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REV-l500 EX + (lI-OO)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
KLUTAS
DATE OF DEATH (MM-Do.Year)
EDNA
MAY
DATE OF BIRTH (MM-Do.Year)
09/09/2007 08/29/1918
(IF APPUCABlE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (AltachcopyofWl)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (dale 01 death allIlr 12-12-82)
D 7. Decedent Maintained a Living Trust (Altach copy ofTrusl)
D 10. Spousal Poverty Credit (dale ofdea1h between 12-31-91 and 1-1-95)
OFFICIAL USE ONL Y
FILE NUMBER
2 1 -0 7 0 8 3 0
COiiN'rvCOOE -YEAR- - - NuiiER- -
SOCIAL SECURITY NUMBER
1 75- 0 3 - 2 2 3 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (dale 01 death priorlD 12-13-82)
D 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Altach Sch 0)
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mj!NI$SEa_i"';'1:81"'~.~i~LEi!:CORRESPONO_E:lNd':.eNNEjt..:~ .. "'SH'lufi!j)ite:OIREmoi<lW6; .....
NAME COMPLETE MAILING ADDRESS
STEPHEN L. BLOOM ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly C>.med Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _(15)
0.00 X _(16)
0.00 X .12 (17)
330,380.75 X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
i-~';~x~~';~m:j;;~~fil Y0f~jrti(E~~i:;ji;'~illil~:}~ffiNbi!1i!~:;-
OFFICIAL USE ONLY
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(8) 387,621.56
17,682.59
3,500.71
(11)
(12)
(13)
21,183.30
366,438.26
36.057.51
(14)
330,380.75
0.00
0.00
0.00
49.557.11
49,557.11
ECK~T"~:'<\<'1;:;'1j(i!fA;'~'fG,U'fi0;i!:~~:i~~;S'j!.\;.,
CITY
NEWVILLE
STATE
PA
Decedent's Com lete Address:
STREET ADDRESS 210 BIG SPRING ROAD
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
49557.11
2.477.86
Total Credits (A + B + C)
(2)
2477.86
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
47 079.25
47079.25
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIA T BLOCKS
1. Did decedent make a transfer and: es No
a. retain the use or income of the property transferred; ........................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D lXI
c. retain a reversionary interest; or ....................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? ............................................................. D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D lXI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 00
Y OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT S PART OF THE RETURN.
ADDRESS 500 STONY CREEK ROAD
DAUPHIN
SIGNATURE OF PREPARER OTH R T IVE
P
ADDRESS
60 WEST POMFRET STREET
CARLISLE
P 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the us of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spous is 0% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing tax retum are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rat~ imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use 0 a natural parent, an adoptive parent,
or a sfepparen(o{ the child is 0% [72 P.S. 99116(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%, except as noted in 72 .S. 99116(1.2) [72 P.S. 99116(a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)). A sibling is efined. under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
,
ADDITIONAL Personal Representatives
Estate of Edna May Klutas - SS# 175-03-2239
...............................................................................
Under penalties of perjury, the undersigned declare that they have examined thi~ return,
including accompanying schedules and statements, and to the best of their know~edge and belief,
it is true, correct and complete.
Signature
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Name
Address Line 1
Address Line 2
City, State, Zip
Brenda Jean Geiman
9932 Circle Drive
Date
St. Thomas, P A 17252
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REV-1503 EX + (6-98)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
. INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KLUTAS
EDNA
MAY
FILE NUMBER
21 07
0830
ITEM
NUMBER
1.
2.
3.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
DREYFUS INVESTMENTS
DREYFUS INTERMEDIATE MUNICIPAL BOND FUND, INC.
