HomeMy WebLinkAbout05-12-15 (2) In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1080
Estate of Karen A Ziegelmeier, Deceased
Late of Township of Hampden
First and Final Account
Patricia Wolf, Executrix
Date of Death: 05/27/2013
Date of Incapacity, if any: None
Date of Executrix's Appointment: 10/10/2013
Date of First Complete Advertisement:
Accounting forthe period: 05/27/2013 to 02/09/2015
Purpose of Account: Patricia Wolf, Executrix, offers this Account to acquaint interested parties with
the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for additional information or questions
or objections can be discussed with:
Kevin D. Dolan Esq.
Gingrich, Smith, Klingensmith & Dolan
222 S. Market Street, Suite 201
PO Box 267 ry
Elizabethtown, PA 17022 rn
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(717)367-1370 �13 ZZI (z):
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SUMMARY OF ACCOUNT
Estate of Karen A Ziegelmeier, Deceased
For the period of May 27. 2013 through February 9. 2015
Fiduciary
Current Acquisition
Proposed Distributions PAGES Value Value
to Beneficiaries 21 50,696.52
PRI OPAL
Receipts: This Account 3 403,587.67
Net Gain (or Loss) on Sales
or Other Dispositions 5 11,974.26
415,561.93
Less Disbursements:
Debts of Decedent 6 6,823.29
Funeral Expenses 5 17,580.27
Administration Expenses 5 53,080.75
Federal, State& Local Taxes 5 62,983.42
Commissions 5 23,000.00
Fees 5 20,000.00
Family Exemption 0.00 183,467.73
Balance Before Distributions 232,094.20
Transfer to (from) Principal 0.00
Distributions to Beneficiaries 13 175,500.00
Principal Balance on Hand 15 56,594.20
For Information:
Investments Made
Changes in Holdings 8
)NCO
Receipts This Account 16 1,497.64
Net Gain (or Loss)on Sales 0.00
or Other Dispositions 1,497.64
Less Disbursements 18 7,395.32
Balance Before Distributions -5,897.68
Transfer to (from) Income 0.00
Distributions to Beneficiaries 0.00
Income Balance on Hand 19 -5,897.68
For Information:
Investments Made
Changes in Holdings
COMBINED BALANCE ON HAND 20 50,696.52
Signature 23
Verification 24
- 2 -
SCHEDULE A
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory Fiduciary
(Valued as of Date of Death) Acquisition
Value
Cash
County of Lancaster-Veteran's death benefit 100.00
CVS Pharmacy-prescription refund 3.02
Discover-refund 25.25
Express Scripts-retirement monthly distribution 64.19
Holy Spirit Hopsital -refund 8.87
Jackson Siegelbaum Gastroenterology-refund 38.86
Medco Cash Balance Retirement Plan payments 227.92
Merck Company-uncashed dividend checks from 3.40
7/9/12-$1.68 and 1/8/13-$1.72
Merck Company-uncashed dividend checks from 361.25
7/9/12-$178.50 and 1/8/13-$182.75
Orthopedic Institute of PA-refund 15.99
Pennsylvania Bureau of Unclaimed property 8.42
Prorated taxes at real estate settlement-per HUD-1 2,364.02
Prudential -uncashed dividends from 12/14/2012- 62.00
$49.60 and 3/21/13-$12.40
The Hershey Company-uncashed dividend checks 5,953.50
from 3/11/2013 to 9/12/13
U.S.Treasury-2013 individual income tax refund 525.00
Total Cash 9,761.69
Personal Property
1996 Buick Regal -bluebook value 500.00
Total Personal Property 500.00
Stocks/Listed
A&P stock-no value 0.00
American Scientific Corp stock-no value 0.00
Campbell Resources stock-no value 0.00
900.00000 shares Hershey Company 80,325.00
2,445.78900 shares John Hancock Bond A Account#00004851649 39,537.62
LaBarge stock-300 shares exchanged for cash 5,775.00
Medco stock-81 shares were exchanged for cash by 2;880.00
Express Scripts
429.00000 shares Merck&Company 20,231.64
- 3 - •
SCHEDULE A
RECEIPTS OF PRINCIPAL
Continued
Fiduciary
Acquisition
Value
New Valley Corp. -no value 0.00
31.00000 shares Prudential 2,060.26
Total Stocks/Listed 150,809.52
Bonds
16 U.S. Savings Bonds Series E and EE-see attached 2,741.46
list
Total Bonds 2,741.46
Real Estate
Real estate-located at 609 Penn Ayr Road, Camp Hill, 239,775.00
Cumberland County, PA 17011,sale price
Total Real Estate 239,775.00
Total Receipts 403,587.67
Total Receipts of Principal 403,587.67
- 4 -
SCHEDULE 6
GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL
Gain LOSS
11/06/2013 John Hancock Bond A Account#00004851649
Net Proceeds 39,034.79
Fiduciary Acquisition Value -39,537.62 -502.83
11/29/2013 Medco stock
Net Proceeds 2,880.00
Fiduciary Acquisition Value -2,880.00 0.00
02/28/2014 Prudential
Net Proceeds 2,593.11
Fiduciary Acquisition Value -2.060.26 532.85
05/16/2014 4.00000 shares Merck&Company
Net Proceeds 212.89
Fiduciary Acquisition Value -188.64 24.25
06/1212014 900.00000 shares Hershey Company
Net Proceeds 87,359.07
Fiduciary Acquisition Value -80,325.00 7,034.07
07/10/2014 425.00000 shares Merck&Company
Net Proceeds 24,928.92
Fiduciary Acquisition Value -20,043.00 4,885.92
TOTAL GAINS AND LOSSES/PRINCIPAL 12,477.09
LESS LOSS -502.83
NET GAIN OR LOSS 11,974.26
- 5 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Debts of Decedent
Allstate
01/2812014 return overpayment 169.77
169.77
Camp Hill Emergency Physicians
12/13/2013 medical expense 33.31 .
33.31
Capital Cardiovascular
03/17/2014 medical expense 13.74
13.74
Capital Cardiovascular As
12/13/2013 medical expense 36.78
36.78
Clem Ciccarelli M.D.
1211312013 medical expense 397.18
397.18
Forest Park Health Center
01/28/2014 medical expense" 3,552.00
3,552.00
Hampden Physician's Assoc.
12/13/2013 medical expense 114.95
114.95
- 6 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Holy Spirit Hod Imetall
12/13/2013 medical expense 8.87
8.87
Howard Roy Cohen M.D.
12/13/2013 medical expense 63.74
63.74
Jackson Siegelbaum Gastroenterology
12/1312013 medical expense 52.60
52.60
Lewin & Nadar Assoc
02/10/2014 medical expense 4.83
4.83
antgomery Medical Eauipment
12/13/2013 medical expense 27.16
27.16
Peerless Credit Services for Internists of Central PA
12/13/2013 medical expense 172.73
172.73
Pennsylvania Department of Revenue
10/23/2014 2013 individual income tax penalty 17.63
17.63
Quantam Imaging
12/1312013 medical expense 35.73
- 7 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
35.73
Rehab Group East
12113/2013 medical expense 72.05
72.05
Silver Spring Ambulance
12/05/2013 medical expense 82.15
82.15
Spirit Physician's Services Inc-,
12/1312013 medical expense 130.61
130.61
The Bridges at Bent Creek
111121/2013 nursing home expenses 765.07
765.07
West Shore EMS-ALS Life Support
1 2/1 312 01 3 medical expense 1,001.62
12/13/2013 medical expense 70.77
1,072.39
Total Debts of Decedent 6,823.29
Funeral Eagnsous
Gingrich Memorial
12/15/2013 headstone 3,636.00
3,636.00
- 8 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Hershey Cemetery Company
06/11/2014 foundation 418.60
418.60
Trefz & Bowser Funeral Home. Inc.
08/15/2014 funeral expenses 13,525.67
13,525.67
Total Funeral Expenses 17,580.27
Administration Expenses
A&M Auto Service Center
12/13/2013 507.74
507.74
Computershare
07/06/2014 surety bond for lost stock certificates 2,855.03
2,855.03
Cumberland Law Journal
11/21/2013 estate publication 75.00
75.00
Escrow for final closing costs
08/15/2014 1,000.00
1,000.00
Hamden TownshiR
12/05/2013 sewer&trash expenses during administration 579.18
- 9 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
579.18
Michael Langan,Tax Collector
12/05/2013 real estate taxes for 2013 2,888.61
02/28/2014 2014 real estate taxes 588.54
3,477.15
P.P. & L.
