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HomeMy WebLinkAbout03-0444Will PETITION FOR PROBATE and GRANT OF LETTERS Estate of ,John D. Jacobs also known as To: Register of Wills for the County of~,rn/~,~t~0~tin the Commonwealth of Pennsylvania ., Deceased. Social Security No. 178-16-5082 The petition of the undersigned respectfully represents that: Your petitioner(s) is/are 18years of age or older and the execut or named in the last will of the above decedent, dated July 27, 1995 ~ and codicil(s) dated (~[at¢ relcvanl clrcurnslances, · g rcnunclahon, death of executor, elc ) Decedent was domiciled at death inCumberland County, Pennsylvania, with his cipal residence at 531 Bosler Avenue, Lemoyne, PA last f.am_~il~.r prin- (hst V,¢el, -umber and mun~clpahty) Decedent, then 89 years of age, died May 16, 2003 at Mealth Rcn,lh Rehabilitation, 1 lpper Allen Township, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated in- competent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 531 Busier Avenue Lemoyne, PA $ $ $ WHEREFORE, petitioner(d respectfully request(s) the probate of the last will armtccd:':!!(:) presented herewith and the grant of letters Testamentary thereon. (lcslamentary, adrnmlstratlon c t a , administration d b n c I a ) 2303 Market Street Camp Hill, PA 17011 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTYOF ~_UflC!t~L~l,J i~ ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal petiti°ner(~~ruly ~st~t)~ estate according to representative(s) of the above decedent law. Sworn to or affirmed and subscribed before me this 30th day of May _ 2003 Donna M. Otto, 1st DeputyF°r the R.o~isler ~ No. 21-2003-444 Estate of John D. Jacobs ., Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, Hay 30th 2003 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s), dated July 27th 1995 described therein be admitted to probate and filed of record as the last will of John D. Jacobs and Letters are hereby granted to Testa~entarv Richard E. Connell ,F.~,~re FEES Probate, Letters, Etc .............. $ Short Certificates ( ). £5 .......... $ ~ ~Pa~es. (6.) ...... $ JCP ~ Filed Call Attorney 865.00 45.00 18.00 10.00 TOTAL ............. $ 938.00 May 30th, 2003 Richard Connell n .~~ ~~ 21542 ATTORNEY (Sup Ct ! D. No,) 2303 Market Street, Camp Hill, PA 17011 ADDRESS (717) 232-8731 PHONE 21-2003-444 LAST WILL AND TESTAMENT OF JOHN D. JACOBS KNOW ALL MEN BY THESE PRESENTS, that I, JOHN D. JACOBS, presently residing at 531 Bosler Avenue, Lemoyne, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts, expenses of my last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: Specific Bequests: I bequeath the following gifts to the individuals or organizations named: A. I bequeath the sum of One Thousand ($1,000.00) Dollars to MRS. CATHERINE HELLMAN, 398 North 19th Street, Camp Hill, Cumberland County, Pennsylvania, if she survives me, for her kindness and friendship with Mary, my wife. B. I bequeath the sum of Fifty Thousand ($50,000.00) Dollars to MS. SUSAN BEEMAN, 729 Erie Street, Astoria, Oregon, if she survives me, in consideration of services rendered and in grateful recognition of her kind and loving friendship. C. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Bethesda Mission, 611 Reily Street, Harrisburg, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. D. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Volunteers of America, 2100 North Third Street, Harrisburg, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. - 1 - E. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Salvation Army, 1122 Green Street, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. F. I bequeath the sum of Three Thousand ($3,000.00) Dollars to Help The Children, P. O. Box 10900, Glendale, California 91209. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. G. I bequeath the sum of Three Thousand ($3,000.00) Dollars to Good Samaritan Mission Services, Flagship Bank Building, P. O. Box 3500, Orlando, Florida 32802. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. H. I bequeath the sum of Five Thousand ($5,000.00) to The Christian Children's Fund, Inc., P. O. Box 26511, Richmond, Virginia 23261. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. THIRD: I give, devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate as follows: (a) If the value of the residue of my estate after deduction of debts, expenses, taxes, fees, bequests in Paragraph SECOND of this Will and costs of administration shall be less than One Hundred Thousand ($100,000.00) Dollars: 1. One-half to Messiah Lutheran Church, Forster and Commonwealth Avenue, Harrisburg, Dauphin County, Pennsylvania to be used for capital improvements in the church, maintenance of the church, property upkeep and other charitable purposes. 2. One-half to the Milton S. Hershey Medical Cen- ter to be used at the discretion of the said Milton S. Hershey Medical Center with no restrictions. (b) If the value of the residue of my estate after deduction of debts, expenses, taxes, fees, all costs of administration and payment of bequests set forth in - 2 - Paragraph SECOND of this Will shall be greater than One Hundred Thousand ($100,000.00) Dollars: 1. Fifty Thousand ($50,000.00) Dollars to Messiah Lutheran Church, Forster and Commonwealth Avenue, Harrisburg, Dauphin County, Pennsylvania to be used for capital improvements in the church, maintenance of the church, property upkeep and other charitable purposes. 2. The net amount of the residue to the Milton S. Hershey Medical Center to be used at the discretion of the said Milton S. Hershey Medical Center with no re- strictions. FOURTH: I hereby nominate, constitute and appoint RICHARD E. CONNELL, ESQ. of the law firm of BALL, SKELLY, MURREN & CONNELL as Executor of this my Last Will and Testament. In the event that the said RICHARD E. CONNELL, ESQ. shall fail to quali- fy or cease to act as Executor as aforesaid, then I nominate, constitute and appoint PHILIP J. MURREN, ESQ. of the law firm of BALL, SKELLY, MURREN & CONNELL as Executor of this my Last Will and Testament. FIFTH: I direct that my Executor and his successor shall not be required to give bond for the faithful performance of duties in any jurisdiction. SIXTH: My Executor and his successors shall have, in addition to the powers and authority conferred upon them by law, the following additional discretionary powers and authority: (a) To retain any property received by them. (b) To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, and upon such terms and conditions as the Executor shall deem wise. (c) To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance annu- ities or other securities, or such property, real or person- al, as the Executor shall deem wise, without being limited by any statute or rule of law regarding investments by the Executor. (d) To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as they deem it wise, and even though such property is not the kind of property my Executor would pur- chase as an investment; and even though to retain such prop- erty might violate sound diversification principles. - 3 - (e) To cause any security or other property which may at any time constitute a portion of my estate to be issued, held or registered in their own name, or in the name of a nominee, or in such form that title will pass by delivery. (f) To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the as- sets of any corporation or other organization, the secu- rities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor, is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to them as the owner of any securities constituting a portion of of my estate; to accept and hold securities resulting from any reorganization, con- solidation, readjustment, sale conversion or subscription. (g) To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including compensation to the Executor. (h) To determine what is "Income" and what is "Princi- pal'' hereunder, and their decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. (i) To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by them, at public or private sale or otherwise. (j) To borrow money from any person, firm or corpo- ration, for the purpose of protecting and preserving or improving my estate hereunder; to execute promissory notes or other obligations for amounts so borrowed. (k) To make distribution in cash or in kind. (1) To execute and deliver all documents necessary or appropriate for the exercise of their powers. (m) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SEVENTH: And I do further direct that: (a) No Executor shall be liable for any loss resulting - 4 - to my estate from any investment or reinvestment made or retained in good faith. (b) No Executor shall be liable for any loss to my estate thereof unless the same shall occur through his own gross neglect or willful malfeasance. EIGHTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executor pay, or provide for payment of all such taxes at such time or times, and in such manner as my Executor deems best. IN WITNESS WHEREOF, I, JOHN D. JACOBS, the Testator to this, my Last Will and Testament, typewritten on five (5) sheets of paper which I have identified at the bottom of each page by my signature, hereunto set my hand and seal the %q~_~ day of July, 1995. (SEAL) The preceding instrument consisting of this and four (4) other typewritten pages, each identified by the signature of the Testator, JOHN D. JACOBS, was on this day and date thereof signed, published and declared by JOHN D. JACOBS, the Testator therein named, as and for his Last Will, in the presence of us, who at his request, in his presence, and in the presence of each other have subscribed our names as witnesses. - 5 - COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF DAUPHIN : I, JOHN D. JACOBS, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. (SEAL) Sworn or affirmed to and a~knowledged before me, by JOHN D. JACOBS, the Testator, this ~7~day of July, 1995. (SEAL) ./ ~ Notary~ Publyc COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF DAUPHIN : We, Nancy L. Loper and Joan M. McDonnell , and Richard E. Connell, Esq. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JOHN D. JACOBS sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by Nancy L. Loper , and Joan M. McDonnell and Richard E. Connell, Esq. , witnesses, this 27th day of July, 1995. (SEAL) Notary P~bl fc ~ Ioria A, Cuddi,gton, Notary Public Harrlsb~,~, Daut:)hin County, PA k4y ¢o~m~!~ Y~.r)ire. s Feb. 14,1998 9Z:6V O[ ~,VI~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. To the Register: John D. Jacobs May 16, 2003 2003-00444 Mary C. Lewis, Register of Wills Cumberland County Admin. No. I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 4, 2003 Name Address Mrs. Catherine Heilman Ms. Susan Beeman The Bethesda Mission The Christian Children's Fund, Inc. Good Samaritan Mission Services Help the Children Messiah Lutheran Church Milton S. Hershey Medical Center The Salvation Army The Volunteers of America 398 North 19th Street, Camp Hill, PA 17011 729 Erie Street, Astoria, OR 611 Reily Street, Harrisburg, PA 17102 P.O. Box 26511, Richmond, VA 23261 Flagship Bank Building, P.O. Box 3500, Orlando, FL 32802 P.O. Box 10900, Glendale, CA 91209 Forster & Commonwealth Avenue, Harrisburg, PA 17102 500 University Drive, Hershey, PA 17033 1122 Green Street, Harrisburg, PA 17102 2100 North Third Street, Harrisburg, PA 17113 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: June 4, 2003 Signature Name Richard E. Connell, Esquire Address 2303 Market Street Capacity: Camp Hill, PA 17011 Telephone (717) 232-8731 X Personal Representative Counsel for personal representative PHILIP J. MURREN RICHARD E. CONNELL MAURA K. QUINLAN TERESA R. McCORMACK THOMAS a. CAPPeR LAW OFFICES BALL, MURREN ~g~ CONNELL 2303 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 (717) 232-8731 FACSIMILE (717) 232-2!42 MAILING ADDRESS: P.O. BOX ~108 HARRISBURG, PENNSYLVANIA 17108-1108 HAND DELIVERED August 14, 2003 WILLIAM BENTLEY BALL (1916-1999) Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of John D. Jacobs Date of Death: May 16, 2003 Our File No. 594.4 Dear Sir or Madam: Enclosed with this letter is a check payable to the Register of Wills, No. 1016, in the amount of Two Thousand Nine Hundred Ninety Two Dollars and Fifty ($2,992.50) Cents representing the pre-payment of inheritance tax as follows: Estate subject to tax = Tax (~ 15%) -- Less 5% Discount = Estimated tax payment = $ 21,000.00 3,150.00 157.50 $ 2,992.50 Please issue the appropriate receipt. Richard E. Connell REC/hrnp Enclosure COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O29OO CONNELL RICHARD E ESQUIRE 2303 MARKET STREET CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 178-16-5082 FILE NUMBER: 2103- 0444 DECEDENT NAME: JACOBS JOHN D DATE OF PAYMENT: 08/14/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/1 6/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,992.50 TOTAL AMOUNT PAID: 92,992.50 REMARKS: RICHARDECONNELLESQUIRE C/O BALL MURREN & CONNELL SEAL CHECK# 1016 INITIALS' SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I'FILE NUMBER COUN2Ty1CODE OFFICIAL USE ONLY 03 00444 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Jacobs, John D. 178-16-5082 Z DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) m THIS RETURN MUST BE FILED IN DUPLICATE WITH THE uJ ~ 05/16/2003 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER -~-00 z 0 [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death pdor to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after [] 5. Federal Estate Tax Return Required 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) -- [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 1 1. Election to tax under Sec. 9113(A) (Attach Sch O) ,lAME Richard E. Connell, Esq. FIRM NAME (If applicable) Ball, Murren & Connell TELEPHONE NUMBER 717/232-8731 COMPLETE MAILING ADDRESS 2303 Market Street Camp Hill, PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 49,310.11 50,611.2~-~ Non~ NoS 637,478.2~. Non~ 40,390.75 5,103.05 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ON[.f (8~ 737,399.57 (11) 45,493.80 691,905.77 640,905.77 51,000.00 (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 51,000.00 x .00 x .045 x .12 x .15 (15) (16) (17) (18) (19) 7,650.00 7,650.00 Cop,,-ight 2000 form softnvare only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: I STKEETADDRESS 531 Bosler Avenue CITY Lemoyne STATE PA ziP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 17043 (1) 2,992.50 157.50 Interest/Penalty if applicable D. Interest E. Penalty 7,650.00 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. ,, B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,150.00 0.00 4,500.00 4,500.00 (4) (5) (5A) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .................................................................................. ~ ~ b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest; or .................................................................................................................. d. rece ve the prom se for fe of ether payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than t~onal representatNe is based on all information of which preparer has any knowledge. S,C.^TU.~ERSO. ~".O.S~S'E F~~..~// ADDRESS DATE Rich~~~/r~ 2303 Market Street ~,~/ O~T/b2/ , Camp Hill, PA 17011 / SIGNATURE OF PER~ON~-ESPONSIBLE F~R FIL~./RETURN ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, Under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jacobs, John D. 2 ] - 03 - 00444 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which proper~ would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 49,310.11 531 Bosler Aveue, Lemoyne, Cumberland County, Pennsylvania Settlement - September 2, 2003 Estate of John D. Jacobs to Karen L. Stevens (copy of settlement sheet attached-reported figure-net proceeds including $2000 deposit fxom Buyer) TOTAL (Also enter on Line 1, Recapitulation) 49,310.11 CO~ONWE~,LTH LAND TITLE INSURANCE COMPANY A. Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 Title Insurance No. D369946CP B. Type of Loan 1. [ ]FHA 2. [ ]FmHA 3.[ ]Cony. Unins. I 6.File Number 17.Loan Number 18.Mortgage Insurance Case No. 4. [ ]VA 5. [X]Conv. Ins. I I 24-00285 I C.Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D.Name and Address of Borrower Karen L. Stevens E.Name and Address of Seller Richard E. Connell, Esquire, Executor of the Estate of John D. Jacobs, deceased F.Name and Address of Lender Waypoint Bank 101 S. George Street York, PA 17401 G.Property Location 531 Bosler Avenue Lemoyne, PA 17043 H.Settlement Agent CO~ONWEALTH LAND TITLE INSURANCE COMPANY Place of Settlement II.Settlement Date 17 S MARKET SQUARE I HARRISBURG, PA 17101 I September 2, 2003 ~.~n~ K. Trively LKT I K. SU~t~RY OF S~?.?.ww.'S TRANSACTION Lemoyne Borouqh, Cumberland County, PA J. SDT~L~RY OF BORROWER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO ~,?.~R 101.Contract sales price 50000.00 401.Contract sales price 50000.00 102.Personal property 402.Personal property 103.Settlement charges to borrower (line 1400) 5238.34 403~ 106.City/town taxes 107.County taxes 108.SCHOOL TAX 109.Refuse Adjustments for items paid by seller in advance to 09/02/03 to 12/31/03 77.74 09/02/03 to 06/30/04 568.03 09/02/03 to 09/30/03 10.58 Adjustments for items paid by seller in advance 406.City/town taxes 407.County taxes 77.74 406.SCHOOL TAX 568.03 409.Refuse 10.58 to 09/02/03 to 12/31/03 09/02/03 to 06/30/04 09/02/03 to 09/30/03 120. GROSS AMOUNT DUE 420. GRoss AMOUNT DUE FROM BORROWER 55894.69 TO SET.~.RR 50656.35 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO 201.Deposit of earnest money 2000.00 501.Excess Deposit (see instructions) 202.Principal amount of new loan(s) 50000.00 502.Settlement charges to seller (line 1400) 1346.24 203.Existing loan(s) 503.Existing loan(s) 206. 506.Deposit or earnest money with seller 2000.00 Adjustments for items unpaid by seller 210.City/town taxes to 211.County taxes to 220. TOTAL PAID BY/FOR BORROWER 52000.00 300. TOTAL AT SETTLEMENT FROM/TO BORROWER 55894.69 52000.00 3,894.69 Adjustments for items unpaid by seller 510.City/town taxes to 511.County taxes to 520 TOTAL REDUCTION AMOUNT DUE SET.T.mR 3346.24 600. CASH AT SETTLEMENT TO/FROM 601.Gross amount due to seller (line 420) 602.Less reductions in amount due seller (line 520) 50656.35 3346.2~ 603. CASH ([XX] TO) ([ ] FROM) SELLER 47,310.11 301.Gross amount due from borrower (line 120) 302.Less amounts paid by/for borrower (line 220) 303. CASH ([XX] FROM) ([ ] TO) BORROWER ?ORM 911 (4-88) ~JD-1 (3-86) RESPA, HB4205-2 D369946CP L. SETTLEMENT CHARGES PAID FROM BORROWER'S FL~gDS AT 700. TOTAL SALES/BROKER'S CO~ISSION based on price $ 50000.00 Division of commission(line 700) as follows: 7o1.$ to 702.$ to 703.Commission Paid at Settlement 704.$ to 800. z'r~MS PAYABLE IN CONNECTION WITH LOAN Page 2 of Form Approved OMB No. 2502-0265 PAID FROM SELLER' S FUNDS AT I SETTLEI~I~I' SETTLEble;NT 801.Loan Origination Fee 802.Loan Discount 803.Appraisal Fee 804.Credit Report 805.Lender's Inspection Fee 808.Underwriting Fee 809.Document Preparation Fee 810.Tax Service Fee 811.Flood Certification 812.Application Fee 815.Escrow Holdback/Repairs % to % to to George Clauser to Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank Waypoint Bank 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901.Interest from 09/02/03 to 09/30/03 ~$ 7.47 /day 901.1 Interest from to ~$ /day 902.Mortgage Insurance Premium for mo. to 903.Hazard Insurance Premium for yrs.to Waypoint Bank [POC $350.00] [POC $250.00] 50.00 115.00 290.00 91.00 14.00 2800.00 216.63 1000.RESERVES DEPOSITED WITH LENDER 104.15 1001.Hazard insurance 5 mo.~$ 1002.Mortgage insurance mo.@$ 1003.City property taxes mo.~$ 1004.County property taxes 8 mo.~$ 1005.SCHOOL TAXES 4 mo.~$ 1008.Aggregate Accounting Adjustment 20.83 per mo. per mo. per mo. 20.11 per mo. 58.38 per mo. i60.88 233.52 -200.59 1100. TITLE CHARGES ll01.Settlement or closing fee to ll02.Abstract or title search to [103.Title examination to ~104.Title insurance binder to L106.Notary Fee to (includes above items No.: L108.Title Insurance to Linda K. Trively ) COMMONWE~J~TH LAND TITLE 10.00 558.75 (includes above items No.: ll01 - L109.Lender's coverage $ Lll0.Owner's coverage $ L112.ENDORSEMENT PA 300 ~ll3.ENDORSEMENT PA 100 - CO. .ll4.ENDORSEMENT PA 900 (ALTA B.1) .lIS.CLOSING SERVICE LETTER(CSL) 1104) 50000.00 50000.00 to CO~40~TH LAND TITLE to CO~94ONWEALTH LAND TITLE to CO~94ONWEALTH LAND TITLE to CO~4ONWEALTH LAND TITLE 50.00 50.00 50.00 35.00 4.00 1200. GOVERNMENT RECORDING AND TRANSFER CT{3%RGES .201.Recording fees: Deed $ 40.50 Mortgage $ 69.50 Releases $ 110.00 .202.City/county tax/stamps: Deed $ 500.00 Mortgage $ 500.00 .203.State tax/stamps Deed $ 500.00 Mortgage $ 500.00 1300. ADDITIONAL SETTLEMENT CHARGES .303.2003-04 School Taxes to Faith A. Nicola, Tax Collector I 700.54 .305.Final Sewer Billing 10-02 to closin to Boro. of Lemoyne I 72.00 .306.Final Refuse Billing to Boro. of Lemoyne I 69.70 1400.TOTAL SETTLEMENT CHARGES (entered on lines 103, SECTION J AND 502 Section K) 5,238.34 t 1,346.2~ 'ORM 912 (4-88) See page 3 for certification and signatures Page 3 of Form Approved OMB No. 2502-0265 Title Application No: D369946CP CERTIFICATION I direct and authorize the Company to make the distributions indicated for my account on the attached HUD-1 Settlement Statement, recognizing that the Company is not responsible for the accuracy or validity of disbursement amounts or the completeness of disclosure of charges made by others. Disbursements made hereunder are guaranteed by the Company. Funds deposited with the Company in connection with the settlement are not held in trust, and interest or other valuable consideration may be earned and retained by the Company on such settlement funds I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Borrowers Address Sellers Address The n~-l~, tlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will deus~.~he funds/~~rsed in accordance with this statement. / WAR/~ING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. Form 471 (Rev. 11/87) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jacobs, John D. 21 - 03 - 00444 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE OI NUMBER DESCRIPTION UNIT VALUE DEATH 1 PNC INVESTMENTS 50,611.23 (Acct. # 45542437) (Met Life Invs. USA Ins. - Annual Renewable SPDA Fixed Annuity Contract 9200504178) ! TOTAl. {Also enter on line 2, Recapitulation) 50,611.23 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jacobs, John D. FILE NUMBER 21 - 03 - 00444 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER ] 2 DESCRIPTION FULTON BANK Certificate of Deposit - Account # 052-0157381 WACHOVIA (formerly First Union) Certificate of Deposit - Account # 247412061520231 PNC BANK Certificate of Deposit - Account # 31300224067 Checking Account # 5140128623 TOTAL 84,395.75 4~399.74 88,795.49 WAYPOINT BANK Checking Account # 20008290 Checking Account # 40000051 Certificate of Deposit Account # 400002271 Certificate of Deposit Account # 461289878 Certificate of Deposit Account #461300269 Certificate of Deposit Account # 7100024424 Certificate of Deposit Account # 8000056643 TOTAL $17,830.87 10,290.95 49,571.49 38,557.59 26,825.96 95,981.54 45,694.13 $284,752.53 M & T BANK (formerly Allfirst Bank) Certificate of Deposit - Account # 80000002028914 Household Goods & Furnishings Sold by Costea's Auction Service 6/30/03 Sale Total: $ 5,078.00 Less: 1,777.30 (Auctioneer Commission) Less: 500.00 (Removal of Unsaleable items-hauling/disposal) TOTAL $ 2,800.70 Coins RVP Auctions, Inc. - Sale 7/26/03 - Sale 8/13/03 (meltdown scrap) Adams Auction Sales/Serv. - Sale 7/13/03 TOTAL Cash at decedent's house. Car - '95 Chevy Beretta (VIN # 1G1LV1542SY135572) $19,344.47 48.85 322.40 $19,715.72 Total of Continuation Schedule(s) TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 40,000.00 103,738.32 88,795.49 284,752.53 95,582.54 2,800.70 19,715.72 53.00 2,000.00 39.93 637,478.23 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jacobs, John D. FILE NUMBER 21 - 03 - 00444 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomh~p must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 10 11 12 13 Comcast (Refund) Verizon (Refund) Allstate (Refund) AT&T (Refund) 2.14 6.22 9.00 22.57 Page 2 of Schedule E COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES ;ATE OF Jacobs, John D. FILE NUMBER 21 - 03 - 00444 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1 FUNERAL EXPENSES: Musselman Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Com, missions Social Security ntative(s): Street Address ~ ~O~ -~/a ~w c,~d mp~; t/ State ~ Zip '701 ( Year(s) Commission paid 2003/2004 Attorney's Fees BALL, ~N & CO~LL Family Exemption: (If de.dent's address is not the same as claimant's, a~ach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip Accountant's Fees Barbush & Hoffrnan (estimated-final lifetime return-fiduciary accounting.) Tax Return Preparer's Fees Other Administrative Costs a. Pennsylvania Water Company $ 83.77 b. Pennsylvania Power & Light 112.27 c. Verizon 65.03 d. UGI 113.30 e. AT&T 45.14 TOTAL (Also enter on line 9, Recapitulation) 3,629.76 30,000.00 2,477.50 938.00 500.00 2,845.49 40,390.75 $ehedul~ H Funeral Expenses & Adn'blis'baf~e Costs ~n~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF_ vlacohs, Jolm D, FILE NUMBER 2 ! - 03 - 00444 g. h. i. k. I. m. n. O. The Sentinel 78.17 Cumberland Law Journal 75.00 Borough of Lemoyne (sewer) 54.00 Randy Durlin (Grass cutting; yard maintenance) 275.00 J.C. Ehrlich (Rodent Treatment) 302.10 L.G. Connor Appraisals 300.00 PNC Checking 97.60 UGI (Refund) 20.46 BALL, MURREN & CONNELL 223.65 Reserve for costs, final accounting and disbursement expenses TOTAL 17000.00 $2,845.49 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Jacobs, John D. 2 ! - 03 - 00444 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT ! West Shore EMS Connor-Rich Associates (Doctor fee) North Dakota State University (Payment of existing pledge) Ball, Murren & Connell (Estate Planning file 594.3-Power of Attorney duties while Mr. Jacobs hospitalized and in care facility.) TOTAL (Also enter on Line 10, Recapitulation) 86.95 100.00 50.00 4,866.10 5,103.05 . REV-1513 EX+ ~9-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Jacobs, John D. 21 - 03 - 00444 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY AMOUNT OR SHARE OF ESTATE 2 II. 1 2 3 4 5 TAXABLE DISTRIBUTIONS (include outright spousal distributions) Catherine Hellman 398 North 19th Street Camp Hill, PA 17011 Susan Beeman 729 Erie Street Astoria, OR RELATIONSHIP TO DECEDENT ~ Not List NONE NONE Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS The Bethesda Mission 611 Reily Street, Harrisburg, PA The Volunteers of America, 2100 North Third Street, Harrisburg, PA The Salvation Army, 1122 Green Street, Harrisburg, PA Help the Children's Fund., Inc. P.O. Box 26511, Richmond, VA 23261 Total of remaining 4 charities PLEASE SEE ATTACHED FOR BREAKDOWN. TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1,000.00 50,000.00 2,500.00 2,500.00 2,500.00 3,000.00 630,405.77 640,905.77 JOHN D. JACOBS FILE NUMBER: 21-03-0444 SCHEDULE J (CONTINUATION) II. NON-TAXABLE DISTRIBUTIONS Total from Previous Page Good Samaritan Mission Services P.O. 3500, Orlando, FL 32802 The Christian Children's Fund, Inc. P.O. Box 26511, Richmond, VA 23261 Messiah Lutheran Church Forster & Commonwealth Ave., Hbg., PA Milton S. Hershey Medical Center 500 University Drive, Hershey, PA (residue-approximate) TOTAL= $ $ 10,500.00 3,000.00 5,000.00 50,000.00 572,405.77 640,905.77 LAST WILL AND TESTAMENT OF JOHN D. JACOBS KNOW ALL MEN BY THESE PRESENTS, that I, JOHN D. JACOBS, presently residing at 531 Bosler Avenue, Lemoyne, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts, expenses of my last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: Specific Bequests: I bequeath the following gifts to the individ-uals or organizations named: A. I bequeath the sum of One Thousand ($1,000.00) Dollars to MRS. CATHERINE HELLMAN, 398 North 19th Street, Camp Hill, Cumberland County, Pennsylvania, if she survives me, for her kindness and friendship with Mary, my wife. B. I bequeath the sum of Fifty Thousand ($50,000.00) Dollars to MS. SUSAN BEEMAN, 729 Erie Street, Astoria, Oregon, if she survives me, in consideration of services rendered and in grateful recognition of her kind and loving friendship. C. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Bethesda Mission, 611 Reily Street, Harrisburg, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. D. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Volunteers of America, 2100 North Third Street, Harrisburg, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. - 1 - E. I bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to The Salvation Army, 1122 Green Street, Dauphin County, Pennsylvania. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. F. I bequeath the sum of Three Thousand ($3,000.00) Dollars to Help The Children, P. O. Box 10900, Glendale, California 91209. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. G. I bequeath the sum of Three Thousand ($3,000.00) Dollars to Good Samaritan Mission Services, Flagship Bank Building, P. O. Box 3500, Orlando, Florida 32802. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1, 1995, this gift shall lapse. H. I bequeath the sum of Five Thousand ($5,000.00) to The Christian Children's Fund, Inc., P. O. Box 26511, Richmond, Virginia 23261. I direct that if, at the time of my death, the said named charity is not providing substantially the same services that it provided on or about July 1 1995, this gift shall lapse. ' THIRD: I give, devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate as follows: (a) If the value of the residue of my estate after deduction of debts, expenses, taxes, fees, bequests in Paragraph SECOND of this Will and costs of administration shall be less than One Hundred Thousand ($100,000.00) Dollars: 1. One-half to Messiah Lutheran Church, Forster and Commonwealth Avenue, Harrisburg, Dauphin County, Pennsylvania to be used for capital improvements in the church, maintenance of the church, property upkeep and other charitable purposes. 2. One-half to the Milton S. Hershey Medical Cen- ter to be used at the discretion of the said Milton S. Hershey Medical Center with no restrictions. (b) If the value of the residue of my estate after deduction of debts, expenses, taxes, fees, all costs of administration and payment of bequests set forth in - 2 - Paragraph SECOND of this Will shall be greater than One Hundred Thousand ($100,000.00) Dollars: 1. Fifty Thousand ($50,000.00) Dollars to Messiah Lutheran Church, Forster and Commonwealth Avenue, Harrisburg, Dauphin County, Pennsylvania to be used for capital improvements in the church, maintenance of the church, property upkeep and other charitable purposes. 2. The net amount of the residue to the Milton S. Hershey Medical Center to be used at the discretion of the said Milton S. Hershey Medical Center with no re- strictions. FOURTH: I hereby nominate, constitute and appoint RICHARD E. CONNELL, ESQ. of the law firm of BALL, SKELLY, MURREN & CONNELL as Executor of this my Last Will and Testament. In the event that the said RICHARD E. CONNELL, ESQ. shall fail to quali- fy or cease to act as Executor as aforesaid, then I nominate, constitute and appoint PHILIP J. MURREN, ESQ. of the law firm of BALL, SKELLY, MURREN & CONNELL as Executor of this my Last Will and Testament. FIFTH: I direct that my Executor and his successor shall not be required to give bond for the faithful performance of duties in any jurisdiction. SIXTH: My Executor and his successors shall have, in addition to the powers and authority conferred upon them by law, the following additional discretionary powers and authority: (a) To retain any property received by them. (b) To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, and upon such terms and conditions as the Executor shall deem wise. (c) To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance annu- ities or other securities, or such property, real or person- al, as the Executor shall deem wise, without being limited by any statute or rule of law regarding investments by the Executor. (d) To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as they deem it wise, and even though such property is not the kind of property my Executor would pur- chase as an investment; and even though to retain such prop- erty might violate sound diversification principles. - 3 - (e) To cause any security or other property which may at any time constitute a portion of my estate to be issued, held or registered in their own name, or in the name of a nominee, or in such form that title will pass by delivery. (f) To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the as- sets of any corporation or other organization, the secu- rities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor, is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to them as the owner of any securities constituting a portion of of my estate; to accept and hold securities resulting from any reorganization, con- solidation, readjustment, sale conversion or subscription. (g) To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including compensation to the Executor. (h) To determine what is "Income" and what is "Princi- pal'' hereunder, and their decision thereon shall be final~ and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. (i) To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by them, at public or private sale or otherwise. (j) To borrow money from any person, firm or corpo- ration, for the purpose of protecting and preserving or improving my estate hereunder~ to execute promissory notes or other obligations for amounts so borrowed. (k) To make distribution in cash or in kind. (1) To execute and deliver all documents necessary or appropriate for the exercise of their powers. (m) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SEVENTH: And I do further direct that: (a) No Executor shall be liable for any loss resulting - 4 - to my estate from any investment or reinvestment made or retained in good faith. (b) No Executor shall be liable for any loss to my estate thereof unless the same shall occur through his own gross neglect or willful malfeasance. EIGHTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executor pay, or provide for payment of all such taxes at such time or times, and in such manner as my Executor deems best. IN WITNESS WHEREOF, I, JOHN D. JACOBS, the Testator to this, my Last Will and Testament, typewritten on five (5) sheets of paper which I have identified at the bottom of each page by my signature, hereunto set my hand and seal the %.-l~!t~ day of July, 1995. f..~ohn D. ,j, ac~bs (SEAL) The preceding instrument consisting of this and four (4) other typewritten pages, each identified by the signature of the Testator, JOHN D. JACOBS, was on this day and date thereof signed, published and declared by JOHN D. JACOBS, the Testator therein named, as and for his Last Will, in the presence of us, who at his request, in his presence, and in the presence of each other have subscribed our names as witnesses. - 5 - COMMONWEALTH OF PENNSYLVANIA .. : COUNTY OF DAUPHIN '. SS: I, JOHN D. JACOBS, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. (SEAL) Sworn or affirmed to and a_~cknowledged before me, by JOHN D. JACOBS, the Testator, this ~7 '~Z-day of July, 1995. (SEAL) COMR~ONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : SS: We, Nancy L. Loper and Joan M. McDonnell , and Richard E. Connell, Esq. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JOHN D. JACOBS sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by Nancy Lo Loper , and Joan M. McDonnell , and Richard E. Connell, Esq. , witnesses, this 27th day of July, 1995. (SEAL) Notary P~blic / Ioria A, Cuddingto. n_, N_otary Public ~;OMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003557 CONNELL RICHARD E P O BOX 1108 HARRISBURG, PA 17108-1108 ........ fold ESTATE INFORMATION: SSN: 178-16-5082 FILE NUMBER: 2103- 0444 DECEDENT NAME: JACOBS JOHN D DATE OF PAYMENT: 02/13/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,500.00 TOTAL AMOUNT PAID: $4,500.00 REMARKS: .... SEAL CHECK# 1029 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Jacobs, John D. No. 21 - 03 - 00444 also known as Date of Death 5/16/2003 , Deceased Social Security No. 178-16-5082 Richard E. Connell, Esquire The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Richard E. Connell, Esq. I.D. No.: 21542 Signature: Richard E. Connell, Esquire Signature: Signature: Address: Telephone: 2303 Market Street Camp Hill, PA 17011 717/232-8731 Personal Property PNC INVESTMENTS (Acct. # 45542437) (Met Life Invs. USA Ins. - Annual Renewable SPDA Fixed Annuity Contract 9200504178) Address: 2303 Market Str,~tc~ Camp Hill, PA EIOH Telephone: 717-232-8731 Dated: 50~,'611.23 WACHOVIA (formerly First Union) Certificate of Deposit - Account # 247412061520231 103,738.32 PNC BANK Certificate of Deposit - Account # 31300224067 Checking Account # 5140128623 TOTAL $ 84,395.75 4,399.74 88,795.49 (Attach additional sheets if necessary) Total Personal Property and Real Estate $697,399.57 Register of Wills of Cumberland County, INVENTORY Estate of Jacobs, John D. also known as continued Pennsylvania No. 21 - 03 - 00444 Date of Death 5/16/2003 , Deceased Social Security No. 178-16-5082 WAYPOINT BANK Checking Account # 20008290 Checking Account # 40000051 Certificate of Deposit Account # 400002271 Certificate of Deposit Account # 461289878 Certificate of Deposit Account #461300269 Certificate of Deposit Account # 7100024424 Certificate of Deposit Account # 8000056643 TOTAL $17,830.87 10,290.95 49,571.49 38,557.59 26,825.96 95,981.54 45~694.13 $284,752.53 284,752.53 M & T BANK (formerly Allfirst Bank) Certificate of Deposit - Account # 80000002028914 Household Goods & Furnishings Sold by Costea's Auction Service 6/30/03 Sale Total: $ 5,078.00 Less: 1,777.30 (Auctioneer Commission) Less ' 500.00 (Removal of Unsaleable items-hauling/disposal) TOTAL $ 2,800.70 95,582.54 2,800.70 Coins RVP Auctions, Inc. - Sale 7/26/03 - Sale 8/13/03 (meltdown scrap) Adams Auction Sales/Serv. - Sale 7/13/03 TOTAL Cash at decedent's house. Car - '95 Chevy Beretta (VIN # IG1LV1542SY135572) Comcast (Refund) Verizon (Refund) Allstate (Refund) AT&T (Refund) $19,344.47 48.85 322.40 $19,715.72 19,715.72 53.00 2,000.00 2.14 6.22 9.00 22.57 Total Personal Property $648,089.46 2 Estate of also known as Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Jacobs, John D. No. 21 - 03 - 00444 , Deceased Real Estate 531 Bosler Aveue, gemoyne, Cumberland County, Pennsylvania Settlement - September 2, 2003 Estate of John D. Jacobs to Karen L. Stevens Date of Death 5/16/2003 Social Security No. 178-16-5082 49,310.11 Total Real Estate $49,310.11 3 BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. 1806D! HARRZSBURG, PA 1711&-060! '04 ~PR 14 RICHARD E CONNELL ES~ BALL ETAL 2303 MARKET ST CAMP HILL ~AtlTY,OZ1 COMMONNEALTH OF PENNSYLVAN/A DEPARTMENT OF REVENUE NOTZCE OF ZNHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE Oq-lZ-ZOOq ESTATE OF JACOBS DATE OF DEATH 05-16-2005 FZLE NUMBER 21 03-Oqqq COUNTY CUMBERLAND ACN 101 Amount Remitted REV-15~i7 EX AFP (01-05) JOHN D MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF NZLLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOT]:CE OF ]:NHER]:TANCE TAX APPRAZSEMENT, ALLONANCE OR D]:SALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JACOBS JOHN D F]:LE NO. 21 O$-Oqqq ACM 101 DATE Oq-12-200q TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNING FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnersh/p Znterest (Schedule C) (3) q. Mortgages/Notes Rece/vable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Costs/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgage L/ab/lit/es/L/ens (Schedule 1) (10) 11. Total Deduct/ons 12. Net Value of Tax Return q9z$10.11 50~611.25 O0 O0 637~q78.23 00 00 (8) q0,390.75 5,103.05 (11) (12) 13. lq. NOTE: Char/table/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Nat Value of Estate Sub~ect to Tax (1~,) If an assess;ent ~as issued previously, 11nes 1~, 15 and/or 16, 17, reflect figures that include the total o~: ALL returns assessed to date. NOTE: To /nsure proper cred/t to your account, subm/t the upper port/on of this form w/th your tax payment. 737,$99.57 ASSESSMENT OF TAX: 15. Amount of L/ne lq at Spousal rate 16. Amount of L/ne lq taxable at L/heal/Class A rate 17. Amount of L/ne lq at Sibling rate 18. Amount of L/ne lq taxable at Collateral/Class B rate 19. Pr/nc/pal Tax Due TAX CREDZTS: PAYMENT RECEIPT DZSCOUNT (+) DATE NUHBER ZNTEREST/PEN PAZD (-) 08-1q-ZO0~ CDOOZ900 157.50 02-13-200~ CD003557 .00 ~5.~g3.80 691,905.77 IF PAID AFTER DATE /NDICATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. 6q0,905.77 51,000.00 18 and 19 will (1~), .00 x O0 = .00 (16) .00 x Oq5= .00 (~7). .00 x 12 = .00 (181 51,000.00 x 15 = 7,650.00 (19)= 7,650. O0 AMOUNT PAZD Z,99Z.50 q,500.00 TOTAL TAX CREDZT I I BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 7,650.00 .00 .00 .00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE 15 REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR INSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December II, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for Iife or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of 2000. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications ara available at the Office of the Register of Mills, any of the ZS Revenue District Offices, or by ceiling the special Z4-hour answering service for fores ordering: 1-800-S62-ZOS0; services for taxpayers eith special hearing end / or speaking needs: 1-800-447-:50Z0 (TT only). Any party in interest not satisfied with the appraisement) alloeance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days oF receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 17IlS-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for e Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (:5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one il) day from the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 198Z bear interest et the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor ~'~ ZOZ .000548 ~'~- 1991 1IX .000301 1983 162 .000438 199Z 9X .000247 1984 llZ .000:501 1993-1994 7X .000192 1985 1:5Z .000:556 1995-1998 9Z .000Z47 1986 IOZ .000Z74 1999 7X . O0019Z 1987 10Z .000274 ZOO0 7Z . ooalgz --Interest Js calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~'~ 9X .000Z47 ZOOZ 6Z .000164 Z00:5 5Z .0001:57 2004 4Z .000110 X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation ta fifteen (la) days beyond the date of the assessment. If payment is sade after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE TIllS REPORT WITIDN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLV UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 John D. Jacobs Name of Decedent: Date of Death: May 16, 2003 Will No.: 21-03-0444 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administrarion of the above-captioned estate: 1. State whether administration of the estate is complete: Ves No X 2. If the answer is No, state when the personal representative reasonably believes All dIstributions were made to all beneficiaries before the end that the administration will be complete: 012004. A small reserve is held to cover any fiduciary taxes. It is expected that all aspects will be completed by Angust 2005. If the answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? Ves No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: C. Did the personal representative state an account informally to the parties In mterest? Ves X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' and may be attached to thlS report. 3. Date: y j;~/()..j- (MAH:nntlAMll) RW.-27 r- Signature Richard E. Connell, Esquire Name (Please type or print) 2303 Market Street, Camp HilI, P A 17011 Address (717)232-8731 Telephone No. Capacity: X Personal Representative Counsel for Personal RepresentJl1 \ C uJ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 4/15/2005 CONNELL RICHARD E POBOX n08 HARRISBURG, PA 17108-1108 RE: Estate of JACOBS JOHN D File Number: 2003-00444 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/16/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~=~L REGISTER OF WILLS cc: File Personal Representative(s) Judge I- Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 CONNELL RICHARD E 2303 MARKET STREET CAMP HILL, PA 17011 RE: Estate of JACOBS JOHN D File Number: 2003-00444 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/16/2006 please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. S~Y~#M~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) - Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 CONNELL RICHARD E ESQUIRE 2303 MARKET STREET CAMP HILL, PA 17011 RE: Estate of JACOBS JOHN D File Number: 2003-00444 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1/ for decedents dying on or after July 1/ 1992/ the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/16/2006 please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, k~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel PLEASE FILE TIDS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: John D. Jacobs Date of Death: Mav 16,2003 Will No.: 21-03-0444 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: C. Did the personal representative state an account informally to the parties In interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphan~~ourt and may be attached to thIS report. c(/~ Signature Date: April 20, 2006 RichardE. Council, Esquire Name (Please type or print) 2303 Market Street, Camp Hill, P A 17011 Address (717) 232-8731 (MAH:rmtl AMJ?l '., itO 'U:"\ (t;J j r,~.... lCfn9~"S~!&td~O~nJ :sU >ltJ318 R W.-21 2*1 :0/ UV /2 YdV 900l Telephone No. Capacity: X Personal Representative Counsel for Personal Reprcsenl~lf I \ c: