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HomeMy WebLinkAbout03-0267 PETITION k1:PROBATE and GRANT OF LETTERS Estate of A~c>>e 'J", No.~I-O~.';~, also known as To: Register ofAVills jor t/1e) . '7 q' "i-YDeceased. County of~~tJ..~ III the Social Security No. ~Z'( .- 2.- 8 I / " Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or ~r an the executi-'i,..K in the last will of the above decedent, dated ~~.e r and codicil(s) dated )J8tJE named ,~() Decendent was domiciled at death in i. lass fjmi or principal residence at , I l V \ Decendent, then C{ ~ at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: {list street, number and munCi:J years of age, died f'I'v&t-~ \~ J ').., C:>D~ ,~ Decendent 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 $ . ~alue of real estate in Penns.Ylv~a . f) () p _ ~ Ij..JJ.. A$ ~ 000, 0"7 situated as follows: z:.. (f) '........ lA ~ vL I.7l v~1{ l7 ' $ IS-O/ t?OO. 0 c . WHEREFORE, petitioner(s) respectfully reque t(s) the robate of the last will and codicil(s) presented herewith and the grant of letters ' . . . theron. 13 ~. (l_~~~Cd'~ ~,.t-1~"-:+0,,,.-, ~t; ~.J'_ ~~- ~ (\.tl f\. 1<(""',..... ] :~ '1'r> · G I 7 0 it I 3~ <1)<+- 50 ~ c:: 00 i;3 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF r.IIMRFRI ANn J The petitioner(s) above-named swear(s) or 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~;~:~ ~~ th~: a~f~~~ed and ,"b:f~~b~{ ~l ~" '1"~~ t I q~~;~ ~ ,~~:H . 2003. li~~ ~ ~ ~~~~~r ~ \1-120-1~ No. ~J-03-d{.,7 Estate of AMBROSE KLAIN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MARr.H?7, 2003 llltL-, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 6-5-2000 described therein be admitted to probate and filed of record as the last will of AMROSE KLAIN and Letters TESTAMENTARY are hereby granted to PHYLLIS M KLAIN ~.~ FEES Probate, Letters, Etc. ......... $ 235.00 Short Certificates( ).......... $ 21.00 ~~~*~*~*X.EXTRA.~AGES. $ 12.00 j cp $ 10.00 TOTAL _ $ 278.00 Filed ..... 3~.2 7. -: 20.0.3 . ..,. . '1 . "d. '3 . . . . . . . atty picked up on ~-2 -L 0 per phone call ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE H 1 O"i.RO,) REV 9/R6 This is to .certifY that t~e. inform~tion he~e given is correctly copied from an original certificate of death duly filed with Local Registrar. The ongIllal certIficate will be forwarded to the Stare Vital Records Office for permanent filing. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 8940891 No. ~i(::!2;/ mtfnh ~ ~/)t'"-~ Date Hl05.;43 Rev_ 2187 COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT Of HEALTH. VITAL RECORDS CERTIFICATE OF DEATH or or K 1 : .. WERE AUlOPSY FINDINGS JeoIlULA8I.E PRtOA 10 COMPlETION OF CAUSE OF DER"H? DUE lDlOA ASACONSEOUENCE OF)' ~NER Of DEATH DATE OF INJURY (Mcnlh. Day.-"" )6 o o ..; .... _. ... ,- I inIIIrwI belween : ~ MddNltl i PART I: OItIersignifkanlcondilionsconrributinglOdnltl.but ftOIl'MUIlinginlM~cauNgivw.inPARTI. nwe 04= INJURY IHJURYJ{fv<<)fU(? DESCRIBE HOW INJURY OCCUFIRED. P.-ding InvnUgalion o o o PLACE OF INJURY - At home. tarm.....laclDry. omc. Y. buikIng. _. tSpeoM 300. ... 0 NoD ....... -..... Suic:idiI -- Va 0 No 0' CouIcI nor be ~mwned 2ab. CERTIFIER iCheckooir~) .CERTIFYING PHYSIClAH (Ph)'SICoaocer\>lylng caulWl cJ oeau'I ",her> anolt18f pn.,.s.c4ll has proncll.lnCac:l deaIh ana com(JleleCl Item 231 T...........ofmyknowledete."-.UlIIKCUnwcldu.1O....l;:&4l..(.)andrn.anner..IaUId...... . ._... ._...... ..... ........ ... .PAONOUNC!HG AND CERTIFYING PHYSICIAN (Phy5lCla(\ tlOltl ,,'OOWnc.f19 aealll and certIIrl(lQ IOcause 01 deatfl\ To U. bMt of my knowle<lg., o..U\ OCC:UrrM.,.... u.n.. d.le, and pIKe, .nd GUIlla IheC&ltM(.) and mann".. ....Ied... . .IIEDICAL EXAMINER/CORONER On the~.. of ....min.Uon and/or in"..Ugalion, in my opinion, de.th occurr.G ..Ihe time, d..e, and place, and due 10 the caY-M(s) and manner...I..ed........ _....... _......... _....................... _... ..............._........... .... .......... _.. 31.. REGISTRAR' 13,2,2 t9,21 SlGIUiJ\JAE n T' o 31b. ~~ UCE~R Q 31cu'//2,1'L NAME AND ADDRESS OF PERSON WHOCOMPlETEDCAUSE OF DE1JH Ihem.;,7)~~~~~~ Jtt.,.,..z;ftl "'<) o ,,,-:> E. ">rl"l. ,t:.f=-r Sf 32. ,dU}:;...i. "'''? / DAtE FILfD (Monfl. OlIr. 'lU'I ,.. .. LAST WILL AND TESTAMENT OF AMBROSE KLAIN d.'- 03 -~(P7 I, AMBROSE KLAIN, ofthe Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding do make, publish and declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils made by me. ITEM I: I direct that the expenses of my last illness and funeral shall be paid out of my Estate as soon after my decease as may be convenient. ITEM II: I direct that my body shall be interred at the Beth Shalom Cemetery in the gravesite which I have chosen and paid for during my life. In the event that any charges or expenses of my burial and interment shall not have been paid for during my life, then and in that event, I direct my Executrix or Substitute Executors to payout of my Estate those charges and expenses. Furthermore, I direct that all arrangements for my burial, and the performance of all ceremonies and services connected therewith shall be arranged and performed with strict observance to the traditions of the Jewish faith and according to the religious teachings and requirements of the Jewish faith. All expenses of these directions shall be paid by my Executrix or Substitute Executors out of my Estate. ITEM III: The rest, residue and remainder of my Estate, real, personal and mixed, I give, devise and bequeath unto my beloved wife, PHYLLIS M. KLAIN. ITEM IV: In the event that my wife, PHYLLIS M. KLAIN, should predecease me (For the purposes of this, my Last Will and Testament the word "predecease" shall be construed 1 to include simultaneous deaths, deaths within sixty days after the death of the "predeceased" individual, or deaths under circumstances in which it cannot be determined whether I or the "predeceasing" individual died first.) then and in that event I give, devise and bequeath the rest, residue and remainder of my Estate, real, personal and mixed, unto my beloved sons, MATTHEW NEWTON KLAIN and DANIEL FRASER KLAIN, according to the following terms: (A) Share and share alike; except that, in the event that both sons are able to agree as to which should take any particular item or items, then the subject or subjects of such agreement shall pass specifically to the agreed upon individual. (B) In the event that one of my sons shall predecease me then the portion of my Estate that would otherwise have passed to that son shall pass to his issue per stit:pes, or in the event ofa failure of his issue, to the other. (C) In the event that both of my sons should predecease me leaving issue, then the shares otherwise going to each individual son shall go to that son's issue per stirpes. ITEM V: I direct that all legacies and shares, while in the hands of my Executrix or Substitute Executors, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any legatee or beneficiary, and shall not be subject to pledge, assignment, conveyance or anticipation. 