12/05/2013 electric bills during administration from date of death 343.66
to 7/10/14
343.66
PA American Water
12/05/2013 water bills during administration from date of death to 109.20
7/10/14
109.20
Real Estate Settlement Charges
07/10/2014 per attached HUD-1 19,015.40
19,015.40
Register of Wills
11/21/2013 Letters Testamentary 408.50
04/24/2014 Short Certificates 10.00
08/19/2014 Additional cost of Letters Testamentary 100.00
518.50
Russell Brown
08/15/2014 Electrical work done at the decedent's residence 600.00
600.00
- 10 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Santander Bank
12/03/2013 check charge 29.20
01/31/2014 account verification fee 20.00
49.20
Scott Solanski
01/08/2014 improvements to the decedent's residence in 9,474.83
preparation for sale
9,474.83
Seller Assist
07/1012014 for the purchase of the decedent's residence per HUD 12,359.72
-1
12,359.72
Shareowner Services
07/06/2014 surety bond for lost stock certificates, replacement 530.00
fee
530.00
Steven Zeigler, CPA
07/31/2014 preparation of decedent's 2013 income tax returns 915.00
915.00
The Patriot News
06/11/2014 estate publication 67.94
67.94
U Q1
12/05/2013 gas bills during administration from date of death to 603.20
7/10114
- 11 -
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
603.20
Total Miscellaneous Administrative Expenses 53,080.75
Federal. State, and Local Taxes
Pennsylvania Department of Revenue
08/14/2014 Inheritance Tax 62,983.42
62,983.42
Total Taxes 62,983.42
Commissions
Patricia Wolf
08/15/2014 23,000.00
23,000.00
Total Commissions 23,000.00
Fees
Gingrich, Smith. Klingensmith & Dolan
08/15/2014 20,000.00
20,000.00
Total Fees 20,000.00
TOTAL DISBURSEMENTS OF PRINCIPAL 183,467.73
- 12 -
SCHEDULE D
DISTRIBUTIONS OF PRINCIPAL
Andre O.Ziegelmeier
08/14/2014 Andre O.Ziegelmeier-partial distribution 35,100.00
Cash-$35,000.00
One-fifth share of decedent's car-$100.00
35,100.00
Caren R. Herbert
08/14/2014 Caren R. Herbert-partial distribution 35,100.00
Cash-$35,000.00
One-fifth share of decedent's car-$100.00
35,100.00
Jennifer Miller
08/14/2014 Jennifer Miller-partial distribution 35,100.00
Cash -$35,000.00
One-fifth share of decedent's car-$100.00
35,100.00
John P.Ziegelmeier
08/14/2014 John P.Ziegelmeier-partial distribution 35,100.00
Cash-$35,000.00
One-fifth share of decedent's car-$100.00
35,100.00
Michael C.Ziegelmeier
08/14/2014 Michael C. Ziegelmeier-partial distribution 35,100.00
Cash-$35,000.00
One-fifth share of decedent's car-$100.00
35,100.00
- 13 -
SCHEDULE D
DISTRIBUTIONS OF PRINCIPAL
Continued
TOTAL DISTRIBUTIONS TO BENEFICIARIES 175,500.00
- 14 -
PRINCIPAL BALANCE ON HAND
Current Value Fiduciary
02/09/2015 Acquisition
#Units Description or as Noted Value
Casb
Santander Bank 376,610.98 376,610.98
Total Cash 376,610.98 376,610.98
ASqat
1996 Buick Regal 500.00
Andre O.Ziegelmeier -35,100.00
Caren R. Herbert -35,100.00
-900.00000 Hershey Company -80,325.00
Holy Spirit Hopsital 8.87
Jennifer Miller -35,100.00
John Hancock Bond A Account#00004851649 -39,537.62
John P.Ziegelmeier -35,100.00
Medco stock -2,880.00
-429.00000 Merck&Company -20,231.64
Michael C. Ziegelmeier -35,100.00
Prudential -2,060.26
Total Assets -320,625.65
376,610.98 56,585.33
SCHEDULE G
RECEIPTS OF INCOME
Dividend
Hershey Company
06/13/2014 436.50
436.50
John Hancock Bond A Account#00004851649
1110712013 28.15
28.15
Merck& Cori any
07108/2013 1.72
07/08/2013 182.75
1010712013 1.72
10107/2013 182.75
