HomeMy WebLinkAbout08-14-14 (2) � 1505610143
REV-1500 Ex,oz_,,, :��
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes �PpRTMENTOFREVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 1080
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
05 27 2013 02 09 1937
DecedenYs Last Name Suffix DecedenYs First Name MI
ZIEGELMEIER KAREN A
(If Applicabie)Enter 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
a1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � � (Attache(:opy�of Trust)a Living T�ust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
� 9. Litigation Proceeds Received � 10. Spousal Povert Credit�(Date of Dea�h � 11.Election to tax under Sec.9113(A)
between 12-31�91 and -t-95) (Attach SChedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
,. ,
KEVIN D DOLAN ESQ (717) �7 13'TD= �?
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n -�=' ;:-;
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�--7.r�_,� c�.:� '__: ' ,'�i.'.
REGISTER��F-WILLS U9��NLY ' --
:� � _ _._. _�
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First Line of Address ��`
CJ�-. -
222 S MARKET STREET SUI ���� -�- �'
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G..�i C7� ;: ;-,-:
Second Line of Address � --t '
PO BOX 2 6 7 � ---� ` �
City or Post Office State ZIP Code DATE FILED
ELIZABETHTOWN PA 17022
CorrespondenYs e-mail address: kdolan(a�gskdlaw.com
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,
correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA E OF PE�iSON RES NSIBLE F R FILING RETURN D TE
.�X� Patricia Wolf � i'�'•/' �
DRESS
253 W. ain Street Hummelstown PA 17036
SIGNATURE P���{RE�2 OT THAN REPRESENTATIVE DA
A� � Kevin D. Dolan Esq. /�� y
i
AD ESS
222 S. Market Street, Suite 201, Elizabethtown, PA
Side 1 �
L 1505610143 1505610143 J
�
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
oa�d8�r5Name: Ziegelmeier, Karen A
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 2 3 9, 7 7 5 . 0 0
2. Stocks and Bonds(Schedule B)............................................................................. 2. 153 ,550 . 98
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 10 ,252 . 82
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 12 , 810 . 52
7. Inter-Vivos Transfers&Miscellaneous Nnn-Probate Property
(Schedule G) �f Separate Billing Requested............ 7. 1 , �8 4 , 4 7 7 . 9 6
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 1 , �j Q Q , $67 . 2 8
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 113 , 5 61 . �2
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 6, 8 05 . 6 6
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 12 O , 3 6 6 . 68
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 , 380 ,500 . 60
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 1 � 38� , rJ00 . 60
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 0 . 0 0
(a)(1.2)X.00 15.
16. Amount of Line 14 taxable 1 , 380 , 500 . 60 16. 62 , 122 . 53
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. T�4X DUE................................................................................................................ 19. 62 , 122 . 53
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-1080
Decedent's Complete Address:
DECEDENT'S NAME
Ziegelmeier, Karen A
STREET ADDRESS
5222 Deerfield Avenue
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 62,122.53
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3) 860.89
q. If Line 2 is greater than Line 1 +line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box 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. (5) 62,983.42
Make Check Pa able to: REGISTER OF WILLS, AGENT.
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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:............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ �
c. retain a reversionary interest;or............................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ Ox
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ 0
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... 0 ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑
contains a beneficiary designation?..................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
� ,,:,:�'�c..,.:f.`<�� ,.s"`a"�a���`���.. x '��r » ';,�"tr� ��.��'� �:"a�"x'' . ,. � '�' � .,....,��"..s s,i
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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 January 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)(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 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(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[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,whether by blood or adoption.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
All real property owned soiely 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 relevanl facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedenYs interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate-located at 609 Penn Ayr Road, Camp Hiil,Cumberland County, PA 17011,sale 239,775.00
price
TOTA�(Also enter on Line 1, Recapitulation) 239,775.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10)
Rev-7503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMON WEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 A&P stock-no value 0.00
2 American Scientific Corp stock-no value 0.00
3 Campbell Resources stock-no value 0.00
4 900 shares of Hershey Company 89.25 80,325.00
5 2,445.789 shares of John Hancock Bond A Account 16.1655891 39,537.62
#00004851649
6 LaBarge stock-300 shares exchanged for cash 5,775.00
7 Medco stock-81 shares were exchanged for cash by 2,880.00
Express Scripts
8 429 shares of Merck&Company 47.16 20,231.64
9 New Valley Corp. -no value 0.00
10 31 shares of Prudential 66.46 2,060.26
11 16 U.S. Savings Bonds Series E and EE-see attached list 2,741.46
TOTAL(Also enter on Line 2, Recapitulation) 153,550.98
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
Include the proceeds of litigation and the date lhe 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 2013 Federal Income Tax Refund 525.00
2 County of Lancaster-Veteran's death benefit 100.00
3 CVS Pharmacy-prescription refund 3.02
4 Discover-refund 25.25
5 Express Scripts-retirement monthly distribution 64.19
6 Jackson Siegelbaum Gastroenterology-refund 38.86
7 Medco Cash Balance Retirement Plan payments 227.92
8 Merck Company-uncashed dividend checks from 7/9/12-$1.68 and 1/8/13-$1.72 3.40
9 Merck Company-uncashed dividend checks from 7/9/12-$178.50 and 1/8/13-$182.75 361.25
10 Orthopedic Institute of PA-refund 15.99
11 Pennsylvania Bureau of Unclaimed property 8.42
12 Prorated taxes at real estate settlement-per HUD-1 2,364.02
13 Prudential -uncashed dividends from 12/14/2012-$49.60 and 3/21/13-$12.40 62.00
14 The Hershey Company-uncashed dividend checks from 3/11/2013 to 9/12/13 5,953.50
15 1996 Buick Regal -bluebook value 500.00
TOTAL(Also enter on Line 5, Recapitulation) 10,252.82
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-7509 EX+�01-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Jennifer Miller 5222 Deerfield Avenue Daughter
Mechanicsburg, PA 17050
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE INCLUDE NAME ODEN NRi PTNON OTI NANOD ANK ACCOUNT %OF �AVA�E OF TH
iTEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECD�S DECEDENT'S INTEREST
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE �NTEREST
1 A 03/24/2009 PNC Bank Checking Account#5006277521 - 10,050.51 50.000% 5,025.26
which includes accrued interest to date of
death in the amount of$0.72
2 A 03/24/2009 PNC Bank Checking Account#5140071356- 13,225.75 50.000°/a 6,612.88
which includes accrued interest to date of
death in the amount of$0.12
3 A 11/17/1995 Santander Bank Savings Account 2,344.75 50.000% 1,172.38
#1054018385-which includes accrued
interest to date of death in the amount of
$0.09
TOTAL(Also enter on Line 6, Recapitulation) 12,810.52
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
Rev-1570 EX+(OS-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF RANSFERSATTACN A COPY OF THE DEED�OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Jackson National Life Insurance Company, Non- 813,983.07 100.000% 813,983.07
Qualified Annuity Account No. 1007970937, including
interest÷nds to 05/27/2013,transferrable upon
death,in equal shares,to decedent's children,Andre
O.Ziegelmeier, Michael C.Ziegelmeier,John P.
Ziegelmeier,Caren R. Herbert&Jennifer Miller.
2 John Hancock Investments,Account#JH4298778, 82,132.49 100.000% 82,132.49
including dividends to 05/27/2013,transferrable upon
death to decedenYs daughter,Jennifer Miller.
3 John Hancock Investments, Individual Account 87,739.17 100.000% 87,739.11
#IJh4264733,including income and dividends to
05/27/2013,transferrable on death, in equal shares,to
decedent's children,Andre O.Ziegelmeier, Michael C.
Ziegelmeier,John P.Ziegelmeier, Caren R. Herbert&
Jennifer Miller-account consists of the following
assets and their value as of the date of death:
Banco Santander SA ADR-$2,078.15
Blackrock Mun Income Tr. Sh Ben Int. -$11.64
Cash-$38,460.13
Delaware Tax Free PA A-$10,212.99
Manulife Finl Corp.Com -$870.42
Prime Fund Capital Reserves Class-$751.72
Putnam American Govt.,A-$6,802.69
Wells Fargo Advtg.Asset Allocation B-$13,783.27
Wells Fargo Advtg. Utility&Telecom C-$14,768.11
4 John Hancock Investments, Non-qualified Annuity 100,605.93 100.000% 100,605.93
Account#FX06018945,including income÷nds
to 05/27/2013,transferrable upon death to decedent's
daughter,Jennifer Miller.
Total of Continuation Schedule ee attached page
TOTAL(Also enter on Line 7, Recapitulation) 1,084,477.96
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
Rev-1510 EX+�08-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH �OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE�RANSERSATTACNTA CO Y OF T�E DEED�OR REAL EST TE. VALUE OF ASSET �NTEREST (IF APPLICABLE) VALUE
5 Signator One IRA Account#JH4-264733-payable to 17.36 17.36
the decedent's children, namely,Caren R. Herbert,
Jennifer Miller,Andre O.Ziegelmeier,John P.
Ziegelmeier and Michael C.Ziegelmeier
TOTAL(Also enter on Line 7, Recapitulation) 1,084,477.96
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENTDEC D NTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
See continuation schedule(s)attached 17,580.27
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Patricia Wolf
StreetAddress 253 W. Main Street
city Hummelstown state PA z;p 17036
Year(s)Commission Paid 23,000.00
2. Attorney's Fees Kevin D. Dolan Esq. 20,000.00
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 418.50
See continuation schedule(s) attached
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 52,562.25
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 113,561.02
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
�; .�� � , �,� .�4�����.��,�„:,�.� � �;� .�. .,.�w� ,
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex en nses
1 Gingrich Memorials-headstone 3,636.00
2 Hershey Cemetery Company-foundation 418.60
3 Trefz&Bowser Funeral Home,Inc. -funeral expenses 13,525.67
H-A 17,580.27
Probate Fees
4 Register of Wills-Letters Testamentary 408.50
5 Register of Wills-Short Certificates 10.00
H-B4 418.50
Qther Administrative Costs
6 A&M Auto Service Center 507.74
7 Computershare-surety bond for lost stock certificates 2,855.03
8 Cumberland Law Journal-estate publication 75.00
9 Escrow for final closing costs 1,000.00
10 Hampden Township-sewer&trash expenses during administration 579.18
71 Michael Langan,Tax Collector-real estate taxes for 2013 2,888.61
12 Michael Langan,Tax Collector-2014 real estate taxes 588.54
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
ITEM
NUMBER DESCRIPTION AMOUNT
13 P.P.&L.-electric bills during administration from date of death to 7/10/14 343.66
14 PA American Water-water bills during administration from date of death to 7/10/14 109.20
15 Real Estate Settlement Charges-per attached HUD-1 19,015.40
76 Russell Brown-Electrical work done at the decedent's residence 600.00
17 Santander Bank-check charge 29.20
18 Santander Bank-account verification fee 20.00
19 Scott Solanski -improvements to the decedenYs residence in preparation for sale 9,474.83
20 Seller Assist -for the purchase of the decedent's residence per HUD-1 12,359.72
21 Shareowner Services-surety bond for lost stock certificates, replacement fee 530.00
22 Steven Zeigler,CPA-preparation of decedent's 2013 income tax returns 915.00
23 The Patriot News-estate publication 67.94
24 U.G.I.-gas bills during administration from date of death to 7/10/14 603.20
H-B7 52,562.25
Copyright(c)2002 form software only The Lackner Group, tnc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+�12-OS)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Allstate-return overpayment 169.77
2 Camp Hill Emergency Physicians-medical expense 33.37
3 Capital Cardiovascular-medical expense 13.74
4 Capital Cardiovascular Assoc. -medical expense 36.78
5 Clem Ciccarelli, M.D.-medical expense 397.18
6 Forest Park Health Center-medical expense 3,552.00
7 Hampden Physician's Assoc.-medical expense 114.95
8 Holy Spirit Hospital -medical expense 8.87
9 Howard Roy Cohen, M.D.-medical expense 63.74
10 Jackson Siegelbaum Gastroenterology-medical expense 52.60
11 Lewin&Nadar Assoc. -medical expense 4.83
12 Montgomery Medical Equipment-medical expense 27.16
13 Peerless Credit Services for Internists of Central PA-medical expense 172.73
14 Quantam Imaging-medical expense 35.73
15 Rehab Group East-medical expense 72.05
