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HomeMy WebLinkAbout07-24-09 (2) 15056041046 REV-1500 EX (05-04) PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN Dept. 280601 l ~ S ~ 12` Harrisburg, PA 17128-0601 RESIDENT DECEDENT . ~ S ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth l a~ ~~ 6c)~~ ~ i { D~ z~©~ o~`.~ l l 9l ` Decedents Last Name Suffix Decedents First Name MI .~~LG ~~ ~N~ ~L~ ~ (If Applicable} Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OPALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number K~~ N ~~~ F ~EWI s ~~c~ 7 f ~ Z~4 ~.~ ~ _ ` Firm Name (If Applicable) : REGISTLF?:O~WILLS U NLY ',~ C~. C.'. ~ c~ r _. First line of address ;' i-.~ f\7 A( ,j,~ C /y I / ~ 1 ` Second line of address ~ .~_ : T~ r ; `-} " ~ .. ~ ' ' lsr FL~~~ - ,, :~~ 7 -~ 1> DATE FILED T ~ City or Post Office State ZIP C de o , /~ /'~ /`" ~ l ~ f~ ~ !\ ~ ~ •/ ~ I ! I / Correspondent's e-mail address: 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 the personal representative is based on all information of which preparer has any knowledge. SIGN RE OF PERK N RESIB~ING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505604],046 15056041046 J 25056042047 REV-1500 EX Decedent's So(c/,i~~al Security N©umber Decedent's Name ~ ~ ~ ~ ~ ~ ~ " RECAPITULATION 1. Real estate (Schedule A) ............................................. t '' • 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship {Schedule C} ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. J D 5 3 ~ .5.~ 3 ~-y g5`I.S~ 9. Funeral Expenses & Administrative Costs (Schedule H} ..................... 9. -~~.~Z 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 11 Q 7 ~ S l l ~ 11. Total Deductions (total Lines 9 ~ 10) ................................. .. . ~ . f , L 12 ~ ~ ~ ~ ~ I L 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) ...................... .. 13. s 12 Li 13 i i 14 ~ S ~ ®~ ~ 14. ) ...................... nus ne ne m Net Value Subject to Tax (L .. . • TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable e at lineal rate X .0 } j ~ ~.7 ~ ~ ~ ~ ~ ~ 16. ~ ,~ ~ ~- ~ • ~ l.~ 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. • ~ D ~ ~ ~ ~' 19. TAX DUE ....................................................... .. 19 • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~`°,'l~~ 15056042047 Side 2 15056042047 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECED NT'S NAME ,~ n ~lu ~~ Il ~cic~~ STREET A ESS ~ ~ ~~ T e ~l~~ds of ~da~~~~~ J ~Z~ Li'sbv~,~ '~ ~- 9 CITY ~~ ~i~I) _ _ _ _ STAT~~ ZIP / / G~ /! Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) __~ ~j . ~l~ ~~ ~~ 2. Credits/Payments -~-~- A. Spousal Poverty Credit B. Prior Payments 1 ~j ~~~ a C. Discount ~ /~ 9 Zi ~ ~ I ~~ Total Credits (A + B + C) (2) ~ C J ~~~ 3. InterestlPenalty 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. Fill in oval on Page 2, Line 20 to request a refund. (4) ~ ~ /5~t ~~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ---~~ A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: 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, benefts or care? ..................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consitleration? .............................................................................................................. ^ 3. Ditl 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. 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 three (3) percent [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 zero (0) percent [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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY occin[nir nCCFnFNT ESTATE OF FILENUM~~ ~~~~~ 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ ~ b ~ ~. ~v~~ons ~ ~la isc~ ~ a~~~ I O •~~ Zt~O~ .~v`,c;~ ~IU C~rZ In IeI~~S'f~ ~~ !' J= Q~ ~I~~ ~~o~- ~'~J~~a~~~ ~~ It ~ ~I~ ~~~ ~ ~~u~~ ~f ~~ ~ h~` ~a~ h~~ A I~ ~e ful~~~ ~,-~~ ~~~~e ~ ~ ~ I ~-~t~n~t mach ~G C~~k a~~~f ~~~~~) 3 q~ ~~ P S ~ 5'~~~m~f a~~~ TOTAL (Also enter on line 5, Recapitulation) , $ ~~ 1~,~ 1 ~,~,j (If more space is needed, insert additional sheets of the same size) REV-1510 EX t (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON•PROBATE PROPERTY ESTATE OF ,. FILE NUMBER X41 ~~I.~ ~~ ~,f~ ~~5 Zc~~~~ -G~11 Z~ This schedule must be completed and 61ed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IFAPPUCnaLE TAXABLE VALUE ,, ,~l~c~~ L~~ ~n~~~f , _ ~ ~ ~~~~ ~~3~ ~~~ ~~r, ~~.3,3; 1 P~vt~Y ~~~~~~~~~ TI~.~t~. gt~~~~s~~~~~ JC~~~' iL~IS~1G'~F~G~ ~D li~C~~'~~ : , ~~~efi~~~u~~c~s ~s,~1 ~~~, ~~~ ~.s~~ ~q~~, ~E~~ ~ l u.~~~~~~ ~ ~~~~~5 ~ . 5~ ~~~cnf a'~ir;~c~' TOTAL (Also enter on line 7, Recapitulation) I $ L~ ~-~r 8 ~~A~l~-. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~ ~~4 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN E L EXPENSES 8~ FUN RA ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF /~ FILE NUM~B`ER ~~`` ~'AV ! / ~~ ~~~1~f3~ ~~Q~ C~~~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. t. FUNERAL EXPENSES: (~ u~5~ I~~+r3 ~~ ~ru l ~~I~e ~~~a~f ~~ ~ Z~~, ~~~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees ~~~~ / / rs` ~-f~r/ l ~~! ~a /7~~~sJ/~~ / /~~r/ / ~ ~f~/L~~ ~l ~ ~~" ~ G'~ / 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees ~~j ~~ Q~~ ~' ~~~ L ~~ 5. ~ Accountant's Fees 6. Tax Return Preparer's Fees ~~~ 11 Q~~~~/ U ~~ ~ G' 7. 1etir.~~~ll ~~~ ~~~ ~ ~ (Sad ~~r'~ A~CI~~J ~~ ~l~ ~ y ~~ ~ ~,~ L f ~c~Je--~s~ ~ ~s~~e ~a~i~ ~~r~i~l~ Z'7~~ ~Z ~~ ~1 TOTAL (Also enter on line 9, Recapitulation) I $ 3 ~ ~,,56. J (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) .. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~L~cE J, ~~~~~~ ~~u 1~f~,- 9 - '7~, aLls i4~ ~~~~5 ~ ~~~ ~~~ 9 ~ ~~~ C~~l, l~; Z~ JE V~ LE, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ (If more space is needed, insert additional sheets of the same size) H D ~ } Q ~ W a ~ (,~ I... 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SAN DIEGO, CA 92130-1021 EXPLANATION OF BENEFITS PLEASE DETACH AND SAVE FOR YOUR RECOI 0780 CHECK NO: 0002792753 DECEMBER 05, 2008 PAYEE: VALERIE J RYAN OWNER: MS ANGELA H JACOBS POLICY NUMBER: 75606964 TRANSACTION: DEATH CLAIM PAYMENT TO BENEFICIARII PLEASE FIND YOUR ENCLOSED CHECK. DETAILS ARE AS FOLLOWS: ~I~•O-SS-~-AYM~NT AMO11N-T_s____ -- _ --- - _ 5538.96.69 FEDERAL TAX WITHHELD: 0.00 STATE TAX WITHHELD: 0.00 AMOUNT OF CHECK: 53,896.69 PLEASE BE SURE TO LET US KNOW IF WE CAN FURTHER ASSIST YOU. YOU CAN REACH US AT 1-800-762-6212 BETWEEN 8:30 A.M. AND 5:30 P.M. EST MONDAY THROUGH FRIDAY. ANNUITY SERVICE MANAGER HOBBIE AUCTIONS 901 North Second Street Harrisburg, PA 17102 Phone: (717) 233 - 0115 Fax: (717) 230 - 8996 email: ~^~~~b3eaucticr;s.uorn Kenneth Lewis, Esq. 1101 North Front Street Harrisburg, PA 17102 11/17/8 Dear Mr, Lewis: Pursuant to your request, on November 14, 2008, I did inspect the contents of the estate of Angela Jacobs located at 824 Lisburn Road, Apartment # 609, Camp Hill, PA 17011. Having been an antique dealer for over fifteen years and an auctioneer for over twenty years, it is my opinion that the value for estate evaluation purposes of the aforementioned items is as follows: Living room - Upholstered couch and two chairs Throw rug, rough Sony TV Victorian style slipper chair Victorian oval white marble top table Pair ceramic Bird of Paradise lamps 14 Delft collector plates on wall Oak washstand Contents Fruit form table lamp Glass top coffee table Wicker magazine racks Foot stool Iron side table 5 Military prints on wall Modern floor lamp 3 Stack side table $-0- $5.00 $25.00 $20.00 $100.00 $40.00 $50.00 $95.00 $5.00 $20.00 $10.00 $5.00 $5.00 $10.00 $50.00 $5.00 $30.00 Brass waste basket $5.00 Oil on canvas, portrait of girl, sgnd. Keil, '37 $50.00 Dining area - Sideboard, burl wood $90.00 Contents -linens, candles $5.00 Sleeve fancy sterling spoons $40.00 Set silver plate $25.00 Plates, serving trays, household $20.00 Top -Sony sound system w/ 25 CD's $10.00 Dresser trays, paper, baskets $10.00 6 collector type plates $10.00 Oil on board, roses $40.00 2 Prints $5.00 Pair Victorian style slipper chairs $60.00 Oak curved glass china closet wit paw feet $350.00 Contents -top shelf- 15 Hummel figurines $375.00 Various small porcelains, miniature Bowls, and figurines $25.00 3 Ivory type carvings $30.00 Shelf #2 - 5 stemware glasses, porcelain figurines, cups & saucers, soap dish, plates $20.00 Shelf # 3 - 3 pieces Wedgwood, 2 cups, One pitcher $30.00 Cups, saucers, porcelains $5.00 Miniature Toby mugs $35.00 Shelf # 3&4 -Stemware, porcelains, baby Feeder, fancy pitcher, 20 cups & Saucers, 3 lady figurines $20.00 Top - 2 ceramic Prussian soldiers in glass Domes, Western Germany $60.00 Various glass pitchers and vases $20.00 Cut glass bowl & flowers in dome $25.00 Oriental style throw rug $20.00 Newer iron cat doorstop $10.00 Small drop leaf table $50.00 2 chairs $10.00 2 German prints $10.00 Kitchen - Contents of top cabinets -usual everyday Dishes and storage $20.00 Countertop -coffee maker, Goldstar micro- Den - Wave, 2 decanters, cut glass vase, iron Skillet, toaster, household supplies $30.00 Gontents of bottom cabinets -everyday Storage and food $15.00 Family photos on wall $-0- German print $20.00 Red bookshelf and books $10.00 Window sill - 4 German steins, lithopanes $80.00 Tall glass pitcher $75.00 4 pieces porcelain and stemware $20.00 Sony TV and stand $10.00 Box games $5.00 2 Bookshelves and books $15.00 Plaster wizard bookends $25.00 Iron elf doorstop $40.00 Staffordshire type dogs $15.00 Castle bookend, biblical & animal figurines $10.00 Lacquer box $5.00 Upholstered chair $-0_ Sarouk type rug 8" X 10' $100.00 Wine rack and military commemorative frame $20.00 Kneehole desk $40.00 Contents -usual supplies and storage $-0- Top -basket, pencils, misc. $-0- Other kneehole desk $20.00 Top -green lamp, wood box, phone $10.00 Drawers - 2 inlaid boxes $20.00 Usual supplies and storage $-0- 2 two-drawer metal file cabinets with personal papers and storage $20.00 Office supplies, wheeled cart, briefcases $5.00 Washstand $25.00 Contents -match book cars $20.00 Cards, games, paper $-0- Top -lamp, personal photos, Christmas Figures, small box tools $5.00 Wall shelves - 9 large Toby mugs (Royal Daulton) $450.00 16 smaller Toby mugs (same) $400.00 Large Meissen covered pitcher $75.00 German porcelain head, feet, hands doll $100.00 2 bookshelves with books $5.00 2 feet length of LP records $5.00 Victorian style slipper chair $20.00 4 boxes books $10.00 Balance of items in room $10.00 Bath - 4 prints $10.00 Balance personal items and storage $-0- Closet -clothes, misc. storage $-0- Walker and linens $5.00 Hall closet - Clothes $_0_ Furs $20.00 Hall - Mirror, two prints $5.00 German oak wall clock $200.00 4 prints $5.00 Bath # 2 - All personal $_0_ Bedroom - Figured maple dark stain 5 drawer chest $25.00 Top -Box with blackjack, antique razor, Old coins, misc. $25.00 Top drawer -Gentleman's and military Jewelry $30.00 2 pocket watches, rough $40.00 Binoculars $20.00 Small lot pocket knives $25.00 Misc. jewelry $30.00 Figured maple nightstand, QA legs $25.00 French provincial bed $5.00 Low chest, maple stained cherry $10.00 Contents top drawer -approx. 14 small boxes Costume jewelry including cameo, Sterling, amethyst, sterling flask, hand Painted porcelain, rings, etc. $200.00 Top contents- 2 boxes costume jewelry $45.00 Jewelry box, empty $20.00 Porcelain French style lamp $10.00 German "North Wind" carved chair $90.00 Panasonic vacuum $10.00 Small Hitachi TV $-0- 4 family portraits $-0- Mirror $10.00 Closet of clothes Dresser Contents of top -Jar of coins Lamp, Beam bottle, mirror, misc Floor lamp Balance of items in room $-0- $5.00 $5.00 $10.00 $5.00 $5.00 TOTAL $4590.00 Hoping this appraisal is helpful to you, I ask that you phone my office if you have any questions. I thank you for letting me be of service in this matte,. Sincerely, r William W. Hobble Auctions 2000 Buick Century -Private Party Pricing Report -Kelley Blue Book Page 1 of 2 ~' THE TRUSTED RESOURCE ' ~'« > Send to Printer Get cash for your Bunker, and more, with GM. ~2JEtrsC.lf€iR'Cr _ _-. ..x: 5>t"~!t @k'~#-~ ... ...__ _- "a .~Qffi~,h` k_.'.. ~~JEFEf~1C~.7 =".~?/C ...,.,,_ ,..ari" - V~S {)DVECfKt7Bl~ ~aE S t~ :~Is~ 5 ClSfP$(?t G~Er~ 3+ 3 rc3*~. =3V!(m~;= ~~~!l~t+~1t!"!'~C±'!~ ti i~~ . ~ i :i i i ~4 L u IV i c ~~ •~ ~' n out it ' qur vehicle, quat'fii" 2000 Buick ~°entury Custom Sedan 4D ,; ~_ ~~~ Do you own this car? a may qualify fora 53,500 or X4,500 credit (in lieu of *.rade-in cash) toward the p;:rchase of a more fuel-efficient new car. ~$ ~I r I•~,~- : 4 [! for Clunkers: '' ~",~'~ There's :ever been a a ~ Netter U!°lQ fOr a tradZ'ift. Conditg~ r vaiu~ ~:F`ii ~ }CI, it'd^f~: ;n uii'8 eix~le' L~F' ~7;:ckL~rS35100Cx54.500ofl ~ Find out if your . Good $3,~3~ vehicle qualifies. (Selected fi vehicle Higl;iicr<6 . r;; Mileage: _ ___ Engine: ~ ,." Liter Transmission: _:,cmatic Drivetrain: = . v Selected et;-~`.. = .. Standard 31ue Boob _ti~'-,~~e Party value Roil .~,~r ~~r ~,~~ .uo~, Private Party Vance 's w!rat a buyer car: expect to pay when buying a used car from a private party. `!-,~ ?rllvate Party Value assumes the vehicle is sold "AS Is" and carries - _ no ~.varranty (ct-er':=^a-. the continuing far_torv warranty). The final sale price may -~ vary depending ^r :'r:; vehicle's actual condition, and local market conditions. This value may aisc 'c_ _sed to derive Fair Market Value for insurance and vehicle donation purposes. ~!ehicie C~-:~°.'; `ratings "_~: ~~~? S~.t~43S • Lco'a -_.. sin excellent mechanical condition. and needs no r°t..~~:G~.~~~~^~ing. • Ne•.er -~• ar.y paint or body ~rrork and is free of rust. htt.,•//cznz~w Irhl, r -~n:/TIRR/TTea~(l'arc/Prinin«T?ar~~..-f ~~,..r7Vo~.-Trl-7nlln~P,A~T;Io.,,.v--'ln1'~1 P. ~»i~nnn 2000 Buick Century -Private Party Pricing Report -Kelley Blue Book Page 2 of 2 • ~..' - . ~ History and will pass a smog and safety insper_tion. • E:rgin~ .^n-apartment is clean, with nc fluid leaks and is free of any ~.vear or vis'.bie defects. • Cer-~ eze and verifiable service -ecords. Less than ~'~; ~ a ' used vehicles fail into this category. ~` Good (seie~~,~a'~ $3,43Q • Free ~~" =:~y major defects. • Clear: t to history, the paints, body, and interior have only minor (if any) blem s~:e=_, and there are no major mechanical problems. • Little ~ nc rust on this vehicle. • Tres --~~~:-: and have substantial tread wear left. • A "g __ ,~''.^ide will need some reconditioning to be sold at retail. Most consume.- cwned vehicles fall into this category. ~=c~. ,~~i: • Some -mechanical or cosmetic defects and needs servicing but is still in reaso--:a~le running condition. • Clear _!'~:e :-,istory, the paint, body and/or interior need work performed by a r-~fessional. • Tires --_ .- need to be replaced. • ?be-a -~ ~ ~ ~e some repairable rust damage. ' ; r . • Se~.~e~-_: -,ecr:anical and/er cosmetic defects and is in poor running condi'c • Ma: '~~ > :,-oblems that cannot be readily fixed such as a damaged frame or a r__:<u_~hrough body. • 6raniec t!:ie (salvage, flood, etc.j cr unsubstantiated mileage. Kelley Blue Boc': apes not attempt to report a value on a "poor" vehicle because the value of :'rese vehicles varies greatly. A vehicle !r. poor condition may require an independe-t appraisal to determir;e it_ value. Pennsylvania -. - _~09 httn•//wunukhh~~mKRR/TTeP~t(`~,-~!A,-;~:,,,,i~o,,,,,-f~~.~..,~v.,.,..ra-~nnno.~,~:~~~._,.--,r"~, o_ -,~-,~-....,~ ~~ ~y_. ~-~~ . .~ ACCOUNT N0. ACCOUNT TYPE STATEMENT PERIOD > PAGE 38304880 M8T CLASSIC CHECKING N/INTEREST OCT.25-NOV.24,2008 1 OF 2 00 0 06123M NM I17 ANGELA H JACOBS 20 SOUTH 39TH ST CAMP HILL PA 17011 INTEREST EARNED FOR STATEMENT PERIOD INTEREST PAID YEAR TO DATE 0.18 308. N0. 4757 0.00 ACCOUNT SUMMARY CHECKS PAID NO. AMOUNT N0, .00 1 35.00 1 HEST SHORE PLAZA POSTING ''` ~' ~. ~ u n ~ A L. 11 V 1 1 Y DATE TRANSACTION DESCRIPTION DEPOSITS,INTEREST OTHER ADDITiONS 10-25-08 BEGINNING BALANCE 10-28-08 CHECK NUMBER 7713 11-14-08 INTEREST PAYMENT 11-14-08 CLOSEOUT 0.01 ENDING BALANCE 7713 10-28-08 35.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 Ga7i.Plli ST PD BALANCE 0.01 0.00 rlons YM1LT 611LANCE 5308.21 35,00 273.21 273.22 0.00 so.oo EFFECTIVE JANUARY 2, 2009, THE FEE FOR MAKING A NITHDRAMAL OR CASH ADVANCE FROM YOUR ACCOUNT AT A NON-M8T ATM LOCATED OUTSIDE THE UNITED STATES MILL BE THE GREATER OF S5 OR 3% OF THE U.S. DOLLAR AMOUNT OF THE TRANSACTION. IF YOU HAVE ANY 4UESTIONS, PLEASE CALL THE M8T TELEPHONE BANKING CENTER AT 1-800-724-2440. L008A 6107; °~ c + ~ +" Free Checking Account Statement PNCBA~I PVC: Bank For the period 10125/2008 to 11/21/2008 ANGELA H JACOBS DECD 20 S 39TH ST APT 609 CAMP HILL PA 17011-4201 Primary account number: 50-0575-1893 Page 1 of 2 Number of enclosures: 0 For 24hour banking, and transaction or a-. -~ interest rate information, sign onto 'a' PNC Bank Online Banking at pnc.com. For customer service call 1-866-PNC-4000 between the hours of 6 AM and Midnight ET. Para servicio en espar~o4, 1-866-HOLA-PNC Noting? Please contact us at 1-866-PNC-4000 Jason Hutton, Relationship Manager Private Client Group 1-717-534-1258 jason.hutton@pnc.com ® Write to: Castanet Service PO Box 649 Pittsburgh PA 15230-9738 Visit us at pnc.cotn TDD terminal: 1-800-531-1648 For hearing impaved r,lients only Important information on FDIC Deposit Insurance Coverage: The FDIC' announced a temporary- deposit insurance co~~erage increase frnm $100.000 to $250,000, per depositor, throagh 12131/09. Also, an}' person, eharit) ornon-profit ma)~ be named as a beneficiar~~ on a pa~~able on death or living trust account. This is a permanent cliante. To learn more, stop b~• an~~ branch or $o to pnc.cou~ or www.fdic.tot~ FI'ee ~(;~ ACCOWtt 5{Npl11a~ Angela H Jacobs Decd Account number: 50-0575-1893 Balance Summary Beginning Deposits and Checks and other balance other additions deductions 14)3.67 3,7t;7.t;7 3,~tfil.34 Average monthly balance ~,09(i.29 Please see the Activity Detail section for additional information. Ending balance .00 Charges and fees .00 Activity Detail Deposits and Other Additior>!g pate Amount Description 11; 03 1,505.30 Ditect Dcp~isit -:1r.>\t~tt Pa~~ 1) x _15-Caevela ncl :ti\X\l't;r 14a 7 11;' 03 l,tl?9.00 Direct Deposit - Soc Sec L'S '1'reasut~- 303 Y\~\`~(i09i:1 lli0ri 1,233.37 llirect llep~~sit - N~-1 ~1nn NeFV 1"ork Life 75606961 Other Deductions pate Amount 1 I;' 13 00 ll '1S 3,91 1.3~~1 Daity Balance Detail Date Balance 10;'25 193.67 Description Ut_tfstanding Item Close llehit'Aiemo Reference Nn 0200f,:'997 Date Balance Date 11,;'03 ?,727.97 11;'05 There were 3 Deposits and Other Additions totaling $3,767.67. There were 2 Other Deductions totaling $3,961.34. Balance Date Balance 3,961.3=4 11 ~' 18 .00 FORM953R-t( Reviewing Your Statement PNCBAN Please review this statement carefully and reconcile it with your recants. C-all the telephone mnnher on the upper right side of the first page of this statement it'. • you have any questions reganiing your account(s): ' vour name or address is incorrect: • you have any questions mgarcling interest paid to an interest-bearing account. Balancing Your Account Update Your Account Register Compare: "1'he activit~~ detail section of your statement to your account register. Check Off: All items in vour account register that also appear on your statement. Remember to begin with the ending date oCyour last statement. (:1n asterisk {* } will appear in the Checks section ii'ihei~e is a gap vt the listing oCconseaetive check mtmhers.) Add to Your Account Register rUw deposits or additions including interest payments and :1Th9 or electronic deposits Baianee: listed on the statement i}tai are not already entered in your register. Subtrata From Your Account iU,y account deductions including fees and ATA'1 or electronic deductions listed on the Register Ba{anee: statement that are not already entered in your register. Update Your Statement Information Step 1: Add together deposits and other additions listed n1 vour account register but not on vour statc;tnent. Date of Deposit Amount Total A Step 2: Add together checks and other deductions listed in vour account register but not on vour statement. Step 3: Enter the enduig balance recorded on your statement ~ Add deposits and other additions not recorded Total :~ + $ Subtotal= 5 Subtract checks and other deductions not recorded Total }3 - ~ 11te result shouiei equal your account register balance = $ Ckeck Number or Dedwctiow Descriptior Amount Total B Verification of Direct Deposits "1'o verify whether a direct deposit or other transfer to your account has occurred, call us 7 days a week from 6:(10 A.M. to 1~lidnight (ET) at the customer service number listed on the upper right side of the first page of this statement. Electronic Funds Transfers Ur case of enors or questions about your etectr-onic tt~usfers or if you need orate information about a transfer. call es 7 days a week from h:0(1:'1,hi. to Tiislnight (I:T) at Ure a+stamer set~•ice munber listed ou the upper right side of the first page of this statetneut. 1 h•. if yon prefer. please write as at: Customer Sen~ice. P.O. Box 6(19, Pittsburgh. PA 15230-(16(19. If you believe drere is a problem, yon un+st cartact ns no later than 60 days after the eucliug c4~te of the first statement on tvltich the error ox• problem appeareel. You will need to pmt-tide the fo(iotviu~ information: ' Yomr name and account uumherts): ' :~ description of the cunt or the transfer you are questioning. Please explaur as clearly as yon eau why yon lleed mOtY ]llfOlxmatlOir Or R'h\' tiron believe an error was made; ' 'iLe dollar amount of the suspected ~rnr. R'e will investigate your complanrt and will correct any error prnmptly. If lire itn~estigation takes longer than l0 business days, we still credit your account for the amount yon think is in erea•. so that you will hn•e use of the finds dwing the tame it takes ms to complete ow• imvestiga6ou. fORM953R-1i Member FDIC D Eaual Hntlcinn I Orr,~o. 3 r ~ n ~ :~ ^> ~ ~3 ~ ;s- o ~' a ~^... v , 9~ a~ ~~ ~^ ~~ c ~~ ~ a Lam" `+ n 'o PD ~n t:.i m ~~ N~ ~r Y ^ n v ~_ _' ~ n < " ~ i ~ fl ~ 6 H < n fl d3 ~~ ~y~^a -ti , 6 ~ A O ~ ~+~~3 Z~ ^ ~ 3 2, o. ~ ~ ~ ~ :. n v. C: N '' J o W r in z ~F mom' ~ n vm= o~~ T 'y T~ p ~ ~ m~ q, m _m n~ ~ X T fl- N w 0 a Z -o a ~ o ~ ~ ' o `t N ~. ~ ~ m ~ •, < 3 S~° Q ~ ~v rn y. = G y ° ~ ~ o , mr' ~ p ~ '~W~~ ~ ~~ ~ ~~ '~"a~Z~ N L2 C 'O ~ G q, - - „ ~ n G ~ ~ ~i Z.~. ~ ~ ~ a~ 1 ' ~ 3 o rn ~. o '~, .~' ~ ° cri o ~~ `~~ ~ , t zm ~w .. "~'~ Z ~ O .,C • .? 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Lewis, Esquire 1101 North Front Street Harrirburg, PA 17102 ~~ William J. Mansfield, Inc. Legal Advertising Suite 1209 998 Old Eagle School Road Wayne, Ply 19087-1805 Your choice for legal advertising Since 1935 In Re: Estate Notice ANGELA HULL JACOBS Service Charge: 10.00 Publications: The Carlisle Sentinel; Carlisle, PA 17013 163.82 Published: 12/13/2008, 12/20/2008, 12/27/2008 Cumberland Law Journal; Carlisle, PA 17013 105.00 Published: 12/12/2008, 12/1912008, 12/26/2008 Total Due: $278.82 INVOICE PAYMENT NOT CONTINGENT ON CLIENT REIMBURSEMENT. ALL INVOICES ARE NET 30 DAYS LEWISK Invoice#:2008110229 Date: 1 I02i2009 Note: Customer copy This copy is for your records. HOBBIE AUCTIONS 901 North Second Street Harrisburg, PA 17102 Phone: (717) 233 - 0115 Fax: (717) 230 - 8996 email: ~.ti- _ - - Kenneth Lewis, Esquire 1101 North Front Street Harrisburg, PA 17102 11/17/8 INVOICE Appraisal of estate contents -Angela Jacobs $250.00 February 26, 2009 Estate of An~ela H. Jacobs 20 South 39 Street Camp Hill, Pennsylvania 17011-4201 Invoice for Income Tax Prepazation Service Rendered February 26, 2009 2008 Federal, & State Income Tax Returns Preparation $ 80.00 Federal Income Tax Return -File by Mail; State Return -File by Mail; 2008 Tax Return Preparation Service Fee total $ 80.00 Thank you for your business. Keep this invoice for your tax records. ~';~ , Michael A. Filanowski 7730 Valley View Avenue Harrisburg, Pennsylvania 17112-3863 717-652-9396 Home Phone 717-608-0512 Cell Phone ,~ ,, -~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDI VIDUA~ TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 010837 LEWIS KENNETH F 1 101 NORTH FRONT STREET FIRST FLOOR HARRISBURG, PA 17102 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: iss-o~-sos~ FILE NUMBER: 2108- 1 1 25 DECEDENT NAME: JACOBS ANGELA HULL DATE OF PAYMENT: 01 / 30/ 2009 POSTMARK DATE: 01 /30/2009 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /03/ 2008 101 ~ S 16, 200.00 TOTAL AMOUNT PAID: REV-1162 EX(11-96 S 16, 200.00 REMARKS: RECEIPT TO ATTORNEY SEAL CHECK# RR0660201 INITIALS: AJW RECEIVED BY: GLENDA EARNER ~TRO~RO~ ~rN REGISTER OF WELLS TAXPAYER RECEIPT FOR PAYMENT ------------------- GLENDA EARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sc~ware Carlisle, PA 17613 JACOBS ANGELA HULL Estate File No. 2008-01125 Paid By Remarks: ALICE J CATALANO AJW Receipt Date: ,:.1/14/20~:~8 Receipt Tine : 09:41: ? `~ Receipt No. 1054722 --------- ------------ Receipt Distribution ------------ ----------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM WILL SHORT CERTIFICATE RENUNCIATION JCP FEE AUTOMATION FEE Check# 1351 Total Received......... 360.00 15.00 32.00 5.00 10.00 5.00 427.00 427.00 CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND BUREAU OF CUMBERLAND COUNTY COUNTY COUNTY COLTI~T T Y RECEIPT COUNTY GENERAL FUN GENERAL FUN GENERAL FUN GENERAL FuN ~ & CNTR M.D GENERAL FUN ~'° . _,.~~> LAST WILL AND TESTAMENT OF ANGELA HULL JACOBS I, ANGELA HULL JACOBS, of the IIorough of. Camp Hill, County of Cumberland, Commonwealth of Pennsylvania, being of_ found and disposing mind and of full age, do make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all Wills or Codicils thereto by me at any time •heretofore made. r. ITEM _I T direct that nll my just debts and funeral Pxpenses be ' paid by my Executor as soon after my decease a.s may be conveniently done. ITEM II I direct that I be interred at Indiantown Gap National Cemetery in Annville, Lebanon County, Pennsylvania. ,ITEM III All the rest, residue and remainder of my estate, of -1- whatever kind and nature, I give, devise and bequeath unto my beloved husband, CHARLES E. JACOBS_ In the event that my sa.i_d husband shall predecease me or shall not have survived me by at least thirty (3Q) days, I give, devise and bequeath all the rest, .residue and remainder of my estate to my daughters, ALICE ,7. CATALANO and VALERIE JACOBS ~ ~2YAN, in equal shares, per stirpes. ITEM_IV In the event that my husband, CHARLES E. JACOBS, and I shall die simultaneously or under circumstances which make it difficult to determine which of us died first, I direct that I Shall be deemed to have survived my husband and I direct further that the provisions of my said Will shall. he construed upon that assumption, irrespective of any provision of. law establishing a contrary presumption or requiring survivorship for a fixed period as a condit-.ion of taking property by inheritance. ITEM V I expressly direct that all principal. and income of any estate or. trust created hereunder shall be free and clear of_ the debts, contracts and engagements of those beneficially interested therein, and from anticipation, assignment, alienation, attachments, executions or sequestrations, by any process, legal -2- or equitable, and shall be paid over di_rec_tly to the persons ntitled thereto hereunder upon their own proper receipt in writing oniy. ITEM__VI Ny Executor shall. have the following powers in addition to those vested in him by law: }~ (a) To retain any or all. of the assets of my estate; •'4~ (b) To sell real and personal property f_or the purpose of paying my debts or making distribution or f.or any other purpose, at public or private sale, for cash and; or credit, without Order of Court or consent of any beneficiary; (c) To compromise claims by or against my estate without Order of Court or consent of any beneficiary; S . (d) To make distribution either in cash or in kind at valuations to be determined by my Executor or his successors. ITEM VI I nominate, constitute and appoint my husband, CHARLES E. JACOBS, to be the Executor of this, my I_,ast Will and 'T'estament . In the event of the death, resignation or inability of my Said husband CHARLES F. JACBOS to serve i.n such capacity, I nominate, constitute and appoint my daughter, VALFRlE JACOBS -3- KYAN, to be Executrix of this, my Last Will and Testament in his stead. Any successor fiduciary shad have the same powers, rights and duties which I have conferred upon the original. fiduciary. No fiduciary hereunder shad be required to enter security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .~,c.c~day of_ November, 1-989. _ _ c t_ _. ANGEL~LL JACOBS SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, ANGELA HiJLL JACOBS, as and for her Last Will and Testament, in the presence of ~_~s, who at her- request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~.~~~~~+a_--n~---r __-----Addresses/3 ~-> ~` / ~ ~ ~ --- ;~_C% ~ ~/),rrw r.~l-~c~. /mot ~ 7F%ji` ----- - -4- ACKNOWLEDGEMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . ss COUNTY OF DAUPHIN WE, ANGELA HULL JACOBS, the Testatrix and witnesses, respectively whose names are signed to the attached instrument, dated the,_~_` day of November, 1989, being duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly, and that. she executed it as her free and voluntary act for the pt.rposes t=herein expressed, and that each of the witnesses, in the presence and hearing ~f_ the 'testatrix, signed the Will. as witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or o7der_, of sound mind and under no constraint or undue influence. ANGELA H LL JACOBS ~ Witness l .~.~---~=L- Witness Subscribed, sworn to and acknowledged before me by ANGELA HULL JACOBS, the Testatrix, and subscribed and sworn to before me by the above, her- witnesses, this 3^~` day of November, 7989. Nbtary Public NOTARIAL SEAT. R{TAW. t~IiOADES, NOTAR`( PUBLIC tiAaRIS6l1RG, DAUPHIN COUNTY ~ MYCOMMI3510N EXPIRES SEPT.1, f992 Member. PennsyMarwi ASeedatiort dt KOfifIU!{ .,, ... m Vi 'y p .r N 1 U ap Ti i~ ti-5 N r I ~ ~ 1A ~" `Gi ~N7rn C~ tom,! "`) ~ '...4 _.. 1 (0 N d _ - , ~~ a ~ 0 z o ~ O ~ 'O - ~ ':. ~ ~ ' I O ~.~ ~ ` ~` ~ 't ` r 1 { I .~ w I I II , ~ ,'---~ y' C ~ ~ I ice' Q Q ~t I ~ ~ ti9 vi ~ ~ ~ ~, ~ ,I~ . 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