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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) . *' '" ~ ~"'''' u"'~ ~:sg ug:a:: ~ '" 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. >- z w o w " w o 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 ~ z '" o z o ~ '" '" ~ ~ o u 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) z o ;:: :3 :::> >- ii: <( " w a: 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 << .-. . . --, --- ;':""~~="'=~,=""c.~~~",_=~",,,,,,,~==,,,,,,,,,,;,",~=;;.:..,"-~=,,,;.:..,,",;.:...",,,,,-,-~,,,,,,,o.c=~=~,,",,"''''';;',",,;_;.:....,",--,_, 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) . *' 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) '* 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) '* 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. \1 \1 I \ ?Iff)-- , 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. 7/' -.g' ') , /' /A~"AY'~/ ) _ / ~ _ / ,......, ./ c-~ -- /'i/ T Z-/. _ r , ~~c.-6~ '7 !\OR>lc6" '. "COg/; i/ SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: 'b k~tr0// ~ initials ~ . 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. -"\y ~;/~~c/A3, NORi\L, ......;' r?-~ 1 J' .12.).... I I~LcL- N(~ Public ;\JOTAR!AL SEAL rc '~3.; J. 3URKHOlDE"\, Nctarl Public i C2nisie, Cumberland County, Pa. '[ ~;'\f ('I"mmi~sicn Expires Feb. 12, 1996 1'_j.J..., . '" { 3 . 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 / ( /' r Witness , I ~/, /~ " ",I. "- :::x jJ,L t'JL(':A.)_' ~jtary Pub c / NOT ,A,RIAL SEAL TERESA j. BUR:<HOLDER. Notary Pt,;bHc Canisle. Cumbmiand CoU:1ty, Pa M.' :'0 "'Vr'\t,...::,!" r-cb 1" leon. ! y \,;cmmiSSl n t:....i".:t;;~ r,,'. ~-, ..N.... 4 ; .t1r, \",,'~_,\[l.L.\ll "~'.r "," -.1/ ~,. oj..: : 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 , '-'",,- 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 Y~J]QQj Mv Yahoo! Mail YAaoo!" FINANCE ~!~~s~~ SlllilJlR~ Search I the Web Page I of2 fiD.9Jlce Horne - ~ Sea rch I Thursday, February 3, 2005, 12:04PM ET - U.S. Markets close in 3 hours and 56 minutes. Quotes & Info Enter Symbol(s): I e.g. YHOO, ^DJl MetLife Inc (MET) ~ ~ Fr~~_Trades l.?t ir>2.~ trad..::; (a~ht'omlS AMEP1Tr.ADE A $aIrade? .$_lQJLC_<t~b,J?Q.D_Ll_S !';~~it Symbol Lookup I Finance Search At 11 :43AM ET: 39.85 ... I ScoftrBdg I $7 Online Trade. N..Q_lngctjvi.tY._f~~_sJ_ "'(:,"1 M Historical Prices Get Historical Prices for: I SET DATE RANGE Ii Daily (" Weekly C Monthly C Dividends Only Start Date: IJun ;:ill127~ . 12004 End Date: IJun ;:ill 129 12004. Eg. Jan 1, 2003 First I Prev I Next I Last PRICES Date Open High Low Close Volume Adj Close' 29-Jun-04 35.51 35.72 35.41 35.60 924,600 35.17 28-Jun-04 35.72 35.94 35.47 35.51 944,900 35.09 25-Jun-04 35.50 35.69 35.16 35.52 2,281,900 35.10 * Close price adjusted for dividends and splits. First I Prev I Next I Last !'Ii DownIQ"c:ITo::;pmad.he~t - ADVERTISEMENT U1K {/;'E/u '7 2/- 7(cl: cJ j . V..../' MetLife@ Account Statement - Duplicate Please see important information on other side. January 14,2005 Retain this number for future reference: Norman G Jacobs 233 Walnut St Carlisle, PA 17013-3734 lnvestor ID: 806339539721 RETAIN FOR YOUR RECORDS ACCOUNT TRANSACTION DETAIL Dale Transaction Description Amount Invested Price Per Share Shares ACQuired Trust Interest Balance ($) ($) or Withdrawn Balancc Forward 35.0000 ACCOUNT SUMMARY Trust Interest Balance As 010]/14/05 Common Stock Closing Price ($) 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 ~ /" ;- I I /' :/ ~i " I ( , <. 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. - ~ ~ ~ "'~ ';:!.';[ s' ~ 0. ~ "" :::.. 's ~, ~'~ ~~. ~ ~ 50 ~ ~ - ~ "'2.0 ~ 0 o 0 ~ ~ o 0 Cl ',:;;- ~:;:r " 0 2..::.. y. "" O'ro """ .~ l"'""" ~ " 1<::1 'J> ':Kl 0 7;;:; ~ - n ~ ,,, ::) o " = "- ~cz: S' ';" e ;;;; ~ n r, ..., ~.S' ""0 0. . -<'; 0- U'," ~ ~~ <0- n ~ ;:;: ~ ." " S. C7 ;;;- ?; ~ ~ ~ ~ o S S; ~ .s.- %. ~ ~. ~ ~ " ~ " r... 9," % ~. ~ .~ ~ n " ~ ,3. '" ~ % 0. s 1-1"', ,.... \:S ~ ~. e.. )>- S! ,.... '" o ,..., .' 9 "" ,..., ,..- (P '" '-' ~ 'f", e?. '2.. U ~ ~. p. 't. ~ ~ N t-' (';) '&% ~ Q en o ;5 ';J;.. Vl (';) ~~ o _. o (") \:l..(';) ~~ Q ~ ;>;" (';) ....... ;5 (") (') " ;::; ~ ~ (P -0 )>- trl~ '/l CIJ:. 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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 . G~f/G'f . {i J: ~J ". /-1 1 ~ t.('N 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: IJ-I tf" /0& I ! --. ,./1 c' ./ .~. .. -A- r' - )"71 l!ttZ/j-//t/ if' ,/ :,.""L; S'ignature ' \7 / f.. ~'1 -, ,/\ I ~ 'K )-. .~ .--;.') _ ,/1 dY! C' ,J.L., .....AI".. :.:.A::.. i'\ ./ Name (Please type or ~rint) O(FJ (7 I;,) L r;::;r /1/ (j-z,.J J" ;- Address C/J{'i-lS 6,; ,"~/i- I 7:; /3 (7Ft') .;..' 43 ' ~A^ ^-- Tel. No. )( Personal Representative IU'''i'l . d J'''''; ,n, '." . '0 I '-,_ J"J' ';'/,......; .._11,-,( "< :~'.'J.~.:.,; ---J---J j~) >~}j:lIJ 9t'l :7/ ~J.d L v .. - J30 9DaZ Capacity: >;( :AAH;~)ijii~M3J> Counsel for personal representative ~