HomeMy WebLinkAbout07-09-15 J Lsos6141as
pennsylvama
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REV-1500 OFFICIAL USE ONLV
Coun�yCoae Year FleNumbee
6ureau of InGividual Taxes INHERITANCE TAX RETURN �i �
Po aoX 28060t RESIDENT DECEDENT Lj � I� O2I �
Harrisbur , PA 1]128-0601
ENTER DEGEDENT INFORMATION BELOW
Social Sewrity Number De�e of Dea�h MMDDVYVY Date of BUN MMO�YVYY
_
i02082015 11241920 _ _ I
__ _.. . .... . MI
Decetlenls Last Name �SuRx Decetlents First Name . . . . . ..
�ZOOK . _ . .... �� ,, ., VESTA .. . . ._. R..
___ .__... .. ___ . . .� _ .. ..._. . .
(If Applicable� Enter Surviving Spouse's Infermalion Below MI
Spouse's Las�Name SuHlx Spouse's First Name
N/A
�� � � THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW 3. Remalnder Rewm (date of death
� 1.OriginelReWm O �� SupplemenlelReWm O p�io�tol2-19�2)
� 4.AgdcWture Exemption(tlate of p S FUNre Inte�est Compmnuse(tla�e o( p 6. FeOeral Esla�e Tax Relum Haquiretl
tleatM1 on or efler]-0-2012) dea�0 a�te� 12-02-82)
� I. Decetlen��letl Teslate O 8. Decetlent Main�ained a Living Tmsl � 9. To�al Numbe�o�Sale�eposit Boxes
(AVachcopyo(wiIIJ �AltacM1copyotims'�.)
it. Noo-Pmbate Transferee ReWm O 12. �e(erral/Eleotion of Spousel Tms6
� 1Q Ll�lgafion Pmcaetls Recaive0 O (Schedule F antl G Assels Onty)
O 13. Business Assets O 14_Spouse Is Sole BeneFlciary
(No Imst Involvetl)
CORRESPONOENT- THIS SECTION MUST BE COMPLETEO.ALL CORFESPONOENLE AND CONFIDENTIAL TPX MFORMATION SHOUL�9E OIRECTE�TO',
Daytime Telephone Number .. _ ...
Name . . � - �- -
�Andrew H. Shaw, Esquire .. � (717) 243 7135
Flrst Line of Adtlress . �
200 S. Spring Garden St ___
SemndLineofAtldress �� � �� � �
Suite 11
Cily or Poet ORlce . . Stale ZIP Code .
Cadisle PA ��17013 .. � �
corre:po�aeors eman aaaress: andrew@ashawlaw.com '
REGISTER OF WILL�SE ONLYA
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REGISTF.ROFWILLSUSEONIV + p
.. DATEFILEOMMOOWYY C'! =� r � A
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PLEASE USE ORIGINAL FORM ONLY ' � '
Side 7
L II�����I���I�I�II�IISOI56I1I4I1I05�1�1�����l�l��l��� 1505614105 �
J Lsos6142os
REV45�0 E%(Fl) Decedenfs Social Securiry Number
.. �...
oe�eaeor:Na��e� Vesta R. Zook
RELAPITULATION -� �����
i. rzeai es�ace (s�nedwe n). . . . .. .. . _ _ . . . _. . . . . . . . .. ... . . . i. �.� ___ 89 900.00
2. Stocks and Bonds(Schedule B) . .. .. . .. . .. . . . . .. . . ... . ..
_. . z .-_ 0.00
- -_" ._
3. Glosely Heltl Corporatlon, PaMership or Sole-PmprietorsM1ip(Schedule C) . . . 3 � �0
__ _
q �.0�
4. Morlgages and Notes Receivable(Schedule 0) . . .. . . .. . . . .. . . .. . . ._ _ _ ,_ _ ___...
5. Cash, Bank Oeposits and Miscellaneous Personal Pmpeny(Schetlule E). . .. . 5 . . 3 425.�7
0 00
6. Jointy Ownetl Property(Schedule F) O Separate Billing Requesletl .. . . . 6 _ _ _ ._
�. Inter-Vivos Transfers 8 Miscellaneous Non-Pmbate Pmperty �.00
(Sc�etlule G) O Separate Billing Requestetl.. . .. . 1 ... .. .
8. Total Gross Assels(to�al Lines 1 tM1rougM1 1�.. ... . ... . . . . . .. . .. . . . .
. . .. . . e. 92,711.14
4 Poneral Expenses antl Atlministralive Cos[s(Schedule H). . ... . .. . . .. . ... 9. 4 036.80_
_ - .
10. Deb[e of Decedant, Mortgage Llabllllies and Liens(Schadule I) .__. . _ .- �0 101 $$6.99
11. To[al Detludions(total Lines 9 and 10). .. . . .. .. . ... . ... . ... 11 �� ,_ �05,593.79
12. Net Value of Estale(Line B minus Line 11) . . . ... . .. . .. . . ... . . 12 � .�� -�2,882.65
13. Chentable entl Govemmen�al Bepueste/Sea 9113 Tmats for which 0,00
an election b Iax has no�been made(Schedule J) . . . .. . . . .. . . .. . . 13 _ _
. . . _ ____ ___. .
14. Net VaNe Subje<t lo Tax(Line 12 minus Line 13) .. . . . . . . . . . . .. . . .. . 14 0.00
TA%CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE ftATES
15. Amount o�Line 141axable
a�the spousal tax ra[e,or . ._.. . - � -
vansfers untler Sec.9116 0.00 �5 0.00
(a)liz)x .o00 . . ._ _ . _ . _ _ __
16. AmounlofLinel4taxa�le ��� 0.0� 16. .� 0.0�
a�linealrace X.045 _. _.. .... . . . .._. . .
n. nmountot�inetataxabie �� � �� �0.00� t�. 0.00
atsiblin9 ra�e X .'.2 . .... . . . _. _ . . .._. .. .. .
18. Amount o!Line 14 taxable � �� � Q.00 ��.. �g � � 0.00
atcollateral rate X .15 �. ._.. _-.._ . .- ------
0.00
19. TA%DUE . .. .. ... . . . . . . . . . .. . ... .. .... . .. . . . . . 19. .
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUNO OF AN OVERPAYMENT �
Untler penalties ol perlury,I tledare I�eve examinatl IM1is reWm,lnclutling acwmpenying scM1edules an0 slatemenes,a�tl to IM1e Ues10!my knowletl9PreparareLel.
It Is We, cortect antl complete_Decleration of praperer o�ner Vian IM1a person respons�le!or Iling�M1e retum is basetl on all Inbrma�ion o!wMCM1 M1es
anyknowletl9e. DATE
9GNATURE O�.pER50N RES NSIB FO FlLING RETURN I p / /
6 S
il i
A DRESS �_ ` ���� �
� J � � �OIJ � ��
SIGNATUR PREPrtjE THAN PERSON RESPONSIBLE FOR FlLIN THE RETURN �AfTE /�
� 1
nooaEs� .� �� /�2x/1 S`� Sr/�v ��� �S�P �✓� (7�'il3
uiiiiiimiiiiiu�i��ii��i�i�i�iyi�uiiuiiiiiiiiiiii s�de2
L 1505614205 J
aev-�woex �cp aeqe� c�ieN�meer
DecedenYs Complete Address:
oEceoeNr�srvnmE
Vesta R. Zook . .. ..._. .-- --- --- -� � —
__. . .. _. .__ . . ._. . . . _. . .._ .. .. --
STREETADDRE55
1000 W. South Streel . .__ . — —� �—� �-
Cltt. . —. ._ ..... _— .__. .. . —. ._ — �., STATE.. . .._ ZIP ___ .. . .
Carlisle PA 17013
Tax Payments and Credits:
1. Tex�ue(Pege 2,Line 19) (1) 0.00
2. CreaitslPaymen�s
A. Prior Payments .__ ._ . 0 00
B.Discoun� 0.00
(See'�nslmdlons) � To�alGredl�s(A*B) (2) 0.00
3. mterest (3) 0.00
4. I�Line 27s greater�han Llne 7 t Cine 3,enter the 4iRerence. This Is Ihe OVERPAYMENT. �Q) 0.00
Fill in oval on Page 2,Line 10�o request a re(und.
5. If Line 1 *Line 3 is grealer�han Line 2,enter Ihe diflerence.This is 1he TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
t�;:•
-�.. -
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decetlent make a Iransfer and: Yes No
a. retaintheu5eorincomeofihepropertylransferre� .._._ .._._. ._......_ _....... ❑ �
b. relain ihe right to designa�e who shall use Ihe property Iransferred or its income _..............__......._._...._.._. ❑ �
c. re�ainareve�sionarymteres� ..._._ ..-...... �������— �---- ""'-"" � �
d. receive the pmmise for life ot ei�her paymenLs,benefits or care� .._........ -....-.- ..---- ❑ �
2 If death occurred afler Dec. 12, 1982,tlid decetlent transfer pmpetly wi�hin one year o�death ❑ ■
- g quaieconsidera�ion� .......... -..-.- —������� -
3 �d dece�n�own an"In Imst for'or payabla-upon-0eath bank accounl or secun�y a�his or her death� .__. ❑ �
4 c�onlains a benefciary des dnatlion�irement aaounl annulty or other non proba�e property which
d decedent own en I 9 .. ..... ....... ........ ........ ❑ ■
IF THE ANSWER TO ANY Of THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
, ., . .., �.:�: . . . .. . .
- . -er.�„ ��.: �.��. .� . ! ^ . , .
For tlates of death on or after July 1, 1994,and before Jaa 1, 1995,�he tax rate imposetl on the netvalue of transfers to orfor the use of ihe survrving spouse
Is 3 percent�l2 P5.§9116(a)(1.1)(I)].
Por dates of death on or afler Jan. 1, 1995, �he tax rate imposed on �he net value of �ransfers to or for the use of the surviving spouse is 0 perwnt
[72 P.S.§9116(a)(1.1)(ii)�.The statute does not exempl a iranster m e surviving spouse(rom tax,and the stafu�ory requiremen�s for dlsclosure o(assets and
fllr.g a tax return are still applicable even If the survrving spouse Is�he only beneficiary-
For tlates of death on or after July 1,2000:
. The tax rate Imposetl on the net value of transfars fmm a deceased chlld 21 years of age or younger a�death to or for the use of a nalural parent,an
adopCrve parent or a step-parent of the child is 0 percent�72 P�S.§9116(a)(1 2)J.
• The�axrateimposedonlhenetvalueofVansferstoorfortheuseofthedecedenfslinealbeneficiariesis4.5percent,exceptasnotedin�72PS.§9116(a��i)].
. The tax rete Imposed on ihe net value of iransfers�o or for Ihe use of the decetlenfs slblings Is 12 percent [72 P.S. §9116�a)(1.3)�.A sibling is tlefined,
under Section 9102,as an individual who has al least one parent in common with ihe decedenL whether by blood or adoption.
LAST WILL AND TliSTAMENT
OF
V6STA R. ZOOK
I, VESTF R_ ZAOK, ma¢ied womav, 0 1621 Waggovers Gup Road, Cadislc,
CumAedanA Comry, Pwnsylva�ia, being of sound nnd dfsponing mind, memory, x�d
�ndecs[andmg,do hereby make,publish,and declare thia as and for my Las[Will avd7kstament,
hcreby revoldng and making vnld any and all W ills by me a[any ume huc�oPore made.
1. ]di�utmyhereina[ternamedL'xecmormpaya0ofmydeb6�owhichlamboundand
the ezpensea of my fnneral,tes�il]ness,and of the atlministm[iov of my estate as soo�af��my
Aea[h as may be tound comeviem�o do so.
2. I declare[hat I am cu¢enOv mertie�i�o Chu[e� L. Zook, and lhet 1 have.six (6)
cltildre¢ W;mda Kell, AlindaFlahnrty,Randall Zook, Shnron Peffer, Roben Znnk. a�d Doreen
Lelw. 1 funhu decluc ihai L have no othe�ehildre�.
3. All the �est, maldue, and remninde�of my eala�e, mal, pe�o�al, or mixed, wid
wheresoeve[the same mey bc simme,] give, devise, and bequea�h m my hueband, ChesterL.
Zook, his heics u�d asnfgns', ro Ihe exelosion of my eAild o�childreq bom or uvbo�q provided
my said husbend sM1all survivc me by a period of vinery(90)days. Iu�he eveu[tha�my seid
husband shwld predecease mc orfvl ro wrvrve me by [he eforesnld periodof niuety(90) dnys,
then in such event all tHeres�, rra'iduc end�emxi�der of my es'tate,real,pe�eonnl a�d mlxed, und
whuesxve�the same may be simete, 1 g[ve, devise and twqueath in equal ahavea m such of my
children as shell survive me by a penod of vinety(90)days, dw sbeee any deceesed child would
haveieceived m pase ro his oc hec issuc perstlrpes,and I([here bc no ixsoc suehshxre shall lapsc
aMheaddedtotheremainingshareorsharespersGmes. A�WeprexemtlmelhaveNchfldrevas
afoeemesiuoned.
4. Shoold a�y pe�son less[huu 21 yeaa of ege be evtlHed m disnib�tio�from my es�ate,
iu soeh eveo[the sherc that pe�son would oHiuwise heve�eceivedshell be paid m my Exuotoq in
[mrt. I airtho�ize[hehe�cin�ameA wsteeor goa�dian ro receive avd imcs[[he eame, and to pay
the inwme arisiug Mem&om,rogethe�with so moch of[he p�incipal[he�eof as in his opiuio�is
nueseary o�desicnble[o be expendod fo��he prope�mainmmuce,suppun, aod education of sueh
pe�son,�o o�foc Ihe benefit of wch persoq end upoo such pe�son aVainl�g 21 years o[ege ro pay
�o him m he[�he[he��emai�ing p�ncipal mge�hu wilh noy undishiboted iowme.
5. I he�eby nomi�ere,ro�stimte,and appointnry husb��d,Ches@r L.Zook, ax Execumr
of rhis my Las�W ill and"Cestament,bot should he preAecease me o�fail ro qualify, then iv euch
event I nominate,consti[u[e, and appoint my my soq Raodall Zook, aod my daugh[er, Alinda
Plaharty,oc ei[hcmf thcm as Execum�s,e�d I(orthe�daect[hat noce of thcro shel l be rcquicul to
pos� auy bo�A �o secum the tnithful perfoannnce of hlr,or her duties in the Commonwealth of
Pennsylvanie ur in any othujucisdictio�.
6. In additiou ro thepowea m�feaed by law, my herein named Execu[o�r,and 7'rvs[ees
sre empowe�ed:
a. 'Ib fnves�any part o[ the vost m�pus i�snch secu�iGes,Imestme.ote, o�o�ie�
prope�Ty as may be deemed advisable aod p�oper, irzrspectiveo[ whethec the name ue
authorized for lhe invesm�em of ws�funds under[he laws of any governing jurisdiction.
b_ Wi�h�espee[m avy eoxporatlo�,[ho srocks,bo�ds, o�olhe�seco�ilicao!wM1ieh
may be held, m vo[e iu person o� by proxy ou any shares of stock:ro co�sent ro Me
megu, c nmlide�ioo or reorga�iaation uC sueh ro�po�a�ious;to covsem m �he leasi�g,
nwilgaging,o� sale of the propeny of any euch w�po�ations; ro make nny suveodeq
exehange o�s�bsb�utfon of soch s�ocks, bo�ds, or other suorltles as en inciden[to[he
mergu, wnsolidatlon o� reoeganization of such corporatlons ro pay aIl assessments,
subxceiptions aud o�hei eome of mouey which may be deerned wise av�expeJient Cor�he
pm�cctlon and meintcna�cc of �hc pmportiuuatc i�[c�cst of Hie inacstmcm in snch
corpocafions;m exemise any optfo�or pmllege wtuch may be con(erred upon the holdeoe
of such erocks,bonde, oc othe�secoritiw of such covpovetio�s ei[hec for the wvversion of
[he same iv[o o�her secuii�ies o�fo�[he p�mhase of additional secori[ies,and�o make auy
avd all neccssarypayme�ts which mny berequirni io comcction Ihc�ewilh;end geneally
m have aud exercise ns to all such srocks, bo�ds, aod o[her suurities,[he powe�s of an
iodividual owue�who is vuder h'us[obligation.
a ID ho]d the hus[cocpus iu onc or moce consolida�ed Nnds i� whlch sepala[e
shares shall haveundivideA interes[e.
/
� � � .�n:
. _Y'.:i �{C- P .
/� e(
Page 1 of 2 pages
d. To aell a[poblic o�priva�sale fo� casM1 or upon c[edII,or panly for cash and
pxrcly on c�edit,avd npo�such te�ms and conditions ns shnll be decmcd proper,any part o�
paz¢of the tmst es[ate,and no pumhvec xt a�y s'uch salc shall bc bo�nd m I�qul�e fmo ihc
expcdic�cy or pmp�iety of a�y soch vale o�ro see m Ihe appliwHonof the pnmhase mouey
arising[heref�om.
c. To keep on hand a�d oninveared�och moneys as may bedeemedpmpe�and fo�
euch period as may be fouod expedien�.
f. To wmpromise,se[tle,or athitrate avy clnfm or demaud in faw�of or agai�suhe
vust csta�e.
g. And authociud in �hc dischargc of fidociary dvties, ro empiny counsel anA to
Ae�ermine andto pay sueh wunsel�easouable wmpeosa�ion which shall be charged ngaiust
[he p�incipnl or incomeof Ihevust fu�d, and shall foMerhe enHHed W chnrgeegains�the
pnmipal or income such othco roasovable expcnscs nnd charges as may be ncccssary aod
p�opc�ro inco�fo�thc propo�discha�ge of tiduciary Auties anA fo�the prope�management
anA administw[ion of the�ms�esmte.
h. In making any division of property into shares foc [hc purpose uf any
distributiou�hereof di�w[ed by the pcovisious of[he [msl, ro meke such drvision o�
distrib�tioq eithe�iu cnsh or in kind, or partly in cash end pa�tly i� ki�d, as shall be
dcemcd most cxpcd7cnt,antl In mxking aoy divisfon oc dislribu�on iu kind may albt avy
specific secunty or pmpe�ry nr any vndivided inte�es�themin m any o�e o�mo�c of such
shaces, and m Iha�eod mny app�aise any o�all of tM1e property so [o be ellntad and Ne
judgmenl as to the pmpnely of such allolmen[and us m the relative val�e for p��poses of
dIs[dbofion of�he suuri�iu or properry so allotted shall be final and conclusivc upon WI
peesoas i�[ercaeA i�[be tmst or in Ne dlvislon or dlstnbufion thereof.
i. AvWonzed to register nny shares of stock or othcv assets of any hust in�heir own
nvmea or m We name uC a vomi�ee.
IN WITNESS WHCR@OF, ou this page 2 of 2 pages, I have he�euntu sel nry hand
end seal lo Ihis my Las�Will and Tsument wrillcn Ihis 2lstdey o(February, 1996.
% '.(.� •� ��� �,�'ALl
VESTA R.ZOOK
Signed, sealed,pnbliehed and dulared,by VfiS7'A R. ZOOK,[he Testat�ix above named,
as nnd for he�Last Will nnd 72stamwt,i�ovr presence,whq in hec preseuce,at he<<eq�ut,nnd
in tlie preseocc of each othu,have bereun�o subseeibed wr names ns�¢esti�g wimessos-
��9.� ,J/. �-
�
��� t���r _
Page 2 oC2 pages
4EN-1502 E%� Q242)
� pennsylvania SCHEDULE A
'�v oev�rz*mcmroFen�enue REAL ESTATE
rvreartnr,cE�tie xe*uurv
aesmErv.oecEoervr
FILE NUMBER:
ESTATE OF: p1-15-0210
Vesta R. Zoak
pli real properry owned solelY a�as a tenant in common mus[be reparhtl at fair market value.Fair marke[value is tlefined as IFe Oricc at rhlch property
wadd be exchangea be[we Real ro�ert�[hat�is' il�i�g s�e�e��e�i[h ri��h[of surv vorsM1 p�must b¢Eisclos�etl on�SCM1etlu pnowletlge ofMe relevant�c[s.
P P Y 1 P 9
P[[ecF a capy ofthe settlement 5heetlfthe propeRy has been sold.