9,780.735 SHARES @ $13.23
FIDELITY INVESTMENTS
FIDELITY ASSET MANAGER 50% - 8,089.539 UNITS @ $16.59
CUSIP #316069103
FIDELITY INVESTMENTS
FIDELITY PA MUNICIPAL INCOME -7,562.773 UNITS @10.72
CUSIP #316344209
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TOTAL (Also enter on line 2, RecapitulatiClln) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
129,492.92
134,205.45
81,072.93
344.771 .30
~-1508 EX + (6-98) ,
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.sTATE OF
CLUT AS EDNA
FILE NUMBER
MAY 21 07
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
0830
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ADAMS COUNTY NATIONAL BANK 3,175.86
SUPER NOW ACCOUNT #223867
2. MEMBERS 1 ST FEDERAL CREDIT UNION 3,202.21
SAVINGS ACCOUNT #133362-00
3. MEMBERS 1ST FEDERAL CREDIT UNION 14,370.55
CHECKING ACCOUNT #133362-11
4. MEMBERS 1 ST FEDERAL CREDIT UNION 22,101.64
MONEY MANAGEMENT ACCOUNT #133362-05
TOTAL (Also enter on line 5, Recapitul~tion) $ 42 850 .26
(If more space is needed. insert additional sheets of the same size)
:\1-1511 EX + (12-99) ,
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COMMbNWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
STATE OF
CLUTAS
EDNA
MAY
21
07 i 0830
i
ITEM I
NUMBER DESCRIPTION i AMOUNT
~. FUNERAL EXPENSES: i
1. EGGER FUNERAL HOME 1,199.97
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 15,400.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 298.00
5. Accountanfs Fees
6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS - FILING FEE 30.00
8. NOTARY FEES 35.00
9. THE SENTINEL - ESTATE NOTICE 158.62
10. CUMBERLAND LAW JOURNAL - ESTATE NOTICE 75.00
11. REGISTER OF WILLS - SHORT CERTIFICATES 16.00
ADAMS COUNTY NATIONAL BANK - DRILL SAFE DEPOSIT BOX 120.00
TOTAL (Also enter on line 9, Recapitulaton) $ 17682.59
Debts of decedent must be reported on Schedule I.
(If more space is needed. insert additional sheets of the same size)
REV-1512 EX + (6-98)
,I.
CQMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KLUT AS EDNA
SCHEDULE'
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
MAY
Include unreimbursed medical expenses.
FILE NUMBER
21 07
0830
ITEM ! VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. DEPARTMENT OF TREASURY - REIMBURSEMENT 2,424.20
2. GREEN RIDGE VILLAGE - NURSING 1,046.05
3. MOHAMMAD ISMAIL, MD - MEDICAL 10.46
4. GRAHAM MEDICAL CLINIC - MEDICAL 20.00
TOTAL (Also enteron line 10, Recapitul tion) $ 3500.71
(If more space is needed. insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
STATE OF
lUMBER
I.
1.
2.
3.
4.
5.
6.
7.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2))
ROBERT STANLEY KLUT AS
500 STONY CREEK ROAD
DAUPHIN, PA 17018
BRENDA JEAN GEIMAN
9932 CIRCLE DRIVE
ST. THOMAS, PA 17252
ELIZABETH ANNE ESTOPINAL
1035 CIALONA ROAD
MADISONVILLE, LA 70447
WADE HOWARD STICKELL
1197 BRECHBILL ROAD
CHAMBERSBURG, PA 17202
SETH ROBERT STICKELL
1197 BRECHBILL ROAD
CHAMBERSBURG, PA 17202
LAUREN KAYE STICKELl
1197 BRECHBILL ROAD
CHAMBERSBURG, PA 17202
KRISTIN LEE FERGUSON
74 MT. PLEASANT ROAD
FAYETTEVILLE, PA 17222
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Collateral
Collateral
Collateral
Collateral
Collateral
Collateral
Collateral
120,118.46
32.78%
120,118.46
32.78%
6,009.59
1.64%
6,009.59
1.64%
6,009.59
24,038.36
24,038.36
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, N REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
FIRST UNITED PRESBYTERIAN CHURCH (3.28%)
BIG SPRING AVENUE
NEWVILLE, PA 17241
NURSES HOUSE, INC. THE VIRGINIA M. DRISCOll CENTER FOR NURSES
2113 WESTERN AVENUE 322
GUllDERLAND, NY 12084-9559 (3.28%)
GREEN RIDGE VILLAGE MEMORIAL FUND
210 BIG SPRING AVENUE
NEWVilLE, PA 17241 (3.28%)
1.
1.
2.
3.
12,019.17
12,019.17
12,019.17
$
36 057.51
TOTAL OF PART II _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
(If more space is needed, inser additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 07 0830
File Number
KLUTAS , I
Decedent's Name
EDNA
MAY
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT i AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions) I
8, LINDA KLUT AS Collateral 12,019.17
500 STONY CREEK ROAD 3.28%
DAUPHIN, PA 17018
9. GARY GEIMAN Collateral 12,019.17
9932 CIRCLE DRIVE 3.28%
ST. THOMAS, PA 17252
LAST WILL A:\il) TF:STAMENT
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I. EDNA MAY KLliTAS. of West Pcnllsboro To\vl1ship. C Imberland County,
Pennsylvania. being of sound and disposing mind and memory. do hereby make publish and declare
this to be my Last \Vill and Testament. hereby revoking any and all former Wil s or Codicils by me
made.