01/0812014 187.00
01/08/2014 1.76
04/07/2014 1.76
04/07/2014 187.00
07/10/2014 187.00
933.46
Prude tial
06/2012013 12.40
09/19/2013 12.40
01/06/2014 16.43
03120/2014 16.43
57.66
TOTAL DIVIDEND INCOME 1,455.77
Interest/Bond
- 16 -
SCHEDULE G
RECEIPTS OF INCOME
Continued
U.S. Savings Bond Interest
05/2712013 41.87
41.87
TOTAL BOND INTEREST 41.87
TOTAL RECEIPTS OF INCOME 1,497.64
- 17 -
SCHEDULEI
DISBURSEMENTS - INCOME
Expense ING0
Federal Withholdina Ta
05/16/2014 62.52
07/10/2014 6,994.80
7,057.32
Pennsylyania Department of Revenue
08114/2014 fiduciary income tax 84.00
84.00
U.S.Treasua
08114/2014 fiduciary income tax 254.00
254.00
TOTAL DISBURSEMENTS OF INCOME 7,395-32
INCOME BALANCE ON HAND
Current Value Fiduciary
02/09/2015 Acquisition
# Units Description or as Noted Value
Gash
Santander Bank -5,897.68 -5,897.68
Total Cash -5,897.68 -5,897.68
-5,897.68 -5,897.68
- 19 -
COMBINED BALANCE ON HAND
Current Value Fiduciary
02/09/2015 Acquisition
# Units Description or as Noted Value
Czab
Santander Bank 370,713.30 370,713.30
Total Cash 370,713.30 370,713.30
Assets
1996 Buick Regal 500.00
Andre O.Ziegelmeier -35,100.00
Caren R. Herbert -35,100.00
-900.00000 Hershey Company -80,325.00
Holy Spirit Hopsital 8.87
Jennifer Miller -35,100.00
John Hancock Bond A Account#00004851649 -39,537.62
John P.Ziegelmeier -35,100.00
Medco stock -2,880.00
-429.00000 Merck&Company -20,231.64
Michael C. Ziegelmeier -35,100.00
Prudential -2,060.26
Total Assets -320,025.65
370,713.30 50,687.65
- 20 -
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Current Value Fiduciary
02/09/2015 Acquisition
or as noted Value
TO: Andre O.Ziegelmeier
One-fifth (1/5)of the residue 10,139.30
10,139.30
TO: Caren R. Herbert
One-fifth (1/5)of the residue 10,139.31
10,139.31
TO: Jennifer Miller
One-fifth (1/5)of the residue 10,139.31
10,139.31
TO: John P.Ziegelmeier
One-fifth(1/5)of the residue 10,139.30
10,139.30
TO: Michael C.Ziegelmeier
One-fifth (1/5)of the residue 10,139.30
10,139.30
Total 50,696.52
- 21 -
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1080
Estate of Karen A Ziegelmeier, Deceased
Signature
Patricia Wolf, Executrix
- 22 -
In the .Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1080
Estate of Karen A Ziegelmeier, Deceased
Verification
Patricia Wolf, Executrix under the Last Will and Testament of Karen A Ziegelmeier, Deceased,
hereby declares under oath that he/she has fully and faithfully discharged the duties of his/her
office; that the foregoing Account is true and correct and fully discloses all significant transactions
occurring during the accounting period; that all known claims against the Estate have been paid in
full; that, to his/her knowledge, there are no claims now outstanding against the Estate; that all
taxes presently due from the Estate have been paid; and that the grant of Letters Testamentary and
the first complete advertisement thereof occurred more than four months before the foregoing
Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn
falsification to authorities.
Dated: O�'� S/,S 242:z
Patricia Wolf, Executrix
- 23 -
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF KAREN A. ZIEGELMEIER, DECEASED
The undersigned is one of the beneficiaries named in the Will of Karen A. Ziegelmeier,
deceased, and desires that the estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper
release and indemnification, which it is the purpose of this document to provide.
