of~ 4. Telephone # 5.,,Socia! Security # 6. Birth,dat~ 7. Sex _/,(,Select ONE ONLY) 8. Name of Primary ~ ~ Non-Qualified (Select ALL that apply.) ~~_~_~_ ~,~ [] 1035 Exchange [] Internal Conv. of Poi.//__._._____ Name of Contingent Beneficiary ,-"_ ~ "J [] IRA (Select ALL that apphj.)  ~ [] Roth IRA [] Tax Year [] SEP/IRA [] Rollover Iwithin 60 days) ~ ~0 ...... ~ Z;a4~¢-¢4. ~ [] Direct Transfer from IRA/SEP 9. Name of Owner if other than Annuitant ~ [] Direct Transfer from Roth IRA Relationship to Annuitant [] Direct Transfer from 401(K); HRIO; 403(b); Pension Plan [] Roth Conversion Street Address [] Internal Cony, of City State Zip Code [] KEOGH / HR-l§ (Mark if applicable) [] TSA-403(b) Trans. [] Internal Cony. of Pol.#~ ~elep~one # Social Security// airthdate Sex [] POPSTi~.,,..~...rl Name of Joint Owner, if any 12. Premium submitted with application $ 13. Anticipated Premium From 1035 Exchange or Relationship to Annuitant Direct Transfer~. 0'~ 14. is this contract applied for to replace ~'~ i-~u~nce or annuity Street Address now in force? [] Yes ~ If "Yes" explain. Give policy nember and insurer. City State Zip Code 5. Special Requests: Terephone # Social Security # Birthdate Sex ( ) ~e Owner agrees to the following: (t) ~e answers ~ t~is application ale ~e to the ~t of ay knowledge and b~tief. (2) Tha effective date o! this Policy will t~e the Policy Date set by t~e Cornpe~y. ($) ~1o agent or person o~er t/tan the o/ricers named i~ the Policy/~s the autt?ofity to ~nge or modify th~s £oli¢y or wa~e any el its prov~ions. PAYME~ MUST 8E ~DE PAYABLE TO AMERICAN ttlVESTOR$ lIFE INSURANCE COMPA~IX DO IVOT t. IAtE AtVY CI'/ECK PAYABLE TO THE AGEfIT OR LEAVE TEE PAYEE 8LANK. O0 tlOT PAY IN CAStY. Any persm ~ /~7owing~/ and with intent to ~ef~aud any Insurance company or other person files an appl'mtion for insu~ce col~ i ' of ' ' nTislea~i,g, inforntat~n y~l~em_ing ~ y fa~/n~tWial//4e~to commie a fraudulent insurance ac~ wfl'-' '- .............. ta n~ any.. rnat~.r~, la.~. info..rnTation or conceals for the purpose Si ned at ' '-~ ...... ,-'~,*'- , .,~ ,~ , ~.-~,.~: w~u ~U~leCS ~u~ person ~o c~ inal ano .g F~ " Slgnature~ ~~-- Date~ ..L._..~ Signature of Owner if h~ ~ - ' ~. . o! O.w. ner_(if ~ an Annul' ~_______ ~gna~ure of Joint Owner{ [_&nv) ,'~ ' ~-~~ Agent's Replacemetlf~ f~i~ Will this a chart e ~, ............... "---'---'- Agent's Signature ~ ~--~~ a other insurance pohcy or annuity? [] Yes Agent's Name (Pri~ ~~ -------- "- -- AWAE (4/99) PA · 1. Name of AnnuitanJ..~_ j) ..,~,~ ~.,~ .. .. .... U,ox 2. Street Address~f ? ~' ~~ ~' ~ '- 10. Pla. PlO 3.6i~ . State Zip 11. Type of 4. Telephone ~ 5. So~ial Sa~uri~ ~ 6. Bi~hd~te, 7. Sex ~ ~on-~u~lilied ~ SEP I 8. N~me of Prima~ Benefi~ia~ ~ ~ Pension or Profit ~ KEOGH / HR-lO ~Oh~ ~,'~[(~ ~'~'~haring Plan Relationship to Annuitant ~ 12. Is This A: Name of Contingent Beneficia~ ~ ~35 Exchange ~Direm Transfer From ...... Relationship to Annuitant ~~ ~ ~ Conversion of Policy 9. Name of Owner if other than Annuitant 13. Premium submi,ed with application $ Relationship to Annuitant $ 15. Annui~ Date: Street Address If ~o specific date is requested, the Annui~ Date will be set at the later of the Policy anniversa~ following the Annuitant's age Ci~ State Zip Code 75 or the 15th Poliw anniversaw. The Annui~ Date may be no earlier than 15 years a~er the Policy Date of this Policy. Telephone ~ Social Securi~ ~ Bidhdate Sex ( ) 16, Is this contract applied for ~e ~y insurance or annui~ now in force? D Yes ~No Name of Joint Owner, if any If "Yes" explain· Give .policy number and insurer. Relationship to Annuitant Street Address Ci~ State Zip Code 17. Special Requests: Telephone ~ Social Securi~ ~ Bi~hdate Sex ( ) Th~ Owner agrees to the following (1) The ~s~ in ~ ~pli~on a~ ~e to the ~t of my knowl~ge