1.
I direct that a] Im1' legally enforceable <.kbts, funcral ex pellses. testamen~ary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by a\lY recipient of any
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property) shall be paid from my residuary estate as soon as practicable after my Idecease and as part
of the administration of my estate. My personal representative shall have no d~lty or obligation to
obtain reimbursemcnt for any such tax so paid. cven though on proceeds ofl insurance or other
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property not passing under this Will.
')
In considering medical progress In the lields of tissuc and organl preservation and
transplantation and the benelit of mankind therefrom. and in considering my faith! that upon death the
spirit and soul continuc in God scparatc and apart from the body. thcrefore. uRon m)' death. after
certification of the fact of my death by a mcdical physician. I hcrcby rea fti I'm my rrevious agreement
to donate all of m)' body unto the HUMANITY GIFTS REGISTR y, or other sulitablc recipient for
the purposes of transplantation. therapy. medical research. or education, in each !instance subject to
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my right of revocation ofthcse donations at any time i.n the manner provided by Pfnnsylvania law. It
is my wish and desire that my family, thc Green Ridge Village Chaplain, and m~ Pastor shall make
arrangements for a mcmorial service i !"so desired by my bmily to be conducted olnl11Y bchalfin lieu
of funeral arrangelllents. r request that my family. fricnds. and relatives shoul not send flowers
upon my death but. in licLI thcreoL should givc Glsh contributions unto the GREF-:N RIDGE
HEAL.TH CARL TRUST. I request that my nephcw. ROIH.:RT STANLEY KI UTAS. notify my
Page 1 o!" 5 Pages
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E.M.K.
relatives upon my death of my v,ishes and arrangements as provided in this Pfragraph of my Last
Will and Testament: and f direct my personal representatives to reimburse my nephew, ROBERT
STANLEY KLUTAS. for SLlch expenscs as he may incur in such process. incllding long distance
phone calls for such notiJicatiol1s.
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I give, devise and bequeath all of m)' estate. whether reaL personal pI" mixed property.
\.vhelher tangihle or intangible. and \vhcrcvn situated. in the tollov,ing manncr;
/\. 3:2. no.o thereol' unto my niecc. BREND/\ JEAN GEfMAN, prorided that she shall
survive me (if she docs 110t survivc me. then her share shall be divided equalI)J betwecn illY grcat
nieces. LAUREN KA YE STICKELL and KRISTIN LEE WEDEL. with subsdtution of issue per
slirpes):
B. 32.78% thcreof"unto mv nephew. ROBERT STANLEY KLUT A$. with substitution
. ,
of issue per s.tirpes:
C. 1.640.-1, thereof unto my niece. ELIZABETH ANN ESTOPfNAL, "vith substitution of
issue per sl irpes;
D. ] .641% thereot"unto m} great-great nephew. W ADE HOWARD ST~CKELL provided
that he shall surv i \'e mc:
E. 1.64% thereof unto my great-great nephew'. SETH ROBERT STI~KELL, provided
that he shall survive me;
r. 6.560/0 thcreot"unto my great niece. LAUREN KA YE STICKEL!" \~ith substitution of
issllc per stirpes:
G. 6.56% thcreof"unto my great niece. KRISTIN LEE WEDEL, provlided that she shall
survive me (and subject. however, to reduction to the extent of the unpaid balance ~fany outstanding
loan which f have made to her during my lit"etime):
H.
3.:2RO;, thl'n.:Of" lInto illY niece-in-Iaw. LINDA KL.UTAS. provided that shc shall
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SUIV\VC Ille:
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3.28% thereof unto my nephcw-in-Im\!. GARY GEIMAN. provided that he shall
surVIve me;
Page ~ of" 5 Pages
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E.M.K.
J. 3.2xol) thereof untl) FIRST l \ITED PRESBYTERIAN CHl RCH or NC'vvville.
Pennsylvania:
K. 3.280~1 thereof unto NURSES I lOUSE. INC.. THE VIRGIN A M. DRISCOLL
CENTER FOR NURSES. presently 01'2 J 13 Western Avenue 322. Guilderland Nev,,' York 12084-
9559: and
L. 3.281~,'O thereof unto GREEN RIDGE VILLAGE MEMORIAL UNO of Newville,
Pennsylvania.
