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HomeMy WebLinkAbout02-27-12 (2)1505610140 RED-.1500 ~` ~~,-,~, PA Department Of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Counly Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 1 2 9 7 _- Hamsburst, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMAT1ON BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 0 2 2 7 3 0 9 1 1 2 9 2 0 1 1 0 4 1 0 1 9 2 9 Decedent's Last Name Suffix Decedent's First Name MI Z I M M E R M A N M A R Y M (If Applicable) Errter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death pnorto 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA7'~N SHOULD BE DStECTEO T0: Name Daytime Telephone Number H U B E R T X G I L R O Y 7 1? 2 4 3 3 3 4 1 REGISTER OF WILLS ONLY N First line of address ~ C*'I ~ ~,%. M A R T S O N L A W O F F I C E S ~ ~ ~ ,,.~ Second line of address ~~ r„ '~ ~ ~~~ 1 0 E H I G H S T ~ s City or Post Office State ZIP Code ~ FILED C] Gf1 ~. C A R L I S L E P A 1 7 0 1 3 ""~ t:on espondent's e-mail address: H G I L R O Y a M A R T S O N L A W• C O M Under penakfes of perJury, I are that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, k itue, correct and aratbn of preparer other than the personal representative is based on all information of which preparer has any RSON F ING RETURN DATE , 2 ADDRESS 100 HA ON LANE CARLISLE PA 170 S RER OTHER THAN REPRESENTATIVE DAT~ d ADDRESS. 10 E H H STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505610140 Side 1 1505610140 J ~ar~- 1505610240 REV-1500 EX .Decedents Social Security Number DecedeM~sName: MARY MACLAY ZIMMERMAN ,2 0 0 2 2 7 3 0 9 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 0 . 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 6 7 9 7 4 . 8 7 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 1 4 5 6 9. 4 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 5 6 7 0. 8 1 7. Inter-vvos Transfers & Miscellaneous N -Probate Property arate Billin Re uested ~ Se h d l S G 7 4 ~ 8 2 6 3. 4 1 g ....... p q u ( c e e ) . 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 6 8 6 4 7 8. 5 3 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 1 8 9 0 7. 3 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 2 1 6 8 . 9 0 11. Total Deductions (total Lines 9 and 10) ............................... 11. 2 1 0 7 6. 2 6 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 6 6 5 4 0 2. 2 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 1 D 0 D . 0 0 14. Net Valus Subject to Tax (Line 12 minus Line 13) ...................... 14. 6 6 4 4 0 2. 2 7 TAX CALCULATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) x.o _ D. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 6 6 4 4 0 2 2 7 2 9 8 9 8 1 0 at lineal rate x .045 . 1 s. . 17. Amount of Line 14 taxable 0 D 0 17 0 D D et sibNng rate X .12 . . . 18. Amount of Line 14 taxable 0 0 0 0 0 D at collateral rate X .15 . 18. . 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE. REQUESTING A REFUND OF AN OVERPAYiNENT 2 9 8 9 8. 1 0 Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent"s Complete Address: DECEDENTS NAME MARY MACLAY ZIIvilviERMAN STREET ADDRESS 1000 WEST SOUTH STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2 Credits/Payments A. Prior Payments B. Discount 1,494.91 3. Interest 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number 21 11 1297 (1) 29,898.10 Total Credits (A + B) (2) 1,494.91 (3) (4) 0.00 (5) 28,403.19 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the Property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of ether payments, benefits or care? ....................................................... ^ 2. If death oaxlrred after Der~mber 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an'in trust for' orpayable-upon-death bank acxwunt or security at his or her death? ......... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefiaary designation? .................................................................................................. ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~... *~ For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (aj (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 stiN applicable even 'rf the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on a net value of transfers from a deceased child 21 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 percent [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 percent, except as noted in 72 P.S. §9116(12): [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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (&98) scH~ou~E s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY M. ZIlVIMF.RMAN 21 11 1297 All properly jolMly-0wned with right of wrvivorship must bs disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 400 shares, The PNC Financial Services Group, Acct. No. 00009825941, CUSIP No.693475105 20,344.00 at 50.86 2. (14206.76 shares, Franklin Money Fund, Acct. No. 21484091, CUSIP No. 354014102 at $1.00; I 14,243.12 + cash in account $36.36 3. 13105.837 shares, PIMCO Total Return, Class C, CUSIP No. 693390429 @10.75 I 33,387.75 (Wells Fargo, Acct. No. 1077-2978) TOTAL (Also enteral line 2, Recapitulation) ~ S (If more space is needed, k~aert additional sheets of the same size) REV-1508 EX + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY M. 21 11 1297 Include dle of Ikigation and the date the proceeds were received by the estate. Allowned with M of wrvivonthip moat M diecio~ed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank, Savings Acct. No. 15004222002492 70,029.54 2. M&T Bank, Checking Acct. No. 9838887405 34,121.75 3. PSE1tS prorated monthly benefit for November, 2011 1,024.40 4. Aetna PEBTF medicap insurance, premium refund 393.75 5. Marco Island Florida, The Charter Club timeshare 9,000.00 TOTAL (Also enter on line 5, Recapitulation) ~ S 114,569.44 (If more space Is needed, insert additional sheets of lire same size) REV-1509 EX~ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY MARY M. ZIIyIlVIERMAN 21 11 1297 Man asset was made jointty owned within one year of the decedent's date of death, it must be reported on Schedule G. 18 Aladdin Road Windham, NH 03087 RELATIONSHIP TO DECEDENT ADDRESS SURVNING JOINT TENANT(S) NAME(S) A. Ann K. Bazber B. Cazol K. Robison C. JOINTLY-0WNED PROPERTY: Daughter fTEM NUMBER LETTER FOR JOINT TENANT GATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF RNANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI 1. A 5/1998 748.7162 shares, common, Fulton Financial Corporation 6,614.91 50. 3,307.46 CUSIP 360271100 @ 8.835 2. B 8/2007 1590 shares, common, AT&T Inc., Acct. No. 03003702382 44,726.70 50. 22,363.35 CUSIP 002068102 @ 28.13 1004 Shannon Lane Cazlisle, PA 17013 TOTAL (Also enter on one 6, Recapitulation) I S 25,670.81 If more space is needed, use additional sheets of paper of the same size. REV-1510 E:X+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIL>ENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUMBER MARY M. ZIlVIMERMAN 21 11 1297 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY N~KXUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHE' TO DECEDENT AND THE DATE OFTRANSFER.ATi/IdiACOPYOFTHEDEEDFORREALESTATE DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION ~FArruc~et~ TAXABLE VALUE 1. AXA Equitable, Annuity Contract No. 303743196; 183,848.24 100.00 183,848.24 Beneficiaries: Ann K. Barber and Cazol K. Robison, daughters (see attached) 2. Allstate Preferred Performance Annuity Contract AC1113818A; 58,948.20 100.00 58,948.20 Beneficiaries: Ann K. Bazber and Cazol K. Robison, daughters (see attached) 3. Western National Annuity Contract AN200971; 197,847.95 100.00 197,847.95 Beneficiaries: Ann K. Barber and Cazol K. Robison, daughters 4. Western National Annuity Contract AN203094; 37,619.02 100.00 37,619.02 Beneficiaries: Ann K. Barber and Cazol K. Robison, daughters 0.00 _ TOTAL (Also enter on Line 7, Recapitulatiat) ~ S 478,263.41 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10.09) penlnsylvania DEPARTMENT OF REVENUE INNERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY M. ZIIyIMERMAN 21 11 1297 Decedents debts must be mported on Schedub I. ITEM -- - NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 2,912.07 2. Patti Plasterer (organist) 100.00 3. Rev. Mark Medina 125.00 4. Rev. William Harder 125.00 5. Shull-Koonta (headstone inscription) 116.00 6. Royer's Flowers 134.59 B, 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP p, Attorney Fees: Manson Law Offices 3, Fami~ Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Register of Wills 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Inheritance tax return filing fee 8. Stock valuation reports 9. M&T Bank checkbook fee 10. Reserve for miscellaneous filing fees and expenses 14,500.00 356.50 15.00 6.20 17.00 500.00 TOTAL (Also enter on Line 9, Recapitulation) I ~ 18,907.36 If more space is r~eded, use additanal sheets of paper of the same size. REV-1512 EX+(12-08) Pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MARY M. ZDywt~ 21 11 1297 Report deals incurred by the decedent prior b destlt that remained unpaid at the date of death, including unreimbursed medical e~x{drnses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sarah Todd Memorial Home 919.29 2. Millennium Pharmacy Systems, Ina 60.02 3. Reading Foot and Ankle, P.C. 181.52 4. M&T Bank checking, outstanding check 1,008.07 TOTAL (Also enter on Line 10, Recapitulation) I S If more space is needed, insert additional sheets of the same size. REV-7513 EX+ (pt-10) Pennsylvania ~ SCHEDULE J DEPARTMENiOFREVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARV M 7TMMRRMAN 21 11 1297 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pnclude ouhy~ht I distr~utlons and transfers under Sec. 91 f6 (a (1.2).] 1. Ann K Barber Lineal 3,307.46 18 Aladdin Road Sch. F, Item 1 Windham, NH 03087 2. Ann iK. Barber Lineal 239,131.70 18 Aladdin Road 1/2 Sch. G, Items 1-4 Windham, NH 03087 3. Ann K. Barber Lineal 80,234.03 18 Aladdin Road 1/2 Residue Windham, NH 03087 4. Carol K. Robison Lineal 22,363.35 1004 Shannon bane Sch. F, Item 2 Carlisle, PA 17013 5. Carol K. Robison Lineal 239,131.71 1004 Shannon Lane 1/2 Sch. G, Items 1-4 Carlisle, PA 17013 6. Carol K. Robison Lineal 80,234.02 1004 Shannon Lane 1/2 Residue Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON=tAXABLE DISTRIBUT~NS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Hood College 1,000.00 401 Rosemont Avenue Frederick, MD 21701 TOTAL OF PART II -.ENTER TOTALNON-TAXABLE DISTRIBUTIONS ON LINE 13 Of REV-1500 COVER SHEET. S 1 000.00 If more space is needed, use additional sheets of paper of the same size. 1~~T~3~~nk 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502.4349 Fax (302) 934-2955 December 7, 2011 Carol Robison 1004 Shannon Lane Carlisle, PA 1'7013 Re;_ Estate of Mary Maclay Zimmerman Social Security: 200-22-7309 Date of Death:.November 29, 2011 } ar it of lVladam: _ Per your inquiry on December 1, 2011, please be advised that at the time of death, the above-nalned decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 9838887405 Ownership (Names o• fl Mary Malay Z.i»vnennan Ann K Barber (POA) Opening Date 01/16/05 Balance on Date of Death $34,121.37 Accrued Interest $ .38 Total $34,121.75 ---------------------------- 2. Type of Account Savings Account Account Number 15004222002492 Ownership (Names o• fl Mary Maclay Zinunennan Opening Date 10/04/11 Balance on Date of Death $70, 012.75 Accrued Interest $ 16.79 Total $70.029 54 . ---------------------------- Sc1,. E, ~~em5 I ~a ~ For any additional hdormatioa on the above accounts, inclading ownershfp and any changes, closures and/or rdmbursemeat of funds, please call the Eitmbethtown O®ce at#7173671{904. We were arable to locate any safe deposit bos for the above-mentioned decedent. 