and belie~ (2) The eflec~ve date of this Poli~ ~11 full initial premium is recei~d at ~e home o~, (3) No agent hm authofiF ~ ~ or modW contram or o~e~se bind the Com~ny PAYM~T M~ST BE MAOE PAYABLE TO AMERIC~ INVESTORS LI~ INSURANCE COMPA~ ~ NOT MAKE ANY CHECK PAYABLE D THE A~ENT OR L~ ~E PAYEE 8~K. DO NOT PAY IN A~ pe~on who kno¢ng~ ~d ~ in~nt to ddmud ~ imu~ com~ny or o~er pe~on filn ~ appt~ion ~r imu~e cohering ~y ~ f~e info~8m or for the pu¢ose of ~isleading, inlo~on con~ing ~ f~ mm~ ~eto comm~ a ~udulent ~u~n~ ~, ~ich ~ a c~me aM sub~ su~ ~ to criminal ~d dvit Signeda ~ // /. ~' L~~, ~ Dine ,6 ~3 O~ Signature of Annuitanl ~ ~~~ Signature of Owner ( ~han A~) Signature of Joint O~ ~if any) ~ Agents Replace~ ~tion: Will t~nui~ repine or change another insu~nce policy or annulS? ~ Yes ~o If ..... Yes, exCam~ndand ~lete any reSult, replacement forms. AgenfsSignature ' ~ ~ ~ Agent's Name (Print) '~ (~~ ' Telephone No~ Agent's Number ~ .... --'~ ~ Agent's License Number AP~ P10 (2~) PA AP~ m0 (2~6) PA COMMONWEALTH OF PENNSYLVANIA '~ ss: COUNTY OF CUMBERLAND j J, William Zimmerman being duly ~n~n according fo law, deposes and saY~rof~azJ~ l~e. _is the Executor ....... 7.1mmerman a/]~/a of the Estate of John Kenneth Zim~.erman late of ~_ar.!i_s_!_e__B_orough ., Cumberland County, Pa., deceased and that the within is an inventory made by J_ wi ] ] i nm ~mmern/an , the said Executor of the entire estate of said decedent, cons~sflng of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of +he Inventory represent it's fair value as of the date of decedenf's death. and subscribed before me, i Z i~ml5~th Street ___ New Cumberland, PA 17070 Date of Death 12 02 2003 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be f~led within thirty days of discovery of additional a~s~s. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , Inventory of the real and personal estate of John K. Zimmerman a/k/a John Kenneth Zimmerman deceased Inventory Estate of John K Zimmerman From 02/12/2003 To 10/31/2003 Description Accrued Income Value Total Form 706 Schedule A Other Real Property Property located at 48 N. East St. 44,712.1~5 Residences Property located at 617 N. East St. 103,525., 0 148,237 5 Form 706 Schedule C Cash on Hand American Investors-monthly checks 380.48 Legionaire Insurance Trust-monthly 52.61 433 ,9 Checking Accounts PNC Bank-Checking Acct. #5140194559 1.00 9,516.89 PNC Bank-Checking Acct. #5140424633 2,206.71 11,723 50 12,156 69 Form 706 Schedule F Household Goods & Furnishings Net proceeds on household goods 230 00 Misc. Personal Property 1977 Bonneville sold to Jim Doyle 5,500.00 1992 GMC Sahara Minivan 690.00 6,190 00 Refunds Highmark, Inc.-refund 59.97 Erie Insurance Group-refund on home 68.00 127 97 6,547 97 166,941 91 COHHONNEALTH OF PENNSYLVANIA ~. BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE ZNHERZTANCLTAX DT~Z$IDN DEPT. 1806~. HARRZSBURG,,PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISENENT, ALLO#ANCE OR DISALLOgANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-IE~TEXAFP(OZ-DS) DATE 01-19-2004 ESTATE OF ZIHHERHAN JOHN K DATE OF DEATH 02-12-2005 FILE NUNBER 21 05-0162 " COUNTY CUNBERLAND DAVID H STONE ACN 101 414 BRIDGE ST Amount Remitted NEN CUHBERLAND PA 17070 HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF ZIHHERHAN JOHN K FILE NO. 21 03-0162 ACN 101 DATE 01-19-2004 TAX RETURN gAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. ReaZ Estate (Schedule A) (1) 148~237.25 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, $. Closely Held Stock/Partnership Interest (Schedule C) ($) .00 submit the upper portion fi. Hortgages/Notes Receivable (Schedule D) (~) .00 of this form with your $. Cash/Bank Daposits/Nisc. Personal Property (Schedule E) (5) 18;704.66 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) $4z717.18 8. Total Assets (8) 201,669.09 APPROVED DEDUCTIONS AND EXEHPTZONS: 16,576.18 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgaga Liabilities/Liens (Schedule Z) (10) .00 11. Tote1 Deductions (11) 12. Net Value of Tax Return (12) 185,092.91 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 1~. Net Value of Estate Sub~ect to Tax (lq) 185,092.91 NOTE: Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spouse/ ra*e (15) .00 X O0 = .00 16. Amount of L/ne 1~ taxable at Lineal/Class A rata (16). 