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HomeMy WebLinkAbout06-21-101505607120 R~~•~ . Ex (ot-toi PA Departrnen! of Rev~ertue pennsylvania r Bur+~w of individual Tatoea °'"'""1°'~°'""~'"` PO t~Ox.280801 INHERITANCE TAX - Hat~rhlburp, PA 17128-0801 RE31t~E11~t" DECE EN?ER DENT ~MATIt'i~l`BELOW Sodas Security Ntmtber Date of Death 107 28 1067 03 25 2010 Decedent's Last Name CLOGS (if Appilcable) End Surviving Spouse's in#ormatlon Below Spouse's Last Name OFFICUL.U8E t)NLY County Cod. Year F~sf -~ 121 to ULAo~i Co Date of Birth 09 O1 1938 Suffix Decedent's First Name MI TII~'TEY N Suffix Spouse's First Name Mi Spouse's Social Security Number THiS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTE~t OF I~flLLS FILL IN APPROPRIATE OVALS BELOW X^ 1. ~fi~ Retum ^ 2. Supplemental Retum Remainder Retum (date of death ^ 3. prior tiD 12-13-82) ^ 4. Limited Estate ^ qa, ~~ ~~ i ^ 5. Federal Estate Tax Ratum Required D.oad.nt a.a r..tate ® 8' (Attach Copy d Wig) ^ ~• ~l~opyn~ist)a Livirq Tnist ~ g, Total Number of SaAe Deposit Bootee ^ 9. Litbation Proceeds Reoefved ^ 10. a~P~~~,~d4f death ^ 11. Eletxion to tax under Sec. 9113(A) (Attach Sch. O) CORREaPONDENT - Tt~ aECTION MUST 8! CONf1Pl.ETED. ALL CORRESPONDENCE AND ONRI TAX tNFORtiU1T10N BHOIX.D 8E DIRECTED TO: Nam• Daytime Telephone Ntnn#ter ktARCI S.. MILLER, ESQ . 717 540 4332 REt318TER ` LLS US i.Y First fine of address ' ..,,.. ~... ~_ ~ ~~ ~~ ~ ~ ~"' t'~! 2 d00 LINGLESTC~N ROAD , •'~-;~ ~' .~-. ~ ~, . Second fine of address ~ ~' C? ~: ~ ' SUITE 202 - -._- ~ _~ y. r A ~.~~ CA City Gir Post Office xARR=s$URG Correspondent': e-mail sddrau: note SMIM s ~-A ~~1io ' ~ ...:..iii~ grt ~iM prep~N !a any kn ~.~ .~,_,__~ bA~ / (~ / / ~~1~ ADDRESS U 1 -- -' , " " - - 20©0 Linglestown Road, HaMaburg, PA "!'T~t10 r71~! ~50560~120 1505607120 J J 1505607220 REV-1:800 EX D-ecederrt's Soda) Security Number '• ~~ Timothy Niles Clops ~ 10 7 2 8 10 67 RECAPITULATlOPI 1. Real Estate (Sd~edub A) ....................................................................................... 1. 2. Stocks and Bortds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sob-Proprietorsh~ (Schedule C)......... 3. 4. Mortgages & Notes Receivabb (Schedub D) ........................................................ 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Sdtedub E) ............... 5. 3 9 , 4 3 6.71 6. Jointly Owned Property (Schedub F) ^ Separate Bil~ng Requested............ 6. 7. Inter-Vrvos Tr~~ers 8 NlisceNaneous lyan; Probate Property (Sd,edub G) Se ar t Bil~ R t d u p a e ng eques e ............ 7. 3 8 ,151.4 0 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8, 7 7 , 5 8 8.11 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 4 , 92 3.0 0 10. Debts of Decedent, Mortgage Liabilities, $ Lbns (Schedub 1) .............................. 10. 884.84 11. Total Deductto~ (total Lines 9 810) ................................................................... 11. 5 , 8 0 7 . 8 4 12. Net Valus of Estate (Line 8 minus Une 11) .......................................................... 12. 71, 7 8 0 . 2 7 13. Charitabb and GrnremmeMal Bequests/Sec 9113 Trusts for which an ebdion to tax has not been made (Sd~edub J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 71,780.27 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxabb at the spousal tax rate, or transfers under Sec. 9116 (a>(1.2> x .00 71, 780.27 15• 0.00 16. Amount of Lira314 taxabb at lineal rate X .045 0. 0 0 16. 0. 0 0 1 T. Amount of Line 14 taxabb at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of line 14 taxabb ' at collateral rate X .15 0.0 0 18• 0.0 0 19. Tax Due .................................................................................................................. 19. 0 . 0 0 20. FILL iN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~ ' Side Z ~' ~..