HomeMy WebLinkAbout04-0650Estate of Norman G. Jacobs
also known as Norman Gabriel Jacobs
PETITION FOR PROBATE and GRANT OF LETTERS
No. ~. I -- 01"~ - '~.~O
Social Security No. 126-14-6313 , Deceased.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rix
in the last will of the above decedent, dated
and codicil(s) dated n/a
To:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
in the
named
November 3, , 1995
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland ~Cou, ntL P.en_nsylyania, with
ix.is last family or principal residence at 233 Walnut Street, Carlisle, cumoenand County,
Pennsyhlvania 17013
(list street, number and muncipality)
Decendent, then 80 years of age, died
at Carlisle, Cumberland County, Pennsylvania
June 28, .,19.2004
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 no~ the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated valueS as follows:
(If domiciled in Pa.) Alt 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:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
therOll. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
Margaret~A. Jacobs /_/
233 Walnut Street, Carlisle, PA ~t~7013
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF Cumberland j'~ $8
Thc petitioner(s) above-named swear(s) or affirm(s) that thc statements in thc foregoing petition are
truc and correct to thc best of the knowledge and belief of petitioner(s) and that as personal rcprescn-
tativc(s) of thc above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmeddand subscribed ~/~z[-(-~)_~ L ~/: (~.w'ff~ C~5~_.?
hiefore me this · · day of ~{~ - - /'/ v- //~-* ~
1~ Ju~, ~ /~ i Ma~garetA. Jacobs /~ ~'
No. 91-t -t05 3 '
Estate of _l~.~,x ~ ~c~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW July [,,~ ,2004 ~ , 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 November 3, 1995
described therein be admitted to probate and filed of record as the last will of
Norman G. Jacobs a/k/a Norman Gabriel Jacobs
and Letters testamentary ;
are hereby granted to Margaret A. Jacobs
FEES
Probate, Letters, Etc .......... $ ~O, O~
Short Certificates( ) .......... $~
TOTAL ~ $.
Filed .--]...'. I.~.-..~-..o:.~...4 ..................
Register of Wills ~-
James D. Flower, Jr., Esquire #27742
ATTORNEY (Sup. Ct. I.D. No.)
26 West High Street, Carlisle, PA 17013
ADDRESS
717-243-6222
PHONE
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.
Fee for this certificate, $2.00
WARNING: It is illegal to duplicate this copy by photostat or photograph,-.{
? ._1_0591075
No.
Date /
H105 143 Rev W87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
~.eP.,.. CERTIFICATE OF DEATH ' '
80 v. , "
~,. I I II I,.v~.28, 24~-~o~. ~ I='-~ ..... a ~n I~
' ~ I I E (If ......... g ....... d ~) IWAS DECEDENT OF HISP~IC ORIGIN? JRACE
~" I'. ~rllsle Borok233Walnut Street I~ .... ";~'---- ' I ....
{ 233 Walnut Street {,$ff~t ~, . .
Jacobs MO/HER'S ~ME (FifSL Mi~e. Malta
~atrice Esse~n
A. Jacobs
~ o~ls~y) 2004
PART I:
INFORMANTS MAILING ADDRESS (Sb'eet. C~ty/T~wn, Slam. Z~p Coae)
Buse Fun. Home & Cremab Grantville
PERFORMED? AVAILABLE PRIOR TO r: DATE OF INJURY TIME OF INJURY
AND ADORES!
(Item 27) Type o~ ~
QATE FILED (MonU1, Day. Yell')
6, -3,o-c7.
PA 17028
DESCRIBE HOW INJURY OCCURRED
Wills~Jacobs.NG\smr
ast ttlill atti stam ttt
OF
NORMAN G. JACOBS
I, NORMAN G. JACOBS, of the Borough of Carlisle, Cumbed~land County,
?
Pennsylvania, do hereby make, publish and declare this instrument to be m~2}-.Last Will and
Testament, in manner and form following:
FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by me.
SECOND: I hereby direct my Executrix to pay all my just debts, funeral and
administrative expenses, estate inheritance, and succession taxes be fully paid, satisfied out
of my estate, as soon as conveniently may be done after my decease.
THIRD: Should my Wife, MARGARET A. JACOBS, survive me, I give to
Farmers Trust Company, of Carlisle, Pennsylvania, In Trust, the largest sum which may be
free of Federal Estate Tax because of the available Federal Estate Tax Uniform Credit (the
federal tax credit equivalent). Trustee shall invest and reinvest the principal and pay all of
the income to my Wife, MARGARET A. JACOBS, in quarterly or other convenient
installments as long as she may live.
A. Should there be insufficient assets to fully fund this trust, it
should be funded to the maximum extent possible.
B. Should the income, when taken together with other income that
my Wife may have from other sources, prove ilasufficient to properly provide
for her welfare, comfort and support, then Trustee may, in its sole discretion,
pay to her whatever sums it deems necessary and appropriate out of the
principal of this Trust, as well as the income, to permit her to maintain a
standard of living similar to that enjoyed by her during her lifetime.
C. The Trustee, on behalf of the beneficiary, may make payments
to others for her use and benefit, to assure her welfare, support and
maintenance.
D. Upon the death of my Wife, the Trust shall terminate and all
assets of the Trust shall be distributed in equal shares to my children,
LAURIE BETH RYAN, and CHARLES BERNARD JACOBS, or the issue of
any deceased child, per stirl~es.
FOURTH: Ali the rest, residue, and remainder of my estate, I give, devise and
bequeath to my Wife, MARGARET A. JACOBS, absolutely.
FIFTH: Should my Wife, MARGARET A. JACOBS, fail to survive me, then I
direct that my residuary estate be distributed among my children, as set forth in paragraph
Third, subparagraph D above.
SIXTH: I nominate and appoint my Wife, MARGARET A. JACOBS, as
Executrix of this my Last Will and Testament. Should my Wife, MARGARET A. JACOBS,
be unable to act as such Executrix for any reason, I nominate, constitute and appoint my
Son, CHARLES B. JACOBS, to act in her place instead. I direct that my Executors shall
not be required to give bond or security for the performance of his, her or its duties in this
or any other jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal thi~'-'~~~4~
day of _.~:~'~4~~, 1995.
O R~'~6.~G. J~cOP~g
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
initials
COMMONWEALTH OF PENNSYLVANIA
COUNq~ OF CUMBERLAND
SS.
I, NORMAN G. JACOBS, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will; that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expresse~d.
Sworn or affirmed to and ackntqwledged before me, by, NORMAN G. JACOBS, the
Testator, this ;.~x--c2k--. day ofX'~ ~.~41UL3-L~ 1995.
,, NOTARIAL SEAL
::EaA J. BURKHOLDER, Notary Public ~
Carlisle, Cumberland County, Pa.
My Commission Expires Feb. 12, 1996,
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
We, ~j/4/'#/-'~ d~.. t~Z'~;9?//_-.-~' and \_J,~'_/4X db. ~,'_-~ .j~, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we are present and saw Testatrix,
NORMAN G. JACOBS, sign and execute the instrument as his Last Will, that he signed
willingly and that he executed it as his free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testator signed the Will as
witnesses; and that to the best of our knowledge the Testator was at that time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
, arlt,d~ ~Tl,~_c3 -~-_ ~O~ ~. ~ , witnesses this
~ ~Cg~ , 19~5. '
day of
Witneds
tary PuN4c
INOTARIAL SEAL
TERESA J. BURKHOLDER, Notary Public
Carlisle, Cumberla~ County, i~a.
~M Commission Expires Feb. i~, 1996
4
CI=RTIFICATI~N OF NOTICF UNDFR RULF
Name of Decedent:
Date of Death:
Estate No.:
To the Register:
NORMAN G. JACOBS
June 28,2004
21-04-0650
I certify that notice of the 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 July 26, 2004.
Margaret A. Jacobs
233 Walnut Street, Carlisle, Pennsylvania 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: July 26, 2004
IS, SHUFF, FLOWER & LINDSAY
Name
co
c~ .~ Address
Capacity:
James D. Flower, Jr.
26 West High Street
Carlisle, PA 17013
Telephone (717) 243-6222
Personal Representative
x Counsel for Personal Representative
.
REV.1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I OFFICIAL USE ONLY
FILE NUMBER
II 04 0650
COt)NTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
43. Future Interest Compromise (date of death after
12-12-82)
Decedent Maintained a Living Trust (Attach
copy of Trusl)
10 Spousal Poverty Credit (date of death between
,12-~,::~1, ,an,d. ,1.~1'~,5,);.;;;.:; .>;-:'"; .<C'" .;,..... . .". _ ': ,',_ ;:~,
.I~,l! SECTlON MUST 1l1t\=.\l!l'lJ'LETED. Al-~ COJl!1;~~I'ONDENCi;.l\Nj $QNFIDENTiAl. TAX INFORMATJON}HOULO B~D1RE~El!.!\l: ~ _" ,
NAME COMPLETE MAILING ADDRESS
James D. FIQwer, Jr.
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Jacobs, Norman G.
DATE OF DEATH (MM-OD-YEAR)
DATE OF BIRTH (MM.DD.YEAR)
06-28-2004
02-28-1924
-- ----- -
; (IF APPLICABLE) SURVIVING SPOUSE'S NAME { LAST, FIRST AND MIDDLE INITIAL}
: x 1. Original Return
2. Supplemental Return
4. Limited Estate
I I
I I 7
x 6
Decedent Died Testate (Attach
copy 01 Will)
9 litigation Proceeds Received
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FIRM NAME (II applicable)
Said is, Shuff, Flower & Lindsay
, TELEPHONE NUMBER
(717) 243-6222
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) , Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
126-14-6313
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return (date 01 death prior to 12.13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A) (Attach Sch 0)
26 West High Street
Carlisle, PA 17013
(1) None OFFICIAL USE ONI- Y
(2) 1,605,267.47 c.
(3) None
(4) NQne
(5) 94,902.05
,
(6) None
(7) 16,004.76 .r,:+-
(8) 1,716,174.28
(9) 44,191.32
(10) 513.70
(11)
44,705.02
1,671,469.26
0.00
(12)
13. Charitable and Governmental Bequests/See 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR AI'PLlCABLE RATES
0.00
20. D
(13)
(14)
1,671,469.26
15.Amount of Line 14 taxable at the spousal tax rate, 1,671,469.26 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
;:: 16. Amount of Line 14 taxable at lineal rate 0.00 x .045 (16)
~
=>
0. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
::;
0
" 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
~ x
19. Tax Due (19)
0.00
0.00
0,00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERI'AYMENT,
-;;iiliiSURE'TQ -ANSWEIt Al'LQUESTIONS Ol! REvER$ESICEANO 'R'ltCHECKMAtH << .-. . . --, ---
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Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev, 6-00;
Decedent's Complete Address:
STREET ADDRESS
233 Walnut Street
CITY Carlisle
STATE PA
!ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
Make Check
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?. ................ I
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 tl"\is return, including accompanyirJg schea\.J\es ana slatements. and \0 Ihe besl of my knowledge and belief. it is true,
correct and
complete.I2~I<lJcltion ofpre~~~r iJ!her thanJ~spnal re~~C!sent<:J-'ive iSbll.~_~~_ o!l all jnto~lion_Qr whiChJ)~C!~er has anY_~.!l~!~ge
SIGNA lURE OF PERSON RESPONSIBLE FOR FIUNCrltETURN ADDRESS
Margaret A Jacobs . \. '..
SIGNA~~E~~-CLI:~~ i
DATE
5
233 Walnut Street
Carlisle, PA 17013
s:. ;;'6 -O~
DATE
ADDRESS
~,;3llhU~
R' ENTAT AD RE
)-~6-::0~ .
DATE
26 West High Street
Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net valuf' _~"u -' . -..
surviving spouse is 3'% [72 P.S. 99116 (a) (1.1) (i)]. N (\ ~
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for thE . A \ r u
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the . .
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 younge ~ II ~
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. ..J ..'1"(,.{S J
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.
99116 1.2) [72 P.S. 99116 (a) (1 )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)1. 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-1503 EX+ (6-98)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENTDECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
CUSIP
NUMBER
DESCRIPTION
UNIT VALUE
VALUE AT DATE
OF DEATH
1
10 units Penn. Insured Muni Bond #5 (cusip
708838503) - at 158.46 per unit
1.584.60
2
100 units Insured Mun. Inc. Trust #84 (cusip
458083664) - at 143.59 per unit
14.359.00
3
11 shares ChevronTexaco (cusip 16676410 0) - at
93.155
1.024.71
4
138 shares Burlington Northern Santa Fe Corp. (cusip
12189Y 10 4) - at 34.775
4.798.95
5
168 shares Edison International - at 27.26
4.579.68
6
20 units Penn. Insured Muni #130 (cusip 70884C313) -
at 191.75
3.835.00
7
20 units Penn. Insured Muni Inc. #25 (cusip
708838511) - at 97.88 per unit
1,957.60
8
21,120 shares Dover Corp. (cusip 26000310 8) - at
42.01
887,251.20
9
22 shares Devon Energy Corp. (cusip 25179M 103) .
at 65.28
1,436.16
10
25 units Penn. Insured Muni Income #153 (cusip
70884C776) - at 292.65
7.316.25
11
3,400 shares Flextronics Int'l, Ltd. (cusip Y2573F 102)
- at 15.425
52,445.00
12
30 units Penn. Insured Income #140 (cusip 70884C511)
- at 235.10
7.053.00
Total of Continuation Schedule( )
See attached
page(sl
1,605.267.47
TOTAL (Also enter on Line 2, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
-
.. Rev-1503EX+ (6-98)
.
.
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
13 35 shares MetLife trust (investor #30633953971) - at 1.249.68
35.705
14 50 units Penn. Insured Mun. Income #77 (cusip 15,756.50
708839774) - at 315.13
15 50 units Penn. Insured Mun. Inc. Trust #30 (cusip 11.511.50
708838396) - at 230.23
16 50 units Penn. Insured Muni. Income #102 (cusip 7.646.00
70884B497) - at 151.92
17 50 units Penn. Insured Muni. Income #61 (cusip 4.138.00
708839451) - at 82.76 per unit
18 83 shares Cateluss Dev. Corp. (cusip 149113102) - at 2.048.86
24.69 per share
19 86 shares Newmont Mining Corp. (cusip 651639) - at 3.415.06
39.71
20 95,000 BSB Bank and Trust, 2.85%, due 12/19/06 93.086.70
(cusip 055653ES4) - at 97.986
21 95,000 Florida Community Bank, 2.90% (cusip , 94.805.25
34060BAVO) - at 99.795
22 95,000 units Camden National Bank, 3.0%, due 3/19/07 93.009.75
(cusip 133033AP5) - at 97.905
23 95,000 units Flagstar Bank, 2.90%, due 12/19/05 (cusip 94.833.75
33847EPC5) - at 99.825
24 97,000 MBNAAmerican Bank, 4.40%, due 12/27/04 98.099.01
(cusip 55264DXM3) - at 101.133
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
-
.. Rev.1503 EX+(6.98)
.
.
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
25 97000 F&M Bank, Kaukauna, 4.30% (cusip 30237RAR3) 98,026.26
- at 101.058
TOTAL (Also enter on Line 2, Recapitulation)
1.605.267.47
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
-
. Rev-1508 EX+(6.98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with the right of survivorship must be disctosed on schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 accrued dividends and interest on Legg Mason acc!. to date of death
2.926.58
2 cash in Legg Mason acc!.
87.655.47
3 Book collection, per attached appraisal
4.320.00
TOTAL (Also enter on Line 5, Recapitulation)
94.902.05
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
-
~ Rev-1510 EX+ (6-98)
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 State Universities Retirement System (ILl, 5,687.20 5.687.20
pension benefits - spouse beneficiary
2 TIM CREF, retirement-pension benefits - 10.317.56 10.317.56
spouse beneficiary
TOTAL (Also enter on Line 7, Recapitulation) 16.004.76
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule G (Rev. 6-98)
4 Rev.1502 EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
PA Cemetery Services
112.23
Subtotal
112.23
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H.A (Rev. 6.98)
~ REV.1151 EX... (12-99)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
Jacobs, Norman G.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-04-0650
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A FUNERAL EXPENSES:
See continuation schedule(s) attached 112.23
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 42,925.00
See continuation schedule(s) attached
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 914.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 240.09
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 44,191.32
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
. Rev-1502 EX+ (6-98)
'*
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Saidis, Shuff, Flower & Lindsay
42,925.00
Subtotal
42.925.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
_ Rev.1502 EX+(6-98)
'*
SCHEDULE H.84
PROBATE FEES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills
914.00
Subtotal
914.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-B4 (Rev. 6-98)
_ Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland Law Journal - estate notice
75.00
2
M&T Bank, check fee
8.62
3
Register of Wills - additional short certificates to transfer stock
27.00
4
The Sentinel - estate notice
129.47
Subtotal
240.09
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512EX+ (6-98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Norman G.
FILE NUMBER
21-04-0650
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 Carlisle Regional medical center
34.35
2 Carlisle Regional Medical Center
367.12
3 Pennsylvania Counseling Services
112.23
TOTAL (Also enter on Line 10, Recapitulation)
513.70
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV 1513 EX. (9-00)
'*
SCHEDULE .I
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jacobs, Norman G. 21-04-0650
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee/51
I. TAXABLE DISTRIBUTIONS [include outright s~ousal
distributions, and ransfers
under Sec. 9116(a)(1.2)]
M & T Bank, Trustee of Testamentary Trust Trust Federal Marital
for the Benefit of Margaret A. Jacobs Deduction
One West High Street Amount
- .". -. ~-^.^
Margaret A. Jacobs Spouse Residue of
233 Walnut Street estate
Carlisle, PA 17013
Total
Enter dollar amounts for distributions shown above on fines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
See continuation schedule(s) attached 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc,
Form PA-1500 Schedule J (Rev. 6-98)
I
I
WiIlsVacobs,NG\smf
15a131 J[t11 atta W~s1am~tt1
OF
NORMAN G. JACOBS
I, NORMAN G. JACOBS, of the Borough of Carlisle, Cumberland County,
Pennsylvania, do hereby make, publish and declare this instrument to he my Last Will and
Testament, in manner and form following:
FIRST: I hereby expressly revoke ~d\ Wills ~\ml Codicils heretofore made by me.
SECOND: I herehy direct my Executrix to p:\y all my just debts, funeral and
administrative expenses, estate inheritance, and succession taxes he fully paid, satisfied out
of my estate, as soon as conveniently may he done after my decease.
THIRD: Should my Wife, IVIARGARET A.. JACOBS, survive me, I gIve to
Farmers Trust Company, of Carlisle, Pennsylvania, In Trust. the largest sum which may be
free of Federal Estate Tax because of the available Federal Estate Tax Uniform Credit (the
federal tax credit equivalent). Trustee shall invest :lIld reinvest the principal amI pay all of
the income to my Wife, MARGARET A. JA.COBS, in quarterly or other convenient
installments as long as she may live.
A. Should there be insufficient assets to fully fund this trust, it
should be funded to the maximum extent possible.
B. Should the income, when taken together with other income that
my Wife may have from other sources. prove insufficient to properly provide
for her welfare, comfort and support, then Trustee may. in its sole discretion,
pay to her whatever sums it deems necessary and appropriate out of the
principal of this Trust, as well as the income. to fJermit her to maintaill a
standard of living similar to that enjoyed by her during her lifetime.
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C. The Trustee, on behalf of the beneficiary, may make p~yments
to others for her use ~nd benefit, to assure her welfare, support and
mainten~nce.
D. Uf'OO-the-ik.at~ Wife. the Trust shall terminate ~nd all
--.'.-(
assets of the Trust shalL& distributed i~ e(lual~h~lr,,~ to my <;.bildre_~,
LAURIE BETH RYAN, and CHARLES BERNARD JACOBS, or the issue of
any deceased child, per stirpes.
FOURTH: All the rest, residue, and remainder of nlV estate, I give, devise and
bequeath to my Wife, MARGARET A. JACOBS. absolutely.
FIFTH: Should my Wife. I\IARGARET A. JACOBS, fail to survive me, then I
direct that my residu~ry estate be distributed among my children, as set forth in paragraph
Third, subparagraph D ~bove.
SIXTH:
I nominate and appoint my Wife, I\IARGARET A. JACOBS, as
Executrix of this my Last Will and Testament. Should my Wife, I\IARGARET A. JACOBS,
be unable to act ~s such Executrix for any reason, [ nominate, constitute and ~ppoint my
Son, CHARLES B. JACOBS, to act in her place instead. [direct that my Executors shall
not be required to give bond or security for the performance of his, her or its duties in this
or any other jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal thi~-U.!Z-CC:::
day of -;::-J;.g:.e,.~~ , 1995.
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SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
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COMMOl'iWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, NORl'YlAl'" G. JACOBS, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will: that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expressed.
Sworn or affirJ1led to and ackn, wledged before me, by NORMAl'! G. JACOBS, the
Testator, this ::?-3"0- day of'-'] U, en\..lL<.-.~ , 1995.
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;\JOTAR!AL SEAL
rc '~3.; J. 3URKHOlDE"\, Nctarl Public
i C2nisie, Cumberland County, Pa.
'[ ~;'\f ('I"mmi~sicn Expires Feb. 12, 1996
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COMMOMVEALTH OF PENNSYLVAl'lIA
ss.
COUNTY OF CUMBERLAl'lD
We, ,-J#1r;'fS )) H/)<'liCj{' and \ Jkrl-': j~. ;:{~Yt/~~.v.', the
,
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we are present and saw Testatrix,
NOR.'V~'l G. JACOBS, sign and execute the instrum"nr as his Last Will, that he signed
willingly and that he executed it as his free amI voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testator signed the Will as
witnesses; and that to the best of our knowled~e the Testator was at that time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by 014-n1r'S '0. Hrr:I1/Pi
'\~~',~ D, ~~w eX , ~ , wi",,,.,,, ,hi. 3"'-- d"yof
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TERESA j. BUR:<HOLDER. Notary Pt,;bHc
Canisle. Cumbmiand CoU:1ty, Pa
M.' :'0 "'Vr'\t,...::,!" r-cb 1" leon.
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: S U R~S
State Universities Retirement System of Illinois
Serving !llinois; Community Colleges and UniversitIes
JC)OJ Fox Drive. Champaif.-'lL lL 6JS20
] -ROO-ASK SVRS
(217) :178-9800 (FAX)
(2] 7) 37,-RROO (e-VI
\Vvv\>,".surs,org
,
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September 16, 2004
Ms. Margaret .lacobs
233 V./alnui St
Carlisle- PA 17013-3734
RE: Nom1an .lacobs
S.S. # 126-14-6313 - original member
S.S, # 382-3~-607R - payee
Dear Ms. Jacobs:
A detennination has been made regarding your claim for benefits from the State Universities Retirelnent
fl" System (SURS).
'-
t The snrvivor benefit consists of $1,000.00 from emplover contribgtions whicb are paid in a ]nmp snm. hl
Jj j acldilian, yon are entitled to a montblv annnity in tbe amonnt of $1 ';6~ AO paid em the first working day Qf
) ),,-, each ca]e~dar montbJrom 07/01/2004 nntil the date ofyonr deat];. Enclosed is your check/statement in the,
j *' 'amount ,*$5,687.20 IF payment of the benefit due to you through~/0l!2004 includ;ng the $1.000.00 Jump
I') ~1, less an) optIOnal health prelI11llms andJedera] lllcome tax dednctlOns. Yomoenefits ale ~lso s"blect \0" ?
-:; j a 3~0~rease 0111L1)01/;005 and fl3~o~ compounded 111Cr:ase each Jam~ tl1ereafte-r:.~-:9 /fL{1:i:::J~~~~(_'
"l J ,/" V'-' - _ G
::!.j 1- Recent U.S Snpreme Court actIOns upheld the Intema] Revenue Sen'lce's (IRS) posltlon that State "7
_ ~j , Umversltles RetIrement System SUI y!vor benefits must be reported as taxahle Il1come All of VOUl benefits
,1' ~ t should be reported as taxable 1llcome, smce the @m.b~1)1a~'reco.vered all of the COlllDlww)lS io. SURS ~n ,.....?
~~~~!' ",--"vhieb federal income texes had be~n~aicL ''Y\~ . , t~Jf)\'?
,\~\<. Your benefit is subject ici.'i;e:l income tax ,vithh~~u'll]ess you elected nDt. to have withbolding apPl; ~'
'{ou may notify the State Universities Retirenlent SystelTI at any tinle to change or discontinue your
withholding. If sufficient tax is ,not withheld, you may incur interest and_penalty on the al110nnt of the
r underpayment. A 1 099R Form reilecting annuity payments and any withholding will be mailed to yo.u in late
t'J v t~~l-' January of each year. \ ,!, I ,.-~~ '1
rtJt Jr.'~ " , "., Jl~ fiLO-Lj \J'.J.J i4CP-,,,,,-,-~, ?
n tJ. J, 'f::.,;,o oenefits payable by SURS are subJect to iliUlQIS mcometax. The portIon oftlus benefit is rep.m:teD-'lL, ~.
t~ {fY't '.~ on your federal retnm and shon]d he enleT'ed ~h1J,].>Jjon OlU'QJ.llJllinoi, renIn) To SLlpp0l1 this '0 () )
y)l' dednction, attach a photocopy of the front page of your Federal 1040 \0 your Illinoi.sJ'E:~;" (' If
Xy~;,J,,'~\,)A~;AFF DETERMINATION .. . . . '__~ ())
o ~v \ bu may file a wntten reqnest for revIew WIth the Deputy DIrector of Member ServIces of SURS /l:11e')
v address shown above if you believe this deternlination is incorrect. This request must be filed 11'itl .n 30 d{(l's
following the date of service (service is c0111plete four days after 111ailing). IfYOll fai] to file a request wit 1111
30 days, the decision \I\li11 become final, because you elected not io seek administrative re-viev,. oftbe decjsiol1.
PleaSe' bear in mind that benefits provided by SURS must be provided in accordance 1vitl1 staTUte. ]Vo employee (!f
SURS has the authority to bind the .~\.stem f..() pa.Y benefirs con trw) , to statute, even in the ('vent o/misstatcment o.ffact
or law By statU/C, SCJRS is required to correct WI_l. mistake in benefit amount. ('ven a/ier payments have begun.
DTHC
UfAC
",
Keep this letter. You will need this information in compJeting your tax retul"ns in future years.
SinCCTF!,:.' yours.
,drfL ~~)
Faye Christman
Member Service Representative
MET: Historical Prices for METLIFE INe - Yahoo! Finance
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SET DATE RANGE
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Start Date: IJun ;:ill127~ . 12004
End Date: IJun ;:ill 129 12004.
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2003
First I Prev I Next I Last
PRICES
Date Open High Low Close Volume Adj
Close'
29-Jun-04 35.51 35.72 35.41 35.60 924,600 35.17
28-Jun-04 35.72 35.94 35.47 35.51 944,900 35.09
25-Jun-04 35.50 35.69 35.16 35.52 2,281,900 35.10
* Close price adjusted for dividends and splits.
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ADVERTISEMENT
U1K {/;'E/u '7
2/- 7(cl:
cJ j . V..../'
MetLife@
Account Statement - Duplicate
Please see important information on other side.
January 14,2005
Retain this number for future reference:
Norman G Jacobs
233 Walnut St
Carlisle, PA 17013-3734
lnvestor ID: 806339539721
RETAIN FOR YOUR RECORDS
ACCOUNT TRANSACTION DETAIL
Dale Transaction Description Amount Invested Price Per Share Shares ACQuired Trust Interest Balance
($) ($) or Withdrawn
Balancc Forward 35.0000
ACCOUNT SUMMARY
Trust Interest Balance As 010]/14/05
Common Stock Closing Price ($) Total Market Value ($)
35.IJOOIJ 4IJ.IJ7IJO 1.40245
Note: You may purchase or sell shares in the Trust under the conditions set lorth in the Purchase and Sale Program.
If your Trust Interest balance is zero (0), your account is closed and you are not eligible to participate in the Program.
D () 118 00\l()!l8g
DUPE (12-02)
Use ONLY if a transaction is requested. Unless you wish to initiate a transaction, no action is required.
PURCHASE INSTRUCTION Change of address:
(See reverse side \0 SELLI
Norman G. Jacobs
8063 3953 9721
Sianature: (if address beino chanced)
Mellon Investor Services
PO Box 382200
Pittsburgh PA 15250-8200
Make check, in U.S. dollars, payable to:
Met Life Purchase Program
Amount Enclosed
1",11,1,1",1,1,1,1,11."1"1",1,111,,,11.,,11,,,11,"1,,,11
Minimum investment $250.00 (except as
described in the purchase and sale brochure)
~
Please be sure this address appears in the
envelope window for PURCHASf:S ONLYl
0000101 102 806339539721 1
---
John Kallmann, Booksellers
9 North Baltimore Avenue
Mount Holly Springs, PA 17065
Telephone: (717) 486-4443
October 8, 2004
,
11rs.11argaretJacobs
233 Walnut Street
Carlisle, P A 17013
Re.: Appraisal of Certain Books of the Late Norman Jacobs
Dear Mrs. Jacobs:
Thank you for the interesting assignment to appraise certain portions of your husband's
library. I found the collection impressive in its scope and depth. As we discussed, a
specialist from New York has already evaluated the Asian Studies collection and that was
removed prior to my inspection.
Remaining were:
1,598 volumes in the front hallway having to do with world religions, particularly those
of the Near East and the Far East; 720 volumes in the middle room dealing mostly with
books about political and economic studies of countries in Asia; and finally, 1,620
volumes in the back room on a variety of subjects such as Economics, History, History of
Science, Political Systems, Philosophy, Anthropology and Sociology.
Total count: 3,938 volumes.
Total appraised value: $40,892.
Appraised value per volume: $10.38.
Hardbound count: 1,694 volumes.
Hardbound appraised value: $34,400
Hardbound value per volume: $20.31
Paperback count: 2244 volumes.
Paperback appraised value: $6,492
Paperback value per volume: $2.89
~
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The following attached sheets describe: (A) My 39 years experience in the book trade,
(B) The methodology ofthis appraisal. (C) Highlight of extraordinary titles.
Please let me know how well this report will serve your needs.
~
/I
Section A. My experience in the book trade
In 1965, after receiving a B.A in English from Marietta College in Marietta, Ohio, I
started work with the Macmillan Company in the sales departtnent. covering library,
college and university as well as retail accounts in the New England states. In the late
1 960' s and ] 970' s I worked for various publishers in New York City, including R. R.
Bowker Company, Praeger Publishers Special Studies Division of Encyclopaedia
Britannica, and R~ader's Digest. In Boston I was doing marketing for Cahners Books, a
technical and professional publisher; then American Broadcasting's Leisure Magazine
Group in Western Massachusetts. Since 1981, 1 have been engaged in the old, used, rare
and reprint book business, first at the Liberty Book Shop in Carlisle, Pennsylvania, then
the Archive Society in Harrisburg and presently with John Kallmann, Booksellers, in
Mount Holly Springs as well as outlets in cooperatives in Carlisle, Harrisburg and
Baltimore.
Section B. Methodology of this Appraisal
The first step was to get a count of all the bound volumes, paperback and hardcover.
Periodicals, saddle-stitched booyJets and other non-book publications were ignored and
given no value in this appraisaL
Then, I reviewed each eligible book and placed it into one of eight per-volume value
categories: $1, $2, $8, $15, $20, $25, $30, and more. Multi-voltllUe sets were broken
down into an individual-volume count to facilitate calculation. TIle latter categol)',
"more," was to take particularly valuable books into account. Some were individual titles
and some were multi-voltllUe sets. I wrote down the title information on some 37 series,
or apparently more valuable single volumes, for later computer look-ups. The computer
matches generally conflTI11ed the per-voltllUe pricing I had assigned to the books on an
intuitive and experience basis with few exceptions. ii/here these price differences were
found, adjusttnents were made and are stated in Section C, which follows.
Section C. Highlight of Extraordinary Titles
THE HISTORY OF MM'KIND by Friedrich Ratzel, 3 volumes, $450.
E. J. Brill's ENCYCLOPAEDIA OF ISLAM, 9 volumes, $500.
APOCR YPl-Li\, Oxford University Press, 2 volumes, $200.
BRITISH OPIUM MONOPOLY IN CHINA AND INDIA, by David Owen,
Yale 1934, $100.
THE OPIUM MONOPOLY, by Ellen N. La Motte, Macmillan 1920, $40.
THE ETHICS OF OPIUM, by Ellen N. La Motte, Century, 1924, $65.
/
/
,
/
THE GLASS PALACE CHRONICLE OF THE KINGS OF BURMA,
by Pe Maung Tin, $400.
BRJTISH OPIUM POLlCY IN CHINA AND INDU\., by David Owen,
Yale liniversity Press, 1934, $100.
A NARRATIVE OF THE MISSION TO THE COURT OF AVA IN 1855, by
Colesworthy Gran! and Linnaeus Tripe, Facsimile. Kaula Lampur, Oxford University
Press, 1968, $200.
EARLY ENGLISH INTERCOURSE WITH BURMA, (1587-1743), by D. G. E. Hall,
Longmans, Green & Co., 1 928, $1 10.
HEGEL'S SCIENCE OF LOGIC, 2 Volumes, George Allen & Unwin, 1929, $100.
THE MUQADDIMAH, AN INTRODUCTION TO HISTORY, by lbn Kha1dun,
3 Volumes, $275.
01'<'E HUNDRED YEARS' HISTORY OF THE CHfr-.TESE IN SINGAPORE, By Song
Ong Siang, Jo1m Murray 1923, $390.
AN ANECDOTAl HISTORY OF OLD TTh1ES IN SING.t\.PORE, by Charles Burton
Buckley, Facsimile of the 1902 Edition, Kuala Larnpur: University of Malaya Press,
1965. $100.
THE NATIVES OF SA.RA W AK AND BRlTISH NORTH BORNEO, 2 Volumes, by
Henry Ling Roth, Singapore: University of Malaya Press, 1968, $425.
PAGAN R.A.CES OF THE MALAY PENINSULA, 2 Volumes, by Walter William Skeat
and Charles Otto Blagden, Barnes & Noble Reprint of the Macmillan, London, 1906,
Edition. $90.
THE TALMUD, Socino Press, London, 1972 and later, 18 volumes [contains all the
contents of the earlier 35-volume edition], $675.
JUDAISM IN THE FIRST CENTURIES OF THE CHRISTLA.N ERA, 3 Volumes, by
George Foote Moore. Harvard University Press, 1927, $100.
SUMMARY: 51 Volumes for $4,320.
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SUBSTITUTE FORM 712
This statement has been prepared as a substitute for U.S. Treasury Department Form 712 which does not appl.v
to our all1luity contracts or certifiCilteS since they have no life insurallce features.
, Namt.' of first Annuitant Datt' of Birth OlltcofDC1\ttl
NORMAN GABRIEL JACOBS 2/2811924 612812004
J\amc of Second Annuitant Date of Birth 1 Date of Death
MARGARET JACOBS 8/2911929 NIA
l\amc of D~ccdcnt Date of Birth Date of Death
NORMAN GABRIEL JACOBS 2/28/1924 612812004
VALUE OF CONTRACT/CERTIFICATE AT DECEDENT'S DEATH
Contract/Certificate Issue Date of the Date of Death Value of Remaining Investment
Number Contract/Certificate the in the
ContractlCertificate ContractlCertificate
TIAA No.: ID30119-9 3/01/1990 $2,425.20 $0
CREF No.: OT61433-6 3/01/1990 $7,892.36 $0 I
I
Notes:
The Federal Estate Tax Value (Date of Death Value) of an annuity at death is what it would cost the
surviving annuitant or beneficiary to replace the continuing benefits. The value is calculated as of the
date of death and therefore does not change. The value does not represent the cash entitlement a
beneficiary is due and is used solely for estate tax purposes. TIAA-CREF fonows accepted industry
standards and procedures in determining the vahle of payout annuities for the estate of a deceased
annuitant.
The Remaining [nvestment in the Contract/Certificate represents any remaining after-tax contributions in
the Contract or Certificate owned by the annuitant. The Remaining Investment in the Contract/Certificate
is non-taxable to the surviving annuitant or beneficiary when it is paid.
THE UNDERSIGNED MANAGER OF TlAA-CREF HEREBY CERTIFIES THAT THIS
STATEMENT SETS FORTH CORRECT AND TRUE INFORMATION.
Sig-nllturc Title Date
Margaret Torrington Manager, Pension Products December 29.2004
BUREAU OF INDIVIDUAI.;:-TAlCES~
INHERITANCE TAX DIVISION' ' '
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
REV-483 EX AFP (06-05)
r" ,.
DATE 11-14-2005
ESTATE OF JACOBS NORMAN G
DATE OF DEATH 06-28-2004
FILE NUMBER 21 04- 0650
COUNTY CUMBERLAND
ACN 201
APPEAL DATE: 01-13-2006
(See reverse side under Objections)
Amount Remitted I ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
C" " , !:, : nit
JAMES D PLOWER JR
SAIDIS ETAL
26 W HIGH ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
~~~_~~~~~_~~~~_~~~~_______~__~~J~J~_~P~JtR_!P~JJP~_fP~_YP~~_fJ~~~__~_____________________
REV-483 EX AFP (03-05) .. NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF JACOBS
NORMAN
G FILE NO.21 04-0650
ACN 201
DATE 11-14-2005
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
.00
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
.00
5. Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (eR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RK
11-14-2005
JACOBS
06-28-2004
21 04-0650
CUMBERLAND
101
APPEAL DATE: 01-13-2006
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
NORMAN G FILE NO. 21 04-0650 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JAMES D FLOWER JR
SAIDIS ETAL
26 W HIGH ST
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17013
ESTATE OF
JACOBS
REV-1547 EX AFP (06-05)
NORMAN
G
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
DATE 11-14-2005
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
1I)
(2)
(3)
(4)
(5)
(6)
(7)
.00
1.605.267.47
.00
.00
94,902.05
.00
16,004.76
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
1I0)
44,191.32
513.70
1I1)
1I2)
1I3)
1I4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
1,716,174.28
44.705 02
1,671,469.26
.00
1,671,469.26
NOTE:
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal
16. Amount of Line 14 taxable at
17. Amount of Line 14 at Sibling
18. Amount of Line 14 taxable at
19. Principal Tax Due
TAX CREDITS:
1,671,469.26 X 00 =
.00 X 045=
.00 X 12 =
.00 X 15 =
1I9)=
rate
Lineal/Class A rate
rate
Collateral/Class B rate
lIS)
1I6)
1I7)
1I8)
.00
.00
.00
.00
.00
n~. (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~
JAMES D FLOWER JR
SAIDIS ETAL
26 W HIGH ST
CARLISLE PA 17013
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRIS8URG PA 17128-0601
REV.736 EX AFP (06-05)
11-21-2005
JACOBS
06-28-2004
21 04-0650
CUMBERLAND
202
APPEAL DATE: 01-20-2006
(See reverse side under Objections)
Amount Remitted I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
NORMAN
G
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +-
----------------------------------------------------------------------------------------------------------------
REV-736 EX AFP (01-02) ** NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER **
ESTATE OF JACOBS
NORMAN
G FILE NO.21 04-0650
ACN 202
DATE 11-21-2005
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
.00
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
.00
5. Pennsylvania Estate Tax Due
.00
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
.00
7. Additional Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
*IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(;y
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/25/2006
FLOWER JAMES D JR
26 W HIGH STREET
CARLISLE, PA 17013-2922
RE: Estate of JACOBS NORMAN G
File Number: 2004-00650
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS 1 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:
6/28/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/25/2006
JACOBS MARGARET A
233 WALNUT STREET
CARLISLE, PA 17013
RE: Estate of JACOBS NORMAN G
File Number: 2004-00650
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
6/28/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~J~
..- l
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
..
"
:
e
,
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Norman G. Jacobs
Name of Decedent:
Date of Death: June 28, 2004
Estate No.: 21-04-00650
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration ofthe above-captioned estate:
I. State whether administration of the estate is complete:
Yes [I] No 0
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. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
b. The separate Orphans' Court No. (ifany) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0. No D
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: May 3, 2006
Name
Said is, Flower & Lindsay
26 West High Street, Carlisle, PA 17013
Address
......717 -243-6222
Telephone No.
C'" ,'"
J ':;J 'J
Capacity:Oflc;:rsonal Representative
C - i, .!~JQ~~nsel for personal representative
, :
.....'-
~,
...J
'\ \'
...
STATUS REPORT UNDER RULE 6.12
Date of Death:
/1;/; ('/) /4 ,vi
.
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Name of Decedent:
Will No. d 1- G L/- C:L1-5C
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No .:<' .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
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Name (Please type or ~rint)
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Counsel for personal
representative
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