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HomeMy WebLinkAbout04-14-15 Jpennsytvania 1505614105 E Ex(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN Ha County Code Year File Number BOX 280601 ' , r Harrisburg, PA 17128-0601 RESIDENT DECEDENT J 1 F ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY - F_t:� k, , zo k-51 FN D;�, -7 q49 I Decedent's Last Name Suffix Decedent's First Name MI zz16i 4aF •J � � a (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI I F PAU L- F-z ac,Let,- I FLI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) C=D 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) C=D 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=) 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name p ( Daytime Telephone Number First Line of Address I W U_3 Second Line of Address City or Post Office State ZIP Code FtAC5� curo?ve�"%_�i6 F—y-, 0,71 C - 2-2;?>9 Correspondent's email address: �laZ�i�2 � d IL1+ilL>r �Ct�l>✓1 REGISTER OF WILLS USE ONLY I�-R_EGIS_TER_OF WILLS USE ONLY 77 1 DATE FILED MMDDYYYY rTry I I _ -o �— DATE=FILEDIST-,,MP 70 { ? O w"h PLEASE USE ORIGINAL FORM ONLY -. - C[� rte— Tj C5 Side 1 L �5�5614105 1505614105 1505614205 REV-1500 EX(FI) `sem�, Decedent's Social Security Number Decedent's Name: 5�iC�. &_ 2TUG LO42- RECAPITULATION 1. Real Estate(Schedule A). . .. .. .. .... .... ... ..... . .. ...... .. .... . .. ... 1. 2. Stocks and Bonds(Schedule B) . .. ... . .. .. .. . ..... .. . .. .. .. .. .. .. .. . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 4. Mortgages and Notes Receivable(Schedule D) . ... ....... . ... ............ 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. .. 5. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . .. .. 6. j 41i ID 000,.CSC- 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. .... .. 7. 8. Total Gross Assets total Lines 1 through 7 8. I 2'3Oo,kril 9. Funeral Expenses and Administrative Costs(Schedule H)...... ... .... .. .. .. 9. 1 i D, 8nZ( 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. .... ... ...... 10. 11. Total Deductions(total Lines 9 and 10).. ... ..... .. .... ... .... .. .. .... .. 11. 12. Net Value of Estate(Line 8 minus Line 11) . .... .. .. .... .. ... . ... . . ...... 12. ; 0 ;00 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) .. .... .. .. . .. .. .. .... .. . 13. I - 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .. .... . ... .... . . .. .. .. 14. I 01 00 TAX'CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable 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_ 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. �4 19. TAX DUE . .. . . .. ..... ..... .. . ... .. ... .. .. . . . ..... .. .... .. . .... .. .. 19.11 Q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete. Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE OF R O E O IBLE FOR FILING RETURN DATE 1 1 G iPC��A L. 7z,t'j ADDRESS _ SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS 1111111111111111111 Jill Side 2 J L 1 614205 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 224D6 --oo 1-13 DECEDENT'S NAME P�IIC� C. 0�ftGLrw_ STREET ADDRESS CITY STATE ZIP U.3 v to�i�2_�"kN PAI Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) L3` 2. Credits/Payments A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) b Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ zi b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0 c. retain a reversionary interest .............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ ❑K 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 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. For dates of death on or after July 1, 1994,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(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 step-parent 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 decedent's 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-1508 EX+(o8-12) pennsylvania SCNEDlJLE E DEPARTMENT OF REVENUE CASH BANK DEPOSITS & M ISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 20L�j._ l�jCry "tJ(i5 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 3tkl=�� V G N C,'-J rA Pf TOTAL (Also enter on Line 5, Recapitulation) $ ( 63D,07 If more space is needed, use additional sheets of paper of the same size. STI FEL NICOLAUS CUSTODIAN FOR January 1- � E ,fANfCE E ZEIGLEF IRA January 5 Page 7 of 10 AccountSTIFL Number: L842OW-4299 i tv Q c1y Retirement Account Bolder: JANICE E ZEIGLER IRA