17d9 letter does not iadnde any accounts io whkh the deceased may bare been listed as Power of Attorney, f~.vtodian of U~form Tran9f~s, Rive Payer, ~ 1Yvstee under a Written Agreement ' Sincerely, ~ n~ ~Y L.. Taznmy Spencer Adjustment Services SCh.~, Z~~mS ~'~ ~ AXA EC~UITABLE iredeflntng/standard s December 14, 2011 Martson Law Office Attn: Melissa l0 East High St Cazlisle PA 17013 1tE: Contract No.: 303743196 Annuitant: Mary M Zimmerman Claim Pending -Important Information Deaz Melissa: This is in reply to your inquiry. The value of this account as of November 29, 2011 clos' What To Do Neat If you have any additional questions or if we can be of any further assistance, please contact our Client Services Department at 1-800-789-7771, Monday through Friday, 8:30 A.M. to 5:30 P.M. Eastern time. If you wish to contact me directly, you may do so by writing to the address below. mce el ~ic ae~Dwy' er Death Claim Team Leader .. CC: John T Lauer AXA Advisors 1701 W Mazket St York PA 17404 AXA Equitable Life Insurance Company 500 Piaza Drive, 6'" Floor, Secaucus, NJ 07094 ~. CAROL K ROBISON 1004 SHANNON LANE CARLISLE PA 17013 Allstate Life Insurance Company Telephone: 1-800-755-5275 PO Box 660191 Fax: 1-86&628-1006 Dallas, TX 75266-0191 RE: Original Allstatee Preferred Performance #i3A18425952 Your leave Alistatee Preferred Performance #AC71t38188 Dear Carol K Robison: nr ..... tom. Transaction Trmtaattion ~ ~~ Mvestntsrtt 'tar >ftis Traction Ttarasctiort Date Type Aherttative Trattsacdon Unft Velus Amount 01 /03/12 Total Claim 1 Year Guarantee Period N!A N!A $-58,948:20 The second table confirms the investment alternatives to which- your portion of the benefit value has been allocated. Please review the information below. If you have any questions concerning these allocations, please contact us at A: _ 1-8IXi~S5=5275:...__ _, _-~ ~ . _ ..F ._ - ,_ ... _ .,: . ,. , ...~... ... .. ,. Transaction Transaction investment Units for this Transaction 1lransscdon Date Type Alternative Transaction Unit Value Amount 01/03/12 Transfer To 1 Year Guarantee Period N/A N/A $29,474.10 Your Total Annuity Vaius as of 01/03/12 $a.00 Distributions taken from non-annuitized contracts are generally considered to come from the gain in the contract first. If the contract is tax qual~ied, generally ail withdrawals are treated as distributions of gain. Withdrawals of gain are taxed as ordinary income. ~ D08H1352.N01 a.aoooeooeN+aeomr~»eoerooo n,4,s ~.~. G ~~ a 5 , Western National Life Insurance P,O. 8ox 871, Amarillo, TX 79105-0871 NAME: POLICY:. TRANSACTION: OWNER: pFtGp Tt~ FEDERAL WITHHOLDING TA AMOUNT OF CHECK TAXABLE INCOME ny CH€CK# 15649380 INTERNAL REFERENCE~M 2201042605 TRANSACTION STATEMENT MARY ZIMMERMAN Dec®mber 23, 2011 AN200971 DEATH CLAIM PR©CEEDS MARY ZIMMERMAN fi/U~tl ~i9R,B~.P ~~Au6-~1-7~i2 S 9,892.40 - S 89,031.51 8 98,923.97 5C tf ~, 2 ~~ -3 Westsm Natl Life Insurance. Comp. P.O. Box 871, Amarillo, TX 791.05-087 t NAME: POLICY: TRANSACTION: OWNER: P/+~ a Tv FEDERAL- WI'fHHOLI?ING T AMOUNT OF CH€CK TAXABLE INCOME ny CHECK,f 156493$2 tNTERNA6 REFERE-dCE,~ 2201042607 TRANSACTION STATEMENT MARY Z1NIM~RMAN December 23, 2011 AN203094 DEATH CLAIM PRQCEEDS MARY ZIMMERMAN S 530.95 - S 18,278.58 $ 5, 309.5 i ~C~ ~~ ~~ Western National Life Insurance Company P.O. Box 871, Amarillo, TX 79105-0871 NAME: POLICY: TRANSACTION: OWNER: Pf~-i ~ _TD AMOUNT OF CHECK TAXABLE ,INCOME CHECK# 15649383 INTERNAL REFERENCE# 2201042606 TRANSACTION STATEMENT MARY ZIMMERMAN December 23, 2011 AN203094 DEATH CLAIM PROCEEDS MARY ZIMMERMAN C191Q,pL 1208/S$~~ ~~bff-7fQ S 18,809.51 S 5,309.51 k Western National .Life Insurance Company P.O. Box 871, Amarillo, TX 79105-0871 NAME: POLICY: ' TRANSACTION: OWNER: (Jftt47 lb' AMOUNT OF CHECK TAXABLE INCOME CHECK# 15649381 INTERNAL