185,092.91X 045 = 8,$29.18 17. Amount of Line lq at Sibling rate (17). .00 x 12 = .00 18. Amount of Line lq taxable at CollateraZ/CZass B rate (18) .00 X 15 = .00 19. PrincipaZ Tax Due (19)= 8,519.18 TAX CREDITS: PAYHENT R[C[ZPT DZSCOUNT ANOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 05-08-200~ CD0025~7 ~68.42 7,000.00 11-14-2005 CDO0$Z$O .00 960.76 TOTAL TAX CREDZT 8,519.18 BALANCE OF TAX DUE J .00 INTEREST AND PEN. I .26 TOTAL DUE I .26 IF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE IS LESS THAN $1) NO PAYHENT ZS RE~UZRED. FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: Estates of decadents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any astata for life or for years, the Commonwealth hereby expressly reserves the right to appralsa and assess transfer Inheritance Taxes at the leafu! Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). PAYHENT: Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1213). Applications ara available at the Office of the Register of #ills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for fores ordering: 1-&OO-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance 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. Z810Z1, Harrisburg, PA 171ZS-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered an 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 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (2) calendar months after the decadant's death, a five percent (Sg) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18j 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa 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 Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent par annum calculated at a daily rate of ,000164. AIl taxes which became delinquent on and after January 1, 1982 will bear interest at a rote which will vary from calendar year to colander yeor with thor rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOX .000548 1987 9X .000Z47 1999 7Z .00019Z 1985 16Z .000438 1988-1991 llZ .000201 ZOO0 8Z .000219 1984 llZ .000201 1992 9Z .000247 2001 9Z .000247 1985 13Z .000256 1995-1994 7Z .O0019Z ZOO2 6Z .000164 1986 IOZ .000Z74 1995-1998 9Z .000Z47 ZOO3 SZ .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must be calculated. REV-1470 EX (6-88) - INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 DECEDEN3'S NAME FILE NUMBER Zimmerman, John K. 2103-0162 REVIEWED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G 2 To be billed directly by the Department. ROW Page 1 STATUS REPORT UNDER RULR 6.17 Name of Decedent: John K. Zimmerman a/k/a John Kenneth Zimmerman Date of Death: February 12, 2003 Will No. 21-03-0162 To the Register: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: (a} Did the personal representative file a final account with the Court? Yes No X (b) The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes X No (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may b9 filed with the Clerk of the Orphans' Court ~ alRt~¢hed to this '.[.~ Dav~e ', Esquire ,.. 414 Bridge Street '~- New Cumberland, PA 17070 i~ 717-774-7435 ~-" Capacity: Personal Representative ' ~ · ~.-.