2 ITEM VI: I direct that all estate, inheritance and succession taxes shall be paid out of my residuary estate to the same effect as if said taxes were expenses of administration, and that all life insurance proceeds, property held with my said wife as tenants by the entireties, legacies, devises and other gifts made by this, my Will, or by any Codicil hereto, shall be free and clear thereof; in the absolute discretion of my Executrix or Substitute Executors, she/they may pay such taxes immediately, or may postpone the time of payment of taxes on future or remainder interests until possession thereof accrues to the beneficiaries. ITEM VII: A. I direct that my Executrix or Substitute Executors shall have the power: For the payment of debts or for any purpose of administration or distribution, to sell, mortgage, lese, alter, improve, partition and exchange all or any of my real estate, and to sell the same public or private sale, for such prices and upon such terms as to cash and credit as she/they may deem best or upon the reservation of ground rents and the said ground rents in turn to extinguish or assign, and to grant and convey good and sufficient title, without liability on the part of the purchasers to see to the application of the purchase or consideration monies. This power shall not be construed to work a conversion of the real estate unless and until the power is actually exercised. B. To sell and transfer, either in person or by attorney, all stocks, bonds, investments and other personal property owned by me without liability on the part of the purchasers to see to the application of the purchase or consideration monies. C. To borrow such sums of money as may be required for the purpose of the Estate, and to secure the loan by a pledge of all or any part of my Estate property, or mortgage, 3 and to execute an accompanying bond authorizing or other evidence of indebtedness. Persons or corporations advancing money to the Executrix or Substitute Executors need not inquire into the necessity. ITEM VIII: I hereby nominate, constitute and appoint PHYLLIS M. KLAIN, my wife, as Executrix of this, my Last Will and Testament. In the event that PHYLLIS M. KLAIN shall predecease me or die prior to the settlement of my Estate, I then nominate, constitute and appoint my sons, MATTHEW NEWTON KLAIN and DANIEL FRASER KLAIN as Substitute Co-Executors of this, my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5 ~ay of ~~ ,2000. 'I C1.~,~ 19' L c~ ~~{;.t:/-/c ~ ~ AMBROSE KLAIN The preceding instrument, consisting of this and three (3) other pages, was on the date thereof signed, published and declared by AMBROSE KLAIN, the Testatrix therein named, as and for his Last Will and Testament 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 hereto. !f--~-l.-' ~ {~l--(t~.-vV Residing bool ~~ Xd-, )z~~~" .~ ,04 ./ I (// ;cvT /j~,-,/J iv~'d' Residing 313 R- 4.). .xfj-e'L~~J< v(~/ C~-'r flA 17 () 2/J' 4 .,~ ." COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF C ('11; 6 e Ie t~A Ai,6 ) WE, AMBROSE KLAIN, an? ,,_.!u. ;( (, -.JVcA-r>u , and k~~~~ ,j (u df.l:r ' the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will, and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Q~?-..{~c;;-c~z( e~ ~ ~:/v~ AMBROSE KLAIN / ~(uuuljtUtftp WItness ~~~~ / Witness Subscribed, sworn to and acknowledged before ~e by AMBROSE KLAIN, the Testator, and subscribe~ and sworn to before me by ~'-~ X) ({,,-d,.J...Jv<L--eryJ , and ,.Lc~~.;' Lu-<.-I:J.:J[ , witnesses, this ~ day of .L..LL / ,200 . ~>>teUu~ Not Pub!" Notarial Seal Catherine J. Walters, Notary Public Camp Hill Bora, Cu:nberland County My Commission Expires Sept. 22, 2003 Member, Pennsylvania AsSOCiation ot Notaries 5 c/ Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) f4Ub~C)8'.e t<\Q.GV\ fV\{~1 ~ I ZVO) 2-003 - cOO z... c; 7 Admin. No. Date of Death: Will No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a served on or mailed to the following beneficiaries of the above-captioned estate on Name Address -Ply \ l i ~ N" K( ((l 'Cl. , "2. 0 G,,-, ",--cl h~ Ca.,,^/, li/Il.A (701/ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: S;gnature j ~ JUvL~ Name LvOV0; _kf\\~t~ Address '2-1 L{ 5fut -e 5i- 3(.U1-^,~j ~LLj, IJ6l pOI I Telephone (7IZ) ?;,., '30 '-r / 1/7 l""\ If) ...- 2: r- I -.-.J ::::l J p " Li s.:: ..,J ::::: :.56 Capacity: _ Personal Representative LCounsel for personal representative __f:h, '(f:::<;f\JI)t:) /'/-~ -/.::;v l---"" REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 0267 COUNTY CODE vEAR NUMBER I- Z W o W U w o DECEDENTS NAME (LAST FIRST, AND MIDDLE INITIAlj Klain, Ambrose DATE OF DEATH (MM-OD-YEAR)I DATE OF BIRTH (MM-DD-YEAR) 03/03/2003 03/24/1910 (IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Klain, Phyllis THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 294-36-2956 SOCIAL SECURITY NUMBER 297-42-8779 W I- :.:::$CJl uIX:':: wQ.u :rOO uIX...I Q.1lI Q. < ~J 1. Original Return [J 4. limited Estate [~] 6. Decedent Oied Testate (AI1.o" mpy of W,fi! [] 9 litigation Proceeds Received o 3. Remainder Return (date ofde.th poor'o 12-13-112) o 5. Federal Eslate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) iAr",cn Son 0) 02, Supplemental Return o 4a. Future Interest Compromise (dale of death .r.., 12-12-82) o 7. Decedent Maintained a living Trust (Attach OOPY of T ",sl) o 10. Spousal Poverty Credit ,date cf oealo belw""" 12-31-91 and 1-1-95) I- Z W C Z o Q. trJ W 0:: 0:: o U THIS secnoN MUST SI!,CoIIPLeTED. ALL.CORReSPONOENCEANDCON~,.~III4FOR11A11()N SHOUlD ~e DlRECTEO TO: NAME COMPLETE MAILING ADDRESS Louis R. Martin 214 State Street FIRM NAME (If Ap"~''-<1t;'.i Harrisburg, PA 17101 TELEPHONE NUMBER (717) 230-9715 1. Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) (3) (4) (5) 6,659.79 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable {Sriledule OJ z o ~ ..J ::J t:: a.. <e( U w 0::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Ollned Property (Schedule F) o Separate Billing Requested (6) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) (7) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (8) 6,659.79 (9) (10) 9,803.16 m___.__________._____.~!.~L~.:.~~_ (11) (12) 13,279.82 ---------_::~&~Q:Q~-_.... 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule Ii 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental BeQuests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) (13) (14) -6,620.03 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::J a.. :ii: o U ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 (15) 0.00 x .0 16. Amount of Line 14 taxable at lineal rate xO (16) __ 17. Amount of Line 14 laxable at sibling rate x .12 (17) ____.___m._.___.__._._.__._.m.___ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20. [J CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSe SIDE AND RECHECK MATH < < . Decedent's Complete Address: TREET ADDRESS 20 Grinnel Drive CITY Camp Hill STATEpA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2, CreditsiPayments A Spousal Poverty Credit 8. Prior Payments C. Discount ZIP 17011 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) TotallnterestJPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) A. Enter the interest on the tax due. B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 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 a, retain the use or income of the property transferred;,.........................................................,..........,..............,..... 0 b. retain the right to designate who shall use the property transferred or its income; ..,..................................,...... 0 c. retain a reversionary interest; or.,........."..,.........,....."..,.................,.......,..,...,..,...........,..........................".."...... 0 d. receive the promise for life of either payments, benefits or care? ....,......,......'................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....,..,...,.,..."....,.......".......",.,......"......,.........",..,"........."...........",.....". 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............., 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..,................,...,...,..........."....,.........,.....,.......,....,.....,...............,............"......... 0 No ~ ~ ~ ~ ~ ~ ~ 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 penalties of perjury, I declare that I have examined this return, induding accompanying schedules and slalemeo1s, and to the best of my knowledge and belief, tt is true, correct and comp/ele. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. SIGNA~~~.SJfLP-E~SON R~SPONSIBLE FOR FILING RETURN J.-L. -1 \.~j V' \ 0.--" ~ -t 1<'( eJ..'1 ('\ ADDRESS 'C.- () 6 rvl. "'".e. U~......JII'- ~~L-l~PJ fLt /"16(1 P . J ~ SIGNATURE OF PREPARE~ OTHERT~A~ REPRESEN~ATIVE ~~ 1\.!4~ ADDRESS '2..~" ~1-~..t... 7"t-' ~~~,~!~ L ')10\ 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. 39116 (a) (1.1) (iii, DATE DATE " , /z., ( f>:? 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 PS. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disciosure of assets and filing a tax return are stiil applicable even if the surviving spouse is the on'y beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net vaiue 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 stepparent of the chi'd is 0% [72 P,S. 39116(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, 39116(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, 39t16(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-15U8 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ambrose Klain FILE NUMBER 21030267 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 NUMBER DESCRIPTION 1. Citizens Bank Checking Account #610077-226-8 VALUE AT DATE OF DEATH 6659,79 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 6,659.79 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ambrose Klain SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21030267 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Reese Funeral Home 8605.41 Transfer from Indiana, PA to Camp Hill, PA - John Lesetah 270,00 8, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Phyllis M. Klain Social Security Number(s)/EIN Number of Personal Representative(s) 294-36-2956 Street Address 20 Grinnel Drive City Camp Hill State ~Zip 17011 Year(s) Commission Paid: 2. Attorney Fees SOO.OO 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4, Probate Fees 427.75 5. Accountant's Fees 6, Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 9,803.16 (If more space is needed, insert additional sheets of the same size) REV-151HX+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ambrose Klain FILE NUMBER 21030267 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Presbyterian Homes 2. Citizens Ambulance Service 3, Dr. Klain VAlUE AT DATE OF DEATH 1750.66 476.00 1250.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 3,476.66 LAST WILL AND TEST AMENT OF AMBROSE KLAIN I, AMBROSE KLAIN, of the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding do make, publish and declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils made by me. ITEM I: I direct that the expenses of my last illness and funeral shall be paid out of my Estate as soon after my decease as may be convenient. ITEM II: I direct that my body shall be interred at the Beth Shalom Cemetery in the gravesite which I have chosen and paid for during my life. In the event that any charges or expenses of my burial and interment shall not have been paid for during my life, then and in that event, I direct my Executrix or Substitute Executors to payout of my Estate those charges and expenses. Furthermore, I direct that all arrangements for my burial, and the performance of all ceremonies and services connected therewith shall be arranged and performed with strict observance to the traditions of the Jewish faith and according to the religious teachings and requirements of the Jewish faith. All expenses of these directions shall be paid by my Executrix or Substitute Executors out of my Estate. ITEM III: The rest, residue and remainder of my Estate, real, personal and mixed, I give, devise and bequeath unto my beloved wife, PHYLLIS M. KLAIN. ITEM IV: In the event that my wife, PHYLLIS M. KLAIN, should predecease me (For the purposes of this, my Last Will and Testament the word "predecease" shall be construed 1 to include simultaneous deaths, deaths within sixty days after the death of the "predeceased" individual, or deaths under circumstances in which it cannot be determined whether I or the "predeceasing" individual died first.) then and in that event I give, devise and bequeath the rest, residue and remainder of my Estate, real, personal and mixed, unto my beloved sons, MATTHEW NEWTON KLAIN and DANIEL FRASER KLAIN, according to the following terms: (A) Share and share alike; except that, in the event that both sons are able to agree as to which should take any particular item or items, then the subject or subjects of such agreement shall pass specifically to the agreed upon individual. (B) In the event that one of my sons shall predecease me then the portion of my Estate that would otherwise have passed to that son shall pass to his issue per stirpes, or in the event of a failure of his issue, to the other. (C) In the event that both of my sons should predecease me leaving issue, then the shares otherwise going to each individual son shall go to that son's issue per stirpes. ITEM V: I direct that all legacies and shares, while in the hands of my Executrix or Substitute Executors, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any legatee or beneficiary, and shall not be subject to pledge, assignment, conveyance or anticipation. 2 ITEM VI: I direct that all estate, inheritance and succession taxes shall be paid out of my residuary estate to the same effect as if said taxes were expenses of administration, and that all life insurance proceeds, property held with my said wife as tenants by the entireties, legacies, devises and other gifts made by this, my Will, or by any Codicil hereto, shall be free and clear thereof; in the absolute discretion of my Executrix or Substitute Executors, she/they may pay such taxes immediately, or may postpone the time of payment of taxes on future or remainder interests until possession thereof accrues to the beneficiaries. ITEM VII: A. I direct that my Executrix or Substitute Executors shall have the power: For the payment of debts or for any purpose of administration or distribution, to sell, mortgage, lese, alter, improve, partition and exchange all or any of my real estate, and to sell the same public or private sale, for such prices and upon such terms as to cash and credit as she/they may deem best or upon the reservation of ground rents and the said ground rents in turn to extinguish or assign, and to grant and convey good and sufficient title, without liability on the part ofthe purchasers to see to the application of the purchase or consideration monies. This power shall not be construed to work a conversion of the real estate unless and until the power is actually exercised. B. To sell and transfer, either in person or by attorney, all stocks, bonds, investments and other personal property owned by me without liability on the part of the purchasers to see to the application of the purchase or consideration monies. C. To borrow such sums of money as may be required for the purpose of the Estate, and to secure the loan by a pledge of all or any part of my Estate property, or mortgage, 3 and to execute an accompanying bond authorizing or other evidence of indebtedness. Persons or corporations advancing money to the Executrix or Substitute Executors need not inquire into the necessity. ITEM VIII: I hereby nominate, constitute and appoint PHYLLIS M. KLAIN, my wife, as Executrix of this, my Last Will and Testament. In the event that PHYLLIS M. KLAIN shall predecease me or die prior to the settlement of my Estate, I then nominate, constitute and appoint my sons, MA TIHEW NEWTON KLAIN and DANIEL FRASER KLAIN as Substitute Co-Executors ofthis, my Last Will and Testament. /.-- /J..--. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~~ , 2000. J CL7-c-~ Ii L c~ -f4!:f/-;(~---, c/ ~.'- 7 AMBROSE KLAIN / The preceding instrument, consisting of this and three (3) other pages, was on the date thereof signed, published and declared by AMBROSE KLAIN, the Testatrix therein named, as and for his Last Will and Testament 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 hereto. r-4~ ~ {~LAt~,-vV Residing beol v{'~ XcL>fz~~--"t-ut~? ,/ ". ~4 ((;; ruT /~-viJ W~(f Residing .3/3 R- tJ ~-tL-l~t ~~. / C~~ fl/l /7 tJ //J 4 COMMONWEALTH OF PENNSYL VANIA ) ) SS: COUNTY OF CO/h6e~L-AIJt) ) WE, AMBROSE KLAIN, and.l ~~'r-i-u-^;f t~AA_fh-' , and j' ;I~~ ,; {J../ ,t.J:.J:t;r ' the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will, and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. C2:!,,~?-.--{~~~<k t!.Q~k:/V/ AMBROSE KLAIN / ~~uP~ . WItness ~;;2~ / Witness Subscribed, swo.rn to and acknowledge'h~efore ~e bYA.~MBROSE KLAIN, the Testator, and subscribed and sworn to before me by ;P:d'--~~;;( ~~>-rJ , and klit,...._v,6 tLJ.J:.C.1f ' ~tnesses, this ~ day of ~~LLJ ,200 . ~Me_UL~~ Publi Nota.rial Seal . Catherine J. Walters, Notary Public Camp Hill Boro, _Cu:nberlancl S:ounty My Commission Expires Sept. ;:2, 2003 Member, Pennsylvania Association ot Notaries 5 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX LOUIS R MARTIN 214 STATE ST HBG DATE ESTATE OF DATE OF DEATH FILE NUMBER 'COUNTY ACN 02-02-2004 KLAIN 03-03-2003 21 03-0267 CUMBERLAND 101 '* .j REY-1547 EX AFP !OI-OSI AMBROSE PA 17101 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i5'4-j-i3f-AFP--foY:03Y-NoYici--oF-YtiHiR-iTANcE-YA'x-APPRAIsiifENT~--Ai:.l-owAifCE-(fR-------------- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KLAIN AMBROSE FILE NO. 21 03-0267 ACN 101 DATE 02-02-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 6,659.79 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 9,803.16 3,476.66 (11) (12) (13) (14) NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 6,659.79 13.279 82 6,620.03- .00 6,620.03- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045 = .00X12= .00X15= (19)= .00 .00 .00 .00 .00 .~... ""''''''.Lr (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE...-('l... A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) '15 } J RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future 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 COMMonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or Money order payable to: REGISTER OF If ILLS . AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, May be requested by COMpleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). OBJECTIONS: 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: --written protest to the PA DepartMent of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter deterMined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this asseSSMent should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post AsseSSMent Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of adMinistratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% 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 would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will 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 198Z through Z003 are: Interest Daily Interest Daily Interest Rate Factor Year Rate Factor Year Rate Year Daily Factor 198Z ZO% .000548 1987 9% .000Z47 1999 7X .00019Z 1983 16% .000438 1988-1991 11% .000301 ZOOO 8% .000Z19 1984 11% .000301 199Z 9% .000Z47 ZOOl 9% .000Z47 1985 13% .000356 1993-1994 7X .00019Z ZOOZ 6% .000164 1986 10% .000Z74 1995-1998 9% .000Z47 Z003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If paYMent is Made after the interest computation date shown on the Notice, additional interest must be calculated. .~ IN THE COURT OF COMMON PLEASPF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose Klain, Deceased 03-03-2003, File Number 21 03-0267 ORDER OF COURT AND NOW, upon presentation of the within Petition, itis hereby ordered and decreed that Barbara Peace, is hereby appointed custodian of Merrill Lynch Account Number 74139716 for Abigail Peace Klainand Number 74139695 for Zoe Anna ~ ! Peace Klainwith authority to equalize deposits in each account and to transfer ' accounts to other appropriate investors, if so desired. 1~a., 'r,. .u>.~ BY THE COURT: ~m>: 1.10-05 ~~'1LUsMN ' bR.IY1~TfflE:w ~/J<I-~k MR, LowsmAR.llNBSQ.. 20 3:' co;g m~("') ::n r- ,,- m , :0 ~u3:;A 000 00"" oc: , ::0 ~-1 )> ,...;) c:::lI c:::lI c:.1'f <- ;:po. % o -0 ::J: 'f? ~~. Qa ;')5 ::0 :--,j CJ IT''1cn :::0 C? C)O --n-n ...-z-:-::D ~.C-) r- rn EDo -n - IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose KIain, Deceased 03-03-2003, File Number 21 03-0267 AMENDMENT TO PETITION TO APPOINT A NEW CUSTODIAN FOR TWO UNIFORM GIFTS TO MINORS ACCOUNTS TO THE HONORABLE, THE JUDGES OF SAID COURT: ,--) :~.j The Petition on behalf of Phyllis Klain, Executrix of the referenced Estllt;e-;-' respectfully represents that: I. A Petition to name a replacement custodian for two accounts was filed with the Prothonotary of Cumberland County on December 10, 2004, a copy of which is attached hereto as Exhibit A. 2. An Order answering the prayer of the Petition was issued by the Court on January 10,2005, a copy of which is attached hereto as Exhibit B. 3. The account numbers included in the proposed Order by the Petitioner were incorrect. 4, The correct account numbers are: for Abigale Peace Klain #8BA35C 15 And for Zoe Anna Peace Klain #8BA35CI8. 5, Accordingly, a proposed new Order with the corrected numbers is included. r:'? WHEREFORE, your Petitioner prays your Honorable Court to order and direct the appointment of Barbara Peace as custodian ofthe Merrill Lynch Uniform Gift to Minors account #8BA35C15 for Abigale Peace Klain and custodian of Merrill Lynch Uniform Gift to Minors account #8BA35C18 for Zoe Anna Peace Klain. Respectfully submitted, -K~lU~ Louis R. Martin, Esq., Pa. ID No. 1984 214 State Street, Harrisburg, P A 17101 Phone Number: 717-230-9715 Attorney for the Estate of Ambrose K1ain --- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose Klain, Deceased 03-03-2003, File Number 21 03-0267 PETITION TO APPOINT A NEW CUSTODIAN FOR TWO UNIFORM GIFTS TO MINORS ACCOUNTS TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition on behalf of Phyllis Klain, Executrix of the referenced Estate, respectfully represents that: 1. The former Ambrose Klain died on March 3, 2003 and his will was presented for probate on March 27, 2003. 2. Letters testamentary were issued to his widow, Phyllis Klain, on March 27, 2003. A short certificate is attached hereto as Exhibit A. 3, Ambrose Klain had established uniform gift to minors accounts for his two granddaughters, Abigail Peace Klain, bom March 21, 1997 and currently residing at 1795 Barkley Road, Clarksburg, Pa, 15725 with her parents Dr. Mathew Klain and Barbara Peace and Zoe Anna Peace Klain bom May 10, 1994 and also residing with her parents at the same address. 4. Mr. Klain was the custodian of these accounts with the investment firm of Merrill Lynch. The account for Abigale Peace Klain is #74139716. The account for Zoe Anna Peace Klain at Merrill Lynch is #74139695, 5. Merrill Lynch requires a court order appointing a new custodian in order to amend the account as desired. (Requirement document attached as Exhibit B.) EXHIBIT A 6. In the absence of Mr. Klain, petitioner on behalf of the Executrix of the Estate requests this Honorable Court to appoint her daughter-in-law, the mother of Abigail and Zoe Anna, Barbara Peace as custodian of both accounts. Your petitioner further requests this Honorable Court the authority to equalize the deposits in each account and if so desired, transfer the accounts. to a different investor. WHEREFORE, your petitioner prays your Honorable Court to order and direct the appointment of Barbara Peace as custodian of the Merrill Lynch Uniform Gift to Minors account #74139716.for Abigail Peace Klain and custodian of Merrill Lynch Uniform Gift to Minors account #74139695 forZoe Anna Peace Klain. Respectfully submitted, Louis R. Martin, Esq., Pa. ID No. 19843 214 State Street, Harrisburg, Pa. 17101 Phone Number: 717-230-9715 Attorney for the Estate of Ambrose Klain u_ Oco -' u.J _ ..: C_),;;::,; E~ -~:- .-_...... ~---' c") L'_J L_:_) '__ ,- {-~ - '..--' .' Or.:.::- C')L'.! t--:--'c:::. a: Bac&IT7 y 1i:n .IAN II 200s D[e J 0 20D4 f IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose Klain, Deceased 03-03-2003, File Number 21 03-0267 ORDER OF COURT AND NOW, upon presentation of the within Petition, it is hereby ordered and decreed that Barbara Peace is hereby appointed custodian of Merrill Lynch Account Number 74139716 for Abigail Peace Klain and Number 74139695 for Zoe Anna Peace Klainwith authority to equalize deposits in each account and to transfer accounts to other appropriate investors, if so desired. ...::fA IJ u.PrR'I 10 I dO 0 5.. BY THE COURT: \::,\ ~O.I~ 't N (') o:~ ~ tt; c~ u~CC' C">Ct-, :x; (f) ~':~'. a:- < w.J ~ _.