HomeMy WebLinkAbout09-11-12
REV-1500 EX (02-11)(FI)
PA Depanment d Revenue
Bureau d Individual Terns
PO BOX 260601
Harcisburg, PA 17126-0601
1505611186
OFFICIAI. USE ONLY
County Code Year File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Decedent's Last Name
~~~~
MMDDYYYY Date of Birth MMDD771'Y
2201920
Suffix Decedent's First Name
ZIEGLER REYNOLD
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Lasl Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLNCATE WITH THE
REGISTER OF WILLS
MI
K
MI
FILL IN APPROPRIATE BOXES BELOW
X^ 1. Original Return ^ 2. Supplemental Relum ^ 3.
iod2r 3 82) (Date of Death
r
P
or t
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Sate Deposit Bones
(Attach Copy of wlq (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 Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTW. TAX INFORMATION SHOULD BE DIRECTED 70:
Name Daytime Telephone Number
RICHARD E FEHR 570-385-1337
REGISTER dF WILLS USE ONLY
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First Line of Address ~- ~
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Second Line of Address ,J`:_ _" --- r-' ~
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Cil of POSt Office
y Slate ZIP Oode
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SCHUYLKILL HAVEN PA 17972 ?' ca ">~
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CorreapondenCS e-mail address:
Under penalties d perjury, I tleclam that 1 have examined this return, inUutling axompenying schedules and statements, and to the best d my knowledge and belid,
it is true, correct end complete. DeUaretion d prepe~[ other then the personal repreaentadva is based on ell informatbn d whbh preparer has any know
F Sf:HI IYI KII I HAVFN PA 17472
SIGN4TURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611186 twasa7sooo 1505611186
J
1505611286
REV-1500 EX (FI)
Decedent's Social Security Number
DsoaaeoeaName REYNOLDKZIEGLER
RECAPITULATION
1. Real Estate (Schedule A) .. .... .. 1. 107,500.00
2. Stacks and Bonds (Schedule B) .... ...................... 2. 62,380.88
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 Properly (Schedule E) 5. 5,326.37
6. Jointly Owned Property (Scfredule~F) ~ Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Biding Requested 7. 23,068.70
a. coal Grose assets (total ones 1 through 7> .. . ............... e. 198.275.95
9. Funeral Expenses and P.dministretive Coals (Schedule H)....... 9. 5,494.17
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 1 p.
11. Toal Deduetlons (total Lines 9 and 10) , .......... 11.
12. Net Value of Esaa (Line 8 minus Line 11) , ....... 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J), ........ 13.
14. Net Value SubJeet to Tax (Line 12 minus Line 13) , 14.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxabe
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 - 15.
16. Amount of Line 14 taxable
at lineal rate x .0 95 113,687.80 1 s.
17. Amount of Line 14 taxable
al sibling rate X .12 17
18. Amount of Line 14 taxable
at collateral rate X .15 1 g.
19. TAX DUE ............... 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
155611286 1505611286
twaeas z.ooo
78,593.98
84,088.15
114,187.80
500.00
5,115.95
5,115.95
J
REV-1500 EX (FI) Page 3
File Number 2Q12-QQ279
UeGBOCOt 5 liOlrl ICIC MUUI CDs.
DECEDENTS NAME
STREET ADDRESS
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CredilslPayments
A. Prior Payments
B. Discount _
3. Interest
(1> 5 115.95
Total Credits (A + B) 1;2)
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. ThIs is the OVERPAYMENT.
FIII in box on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5 115.95
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 properly transferted .......................: ~ lll''~ggg~~)
b. retain the right to designate who shall use the property transferred w its incwne ..........
c. retain a reversionary interest ................................. .
d. receive the promise for I'rfe of etther payments, benefits w cere4 ................ .
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^
without receiving adequate consideradon7 ............................. X
3. Did decedent own an "in trust for" or payable-upon-death bank account w security at his or her death? ^X
4. Did decedent own an individual retirement account, annuity, or other non-probate properly, which ^ ^
contains a beneficiary designation? ........ .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE <i AND FILE IT AS PART OF THE RETURN.
,. ,.:
Fw dates of death on or after Juy 1, 1994, and before Jan. 1, 1995, the lax 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)].
Fw 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 (a) (t.t) (iq]. 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.