~" X Counsel for Personal · '.mi :~ Representative est\rel\zimmermanbill IN RE: ESTATE OF JOHN K. ZIMMERMAN: IN THE COURT OF COMMON PLEAS OF A/K/A JOHN KENNETH : CUMBERLAND COUNTY, PENNSYLVANIA ZIMMERMAN, : LATE OF THE BOROUGH OF : CARLISLE, CUMBERLAND COUNTY: ORPHANS' COURT DIVISION PENNSYLVANIA : NO. 21-03-0162 RECEIPT, RELEASE AND WAIVER OF ACCOUNTINC KNOW ALL MEN BY THESE PRESENTS, that I, J. WILLIAM ZIMMERMAN, being the sole beneficiary under the will of JOHN K. ZIMMERMAN A/K/A JOHN KENNETH ZIMMERMAN, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of JOHN K. ZIMMERMAN A/K/A John KENNETH ZIMMERMAN, in full satisfaction and settlement of all of my rights and claims under his estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, J. William Zimmerman, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as afore- said, and of and from all actions, suits, payments, accounts, reckon- ings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the ~ day of ~~.~ , 2004. COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : On this, the %~ day of~ , 2004, before me a Notary Public, the undersigned officer, personally appeared J. William Zimmerman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. Notary Public TAn~AL SEAL ~OL L ~OXELL, N~ ~o~o. Cumberland Co~ - 2 - off ~xplr~ ~c. 27, 2005] BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE .....<:h !'-MQtfic€illF INHERITANCE TAX APPR.A.XSEKENT..L... ALLONANCE OR DISALLONANCE OFDEDUCTION~. AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS '* REV-1548 EX AFP 112-04) r")Q . ,:'0 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 02-07-2005 ZIMMERMAN 02-12-2003 21 03-0162 CUMBERLAND 174-05-1467 04001795 Allount Rellitted JOHN K JENNETTE NEELY 59 NORTH EAST STREET CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-y=is4-i-Ex--AFP--foi-:oil------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-07-2005 ESTATE OF ZIMMERMAN JOHN K DATE OF DEATH 02-12-2003 COUNTY CUMBERLAND FILE NO. 21 03-0162 TAX RETURN WAS: S.S/D.C. NO. 174-05-1467 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 04001795 FINANCIAL INSTITUTION: AMERICAN INVESTORS LIFE ACCOUNT NO. 405948 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 01-01-2003 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 37.431.87 1. 000 37.431.87 .00 37.431.87 .15 5.614.78 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 02-15-2005 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 5.614.78 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 299.13 TOTAL DUE 5.913.91 . IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR). YOU MAY BE DUE A REFUND. ~~~ R~U~RS~ SYOE OF THYS FORM FOR INSTRUCTIONS. ) ~ ..........-----.-_~~_~_..,r_~_~...,.....-__~~__ '-'c==-'AR J 8 200. ~,-" I IN RE ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN K ZIMMERMAN ORPHANS' COURT DIVISION DECEASED NO. TERM r' "" ~.-t! - ()3. -l'\ IU) 1-- ORDER Now, to wit this the L ry I ~ day of Vi,;(.0 LL 2.607 ' upon consideration of the I foregoing Petition, it is ORDERED and DECREED that YOU, Jennette Neely, Transferee for the Estate of John K. Zimmerman, deceased, are hereby cited to be and appear at Courtroom No. ...l 'vY) {lei I ' on the ItJ It[, day of 1// tU;j- /) , in the Courthouse of Cumberland County, Pennsylvania, at .M., then and there show cause, if any there be, why the Inheritance Tax in said estate should not be paid; and to further direct that the cost of this action be borne by the said Transferee; said citation returnable at/b;'!f.(t.: on the ICI'Jay of ~, 2017. BY THE COURT .~ \ \ ,-' /II':'.~: Ii, " i // / /.. a. DIVISION 1. . \' r:'-l ,'r In Re: ESTATE OF JOHN K ZIMMERMAN DECEASED ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-03-0162 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 03-27-07 JUDGE'S INITIALS: JWO TIME STAMP DATE: 03-27-07 IN RE: ORDER SERVICE TO: JENNETTE NEELY AND ANASTASIA DIBARTOMOMEO(DEPT OF REV) METHOD OF MAILING: ENVELOPES PROVIDED BY: t:8:I USPS DRRR D HAND DELIVERED D OTHER_ D PETITIONER D JUDGE t:8:I CLERK OF ORPHANS COURT MAILED: 03-28-07 SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: D USPS DRRR D HAND DELIVERED D OTHER_ D PETITIONER D JUDGE D CLERK OF ORPHANS COURT MAILED: 0.~t ~ Clerk of Orphans' Court .. IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN K. ZIMMERMAN, ORPHANS' COURT DIVISION DECEASED 21-03-0162 IN RE: PETITION FOR CERTIFICATION ORDER OF COURT AND NOW, this 10th day of May, 2007, upon consideration of the Petition for Certification in the above-captioned matter, and following a hearing, which has not yet been completed, the record shall remain open, and a further hearing is scheduled in this matter for Thursday, May 31, 2007, at 3:00 p.m., in Courtroom Number 1, Cumberland County Courthouse, Carlisle, Pennsylvania, at which time and place Jennette Neely is directed to appear. The purpose for this continuance lS to afford Ms. Neely an opportunity to secure counsel in the matter if she chooses to, and to facilitate the acquisition of paperwork relating to the bank account which is the subject of this proceeding. Jennette Neely is directed to produce said paperwork at the hearing as continued, and is further directed to supply to Petitioner any releases for information respecting this account that Petitioner requests. By the Court, J. J. f'-..) ':~~J C':::""'J -_J Lora A. Kulick, Esquire Room 1032, Strawberry Square 4th and Walnut Streets Harrisburg, PA 17128-1061 For Petitioner .i..,';.:a -< ..e:- ...,.., \.-' Jennette Neely 59 North East Street Carlisle, PA 17013 ill :mae :r .. . In Re: JOHN K ZIMMERMAN ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-03-0162 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 05-10-07 JUDGE'S INITIALS: JWO TIME STAMP DATE: 05-14-07 IN RE: ORDER OF COURT-PETITION FOR CERTIFICATION SERVICE TO: LORA A KULICK ESQ FOR PETITIONER JENNETTE NEELY METHOD OF MAILING: ENVELOPES PROVIDED BY: ~ USPS DRRR D HAND DELIVERED D OTHER_ D PETITIONER ~ JUDGE D CLERK OF ORPHANS COURT MAILED: 05-15-07 """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: D USPS DRRR D HAND DELIVERED DOTHER_ D PETITIONER D JUDGE D CLERK OF ORPHANS COURT MAILED: ~:J epty Clerk of Orphans' Court IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ORPHANS' COURT DIVISION ESTATE OF JOHN K. ZIMMERMAN, DECEASED NO. 21 03-0162 PRAECIPE TO DISCONTINUE WITHOUT PREJUDICE To Glenda Farner Strasbaugh, Clerk of Orphans' Court and Register of Wills: The above-captioned action is a Citation for failure to pay inheritance tax. Please mark this action discontinued without prejudice upon paYment of costs by the Estate as the transferee of the Estate entered into a deferred paYment plan with the Department, agreeing to pay the inheritance tax due in monthly installments. DATE: May 25, 2007 -,' .I ~~~ Lora A. lck Attorney for Petitioner PA Department of Revenue Office of Chief Counsel P.O. Box 1061 Harrisburg, PA 17128-1061 Attorney I.D. No. 69436 C'.j ell C'..J ..........:..- r-- c-:,~...,. J OFFICE OF CHIEF COUNSEL P.O. BOX 1061 HARRISBURG, PA 17128-1061 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ;- May 25, 2007 Lara A. Kulick Direct Dial: (717) 346-4644 Fax: (717) 772-1459 Ikulick@state.pa.us Glenda Farner Strasbaugh Clerk of Orphans' Court and Register of Wills Cumberland County Court of Common pleas Orphans' Court Division Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 VIA EXPRESS MAIL Re: Estate of John K. Zimmerman, deceased Court of Cornmon Pleas of Cumberland County Orphans' Court Division No. 21 03-0162 Citation for Failure to Pay Inheritance Tax Dear Ms. Farner Strasbaugh: Enclosed for filing please find an original and one copy of the Commonwealth of Pennsylvania, Department of