Espr014544 PDF

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT
THE IOWA STATE BAR ASSOCIATION_!_

Official Fonn No. P-203
..,.,
Bruce Becker
FOR THE LEGAL EFFECT OF THE USE OF

THIS FORM, CONSULT YOUR LAWYER
THE IOWA DISTRICT COURT
'{.
o+
~Oc[p..'t.,.
SAC
COUNTY
IN THE MATTER OF
THE ESTATE OF
Probate No. ESPRO
JOHN H. CRISS
Deceased
STATE OF
IOWA
PETITION FOR PROBATE OF WILL

AND APPOINTMENT OF EXECUTOR(S)
'
SAC
, COUNTY OF
'ss:
The undersigned being first duly sworn (or affirmed) states as follows:
died at Sac Ci!Y, Iowa
1. John H. Criss
28th
2015
Ma~
on the
day of
, then domiciled in and a resident of
Sac
Iowa'
County,
, and at the time of death,
or afterwards, had property in this County subject to administration.
2. Said decedent made and executed an instrument designated as a Last Will and Testament, dated
the
22nd
day of
January
, 2014
,
Codicil dated 6/24/2014
(Designate Codicil[s] if any, with date[s])
filed herein, and the undersigned petitions that the same be admitted to Probate in this Court as provided
bylaw.
3. The undersigned
brother
petitions that
(Indicate relationship or interest)
Eugene Criss, Jr. and Renae Jacobsen

a ~ualified fterson(sbor corporation whose address(es) Jis} (are) respectively
47 West 1 th Ave., nit 9A, Denver, CO 80204; 3045 Wa sle~ Ave., Sac Cit~, lA 50583
be appointed Executor(s) without bond.
Strike (A) or (B)
4. (A) Said nominee(s) (ist-(are) nominated in said Will, to act without bond.
{8} =FI=Ie peFsefl eF eeFpeFetiefl fleffliflateel ifl saiel Will {is} {aFe} Aet pFepeseel as Ex:ee~:~teF{s) eeea~:~se:
* 5. If bond is required under the Will the estimated value of the personal property of the estate plus the
estimated gross annual income of the estate during the period of administration is$
6. The undersigned personally knows that the statements herein made are true, as such petitioner
verily believes.
WHEREFORE, the undersigned prays that this affidavit be treated as a Petition for Probate of Will and
Appointment of Executor(s) with appropriate orders accordingly.
I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true
and correct.
*Omit if no bond is required.
For waiver of bond see
Official Form No. P228
-~ ../~&
EU;lfi:s,k
Address 475 W. 12th Ave.-
Petitioner
'f4
Denver CO 80204
Probate Code Sections 290-293
inclusive and 12 and 170 (Foreign
Executor, Sections 502 and 503
do not use this form)
C> The Iowa State Bar Association 2003

IOWADOCSe
P-203 PETITION FOR PROBATE OF WILL AND APPOINTMENT OF EXECUTOR(S)

Revised January, 1999
Last Will and Testament

Of
JohnH Criss
I, John H. Criss of Sac City, Sac County, Iowa, being of sound and disposing mind and
memory, and mindful ofthe uncertainty ofhuman life and intending to dispose of all my property
and estate upon my death, do make, publish and declare this to be my Last Will and Testament,
hereby expressly revoking all other wills, codicils, or testaments by me at any time heretofore
made.
I
I direct that my executor shall pay my debts and charges from my estate, including my
funeral expenses and expenses of my last illness; provided, however, that my executor shall not
accelerate and prepay the principal balance remaining on any mortgage, installment purchase
contract, or other evidence of indebtedness secured by a security interest upon any property or
interest in property I own, unless my executor, in my executor's sole discretion, determines that it
is in the best interest of my beneficiaries to do so. My executor shall pay these debts out of the
first moneys coming into my executor's hands and im:ome ..;arned during the administration of
my estate.
II
I specifically give, devise and bequeath the sum of $20,000.00 to Dwaine Reece. In the
event Dwaine Reece does not survive me, this bequest shall lapse and become part of the residue
of my estate.
III
I specifically give, devise and bequeath the sum of $5,000.00 to Julie Foreman. In the
event Julie Foreman does not survive me, this bequest shall lapse and become part ofthe residue
of my estate.
IV
I specifically give, devise and bequeath the sum of $20,000.00 to Ranae Jacobsen. In the
event Ranae Jacobsen does not survive me, this bequest shall lapse and become part of the
residue of my estate.
v
I specifically give, devise and bequeath the sum of $25,000.00 to my nephew, Kurt Criss.
In the event Kurt Criss does not survive me, this bequest shall lapse and become part of the
VI
I specifically give, devise and bequeath the sum of $10,000.00 to Annika Criss. In the
event Annika Criss does not survive me, this bequest shall lapse and become part of the residue
of my estate.
VII
I specifically give, devise and bequeath the sum of $10,000.00 to Kelby Criss. In the
event Kelby Criss does not survive me, this bequest shall lapse and become part ofthe residue of
my estate.
VIII
I specifically give, devise and bequeath the sum of $25,000.00 to my nephew, Eric Criss.
In the event Eric Criss does not survive me, this bequest shall lapse and become part of the
IX
I specifically give, devise and bequeath the sum of $10,000.00 to Elizabeth Criss. In the
event Elizabeth Criss does not survive me, this bequest shall lapse and become part of the residue
of my estate.
X
I specifically gtve, devise and bequeath the sum of $25,000.00 to my mece, Jana
Hutchins. If Jana Hutchins does not survive me, this bequest shall lapse and become part of the
XI
I specifically give, devise and bequeath the sum of $10,000 to Leah Hutchins. If Leah
Hutchins does not survive me, this bequest shall lapse and become part of the residue of my
estate.
XII
I specifically give, devise and bequeath the sum of $10,000.00 to Tommy Hutchins. If
Tommy Hutchins does not survive me, this bequest shall lapse and become part of the residue of
my estate.
XIII
I specifically give, devise and bequeath the sum of $25,000.00 to the Loring Healthcare
Foundation of Sac City, Iowa.
XIV
I specifically give, devise and bequeath the sum of $20,000.00 to the First Presbyterian
Church of Sac City, Iowa.
XV
I specifically give, devise and bequeath the sum of $10,000.00 to the Sac Community
Recreation Center of Sac City, Iowa.
XVI
I specifically give, devise and bequeath the sum of $10,000.00 to the Sac City Public
Library of Sac City, Iowa.
XVII
I specifically give, devise and bequeath the sum of $5,000.00 to the Sac City Museum of
Sac City, Iowa.
XVIII
I specifically give, devise and bequeath the sum of $100,000.00 to my brother, Eugene
Criss, Jr., if he is living at the time of my death.
If Eugene Criss, Jr. does not survive me, this
bequest shall lapse and become part of the residue of my estate.
XIX
All the rest, residue and remainder of my estate, of whatsoever kind and nature and
wheresoever situated, I give to the Trustees identified below to be administered under the terms
and conditions of the John H. Criss Trust.
JOHN H. CRISS TRUST
A
The purpose of this trust is to provide for the beautification of and general improvements
to the City of Sac City, Iowa, as the trustees, in their unrestricted discretion, believe will
improve and beautify the City of Sac City, Iowa, regardless of the existence of other funds
available for that purpose; however, the trustees shall not use the funds in this trust for the
improvement of sanitary sewers, streets, or sidewalks. All or part of the funds can be used at
anytime by my trustees in their discretion and, when all of the assets funding this trust have been
exhausted, the trust shall be declared closed and the trustees exonerated and discharged from
further responsibility.
B
I name as trustees of this trust, Ranae Jacobsen, Dwaine Reece, and the Mayor of Sac
City, Iowa. My trustees shall each be entitled to receive up to $2,000.00 annually for services
rendered in administering this trust.
c
My trustees shall have the power and authority to do any act or thing reasonably
necessary or advisable for the proper administration and distribution of my estate, including all
powers, duties and responsibilities provided expressly for trustees in the Iowa Code.
In
extension, but not in limitation, of any power, right or discretion otherwise possessed of my
trustees, I grant to them without the necessity of notice to or approval of any Court or person the
power and authority to hold, manage, control, invest, reinvest, sell, exchange, grant, convey,
distribute, mortgage, lease, divide, partition, subdivide, assign, transfer or otherwise deal with or
dispose of the property within this trust.
D
Included within the assets in this trust is approximately 42 acres in Section 25, Township
88 North, Range 36 West of the 5th P.M., Sac County, Iowa, which is owned by Chief Clothing
Company of which I am the sole stockholder. The trustees shall have the right to sell all or part
of the above described real estate without the necessity of obtaining court approval or obtaining
the consent to the sale by anyone nor any entity.
E
The Trustees above-named shall be appointed without bond and shall not be required to
make an accounting with the Court of the transactions of this trust.
XX
My executor shall have the power and authority to do any act or thing reasonably
.....
'
powers, duties and responsibilities provided expressly for executors in the Iowa Probate Code. In
executor, I grant to him without the necessity of notice to or approval of any Court or person the
dispose of the property of my estate, without any duty upon any persons dealing with it to see to
the application of any money or other property delivered to it.
XXI
I nominate and appoint as co-executors hereof Eugene Criss, Jr. and Ranae Jacobsen, or
either of them as they may select, and request that they be permitted to qualify and act in such
capacity without providing surety upon their bond or upon any bond which may be required of
them in the course of administration of my estate.
IN WITNESS AND TESTIMONY WHEREOF, I have hereunto subscribed my name and
affixed my seal this
,)J~ay of January, 2014.
~~
John H. Criss
The above instrument was, on this c:J.;J.~ day of January, 2014, signed, published and
declared by the said John H. Criss to be his Last Will and Testament in our presence, who at his
request, have hereunto subscribed our names as witnesses in his presence and in the presence of
7L /L_L_
-,~~---=-:.._______..__L_---=---~~--'-'---'---
~-%--.f----L--L~__:___
resiiling ru ___:,::..____!
residing at
__
-~=--.lo!cG~"'~~~&~z;-+\.........=:.At..~rz:...~-
CODICIL TO THE

Of
John H. Criss
memory, and mindful of the uncertainty of human life and intending to dispose of all my property
and estate upon my death, do hereby make, publish and declare this to be a Codicil to my Last
Will and Testament heretofore executed on the 22nd day of January, 2014.
ONE:
I hereby specifically delete Article XIX(D) of my said Last Will and Testament
pertaining to the John H. Criss Trust because the real estate described in that Article has been
sold at public auction. The proceeds from that sale, which are part of the rest, residue and
remainder of my estate that have not been used to satisfy Articles I through XVIII as set forth in
said Last Will and Testament, shall be administered as part of the John H. Criss Trust.
TWO: In all other respects, I hereby confirm my said Last Will and Testament.
IN WITNESS WHEREOF, I have affixed my signature on this
day of June, 2014.
> C z? i:/~P~
John H . nss
~ ~y
The above instrument was, on this J...

of June, 2014, signed, published and declared
by the said testator, John H. Criss, to be a Codicil to his Last Will and Testament in our presence,
who at his request, have hereunto subscribed our names as witnesses in his presence, and in the
P'7:r~:~th~
J
n
-----=,.._....~-----:::::=------residing at ...Lic...o..
~
residing at S~ / 0 ' ,\ _Jru?L
-_~_1-=-c~-----'--~-=--;B=!'---d"-'-o~,__j=-.........__..._-6
~-
S4

THE IOWA STATE BAR ASSOCIATION!
Official Fonn No. P-21 0
Bruce Becker


_________S_A_C_________ COUNTY
IN THE MATTER OF
THE ESTATE OF
JOHN H. CRISS
...:P...:r.=.ob:;.;a:..:.te:___ _ _ _ _ No. ESPRO
COURT OFFICER'S OATH (INDIVIDUAL)

(STATUTORY)
I, the undersigned, do solemnly swear (or affirm) that as a Court Officer and as Fiduciary in the above
matter, I will faithfully discharge the duties imposed by law, including the duty to account, to the best of my
ability.
I certify under penalties of perjury and pursuant to the laws of the State of Iowa that the preceding is true
and correct.
Dated this
----:8~-- day of ~
Cl The Iowa State Bar Association 2008

IOWADOCS"
---
P-210 COURT OFFICER'S OATH (INDIVIDUAL)

Revised March 2008

THE IOWA STATE BAR ASSOCIATION!
I
Official Fonn No. P-21 0
Bruce Becker


_________S~A_C~________ COUNTY
IN THE MATTER OF
_P_r_ob_a_te,;,__ _ _ _ _ _ No. ESPRO
THE ESTATE OF
COURT OFFICER'S OATH (INDIVIDUAL)

(STATUTORY)
JOHN H. CRISS
I, the undersigned, do solemnly swear (or affirm) that as a Court Officer and as Fiduciary in the above
matter, I will faithfully discharge the duties imposed by law, including the duty to account, to the best of my
ability.
I certify under penalties of perjury and pursuant to the laws of the State of Iowa that the preceding is true
and correct.
Dated this _
_;e=:.__ day of
ICl The Iowa State Bar Association 2008

IOWADOCS"
()u'!l--
P-210 COURT OFFICER'S OATH (INDIVIDUAL)

Revised March 2008
THE IOWA STATE BAR ASSOCIATION

Official Fonn No. P205
Bruce Becker


SAC
COUNTY
Probate No. ESPRO
IN THE MATTER OF
THE ESTATE OF
-------
TESTIMONY OF SUBSCRIBING
WITNESS ON PROBATE OF WILL
John H. Criss
---------------------------------'
Deceased
SAC
STATE OF ----=I~O...;..;Wc...:...A=----- , COUNTY OF
I, the undersigned, being first duly sworn, state as follows:
I, the undersigned,
; I knew the identity of the testator on the, ~ day of
lJ.I\l
,
is
attached
2014 , the date of the instrument, the original or exact reproduction of

hereto,
now
the
to
Will
me,
and
and
purporting
Testament
of
to
be
the
the
said
, deceased. I am one of the subscribing witnesses to said
John H. Criss
at
shown
Last
Codicil to
instrument;
, State of
Sac
reside in the County of
Iowa
which
, ss:
said
date
Taney Becker a/k/a Frances L. Becker
of
said
instrument,
knew
the
identity
of
the other SUbscribing Witness; that said instrument WaS
exhibited to me and to the other subscribing witness by the testator, who declared the same
to be the testator's Last Will and Testament, and was signed by the testator at
Sac City
, in the County of
Sac
, State of
_Io_w_a_ _ _ _ _ _ _ _ _ _ _ , on the date shown in said instrument, in the presence of
myself and the other subscribing witness; and the other subscribing witness and I then and
there, at the request of the testator, in the presence of said testator and in the presence of
each other, subscribed our names thereto as witnesses.
/2
.j ~
. ~_,1~
-~
Bruce Becker (Name of Witness)
Sac City, lA 50583

(Address of Witness)
Signed and sworn to (or affirmed) before me on this

by Bruce Becker
*.t"1.~
~*
,,.,.
l
j
KODI BROTHERSON
~ay of_\.._3"""\\)l\j,.___ _ _,2brs=~
.I
Signature of Notary Public
Corrmisslon Nu~ 7WzTo_vr:l.

My Comm. exp:-1\"3 11 ~I
Code Section 633.295, "... one or more of the subscribing witnesses ... "
IOWADOCS
P205 TESTIMONY OF SUBSCRIBING WITNESS ON PROBATE OF WILL

Revised August 2013

Official Fonn No. P205
Bruce Becker


SAC
COUNTY
Probate No. ESPRO
IN THE MATTER OF
THE ESTATE OF
-------
TESTIMONY OF SUBSCRIBING
WITNESS ON PROBATE OF WILL
John H. Criss
------------------------~-------'
Deceased
STATE OF _ _ _I_O_W_A_ _ _ , COUNTY OF
, ss:
SAC
I, the undersigned, being first duly sworn, state as follows:

I, the undersigned, reside in the County of
; I knew the identity of the testator on the,
Iowa
January
which
is
, State of
Sac
attached
day of
22nd
2014 , the date of the instrument, the original or exact reproduction of
hereto,
now
shown
Last
Will
to
me,
and
and
purporting
of
Testament
to
be
the
the
said
, deceased. I am one of the subscribing witnesses to said
John H. Criss
date of said instrument, I knew the identity of

, the other subscribing witness; that said instrument was
instrument; at the said

Frances L. Becker
exhibited to me and to the other subscribing witness by the testator, who declared the same
to be the testator's Last Will and Testament, and was signed by the testator at
Sac City
, in the County of
Sac
, State of
, on the date shown in said instrument, in the presence of
Iowa
myself and the other subscribing witness; and the other subscribing witness and I then and
there, at the request of the testator, in the presence of said testator and in the presence of
~/1.-L
each other, subscribed our names thereto as witnesses.
Bruce Becker (Name of Witness)
Sac City, lA 50583

(Address of Witness)
Signed and sworn to (or affirmed) before me on this & a y of ,

by Bruce Becker
~;;;;;:f
~I KOOIBII01M~~l
; ... * \Comrrisslon~"j\\ut l
''"
My eomm. Elcp.
j)AI\.Sl
, 2-:blS:
Notary Public
Code Section 633.295, "... one or more of the subscribing witnesses ... "
The Iowa Stale Bar Association 2013
IOWADOCS
P205 TESTIMONY OF SUBSCRIBING WITNESS ON PROBATE OF WILL

Revised August 2013

~~ffi1\ ~

Bruce Becker
~:!:
<~'sbct,o."\:~o
"7
SAC
COUNTY
IN THE MATTER OF
Probate No. ESPRO
THE ESTATE OF
DESIGNATION OF ATTORNEY
JOHN H. CRISS
The fiduciary(ies) to assist in the administration of this matter, designate(s):

Name of the Attorney
in charge:
Bruce Becker
Name of Firm:
Becker & Brotherson Law Office
Post Office Address:
PO Box 38, Sac Ci~, lA 50583
Telephone Number:
(712) 662-4771
Dated:
6-8-15
z:?s
,,. ,)~~
Cj
Eugene
s, Jr.
Signature of Fiduciary
475 W. 12th Ave. 2 Unit 9A 2 Denver2 CO 80204

Post Office Address
cz-i. a/J L~-
,,.
.,
RJnae Jacobs~
ignature of Second Fiduciary
3045 Wadslel:: Ave. 2 Sac Ci!);:: 2 IA 50583

Post Office Address
Section 633.82, The Code

DESIGNATION OF ATTORNEY
C> The Iowa State Bar Association 2003

IOWAOOCS 8
P-216 DESIGNATION OF ATTORNEY

Revised January,1999
IN THE IOWA DISTRICT COURT FOR SAC COUNTY
ESPR014544
IN THE MATTER OF THE ESTATE OF
JOHN H. CRISS, Deceased..
ORDER ADMITTING WILL TO

PROBATE AND APPOINTING
EXECUTORS
This matter comes on for hearing of the proof of the instrument dated the 22nd day of
January, 2014, filed herein and purporting to be the Last Will and Testament of the above-named
decedent and the instrument dated the 24th day of June, 2014, filed herein and purporting to be
the Codicil to the Last Will and Testament of the above-named decedent, and the evidence being
seen and heard in the manner provided by law, it is found that said instrument was executed and
witnessed as provided by law; and is the Last Will and Testament and Codicil to the Last Will
and Testament of the above-named decedent; that the Executors named in the last Will and
Testament hereinafter named are qualified to act in such capacity.
IT IS THEREFORE ORDERED AND ADJUDGED that the above-described instrument
is admitted to probate as the Last Will and Testament and Codicil to the Last Will and Testament
of said decedent, and that Eugene Criss, Jr. and Ranae Jacobsen a/k/a Renae Jacobsen are
appointed Executors thereof without bond.
State of Iowa Courts

Type:
ORDER ADMITTING WILL TO PROBATE
Case Number
ESPR014544
Case Title
ESTATE OF JOHN H. CRISS
So Ordered
Electronically signed on 2015-06-10 11:49:33
page 2 of 2
E-FILED 2015 JUN 10 12:07 PM SAC - CLERK OF DISTRICT COURT

IN THE MATTER OF THE
Case No. 02811 ESPR014544
Certificate of Admission
of Will to Probate
Docket Event Code: COAW
I hereby certify that the Will/Codicil(s) of JOHN HENRY CRISS , deceased, was duly proved, and admitted to probate and
recorded in said District Court, in accordance with Iowa Code section 633.300.
Will/Codicil(s) filed on 6/09/2015.
Dated: 06/10/2015
/s/ Brenda McClure

Clerk of Court/Designee
SAC County
E-FILED 2015 JUN 10 12:09 PM SAC - CLERK OF DISTRICT COURT

Letters of Appointment
Docket Event Code: LEAP
KNOW ALL PERSONS BY THESE PRESENTS:

That having been duly appointed and qualified as Co-Executors of the above entitled matter,
Eugene Criss, Jr. and Ranae Jacobsen a/k/a Renae Jacobsen
are vested with all powers authorized by law in the premises.

Letters issued: 6/10/2015
/s/ Brenda McClure

SAC County
THEIOWASTATEBARASSOCIATION
Bruce Becker

THIS FORM, CONSULT YOUR LAWVER
IN THE IOWA DISTRICT COURT FOR

SAC
COUNTY
Probate No. ESPRO
IN THE MATTER OF
THE ESTATE OF
~J~ob~n~H~.~c~ri~s~s
__________________ ,
YS lfL{
RELEASE FROM
ESTATE RECOVERY
PROGRAM
>
Deceased.
STATE OF IOWA, _ _ _....~o~S"'-&A..lo<C_ _ _ COUNTY, ss.

, first being duly sworn on oath
I, Bruce Becker
depose and state:

1. I am the attorney for the above-captioned estate.
2. Attached hereto is a correct photocopy of the response from the Iowa Department of
Human Services Estate Recovery Program showing that the Department has no
Estate Recovery Claim.
I certify under penalty of perjury and pursuant to the laws of the state of Iowa that the
preceding is true and correct this 19th day of
June
2015
Bruce Becker, Attorney
C The Iowa State Bar Association 2014

IOWADOCS
P-367 RELEASE FROM ESTATE RECOVERY PROGRAM

Revised Januarv 2012
Bruce Becker
From:
Sent:
To:
Subject:
ESTATES <estates@sumogroup.com>
Tuesday, June 16, 2015 2:50 PM
Bruce Becker
John Criss
The Iowa Department of Human Services, through its Estate Recovery Program, has reviewed the records for
In the District Court of Iowa in and for Sac County

In the Estate of John H. Criss , Deceased. Probate No. ESPR014544
and based upon the information that you have provided to our office, we have found the following:
The Department has no Estate Recovery claim.
Ruth Staplin
Estate Recovery Program

omclal Fonn No. P222
Bruce Becker


SAC
COUNTY
No. ESPR014544
IN THE MATTER OF
THE ESTATE OF
JOHN H. CRISS
AFFIDAVIT OF MAILING NOTICE
STATE OF _ _ _I_O_W_A_ _ _ , COUNTY OF _ _ _ _ _S_A_C_ _ _ _ _ , ss:

The undersigned, first being duly sworn (or affirmed), states that on the 22nd day of
June
, he/~ personally mailed to each of the following named persons a
, 2015
Notice (a true copy of which Notice is attached hereto and made a part hereof),
* Last Will and Testament of John H. Criss dated 1/22/2014 and Codicil to the Last Will and Testament of John
H. Criss dated 6/24/2014; Notice of Probate of Will, of Appointment of Executors; and Notice to Creditors
by
ordinary
mail, each such notice, together with other enclosures if so indicated
above, being mailed in a sealed envelope with proper postage thereon, addressed to the said
persons respectively, at their last known Post Office addresses, by depositing the same on
said date in a United States Post Office mail receptacle in said County, to-wit:
See 1 in Addendum
(If return receipts are required so state and attach)
Bruce Becker(Affiant)
This record was acknowledged before me this
Bruce Becker
I ~~~~
.Z~
,,...
t'
KODI BROTHERSON
Conmsslon ~ ~~703
My Comm. Exp~ I '2.,) \ 11?'".
-~--=-.......UQ....L...tJ-=---V~fl---4--,..t-'-'Z...../t?.....;;....:~~---' by
Signature of Notary Public

(OR) Clerk of said District Court
* If there are other enclosures, such as Final Report, Annual Report, etc., so state
Probate Code Sections 38, 40 and 47.
IOWADOCS
P222 AFFIDAVIT OF MAILING NOTICE

Revised August 2013
Addendum 1/2
1.
Kurt Criss
429 Cottonwood Dr.
Elko, NV 89801
Annika Criss
429 Cottonwood Dr.
Elko, NV 89801
Kelby Criss
429 Cottonwood Dr.
Elko, NV 89801
Erik Criss
480 Yuma St.
Denver, CO 80204
Elizabeth Criss
480 Yuma St.
Denver, CO 80204
Leah Hutchins
1650 Domain Loop S.E.
Rio Rancho, NM 87124
Eugene Criss, Jr.
475 West 12th Ave.
Unit 9A
Denver, CO 80204
Janna Hutchins
6055 West Progress Ave.
Denver, CO 80123
Thomas Hutchins Cumberland
Denver, CO 80123
Julie Foreman
2324 Dakota Ave.
Lytton, lA 50561
Dwaine Reece
204 North 2nd St.
Addendum 2/2
Sac City, lA 50583
Renea Jacobsen
3045 Wads ley Ave.
Sac City, lA 50583
Sac City Public Library
1001 West Main
Sac City, lA 50583
Sac Community Recreation Center
1015 West Main
Sac City, lA 50583
Loring Healthcare Foundation
211 Highland Ave.
Sac City, lA 50583
First Presbyterian Church
812 Audubon St.
Sac City, lA 50583
Barbara Powell
Mayor of Sac City
1420 West Main
Sac City, lA 50583
Sac City Museum
c/o Wilma Fort
711 Platt St.
Sac City, lA 50583
obate
The Iowa District Court
Sac County
In the matter of the estate of
.: John H. Criss,-deeeased.
~ Probate No. ESPA014544
.
. NOTICE OF PROBATE OF WILL, OF APPOINTMENT OF EXECUTOR, AND NOTICE
... . TO CREDITORS
. 'T<? An Persons Interested in the Estate of
John H. Criss, Deceased who died on or about
Ma~ 2a~ .2a1.s::
. ;. , -~ :_
;. .
..
.. :; You are hereby n6tified that on the 1Oth day

. o(June; 2015; the last win 'and testament of
John H. Criss, deceased, bearing date ofthe
22nd' day of Janualy;>2014;: and codicil dated
June 24, 2014 wetet' admitted to probate in the
. abov{riamed court and)hat EugeneGriss, Jr. .
.and Renae Jaccibsen' were appointed executors of the estate; Any action to set aside the
will must be brought in the district court of said
.' . county within the later to pccur of. four months
., . from'the dat~ o(the second. p'ublication :o(this.
notice bt erie month froni :the date''o(inailirig
. of thisn~tice'toan.h~irs ofthe'decedenfand
' devisees under the 'will' whose: identities ' are
reasonabfyascertainable,'o{theh3atter be'forever barred. .
. '
. Notice is: further given. that all persons indebtedto the ,estate are 'requested to make
immediate payment to the undersigned, "and
, creditors having Claims against the estate shall
fife. them with the clerk of the above named .
distlictcourt, as provided by law, duly authenti- -'1
cated, f!Jr allc)\vance, and unless so filed by: the .~
later to occur of four months fromithe second
publication-of this notice or ohe month from the
date of' mailing of this notice (unless otherwise
allowed or paid) a claim is thereafter forever
_
.:
,'
barred .. :< ,
bated thisjot~ ~ay~of June:2Q1?< . ::_
-- > Eug~ne Criss, Ji-.; Executo(of estate
, , . - -.,~.,-475 West 12th
lJiiit 9A
Denver, CO 80204
. Renae Jacobsen, Executorof estate
3045 Wadsley Ave.
sa.c City, lA 50583
Ave.,
. Bi-uce Beck~r ,_ ~~- . :~ ~ . ~>.

- Attorney tor executors
POBox 38 ..
SacCity,IA50$83
' '
.
: ~.. . ':' _Date'bt second publicatioh
. . .. 23rd day bt June, ~o1s

Of
JohnH Criss
memory, and mindful ofthe uncertainty ofhuman life and intending to dispose of all my property
made.
I
first moneys coming into my executor's hands and im:ome ..;arned during the administration of
my estate.
II
of my estate.
III
I specifically give, devise and bequeath the sum of $5,000.00 to Julie Foreman. In the
event Julie Foreman does not survive me, this bequest shall lapse and become part ofthe residue
of my estate.
IV
v
I specifically give, devise and bequeath the sum of $25,000.00 to my nephew, Kurt Criss.
In the event Kurt Criss does not survive me, this bequest shall lapse and become part of the
VI
of my estate.
VII
event Kelby Criss does not survive me, this bequest shall lapse and become part ofthe residue of
my estate.
VIII
In the event Eric Criss does not survive me, this bequest shall lapse and become part of the
IX
event Elizabeth Criss does not survive me, this bequest shall lapse and become part of the residue
of my estate.
X
I specifically gtve, devise and bequeath the sum of $25,000.00 to my mece, Jana
XI
I specifically give, devise and bequeath the sum of $10,000 to Leah Hutchins. If Leah
estate.
XII
my estate.
XIII
XIV
I specifically give, devise and bequeath the sum of $20,000.00 to the First Presbyterian
XV
XVI
XVII
Sac City, Iowa.
XVIII
bequest shall lapse and become part of the residue of my estate.
XIX
JOHN H. CRISS TRUST
A
exhausted, the trust shall be declared closed and the trustees exonerated and discharged from
B
c
In
D
88 North, Range 36 West of the 5th P.M., Sac County, Iowa, which is owned by Chief Clothing
E
make an accounting with the Court of the transactions of this trust.
XX
.....
'
XXI
either of them as they may select, and request that they be permitted to qualify and act in such
,)J~ay of January, 2014.
~~
John H. Criss
The above instrument was, on this c:J.;J.~ day of January, 2014, signed, published and
7L /L_L_
-,~~---=-:.._______..__L_---=---~~--'-'---'---
~-%--.f----L--L~__:___
resiiling ru ___:,::..____!
residing at
__
-~=--.lo!cG~"'~~~&~z;-+\.........=:.At..~rz:...~-
CODICIL TO THE

Of
John H. Criss
ONE:
pertaining to the John H. Criss Trust because the real estate described in that Article has been
said Last Will and Testament, shall be administered as part of the John H. Criss Trust.
day of June, 2014.
> C z? i:/~P~
John H . nss
~ ~y
The above instrument was, on this J...

of June, 2014, signed, published and declared
P'7:r~:~th~
J
n
-----=,.._....~-----:::::=------residing at ...Lic...o..
~
residing at S~ / 0 ' ,\ _Jru?L
-_~_1-=-c~-----'--~-=--;B=!'---d"-'-o~,__j=-.........__..._-6
~-
S4
obate
- ...

Sac County
. John H. Criss,-dedeased.
: -~- Probate No. ESPR014544
'
. NOTICE OF PfiOBATE OF WILL, OF A'P~

POINTMENT OF EXECUTOR, AND NOTICE
. .
. TO CREDJiOf:IS
To All Persons Interested In the Estate of
MaY 2a, 2015:
:
_ .
/You are hereby. nbtitied that onthe 1Oth day
- {)(JI.lne; 201 b; the last Wili and testament of
John H. Criss,. deceased, beating date pf the
22nd' day of Janualy; 2014;; and codicil i::lated
June 24, 2014 wete- admitted to probate in the
above named court ahd~that Eugene Criss, Jr..
and. Renae Jaccibseri were appoint~d executors of the estate; Any action to set aside the
will must be brought in the district court of said
county Within the later to occur of four months
-from'the' d~te
the seco'nd pu&lidition 'of)his
' notice bi:_ one month from.tl:le date':of'mailirig
; of this notice'to all h~irs ofthe 'decadent and '
' 'devisees under t~e'wiWwhOs~;,ide~tities are
reasonably- ascertainable, or thereafter be forever barred.
'.
-- .
..
Notice is: further given that all persons in.debted to the ,estate are requested to make
immediate payment to the undersigned, and
, creditors having Claims against the estat_e shall
file_thell1 with the clerk of the aboye named. '
distiict court, as provided bylaw, duly authenti~ .::;
cated, fgr alloi,vance, and unless so filed by: the ~
later to occur of four months fromithe second
publication 'of this notice or one 'month from the
date ot' mailing of tl:lls 'notice (unless otherwise
alloWed or paid) a claim is thereafter forever
barred .:.._-,' -. __
-,. ::
-.'Dated this. ~qt~ d~y.of. J~litt2Q1. 5. ':. ,,.;:-::

. ..- Eu-gen~ CriSS, Jr.; Executorof estate
-~!. :: . ...:~:~ :::~~-475. We.St .1:2th AVe~-. urtit 9A
' -
Denver,
80204
. Renae Jacobsen, Executor of estate
3045 Wadsley Ave ..
Sac City, .lA 50583
of
co
. sruce Be.ckSr . . ~--
...
. Attorney for executors .

Becket & Brotherson Law Office
P08ox38 .
. S~c: CitY, 1Aoi:l583 . . . .. .
__ . . .
-~-:. i .-' _Date of ~ecoric!'pUblica:tiCI'l
'' '
. 23rd day of Juhe, ?015
E-FILED 2015 JUL 27 11:31 AM SAC - CLERK OF DISTRICT COURT
IN THE DISTRICT COURT OF IOWA IN AND FOR SAC COUNTY

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
APPLICATION FOR GUARDIAN
JOHN H. CRISS
AD LITEM
t
COMES NOW Renae Jacobsen and Eugene Criss, Jr., the duly pointed Co-Executors in
this estate and in support of this Application For Guardian Ad Litem state:
1. The decedent bequeathed the sum of$10,000 each to his grandniece, Annika Criss, his
grandnephew, Kelby Criss, and his grandniece, Elizabeth Criss.
2. All of the aforesaid individuals are minors in that Annika Criss was born March 29,
2000, Kelby Criss was born June 7, 2002, and Elizabeth Criss was born April
f.. 2000.
3. A Guardian Ad Litem should be appointed by this court to protect the interests of

Annika Criss, Kelby Criss and Elizabeth Criss.
4. Kevin Murray, a licensed Iowa attorney in Sac City, Iowa, is a proper and suitable
person to appointed Guardian Ad Litem by this Court.
WHEREFORE, the undersigned prays that Kevin Murray be appointed as Guardian Ad
Litem to protect the interest of Annika Criss, Kelby Criss, and Elizabeth Criss in this Estate.
E-FILED 2015 JUL 27 12:57 PM SAC - CLERK OF DISTRICT COURT

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
ORDER APPOINTING
JOHN H. CRISS
GUARDIAN AD LITEM
_________________________________
This matter comes before the Court on the Co-Executors application of Kevin Murray as
Guardian Ad Litem for the decedents grandnieces, Annika Criss and Elizabeth Criss and the
decedents grandnephew, Kelby Criss. The Court finds that the application should be approved.
IT IS THEREFORE ORDERED, that Kevin Murray is appointed Guardian Ad Litem in

this cause to protect the interest of the minor children, Annika Criss, Kelby Criss and Elizabeth
Criss in this estate matter.
E-FILED 2015 JUL 27 12:57 PM SAC - CLERK OF DISTRICT COURT

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 2 of 2

omclal Fonn No. P222

No. ESPR014544
IN THE MATTER OF
The Estate of John H. Criss
STATE OF _ _ _I--..:O_W--..:A..::__ _ , COUNTY OF _ _ _ _ _S_A_C_ _ _ _ _ , ss:

The undersigned, first being duly sworn (or affirmed), states that on the 28th day of
July
, 2015 , he/~ personally mailed to each of the following named persons a
* Last Will and Testament of John H. Criss and Codicil to Last Will and Testament of John H. Criss
by _ _ _
or_d_in_a-=ry_ _ _ mail, each such notice, together with other enclosures if so indicated
Kevin Murray
114 N 6th Street
Sac City, lA 50583
(If return receipts are
ecee~u:~e~
/l_L__
PO Box 38 -----------:::----=.
Sac City, lA 50583
This record was acknowledged before me this _ _ ___:::28:::.:t!!.h..!!d.::.avt:....o~f~J~u!J..lv.l...,::.:20~1~5_ _ _ _ , by

Bruce Becker
II
Si nature of Notary Public

I
l
Bruce Becker

SAC
COUNTY
MYRAJ.HORTON
i..-~
t.\ commissiOn
Number 187604
~
MY C9MMlSSION EXPIRES
lOW._
1_-l!f_~ <MI 1
*If there are other enclosures, such as Final Report, Annual Report, etc., so state
C The Iowa State Bar Associatioo 2013
IOWADOCS
P222 AFFIDAVIT OF MAIUNG NOTICE

Revised August 2013
rob ate
Sac County
John H. Criss, deceased.
Probate No. ESPR014544
NOTICE OF PROBATE OF WILL, OF AP
POINTMENT OF EXECUTOR, AND NOTICE
TO CREDITORS
To All Persons Interested in the Estate of
In then
John
Proba May 28,2015:
You are hereby notified that on the 1Oth day
NOTICE OFF
of June, 2015, the last will and testament of
POINTMENTO
John H. Criss, deceased, bearing date of the
T
22nd day of January, 2014, and codicil dated
To All Perso1
. June 24, 2014 were admitted to probate in the
John H. Criss, o
above named court and that Eugene Criss, Jr.
May 28, 2015:
and Renae Jacobsen were appointed execuYou are herel
tors of the estate. Any action to set aside the
of June, 2015,
will must be brought In the district court of said
John H. Criss, c
county within the later to occur of four months
22nd day of Jar
from the date of the second publication of this
June 24, 2014\o\
notice or one month from the date of mailing
above named CG
of this notice to all heirs of the decedent and
and Renae Jacc
devisees under the will whose Identities are
tors of the estatt
reasonably ascertainable, or thereafter be forwill must be brou
county within the ever barred.
Notice is further given that all persons In
from the date of
debted to the estate are requested to make
notice or one m<
of this notice to , immediate payment to the undersigned, and
devisees under 1 creditors having claims against the estate shall
file them with the clerk of the above named
reasonably ascer
district court, as provided by law, duly authentl
ever barred.
cated, for allowance, and unless so flied by the
later to OCGUr of four months from the second
publication of this notice or one month from the
date of mailing of this notice (unless otherwise
allowed or paid) a claim is thereafter forever
barred.
Dated this 10th day of June 2015.
Eugene Criss, Jr., Executor of eiltate
475 West 12tll Ave., Unit 9A
Denver, CO 80204
Renae Jacobsen, Executor of estate
3045 Wadsley Ave.
Sac City, lA 50583
PROOF OF PUBLICATION
Sac City, Iowa
te
given that all persons inare requested to make imthe undersigned, and credagainst the estate shall file
f the above named district
y law, duly authenticated,
nless so filed by the later to
s from the second publicaone month from the date of
(unless otherwise allowed
ereafter forever barred.
ay of June 2015.
riss, Jr., Executor of estate
75 West 12th Ave., Unit 9A
Denver, CO 80204; 3045
cobsen, Executor of estate
Wadsley Ave.
Sac City, lA 50583
rs
Law Oflice
Date of second publication
23rd day of June, 2015
The Sac Sun
[e -J3
,20)S
STATE OF IOWA
Sac County, ss.
I, _Dale Wegner, publisher of the Sac Sun, a weekly newspaper pubhs.hed at Sac City, low!}, being duly sworn on oath say
that the ;otlce hereto attached was published in said newspaper
for
0'
consecutive
week(s), the last publication being
(y_ -X3:>- ).S
Signed
[a___ f~
. I, Dale Wegner, do hereby state that I certify, under penalty

of perJ~ry. and pursuant to the laws of the State of Iowa, that the
precedmg IS true and correct as I verily believe.
---~~=----~d-3~-- 20 /5
Publication
Fee:
$-----=--59...1..__B._
,
Bruce Becker
Attomey for executors
P0Box38
Sac City, lA 50583
Date of second publication
23rd day of June, 2015

Of
John H. Criss
made.
I
first moneys coming into my executor's hands and income earned during the administration of
my estate.
II
of my estate.
III
I specifically give, devise and bequeath the sum of $_5,000.00 to Julie Foreman. In the
event Julie Foreman does not survive me, this bequest shall lapse and become part of the residue
of my estate.
IV
v
I specifically give, devise and bequeath the sum of $25-,000.00 to my nephew, Kurt Criss.
In the event Kmt Criss does not survive me, this bequest shall lapse and become part of the
VI
of my estate.
VII
event Kelby Criss does not survive me, this bequest shall lapse and become part of the residue of
my estate.
VIII
In the event Eric Criss does not survive me, this bequest shall lapse and become pmt of the
IX
event Elizabeth Criss does not survive me, this bequest shall lapse and become pmt of the residue
of my estate.
X
I specifically gtve, devise and bequeath the sum of $25,000.00 to my niece, Jana
XI
I specifically give, devise and bequeath the sum of $10,000 to J,eah Hutchins. If Leah
estate.
XII
my estate.
XIII
XIV
I specifically give, devise and bequeath the sum of $~0,000.00 to the First Presbyterian
XV
XVI
XVII
Sac City, Iowa.
XVIII
bequest shall lapse and become patt of the residue of my estate.

XIX
and conditions of the Jolm H. Criss Trust.
JOHN H. CRISS TRUST
A
exhausted, the bust shall be declared closed and the trustees exonerated and discharged from
B
c
In
D
88 North, Range 36 West of the
5th
P.M., Sac County, Iowa, which is owned by Chief Clothing
E
make an accounting with the Comt ofthe transactions of this trust.
XX
XXI
either of them as they may select, and request that they be pennitted to qualify and act in such

ol.J~ay of January, 2014.
~~
Jolm H. Criss
The above instrument was, on this oZ.;l."~ day of January, 2014, signed, published and
e/achoL/~
residing at
uz;
__
-~-hl- - - ,-{_t:___
.Jl.-b- -1-~-L.~------
-,-~~-L_--~-;;;-----residing at -~--"~~-'-"'eLL..._b~zs--t\__.:;-~~~-
CODICIL TO THE
Last Will and Testan1ent

Of
John H Criss
ONE:
pertaining to the John H. Criss Trust because the real estate described in that Atiicle has been
said Last Will and Testament, shall be administered as pati of the John H. Criss Trust.
__1j_ day of June, 2014.
"I i-l
The above instrument was, on this~ day of June, 2014, signed, published and declared
presi~.eootf eeaacch~ ootther.
~
_ _,
_ ~
/
/l_
-{
J3 at:-1---
residing at
__::=--=--:.___c""t;-::;~---==---t>"t>~---
residing at
SC1=
~"'-"~"'--s~ ('ft:
8 d )\ .)JruZXJ
2'
E-FILED 2015 SEP 01 9:35 AM SAC - CLERK OF DISTRICT COURT
E-FILED 2015 OCT 20 8:16 AM SAC - CLERK OF DISTRICT COURT

Official F<~rm No. P-706.1
''$
/1
i\
/II~
i
Bruce E ecker

-.:).'_.... . . Ct~
SAC
~'oCJ,.:{'
COUNTY
PROBATE NO.J~SPR014544
JOHN H. CRISS
REPORT AND 11\IVENTORY
DECEASED
The undersigned Executor
CIT NO.
Regular estate (Chapter 633) [&]

Small estate (Chapter 635) D
CIT (Chapter 450.22)
D
lXI, Administrator D , or otht!r
'
(cc;pacity)
whose name and post office address is: Renae Jacobsen, 3045 Wadsley Ave., Sac City, lA 50583
reports as follows:
Name of Decedent
Age
88
John H. Criss
Last Residence
Date of Death
208 S. 8th Street, Sac City, lA 50583
05/28/15
1. The designated attorney is: Bruce Becker

whose address and telephone number is:
PO Box 38 1Sac Ci!l:1lA 50583
(712} 662-4771
$ 615561551.13
2. Amount of gross estate for Federal Estate Tax RUrposes:
Will a Federal Estate Tax Return be filed? Yes lXI , No[].
3. The decedent died testate
lXI , intestate D.
4. If testate, was a child born to or adopted by decedent after execution of the Will?
include each such child in 6. below:
5. Did decedent leave a surviving spouse? Yes
6.
Yes
D, No lXI.
If yes,
D, No 123.
List (a) surviving spouse, if any, (b) beneficiaries under decedent's will, (c) heirs at law, (d) transferees, and
(e) surviving joint tenants.
Name
Age
Post Office Address
Relationship
to Decedent
See Attached Addendum 1/2 and

2/2

IOWADOCS"
P-706.1 INVENTORY COVER SHEET

Revised January 2007
Addendwn 112
1.
Kurt Criss
429 Cottonwood Dr.
Elko, NV 89801
Annika Criss
429 Cottonwood Dr.
Elko, NV 89801
Kelby Criss
429 Cottonwood Dr.
E1ko, NV 89801
Erik Criss
480 Yuma St.
Denver, CO 80204.
Elizabeth Criss
480 Yuma St.
Denver, CO 80204
Leah Hutchins
Eugene Criss, Jr.
475 West 12th Ave.
Unit 9A
Denver, CO 80204
Janna Hutchins
Denver, CO 80123
Denver, CO 80123
Julie Foreman
2324 Dakota Ave.
Lytton, IA 50561
Dwaine Reece
204 North 2nd St.
.,
Addendmn 2/2
Sac City, lA 50583
Renea Jacobsen
3045 Wadsley Ave.
Sac City, lA 50583
1001 West Main
Sac City, lA 50583
1015 West Main
Sac City, IA 50583.
211 Highland Ave.
Sac City, IA 50583
812 Audubon St.
Sac City, IA 50583
Barbara Powell
Mayor of Sac City
1420 West Main
Sac City, IA 50583
Sac City Museum
c/o Wilma Fort
711 Platt St.
Sac City, IA 50583

Official Fonn No. P706.2
~r-m.sTA'f'~\
~1 {j' ~~ ~
-~
Bruce Becker

QUESTIONNAIRE AN[I RECAPITULATION

Answer all questions. Include all items subject to Iowa Inheritance tax
ATTACH ONLY SCHEDULES APPLICABLE. If Schedule is not attached, state NONE.
0
oc,,._"~
1
'
1
t
J
A. Did the decedent at time of death $

own any real estate not held in joint
tenancy? If yes, complete Schedule A
135,000.00 A
B. Did the decedent at time of death $

own any stocks or bonds not held in joint
tenancy? If yes, complete Schedule B.
6,179,241.52 B
C. Did decedent at time of death own $

any mortgages, notes or cash not held in
joint tenancy?
If yes, complete
Schedule C.
74,673.45 c
D. Is there any insurance on the life of $

the decedent?
If yes, complete
Schedule D.
10,186.40 D
f
~
H. Did the decedent possess a general $

H
power of appointment over any property,
--------or did the decedent exercise or release a
general power of appointment within
three years of death? If yes. complete
Schedule H.
I. Did the decedent own or have an $
145,949.761
interest in any annuities, supplementary
_ _ ___::..:.::.z:....:.::..:.:...::.
or other income contracts, retirement
If yes,
benefits, or pension funds?
complete Schedule I.
$ _ _ _6::. , 5: . ;:5;.;:.6=,5.: . :51:.:.;.1:.=. .3
TOTAL (Iowa gross estate)
E. Did decedent at time of death own $

E
any property held in joint tenancy with
--------spouse?
E-1
E-1. Did decedent at the time of death $
own any property held in joint tenancy
--------with others? If yes, complete
Schedule E-1.
F. Did decedent at time of death own $
any other property not shown on any
If yes, complete
other schedule?
Schedule F.
F-1. If intestate or election to take $
against the Will, did decedent at the time
of death own any property exempt from
execution? If yes, complete
Schedule F-1.
11,500.00 F
0.00 F-1
G. Did decedent make any gift within $ _________ G

three years of death in excess of the gift
tax exdusions allowable under I.R.C.
2503(b) and (e)? Did the decedent,
prior to death, make any transfer where
the decedent retained a life estate or
interest, or which were to take effect in
possession or enjoyment at death? If
the answer to either question is yes,
complete Schedule G.
INFORMATION RESPONSIVE TO SECTIONS

633.361.9,.12 AND .13, THE CODE.
1. Did the decedent die owning real $

NONE
estate located outside the State of Iowa
_ _ _ _ _....:.::..::::=:=:
not otherwise reported? If yes, attach
Schedule showing extent of interest,
legal description, and estimated value
2. Is any property required to be $

NONE
reported for federal estate tax purposes
-------'-"-"'..:..:.;=
which is not induded in the Iowa gross
estate or on line 1 above? If yes, attach
Schedule showing items and values.
3. Was any gift made by decedent that $
NONE
reduced the amount of the unified credit
-------'-"-"'..:..:.;=
available for federal
estate tax
If yes, attach Schedule
purposes?
showing the description and value of the
gift, date and amount of unified credit
daimed.
CERTIFICJI.TION
I certify under penalty of pe~ury and pursuant to the laws of the State of Iowa that the preceding is true and correct.
Date
/0-/'J-/
Capacity or TitiEt
.. S.ian~~r~O
/_
j~~~~~
Executor
,..
Executor
~?
1 _
URenae Jacobsen
;;?;_ ~~
Eugene Cfiss, Jr.
Estate of _ _ _ __.J.,.o..,hn....,..H......,C..,n.,..s..,.s_ _ _ _, Deceased.