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Ex cept as "th mvi so des ignated a bo vc. the share 0 f any hene lie iary who jredeceases me shall
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lapse and said share shall be distributed proportionally to the remaining individulal heneficiaries (but
not to the corporate or institutional beneliciarics). Further. to the extent that any ~eneficiary shall not
have attained the a\!e oftwcntv-one (21 ) vears as of the date set for distributionl of his or her share.
then sllch share sha~1 he held il~ trust for sl;ch beneficiary by my personal rcprese!ltatives as Trustees
until such age has. been attained. subject to the power of my said Trustees to applly the principal and
any income or such trust to the support. maintenance and education of such beneficiary, in the sole
discretion of my Trustees.
4.
I nominate. constitute and appoint my nephcw. ROBERT STANLEY KLUTAS. and my
niece. BRENDA .lEAN GL::IMAN. or the survivor orthem as Executors of my estate.
).
I direct that my personal representatives shall not be required to tile a bond to secure the
faithful performance ol'thcir duti~s in any jurisdiction.
6. 1:
I authorize and empower I11Y personal represcntatives and Trustees. in th ir sole and absolute
discretion, to purchase or otherwise acquire and retain any investments or any Ill' perty orany nature
which I own at my death; to sell, lease. pledge. mortgage. transfer. exchange, ~Iisposc of or grant
options in regard to any or all propcrty of any kind forming a part of my cstatclror sllch terms and
Page:; 0 r 5 Pages
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E.M.K.
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such prices as they may deem advisable; to botTO\\' money for any purposes connected with the
protection and preservation of my estale: to mortgage or pledge an.y real or perso 1al property fanning
a part of my estate or to join in or secure the partition of same: to compr mise any claims or
demands of my estate against others or of others against my estate: to make dis ribution in kind and
to cause any share to he composed or cash. property or undivided fractiona shares in property
different in kind from L1ny other share: to employ agents. attorneys and proxie' and to delegate to
them such power as my personal representatives and Trustees consider d sirable and to pay
reasonable compensation Cor such services as may be rendered by sLlch agents, at orneys and proxies;
and to execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition. r direct that my personal representatives shall have the power to conduct an inventory of
any safe deposit box necessary to the administration of my estate,
IN WITNESS WHEREOf I have hereunto set my hand and seal this 5th day of May, 2005.
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Edna i"by KluhlS/
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SIGNED, SEALED. PURLlSIIFD AND DECLARED by the above-mml~d Testatrix. as and
for her Last Will and Testament. in the presence orus. who at her request. have h1reunto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each I other.
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Page 4 (1 1':) Pag~s
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COMMONWFALTI [ OF rFN:\SY!.V.'\NIA
SS.
COUNTY OF CUMBIJZLA:\O
1. EDNA MA Y KLUTAS. Tcstatrix, whosc name is sil!ncd to the at ached or foregoino
~ '0
instrumcnt having been duly qualified according to law. do hereby acknowled 'e that I signed and
executed the instrument as my Last Will: that I signed it vvillingly: and that I sig cd it as my free and
voluntary act for thc purposes therein cxpressed.
Edna May Klutas
Svvorn or artirmed to and ackno\vled~ed before mc by EDNA MA Y KLL T AS, the Testatrix,
this 51h day of I'v1ay. 2005. ~ -
,'~---
COMMONWEALTH OF PENNSYLVANIA
i 'c!ario1l Seal
i Sharon E Broom. Notary Public
! North :~Iddleto T ~:p '. Cumberland County
~ COIl1l11I!).'::1 n t:xprrE.s August 5, 2006
Member, Penns', V,'wa Il,$zoc:alion Of Notarie3
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We,' .~--:"-rt' i-~ hell t,- 'l:.-iL L ,\I and :'LD,{.c(\ L iL+"..'"', /'
thc witnesses whose dames are signed to the attached or foregoing instrument, b - mg uly qualified
according to law, do depose and say that "'ie were present and saw EDNA M Y KLUT AS, the
Testatrix. sign and execute the instrument as hcr Last WilL that the Testatrix si Tned willingly and
that the Testatrix executcd it as her free and voluntary act for the purposes the I' in expressed: that
each of us, in the hearing and sight of the Testatrix. signed the Will as witnesses: ll1d that to the best
of our knowledge the Testatrix \Vas at that timc 18 or morc years of age, of sound nind and under no
constraint or undue influcnce,
COUNTY OF CUMBERLAND
,.
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Address
Address
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Sworn or affirmed to and subscribed beforc 111e this Sir day of May. ?Sf 0 ._
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Notan' Public
Pagl' .'i of 5 Pages
No ariAI Seal ,
Sharon E Boom, Notary Public I
North Middleton T ,po, Cumbet1and County
My Commission : xprt=:n; August 5, 2006
Member. Ptml1svlv~l;;;A:;:(;;a~on Of NtJlarie:;
t ,.f lITIL'L' - I "":I;tl,: 111,1I::1ill~ !ll' I ',I! \\ J!! i dll;.
Dreyfus
A Mellon Financial Company'"
DREYFUS INVESTMENTS
A DIVISION Of MBSC SECURITIES CORPORATION
MEMBER NASD
November 5, 2007
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NOV - 7 2007
Mr. Stephen L. Bloom, Esq.
Irwin & McKnight
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 17013-3222
rR ViI: ~ t~i'v1cIG~!GHT
Re: Edna May Klutas
Dreyfus Intermediate Municipal Bond Fund, Inc.
AJCNo.0947-0000266916
Ref. No. 20071101092307
Dear Mr. Bloom:
As per your request, the following is a summary of the Date of Death balanc for the
referenced account. Since the date of death was not a business day, we have rovided the
balance for the last business day, prior to the date of death.
The balance of the Dreyfus Intermediate Municipal Bond Fund, Inc., AlC N .
0947-0000266916, as of September 7, 2007 was $129,492.92, representing ,780.735
shares at a price per share of $13.23. The accrued dividends, $93.80, are incl ded in the
balance.
This Individual Account is the only account bearing Ms. Klutas' name or the Social
Security number 175-03-2239 that we were able to locate. Our records indica e that the
account was established, as an Individual Account, on March 16, 1984.
The Death Certificate and Short Certificate that accompanied your letter will e retained
in our files, pending disposition of the account.
If you have any questions about this information, representatives are availabl Monday
through Friday, 8 am to 6 pm, Eastern time, at our toll-free number, 1-800-64 -6561.
144 GLENN CURTISS BLVD.
UNIONDALE, NEW YORK 11556-0144
T~lEPHONE; (516)338-3300
DID
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October 31,2007
Law Offices Irwin & McKnight
Attn: Stephen L Bloom
West Pomfret Professional Building
60 West Pomfret Street
Carlisle PA 17013-3222
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Dear Stephen L Bloom:
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We are responding to your request for information about Edna M KIutas' account with
Fidelity. The table below lists the account holdings and values as of 09/09/ 007.
Unit Valu
$16.59
$10.72
Market Value
$134,205.45
$81,072.93
$215,278.38
The table below shows the accrued unpaid dividends from 9/1/2007 throug 9/9/2007
Dividends
$76.68
We hope this information is helpful. For questions concerning account hol ings or
instructions on how to transfer the ownership of the accounts, please call ou Inheritor
Services Group at 800-544-0003 between 8:00 A.M. and 6:30 P.M. Eastern time Monday
through Friday or visit our website at www.fidelitv.com.
Sincerely,
Fidelity Investments
Our file: WOl1247-280CT07
BroKerage 8(""C8S proVideo by Fidelity Brokerage Services llC Mamber NYSE. :oiPC
Cleanng, GustOdy, and SHWemei~t sp,rvices by National Financial Services LLC Me!1'jbt.~r NYSE. Sf PC
P.O. Box "170001. CinC:nn,';!,1i, OH 45277,(X)34
September 14, 2007
~
ADAMS
COUNIY
NATIONAL BAt"lK
IRWIN & MCKNIGHT
A1TN: STEPHEN L BLOOM
60 W POMFRET ST
CARLISLE P A 17013
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Re: Estate of Edna May Klutas
Dear Mr. Bloom:
The following information is being provided as per your request:
Acct. Type Account No. Account Accrued Ownership
Principal on Interest to
D.O.D. D.O.D.
Super NOW 223867 $3,175.86 $0.11 Jt/w Brenda K
Account Geiman
Safe Deposit 807-467 N/A N/A Individual
Box
Inquiries concerning ACNB Corporation stock information should be directed to the egistrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact eat (717)339-5122.
Sincerely,
~luCL {12i~Lt^-
I Barbara J W ~
Adams Coun ational Bank
Deposit Servi s Representative II
PO Box 3129, GETTYSBURG, PA 17325 I PHONE 717.334.3161 I TOll FREE 888.334.2262 I www.ac~b.com
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
MONEY MANAGEMENT ACCOUNT:
Account Number/Suffix'
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
VISA ACCOUNT:
Account Number
Date Opened
Credit Balance at Date of Death
Name of Joint Cardholder
Estate of: EDNA MAY KLUT AS
Date of Death: 09/09/2007
Social Security Number: 175-03-2239
rvl~
MEMBERS 1st
FEDERAL CREDIT UNION
n.
i.._.\. -"
133362-00
06/17/1993
$3,201.51
$.70
$3,202.21
None
133362-11
06/17/1993
$14,369.81
$.74
$14,370.55
None
133362-05
1 0/04/1993
$22,092.05
$9.59
$22,101.64
None
4121449991333621
04/25/1996
$.00
None
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:leT 3 2007
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I
BERS 1ST FEDEfAL CREDIT UNION
- ~~ -~
amelle A. Kline
Insurance Services Specialist
October 2,2007
5000 Louise Drive. Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 WW\v.members1st.org
I
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1 5 Big Spring Avenue
NEWVillE, PENNSYLVANIA 17241
.
F. CHARLES EGG~, Supervisor 717-776-3414 FRJ NK C. EGGER, Funeral Director
October 15,2007
Obituary Bills for Edna May Klutas
Patriot News Obituary with Picture
$438.97
Sentinel Obituary with Picture
$314.00
Public Opinion Obituary with Picture
$150.00
Total
$902.97
I
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15 Big Spring Avenue
NEWVillE, PENNSYLVANIA 17241
F. CHARLES EGGER, Supervisor 717-776-3414 FlU NK C. EGGER, Funeral Director
September 11, 2007
Funeral Bill for Edna M. Klutas
Date of Death September 9, 2007
Removal from Green Ridge Village, and Refrigeration
$185.0(
Transportation to Hershey Medical Center
Paid by Humanity Gifts
$50.00 fIJ,';r ()
Securing Death Certificate, and Disposition Permit
$40.00
12 Death Certificates $6.00 a piece
$72.00
Total Due
$297.0(
For Paperwork Reduction Act Statement
And Burden Estimate Statement See Reverse
Side "Notice to Account Owners" Copy
24000002
OMB NO. 1510-0043
POSII
FROM:DEPARTMENT OF HE TREASURY
FINANCIAL MANA EMENT SERVICE
SF REGIONAL FINANCIAL CENTER
POST OFFICE BOX 24760
OAKLAND, CA 94623-1760
"ELECTRONIC FUNDS TRANSFER
FEDERAL RECURRING PAYMENTS
NOTICE OF RECLAMATION
111111111I111111I1111111111111I11111I1111I1111111111111I1111
3901500095
RECIPIENT AND/OR BENEFICIARY NAME
EDNA M KLUTAS
DATE: 10/29/2007
CLAIM NUMBER
24688380A
14264741
DATE OF DEATH
09/09/2007
DATE OF
PAYMENT
AGENCY
AND/OR TRACE TYPE OF
TYPE OF NUMBER ACCOUNT
PAYMENT
DEPOSITOR
ACCOUNT NUMBER
AMOUNT
10/01/2007
OPM-CSA 12173615 2708289 C
133362000
2,424.20
AMOUNT OF PAYMENT RECEIVED
WITHIN 45 DAYS
OUTSTANDI G TOTAL
2,424.20
NonCE TO ACCOUNT OWNERS FROM THE GOVERNMENT
The Government has received information. that the person named on this notice is. decease . The purpose of this notice
is to inform you that by law entitlement to Government benefits for this person en ed at death. Therefore, the
Government must recover all payments made after the date of death. If there has been an error and this person is not
deceased, or if the date of death is wrong, this notice explains how to correct the mista e. If you do not understand
this notice, please get help from either your financial institution or the Government agency that was aking payments.
PAYMENTS TO THIS PERSON HAVE BEEN STOPPED
Your financial institution has been asked to return the payments shown on this notice to the Government because
they were issued in error. The Government has asked your financial institution to sent thi notice to you, the account
owner. Your financial institution must notify you if it has taken action to recover the e funds from the account.
Contact your financial institution immediately if you do not understand its actions. If t e Government is unable to
collect from the financial institution the full amount of the payments made after death, y u may be contacted by the
agency which made the payments.
IF THE PERSON IS NOT DECEASED
If the person is not deceased, immediately contact both you financial institution and the agency that made the
payments to correct the error. The Government regrets any inconvenience this error may ause. Your financial institu-
tion can correct the collection action if it is given satisfactory proof that the person s alive. NOTE: YOU MUST
CONTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED FURTHER
PAYMENTS. ONLY THE AGENCY CAN RESTART THE PAYMENTS.
NOTICE TO ACCOUNT OWNERS