Revenue's Praecipe to Discontinue the Citation issued in the above- captioned Estate for failure to pay inheritance tax. please file the original and time-stamp the copy and return it to me in the enclosed, self-addressed, stamped envelope. As this matter has been discontinued, please be advised that the May 31, 2007 hearing regarding it should be removed from the Court's docket. Please contact me if you have any questions. Thank you for your assistance. Sincerely, Lora A. Kulick Senior Counsel Enclosures ... -r~..J cc: Honorable J. Wesley Oler, Jr. Jennette Neely Anastasia L. Dibartolomeo t" ", \..'- LAK:seh #21185 c n, " . MAY 3 e ZDU1p,d IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF JOHN K. ZIMMERMAN, DECEASED ORPHANS' COURT DIVISION NO. 21 03-0162 ORDER OF COURT AND NOW, this .~ I ~ t- day of (n'l , 2007, upon consideration of a Praecipe to Discontinue Without Prejudice the within action, the Motion is granted, the Rule is dismissed and the Citation is discharged upon paYment of costs by the Estact:e. 1-- Q,~ "'-C '-,~-~ r , f~~~~' .' Ll .... L c:; I, ts I .. '_. ....~ ._-1 ---) r-- =, . ":.:~.' ;...~-......: ~ ~ ,I/} ;7/ ~.!_/~6/ ~~~ BY .THE COURT: ~~Ad ~11fi-11/)/ .3 .. In Re: JOHN K. ZIMMERMAN ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-03-0162 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 05/31/07 JUDGE'S INITIALS: JWO TIME STAMP DATE: 06/01/07 IN RE: ORDER OF COURT """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" SERVICE TO: LORA KULICH ESQ JEANETTE NEELY METHOD OF MAILING: ENVELOPES PROVIDED BY: [8J USPS DRRR o HAND DELIVERED o OTHER_ o PETITIONER [8J JUDGE o CLERK OF ORPHANS COURT MAILED: 06-01-07 """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""".., SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: o USPS DRRR o HAND DELIVERED o OTHER_ o PETITIONER o JUDGE o CLERK OF ORPHANS COURT MAILED: & Um-? ~leru of Orphans' Court ~.~ ,~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NEELY JENNETTE 59 NORTH EAST STREET CARLISLE PA 17013 Pennsylvania DEPARTMENT OF REVENUE REV-1165 IT DOCEXEC (12-10) NOTICE OF ASSESSMENT TAX AMNESTY NONPARTICIPATION PENALTY FILE NUMBER :............................ 2103-0162 ESTATE NAME ............................ JOHN K ZIMMERMAN NOTICE DATE :............................. December 17, 2010 ASSESSED PENALTY DUE:........ $394.62 Inquiries : 717-787-8327 Special Speaking/Hearing Needs Hotline: 1-800-447-3020 Appeal Due Date: February 15, 2011 If due date is on a weekend, petition may be filed the next business day. BASIS OF ASSESSMENT TAX AMNESTY NONPARTICIPATION PENALTY The account identified above was notified of the opportunity to participate in Pennsylvania's Tax Amnesty program, which ran from April 26 to June 18, 2010. During the Tax Amnesty program, the Department of Revenue waived all penalties and half the accrued interest for anyone who filed and paid state taxes delinquent as of June 30, 2009. In accordance with Act 48 of 2009, any taxpayer who failed to take advantage of this limited opportunity is subject to a 5 percent nonparticipation penalty. Department records indicate this taxpayer did not participate in the 2010 Tax Amnesty program or the taxpayer's tax amnesty application was denied. Therefore, the 5 percent nonparticipation penalty applies to all amnesty-eligible periods and was calculated on the balance of remaining tax, penalty and/or interest. This assessment may be appealed by petitioning the Board of Appeals. However, the board will only consider petitions contesting the 5 percent nonparticipation penalty assessment, because the appeal period(s) expired for the overdue tax, interest and/or other penalties that serve as the basis of this assessment. See reverse for appeals information. The assessed penalty due includes only the 2010 Tax Amnesty 5 percent nonparticipation penalty. To make payment, call 717-787-8327 for the current balance, then make check payable to REGISTER OF WILLS, AGENT. Include the file number on the check, provide a copy of this assessment notice along with the check and mail payment to: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 n ~ ~ zj ;. r-- r ~. ~: ~ i ~, r::7 . 