REFERENCE# 2201042604 TRANSACTION STATEMENT MARY ZIMMERMAN December 23, 2011 AN200971 DEATH CLAIM PROCEEDS MARY ZIMMERMAN S 98,923.98 S 98,923.98 PLEASE DETACH AND KEEP THIS STUB FOR YOUR RECORDS . ~ a ~ ~y LAST WII.,L OF MARY MACLAY ZIMMERMAN I, MARY MACLAY ZIA~IlVIERMAN, of Susquehanna Township, Dauphin County, Pennsylvania, (SSN: 200-22-7309), declare this to be my Will, hereby revoking any and all prior wills. and codicils. ITEM I: I give and bequeath one-thousand dollars ($1,000.00) to Hood College, of Frederick, Maryland, to be used for its general institutional purposes. ITEM II: I give, bequeath and devise all the rest, residue and remainder of my estate, of whatever nature and wherever situate, unto my daughters. ANN BARBER, of Windham, New Hampshire, and CAROL ROBISON, of Carlisle, Pennsylvania, share and share alike, or their issue, per stirpes. ITEM III: No interest of any beneficiary hereunder shall be assignable by, or available to anyone having a claim against, a beneficiary before actual payment to the beneficiary. ITEM TV: I authorize my executrices, in the exercise of their discretion, and as necessary: (a) To retain and to invest in all forms of real and personal property, regardless of any limitations imposed by law on investments by fiduciaries, or any principle of law concerning investment diversification; (b) To compromise claims and to abandon any property which, in my executrices' opinion, is of little or no value; m~~ e ' y (c) To borrow from anyone, even if the lender is a fiduciary hereunder, and to pledge property as security for repayment of the funds borrowed; (d) To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; (e) To join in any merger, reorganization, voting-trust plan or other concerted __ action of security holders, and to delegate the discretionary duties with respect thereto; (~ To allocate any property received or charge incurred to principal or income or partly to each, without regard to any law defining principal and income; (g) To distribute assets in kind. These authorizations shall extend to all property at any time held by my executrices and shall continue in full force until the actual distribution of all such property, except as specifically stated. All powers, authorities and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without Court authorization. ITEM V: I appoint my daughters, ANN BARBER and CAROL ROBISON, or the survivor of them, as the executrices of this will. No fiduciary acting hereunder shall be required to post bond for the faithful performance of such duties. 2 /~ ~n z IN WITNESS WHEREOF, I, MARY MACLAY ZIMMERMAN, herewith set my hand otir Cat) M 1')'1,~ and seal to this, my last Will, typewritten on pages including the self-proving attestation clause and signatures of witnesses, this '~ i~ day of December, 2004. __ - _ Glu/IZ~~) MARY MACLAY RMAN Witnessed: ` residing at ~~ (S f/ ~•A~.h'Z . ~`~'`'~ ~ residing at `~ ~ ~G residing at 3 ~~~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF ~ v'r", ~~~~ SS: MARY MACLAY ZIlVIlVIERMAN (the testatrix), ~ \ 4~ V~tn ~ ~L~-- , ;T ~r^as ~ . l~'C (,w and (the witnesses), whose names are signed to the foregoing instnunent, being first duly sworn, each hereby declares to the undersigned authority-that the testatrix signed and executed the insttvment as her-last-- will in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and. voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. WITNESS: ~JVITNESS: ~-~- TESTATRIX: GrX,t~~c~1~y MAR MACLA MMERMAN Subscribed, sworn to and acknowledged before me by MARY CLAY ZIMMERMAN, the testatrix and subsc ' ed d sworn to before me by G~ NM?~ ~' ~'~ ~''~ , /~' and the witnesses, this a~ day of December, 2004. ~-~, otary Public `, ~~ (SE Notarial seal Gayle A. Goorge, Notary Public Camp H~i~ll Bo% Cumberland County My Ca aaion Expires June 18, 2006 M@t11b8r, PPhrn,.l~M~ligAS~1G~2finn (1t ~1t?^.@S 4 ~~ z