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HomeMy WebLinkAbout03-0835PETITION FOR PROBATE and GRANT OF LETTERS Estate of EUGENE F. VON KLAU, II also known as , Deceased. To: Register of Wills County of Cumberland in the Social Security No. 560 - 58 - 1837 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner, who is 18 years of age or older, is one of the personal representatives named in the last will of the above decedent, dated MAY 20, 2003. Decedent was domiciled at death in SOUTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, with her last family or principal residence at 3 LIBERTY DRIVE, MT. HOLLY SPRINGS, CUMBERLAND COUNTY, PENNSYLVANIA 17065. Decedent, then 58 years of age, died SEPTEMBER 16, 2003 at M.S. HERSHEY MEDICAL CENTER, HERSHEY, DAUPHIN COUNTY, PENNSYLVANIA. 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. Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 92,000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: $ TOTAL $ 92,000.00 WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. CAROLYN L. VtI~N KLAU 3 LIBERTY DRIVE MT HOLLY SPRINGS PA 17065 Donna M. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner above-named swears that the statements in the foregoing petition are true and correct to the best of the knowledge of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to and subscribed R~v~''''~ ~. w~ ~' before me this ~St~ayof CA KLAU O~OBER, 2003. . Otto, 1st ~puty ' 21-2003-835 Estate of EUGENE F. VON KLAU, II, deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, OCTOBER 15th2003, in consideration of the petition attached hereto, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated MAY 20, 2003 and described therein, be admitted to probate and filed of record as the last will of EUGENE F. YON KLAU, II and Letters Testamentary are hereby granted to CAROLYN L. VON KLAU. RD~ng~sater of Wills ' FEES Probate, Letters, Etc. $ 20o.oo Short Certificates (6) $ 18.00 ~j~ X-Peges( 3 )$ 9.00 JCP $ 10.00 TOTAL $ 237.00 Filed: October 15th, 2003 C~] ] Attorney's office on 10-15-03 HAROLD S. IRWIN "I((ID NO 2~920) 64 South Pitt Street ~ Carlisle, PA 17013 717-243-6090 105.8115 REV 9/g6 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9609797 No. [)are H105.143 Rev. 2/87 /PRINT -'K INK i COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH AGE(~sI~v) I UNDER1Y~ J UNOER1D~y DATEOFBIR~ 81RTHP~CE'- ,.~ I;'~'~ 1=.560 --58 -- 1837 1~9/16/2003 ' DECEDENT'S USUAL OCCUPATION I KIND OF BUSINESS I INDUSTRY f2tS DECEDENT EVER IN{$pe~ ~.i~ ~ ffi =.~;.~1} MARITAl. STATUS. Ma~, ~ SURVIVING U.S, ~MED FORCES? DECEDENTS EDUCTION DEC~DEN~S ~LING ADDRESS ($~. C~, ~, ~ ~) ~ DECEDENTS INFerNOS NAME (T~nt)I INF~NTS ~ILING ADDRESS (S~ ~, S~, ~ ~e) 23~ I I[~, ~y, Year) SequemiMy list con.i~o.~ b. ,, CAUSE (Disease or inju~ c. r.~}DATE OF INJURY ITIME OF INJURY (Month, D~y. Vllr) r'-~[3oa. Dob M IIIpLACEOFINJURY Athm~e fa 'ltme fa ' j 3~,~...~ (s,.~,,) ~ , CERTIFIER (Chec~ ~ly oee) *PTR~O.~NO ~U N ClN.G AND CERTIFYING PHYSICIAN (Physician IxXh pe0noJnctn- death a ........ "' I ,l INJURY AT WORK? J DESCRIBE HOW INJURY OCCURRED. Y-El NoEl 34. $1GNATIJR~E ~D TITLE ~.F CERTIF.~ ,,,. 7-wJoOn O' DO LICENSE NUMBER OA~ SlGNEO~M~, Day, Ye~) ~. S. Hemhey Med/~] Center Hemh~, PA 17033 21-2003-835 LAST WILL AND TESTAMENT I, EUGENE F. VON KLAU, II, of 3 Liberty Drive, Mt. Holly Springs, Cumberland County, Pennsylvania 17065, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills previously made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at either public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. All the rest, residue and remainder of my property, real and personal, I give, devise and bequeath to my spouse, Carolyn L. Von Klau. 4. If my spouse does not survive me by a period of sixty (60) days, then my estate I give, devise and bequeath as follows: A. 50% to my children, Eugene F. Von Klau, III and Robin P. Requenez, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living; and B. 50% to my spouse's daughter, Nicole S. Gsell, or if she is deceased then to her children, share and share alike. 5. If any beneficiary is under the age of twenty-one (21) at my death, then that beneficiary's share of my estate I give, devise and bequeath to be held in trust by my hereinafter named beneficiary according to the following terms and conditions: The trustee, as well as my representative, is hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property, to or for the use of such beneficiary or to accumulate it in the sole discretion of the trustee. The trustee is also authorized and empowered to pay over to, or for the use and benefit of such beneficiary, such portion of or all of the principal of the trust estate, as in the trustee's sole discretion seems proper for such beneficiary's support, maintenance, education, or medical care. My primary object is to insure the support, maintenance, education and me(~ical care of such beneficiary until he or she reaches the age of twenty-one (21) years. When such beneficiary reaches the age of twenty-one (21) years, then whatever remains of the trust estate shall be distributed to such beneficiary. 6. I nominate and appoint my spouse to be the personal representative of my estate, to serve without bond. If for any reason my spouse cannot or does not serve then I appoint Robin P. Requenez and Nicole S. Gsell as substitute co-personal representatives without the filing of any bond and with the same powers. 7. I nominate and appoint Commerce Bank to be the trustee of any trust established pursuant to paragraph five above. 8. I suggest that my personal representative retain the legal services of Harold S. Irwin, III, Esquire, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 20th day of May, 2003. E F. VON~KLAU, II Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who, at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ACKNOWLEDGMENT AND AFFIDAVIT WE, EUGENE F. VON KLAU, II, RHONDA S. IRWIN and ROBERT D. STAMBAUGH, the testator and witnesses respectively, whose names are signed to the 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 purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. EUG~ F. VON KLAU, II RHONDA S. IRWIN I~OBI~RT D. STAMBAUGH - J COMMONWEALTH OF PENNSYLVANIA · :SS: COUNTY OF CUMBERLAND · Subscribed, sworn to and acknowledged before me by EUGENE F. VON KLAU, II, the testator herein, and subscribed and swor, p to before me by RHONDA S. IRWIN and ROBERT D. STAMBAUGH, witnesse~ Notary Public ~ . NOTARIAL SEAL ~ I HAROLD S. IRWIN, III. NOTARY PUBUG_ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ~N/ame of Decedent: EUGENE F. VON KLAU. II Date of Death: 9/16/2003 Will No. 2003-00835 Admin. No. 2103 - 0835 To the Register: I certify that notice of (beneficial interest) estate admini~["a{ion required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 10/27/2003 · Name Address CAROLYI~ ' L. VON KLAU 3 LIBERTY DRIVE MT HOLLY SPRINGS PA 17065 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:. NONE Date: 10/27/200:~ Signature ~ Name: HAROLD S. IRWIN. III Address: 64 SOUTH PITT STREET CARLISLE PA 17013 Telephone(717) - 243- 609 Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I-- Z Ll.I 1:3 1.1.1 U.I Z 1,1.1 Z o I.U z Z REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL' VON KLAU, EUGENE f., II DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 09/16/2003 I 12/12/1944 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 0 -6~'~-'"e COUNTf COOE YEAR NUMBER SOCIAL SECURITY NUMBER 5 6 0-5 8-1 8 3 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~]1. Original Return 4. Limited Estate r~6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received r'-~ 2. Supplemental Retum D4a. Future Interest Compromise (dae of death after 12.12-82) D7. Decedent Maintained a Living Trust (Attach copy of Trust) [~] 1 0. Spousal Poverty Credit (date of death between 12.31-91 and 1.1.95) [-'--~ 3. Remainder Retum (dateofdeathpriorto12.13.82) r-'] 5. Federal Estate Tax Return Required m 8. Total Number of Safe Deposit Boxes E~11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME HAROLD S. IRWIN~ III FIRM NAME (If Applicable) IRWIN LAW OFFICE TELEPHONENUMBER 717-243-6090 COMPLETE MAILING ADDRESS 64 SOUTH PITT STREET CARLISLE PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Parmership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) O Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 0.00 5,o51.80 0.00 0.00 103,856.56 0.00 0.00 OFFICIAL USE ONLY (8) 108~908.36 10,905.42 (11) 10,905.42 (12) 98,002.94 (13) 0.00 (14) 98,002.94 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rata 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 98,002.94 x .00 (15) 0.00 x ~ (16) x .12 (17) x .15 (18) (19) 0.00 20. Decedent's~ Complete Address: STRE.. T ADDRF '"'S 3 121BERT~" DRIVE CITY STATE MT. HOLLY SPERINGS PA ZIP 17065 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the dght to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] 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 th s return includin~ accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the persona representative is based on all Information of which preparer has any knowledge. SIGNATURE OF P~ERSON RF__SPONSIBI,,E FOP~FILING RETURN ADDRESS 3 LIBERT"~DRI~E 7//'G/2004 .~/IT HOLLY SPRINGS PA 17065 SIGNATURE 7(~,~TH~ ADDRESS L,"6~'-SOUTH P~-TT STREEt- CARLISLE PA 17013 DATE 7//~'2004 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX + (6-98) COMMONWEALTH OFPENNSYLVANIA INHERITANCE TAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER YON KLAU. EUGENE F., II 21 03 00836 All real property owned solely or as a tenant In co.ii, on must be ~epoited at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. NONE DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 $ 0.O0 REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF YON KLAU, EUGENE F., II FILE NUMBER 21 03 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 00836 ITEM NUMBER DESCRIPTION UBS FINANCIAL SERVICES INC. Rollover IRA Account No. GE10177 - UBS Pace Large Comp Investment Fund CL A 117.398 Shares @ @2.92 per share (See Exhibit "B") MELLON INVESTOR SERVICES Account VONKLAU-CAROL0000 - COntrol No. 200311190002257 50.7177 Shares of Caterpillar, Inc. Stock @ $69.70 per share (See Exhibit "C") TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of lfle same size) VALUE AT DATE OF DEATH 1,516.78 3,535.02 5~051.80 REV-1504 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER YON KLAU, EUGENE F., II 21 03 00836 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. NONE DESCRIPTION TOTAL (Also enter on line VALUE AT DATE OF DEATH 0.00 $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT $CHEDUL£ I~ MORTGAGES & NOTES RECEIVABLE ESTATE OF VON KLAU, EUGENE F., II FILE NUMBER 21 03 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. 00836 ITEM NUMBER 1. NONE DESCRIPTION TOTAL (Also enter on Pine 4, Recapitulation) (If mom space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ 0.00 0.00 RI::V-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER VON KLAU. EUGENE F., II 21 03 00836 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 6,101.88 WELLS FARGO BANK, NA Certificate of Deposit Account No. 026-3159832 (See Exhibit "D") MASSMUTUAL FINANCIAL GROUP CRST International, Inc. - Profit Sharing 401(k) Plan (See Exhibit "E") CITISTREET WASTE MANAGEMENT Retirement Savings Plan (See Exhibit "F") ESTATE OF AUGUSTA VON KLAU DOD May 23, 2002; Distribution to Estate on April 30, 2004 (See Exhibit "G") MELLON INVESTOR SERVICES Caterpillar, Inc, Dividend Payment 20,686.22 15,637.79 61,411.90 18.77 TOTAL (Also enter on line 5, Recapitulation) $ 103,856.56 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER VON KLAU, EUGENE F., II 21 03 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 00836 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. C JOINTLY-OWNED PROPERTY: L~-~ ~-H DATE DESCRIPTION OF PROPEH ~ ~' %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERE$ 1. A. Any jointly owned property was jointly owned with 0.00 0.0£ surviving spouse, Carolyn L. vonKlau TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If mom space is needed, insert additional sheets of We same size) REV-1510 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER YON KLAU, EUGENE F., II 21 03 00836 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is ~ ,es. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OFTHE ?RANSFEREE, THEIR RELA'~1ONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATrACH A COPY OF 3'HE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLE} VALUE 1. NONE 0.00 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 0,00 (If mom space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF YON KLAU. EUGENE F., II FILE NUMBER 21 03 00836 Debts of decedent must be reported on Schedule i. DESCRIPTION AMOUNT FUNERAL EXPENSES: EWlNG BROTHERS FUNERAL HOME ITEM NUMBER A. 8. 9. 10. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representa§ve (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees IRWIN LAW OFFICE Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant CAROLYN L. VON KLAU Zip Street Address 3 LIBERTY DRIVE City MT HOLLY SPRINGS Relationship of Claimant to Decedent SPOUSE Probate Fees REGISTER OF WILLS State PA Zip 17065 Accountant's Fees Tax Return Preparer's Fees REGISTER OF WILLS - File Inventory and Appraisement HAROLD S. IRWIN, III - Notary Fees JEANETTE ORMAN - Additional Notary Fees USPS - Postage TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4,119.00 3,000.00 3,500.00 237.00 25.00 10.00 10.00 4.42 10,905.42 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF YON KLAU, EUGENE F., II ITEM NUMBER 1. FILE NUMBER 21 03 Include unreimbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 00836 VALUE AT DATE OF DEATH REV-1513 EX + (9-nm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAXRETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF YON KLI~U, EUGENE F., II NUMBER I. 1. II. 1. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] CAROLYN L. VON KLAU 3 LIBERTY DRIVE MT HOLLY SPRINGS PA 17065 FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SPOUSE 100% 00836 AMOUNTOR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE NONE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NONE TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (if more space is needed, insert additional sheets of the same size) 0.00 0.00 0.00 EXHIBIT 'A' LAST WILL AND TESTAMENT I, EUGENE F. VON KLAU, II, of 3 Liberty Drive, Mt. Holly Springs, Cumberland County, Pennsylvania 17065, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills previously made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at either public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in andy business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. All the rest, residue and remainder of my property, real and personal, I give, devise and bequeath to my spouse, Carolyn L. Von Klau. 4. If my spouse does not survive me by a period of sixty (60) days, then my estate I give, devise and bequeath as follows: A. 50% to my children, Eugene F. Von Klau, III and Robin P. Requenez, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living; and B. 50% to my spouse's daughter, Nicole S. Gsell, or if she is deceased then to her children, share and share alike. 5. If any beneficiary is under the age of twenty-one (21 ) at my death, then that beneficiary's share of my estate I give, devise and bequeath to be held in trust by my hereinafter named beneficiary according to the following terms and conditions: The trustee, as well as my representative, is hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property, to or for the use of such beneficiary or to accumulate it in the sole discretion of the trustee. The trustee is also authorized and empowered to pay over to, or for the use and benefit of such beneficiary, such portion of or all of the principal of the trust estate, as in the trustee's sole discretion seems proper for such beneficiary's support, maintenance, education, or medical care. My primary object is to insure the support, maintenance, education and medical care of such beneficiary until he or she reaches the age of twenty-one (21) years. When such beneficiary reaches the age of twenty-one (21) years, then whatever remains of the trust estate shall be distributed to such beneficiary. 6. I nominate and appoint my sPouse to be the personal representative of my estate, to serve without bond. If for any reason my spouse cannot or does not serve then I appoint Robin P. Requenez and Nicole S. Gsell as substitute co-personal representatives without the filing of any bond and with the same powers. 7. I nominate and appoint Commerce Bank to be the trustee of any trust established pursuant to paragraph five above. 8. I suggest that my personal representative retain the legal services of Harold S. Irwin, III, Esquire, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 20th day of May, 2003. ~ F. VON~KLAU, II Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who, at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ACKNOWLEDGMENT AND AFFIDAVIT WE, EUGENE F. VON KLAU, II, RHONDA S. IRWIN and ROBERT D. STAMBAUGH, the testator and witnesses respectively, whose names are signed to the 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 purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. EUGF. J~ F. VON KLAU, II RHONDA S. IRWIN I~OBI~RT D. STAMBAUGH J COMMONWEALTH OF PENNSYLVANIA : :SS,' COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by EUGENE F. VON KLAU, II, the testator herein, and subscribed and sworp to before me by RHONDA S. IRWIN and ROBERT D. STAMBAUGH, witnesse~, th?_~20TH day of May, 2003. Notary Public I HAROLD S. IRWIN, III, NOTARY PUBLIC_ C~RmL~ ~0~0UC.,H. 00U~m 0F CUMBERU~'~ ~ COM~SSlON EX, RES OCTOBER 22, 2O06 EXHIBIT 'B' ~ UU~ UBS Financial Services Inc. Marlton Executive Park 701 Route 73 South, Suite 410 Marlton, NJ 08053 Tel. 856-596-5400 Fax 856-985-204D Toll Free 80D-526-5460 www.ubs.com June 24, 2004 RE: Account Number GE-10177, Eugene F. Von Klau Our records show that on September 16, 2003 the above referenced account ,had 117.398 shares of UBS Pace Larcje CompGrowth Equitylvalued at $12.92 per share. Enclosed please find a copy of the July-September 2003 account statement, which is the official record of assets held in the account. Sincerely, Marion Maiorino Divisional Vice President Operations Manager UBS Financial Services Inc. Is a subsldla~ of'UBS AG. EXHIBIT 'C' Mellon Mellon Investor Services Mellon Investor Services P.O. Box 3333 S. Hackensack, NJ 07606 November 19, 2003 CAROLYN L VON KLAU 3 LIBERTY DR MT HOLLY SPRINGS PA 17065-1023 Company Name CATERPIIJ.AR INC. Account Key VONKLAU-- CAROL0000 Control Number 200311190002257 Telephone Number 1866-203-6622 Dear Ms. Vonklau: Thank you for your inquiry requesting information for this account. Our records show this account has 50.7177 shares of CATERPIIJ~AR INC. stock. The closing price on 2003-09-16 was $ 69.7000 per share. We hope that this information has been helpful. If you have additional questions, please call our Customer Service Center at the number listed above or you may access your account online via Investor ServiceDirect at www.melloninvestor.com. Sincerely, Mellon Investor Services Overpeck Centre · 85 Challenger Road · Ridgefield Park, NJ 07660 www.melloninvestor, com A Mellon Financial Company/M ~ 0 ~ EXHIBIT 'D' DATE OF DEATH BALANCE REQUEST RESPONSE FORM WFSC File Humber 175079 Decedent Gene Vonklau Completed By Chau Nguyen Dale et Death Tuesday, September 16, 2003 Contact Phone Number (503) 721-5388 Requested By Rhonda Irwin Letter Date 12/16/2003 Fax Number 717-243-9200 Interest Paid Principal Balance Year To as of A¢counl Hame Account Type Account Humber Date of Death Date of Death Accrual Interest ~ ~_ . , .1 ....... _- ._~,. ........................ . .... _ ~...._.....~ Gene Vonk]au. sole ovmet ~e of _1:;~_~ lY26-3159632 $11.39 $6~)94.11 S7.77 · ' I~mey MsnXet ~-x-.:~nl~ mia ~ Market ~.x=~ eccounl~ I~¥ dividm~ls only. Demd~mt: G-ne. Vonklau Conlael: Cl~su Idguy,e~ - (5l)3) 721-~:~.88. 12/1B,,r2tH)3. Dale of Death Balance ......... ~ ...... :.-.:-.. ~ -::-.:: EXHIBIT 'E' T-15~ P.002/004 F-699 Statement of Account Eugene F. Von Klau CRST International, Inc. Profit Sharing .40t(k) Plan Subscription: CRST Intem.ational, Inc. Subset~ S~ff A s:atement of account is available for any period up to one year in lengzh. The statement period must fall whhin the two year period ending 111412003, (~ Transaotion Detail Available to Participants: Yes · Statement of Account for the period 0910tl2003 to 0911612003 Inveslxnent Summary Soume Summary Loan Su,~mary Account Summary $20,437.75 beginning balance SO.CA) contributions $O.0O distributions SO.Q0 other activity .~.~S~~ .~ invesl~en, income ~_....~2~ ending balance ' Your Account Rate of Return- ~_~)_j~ ~ ~/~ 1~-~% "This estimatec~ dollar-weighted ram of return ts based on the cash flow in your acoount, The calculation assumes an evenly distributed oash flow throughout the applicable period. Your return coulcl be distorted I~y non-periodic trarlsacfions anti ~'nay differ from the investment option performance because of me level and timing of your caen flows. Pest pom'~orr~anoe ~ no guarantee of future resu Its. Th~s statement displays the activity on your account for trte business days cludiqg ~lle per~od you select. Activity pub-ted ~fler ~he close of business will be reflecl~l in :he ~atement for the following business c~ay, Balances am SUb)ect to your plan's vesting requirements. Your cun'ent vested balance La displayecl on the Account Balan~..s page, ~ © 1997 - 2003 Massachusetls Mutual Life Inaurance Company. All rights reserved. Privacy/Legal Nobce hups:/lwwwrs.massmuuml.com/n'c/j ourney/accoun'JSm-t, cmentA-c c°unt'asp?daT¢ 1 ~--09/01/20.3 111512003 EXHIBIT 'F' ' 'ci street CitiStreet EO. Box 1389 Boston, MA 02104-t389 November 16, 2003 Mrs. Carolyn L. Von Klau 3 Liberty Drive Mt. Holly Springs, PA 17065 Dear Mrs. Von Klau: // Please accept our condolences on your loss. We have processed the transfer of your late husband's account to your name and social security number. Under separate cover you will receive a Personal Identification Number (PIN) which will allow you to access your account and transfer the funds should you desire. You will also receive a Summary Plan Description for the Waste Management Retirement Savings Plan. The value of the account as of your husband's date of death was $15,637.79. J~ Should you need further assistance you may call the Waste Management Retirement Savings Plan Information Line at 877-964-4015. Participant Service Representatives are available Monday through Friday, 9am - 8pm, Eastern Time, except New Yerk Stock Exchange holidays. Sincerely, Waste Management Retirement Savings Plan Administration CitiStreet A State Street and Citigroup Company EXHIBIT 'G' THIS CHECK VOID IF NOT 0 5 2 0 3 21 WASHINGTON MUTUAL BANK, FA CASHED WITHIN 6 MONTHS ANAHEIM BUSINESS BANKING CENTER #3414 · TELEPHONE BANKING: 1-800-374-4646 ~ 9o-7~52-~ 082985 0~/29/200~ ~ ESTATE NO, DATE ]~ ELEVEN ............ 61q11,9~OUNT ~ NINETY,CENTS SIXTY-ONE THOUSAND FOUR-HUNDRED PAY AND, TO THE ESTATE OF ORDER EUGENE FREDERICK V0N KLAU II OF DESCRIPTION BOB DOYLE SHERIFF-CORONER PUBUC ADMINISTRATOR 800 S. REDLANDS AVE. PERRIS, CA 92570 cHL, c~S~O~Ei~9 ,000.00 REQUIRE 2 SIGNATURES BOB DOYLE SHERIFF-CORONER PUBLIC ADMINISTRATOR RIVERSIDE COUN'~f DATE DETACH AND RETAIN THIS STATEMENT THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW IF NOT CORRECT PLEASE NOTIFY US PROMPTLY NO RECEIPT DESIRED 05203.2.. AMOUNT DATE: Oq/29/200q CHECK NO,: 52052 CLIENT NAME: CASE #: V0N KLAU, AUGUSTA 082985 HEIR'S SHARE PER ORDER AMOUNT 61qll.90 TOTAL AMOUNT: 61411,90 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of EUGENE F. VON KLAU, II also known as , Deceased Date of Death 9/16/2003 Social Security No. 560-58-1837 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We vedfy that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name o~ Personal Representative: Attomey: ~A~R~OLD S. IRW~.~ CAROLYN L. VON KLAU I.D. No.: 29920 Address: 64 SOUTH PITT STREET CARLISLE PA 17013 Dated JULY ,2004 Telephone: 717-243-6090 Description UBS FINANCIAL SERVICES IRA Account No. GE10177 117.398 Shares @$2.92 per share MELLON INVESTOR SERVICES Account No, VONKLAUCAROL0000 -COntrol No. 200311190002257 50.7177 Shares Caterpillar, Inc.@ $69.70 per share WELLS FARGO BANK, NA Certificate of Deposit Account No. 026-3159832 MASSMUTUAL FINANCIAL GROUP CRST International, Inc. - Profit Sharing 401(k) plan CITISTREET WASTE MANAGEMENT Retirement Savings Plan ESTATE OF AUGUSTA VON KLAU DOD May 23, 2002 Distribution to Eugene F. vonKlau, II Estate on April 30, 2004 (Attach Additional Sheets if necessary) Value 1,516.78 3,535.02 6,101.88 20,686.22 15,637.79 61,411.90 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory, RW-4 EUGENE F. VON KLAU, II Continuation of Inventory Page 1 Description of Inventory Description MELLON INVESTOR SERVICES Caterpillar, Inc,. Dividend Payment 21 03 Value 18.77 Grand Total $ 108,908.36 Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor OFFICES OF One Courthouse Square Carlisle, Pa. 17013 (717) 240-6345 FAX (717) 240-7797 t~egister of i~till5 anb Clert~ of toe ®~Oan~' Court tgountp of tgun~erlan~ TO: Harold S. Irwin, III 64 South Pitt Street Carlisle, PA 17013 ESTATE OF: Eugene F. Von Klau, II 21-03-835 IN RE: Additional Probate Date: July 19, 2004 The Probate fees on the above estate are $ 235.00. We have received $ 200.00 of that amount. Please remit the balance due of $ 35.00 to the attention of Sue. Thank you BUREAU OF TNDIVZDUAL TAXES THHERTTANCE TAX DTVZSTON DEPT. Z80601 HARRISBURG., PA 171Z8-0601 CONMON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1547 EX AFP (01-03) HAROLD S IRWIN III IRWIN LAW OFFICE 64 S PITT STREET CARLISLE PA 17015 DATE 09-06-Z004 ESTATE OF VONKLAU II DATE OF DEATH 09-16-Z005 FILE NUHDER 11 03-0835 COUNTY CUMBERLAND ACN 101 EUGENE .... r~' f-~ -I ~.'~. MAKE CHECK PAYAnLE AND R~T PAYHENT TO: REGZSTER OF N~LLS I . . CUH~ERLAND CO. COURT ~USE CARLZSLE, PA ~':1701S ~ REV-1547 EX AFP C01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, A~.~'~ANCF.~gR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF VONKLAU II EUGENE F FILE NO. 21 05-0855 ACN 101 DATE 09-06-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) $ Closely Hold Stock/Partnership Interest (Schedule C) Hortgages/Notes Receivable (Schedule D) 5 Cash/Bank Daposits/Hisc. Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) 7 Transfers (Schedule G) 8 Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9 Funeral Exponses/Adm. Costs/H/sc. Expenses (Schedule H) 10 Dobts/Hortgage L/ab/1/tias/L/ons (Schedule I) 11 Total Deductions 12 Net Value of Tax Return (1) O0 (3) (4) (5) (6) (7) 5z05! 80 00 00 105~856.56 O0 O0 {9) 10,905.42 (lo) .00 NOTE: To insure proper crad/t to your account, submit tho upper portion of this form with your tax paymant. 15 NOTE: ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rats 16. Amount of L/ns lq taxable at L/neaX/CXass A rata 17. Amount of L/ns 14 st S/bl/ng rata 18. Amount of L/nm 14 19. Pr/nci*al Tax Due TAX CREDXTS PAYH~NT RECE/PT DISCOUNT DATE NUHBER XNTEREST/PEN PA~D 108,908.$6 (11) 10.905.42 (12) 98,002.94 Char/table/governmental Bequests; Non-eXacted 911:5 Trusts (Schedulm J) (15) .00 Net Value of Estate Subject to Tax (14) 98,002.94 ]:f an assessment Has issued previously, 11nas :14, 15 and/or 16, 17, 18 and 19 ~ill reflect flgures that lnclude the total of ALL returns assessed to date. IF PAID AFTER DATE INDZCATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (~$). 98,002.94 x O0 = .00 (16). .00 x 045= .00 (17). .00 x 12 = .00 (18), .00 x 15 = .00 (19)= . §0 AHOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REg)UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU NAY BE DUE, A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~, RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for lifo or for years, tho Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which Has not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Nills, any of tho 22 Revenue District Offices, or by calling the special Iq-hour ansaaring service for forms ordering: 1-800-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-~7-30Z0 (TT only). Any party in interest not satisfied aith 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: --arittan protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-1DZ1, OR --election to have tho mattar determined at audit of the account of the personal representative, OR --appeal to tho Orphans' Court. 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. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after the dacedant's death, a five percent (SI) discount of tho tax paid is alloaad. The 15Z tax amnesty non-participation panalt~ is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the saaa manner and in the the same time period as you would appeal tho tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith 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 [6Z) percent per annum calculated at a daily rate of .00016~. All taxes ahich became delinquent on and after January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .0005~8 ~)'~8-1991 llX .000301 L~ 9X .ooogq7 1983 162 .000q58 199Z 92 .O00Z~7 ZOOZ 62 .O0016q 198~ llZ .000501 1995-199q 7Z .O00IgZ ZOO5 5Z .000157 1985 15Z .000356 1995-1998 92 .O00Zq7 ZO0~ qZ .000110 1986 lOX .O00Z7~ 1999 72 .O0019Z 1987 ZOZ .O00ZTq ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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, additiona! interest must be calculated. REV.1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712B.0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o w u w o w !;( >< _U> u "'>< w ~o :J:o::9 u.... .. < OECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) VON KLAU, EUGENE F., II DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (Mt.WD-Year) D 1. Original Return D 4. Limited Estate lXl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received !Xl 2. Supplemental Retum D 4a. Future Interest Compromise (dale of death after 12.12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1.1.95) OFFICIAL USE ONLY FILE NUMBER ? 21-030083' C5UNTv""OOiiE ---y~ - - NUt:i"EH-- SOCIAL SECURITY NUMBER 5 6 0 - 5 8 - 1 837 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return {dateofdeath prior 10 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) IAlt~h Soh 01 THIS SECTION MUST BE COMPLEtED. ALL CORRESPONDENCE AND CONI'IOENTIALTAX INFORMATION SHOuLD.BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS HAROLD S. IRWIN, III 64 SOUTH PITT STREET FIRM NAME (II Applica~el IRWIN LAW OFFICE CARLISLE PA 17013 TELEPHONE NUMBER 717-243-6090 z o g :J l- ii: <( <.) w It: 1 ,945.34 X ~ (15) X_(16) X .12 (17) X .15 (18) (19) 09/16/2003 12/12/1944 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ... z w c z o .. U> W '" '" o u 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprtetorshlp (3) 4. Mortgages & Notes Reoeivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (to) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value SubJect to Tax (Une 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o S ::J Do ::= o <.) ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Une 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CIlECK ilEnE Ir YOU AnE nEQlJESTING A nEFUND OF AN OVERPAYMENT 0.00 0.00 0.00 0.00 2,270.34 OFFICIAL USE ONLY -'_1 GJ 0.00 ) :-~,... 0.00, ...- (8) 2,270.34 330.00 0.00 (11) (12) (13) 330.00 1 ,940.34 0.00 (14) 1 ,940.34 0.00 0.00 > >'BESURE TO ANSWERALL.QUESTIONS ON REVERSE SIDE AND .RECHECKMATH"'''; < Decedent's Comolete Address: STREET ADDRESS 3'L1BERTY DRIVE CITY I STATE I ZIP MT. HOLLY SPERINGS PA 17065 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interesl E. Penalty T olallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is Ihe OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enler the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total 01 Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a. retain the use or income of the property transferred; ............................................ .............................. D b. retain the right to designate who shall use Ihe 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 alter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................... ........................................................................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security al his or her death? ................. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which t . be f" d . t' ? ')(1 con alns a ne IClary eSlgna Ion. ....................................................................................................... ~ No IZI [RJ [RJ [RJ [RJ IZI o 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 pe~ury, I declare that I have examined thIs return, IncludinQ accompanying schedules and statements, and to the best 01 my knowledge and beliel, it Is true, correct and complete. Declaration 01 preparer other than the personal representallve is based on alllnlormation 01 which preparer has any knowledge. SIGNATURE OF P SON RESPONStt FOR FILING RETURN DATE -r, 61 2005 ADDRESS 329 GARL ND DRIVE CAR ISLE PA 17013 StGNATURE OF ER OTHER THAN R DATE 6tZtk005 ADDRESS 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. 99116 (a) (1.1) (i)]. Fordates of death on or alter January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99118 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still appiicable even if the surviving spouse is the only beneficiary. For dates of death on or alter July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.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. 99118(1.2) [72 P.S. 99116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with Ihe decedent, whether by blood or adoption. REV-1502 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FilE NUMBER VON KLAU EUGENE F II 21 03 00836 All real property owned solely or as a tenant in common mUst be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real nr009rtv which is lolntlv-owned with rlQht of survivorshln must be disclosed on Schedule F. SCHEDULE A REAL EST ATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enler on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1503EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF VaN KLAU EUGENE F.. II FILE NUMBER 21 03 All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. 00836 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1504 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF VON KLAU EUGENE F. II FILE NUMBER 21 03 00836 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enteron line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0_00 REV-1507 EX + (6~9a) '* COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF VON KLAU. EUGENE F.. II FILE NUMBER 21 03 00836 All property jolnUy-owned with the right of survivorship must be disclosed on SchedUle F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-15OS EX + (6-98) '* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF VaN KLAU EUGENE F. II FILE NUMBER 21 03 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolnUy-owned with right 01 survivorship must be disclosed on Schedule F. 00836 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 2,270.34 ESTATE OF AUGUSTA VaN KLAU DaD May 23, 2002; Distribution to Estate Received June 20, 2005 (See Exhibit "A") TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 270.34 REV-1509 EX + (6-9B) *' COMMONWE"LTH OF PENNSYLV"N'" INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF VaN KLAU EUGENE F.. 1\ FILE NUMBER 21 03 00836 rt an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B c JOINTL y.oWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCiAl INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. NONE 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 0.00 {Ii more space is needed, insert add1tional sheets of the same size) REV-1510 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 03 00836 ESTATE OF VON KLAU. EUGENE F. II This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPV OFTHE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1. NONE 0.00 0.00 TOTAL (Also enteron line 7 Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV.1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF VON KLAU EUGENE F. II FILE NUMBER 21 03 00836 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT !>.. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number{s)/EIN Number of Personal Aepresentatlve(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees IRWIN LAW OFFICE 300.00 3. Family Exemption: (11 decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship ot Claimant to Decedent 4. Probate Fees 5. Accountants Fees 6. Tax Return Preparer's Fees 7. REGISTER OF WILLS - File Supplemental Appraisement 30.00 TOTAL (Also enter on line 9. Recapitulation) $ 330.00 (If more space is needed, insertadditionat sheets at the same size) REV-1512 EX + (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF VON KLAU. EUGENE F.. II FILE NUMBER 21 03 00836 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. NONE VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 10. Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV.1513 EX > ',*. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF \inN K' 1I1 1=11t::ENE F II NUMBER I. SCHEDULE J BENEFICIARIES 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transters under Sec. 9t16 (a) (1.2)1 CAROLYN L. VON KLAU 329 GARLAND DRIVE CARLISLE PA 17013 FILE NUMBER 21 01 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SPOUSE nnSl''', AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-I500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. NONE 0.00 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NONE TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-I500 COVER SHEET (If more space IS needed, insert additional sheets of the same size) 0.00 $ 0.00 RlVERSID~ COUNTY Sheriff CORONER-PUBLIC ADMINISTRATOR 800 S. REDLANDS AVENUE' PERRIS. CA 92570' (951) 443-2300 . FAX (951) 443-2303 BOB DOYLE, SHERIFF CORONER PUBLIC ADMINISTRATOR June 14,2005 Irwin Law Office 64 S Pitt Street Carlisle P A 17013 RE: Estate of Augusta Von Klau, Deceased Regarding the above-referenced matter, please find enclosed herewith distribution check for Estate of Eugene Frederick Von Klau II. Pursuant to your request. For your information. Please sign and return to this office in the self addressed envelope. Please file with the Court and return a conformed copy for our file. X Other: Receipt on Supplement"l'Distribution enclosed. , , Very truly yours, BOB DOYLE Public Administrator ::>8 DOYLE SHERIFF - CORONER PUBUC ADMINISTRATOR DETACH AND RETAIN THIS STATEMENT THE ATIACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW IF NOT CORRECT PlEASE NOTIFY US PROMPTLY NO RECEIPT DESIRED DESCRIPTION 56452 AMOUNT Check No.: 56452 Case #: Amount ------------------------------ -------- ------------------------------ -------- ------------- ------------- VON KLAU, AUGUSTA 082985 $ FINAL DISTRIBUTION PER ORDER 2270.34 ---------------------------------------------------------------------------- ---------------------------------------------------------------------------- TOTAL AMOUNT: $ 2270.34 08-29-2005 VONKLAU II 09-16-2003 21 03-0835 CUMBERLAND 101 APPEAL DATE: 10-28-2005 ( See reverse side under Objections) Amoun't Remi't'tedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOIIER PORTION FOR YOUR RECORDS - REV:is4;-EX-AFP-io3:0si-NOTicE-OF-iNHERiTANCE-TAX-APPRAisEKENT:-ALLOWANCE-OR--------------- DISALLOIIANCE OF DEDUCTIONS AND ASSESSMENT OF TAX EUGENE F FILE NO. 21 03-0835 ACN 101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DCIY\Di'm nrC'CE nr: NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAll;:!~~:/ ~:,rl , ,~' APPRAISEHENT, ALLOWANCE OR DISALLOWANCE ~~~T~~~D1"X Dlt.J1S10HH,:: "" :~;--,\,~ L::. OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG PA 17128-0601 lon, Al'!' ':\0 p'l I,,: 21 I..:Uv hC) v II DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN Ci_EF.< c:'~ Opc,' . l',' I,; HAROLD SCIRWIN III IRWIN LAW OFFICE 64 S PITT ST CARLISLE PA 17013 ESTATE OF VONKLAU II *' REV-1547 EX AFP (06-05) EUGENE F TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED DATE 08-29-2005 I~ an asses..en't was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will r~lec't ~i9ures 'tha't include 'the 'to'tal o~ ~ re'turns assessed 'to da'te. ASSESSMENT OF TAX: 15. Mount of Line 14 at SpouRl rat.e (IS) 16. AMount of Line 14 taxable at Lin..l/Class A rat. (16) 17. ~ount of Line 14 at Sibling rat. (17) 18. Anount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due DITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Re.l Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. CeshIBank Deposits/Misc. Personal Property (Schedule E) (5) 6. ~ointly Owned Property (Schedule f) (6) 7. Transfers (Schedule ~) (7) 8. Total Assets NO. 01 .00 .00 .00 .00 2.270.34 .00 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. funeral Expenses/Adm. Costs/Misc. ExPenses (Schedule Hl 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate SUbiect to Tax 191 1101 330.00 .00 1111 1121 1131 1141 NOTE: 99,943.28 X .00 X .00 X .00 X T + AHDUNT PAID INTEREST/PEN PAID I-I DATE NUMBER ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure Proper credit to your account, submit the upper portion of this fOMl with your tax payment. 2,270.34 330 00 1,940.34 .00 99,943.28 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 1191= .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIDNS.I Ll.-..: _ ~L~' .-~ t_l C C. ' L:, ' C:", C'-- c.' C [' STATUS REPORT UNDER RULE 6.12 Name of Decedent: EUGENE F. VON KLAU II Date of Death: 9/16/2003 Will No. 21 - 03 - ~ ~35 Admin. No. 2103-~ ~3s- Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether administration of the estate IS complete: Yes X No 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. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans I Court No. (if any) for the personal representative I s account is : N/A c . Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with e Clerk of the Orphans I Court and may be attached to this re ort. Date: 8/31/2005 HAROLD S. IRWIN. III Name (Please type or print) 64 SOUTH PITT STREET CARLISLE PA 17013 Address ..:j" L0 ~ ( 717 ) - 2436090 Tel. No . ,_,e- C0 Capacity : LI' C!:) ~!.: , L... C):.. X u--:> <,:-:j C.-":") C'--J Personal Representative Counsel for personal representative eP