This form is in compliance with Administrative Dirnctive of the State Court Administrator 2014-1
IOWADOCS
P-706.2 QUESTIONNAIRE AND RECAPITULATION

Revised May 2014
j
l

1

Official Form No. P-706 Schedule A
Bruce Becker

Estate of: John H. Criss
SCHEDULE A- REAL ESTATE

(Jointly owned property must be disclosed on Schedule E.)
Item
Number
Description
Alternate
Valuation Date
Alternate Value
Value at Date of Death
See Below
$135,000.00
The North fifty (50) feet of Lots one and two (1 & 2) in Block one (1), Platt's Addition
to Sac City, Iowa, and fully described as follow5: Starting at the northeast comer of
Lot one (1 ); thence in a westerly direction along the north line of said lots 1 and 2 one
hundred-twenty (120) feet to the northwest como~r of said Lot 2; thence in a southerly
direction along the west ine of said lot 2 fifty (50) feet; thence in an easterly direction
one hundred twenty (120) feet parallel with the north line of said lots 1 and 2 to a
point in the east line oflot 1 fifty (50) feet south of the north line of said lot 1; thence
in a northerly direction fifty (50) feet to piont of starting. Also the north fifty (50) feet
oflot three (3) in block one (1) of Platt's Addition to Sac City, Iowa except the west
twenty (20) feet of said tract, and more fully de5cribed as follows: Commencing at a
point twenty (20) feet east of the northwest corner of said Lot three (3) above
described; thence south on a line parallel with the west line of said lot 3 fifty feet (50);
thence east on a line parallel with the south line of lot 3 forty (40) feet; thence north to
the northeast comer of said lot 3; thence west to the place of beginning.
TOTAL. Enter in the Recapitulation . . . . . . . . . . . . . . . . . . .......... .
$135 000.00
SCHEDULE A

IOWADOCS"'
P-706 SCHEDULE A REAL ESTATE

Re\ised January, 1999

Olllclal Fonn No. P-706 Schedule B
Bruce Becker

SCHEDULE B - STOCKS AND BONDS

(Jointly owned property must bEl disclosed on Schedule E.)
Item
Number
Description Including Face Amount of Bonds

or Number of Shares and
Par Value Where Needed for Identification
Number
of Units
UnltVa ue
Alternate
Valuation Date
Alternate Value
Chief Clothing Co. (sole shareholder)

(Attached as B-1)
1.00
$4,119,5!:8.150
$4,119,588.15
Ameriprise Financial Mutual Fund

Account No. 02014812645 002
1.00
$138,794.7400
$138,794.74
Wells Fargo
(Attached as B-2)
1.00
$47,425.3300
$47,425.33
Charles Schwab Stocks Acct.

6096-9990
(Attached as B-3)
1.00
$12,069.7100
$12,069.71
Merrill Lynch
See attached (stocks held at Merrill
Lynch at time of death)
(Attached as B-4)
1.00
$360,420.8400
$360,420.84
Merrill Lynch
See attached (stocks held outside
Merrill Lynch at time of death)
(Attached as B-5)
1.00
$1,458,7~8.330
$1,458,738.33
Great Iowa Treasure Hunt

(MFS Government Market Income
Trust)
1.00
$25.00(10
Eaton Vance, National Mutual Inc.

Fund
1.00
$41,879.4200
Oak Terrance Estates Refund
1.00
$300.0(100
TOTAL. Enter in the Recapitulation .............................. .
$25.00
$41,879.42
$300.00
$6,179,241.52
SCHEDULE B

IOWADOCS
P-706 SCHEDULE B STOCKS AND BONDS

B -1
CHIEF CLOTHING COMPANY.
MAY 28,2015 VALUE
Investment Center, Sac City, Iowa
Bank Deposit Sweep
4 7. 79 shares
Advisors Disciplined Tr
Unit 1260 Steelpath MLP
& Income Port SER 2014-3
An OFI Steelpath Port
5353.00 shares
$43,456.42
47.79
Ameriprise Financial, Sac City, Iowa

$719,036.06
Deferred Annuity Acct. No. 93002814104 004

Large Core Quant - A
33,210.863 shares
$334,433.39
Merrill Lynch Account # 660-07402

See attached (stocks held at Merrill Lynch at time of death)
See attached (stock held outside Merrill Lynch at time of death)
Iowa State Bank

Checking Account No. 52992
$709,630.60
$2,277,050.39
$ 35,933.50
Total Assets
$4,119,588.15
f.i\.~
-I
B- 1
Merrill Lynch
~ WeaHh Management
Bank of America Corporation
Historical Date of Death Valuation

Chief Clothing Date of Death Valuation
Date of Death
Valuation Date
Processing Date
Report Type
Number of Account(s)
05/28/2015
05/28/2015
08/18/2015
CHIEF CLOTHING CO
208 S 8TH ST
SAC CITY lA 50583-2220
Number of Security(s) : 24
Account# 660-07402
Shares Security
or Par Description
1)
Date Of Death
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
332.4881 ALTRIA GROUP INC (02209S103)
New York
05/2812015
2)
52.01000
51.50000 H/L
51.755000
17,207.92
131.520000
69,048.00
144.540000
57,816.00
525.0000 APPLE INC (037833100}

NASDAQGS
05/2812015
3}
131.94000
131.10000 H/L
400.0000 BERKSHIRE HATHAWAYINC (084670702}

DELCLB NEW
New York
05/28/2015
145.06000
lI
!
144.02000 H/L
-~
B- 1
CHIEF CLOTHING CO
208 S 8TH ST
SAC CllY lA 50583-2220
Shares Security
or Par Description
4)
Number of Securlty(s) : 24
Account# 660-07402
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value
380.0000 BOEING COMPANY (097023105)

New York
05/28/2015
143.02000
141.58000 H/L
54,074.00
142.300000
345.80
lnt/Div: 0.91 Ex: 05/06/2015 Rec: 05/08/2015 Pay:. 06/05/2015
5)
555.0000 CANADIAN NATURAL RES LTD (136385101)

Toronto
05/28/2015
30.78282
30.26080 H/L
30.521810
16,939.60
320~755000
16,831.58
Price has been adjusted for the exchange rate on the pricing date and is priced in U.S. Dollars.
6)
52.4749 CF INDS HLDGS INC (125269100)

New York
05/28/2015
323.05000
318.46000 H/L
78.71
lnt/Div: 1.50Ex: 05/13/2015 Rec: 05/15/2015 Pay: 05/29/2015
7)
450.5280 CUMMINS INC COM (231021106)

New York
05/28/2015
140.29000
138.75000 H/L
139.520000
8)
62,857.66
351.41
lnt/Div: 0.78 Ex: 05/19/2015 Rec: 05/21/2015 Pay: 06/01/2015
304.0000 EDWARDS LIFESCIENCES CRP (28176E108)

New York
05/28/2015
131.42000
129.80000 H/L
130.610000
39,705.44
-I
.['
B- 1
CHIEF CLOTHING CO
2085 8TH ST
Shares Security
or Par Description
9)
Account# 660-07402
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt

Accruals
254.4042 HANESBRANDS INC (410345102)

New York
05/28/2015
32.07000
31.74000 HIL
8,116.76
31.905000
25.44
lnt/Div: 0.10 Ex: 05/19/2015 Rec: 05/21/2015 Pay: 06/11/2015
10)
405.6711 LOWE'S COMPANIES INC (548661107)

New York
05/28/2015
11)
12)
Security
Value
176.4658 MONDELEZ INTERNATIONAL (609207105)

INC
NASDAQGS
05/28/2015
70.88000
40.65000
70.34000 HIL
70.610000
28,644.43
40.302500
7,112.01
47.705000
17,224.67
39.95500 H/L
361.0665 MICROSOFT CORP (594918104)

NASDAQGS
05/28/2015
48.01500
47.39500 HIL
111.93
lnt/Div: 0.31 Ex: 05/19/2015 Rec: 05/21/2015 Pay: 06/11/2015
13)
348.1834 NUCOR CORPORATION (670346105)

New York
05/28/2015
47.63000
47.21000 H/L
47.420000
16,510.85
B- 1
CHIEF CLOTHING CO
2085 8TH ST
SAC CllY lA 50583-2220
Shares Security
or Par Description
14)
.t
Account# 660-07402
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
264.9635 PHILIP MORRIS INTL INC (718172109)

New York
05/28/2015
15)
84.72000
83.66000 H/L
84.190000
22,307.27
96.665000
22,091.83
228.5402 PEPSICO INC (713448108)

New York
05/28/2015
16)
353.9055 PFIZER INC (717081103)

New York
05/28/2015
97.39000
34.53000
95.94000 H/L
34.27500 H/L
12,175.23
34.402500
99.09
lnt/Div: 0.28 Ex: 05/06/2015 Rec: 05/08/2015 Pay: 06/02/2015

17)
304.6288 PROCTER & GAMBLE CO (742718109)

New York
05/28/2015
79.45000
79.02000 HIL
24,137.26
79.235000
18)
345.0000 J M SMUCKER CO (832696405)

New York
05/28/2015
120.30000
119.15000 HIL
41,305.12
119.725000
lnt!Div: 0.64 Ex: 05/13/2015 Rec: 05/1512015 Pay: 06/01/2015
220.80
I
I
~
I
~.
B- 1
CHIEF CLOTHING CO
208 S 8TH ST
Account# 660-07402
Shares Security
or Par Description
24)
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
00.0000 CASH
3,206.45
----------.
$707,888.34
Total Value
Total Accrual
$1,742.26
$709,630.60
Total
----------------------
---
Total Security Value :
$707,888.34
$1,742.26
Total Accruals :
ct7na
Total Combined Value :
~-:~n ~n
"t'l """"'""""""W"""""
---------------- ------ - -----------The Information herein has been obtained from a source we believe to be reliable, but we do not guarantee its accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. A.rry tax
statements contained herein were not intended or written to be used, and cannot be used for the purpose of avoiding U.S., federal, state or local tax penalties. Please consult your advisor as to any tax, accounting
or legal statements made herein.
Disclosures:
There is NO fee associated with the use of this application at this time.
Alternative Date of Death valuations are not available In this application. Please consult your tax advisor for assistance in obtaining this report.
Report may Include trades that are not settled as of valuation date.
All security positions are based on trade date.
Money funds, money market and/or bond/fixed Income mutual funds may or may not include dividends/interest accruals prior to month end payment.
For accounts with Credit and/or Debit card(s), the cash posiUon may not reflect reduction for purchases of goods or services which are paid for by automatic debit on the Wednesday before the last Friday of each
month.
Cash balance may not reflect outstanding checks written prior to valuation date or unsettled cash as of valuation date.
All items flagged "!" and hlghHghted In red reflect manually adjusted transactions (for price, shares, market value or security name) or positions with no available price.
Asset positions provided to Bank of America I Merrill Lynch from an outside financial institution (i.e. Annuities), may require the Securities Description line to be manually updated.
Fee accruals are not captured In TMA accounts.
All mortgage backed securities have the paydown factor I amortization factor automatically applied.
If the account you are valuing is a goo series account (international), the values will be reported based on the currency the account holds. not USD. Please also note that if this account is valued along with other
USD accounts. you will not receive an accurate valuation; please run these accounts separately from USD accounts held in the client's household.
B-1
Symbol
T
BAX
BOX
BP
CAH
CTL
CMCSA
CSAL
cvs
FTR
NCR
OXY
s
TSN
USB
vz
WIN
ADX
CRC
Company Name
AT&T INC
BAXTER INTL INC
BECTON DICKINSON & CO
BP PLC
CARDINAL HEALTH INC
CENTURYLINK INC
COMCAST CORP NEW
COMMUNICATIONS SALES & LEASING
CVS HEALTH CORP
FRONTIER COMMUNICATIONS CORP
NCR CORP
OCCIDENTAL PETE CORP
SPRINT CORP
TYSON FOODS INC
US BANCORP NEW
VERIZON COMMUNICATIONS INC
WINDSTREAM HOLDINGS INC
ADAMS DIVERSIFIED EQUITY FUND
CALIF RESOURCES CORPORATION
CUSIP
00206R102
071813109
075887109
055622104
14149Y108
156700106
20030N101
20341J104
126650100
35906A108
62886E108
674599105
85207U105
902494103
902973304
92343V104
97382A200
006212104
130570107
Shares
2,708
1,520
10
7,938
283
193
107
48
382
462
14
17,828
635
864
1,342
1,619
40
7,672
5208
Date
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
The information has been obtained from sources we believe to be reliable but we do not guarantee
its accuracy. Past performance is not indicative of future performance.
Adjusted Stock Pricing; Unadjusted Mutual Fund Pricing
Close
34.80
36.48
141.43
41.55
88.11
34.06
59.03
25.98
103.19
5.17
30.14
77.73
4.63
42.35
43.7
49.54
8.28
14.24
7.89
Total
94,238.40
55,449.60
1,414.30
329,823.90
24,935.13
6,573.58
6,316.21
1,247.04
39,418.58
2,388.54
421.96
1,385,770.44
2,940.05
36,590.40
58,645.40
80,205.26
331.20
109,249.28
41,091.12
2,277,050.39
JOHN H. CRISS ESTATE PROBATE INVENTORY

SCHEDULE B ADDENDUMS
B-2
WELLS FARGO STOCKS & ETFs
Description
CENTURYLINK INC.
DEERE&CO
PETMED EXPRESS INC
TEVA PHARMACEUTICAL
Quantity
212.07400
204.15400
523.56600
204.09700
Value on May 28,2015

$7,223.24
$19,088.40
$ 8,696.43
$12,417.26
B-3
CHARLES SCHWAE: INVESTMENTS
Description
ADAMS DIVERSIFIED EQUITY
CISCO SYSTEMS INC
INTEL CORP
Quantity
295.0000
111.1137
135.5025
Value on May 28,2015

$4,200.80
$3,261.19
$4,608.44
1-J\~ Merrill Lynch

~ Wealth Management
B- 4

John Criss Merrill Lynch Date of Death Valuation
Date of Death
Valuation Date
Processing Date
MR JOHN H CRISS DCSD

208 S 8TH ST
Shares Security
or Par Description
1)
Report Type
05/28/2015
05/28/2015
08/21/2015
Date Of Death
Account# 660-56348
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
275.0000 BP PLC SPON ADR (055622104}

New York
nr::J'la nn1 r::
"""'~""'.._"".""
'!1.60000
'! 1.26000 H/L
41.430000
2)
11,393.25
704.4330 CSX CORP (126408103)

New York
05/2812015
35.05000
34.38000 H/L
34.715000
lnt/Div; 0.180000 Ex: 05/27/2015Rec: 05129/2015 Pay: 06115/2015
3}
200.0000 CONTINENTAL RESOURCES (212015101}

INC
New York
05/28/2015
45.49000
+0.160000
34.895000
24,581.18
44.870000
8,974.00
44.25000 H/L

208 S 8TH ST
Shares Security
or Par Description
4)
B-4
Account# 660-56348
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value
427.9017 CHESAPEAKE ENERGY OKLA (165167107)

New York
05/28/2015
5)
14.74000
14.00500 H/L
14.372500
6,150.01
29.360000
6,495.69
67.385000
25,151.99
110.070000
23,433.40
221.2429 CISCO SYSTEMS INC COM (17275R102)

NASDAQGS
05/28/2015
6)
29.56000
29.16000 H/L
373.2580 COLGATE PALMOLIVE (194162103)

New York
05/28/2015
7)
67.60000
67.17000 H/L
212.8955 DISNEY (WALT) CO COM STK (254687106)

New York
05/28/2015
8)
110.54000
109.60000 H/L
229,3118 DUPONT E I DE NEMOURS (263534109)

New York
05/28/2015
71.49000
70.50000 H/L
16,279.99
70.995000
lnt/Div: 0.49 Ex: 05/13/2015 Rec: 05/15/2015 Pay: 06/12/2015
112.36

208 S 8TH ST
Shares Security
or Par Description
9)
B-4
Account# 660-56348
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value
206.1767 FIRST HORIZON NTNL CORP (320517105)

New York
05/28/2015
14.92000
14.75000 H/L
3,058.63
14.835000
10) !
561,042.0000 FRAC FIRST HORIZON NATL (DCA517101)

CORP
we are unable to pnce this 1ssue.

11)
223.6843 FORTUNE BRANDS HOME AND (34964C106)

SECURITY INC SHS
New York
05/2812015
46.66000
46.18000 HIL
46.420000
lnt/Div: 0.140000 Ex: 05/27/2015 Rec: 05/29/2015 Pay: 06/17/2015
12)
+0.140000
46.560000
10,414.74
15.910000
19,203.37
1,207.0000 !SHARES SILVERTR (464280109)

NYSEArca
05/2812015
13)
15.99500
15.82500 H/L
244.3874 HONEYWELL INTL INC DEL (438516106)

New York
05/28/2015
105.77000
104.83000 H/L
25,733.99
105.300000
lnt/Div: 0.52 Ex: 05/19/2015 Rec: 05/21/2015 Pay: 06/10/2015
126.47

208 S 8TH ST
Shares Security
or Par Description
14)
B-4
Account# 660-56348
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
105.4690 JOY GLOBAL INC DEL COM (481165108)

New York
05/28/2015
15)
40.75000
39.16000 H/L
39.955000
4,214.01
101.245000
25,310.21
249.9898 JOHNSON AND JOHNSON COM (478160104)

New York
05/28/2015
101.68000
100.81000 HIL
lnt/Div: 0.75 Ex: 05/21/2015 Rec: 05/26/2015 Pay: 06/09/2015
16)
187.49
312.7634 KELLOGG CO {487836108)

New York
05/28/2015
62.82000
62.25000 H/L
62,535000
lnt/Div: 0.490000 Ex: 05/28/2015 Rec: 06/01/2015 Pay: 06115/2015
17)
+0.490000
63.025000
19,711.91
75.625000
13,878.86
183.5222 Ell LILLY & CO (5324571 08)

New York
05/28/2015
76.48000
74.77000 H/L
lnt/Div: 0.50 Ex: 05/14/2015 Rec: 05/18/2015 Pay: 06/10/2015
18)
91.76
469.3040 MEDTRONIC PLC SHS {G5960L 103)

New York
05/28/2015
77.83000
76.94000 H/L
77.385000
36,317.09

208 S 8TH ST
Shares Security
or Par Description
19)
B- 4
Account# 660-56348
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value

New York
05/28/2015
20)
47.21000 H/L
47.420000
16,510.85
96.665000
22,091.83
17.490000
122.53
5.875000
176.25
90.280000
9,028.00
228.5402 PEPSICO INC (713448108)

New York
05/2812015
21)
47.63000
97.39000
95.94000 HIL
07.0060 ROUSE PROPERTIES INC SHS (779287101)

New York
05/28/2015
22)
i 7.33000 HiL
30.0007 SEVENTY SEVEN ENERGY INC (818097107)

SHS
New York
05/28/2015
23)
17.65UUU
6.01000
5.74000 HIL
100.0000 SCHLUMBERGER LTD (806857108)

New York
05/28/2015
90.83000
89.73000 H/L

208 S 8TH ST
Shares Security
~ Description
24)
25)
B-4
r;
Account# 660-56348
High I Ask
206.0000 SPDR GOLD TRUST (78463V1 07)

NYSEArca
05/28/2015
114.16000
Low/ Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
113.22000 HIL
113.690000
23,420.14
36.325000
7,265.00
200.0000 TOLL BROS INC COM {889478103)

New York
36.79000
05/28/2015
26) !
35.86000 H/L
00.0000 CASH
985.84
---------------- -------
------ -- - - - - - - - - - - - -
$359,902.76
Total Value
$518.08
Total Accrual
$360.420.84
Total
---------------------------------------$359,902.76

Total Accruals :
$518.08
$360,420.84
The information herein has been obtained from a source we believe to be reliable, but we do not guarantee its accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. Any tax
statements contained herein were not intended or written to be used, and cannot be used for the purpose of avoiding U.S., federal, state or local tax penalties. Please consult your advisor as to any tax, accounting
Disclosures:
~W:W i'l!\f'FM%1!!1iiQ!i!B\ u;:;::lii\;;JQ:i:&Q!i'!QIIIi~.l\L M t
.. / !Jll'i\Vf!Jk$! '!i'!.Mi@-#XiAA!I
AA%A-'JI4i
WQ l'fJ!II'I
Mlltll"t
HI
J;;
Uti
& Mil(
QIM
B-5
Assets held outside of Merrill Lynch for John Criss

Symbol
BAC
BMY
ETR
XOM
GXP
HNI
LNCO
ZBH
CASY
HTLD
PXD
MGF
MMT
FOXA
TEMGX
Com__Q_any Name
BANK OF AMERICA CORP NEW
BRISTOL-MYERS SQUIBB CO
ENTERGY CORP
EXXON MOBIL CORP
GREAT PLAINS ENERGY INC
HNI CORPORATION
LINN CO LLC
ZIMMER BIOMET HOLDINGS INC
CASEYS GEN STORES INC
HEARTLAND EXPRESS INC
PIONEER NATURAL RESOURCES
MFS GOVT MKTS INCM TR
MFS MULTIMARKET INCM TR
21ST CENTURY FOX
Templeton Global Smaller Co Fund
CUSIP
60505104
110122108
29364G103
30231G102
391164100
404251100
535782106
98956P102
147528103
422347104
723787107
552939100
552737108
90130A101
88022L102
Shares
1,650
2,015
1,863
5,309
106
5,727
67
114
1600
4544
167
1000
500
1388
8401.791
Date
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
5/28/2015
Close
16.67
69.15
76.55
85.11
26.13
49.19
10.54
113.39
89.58
21.55
148.69
5.59
6.43
33.96
9.2
Total
I
27,505.501
139,337.25
142,612.65
451 ,848.99!
2,769.78
281,711.13
706.18
12,926.46
143,328.00
97,923.20
24,831.23
5,590.00
3,215.00
47,136.48
77,296.48
1 ,458, 738.33
~~~".N'I!I!:Q~~~:~~,M!_., ..,K!ll):;t)}$f,,!b(ilf'i,'""'f~~.---,"<'!!)P,,J,-%-)!!Q)!{4M.hii)}AP:Pl!i:U ..!L4t:J
f&.\;
#.J?i%#$1
!$,!,.
MtW% .. Uli%WJlitW)IJ!WHlW<i!li+-
ll
lllit
~M;
-"""'M!OI'tlllli!H 1
M-
II&
-M

Offlclal Fonn No. P-706 Schedule C
Bruce Becker

SCHEDULE C - MORTGAGES, NOTES AND CASH

Item
Number
Description
Alternate
Valuation Date
Alternate Value
$64,678.58
Iowa State Bank checking account no. 66816
Wells Fargo Sweep Account
$7,958.48
Charles Schwab Deposit Account
$2,036.39
TOTAL. Enter in the Recapitulation ............................... .
$74 673.45
SCHEDULEC
Cl The Iowa Slale Bar Association 2003

IOWADOCS 8
P-706 SCHEDULE C - MORTGAGES, NOTES AND CASH

Relised January, 1999

Oftlclal Form No. P-706 Schedule D
Bruce Becker

SCHEDULE D - INSURANCE ON THE DECEDEt.JT'S LIFE

Identify policy or contract, designated beneficiary, amount, and show value. Also identify each item as to whether
it is includable or excludable in the est:~te subject to Iowa inheritance tax.
Item
Number
Description
Alternate
Valuation Date
Alternate Value
$10,186.40
Veteran's Benefit
TOTAL ..................................................... .
Less amounts excluded for Iowa inheritance tax ..................... .
Amount subject to Iowa inheritance tax. Enter on the Recapitulation ..... .
$10,186.40
SCHEDULED
IOWADOCS"
P-706 SCHEDULE D - INSURANCE ON THE DECEDENrS LIFE

Revised Januarv, 1999

Official F rm No. P-706 Schedule F/F-1

Bruce Becker
SCHEDULE F - MISCELLAr~EOUS PROPERTY NOT

REPORTABLE UNDER ANY OTHER SCHEDULE
(Joint owned property must be disclosed on Schedule E.)
1. Did the decedent, at the time of death, own any articles of artistic or collectible value in excess of $3,000 or any
collections whose artistic or collectible value combined at date of dea:h exceeded $3,000?
If "Yes", full details must be submitted on this schedule.
2. Has the decedent's estate, spouse, or any other person, received (or lllill receive) any bonus or award as a result of
the decedent's employment or death?
3. Did the decedent at time of death have, or have access to, a safe
de~osit
box?
If "Yes", state locations, and if held in joint names of decedent and ar,other, state name and relationship of joint
depositor.Iowa State Bank Sac City lA
'
'
If any of the contents of the safe deposit box are omitted from the sctedules in this return, explain fully why omitted.
4. Did the decedent, at the time of death, own any other miscellaneous property not reportable under any other
schedule?
X
Item
Number
Description
Alternate
Valuation Date
$10,000.00
Household Goods and Personal Property
Alternate Value
$1,500.00
1995 Cadillac
TOTAL. Enter in the Recapitulation .......................... .

SCHEDULE F
e The Iowa State Bar Association 2003

IOWADOCSe
P-706 SCHEDULE F/F-1 MISCELLANEOUS PROPERTY NOT REPORTABLE/EXEMPT

Relised January. 1999
""'

Official Fonn No. P-706 Schedule I
Bruce B;:cker

THIS FORM CONSULT YOUR LAWYER

SCHEDULE I - ANNUITIE:S AND 529 PLANS
Description
Item
Number
Alternate
Valuation
Date
Alternate
Value
Value at Date
of Death
Instructions- Annuities: (1) Describe completely; (2) include if the annuity was derived from an
employee's pension or retirement plan; (3) or if an IRA whether it was a traditional or Roth IRA and (4)
include the beneficiary's name and relationship to the decedent.
1
The Hartford, Contract No. 712586732
$58,393.77
The Commonwealth , Contract No. SD 10005019
$35,884.00
Charles Schwab Rollover IRA, Acct No. 2309-5670
$51,671.99
Instructions- Section 529 Plans: Qualified Section 529 Plans are reportable but are not taxable. For
each amount listed, provide the plan name, date estab ished, named beneficiary, and named
beneficiary's age at the time of decedent's death. List amounts in line 2, "Nontaxable Amount," below.
TOTAL
$145,949.76
Nontaxable Amount
TAXABLE AMOUNT. Subtract line 2 from line 1
Enter the Taxable Amount in the Summary of Gross Estate, page 2, line 35.
IOWADOCS
$145,949.76
SCHEDULE I
P-706 I -ANNUITIES

Official F~rm No. P-706 Schedule J
IFORTHISTHEFORM
LEGAL EFFECT OF THE USE OF
CONSULT YOUR LAWYER
Bruce Becker

SCHEDULE J - Funeral Expenses and Expenses Incurred
in Administering Prope11y in the Gross Estate.
Note: List on this schedule expenses of administering property in the gross estate. For those expenses, see Iowa Code section 450.12(1).
Executors' commissions, attorneys' fees, etc., are allowed as a deduction for Iowa inheritance tax purposes. If they are allowed as a deduction in
comoutina the taxable estate for federal estate tax ourooses thev are not allowable as an income tax deduction on form lA 1041.
Item
Description
Amount
Number
A. Funeral Expenses:
Farber & Otteman Funeral Home
6,724.16
278.65
David Whitehall Co. (Urn)

Monument
Total. ......................................
7,002.81
B. Administrative expenses allowable under Iowa Code section 450.12

1
Executors' commissions: Amount estimated
00Jgi1!:J!~D~
131 251.03
131 251.03
Enter zero if fee waived by executor.

2
Attorney fees: Amount estimated /liWJei!XOUOK/Xllltc!.
Federal estate tax paid.
Miscellaneous deductible expenses:
13,060.00
Court Costs (est.)
TotaiA&B
Item
Number
1
2
3
4
Description
282 564.87
Amount
For use only if decedent had property outside Iowa

C. Iowa Portion of A & 8
Total Iowa Gross Estate
Total Gross Estate (Iowa and Non-Iowa property)
Iowa percentage: Divide line 1 by line 2
Amount deductible: Multiply total of A & B by percentage
on line 3 and list on line 37 of the lA 706
TOTAL. Also enter in the Summary of Gross Estate, Page 2, Line 37 ........................
282,564.87
SCHEDULE J
The Iowa State Bar Association 2007

IOWAOOCS
P-706 SCHEDULio J Funeral Expenses and Expenses Incurred In Administering Property
Revised March. 2003
E-FILED 2015 OCT 21 1:32 PM SAC - CLERK OF DISTRICT COURT

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
APPLICATION TO HIRE
JOHN H. CRISS
ATTORNEY
COMES NOW Renae Jacobsen, executor of the estate of John H. Criss and in support of
this application states:
1. A Petition to Set Aside/Contest Probate of the Last Will and Testament of John H.
Criss has been filed by Eugene Criss, Jr. in this estate.
2. The undersigned executor resists the Petltion to Set Aside/Contest Probate of the Will.
3. An attorney must be hired to resist the Petition to Set Aside/Contest Probate of Will
and defend the Estate of John H. Criss and the undersigned as executor of that Estate.
4. The undersigned believes that John Gray of the Heidman Law Firm in Sioux City,
Iowa should be hired by the undersigned to resist the Petition to Set Aside/ Contest Probate of
Will at the rate of$210.00 per hour.
WHEREFORE, the undersigned executor of the John H. Criss Estate prays that the Court
authorize her to hire John Gray of the Heidman Law Firm in Sioux City, Iowa at the rate of
$210.00 to fully resist the Petition to Set Aside/Contest Probate of Will and defend the Estate of
John H. Criss and the undersigned as executor ofth:tt Estate.

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
ORDER TO HIRE
JOHN H. CRISS
ATTORNEY
_________________________________
THIS MATTER COMES before the Court on the application by Renae Jacobsen,
executor of the Estate of John H. Criss, to hire an attorney to resist the Petition to Set
Aside/Contest Probate of the Will that has been filed by Eugene Criss, Jr. in this Estate. The
Court finds that the executor should be authorized to hire John Gray of the Heidman Law Firm in
Sioux City, Iowa at the rate of $210.00 per hour to resist the Petition to Set Aside/Contest
Probate of Will and defend the Estate of John H. Criss and Renae Jacobsen as executor of that
Estate.
IT IS THEREFORE ORDERED that Renae Jacobsen as executor of the Estate of John H.
Criss is authorized to hire John Gray of the Heideman Law Firm of Sioux City, Iowa at the rate
of $210.00 per hour to resist the Petition to Set Aside/Contest Probate of Will and defend the
Estate of John H. Criss and Renae Jacobsen as executor of that Estate.

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 2 of 2
E-FILED 2015 NOV 03 3:29 PM SAC - CLERK OF DISTRICT COURT
E-FILED 2015 NOV 04 9:39 AM SAC - CLERK OF DISTRICT COURT
In the Matter of
the Estate of
ORDER
EUGENE CRISS, JR.
The Motion to Dismiss of Renae Jacobsen, Individually, comes before the Court. A hearing on same
is scheduled as provided below.
Hearing is scheduled on 11/16/2015 at 1:30 PM at the Sac Co. Courthouse, 100 NW State St., Sac
City, Iowa.
Copies To:
Counsel of Record and Pro Se Parties
1 of 2

Case Number
ESPR014544
Type:
Case Title
OTHER ORDER
So Ordered
2 of 2
Save
Print
Clear Form
Rule 25.10Form 1: News Media Coordinators Notice of Request for Expanded News Media
Coverage of Trial or Proceeding
The expanded news media coordinator uses this form to give notice of a request for expanded news media coverage to the
attorneys for all parties and the judicial officer at least seven days before the proceeding begins.
A separate request for expanded news media coverage must be made for appellate court arguments.
SAC
In the Iowa District Court for
County
County where you are filing this form
No. ESPR014544
News Media Coordinators Notice of

Request for Expanded News Media
Coverage of Trial or Proceeding
Plaintiff Full name: first, middle, last

vs.
Defendant Full name: first, middle, last

The undersigned news media coordinator states as follows:
1.
Certain representatives of the news media want to use: Check each that applies
A.
Photographic equipment,
B.
Television cameras,
C.
Electronic sound recording equipment, or
D.
Other electronic devices,
in courtroom coverage of the above proceeding.

2.
The trial or proceeding to be covered by expanded news media coverage is scheduled for
a.m.
the 16
day of NOVEMBER , 20 15
, at 1:30
at the SAC
p.m.
Day
Month
County Courthouse, SAC CITY
Year
Time
County
, Iowa. The request for expanded news media
City
coverage includes every part of such proceeding as allowed under Chapter 25 of the Iowa
Court Rules.
3.
The request for expanded news media coverage is described as follows (for example, the
number of photographers with still cameras):
Show Lines
A COMBINATION OF NOT MORE THAN FIVE MEDIA MEMBERS USING

NEWSGATHERING EQUIPMENT AS DESCRIBED IN QUESTION 1.
Hide Lines
Continued on next page
May 2014
Rule 25.10Form 1
Page 1 of 2

Rule 25.10Form 1: News Media Coordinators Notice of Request for Expanded News Media Coverage of Trial or Proceeding,
continued
4.
This notice of request for expanded news media coverage is filed: Check one
A.
At least seven days in advance of the proceeding for which expanded news media
coverage is requested; or
B.
This notice cannot be filed within seven days of the proceeding because of the
following reasons:
Show Lines
Hide Lines
5.
A copy of this notice will be sent electronically, delivered by ordinary mail, or delivered in
person to the last known address of all attorneys of record, parties appearing without
attorney representation, the district court administrator for this judicial district, and the
judicial officer expected to preside at the trial or proceeding for which expanded news
media coverage is requested, as follows:
Attorneys:
JOHN CALHOON GRAY, MARY C. HAMILTON, BRUCE EDWARD BECKER
Show Lines
Hide Lines
Parties appearing without attorney representation:

Show Lines
Hide Lines
District court administrator: SCOTT HAND

Presiding judge: THOMAS J. BICE
6.
The undersigned news media coordinator requests expanded news media coverage of this
proceeding as described in this notice.
/s/
News media coordinators signature
Peter Kaspari
News media coordinators printed name
2nd
Judicial District of Iowa
713 Central Ave.
Mailing address
Fort Dodge
City
IA
State
50501
ZIP code
( 515 ) 573-2141
Phone number
pkaspari@messengernews.net
Email address
crime@messengernews.net
Additional email address, if available
May 2014
Rule 25.10Form 1
Page 2 of 2
Notice ID: 2RCV08

In the Matter of
Estate of
JOHN HENRY CRISS
ORDER
A hearing in this matter is set for November 16, 2015. There has been a news media notice of request for
expanded media coverage.
ACCORDINGLY, this request is granted pursuant to the request filed.
1 of 2

Case Number
ESPR014544
Type:
Case Title
OTHER ORDER
So Ordered
2 of 2
IOWA DISTRICT COURT FOR SAC COUNTY

IN THE MATTER OF THE ESTATE
OF JOHN H. CRISS, Deceased
EUGENE CRISS, JR.,
Plaintiff,
vs.
RENAE JACOBSEN, Individually and
As Executor of the Estate of John H.
Criss, and the ESTATE OF JOHN H.
CRISS,
Defendants.
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
No. ESPR014544
Order
The captioned matter was set for hearing on todays date. The
purpose was to address the Motion to Dismiss filed on behalf of Executor Renae
Jacobsen.
The Court notes that Plaintiff has moved to strike the words
Individually and and from the caption of the Petition. As a consequence, the
Court determines that this matter has become moot. The Motion to Dismiss is
hereby granted and the action against Renae Jacobsen is hereby dismissed.
IT IS THE FURTHER ORDER OF THE COURT that the Clerk of
Court reissue letters of appointment to Renae Jacobsen individually. This is the
result of Eugene Criss resigning as co-executor of the estate herein.

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 2 of 2

Letters of Appointment
Docket Event Code: LEAP
KNOW ALL PERSONS BY THESE PRESENTS:

That having been duly appointed and qualified as Executor of the above entitled matter,
Renae Jacobsen
is vested with all powers authorized by law in the premises.

Letters issued: 11/17/2015
/s/ Brenda McClure, Designee

SAC County
E-FILED 2015 DEC 07 3:08 PM SAC - CLERK OF DISTRICT COURT

Olllclal Fonn No. P-708.1
~ffi.
s.

"':,~
Bruce Becker
SAC
Cl~
Oct,~f'
COUNTY
PROBATE NO .. ESPR014544
JOHN H. CRISS
REPORT AND INVENTORY
AMENDED
DECEASED
CIT NO.
Regular estate (Chapter 633) ~

Small estate (Chapter 635)
0
lXI, Administrator 0, or other
(capacity)
whose name and post office address is: Renae Jacobsen, 304!i Wadsley Ave., Sac City, IA 50583
reports as follows:
Age
Name of Decedent
~8
John H. Criss
Date of Death
Last Residence
05/28/15

PO Box 38 1 Sac Cin:: 1 IA 50583
(712} 662-4771
2. Amount of gross estate for Federal Estate Tax f:1U!J)oses:
Will a Federal Estate Tax Return be filed? Yes lXI, No[].
$6 23422525.49
lXI, intestate 0.
5. Did decedent leave a surviving spouse? Yes
Yes
0, No lXI.
If yes,
0, No~~.
6. List (a) surviving spouse, if any, (b) beneficiaries under decedent's will, (c) heirs at law, (d) transferees, and
Relationship
to Decedent
Post Office Address
Age
Name
See Attached Addendum 112 and
2/2
---
'
*Amended to add News Corp Stock on B-5, Alcatel/Lucen Stock

on B-1 and to establish alternate valuations of assets six months
after the decedent's dea1h on all property included in the gross
estate
'
!
r
I
c The Iowa Stale 811" Association 2007
IOWADOCS
I
P-706.11NVENTORY COVER SHEET
R&llised January 2007
Addendum. 1/2
1.
Kurt Criss
429 Cottonwood Dr.
Elko, NV 89801
Annika Criss
429 Cottonwood Dr.
Elko, NV 89801
Kelby Criss
429 Cottonwood Dr.
Elko, NV 89801
Erik Criss
480 Yuma St.
Denver, CO 80204.
Elizabeth Criss
480 Yuma St.
Denver, CO 80204
Leah Hutchins
Eugene Criss, Jr.
475 West 12th Ave.
Unit 9A
Denver, CO 80204
Janna Hutchins
Denver, CO 80123
Denver, CO 80123
Julie Foreman
2324 Dakota Ave.
Lytton, IA 50561
Dwaine Reece
204 North 2nd St.
Addendu;n 2/2
Sac City, IA 50583
Renea Jacobsen
3045 Wadsley Ave.
Sac City, IA 50583
1001 West Main
Sac City, IA 50583
1015 West Main
Sac City, IA 50583.
211 Highland Ave.
Sac City, IA 50583
812 Audubon St.
Sac City, IA 50583
Barbara Powell
Mayor of Sac City
1420 West Main
Sac City, IA 50583
Sac City Museum
c/o Wilma Fort
711 Platt St.
Sac City, IA 50583

Official Fonn No. P-706.2
!~~
~r~ f ~~ ~
Bruce Becker

QUESTIONNAIRE AND RECAPITULATION

<to Cl"~,c
A. Did the decedent at time of death

tenancy? If yes, complete Schedule A.
135,000.00 A
H. Did the decedent possess a general

power of appointment over any property,
or did the decedent exercise or release a
lhree years of death? If yes, complete
Schedule H.
$ --------- H
B. Did the decedent at time of death

5,973,301.90 B
I. Did the decedent own or have an

If yes,
::omplete Schedule I.
74,673.45 c
$ _ __:6::..~.:,3::....:.4.::.!2,.::..:52:.::.5.:....:..4.::...9
I37,7I4.15 1
_ _ ___;:..:::...:...t:....:....::.:...:.::.
any mortgages, notes or cash not held in

joint tenancy?
If yes, complete
Schedule C.
I0,335.99 D
D. Is there any insurance on the life of

the decedent?
If yes, complete
Schedule D.
E. Did decedent at time of death own

spouse?
E-1. Did decedent at the time of death

with others? If yes, complete
Schedule E-1.
F. Did decedent at time of death own

other schedule?
If yes, complete
Schedule F.
F-1. If intestate or election to take

Schedule F-1.
G. Did decedent make any gift within

three years of death in excess of the g itt
tax exdusions allowable under I.R.C.
$ --------- G
E
--------E-1

633.361.9,.12 AND .13, THE CODE.
---------
I. Did the decedent die owning real $
II 500.00 F
0.00 F-1
'state located outside the State of Iowa

1ot otherwise reported? If yes, attach
egal description, and estimated value
l. Is any property required to be

-eported for federal estate tax purposes
Nhich is not induded in the Iowa gross
'state or on line 1 above? If yes, attach
NONE
-----.....!.~=:::
NONE
-----.....!.~=:::
S. Was any gift made by decedent that $

NONE
-educed the amount of the unified credit
_ _ _ _ _....!..::..:::::.:...:..:::
available
for
federal
estate
tax
Jurposes?
lift, date and amount of unified credit
:!aimed.
CERTIFICATION
I certify under penalty of pe~ury and pursuant to the laws of the S1ate of Iowa that the preceding is true and correct.
Date
/:J.- 1 -{;'
Estate of
/J
Capacity or Title
Executor
OAt ~
Siallllure
-;k[i() ~'h
Renae Jacobsen
John H. Criss
, Deceased.
This form is in compliance with Administrative DirEctive of the State Court Administrator 2014-1

IOWADOCS

Revised May 2014

omclal Form No. P-708 Schedule A
Bruce E ecker

SCHEDULE A- REAL ESTATE

Item
DeacrlpUon
Number
See Below
Altemme
Valuation Date
11127/2015
Altemme Value
Value at Date or Death
$135,000.00
$135,000.00
The North fifty (50) feet of Lots one and two (1 & 2) in Block one (1), Platt's Addition
to Sac City, Iowa, and fully described as follows: Starting at the northeast comer of
Lot one (1); thence in a westerly direction along the north line of said lots 1 and 2 one
hundred-twenty (120) feet to the northwest comer of said Lot 2; thence in a southerly
one hundred twenty (120) feet parallel with the north line of said lots 1 and 2 to a
point in the east line of lot 1 fifty (50) feet south of the north line of said lot 1; thence
in a northerly direction fifty (50) feet to piont of starting. Also the north fifty (50) feet
of lot three (3) in block one (1) of Platt's Additior. to Sac City, Iowa except the west
twenty (20) feet of said tract, and more fully desc:-ibed as follows: Commencing at a
point twenty (20) feet east of the northwest comer of said Lot three (3) above
thence east on a line parallel with the south line o:: lot 3 forty (40) feet; thence north to
the northeast comer of said lot3; thence west to the place of beginning.
TOTAL. Enter in the Recapitulation ............................. .
c The Iowa SIBle Bar AssOCiation 2003

IOWADOCS
$135
ooo.oc
$135 000.00
SCHEDULE A
P-706 SCHEDULE A- REAL ESTATE

Reloised Januarv. 1999

Oftlclal Fonn No. P-706 Schedule B

Bruce B:::cker
SCHEDULE B -STOCKS AND BONDS

Item
Numbe
Description Including Face Amount of Bonds

Par Value Where Needed for ldentincallon
Number
of Units
UnltVal~e
Alternate
Valuation Date
Alternate Value

(Attached as B-1)
1.00
$4,119,588.150 11127/2015
$3,963,628.58
4119588.15

Account No. 02014812645 002
1.00
$138,794 7400 11127/2015
$141,779.00
138794.74
Wells Fargo
(Attached as B-2)
1.00
$47,425.3300 11/27/2015
$43,734.69
47425.33

6096-9990
(Attached as B-3)
1.00
$12,069.7100 11127/2015
$11,540.05
12069.71
Merrill Lynch
(Attached as B-4)
1.00
$360,420.8400 11127/2015
$350,711.79
360420.84
Merrill Lynch
(Attached as B-5)
1.00
$1,458,738.330 11/27/2015
$1,419,092.73
1458738.33

Trust)
1.00
$25.0000
11127/2015
$25.00
25.00

Fund
1.00
$41,879A200 11/27/2015
$42,490.06
41879.42
1.00
$300.0000
11/27/2015
$300.00
300.00
$5,973,301.90
$6,179,241.52
TOTAL. Enter in the Recapitulation ...............................
SCHEDULE B
IOWADOCS
P-706 SCHEDULE B- STOCKS AND BONDS

B -1
CHIEF CLOTHING COMPANY
NOVEMBER27, 2015 AJ ..TERNATE VALUES
Bank Deposit Sweep
4 7. 79 shares
5353.00 shares
$26,404.21
47.79

$713,198.51
Deferred Annuity Acct. No. 93002814104 004

(Check received on 8/24/2015 and deposited)
33,210.863 shares
$329,119.65
Merrill Lynch Account# 660-07402

See attached (stocks held at Merrill Lynch at time of death)
Iowa State Bank

$715,886.45
$2,143,038.47
$ 35,933.50
Total Assets
$3,963,628.58
B-1
1-i\.~ Merrill Lynch

~Wealth ............
Bank ar America Corporation

Date of Death
Valuation Date
Processing Date
Report Type
11/27/2015
11/27/2015
12103/2015
CHIEF CLOTHING CO
208S 8TH ST
Account# 660-07402
Shares Security
High/ Ask
Mean and/or
Adjustments
Low/ Bid
or Par Description
1)
Date Of Death
1
Div and lnt

Accruals
Security
Value
339.0080 ALTRIA GROUP INC (022095103)

New York
... , , ... _ , _
"'1 "', ,n7
n not r:.
2)
r:a n'lnnn
-------
57.50000
!-l_n_
57.765000
19,582.79
117.985000
61,942.12
135.025000
54,010.00
525.0000 APPLE INC (037833100)

NASDAQGS
11/2712015
3)
118.37000
117.60000 HIL
400.0000 BERKSHIRE HATHAWAYINC (084670702)

DELCLB NEW
New York
11/2712015
135.58000
134.47000 HIL
B-1
CHIEF CLOTHING CO
208S 8TH ST
Shares Security
or Par Description
4)
Account# 660-07402
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
380.0000 BOEING COMPANY (097023105)

New York
11/2712015
147.66000
146,68000 HIL
147.170000
lnt/Div: 0.91 Ex: 11/04/2015 Rec: 11/06/2015 Pay: 12/04/2015

5)
Security
Value
55,924.60
345.80

Toronto
11/27/2015
24.59332
23.85695 HIL
24.225135
13,444.94
Price has been adjusted for the exchange rate on the pricing date and is priced in U.S. Dollars.
6)
264.9211 CF INDS HLDGS INC (125269100)

New York
11/27/2015
45.30000
44.66000 HIL
44.980000
lnt/Div: 0.30 Ex: 11/1212015 Rec: 11116/2015 Pay: 11/30/2015

7)
11,916.15
79.47
456.6418 CUMMINS INC COM (231021106)

New York
11/27/2015
100.10000
99.22000 H/L
99.660000
lnt/Div: 0.98 Ex: 11/18/2015 Rec: 11/20/2015 Pay: 12/01/2015
8)
45,508.92
445.22

New York
11/27/2015
165.86000
163.33000 H/L
164.595000
50,036.88
~~~:"~~""'-"'1~..,.,~~W1~'"'''{'-~~~~'~!Iom>~''?'''f."'ll-lf1~~~~~-.,,'I!'I\~,>:'!WN>'~'1'-':'f'f~~-~,"tt''f~~~~~~il\"!\11'l'f>~?J'~~~~,J'fi,l;l.Jill(!ft1'11'ii!~.\liJlll~~l\1>>'1'!l!~'!~'!'IIPI'9\~~f,p
B-1
CHIEF CLOTHING CO
208 S8TH ST
Shares Security
or Par Description
9)
Account# 660-07402
High I Ask
Low/ Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
255.9865 HANESBRANDS INC (410345102}

New York
11/27/2015
31.59000
31.01000 HIL
8,012.37
31.300000
25.59
lnt/Div: 0.10 Ex: 11/13/2015 Rec: 11/17/2015 Pay: 12/08/2015
10)

New York
11/27/2015
11)
78.00000
77.15000 HIL
77.575000
31,707.84
44.175000
7,850.85

INC
NASDAQGS
11/27/2015
12}
44.56000
43.79000 HIL
365.9205 MICROSOFT CORP (594918104)

NASDAQGS
11/27/2015
54.07500
53.81000 H1L
19,738.66
53.942500
131.73
lnt/Div: 0.36 Ex: 11/17/2015 Rec: 11/19/2015 Pay: 12/10/2015
r
I
1:
13)
354.0041 NUCOR CORPORATION (670346105}

New York
11/27/2015
41.87000
41.27000 H1L
41.570000
14,715.95
~~~v~~~~!"'~~~%~"it~~.~~'i~~~~~~~~~.'l\!~~~~~'lfl'~~~~~~~~>w~~"
B-1
CHIEF CLOTHING CO
208 S8TH ST
Shares Security
or Par Description
14)
Account# 660-07402
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
271.2485 PHILIP MORRIS INTL INC (7181721 09)

New York
11/27/2015
15)
87.67000
86.83000 HIL
87.250000
23;666.43
100.690000
23,348.42
32.835000
11,808.37
231.8842 PEPSICO INC (713448108)

New York
11/27/2015
16)
100.99000
100.39000 HIL
359.6277 PFIZER INC (717081103)

New York
i ii27i2vi5
33.00000
32.67000 HfL
lnt/Div: 0.28 Ex: 11/04/2015 Rec: 11/0612015 Pay: 12101/2015

17)
100~69

New York
11/27/2015
76.35000
75.50000 HIL
75.925000
18)
23,528.40
345.0000 J M SMUCKER CO (832696405)

New'York
1112712015
123.97000
122.63000 HIL
123.300000
lnt/Div: 0.67 Ex: 11/10/2015 Rec: 11/13/2015 Pay: 12101/2015
42,538.50
231.15
~'to."""~~l'I"'~'"<:'"K'!l!!-~~'{f"~~~~~~~~~'~W!!!_~~~~~~~~,.,!11!i-,.f~,.~jli_OJ!~~;
B-1
CHIEF CLOTHING CO
208 S 8TH ST
Account# 660-07402
Shares Security
or Par Description
19)
High/ Ask
Low/ Bid
Mean and/or
Adjustments
Dlv and lnt
Security
Accruals
Value
879.1835 SOWEST GAS CORP (844895102)

New York
11/2712015
56.59000
56.01000 HIL
49,498.03
56.300000
356.06
lnt/Div: 0.41 Ex: 1111212015 Rec: 11/1612015 Pay: 12101/2015
20)
427~3550 WELLS FARGO & CO NEW DEL (949746101)
New York
1112712015
55.46500
54.98000 HIL
23,599;61
55.222500
160.25
lnt/Div: 0.38 Ex: 11/0412015 Rec: 11/0612015 Pay: 1210112015
21j
""'"""' """'""'"-
0,;).;).0!:1.0:.U
~P"'ll ~""I. I " ' Ill. IA \&ll""t.f""ll """'ll"lftftAftV"'I"\A\
I J;;IVIr-LJ;; I VI" vnll"'"' VV\JJ">LL.I \OUU IUA..:.U I J
FUNDCLA
11/2712015
22)
27.25000 MKT
27.250000
22,723.55
10;330000
71,779~03
10.560000
254.72
6,948.6000 PRINCIPAL PREFERRED (74254T252)

SECURITIES FUND A
11/27/2015
23)
0.00000
0.00000
10.33000 MKT
24.1220 BLACKROCK US GOVERNMENT (091928549)

BOND PORTFOLIO A
1112712015
0.00000
10.56000 MKT
~~~.o:m:~-m~-:n~'*t\">!'~'"'~~'!\~~'0!~~~,!1.~~~~,~~~.t.l'~t-\~f',.~H%,.\,~,.~\#.,fli,,k,.Al'~~!'l~,~~~~~.~P'l~1'f!.<;!J~~~~~~'I'J-~~
,\!\.
,;;;p~
B-1
CHIEF CLOTHING CO
208 S 8TH ST
Shares Security
Account# 660-07402
High I Ask
Low/Bid
or Par Description
24)
Mean and/or
Adjustments
Divand lnt
Accruals
Security
Value
00.0000 CASH
28,749.32
$715,886.45
Total Value
$1,875.96
Total Accrual
$717,762.41
Total
---
$715,886.45

$1,875.96
Total Accruals :
$717,7R?41
The Information herein has been obtained from a source we believe to be reliable, but we do not guarantee Its accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. Any tax
statements contained herein were not Intended or written to be used, and cannot be used for the purpose of avoiding U.S., federal, state or focal tax penalties. Please consult your advisor as to any tax, accounting
Disclosures:
Alternative Date of Death valuations are not available in this application. Please consult your tax advisor for assistance in obtaining this report.
All security positions are based on trade date.
Money funds, money market and/or boncllllxed Income mutual funds may or may not Include dividends/Interest accruals prior to month end payment.
For accounts with Credit and/or Debit card(s), the cash position may not reflect reduction for purchases of goods or services which are paid for by automatic debit on the Wednesday before the last Friday of each
month.
Cash balance may not reflect outstanding checks written prior to valuation date or unsetued cash as of valuation date.
All Items flagged "!" and highlighted In red reflect manually adjusted transactions (for price, shares, market value or security name) or positions with no available price.
Asset posfUons provided to Bank of America I Merrill Lynch from an outside financial Institution (I.e. Annuities), may require the SecuriUes Description fine to be manually updated.
All mortgage backed securities have the paydown factor I amortization factor automatically applied.
If the account you are valuing is a "900" series account (international). the values will be reported based on the currency the account holds, not USD. Please also note that if this account is valued along with other
USD accounts. you will not receive an accurate valuation; please run these accounts separately from USD accounts held in the client's household.

Symbol
T
BAX
BOX
BP
CAH
CTL
CMCSA
CSAL
cvs
FTR
NCR
OXY
s
TSN
USB
vz
WIN
ADX
CRC
ALU
Company Name
AT&T INC
BAXTER INTL INC
BP PLC
CARDINAL HEALTH INC
CENTURYLINK INC
COMCAST CORP NEW
CVS HEALTH CORP
NCR CORP
SPRINT CORP
TYSON FOODS INC
US BANCORP NEW
ALCATELI/LUCENT
CUSIP
00206R102
071813109
075887109
055622104
14149Y108
156700106
20030N101
20341J104
126650100
35906A108
62886E108
674599105
85207U105
902494103
902973304
92343V104
97382A200
006212104
130570107
013904305
Shares
2,708
1,520
10
7,938
283
193
107
48
382
462
14
17,828
635
864
1,342
1,619
40
7,672
5208
59
Date
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
Close
33.57
37.68
151.29
34.83
87.29
27.06
61.59
19.2
94.63
4.96
27.23
75.19
3.73
50.55
43.9
45.23
6.22
13
4.17
3.91
I
Chief Clothing Transfer Agent Holdings- as of 11/27/2015
Total
90,907.56
57,273.60
1,512.90
276,480.54
24,703.071
5,222.58
6,590.13
921.60
36,148.66
2,291.52
381.22
1,340,487.32
2,368.55
43,675.20
58,913.80
73,227.37
248.80
99,736.00
21,717.36
230.69
.... _ --- .
~. 14,j,U,j0.4fl

B-2
Description
CENTURYLINK INC.
DEERE&CO
PETMED EXPRESS INC
TEVA PHARMACEUTICAL
Quantity
212.07400
204.15400
52355600
204.09700
Value on 11/27/15
$ 5,738.72
$16,146.54
$ 8,895.39
$12,954.04
B-3
Description
CISCO SYSTEMS INC
INTEL CORP
Quantity
295.0000
111.1137
135.5025
Value on 11/27/15
$3,835.00
$3,035.63
$4,669.42
B-4
P\.~ Menill Lynch

~w..lth ..........t

Date of Death
Valuation Date
Processing Date

208S 8TH ST
Shares Security
or Par Description
1)
Report Type
Number of Account(s}
11/27/2015
11/27/2015
12103/2015
Account# 660-56348
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
275.0000 BP PLC SPON ADR (055622104)

New York
712.2425 CSX CORP(126408103}

New York
11/27/2015
3"!.9"!000
29.05000
34.75000 H!L
200.0000 CONTINENTAL RESOURCES (212015101}

INC
New York
11/2712015
36.84000
34.845000
9,582.37
28.880000
+0..180000
29;060000
20';697.76
36.400000
7,280.00
28.71000 HIL
lnt/Div: 0.180000 Ex: 11/2512015 Rec: 11/30/2015 Pay: 12115/2015
3}
-4"'
,.,"7 Mn<4 r::.
I li.116-V 1'-1
2}
Date Of Death
35.96000 HIL
B-4

208S 8TH ST
Shares Security
or Par Description
4)
Account# 660-56348
High I Ask
Low/Bid
Mean and/or
Adjustments
Dlvand lnt
Security
Accruals
Value

New York
11/27/2015
5)
5.20000 HIL
5.285000
2,261.46
27.355000
6,139.08
66.475000
25,08&.28
115.100000
24,635.49
67.125000
15~615.34

NASDAQGS
11/27/2015
6)
5.37000
27.47000
27.24000 HIL
3n.4093 COLGATE PALMOLIVE (194162103)

NewYork
;:;;;t(i20i5
7)
66.75000
66.20000 HiL

New York
11/27/2015
8)
116.50000
113.70000 HIL
232;6309 DUPONT E I DE NEMOURS (263534109)

New York
1112712015
67.39000
66.86000 H/L
lnt/Div: 0.38 Ex: 11/10/2015 Rec: 11/13/2015 Pay: 12/14/2015
88.39
044J,,?.,M.!-#*"-h
~ ~.....,.,.~~~~)'1'11-Jit5-"'lt]."*~~i?.~~'fl''~'~~~~~~'l\W~~~-1>~~~
1
;~~
~-----------------
B-4
I
II
I

208S 8TH ST
Shares Security
or Par Description
9)
Account# 660-56348
High I Ask
Low/Bid
Mean and/or
Adjustments
Dlv and lnt
Security
Accruals
Value

New York
11/27/2015
14.96000
14.80500 HIL
3,092.40
14.882500
10) !

CORP
Weare .unab_le to price this issue.
11)
223.6843 FORTUNE BRANDS HOME AND (34964C1 06)

SECURITY INC SHS
New York
11/27/2015
56.01000
55.42000 HIL
12,462.57
55.7i5000
31.31
lnt/Div: 0.14 Ex: 1112412015 Rec: 1112712015 Pay: 12/1612015
12)
1,207.0000 !SHARES SILVER TR (464280109)

NYSEArca
1112712015
13)
13.50000
13.36000 H/L
13.430000
16,210,01
103.975000
25,660.41

New York
11/27/2015
104.40000
lnt/Div: 0.60 Ex: 11/1712015 Rec: 11/19/2015 Pay: 12110/2015
103.55000 H/L
146.84
B-4

208 S 8TH ST
Account# 660-56348
Shares Security
or Par Description
14)
High/ Ask
Low/Bid
Mean and/or
Adjustments
Divand lnt
Security
Accruals
Value
107.1643 JOY GLOBAL INC DEL COM (481165108)

New York
1112712015
15.61000
15.01000 HIL
15.310000
15)
1,640.68

New York
1112712015
102.62000
101.87000 HIL
102.245000
lnt/Div: 0.75 Ex: 11120/2015 Rec: 11/24/2015 Pay: 12/08/2015

16)
25,949.70
190.34
317.4447 KELLOGG CO (487836108)

fliew-Yoi'K
11/27/2015
69.45000
68.74000 HIL
69.095000
lnt/Div: 0.500000 Ex: 1112712015 Rec: 12/0112015 Pay : 12/15/2015
17)
+0.500000
69.595000
22,092.56
185.6806 Ell LILLY & CO (532457108)

New York
11/2712015
84.14000
83.60000 H/L
83.870000
lnt/Div: 0.50 Ex: 1111012015 Rec: 1111312015 Pay: 12/1012015

18)
15,573.03
92.84
469.3072 MEDTRONIC PLC SHS (G5960L103)

New York
11/27/2015
76.99000
76.27000 HIL
76.630000
35,963.01
B-4

208S8TH ST
Shares Security
or Par Description
19)
Account# 660-56348
High/ Ask
Mean and/or
Adjustments
Low/Bid
Divand lnt
Security
Accruals
Value

New York
11/2712015
20)
41.87000
41.27000 H/L
41.570000
14,715.95
100.690000
23,348.42
16.355000
114.58
1.170000
35.10
76.970000
7,697.00
231.8842 PEPSICO INC (713448108)

New York
11/2712015
21)
100.99000
100.39000 H/L

New York
i1l2il2Qi5
22)
... ~ t:.r:.nnn
'""""'"""'"'"'
.otC! .otc.nnn
Uti
'""''"""'"""' ,.,_
30.0007 SEVENTY SEVEN ENERGY INC (818097107)

SHS
New York
1112712015
23)
1.20000
1.14000 HJL
100.0000 SCHLUMBERGER LTD (8068571 08)

New York
11/2712015
77.50000
76.44000 H/L
~'~l'i~.1~~~~~~~~~~1r~~"~~~~~~~~~~~i;fi,W~lii!~'
.._,..____,.....,.,_,...._.,_._,,,.,,,,,,""""""" _ _ _ _
---"-"~~---~-~-.--~---~-~._
.......___~-.w.;~~~~~-x.,{l.,.
B-4
MR JOHN H CRISS DCSO

208 58TH ST
Account# 660-56348
Shares Security
or Par Description
24)
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
206.0000 SPDR GOLD TRUST (78463V1 07)
NYSEArca
1112712015
25)
101.62000
101.00000 HIL
101.310000
20,869.86
37.725000
7,545.00
200.0000 TOLL BROS INC COM (889478103)
New York
11127/2015
26) !
37.98000
37.47000 H1L
00.0000 CASH
6,441.73
Total Value
$350,711.79
Total Accrual
$549.72
Total
$351,261.51
$350,711.79
Total Accruals :
$549.72
$351,261.51
The information herein has been obtained from a source we believe to be reliable, but we do not guarantee its accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. Arry tax
statements contained herein were not Intended or written to be used, and cannot be used for the purpose of avoiding U.S., federal, state or local tax penalties. Please consult your advisor as to any tax, accounting
Dlsclosurea:
~*1
B-5

Symbol
BAC
BMY
ETR
XOM
GXP
HNI
LNCO
ZBH
CASY
HTLD
PXD
MGF
MMT
FOXA
TEMGX
NWSA
Company Name
ENTERGY CORP
EXXON MOBIL CORP
HNI CORPORATION
LINN CO LLC
21ST CENTURY FOX
News Corp
CUSIP
60505104
110122108
29364G103
30231G102
391164100
404251100
535782106
98956P102
147528103
422347104
723787107
552939100
552737108
90130A101
88022L102
65249B109
Shares
1,650
2,015
1,863
5,309
106
5,727
67
114
1600
4544
167
1000
500
1388
8401.791
347
Date
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
ii:s at.;t.;Urat.;y. Pa:si performance is not indicative oi iuture perrormance.
Criss Personal Holdings at Transfer Agents- Updated DOD 11/27/2015
Close
17.48
67.85
66.17
81.23
26.97
44.97
1.76
101
118.38
19.82
144.63
5.25
5.68
29.54
8.25
14.25
Total
28,842.00
136,717.75
123,274.71
431,250.00
2,858.82
257,543.19
117.92
11,514.00
189,408.00
90,062.08
24,153.21
5,250.00
2,840.00
41,001.52
69,314.78
4,944.75
1,419,092.73

Oftlclal Fonn No. P-706 Schedule C
Bruce Becker

SCHEDULE C - MORTGAOES, NOTES AND CASH

Item
Number
Description
Alternate
Valuation Date
Alternate Value
11/27/2015
$64,678.58
$64,678.58
11/27/2015
$7,958.48
$7,958.48
I
3
11/27/2015
$2,036.39
$74 673.45
$2,036.3<l
$74 673.45
SCHEDULEC

IOWADOCS 8
P-706 SCHEDULE C MORTGAGES, NOTES AND CASH

Revised Januarv. 1999

Oftlclal Fonn No. P-706 Schedule D

Bruce Becker
SCHEDULE D - INSURANCE ON THE DECEDENT'S LIFE

it is includable or excludable in the estate subject to Iowa inheritance tax.
Item
Number
Description
Veteran's Benefit
Alternate
Valuation Date
11127/2015
Alternate Value
$10,335.99
$10,186.40
TOTAL .......................................... . :. . :. . :. .:. . :. . :....:...:....:.... :. . :....:-+----=$1:..:::0.z.::3.::..:35::..:..9::...::9+---$~1-=-0,'"""1=86:..:....4=-0 11

Less amounts excluded for Iowa inheritance tax .......... .:. . .:. . :....::....:~~...:....:.~~. :. + - - - - - - - f - - - - - - - - l l
Amount subject to Iowa inheritance tax. Enter on the Recapit~u~la~ti~o:.!.!n...:.~..:....:...:. . :.....~.-_ _ _ _ _ __.J-_ _ _ _ _ _ _ 11
SCHEDULED
IOWADOCS
P-706 SCHEDULE D INSURANCE ON THE DECEDENrS LIFE

Rellised January. 1999

Olllclal Fonn No. P-706 Schedule F/F-1
Estate of:

Bruce Becker
John H. Criss
SCHEDULE F - MISCELLAI~EOUS PROPERTY NOT

REPORTABLE UNDER AINY OTHER SCHEDULE
1. Did the decedent, at the time of death, <7ollll any articles of artistic or collectible value in excess of $3,000 or any
collections whose artistic or collectible value combined at date of deeth exceeded $3,000?
If ''Yes", full details must be submitted on this schedule.
2. Has the decedent's estate, spouse, or any other person, received (or INill receive) any bonus or award as a result of
3. Did the decedent at time of death have, or have access to, a safe dei>OSit box?
If ''Yes", state locations, and if held in joint names of decedent and another, state name and relationship of joint
depositor.Iowa State Bank, Sac City, lA
If any of the contents of the safe deposit box are omitted from the schedules in this return, explain fully why omitted.
4. Did the decedent, at the time of death, <7ollll any other miscellaneous property not reportable under any other
schedule?
X
Hem
Number
Deecrlptlon
AHem ate
Valuation Date
AHemate Value
11127/2015
$10,000
$10,000.00
1995 Cadillac
11127/2015
$1,500
$1,500.00
TOTAL. Enter in the Recapitulation . . . . . . . . . . . . . . . . . . . . . . . . . . .
$11
--------~----~~~~----~~~~
SCHEDULE F
IOWADOCS 8
P-706 SC ~EDULE F/F-1 MISCELLANEOUS PROPERTY NOT REPORTABLE/EXEMPT

Re'Jised January, 1999

Offlclal Fonn No. P-706 Schedule I
Bruce Becker


SCHEDULE I - ANNUITII:S AND 529 PLANS
Item
Number
Description
Alternate
Valuation
Date
Alternate
Value
Value at Date
of Death
Instructions -Annuities: (1) Describe completely; (2) include if the annuity was derived from an
1
11/27/2015
$63,878.01
$58,393.77
The Commonwealth , Contract No. SD 10005019
11/27/2015
$26,531.32
$35,884.00
Charles Schwab Rollover IRA, Acct No. 2309-5671)
11/27/2015
$47,304.82
$51,671.99
Instructions - Section 529 Plans: Qualified Section 529 Plans are reportable but are not taxable. For
each amount listed, provide the plan name, date estab ished, named beneficiary, and named
beneficiary's age at the time of decedent's death. List etmounts in line 2, "Nontaxable Amount," below.
TOTAL
$137,714.15
$145,949.76
$137,714.15
$145,949.76
Nontaxable Amount
IOWADOCS
SCHEDULE I
P-7061 ANNUITIES

Oftlclal Form No. P-706 Schedule J

Bruce Becker

SCHEDULE J - Funeral Expenses and Expenses Incurred
in Administering Prope11y in the Gross Estate.
comoutina the taxable estate for federal estate tax ourooses thev are not allowable as an income tax deduction on form lA 1041.
Item
Number
Description
Amount
6,724.16
278.65

Monument (no bill received yet)
Total. ......................................
7,002.81
B. Administrative expenses allowable under Iowa Code section 450.12

1
bm!Ieli::Jmm~~
126 970.51
126 970.51

/~!II!KOpO.KQp)IIXI.
Attorney fees: Amount estimated
13,060.00
Court Costs (est.)
Total A& B
Item
Number
1
2
3
4
Description
274 003.83
Amount

C. Iowa Portion of A & B
Il
.
274,003.83
SCHEDULEJ
IOWADOCS
P-706 SCHEDULE J- Funeral Expenses and Expenses Incurred In Administering Property

Revised March, 2003
E-FILED 2015 DEC 08 11:43 AM SAC - CLERK OF DISTRICT COURT

IN THE MATTER OF
:'l"O. ESPR014544
THE ESTATE OF
APPLICATION
JOHN H. CRISS
TO REFORM TRUST
COMES NOW Renae Jacobson a/k/a Ranae Jacobsen, the Personal Representative for
the John H. Criss Estate, and states to the Court as follows:
1. The Last Will and Testament of John H. Criss provides that the residue of the estate be
held by the John H. Criss Trust to be administered pursuant to the terms of that trust by Renae
Jacobson, Dwain Reece, and the Mayor of Sac City, Iowa. The purpose of the trust is for the
beautification of and general improvements to the City of Sac City as the Co-Trustees in their
unrestricted discretion believe will improve and beautify the City of Sac City regardless of the
existence of other funds available for that purpose; however the Co-Trustees shall not use the
funds in this trust for the improvement of sanitary sewers, streets, or sidewalks.
2. The trust provisions also provide that the Co-Trustees have the power and authority to
do any act or thing reasonably necessary or advisable for the proper administration and
distribution of the estate, including all powers, duties, and responsibilities provided expressly for
trustees in the Iowa Code.
3. Iowa Code Section 633A.2206(2) provides that the terms of a trust may be construed
or modified in a manner that does not violate the settlor's probable intent, to achieve the settlor's
tax objectives.
4. The testator intended that the trust which forms the residue of this estate be treated as
a tax-exempt entity for purposes of Federal Estate Tax, Federal and State income tax, and Iowa
Inheritance Tax purposes. In order to claim this tax-exempt status, a determination letter needs
to be received from the Internal Revenue Service tha.t an Application for Tax-Exempt Status has
been approved.
5. The aforesaid determination letter will bt:: issued in a more expeditious manner if the
trust is reformed to specifically provide that the trust assets can only be used for exempt
charitable purposes and that none of the trust assets nor any of the income from the trust assets
would inure to the benefit of any private individual and that no part of the activities of the trust
would be involved in any attempt to influence legislation by propaganda or otherwise.
6. The Personal Representative proposes that subparagraph A of Article XIX of the
decedent's Last Will and Testament be reformed to read as follows:
XIX
JOHN H. CRISS TRUST
A
The purpose of this Trust is to provide for the beautification of and general improvements
to the City of Sac City, Iowa, as the Trustees, in their unrestricted discretion, believe will
available for that purpose; however, the Trustees shall not use the funds in this Trust for the
improvement of sanitary sewers, streets or sidewalks. All or part of the funds can be used at any
time by my Trustees in their discretion, and when all the assets funding this Trust have been
exhausted, the Trust shall be declared closed, and the Trustees be exonerated and discharged
from further responsibility. Provided, however, that this Trust is formed and must be operated
exclusively for exempt charitable purposes as
defin~d
by Second 501(c )(3) of the Internal
Revenue Code. The Trust may not undertake any a~::tivities not permitted by Section 50l(c )(3)
of the Internal Revenue Code. Distribution of Trus1: income and principal are to be made only to
a qualified charitable organization that promotes any one or more of the purposes above stated.
No part of the net earnings of this Trust may inure, in whole or in part, to the benefit of
any individual as the terms "individual" and "inure" are defined by Treasury Regulation Section
1.501(a)(l-l)c. In addition, under no circumstanceH may any of the assets of this Trust be
distributed to or for any person, agency, or organization who or which is not an exempt
organization under the requirements of Section 501 (c )(3) of the Internal Revenue Code. Further,
the Trust may be modified at any time or times by the foundation Trustees so as to conduct the
affairs ofthe Trust in accordance with the provisions of Section 501(a)(3) ofthe Internal
Revenue Code (and as governed by any future amendment to or revision of the Internal Revenue
Code.) No modification would be permitted that would cause this Trust to be classified as or to
be treated as a non-exempt charitable organization.
7. The designated Trustees of the John H. Criss Trust have consented to the relief
requested by this Application and have waived further notice or hearing in this matter.
8. The effective date of this reformation shall be treated as of the date of death of John H.
Criss.
WHEREFORE, the undersigned respectfully requests that the Court approve this
Application and authorize the reformation and modification of the Trust established under the
Last Will and Testament of John H. Criss according to the terms of the reformation contained in
this Application; and for such other and further relief as the Court deems appropriate.
Renae Jaco en a/k/a Ranae Jacobsen,

Personal Representative
STATE OF lOWA, COUNTY OF SAC ss:

I, Renae Jacobsen, a/k/a Ranae Jacobsen, bdng first duly sworn state that I am one of the
fudiciaries in the above-entitle estate, that I have read this Application to Reform Trust and know
its contents and that its statements are true to the best of my knowledge.
Renae Jac sen a/k/a Ranae Jacobsen,

Personal Representative
Subscribed and sworn to before me this
_7'------ day of December, 2015
~ot.~ Commission
MYRA J. HORTON
Number 187604
owt.
MY
C!lMMISSION EXPIRES
1
!1-19 -aorz
CONSENT TO APPLICATION
The undersigned designated trustee of the John H. Criss Trust consents to the aforesaid
application to reform Trust.
DwiDnRe~~
(~~~
Barbara Powell Bloes, Mayor of Sac City

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
ORDER FOR HEARING
JOHN H. CRISS
_________________________________
THIS MATTER COMES before the Court on the Executors Application to Reform
Trust to allow the residue of the Estate to be treated as a tax exempt entity for purposes of federal
estate tax, federal and state income tax, and Iowa Inheritance Tax purposes.
The Court finds that the Application should be set for Hearing with notice given to all
interested parties.
IT IS THEREFORE ORDERED, the Hearing on the executors Application is set for the
4th day of January, 2016, at 9:00 a.m. in the Court Room of the Sac County Courthouse in Sac
City, Iowa.
IT IS FURTHER ORDERED that a copy of the Application and Notice of Hearing shall
be served on each of the beneficiaries named in the Last Will and Testament of John H. Criss by
ordinary mail at least twenty days before the time and place of hearing. Proof of mailing shall be
done by Affidavit and filed with the Sac County Probate Clerk in this cause.

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 2 of 2

Oftlclal Fonn No. P222
Bruce Becker

THE IOWA DIST'RICT COURT

SAC
COUNTY
IN THE MATTER OF
No. ESPR014544
John Criss Estate
STATE OF _ _ _I_O_W_A_ _ _ , COUNTY OF _ _ _ _ _S_A_C_ _ _ _ _ , ss:

The undersigned, first being duly sworn (or affirmed), states that on the 9th day of
December
, 2015 , he/~ personally maiiHd to each of the following named persons a
* a copy of the Application to Reform Trust filed with the Sac County Clerk of Court on December 8,
2015 as well as a copy of the Notice of Hearing
by
ordinary
mail, each such notice, together with other enclosures if so indicated
See 1 in Addendum
(If return receipts are required so state and attach)
This record was acknowledged before me this _ _____;9: . . :t: .:.h-=d=ayJ.. . .: :.o.:. . f=D-=-e.=. ;ce:.:.m:.:.b: . : e:.:. r,:z. . :2: . : 0:. . .:1. .:;.5___ , by
Bruce Becker
t1ffP. f!lslru:km
'
9natUre
of Notary Public
. ..u.
i.,..4..\
a:
MYRA J. HORTON
commission Numbe~~7604
MY 19~~SJ~/~ IRES
*If there are other enclosures, such as Final Report, Annual Report, etc., so state
IOWADOCS
P222 AFFIDAVIT OF MAILING NOTICE

Revised August 2013
Addendum
1.
Kurt Criss, 429 Cottonwood Dr., Elko, NV 89801

Annika Criss, 429 Cottonwood Dr., Elko, NV 89801
Kelby Criss, 429 Cottonwood Dr., Elko, NV B9801
Eric Criss AKA Erik Criss, 480 Yuma St., D<:nver, CO 80204
Elizabeth Criss, 480 Yuma St., Denver, CO 80204
Leah Hutchins, 1650 Domain Loop S.E., Rio Rancho, NM 87124
Eugene Criss, Jr., 475 West 12th Ave., Unit 9A, Denver, CO 80204
Janna Hutchins, 6055 West Progress Ave., Denver, CO 80123
Tommy Hutchins AKA Thomas Cumberland, 6055 West Progress Ave., Denver, CO
80123
Julie Foreman, 2324 Dakota Ave., Lytton, lA 50561
Dwaine Reece AKA Dwain Reece, 204 North 2nd St., Sac City, lA 50583
Ranae Jacobsen AKA Renae Jacobsen, 3045 Wadsley Ave., Sac City, lA 50583
Sac City Public Library, 1001 West Main St., Sac City, lA 50583
Sac Community Recreation Center, 1015 We;;t Main St., Sac City, lA 50583
Loring Healthcare Foundation, 211 Highland Ave., Sac City, lA 50583
First Presbyterian Church, 812 Audubon St., :~ac City, lA 50583
Barbara Powell, Mayor of Sac City, 1420 West Main, Sac City, lA 50583
Sac City Museum, c/o Wilma Fort, 711 Platt ~t.. Sac City, lA 50583
Kevin Murray (Guardian Ad Litem for Annika Criss, Kelby Criss and Elizabeth Criss)
114 N. 6th St., Sac City, lA 50583
John Gray, 1128 Historic Fourth Street, P.O. Box 3086, Sioux City, lA 51102
Willis Hamilton and Mary Hamilton, P.O. Box 188, 606 Ontario Street, Storm Lake, lA
50588
IN THE DISTRICT COURT OF IO\VA IN AND FOR SAC COUNTY

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
NOTICE OF HEARING
JOHN H. CRISS
TO:
Kurt Criss, 429 Cottonwood Dr., Elko, NV 89801
Annika Criss, 429 Cottonwood Dr., Elko, NV 89801
Kelby Criss, 429 Cottonwood Dr., Elko, NV 89801
Eric Criss AKA Erik Criss, 480 Yuma St., Denver, CO 80204
Elizabeth Criss, 480 Yuma St., Denver, CO 80204
Leah Hutchins, 1650 Domain Loop S.E., Rio Rancho, NM 87124
Eugene Criss, Jr., 475 West 12th Ave., Unit 9A, Denver, CO 80204
Janna Hutchins, 6055 West Progress Ave., Denver~ CO 80123
Tommy Hutchins AKA Thomas Cumberland, 605S West Progress Ave., Denver, CO 80123
Julie Foreman, 2324 Dakota Ave., Lytton, IA 50561
Dwaine Reece AKA Dwain Reece, 204 North 2nd St., Sac City, IA 50583
Ranae Jacobsen AKA Renae Jacobsen, 3045 Wadsley Ave., Sac City, IA 50583
Sac City Public Library, 1001 West Main St., Sac City, IA 50583
Sac Community Recreation Center, 1015 West Maln St., Sac City, IA 50583
Loring Healthcare Foundation, 211 Highland Ave., Sac City, IA 50583
First Presbyterian Church, 812 Audubon St., Sac City, IA 50583
Barbara Powell, Mayor of Sac City, 1420 West Main, Sac City, IA 50583
Sac City Museum, c/o Wilma Fort, 711 Platt St., Sac City, IA 50583
Kevin Murray (Guardian Ad Litem for Annika Cri~s, Kelby Criss and Elizabeth Criss)
114 N. 6th St., Sac City, IA 50583
John Gray, 1128 Historic Fourth Street, P.O. Box 3086, Sioux City, IA 51102
Willis Hamilton and Mary Hamilton, P.O. Box 188, 606 Ontario Street, Storm Lake, IA 50588
You and each ofyou are hereby notified that an Application to Reform Trust is now on
file in the Office of the Clerk of the Iowa District Court in the above named county. A file
stamped copy of said Application to Reform Trust :s attached hereto and made a part hereof.
You are further notified that a hearing on tt.e Application to Reform Trust will be held on
Monday, January 4, 2016 at 9:00a.m. at the court room in the Sac County Courthouse in Sac
City, IA. Objections to the Application must be made before the date set for hearing and you
should personally appear at the hearing if you objeet to the Application. Failure to object and
appear at the hearing on Monday, January 4, 2016 at 9:00a.m. at the courtroom in the Sac
County Courthouse in Sac City, Iowa will result in an Order approving the Application.
TAKE NOTICE AND GOVERN YOURSELF ACCORDINGLY.

Beckt::r & Brotherson Law Offices
PO Box 38
Sac City, IA 50583
T. (712) 662-4771
ATTORNEY FOR ESTATE
Bruce Becker
Rule 23.5Form 2: Trial Scheduling and Discovery Plan

Do not file this form in an Expedited Civil Action case, instead use Form 3.
This form is to be filed within 7 days after the parties' discovery conference and before the trial-setting
conference with the court.
The parties should complete the entire form except as otherwise indicated.
SAC
In the Iowa District Court for
County
No ESPOQ14544
Trial Scheduling and Discovery Plan
EUGENE CRISS, JR.,
Use of this form is mandatory
Plaintiffjs) / Petitioner(s)
Full name: first, middle, last
Date Petition filed:"10
/ 31
Case type: ? Law
vs.
Trial type:
I 20^5
dd
mm
yyyy
10 Equity
O PGR
? Judicial Review
gfJury
? Nonjury
Expected trial length: 3

Defendant(s) / Respondent(s).
O Other
days
The amount in controversy

exceeds $10,000.
[gjYes
Full name: first, middle, last
[~]No
Appearances:
Plaintiff(s) / Petitioner(s)
Mary C. Hamilton, Willis Hamilton, P. O. Box 188, 606 Ontario St., Storm Lake, IA 50588
Defendant(s) / Respondent(s)
John C. Gray, P. O. Box 3086, 1 128 Historic 4th St., Sioux City, IA 51 102
It is ordered:
1.
Trial
Note to parties: Unless you have obtained a trial dale from court administration, leave this date blank;
the court will enter the date after the (rial-setting conference.
? a-m.
20
Trial of this case is set for

Day
Month
? P-m.
at
Year
Time
in the district court in the courthouse of the county named above.

2.
Pretrial conference
Check one. Note to parties: Ifbox A is checked, leave the date blank unless you
have obtained a pretrial conference datefrom court administration. Ifyou do not have a pretrial conference
date and check box A, the court will enter the date, by order, after the trial-setting conference.
A.
? A pretrial conference will be held on

Day
? p.m.
at
, 20.
Month
j~] a.m.
Year
Time
The conference may be held telephonicaliy with prior approval of the court.
B.
3.
[X] A pretrial conference will be held upon request.
New parties
No new parties may be added later than 180 days before trial or
dd
mm
If you nBed assistance to participate In court due to a disability, contact the disability coordinator at: (
yyyy
Persons who are
hearing or speech Impaired may call Relay Iowa TTY (1-B00-735-2942). Disability coordinators cannot provide legal advice. Disability coordinator
contact Information available at: http://www.lowacourts gov/Adminlslration/Directories/ADA_Accoss/
April 2015
Rule 23.5Form 2
Page 1 of 5
Rule 23.5Form 2: Trial Scheduling and Discovery Plan, continued
4.
Transcripts and records
All required agency records or prior criminal transcripts will be filed within 30 days of the date of
this Plan or by
dd
mm
5.
my
Pleadings
Pleadings will be closed 60 days before trial or
mm
6.
dd
ym
Initial disclosures Check all thai apply

A.
? The parties have exchanged initial disclosures.
B. [x] The parties will provide initial disclosures no later than December 15, 2015
C. ? The parties have stipulated that the following will not be included in initial disclosures:
List items not included
7.
D.
? The parties have stipulated not to provide any initial disclosures.
E.
? The following party objects to providing initial disclosures on the following grounds:
Identify the party and state all applicable grounds
Discovery
The parties have held a discovery conference as required by Iowa Rule of Civil Procedure 1.507.
All written discovery will be served no later than 90 days before trial. All depositions will be
completed no later than 60 days before trial. Or, all discovery will be completed by
/
mm
dd
yyyy
Check all that apply
A.
[3 No discovery of electronically stored information is expected in this case.
B.
? The parties have conferred about discovery of electronically stored information and reached
agreement as set out in Attachment
C. ? The parties have conferred about discovery of electronically stored information and have
been unable to reach an agreement. Note to parlies: Ifbox C is checked, leave thefollowing
information blank unless the parties have obtained a hearing date, time, and locationfrom court
administration.
Oa-m.
OP-m.
at:
A hearing is set for

mm
dd
yyyy
Time
County Courthouse, courtroom
n at the
or
Courtroom number
County
O at the following location:

D. ? The parties have agreed to a discovery plan, and their agreement is set forth in Attachment
E.
? The parties have agreed to deviate from the limits on discovery otherwise applicable to this
action, and their agreement is set forth in Attachment
.
F.
? The parties have agreed to conduct discovery in phases, and their agreement is set forth in
Attachment
April 2015
Rule 23.5 Form 2
Page 2 of 5
Rule 23.5 Form 2: Trial Scheduling and Discovery Flan, continued
G. ? The parties have reached an agreement under Iowa Rule of Evidence 5.502 as set forth in
Attachment
H.
? The parties have reached an agreement under Iowa Rule of Civil Procedure 1 .504 as set
forth in Attachment
I.
? The parties have conferred about a discovery plan and have been unable to reach
agreement on the issues set forth in Attachment
. Note to parties: Ifbox I is checked, leave
the following information blank unless the parlies have obtained a hearing date, time, and location
from court administration.
? a.m.
? p.m.
at:
A hearing is set for

dd
mm
Time
yyyy
County Courthouse, courtroom
? at the
or
Courtroom number
County
? at the following location:

8.
Expert witnesses
A.
A party who intends to call an expert witness, including rebuttal expert witnesses, shall certify to
the court and all other parties the expert's name, subject matter of expertise, and qualifications,
within the following time period, unless the Iowa Code requires an earlier designation date (see,
e.g., Iowa Code section 668.11):
(1 )
(2)
(3)
Plaintiff: 21 0 days before trial or 05
/01
nun
dd
/_2016_
yyyy
Defendant/Third Party Plaintiff: 150 days before trial or ^
/!
nun
dd
Third Party Defendant/Others/Rebuttal: 90 days before trial or 08

mm
B.
yyyy
/01
/ 201 6
dd
yyyy
Any disclosures required by Iowa Rule of Civil Procedure 1.500(2)(b) will be provided:
Check each that applies
(1 )
(x] At the same time the expert is certified.
(2)
? According to the following schedule:

a.
Plaintiff:
mm
b.
dd
yyyy
Defendant/Third Party Plaintiff:

mm
c.
dd
yyyy
Third Party Defendant/Others/Rebuttal:

mm
C.
/2016
dd
yyyy
This section does not apply to court-appointed experts.
The deadlines listed in paragraphs 5, 6, 7, and 8 may be amended, withoutfurther leave ofcourt, byfiling a
Stipulated Amendment to this Plan listing the dates agreed upon and signed by all attorneys and selfrepresented litigants. Such Stipulated Amendment may not override any requirement ofthe Iowa Court Rules
and cannot serve as a basis for a continuance of the trial date or affect the datefor pretrial submissions.
9.
Pretrial submissions
At least 14 or ]_
(the parties may enter another number but not less than 7) days before trial,
counsel for the parties and self-represented litigants must:
A.
File a witness and exhibit list with the clerk of court, serve a copy on opposing counsel and
self-represented litigants, and exchange exhibits. In electronic cases, witness and exhibit lists
must be electronically filed, and the EDMS system will serve copies on all registered parties.
Exhibits must be electronically submitted in lieu of exchanging them. These disclosures must
April 2015
Rule 23.5 Form 2
Page 3 of 5
Rule 23.5 Form 2: Trial Scheduling and Discovery Plan, continued
include the following information about the evidence that the disclosing party may present at trial
other than solely for impeachment:
(1)
The name and, if not previously provided, the address, telephone numbers, and electronic
mail address of each witness, separately identifying those the party expects to present and
those the party may call if the need arises.
(2)
The page and line designation of those witnesses whose testimony the party expects to
present by deposition and, if not taken stenographically, a transcript of the pertinent parts of
the deposition.
(3)
An identification of each document or other exhibit, including summaries of other evidence,
separately identifying those items the party expects to offer and those it may offer if the
need arises. The following rules govern exhibits and exhibit lists:
a.
Plaintiff will use numbers and Defendant will use letters. Pretrial exhibit lists will identify
each exhibit by letter or number and description. Exhibits must be marked before trial.
b.
Immediately before commencement of trial, the court must be provided with a bench
copy, and the court reporter with a second copy, of the final exhibit list for use in
recording the admission of evidence.
c.
In nonjury cases, immediately before commencement of trial, parties must provide the
court with a bench copy of all exhibits identified on the exhibit lists.
d.
Within 7 days after the filing of an exhibit list, or within 4 days if the deadline for filing of
the list is less than 10 days before trial, counsel and self-represented litigants must file
with the clerk of court, and serve on each party, any identification, authentication, and
foundation objections to the exhibits listed; otherwise such objections are deemed
waived for trial purposes. In electronic cases, any identification, authentication, and
foundation objections will be electronically filed, and the EDMS system will serve
copies on all registered parties. Electronic filing of these objections must be done
within 7 days of the filing of an exhibit list, or within 4 days if the deadline for filing of the
list is less than 10 days before trial; otherwise, such objections are deemed waived for
trial purposes.
10.
B.
File and serve motions in limine, with supporting legal authority.
C.
File and serve ail proposed jury instructions in a form to be presented to the jury, including a
statement of the case, the stock jury instruction numbers, and verdict forms. The court must be
provided the instructions in written form and electronically.
D.
Deliver to the judge and serve a concise trial brief addressing factual, legal, and evidentiary
issues, with citation to legal authorities.
Motions
All motions including motions for summary judgment and except motions in limine, must be filed with
the clerk of court's office or electronically filed at https://www.iowacourts.state.ia.us/EFile/ at least 60

days before trial, with copies to the assigned judge.
11. Settlement conference Note to parlies: IfA or B is checked, leave any date blank; the court will enter
the settlement conference date, by order, after the trial-setting conference.
A.
Month
at the
[]a.m.
Day
? p.m.
, at
20
O A settlement conference will be held on
Year
Time
County Courthouse.
All parties with authority to settle must be present.
B.
? a.m.
? A settlement conference will be held on

Month
Day
? p.m.
at
20
Year
Time
at the following location

April 2015
Rule 23.5 Form 2
Page 4 of 5
Rule 23.5Form 2: Trial Scheduling and Discovery Plan, continued
C. ? A settlement conference will occur at a date, time, and location arranged by the parties.
D. |xj] A settlement conference will be held upon request.

The parties are encouraged to consider alternative dispute resolution including private mediation or
arbitration.
12.
Settlements
The parties are responsible for immediately notifying the court administrator of settlement.
1 3.
Late settlement fees

Late settlement fees under Iowa Rule of Civil Procedure 1.909 are applicable.
14.
Continuances
Continuances are discouraged and will only be granted for good cause. Motions to continue are
governed by Iowa Rule of Civil Procedure 1 .91 0. In the event the trial date is continued, all time
deadlines in this Plan and any Stipulated Amendments remain in effect relative to the new trial date
unless the court approves new deadlines.
15.
Notice
Failure to comply with any of the provisions of this Plan or Stipulated Amendments to this Plan may
result in the court imposing sanctions pursuant to Iowa Rule of Civil Procedure 1.602(5), including
limitation and exclusion of evidence and witnesses and payment of costs or attorney fees. The court
will resolve disputes regarding oral agreements on scheduling by reference to this Plan or any
Stipulated Amendments to this Plan.

At least one signature to the Trial Scheduling and Discovery Plan is required. The signer certifies that all listed
parties have joined in this Trial Scheduling and Discovery Plan, subject to any objections noted.
I certify that all parties and attorneys to this action have agreed to this Trial Scheduling and
Discovery Plan and have been served with a copy.
Is I John C. Gray
20
Month
Signed:
Day
/s/ Willis J. Hamilton
PO Box 188, Storm Lake, IA 50588

Mailing address
Phone number
Party's or attorney 's signature
Heidman Law Firm, LLP, PO BOX 3086

Attorney 's lcr\v firm, if applicable
Printed name
(. 712
Year
732-2842
IA
Sioux City,
City
Wiliis@Hamiltonlawfirm.com
Email address
Slate
51102
ZIP code
John.Gray@Heidmanlaw.com
Additional email address, ifavailable
Original filed with the clerk of court or electronically filed at https://www.iowacourts.state.ia.us/EFile/.

Copies to: counsel of record, self-represented litigants, and court administration.
For questions regarding documents filed with the court in this case, please see
www.judicial.state.ia.us/Online_Court_Services/Online_Docket_Record/ or call the clerk of court.
April 2015
Rule 23.5Form 2
Page 5 of 5
IN THE MATTER OF THE ESTATE
ESPR014544
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
OF JOHN H. CRISS, DECEASED,

EUGENE CRISS, JR.,
Plaintiff,
vs.
RENAE JACOBSEN,
as Executor of the Estate
of John H. Criss, and the
ESTATE OF JOHN H. CRISS,
Defendant.
NOTICE OF SERVING
INITIAL DISCLOSURES
NOTICE IS HEREBY GIVEN that the undersigned party has this date served upon the
Plaintiff, in the above action, Initial Disclosures.
DATED this 16th day of December, 2015.
Respectfully submitted,
FIEIDMAN LAW FIRM, L.L.P.
By:
/s/ John C. Gray

JOHN C. GRAY, AT0002938
1 128 Historic Fourth Street
Sioux City, I A 51 101
Phone: 712-255-8838
John.Grav@Heidmanlaw.com
ATTORNEYS FOR DEFENDANT

RENAE JACOBSEN
Copy via EDMS to:
Mary C. Hamilton
PROOF OF SERVICE
Willis J. Hamilton
P. O. Box 188
Storm Lake, I A 50588
I certify that a true copy of this document was

served upon each of the attorneys of record of all
parties to this action at the addresses disclosed
by the pleadings on
By:
? U.S./Mafl
? Facsimile
Signature
~/
?
nd
ithi
. 2</C)
Kurt E. Criss
429 Cottonwood Drive
Elko, Nevada 89801
December 27, 2015
lowa District Court for Sac County
Courthouse
100 Northwest State Street; Suite 12
Sac City, lowa 50583
Re: Objection to Case No. ESPR014544 Application to Reform Trust
Your Honor:
I am a beneficiary ofthe John H. Criss estate and am writing in objection to Case No.
ESPR014544, Application to Reform Trust.
And in my capacity as guardian of my two minor children, Annika A. Criss and Kelby E. Criss who
are also beneficiaries ofthe John H. Criss estate, I am also filing their objection to Case No.
Sincerely,
Kurt E. Criss, beneficiary
Annika A. Criss, beneficiary by Kurt E. Criss, father/guardian
Kelby E. Criss, beneficiary by Kurt E. Criss, father/guardian
Erik Criss
480 Yuma Street
DISTRICT COURT GF IOWA

SAC COUNTY
FILED
2015DEC3J PM 12: It*
Denver, CO 80204
December 28, 2015
Courthouse
Your Honor:
I am one of many beneficiary of the John H. Criss estate.
I am writing in objection to Case No. ESPR014544, Application to Reform Trust.
E-FILED 2016 JAN 04 9:50 AM SAC - CLERK OF DISTRICT COURT
2RCV44
In the Matter
of the
COURT REPORTER
MEMORANDUM AND
CERTIFICATE
COURT REPORTER MEMORANDUM

(The court reporter shall file this memorandum with the district court clerk.)
Appearances:
For Plaintiff/Petitioner: Bruce Becker
For Defendant/Respondent: Steve Hamilton & Mary Hamilton
Other:
Information required by Iowa Rule of Civil Procedure 1.903(3):
I, Nancy A. Timmons, am providing the following information as required by Iowa Rule
of Civil Procedure 1.903(3):
1. The type of proceeding that was reported: reform trust
2. The date(s) on which the proceeding occurred: January 4, 2016
3. The name of the court reporter who reported the proceeding: Nancy A. Timmons
4. The name of the judge who presided over the proceeding: William C. Ostlund
5. The reporting fee for the proceeding: $40.00
6. We, the undersigned judge before whom the above-entitled case was tried, and
the official court reporter who, by order of the Court, reported the same, do hereby
certify that the above and foregoing is the report of the whole proceedings upon the trial
and/or hearing of the above-entitled cause made and taken pursuant to the order and
direction of the Court, in accordance with Iowa Code Section 624.10.
/s/Nancy A. Timmons
1 of 3
__________________________________________
2 of 3

Case Number
ESPR014544
Type:
Case Title
COURT REPORTER MEMORANDUM AND CERTIFICATE
So Ordered
3 of 3
Eugene Criss, Jr.

th
475 W. 12 Avenue, #9A

Denver, Colorado 80204
o
cn
December 29, 2015

Courthouse
Your Honor:
I am a beneficiary ofthe John H. Criss estate and am writing in objection to Case No.
Sincerely,
a:
i
3D
Leah C. Hutchins
2014 N. Main St.
Lovington, NM 88260
December 28, 2015
Courthouse
Your Honor:
I am a beneficiary of the John H. Criss estate and am writing in objection to Case No.
Sincerely,
co
E-FILED 2016 JAN 05 3:39 PM SAC - CLERK OF DISTRICT COURT

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
ORDER APPROVING APPLICATION
JOHN H. CRISS
TO REFORM TRUST
_________________________________
THIS MATTER COMES before the Court on the 4th day of January, 2016 on the personal
representatives Application to Reform Trust. Bruce Becker appeared as attorney for the Estate
and the executor, Renae Jacobsen; Kevin Murray appeared as Guardian Ad Litem for Annika
Criss, Kelby Criss and Elizabeth Criss; Willis Hamilton and Mary Hamilton appeared
representing Eugene Criss who has filed a petition to set aside the Will John H. Criss executed
on January 22, 2014 and the Codicil executed June 24, 2014 which are subject to probate. This
Court notes that Kurt E. Criss and Erik Criss filed Objections with the Court to the Application
but those are untimely. This Court, having reviewed the file, having heard from the Counsel
identified above, and being fully advised in the premises FINDS:
1.
The Last Will and Testament of John H. Criss which is subject to probate in this
matter provides that the residue of his estate be held in trust for the beautification and general
improvements to the City of Sac City, Iowa, as determined by the co-trustees identified in the
Trust.
2.
The aforesaid Trust states that the co-trustees have the power and authority to do
any act or thing reasonably necessary or advisable for the proper administration of the Trust, as
established by the decedents Will, including all powers, duties, and responsibilities provided
expressly for trustees in the Iowa Code.
3.
Iowa Code Section 633A.2206(2) provides that the terms of a Trust may be
construed or modified in a manner that does not violate the settlors probable intent. Internal
Revenue Code Section 2055 and Iowa Code Section 633A.2206 authorizes the administrator of
an estate to file an application and seek the relief requested in an effort to obtain a determination
letter from the Internal Revenue Service for tax exempt status.
4.
The Trustees identified in the trust provisions of the Last Will and Testament of
John H. Criss have consented to the Application so that the Trust assets can only be used for
exempt charitable purposes and that none of the Trust assets nor any of the income from the
Trust assets would inure to the benefit of any private individual and that no part of the activities
of the Trust would be involved in any attempt to influence legislation by propaganda or
otherwise.
5.
The Trust is formed and will be operated by the Trustees exclusively for exempt
charitable purposes as defined by 501(c)(3) of the Internal Revenue Code.

6.
Eugene Criss will not be prejudiced by this Court granting the personal
representatives Application nor will the granting of the Application prejudice Eugene Criss in
his endeavor to set aside the Will and Codicil under Probate.
IT IS THEREFORE ORDERED that the personal representatives Application to Reform
Trust filed on or about December 8, 2015 with this Court is granted in its entirety effective as of
the date of death of John H. Criss.
IT IS FURTHER ORDERED that neither the Estate nor the objectors to the Will and
Codicil shall refer to the Application nor this Court Order at trial of the Will Contest.
IT IS FURTHER ORDERED that the Court Administrator shall set a trial scheduling
conference on the Will contest matter as soon as possible.

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 3 of 3

IN THE MATTER OF
NO. ESPR014544
THE ESTATE OF
ORDER APPROVING APPLICATION
JOHN H. CRISS
TO REFORM TRUST
_________________________________
THIS MATTER COMES before the Court on the 4th day of January, 2016 on the personal
representatives Application to Reform Trust. Bruce Becker appeared as attorney for the Estate
and the executor, Renae Jacobsen; Kevin Murray appeared as Guardian Ad Litem for Annika
Criss, Kelby Criss and Elizabeth Criss; Willis Hamilton and Mary Hamilton appeared
representing Eugene Criss who has filed a petition to set aside the Will John H. Criss executed
on January 22, 2014 and the Codicil executed June 24, 2014 which are subject to probate. This
Court notes that Kurt E. Criss and Erik Criss filed Objections with the Court to the Application
but those are untimely. This Court, having reviewed the file, having heard from the Counsel
identified above, and being fully advised in the premises FINDS:
1.
The Last Will and Testament of John H. Criss which is subject to probate in this
matter provides that the residue of his estate be held in trust for the beautification and general
improvements to the City of Sac City, Iowa, as determined by the co-trustees identified in the
Trust.
2.
The aforesaid Trust states that the co-trustees have the power and authority to do
any act or thing reasonably necessary or advisable for the proper administration of the Trust, as
established by the decedents Will, including all powers, duties, and responsibilities provided
expressly for trustees in the Iowa Code.
3.
Iowa Code Section 633A.2206(2) provides that the terms of a Trust may be
construed or modified in a manner that does not violate the settlors probable intent. Internal
Revenue Code Section 2055 and Iowa Code Section 633A.2206 authorizes the administrator of
an estate to file an application and seek the relief requested in an effort to obtain a determination
letter from the Internal Revenue Service for tax exempt status.
4.
The Trustees identified in the trust provisions of the Last Will and Testament of
John H. Criss have consented to the Application so that the Trust assets can only be used for
exempt charitable purposes and that none of the Trust assets nor any of the income from the
Trust assets would inure to the benefit of any private individual and that no part of the activities
of the Trust would be involved in any attempt to influence legislation by propaganda or
otherwise.
5.
The Trust is formed and will be operated by the Trustees exclusively for exempt
charitable purposes as defined by 501(c)(3) of the Internal Revenue Code.

6.
Eugene Criss will not be prejudiced by this Court granting the personal
representatives Application nor will the granting of the Application prejudice Eugene Criss in
his endeavor to set aside the Will and Codicil under Probate.
IT IS THEREFORE ORDERED that the personal representatives Application to Reform
Trust filed on or about December 8, 2015 with this Court is granted in its entirety effective as of
the date of death of John H. Criss.
IT IS FURTHER ORDERED that neither the Estate nor the objectors to the Will and
Codicil shall refer to the Application nor this Court Order at trial of the Will Contest.
IT IS FURTHER ORDERED that the Court Administrator shall set a trial scheduling
conference on the Will contest matter as soon as possible.

Type:
OTHER ORDER
Case Number
ESPR014544
Case Title
So Ordered
page 3 of 3
Notice Id: 2CA006

Case Title : ESTATE OF JOHN H. CRISS
Case No : 02811 ESPR014544
Notice of Trial Setting Conference
A scheduling conference will be held on 01/26/16 at 10:30 AM with Kellie Orres, as District Court
Designee, pursuant to I.R.C.P 1.602.
This conference shall be conducted by telephone conference call initiated by plaintiff's
counsel. Kellie Orres may be contacted via telephone at: (515) 574-3752.
1. PARTICIPATION: All attorneys appearing in the case shall participate in this conference. A party
who is not represented by counsel shall contact the Court Administrator's office (at the above phone
number) prior to the date and time of the conference call.
2. TRIAL SCHEDULING: A firm trial date shall be established in accordance with the Supreme
Court's time standards as provided by Chapter 23, Iowa Court Rules. NO CONTINUANCES SHALL
BE GRANTED EXCEPT BY COURT ORDER, UPON GOOD CAUSE SHOWN.
3. SANCTIONS: If a party or attorney fails to participate in the scheduling conference or is
substantially unprepared to participate in the conference, the Court may impose appropriate
sanctions, including reasonable expenses and attorney fees. (I.R.C.P 1.602(5)).
If this matter was filed on or after January 1, 2015, and is not exempt as per Iowa Court Rule 1.500(1)(e), then
prior to the trial-setting conference, the parties must file a Trial Scheduling and Discovery Plan, Iowa Court Rule
23.5-Form 2.
/s/ Kellie Orres

--------------------------------------Designee of the Court
Clerk to provide copies or
notice of document to attorneys
of record and parties appearing
pro se.

Ol!lclol Fonn No. P-706.1
'
f$.
7<1'

THE IOWA DISifRICT COURT
Bruce Becker
SAC
-~'oc1 st'0

JOHN H. CRISS
DECEASED
COUNTY
PROBATE NO. ESPR014544

SECOND AMENDMENT ~
REPORT AND INVENTORY
CIT NO.
Regular estate (Chapter 633) [N

Small estate (Chapter 635) D
D
00 , Administrator
D , or other
(capacity)
whose name and post office address is: Renae Jacobsen, 3045 Wadsley Ave., Sac City, IA 50583
reports as follows:
Name of Decedent
Last Residence
Age
88
John H. Criss
Date of Death
05/28/ 15

'

PO Box 38 2 Sac Ci!1 2 IA 50583
(712} 662-4771
2. Amount of gross estate for Federal Estate Tax Rurposes:

Will a Federal Estate Tax Return be filed? Yes 00 , NoD .
00 , intestate D
$6 23642165.40
Yes D , No 00 . If yes,
5. Did decedent leave a surviving spouse? Yes [X] , No D.
6. List (a) surviving spouse, if any, (b) beneficiaries under decedent's will, (c) heirs at law, (d) transferees, and
Name
Age
Post Office Address
Relationship
to Decedent
See Attached Addendum 1/2 and

2/2
'
*Amended to add Chevron Corp Stock to Schedule B-1, QLT Inc. Stock in
Schedule B-5, Northwestern Mutual Life Insurance Company benefits on

~chedule D and Northwestern Mutual Life Insurance Company interes
on Schedule C.

IOWADOCS
P-706.1 INVENTORY COVER SHEET

R<Msed January 2007
Addendmn 1/2
1.
Kurt Criss
429 Cottonwood Dr.
Elko, NV 89801
Annika Criss
429 Cottonwood Dr.
Elko, NV 89801
Kelby Criss
429 Cottonwood Dr.
Elko, NV 89801
Erik Criss
480 Yuma St.
Denver, CO 80204.
Elizabeth Criss
480 Yuma St.
Denver, CO 80204
Leah Hutchins
Eugene Criss, Jr.
475 West 12th Ave.
Unit 9A
Denver, CO 80204
Janna Hutchins
Denver, CO 80123
Denver, CO 80123
Julie Foreman
2324 Dakota Ave.
Lytton, IA 50561
Dwaine Reece
204 North 2nd St.
Addendmn 2/2
Sac City, lA 50583
Renea Jacobsen
3045 Wadsley Ave.
Sac City, lA 50583
1001 West Main
Sac City, lA 50583
1015 West Main
Sac City, lA 50583.
211 Highland Ave.
Sac City, lA 50583
812 Audubon St.
Sac City, lA 50583
Barbara Powell
Mayor of Sac City
1420 West Main
Sac City, lA 50583
Sac City Museum
c/o Wilma Fort
711 Platt St.
Sac City. lA 50583

Official Form No. P-706.2
t2S~
7~~ ~ ~~ ~
Bruce Becker

QUESTIONNAIRE ANC RECAPITULATION

1
~Oct~~'"
A. Did the decedent at time of death

tenancy? If yes, complete Schedule A.
B. Did the decedent at time of death

135,000.00 A
5,976, 781.03
74,927.19 c
H. Did the decedent possess a general

power of appointment over any property.
or did the decedent exercise or release a
three years of death? If yes, complete
Schedule H.
$-------- H
I. Did the decedent own or have an $

137,714.15 1
_ _ ___:..::...:...z..:...;:....:..:..:..:;.
If yes,
complete Schedule I.
$ _ _.....:6!.1.:,3~6:::.:4,.!.!16!..:::.5.::::..40!!..
any mortgages. notes or cash not held in

joint tenancy?
If yes, complete
Schedule C.
28,243.03
D. Is there any insurance on the life of

the decedent?
If yes, complete
Schedule D.
E. Did decedent at time of death own

spouse?
E-1. Did decedent at the time of death

with others? If yes, complete
Schedule E-1.
F. Did decedent at time of death own

other schedule?
If yes, complete
Schedule F.
F-1. If intestate or election to take

Schedule F-1.
G. Did decedent make any gift within

three years of death in excess of the gift
tax exclusions allowable under I.R.C.
$ ________ G
E
-------E-1

633.361.9,.12 AND .13, THE CODE.
--------
11 500.00 F
0.00 F-1
1. Did the decedent die owning real $

estate located outside the State of Iowa
not otherwise reported? If yes, attach
legal description, and estimated value
NONE
2.
Is any property required to be

reported for federal estate tax purposes
which is not included in the Iowa gross
estate or on line 1 above? If yes, attach
NONE
-----~=~
3. Was any gift made by decedent that

reduced the amount of the unified credit
available for
federal
estate
tax
purposes?
gift, date and amount of unified credit
claimed.
NONE
-----~==
CERTIFICATION
I certify under penalty of pe~ury and pursuant to the laws of the State of Iowa that the preceding is true and correct.
Estate of
Date
Capacity or TitlE~
I- !3 -;b
Executor
John H Criss
.~
~)du
I
Sianature
ku.-ahA. r
Venae Jacobsen
, Deceased.
This form is in compliance with Administrative Dimctive of the State Court Administrator 2014-1
IOWADOCS

Revised May 2014

THE IOWA STATE BAR ASSOCIAOON
'Oftlclal Fonn No. P-708 Schedule A
Bruce Becker

SCHEDULE A -
~!EAL
ESTATE

Item
Number
Description
SeeBelow
AJtemate
Vlluatlon Date
11127/2015
Alternate Value
Value at Date or Death
$135,000.00
$135,000.00
The North fifty (50) feet of Lots one and two (1 '~ 2) in Block one (1), Platt's Addition
to Sac City, Iowa, and fully described as follows: Starting at the northeast corner of
Lot one (I); thence in a westerly direction along :he north line of said lots 1 and 2 one
hundred-twenty (120) feet to the northwest corner of said Lot 2; thence in a southerly
one hundred twenty (120) feet parallel with the n:>rth line of said lots 1 and 2 to a
point in the east line oflot 1 fifty (50) feet south of the north line of said lot 1; thence
in a northerly direction fifty (50) feet to piont of ~:tarting. Also the north fifty (50) feet
of lot three (3) in block one (1) ofPlatt's Addition to Sac City, Iowa except the west
twenty (20) feet of said tract, and more fully described as follows: Commencing at a
point twenty (20) feet east of the northwest corner of said Lot three (3) above
thence east on a line parallel with the south line of lot 3 forty (40) feet; thence north to
the northeast corner of said lot3; thence west to be place of beginning.
TOTAL. Enter in the Recapitulation ............................. .
$135 000.00
$135 000.00
SCHEDULE A
0 The Iowa State Bar Assodatian 2003
IOWAOOCs
P-706 SCHEDULE A REAL ESTATE

RIIIAsed Jaruarv. 1999

Official Form No. P-708 Schedule B
Bruce Becker

SCHEDULE B - STOCKS AND BONDS

Item
Number
Desc:rlpUon Including Face Amount of Bonds

Par Value Where Needed for ldenUftc.Uon
Number
of Units
Unit Value
Altemate
Valuation Date
Alternate Value
$3,966,520.42
$4,122,891.83
$141,779.00
$138,794.74
Wells Fargo
(Attached as B-2)
$43,734.69
$47,425.33

6096-9990
(Attached as B-3)
$11,540.05
$12,069.71
Merrill Lynch
(Attached as B-4)
$350,711.79
$360,420.84
Merrill Lynch
(Attached as B-5)
$1,419,680.02
$1,464,842.26

Trust)
$25.00
$25.00

Fund
$42,490.06
$41,879.42
$300.00
$300.00
$5,976,781.03
$6,188,649.13

(Attached as B-1)

Account No. 02014812645 002
TOTAL. Enter in the Recapitulation .............................. .
SCHEDULE B
IOWADOCS
P-706 SCHEDULE B - STOCKS AND BONDS

B -l
(2nd Amendment)
CHIEF CLOTHING COMPANY

NOVEMBER 27, 2015 Al~TERNATE VALUES
Bank Deposit Sweep
4 7. 79 shares
5353.00 shares
$26,404.21
47.79

Deferred Annuity Acct. No. 93002814104 (104
(Check received on 8/24/2015 and deposited)
$713,198.51
33,210.863 shares
$329,119.65
See attached (stocks held at Merrill Lynch CJ.t time of death)

$715,886.45
$2,145,930.31
Merrill Lynch Account# 660-07402
Iowa State Bank

$ 35,933.50
Total Assets
$3,966,520.42
f:i\.~
B-1
Merrill Lynch
~ Wealth ltaupnaent
Bank of America Corpol'lltlon

Date of Death
Valuation Date
Processing Date
Report Type
11/27/2015
11/27/2015
12103/2015
CHIEF CLOTHING CO
208S 8TH ST
Account# 660-07402
Shares Security
or Par Description
1)
Date Of Death
1
High/ Ask
Low/Bid
Mean and/or
Adjustments
Divand lnt
Accruals
Security
Value
339.0080 ALTRIA GROUP INC (02209S103)

New York
~~!27!20~5
2)
58.03000
5?.50000 H.n_
57.765000
19,582.79
117.985000
6t,942.12
135.025000
54,010.00
525.0000 APPLEINC(037833100)
NASDAQGS
11/27/2015
3)
118.37000
117.60000 HIL
400.0000 BERKSHIRE HATHAWAYINC (084670702)

DELCLBNEW
New York
11/2712015
135.58000
134.47000 HIL
~!':~~~~~'f~,~"'J~~,~Jiftjfjdl,,fflJ(Jl6..,.~~~~~~"<
f,,','.-.
)~~:t:J:~~'W'.'!~~?.l.~~~~h~""
B-1
CHIEF CLOTHING CO
208S 8TH ST
Shares Security
or Par Description
4)
Account# 660-07402
High/ Ask
380.0000 BOEING COMPANY (097023105)

New York
11/27/2015
Low/Bid
147.66000
Mean and/or
Adjustments
Divand lnt
Accruals
146.68000 HIL
147.170000
lnt/Div: 0.91 Ex: 11/04/2015 Rec: 11/06/2015 Pay: 12/04/2015

5)

Toronto
11/27/2015
Price has been adjusted for tha exchange
6)
24.59332
55;924.60
345.80
23.85695 H1L
24.225135
13,444.94
44.980000
11,916:15
rate on the pricing date and Is priced In U.S. Dollars.
264.9211 CF INDS HLDGS INC (125269.100)

New York
11/27/2015
45.30000
44.66000 HIL
lnt/Oiv: 0.30 Ex: 11/1212015 Rec: 11116/2015 Pay: 11/30/2015

7)
456.6418 CUMMINS INC COM (231021106)

New York
11/27/2015
100.10000
79.47
99.22000 HIL
99.660000
lnt/Div: 0.98 Ex: 11/18/2015 Rec: 11/20/2015 Pay: 12/01/2015

8)
Security
Value

New York
11/27/2015
165.86000
45,508.92
445.22
163.33000 HIL
164.595000
50,036.88
"""'''"''''"<~'"'''""-~~~~~~-J!'.i\i!ii\l'
...v,tm~?~~-<W<;tW~r~.~JI"'JII>~"!!~~~:'?>.,"'*N'W'"',""'"l~"l:~'"~'~~~~-"''1"~'~~~~w~~~~~~~l(~~~~i>f~'YI'~~~.,i!'l.'l~i>n'i'l<tul'{~,~~~-
B-1
CHIEF CLOTHING CO
208 S8TH ST
Account# 660-07402
Shares Security
or Par Description
9)
High I Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value
255.9865 HANESBRANDS INC (410345102)

New York
11/2712015
31.59000
31.01000 HIL
31.300000
lnUDiv: 0.10 Ex: 11/13/2015 Rec: 11/1712015 Pay: 12/0812015
10)
8,012.37
25.59

New York
11/27/2015
11)
78.00000
77.15000 H1L
77.575000
31,707.84
44.175000
7,850.85
53.942500
19.738.66

INC
NASDAQGS
11127/2015
12)
44.56000
43.79000 HIL
365.9205 MICROSOFT CORP (594918104)

NASDAQGS
11/27/2015
54.07500
53.81000 HIL
lnt/DiV: 0.36 Ex: 11/17/2015 Rec: 11/19/2015 Pay; 12110/2015
13)
131.73

New York
11/27/2015
41.87000
41.27000 HIL
41.570000
14,715.95
~'W"=~~~~~w~..,.,,~'?l"''l"'","""!">'Wl~Jtm~''~~~~"V'~~"~~f"i'~'~"$'l>~~-~~~~P-<~~~rfl'!.~~'~'*"~'~~~~~~-""~'."~'P""~~~~~
B-1
CHIEF CLOTHING CO
208 SBTH ST
Shares Security
or Par Description
14)
Account# 660-07402
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals
Security
Value
271.2485 PHILIP MORRIS INTL INC. (718172109)

.New York
11127/2015
15)
87;67000
87.250000
23;666.43
100.690000
23,348.42
231.8842 PEPSICO INC (713448108)

New York
11/27/2015
16)
86.83000 HIL
100.99000
100.39000 HIL
359;6277 PFIZER INC (717081103)

New York
11/2712015
33.00000
32.67000 HIL
32:835000
11,808.37
lnt/Div: 0,28 Ex: 11/0412015 Rec: 11/06/2015 Pay: 12/01/2015
17)
100;69

New York
11/27/2015
76.35000
75.50000 HIL
75.925000
18)
345.0000
23,528.40
JM SMUCKER. CO (832696405)
NewYork
11127/2015
123.97000
122.63000 H1L
123.300000
42,'538.50
lnt/Oiv: 0.67Ex: 11110/2015 Rec: 11/13/2015 Pay: 12/01/2015
:231.15
~~~"~'!"l'i~tl'lfe!llt!l'~~~~wm~,~""'k 9M,_/ffi'1%\Pqi4\*' .i1fff'i~+NI'*A-9-M 'fo.f:&1~-~~"~' .
.,.J.
""'mHOI!Q P . . 31!!",,,!1,J
!'l~., .. n.,~I!P'.Ili.lfll' .w~.~$J'?.1,HJ.I~h.,~~~~<tt.~.~,~7~n
: HH.
4.
~e--.. ~~- !._~.P~Il'll
. A'*
w~ -~~~sq.}IFI.
'~
.L .,r
:~.L UJQ~ ~-~-":t;r::w;,_;;;q;;
fK-"i'!
u:
~~4'1.,~ ~Ju,m;
v"''*t..;
B-1
CHIEF CLOTHING CO
208S8THST
Shares Security
or Par Description
19)
Account# 660-07402
High/Ask
Low/Bid
Mean and/or
Adjustments
Dlvand lnt
Accruals
Security
Value
879.1835 SOWEST GAS CORP (8448951 02)

New York
11/2712015
56.59000
56.01000 HIL
56.300000
lnt/Div: 0.41 Ex: 11/1212015 Rec: 11/1612015 Pay: 12101/2015
49,498.03
356.06
427.3550 WELLS FARGO & CO NEW DEL (949746101)
20)
New York
1112712015
55.46500
54.98000 HIL
55.222500
lnt/Div:0.38 Ex: 11/04/2015 Rec: 11/06/2015 Pay: 1210112015
.,-'I
.
D'2'2 DO')n
vvv.wwv
Tt::UDI CTI"\11.1 I"UIII.IA \AII"\01

,._, ...
23,599;61
160.25
taan-tDV')nof\
-----"...,,,.__,,..,..,,..,,~""''/
FUNDCLA
11/2712015
0.00000
27.25000 MKT
27.250000
22,723.55
10;330000
71,779~03
10.560000
254.72
6,948.6000 PRINCIPAL PREFERRED (74254T252)

SECURITIES FUND A
2Z)
11/27/2015
23)
24.1220 BLACKROCK US GOVERNMENT (091928549)

BOND PORTFOLIO A
11/2712015
0.00000
0.00000
10.33000 MKT
10.56000 MKT
~~~;8 !~'t0f/?~~~~1tt"''1''~'"~1'!'!"i'!ll\~~~~~~~~~~~~~~~~~A~~~~~~~~I)\'}I"m"~~~{'fl'i?~'l\f'l>Nil'~''~~~.!RIIi~'"i?$\-*
Qi;\~!4\
B-1
CHIEF CLOTHING CO
208S8TH ST
Shares Security
or Par Description
24)
Account# 660-07402
High/ Ask
Low/Bid
Mean and/or
Adjustments
Divand lnt
Accruals
Security
Value
00.0000 CASH
28,749~32
Total Value
$715,886.45
Total Accrual
$1,875.96
Total
$717,762.41
$715,886.45
Total Accruals :
$1,875.96
$717,76? 41
The Information herein has been obtained from a source we bellew to be reliable, but we do not guarantee Its accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. Arry tax
Disclosures:
Alternative Date of Death valuations are not available in this application. Please consult your tax advisor for assistance in obtaining this report.
All security posHions are based on trade date.
Money funds, money market and/or bondlflxed income mutual funds may or may not Include dividends/Interest accruals prior to month end payment.
For accounts with Credit and/or Debit card(s), the cash position may not reflect reduction for purchases of goods or services which are paid for by automatic debit on the Wednesday before the last Friday of each
month.
Cash balance may not reflect outstanding checks written prior to valuation date or unsetued cash as of valuation date.
All items flagged "!" and highlighted in red reflect manually adjusted transactions (for price, shares, market value or security name) or posHions with no available price.
Asset positions provided to Bank of America I Merrill Lynch from an outside financial Institution (I.e. Annuities), may require the Securities Description line to be manually updated.
All mortgage backed securities haw the paydown factor I amortization factor automaUcally applied.
If the account you are valuing is a "900" series account (international). the values will be reported based on the currency the account holds, not USD. Please also note that If this account is valued along with other
USD accounts, you will not receive an accurate valuation; please run these accounts separately from USD accounts held in the client's household.
B-1
WIN
ADX
CRC
ALU
Company Name
AT&T INC
BAXTER INTL INC
BP PLC
CARDINAL HEALTH INC
CENTURYLINK INC
COMCAST CORP NEW
CVS HEALTH CORP
NCR CORP
SPRINT CORP
TYSON FOODS INC
US BANCORP NEW
ALCATELI/LUCENT
C'vi\.
Chevron Cu.-p
Symbol
T
BAX
BOX
BP
CAH
CTL
CMCSA
CSAL
cvs
FTR
NCR
OXY
s
TSN
USB
vz
CUSIP
00206R102
071813109
075887109
055622104
14149Y108
156700106
20030N101
20341J104
126650100
35906A108
62886E108
674599105
85207U105
902494103
902973304
92343V104
97382A200
006212104
130570107
013904305
A~~.,.,..A-Ann
JUUfU"tiUU
Shares
2,708
1,520
10
7,938
283
193
107
48
382
462
14
17,828
635
864
1,342
1,619
40
7,672
5208
59
""
-JL
Date
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
"'I""-I I,..._,,"n.t
t:
L I I ' U IV
Close
33.57
37.68
151.29
34.83
87.29
27.06
61.59
19.2
94.63
4.96
27.23
75.19
3.73
50.55
43.9
45.23
6.22
13
4.17
3.91
Total
90,907.56
57,273.60
1,512.90.
276,480.54
24,703.07
5,222.58
6,590.13
921.60
36,148.66
2,291.52
381.22
1,340,487.32
2,368.55
43,675.20
58,913.80
73,227.37
248.80
99,736.00
21,717.36
230.69
nn .,,
.., on-t.OA
VU.VI
&. 1uv 1.U""T
2,145,930.31
Chief Clothing Transfer Agent Holdings- as of 11/27/2015
I
l

I
l
!
B-2
Description
Quantity
CENTURYLINK INC.
DEERE&CO
PETMED EXPRESS INC
TEVA PHARMACEUTICAL
212.(,7400
204.15400
523.56600
204.09700
Value on 11/27/15
$ 5,738.72
$16,146.54
$ 8,895.39
$12,954.04
B-3
Description
Quantity
Value on 11/27/15

CISCO SYSTEMS INC
INTEL CORP
295.01)00
lll.ll37
135.5025
$3,835.00
$3,035.63
$4,669.42
B-4
P\.~ Merrill Lynch

~ Wealth Maupment

Date of Death
valuation Date
Processing Date

208 S 8TH ST
Shares Security
or Par Description
1)
Report Type
11/2712015
11127/2015
12103/2015
Date Of Death
Account# 660-56348
High/ Ask
Low/Bid
Mean and/or
Adjustments
Accruals
Security
Value
275.0000 BP PLC SPON ADR (055622104)

New York
1112712015
~4
R4000
34.75000 H!L
34.845000
2)
Div and lnt
9,582.37
712.2425 CSX CORP (126408103)

NewYork
1112712015
29.05000
28.71000 HIL
28.880000
+0~180000
lnt/Div: 0.180000 Ex: 1112512015 Rec~ 11/3012015 Pay: 1211512015
20;697.76
29;060000
3)
200.0000 CONTINENTAL RESOURCES (212015101)

INC
New York
11/2712015
36.84000
35.96000 H1L
36.400000
7,280.00
B-4

208S8TH ST
Account# 660-56348
Shares Security
or Par Description
4)
5)
6)

.New York
1112712015

NASDAQGS
11/2712015
8)
5.37000
27.47000
Low/Bid
5~20000
Mean and/or
Adjustments
Dlvand lnt
Accruals
Security
Value
HIL
5;285000
2,261A6
27.355000
6,139.08
66.475000
25,086;28
115.100000
24,635.49
27.24000 H1L
377.4093 COLGATE PALMOLIVE (194162103)

NewYork
t-'!!27.12015
7)
High/ Ask

New York
11/27/2015
232.6309 DU PONTE I DE NEMOURS (263534109)

NewYork
11127/2015
,..,.. ...,r"ll'"'"''' ....
VU.f;;JVUU
116.50000
67.39000
66.20000 HiL
113.70000 H1L
66.86000 HIL
67.1:25000
Jnt/Div: 0.38 Ex: 11/1012015 Ree: 11/1312015 Pay: 12114/2015
15~61'5.34
88.39
~t-1f,JW<J<~'"'FB'm;~~'"-''~'F'~~~~~~~<f'4'~~~'~"'~'!"~~~~'
~?~~rP,.;<!!Rl!'~~~~~~>"~"'!i~...-~,w~~~~~:;,"":!ll!'l11!'!tAJ,.,W.AL".MJP'!it'i1:!f.
~------------
B-4

208S 8TH ST
Shares Security
or Par Description
9)
Account# 660-56348
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt

Accruals

New York
11/27/2015
14.96000
14.80500 HIL
14.882500
10) !
Security
Value
3,092.40

CORP
\1\/e an;; unabl~ to price this iSsue.
11)
223.6843 FORTUNE BRANDS HOME AND (34964C1 06)

SECURITY INC SHS
New York
11/2712015
56.01000
55.42000 HIL
55.11o0UU
lnt/Div: 0.14 Ex: 11/2412015 Rec: 11/2712015 Pay: 12/1612015
12)
1,207.0000 !SHARES SILVER TR (464280109)

NYSEArca
11/27/2015
13)
12,462.57
31.31
13.50000
13.36000 H/L
13.430000
16,210~01
103.975000
25,660.41

New York
11/2712015
104.40000
lnt/Dlv: 0.60 Ex: 11/17/2015 Rec: 11/19/2015 Pay: 12/10/2015
103.55000 H/L
146.84
%?"f'&,A\i;tt,N4 W-lf\Ki.J
""""~~i'1'"*'<a!!i#i*iJt#lP!Ml~~~~~~~~'l!l'!!i'iM?i~. ,,4/S.rnft$'.. t4..ii!QJ4\i)Si'h\,.!f%$i'l.~~~~;..,IJ1!fA,Ji\0H!M8'%)!!iii7it}d$\.t}t1~flfll~!'G1\~{!(I.WJM~J
B-4

208S8TH ST
Account# 660-56348
Shares Security
or Par Description
14)
High/ Ask
Low/Bid
Mean and/or
Adjustments
Divand lnt
Security
Accruals
Value
107.1643 JOY GLOBAL INC DEL COM(481165108)

New York
11/2712015
15.61000
15~01000
H/L
15.310000
15)
1,640.68

New York
11/27/2015
102.62000
101.87000 H/L
102.245000
lnt/Div: 0.75 Ex: 11120/2015 Rec: 11/24/2015 Pay: 12/08/2015

16)
25,949.70
190.34
317.4447 KELLOGG CO (487836108)

N~York'
11/27/2015
69A5000
68]4000 HIL
lnt/Div: ,O.SOOOQO;Ex: 11/27/2015 Rec: 12/0112015 Pay: 12!15/2015
17)
69.095000
+0.500000
69.595000
22;092~56
83.870000
15,573.03
185.6806 Ell LILLY & CO (532457108)

New York
11/27/2015
84.14000
83.60000 H/L
lnt/Div: 0.50 Ex: 1111012015 Rec: 11/13/2015 Pay: 12/10/2015

18)
92.84
469.3072 MEDTRONIC PLC SHS (G5960L103)

New York
1112712015
76.99000
76.27000 Hit
76.630000
35,963;01
B-4

208S8TH ST
Shares Security
or Par Description
19)
Account# 660-56348
Div and lnt
Accruals
Security
Value
41.87000
41.27000 HIL
41.570000
14,715.95
100.99000
100.690000
23,348A2
16.355000
114.58
1.170000
. 35:10
76.970000
7,697.00
100.39000 H/L

New York
11/?7/?015
22)
Mean and/or
Adjustments
231.8842 PEPSICO INC (713448108)

New York
11/2712015
21)
Low/Bid

New York
11/2712015
20)
High/ Ask
~6.55000
~6.~5000
H!L
30.0007 SEVENTY SEVEN ENERGY INC (818097107}

SHS
NewYork
11127/2015
23)
100.0000 SCHLUMBERGER LTD (806857108)

New York
1112712015
1.20000
77.50000
1.14000 HIL
76.44000 HIL
--
------
~--
B-4
MR JOHN H CRISS DCSO

208 S8TH ST
Account# 660-56348
Shares Security
or Par Description
24)
High/ Ask
Low/Bid
Mean and/or
Adjustments
Div and lnt
Security
Accruals
Value
206.0000 SPDR GOLD TRUST (78463V10n
NYSEArca
11/2712015
25)
101;62000
101.00000 H1L
101.310000
20,86R'86
37.725000
7,545.00
200.0000 TOLL BROS INC COM (889478103)
New York
11/27/2015
26) !
37.98000
37.47000 HIL
00.0000 CASH
6,441'.73
$350,711.79
Total Value
$549.72
Total Accrual
$351,261.51
Total
$350,711.79

$549.72
Total Accruals :
$351,261.51
The Information herein has been obtained from a source we believe to be reliable, but we do not guarantee Hs accuracy or completeness. Merrill Lynch does not provide tax, accounting or legal advice. Arrj tax
Disclosures:
B-5
Symbol
BAG
BMY
ETR
XOM
GXP
HNI
LNCO
ZBH
CASY
HTLD
PXD
MGF
MMT
FOXA
TEMGX
NWSA
QLTI
Company Name
ENTERGY CORP
EXXON MOBIL CORP
HNI CORPORATION
LINN CO LLC
21ST CENTURY FOX
News Corp
QLT Inc -Canada
CUSIP
60505104
110122108
29364G103
30231G102
391164100
404251100
535782106
98956P102
147528103
422347104
723787107
552939100
552737108
90130A101
88022L102
65249B109
746927102
Shares
Date
1,650
2,015
1,863
5,309
106
5,727
67
114
1600
4544
167
1000
500
1388
8401.791
347
209
1 - - ~--~------L=-- L - - L - - - -'-&.-:---1 ~--- - - - - - - - &... ..... 1:- 4- .......... ., ..... 1: ..... 1...1 ..... l.o..,,.a., .......
(((t:: IIIIUIIIIdliUII lid;:. UCCII UULC::UIICU II VIII ~VUIVt::o::t VVt:: LJCIICVt:O LV uc ICIICJIJIC LJUL vn~

Criss Personal Holdings at Transfer Agents- Updated DOD 11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
11/27/2015
...I ..... - -
uv
IIVL
--r--+--
~ucucunvv
Close
17.48
67.85
66.17
81.23
26.97
44.97
1.76
101
118.38
19.82
144.63
5.25
5.68
29.54
8.25
14.25
2.81
Total
28,842.00
136,717.75
123,274.71
431,250.00
2,858.82
257,543.19
117.92
11,514.00
189,408.00
90,062.08
24,153.21
5,250.00
2,840.00
41,001.52
69,314.78
4,944.75
587.29
1,419,680.02

Oftlclal Fonn No. P-706 Schedule C
Bruce Becker

SCHEDULE C -MORTGAGES, NOTES AND CASH

Item
Deacrlpllon
Number
Alternate
Valuation Date
Alternate Value
$64,678.58
$64,678.58
$7,958.48
$7,958.48
$2,036.3q
$2,036.39
I
1:
$253.7~
Northwestern Mutual Life Insurance Company interest
$253.74
$74 927.19
$74 927.19
SCHEDULEC
Q The Iowa State Bar Association 2003

IOWADOCS
P-706 SCHEDULE C - MORTGAGES, NOTES AND CASH

Rellised January. 1999

Olllclal Fonn No. P-706 Schedule D
Bruce Becker

SCHEDULE D - INSURANCE ON THE DECEDENT'S LIFE

it is includable or excludable in the estate subject to Iowa inheritance tax.
Item
Number
Description
Alternate
Valuation Date
Alternate Value
Veteran's Benefit
$10,335.99
$10,186.40
Northwestern Mutual Life Insurance Company

(Beneficiary: Estate)
$17,907.04
$17,907.04
TOTAL .......................................... ..:....:....:. . :. . :. . :....:....:....:... :. . +----..:::.$2::.;8:z2::...:4.::..:3.~01~--..::::$2=-=8~,0~93:;.;..4..:....4:..11

Less amounts excluded for Iowa inheritance tax ........... .:. . :. . ; :. . ::. . :. . :.. :. ..:... :. ..:. . .:. . +--------t---------.:!:.$0::..:~00::..11
Amount subject to Iowa inheritance tax. Enter on the Recapitu::.:la::.::t::..::io:..:..;n:....:....:...:....:... :. ..:. . .......__ ____,$::.:2:..::8...:2:....:4.:::.3:..::.0..:..1..___ __,$:.:2.: :.8'""'0.: . ;93::. :. :. 44-'-11
SCHEDULED
=--

IOWADOCS
P-706 SCHEDULE D - INSURANCE ON THE DECEDENrS LIFE

Reloised January, 1999
712
bRe~va~~~~rg?f~e Treasury
Form
LIFE INSURANCE: STATEMENT
Internal Revenue Service
I
OMB No. 1545-0022
.
Decedent - Insured (To Be Filed by the executor With Fcrm 706, United States Estate (and Generation-Skipping Transfer)
Tax Return or Form 706-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a
citizen of the United States.)
1 Decedent's first name and middle initial I
JOHNH
5
6
2 Decedent's last name

CRISS
4 Date of death
Decedent's social security number
482-20-7942
05/28/2015
Name and address of insurance comP.any
The Northwestern Mutual L1fe Insurance Company, Milwaukee, WI 53202

7 Policy number
Type of policy
3207373
PAID UP LIFE
9 Date issued
Owner's name. If decedent is not owner,

attach COQY of application
12/22/1942
OWNER IS INSURED
12 Value of the policy at the
time of assignment
1 Date assigned
10 llssignor's name. Attach copy of assignment
13 Amount of premium (see instructions)
Paid Up
--==
14 Name of beneficiaries
ESTATE OF JOHN H CRISS

ESTATE
15
16
17
18
19
Face amount of poliqt ...............................................................................................................................................
Indemnity benefits .....................................................................................................................................................

Additional insurance ..................................................................................................................................................
Other benefits ............................................................................................................................................................
-=--
Principal of any indebtedness to the company that is deductible in detmmining net proceeds ........................ .
20 Interest on indebtedness (line 19) accrued to date of deatb. .................................................................................

21 Amount of accumulated dividends ...........................................................................................................................
22
23
24
25
26
--
Amount of post-mortem dividends ...........................................................................................................................

Amount of returned premium ....................................................................................................................................
Amount of proceeds if payable in one sum .............................................................................................................
i iiiiiii
!!!!!!!!!!!!!!
Value of proceeds as of date of death (if not payable in one sum)...................................................................... .

Policy provisions concerning deferred payments or installments
Note: If other than lump-sum settlement is authorized for a surviving soouse, attach a copy of the
insurance policy.
27 Amount of installments. ............................................................................................................................................

28 Date of birth, sex, and name of any person the duration of whose life rnay measure the number of payments
29 Amount applied by the insurance company as a single premium repre:;enting the purchase of
installment benefits. ..................................................................................................................................................
30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits
31 Were there any transfers of the policy within the three years prior to the death of the decedent2 ................... .
32 Date of assignment transfer:
I
I
Month(MM)
33
34
Oay(OO)
Yes
gz) No
Yes
gz) No
Year(YYYY)
Was the insured the annuitant or beneficiary of any annuity contract issued by the company'? ....................... .
Did the decedent have any incidents of ownership on any policies on his/her life, not owned by him/her at the
DYes
date of death?
No
35 Names of companies with which decedent carried other policies and c; mount of such policies if this information is disclosed by your
records
The undersigned officer of t
Signature ~
abovena ed insurance pmpa_n~ropriate Federal.agency sy:;tem offi~ial) hereby certi~ies that this statement sets forth true and correct information
~~
For Paperwork Reduction Act Notice, see page 2

15-0484 (1112)
81
Title
~Director of L1fe BenefitS
Cat. 1-.Jo. 10170V
---
Date of Cert1f1cat1on
Form
~ 12/22/2015
712
(Rev. 4-20~~
3560000017G0050

Oftlclal Fonn No. P-706 Schedule FIF-1
Estate of:

Bruce Becker
John R Criss
SCHEDULE F - MISCELLANIEOUS PROPERTY NOT

REPORTABLE UNDER A~IY OTHER SCHEDULE
1. Did the decedent, at the time of death, own any articles of artistic or ccllectible value in excess of $3,000 or any
collections whose artistic or collectible value combined at date of death exceeded $3,000?
2. Has the decedent's estate, spouse, or any other person, received {or
\1~11
receive) any bonus or award as a result of
3. Did the decedent at time of death have, or have access to, a safe deposit box?
If ''Yes", state locations, and if held in joint names of decedent and another, state name and relationship of joint
depositor.Iowa State Bank, Sac City, lA
If any of the contents of the safe deposit box are omitted from the schtldules in this return, explain fully why omitted.
4. Did the decedent, at the time of death, own any other miscellaneous property not reportable under any other
schedule?
Item
Number
Description
Alternate
Valuation Date
Alternate Value
11/27/2015
$10,000
$10,000.00
1995 Cadillac
11/27/2015
$1,500
$1,500.00
TOTAL. Enter in the Recapitulation .......................... .

SCHEDULE F
IOWADOCS
P-706 SCHEDULE F/F-1 MISCELLANEOUS PROPERTY NOT REPORTABLE/EXEMPT

Re~sed JanuatY. 1999

Official Fonn No. P-706 Schedule I
Bruce Becker


SCHEDULE I -ANNUITIES AND 529 PLANS
Item
Number
Description
Alternate
Valuation
Date
Alternate
Value
Value at Date
of Death
Instructions- Annuities: (1) Describe completely; (2) nclude if the annuity was derived from an
1
11/27/2015
$63,878.01
$58,393.77
The Commonwealth, Contract No. SD10005019
11/27/2015
$26,531.32
$35,884.00
Charles Schwab Rollover IRA, Acct No. 2309-5670
11/27/2015
$47,304.82
$51,671.99
Instructions - Section 529 Plans: Qualified Section 5:~9 Plans are reportable but are not taxable. For
each amount listed, provide the plan name, date established, named beneficiary, and named
beneficiary's age at the time of decedent's death. List amounts in line 2, "Nontaxable Amount," below.
TOTAL
$137,714.15
$145,949.76
$137,714.15
$145,949.76
Nontaxable Amount
IOWADOCS
SCHEDULE I
P-7061 - ANNUmES

Official Fonn No. P-706 Schedule J

Bruce Becker

SCHEDULE J - Funeral Expen:ses and Expenses Incurred
in Administering Property in the Gross Estate.
comoutina the taxable estate for federal estate tax ourooses thev are not allo.vable as an income tax deduction on form lA 1041.
Item
Number
Description
Amount

Monument (no bill received yet)
6,724.16
278.65
Total .......................................
7,002.81
B. Administrative expenses allowable under Iowa Code sectior,450.12

OOI!Ig~:MPQ~:~~
127 403.31
127 403.31
Attorney fees: Amount estimated /::QOe~K/.lQlltcl.
13,060.00
Court Costs (est.)
Total A& B
Item
Number
1
2
3
4
Description
274 869.43
Amount

C. Iowa Portion of A & B
274,869.43
SCHEDULEJ
IOWADOCS
P-706 SCHEDULE
J Funeral Expenses and Expenses Incurred In Administering Property

Revised March, 2003

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E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

THE IOWA STATE BAR ASSOCIATION_!_

FOR THE LEGAL EFFECT OF THE USE OF

THE IOWA DISTRICT COURT

Probate No. ESPRO

PETITION FOR PROBATE OF WILL

Eugene Criss, Jr. and Renae Jacobsen

Address 475 W. 12th Ave.-

C> The Iowa State Bar Association 2003

P-203 PETITION FOR PROBATE OF WILL AND APPOINTMENT OF EXECUTOR(S)

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

Last Will and Testament

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

If Eugene Criss, Jr. does not survive me, this

bequest shall lapse and become part of the residue of my estate.

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

,)J~ay of January, 2014.

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

Last Will and Testament

day of June, 2014.

The above instrument was, on this J...

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

FOR THE LEGAL EFFECT OF THE USE OF

THE IOWA DISTRICT COURT

...:P...:r.=.ob:;.;a:..:.te:___ _ _ _ _ No. ESPRO

COURT OFFICER'S OATH (INDIVIDUAL)

Cl The Iowa State Bar Association 2008

P-210 COURT OFFICER'S OATH (INDIVIDUAL)

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

FOR THE LEGAL EFFECT OF THE USE OF

THE IOWA DISTRICT COURT

COURT OFFICER'S OATH (INDIVIDUAL)

ICl The Iowa State Bar Association 2008

P-210 COURT OFFICER'S OATH (INDIVIDUAL)

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

THE IOWA STATE BAR ASSOCIATION

FOR THE LEGAL EFFECT OF THE USE OF

THE IOWA DISTRICT COURT

; I knew the identity of the testator on the, ~ day of

2014 , the date of the instrument, the original or exact reproduction of

, deceased. I am one of the subscribing witnesses to said

reside in the County of

Taney Becker a/k/a Frances L. Becker

the other SUbscribing Witness; that said instrument WaS

Bruce Becker (Name of Witness)

Sac City, lA 50583

Signed and sworn to (or affirmed) before me on this

~ay of_\.._3"""\\)l\j,.___ _ _,2brs=~

Signature of Notary Public

Corrmisslon Nu~ 7WzTo_vr:l.

P205 TESTIMONY OF SUBSCRIBING WITNESS ON PROBATE OF WILL

E-FILED 2015 JUN 09 9:37 AM SAC - CLERK OF DISTRICT COURT

FOR THE LEGAL EFFECT OF THE USE OF

THE IOWA DISTRICT COURT

I, the undersigned, being first duly sworn, state as follows:

; I knew the identity of the testator on the,

2014 , the date of the instrument, the original or exact reproduction of

, deceased. I am one of the subscribing witnesses to said

date of said instrument, I knew the identity of

instrument; at the said