Fw dates of death on or after Juy 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased chlltl 21 tears 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 tlecedenl's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)J.
• 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 et least one parent in common with the decedent, whether by blood or adoption.
iwasn r.ooo
REV-1502 EX ~ (01.10)
pennsyivania SCHEDULE A
OEPPRTMEMOf REVENUE
eaVEPoTANCE TP%RETURN REAL ESTATE
RESrOEMCEGEOEM
ESTATE OF; FILE NUMBER:
REYNOLD K ZIEGLER 2012-00279
All real property owned toNty or as a tenant In common must M reporbd at hlr market value. Fair market value: is defined as the pace at which property
woultl be exchanged between a willing buyer entl a willing seller, neither being compNletl to buy or sell, both having reasonable knowledge dthe relevant facts.
Real propeM1y that M Jolntly~owned wttll Mght of aurvivonhip moat G disclosed on SchaduM F.
Attach a wpy of the settlement sheet y the property has been sdd.
ITEM Include a copy of the deed showing decetlent's interest y vwnetl as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2173 Yale Avenue, Camp Hill, PA 17011 107,500.00
TOTAL (Also enter on Line 1, RepapRulalion.) S 10 7 , 5
lwnsss 1.000 If more space is needed, use additional sheets of paper of the same size,
REV-1503E%+Q-11)
~enns~ivania SCHEDULE B
AR NT OF REVENUE
INHERffANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
REYNOLD K ZIEGLER 2012-00279
All property jointly owned wkh right of sunrWOrshlp must be tlbcbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 476.917 SHS OPPENHEIMER CAPITAL APPRECIATION FUND 21,766.99
2. 1195.299 SHS OPPENHEIMER MAIN STREET A 90,614.39
TOTAL (Also enter on Line 2, Recapitulation) 3
1 W4696 2.000 If more space is needed, insert additional sheets of the same size
REV-1500E%a (11-10)
Pennsylvania
LERPRTMEMOF REVENUE
aa1ERITANCE TAX RETURN
RESICENi DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF:
REYNOLD K ZIEGLER
Include the pr«
All roe olntl
ITEM
NUMBER
1. ~. MST BANK CHECKING ACCOUNT
2. MST BANK ESCROW ACCOUNT
o(litigation and the tlate the proceeds were received by the estate.
~d with rlaht of survNorshlo must be dkclosad on 3<:her
1waeA0 1.000 If more space fs needed, use additional sheets o(papar of Me same s¢e.
7
VALUE AT DATE
OF DEATH
2,727.23
2,599.14
5.326.37
REV-1510 EX ~ (OB-09)
pennsylvania
DEPARIMENTOF REVENUE
REYNOLD K ZIEGLER
79
This schedule must be completed and filed ii the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBE DESCRIP710N OF PROPERTY
unucEt~avaacFtrem,RSFeREE. ~RaEUnoRSaR ro oECEOEmm an
11EM1E0F1Wt8~13i ATTPp1ACOPf OF nE OEFD FOR RFK ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
IXCLUSION
~APWCABLE
TAXABLE
VALUE
t. ALLIANZ INSURANCE CO OE N AMERI 5,156.89 100 5,156.89
ANNUITY - 7030829
2. ALLIANZ INSURANCE CO OF N AMERI 17,911.81 100 17,911.81
ANNUITY - 70309093
TOTAL (Also enter on line 7, Recapitulation) $
SCHEDULE G
INTER-VlVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
068.70
Ir more space is needed, use addifrone~' sheets of paper d Ne same size.
1 W46AF 1.000
REV-1511 EX~ (10-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
REYNOLD K ZIEGLER ~ 2012-00279
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1. ELIZABETH ZIEGLER - FUNERAL DINNER 350.00
2. CUMBERLAND COUNTY REGISTER OF WILLS 277.50
3. LEBANON NEWSPAPER - DEATH NOTICE 127.20
9. PARTY FUNDAMENTALS - FUNERAL EXPENSE 100.00
5. CREDIT CARD - FUNERAL DINNER 184.18
6. THE PATRIOT NEWS - NEWSPAPER DEATH NOTICE 419.29
7. MUSSELMAN FUNERAL HOME - FUNERAL EXPENSE 1,823.00
8. ST JOHN'S REFORMED CHURCH - FUNERAL RECORD 50.00
9. SAUSSER MONUMENT & MEMORIAL COMPANY - LETTERING (125.+215.) 390.00
10. SCHEDULED - SEE ATTACHED 774.09
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. ~ Attorney Fees:
3. I Family F~cemption: (If decedent's address is not the same as daimanNs, attach explanation.)
Claimant
Street Address
City State ~ ZIP
Relationship of Claimant to Decedent
4. I Probate Fees:
5. Accountant Fees: 750.00
6. Tax Return Preparer Fees: 13 5 . 0 0
7. US POST OFFICE - POSTAGE (9.+3.35+4.50) 16.85
8. THE SENTINEL - ESTATE NOTICE 147.06
1WABAG 1.000
TOTAL (Also enter on Line 9, Recaptl
If more space is needed, use atldttional sheets of paper of the same sire.
5,999.17
REV-1511 EX~ (1609)
Pennsylvania
OEPPF2TMENi OF REVENUE
INFIEPoTANCE TAX RETURN
SCHEDULE H
FUNERALEXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
REYNOLD K ZIEGLER 2021-00279
Decedent's debts must be reported on Schedub I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~, SCHEDULED:
CENTRE DAILY TIMES - NEWSPAPER DEATH NOTICE 260.59
THE REPUBLICAN & HERALD - NEWSPAPER DEATH NOTICE 157.30
LATROBE BULLETIN - NEWSPAPER DEATH NOTICE 25.00
LANCASTER NEWSPAPER - NEWSPAPER DEATH NOTICE 331.20
6.
1.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Citv
State ZIP
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (Ii decedent's address is not the same as claimant's, attach el~lanation.)
Claimant
Ciry State ZIP
Relationship of Claimant to Decedent
4. Probate Foes:
5. Accountant Fees:
6. Taz Return Preparer Fees:
7.
TOTAL (Also enter on Line 9. Receoitulalion) $ 7 7 4 . 0 9
Slfeet fWdreS3
1 W46AG 1.000 If more space is needed, use additional sheets of paper of the same size.
REV-, 512 EX~„ 2-0B) SCHEDULE
Pennsylvania
OEPPRTA£M OF REVENUE DEBTS OF DECEDENT,
INHERRANCE TAX RETURN MORTGAGE LIABILITIES 8 LIENS
RESIOEM OECEbEM
ESTATE OF IFILE NUMBER
REYNOLD K ZIEGLER 2012-00279
Report debts incurretl by the decedent prior to death that remained unpaW at the date of death, including unretmbureed medkal expenses.
VALUE AT DATE
ITEM
NUMBER
DESCRIPTION
OF DEATH
t. JANET MILLER, TAX COLLECTOR - REAL ESTATE TAXES (856.68-609.50) 247.19
2. ST RAUB & ASSOCIATES REAL ESTATE GROUP - REAL ESTATE COMMISSION 6,450.00
3. JANET MILLER, TAX COLLECTOR - TAX CERTIFICATE 5.00
4. REAL ESTATE TRANSFER TAX - 1$ 1,075.00
5. M&T BANK - MORTGAGE PAYABLE 62,523.02
6. M&T BANK - OVERNIGHT PAYOFF FEE 25.00
7. RICKEY A SHULER - SELLER'S ASSISTANCE 2,500.00
8. PPL ELECTRIC - ELECTRICITY BILL 163.05
9. PA WATER COMPANY - WATER 159.93
10. UGI - GAS 157.85
11. HOLY SPIRIT HOSPITAL - HOSPITAL BILL 226.77
12. JEWISH HOME - NURSING HOME CARE 727.73
13. PINNACLE HEALTH HOPPITAL - HOSPITAL BILL 12.11
19. PINNACLE HEALTH CARDIOVASCULAR INST. - MEDICAL BILL 2.67
15. SUSQUEHANNA INTERNAL MEDICINE - MEDICAL BILL 5.42
16. BORO OF CAMP HILL - SEWER BILL 150.00
