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04-0031
Estate of Klaus J. Barthel also known as PETITION Jennifer Dauchess Petitioner(s), who is/are 18 years of age or older, apply(les) for: FOR GRANT OF Deceased LETTERS No. Social Security No. 355-52-5347 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or [] Decedent, dated 8/13/96 and codicil(s) dated N/A named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland residence at 162 Meadow Lane, Mechanicsbur~, Pennsylvania (list street, number and municipality) Decedent, then 65 years of age, died January 7 ,20014, at his residence. (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: County, Pennsylvania, with his/her last family or principal 400,000.00 47,85O.O0 447,850.00 162 Meadow Lane, Mechanicsburg, Cumberland County, Pennsylvania Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Wilt and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Jennifer Dauchess 914 BrittleyWa¥ Apex, NC 27502-6438 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will we~l and truly administer the estate acc~ording to la.W. ~ Sworn to and affirmed and subscribed C,., ,,)_] )'~ ~ Z2~ ~J ~ Jennifer Dauche~.~' ,/p~%re me this /'r~/-~''~'/' d ay of DECREE OF REGISTER Estate of Klavs ,,I. BCrthel also known as Deceased Social Security No: 355-52-5347 Date of Death: 1/7/04 2004 , in consideration of the Petition AND NOW, , on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary I-I of Administration (c.t.a., dbn.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to Jennifer Dauchess in the above estate and that the instrument(s), if any, dated August 13, 1996 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ............................ ~ ....... $~ · Short Certificate(s) ............... $ Renunciation .......................... Affidavit ( ) ....................... $ Extra Pages ( ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ TOTAL ............................. $ 340.00 30.00 Register of ~'~ills J 15.00 10.00 Attorney 395.00 Attorney: David R. Getz, Esquire/WIX, WENGER & WEIDNER I.D. No: 34838 Address: 508 North Second St/P.O. Box 845 Harrisburg PA 17108-0845 Telephone: (717) 234-4182 DATE FILED: RW-7A his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal Re, gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. TYPE/PRfNT PERMANENT BLACK INK I COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH t129-182 (Coroner) Klaus J. Barthel 2. MaleJ3. ~3'~' ~'o~ 3-/'/7 4. January 6, 2004 ~SDEC~NT~HIS~NIC~IN? 10. ~ '~ Cumberland I~. Monroe [~. 162 Meadow Lane I ~ ~ Crml~ ~ RI~vN from ~'~ I(~' ~y' I-. 11:38 ~. I-. January 7, 2004 Smoke Inhalation House Fire j __ 'OU~; TO(OfiA~,.~CL;N~L(J[J[N(~[ O/): h ........... ~' ' ' A -- I Inhalation of smoke ,.,,,~ [] Ho~<~ [] Jan. 6, 2004 prx. .... JAcciden{ ,~ P,~ ..... ~ .... ~ 30. J~ 11:30 PM 'J~ J~during fire in home Yes ~ No ~ Yes ~ ~ U ~ ~1 P~E~INJURY-N~mI. fa~ M~W ll~*~' ' L~N(Sb~ ~ay~wn S,ale ~. ,. ~ ~. ~ome ~. ea [n ~eC~aD~CSDU~ T~h~b~d~1y~1~d~4~h~Xj~he~11~d4~e~1d~r~dd~th~m~ .......................... [] I1,=. 3anuary 10~ 2004 *MEDICALEX~MINER/CO~ONER :#am27)TypeMP~inl Michael L. Norris, Coroner m~i~n~r~tth~b~i~x~mm~tkXt~nd~r~n~t~g~U~n~nmy~n~n~de~th~curred~t~h~t~me~d~e~nd~ce~n~du~t~th~c~u~e(~)and~tited .................................................................................................. ~ 6375 Basehore Road, Suite ,3. Mechantcsb~r Pa. 17050 his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal R?gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9825472 No. Local Registrar H$05 144 Rev 1/91 TYPE/PRINT PERMANENT BLACK INK #29-182 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) SI'AT E FILE NUME~ER I SOClAL SECURITY NUMBER Barthel ,Male 3. ~.5'.j' .~o~ .f'~7 '/7 Klaus J. AGE (Lasl Bwlh~ay) ~ UNDER 1 YEAR UNDER I DAY I 64 Y,,. DATE OF BIRTH (Mo~e~, Day. Year) Sept. 8,1939 Cumberland Monroe KIN D OF 8U SINE SS/INDUSTRY 162 Meadow Lane F~I'BER'$ NAME (F~I, M~3(le. La~) IOTHER: .om. [] R.i,*.~.,~ ~,,)[] Burial [] Cremation E~"omovaifromS~ater~ M as. Januar 2004 Smoke Inhalation House Fire DUE TO (OR AS A CONSEQUENCE Of:): .or~ ~ (~,.o~.~--) - ~ Inhalation of smoke INalur~ ~ ~m~ ~1 Ja" 6 200a I ~prx. I v. ~ .o~ I .... [~ ~ P~,~o. ~ aa ~ 11:30 PM aW ~during fire in home ~. . Ia. 13~. uome I~.~ea~ bn~ ~ecna~[csDu~a 3~,. ~. Hechan~csbur ~a. [7050 O~E FILED (M~, ~y. ~) LAST WILL AND TESTAN~NT _KLAUS J. BARTHE?. I, Klaus J. Barthel, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. .ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ITEM II: I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executor, and all property subject to all such powers of appointment shall be included in my Estate. ITEM III: I give and bequeath: (a) if one or both of my parents, Hans Barthel and Gertrud Barthel, survive me, all of my one-half (1/2) interest in my said parents, house, located at 28 Highland Drive, Camp Hill, Pennsylvania, to my said parent(s); and (b) if my Wife, Diane M. Barthel, survives me, all of my household furniture and furnishings, automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel and all other like articles of household or personal use and adornment to my said Wife. 1 of 4 ~TEM IV: I give, devise and bequeath all the rest, residue and remainder of my property, real, personal and mixed to my Wife, Diane