In consideration of the willingness of the Executrix to distribute and terminate the estate in
accordance with the terms of the Will without the protection afforded her by a formal adjudication
of her account, the undersigned beneficiary, individually with respect to their heirs, personal
representatives, successors and assigns, does hereby:
1. Acknowledge that I have read this Agreement and represent that the facts set forth above
are true and correct to the best of my knowledge,information and belief. I further acknowledge that
I am familiar with the provisions of the Will of decedent;
2. Waive the filing of a formal account of the administration of this Estate,with respect to
the income and principal thereof, in any court which has jurisdiction, in particular the Orphans'
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania;
3. Declare that I have examined the account and statement which is attached hereto and
incorporated herein, and find them to be true and correct in all particulars; accept and approve the
informal account with the same force and effect as if it had been prepared and duly filed with,
audited,adjudicated and confirmed absolutely by such court which has jurisdiction over this estate,
and as if the balance of principal and income had been awarded by said court in accordance with this
Agreement and the account and statement;
4. Warrant that I know of no outstanding and unsatisfied claims against the estate and
approve the distribution of the balance of principal and income shown on the attached account and
statement as set forth above;
5. Absolutely and irrevocably release and discharge the Executrix, her personal
representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and
demands, including specifically but not limited to liability arising in connection with any mistake
of fact or law, or negligent or careless act or omission by the Executrix, in connection with the
administration and distribution of assets shown in the statement,without a formal court accounting
and adjudication;
6. With respect to any distributions of income or principal, which I have received, or will
receive upon execution of this agreement, agree to indemnify and hold harmless the Executrix,her
personal representatives,heirs,successors and assigns,from any liability,loss or expense(including
but not limited to costs and counsel fees),arising from any cause whatsoever,which may be incurred
by the Executrix as a result of the administration of this estate or distribution in accordance with this
agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania
inheritance tax or any other death taxes and federal and state income taxes,together with any interest
and costs incidental thereto, relating in any way to the Estate and also including,but not limited to,
any assets received or payments or distributions made by reason of any negligence or mistake of fact
or law;
7. Agree to refund to the Executrix, if and or as may be necessary, some part of the
distributive share of the Estate received by me and which was distributed to me which may at any
time be determined to have been an erroneous distribution to me. However, based upon all
information known and now available to the Executrix it is believed that no such request will be
necessary.
8. Agree to indemnify and hold harmless, KEVIN D. DOLAN, ESQ., and GINGRICH,
SMITH, KLINGENSMITH & DOLAN, attorneys, of and from any claims including tax claims or
demand ever made against him and his law firm by any heirs in the estate.
9. Agrees that this agreement shall be governed by the laws of the' Commonwealth of
Pennsylvania.
I1 WITNESS WHEREOF, I agree to be bound hereby and have signed this agreement this
day of2015. f �.
r
Z,
Andre ?�VeWlme-ier
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF KAREN A. ZIEGELMEIER, DECEASED
The undersigned is one of the beneficiaries named in the Will of Karen A. Ziegelmeier,
deceased, and desires that the estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper
release and indemnification, which it is the purpose of this document to provide.
In consideration of the willingness of the Executrix to distribute and terminate the estate in
accordance with the terms of the Will without the protection afforded her by a formal adjudication
of her account, the undersigned beneficiary, individually with respect to their heirs, personal
representatives, successors and assigns, does hereby:
1. Acknowledge that I have read this Agreement and represent that the facts set forth above
are true and correct to the best of my knowledge,information and belief. I further acknowledge that
I am familiar with the provisions of the Will of decedent;
2. Waive the filing of a formal account of the administration of this Estate, with respect to
the income and principal thereof, in any court which has jurisdiction, in particular the Orphans'
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania;
3. Declare that I have examined the account and statement which is attached hereto and
incorporated herein, and find them to be true and correct in all particulars; accept and approve the
informal account with the same force and effect as if it had been prepared and duly filed with,
audited,adjudicated and confirmed absolutely by such court which has jurisdiction over this estate,
and as if the balance of principal and income had been awarded by said court in accordance with this
Agreement and the account and statement;
4. Warrant that I know of no outstanding and unsatisfied claims against the estate and
approve the distribution of the balance of principal and income shown on the attached account and
statement as set forth above;
5. Absolutely and irrevocably release and discharge the Executrix, her personal
representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and
demands, including specifically but not limited to liability arising in connection with any mistake
of fact or law, or negligent or careless act or omission by the Executrix, in connection with the
administration and distribution of assets shown in the statement,without a formal court accounting
and adjudication;
. Ir
6. With respect to any distributions of income or principal, which I have received, or will
receive upon execution of this agreement, agree to indemnify and hold harmless the Executrix,her
personal representatives,heirs,successors and assigns,from any liability,loss or expense(including
but not limited to costs and counsel fees),arising from any cause whatsoever,which may be incurred
by the Executrix as a result of the administration of this estate or distribution in accordance with this
agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania
inheritance tax or any other death taxes and federal and state income taxes,together with any interest
and costs incidental thereto, relating in any way to the Estate and also including,but not limited to,
any assets received or payments or distributions made by reason of any negligence or mistake of fact
or law;
7. Agree to refund to the Exccatrix, if and or as may be necessary, some•part of the
distributive share of the Estate received by me and which was distributed to me which may at any
time be determined to have been an erroneous distribution to me. However, based upon all
information known and now available to the Executrix it is believed that no such request will be
necessary.
8. Agree to indemnify and hold harmless, KEVIN D. DOLAN, ESQ., and GINGRICH,
SMITH, KLINGENSMITH &DOLAN, attorneys, of and from any claims including tax claims or
demand ever made against him and his law firm by any heirs in the estate.
9. Agrees that this agreement shall be governed by the laws of the Commonwealth of
Pennsylvania.
IN WITNESS WHEREOF, I agree to be bound hereby and have signed this agreement this
1�tTH day of M R c 1-1- , 2015.
Michael C. Ziegelmeier
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF KAREN A. ZIEGELMEIER, DECEASED
The undersigned is one of the beneficiaries named in the Will of Karen A. Ziegelmeier,
deceased, and desires that the estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper
release and indemnification, which it is the purpose of this document to provide.
In consideration of the willingness of the Executrix to distribute and terminate the estate in
accordance with the terms of the Will without the protection afforded her by a formal adjudication
of her account, the undersigned beneficiary, individually with respect to their heirs, personal
representatives, successors and assigns, does hereby:
1. Acknowledge that I have read this Agreement and represent that the facts set forth above
are true and correct to the best of my knowledge,information and belief. I further acknowledge that
I am familiar with the provisions of the Will of decedent;
2. Waive the filing of a formal account of the administration of this Estate, with respect to
the income and principal thereof, in any court which has jurisdiction, in particular the Orphans'
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania;
3. Declare that I have examined the account and statement which is attached hereto and
incorporated herein, and find them to be true and correct in all particulars; accept and approve the
informal account with the same force and effect as if it had been prepared and duly filed with,
audited, adjudicated and confirmed absolutely by such court which has jurisdiction over this estate,
and as if the balance of principal and income had been awarded by said court in accordance with this
Agreement and the account and statement;
4. Warrant that I know of no outstanding and unsatisfied claims against the estate and
approve the distribution of the balance of principal and income shown on the attached account and
statement as set forth above;
5. Absolutely and irrevocably release and discharge the Executrix, her personal
representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and
demands, including specifically but not limited to liability arising in connection with any mistake
of fact or law, or negligent or careless act or omission by the Executrix, in connection with the
administration and distribution of assets shown in the statement,without a formal court accounting
and adjudication;
6. With respect to any distributions of income or principal, which I have received, or will
receive upon execution of this agreement, agree to indemnify and hold harmless the Executrix,her
personal representatives,heirs,successors and assigns,from any liability,loss or expense(including
but not limited to costs and counsel fees),arising from any cause whatsoever,which may be incurred
by the Executrix as a result of the administration of this estate or distribution in accordance with this
agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania
inheritance tax or any other death taxes and federal and state income taxes,together with any interest
and costs incidental thereto, relating in any way to the Estate and also including, but not limited to,
any assets received or payments or distributions made by reason of any negligence or mistake of fact
or law;
7. Agree to refund to the Executrix, if and or as may be necessary, some part of the
distributive share of the Estate received by me and which was distributed to me which may at any
time be determined to have been an erroneous distribution to me. However, based upon all
information known and now available to the Executrix it is believed that no such request will be
necessary.