16 Silver Spring Ambulance-medical expense 82.15
17 Spirit Physician's Services Inc.-medical expense 130.61
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 10, Recapitulation) 6,805.66
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
Rev-1512 EX+(�p-OS)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OFREVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Ziegelmeier, Karen A 21-13-1080
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 The Bridges at Bent Creek-nursing home expenses 765.07
19 West Shore EMS-ALS Life Support-medical expense 1,001.62
20 West Shore EMS ALS Life Support-medical expense 70.77
TOTAL(Also enter on Line 10, Recapitulation) 6,805.66
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BEN EFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Zie elmeier, Karen A 21-13-1080
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
Caren R. Herbert Daughter 1/5th of residue
305 Iroquous Trail
York Haven, PA 17370
Jennifer Miller Daughter 1/5th of residue
5222 DeerField Avenue
Mechanicsburg, PA 17050
Andre O.Ziegelmeier Son 1/5th of residue
15 Third Avenue
Apt. 1
Claymont, DE 19703
John P.Ziegelmeier Son 1/5th of residue
6193 Seven Springs Blvd.
Green Acres, FL 33463
Michael C.Ziegelmeier Son 1/5th of residue
64 North Conley Lane
Etters, PA 17319
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
LAST WILL AND TESTAMENT OF KAREN A. ZIEGELMEIER
I, KAREN A. ZIEGELMEIER, a resident of 609 Penn Ayr Road,
Camp Hill, Pennsylvania, being of sound mind, memory and understanding,
do make, publish and declare this as and for My Zast Will and Testament,
hereby revoking and making null and void any and al� Wills and Testaments
or writings in the nature thereof by me at any time heretofore made.
ITEM I - I direct that my hereinafter named Executor pay all _
my just debts and expenses as soon as may be conveniently done after my _
death.
ITEM II - I give, devise and bequeath my entire estate, what-
ever the nature of such property may be, whether real, personal or mixed
and wheresoever situate, unto my husband, OSCAR C. ZIEGEL.MEIER.
ITEM III - If my husband, OSCAR C. ZIEGELMEIER, should pre-
decease me, then and in that event, I give, devise and bequeath my
entire estate, whatever the nature of such property may be, whether
real, personal or mixed and wheresoever situate, unto my children,
share and share alike or to the survivor.s of them sharz ard share �like.
ITEM IV - If because of the deatn oi' ruy hus�and ard me, it is
necessary that a guardian be appointed for the persons of my children,
it is my desire that the Court appoint my sister, PATRICIA WOLF, of
253 Main Street, Hummelstown, Penna. , as such Guardian.
. _
__ _ _ _ _ _ _ __ -- _ .
ITEM V - I nominate, constitute and appoint my husband,
OSCAR C. ZIEGELMEIER, as Executor of this My Last Will and Testament.
In the event my husband, OSCAR C. ZIEGELMEIER, should predecease me,
then and in that event, I nominate, constitute and appoint my sister,
PATRICIA WOLF, as Executrix of this My Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
my above Will, consisting of these two (2) typewritten pages, thisC��J .
day of January A. D. One Thousand Nine Hundred Eighty-two (1982) .
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Signed, sealed, published and declared by the above names Testatrix, as
and for Her Last Will and Testament, in our presence, who, in her pre-
sence, at her request, and in the prese�ce of e h other, have hereunto
set our hands as attesting witnesses. �
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� 48500041�46
REV-485 EX(05-04)
SAFE DEPOSIT
BOX INVENTORY
PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY
Social Security or Death Certificate Number Date of Death County Code Year File Number
� 1 8 0i 2 6: 7� 3 4 1� 0. "� 2 .,7 2 :Q 1 3 21. 1 � 3 b . 1 0 8 0
DecedenPs Last Name Suffx First Name M�
., ,
.
Z` I' E G E L M E I E R ' K `A. R �E N ' A ;.
ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE:
5222 Deerfield Avenue Mechanicsbur Penns lvania 170
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
NAME: �,{. Hummelstown PA. 17036
Pa t r;�;a W,�1 f �5 3�Te�.t Ma i n—S..t�� �-
STREETADDRESS: � CITY: STATE: ZIPCODE:
� NAME,ADDRESS AND RELATIONSHIP(IF ANY}TO DECEDENT,�F PERSON(S)PRESENTAT THE BOX OPENING
a. NAME: RELATIONSHIP:
Patricia Wolf Fx u ix
STREETADDRESS: CITY: STATE: ZIP CO�E:
253 West Main Street, Hummelstown, PA 170�6
b. NAME: RELATIONSHIP:
STREET ADDRE55: CITY: STATE: ZIP CODE:
c. NAME: RELATIONSHIP:
STREETADDRESS: CITY: STATE: ZIPCODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE QEPOSIT BOX IS LOCATED
NAME:
M&T Bank --
STREETADDRESS: CITY: STATE: ZIPCOOE:
3805 Trindle
. NAME OF PERSON MAKING LAST ENTRY DA7E AND TIME OF LAST ENTRY
P cia Wolf ''�� i�. �x �> 3 �-�1�� +�
;D TE OF CONTRACT TO tR�ENT BOX ' NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REQUEST�D �
-�::L,::.,' --. - �
;�ti.,3�,��; t.�. �:;;;:��-� 218 K a r n
NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX
a.��P1AME: ; _, b. NAME:
z -
-��'� , ,4 ;` ,{= ,
,.- TRE ADDRESS: STREETADDRESS:
�, �� _� _ `.
� ,, :
.'� . .::..c_�� -.; s ��- ,4 d ..��:— �
F.1 CITY: � .�STATE: ZIP CODE: CITY: STATE: ZIP CODE:
s
L;.� ♦-... .- r g•��'_�� i... '` a �--�����.� .
�k....v `i t'�-' �_�.,= i :-',.
NAME AND TITLE OF EMPLOYEE TAKING THE INVEN70RY r r `
�� - �� ;: � ��:
�i<.� j
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:
Patricia Wolf, 253 West Main St . , Hummelstown, PA. 17036
STREET ADDRESS: CITY: STATE: ZIP CODE:
c. Name and address of attorney,if any
NAME:
Kevin D. Dolan, Esq. , 222 S. Market St. , Elizabethtown, PA. 170 2
STREET ADDRESS: CITY: STATE: ZIP CODE:
� 48500041046 48500041046 J
REV-485EX SAFE DEPOSIT BD)C INVENTORY Pa9e �f
INSTRUCTIONS
(1) Cash:Report total only.
(2) Stocks: List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by
name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock.
(3) Obligations of U.S.Government:Number of items,date of issue,face value,names in which registered and type of ownership,
i.e.,jointly held,payable on death,etc.
(4) Bonds: Designate by name,amount,seriai number,or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks:State name of depositor, number of book,last date appearing in book,name of bank -
and branch,and balance.
(6) Jeweiry;Coins,Stamps,Manuscripts,etc:List and describe as fully as possible.
(7) Deeds, Mortgages,Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
1NHERITANCE TAX DIVISION
DEPT.280601 -
. HARRISBURG,PA 17128-0601 ,��'�
ITEM ITEM DESCRIPTION
NO. �f
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I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORREC AKD COMPLETE TO THE `EST OF MY KNOWLEDGE AND BELIEF. S DEPOSIT BOX INVENTORY:
SIGNATUR ; � , SI ATU n
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PRINT NAME-_-' 8.�21NT NAME AND CHECK APPROP�2IATE OX BELOW:
� �_ �
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PRINT TITLE , OATE CHECK APPROPRIATE BOX:
~""�. �"Executor(triz) �Administrelor(trix)
'�''`�,�f � .�`� � ,J f f_:';-'' i ° -� e ° �Estate Represenlalive �Join[owner of safe deposit box
� ��� � �� � � 1�i �� . r..z 1��.-'1 y •.
NOTE Attach addit�onal 8'/:"x-11"sheet(s) if necessary or use duplicates of this page of form.
The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in eonnection with administering state(ax laws.The Department uses the
Sociai Security number to identify the decedent and personal represeritatives of the estate.The Commonwealth may also use the informa6on in exchange of tax information agreements
with Federal and local taxing authori6es.The stafe law prohibits the Commonwealth's personnel from disclosing confiden6al laz information except for otficial pu�poses.
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,ra"ncxr�y,o qIAB Approval No.2502-0285
� •�*`W
�e = A. Settfement Statement(HUD-1)
��N Od�E�'�
B.Type of Loan
7.Q FHA 2.Q RHS 3.�X Corn�Unins. 8. Fie Number: 7. Loen Number: 8. Mortgage lnsuren�a Case Num6er:
4.Q VA 5.0 Conv.Ins. 201408469.PFD 0422082737
C. Note: 7his fam Js lumiahed to glre you e sEetemeM of ecxual aatGement aosts MnuntapeJd to e�by the selMamenf agent ere shown.
Rems merhed(p.o.a)"were paid outside fhe duhg:�eyere shown here far[nformaUoneJpurposes end ere not Mduded fn fhe totals.
D. Name and Address of 8orro�xer: E Name and Addresa of Seiler. F. Name and Addreea of Lender:
.kmk E Clarlc Eslale of Keren A.Ziegelmeter WeMs Fargo Benk NA,
Jeime L Clerk 809 Pann Ayr Road Cs auaoas+ors and or easigna
4 Sheron Road Cemp H81,PA 17011 1017 Mumme Roed
Enola,PA 17025 Wormbysburg,PA 17043
O. Property Lowlbn: H. SeltlamenlAgenl: I. Selllement Dato:
609 Pann Ayr Road Centrel Pam Lend TrensFer,LLC
Camp H�I,PA 17011 38�0 Ma►ket SVeet July�0,2014
Cumberland CouMy,pennsylvenie Cemp Fiif,PA 17011 Ph. (71�695-3166
P�oe a Settlement:
3800 Market Street
Cam Hii,P1417011
J. Summary ot Bonowsrs t�nsactlon K. Summary of SelNrs transactlon
1�. OrossAmouM Due irom Borrower: 400. GroasMnount Due to 5elbr.
101.Cantrad miss rfoe 239 775.00 401. CoMtect aeles rice 239 775.00
102. Peroonal r 402. Persanal r
t08. Sedlemeet Char M Bmower Ltna 1400 10 552.98 403.
104. 404.
105. 405.
Ad uatmsnta for itams afd b 8eller In advance Ad uatments for ksme ald b Seller In advanes
1�. C /Town Taxes l0 406.C own Ta�ms to
107. Cou Ta�aee 07/11M4 W 01N1/15 26D.58 A07.Coun Ta�aes 07l11/14 lo Ot/01l15 280.58
108. SGwolTaxes 07M1/14 l0 07N7/15 1 94526 408.SchoolTexea 07/17H4 l0 07/01115 1945.26
109. Sewer Praralbns 07111M4 to 10101H4 138.20 409.Sewer PraraUona 07H1H4 to 10lO1H4 136.20
110, 410.
iti. 411.
712. 412.
120. Groea Amaunt Due from Borrower 252,891.98 420.Gross Amount Due to Saller 242,139.02
200.Amounts Pald b or In Behalf ot eo�rower 500. Reduetlons In Amount Duo Sellar:
20t. De or earne5t mon 1 D00.00 501. Bxoe�d sae Inat�ucibns
---202.P emouM of_aaw.be s _. 215 787.OQ 502. 3eltlemaM d�er ea to Selbr Line 1400 19 015.40 _ _ -
203. E�etN� ba e taken w et to 503. E�l ban s falrn au lo
204. 504.Pay�f Flrsl Mortgape
205. 505.P SeCOmi MoA
206. 506.
207. 507. D dbb.as roaeeds I
208. 508.
209. SeOerAealst 12 359.72 509.5e�erAeskt 12 359.72
Ad ustmants tor Msms un aid b Sslkr Ad uatmvets tor M�ms un ald Seller
210. C' own Ta�me l0 510.C' own 7e�ae9 tD
211. Cou Taxea to 511. Coun Texes to
2S2 SclaalTa�a W 512.SchoolTaxes to
213. 513.
214. 594.
215. 5t5. i
218. 516. � `
217. 577. "
219. 616.
219. 519.
�20.Tofal Pald b Ror Bonowsr 229.158.72 530.Total Raduetton Amount Dua Seller 31,375.12
�00.Cash et Settle�+t fromtto Bortoxrer �0.Caah at wtllement toHmm Seller
301. Groas amouM due from Barower mfe l20 252 891.98 801. Groas amouM due to Seller line 420 242139.02
302. Laaa emouM Id or Borrowsr 1na?2 ( 229,'158. 802 le�rodudbna due SeAer If�e 520 ( 31,375.1
303. Cash a From � To Bortower 23,535.26 803.Caeh X❑70 � f rom Sellar 210,783.90
�waame.adaripqr bvro.w(B�.a�Wb7.�en.ey.v MrawM1T1
The unde►dgned here �dmowledge ipt Fe pbted copy af this slslement&erry attachments referred to herein
Borrwvar �_� ��� Estate of KarenA 2iepetmeler
b E.CN1k
-�.- * ` � ��
- . .��� . 0
Patr� olF.Exewtor
TTeP�dic Repo'ting&`den fa tttis cdlxUOn of IMOfine4dlls esOmal¢tl el36mi7�1e9 pef respoflse la cdlectlnq rev�e�xtg.antlrepa'hng NBCaIa rhis egefky mqi leloaAact We rtdameAal endya erenOtfequredmcampflte
OW(Qm,uime�ibsqeya aaRatlY wb��d��Nowfitlenum7ry�s meureq ths dWarrsl�mnfe�y.Ths is das�gnetl b pwiaa Nepa9a to a RESPAcovwetlaauxtlmvAN ntlorm Na+d+IngNee�tleme9
R��
Page 1 of 3 HUD-1
(201406469.PFD/20140848D.PF Df48)
L.SettlemeM Cha os
1Cb;"F � :5�1�;8a�.6tl. _,:�y;.; .,...��:---.-� _-. Pew F�an Paia F�n
Di�inn o/oommiaeaon{pns 700}as No6owr Bortowers Selkrs
701.E 8.613.25 lo Centu 21 Rea Servkes Funda et Funds et
702.S 6,318.25 lo Danie�Real Fstete Group Soltiamerd Se��tamaR
703.Com n aid at aetllamant �p 31,gp
764.Broker Fae to Joy Denbls Rael E�tafe Cxoup 395.00
�COiI .W j�I-- ;'Y�r:�,�_.,..e:j: _ _ i« _.
801.Our or inetbn fiar S•�895.00 from GFE 01
802.Y aedR or ta for w i srest r 7 from E#2
800 r ated or inatlon e a Vom F #A 2 78
804- abe to Is VY 'n from E#3 POC: .32 20.BB
805.Credi R to Core Credao L�C from GFE#3 P.O.C.S44.00 B•
808- sendce to m GFE
907.Flood don to GFE M3
from GFE li3
from GFE M3
810. from GFE tK!
811. (from GFE#3)
.i'�E.. , ' °� 06fi. '�s' - o:'_ - - - .-- --� - ---
�-
901.De m6ereetche eefrom 07l1W14 to 08107114 ^ 22 524.�DOOO/da iromGFEiF10 536.58
802.M a e huurence p►emium tor manlhs W (from GFE�13)
803.Homeowner's lnwrenoe tor 1.o ara lo Stete Farm (trom GFE#71) 833.00
`�4. (from GFE#71)
905. (frotn CaFE p11)
.. r_' . � . . .r i...'... .w� ,. p�r... . . . . .
. . � �..._ 'r . 'F�'�:�i _ . . .. _. ..'_' _
. , ... .
� ., ��� ..�.a�:�{y:�'f'!'�.: F�'?r.�_: ..:';°.^.,. ... . �'�' ''
1001.Indial de oeR(or your secrow a000unt (from c3FE f�) 545.73
1002.Haneowner's ineuranm 3.000 months S 52J5 r moMh $ 158.25
1003.Morl e mwrance monthe ; r month S
1004.Pro ta�aas S 300.30
Coun T�ma 6.000 monlhe S 50.06 r month
Sdwol Texee rtqnihs S per month
1005.
1Q06.Sclaol Texes 2.000 monlhs S 770.07 per month S 340.14
1007. months $ per month S
�ooe. a
1A09. repeleMusUnern a -z5z.98
..
. ;�� �; F.,, ..m F'L...;7' �,�,. ��•;:� -- ::1::ss• _�. .... ... . ........, .
1101. Tdbeery(cesandbnderb1�11ebaurenoe .•(fromGFE#4) 1,824.50 20.00
1102. Selfbment or Tee S
7103. Ownera Gla inauranoe to F4alAmerian TiGe Irourants Compa (from GFE 0� 120.00
1104. Lender's tAle�surence fo FirW Nnerian Tftb Insurenae Company 5 �,�0.00
----.__1105.._Lendetatitle. Amri . E _ 215.797.00 __ ___ _-- . ___.___
---- ___ -- _
1108. Owner's tib pollcy Bmn S 238,775.00
1107, enPa rtbn of fhe tolsl tille imuranae Ium ta Central Penn Land Trender,LLC S 1,487.50
1708. Unde�wrier's porGon oi the tolal t�le inaurenoe promium to Firsl Ameron Title I�wrenrs Compa S 282.50
1709. Deed Prep Fee to Pur�yAbstred S 150.00
7110. S
1111. $
t��z. a
»�3. a
`.. , .:�. , ;��,� ����:. .
1201.Government recotdin ee to Cumbarlend Coun Reaorder of Deeds hom GFEit ,. 166.00
1202.Daed E 6200 M a a 104.00 Rebeaes S Olher S
1203.Tramfar imma to Cumberland Cotmly Reoorder of Deeds (from OFEl18) 2,397.75
12D4.C' /Cou ta�dst Deed S 2 397.75 S 2 397.75
1205.Stete laxlsta e Deed S 2 397.76 Mort S
1206.
1
�� t a' �.�t. . . :t��r .i ''.+i - -- - -.. .
1 1.Requir eervloes at you wn aho for i�.�- ((rom .. � 1 B.OD
1302.Sewer Bi Due W Flem en TWp. S 1/7-9130 518.09
1303.HomeITarmadRadvn I lon lo The V6tua Grou S A25.00
1304.2014 SChod Tsxe� to Mi�haai Len n S 2,000.06
i305.Fbod LYe of Loan Fee lo WeOs Fargo Flood Servioes 5 19.00
�308.Tax Servioe Fee lo WF R�(Esl Tax Se�viaes S 100.00
1307,Radon lo Centrat Penn Redon S ��-�Q
1308.Termtle 8 PeW Conlrol to Sudden Death S 686.50 235.00
') i: 9M ''e11 r Rf`n.,...� �1!'�1 •'- i8 i. -16� 1
•vra auis ddaW bv barar(el,�dirfsl,i�fy.a mrapsiy�'�
B�spV�ppya 1 d Ws eteisne'1,Ile M@tlola eWoMatlperoospde mnpMOtl mq d pqe 2i 9d Wc hr pepoeldemat
nn Lend lYansfer,LLC, enlAgent
Pege 2 of 3 HUD-1
(201406469.PF D201408469.PFDl49)
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 05/2013
Total Price Total Value Total Interest YTD Interest
900.00 2 741.46 1 841.46 51.88
Bonds: i-16 of 16
Issue Next Final Issue Interest
Serial # Series Denom Date Accrua) Maturity Price Interest Rate Value Note
L481382873EE EE $50 li/1992,il/2013 11/2022 $25.00 $46.18 4.00% $71.18
C553640742EE EE $100 01/1996 07/2013 01/2026 $50,00 $50.00 0.59% $100.00
K97553320EE EE $75 01/1993'07/2013 01/2023 $37.50 $67.17 4.00% $104.67
K97553321EE EE $75 O1/1993 07/2013 01/2023 $37.50 $67.17 4.00% $104.67
L534857528EE EE $50 01/1995 06/2013 01/2025 $25.00 $26.68 4.00% $51.68 _
L525114262EE EE $50 10/1995 10/2013 10/2025 $25.00 $25.20 0.59% $50.20
L545084590EE EE $50 O1/1996 07/2013 01/2026 $25.00 $25.00 0.59% $50.00
R99667674EE EE $200 07/1993 06/2013 07/2023 $100.00 $119.44 4.00% $219.44
R104093936EE EE $200 10/1993 06/2013 10/2023 $100.00 $117.28 4.00% $217.28
R16290192EE EE $200 11/1983 li/2013 11/2013 $100.00 $352.24 4.00% $452.24
R93924316EE EE $200 04/1993 06/2013 04/2023 $100.00 $121.60 4.00% $221.60
R110783245EE EE $200 04/1994 06/2013 04/2024 $100.00 $112.96 4.00% $212.96
R107636777EE EE $200 02/1994 06/2013 02/2024 $100.00 $114.40 4.00% $214.40
----- - -L-264809692E E -- -$50 07/1953--- 07/1993. $37.50 $294..12 -- $331.62 MA
-
Q1142779566E E $25 02/1954 02/1994 $18.75 $150.11 $168.86 MA
Q1006538807E' E $25 01/1952 01/1992 $18.75 $151.91 $170.66 MA
Totals for 16 Bonds 900.00 1 841.46 2 741.46
N otes
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penafty
MA Matured and not earnin interest
http://www.treasurydirect.gov/BC/SBCPrice 10/31/2013
Hershey Co.,HSY Historical Quote-(NYSE)HSY,Hershey Co. Stock Price-BigCharts.com Page 1 of 1
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�1�j Enter Symbol: hsy Enter Date: 5124113� ��
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Closing Price�. 89.25
ove�: 88.99
High' 89.ZrJ
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Merck&Co.Inc.
Fn,May 24,2013
Ciosing Price: 47.16
oPe�: 47.05
H�yn: 47.16
�aw: 46.60
voi�me: 15,795,941
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ope�: 66.01
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8/I 1/2014
Oct, 28. 2013 11 : 16AM PNC Bank No. 8290 P. 1
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October 28,2013
Ke�vin D Dolan Esq.
Gingrich Smith.KJingensmith
&Dolan Attys at La�uv
222 S Market St Ste 201
Elizabethtown,PA 17022
RE: Karen A Ziegclm.eier
SSN: 180-26-7341
DOD: OS-27-2013
Dear Mr. Dolan:
In response to your request for Date of Death(DOD)balances for the customer noted above, our
records show the follovving_
Ch�cking Accuunt
---- ---
Account# 5140071356 . Esfsblished: 03=24=20 -
KAIZEN A ZTEGrELMEYER
JEN'1�TT�'ER A MII.LEIt
DOD balance: $ 13,225.63 +0_12 accrued interest
Interest paid O1-01-2013 t�uu OS-27-2013 $0.62 YTD
Savings Account
Account#5006277521 Established: 03�24-2009
KAREN'A ZIECrELMEYER
JENN�IFBR,A 1V�ILLER
DOD balance: $ 10,050.39-�0.12 accrued interest
Interest paid 01-01-2013 thru.05-27-2013 $3.32 YTD
Please note tb,at this o ,ffitce pzovides date of death balances for deposit accounts(IItAs,CDs,Cbec),�iuog an.d
Savi.ngs). 'We c�o not process any fioancial transactions or provide statements. If you need assistance with
an�r of these it�ms,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your Ioca1 PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDTC
Page 1 of 2
Oct. 28. 2013 11 : 16AM PNC Bank No. 8290 P. 2
This message is intended for the use of the individual or eritzry to which it is ada�exsed and may
contazn informatior�that is privrlegea; confrdential and exempt from disclosure under applicable law.
1'f t�ie reader of thzs message is not the intended recipient or�he employee or agent responsible for
deliver�ng this message to rhe intended recipient,you are hereby notified rhat mzy dissemrnation,
disaribution or copying of this communications is strictly prohibited_ 1'f you have received thas
corrarraunac.ation in error,please notify me immediately by reply or by telephone at 800-76Z-1775 and
immediately destroy this faxed document_
�'age 2 of 2
. � • -
Court Order Processing\Decedents- MA1-MB3-02-10 - P.O.Box 841005 - Boston,MA 02284
January 13, 2014
�
s
� Kevin D. Dolan, Esq.
p Gingrich, Smith, Klingensmith & Dolan
� 222 South Market Street, Suite 201
� P.O. Box 267
:� Fliz�h�th#�u�n; PA 17022
�
0
� RE: Estate of Karen A Ziegelmeier
" Date of Death: 05/27/2013
4
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� Dear Mr. Dolan:
�
s Per your request, enclosed please find the account information as of the date of death
#or-the above=named-�ecedent: For-your iFl#ormati�n�ecrued=t�rt�res#--ES--r�e�I+a�-iT-.-
�� the date of death balance.
� Please feel free to contact me if I can be of any further assistance.
�
g Very truly yours,
Z
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5 �'�'_�
a Ed Stevens
5 CC�P Spee!�l'!st
� 617-514-5189
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Santander
ESTATE OF Karen A Ziegelmeier
SOCIAL SECURITY#: 180-26-7341
DATE OF DEATH: May 27, 2013
Account#: 1054018385 Type: Savings Open date: 11/17/1995
In the name of: Karen A Ziegelmeier or Jennifer A Miller
Date of Death Balance: $2,344.66
Int.(YTD) from 1/1/2013 to 5/1/2013 $0.32
Accrued interest to date of death: $0.09
Other Info:
Page 1 of 1
Comparative Holdings with Detail ___ _
Karen A Ziegelmeier Mr Raymond F Wolfgang Jr Combined Account Portfolio
5222 Deertield Ave Keystone Financial Management Period:05/27/2013-05/27/2013
��y(�TO�' Mechanicsburg, PA 17050 2431 North 2nd St Created:07/19/2013
=Financial Management Harrisburg, PA 17110
� ------ - - 717-234-7607
Karen A Ziegelmeier
Acct Name:KAREN A ZIEGELMEIER 5222 DEERFIELD AVE MECHANICSBURG PA 17050-6824
Acct No:00004851649 AcctType:Generai
Rep.No:24636
Asset Name BegInninq Purchases($) Redemptions Other Activi�( Changein Ending Value °�Return
Va1ue($) ($) (�) Value($) ($)
05/27/2013 (05/27/2013-05/27/2013) 05/27/2013
BOND A 39,537.62 0.00 0.00 0.00 0.00 39,537.62 0.00
AccountTotal: $39,537.62 $0.00 $0.00 $0.00 $0.00 $39,537.62 0.00°/a
Acct Name:KAREN ANN ZIEGELMEIER 5222 DEERFIELD AVE MECHANICSBURG PA 17050 US
Acct No:FX06018945 AcctType:Non-Qualified
Asset Name Beginning Purchases($) Redemptions Other Activity Change In Ending Value °k Retum
Value($) :($) ($1 Value($) ($) :
05/27/2013 (05/27/2013-05/27/2013) 05/27/2013
1 YEAR 100,605.93 0.00 -100,630.35 0.00 24.42 N/A p,02e
Account Total: $100,605.93 $0.00 -$100,630.35 $0.00 $24.42 N�A 0.02%6
Acct Name:KAREN ANN ZIEGELMEIER TOD BENEFICIARY ON FILE 5222 DEERFIELD AVE MECHANICSBURG PA
17050
Acct No:JH4264733 AcctType:Transfer On Death-Individual
Rep.No:ZJ8
Asset Name Beginning Purchases($) Redemptions Other Activity Change In Ending Value %Return
Value($) ($) (S) Value($) �$)
05/27/2013 (05/27/2013-05/27/2013) 05/27/2013
BANCO SANTANDER SA ADR 2,078.15 0.00 0.00 0.00 0.00 2,078.15 0.00
BLACKROCK MUN INCOME 11.64 0.00 0.00 0.00 0.00 11.64 0.00
TR SH BEN INT
CASH 38,460.13 0.00 0.00 0.00 0.00 38,460.13 N/A'
DELAWARE TAX FREE 10,212.99 0.00 0.00 0.00 0.00 10,212.99 0.00
PENNSYLVANIA A
MANULIFE FINL CORP COM 870.42 0.00 0.00 0.00 0.00 870.42 - 0.00
PRIME FUND CAPITAL 751.72 0.00 0.00 0.00 0.00 751.72 0.00
RESERVES CLASS
PUTNAM AMERICAN 6,802.69 0.00 0.00 0.00 0.00 6,802.69 0.00
GOVERNMENT A
WELLS FGO AVTG ASSET 13,783.27 0.00 0.00 0.00 0.00 13,78327 0.00
ALLOCATION-6
WEILS FGO AVTG UTILITY 14,768.11 0.00 0.00 0.00 0.00 14,768.11 0.00
AND TELECOMM-C
Account Total: $87,739.11 $0.00 $0.00 $0.00 $0.00 $87,739.11 0.00%
Incomplete if presented without accompanying disclosure pages Page 7 of 3
Comparative Holdings with Detail _ _
Karen A Ziegelmeier Mr Raymond F Wolfgang Jr Combined Account Portfolio
5222 Deerfield Ave Keystone Financial Management Period: 05/27/2013-05/27/2013
��7CTo� Mechanicsburg, PA 17050 2431 North 2nd St Created:07/19/2013
lu.�1 V 1 Harrisburg, PA 17110
�� Financial Management
717-234-7607
Acct Name:KAREN ANN ZIEGELMEIER TOD BENEFICIARY ON FILE 5222 DEERFIELD AVE MECHANICSBURG PA
17050
Acct No:JH4298778 AcctType:Transfer On Death- Individual
Rep.No:ZJ8
Asset Name Beginning Purchases($) Redemptions Other Activi Change in Ending Value %Return
Value($) ($) (� Value($) ($)
05/27/2013 (05/27/2013-05/27/2013) 05/27/2013
HERSHEY CO COM 82,132.49 0.00 0.00 0.00 0.00 82,132.49 0.00
AccountTotal: $82,132.49 $0.00 $0.00 $0.00 $0.00 $82,132.49 0.00%
Acct Name:KAREN ZIEGELMEIER JENNIFER A MILLER POA 5222 DEERFIELD AVE MECHANICSBURG PA 17050
17050
Acct No:1007970931 Acct Type:Non-Qualified
Rep.No:24636
Asset Name Beginning Purchases($) Redemptions Other Activi�l Change In Ending Value °�Retum
Value($) ($) (3) Value($) (S)
05/27/2013 (05/27/2013-05/27/2013) OS/27/2013
JNL/PIMCO TOTAL RET BOND 389,993.90 0.00 0.00 0.00 0.00 389,993.90 0.00
JNUPPM AMERICA HIGH YLD 210,470.89 0.00 0.00 0.00 0.00 210,470.89 0.00
BOND
JNL/WMC BALANCED 213,518.28 0.00 0.00 0.00 0.00 213,518.28 0.00
Account Total: $813,983.07 $0.00 $0.00 $0.00 $0.00 $813,983.07 0.00°/a
InvestorTotal: $1.�23,998.22 $0.00 -$100,630.35 $0.00 $24.42 $1,023,392.29 O.00�o
PortfolioTotal: 51,723,998.22 $0.00 -$100,630.35 $0.00 $24.42 51,023,392.29 0.00°/a
Incomplete if presented without accompanying disclosure pages Page 2 of 3
� �
��� ���� s t p �
3�'r��j:>§��
�refi & Bo�wser �uneral�-fome, �nc.
114 West Main Street
Hummelstown, PA 17036
717-566-0451
Date of Death 5/27/2013
invoice
Description Amount
FUNERAL EXPENSES FOR KAREN A.ZIEGELMEIER
Services of Funeral Director&StafF 1,725.00
EmUalming 900.00
Other preparation of an embalmed the body 440.00
Use of facilities and services for viewing,Evening before daytime service 190.00
Use of facilities and services for viewing,daytime before service 190.OQ
Use of facilities and services for Funeral ceremony � 830.00
iJse of services for Graveside service 425.00
Vehicle to transfer remains to Funeral Home 350.00
Hearse(local) 300.00
Limousine(local) 200.00
� Flower car or floral disposition(local) 130.00
Acknowledgement cards 30.00
_— _ Register Book 40.00
-_ __ _ ___ _._
Memorial foiders/Prayer cards 60.60
Standard Package discount -562.00
CASKET Provincial 3,'710.00
OUTER BURIAL,CONTAINER Guardian 1,140.00
Grave opening paid to Hershey Cemetery 1,200.00
Cemetery Equipment charge 400.00
Clergy/Mass Offering 150.00
Obituaries The Patriot 380.72
Obituaries The Sun 90.00
Certified copies(10 at$6.00 each) 60.00
Flowers 771.95
Organist or Pianist � 125.00
Saturday Fee 250.00
Total $13,525.67
Payments $0.00
Payment Due Upon Receipt , Balance Due $13,525.67
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