17. VOHRA WOULD PHYSICIANS - MEDICAL BILL 29.24
18. QUANTUM IMAGING - MEDICAL BILL 8.68
19. DAILEY EYE ASSOC. - MEDICAL BILL 7.81
20. COCOA UROLOGY ASSOC - MEDICAL BILL 30.16
21. UROLOGY OF CENTRAL PA - MEDICAL BILL 8.11
22. PENN WASTE INC - GARBAGE BILL 95.75
23. COMMUNITY LIFE TEAM EMS - MEDICAL BILL 100.00
29. HOSPICE OF CENTRAL PA - MEDICAL BILL 2,590.00
25. ADVANTAGE MEDICAL TRANSPORT - MEDICAL BILL 53.13
26. COMCAST - CABLE BILL 3.21
27. PINNACLE HEALTH - MEDICAL BILL 5.50
28. M&T BANK - BOX KEY 10.00
29. VOHRA WOUND PHYSICIANS - MEDICAL BILL 11.66
30. PINNACLE HEALTH EMERGENCY - MEDICAL BILL 13.99
31. SUSQUEHANNA TWP EMS - AMBULANCE 31.26
32. JANET MILLER, TAX COLLECTOR - REAL ESTATE TAXES 768.12
33. PINNACLE HEALTH MED SERVICES - MEDICAL BILL 11.63
39. BO RO OF CAMP HILL SEWER - SEWER BILL (150. - 49.18) 100.82
35. QUANTUM IMAGING - MEDICAL BILL 17.51
36. SOUTH CENTRAL EMS INC - AMBULANCE 17.94
37. ERIE INSURANCE - HOME OWNERS INSURANCE 62.34
38. KATHRYN CRISWELL - TITLE FEES 103.50
39. CAPITAL CARDIOVASCULAR ASSOC - MEDICAL BILL 8.01
90. AFNI COLLECTION AGENCY - VERI ZON TELEPHONE BILL 79.66
41. PINNACLE HEALTH MEDICAL SVCS - MEDICAL BILL 50.77
, W46AH 1.000 If more space is needed, insert additional sheets of the same size.
REV-7513 EX+(07-10)
Pennsylvania
OEPARTFEM OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
tJ1Alt OF:
FILE NUMBER:
REYNOLD K ZIEGLER ~ni~-nn~~A
RELATIONSHIP l"O DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List irvates(s) OF ESTATE
t TA%ABLE DISTRIBUTIONS [Indude ouhiyht spousal disbibudons and transfers under
Sec. 9116 (a) (1.2).~
1.
t. GWEN DOLYN C. SANCHEZ, 8820 MOUNTAIN ROAD, GRANDDAUGHTER 2,000.00
GRANTVILLE, PA 17026
2. CARMEN S. GLACKIN, 19 N CHESTNUT ST, GRANDDAUGHTER 2,000.00
BOYERTOWN, PA 19512
3. AHBRAHAM Z. KLEIN, 641 RECREATION FIELD RD. GRANDSON SD0.00
PLAINFIELD, VT 05667
9. JACOB Z. KLEIN, 691 RECREATION FIELD RD. GRANDSON 500.00
PLAINFIELD, VT 05667
5. HARRY R. CRISWELL, 301 FARMINGTON DR GRANDSON 500.00
SHIPPENSBURG,, PA 17257
6. AARON Z. CRISWELL, 301 FARMINGTON DR GRANDSON 500.00
SHIPPENSBURG, PA 17257
7. ELIZABETH ZIEGLER, 641 RECREATION FIELD RD. DAUGHTER RESIDUAL
PLAINFIELD, VT 05667
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV•1500 COVER SHEET, AS APP ROPRIATE.
11 NOPFTAXABIE DISTRIBUTIONS
A. SPOUSAL DISTRIBt1710NS UNDER SECTION 8113 FQR WHICH AN.ELECTION 70 TA% IS NOT TAKEN:
1.
B. CHARITABLE ANDGOVERNMENTAL DISTRIBUTIONS:
~. CHAPEL HILL UCC - 701 POPLAR CHURCH RD, CAMP HILL, PA 17011 500.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 5 0 0 . 0 0
twasgl to0o n mule space is nee0e0, use 9IXlmonal sheets of papal o(the same Size.
R
WILL OF
REYNOLD ZIEGLER
I, Reynold Ziegler of Cumberland County, Carnp Hill,
Pennsylvania, declare this to be my last Will and herf~by revoke all
prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid' out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I leave $2,000.00 to my granddaughter Gwendolyn
Christine Sanchez
B. I leave $2,000.00 to my granddaughter Carmen
Stacy Glackin.
C. Should either Gwendolyn Christine Sanchez or
Carmen Stacy Glackin predecease me, their share
shall go to the surviving granddaughter.
D. I leave $500.00 to my grandson .Abraham Ziegler
Klein.
E. I leave $500.00 to my grandson Jacob Ziegler
Klein.
F. I leave $500.00 to my grandson Harry Ryan
Criswell.
G. I leave $500.00 to my grandson ,Aaron Zachary
Criswell.
H. Should any of my grandson's preldecease me,
their share shall be divided in equal shares
between the surviving grandson:;.
LAN' OFFICES OF
TEPHENJ.HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
lt7-bd9- ~{rPz3
I leave $500.00 to Chapel Hill United Church of
Christ Camp Hill.
/~~~"
~~
dau9~`tec,
es~at~ tO ray ase
v e
a,~det `~\e~n• ~ P~eee~raaende~
e ~~fiZ,e9~e \e~ ~~0 tO;~ e <e e9\e~
\\ea~ net Prfi ~r Prno a ~S~N~\\ P Cara sr `es
~\`Za .,~~~~Zaa~ adart°{ n ~S°r' 9 ~~~eaJ ~ I~
-~ - ,
J. I leave the remainder of my estate to my daughter,
Elizabeth Ann Ziegler Klein.
K. Should Elizabeth Ann Ziegler Klein predecease
me, I leave an additional $500.0() to the Chapel
Hill United Church of Camp Hill and the remainder
of my estate to my grandson's Abraham Ziegler
Klein and Jacob Ziegler Klein in equal shares.
4. I appoint Richard Fehr, as Executor of this my last Will.
5. The Executor of this Wili shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
e
IN Vj(ITNESS WHEREOF, I ha~v
he..re~nto set my hand this
.,//
%
~
~
_^~ day of L
~Gc . ~"~u,~^= , 2009.
R nd'. 1 ~l ~ ~,
LAW OFf ICES OF
PEPHEN J. HOGG
9 5. HANOVER STREET
SUITE 101
CARLISLE, PA 17013 -
,~~
!A0.' OFFICES OF
TEPHENJ.HOGG
9 S. HANOVER STREET
SUITE 101
CARLISLE, PA 170!3
The preceding instrument consisting of this and two other pages
was on the day and date hereof signed, published and declared by
Reynold Ziegler as and for his last W ill in the presence of us, who at
his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
~ltu,~. ~ { ''Etc2 ~
WITNES
I NES `~~~~~~~°"'
`~~
i
LAW OFFIfES OF
TEPHEN J. NOGG
9 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
The preceding instrument consisting of this and two other pages
was on the day and date hereof signed, published and declared by
Reynold Ziegler as and for his last Will in the presence of us, who at
his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
~~' G~(~ '~1l[2-~
W ITNES
I NES
ACKNOWLEDGMENT
State of Pennsylvania
County of Cumberland
ss
I, Reynold Ziegler, the 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 as my free and
voluntary act for the purposes therein express
~)-~
iegl ~
Sworn to or affirmed a d acknowle d bef re~ me,~Cy_Reyr
Ziegler the Testator, this Gay of 2~" , 2009.
,~....~,.....~.~....E.m.".v...: Nota, Public/Attor~~
State of Pennsylvania
County of Cumberland
ss
We, ~~l'~(~~y1CtCt~ and .C/.SCr 7C 6, ~C., the
1.4W OFFICES OF
'EPHEN J. HOGG
I S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
witnesses whose narrles are signed to the attached or foregoing
instrument,. being duly qualified according to law, do depose and say
that we were present and saw the Testator sign and execute the
instrument as his last Will; that the Testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the heariing and sight of
the Testator signed the Will as a witness; 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 influe ce.
~~~~~~~
rn to or affi d and
this day of --~f~~
Notary
~ll Bpq,CNMFALyp Cp f4
~- ~ W.~,..o.
AFFIDAVIT
before me by witnesses,
_, 2009.