8. Agree to indemnify and hold harmless, KEVIN D. DOLAN, ESQ., and GINGRICH,
SMITH, KLINGENSMITH & DOLAN, attorneys, of and from any claims including tax claims or
demand ever made against him and his law firm by any heirs in the estate.
9. Agrees that this agreement shall be governed by the laws of the Commonwealth of
Pennsylvania.
IN WITNESS WHEREOF, I agree to be bound hereby and have signed this agreement this
0 h day of JB A,2G l-r- - 32015.
John P. Z , elmeier
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF KAREN A. ZIEGELMEIER, DECEASED
The undersigned is one of the beneficiaries named in the Will of Karen A. Ziegelmeier,
deceased, and desires that the estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper
release and indemnification, which it is the purpose of this document to provide.
In consideration of the willingness of the Executrix to distribute and terminate the estate in
accordance with the terms of the Will without the protection afforded her by a formal adjudication
of her account, the undersigned beneficiary, individually with respect to their heirs, personal
representatives, successors and assigns, does hereby:
1. Acknowledge that I have read this Agreement and represent that the facts set forth above
are true and correct to the best of my knowledge,information and belief. I further acknowledge that
I am familiar with the provisions of the Will of decedent;
2. Waive the filing of a formal account of the administration of this Estate, with respect to
the income and principal thereof, in any court which has jurisdiction, in particular the Orphans'
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania;
3. Declare that I have examined the account and statement which is attached hereto and
incorporated herein, and find them to be true and correct in all particulars; accept and approve the
informal account with the same force and effect as if it had been prepared and duly filed with,
audited,adjudicated and confirmed absolutely by such court which has jurisdiction over this estate,
and as if the balance of principal and income had been awarded by said court in accordance with this
Agreement and the account and statement;
4. Warrant that I know of no outstanding and unsatisfied claims against the estate and
approve the distribution of the balance of principal and income shown on the attached account and
statement as set forth above;
5. Absolutely and irrevocably release and discharge the Executrix, her personal
representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and
demands, including specifically but not limited to liability arising in connection with any mistake
of fact or law, or negligent or careless act or omission by the Executrix, in connection with the
administration and distribution of assets shown in the statement,without a formal court accounting
and adjudication;
6. With respect to any distributions of income or principal, which I have received, or will
receive upon execution of this agreement,agree to indemnify and hold harmless the Executrix,her
personal representatives,heirs,successors and assigns,from any liability,loss or expense(including
but not limited to costs and counsel fees),arising from any cause whatsoever,which may be incurred
by the Executrix as a result of the administration of this estate or distribution in accordance with this
agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania
inheritance tax or any other death taxes and federal and state income taxes,together with any interest
and costs incidental thereto,relating in any way to the Estate and also including,but not limited to,
any assets received or payments or distributions made by reason of any negligence or mistake of fact
or law;
7. Agree to refund to the Executrix, if and or as may be necessary, some part of the
distributive share of the Estate received by me and which was distributed to me which may at any
time be determined to have been an erroneous distribution to me. However, based upon all
information known and now available to the Executrix it is believed that no such request will be
necessary.
8. Agree to indemnify and hold harmless, KEVIN D. DOLAN, ESQ., and GINGRICH,
SMITH, KLINGENSMITH & DOLAN, attorneys, of and from any claims including tax claims or
demand ever made against him and his law firm by any heirs in the estate.
9. Agrees that this agreement shall be governed by the laws of the Commonwealth of
Pennsylvania.
IN WITNESS WHEREOF,I agree to be bound hereby and have signed this agreement this
4 day of �� , 2015.
� r .
Caren R. Herbert
APPROVAL OF ACCOUNT,RELEASE AND INDEMNIFICATION
ESTATE OF KAREN A. ZIEGELMEIER, DECEASED
The undersigned is one of the beneficiaries named in the Will of Karen A. Ziegelmeier,
deceased, and desires that the estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper
release and indemnification, which it is the purpose of this document to provide.
In consideration of the willingness of the Executrix to distribute and terminate the estate in
accordance with the terms of the Will without the protection afforded her by a formal adjudication
of her account, the undersigned beneficiary, individually with respect to their heirs, personal
representatives, successors and assigns, does hereby:
1. Acknowledge that I have read this Agreement and represent that the facts set forth above
are true and correct to the best of my knowledge,information and belief. I further acknowledge that
I am familiar with the provisions of the Will of decedent;
2. Waive the filing of a formal account of the administration of this Estate, with respect to
the income and principal thereof, in any court which has jurisdiction, in particular the Orphans'
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania;
3. Declare that I have examined the account and statement which is attached hereto and
incorporated herein, and find them to be true and correct in all particulars; accept and approve the
informal account with the same force and effect as if it had been prepared and duly filed with,
audited,adjudicated and confirmed absolutely by such court which has jurisdiction over this estate,
and as if the balance of principal and income had been awarded by said court in accordance with this
Agreement and the account and statement;
4. Warrant that I know of no outstanding and unsatisfied claims against the estate and
approve the distribution of the balance of principal and income shown on the attached account and
statement as set forth above;
5. Absolutely and irrevocably release and discharge the Executrix, her personal
representatives, heirs, successors and assigns, from any and all actions, liabilities, claims and
demands, including specifically but not limited to liability arising in connection with any mistake
of fact or law, or negligent or careless act or omission by the Executrix, in connection with the
administration and distribution of assets shown in the statement,without a formal court accounting
and adjudication;
6. With respect to any distributions of income or principal, which I have received, or will
receive upon execution of this agreement, agree to indemnify and hold harmless the Executrix, her
personal representatives,heirs,successors and assigns,from any liability,loss or expense(including
but not limited to costs and counsel fees),arising from any cause whatsoever,which may be incurred
by the Executrix as a result of the administration of this estate or distribution in accordance with this
agreement including, but not limited to, any liability for any federal estate tax, Pennsylvania
inheritance tax or any other death taxes and federal and state income taxes,together with any interest
and costs incidental thereto,relating in any way to the Estate and also including,but not limited to,
any assets received or payments or distributions made by reason of any negligence or mistake of fact
or law;
7. Agree to refund to the Executrix, if and or as may be necessary, some part of the
distributive share of the Estate received by me and which was distributed to me which may at any
time be determined to have been an erroneous distribution to me. However, based upon all
information known and now available to the Executrix it is believed that no such request will be
necessary.
8. Agree to indemnify and hold harmless, KEVIN D. DOLAN, ESQ., and GiNGRICH,
SMITH, KLINGENSMITH &DOLAN, attorneys, of and from any claims including tax claims or
demand ever made against him and his law firm by any heirs in the estate.
9. Agrees that this agreement shall be governed by the laws of the Commonwealth of
Pennsylvania.
IN WITNESS WHEREOF, I agree to be bound hereby and have signed this agreement this
149 day of ) 2015.
tJ 'fer ler
Beaverson, Danielle
From: Yvonne Yohe <YYohe@gskdlaw.com>
Sent: Tuesday, May 12, 2015 11:00 AM
To: Beaverson, Danielle
Subject: Karen A.Ziegelemeir Estate
Danielle,
Please be advised that the First and Final Account that you have in your offices for filing for the Estate of Karen A.
Ziegelmeier is an "Informal Account".
The $15.00 check is to be applied toward the filing fee.
Thank you for your assistance.
Yvonne M. Yohe
Paralegal for Kevin D. Dolan, Esq.
Gingrich, Smith, Klingensmith & Dolan
222 South Market Street
P.O. Box 267
Elizabethtown, PA. 17022
(717) 367-1370 ext. 132
(717) 367-3219 (fax)
NOTICE: Confidentiality Notice and Disclaimer This e-mail transmission, including any attachments, is intended only for
the recipient(s) listed above and may contain information that is confidential and privileged. Any unauthorized review,
use, disclosure,forwarding or distribution is prohibited. If you are not the recipient, please contact the sender by reply
e-mail and destroy all copies of the original message.
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