7 ' ~ - ,_ - ::~ ^~) L ~ ~.~ .~~ r~~ C__. t '~ ~'~ ~I . ~ ,,~ ~ C~.' "' ~ 7 GENERAL APPEAL INFORMATION PETITION FOR REASSESSMENT An appeal may be filed electronically at www.boardofanaeals.state.~a.us or Any taxpayer against whom an assessment is made may petition for a in writing using a petition form (REV-65) and appeal schedule (REV-39). record adjustment electronically or in writing within 60 days of the Forms are available online at www.revenue.state.na.us or by calling assessment notice date. Petitions must set forth in reasonable detail the 1-888-728-2937. grounds upon which the taxpayer claims the assessment is erroneous or unlawful. Each Petition must contain the following: 1. Name and Address of Taxpayer The department may require the filing of a bond or other security from 2. File Number anyone petitioning for reassessment. If required, a bond must be issued by 3. Notice Date a surety company authorized to do business in Pennsylvania and approved 4. Estate Name by the Insurance Commissioner. 5. Assessed Penalty Due (call 717-787-8327 for current amount due) FILING OF LIEN Each Petition must be signed and include an affidavit or affirmation that the The department must receive full payment or an appeal petition in the allotted time or a lien may be filed against the taxpayer for the assessed facts contained are true and correct. If filing electronically, refer to the " " liability. signature tab on the Board of Appeals online petition form. if filing an appeal by mail, send to: PA DEPARTMENT OF REVENUE BOARD OF APPEALS PO BOX 281021 HARRISBURG, PA 17128-1021 An appeal is considered to be timely if: (a} It is electronically submitted by 11:59 p.m. Eastern Time on or before the appeal due date; or (b) It is submitted in writing and bears a U.S. Postal Service postmark on or before the appeal due date. The Board of Appeals will hold hearings upon petitions as necessary, and a taxpayer will be notified of the time and place of any hearings. PAYMENT OF ACCOUNT: The assessed penalty due includes only the 2010 Tax Amnesty 5 percent nonparticipation penalty. To make payment, call 717-787-8327 for the current balance, then make check payable to REGISTER OF WILLS, AGENT. Include the file number on the check, provide a copy of this assessment notice along with the check and mail payment to the appropriate County Register of Wills. OTHER CHARGES • Per Act 40 of 2005, any case referred to a collection agency may be subject to additional fees, including but not limited to attorney's fees and collection fees up to 39 percent of the liability not paid before referral. Questions to the Board of Appeals may be directed to 717-783-3664. Other options for voicing objection include appealing to the Orphans' Court or filing election to have the matter determined at the audit of the account of the personal representative. •'" FILE NUMBER :............................ 2103-0162 CALCULATION DETAIL: 2010 TAX AMNESTY NONPARTICIPATION PENALTY ESTATE NAME JOHN K ZIMMERMAN TAX TYPE: INHERITANCE TAX ACN Liability NPP Penalty ACN Liability NPP Penalty ACN Liability NPP Penalty 04001795 7,892.40 394.62 Total 2010 Tax Amnest Non artici ation Penalt $394.62 NOTE: Liability includes tax, interest and/or penalties. NPP Penalty is the 2010 Tax Amnesty 5 percent nonparticipation penalty authorized by Act 48 of 2009. For the current payoff amount call the BUREAU OF INDIVIDUAL TAXES at 717-787-8327.