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Home My WebLink About02-0707 REV-1500 EX (6-00) " ;1-~b-~; c. OFFlOAL USE ONLY COMMONWEALTH OF REV-1 500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128.0601 RESIDENT DECEDENT 21 - 02~ .--SJ70L -- COUf\fTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOC~LSECU~TYNUMBER ~ Zinnr Janet M. 193-18-6121 z w DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM+DD-YEAR) THIS RETURN MUST BE FI1.ED IN DUPLICATE. WITH THE 0 W 05/08/2002 REGISTER OF WILLS '-' w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCtAL SECURITY NUMBER 0 w [Xl Original Return D 2. Supplemental Return D :r 1 3, Remainder Return (dale of dealh prior to 12+13-82) "'-"' 0 D 4a. Future Interest Compromise (date of death after 12-12-82) 0 ,,"'''' 4 Limited Estate 5. Federal Estate Tax Retum Required w"" ",00 D 6 Decedent Died Testate (Attach copy of Will) [Xl 7. Decedent Maintained a Living Tf1Jst (Attach copy ofTrust) 8 Totai Number of Safe Deposit Boxes ,,"''''' - ..'" .. D D 10. Spousal Poverty Credit (date or death between 12-31-91 afll1-H5) [J '" 9 Litigation Proceeds Rece\\led 11. Election to tax under Sec. 9113(A)(Atl~hSChOI >-- THIS SECl'lPN Ni,I.lS-r.'SE C:OMPLEiTl;cl:'.ALL'CORRIiSPO!<lDE!<IClIiANI!X(; 6NF(orfNTI.4,tl'lr'~jNFilRNI:4i~i6N's~oiliili.!iEPIRae:l'ED'.tr.& z NAME COMPLETE MAiliNG ADDRESS w Q Mark R, Parthemerr Esq. z 0 FIRM NAME (If Applicable) 100 Pine Street .. '" P,O. Box 1166 w McNees Wallace & Nurick LLC " " Harrisburg, PA 17108 0 TELEPHONE NUMBER u 717-237-5250 1. Real Estate (Schedule A) (1) 0,00 OFFIQAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0,00 4. Mortgages & Notes Receivable (Schedule 0) (4) 0,00 5. Cash, Bank Deposits & Miscellaneous Persona! Property 27,569.29 (ScheduJeE) (5) Z 6 Jointly Owned Property (Schedule F) (6) 0.00 0 D Separate Billing Requested ;::: I ::i 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) 360,999.43 ::J (Schedule GorL) ~ a: , Total Gross Assets (total Lines 1-7) (8) 388,568.72 <I: '-' 13,253.71 w 9. Funeral Expenses & ACmir.lstratl\l8 Cos1s (Schedule H) (9) r:r: 10. Debts of Decedent, Mortgage LiabiHties, & Liens ($d1edule I) (1Q) 10,404,08 11. Total Deductions (Iotal Lines 9 & 10) (11) 23,657.79 12. Net Value of Estate (Line 8 minus Line 11) (12) 364,910,93 13. Charitable and GO\l8mmental Be uests/See 9113 Trusts for which an election to tax has not been made (Schedule J) Q (13) 0,00 14. Net ValLie Subject to Tax (Line 12 minus Line 13) (14) 364,910,93 SEe INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousai tax z rate, or transfers under Sec, 9116 (a)(1.2) o ~ 16 Amount of Line 14 taxable at lineal rate .... ::> ~ 17. Amount of Line 14 taxable at sibling rate o () 18 Amount of Line 14 laxable atcoilateral rate X '" I- 19 Tax Due 0,00 x.OO_(15) (19) 0.00 16,420,99 0.00 0.00 16,420.99 364,910.93 0,00 0,00 x_04~(16) x.12 (17) x .15 (18) 20. [gJ CHECK HERE IF YOU ARE. REQUESTING A REFUND OF AN OVERPAYMENT > > BE$JilRE 'TO AA$WERl\l;/:./lWj;$T!ON$cOIil! R.EV"'(l;'~SIOE AND ~l!ekECKl1IIAl'k< < 2W46451.000 Decedent's Complete Address: STREET ADDRESS (MeSSiah Village iCIlY ! Mechanicsburg \ STAl'E PA ! ZiP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditsJPayments A Spousal Poverty Credit B. Prior Payments C. Discount (1) 16,420.99 0.00 17,000.00 821. 05 Total Credits (A + 8 + C) (2) 17,821.05 3. Interest/Penalty if appllcable D. Interest E. Penal!)' 0.00 0.00 TotallnterestlPenalty (D + E) (3) 0.00 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 1,400.06 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A Enter the interest on the tax due. (5A) 8 Enter the total of Line 5 -+- SA. (58) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: a. retain the use or income of the property transferred:. . . , . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest, or . . . . . . . , . . . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12. i 982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . , . . . . . . . . . . . . . . [X] 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [Z] 0 IF THe ANSWER TO ANY OF THE ABOVE QUeSTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Unoer penalties 01 penury, \ declare thaI I have examirled this relum, Includirlg accompanying schecules and statements, al1d to me best ot my knowledge and belief, it IS true, correl:t aM complete Oeciar"H10n of preparer otner than the personal representative is based on all information of wl1'Ch preparer l1as any knowledge, SI ATURE OF PERSON RESPONSIBLE FOR FILING RETURN Yes No o " o n 00 [Xl IXJ 00 ~ 00 \\~ \\. ~~ DATE II ~'?\D3 17019 DATE i 03 ox 5liPJt~K~lYtJf'8i~', .., ~.,~~ma~ill For dates of death en or after July 1, 1994 and before January 1, 1995. the tax rate Imposed on the net value of transfers to or for the use oflne surviving spouse is J% (72 p.s, S 9916 (a) (1,1) (i)). For dates of death on or after January 1. j995, the t;3x rate imposed on the net value of transfers to or far the use of the surviving spouse is 0% [72 P.S. 3 9116 (a) (1.1) (iil] The statute does nOI 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 jf the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000 The tax rate imposed en the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent. or a stepparent of the child is 0% [72 p,s, 8 9116(a)(1 ,2)] The tax rate imposed Dn the net value of transfers to or for the use of the decedent's linesl beneficiaries is 4.5%, except as noted in 72 P,S. 9 9116(1.2) [72 P.S. 8 9116(a}(1 )J. The tax rate imposed on the net value oftransfers to or for the use otthe decedent's siblings is 12% (72 P,S, g 9116(a)(1 .3)\, A sibling is delined, under SectiQl1 9102, as an indi....idual who has at least one parent in common with the decedent. whether by olood or adoption W46A.61.000 REV-15GB EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Zinn, Janet M. FILE NUMBER 21-02-0707 Include the proceeds of litigation and the date the proceeds were recei>red bytne ~state. All property jointl)l-owned with the light of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Fulton Bank Account No. 3632-35671; Account payable to Janet Zinn Trust VALUE AT DATE OF DEATH 27,549.87 Accrued Interest 3.25 2 United States Treasury - Refund re 2000 income tax return 16.17 2W46AD 2.000 TOTAL (Also enter on tine 5 Recaoitulation\ $ (If more space is needed, insert additional sheets of the same size) 27,569.29 REV-1510 E.X+ (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERiTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zinn, Janet M. FilE NUMBER 21-02-0707 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~1500 COVER SHEET is yes. ITEM NUMB'" 1. DESCRIPTION OF PROPER1Y INCLUDE THE NAIVE OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT A.NDTHE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE Cash Gifts made from May 8, 2001 to May 8, 2002 to Diane Huffman (Daughter) DATE OF DEATH VALUE OF ASSET 14,900.00 2 Cash Gifts made from May 8, 2001 to May 8, 2002 to Ny1ene K. Trump (Daughter) 10,000.00 3 Allstate Life Insurance Company Annuity Contract No. PA00026800; Annuity owned by the Janet Zinn Trust (revocable trust) 271,438.27 Beneficiary: Janet Zinn Trust Valued as of May 8, 2002; See valuation letter attached. 4 IDS Life Insurance Company Annuity Contract No. 9300-5940211; Annuity owned by Janet Zinn Trust (revocable trust) 70,661.16 Beneficiary: Janet Zinn Trust See valuation letter attached. %OF DECO'S INTEREST 100.00 100.00 100.00 100.00 TOTAL (Also enter on fine 7, Recapitulation) $ 2W46AF2.000 (If more space is needed, insert additional sheets of same size,) EXCLUSION IF APPUCABLE 3,000.00 3,000.00 0.00 0,00 TAXABLE VALUE 11,900.00 7,000.00 271,438.27 70,661.16 360,999.43 REV-1511 EX+(1-97} SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zinn, Janet M. FILE NUMBER 21-02-0707 Debts of decedent must be reoorted on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAl EXPENSES: 1. Cocklin Funeral Home 8,328.18 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year{s} Commission Paid: 2. Attorney Fees Name: McNees Wallace & Nurick LLC 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tal< Return Preparer's Fees Name: Susquehanna Financial Services 350.00 7. McNees Wallace & Nurick LLC; Costs Advanced as 25.53 follows: Duplicating $20.40 Long Dist. Telephone .71 Postage 4.42 8 McNees Wallace & Nurick LLC - Reserve for closing 50.00 costs re duplicating, postage, etc. TOTAL (Also enter on line 9, Recapitulation) $ 13,253.71 2W46AG2,OOO (If more space is needed, insert additional sheets of same size) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE DF Zinn, Janet M. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-02-0707 Include unreimbursed medical eXDenses. ITEM NUMBER DESCRIPTION AMOUNT 10,338.88 1, Fulton Bank - Outstanding Checks at date of death 2 MSHl-1C Physicians Group; Medical Expense 27.61 3 Quantum Imaging & Therapeutic Associates, Inc.; Medical Expense 37.59 2W46AH2,OOO TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10,404.08 REV-1513 EX. (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zinn Janet M NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVlNG PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Huffman, Diane 527 North Willey Street Seafood, DE 19973 1. 2 Trump, Nylene K. 47 Impala Drive Dillsburg, PA 17019 3 Huffman, Patrick 527 North Willey Street Seafood, DE 19973 4 Trump, Christopher 47 Impala Drive Dillsburg, PA 17019 5 Trump, Ani ta 47 Impala Drive Dillsburg, PA 17019 FILE NUMBER 21-02-0707 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter Grandson Grandson Granddaughter AMOUNT OR SHARE OF ESTATE 172,405.47 167,505.46 5,000.00 5,000.00 5,000.00 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 B. AS APPROPRIATE. ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 2W46AIHlQO TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space \s needed, Insert addItIonal sheets of the same Size) $ 0.00 Estate of: Zinn, Janet M. Schedule J Part 1 -- Beneficiaries Item No. Name and Address of Person(s) receiving property Relationship Page 2 21-02-0707 Amount or Share of Estate 5,000.00 6 Zinn, Leah 111 West Greenhouse Road Dil1sburg, PA 17019 7 Zinn, Rebekah 111 West Greenhouse Road Dillsburg, PA 17019 Granddaughter Granddaughter 5,000.00 ESTATE OF JANET M. ZINN PENNSYLVANIA INHERITANCE TAX RETURN TABLE OF CONTENTS (EXHIBITS) A. Miscellaneous Documents 1. Table of Contents - Exhibits 2. Copies - Trust Agreement dated September 24, 1996, First Amendment to Trust Agreement dated May 10, 1999, and Second Amendment to Trust Agreement dated September 28, 2001 3. Copy - Official Receipt from Dept. of Revenue - 3 month inheritance tax payment B. Schedule E - Cash, Bank Deposits, & Misc. Personal Property; Copy of Fulton Bank account statement C. Schedule G - Inter-vivos Transfers & Misc. Non-Probate Property 1. IDS Annuity Valuation (Item 1) 2. Allstate Annuity Valuation (Item 2) JA.'! M. WILEY & ASSOCIATES :\rrORNE'iS.U \.AW ONESOUTH BA1.11MOR!:sr, D'LL.sBURC. 1.0\ 11019 I 'i i :\ i ~VJ C\ 'to ~S CCOfY TRUST THIS this '2if{, of TRUST AGREEMENT, made day C::-P' n-t I 1996, by and bet'Neen JANET M. ZINN, of Messiah Village, .- Mechanicsburg, Pennsylvania, hereinafter referred to as TRUSTOR, and NYLENE .K. TRUKP and LYNN E. TRUMP, of 47 Impala Drive, Dillsburg, Pennsylvania, hereinafter referred to as TRUSTEES. WIT N E SSE T H WHER~~S, TRUSTOR is now the owner of preper~y and asse~s as described in Ex.l-tibit "A", attached hereto; whER~.S, TRUSTOR desires to make previsions for the care and management of such property and assets, the collection of the income therefrom, and the disposition of both such income and such property and assets in the manner herein provided; NOW THEREFORE, for the reasons set forth above, and in consideration of the mutual covenants set forth herein, TRUSTOR and TRUSTEES agree as follows: 1. TRUST ESTATE: TRUSTOR assigns, transfers, and conveys to TRUSTEES the property and assets described in Exhibit / A", attached and :1 incorporated by reference herein, receipt of which is hereby I acknowledged by TRUSTEES (such property and assets hereinafter referred to as principal). The principal shall be held by JAN M. WILEY &: ASSOCIATES "nOINEY! AT LAW Of'll:. SOUTllllALllMOREST. DILLSBUllG.. PA, t'tllt') powers, all of which shall be exercised in a fiduciary capacity and primarily in the interest of the TRUSTOR: (al To retain any property or undivided interest in property, received from the TRUSTOR or from any other , source including residential property, regardless of any lack of diversification, risk cr non-productivitYi (b) To invest and reinvest the Trust Es~ate in bonds, !1otes, stocks, or corporation regardless of class, real est:ate or any interest in real es~,:;..ce / and inte~est in trus~ i~cluding common trust funds, or any other property or undi vided interes~ in proper~y, wherever located, without being limited by any statute or rule of law concerning investments by TRUSTEEi (c) To sell any Trust property, for cash or on credit, at public or private sales; to exchange any Trust property for other properties i to grant options to purchase or acquire any Trust property; and to determine the prices and terms of sales, exchanges, and options. (d) To operate, maintain, repair, rehabilitate, alter, improve or remove any improvements on real estatei to make leases and subleases for terms of any length, even though the terms extend beyond the may termination of the Trusti to subdivide real estate; to JAl'l M. WILEY &: ASSOCIA ITS ATTORNEYS AT u,w ONESQL'TH BA.LnMORESf. DILLSBliRe. P.... 17019 I I I I I I grant easements, gi ve consents, and make contracts related to real estate or its use; to release or dedicate any interest in real estate; (el To borrow money for any purpose and to mortgage or .- pledge any Trust properties; (f) To employ attorneys, auditors, depositaries, proxies and agents with or without discretionary powers; and to keep property in the name af a trustee or nominee, ftlith ",.;i thout disclosure of or any fiduciary relationships or in bearer forms; (g) To determine the manner or ascertainment of income and principal, in the allocation or apportionmen~ between income and principal of all re.ceipts and disbursements; (h) To take any action '"ith respect: to conserving or realizing upon the value of any Trust property, and in respect to foreclosures, reorganizations or other charges affecting the Trust property; to collect, pay, contest, compromise or abandon demands of or for against the Trust Estate wherever situated; and to execute cont:-acts, notes and other conveyances instruments, including instruments containing covenants and warranties binding upon and creating a charge against the Trust Estate, and containing JAN M. WILEY & ASSOCIATES .4.lrORNEYS At LAW QNESOllTH BA1.nMQU5r. DILL.SBURG. PA litll9 'I provisions excluding personal liabilities; (il To receive additional property from any source and add it to and commingle it with the Trust Estate; II I I I I , ! (j) To make any distribution or division of the Trust property in cash or in kind or both, and to continue to exercise any powers and discrecion hereunder for a reasonable period after the termination of the Trust, but only for so long as no rule of law relating to perpetuities wculd be violated. (k) To invest principal and income without restriction to so-called investments" for fiduciaries. "legal TRUST~ES may make short and/or lcng-te~ inve5~~ents with trust principal and income in a money market fund for ",.;hich TRUSTEES receive fees for ::-acarj-keeping and/or other services it performs for such fund, or in a deposit account at a bank affiliated with TRUSTEES, or TRUSTEES themselves. 7. DURATION OF TRUSTEES' POWERS: :1 All of the rights, powers, authorities, privileges and immunities given to TRUSTEES by this Agreement shall continue I after termination of the Trust created hereby until TRUSTEES ! shall have made actual distribution of all property held hereunder. 8. F"EES: JA8 M. WILEY & ASSOCIATES .'I.TTOlU'lnS ,,,,7 u,w l),"ESOlrrH 8Al.n.\fORES'f. O'LLSBURG. P.\ Itat9 II j i I I I I As compensation for services hereunder, TRUSTEES may retain from time to time from the trust principal, income, or partly from each, a reasonable fee for services rendered. 9. TERMINATION OF TRUST: This Trust shall te~inate upon the death of the TRUSTOR herein, or in the event that the assets of the Trust Estate are completely extinguished. !n the event of death, the balance of the Trust corpus and any accumulated income shall be paid to NYLENE K. TR1JM1', JERE A. znm and DIANE HUFFMAN, in ec;ual shares, per sti=pes. 10. GOVERNING tAW: This Agreement and the dispositions hereunder shall be construed and regulated, and their validity and effect shall be determined, by laws of the State of Pennsylvania. IN WITNESS WHEREOF, TRUSTOR and Le<..v;..sb-er'-1 &-r- . L .., I ff"1 L J. .- 1 ( TRUSTEES have executed this Agreement at , Pennsylvania, on the day and date above first written. WITNESS: ~ C--/~ I ~ I r-; ( 1_" . r ;b-r ,~- \ JANET M. znm y '{\, '.\ rl \ u,;,;tJc'N.. n ,\ c'^'" '<,~ NYLERE K. TRUMJ? t ~~ /. ,/ (SEAL) ( SEJ.-L) v~ ~ , / ( SEl'-L) \ -~... .:::- \ ,- " LYNN E. TRUMP \ if - . JA:-I M. Wll.EY & ASSOCIATES ATI'OR."IEYS ",r LAW ONESOl."TH BALlDtOREST. OfU.,sBURC" 1"."- t1ll1'} .- "SCHEDULE A" I I , FIRST AMENDMENT TO HEALTH CARE TRUST I, JA.c"<cT M. ZINN, of York County, Pennsylvania declare this to be an Amendment to my Health Care Trust dated September 24, 1996. First: I hereby revoke Paragraph 4 (c) of my said Trust in its entirety and in lieu thereof substitute the following: (c) Upon the death of the Trustor herein, the Trustees may pay the expenses of the Trustor's last illness and funeral, and also any inheritance tax from the Trust Estate unless other adequate provisions shall have been made therefore. When said payments have been made the balance of the Trust corpus and accumulated income shall be paid to NYLENE K. TRUMP, SERE A. ZINN and DIANE H1JFFMAN, in equal shares, per stirpes. Provided, however, that the share for my son, JERE A. ZIl\'N, be held in Trust for his benefit, per stirpes, with the principal and income to be distributed in the sole discretion of the Trustees, who may merge this Trust with the similar Trust for my son set torth in my Last Will and Testament. Second: In all other respects I ratify, confirm and republish my Health Care Trust dated September 24, 1996. 645591516/9<;1 . COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF DAUPHIN We, JANET M. ZINN, the Tmstor, and Edwsrd P. Gormley and Mark R. Parthemer , the witnesses, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that JANET M. ZINN, the Trustor, signed and executed the instrument as and for an Amendment to the Trustor's Health Care Trust dated November 9, 1977, and that the Tmstor signed willingly, and that the Trustor executed it as the Trustor's free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Trustor, signed the lvnendment as a witness and that to the best of the witnesses' knowledge the Trustor was at that time over eighteen years of age, of sound mind and under no constraint or undue influence. . "'L~_",-'t- >"17 ~:L-;'-1.-.--n._- JA~T M. ZINN ,~) J/V ~k:l j7 , ~~ Witness , Edward p" ...: .../'/y' .' .-,,- . /_~ ' /:::;;7,c:<;::_'/~_.YC.--/" 2: ~- >T_ - C . WItness, M~rk R. Parthemer Subscribed, sworn to and acknowledged before me by JANET M. ZINN, the Trustor, and subscribed and swornto before me by Ed war d P. Go r m 1 e y and Mark R.: Parthemer , the witnesses, this / C day of May, 1999. ! /" / /.., ! \.~. \-.\; ~- \..~ ,,', (\ + l_~ ;" ;' f ,f . \-,-\. Notary Public -'. ~~,~"W'II,~,,,,,,,,_,~~",,,,,,,,~,..,,,.o;,,,",,..~,,,,,,,,,,,,,~__r",,,: I' ~ i NOTARiAL BE."'L f, M8JOnGtta ~~, MlHer, Notarv Public ~ . ~arrisbu~g, :"'~ _?~,~l:~j:.C~tlf1~'n ~. ~ N\'fccmtrm:::;...!u,\ :>_';,!f'~_;, ._,,;,-L ,0, ,~OI~O ~ ~~~,T"\ "'of'''' "--_"''''''-'i'''~~.'''''~ o -j- IN WITNESS WHEREOF I have hereunto set my hand and seal this I ~. day of May, 1999. (7-7 )17 -\-rQ..VL-e.-1..- . ( -1~-'Y:'--"--.- /.r.4N1n M. ZINN ij SIGNeD, SEALED, PUBLISHED Ah'D DECLARED by the above named (SEAL) JANET M. ZINN, the Trustor, as and for an Amendment to the Trustor's Health Care Trust dated September 24, 1996. in the presence of us who, at the Trustor's request, in the Trustor's presence and in the presence of each other, have hereunto subscribed our names as witnesses. ,/J ~<l/Y /7 ~.d/$2~P~~ / wffNESS: ./ / "-<- v>' / ...-'J1,...__ ....in..... .~,.*",.i?j /,,;,,~. /. "" //./ t"'/'(/'}/'--,".:i~Y_ i,/1,r/"~(':-j .. / /' ADDRESS: / ~/~- ....,.--_.,,':.-"t/>..........-.:.~/,-...-- -" .,' -: .... /. / ~ ',__~.- .." _,,-,, - <. /" e;<;;<'~~--"-C~-' -"':::;-_..:,..:~".~..._- yfrTNESS: /-:'.' _ ,,{: ~._ ;-:;:7'1" ADDRESS:" -2- SECOND AMENDMENT TO HEALTH CARE TRUST THIS SECOND AMENDMENT, made, executed and delivered this ;J'~of September 2001, is made by JANET M. ZINN, Trustor under the Health Care Trust dated September 24, 1996 (the "Trust"). WITNESSETH: On September 24, 1996, Janet M. Zinn executed a Health Care Trust between herself as Trustor and her daughter, Nylene K. Trump, and her son-in-law, Lynn E. Trump, as Trustees (collectively, "Trustees"). On May 10, 1999, Janet M. Zinn executed a First Amendment to the Trust modifying the remainder beneficiary provisions of the Trust. NOW THEREFORE, the Trustor wishes to further modify the remainder beneficiary provisions due to the death of her son, a previous beneficiary hereunder. Accordingly, in consideration of these premises and the mutual covenants herein contained, Janet M. Zinn, Trustor of the Trust, intending to be legally bound hereby, declares this to be a Second Amendment to her Health Care Trust. 1. Under Paragraph 2 of the Trust, Trustor reserved the right to amend the Trust in whole or in part, and by the within Second Amendment thereto, Trustor amends the Trust as follows: Paragraph 4(c) of the Trust as originally stated and as restated in my First Amendment is hereby revoked in its entirety. In lieu thereof, I substitute the following: (c) Upon the death of the Trustor herein, the Trustees may pay the expenses of Trustor's last illness and funeral, and also any inheritance or other death tax, from the Trust estate. Next, my Trustees shall pay Five Thousand Dollars ($5,000.00) to each of my then-living grandchildren (currently Rebekah L. Zinn, Leah C. Zinn, Patrick K. Huffman, Anita M. Trump and Christopher L. Trump). The rest, residue and remainder of the Trust assets shall be distributed by my Trustees to my daughters, Nylene K. Trump and Diane Huffman, in equal shares, per stirpes. 2. In all other respects, the Trust, as amended by the First Amendment and this Second Amendment, shall remain in full force and effect. IN WITNESS WHEREOF, Janet M. Zinn, has duly executed this Second Amendment effective the day and year first above written. f 7 .~ /( '<.-. /,lJ'1 ' i, frc( ')<'l.-?-- i /,:;>;A-'rv- JANEt M. ZINN, as i'iJlStor // '- . ( /~/ COMMONWEAL TH OF PENNSYLVANIA : ss: COUNTY OF (2-Cj\,iBEELi\I',:,('J en. I ,("1" We, JANET M. ZINN, C. d LL'(L'(IL r. (,ct:m k,,/ and J" f\1'Je '((. '2l'..thUl\/L. the Trustor and the witnesses, respectively, whose'names are subscribed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Trustor signed and executed the instrument as her Second Amendment to Health Care Trust 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 Trustor, signed the Second Amendment to Health Care Trust as witnesses and that to the best of each such witnesses' knowledge, the Trustor was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. WITNESS: ~/'~7 "'" /' (' ~ .c:;'2/.. /,pLL- .~~- / ~/ c__.__ / v TRUSTOR: ) .', L ,;(K'--'-"L.>'-. }'Y::fv 7\-. i'~// JANET M. ZINN WITNESS: ...:7 ... ,/ /.. //. './ .....~........././-...c "~' ... ..- //- .. -,' /" / '- .. /" ..' .. " ,,- '/ ,- /f?:-'?/.-;) /,///;..../."<"7."",... '. '" /' ,- -. -~. ,_.,~-" ':.-.-~ - .-....... ,,/ .. .../ Subscribed, sworn to and acknowledged before me by JANET M. ZINN, Trustor, and '" i subscribed and sworn to before me by (' dUXl!\ Cl r' i - ,~'r'~1?_iY\ll/ '.i and iUC.ll L .~ ii( L<'~, .Li.1",_.-; I, i,)..,\ \ r\_t)'V Irk. . . '1 ,,-rj'l , the Witnesses, thIS,..d I day Of'~l)!:~!\Au..~_ 2001. (\.,! " '--~/ / i!,,{{(..::'c(,: " A J "/// ;/1 Notary Public , '--' ! .) I' /, .,; _)-{"L.,\__~~__ - (SEAL) NOTARIAL SEAL LINDA M. ",SHELMAN. Notary PUblic Harrisburg, PA Dauphin County My Commission Explree Sept. 5. 2005 COMMONWEALTH OF PENNSYLVANIA DEPARTME:'JT OF REVENUE BUREAU OF INDtVIOIJAl TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV"1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MARK R PARTHEMER ESQUIRE 100 PINE STREET PO 1166 HARRISBURG, PA 17108-1166 u___<__ fold EST A TE INFORMATION: SSN, 193-18-6121 FILE NUMBER: 2102-0707 DECEDENT NAME: ZINN JANET M DATE OF PAYMENT: 08/07/2002 POSTMARK DATE: 08/06/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/08/2002 NO. CD 001491 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $17,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: NYlENE K TRUMP C/O MARK R PARTHEMER CHECK#1004 SEAL INITIALS: CW RECEIVED BY: TAXPAYER $17,000.00 MARY C. lEWIS REGISTER OF WILLS lU..) J UUb4 j')4-'U 'i , , i I , , F"'luton Banl<. Capiml DiviSion STATEMENT OF ACCOUNTS 3632-35671 STATEMENT PERIOD FROM THROUGH 4-18-02 5-19-02 7 PAGE 1 OF 2 x Drovers Bank Divl:::ion GrecH Vailcv DivislOn Llnl.2<1SienCheS1.C:1" DIvision JANET M ZINN OR NILES 0 ZINN 47 IMPALA DRIVE DILLSBURG PA 17019-1350 o ENCLOSURES o FULTON CLASSIC CHECKING PREVIOUS STATEMENT BALANCE 32,594.91 DEPOS ITS / CREDITS 2 305.03 CHECKS / DEBITS 8 5,370.04 ACCOUNT: 3632-35671 SERVICE FEES .00 ENDING BALANCE 27,529.90 INTEREST PAID THIS YEAR ACCOUNT/INTEREST INFORMATION 25.85 DEPOSITS/ CHECKS / DATE ACTIVITY DESCRIPTION REFERENCE CREDITS DEBITS BALANCE 04-13 BEGINNING BALANCE 32,594.91 04-18 CHECK 795 00451000770 /-~- , 7.64 32,537.27 i 04-19 US TREASURY 220 00077900000 ~~OO TAX REFUND 041902 193186121 IRS 32,887.27 04-22 CHECK 792 01365803300 18.34 32,868.93 04-24 CHECK 798 01363703100 74.67 32,794.26 04-25 CHECK 790 01360902910 244.43 04-25 CHECK 796 00956005560 4,970.00 27,579.83 04-26 CHECK 799 00853309340 4.96 27,574.87 05-07 CHECK 800 00960103870 25.00 27,549.87 05-10 CHECK 803 00703603440 25.00 27,524.87 05-17 INTEREST CREDIT 5.03 27,529.90 05-19 ENDING BALANCE 27,529.90 CHECK SUMMARY ~ INDICATES SKIP IN CHECK NUMBERS CHECK NO 790 792* 795* 796 TOTAL NUMBER OF CHECKS AMOUNT 244.43 18.34 7.64 4,970.00 8 CHECK NO 798* 799 800 803* TOTAL AMOUNT OF CHECKS AMOUNT 74.67 4.96 25.00 25.00 5,370.04 **k* ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM ANNUAL PERCENTAGE YIELD EARNED AVERAGE DAILY COLLECTED BALANCE INTEREST EARNED 4-18-02 THROUGH .20% 28,705.72 5.03 5-19-02 *,,,* DIRECT INQUIRIES TO: TELEPHONE; FULTON BANK CAPITAL DIVISION DIRECT BANKING CENTER 1-800- FULTON4-----------. !\'lenliwl" rD.!.C. 'Nww.fuJtonbani<:.com 1057 0064 35451 Y lihl.,~,nn 'P"='l1Y'1-ar ..J,.\...UiUU..lA ~Cill.2~ CctpiLul Divisiun STATEMENT OF ACCOUNTS 3632-35671 x Dnwcrs Bank D1Vl~iol1 C3reat Vaiky D1\,j:sion LaUClStCfiC:heSler Divisiun STATEMENT PERIOD FROM THROUGH 4-18-02 5-19-02 7 PAGE 2 OF 2 JANET M ZINN OR NILES 0 ZINN 47 IMPALA DRIVE DILLS BURG PA 17019-1350 o ENCLOSURES o FULTON CLASSIC CHECKING ACCOUNT: 3632-35671 SERVICE FEE BALANCE INFORMATION FROM 4-18-02 THROUGH 5-19-02 AVERAGE LEDGER BALANCE 28,705.71 AVERAGE COLLECTED BALANCE MINIMUM LEDGER BALANCE 27,524.87 MINIMUM COLLECTED BALANCE 28,705.71 27,524.87 EXPECT MORE FROM YOUR CHECKING ACCOUNT! ASK US ABOUT RELATIONSHIP CHECKING WHERE THE REWARDS ARE WORTH IT, INCLUDING FREE ONLINE BANKING INQUIRY, 50% OFF YOUR SAFE DEPOSIT BOX RENTAL, NO FOREIGN ATM FEES AND SO MUCH MORE. DIRECT INQUIRIES TO: TELEPHONE: FULTON BANK CAPITAL DIVISION DIRECT BANKING CENTER 1-BOO-FULToN4 .. il.;lember PO.Le. Nww.rultonbank.com IDS Life Insurance Company 70100 AXP Financial Center Minneapolis MN 55474 An American Express company May 22, 2002 Claim Number : Policy Number: 252232 9300-5940211 JANET M ZINN JANET M ZINN 47 IMPALA DR DILLSBURG PA HEALTH CARE TRUST , 17019-1350 Dear Recipient: The attached check for $70,661.16 represents the death benefits due you under this contract. These benefits are made payable to JANET M ZINN HEALTH CARE TRUST. If you have questions, please contact our office at the telephone number below. Sincere ly , IDS Annuity Claims (800) 862-7919 Detacn And Retain For Your Records OCL.L.Sa040 'OlI!12) IDS I..IFE INSURANCE COMPANY " AMERICAN EXPRESS FUNDS AMERICAN EXPRESS CERTIFICATE COMPANY AMERICAN EXPRESS BROKERAGE 70100 AX? Financial Center Minneapolis, MN 55474 May 20, 2002 NYLEifE TRUM AND LYNN TRUMP 47 IMPALA DRIVE DILLSBURG,PA 17019 Dear "',YLE"E TRUIvl AHD L Yi';'N TRUMP: We have received notification of JANET M ZIN'N's death. Please accept our condolences on your loss. The deceased's name appears on the fonowing accounts. At the end of this letter, you will find a list of beneficiaries shown in our initial review of the deceased's accounts. Account Information Annuities - Post 1985 Account Number 93005940211 3 004 O\\11ership Trust Account Disposition Account disposition is based on how an account is owned (the ownership type). The following information will help you understand the process that will be used to settle the accounts. Accounts may be subject to market flucmation as governed by each product. Disposition for Trust ownership The deceased was the annuitant on at least one annuity account previously listed. Upon the death of the annuitant, account proceeds typically pass to the beneficiaries named at the time of death. If no beneficiary was designated the proceeds become part of the estate for distribution. DEFERRED ANNUITY NOTICE: The beneficiary(s) has the option of taking the annuity death benefit either as a fun distribution or under an annuity payment plan. If the beneficiary(s) wishes to elect an annuity payment plan, we must receive written notice of this election within 60 days of our receIpt of due proof of death. Due proof of death IS considered to mean our receipt of a certified copy of the death certificate, a completed death claim statement, and any other required claim documents. If there are multiple beneficiaries, the 60 day window for electing an annuity payment plan begins for ALL beneficiaries on the date we receive complete requirements from the fIrst claimant. Required Docnments In order to take appropriate steps to settle the accounts we will need these documents: insurance and annuities are issued by IDS Life lmwrance Company, an American Express comoany. American Express Srokerage is provided by American Exoress Financial Advisors Inc. American Express Financial Advisors Inc, Member NAsa ,American Exoress Comoany is separate from Amencan Express rinancial Advisors Inc. and is not a broker-dealer. Certified Death Certificate-- Received (For accounts: 93005940211 3 004) The death certificate must be an original document that bears certification from the health department or local registrar and includes the cause of death. Death Claim Statement Form (33047P) --Received (For accounts: 93005940211 3 004) To process a death claim on an annuity or life insurance account, we must receive a completed Death Claim Statement Form (33047P) from each claImant. If an older version of the form is used. the claimant must also fill out a W-9 form with a revision date of at least 12/00. A completed death claim statement must contain the following: The deceased's client infom1arion and account number, an acceptable n10de of settlement, and a completed claimant informanon section. If any of this information is incomplete, the fonn will be returned. If a tax withholding election is not selected, we will automatically withhold from the disrributicn 10% ofth~ taxable amount ror federal income taxes. Trust Document Pages (For accmfits: 93005940211 3004) A trust is designated as beneficiary, Therefore, we require the pages of the trust containing the trust name, type, date. named trustee(s), named successor trustee(s) and the signature page, This is used to verify that the trust is in existence and to verify who the trustee(s) or successor tTIIstee(s) are. Photocopies of the trust pages are acceptable. Please contact our American Express Financial Advisor, SARA. NEAGLEY at (717) 975-5555 for forms and assistance. Please contact us if you have an)' questions as you work through these difficult times, and once again, you have our smcerest sympathy. Thank you. Sincerely, Wendy SeIpel Death Settlements Processing Team 70310 AXP Financial Center Minneapolis, 1vfN 55474 1-800-862-7919, Opllon 0,18656 Attachment: Beneficiary Information Insurance and annuities are Issued by IDS Life insurance Comoanv, an American Express company_ ,Amen can Express BroKerage is provided by American Exoress Financial Advisors Inc. Amer~can Express Financiai AdVisors Inc. Member NASD. American Express Comoany is seoarate from Amencan Express tinancIai Advisors Inc, and is not ::1 oroker-dealer. Beneficiary Information We have the following beneficiaries on record for the deceased's accounts. Accoun! Number: 93005940211 3 004 Designation: PRIMARY BENEFICIARY LYNN & "iYLENE TIZUMP AS TRUSTEE FOR JANET M ZIJ\"N HEALTH CARE TIZUST DATED 09/24/1996 100.00% Iml.lr8\\C'.8 and armU\MS are issued ov IDS Life Insurance Company, an American Express GompanyAmericanExoress Brokerage is provided by Americali Express Flnane'lal Adv'lsors Inc. American Express FinanCial Advisors Inc. Member NASD. American Express Company is separate from American Express ,::inanciai Advisors inc. and is nOT a broker-dealer. Allstate Life InSl"rance Company PO. Box 942!2 Palatine, IL 6009-4-.1212 ~Allstate. FINANCIAL May 23, 2002 Janet M Zlnn Trust 47 Impala Dr Dillsburg, pp., 17019 Re: Contract Number: Claim Number: Janet Zinn P A00026800 PA1083 Dear Janet M Zinn Trust: We, at Allstate Life Insurance Company, are sorry to hear of your loss and extend our sympathy. Your claim for benefits under We above referenced annuity has been completed. A check has been sent to you under separate cover and will arrive within the next five business days. This payment was computed as follows: Annuity Value as of 512212001 Portion Payable to You: Federal Withholding: State Withholding: Claim interest: Total Net Proceeds: $312.322.04 $312.322.04 $0.00 $0.00 $0.00 $312,322.04 This annuity is subject to federal income taxes (on non-qualified annuities, only the mterest earned is taxable.) A 1099 tax statement reflectmg $'15,242:19 as your taxable income will be sent next January to assist you in preparing your tax return for 2002. ;,;. The annuity value on the date of death, 0510~1?2 was $271,438.27. This may be necessary for estate ~=9 ! If you have any questions or need further aSSistance, l1ease contact me at 1-877-499-6418 Smcerely, \ /;~~lliJC ~dlil!aU\/V) Theresa Parsons Life and Annuity Claims Enclosures Overnight Address: 300 North Milwaukee Avenue, Vernon Hills, IL 60061 Toll Free Fax: 1-866-635-4523