~ 1505607220 1505607220 II, REV 1500 EX Page 3 D+~dent's Coma Addir~s: File Number 21-10 DECEDENT'S NAME Timothy hiii~a Cloos STREET ADDRESS 87 Northview Drive '~ CITY Me6hanicsbur'9 STATE PA ZIP 17050 j Tax Payments and Credks: 1. Tax Due (Page 2, Line 19) 2. Crodita/PaymeMs A. Prior Payments B. Discount 3. Interest 0.00 4, If Line 2 is greater than LMe 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Pape 2 Line 20 to roquest a refund 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. check Payable to: (1) Total Credits (A + B) (2) (3) (4) (5) ~.~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "~" IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes ~ a. rotate the use or income of the property transferred :................................................ ............................... b. reta~ the right to designee who shall use the property transferred or its income :.................................. c. rotain a roversionary interest; or ............................................................................................................... x d. receive the promise for Nfi of either payments, benef~s or care? ............................................................ x 2. ff death ocxurred after Decerr-ber 12, 1982, did decedent transfer property within one year of death wkhout receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for~ or payable upon death bank aocount.or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? .................................................................................................................. x IF THE AiMiVYER TO ANY OF THE AEIOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE Fsp~ousis~ ^~ ~ZrPafter 91yg ( }9941,nd]before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving 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 peroent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does Hat exempt a transfer to a surviving spouse from tax, and the statutory requiroments for discbsuro of assets and fNleg a tax return are still applicabb even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax Hate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chikt is 0 percent (72 P.S. §9116 (a) (1.2)]. . The tax Hate imposed on the net value of transfers to or for the use of the decedent's lines! beneficiaries is 4.5 percent, 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 a~lings is 1 ~ percent [72 P.S. §9116 (a) (1.3) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whe~er by r adoption. av-~ioe oc+ f~l SCN~Q1i~ E CASH, BASK DEPOSITS, & MISC. PERSONAL PROPERI"'1r ca~~~.mo~v,~- ESTATE OF FILE wUili~ER Cicilos Timoth Niles 21-10 ~nckxN ~. d and th. cIM. a,. prao«d. ~ ~ eW~te. A~ prop~rtyr j~ 1~~+~d~ ti~ivt of swwhro~sMP nMNt b~ di~~foMd on w F. I ITEM VALUE AT DA Nl51At3ER DESCRIPTION OF DEATH 1 Susquehanna Valley Federal Credit Union - Member 84778 - 00 -Regular shares acct 2.786. 2 Susquehanna Valley Federal Credit Union - Msm~ber 84778 - 40 -Share Draft 523• 3 Wichovia Acct #3000121102350 1 ~~• 4 1868 Pontiac Firebird -convertible - as per attached NADA Guides vehicle. pricing average 23.800. retail 5 1872 Dotson 2402 - as per attached NADA Guides vehicle pricing aven~lg+a retail 10.600. TOTAL (Also enter on Lane 5. Recapitulation) l 38.436.71 (If more space is needed, additional papas of the same size) Copyright (c) 2002 forth software only The Lackner Group, Inc. Fosrn PA-1600 Schedule E (Rev. 6-98) Rev1610 EX+ (i~YS) ~~~~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ~~~~v~ aa~rttr~s rNC ~en~nn ~aaaaKraECt~ ESTATE OF I FILE NUMBER CW~os, Timothy Mies _ ~ _ 21-10 This schedule must be vomplslsd and tied it tM answer to any d qusstiora 1 through 4 on the revers side d the REV-1500 COVER 31iEET is yes. ITEM NUMBER DESCRIPTI~1 OF PROPERTY ,~~~~~rr~+~ ~ i~~~ ~c~~ist~i E. DATE OF fJEATH VALUE OF;ABBEY ~ of oEC.trs ~~ Exr.~us>aN ~'~.~uE) TAXABLE VALUE 1 Fidelity Imrastmenls -IRA Acct #~2AA-959618, 4.534.E 100.000'K 4.334.88 beneflcfary is spouse, Joan Cloos 2 Susquehanna Valley Federal Credit Union -Member 8.533.80 100.0009E 8.533.80 #4779 - 9257 IRA -Beneficiary is spouse, Joan Cloos 3 Si~quehanna Valley Federal Credit Union -Member 19.199,25 100.000X 19.199.25 #4779 -10381 IRA - Beneflciary is spouse, Joan Cloos 4 T Rowe Price -IRA Acct. 94009550293-9 -beneficiary 6.083.47 100.00096 6.083.47 is spouse, Joan Cloos TOTAL (Also enter on Line 7. Recapitulation) 38.151.40 (If more space is nestled, additlonsl papsa of the sane size) Copyright (c) 2002 form aoltware only The Lackner Group, Inc. Fomn PA-1500 Schedule G (Rev. 8-98) ,,.. ~ _ . _ -r Rt:1/-1161 EX; (10-0i) coM ~ ~aaa- SCif~ H FUNERAL EXPENSES ~ 1QiYitN~STRATiVE COST: ESTATE OF FILE NU~ER Ckl~t, Thncylhy Niletc 21-10 Debts of decedent must be reporbsd on ~tte(suie 1. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: Auer Funeral Home 2,023.00 B. AD1iI1Ni'STRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Reprosentative(s) Street Address City State Zb Y®arfsl Commission uaid 2. { Attomev's Fees HaZ!-n Eider Law 3. Family Exemption: (ff decedent's address is not the same as claimant's, attsdt explanation) Claimant Street Address City State Zip Relat~nshio of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Proparer's Fees 7. Other Administrative Costs 2,900.00 TOTAL (A~ enbsr on Ilne 9, Recaplt~rtion) I 4,923.00 Copyrigfit (c) 2009 form software ony The i.ackner Group, Inc. Form PA-1lf00 Sd~edule H (Rev. 10-06) Rw-1a12 EX+ (12-0QI ~~~~~~~~ DEBTS OF DECEDENT, MORTGAGE LtAgil.ITIES, S LIENS ~.~+aFw,~,- t~ ESTATE OF Nites FILE-NUAABER Z'I-10 _.._ ti~grre d~bes M~curwd bye lM prior to dMlh tlat wnMimd unpNd at tlN da of dMth. a ~ ~.e~,~ ~.....~ to more space is needed, additional papas of the same size) ~Py~'19~ (c) 2009 fomt softwaro only The Lackner' C3rvup, inc. Form PA-1QQ0 Schedub 1(Rev. 12-08) SCHE~tILE J ""~ BENEFICIARIES ESTATE OF 1riLE ~~~~~ Cloos Niters 21-10 AND ADDRESS OF RELATIONSWIP TO SHARE OF ESTATE NT OF ESTATE NUMBER PERSON(S) REGE(VING PROPERTY DECEDENT ~,~~) (~) I TAXABLE DISTRIBUTIONS [irtduds outri~M spouse{ • distr~utbn:, and U~ansiers under Sec. 911 a 1.2 1 Joan K Cloos Spouse 100'6 of Estate 87 Northview Drive Mechanicsburg, PA 17050 Total slroMm above ort Uines 15 18 on Rev 15 00 hovers es . NON-TAX~t11-i.E btSTR1~UT'IONS: n. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL 1~ - R TOTAL. NON-T DISTRI C~1 LINE 13 OF REV 1500 CAPER SHIE Copyc{ght (c) 2009 form st~f lwsre aNy Tt~e Ledcner Gr+cwp, Inc. Form P/~1500 Schedub J (Rey. 11-08) LAST WILL AND TESTA1ViENT of TIMOTHY N. CLOGS FILE Cpp~, I, TIMOT~iY N. CL~OS of Mechanicsburg, Cumlberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all prior Wills and Codicils. ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ~ M II. All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to clean reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. ITE III. I give, devise and bequeath my tangible personal property to my wife, JOAN K. CLOGS. In the event JOAN K. CLOGS predeceases me or fails to survive me by thirty (30) days, then I give, devise and bequeath my tangible p-~rsonal property in accordance with any memorandum which I have handwritten or signed, loc$ted with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the. latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Item IV hereof. ITEM IV. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my wife, JOAN It. CLOGS, of Cumberland County, Pennsylvania. In the event that JOAN K. CLOGS predeceases me or does not survive me by thirty (30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever nature and wheresoever situate according to the following: A. The sum of FIFTY THOUSAND DOLLARS' (S50,Q~.00) of my residuary emote to be held in a Special Supplemental Care Trust, for my daughter JENNIFER S. CLOGS, to be held, managed, and administered according to ITEM V; and B. The rest and residue of my estate to my son TIMOTHY J. CLOGS, of Cumberland County, Pennsylvania, Per Stirpes. In the event that JENNIFER S. CLOGS predz~ceases me or fails to survive me by thirty (30) days, then her share shall be distributed to my son, TIMOT~IY J. CLOGS, Per Stirpes. In the event that TIMOTHY J. CLOGS predeceases me or fails to survive me by thirty (30) days, leaving no surviving issue, then his share shall be distributed as follows: A. ONE-THIRD (1/3) of