QMS WpprOV31 No. 2502b265
atYlmryt
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D. Type o1 L08a '
8. Ib Number: .loan umber: S: MOdgaBe nauran eC S, Numtier.
1.[j FIM 20RH5 3.(]COny. Unine. 20120289
4.~VA S.Q GOOV. Ins. ^Olher
Thls rom s fumla ed ro glue you a aWtament of actual cenlamenl coele. Amo nls peltl {eland 4Y 01a ae111461 e0t ate snown.
C. Note:
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D. NaOts b Addroaa Rkkey A. Snakq 34 alb Visla Dove, Marysville. PA 17053 I
of ~o rawer:
Rr. Na a S Ad esa Estate o ReymM 2bpler
W Selbr:
F. Name S Address
of 4ondar:
G. ProPedy LOeatton: Property Addms ~ I
2173 Vele AvenW Camp Hifl, Pamaylvanla 17011
PIN
01-22-0535-0N
H. Settlement Agent: Greet oatl t men{ Servkes, LLC, 8 .17th Slree , amp HB, 'A 77011,(71 p31-T 0 '.
Pfau of SsttbmenD 3 S. ltth SIree1, Camp HIII, PA 17011 '
I. Settbment Dab; 5131/2012 Proratlon Dala: S13112D12 'Dlsburay4 nl 3t-: 513112012
`'J'9uni _tdi 1> .~.~ , ~ fir?
coati' "'~ fid. 1 m,.~
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lat. CanlraM Sales pru 5107,500.0041. Canlre0l ssw 5107500.00
102. Pirsonel IxopertY 4b2. Penned prepany _ _ _ __
103. Sethament charges to bonawer OMe 19001 53,018.88 d 03.
--
104. 4 01. ~
105. 4 05.
Ad}OS Menb oNA1Pi SItl ~ eIW Ip'ya Iw •.. A~4( la - ` A M _0 a ,R ~ ~ ~ 1 -"iN I rPrS, )r1 rt lyye
108. Cayaown laYea 4 C3Yllovm texas
109, County Mxes 513- /2012 to 1213112012 3448.25 4 0T. Count' Mxea 5131 12 b 1 ik01 544835
108. Aasessmenn 4 05. Apeaarlanta
109. Scholl Tex 5/311201210 8/3012012 3183.2 9. 3c)ad Tax 5131 12 b 513 12 318315
110. 2rM Cllr Sewer 5131/2012 to 813012012 149.18 4 T0. 2nd Car Sewa Sl3 P201P lo' 0/201R 549.15
111. 4 Y 1.
112 U2. _
130, Gross AmountOw from BORdawr 5111,117.334 0. Oroae AmeuM •b Salbr 5108,153.88
24Rx I'n -BtUOW,~. 12 0 14 . N'9Y.. .. .. ...., , rr .Ilk 1 , 'f I l t+ ' ., ti?e
201. Depoaita eameit nawY 31,000.00 1. Exeess dSpdSN( -bs3agblia) _
202. PMlapal amouMol ww ban(s)
Sb2.
3etlbmeal pSMrye b Nlbr (8M 1400) _
313,888.88
203. Exlatlng ban(s) iBken sugM to 503. Exiedng lan(S) btsn SubpM b
204 904. Payoff of hsl ape ban tQ MBT ank
r 583,523.02
205. 5. PeyOn of secant g8ge lotm
l
208 508. OvenNBM Payoff l¢ M3T 325.00
207. 807.
203. ~ 508.
209. SeBen Nelabrw.e 52,500.00 908. Se3en MdaWln 32,500.00
Atl'u Rp .:'a n 4. '. , -b. 1. AIM a . 4.~ I,.,,~.:
210 Cilyttawi lezee 10. City/lawn Mxea
211. Comfy Wawa 511. Com,tY Mxas
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212. Asaeuments 12. Auoasmenls
213. 313.
SUB3TRUTE FORM 1051 8ELLER bTATEMEM - TM Inlomlehm conlelrwd In Slacks E, G, M erd I arq on IIM pt (a. M Em 401 I~ ge
eM 106413 (appllode yen d buyelsnal ealate lax repwaEb b Ma IRS) la Impaunt IaY Mbmalim aq Is Eel Nmlaned 1~ iha Inlarn~
aquind N ale a mrum a rropllpence penalty a aupr aaatlm w111 M Impo+etl on you R th{j hem la rpOlrW b M ra 4M pI{Me IRS Ndl~i
SELLER INSTRUCTION - II MIa real eLWa wu ybur pMtlpal rosiaarly, flb brm 2118, $als or Ew:Mrlpa d PnngOtl Nbidan for ~ntl Q
ra oMer tren+ecuona, comNae Ma appliceda pat`` q brm 4]B], Fam 8252 anNa Sch ule D (Farm 1040). ', '
You an required 10 pmvka Me Sentiment ABenl v31h your Wnea 1%xpya Mlenalcatlon nUmEx.
If you tlo nd provitle Me Sememenl ABeM wIM yalr mrrad taxpayer 1dan0flce5on numEer,jyou meY W wgad M tMl a glmMellPoneldea.
ESTPTE OF REYNOLD YIEGLER
Rlcham E. FeM
nN,.~~ml~. Rapathg aua~ 1a nand r'mularretl b aanolete Ntla lamlunlee+ M1 dlnola aleecurre~~ ~ p IB In ~ By ~+aM
NU0.
517112012 1:22:03 PM !File Ndmber: §0120189
_..L $aR13~MSC larga5 ~::~ t Yurmf le*tm ,,,,.;. •~ t ~ r. •R,"„~'~^"
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'190. Total Reak Ealele Broker Feea based on price 5107,500.00®8000000/. b6,450.00 P91 Frolp ( paid From
Division o(wmmlaslon (line ]00) es fottows: - Bdrtovrer's Sellefs
701. 43,225.0010 RS Realtors Inc FUnds at Funds at
702. 13,2250010 Stra86 S Assocletea Real Estate Group, Inc. SeltlemanL ! Settlement
703. Commissbnp at selllemeM 5&,450.00 56,450.00
_
704. _
705. 0mker Fee to Straub S Assodete~~s~~--R+eal Estate Group. Ina
00..~1)eMaCa `ry blp (nftortnsd7Gn ~Vlel,laan`,F 41 ., ~, .'".T.S,ekT+1~'f 4i~„'}.1~~ P 32U8.
IJ:rtv( .'I1 0
1, 5
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Ot. Our origination chprpe (horn GFE 31) _
502. Your uedd ar cheige (poinb) br IM spedh: inteml reN ctwsen Ihom GFE 32) _. _
003. Your atl~usbtl atl91na5on rhar9es (ham GFE A) _ _ _
804. Appraisal fee lhom GFE 3.9) _
X05. Cretlit report (hom GFE N3)
_
O6. Tez service (Iran GFE 3J)
807. Food Ced3x:BIiM (from GFE 39j.
tlOS.
OOdOd1n3R~, (ri ~~. 4V~ 4 9. '~.1 ~n ~
BOL 'DaiN interest chb es iron (Irpm GFE 310) _
8
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X02. Mortgage Insuance prembm br (from GFE 33)
003. Homeovnrofelneurenp for (Imm GFE Ntt)
804.
i)OS.
haUgr R
1001. IMMN depba8b our eecrov acc0unl (hen GFE NB)
1 '
'
'1002. HomeoYmefa Insurance
;11103 Mort0el9e lnfurenca _,
1004. CNy propMh was ~
_ ,
'1005. Counh prbperty Nzea __
9008. _
1100].
i
1ooe.
1ooe.
a'og~,C
'.f 101. TNa aarvkes anq lantleh Stla kxurenw (ham GFE W).
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f 6
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11102. Se9bmeM or oloeNlO tee
'1103. (lwnafs tNle ins araab Great Road SstlNment Sarvbea,LLC (hen GFE 35)
1104. Landefa Mla Mnyrenca b GnN Rob SaltlsmsM Ssrvkss, LLC 596].83
'1105. LaMefa Slle paXOy GmH 5110.000.00
,1106. bwnafs lple poligY hnN 570],500.00
1107. Agent's PPr1Nn ar rile total 0{'S.Inawerme PrenYum to Greet Road SsttlameM Sxvkna, LLC SM5.20
troe. llrberwdleh poNOn of Ns 1otN INN Inaaance pramlum N SIewM Ti1N Ouaronh ComparN 3122.56
f 108. Ntludas ends 100, 300, 000
1110. Iloc Prop F» to Gnat Rued SatSwlwnl3srvicea, LLC 525D.00
1111. pvernighlAMra to Groh Road 6sltlemanl Services, LLC SB5.00 '
1112. CbNrp Protedidn Latter to Stewart Tttle Guar+ntY COmOanY 5]5.00
1115. Naery Fee (0 Greet ROatl SgltMment Servke; LLC 5:16.00
1114. Tex Cert b Jaxff Miller. Tax Cdleclor f$.pD
1115.