M. Barthel, if she survives me, or, if she does not survive me, to my Children, Christopher Barthel of San Francisco, California, and Jennifer Dauchess of Gaithersburg, Maryland, per stirpes. ITEM V: In the settlement of my Estate, my Executor shall possess, among others, the following powers to be executed for the best interest of the beneficiaries: (a) To sell, either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons, or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust, and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor this ITEM V(a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate or a Trust. My Executor shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the 2 of 4 date(s) of their distribution. (d) To retain any investment I may have at my death so long as my Executor may deem it advisable to my Estate to do so. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as my Executor shall deem wise, without being restricted to so-called "legal investments.,, (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration, or inheritance, legacy, estate and other taxes. (h) To vote any shares of stock which form a part of my Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. (j) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by my Executor with respect to any pension, profit-sharing or other retirement plan in which I am a participant. (1) To do all other acts, in the judgment of my Executor, necessary or desirable for the proper and advantageous management, investment and 3 of 4 distribution of my Estate. ITEM VI: Any person who shall have died at the same time as Testator, or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, or who fails to survive the Testator for ninety (90) days, shall be deemed to have predeceased him. ITEM VII: I hereby nominate, constitute and appoint my Wife, Diane M. Barthel, to be my Executrix (herein referred to as "Executor..). In the event of the death, resignation, refusal or inability of my said Wife to serve as my Executor, I nominate, constitute and appoint my daughter, Jennifer Dauchess, to serve as successor Executor. In the event of the death, resignation, refusal or inability of my said daughter to serve as successor Executor, I nominate, constitute and appoint my son, Christopher Barthel, to serve as successor Executor. My Executor is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament consisting of this and the preceding three (3) pages this ...~ day of ~(~, 1996. Klaus J. B~arthel KJBARTHEL.WIL DRG20 4 of 4 SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, Klaus J. Barthel, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : SS. I, Klaus J. Barthel, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Klaus J. Barthel the Testator, this ~%45 day of ~(_~L 1996. ' Klaus j. B~rthel ~es~a~or /? (SEAL) NOTARIAL SEAL ..... I LISA M. LONG, Notary Public City of Harrisburg, Dauphin County M,y Commission Expires April 28, 1~7', , AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : COUNTY OF DAUPHIN : SS. and ~~ ~. t~Ot~,~e£~-, the witnesses whose names are signed to the attached or Ioregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testator, signed the Will as a witness; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. , 1996. Sworn to or affirmed and subscribed to before me by , witnesses, this k~-day of Wftn~ss t~_ ~_z ~ Witness No~Zar~ P~b 1 ic My Commission Expires: (SEAL) City of Harrisburg, Dauphin County IN THE REGISTER OF WILLS OFFICE FOR CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF KLAUS J. BARTHFL DATE OFDFATH: JANUARY 6, 2004 ESTATE NO. 21-04-31 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) TO THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 16, 2004: Mrs. Jennifer Dauchess 914 Brittley Way Apex, NC 27502 Mr. Christopher Barthel 425 Judah Apt 301 San Francisco, CA 94122 Mr. Hans Barthel 28 Highland Drive Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Respectfully submitted, WIX, WENGER & WEIDNER By: ":::.~ . David R. Getz, Esquire. '" Attorney ID No. 34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Dated: January 16, 2004 RICHARD H. WIX THOMAS L. WENGER DEAN A. WEIDNER STEVEN C. WILDS THERESA L. SHADE WIX * DAVID R. GETZ STEPHEN J. DZURANIN STEVEN M. WILLIAMS JEFFREY C. CLARK PETER G. HOWLAND · AlSo Member Massachusetts Bar WIX, WENGER & WEIDNER A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HARRISBURG, PENNSYLVANIA 17108,-0845 (717) 234-4182 TELECOPIER (717) 234-4224 www.wwwpalaw.com 4705 DUKE STREET HARRISBURG, I~A 17109-3099 (717) 652-8455 TELECOPIER (717) 652-6290 March 18, 2004 Ms. Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re:/,"/Estate of Klaus J. Barthel L..._~File No. 21-04-31 Dear Ms. Strasbaugh: We enclose our client's check in the amount of $18,000.00, made payable to the "Register of Wills, Agent," representing prepayment of the estimated inheritance taxes due from the above-captioned estate. Please process this payment as soon as possible and forward a receipt for same to our office. Thank you for your assistance in this matter. If you have any questions regarding the above, please call me~ Sincerely, WIX, WENGER & WEIDNER Paralegal /dbw Enclosure cc: David R. Getz, Esquire WIX, WENGER g WEIDNER ATTORNEYS AT LAW .508 NORTH SECOND STREET POST OFFICE BOX 8zl,.5 HARRISBURG~ PENNSYLVANIA 17108-08,4.5 Ms. Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 8URE~AU OF INDIVIDUAL TAXES DEPT. '280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003701 GETZ DAVID R 508 NORTH SECOND STREET HARRISBURG, PA 17101 ........ fold ESTATE INFORMATION: SSN: 355-52-5347 FILE NUMBER: 2104- 0031 DECEDENT NAME: BARTHEL KLAUS J DATE OF PAYMENT: 03/19/2004 pOSTMARK DATE: 03/1 8/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $18,000.00 REMARKS: ...... SEAL CHECK# 309 TOTAL AMOUNT PAID: 8,000.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS RICHARD H WiX THOMAS L WENGER DEAN A WEIDNER STEVEN C WILDS THERESA L SHADE WIX * DAVID R GETZ STEPHEN J. DZURANIN STEVEN M WILLIAMS JEFFREY C. CLARK PETER G HOWLAND WIX, WENGER & WEIDNER A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HARRISBURG, PENNSYLVANIA 17108-0845 (717) 234-4182 TELECOPIER (717) 234-4224 www.wwwpalaw.com 4705 DUKE STREET HARRISBURG, PA 17109~3099 (717) 652-8455 TELECOPIER (717) 652-6290 August25,2004 Ms. Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Klaus J. Barthel - File No. 21-04-31 N Dear Ms. Strasbaugh: We enclose the following documents for filing on behalf of the above-captioned estate: 1. The original and two copies of the Inheritance Tax Return; An estate check in the amount of $5,854.18, made payable to the "Register of Wills, Agent," representing the additional tax due; and Our check in the amount of $15.00, made payable to the "Register of Wills," representing your filing fee. Please process these documents at your earliest convenience and return a time- stamped copy of the tax return to our office. A self-addressed, stamped envelope is enclosed for your convenience. Thank you for your assistance in this matter. If you have any questions regarding the above, please call me. Sincerely, WIX, IDNER Denise B. VVilliamson Paralegal /dbw Enclosures cc: Mrs. Jennifer Dauchess David R. Getz, Esquire Z Z X I-- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA17128~601 DECED£NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL Barthel, Klaus J. DATE OF DEATH (MM-DB-Year) 01/06/2004 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A REV-1500 INHERITANCE TAX RETURN F,'ENU ,BERd RESIDENT DECEDENT SOCIAL SECURITY NUMBER 3 8 5-3 2-5 3 4 7 DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE W~TH THE 09/08/1939 REGISTER OF WILLS SOCIAL SECURITY NUMBER ] 1. Odginal Return r~4 Limited Estate [-~6 Decedent Died Testate ts~ch copy of Will) E~9 Lit~ation Proceeds Received NAME David R. Getz, Esquire FIRM NAME (If Applicable) WIX, WENGER & WEIDNER TELEPHONE NUMBER (717) 234-4182 r~2. Supplemental Return ] 4a. Future Interest Compromise(dateofdeath~lter12.12.82) --]7. Decedent Maintained a Living Trust (At~ach copy of Trust) ] 10. Spousal Poverty Credit (dateoldeath between 12-31-91 and I-1-95) COMPLETE MAILING ADDRESS 508 North Second Street P.O. Box 845 Harrisburg, [~]5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes E~]11. Election to tax under Sec 9113(A) IAb¢ Sch OI PA 17108-0845 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3 Closely Held Corporation, Partnersh)p or Sole-Proprietorship (3) 4 Modgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6 Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (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. Medgage Liabilities, & Liens (Schedule I) (10) 11 Total Deductions (total Lines 9 & 10) 12 Net Value of Estate (Line 8 minus Line 11) (8) 89,900.00 OFFICIAL USE ONLY 174,483.14 441 2~93.91 ~ 1i:~,869.21 ~ ; 0.00., ':' , (11) 778,546.26 25,424.06 201,976.82 (12) 227,400.88 551,145.38 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 551,145.38 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9I 16 (a)(1.2) 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. X (15) 551,145.38 X .045 (16) X .12 (17) X .15 (18) (19) 24,801.54 24,801.54 Dec6dent's Complete Address: I5m~bl ADDRESS 162 Meadow Lane CITY Mechanicsburg I STATE PA I zip 17055 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19} 2. Credits/Payments A. Spousal Poverty Credit B Prior Payments C Discount 18~000.00 947.36 3. Interest/Penalty if applicable D Interest E Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference This is the TAX DUE. (5) A Enter the interest on the tax due~ (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a retain the use or income of the properly transferred; ........................................................................... [] [] b retain the right to designate who shall use the properly transferred or its income; ........................................ [] [] c retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent tranefer properly within one year of death without receiving adequate consideration? ............................................................................................... [] [] 3~ Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4 Did decedent own an Individual Retirement AccounL annuity, or other non-probate properly which contains a beneficiary designation? ....................................................................................................... [] [] 24,801.54 18,947.36 0.00 5,854.18 5,854.18 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalpes of perjury. I declare that I have examined this return, including ~;companying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete ; le~ ~4r: iT°~J ~fE ~; ;rE;f~)t~a~ ;; ppeomr~srl~ ~L'~re~a;vl~asRe~'~ja~;f°r~ Hi°n °f which preparer has any kn°wledge' D~E) ~:>/ ADDR 5 SS '~jj ';]nn f~er"~D a~u~ees s ~ ~"'~ ~ 916 Brittle)`' Wa),,, Apex NC 27502 ADDRESS Dawd R. Getz, Esqu~re/WlY/, WENGER & WEIDNER 508 North Second Street/P.O. Box 845, Harrisbur~l PA 17108-0845 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 use of the surviving spouse is 3% [72 P S. §9116 (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 spouse is 0% [72 P.S. §9116 (a) (1 1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepoarent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)] The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-150~ EX + (6-98) " COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER BQrthel. Klaus J. exchanged bet',~ee~ a willing buyer and a wfifing seller, neither being compelled to buy or se/l, both having reasonable knowledge of the relevant facts, All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be Real property which is jointly-owned with ri~]ht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Lot situate at 162 Meadow Lane, Mechanicsburg, Cumberland County, Pennsylvania being Tax Parcel No. 22-10-0640-100 (valued per attached Settlement Statement) VALUE AT DATE OF DEATH 89,900.00 TOTAL (Also enter on line t, Recapitulation) $ 89,900.00 REV-1503 EX + (6-98) " COMMONWEALTH Of PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER B~rthel. Klaus J. All property jointly-owned with dght of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION H&R Block Financial Brokerage Account No. 1357-0013 Security Valuations: $144,772.32; Accrued Interest/Dividends: $73.43 (security itemizations and valuations attached) Charles Schwab Brokerage Account No. 13817651 Security Valuations: $29,637.39; Accured interest/Dividends: $0 (security itemizations and valuations attached) VALUE AT DATE OF DEATH 144,845.75 29,637,39 TOTAL (Also enter on line 2, Recapitulation) $ 174,483.14 (If more space is needed, insert additional sheets of the same size) REV-150~ ~X + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Barthel. K[aus J. Schedule CA or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest at the decedent, other than a sole-proprietorship. See instru~ons for the supporting information to be submi~ed for sole-proprietorships, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, None 0.00 TOTAL (Also enter on line 3, Recapitulation) · REV-15~7.EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF B~rthel. Klaus J. 1TEM NUMBER 1 FILE NUMBER All property jointly-owned with the right of survivorship must be disclosed on Schedule F. DESCRIPTION None VALUE AT DATE OF DEATH 0,00 TOTAL (Also enter on line 4, Recapitulatior $ REV-15~8 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Barthel. Klaus J. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 673.98 2. 3. 4. 5. 6. 7, 8. 9. 10. 11, Citizens Bank Savings Account No. 6201167165 DOD Value: $673.98 Accrued Interest: $0 Members 1st Federal Credit Union Savings Account No. 116280-00 DOD Value: $2,132.59 Accrued Interest: $.21 Members 1st Federal Credit Union Checking Account No. 16280-11 DOD Value: $8,604.30 Accrued Interest: $.24 H&R BLock Roth IRA Brokerage Account No. 1356-9924 (no designated beneficiary) Insurance proceeds received for residence (destroyed by fire) Insurance Proceeds received for household goods (destoryed by fire) Insurance Proceeds received for vehicle (destroyed by fire) Insurance proceeds received for demolition/excavation of real estate Miscellaneous refunds/credits received regarding sale of Lot (see attached settlement statement) 2003 Income Tax Refund 2003 School Tax Refund 2,132.80 8,604.54 42,554.24 243,000.00 81,038.80 6,600.00 12,150.00 595.72 2,878.00 1,065.83 TOTAL (Aisc enter on line 5, Recapitulation) $ 401,293.91 (If more space is needed, insert additional sheets of the same size) . REV-15d9 EX + (6-98) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Barthel. Klaus J. If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Hans Barthel Father 28 Highland Drive Camp Hill, PA 17011 JOINTLY-OWNED PROPERTY: LSTTER DATE DESCRIPTION OF PROPERTY % OF OATE OF DEATH iTEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND SANK ACCOUNT NUMBER OR SIMLLAR DATE OF DEATH DECD'S VALUE OF ~UMBER TENANT JOINT IDENTIFYING NUMSER. ATTACH DEED FOR JOINTLY-HELD RF-AL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. House and lot situate at 28 Highland Drive, Camp Hill, 99,39000 50 49,695.0£ Cumberland County, Pennsylvania, being Tax Parcel No 13-23-0547-451 (tax assessment value) 2. A. 2/2/00 H&R B[ock Brokerage Account No. 1356-9746 126,348.42 50. 63,174.21 Security Valuations: $126,348.42 (security itemization and valuations attached) O.OC O.OC 0.0( TOTAL (Also enter on line 6, Recapitulation) $ 112,869,2 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BartheL Klaus J. This schedule must be completed and filed if the answer to any of questions I through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY ITEM INGtU~¥HE Nc~MEOFmETR~ISFI~REE, THEIRRELATIONS'IPTOOECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE ',lUMBER THE DATE OF TRANSFER ATTACH A CO~y OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF AFf~JCAgLE} VALUE 1, TOTAL {Also enter on line 7 Recapitulation) $ O.0( REV-151 ~ EX + (12*99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Barthel. Klaus J. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION 8. 9, FUNERAL EXPENSES: Neill Funeral Home Reception costs ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pemonal Representative (s) Social Secudty Number(s)lEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attomey Fees Wix, Wenger & Weidner (estimated) Family Exemption: (If dacedent's address is not the same as claiman['s, attach explanation) Claimant Zip Street Address city Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills State Zip Accountanfs Fees Tax Retum Preparer's Fees The Sentinel Cumberland Law Journal Closing costs associated with sale of lot (see attached settlement statement) AMOUNT 2,685,00 457.79 Jennifer Dauchess (reimbursements for out-of-state executor) Mark Hilbert - Property Appraisal Wix, Wenger & Weidner (estimated out-of-pocket expenses) 7,500.00 410.00 143.15 75.00 13,329.75 523.37 200.00 100.00 TOTAL (Also enter on line 9, Recapitulation $ 25,424.06 (If more space is needed, insert additional sheets of the same size) . ' REV-1532 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS FILE NUMBER Barthel. Klaus J. Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. 6. 7. 8. ,?,itizens Bank Mortgage Discover Card Met Ed Comcast Verizon Holy Spirit Hospital Mary Murray, Property Taxes Chambersburg Hospital 200,044.63 1,256.00 182.I2 313.29 11.14 25.00 119.64 25.00 TOTAL (Also enter on tine 10, Recapitulation) $ 201,976,82 (if more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFIClAEIES ESTATE OF FILE NUMBER Barthel. [' laus J. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [inciudeoutdghtspousaldistfibutions, and transfers under Sec. 9116 (a)(1.2)] Hans Barthel 28 Highland Drive Camp Hill, PA 17011 Jennifer Dauchess 914 Brittley Way Apex, NC 27502 Christopher Barthel 426 Judah Apt 301 San Francisco, CA 94122 Father Daughter Son $49,695.00 50% residue 50% residue NON-TAXABLE DiSTRiBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ][][ - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ~T W'rL?, ~ TESTi~I~ENT KL~US ~. B~RTHEL I, Klaus J. Barthel, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking all Wills and codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ~: I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executor, and all property subject to all such powers of appointment shall be included in my Estate. ITEM III: I give and bequeath: (a) if one or both of my parents, Hans Barthel and Gertrud Barthel, survive me, ell of my one-half (1/2) interest in my said parents' house, located at 28 Highland Drive, Camp Hill, Pennsylvania, to my said parent(s); and (b) if my Wife, Diane M. Barthel, survives me, all of my household furniture and furnishings, automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel and all other like articles of household or personal use and adornment to my said Wife. i of 4 ITEM IV: I give, devise and bequeath all the rest, residue and remainder of my property, real, personal and mixed to my Wife, Diane M. Barthel, if she survives me, or, if she does not survive me, to my Children, christopher Barthel of San Francisco, California, and Jennifer Dauchess of Gaithersburg, Maryland, per stirpes. ITEM V: In the settlement cf my Estate, my Executor shall possess, among others, the following powers to be executed for the best interest of the beneficiaries: (a) To sell, either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons, or acquired after my death by my Executor, and to oons~mmate said sale or sales by sufficient deeds or other instruments to the purchaser er purchasers, conveying a fee simple title, free and clear of all trust, and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor this ITEM V(a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate or a Trust. My Executor shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the 2 of 4 date(s) 'cf their distribution. (d) TO retain any investment I may have at my death so long as my Executor may deem it advisable to my Estate to do so. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as my Executor shall deem wise, without being restricted to so-called "legal investments." (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration, or inheritance, legacy, estate and other taxes. (h) To vote any shares of stock which form a part of my Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. (J) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by myExecutor with respect to any pension, profit-sharing cr other retirement plan in which I am a participant. (1) To do all other acts, in the judgment of my Executor, necessary or desirable for the proper and advantageous management, investment and 3 of 4 distribution of my Estate. ITEM VI: Any person who shall have died at the same time as Testator, or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, or who fails to survive the Testator for ninety (90) days, shall be deemed to have predeceased him. ITE~_ VII: I hereby nominate, constitute and appoint my Wife, Diane M. Barthel, to be my Executrix (herein referred to as "Executor"). In the event of the death, resignation, refusal or inability of my said wife to serve