TIMOTHY J. CLOGS' ~ of my estate to the Special Supplemental Care Trust, for the benefit of JENNIFER S. CLOGS; B. ONE-THIRD (1/3) of TIMOTHY J. CLOGS' share of my estate to my daughter-in-Iaw, 'VICKI ENGLAND CLOGS, Per Stirpes; and C. ONE-THIRD (1/3) of TIMOTHY J. CL005' share of my estate to my brother, EDWARD J. CLOGS, Per Stirpes. ITEM V. 3t~ecial Sup~lenentt~l Card Trust for JENNIFER S. CLOGS. a disabled t. I heresy nominate and appoint my son, TIMOTHY J. CLtyOS, as Trustee of the Special Supplemental Care Trust under this my Last Will and Testament. The share of my estate that is set aside for JENNIFER S. CLOGS shall be held by my Trustee, TIIVIOTHY J. CLOGS in 2 trust for JENNIFE~t S. CLOOS's benefit in a Special Supplemental Care Trust in accordance with the following provisions: A. IIVT'ENT It is my intention by this trust to create a purely discretionary supplemental care fund far the benefit of JENNIFER S. CLOGS and not to displace financial assistance that may otherwise be available to her. Illustrative of the kinds of supplemental, non-support d~ursements that would be appropriate for my Trustee to make from this trust for JENNIFER S. CLOGS include: sophisticated medical or dental or diagnostic work or treatment for which there are not funds otherwise available, including plastic surgery or other non-necessary medical pmocedures; private rehabilitative training; dental care; recreation and transportation; differentials in cost between housing and shelter for shared and private Looms in institutional settings; supplemental nursing care and similar care that assistance programs may not otherwise provide; telephone and television service; companions for travel, reading, driving and cultural experience`s and payments to bring her brother or others for visitation in the event my Trustee deems that appropriate and reasonable. B. It is important that JENNIFER S. CLOGS maintain a high level of human dignity and that her care be humane. If this trust were to be eroded by creditors, subjected to .liens or encumbrances, ar cause assistance benefits to be unavailable or terminated, it is likely that the trust corpus would be deleted prior to her death, especially if the cost of care for her would be high. In such event there would be no coverage for emergencies or supplementation to basic needs. The mist provisions contained in this instrument should be int~ed by my Trustee in light of these contains and this intent. C. My Trustee shall pay or apply for the benefit of my daughter .for her lifetime such amounts from the principal .or income, or both, of this trust up to the whole tf, as the 3 Trustee, in the Trustee's sole and absolute discretion, may from time to time deem necessary or advisable for the satisfaction of JENNIFER S. CLOOS' special non-support needs, if any. Any income not distributed shall be added annually to principal. As used in this instrument, "special non-support needs" refers to the requisites for maintaining my daughter's good health, safety and welfare when, in the discretion of the Trustee, such requisites are not being provided by any public agency, office or department of the state where she lives ar of the United States, or are not otherwise being provided by other sources of income available tca her. Special non-support needs shall include but shall not be limited to the list of suggested rton-support items set out in this article. D. In the event that she is unable to maintain and support herself indepwendently, the Tn~stee may, in the exercise of the Trustee's best judgment and fiduciary duty, seek support and maintenance for he°r from all available public and private sources. The Trustee shall take into consideration the applicable resources and limitations of any public assistance program for which she is eligible. In carrying out the provisions of this trust, my Trustee shall be mindful of the probable future needs of my daughter, but not of the trust remainder beneficiaries. E. No part of the corpus of the trust created by this article shall be used to supplant or replace public assistance benefits of any county, state, federal or other goverrunental agency that has a legal responsibility to serve persons with disabilities that are the same or similar to those which JENNIFER S. CLOOS may be experiencing. For .purposes of determining my daughter's public assistance eligibility, no part of the principal or undistributed income of the trust shall be considered. available to her. In the event that the Trustee is required to release principal or income of the trust to or on behalf of JENNIFER S. CL04S to pay for benefits or services which such public assistance . is otherwise authorized to provide were it not for the existence of this trust, or in the event the Trustee is requested to petition the court or any other 4 administrative agency for the release of trust principal or income for this .purpose, the Trustee is authori2cd to deny such request. My Trustee is authorised, in the Trustee's discretion, to take whatever administrative or judicial steps may be necessary to continue the public assistance program eligibility of JE1V1V'IFER S. CLOGS, including obtaining instructions from a court of competent jurisdiction ruling that the trust corpus is not available to the beneficiary for such eligibility purposes. Further, my Trustee should cooperate with the beneficiary's conservator, guardian, or legal representative to seek support and maintenance for the beneficiary from all available resources, including but not limited to, the Supplemental Social Security Income Program (SSI); the Medicaid Program; and any additional, similar or successor programs; and from any private support sources. Any expense of the Trustee, including reasonable attorney fees, shall be a proper charge to the trust. F. SPENDTHRIFT PROVISIONS No interest in the principal or income of this trust shall be anticipated, assigned or encumbered or shall be subject to any creditor or to any legal process prior to the actual receipt by the beneficiary. Furthermore, because this trust is to be conserved and maintained for the special non-support needs of JENNIFER S. CLOGS throughout her life, no part of the corpus hereof, neither principal nor undistributed income, shall be construed as part of JENNIFER S. CLOGS' estate or be subject to the claims of voluntary or involuntary creditors forthe provision of care and services, including residential care by any public entity, office, department, or agency of any state or the United States or any governmental agency. Under no circumstances can the beneficiary compel a distribution. 5 G. TRUSTEE AUTHORITY TO TERMINATE TRUST Notwithstanding anything to the contrary contained in this trust, in the event that the trust has the effect of rendering JENNIFER S. CLOGS ineligible for any program of public benefit, the Trustee is authorized, but not required, to terminate this trust. In determining whether the existence of the trust has the effect of rendering JENNIFER S. CLOGS ineligible for any program of public benefit, my Trustee is granted full and complete discretion to initiate either administrative or judicial proceedings, or both, for the purpose of determining eligibility. All costs relating thereto, including reasonable attorney fees, shall be a proper charge to the trust. In the event of voluntary termination, the undistributed balance of the trust shall be distributed to my son, TIMOTHY J. CLOGS, Per Stirpes~ If TIMOTHY J. CLOGS predeceases me, leaving no surviving issue, the undistributed balance of the trust shall be distributed to my brother-in-law, JOHN VAN WORMER, Per ~'tirpes. H. VOLUNTARY CARE It is my wish that subsequent to the termination of the trust for the benefit of JENNIFER S. CLOGS, if my contingent beneficiaries are living and distribution has been made outright to them, if JE1~tNIFER S. CLOGS is still living because there has been a voluntary termination of the trust in accordance with the provisions of this article, that such contingent beneficiaries will conserve, manage and distribute the proceeds of the former trust for the benefit of JENNIFER S. CLOGS to insure that she receives sufficient funds for her basic living and supplemental needs when public assistance benefits are unavailable or insufficient. This request pertaining to the use and management of the trust proceeds after the termination of the trust is not mandatary, but is an expression of my wishes only. 6 I. E~~tEF~~~.ARIES OF TRUST RESIDUE UPON DEATH (3F DISABLED BE~tEFICIARY Unless sooner terminated, the trust crested for JENI'~'IFER S. CLOGS shall terminate upon het death. At that time all remaining trust assets shall be distributed to my son, TIMOTHY J. CLOGS, Per Stirpes. If TIMOTHY J. CLOGS predeceases or fails to survive JENNI~`ER S. CLOGS by thirty (30) days, leaving no surviving issue, then the remaining trust assets shall be distributed IN EQUAL SHARES to my daughter-in-law, VICKI ENGLAND CLOGS and my brother, EDWARD J. CLOGS, Per Stirpes. J. TRUSTEE'S. POWERS Subject to the requirement that my Trustee be prudent, my Trustee sha11 have full power and authority to m8nage and control the mist estate and to sell, exchange, lease, rent, assign, transfer and otherwise dispose of any or part thereof upon such terms and conditions as my Trustee may, in my Trustee's discretion, deem proper. My Trustee may invest or reinvest all or any part of the trust estate in such common or preferred stocks, bonds, d~.itures, mortgages, deeds, deeds of trust, notes and other securities, investments of property, including common trust funds, which my Trustee, in my Trustee's absolute discretion, may select or determine. It is my express intention that the Trustee shall have full power to invest atid reinvest the trust fluids as I might do if living, without being restricted to forms of investments which Trustees may be otherwise pernutted by law to make, and without any requirements as to diversification of investments. My Trustee may continue to hold in the form in which received, any securities or any property which I might own at the time of my death or which my Trustee may at any time acquire h+~r~eunder; and may invest any part of the trust funds in property located within or outside of the Commonwealth of Pennsylvania. My Trustee is further authorized to invest in life, annuity, accident, sickness, .including. disability, and medical insurance on behalf of and for the benefit of the mist beneficiaries. My Trustee shall not be obligated to undertake litigation far collection of any benefits or assets payable by reason of my death including, but not limited to, such benefits under life insurance policies, employee benefit plans or other contracts, plans or an~angements providing for payment or transfer at death which are payable to my Trustee unless my Trustee is indemnified to my Trustee's satisfaction against any liability and the expense of such litigation. Payment to my Trustee and the receipt of or release by my Trustee shall fully discharge any payor, and no payor need inquire into or take notice of my Will to see to the application of such payment. My Trustee shall, in addition to the powers granted above, have all powers otherwise granted under the Pennsylvania Fiduciaries' Powers Act as amended after the date of my Wi11 and after my death. My Trustee shall specifically have the powers to invest in Iron-income producing assets. K. t,JNSUPERVISED ADMINISTRATION The trust created by this Will may be administered by my Trustee free from the control of any court that may otherwise have jurisdiction over my estate. ITEM X. I nominate and appoint my wife, JOAN K. CLOGS as Executrix of my Will. If JOAN K. CLOGS is unable or unwilling to act as Executrix, I appoint my son, TIMOTHY J. CLOGS as Executor of my Will. I direct that my Executrix or Successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power to sell both .real and personal property, at private or public sale, to invest cash without s being limited to statutory investments, to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. nacoa ~ S~3/ coos O . CLOOS In our presence, the above-named TII1t~IOTHY N. CLOtaS signed this and declared this to be his Last Will and now at his request, in his presence, and in the presence of tech other, we sign as witnesses. ~~ ~n f ~ ,~~lJyO f .=„~5 9 I, TIMOTHY N. CLOGS, Testator, who signed the foregoing instrument, having been duly qualified according to law,. acknowledge that I signed and executed this instrument as my Will, and that I signed it v~nllingly as my free and voluntary act for the purposes therein expressed. Sworn to or at~irmed and acknowledged before me by TIMOTHY N. CLOGS, the Testator, this ~ day of ~' 2005. Pub c w iVoukisi sad ~0p`' Pab " ~. My C~ ~ , ~ ,~- TII130T .CLOGS V'Ve, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrucment as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight amd hearing sgc~ed the Will as witnesses, and that to the best of our knowledge, .that he was at #hat time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or a#~rmed and subscribed to before me by -..~~ 9.~~:.~- and ~~ witnesses, this -~ day of _ , 2005. Notify Publ w . to --- F ~ ~~ .... u'~'~ ~+ o0ob z~, ~. _, _5 ~ 1969 Firebird 2 Door Convertible price report at NADAguides.com Page 1 of 1 ~ ~ ~~awi~ NfADl4quHd~sco~n care > c.Mpay > M.k. > YMr > ModN ~ opine. > vw. Rgort Classic Gr Consumer pNas tN~9 Pei~nt4lc FinMrd 3 Doet'r Caw~rrtlW~ Naae i') f111E8NlD 4001330 -Ns 1l~. RAM AIR ('h lO ~OQi346 FIP 1881. RAM NR IV ("') ONLY EION7 PRODUCED. ~ odasw..~oll - silcena~~ri~+. PRICING .arrr. M. ueo rwalK: s,~e Orlpinal MSRP: t3,1l8 14011 A1!!~t !!rA ~ i~ ~ ~M Prle~ 113.000 123,900 344,000 rornL rRree •>:~ >fss,~eo s44,soo Nora: 4ehklas WiM kw mpMga Urr are ~ aXCaptbnapy good taedd+on atxi/or ~nUud+e a rnanuisdursr cenHfGplon can ba worM+ a m9~a~Y higher value Urn 1Na Rapp rxi0e srw~wn. .4lRCl2ElA!l..414S~RmS fiGopyrigM ZOfO NADAquid~a.wm. Ap Righb Reosrved. 47NPGA.4C M10. M Rgals Rawrv.d. http://www.na~iaguides.com/default.aspx?LI=8848-22-1-5013-0-0-0&1=8848&w=22&p=1... 6/9/2010 1972 2402 2 Door Coupe price report at NADAguides.com •~a -~Apuides.com Sfart > cstepory Mike > y.,,r > ModN > Opi„w WNM RaPort . _ . .. Classic Car Consumar PrlCes 1972 Nlssan/Dabutt 21OZ 2 poor Coupe PltICIN(i vw~: z,soo Orlplnai MSRP:14,106 (~ ~ROQ ~ S#11.~Y~lYt .~. o~, moo ~ ~ ~ BEM Pric6 ~A00 =10,eD0 NY,200 TOTAL URIC! N.aee >fIO,f00 >]1~,200 potr: Vshicirc wMh bw miWge ttwt m M rzeeptbrrllyr good cond~Wn and/or inc4ida Mpffer valor thrt thr RNail price shown. a manuiadtpar esrtificatbn can be worth s srgrdMcarxly piacbsve WNeRrent 9Y:uprpM 2010 NAOAawks.oom. Ap Rtahls Rewrved. C%NAGhBC 2010. b Rp/nn Rearrvua. Page 1 of 1 http://www.nadaguides.com/default.aspx?LI=8848-22-1-5013-0-0-0~1=8848&w=22&p=1... 6/9/2010 ~~ ~W An Estate Planning!, Elder Lacy and Special Needs Planning Lain Firm 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 ~.: (71?) 3404332 FAx: (717) 540.4313 June 16, 2010 CER?'IFIED 11L4IL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Timothy N. Cloos File No.: 21-10 Social Security No.: 107-28-1067 Inheritance Taz Return To: The Register of Wills: www.HazenElderLaw.com MaxieUe F. Hagen, CF1A* Mard S. Miller, Aeeodate ~-- ~~~~ ` ~~ ~ ~~ ~~ r ..... ~:7 k,...:~ ,;~, ~. ~~ ~ -~ ~. .. a+ Enclosed for filing please find the original and one copy of the above-referenced Inheritance Tax Return, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and return it to my office in the enclosed self-addressed envelope. Also enclosed is a check for the filing fee in the amount of $15.00. If you have any questions or require any additional information, please do not hesitate to contact me. Enclosures cc: Joan Cloos Sincerely, . ~ ~~ '~~' Corinne Eggers Woodhouse Paralegal *Certified Elder Lace Attorney by the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court ca G> ~ w~~ ;~~'~~ a „ ~, w m ~ W ~`"" ~` a~~~ ~ ~ ~ t~*1 ~ ~~ ~` t~ ~,~„ g ~, p a ~ ~~~ ~ ~- ~, ~, ~~~, ;Q~ r ~ ~ _---. i4 i r ~ ~ 4 c~- ~~~, '~ ~~ may: ~ ,,. •• ;; .~ .~; ', ss- .~ .. ~ ~~ '' ,~ i~ { ;. ~~,, " t'"` 4 ~` ~ ~ ~ c `~, 4? ~ M p"^ ~c3 ~ a, ~a W ~ '~ ~ a o N ti a 0 o ~ ~~ a~~ ~/~~,~ o p o w ~ ~ ~~ '~;~~~ o~ U ~ U ~~ o tJ io