VA�_UE AT DATE
ITEM Induee e mpY of[he deetl showing tlecetlenfs Interesttf ownetl as tenan[in common. OF DFATH
NUMBEd DSCRIV'IOtt
1� 960 Easy Road,Catlise,PA',Taxld No.29-O6-0023-007 89�900���
70TpL(Alsa en[er on Llne 1, Recapitulatlon.) $ b9,90Q00
If morespace Is neeGed,use a0aibonal s�eets of paDer of lhe same su.
OM6 ApP���l No.25p1 p�65
� ����w� A. Settl2ment .,tiacemenz (ttU�-1)
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��� �]F n z �u s e.O� ,�v.w�. e c _v.�ma.: � i ���rv„��ea e �n e a � a��ec eN�,�oed"
1,=� � � �
n []vn arJcn�_m
a o�d.ms mrm��i i�.,.�n-m e��erv�e s�e��om oi en�ai sema��e�i�osis ama�ms vae�o a�a ov mo somamam aqam:are mo.�aems m.rvea
.'�o q". ro eam ow:ae me�ios��s:mer ere s�o.�nare mr���mrmeno�ai p��eo�e��a are�m.��Hoea��mo m�ais
on�i��anaorassoraormwer: �e. v anoa rs �i �F.n sao :assondmer.
i r,:�y�.zooczrceamort ocnaazooKa�v v iaRoma;nazmx :`oa�x .i o. s
a n e�r aoaa,can�e,Fn vou j v,o emero.snu���.d��s oaie,an i ro90
. _______.__._ _ _-___ -_ -__
c.wooeny�o�acm� H sememem nqem�. i.sewamem oa�e:oaioyzms
aeoe�syaoaa rne�awon'�«oi�are.�,.sna..ac olso�rsememoam:onmyzms
Carlsie,PAl]015 4]OSSO��ng6a�oaiSecei.5uiell,Canlsie,PNPOt3
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SCREDULE E
e,� oeann.nervrornevenue CASH, BANK DEPOSITS & MISC.
:nxexrrnn�c*nxaeruav pERSONALPROPERTY
aesmEi+r oecEOErn
ESTATE OF: FILE NUMBER:
Vesta R. Zook 21-15-0210
Indu�c the pm<eeds of litiga[ion an�[hc date the pmceeds were re�eived bV Me es[ate,
All properfy jointly owneE wifh right of survivorship mus[be disclosed on Schedule f.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF�EATH
�, MBTBankAcwunt#15004216658996 60073
p M&TBankAccount#628468 ��09B-91
3, M&TBankAccount#9864273637 1,11150
q Pro-rated tax refund at settlement 613.93
TOTAL(Also enter on Line 5, Rerapitulation) ; 3,425.07
If more space Is neede0,use additional sheets of paper of!he same slze.
i I x�' � a ,�� x ;,^t'"�"�"� �re{�.ax�mA`Fp:.���1+9,�Q�
€ 1 . �I f FI �.._ , . ��.. ' r �y :'::� i .`, I 1 „ i ��. . .
. ._._. ____. .. . . . .. . .
PORINQUIRIESCqLL (800�]29-2aa0 � � nCCOUN� rvPR
� qF.LA(IONSHIPS'AVINGS �
00 OOA319MNM01/ -. ��-�. . - .. -.- . - .. � ��
ACCOUNTNUldFILH � SiAthfAPNiAERIOp
�i 15004216656996 . NOV20-FEe._91015
p I
00000459� HDSi54900V021915PG UZ OUOUO� -
�Ej F BEGINNMG BAl ANCF � $6U0]0
� YESTA fl ZOOK
C/O CINDY ZOOK DEPOSIiS&CREDITS . _ 000
]OWILLOWGROVERD LESSCHECKS&DEBITS _ 000
CARLISLE PA 17013 INi6RES� 003
I.ESSSEflY10ECHARGES � 0.00 �
�ENDING�BALANCE I� � 5&00.13
W�EflFSfEARNE�PONSTAiEMF_NTPCRI00 $O.U3 HIGHSIrI�GT-CARLISU=
IN�LR[STPAIDYEARIODAIF $0A2
ACCOUNTSUMMARY
� BEGINNING OEPOSITSSOTHEfl WITHDRAW4L58 CURRENT ENUING
BALFNCE CREDITS + OTHEflDEBITS - MTEfiESI'PAIO BAI.ANCE
NO FMOUNT NO. AMOUNT
$600]0 0 $a 00 0 $U.00 , SJ.03 8800./3
ACCOUNT ACTWITY
POSTING TqqNSACTI0NDE5CRIPTION DEPOSIT580THER WITHOPAWALS& DAILY
DFTE CREDITS + OiHEROEBITS - BALNNCE _
1ll2012014 HEGINNWC I3AI ANCE Ff,On�p
12/19l'2014 INiFR[Si PAVMF_NT $O.Ot 600.]I
01/16l'1015 INl EREST PAVMENT O.Ot 600.I]
02/19/1015 IN�EHEST PAVMFNi O.o� G00]3
EN�ING BAtANCE ___ .600.19
ANNUAL PENCFNTAGF YICLU EHRNLU- 0.a1%
FAGEtOF1
� � � �.
� �� < • .
x,5 �.,.. s .asr,-_ t . � _ �`� ,
FOR IN(]UIBIES C4LL: (d00) ]24-2J00 r _ ACCOUNf TYPC . — . ..��
IMBTClA55�CCHECKINGW/INI6RESt
00 004319MNM Ot! r qCCOUNiNUM9ER afATEMENIPERIOD
- _ _
�� 628968 ..f.___JANtOFEB.Os.2�i5
000003558FiD5t549U01,'020915a202C1Q0iJ0 -.- — - -
YESiARZOOK I9EGINNMGBALANCE �51,03693 ��
� GO GNDV ZOOK OEPOSITS&CRE�IT$ 96/�
LESSCHECKSB �EBITS 90503
]0 WLLLOW GROVE RD INTEflEST � � � � O.Ot
CARLISLE PA 1]013 �-- - -
LESS�SEPYIGECHARQES 0��
_— .
. ' eNbtM�dgr:i+Nc� _t,.ove.v,
INrFREsIFnRNLu �-0FaSrniEMENiFFRiW BnAo r11f1I51AEEl-cH�1usLE
INTFRESTP�IDVCPPTOOAIt �0-J�
ACCOUNTSUMMARY
BEGINNING OEPOSIT580THER CURRENT ENDING
BAIANCE CRE�ITS ♦ CHECKS PAI� OTHEP DEBITS(-) �MEflEST PD BALANCE
NO. AMOUNT NO. AMOUNT NO. AMOUN�
81006 d 1 $96)00 1 $9050.3 0 $OAO 50.01 $1,09tl.91
; ACGOUNT ACi1VITV
POStING TqpNSACT10NDE5CRIPTION DEPOSITS80THER WITHORAWAl58 OAILV
�ATE _ CREDITS • OTHERDEBITS(-i BALANCF
01/10/2015 �FGINNMG�AIANCt $1P3E.93
012�/2015 GIF.CKNUMElER3653 $905.08 13190
02103/2015 SSATR[AS3I�HXSOCSW $9tiZ00 1,098.90
- J2I0912o15 Mi[RCSTPAYMLN� �,Ot ��09B.9t
ENDWG tJALANCE � ��e'y�
� CHECKS PAID SUMMARV
; CHECKNO. DATE AMOUNT CHECKNO. OATE AMOUNT CHECKNO. DpTE AMOUNT
S 3653 - OVP9I15 90503 -
ANNI INL PF.19GtN fAG[YIELD�AFN[0=0.00 0
SIIOW YOUR SiVLE WIiYIAGUSTGMIZFD DLtlII CAR�!GET F CU5fOM IMAGLON VO�H M8T
f]ERIT CAHD FON JUST$295.VISIi MTB.COM/CUSTOMCNRD �O t3Ei SlANiFD.
115F OF TI I[M8T CUS fOM CARD D[SIGN SERVICF IS SU9JF_C i f0 PROGH�M iERMS 4ND
CONDITIDNS AND IMAG[GUIDELWES.A$2951MAG[SFT-UP FEt FOH EACH NEWI.Y
APPROVED CUS�OM CAHD�FSIGN MAY AFPLV.ONE FFE WILL BE CHNHGED PER APPROVLD
CUSTOM OFSIGN.RCPLAC[M[NT CAH[1S WILL NOT INCUH fHIS FEE IF iHE Cl1STOM OLSIGN
HEMAINS UNCHANGt�-
PAGE 1 OF 1
_.__ ......
�� s .
OR INOUIPIES CALL: (BOD)12q�2940 ACCOUNT TYPE
� � PREECHECKING �
00 0 04345M NM 017
ACCOIINT NUMBER STATEMENT PERIOO
Wo0(I26taF105154sDOVa2YI15W0]OID000 P I__ 98692]3W1 _ . JAN2&FE8.2],2015 1
� VESTA R ZOOK BEGINNING BALANCE 51.095.50
ALIN�A M FLAHARTY, LEGAL CUSTOOIAN DEPOSITS b CREDITS 90.00
1�0WILLOWGROVERD LE55CHECNS&UEBITS 19.00
CAHLiSLE PA t7013 LESSSERVIGECHARGES� 0.00
��'�aN�BALMICE 51,111.50
JTERESTEARNE�FORSTATEMENTPERIOD $000 STONEHEDGE
ACGOUNTSUMMAHY
BEOINNING DEP0.SIT580THER CURREM ENOING
BALANCE CHEDITS « CHECKSPAID OTHEROEBITS(-) �NTERESTPU BALr1NCE
N0. AMOUNT NO. AMOUNT NO. AMOUM
$1,095.50 1 $90.00 1 $]4.00 0 $0.00 $0.00 $1,111.50
ACCOUNT AC7IVITY
POSTING DEPOSIT580TMEq WITHURAWAL58 �AILV
DqTE TRANSACTIONDESCRIPTION �REDITS ♦ OTHERDEeIT - BALAN E
OV2BI2015 BEGINNINGBALANCE $1,O9S50
01I30i2015 VAGPTHtA5310X%VABENEF � $90.00 1,10550
02/09/2015 CHECK NUMBER 010A
$]4.Op 1.111.50
EN�INGBALANCE � ��� �p
CHECKS PAID SUMMARV
CHECKNO. �ATE AMOUFt� CHECKNO. DATE AMOUNT CHECKNO. DATE pMOUNT
109 02/09/15 ]4.00
SHOW VOUF STYLE WRH A ClISTOMIZEfI DEBIi GARDI GFT A CUSTOM IMAGE ON YOUH M8i
DEBIT CARD FOR JUST$2.95.ViSIT MTB.COM/CUSiOMCAR�TO GFT STARTEU.
115[OF THE M&T CUSTOM CAR�DESIGN SERVICE IS SUBJECT TO PFOGHAM TERMS AND
CONUI fIONS ANO IMAG[GUI�ELINES.A$2951MAGE SET-UP FEE FOR EACH NEWLV
APPROVED CUSTOM CARD DESIGN MAY APPLV.ONE FEE WILL BE CHARGE�PEP APPRWE�
CUSTOM DESIGN. REPLACFMENT CARDS WILL NOT INCUR fHiS FEE IF THE CUSTOM DFSIGN
REMAINS UNCHANGED.
PAGE10F1
FCV-ISll E%� (OB-13) �
`'i� pennsytvania SCHEDULE H
Til uEvna.nenroFaevErvuc FUNERAL EXPENSES AND
�n�ea�rAr+ce*axa�aN ADMINISTRATIVE COSTS
ESTATE OF FiLe riuMuEn
Vesta R. Zook 21-15-0210
DeceOent's deb[s must be re0orted on Schedule 1.
ITEM AM011NT
NOMBER DESCRIPTION
A. Fl1NERAl EXPENSES:
1� Hoffman-Roth Funeral Home&Crematory, Inc. 306.56
z. WesMinster Cemetary, LLC 499.00
B. ADMW[STRATIVECOSTS�,
t. Personalaep�esena'iveCommissicns: 1,000.00
Nare(s)o'Permnal Represen[a[:ve�s) Randall ZOOk and Alinda Flahafly _ _ _
SfreetA�dress . _ . . . . . . -
City__ - � _ . . .. . __Stace .ZIP_. _
Yeajs)Commis9�on Pa10�. . . . -— — —
1,900.00
2- qttomey Fees-
3. Famtly Exemp[ion'. (If DecedenPs atltlress's not the same as cla�man:'s, attach evplaration.)
Clalmant . .. ... . .. _ _—_ _.__.
Sheet Address . . ___. . ._... . . .—.. . ___ ... . . .. ..
Ciry— __ _ . . ... .___ Sta[C .... . ZIP__. .— _..
Re.ationshipofGaimanttoDecetlent_ ___. ___. _ .._— . — — ----�
315.50
4. Pmba[e Pees:
5. Acro�ntaolfees'.
6. Tax ReNrn Preparer Fees'.
7, Checks for Estate Checking Account �5.�4
TO7AL(Also enter on Line 9, Re:apiNla[ion) S 4,036.80
If more space Is neetled,use a0ditional sheets of paaer oF the same size.
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Febmary 26, 2015
Randall Zook .
70 Willow Grove Road
Carlisle, PA 17013
Statement of Funeral Expenses for: Vesta Romaine Zook
Date ot�eath: Pebmary 8, 2015 Account Id� 17436-043
PACKAGE:
Tredi[ional Fune2i Service
TRADITIONAL FUNERAL SERVICE PACKAGE $ 5,150.00
Sub Total: $ 5,150.00
TOTAL FUNERAL HOME CHARGES: $ 5,150.00
CASH ADVANCES:
10 Certified Death Certifcates at$ 6.00 each $ 60.00
Nevrspaper Notice-Sentinel $ z65.99
Newspaper Notice- Patriot $ 293.00
Flowers $ 159.00
Hairdresser $ 40.00
Sub Total: $ 817.99
Columbian Financial Group Check 0400584182 Feb 26, 2015 5,661.43
TOTAL FUNERAL EXPENSE: $ 5,967.99
7otal Payments Made: $ 5,661.47
Balance: $ 306.56
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0.Ev.�s 12 Ex.Gz-12l
`"Jpennsylvania SCHEDULE I
�i7 oevearnervraFnsveuue DEBTS OF DECEDENT�
innea�.r.Nce*A.aer�ar� MORTGAGE LIABILITIES & LIENS
aesmervrorceoervr
ESTATE OF FILE NUMBER
Vesta R. Zook 21-15-0210
Report debts incurre0 by the EeceAent priar to Eea[h that remaineJ unpaiG al[he tlah of death,intluEing unreimbursetl medical expenses.
1'EM VFLUE AT DATE
VOMBER DESCRIPTION OF�EATH
�� Sarah A.Todd Memorial Home 938�99
2. �uaRerly Homeowner lnsurance 125.00
3. DepadmentofHumanServicesEstateRecoveryClaim g9�g69�88
a. Closing costs on sale of real estate at 460 Easy Road,Wrlisle,PA 523.12
TOTAL(Also enter on Line 10, Recapitulation) $ �4�.556.99
If more space Is neetleQ Insert ad01[onal sheets of Me sameslze.
STATEMENT
Sarah A iodd Memorial Home
1000 West South Street Stateinent Date: 02/11/2015
Carlisle, PA 17013-2798
Telephone: (7ll) 245-2187 Due Uate: 07./25/2015
Amoun[ Endased $
Amount Due: $ 938.99
Account #: 102281
RE Vesta R Zook
Cindy Zoak
70 Willow Grove Road
Carlisle, PA ll013
-k� ' ': at s.'„ Ax��� ,�
'43te*d ,Ax ealance B/F k * Oexri �k�4n���, �µ� `pa C »� Ratw„5s. xMi4�`fiS'� 4 Vi �'n t �,�d��jnca9 �.:
OL/l9/l5 ZOOK, CIN�Y 905.03 905.03
Ol/Ol/15 RES[DENT WCOME 905.03 .00
02/Ol/l5 RESIDENi MCOME 16�98 16.98
922.01 938.99
— _
Curte t 31 60 Days � 61-90Oays Over 90 Days Amount Due
�_ .. � ' -�._ �
� 922 Ol 16 98 00 .00 "93$.89'�,1`�'...e.;
NOI'E � •ppYMENT IS Dl1F UPpN RhCEfP�+i++�• BUT NO WTER - —�
➢IE 25TH OF TIIE MOiYTM ""'�t Please remi[Ihe AMOUNT DUF.
your s[a[emen[. I�IuOe[he ACCrN hom[he 4a[emen[on[he MEMO $td[emepl DdCe: 02/11/2015
of your check.Paymen6 after 2/10/IS do na[refleR on s[atement.
NOTE: "�IATE PqVMENTS NRE SUB)ECT TO F LS%LA�E CHARGF GER DUC DdIB: 02�25�20 LS
MONTH *+A g2p.00 FEF WIIL BE Ck1ARGED for RERIRNED CHECKS"+
Vesta R Zook -Account N: t0228t
Sarah A 7odd Memorial Home
1000 West South Street
Carlisle, PA ll013-2798
Telephone: (7V) 245-2187
��
�egis
AEGIS SECURRV INSURANCE COMPANV RENEWAL PREMIUM BILL � �
P. 0. Box 3153
Harrisburg, PA 171053153
Insured: VESTA ZDOK
01/20/15 Policy Term: 02/26/15 ta 02/26/76
Policy Number: 2 1 0031 6 71 1
Loan Number:
002001 002341
Agt: STRICKLER AGENCV, INC.
VESTA ZOOK
C/O CINDY ZOOK
70 WILLOW GROVE ROAD
CARLISLE, PA 17013
THANK YOU FOR CHOOSING AEGIS SECURITV INSURANCE COMPANV TO MEET YOUR
INSURANCE NEEDS. YOUR PRESENT MOBILEHOME POLICY EXPIRES ON 02/26/15 AT
12:01 A.M. EST. THIS IS YOUR RENEWAL NOTICE. TO CONTINUE COVERAGE�, PLEASE
SEND YOUR PAVMENT PRIOF TO THE EXPIRATION DATE, AS THERE IS NO GRACE
PERIOD. FOR POLICY INQUIRIES OR CHANGES, CONTACT VOUR AGENT AT
717-243-2921.
Please select one of the following plans:
FULLPAYMENT "TWOINSTALLMENTS 'FOURINSTALLMENTS 'EIGHTINSTALLMENTS
AMOUNT DUE-OATE AMOUNT DUE-DATE ApA0UG4L-DUE-�eTF� AMOUNT DUE-DATE
$456.00 02/25/15 $234.00 02/25/IS �$120.00 02/25/15 ! $110.88 02/25/IS
$234.00 06/26/]5 ��$I20.00 � 04/07/IS $56.16 04/07/l5
\
� ��. $120.00 06/26/li $56.t6 OS/17/l5
��` �5 sizo.00 osizsns $se.ie oeiz6ns
�"'^��`'"�= �'�" C� $56.16 08/OS/15
Cv.�a1���c�` ;�=p�4' $56.16 09/14/IS
�se.ie ioiaans
$56.16 I2/03/IS
$456.00 5468.00 $4R0.00 $504.00
`AN INSTALLMENT FfE OF S 6/S lNCLUOED lN EACH PAYMENL RfTUflN CHECK FEE$25;LATE PAYME T .EE�
TO PROVIDE CONTINUOUS PROTECTION, PAYMENT MUST REACH US BY THE DUE DATE.
COMMONWEPLiH O�PENNSYLVANIA
BUFFNU OF PROGRPM IMEGRIiV
�IVISION pF THIR11 PPRN IIABILIiV
RELOVCRYSECTION
.� PO BO%BLE6
INRRISBUR6,PA P1058086
February 23,2015
STATEMENT OF GIAIM SUMMARY
NAME ESUte of ZOOK,VESTA
ID Z10Z58069
ME�ICFL CLA553 CLASS5.1 TOTHL
. INPATIENT .00 .00 .00
OUTPATIENT .00 3.50 3.50
LONG TERM CARE 3],949.96 66,43L01 99,866.99
DRUG 31.81 6].59 ]9./1
REIMBURSEMENTTODPW 31,481.]8 fi6,<86.10 99,969.88
� COMMONWEALTHOFPENNSYLVANIA —
� DEPARTMENT OP PUBLIC WELFARE
�. EIN- 23-6003113
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