as my Executor, I nominate, constitute and appoint my daughter, Jennifer Dauchess, to serve as successor Executor. In the event of the death, resin[nation, refusal or inability of my said daughter to serve as successor Executor, I nominate, constitute and appoint my son, Christopher Barthel, to serve as successor Executor. My Executor is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WH~REOF, I have hereunto set my hand and seal to this my Last Will and Testament consisting of this and the preceding three (3) pages this I~day of ~, 1996. Klaus J. ~arthel 4 of 4 SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, Klaus J. Barthel, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. COMMONWEALTH OF pENNSYLVANIA cOUNTY OF DAUPHIN SS. I, Klaus J. Barthel, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. sworn to or affirmed and acknowledged before me by Klaus J. Barthel, the Testator, this I~wh day of ~-~ , 1996. Klaus J. B~rthel My Commission Expires= (SEAL) COMMONWEALTH OF PENNSYLVAI~IA : : COUNTY OF DAUPHIN : SS. and ~. ~1~,~-. the witnesses whose names are signed to the attached or ~oregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testator, signed the Will as a witness; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of sound mind end under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~.f~_~n 5. ~c..4e~ and , witnesses, this a~%~--~ay of W~tn~ss No"ar9 P~blic My commission Expires: (S~L) A. HUD-t UNIFORM SETTLEMENT STATEMENT B. Type of Loan t. j ]F,A Z [ ] Fm~ *. [ )Cony. Unir~. Je.,le,umb., I'. Loa,""mber: 15. Mo"gage Ins"~"ce Oa" Numbe~ 4, [ )VA 5.[ ] Cony. Ins. C, NOTE: This form fumidhes a statement of settlement costs. Am=uts paid to and by the setttsment agent are shown, Items mar~ed "(p.o.c)" were paid outslds the clcSthl~; they are shown for informational purposes and are not included in the to~ls, D. Name & Address of Sorrower: .. Name, Address and TIN of Seller: F. Name & Address of Lende:n/a Charles E. Swartz and Azlynn N. Swaffz Jennifer Dauchess, Exec~thx 1155 Meadow Lane =state of I(idus J. Barthal, Deceased ~echanidsbu~g, PA 17055 TIN of Se{{er: I Date of Seblement IApri129, 2{304 ~dlustments for items Fald by salter In advance ~.d~ustmente t'or Items paid by Sedsr In advance The information in Bisc~s E, G, H, I & line 401 (or if line 401 is asterisked, line 405 and 404) is important tax in[hrmction and is being furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be Impc~ed on you [f this item is required to be reporidd and the iRS determines that it has not been raper[ed. If this mai estats is your Prt~cibal residence, file FORM 211g, Sale or Exchange of p~inctpal Residence, for any gai~, with your income tax return; iht ether ~ansactions, complete [he applicable pads of Fo~m 4797, Form 6252 and/er Schedule D (Form 1040). YOU are required to provide the Settlement Agent (named above) wf~ your tax~oayer identification number. If you do not provide the Se~tidment Agent with your thxpeyer identification number, you may be subject to cNil or criminal penaitids imposed by law. Under penalties of perjury, I cer[ify that the number shown on [his statemen~ is my correct taxpayer Identification number. Seller Seller ,~' Jenner [:)auches$, Execu~x of Esta~ o~'Klaus J. Sarthel ChaHes~/(~Sw,arlz ~ J~' t WARNING: It is a crime to knov~llgly make false statements to ~e United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonlllent. For details see: Title 18 U.S. Code Section 10{]1 and Section 1010. Date of Death: 01/06/2004 Valuation Date: 01/06/2004 Processing Date: 02/02/2004 Shares Security or Par Description High/Ask Low/Eld 1) 2000 2) 1000 3) 667 BED BATH & BEYOND INC (075896100) COM NASDAQ - Industrial 01/06/2004 43.00000 41.82000 H/L LEHMAN BEDS HOLDINGS CAS TRI (52518B200) PFD SER I 8% New York Stock Exchange 01/06/2004 25.51000 25.34000 H/L NICHOLAS-APPLEGATE CV & INC FO {65370F101) COM New York Stock Exchange 01/06/2004 16.95000 16.75000 H/L Div: 0.08 Ex: 12/24/2003 Eec: 12/29/2003 Pay: 01/16/2004 Div: 0.03009 EX: 12/24/2003 Eec: 12/29/2003 Pay: 01/16/2804 4) 23188.37 Cash (CASH) Estate of: Klaus J Harthei Account: 1357-0013 Report Type: Date of Death Number of Securities: 4 File ID: barthel-dod Mean and/or Div and Iht Security Adjustments Accruals Value 42.460000 84,920.00 25.425000 25,425.00 16.850000 11,238.95 53.36 20.07 23,188.37 Total Value: Total Accrual: Total: $144,845.75 $73.43 $144,772.32 Page 1 This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. {Revision 7.0.3) Schwab Securmes Valuatton Service® ~s~a~e Valuation Date of Death: 01/06/2004 Valuation Date: 01/06/2004 Processing Date: 06/04/2004 Estate of: KLAUS J BARTHEL Account: 13817651 Report Type: Date of Death Number of Securities: 2 File ID: 13817651 Shares Security or Par Description High/Ask Low/Bid Mean and/or Div and Int Security Adjustments Accruals Value 1) 2) 2.56 SCHWAB CHABLES FAMILY FD (SWMXX) MONEY MKT FD 01/06/2004 1098.4 AMERICAN CENTY MUT FDS INC (025083882; TWCUX) ULTRA FUND Mutual Fund (as quoted by NASDAQ) 01/06/2004 1.00000 26.98000 Mkt 1.000000 26.980000 2.56 29,634.83 Total Value: Total Accrual: Total: $29,637.39 ACCOUNT TITLE: KLAUS J BARTHEL CHARLES SCHWAB & CO INC.CUST ROTH CONVERSION IRA Portfolio gndnotes $0.00 $29,637.39 Page 1 Please visit your local Schwab office with questions or call (800) 435-4000. Historical quote information will be obtamed ~om sources believed to be reliable, but ~s accuracy and c~mpleteness cannot be guaranteed. The m fonnauon ~s being prodded for your personal noncommeraa use only. Charles Schwab & Co., Inc. does not ~ t~x advice and is not responsible for performing mathematical computations beyond those presented. ©2003 Charles Schwab & Co., Inc. All rights reserved. Member SIPC/NYSE. LTRI3319-02(07/03) CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburgh, PA 15219 February l7, 2004 WIX WENGER & WEIDNER 508 NORTH SECOND STP,~ET P O BOX 845 HARRISBURG, PA 17108-0845 Estate of KLAUS J BARTHEL Date of Death: Jan 06, 2004 SSN: 355-52-5347 Dear Sir/Madam: In accordance with your request, the attached information sheet has been prov/ded in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please cai1 412.867.3815. Sincerely, Ann Rhodes Operations Services CITIZENS BANK Account Number 6201167165 Account Title Klaus J Barthel Date Opened 2/11/2003 Account Type Checking Principal Balance as of DOD $673.98 Interest fi:om Last Posting to DOD $ .00 Account Balance as of DOD $673.98 YTD Interest to DOD $ .00 MEMBERS REGULAR SAVINGS ACCOUNT: Account NumbedSuffix 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 16280.00 07/12/1974 $2,132.59 $.21 $2,132.80 None 16280 -tl 02/17/1981 $8,6O4.30 $.24 $8,604.54 None /~inis4ree~A,BERS 1sT FEDERAL CREDIT UNION Insurance Supervisor February 2, 2004 Estate of: KLAUS J. BARTHEL Date of Death: 01/06/2004 Social Security Number: 355-52-5347 5000 Louise Drive · EO. Box 40 · Mechamcsburg, Pennsyivania 17055 · (717) 697-1161 · ww~v. memberslst.org Date of Death: 01/06/2004 Valuation Date: 01/06/2004 Processing Date: 02/02/2004 HRBFA Estate Valuation Roth IRA Shares Security or Par Description Sigh/Ask Low/Did 1) 2~ 1367.922 ALLIANCEBEDNSTEIN PREMIER GRW (01877C101) CL A Mutual Fund (as quoted by NASDAQ) 01/06/2004 367.524 ALLIANCEDERNSTEIN TECHNOLOGY (018780304) CL B Mutual Fund (as quoted by NASDAQ) 01/06/2004 3) 290 Cash (CASH) Estate of: Klaus J Sarthel Account: 1356-9924 Seport Type: Date of Death Number of Securities: 3 File ID: barthel-ira-dod Mean and/or Div and Int Security Adjustments Accruals Value 17.06000 Mkt 17.060000 23,336.78 51.50000 Mkt 51.500000 18,927.49 290.00 Total Value: Total Accrual: Total: $42,554.24 $0.00 $42,554.24 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsy$.com. {Revision 7.0.8) SRBFA Estate Valuation Joint Investment Account Date of Death: 01/06/2004 Valuation Date: 01/06/2004 Processing Date: 02/03/2004 Estate of: Sans & Elaus Barthel JT WROS Account: 1356-9746 Report Type: Date of Death Number of Securities: 4 File ID: barthel-joint-dod Shares Security or Sar Description High/Ask Low/Bid Mean and/or Div and Iht Security Adjustments Accruals Value 1000 AIM SELECT REAL ESTATE INCM FD (00888R107) SHS New York Stock Exchange 01/06/2004 16.50000 16.17000 S/L 16.335000 16,335.00 2) 1333 EATON VANCE INS PA MUN ED FD (27828W102) tOM A~erican Stock Sxchange 01/06/2004 15.84000 15.75000 16.795000 21,054.74 3) 3333 NUVEEN PA DIVID ADVANTAGE MUN (67071W102) COM American Stock Exchange 01/06/2004 15.68000 15.73000 S/L 15.005000 52,678.07 4) 36280.61 Dash (CASH) 36,280.61 Total Value: Total Accrual: Total: $126,346.42 $0.00 $126,348.42 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818} 313-6300 or www.evpsys.com. {Revision 7.0.3) TO: WIX, WENGER & WEIDNER ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HAILRISBURG, pENNSYLVANL~ 17108 0845 Ms, Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 6UREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004311 GETZ DAVID R 508 NORTH SECOND STREET HARRISBURG, PA 17101 ....... fold ESTATE INFORMATION: SSN: 355-52-5347 FILE NUMBER: 2104- 0031 DECEDENT NAME: BARTHEL KLAUS J DATE OF PAYMENT: 08/26/2004 POSTMARK DATE: 08/24/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,854.18 TOTAL AMOUNT PAID: $5,854.18 R~MARKS. CHECK# 323 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS INVENTORY Estate of Barthel, Klaus J. also known as ., Deceased Jennifer Dauchess, No. :~- ~ ' ~ Date of Death 1/6/04 Social Security No. 355325347 Personal Representative(s) of the above Estate, deceased, veri~ that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attorney: David R. Get. z, Esquire I.D. No.: 34838 Address: 508 North Second Street Harrisburg, PA 17108 Jennifer Dauchess, E~ecutor Telephone: (717) 234-4182 Description H&R Block Financial Brokerage Account Charles Schwab Brokerage Account Citizens Bank Savings Account Members 1st Federal Credit Union Savings Account Members 1st Federal Credit Union Checking Account H&R Block Roth IRA Brokerage Account (no designated beneficiary) (Attach Additional Sheets if necessary) Total 'L¢4~45.75 2@~637.3g · 673.98 2,132.80 8,604.54 42,554.24 665,677.05 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Barthel, Klaus J. Description of Inventory Description Continuation of InVentory Pa,qe 1 Value Insurance proceeds received for residence (destroyed by fire) Insurance Proceeds received for household goods (destoryed by fire) Insurance Proceeds received for vehicle (destroyed by fire) Insurance proceeds received for demolition/excavation of real estate Miscellaneous refunds/credits received regarding sale of lot 2003 Income Tax Refund 2003 School Tax Refund Lot situate at 162 Meadow Lane, Mechanicsburg, Pennsylvania being Tax Parcel No. 22-10-0640-100 243,000.00 81,038.80 6,600.00 12,150.00 595.72 2,878.00 1,065.83 89,9O0.OO Subtotal $ 437,228.35 Grand Totat $ 665,677.05 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARR/SBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-15~i? EX AFP (01-D5) DAVID R GETZ ESQ NIX ETAL PO BOX 845 HBG DATE 10-25-2004 ESTATE OF BARTHEL DATE OF DEATH 01-07-2004 FILE NUMBER 21 04-0051 COUNTY CUMBERLAND Aeoun~ Reei~ad .A 171o : i, ...... KLAUS HAKE CHECK PAYABLE AND REM/T PAYMENT TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOT/CE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BARTHEL KLAUS J FILE NO. 21 04-0031 ACN 101 DATE 10-25-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVAT/ON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule Bi (2) $. Closely Held S~ock/Par~narship Zn~eras~ (Schedule C) (3) 4. Hot,gages/No,es Receivable (Schedule D) (4) 5. Cash/Bank Daposi~s/Hisc. Personal Proper~y (Schedule E) ($) 6. Jo/n*ly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~a! Asse~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Ada. Costs/H/sc. Expenses (Schedule H) (9) 10. Dab~s/Hor~gage L/ab/li*ies/Lians (Schedule 1) (10) 11. To,al Daduc~/ons 12. Ne~ Value of Tax Re~urn 89~900.00 .00 .0O 401~295.91 1121869.21 .00 (8) 25,424.06 NOTE: To insure proper cred/~ ~o your account, submi~ ~he upper portion of ~his fore wi~h your ~ax payment. 13. 14. NOTE: 778,546.26 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ASSESSMENT OF TAX: 15. Aeoun~ of L/ne 1~ a~ Spousal ra~e 16. Amount of L/ne 14 ~axable a* Lineal/Class A ra~e 17. Aeoun~ of L/ne lfi 18. Amoun~c of L/ne 14 ~axable a~ Collateral/Class B ra~e 19. Prlncipal Tax Due TAX CREDZTS: PAYItENT R~CEZPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAZD (- 0~-18-2004 CD005701 947.$7 08-24-2004 CD004511 .00 (15) .00 x O0 = .00 (16) 551,145.$8 x 045= 24,801 (17) .00 x 12 = .00 (18) .00 x 15 : .00 (19)= 24,801 AHOUNT PAID 18,000.00 5,854.18 reflect figures that include the total of ALL returns assessed to date. TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 24,801.55 .01CR .00 · 01CR ( TF TOTAL DUE 'rs LESS THAN $1, NO PAYHENT 'rS REI;iU'rRED. 'rF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR):. YOU NAY BE DUE A REFUND. SEE REVERSE S.rDE OF THTS FORH FOR .rNSTRUCT.rONS. } Cher/~able/Govarneen~al Bequests; Non-elac'l:ed 9113 Trusts (Schedule J) (13) . O0 Ne~: Value of Es~:a~:e Subjec~ ~:o Tax (14) 551,145.$8 z~ an assessment ~as ~ssued prev~ousZy, ~nes 1% 15 and/or ~6, ~7, ~S and ~9 201,976.82 (11) 227.~§§.88 (12) 551,145.$8 RESERVATION: PURPOSE OF NOT[CE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: iNTEREST: Estates of decedents dying on or before December 11, 1981 -- [f any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaaoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 91qO). Detach the top portion of this Notice and submit eith your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILLSj AGENT A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-l$133. Applications ara available at the Office of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special 24-hour ansaering service for forms ordering: 1-800-36Z-2050~ services for taxpayers e[th special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --eritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA I71Ze-IOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered an this assessment should be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. Z80601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacadent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1982 mill bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOq are: Interest Daily Interest Da[Iv Year Rate Factor Year Rate Factor Year 1981 201 .0005~8 ~'~'~'8-1991 111 .000301 ~ 1985 162 .000~58 1992 92 .0002~7 ZOOZ 198q llX .000301 1993-199q 7X .000192 2003 1985 137. .000356 1993-1998 97. .0001~7 Z004 1986 101 .00017~ 1999 71 . O0019Z 1987 lOZ .000274 2000 7Z .000191 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR Interest Daily Rata Factor 91 .0001~7 61 .00016~ 51 .000157 ~Z .000110 --Any Notice issued after the tax becomes delinquent mill reflect an interest calculaUon to fifteen (15) days beyond tho date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. LI 0(/ L.\...J - ~3 1.1 . \._-' , (...:J :),; I..el C':~ (~ c.=) l.~__~ c._ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Estate No.: Klaus J. Barthel January 6, 2004 21-04-31 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes.lL No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N/A 3. If the answer to No.1 is Yes, state the following: N ...:.r (....) c::... c.., :':,.:': C./) . ~J": :'::,., '---'--J-''--. [) :{~ ~-, n.., eL: ~ _ o::;o~ <:::> a. Did the personal representative file a final account with the Court? Yes No---K- b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes 15-.. No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Respectfully submitted, WIX, WENGER & WEIDNER ~ i -J/e 'I:... '-:1 By: .... <-<---r:\ . < . I David R. Getz, Esquire Attorney ID No. 34838 508 North Second Street P.O. Box 845 Harrisburg, P A 17108-0845 (717) 234-4182 ..-::: -) U"O> c,,-::;:::> = "" Dated: January 1 0, 2005 Counsel for personal representative vA