1100. ~ ~ g '#~.
1201. GovemmeM racgrMnO Mlarges (hen GFE 37)
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1202. Deed 553.60 Moltgelp 589.50 Rskeaea 3143.00
X
1203. Trenabr wee (hen GFE3B) 31,U7i
00
1201. CNYICouMYtWilampa Deed 31,0]5.00 51,145.00 '
1205. $bte w]aNTPlj Oaad 51.076.00 51,095.00
1208. UPI Cani/kafion Pee3 S10.0p MOrtpps 510.00 'b20.00
120]. E-Rata ' Fs4 Deetl 525.00 Mortpegs 125.00 '{50.00
iMgr ~'
13m Rwe+•dh ~"ma ra een shop for (M1Vn GFE 361 .
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1302. 2rd Gtr 9,ewxt CemP NiO Soragh POCS SIS. '
1303. Pest NSpacwl oArcJw PaaLCOmrd 553,00 L --
1304. 2012 CounNROHeiehip Tez (61Umetad) b Janet MiNer, Tex CoINCM ~ , SB, .eB
1305. 2011 Sr.Floot Ta bn eYtt/M12 N Jarpt MaNr, Tax CoOSda POCS 31.09 6 }" _
1308. mn«imnw Tez Mum (F~agpw) to PA DepenmeM 01 Rewnus
i ;55,5 .W
1400.' 701st Sa snw Lb s r on IIMa 101, Sac3on J and 502, Sadlon N) p S
~ 13, 6D
hems inad:W "POC` weM pld ouNba'me tloain8 b/: Bottovnr (POCB), lender (POCq, Morlgpu Broker (POCM), OmN ( QO) R
I! NN ) a $jiaf(PpCS).
1 ;
PreviWS eddiOns are obsolete Paget ~- ulir
b/31I2012 1:32:03 PM File NLm0ed 20124289
A ~ OERTIFIg1T10N; I have cercMry revrewed 1M HU0.f Settlement SWlemenl and to the oast of my knovdedpe~ and fie[ d is a uue end aagretp stelgmenLallall receipts end
disburyerpenH made on my aceounl or by ma in NI trsnmcaon. I NrNer uNly Thal l have (eulved a copy IX NUD~15edllamem ~Wtem~n'. The ~e nlA9~n1 does not
' wartent at ropresam me e~xunty M InfoemeWn pro Ided Ey any party, McWdMq In/ormatiotl concetniip POC Ilema a Inmrmabpa aupolled W mp r'in;lh IrpmaKllon
oppeer nq on mH HU0.f et ement Stplemenl pe Munq to'COmperison of GcoO Feim Estmata (GFE) end XUDn nary' ei and'LOa iadns' Ani paati s Add harmlejs
me SefNeirrenf A Bnl t e inauurages in such ea6r.
ES7A7EfJF R NN{J~&ZI R .~~~
lilckq A. Shvler ~" ` ~""~
l
RkMrdE:. Fehr '' ~ '
To the Eeel d my knovAadge, ar - i e1lNmanl Setlement whlrlr I HVS papered If a bue and ercwete ncwum 1 Na Iundn wniU Were ved Arid i{bW been ai wNl qe
d!aburnedby aie vpders~' _ s part of/L ~m`a'tlleml{nt or MIa Vaneaclbn. ~ ~ n : /
Jamea A.. ar, a9~Ga ~ et1$ i 1. ` F--9
' .WAR It Ia a coma b k nqy make relu s+plsmanta bar UnMd 54tea on tMa a erry alur slMler btm. elljen upon conyi acn un InHUtle aNr~ antl
~! ~ an wprheM Fondarlla, 18: U.S. Coda 3 1001 Jn0 SaGbn 1010. I .