~ _.J ~ C:-. r ......J-.,.' .........0-0:., 0:: -os a:=; u ..;;'..- 0- c:> ~ :a: -, u-> = = c-.. EXHIBIT B STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I , DONNA M. OTTO Register for the Probate of wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 27th day of March A.D" Two Thousand and Three, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of KLAIN AMBROSE (LA~l, t~K~l, M~UUL~i , late of CAMP HILL BOROUGH in said county, deceased, to KLAIN PHYLLIS M (LA~l, t~K~l, M~UUL~) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 27th day of March A,D., Two Thousand and Three. File No. PA File No. Date of Death S.S. # 2003-00267 21-03-0267 3/03/2003 ~ rflN:t.tl lId KJ'f"'~6 {JPr~,OI~O ~1J 297-42-8779 Register NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL El<.A,Jd A Merrill Lynch P.O. Box 29002 Hot Spring, AR 71903-9002 TOTAL MERRill" Important Notice This letter is in regards to your account. In order to process this account, we will need the following: . Certified copy of the custodian's Death Certificate, . Copy of the minor's birth certificate. . Court Order appointing a new custodian dated within 60 days of Merrill Lynch receipt stating they are in full force and effect with a visible court seal. . Letter of Authorization from the successor custodian accepting custodianship of the account. . Client relationship agreement completed and signed by the new custodian. . New Custodian must call 888-657-8278, option 1, in order to be profiled. The forms listed above typically contain adequate information to complete your request. However, upon review additional infOlTnation may be required. When sending documentation, please follow the procedures listed bekm: . Please make a copy of any document you are sending to Merrill Lynch. . Please write the account number on the upper right comer of any documentation you send. . Please be sure to use the endosed, aldressed retum envelope. To ensure proper handling of all requests, please do not personally address any correspondence to Merrill Lynch employees by name, If you have any questions, please contact the Merrill Lynch Legal & Estate Team at (888) 654-6837, and ask for extension 0835. Mail all documents to: Merrill Lynch P.O. Box 29002 Hot Springs, AR 71903-9002 LEll Ey.h,J,it t3 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/02/2005 MARTIN LOUIS R 214 STATE STREET HARRISBURG, PA 17101 RE: Estate of KLAIN AMBROSE File Number: 2003-00267 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO, 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 3/03/2005 Your prompt attention to this matter will be appreciated, Thank You. Sincerely, ,&~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ,} . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ambrose K1ain Date ofDeath: 0}-0}-200} E 21-0}-0267 state No.: 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 ~hether administration of the estate is complete: . Yes ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a fmal account with the Court? Yes 0 No E9 b, The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes jgi No 0 Date: 2/16/05 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the O\1lhans' Court and may be attached to this report. D 6-... .(~(Q~J.AAGtM~A~ Signature Louis R. Martin, Esq. Name 214 state st., Harrisburg, PA 17101 Address 717-2)0-9715 Telephone No, Capacity: 0 Personal Representative JZl Counsel for personal representative ..)--- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose Klain, Deceased 03-03-2003, File Number 21 03-0267 PETITION TO APPOINT A NEW CUSTODIAN FOR TWO UNIFORM GIFTS TO MINORS ACCOUNTS -u ='-c N , -->~ 0 1. The former Ambrose Klain died on March 3, 2003 and his will was presented for probate on March 27, 2003. 2. Letters testamentary were issued to his widow, Phyllis Klain, on March 27, 2003. A short certificate is attached hereto as Exhibit A. 3. Ambrose Klain had established uniform gift to minors accounts for his two granddaughters, Abigail Peace Klain, born March 21, 1997 and currently residing at 1795 Barkley Road,'Clarksburg, Pa.. 15725 with her parents Dr. Mathew Klain and Barbara Peace and Zoe Anna Peace Klain born May 10, 1994 and also residing with her parents at the same address. 4. . the deceased Mr. Klain was the custodian of these accounts with the investment firm of Merrill Lynch. The account for Abigale Peace Klain is #8BA35C15. The account for Zoe Anna Peace Klain at Merrill Lynch is #8BA35C18. v t--.:l <c:o;) c::> e;'" (/) r"1 ~'O r,) U1 --'0 rn C) . c""") ...u I:~~ C) c,C) Ii -n -n : C) -- n"1 ,...n,-::J "'1 t . 5. Merrill Lynch requires a court order appointing a new custodian in order to amend the account as desired. (Requirement document attached as Exhibit B.) 6. In the absence of the deceased Mr. Klain, petitioner on behalf of the Executrix of the Estate requests this Honorable Court to appoint the Executrix, Phyllis Klain. Your petitioner further requests this Honorable Court the authority to equalize the deposits in each account and if so desired, transfer the accounts to a different investor. WHEREFORE, your petitioner prays your Honorable Court to order and direct the appointment of Phyllis Klain as custodian of the Merrill Lynch Uniform Gift to Minors account #8BA35C15 for Abigail Peace Klain and custodian of Merrill Lynch Uniform Gift to Minors account #8BA35C18 for Zoe Anna Peace Klain. Respectfully submitted, ~<LrJL Louis R. Martin, Esq., Pa. 10 No. 19843 214 State Street,' Harrisburg, Pa. 17101 Phone Number: 717-230-9715 Attorney for the Estate of Ambrose Klain t f\(~J~ ~ STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, DONNA M. OTTO Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 27th day of March A.D., Two Thousand and Three, Letters TESTAMENTARY estate of KLAIN AMBROSE (LJ\~T, 'J:';l.K~T, Ml.UUL~) in common form were granted by the Register of said County, on the , late of CAMP HILL BOROUGH in said county, de~eased, to .~.:_~-~~---<: KLAIN-~PHYLLIS M (~'l.', l'"l.K::>T, Ml.UUL~) ,.....'.'"'