HomeMy WebLinkAbout03-1070PETITION FOR PROBATE and GRANT OF LETTERS
Estate of MILDRED E. JACOBY
also known as
No.
To:
, Deceased.
Social Security No. 201-07-5222
The petition of the undersigned respectfully represents that:
Register of Wills for the
County of CUMBERLAND
Commonwealth of Pennsylvania
Your petitioner(s), who is/are 18 years of age or older an the execut ors
in the last will of the above decedent, dated JULY 10, 1970
and codicil(s) dated
in the
named
(o.
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in DICKINSON TWP. CUMBERLAND County, Pennsylvania, with
h er last family or principal residence at 4510 CARLISLE ROAD, GARDNERS, PA 17324
(list street, number and municipality)
Decedent, then 89 years of age, died 12/24/2003
at VILLAGE OF LAUREL RUN, 6375 CHAMBERSBURG ROAD, FAYETTEVILI F, PA 17222
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 ajudicated
incompetent:
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:
55,000.00
175,000.00
$ 230~000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
thereon.
LESLIE LEE JACOBY
(testamentary; administration c.t.a.; administration d.b.n.e.t.a.)
388 GEORGETOWN ROAD
GARDNERS PA 17324
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ]
COUNTY OF CUMBERLAND
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affu-med and subscribed ._ ~q ~_.j2_
before me this ~ 30th day of / ~._
~DECEMBER, 2003 . J
~,,~ .... Donna M. Otto, 1st Regis~r ,e.~:~'.~;, ) ~t(oL~-.41~
/ '/-/~'5-// Deputy ~ ~ '~~'
No. 21-2003-1070
Estate of MILDRED E. JACOBY __----, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW DECEMBER .', 30th; :L2Q03 , 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 7~1011970
described therein be admitted to probate and filed of record as the last will of MILDRED E. JACOBY .
and Letters TESTAMENTARY
are hereby granted to
LESLIE LEE JACOBY
FEES
Probate, Letters, Etc ......... $ _270,00
Short Certificates ( 6 ~ ...... $ 18.00
xe x .x-Pages' (' ]: )' $ 3.00
- ~ 10.00
TOTAL ~ 301.00 '
Filed. DeGember .30th,'2003 ........
Call Attorney Harold S. Irwin
on 12/30/03.
HAROLD S. IRWIN, III
29920
ATTORNEY (Sup. (Et. I.D. No.)
64 SOUTH PITT STREET
CARLISLE PA 17013
ADDRESS
717-243-6090
PHONE
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
21-2003-1070
OATH OF NON-SUBSCRIBING WITNESS
ESTATE OF MILDRED E. JACOBY
will is in the handwriting of the testrtrix
Sworn to or affirmed and sub-
scribed before me this 30th day of
~ December, 2003 ,..,
Donna Yl. O~t~to., 1st .~F'or:t~e Rffg~'ster ~
ueputy , ff
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that_~ ¢lg~ ftR. E
familiar with the signature of MILDRED E. JACOBY testat rix of(one of the
codicil ~ d~, ' ~
subscribing witnesses to) the(~presented herewith and that.!~ w ¢- believe[ the signature on the
codicil ~
to tl~e best of~bis 0[~ R knowledge and belief.
64 S. PITT ST, CARLI9SLE;"P~ 17013
(Address)
(^ddr¢~$)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9888977
No.
DI:' [: fi 2003
II'ate
INK
,. Mildred E. Jacob{/
~. Adam~
,,..Labo/to_.'t
6375 Chambcrsburg Rd.
Fayettevi£~e, PA 17222
COMMONWEALTH OF PENNSYLVAN}A * DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
z Female 3. 201 --07 _5222
7/18/1914 ?Gard~rs, PA I
e - l~- [
~. F~,k~n Twp. .
ACTUAL lie. Stat. P~II~II~
,,. John H~rsh~ ,,. Edna Sterner
~. Les~i~ L. Jaeoby Sr. ,~ 388 Georgetown Rd. Gardn~rs, PA 17324
~O ~ 0,~. 12/29/2003
~'~ [,~.Mt. Ho~tg Sprinqs Cemeter~,~t. Ho~q Sprinqs, PA 17065
I,.. 7 7~ ~. ~-~,~/~,~,~ ~ . I,,, ~f~' -~ <~ ~' I_
~ ~ A~SY d.
~ ~ ~U~~e~ "R~ ~ J .... ER OF DEATH~
21-2003-1070
LAST WILL AND TESTAMENT
I, MILDRED E. JACOBY, of R. D. 2, Gardners, Cumberland
County, Pennsylvania, being of sound mind, memory and under--
standing, do make, publish and declare this as and for my last
will and testament, hereby revoking and making void all former wills
by me at any time heretofore made.
FIRST. I direct all my just debts and funeral expenses,
including all inheritance taxes, be fully paid and satisfied out
of my Estate by my Executor hereinafter named as soon as conveniently
may be after my decease.
SECOR~. I give, devise and bequeath my entire Estate whatsoever
and wherever situate unto my husband, Eugene C. Jacoby, to be his
absolutely.
THIRD. In the event that my said husband should predecease
me or we should both die as the result of a common disaster, then
in either of those events I give, devi~e and bequeath my entire
Estate whatsoever and wherever situate unto my son, Leslie Lee Jacoby,
or his issue if he should predecease me.
FOURTH. If any of the issue of my son, Leslie Lee Jacoby,
shall be entitled to any of my Estate as set forth above and are
minors at the time of my decease, then in that event I hereby
appoint the Cumberland County National Bank and Trust Company
guardian of any Estate of said minor issue until they reach the
age of 21 years.
LASTLY, I hereby nominate, constitute and appoint my husband,
Eugene C. Jacoby, Executor, if/living and able to serve; otherwise
my son, Leslie Lee Jacoby, successor Executor, of this my last
will and testament. I direct that my Executor employ George B.
Stuart, Esquire, as attorney in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this /~Z~day of .. ~7~/ , 1970.
Signed, sealed, published and declared by the above named
Testatrix, Mildred ~. Jacoby, as and for her last will and testament,
in the presence of ua, who, at her request and in her presence and
in the presence of each other, have hereunto subscribed our names
as witnesses thereto.
GEORGE B. STUART
ATTORNEY AT LAW
3 SOUTH HANOVER ST.
CARLISLE, PENNA.
i I I
=1'O TI-'II: REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: MILDRED E. JACOBY
Date of Death: 12/24/2003
Will No. 2003-01070
Admin. No. 21 - 03 - 01070
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 12/31/2003 :
Name Address
LESLIE LEE JACOBY
388 GEORGETOWN ROAD
GARDNERS PA 17324
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
NONE
Date: 12/31/2003
S~Name: HAROLD S. IRWIN. III ~
Address: 64 SOUTH PITT STREET
CARLISLE PA 1701:~
Capacity:
Telephone(717) - 2436090
Personal Representative
Counsel for Personal
Representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died
without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY
In re Estate of MILDRED E. JACOBY
File No. 2003 - 01070
TO: LESLIE LEE JACOBY
, PENNSYLVANIA
, deceased,
(beneficiary)
388 GEORGETOWN ROAD
GARDNERS PA 17324
(address)
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent, MILDRED E. JACOBY , died on 12/24/2003
in VILLAGE OF LAUREL RUN, FAYETTEVILLEL, PA
X The Decedent died testate (with a Will) __ The Decedent died intestate (without a Will)
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name Address
LESLIE LEE JACOBY 388 GEORGETOWN ROAD, GARDNERS, PA
Telephone
717-486-3080
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of:
CUMBERLAND COUNTY PA
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of:
X A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
__ A copy of the Will or Petition is attached. // ~/~
SignatureName 6H4AsRoO~DT HS ~IiRTTW~N~~
Address
Date 12/31/2003
Capacity:
X
Personal Representative
Counsel for Personal
Representative
CARLISLE PA 17013
Telephone 717-243-6090
C(;MMONWEALTH 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)
OO3694
IRWIN HAROLD S III
64 SOUTH PITT STREET
CARLISLE, PA 17013
fold
ESTATE INFORMATION: SSN: 201-07-5222
FILE NUMBER: 2103- 1070
DECEDENT NAME: JACOBY MILDRED E
DATE OF PAYMENT: 03/18/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 12/24/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,336.47
TOTAL AMOUNT PAID:
$6,336.47
REMARKS:
...... SEAL
CHECK//8715
INITIALS: JA
RECEIVED BY'
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1500 EX + (6-00)
0
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
JACOBY~ MILDRED E.
DATE OF DEATH (MM-OD-Year)
12/24/2003
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IDATE OF BIRTH (MM-OD-Year)
07/18/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 3 0 1 0 7 0
GOUNTY CODE YEAR NUMBER
SOCIALSECURITYNUMBER
2 0 1 -0 7-5 2 2 2
THIS RETURN MUST BE RLED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
r~l. Original Return
r-J4. Limited Estate
~-]6. Decedent Died Testate (Attach copy of Will)
r-'] 9. Litigation Proceeds Received
D2. Supplemental Retum
O4a. Future Interest Compromise (date of death after 12-12-82)
D7. Decedent Maintained a Living Trust (Attach copy of Trust)
O10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
[~3. Remainder Return (date of death pdor to12-13-82)
O5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
r"-] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
;HIS S EC~ON UBST;BEGOaP[ETED; ~ CORRESpONDEN~AND C~IDEN~TAXiNFORMA11ONGHOUEDBE DiREC~D T O~
NAME
HAROLD S. IRWIN~ III
FIRM NAME (If Applicable)
RWIN LAW OFFICE
TELEPHONE NUMBER
717-243-6090
COMPLETE MAILING ADDRESS
64 SOUTH PITT STREET
CARLISLE PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, 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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and 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)
94~000.00
6~_~.TM
~ ~0.00
- 0.00
9;353.98
: 0.00
0.00
OFFICIAL USE ONLY
(8)
16~844.00
122.19
(11)
165~776.91
16,966.19
(12)
(13)
148,810.72
0.00
(14)
148~810.72
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
x ~ (15)
148,810.72 x .045 (16)
6,696.48
6,696.48
17. Amount of Line 14 taxable at sibling rate
X .12 (17)
18. Amount of Line 14 taxable at collateral rate X .15 (18)
19. Tax Due (19)
20. r~
> >:~ BE SURE TOANSWER ~E QUESTIONS ON R~ERSE SIDE AND RECHECK MATH;,;: ~ ,~
Decedent's Complete Address:
STREET ADDRESS
4510 CARLISLE ROAD
Cl~
GARDNERS
ISTATE PA I ziP 17324
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 334.82
6,696.48
Total Credits ( A + B + C ) (2)
334.82
0.00
6,361.66
6,361.66
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this retum, 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 the personal representative is based on all ~nformation of which preparer has any knowledge.
SIGNATURE OF P.ERS,~N F~SPONSIBLE FOR FILING RETURN
ADI~RESS 38~ GE-fl3JRGET~VN ROAD
PA 17324
SIGNATUI OTHER'
64 SOUTH PITT
CARLISLE PA 1
DATE
DATE
7 /, ozk
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P.S. {}9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116{a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
JACOBY. MILDRED E. 21 03 01070
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 pdce at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real propert~ which is jointly-owned w~ right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
HOUSE AND LOT Of LAND AT 4510 CARLISLE ROAD, GARDNERS, CUMBERLAND
COUNTY, PENNSYLVANIA 17324 (Value based on appraisal attached as Exhibit "B")
VALUE AT DATE
OF DEATH
94,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 94~000.00
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
JACOBY. MILDRED E. 21 03
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
US SAVINGS BONDS
(Value as noted on schedule attached as Exhibit "C")
TOTAL (Also enter on line 2, Recapitulation)
VALUE AT DATE
OF DEATH
62,422.93
62,422.93
(If more space is needed, insert add~onal sheets of the same size)
REV-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
FILE NUMBER
JACOBY. MILDRED E.
ITEM
NUMBER
1.
21 03 01070
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
DESCRIPTION
Rone
TOTAL (Also enter on line 3, Re¢.arn!tulation)
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
0.00
$ O.Ou
REV-1507 EX + (6-98)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCE TAXRETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
JACOBY, MILDRED E.
ITEM
NUMBER
1. NONE
FILE NUMBER
21 03
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
01070
DESCRIPTION
VALUEAT DATE
OF DEATH
0.00
TOTAL (Also enter on line 4, Recapitulation)j $ 0.0U
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OFPENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
J~,COBY. MILDRED E,
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 03
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disc!n_~d on Schedule F.
DESCRIPTION
ITEM
NUMBER
1.
FURNITURE AND MISCELLANEOUS PERSONAL PROPERTY
Value based on appraisal attached as Exhibit"D"
HARTFORD LIFE INSURANCE COMPANY
Uncashed Annuity Check
CAPITAL BLUE CROSS
Refund of Unearned health Insurance Premium
M & T BANK
Checking Account No. 9830244696
Value based on bank letter attached as Exhibit "E"
TOTAL (Also enter on line 5, Recapitulation)
01070
VALUE AT DATE
OF DEATH
985.00
228.43
318.24
7,822.31
9,353.9R
(Ifmorespaceisneeded, inse~add~onalshee~ofthesamesize)
REV-1509 EX + (698)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAXRETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
JACOBY, MILDRED E. 21 03 01070
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G,
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
JOINTLY-OWNED PROPERTY:
I J= i i ~-H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. Al-tACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERE$
1. None 0.00
TOTAL (Also enter on line 6, Recapitulation) $
0.00
;pace is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JACOBY, MILDRED E.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 03 01070
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is les.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHE NAME OF3~'IE THANSFEREE. THEIR RELATIONSHIP TO DECEBENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
N U M DER THE DATE OF TRANSFER. ATrACH A COPY OF THE DEED FOR REAL ESTATE.
VALUE OF ASSET INTEREST (IF APPUCABLE) VALUE
1.
O.OC
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
lie ~.~ ~ .... : .......~ J ~-__ ~ ,, ....... ·
(If more space is needed, insert additional sheets of lhe same size)
I~EV-1511 EX + (12~99)
COMMONWEALTH OF PENNSYLVAN~
INHERITANCE TAXRETURN
RESIDENT DECEDENT
ESTATE OF
JACOBY, MILDRED E.
ITEM
NUMBER
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 03 01070
DESCRIPTION
FUNERAL EXPENSES:
HOLLINGER FUNERAL HOME & CREMATORY, INC.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees IRWIN LAW OFFICE - HAROLD S. IRWIN, III
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
C~y State
Relationship of Claimant to Decedent
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
Accountant's Fees
Tax Return Preparer's Fees
HAROLD S. IRWIN, III - Notary Fees
DIVERSIFIED APPRAISAL SERIVCE - Real Estate Appraisal
Zip
TOTAL (Also enter on Pine 9, Recapitulation) $
AMOUNT
7,758.00
8,500.00
301.00
10.00
275.00
(If more space is needed, insert additional sheets of the same size) 16,844.0(
REV-1512 EX + (6-98}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~ & LIENS
FILE NUMBER
J,ACOBY, MILDRED E.
21
Include unmimbursed medical expenses.
iTEM
NUMBER DESCRIPTION
1. METROPOLITAN EDISON COMPANY- Electric Bill
03
01070
PRO-MED SERVICES, INC. - Medical Bill
TOTAL (Also enter on line 10, Recapitulation)
VALUE AT DATE
OF DEATH
9.71
112.48
$ 122.19
(Ifmom ~amisneeded, in~additional~ee~of~e~mesize)
RE~/-1513 EX + (.o...nn~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAXRETURN
RESIDENT DECEDENT
ESTATE OF
JA¢OBY MILDRED E.
NUMBER
II.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
LESLIE L. JACOBY
388 Georgetown Road
Gardners, PA 17324
:ILENUMBER
~1 03 01070
RELATIONSHIPTO DECEDENT AMOUNTORSHARE
DoNotListTrustee(s) OFESTATE
~on
100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
NONE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
NONE
0.00
0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
EXHIBIT 'A'
LAST WILL AND TESTAMENT
I, MILDRED E. JACOBY, of R. D. 2, Gardners, Cumberland
County, Pennsylvania, being of sound mind, memory and under-
standing, do make, publish and declare this as and for my last
will and testament, hereby revoking and making void all former wills
by me at any time heretofore made.
FIRST. I direct all my just debts and funeral expenses,
including all inheritance taxes, be fully paid and satisfied out
of my Estate by my Executor hereinafter named as soon as conveniently
may be after my decease.
SECOND. I give, devise and bequeath my ent~m Estate whatsoever
and wherever situate unto my husband, Eugene C. Jacoby, to be his
absolutely.
THIP~. In the event that my said husband should predecease
me or we should both die as the result of a common disaster, then
in either of those events I give, devise and bequeath my entire
Estate whatsoever and wherever situate unto my son, Leslie Lee Jacoby,
or his issue if he should predecease me.
FOURTH. If any of the issue of my son, Leslie Lee Jacoby,
shall be entitled to any of my Estate as set forth above and are
minors at the time of my decease, then in that event I hereby
appoint the Cumberland County National Bank and Trust Company
guardian of any Estate of said minor issue until they reach the
age of 21 years.
LASTLY, I hereby nominate, constitute and appoint my husband,
Eugene C. Jacoby, Executor, if/living and able to serve; otherwise
my son, Leslie Lee Jacoby, successor Executor, of this my last
will and testament. I direct that my Executor employ George B.
Stuart, Esquire, as attorney in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this /~Z~day of ~z~J , 1970'
~?~_ ~ ~ ~~ (SEAL)
Signed, sealed, published and declared by the above named
Testatrix, Mildred E. Jacoby, as and for her last will and testament,
in the presence of us, who, at her request and in her presence and
in the presence of each other, have hereunto subscribed our names
as witnesses thereto.
EXHIBIT 'B'
APPRAISAL REPORT
4510 CARLISLE ROAD
GARDNERS, PENNSYLVANIA
Diversified Appraisal Services
Real Estate Appraisers and Consultants
APPRAISAL REPORT
4510 CARLISLE ROAD
GARDNERS, PENNSYLVANIA
PREPARED FOR
THE ESTATE OF MILDRED E. JACOBY
BY
LARRY E. FOOTE
DIVERSIFIED APPRAISAL SERVICES
35 EAST HIGH STREET, SUITE 101
CARLISLE, PENNSYLVANIA
17013-3052
(717) 249-2758
SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS
LOCATION:
TAX PARCEL NUMBER:
IMPROVEMENTS:
PROPERTY RIGHTS:
SCOPE OF THE ASSIGNMENT:
OBJECTIVE:
EFFECTIVE DATE:
HIGHEST AND BEST USE:
COST APPROACH:
SALES APPROACH:
INCOME APPROACH:
FINAL VALUE CONCLUSION:
4510 Carlisle Road
Gardners, Pennsylvania
08-38-2175-025
Two-story detached single-family dwelling.
Fee simple interest.
The scope of the assignment included an analysis of the
subject's area, an inspection of the subject property, an
estimation of the property's highest and best use,
consideration of all three approaches to value, and the
application of those relevant to the valuation of the
subject.
To estimate the market value of the subject property as
unencumbered.
December24,2003.
Continued use as a single-family residence.
N.A.
$94,000
N.A.
$94,000
APPRAISAL CERTIFICATION
I hereby certify that upon application for valuation by:
THE ESTATE OF MILDRED E. JACOBY
the undersigned personally inspected the following described property:
All that certain triangular piece or parcel of land, with the improvements thereon
erected, situate in Dickinson Township, Cumberland County, Pennsylvania, bounded and
described as follows:
TRACT NO. 1: Beginning at a stone wall and running North and making a straight line
with the stone wall, along lands ofHoyt B. Sowers, 236 feet, more or less, to a pin at concrete
highway; thence running South along concrete highway 198 feet, more or less, to a concrete
abutment; thence West 95 feet, more or less, along lands of Eugene C. and Mildred E. Jacoby
to the place of beginning. Containing .26 acre, more or less.
TRACT NO. 2: Beginning at a concrete abutment on the West side of the State
Highway leading from Gettysburg to Carlisle; thence South 67 degrees West 5.8 perches to an
iron pipe; thence South 13.5 degrees West 6.6 perches to an iron pipe; thence South 7.5 degrees
East 11.5 perches to the place of beginning. Containing .36 acre, more or less,
TRACT NO. 3: Beginning at an iron pipe at point of lands of Eugene Jacoby and Hoyt
B. Sowers on the North running in an Easterly direction 145 feet to pin at State Highway;
thence along State Highway 50 feet in a southerly direction to iron pipe at point of lands of
Hoyt B. Sowers; thence along said lands 145 feet Westerly to iron pipe on lands ofHoyt B.
Sowers; thence 50 feet in a Northerly direction to iron pipe, the place of beginning. Containing
· 15 acre, more or less.
TRACT NO. 4: Beginning at an iron pipe on the West side of Pa. Route 34, on line of
land now or formerly of G.E. Murray; thence by the Western side of Route 34, South 5 degrees
45 minutes East 20.7 feet to an iron pipe; thence by land now or formerly of Eugene C. Jacoby,
South 15 degrees 15 minutes West 350 feet, more or less, to a stake; thence by the same, South
3 degrees 15 minutes West 50 feet to an iron pipe; thence by land now or formerly of Earl G.
Rank, Jr., North 72 degrees 30 minutes West 112 feet to a stake; thence by the Same, North 17
degrees 45 minutes East 56.5 feet to a stake; thence by land now or formerly of Rank, North 14
degrees 45 minutes East 360 feet to a stake on line of land now or formerly of G.E. Murray;
thence by said land, South 73 degrees 45 minutes East 101.8 feet to the place of beginning.
Containing .96 acre, more or less.
To the best of my knowledge and belief the statements contained in this report are true
and correct, and that neither the employment to make this appraisal nor the compensation is
3
contingent upon the value reported, and that in my opinion the Market Value as of December
24, 2003 is:
NINETY-FOUR THOUSAND DOLLARS
$94,000
The property was appraised as a whole, subject to the contingent and limiting conditions
outlined herein.
Larry E. Foote
Certified General Appraiser
GA-000014-L
4
PURPOSE OF THE APPRAISAL
The purpose of this appraisal is to estimate the Market Value of the subject property as
of December 24, 2003.
Market Value, as defined by the courts, is the most probable price estimated in terms of
money which a property will bring if exposed for sale in the open market, allowing a
reasonable time finding a purchaser who buys with knowledge of all the uses to which it is
adapted and for which it is capable of being used.
Frequently, it is referred to as the price at which a willing seller would sell and a willing
buyer would buy, neither being under abnormal pressure.
HIGHEST AND BEST USE
Highest and Best Use is defined by the Appraisal Terminology and Handbook,
published by the Appraisal Institute, as "the most profitable likely use to which a property can
be put". The opinion of such use may be based on the highest and most profitable continuous
use to which the property is adapted and needed, or likely to be in demand, in the reasonable
near furore.
However, elements affecting value that depend upon events or a combination of
occurrences which, while within the realm of possibility, are not fairly shown to be reasonably
probable, should be excluded from consideration. Also, if the intended use is dependent on an
uncertain act of another person, the intention cannot be considered.
Based on the above definition and after seeing the site, neighborhood, and area, it is my
opinion that the present use of the subject is its Highest and Best Use.
5
SITE DATA
ADDRESS:
TOWNSHIP:
COUNTY:
STATE:
LOT SIZE:
SEWERS:
WATER:
ELECTRICITY:
LANDSCAPING:
4510 Carlisle Road
Dickinson
Cumberland
Pennsylvania
Approximately 1.73 acres.
On-site septic system.
On-site well.
Met-Ed
Typical for the area, with a sodded lawn, trees and shrubs.
None.
DETRIMENTAL INFLUENCES
Pride of ownership is evident throughout the neighborhood.
DESCRIPTION OF IMPROVEMENTS
GENERAL DESCRIPTION: One-story detached single-family dwelling containing
approximately 1,030 square feet of gross living area above grade.
CONDITION: Exterior: Fair to average.
Interior: Fair to average.
ROOMS:
First Floor:
Basement:
Living room, kitchen, sitting room, two bedrooms and a
full bathroom.
Full,
EXTERIOR:
Foundation:
Walls:
Sash:
Gutters:
Roof'.
Storm units:
Stone
Aluminum siding.
Wood-framed, single-glazed.
Aluminum, painted.
Metal
Combination throughout.
INTE~O~ PRINCIPAL ROOMS:
Flooring:
Walls:
Ceilings:
Trim:
Carpet
Wood paneling and papered plaster.
Acoustical tile blocks and papered plaster.
Wood, natural finish.
KITCHEN:
Cabinets:
Counters:
Walls:
Flooring:
Sink:
Wood, natural finish.
Formica
Wood paneling.
Vinyl
Double-bowl, porcelain.
BATHROOM:
Flooring:
Walls:
Bathtub:
Lavatory:
Water closet:
Carpet
Vinyl and painted plaster.
Built-in, with shower.
Wall-mounted.
Two-piece.
Medicine cabinet: Wall-mounted.
CONSTRUCTION:
Joists: Wood
Beams: Wood
Columns: Wood
Plumbing: Copper and iron.
HEATING:
Oil-fired hot water.
HOT WATER:
Electric, 50-gallon.
OTHER: There is a stone fireplace in the living room. Attached to the dwelling is
a large covered front porch and a small covered rear porch. Also located on the site is a
detached frame one-car garage, detached 30' x 40' concrete block garage, frame poultry house
and a frame outhouse.
GENERAL CONDITION: All improvements are considered to be in fair to average condition
on the interior and on the exterior, with mechanical systems appearing to be adequate and
functioning properly.
7
THE APPRAISAL PROCESS
Three approaches to value are generally included in an appraisal report. These
techniques include the cost approach, sales comparison approach, and income approach to
value.
The cost approach to value is based on the assumption that the reproduction cost of a
building plus land value, tends to set the upper limit to value. A key assumption is that a newly
constructed building would have advantages over the existing building, therefore an evaluation
focuses upon disadvantages or deficiencies (depreciation) of the existing building compared to
a new facility. Due to the age of the subject improvements, the cost approach is considered to
be inappropriate and has, therefore, not been included in the development of this 'appraisal
report.
The sales comparison approach to value assumes that under normal conditions, a given
number of parties acting intelligently and voluntarily, tend to set a pattern from which value
can be estimated. Application of this approach relies on a comparison of the subject with a
sufficient number of recent transactions of comparable properties in the market, based on a
common unit, such as price per square foot of building area.
The income approach concerns itself with present worth of the future potential benefits
of a property. The initial estimate involves the net income, which a fully informed person is
justified in assuming the property will produce during its remaining useful life. This estimated
net income is then capitalized into a value estimate, based upon the level of risk as compared
with that of a similar type and class. Since homes similar to the subject are not typically
utilized as income-producing investment properties, the income approach to value is considered
to be inappropriate and has, therefore, not been included in the development of this appraisal
report.
SALES COMPARISON APPROACH
!
!
In arriving at this conclusion of the value of the subject property, the appraiser made a
survey of properties that have sold in the area of the subject property.
Consideration was given and adjustments were made on each comparable sale as to
time of sale, size, location, as well as all other factors that might affect value. A resume of
some of the sales considered by the appraiser is as follows:
SALE NO. 1:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
109 Pine Road, Mt. Holly Springs.
July 24, 2002.
$90,900
976 square feet.
$93.14 per square foot.
SALE NO. 2:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
816 Baltimore Pike, Gardners.
February 24, 2003.
$82,000
797 square feet.
$102.89 per square foot.
SALE NO. 3:
Location:
Date of Sale:
Sale Price:
Size:
Unit Price:
974 Myerstown Road, Gardners.
November 27, 2002.
$99,900
1,200 square feet.
$83.25 per square foot.
The appraiser, in addition to the sales listed, also considered several additional sales in
arriving at his final opinion of value. On the Sales Comparison Analysis form that follows this
page are dollar adjustments reflecting market reaction to those items of significant variation
between the subject and comparable properties. If a significant item in the comparable
property is superior to, or more favorable than, the subject property, a minus (-) adjustment is
made, thus reducing the indicated value of the subject;/fa significant item in the comparable is
inferior to, or less favorable than, the subject property, a plus (+) adjustment is made, thus
increasing the indicated value of the subject.
After making all of the necessary adjustments, it is the appraiser's considered opinion
that the indicated value of the subject property by the Sales Comparison Approach is $94,000.
9
SALES COMPARISON ANALYSIS
~ [-'--- ITEM SUBJECT I COMPARABLE #1 COMPARABLE #2 COMPARABLE #3
~ I4510 Carlisle R°ad t 109 Pine Road I 816 Baltimore Pike 974 Myerstown Road
--L---~I Address I~ Mt.. Holly Springs Oardners . Gardners
~.~:~: ~-~JUSTMENTS ~SCRIFIION $ Adjust DESCRIPTION $ Adjust.D~.scmm~ON I $ ^djust,
~'~7f2:::~ ~ll I ~l/*°°°
~[m~o: i^~ i~.-.~ .,,ooo i~ I _ s~:~
~.tD¢,~i~ and Appeal I O~e-~ton, domch~d I S~l~ I S~ ] Similar
l[ Construction I AI~ Bn'ek -5,000 I Vinyl siding ] Aluminum siding /
~t~c°~"°~ I~~'°°° ~1~°~ . I -~,ooo su~o~ ! -~,ooo
Room Count I I I I I I I
iffiil' I~ 12 ~ I~ 2 I1 I~ 2 II 1+2,000 ~ I2 I1 i ,
ileal~°'~[~n~ I I~° I'~~ I +,,000 1.zoo.,~, /
lt' Basement &Finished [ I [
!
II' Rooms Below Orade I Full basernem [ Simfl' ar [Similar [ Similar
~l~[.F~°r~Um~ I^w~ I s~ Is~h~ I s~,~ar /
~ilq.. Heatin8 / Coolinl~ I Oil~ FHA w/c. air -3,ooo I Similar I Similar
ilikc.~a~, / Can~o~t I One-~ar ~,s~ I Uon~ +3.000 I~on~ I +3.000 1-oar ~o~t [ +l.O00
!l[~.~'ool~. ~. I ~~0 o~uaain~. I +,.000 ~on~ ] +12.soo
~[: Special Energy I Typical for the I I 1
~m,i~t ~t~ I r~io~ ~S~ilar I Similar I Simaar /
I~?ireplace(s) I Fi~ePlace t Similar IN°ne I +I,000 Woodbuminl~ stove
~:Oth~(,.S. ~it~n [ I
[~imilar' ?quip., remodeling) Built-ins. Similar
i sT,
I:L~N tAdj. (total) +2,900 +29,600 ~ +7,700
~6fSub'eet
FINAL INDICATED VALUE OF SUBJECT PROPERTY: $94,000
10
CORRELATION
Correlation may be defined as "the bringing together of parts in a proper relationship."
The parts of this appraisal report are the following approaches to value your appraiser used:
Value Indicated by Cost Approach
Value Indicated by Sales Comparison Approach
Value Indicated by Income Approach
N.A.
$94,000
N.A.
These approaches are representative of the market value of the subject property. I have
carefully reexamined each step in each method, and I believe the cOnclusions accurately reflect
the attitude of typical purchasers of this type property in this neighborhood. It is my belief that
this reexamination has confirmed the original conclusions.
The Cost Approach will result in an excellent estimate if all elements are figured
accurately, because no prudent person will pay more for a property than the cost to produce a
substitute property with equal desirability and utility. Purchasers of the type of dwelling
typical of the subject property are more concerned with amenities than with hypothetical
replacement of the property. Due to the age of the subject improvements, the COst Approach is
considered to be inappropriate and has not been included in this appraisal report.
The Sales Comparison Approach was based on several recent sales of properties similar
to that of the subject, all of which are located in the same general area. The adjusted sales
prices are most consistent under comparison. This approach is the most reliable because it
reflects the reactions of typical buyers and sellers in the market.
The Income Approach is most applicable to income producing properties or properties
that are primarily utilized for income producing Purposes. Purchasers of income producing
properties are willing to pay no more for a particular property than the net operating income
will support. Since the majority of properties similar to the subject are not utilized for income
producing purposes, this approach to value has not been included in this appraisal report.
Therefore, as a result of this appraisal and analysis, it is this appraiser's considered
judgment and opinion that the Market Value of the subject property, as of December 24, 2003,
NINETY-FOUR
THOUSAND DOLLARS
$94,000
11
UNDERLYING ASSUMPTIONS AND LIMITING
CONDITIONS SUBJECT TO THIS APPRAISAL
I assume no responsibility for matters legal in nature, nor do I render any opinion as to
the title, which is assumed to be marketable. The property is appraised as though under
responsible ownership.
The legal description used herein is correct.
I have made no survey of the property, and the boundaries are taken from records
believed to be reliable.
I assume that there are no hidden or unapparent conditions of the property, subsoil or
structures which would render it more or less valuable. I assume no responsibility for
such conditions or for engineering which might be required to discover such factors.
The information, estimates, and opinions furnished to me and contained in this report
were obtained from sources considered reliable and believed to be true and correct.
However, no responsibility for accuracy can be assumed by me.
This report is to be used in its entirety and only for the purpose for which it was
rendered.
Neither all nor any part of the contents of this report (especially any conclusions as to
value, the identity of the appraiser or the firm with which he is connected) shall be
reproduced, published, or disseminated to the public through advertising media, public
relations media, news media, sales media, or any other public means of communication,
without the prior written consent and approval of the appraiser.
This appraisal was prepared for the exclusive use of the client identified in this appraisal
report. The information and opinions contained in this appraisal set forth the
appraiser's best judgment in light of the information available at the time of the
preparation of this report. Any use of this appraisal by any other person or entity, or
any reliance or decisions based on this appraisal are the sole responsibility and at the
sole risk of the third party. The appraiser accepts no responsibility for damages
suffered by any third party as a result of reliance on or decisions made or actions taken
based on this report.
12
CERTIFICATE OF APPRAISAL
Your appraiser hereby certifies that:
1. The statements of fact contained in this report are true and correct.
The reported analyses, opinions, and conclusions are limited only by the reported
assumptions and limiting conditions, and are my personal, impartial, and unbiased
professional analyses, opinions, and conclusions.
3. I have no present of prospective interest in the property that is the subject of this report,
and no personal interest with respect to the parties involved.
4. I have no bias with respect to the property that is the subject of this report or to the
parties involved with this assignment.
5. My engagement in this assignment was not contingent upon developing or reporting
predetermined results.
My compensation for completing this assignment is not contingent upon the
development or reporting of a predetermined value or direction in value that favors the
cause of the client, the amount of the value opinion, the attainment ora stipulated result,
or the occurrence of a subsequent event directly related to the intended use of this
appraisal.
To the best of my knowledge and belief, the statements of fact contained in this
appraisal report, upon which the analyses, opinions, and conclusions expressed herein
are based, are true and correct.
This appraisal report sets forth all of the limiting conditions (imposed by the terms of
my assignment or by the undersigned) affecting the analyses, opinions, and conclusions
contained in this report.
This appraisal report has been made in conformity with the Uniform Standards of
Professional Appraisal Practice adopted by the Appraisal Standards Board of the
Appraisal Foundation, and is subject to the requirements of the Code of Professional
Ethics and Standards of Professional Conduct of the National Association of Realtors
Appraisal Section.
13
10. No one other than the undersigned prepared the analyses, conclusions, and
opinions concerning real estate that are set forth in this appraisal report.
Certified General Appraiser
GA-000014-L
14
PRIVACY NOTICE
Pursuant to the Gramm-Leach-Billey Act of 1999, eff'ective July 1,2001, appraisers,
along with all providers of personal financial services are now required by federal law to
inform their clients of the policies of the firm with regard to the privacy of client nonpublic
personal information. As professionals, we understand that your privacy is very important to
you and are pleased to provide you with this information.
In the course of performing appraisals, we may collect what is known as "nonpublic
personal information" about you. This information is used to facilitate the services that we
provide to you and may include the information provided to us by you directly or received by
us from others with your authorization.
We do not disclose any nonpublic personal information obtained in the course of our
engagement with our clients to nonaffiliated third parties, except as necessary or as required by
law. By way of example, a necessary disclosure would be to our independent contractors, and
in certain situations, to unrelated third party consultants who need to know that information to
assist us in providing appraisal services to you. All of our independent contractors and any
third party consultants we engage are informed that any information they see as part of an
appraisal assignment is to be maintained in strict confidence within the firm. A disclosure
required by law would be a disclosure by us that is ordered by a court of competent jurisdiction
with regard to a legal action to which you are a party.
We will retain records relating to professional services that we have provided to you for
a reasonable time so that we are better able to assist you with your needs. In order to protect
your nonpublic personal information from unauthorized access by third parties, we maintain
physical, electronic and procedural safeguards that comply with our professional standards to
insure the security and integrity of your information.
15
LARRY E. FOOTE
REAL ESTATE APPRAISER
EXPERIENCE:
1979-Present: Chief Appraiser, Diversified Appraisal Services, Carlisle, Pa.
Principal Broker, LaRue Development Company, Carlisle, Pa.
1976-1979: Associate Broker, Colonial Realty, Carlisle, Pa.
1972-1976: Realtor Associate, Jack Gaughen Realtor, Carlisle, Pa.
Appraisal experience included undeveloped land, farms, building lots, single-family dwellings, mobile
home parks, medical centers, nursing homes, motels, apartment buildings and complexes, office
buildings, service stations, veterinary clinics, rehabilitation centers, retail buildings, daycare centers,
warehouses, and manufacturing facilities.
EDUCATION:
Bachelor of Business Administration, Pennsylvania State University, 1976.
Associate Bachelor of Business Administration, Harrisburg Area Community
College, 1974.
Diploma, Carlisle Senior High School, 1965.
Certificate, Pennsylvania Realtors Institute, GRI I, GRI II, GRI III.
Certificate, Realtors National Marketing Institute, CI 101, CI 102, CI 103, CI 104,
CI 105.
Standards of Professional Practice, American Institute of Real Estate Appraisers.
Real Estate Appraisal Principles, American Institute of Real Estate Appraisers.
Residential Valuation, American Institute of Real Estate Appraisers.
Appraisal Procedures, Appraisal Institute.
Principles of Income Property Appraising, Appraisal Institute.
Case Studies in Real Estate Valuation, Appraisal Institute.
Report Writing and Valuation Analysis, Appraisal Institute.
PROFESSIONAL LICENSES:
General Appraiser #GA-000014-L, Commonwealth of Pennsylvania.
Real Estate Broker #RB-029729-A, Commonwealth of Pennsylvania.
PROFESSIONAL DESIGNATIONS:
GRI: Graduate of the Pennsylvania Realtors Institute, awarded by the Pennsyl-
vania Association of Realtors.
CRS: Certified Residential Specialist, awarded by the Realtors National Market-
ing Institute of the National Association of Realtors.
CCIM: Certified Commercial Investment Member, awarded by the Realtors
National Marketing Institute of the National Association of Realtors.
PROFESSIONAL ORGANIZATION AFFILIATIONS:
National Association of Realtors Appraisal Section.
Carlisle Association of Realtors.
Pennsylvania Association of Realtors.
National Association of Realtors.
Realtors National Marketing Institute.
16
PAST
CLIENTS:
Borough of Carlisle
Keystone Financial Mortgage
Cornerstone Federal Credit Union
Pennsylvania State Bank
Commerce Bank
Cumberland-Perry Association for Retarded Citizens
Carlisle Suburban Authority
Members l't Federal Credit Union
Pennsylvania National Bank
Evans Financial Corporation
Oreenawalt & Company, CPA
Smith's Transfer Corporation
Carlisle Depa~-tment of Parks and Recreation
Executive Relocation Services
Carlisle Area School District
Messiah Homes, Incorporated
ERA Eastern Regional Services
Pennsylvania Turnpike Commission
Chase Home Mortgage Corporation
Defense Activities Federal Credit Union
Pennsylvania State Employees Credit Union
PNC Mortgage Corporation
F&M Trust Company
National City Mortgage Corporation
Washington Mutual Home Loans, Inc.
Prudential Relocation Services
Lender's Choice
Market Intelligence, Incorporated
United Telephone Employees Federal Credit Union
Cumberland County Commissioners
Allstate Enterprises Mortgage Corporation
Dickinson College
PPG Industries, Incorporated
Gettysburg College
Redevelopment Authority of Cumberland County
Record Data Appraisal Services, Incorporated
First United Federal Savings Association
Fulton Bank
United States Marshall Service
GMAC Mortgage Corporation
Orrstown Bank
Letterkenny Federal Credit Union
BancPlus Mortgage Corporation
Coldwell Banker Relocation Services, Incorporated
Central Pennsylvania Savings Bank
Mellon Bank
Provident Home Mortgage Corporation
Drovers Bank
17
American Home Bank
Trans Union
M&T Mortgage Corporation
Cody Financial Mortgage Services
Waypoint Bank
Northwest Savings Bank
Blue Ball National Bank
Adams County National Bank
Countrywide Home Loans
Aarrow Mortgage
Various law firms and individuals
PHOTOGRAPH OF COMPARABLE SALE NUMBER I
PHOTOGRAPH OF COMPARABLE SALE NUMBER 2
PHOTOGRAPH OF COMPARABLE SALE NUMBER 3
EXHIBIT 'C'
~saV]ngs Bona Calculator
i°1/2°°4 !7llpd''te i [. 14~
Series Denomination Serial Number
$i !
# Bonds Total Price Total Interest
88 $8,362.50 $54,060.43
issue
Serial Number Issue Date Series Denom Price
M101700759 04/1973 E $1,000 $750.00
M101700760 04/1973 E 1,000 750.00 4,445.60
D100822197 06/1973 E 500 3?5.00 2,229.00
D100823977 04/1973 E 500 375.00 2,222.80
D101221883 04/1973 E 500 375.00 2,222.80
D101396865' 04/1973 E 500 375.00 2,222.80
R45311723 06/1973 E 200 150.00 891.60
R45443574 04/1973 E 200 150.00 889.12
R45443577 05/!973 E 200 150.00 889.12
R100238389 04/1973 E 200 150.00 889.12
R100949028 04/1973 E 200 150.00 889.12
C1010664052 01/1973 E I00 75.00 443.24
C1010664053 01/1973 E 100 75.00 443.24
C1010664054 01/1973 E 100 75.00 443.24
C1010664055 01/1973 E 100 75.00 443.24
C1010664056 01/1973- E 100 75.00 443.24
C1010664057 01/1973 E 100 75.00 443.24
C1010664058 01/1973 E 100 75.00 443.24
C1010664059 01/1973 E 100 75.00 443.24
C1010664060 01/1973 E 100 75.00 443.24
C1010664061 01/1973 E 100 75.00 443.24
C1010664062 01/1973 E 100 75.00 443.24
C1010664063 01/1973 E 100 75.00 443.24
C1010664069 01/1973 E 100 75.00 443.24
C1009100870 01/1973 E 100 75.00 443.24
C1010664072 01/1973 E 100 75.00 443.24
C1010664073 01/1973 E 100 75.00 443.24
C1010664074 01/1973 E 100 75.00 443.24
Total Value
$62,422.93
Interest
Interest Value Rate
$4,445.60 $5,195.60
5,195.60
2,604.00
2,597.80
2,597.80
2,597.80
1,041.60
1,039.12
1,039.12
1,039.12
1,039.12
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
Page 1 of 3
Savinc
Issue Date
YTD In~
$15.,
Next Final
Accrual Maturit:
04/200_"
04/200_-
06/200.-
04/2002
04/200:
04/2005
06/200'-
04/200_'-
05/200.'-
04/200.'-
04/200.-
01/200_'-
01/200..
01/2005
01/200.'.
O1/200Z
01/2005
01/200:
01/200_-
Ol/200Z
O1/200Z
01/200.'-
01/200..
01/200_'-
01/200:
01/200.'-
01/200.'-
01/2005
httv://wwws.vublicdebt.treas.~ov/BC/SBCPrice 1/22/2004
· ,5avm'gs Bond Calculator Page 2 of 3
C1010664075 01/1973
C1010664311 01/1973
C1010664312 01/1973
C1010664313 01/1973
C1010664314 01/1973
C1010664315 01/1973
C1010664316 01/1973
C1010664317 01/1973
C1010664318 01/1973
C1010664319 01/1973
C1010664320 01/1973
C1010664321 01/1973
C1010664322 01/1973
C1010664323 01/1973
·
C1015484826 04/1973
C1008870076,04/1973
C1010655925 04/1973
C10!4260477 04/1973
C1010664071 01/1973
C436140984 09/1963
C436140991 10/1963
C445521469 07/1964
C450799375 03/1965
C522936322 07/1971
C522936323 07/1971
C522936324 07/1971
C522936325 07/1971
C1009100867 01/1973
C1009100868 01/1973
C1009100869 01/1973
C1010664051 01/1973
K204130 12/1965
K7259133 07/1971
K13440627_.~01/1_973
L610831529 11/1963
L614917622 12/1963
L1004679606 04/1973
L1025290260 04/1973
E I00 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
· E 100 75.00
· E 100 75.00
o E 100 75.00
· E 100 75.00
· E 100 75.00
, E 100 75.00
.E 100 75.00
- E I00 75.00
· E 100 75.00
· E 100 75.00
' E 100 75.00
'E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.00
E 100 75.O0
~ E 75. 56.25
! E 75 56.25
E 75 56.25
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
443.24
444.56
444.56
444.56
444.56
443.24
817.68
817.68
815.32
746.44
429.24
429.24
429.24
429.24
443.24
443.24
443.24
443.24
328.11
321.93
332.43
408.84
411.60
222.28
222.28
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
518.24
519.56
519.56
519.56
519.56
518.24
892.68
892.68
890.32
821.44
504.24
504.24
504.24
504.24
518.24
518.24
518.24
518.24
384.36
378.18
388.68
446.34
449.10
259.78
259.78
4.00%
4.00%
04/2004
06/2004
01/200~
01/200_"
01/200."
01/2005
01/200.'
01/2005
01/200:
01/200_"
01/200:
01/200:
01/200.'
01/200_'-
01/200."
01/2005
04/200~.
04/200~
04/200.'-
04/200Z
01/200_-
09/200:
10/200~
07/200~
03/200'.
07/200]
07/200]
07/200]
07/200]
01/2002
01/2002
01/200_'-
01/2002
12/199:
07/200]
01/200.-
11/200."
12/200.'-
04/200."
04/200:
~,,.~. / /.,,.,~x,~ n,,hl ic. deht. trea.~.eov/BC/S BCPrice 1/22/2004
· Savings Bond Calculator Page 3 of 3
L1025303004 04/1973
L614917634 01/1964
L619540219 02/1964
L612905330 10/1964
L590604201 02/1963
L590604202 02/1963
L590604203 02/1963
L591819606 03/1963
L591549842 04/1963
L591549849 05/1963
L597585069 05/1963
L597585084 06/1963
L602890822 08/1963
L602890850 10/1963
L610831524 11/1963
Q1975277466 03/1963'
Q2014294146,10/1963.o
Q2029517333.01/1964
Q506197655q 01/1973
Q5061976560-01/1973
Q5061976561,01/1973
E 50 37.5O
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 50 37.50
E 25 18.75
E 25 18.75
E 25 18.75
E 25 18.75
E 25 18.75
E 25 18.75
25 18.75
Q5074285274 ,04/197-3 .E
i Vi, ~w l____p_Bjlviewing Bonds 1:88
222.28
411.60
411.44
414.10
397.12
397.12
397.12
399.14
399.08
399.08
399.08
402.40
406.72
408.84
408.84
199.57
204.42
205.80
110.81
110.81
110.81
111.14
259.78
449.10
448.94
451.60
434.62
434.62
434.62
436.64
436.58
436.58
436.58
439.90
444.22
446.34
446.34
218.32
223.17
224.55
129.56
129.56
129.56
129.89
4.00%
4.00%
04/200Z
01/200~
02/2004 02/200z
07/2004 10/200z
02/200Z
02/200."
02/200~
03/200.'
04/200_"
05/200_-
05/200:
06/200.'-
08/200.-
10/200:
11/200:'-
03/200.'-
10/200:
01/200~
01/200:
01/200"
01/200~
04/200~
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
ME Matured (Exchangeable for HH)
MN Matured (Not Exchangeable for HH)
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httn://wwws.r~ublicdebt.treas, eov/BC/SBCPrice 1/22/2004
EXHIBIT 'D'
EXHIBIT 'E'
MaTBank
January 20, 2004
Irwin Law Office
64 South Pitt Street
Carlisle, PA 17013
499 Mitchell Street, Millsboro, DE 19966
Estate of Mildred Jacoby
Date of Death: December 24, 2003
Social Security Number: 201-07-5222
Dear Mr. Irwin:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
Account Ttjpe. .......................... Checking Account
Account Number. ...................... 9830244696
Ownership (Names oJ) ..............Leslie L. Jacoby, Mildred Jacoby
Opening Date ........................... 07/31/03 (account closed 12/31/03)
Balance on Date of Death. .........$7,817.73
Accrued Interest $ 4.58
Total. ...................................... $7,822.31
Sincerely,
Charlene Warrington, Associate I
1-888-502-4349
REGISTER Of WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of MILDRED E. JACOBY
also known as
, Deceased
LESLIE L. JACOBY~ Executor
No. 21 03 01070
Date of Death 12/24/2003
Social Security No. 201-07-5222
Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities.
Personal Representative:
Attorney: HAROLD S. IRWIN~ III
LD. No.: 29920 LESLIE L. JACOBY
Address:
64 SOUTH PITT STREET
CARLISLE PA 17013
Dated MARCH l~ 2004
Telephone: 717-243-6090
Description
HOUSE AND LOT AT 4510 CARLISLE ROAD, GARDNERS, PA
US SAVINGS BONDS
FURNITURE AND MISC PERSONAL PROEPRTY
HARTFORD LIFE INSURANCE COMPANY - Annuity Check
CAPITAL BLUE CROSS - Refund of Unearned Premium
M & T BANK - Checking Account
(Attach Additional Sheets if necessary)
Total
Value
94,000.00
62j~22.93
;985.00,,
228.43
318.24
7,822.31
165,776.91
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
BUREAU OF INDIVIDUAL TAXES
/NHERITANCE TAX DIVTSTOH
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRA/SEMENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-15~i7 EX AFP (01-05)
HAROLD S IRWIN III
IRWIN LAW OFFICE
6q S PITT ST
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
05-O$-ZOOq
JACOBY
1Z-Zq-ZO0$
Z1 05-1070
CUMBERLAND
101
Alnount Remitted
MILDRED E
PA 17013
HAKE CHECK PAYADLE AND REHZT PAYHENT TO.'
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LTNE ~.~ RETATN LOWER PORTION FOR YOUR RECORDS ""~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF JACOBY MILDRED E F/LE NO. 21 05-1070 ACH 101 DATE 05-03-200~
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST ' SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCT/ONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
9~000.00
62~22.95
.00
.0O
9z~55.98
.00
.O0
(8)
16,8~q.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
13.
NOTE:
(1~-18-200~
ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rate
17. Aeount of Line lq at Sibling rate
18. Aeount of Line lq taxable et Collateral/Class B rate
19. Princi)al Tax Due
rAX CRED/TS:
PAYMENT RECEIPT DISCOUNT
DATE NUHBER INTEREST/PEN PAID (-)
CD00~69~ 3~$.50
165,776.91
122.19
(11) 16.96&. 19
(1:') lq8,810.72
.00
(18)
6,696 .q8
TOTAL TAX CREDIT
BALANCE OF TAX
DUEI
INTEREST AND PEN.I
TOTAL DUE
6,669.97
Z6.51
.00
26.51
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
IF PA/D AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
PAYMENT MUST BE MADE BY 09-Zq-ZOOq.~.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Subject to Tax (lq) lq8,810.72
If an assesseent was lssued previously, 1/nas 14, 15 and/or 16, 17, 18 and 19 w111
reflect figures that /nclude the total of ALL returns assessed to date.
(15) .00 X O0 = .00
(16) lq8,810.72 x Oq5: 6,696.q8
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADHZN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY~
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
et the lawful Class 8 (collateral) rate on any such future interest.
To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act ZS of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #/ELS, AGENT
A refund of a tax credit, which aaa not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ara available at the Office
of tho Register of Hills, any of the Z3 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, 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 Individua2 Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 27128-0602
Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of admlnistratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SX) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 28, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
1983
1984
1985
1986
1987
--Interest is calculated as follows:
TNTBREST = BALANCE OF TAX UNPAID
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 2982 bear interest at tho rate of
six (62) percent par annum ca2culatsd at a daily rate of .000264. Ali taxes which became da2inquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are:
Interest Daily Interest DaJJy Interest Daily
Rata Factor Year Rate Factor Year Rate Factor
ZOZ .000548 ~'8-1991 112 .000301 2001 92 .000247
162 .000438 1992 92 .000247 ZOOZ 62 .000164
112 .000S01 1993-1994 7Z .000192 2003 5Z .000137
132 .000356 1995-1998 92 .000247 2004 42 .000110
1gl .000274 1999 72 .000192
ZOZ .000Z74 ZOO0 7Z .000192
X NUHBER OF DAYS DELTNQUBNT X DALLY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Netice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHE~ITANC£ -TAX DIVISION
DEPT. 18060!
HARRISBURG., PA 17118-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLOHANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-I~rl7 EX AFP COl-OS)
HAROLD S iRWIN TI1
IRWIN LAW OFFICE
6q S PITT ST
CARLISLE
DATE 05-03-200q
ESTATE OF JACOBY
DATE OF DEATH 1Z-IR-ZOOS
FILE NUMBER 21 05-1070
COUNTY CUMBERLAND
ACN 101
Amoun~ Ram l'l:'l:ad
MILDRED E
HAKE CHECK PAYABLE AND REM'rT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *"~
REV-15~7 EX AFP [01-03) NOTTCE OF TNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR D'rSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF dACOBY MILDRED E FTLE NO. 21 05-1070 ACN 101 DATE 05-05-Z00~
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a*e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nership Zn~ares~ (Schedule C) ($)
q. Hor~gagas/No~as Receivable (Schedule D) (q)
5. Cash/Bank Daposi~s/Hisc. Personal Propar~y (Schedule E) (S)
6. Jointly O~ned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Cos~s/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. To~el Deductions
12. Ne~ Value of Tax Re~urn
9~/000.00
62/~22.95
.00
.00
9/353.98
.00
.00
(8)
16,8q~. O0
122.19
(11)
(12)
13.
NOTE:
Charitable/Governmental Bequests; Non-elac~ed 9115 Trusts (Schedule J) (15)
Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq)
Zf an a'.;sessment ~as lssued previously, lines 1~, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amoun~ of Line 1~ at Spousal ra~e
16. Amoun~ of Line 1~ *axable a~ Lineal/Class A ra~e
17. Amoun~ of Line 1~ a~ Sibling ra~e
18. Amoun~ of Line 1~ ~axable a~ Collateral/Class B ra~e
19. Princlpal Tax Due
TAX CREDITS:
PAYMENT KEC~/PT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
03-18-200~ CD00569~ $53.50
NOTE: To insure proper
credi~ ~o your account,
submi~ ~ha upper portion
of ~his form wi~h your
~ax payment.
165,776.91
1~.9~.19
1~8,810.7~
PAYMENT MUST BE MADE BY 09-Zq-Z00q~.
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
lq8,810.72
18 and 19 Nill
(is) .00 x O0 = .00
(16) lq8,810.72 x Oq5: 6,696.q8
(17) , O0 x 12 = . O0
(18) .00 X 15 = .go
(19)= 6,696.q8
AHOUNT PAID
6,$$6.q7
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6,669.97
26.51
.00
26.51
( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCT/OHS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR}:
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- if any futura lntarest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves tho right to appraise and assess transfer Znheritance Taxes
at the iaNfuZ Ctass D (cottaterai) rate on any such future interest.
To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TI P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, ~hich was not requested an the Tax Return, amy ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special 24-hour
ansaarino servlce for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only)o
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171Ze-10Z1, 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. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is allo~ad.
The 15X tax amnesty non-participation penalty is computed on the total cf the tax and interest assessed, and not
paid before January 18j 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 ~ith first day of delinquency, or nine (9) months and one (1) day from the date of
deathj to the date of payment. Taxes which became delinquent before January 1, 1982 hear interest at the rate of
six (6Z) percent par annumcalculated 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 with that rate
announced by the PA Department of Revenue. The appllcable interest rates for 1982 through ZOO4 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1982 ZOZ .000548 ~'~- 1991 11Z .000501
1982 16Z .000438 199Z 9Z .000247
1984 112 .000501 1993-1994 7Z .OO019Z
1985 15Z .000556 1995-1998 9Z .000247
1986 IOZ .000Z74 1999 7Z .00019Z
1987 IOZ .000Z74 ZOO0 7Z . OO019Z
--Interest is calculated as follo~s:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9Z .0002~7
ZOOZ 6Z .000164
2002 5Z .000127
2004 4Z .000110
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notlca issued after the tax bmcomes delinquent ~ill reflect an interest calculation to fifteen (15) days
beyond the date of the assessaant. If payment is made after the interest computation date shown on the
Notice, additiona! interest aust be calculated.
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 003900
IRWIN HAROLD S III
64 SOUTH PITT STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 201-07-5222
FILE NUMBER: 2103- 1070
DECEDENT NAME: JACOBY MILDRED E
DATE OF PAYMENT: 05/04/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/24/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $26.51
REMARKS:
TOTAL AMOUNT PAID'
$26.51
· SEAL
CHECK# 8833
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
1NHERTTANCE TAX DTVTSTON
DEPT. 180601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
REV-Ig07 EX AFP (01-05)
HAROLD S IRWIN III
IRWIN LAW OFFICE
64 S PITT ST
CARLISLE PA 17013
DATE 06-01-2004
ESTATE OF JACOBY
DATE OF DEATH 11-24-2003
FILE NUMBER 21 03-1070
COUNTY CUMBERLAND
ACN 101
Amount
MILDRED E
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper port/on of this form with your tax peymmnt.
CUT ALONG THIS LINE I~- RETAIN LOWER PORT'rON FOR YOUR RECORDS *-~
REV-1607 EX AFP (01-03)
ESTATE OF JACOBY
~x~ INHERITANCE TAX STATEMENT OF ACCOUNT
MILDRED E FILE NO. 2! 03-1070 ACN 101 DATE 06-01-2004
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAMED ESTATE. SHO#N BELOW
ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 05-03-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
6,696.48
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
333.50
03-18-2004
05-04-2004
CD003694
CD003900
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADD/T/ONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT IS REQU/RED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR),
.00
6,336.47
16.51
TOTAL TAX CREDIT 6,696.48
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. )
PAYNENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT maks check or money order payable to: REGISTER OF NZLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, Nhich ems not requested on the Tax Return) may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS13). Applications are available at
the Office of the Register of Nills) any of the 13 Revenue District Offices or from the Department's Z~-hour
answering service for forms ordering: 1-B00-361-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-3010 (TT only).
REPLY TO:
questions regarding errors contained on this notice should be addressed to: PA Department of Revenue) Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit) Dept. 180601, Harrisburg, PA l?lgB-O60i, phone
(7173 787-650S.
DISCOUNT:
If any tax due is paid within three ($) calendar months after the decedent's death) a five percent (SI) discount
of the tax paid is allowed.
PENALTY:
The 15Z 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.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to tho date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (6Z) percant per annum calculated at a daily rate of .00016~. Al! taxes which became dalinquent on and efter
January 1, 1982 will bear interest at a rate which wil1 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOfi are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor Year Rate
198Z ZOZ .O00Sq8 1988-1991 111 .000301 2001 9Z
1983 162 .000q38 1992 92 .000Z¢7 ZOOZ 62
198q 112 .000301 1993-199~ 72 .000192 2003 52
1985 132 .000356 1995-1998 91 .0001~7 2OOq ~Z
1986 iOZ .O00Z7fi 1999 72 .00019Z
1987 92 .O00Zq7 ZOO0 BZ .000219
Daily
Factor
.OOOZq7
.00016~
.000137
.000110
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUBNT X DAZLY ZNTBREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice) additional interest must be calcuZatad.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/15/2005
IRWIN HAROLD SIll
64 SOUTH PITT STREET
CARLISLE, PA 17013
RE: Estate of JACOBY MILDRED E
File Number: 2003-01070
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. I, 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: 12/24/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/28/2005
JACOBY LESLIE LEE
388 GEORGETOWN ROAD
GARDNERS, PA 17324
RE: Estate of JACOBY MILDRED E
File Number: 2003-01070
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: 12/24/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FA~~ER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
STATUS REPORT UNDER RULE 6.12
Name of Decedent: MILDRED E. JACOBY
Date of Death: 12/24/2003
Will No. 21 .03 - 1070
Admin. No. 2103 - 1070
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 . State whether administration of the estate IS complete:
Yes X No
2 . If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete :
3 . If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
b . The separate Orphans' Court No. (if any) for
the personal representative's account is: N/A
c . Did the personal representative state an
account informally to the parties in interest? Yes X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with he
Clerk of the Orphans' Court and may be attached to this r ort.
Date: 12/ /2005
HAROLD S. IRWIN III
Name (Please type 0 ri
64 SOUTH PITT STREET
CARLISLE PA 17013
Address
M
V)
C-.of
L
( 717 ) - 2436090
Tel. No .
CCJ
I
r~ ,....
Capacity :
~~~--:
(
X
Personal Representative
Counsel for personal
representative
'vt
RELEASE
I, LESLIE L. JACOBY, hereby acknowledge that I have this day had and received from
the executor and HAROLD S. IRWIN, III, the legal counsel for the ESTATE OF
MILDRED E. JACOBY, deceased, the final sum of Sixty-two Hundred Twelve and
97/100 ($6,212.97) Dollars in full satisfaction and payment of my share in the estate.
AND THEREFORE, I, the said LESLIE L. JACOBY, by these presents remise, release,
quit claim, and forever discharge the said executors and attorney, their heirs, executors
and administrators, of and from the said share and of and from all actions, suits,
payments, accounts, reckonings, claims and demands whatsoever, for or by reason
thereof, or any other act, matter, cause or thing whatever, from the beginning of the
world to the day of the date of these presents.
And I hereby consent and agree that the Orphans' Court of Cumberland County may
discharge the said executor and legal counsel as to this share upon application, without
further notice to me.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the
December, 2005.
7~
day of
~~
LESLIE L. J · ~
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
:SS:
COUNTY OF CUMBERLAND
On this, the 7 -r-- day of December, 2005, before me, the undersigned officer,
personally appeared LESLIE L. JACOBY, known to me (or satisfactorily proven) to be
the person whose name is subscribed to the within instrument, and acknowledged that
he executed same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
(SEAL)
COMMC"iV;!~61.11LOF PENNQLVANIA
COM ONWEAl;rH' OFCPENNSYLVANIA
, U Ie '
Carlisk Notanal Seat" "'J.\'"tv !
My ams, Notary Pubhc': "8 ! I
ro CU11lberllird County" I
My tommissio~ Expi'ieSSePt 6, 20mr' I