Primary Beneficiaries: PAUL L 2EIGLER Spouse 100-00*4CAJ Contingent Beneficiaries: BETH PARKINSON 100.06$0 rr CONTMBUTION/01STRI[iE1TION SUMMARY 71 Tyke ofActivrfy Previous Yew cufrenf Year r IRA Contributions 0.00 D.00 C) Rollovers 0.00 D.00 O r z3 IRA Distributions 0.00 MI) Tax Withholding 0.00 0.00 -n (A 7 4 1 MINN STIFEL NICOLAUS CUSTODIAN FOR January 9- � JANICE I=ZEEGLt=12 IRA January 31,2015 Page 8 of 90 STIFEL � AccounNut Number:txar: L842 1,299 ry 0 M (n Y N 1 IRA Withhoidina Notice: _._Forrrr W-4P! OMB No.1545-0074 Individual Retirement Account (IRA) withdrawals you are currently receiving or plan on receiving in the future (except an ESA} are subject to federal income tax withholding at a mandatory rate of 10%. unless you elect not to have withholding apply. Your approved federal income tax withholding for all 'Periodic" and'On-Demand" distribution requests wilt remain in effect until it is changed or revoked by you in writing. You may change or revoke your distribution amount and your federal income tax withholding percentage at any time co and as often as you wish by completing and submitting Stifet's IRA Withdrawal Form to your Financial Advisor_ U.S.citizens or resident aliens may not rcpt out of the M*mandatory � withholding on any distributions delivered outside the U.S.or its possessions. If you have elected IRA check writing, you will have automatically elected to have'NO'withholding on all -n checks written by you and.processed by Stifel. If you elect to have federal income tax withheld,all check writing privileges will automatically be revoked_ If you elect not to have taxes m withheld you will be liable for all taxes due on the taxable portion of your distribution. You may also be liable for.any penalties related to underpayment of estimated taxes for the L current tax year. Please contact your Financial Advisor to discuss your withdrawal options and erections and review IRS Publication 505 and 515 at wwow.irs.gov, � 0 17- C C Lr) N W 1 r Cn 8 4 1 asIMO SSNHO2105 REV-1511 EX+(02-15) apennsylvania SCHEDULE H ll DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF `.- FILE NUMBER 20 is- C)o C-18 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' PX�z F�t� q� � ro'1� 4383 ;.0 C) lc .-L P A OR (Lim v`[it r"C A-nc uc. ToC 6 �2pcnf o tri Ij I�Ir sC �Mvv-o �2 �AD2A'T'it-t 71 .3® C 2P,-nc W OF U t-& FUNC— loN eoo,Ntii*6j cLua, op 144V 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. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 10%?Zr2I If more space is needed, use additional sheets of paper of the same size. P S E Document Number: 2892233 Account 8047XXXXXX ZEIGLER,JANICE E Effect: 02/20/15 Post: 02/20/15 Tlr: 0166 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE IRAN AMOUNT SEQ ------------------------------------------------------------------------------ Withdrawal from REGULAR SHARE Prev Bal: 13,630.67 01 13,630.67- 0.00 0.00 0.00 13,630.67 #981430 ------------------------------------------------------------------------------ Check Disbursed ESTATE OF JANICE E ZEIGLER 13,630.67- JANICE E ZEIGLER 1654 LOWELL LN NEW CUMBERLAND PA 17070-2239 i i Document Number: 2892233 Account 8047XXXXXX ZEIGLER,JANICE E Effect: 02/20/15 Post: 02/20/15 Tlr: 0166 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE TRAN AMOUNT SEQ ------------------------------------------------------------------------------ Withdrawal from REGULAR SHARE Prev Bal: 13,630.67 01 13,630.67- 0.00 0.00 0.00 13,630.67 #981430 ------------------------------------------------------------------------------ Check Disbursed ESTATE OF JANICE E ZEIGLER 13,630.67- NO STOP PAYMENT PERMITTED PSECU is obligated to pay this Cashier's Check according to its terms at the time it was issued. If the check is lost, stolen or destroyed please contact us at (800) �_ 23-74328 nationwide nationwide--- ------ - - REV-1509 EX+(02-15) ,yV pennsytvania SCHEDULE F DEPARTMENT REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAXAX RETURN RESIDENT DECEDENT ESTATE OF: SAN 1cf FILE NUMBER: "tG -01r- If vimIf an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT @t-- kteLo B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST >. A. it %Pr- i4brA r-.: i 6q4 L0514Z � 2t�i 3�G pGC3 5�'�c I'g�,vC�(� ,v,� Co 44 G� q D, tPA ic- tla-1 c t o ;��tr c�� Q�;t LT►C 'tJ LCtc is UGt [ iq C TOTAL(Also enter on Line 6, Recapitulation) $ (e(©,C)4 0.00 If more space is needed, use additional sheets of paper of the same size. l sq5 R Prepared by and Return to: ' 001 VQX Cornerstone Land Transfer, Inc. 4705 E. Trindle Road Mechanicsburg,PA 17050 717-730-9664 File No. CL 10062 Parcel ID# 13-25-0008-416 Tbi!6 Iubeuture, made the 15th day of July, 2010, 38etbjeen PAUL L.ZEIGLER,SINGLE PERSON,AND JANICE E. SHIRK,SINGLE PERSON,AS JOINT TENANTS WITH THE RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (hereinafter called the Grantors), of the one part,and PAUL L. ZEIGLER AND JANICE E. SHIRK,HUSBAND AND WIFE (hereinafter called the Grantees), of the other part, VItrie$9'etb, that the said Grantors for and in consideration of the sum of ONE Dollars 00/100 ($1.00) lawful money of the United States of America, unto them well and truly paid by the said Grantees, at or before the sealing and delivery hereof, the receipt whereof is hereby acknowledged, have granted, bargained and sold, released and confirmed, and by these presents do grant, bargain and sell, release and confirm unto the said Grantees, as tenants by the entirety ALL THAT CERTAIN piece or parcel of land situated in Lower Allen Township, Cumberland County,Pennsylvania,more particularly bounded and described as follows: BEGINNING at a point, located on the eastern right-of-way line of Lowell Lane, Twenty five feet(25') from the centerline of the same and being the front property corner with lot #119. THENCE along said right-of-way,North sixty-two degrees sixteen minutes zero seconds East, a distance of twenty and seventy-nine hundreds feet (N 62° 16' 00" E-20.79') to a point on the same, being a point of curvature. THENCE along the same, with a curve to the left having a radius of two hundred five and zero hundredths feet, an arc length of thirty-eight and thirty three hundredths feet, a bearing of North fifty-six degrees fifty-four minutes thirty nine seconds East, a chord distance of Thirty-eight and twenty-seven Hundredths feet ( R= 205.001, A=38.33', N 56° 54' 39"E-38.27')to a point on the same,the northwestern corner of Lot#117. c � THENCE leaving said right-of-way and along Lot #117, South thirty eight degrees twenty-six minutes forty-three seconds east, a distance of one hundred twenty and zero hundredths feet (S 38° 26' 43" E-120.00') to a point on the southern corner of Lot#117 and on the western edge of a sanitary sewer easement. THENCE South sixty-two degrees sixteen minutes zero seconds West, a distance of eighty-one and twenty hundredths feet (S 62° 16' 00" W- 81.20') to a point on the southeastern corner of Lot#119. THENCE along the property line with Lot #119, north twenty-seven degrees forty-four minutes zero seconds West, a distance of one hundred fourteen and thirty-four hundredths feet (N 27° 44' 00" W-114.34) to a point on the eastern right-of-way line of Lowell Lane,the Point and Place of BEGINNING. CONTAINING 8,094.06 square feet or 0.186 acres. BEING Lot No. 118 on the Final Subdivision Plan of the Heights of Beacon Hill, Phase 2, prepared by Melham Associates, P.C. dated May 15, 2000, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Plan Book 82, Page 47, and ALSO being Unit No. 118 of the Heights of Beacon Hill Planned Community, the Declaration of which is recorded in Cumberland County, Pennsylvania at Miscellaneous Book 675, page 1092 and as shown on the Declaration Plat recorded in Right-of-Way Plan Book 12,Page 130. UNDER AND SUBJECT to a Declaration of Planned Community dated and recorded May 24, 2001 in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Miscellaneous Book 675,Page 1092. ALSO UNDER AND SUBJECT NEVERTHELESS, to all easements, restrictions and other matters of record or that which a physical inspection or survey of the premises would reveal. BEING the same premises which BHH Partners, a Pennsylvania General Partnership, by its attorney in-fact Don E. Haubert, Sr., by Deed dated September 18, 2001, and recorded November 9, 2001, in the Office of the Recorder of Deeds in and for the County of Cumberland, Pennsylvania, in Book 219, Page 791, granted and conveyed unto Paul L. Zeigler, single person and Janice E. Shirk, single person, as joint tenants with the right of survivorship and not as tenants in common, in fee. THIS IS A TRANSFER BETWEEN HUSBAND AND WIFE AND HUSBAND AND WIFE AND IS THEREFORE EXEMPT FROM PA REALTY TRANSFER TAX Togetber Witb all and singular the buildings and improvements, ways, streets, alleys, driveways, passages, waters, water-courses, rights, liberties,privileges, hereditaments and appurtenances, whatsoever unto the hereby granted premises belonging, or in anywise appertaining, and the reversions and 2 remainders, rents, issues, and profits thereof; and all the estate, right, title, interest, property, claim and demand whatsoever of them,the said grantors, as well at law as in equity, of, in and to the same. To babe attb to bOlb the said lot or piece of ground described above, with the buildings and improvements thereon erected, hereditaments and premises hereby granted, or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees,their heirs and assigns, forever. 01tlb the said Grantors, for themselves and their heirs, executors and administrators, do, by these presents, covenant, grant and agree, to and with the said Grantees, their heirs and assigns, that they, the said Grantors, and their heirs, all and singular the hereditaments and premises herein described and granted, or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, against them, the said Grantors, and their heirs, will Specially Warrant and Defend against the lawful claims of all persons claiming by,through or under the said Grantors but not otherwise. In Vfttleg.5 VbCrM, the parties of the first part have hereunto set their hands and seals. Dated the day and year first above written. bealeb aub Melibereb IN THE PRESENCE OF US: a,"--,e I L_,' 0 &�& 4�9 (SEAL) cr Paul L. 9L {SEAL) J nice E. Shirk Commonwealth of Pennsylvania1 ss County of Cumberland f On this, the 15th day of July, 2010, before me, the undersigned Notary Public, personally appeared Paul L.Zeigler and Janice E. Shirk,husband and wife known to me(or satisfactorily proven)to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. N ary Public �`1 y commission expires MCx(4Z)N_Vk 1 The precise residence and the complete post office address of the above-named Grantees is: COMMONWEALTH OFPENNVLVAktA 1654 Lowell Lane NOTARIAL SEALJOLENE M.GEORGE,Notary Public ew Cumberland,PA 17070 Hampden Twp.,Cumberland County M Commission Expires March 13,2011 U, On behalf of the 1r1 ees 3 Dab s Parcel ID# 13-25-0008-416 - Paul L. Zeigler and Janice E. Shirk TO Paul L. Zeigler and Janice E. Shirk Cornerstone Land Transfer, Inc. 4705 E. Trindle Road Mechanicsburg, PA 17050 Telephone: 717-730-9664 Fax: 717-730-9665 r r f l ROBERT P. ZIEGLER i RECORDER OF DEEDS 00��14N-.. CUMBERLAND COUNTY 1 COURTHOUSE SQUARE ± CARLISLE, PA 17013 = °� 717-240-6370 Instrument Number-201019595 Recorded On 7/21/2010 At 8:10:59 AM *Total Pages- 5 *Instrument Type-DEED Invoice Number-69465 User ID-AF *Grantor-ZEIGLER,PAUL L *Grantee-ZEIGLER,PAUL L *Customer-CORNERSTONE *FEES STATE WRIT TAX $0.50 Certification Page STATE JCS/ACCESS TO $23.50 JUSTICE DO NOT DETACH RECORDING FEES - $11.50 RECORDER OF DEEDS This page is now part PARCEL CERTIFICATION $10.00 FEES of this legal document. AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 WEST SHORE SCHOOL $0.00 DISTRICT LOWER ALLEN TOWNSHIP $0.00 TOTAL PAID $62.00 I Certify this to be recorded in Cumberland County PA �y Cf CUMe� ,o /D7EDS RECORDER O *-Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 001 VQX IIIIII IIIIIIIIIIIII III III REV-1510 EX+ (02-15) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER 3Pd4 i GL 'C-, 2E1 CAL�-A2 2�V5—Est% y-1 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE LSi-k �1ABUFL AlgNO �'1f � v �"X34-2-2i2�12 TOTAL(Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size. January 1- January 31.2015 Pane 1 oto Account Number: L841 �94115 STIFEL ;; rQ STIFEL PRESTIGe ACCOUNT STATEMENT Vl YOUR STI EL ACCOUNT SUMMARY January 31 December 31 I I 1105166"SlINK021115 Cash Equivalents � JANICE ZEIGLER Net Portfolio Assets held at Stifel 1654 LOWELL LANE Net Portfolio Assets not hold at Stifel 143,157.75 144,714.86 NEW CUMBERLISID PA 170702239 Not Portfolio Value, S1143.1157J5 $144,TI4,86 YOUR CHANGE IN PORTFOLIO VALUE January 31 December 31 W to Net Cash Flow(Infloxs/Ouifflows) Securities Transferred In/Out T1M Income and Distributions r- Four Financial Advisor, Oftice Ser-doing 1'2ur Account: ChaNer in Securities Value -2,1 6.42 1ATTISTEI-1.1 11OLLAND W"EALTl-T slo CUIVIKKLAND SrREtiT Not Change in Portfolio Value -$2,198.42 0 AANAGENIENT CROUP LEBANON PA 17042 ,,W`HAEL BATFISTIFLIA-SRETT HOLLAND telephone:(7t 7}271-3510 I Investment information is provided for informational purposes only:assets are not covered by SIPC, 2 Does not include cost or proceeds for troy xx sell transactions. PRIWAY INIVE-S'VINIENT OBJECTIVE:Growth&Incoww 3 May include Assets Not Held At Stifel. RISK TOLERANCE: Madcrate Growth For a full definition of this objective and risl tolerance, including the use of margin, please see vdww-stifel,corr, IMPORTANT DISCLOSURES. or contact your Financial Ndvisor. It you have any questions concerning your investment objective or risk tolerance, or wish to make a change, please contact your Financial Advisor, or the YOUR ASSET SUMMARY Branoh 164anager for this office- TRADING TAX LOTRELIFF METHOD: First In,First Out I Nor E STOR UPDATE According to a recent study, more than 7D% of workers are expected to fall short of meeting their financial needs in retirement.Ate you prepared?This month's Investment Strategist provides some tips to help you avoid a retirement savings shortfall. ACCOUNT PR(YrECTION value on Percentage of Stifel, Nicolaus & Company, Incorporated provides up to$150 million of coverage for January 31,2015($} youraccount securities held in client accounts, of which $1,15 million may be in cash deposits. Ask H insurance Products 143,161,75 10D.60% your Financial Advisor for more details. Total Assels $143,157.75 100J00% H Thank yoa for atioNvingStifel-Nicolalls IQ serve you. In ordcr to protect your rLehis.,including riots vMerthe Securrifie-,Invcstor Proft6m Act(SlPIA),,picric promptly report,in wriling,any inaccuracies or discrcixtuciL5 in this account of 5latoncat to the Compliame DMrtment of Stifut Nicolaucat the a4drcss bellGw.Ifyou bave anyquestionq regarding your account ortbis isatcrricot,p)caw contact your Finamakill Advisor oar the Branch Msawr fbrflwis office.Foramilivnal information resuding your stiftl aocwm in e rater IQ site corrent St tel Account Agrcement and Disclosure Booklet,which is available at and the cnelosed in"C"'Iment Strategi4l no+ tV Stillel,NIOMOVS&Company,Incorporated I Merober-%]PC&NYSE I www.stifel.00rn I one Financial Plaza 1501 North Broadway I St.Louis,Misseuti 63102 JANICE ZEIGL R January 4- January 3i,2411 Oajij2 of d STIFEL Account Number: L11342'>�9415 Q I I+J r� t17 Value as of January 31,2015 Gainsl(-)Losses F?ealized At Stifet Not at SUW Total assets Unreafized This Period Year-to-date, #ash Money Market Funds to argin Balance 4.. Net Casts Equivalen.4 'S0.00 �����'�� �� m F- 3. 3. Equities Preferreds r- 3. Municipal Bonds c E Corporate/Gov Bonds ccs F. Mutual Funds G. Unit Investment Trusts N. Insurance Products 143,157.75 143,157.75 tt}r�.�l to 1. Alternative Investments J. Other Investments Net Portfolio Assets $0.00 $1:43,157.75 $ Rt 5 5tM 100.00% Sff.00 X1}.00 $IF.UD Net.Portfollo Value ° $Or.90 ; X143,157.75 ' r t 100.00°la $tM.00 $Q.t1iI:, $0.00 Security Type Year4o-date This period Securdy Type Yvar-to•date Thisperiod Dividends Tax-Exempt Accrued Interest Paid Tax-Exempt Taxable Taxable interest Tax-Exempt Accrued Interest Tax-Exempt Taxable Received Taxable Capital Gain Distributions Gross Proceeds Return of Principal Federal Withholding Other Foreign Taxes Paid Ttitei"Iricufrle: C1ist4bsil<i6ns $0.1}0::: SD.00. Margin Interest Charged "Please note"`o of assets"figures are shown gross of any amounts owed to Stifel andfor net short positions. rU r-' ctI 2 1 A riiSB6r�88NMD210S 1) JANICE ZEIGLER January 1- U January at,2015 Page 3 of 4 T IFEL Account Number: L3420111109415 to Crl section shows the cash equivalents aTidlar securities in your account.Prices obtained frorn outside sources are considered reliable but are not guaranteed by SOW-Actual prices may vary,and upon sale,you nay receive more or less than your original purchase price.Contact your Financial Advisor for current price quotes.GairilLoss is provided for infonnational purposes only.Cost basis may be adjusted tor,but not 01 invited to,arivrtizalion,accretion,principal paydowns,caplial changes,fisted option premiums,gifftng rules,inheritance step-up,or wash sales,The GairdLossInTormation should riot be used for tax preparation -jithout the assistance of your tax advisor, —classifcatiorks listed below security descriptions.- ,overe& Tax basis information for this security is covered by IRS reporting requirements, 4oncovered: Tax basis information for tillis,security is not covered by IRS reporting requirements.. 0) Mixed: Tax basis information for this security incluclas both covered and noncovered tax lots. Nash; The tax basis for this security has been adjusted flue to wash sale activity as defined by IRS regulations. -171 Gift: Security ]99�Lw M _Lx>sL1L _ILWi� nfti��diq indicative or loss that would be realized u sate of Security due to tax rules iftedstock� includes„gifts shares, Unrealjzed-a�L_ 9 IF L -NET CASH EQUIVALEN T'S F� Estimated 0 Anvrialized Estimated T) Corwrd value cclst5asis lncwDme Yield% r_– Total Not Cash E41livalents, P01tTF01,10 ASSFTS-NOT ITFUD AX STWEL Networked Insurance Products PromhIM(Sj Current Value Valve Date Contractipoticy Selected investment inforrn;M)is wo-vicied foe informational purpose-.and might notrepresentall of your insurance investments- These investments may be owned by a different registered ovirier from,this Slifel account. Additonalty,the insurance company may have beneRclailes;that differ from the beneficiaries listed on your Stifel account, The insurance company is responsible for the safekeeping and tax reporting of these investments and wit]send you a Separate statement coniirminthose holdings.Please rely on the Fund ManagerfCairier for cost basis information.These investments are not covered by SIPC- LINCOLN NATL LIFE 101,043,180 1143,157.75 WMIS 924070M Vatiabls,Annuity GKOICEPLUS ASSURANCE LSHARE VARMLE ANNUITY CUSIP:53422E512 T6tal Networked Insurance Products, Estimated Unrealized Annualized Estimated Current Vah4e cost Basis G-7irw(-XQsS* Worne yietd% (i -Not Pd hTsilfiel 7 su I I. : r. . — . rpritfoll Assets 7. citai Net b value 00 7 0 Please note I.Inrealind Gainf(-)Loss'does.not equal the total current.value minus the total Wet I if any valur,or cost amounts are missing- Unrealized gains or tosses are provided for your information only and Should not be used for tax purposes- 3 2 1 OSIN77 S-SNH02105 JAKE ZEIGLER January I- January 31,2015 Page4 of 4 Account Number: L842 4m STIFEL QTrj e of Ac6vily Activit y Year-lo-date This period Cash Mone Market margit? Opening Balance-filet Cash Equivalents $0VO $0.00 KOO $0.00 3uy and Sell Transactions Assets Bought Assets Sold/Redeemed 3eposits Deposits Made To Your Account Nithdrawals Withdrawals From Your Account LO noorne and Distributions Income and Distributions 'n Money MarRetActivity Money Market Activity m 'Aargin Interest feller in Interest Charged Dther Other Transactions 0 Cash Management Activity Card Activity ACH/A7M Activity C Checkwriting Activity Checks You Wrote U) Closing Balance-filet Cash Equivalents $0.00 $9.00 $0,00 $0.00 Securities Transferred Securities Transferred In/Out Th;s RkQd Cash Money Uaftpt Marair? Opening Balance-Not Cash Equivalents $0,00 $0.00 $0.00 $0.00 This period cash Money Market margin Closing Balance.-Met Cash Equivalents $0.00 $0.00 $0.00 G 42 1 D51WTSSN02105 r January 1- January 31,2015 P"of 10 TIFEL A=unt Number: Lt3A . 2139 � hJ r STIFEL PRESTIGe ACCOUNT STATEMENT W YOUR STIFEL ACCOUNT SUMMARY January 31 December 31 cw I I s M5IMS SSNH02103 trash Equivalents " 7.64 7.64 STIFEL NICOLAtI S CUSTODIAN FOR Net PortfoliD Assets held at Stifel 162,686.25 964,720.41 JANICE E ZEIGLER IRA Net Portfolio Assets not held at Stifel 1654 LOWELL LANE Nvt Portfolio Value $1$2,693.$4 $164,728.05 NEW CUM1I3EftLNt3 PA 17070-2289 YOUR CHANGE IN PORTFOLAO VALUE January 31 December 31 co Net Cash Flow JInlfowslClutnows) 2 -30.00 T Securities Transferred In/Out r Income and distributions 56.43 9,684•?2 Change in Securities Value -2,090.59 -11,021.24 r(nrr F-inanciol Ad►-cor: Office Seri icing Your Accowa: Net Change in Portfolio Value -#2.Q3 3ATTISTELLI HOLLAND WEALTH 810 CUMBERLAND STREET �1.18 -Si,366.52 0 v1ANAGEMENT GROUP t_HBANO'N.PA 117042 n Room C 41CRALL BATTISTELLIDRETT HOLLAND LO 1"eltphone:(717)279-3514 "Seo Insured Bank Deposit Program Seelinn for additional information. ("RI MARY M-EST"riCN"I-©SJECTIVE:Growth&htenmc Does not lnclvde cost or proceedS for buy or Sell ir8ns3c1i4ns. RISK TOLERANCE: Nlodcratc Grewtb =or a full definition of this objective and risk tolerance, including the use of margin, Tease see www.stifel.com, IMPORTANT DISCLOSURES, or contact your Financial kdvisor. If you have any questions concerning your investment objective or risk :oteranee, or wish to make a Change, please contact your Financial Advisor, or the YOUR ASSET SUMMARY 3ranch Manager for this office. I'RADING TAX LOT RELIEF METHOD: First in,first Out INr►rESTOR UPDATE 4ocording to a recent study, more than 7Wk of workers are expected to fall short of meeting their financial needs in retirement.Are you prepared?This month's Investment Strategist provides some tips to help you avoid a retirement savings shortfall. ft F Value on Percentage or � ACCOUNT PROTECTION January 39,2015(g) your accounl Stifel, Nicolaus & Company, Incorporated firovides up to $154 million of coverage for A Net Cash Equivalents 7.64 0.06% securities held in client accounts, of which $1.15 million may be in cash deposits. Ask F Mutual Funds 162,68625 10(3.00% �. your Financial Advisor for more details. Total Assets $162,693.89 100.00% F Think you f©ralfowing Stifel NicolaiL to serve you. In order to prutectyour Tight;,includingrighiS uudertlte SeeuririeS Investor Protection Act(SIPA),plewcprotuptly tVport,in tvtking,any ivaeoivacies or di:.,crepancies in ibis a¢oount or WdQmcui to the Cotnptianut:Department ofSlifel Niwlaus at rhe address baton.If you haw any question regarding,your account or this surtement,pleme oontact)vw Finaaciai Advisor or the Rmnrh Manager for this � office.ror additianal inform mon regarding)vvr Slifel acvmut,please referto the current Stilet Acounni Agrecmon and Diw-losum Booklet,which is available at and ill:enclosed G bwesimeni Strategist zscts;letler. Stifel,Niodous&Company,Incorporated I Member SIPC&.NYSE I+mvw.stifel.aom I One Financial Plaza 1501 North Broadway I St.Louis,Missouri 63102 cn M, STI IC NIZEI LE CUSTODIAN FOR Januwy 1_ n #ANILE Er s?EI t ER IRA January 3 i,2f3i5 1' e 2 at 70 In Aomurd Number. LBi�'4299STIFEL ,y to Value as of January 31,2415 Gains+)Losses OD %a ( Realized At Stites! Not at Stifol Total assets` Unmalized This!-a iod Year-(04ate `'asl3 Aoney Market Funis 7.64 Aargin Balance LO k. Net Gash Equivalents 57,64 - =r p£, : x.40°, m b _ r 3. Equities Preferreds 0 ). Municipal Bonus c :. CorporatetGov Bonds cn =. Mutual Funds 162,686.25 16.2, 6.25 100.00`;'0 11,377.49 3. !Unit Investment Trusts -i. Insurance Products Alternative Investments 1. QtheT Investments Yet Portfolio Assets $162,686.25 $0.194 :? ;>��� LL 6�2�Y 100,67 $11,377.49 " I;9.00 $0.00 stet Portfolio Value , a 00.0{ S1 37 WOO:- $0.00 �$ 1 % , 7.... . security Type 'Year-to-date 777is period Secadly Type Year-to-date This period 3ividends Tax-Exempt Accrued Interest Paid Tax-Exempt Taxable 56,13 56.43 Taxable Interest Tax-Exempt Accrued Interest Tax-Exernpt Taxable Receivers Taxable Capital Gain,Distributions Grass Proceeds Return of Principal Federal Withholding Other Foreign Taxes Paid T4lat 1r;cotrr 8�UistribUticsns. SSIi 43: 0.43 v 'Please note"%of assets"figures are shown grass of any amounts owed to Stifel andlor net short positions. m 2 1 ioateeo8SNN021�s STIFEL NIC3)OLAUS CUSTODIAN FOR January I- 0 M January 31,2015 Page 3 of 10 t" 'r JANICE E ZEIGLER IRA Account number: LW' -4299 ry (J9 VIC his SC-CtiDn showis the cash equivalents andfoT securities in your account.Prices obtained from outside sources are con re]iab18 butnot gUEtrantor!by Stifef.Actual prices may vary,and upon sale,You my receive more of tens than your original purchase price.Contact your Financial Advisor for current price quotas.GaIrvLossisprovided for inlofmatiortal purposes rAy-Cost basis may be adjusted for,bud not W -nited to,amortization,accretion,principal paydowns,capital changes.listed option premiums,gifting rules,inheritance step-up,orvmsh sales.The GainlLcrss infoTmallon should not be used for tax preparation ,111hout the assistanop,of your tax advisor, IPT CASH EQUIVALENTS Estimated Annualized Estimated Current value Cost Saw's Income yield% M 4SURED BANK PROGRA14 7.64 7-f34 0,00 0011% 'otal Not Cash Equivalents $7.84 $7.44 .30.00 0.01% Insuted Bank Program deposits may be held at multiple baftks.For information regarding specific banks visit IMPORTANT DISCLOSURES on w4w.slifel,com-The deposits are not covered by the 0 r- Securities Investor Protection Act(SIPC).Balances in the Program are insured up to the FDIC firnit in each bank. Balances in the!Insured Bank Program or in any money market fund offered as an avollable fund for Cash Investment 5ervic45 at Stif4l can be liquidated Upon request and returned to your brokerage account or remitted directly to you. 'ORTFOLIO ASSETS-HELD AT STIVRI. Estimated Ylutual Funds -'�Ynlboy Currant Pwce/ Averagc Unit CaW unrealized Annuakked Estimated Open-End Funds Type avariffly Curren!Value CostBasis Gumulative RvturW G2!�U-Loss* Inwme Weld% NVESCO ACfRX 4:577.246 9.91]100 &9568 32,830.62 4,271.59 434.83 0.%W% EQUITY to INCOME Cash 45,31433 41,043.25 12A84-11 C-L C GUSIP:O6142J453 Di vfrfund Op lion:Reinvest ................. .................... ...... ................ WERICAN 8ALCX 2.329.804 24,28W 19.0-%9 12,IT1.21 431 B1 0.76% SALANGED Cash 58,567.64 44,396-43 16,943.36 CLC GUSIP.024071300 01vidsnd oplion:Reinvest 0) S71FEL NICOLAUS CUSTODM FOR January-I- JANICE CZEIGLE-R IRA January 31,2015 Page 4 of 10 STIFEL Amount Number: L842WSM299 to 'ORTFOLtO ASSIETS-HELD AT SrIFFT,(vionfinued) EsUmatod SYMW C""m Pdoe, Average Unit Cook/ Ofigin8finvesrnlentl Unrealized Anruja0zed E.Wraelecr Mutual Funds Type Quariffy Curren,Valuo cost aesig camulaweRefUM2Gah*-)Loss' Income Yield% Open-End'Funds IDELITY ADVISOR FNr-X 302.382 23,8000 24-3769 5,925M -174-45 fiffiA NIA NEV'?INSIGHTS Cash 7.196,69 7,371.14 1.271.69 CLC rn CUSIP--316071505 Divicfencr oprion:Peravest 1IMC0 TOTAL RETURN PTTCX 920.060 10.9300 f 11,0456 7,614.35 -106.40 99.36 G.99% 0 CL C Cash I0,t M26 10,162 E5 2,441.90 CUSIP:693390429 C Divfdend Option:Refbyesf 1IMC0 ALL ASSET PAU(,'X 2,085243 9,2000 110.67% 10,312,55 -3,076.99 M 890.39 4.64% ALL AUTHORITY CL C Cash 19.184.23 22,261.22 -128-32 CUSIP-7220DO216 Dividend Option:Reinvest 5IMCO Puarlx 851.870 11,1600 11,2593 9,500.00 -64.57 28.11 03PA UNCONSTRAINED BOND Cash 9.506-66 9,591,44 6,66 CLC CUSIP:7220114297 Dividend Option:Fininvest rEMPLETON TEGBX 1.198.375 12A000 13.7542 13,530.00 -1,522.81 403,85 2.72% GLOBAL BOND Cash 14.M3-85 16,482.63 t'3?9Z5 CLC CUStR 8802011301 Dividend 0phw--,Reihvet;t Total Mu.tuW Funft: $1111;377.49 $2;287.55 IAI*I,, Total'"Wolio Astelri-:Hero livatifit `Vj2 745; 1A1% $151 08,76 -rotat Not 0ortf6flo—val Me., 1$2,64j 3,8 9 '�'.'$2 20.7,55 :1 A11% Original Investment:Total amount invested in the purtbased shares still held in the account. Does not include shares purchased through automatic reinvestment of capital gains anti dividends. Cumulative Return:Current Value minus Original Investmceni. This is the capital approcialion(depreciation)of all shares purchased,including shares purchased through automatic feirwesiment of capital gains and dividends_ Pleasnote'Unrealized Gain!(-)LoW does not equal the total current value minus the total cost it any value Or cost anio"Is are rnissing, Unrealized gains or losses are provided for your information only and should not be used far tax purposes. 4 2 ICS11605SHM92105 D STIFFJANIC E ZEIG E CUSTODIAN FOR January 9- JANiCE E 2EIt;LEF2 IRA January 31,201$ Page 5 Of 14 Aowunt Number: 1.8424299 STIF E- L1 N tSr r to s, "ype Of Activity Activity Year-ta-date This period Cash Money Mad-,et Margin - - Opening Balance-Net Cash Equivalents $7.64 $0.00 $7.64 $0.00 ry 'try and Sell Transactions Assets Bought -56.43 -5fi_43 -56.43 Assets Sold/Redeemed Ieposits Deposits Made To'YourAccount Vithdrawats Withdrawals From Your Account rn ncome and Distributions Income and Distributions 56,43 56A3 56.43 -n Aoney Market Activity Money Market Activity Aargin Interest Margin interest Charged )then Other Transactions c� )ash Management Activity Card Activity 0 ACHIATM Activity c :hecicwriting Activity Checks You Wrote Chtsing Balance-Net Gash Equivalents $7.64 $0.00 $7,64 $0.00 Securities Transferred - Securities Transferred In/Out CASH EQUI[VALL'NiNTS This oer?od Cash Money Market jyfargirt Opening Balance-Net Cash Equivalents $7.64 $0.00 $7A4 30.00 Assets Bought tate AdWy Quantity Price Dcscrrthton Tatef Cash Money'Rialket Margin 112RO15 Reinvest Div 1.237 PIMCO TOTAL RETURN 13.19 -13.19 CLC CUSIP:693390429 ...'note... REINVEST AT 10.660 11212015 Reinvest Div 1.097 PIMCO -12.27 -12.27 UNCONSTRAINED BOND CL C CUSIP:1220IM297 ""`nate"'• REINVEST AT 11.1,80 Y aj Q r eA 5 3 �D3i6980 SS71ND21D5 STIFEL td ZEtG US CUSTODIAN FOR ,January#- � STIFEL ,tAEQICE E ZEEGLER ERA January 3#,20t5 Fags S of 10 Account Number: L04MW299 0 I r� 4sets Rougbt continued t Date Addy Quanii#y Puce Descnptiorn Total Ce$h Money MuAyt A4ergin 12MO15 RelnvesEDiv 2.492 TEMPLETON -30-97' -30.97 GLOBAL BOND CL C CUSIP:880208301 R1r4EYVEST AT 12.430 Total Assets Bought : . 458.43 -$58:43 name and 061ributions Date Activity Quantity Description Tota! Casfl mormyMa&et margin r 0 02015 DIVICIand P144C070TAL RETURN 13.19 13.19 r- CLC r_ 121231148E6.82300 co CUSIP:693380429 11212015 Dividend PEMC3 12.27 12.27 UNCONSTRAINED HOND CL C 123114 850.77300 CUSEP:72201 M297 112D12015 Dividend TEMPLETON 30.97 30.97 GLOBAL BOND CL C 012015 1,195.88300 CUSIP:880206341 Total Income and Distributions $86A3 $56,43 This period CaSh Money Market margin Closing Batavice-Net Cash Equivalents 1, $7.64 sine: 87.64 ffiO.OF 6 3 1 Oslo"SSKtlM06;