.... and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 27th day of March A.D., Two Thousand and Three. File No. 2003-00267 PA File No. 21-03-0267 Date of Death 3/03/2003 ~.{Y)rti-n ~'~~I h~ .p>.r 9-. O.u.09~ Register S.S. # 297-42-8779 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ~X.h"h;t A . .JO Merrill Lynch P.O. Box 29002 Hot Spring, AR 71903-9002 ..- \ l~' TOTAL MERRILL- Important Notice This letter is in regards to your account In order to process this account, we win need the following: · Certified copy d the custodian's Death Certificate. · Copy of the minor's birth certificate. · Court Order appointing a new custodian dated within 60 days of Memn lynch receipt stating they are in fuI fort:e and effect with a visIJIe 00lIt seal. · Letter d Aulhorizationi9m the suocesso.alStDdian ~ 0JSt0cianship d the a<XXllI1l ",~w6i-';' ,._,.~";'., · Client relationship ~ ~ and signed by IhEtnew alStodian. · New Q IStodan roost caI 888-657-8278, option 1, i1 order b be prdiIed. The fonns isted above t)1licaIy oonlain ~ tale information b COIllJIete ycx.r request. Ho.YeYer, ~ I'e'v'iew adcitional infan dion may be reqlftd. When sending cbct.mentation, please tlbN the procedues listed beloN: · Please make a copy ct any doct.ment yoU are sending to Merrillynch. · Please write the account number on the upper right comer of any documentation you send. · Please be sure to use the enclosed. a:kIressed retlm envelope. To ensu-e proper handing of all requests, please do not personaIy address any correspondence to Menilllynch employees by name. If you have any questions, please contact the Merrill Lynch legal & Estate Team at (8SS) 6~37, and ask for extension 0835. Mail all documents to: Merrillynch P.O. Box 29002 Hot Springs, AA 7190:HlOO2 LEll E'ih i".tf-.8 IN RE: THE ESTATE OF AMBROSE KLAIN IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-0267 IN RE: PETITION TO APPOINT NEW CUSTODIAN FOR TWO UNIFORM GIFTS TO MINORS ACCOUNTS ORDER AND NOW, this 3*:i day of October, 2006, a rule is issued on Dr. Matthew Klain and Barbara Peace, natural guardians of Abigail Peace Klain and Zoe Anna Peace Klain, to show cause why the relief requested in the within petition ought not to be granted. This rule returnable fifteen (15) days from service. Service hereof by certified mail is authorized. BY THE COURT, --:,5 -'- J \:.) o w c... c C LIl .-"I U.S. Postal Service CERTIFIED MAIL RECEIPT (DomestIc Mall Only; No Insurance Coverage ProvIded) c <tr c:o LIl 63 -).~1 Postmark Return Receipt Fee f (:::=~::i: (JLU (H~ '5 (Endorsement Required) c1 tft Total Postage & Fees $ . / SentToLwlb ILl JVlu. tfW {U ~ D ~ ~ -~tJ~:::.:o~.; m___________hn__m___..____________n_____.._____ ------ ------------ ~ -City,- State.-Zip+4---- - --- -, -- - --- - - - - -- - ----- -- -- -- ---- ---- ---- - - --- - ____n__ - - --- - - -- - - -,- Postage $ Certified Fee ..D C C C C .-"I LIl ru I . C,~t- F=lt~ "IS'- rUt Iii ttl..ctlons m ..D .::r .-"I U.S. Postal Service CERTIFIED MAIL RECEIPT (DomestIc M,III Only; No Insurance Covel age Provided) C IT" c:o LIl Postage $ Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) I ( I I H t I I( r III tIll 111111", ..D Ul .::t' .-"I U.S. Postal Service CERTIFIED MAIL RECEIPT (DomestIc Mail Only; No Insurance Coverage ProVIded) e IT" CO LIl Postage $ Certified Fee Postmark ...a e o c Here, ~A.Ak ~f~ lfl f5 rJ'1f Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) o M Total Postage & Fees $ U1 : _~~~~~~_ ..m_\I.JJ!__s__~Jf\lcn_________________n_______ ____n___n.._ Street, Apt. No.f o or PO Box No. e ['- -City,'Stafe,-Z{P+4- ---- -- -- ------. - .-- - - -- -- -- --.. -- --. - -- -" - - --- - ------, - -- - -" - ---- I I I II [II I JIIII 11(11 )( I lit \,11 t t II III (lll( 11(/11, I .. v- .~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: The Estate of Ambrose Klain, Deceased 03-03-2003, File Number 21 03-0267 PETITION TO APPOINT A NEW CUSTODIAN FOR TWO UNIFORM GIFTS TO MINORS ACCOUNTS TO THE HONORABLE, THE JUDGES OF SAID COURT: () The Petition on behalf of Phyllis Klain, Executrix of the referenced Est~:&~~ respectfully represents that: ) 1." -~ 1. , --: 0 The former Ambrose Klain died on March 3, 2003 and his will was presented for probate on March 27,2003. 2. Letters testamentary were issued to his widow, Phyllis Klain, on March 27, 2003. A short certificate is attached hereto as Exhibit A. 3. Ambrose Klain had established uniform gift to minors accounts for his two granddaughters, Abigail Peace Klain, born March 21, 1997 and currently residing at 1795 Barkley Road, Clarksburg, Pa. 15725 with her parents Dr. Mathew Klain and Barbara Peace and Zoe Anna Peace Klain born May 10, 1994 and also residing with her parents at the same address. 4. . The deceased Mr. Klain was the custodian of these accounts with the investment firm of Merrill Lynch. The account for Abigale Peace Klain is #8BA35CI5. The account for Zoe Anna Peace Klain at Merrill Lynch is #8BA35C18. 1'--" ~~5 r::.t'" ....,.... ..... r~ (J l("J ~;~ ;:0';.::', c=.J C) C) . -; ~i . (-) ::~~ \':~11 (I) cq "0 r'.) U\ i:-? -~ '. 5. Merrill Lynch requires a court order appointing a new custodian in order to amend the account as desired. (Requirement document attached as Exhibit B.) 6. In the absence of the deceased Mr. Klain, petitioner on behalf of the Executrix of the Estate requests this Honorable Court to appoint the Executrix, Phyllis Klain. Your petitioner further requests this Honorable Court the authority to equalize the deposits in each account and if so desired, transfer the accounts to a different investor. WHEREFORE, your petitioner prays your Honorable Court to order and direct the appointment of Phyllis Klain as custodian of the Merrill Lynch Uniform Gift to Minors account #8BA35C 15 for Abigail Peace Klain and custodian of Merrill Lynch Uniform Gift to Minors account #8BA35C18 for Zoe Anna Peace Klain. Respectfully submitted, ~~fJ~ Louis R. Martin, Esq., Pa. 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Cli ii ~ i cD :-'" "0 "(0 c.. -I/) 0 '(0 ~ ..... :;'u. 6 . ~o!S 0 ~ (OQ) Z ~ q ~(J) ~ ~ t;iIJ Q.. .... f/) .... o(J) Q) "~ 8 :: u:.c..::>Q..l .S - -.:t ~~ .~ + .-; 0- if; ~ -:: N ,....., 6 .g -; -0 "-~ - c: ~ ...; - - to ..... ~ -:: 0 - == Ii :e - - f/) ....:; - - Q) {h.2 - - '- ~U-d ~ ....;. -0 - -0 -:: - to ~~j &<cn - cD ~ ~tJ),...-I --:: E ~~~~g .-:::. to , -::: c: ~..... ~,...-I .... :!!J ~~u~<C - ~ a -:: 0 ~~~p.. 'i3 ~ ~~OoJ C ,..:::. ~ eQ ~ ~u ~ - "t: -0 (Jl a .... -s 0- ~\ 5 'SO 0 ~ ~ w Q) - (() ~ 0, G~uou - ;i -:: Q) \ t; 0: - 0 0- ~ ~ ,", ~ ." c: Z ~ Q) U> ({) . l c-l g I " ~ 0 Z \.~ ? .~ ...... In Re: AMBROSE KLAIN ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-03-0267 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 10/03/06 JUDGE'S INITIALS: KAH TIME STAMP DATE: 10/04/06 IN RE: ORDER OF COURT S RULE ISSUED WHY RELIEF SHOULD NOT BE GRANTED """ '\...".. '" ,... ,...... , ............",,, '\...... ,..........,...." '\" '\""" '" '\ ""..."".... '\ "'" '\.. '\...."" """",..."""'..,,.. ",....".. "".. ".. "'" "" '\ '" SERVICE TO: PHYLLIS KLAIN. MERRILL LYNCH. LOU MARTIN. ESO METHOD OF MAILING: ENVELOPES PROVIDED BY: IZI USPS IZIRRR o HAND DELIVERED o OTHER_ o PETITIONER o JUDGE IZI CLERK OF ORPHANS COURT MAILED: 10-05-06 ...,"'"".. '\..""""...." '\ '\"..""..... ,,,..,,...... '\"".. ""......... '\...,.. '\.." """,......""", '\"""..."..""..... ",...""... '\""" '\....""..... '\ '\" '" "" SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: o USPS DRRR o HAND DELIVERED o OTHER_ o PETITIONER o JUDGE o CLERK OF ORPHANS COURT MAILED: ~ 1/14 ~ Deputy 0 Clerk of Orphans' Court NOV 0 3 2006 INRE: THE ESTATE OF AMBROSE KLAIN i IN THE COURT OF OMMON PLEAS OF CUMBERLAND CO TY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-0267 i MOTION TO MAKE RULE ABSOL~.IE I 1. On September 22, 2006, a Petition to Appoint a New Custodian for Two Uniform Gifts to Minor Accounts was placed in first class mai~ to the Cumberland County Register of Wills and it was filed shortly thereafter. I 2. The Petition seeks to have Phyllis Klain, Execuitrix of the Estate of Ambrose Klain, replace the deceased as custodian for two uni(orm gifts to minors' accounts set up for the granddaughters of the deceased and th~ Executrix. 3. On October 3, 2006, the Honorable Kevin A. ~ess, by order, issued a rule to show cause on Dr. Matthew Klain and Barbara Peace, natwhl guardians of Abigail Peace Klain and Zoe Anna Peace Klain, as to why the relief r~quested in the stated petition ought not to be granted. 4. The Rule was returnable in fifteen days. 5. The time for response to the Rule has passed ~d the natural guardians of the minors have not responded. 6. WHEREFORE, your Petitioner respectfully m~ves the Honorable Court C) ~ ,- t::::l to make the rule absolute and issue the accompanying order. ;; Q Respectfully submitted, ~~~M~2 Loui~ R. Martin, Esq., P . ID No. 19843 214 State Street, Harri;'urg, Pa. 17101 Phone Number: 717-23 -9715 Attorney for Estate of brose Klain ':--? w co -.,::: "J:') r.D C) C) =0 :-;.J t::J c.. _J --r, "Ii o fT1 ::;? I r-v :'2 ~- ~ LOUIS,R. MARTIN COUNSELOR AT LAw -,- October 30,2006 Colleen Myers Cumberland County Courthouse Orphans' Court, Register of Wills Carlisle, P A 17013 I Re: Ambrose Klain - Motion to Make Rule AbSOlut Dear Colleen: 2 I 4 STATE STREET HARRISBURG, PA 1 7 1 0 1 . (717) 230-9715 FAX (71 7) 230-8534 Enclosed please find the Motion to Make Rule Absolut with an attached Order to be certified by the court. I'have also enclosed a check in the ount of$15.00to cover the feels for filing and staniped envelopes for service of the or er. If you have any questions or need additional information, please feel free to co tact my office. Thank you for your assistance in this matter. ~e .t.ru, IY.,YOurs, I., ~,', . . . . ~M~ · Louis . Martin, Fsq. LRM:skj Enclosures Cc: Phyllis Klain --.... ~~ 1'-.,.) c:::-.) ~ e;;:r. :t': <:::) oIO'!:: , N ::::2 --~ r:? w co ::a r-r) C") C) =0 ' r.:-:J r--rl C::J :::::> C) I ' '~ n n"l C'> -71 - I NOV 03 2006 INRE: THE ESTATE OF AMBROSE KLAIN IN THE COURT OF CUMBERLAND CO ORPHANS' COURT NO. 21-03-0267 OMMON PLEAS OF TY, PENNSYLVANIA IVISION ORDER AND NOW, a Rule having been issued by this Court on October 3,2006, giving natural guardians of the minors fifteen days from date of serviJe to show cause why grandmother of the minors should not be appointed as custodi$1 of Two Uniform Gifts to Minors Accounts and no such cause being shown, it is hereby ~rdered and decreed that i Phyllis Klain, grandmother to Abigail Peace Klain and Zoe Anna Peace Klain, is hereby appointed custodian of Merrill Lynch Account #8BA35C15 fO~ Abigail Peace Klain and #8BA35C18 for Zoe Anna Peace Klain, with authority to equ~lized deposits in each account and to transfer accounts to other appropriate investors~ if so desired. p,~ :?':! ~ 6 , BY THE COURT ~I l"'..;l = c::;::) en ~ c::> ~t.:: I W ~ (-) ::T~l .'Tl C5 _ iTl - . . ~~...' ':> OJ 't<~ In Re: Estate of Ambrose Klain ORPHANS'~ CT DIVISION COURT OF CO ON PLEAS OF CUMBERLA COUNTY PENNSYL V ANr : NO. 21-03-0267! CERTIFICATE OF SERVICE OF ORD~ ORDER DATE: 11/3/06 JUDGE'S INITIALS: MLE TIME STAMP DATE: 11/03/06 INRE: I "......"..."..."..."......... "'".......................................................................................................................... ,.................. "'......"..."..." "...................................................... "...... ,,,......,.........,,......,,,, "'... ,............ "'... '" 'I"'''' Order SERVICE TO: Christooher J Marzzacco. Eso. David 1. Lenox. Eso. Victoria 1. {\mbrose. Prosrressive Ins Com. GEICO Insurance. and J. Paul Dilbert- Dent of Revenue I I ENVELOPES ptOVIDED BY: ~ PETITIONE* D JUDGE ! D CLERK OF Q>RPHANS COURT METHOD OF MAILING: ~ USPS DRRR D HAND DELIVERED D OTHER_ MAILED: 11/3/06 SERVICE TO: D USPS DRRR D HAND DELIVERED D OTHER_ I ENVELOPES P*OVIDED BY: D PETITIONER D JUDGE I D CLERK OF iRPHANS COURT I METHOD OF MAILING: MAILED: t:w~Yf~c ~ 1 st Deputy I Clerk of Orphans' ct In Re: Estate of Ambrose Klain T DIVISION ON PLEAS OF CUMBERLA COUNTY PENNSYL VAN ORDER DATE: 11/3/06 NO. 21-03-0267 CERTIFICATE OF SERVICE OF ORDt JUDGE'S INITIALS: KAH TIME STAMP DATE: 11/03/06 IN RE: Order "" , " , '" " '" , " , '" ,. .." " " " " '" , '" "" , "" "" " , "" , " "'" , "" """'" , """'" '" " j' "" " """ "'''' " , SERVICE TO: Phyllis Klain - CC I Louis R Martin Eso - CC I Dr Matthew Klain and Barbara Peace t METHOD OF MAILING: ENVELOPES P~OVIDED BY: [8J USPS [8J PETITIONEt D~ DJUD@ D HAND DELIVERED D CLERK OF ,RPHANS COURT D OTHER_ I I I I MAILED: 11/3/06 I ~~~~;~~. ;~~.......".."...."............""."..... ".."......"" "......... ""."...... r......."....."..... METHOD OF MAILING: ENVELOPES P OVIDED BY: D USPS D~ D HAND DELIVERED D OTHER_ D PETITIONE D JUDGE o CLERK OF jRPHANS COURT MAILED: