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FAMILY SETTLEMENT AGREEM�NT A1�1D FINAL RE�,EASE
IN'THE�STATE OF LOUISE�I.JACQBS
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�,NOW ALL M�N BY THESE PRESENTS, that, WHEREAS, Louise H. Jacob�, late of
Curnberland County, Pennsylvania,died testate on Apri134, 2012 , haviMg first made her last will
. and test�ment duly executed pn May 23, 1978;
WHEREAS,the said Louise H.Jacobs,by the aforesaid last will and testament,named Kirk
E. Jacobs and Brian L. Jacobs, Co-Executors of said last will;
WH�REAS, letters testamentary on the estate of the said decedent were duly issued by the
Register of Wills of Cumberland County,Pennsylvania, to the said Co-�xecutors, Kirk�. Jacobs ,
and Brian�,. Jacobs hereafter collectively called the personal representa.tives.
WHEIZEAS, the personal representa.tiv.es have gathered the assets of the estate of the said
decedent and the assets consist of personal and real property,to a total value as set forth in Exllibit�
"A", a copy of the Pennsylvania lnheritance T�Return filed by said personal representatives, and
�vhich has been provided to each heir;
WHEREAS,the debts and deductions, including the payment of inheritance tax in the said
estate are further referenced in Exhibit"A";
NOW,THEREFORE,KNOW YE,that we,being all of the named beneficiaries of the will
and the said decedent, do hereby each of us, acknowledge that we have this day had and received
from the aforesaid personal representative, in full satisfaction and payment of all sum or sums of
money, legacies, bequests, and devised as are given, devised and bequeathed to each of us
res ectively b the said will of Louise H. Jacobs in the amounts due �s under s�wi � ich
` P Y � � t..� �` �
amounts we have received this date. � � `--{ �� �
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AND,each of us does hereby stipulate that in order to avoid the expense and time involved
in the filing of a formal account and schedule of distribution, we each agree that no account is
necessary and we do hereby agree that we do consent to distribution being made without the filing
of an account and schedule of distribution,the same to be with the same force and effect as if they
had been filed and confirmed by the Orphan�j Court l�ivision of the Court of Cumberland County.
THEREFORE,we and each of us,do hereby remise,release,quitclaim and forever discharge
the said personal representative,heirs,executors,and administrators and assigns of and from the said
estate and from all actions, suits,payments,accounts,reckonings,claims and demands whatsoever
for or by reason thereof,or for a.riy other use,matter,cause or thing whatsoever,touching upon the
estate of the said decedent,and each of us do further hereby covenant and agree with each other and
the aforesaid personal representative, that we will contribute pro-rata, our share of the estate to
satisfy any and all claims,demands,suits,or causes of action which may be successfully prosecuted
against the said estate or aforesaid personal representative after the signing,sealing and delivery of
this family settlement agreement and final release.
IN WITNESS WHEREOF,and intending to be legally bound hereby,we have hereunto set
our hands and seals on the dates below indicated.
WITNESS: .
Q�.9�. �4� � ..
K' k E. Jacobs
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
AND NOW, this � day of Q�j�/� , 2013, before me, the undersigned
officer,personally appeared Kirk E.Jacobs,known to me(or satisfactorily proven)to be the person
whose name is subscribed to the within instrument,and acknowledged that he executed same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
NOTARIAL SEAI �
KATHY L. RUSSELL,Notary Pub{ic '
' , cartis�e,Cumt�and County No ublic
My Comrmisston Explres�ept. i?,2014
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� 1505610105 �
REV-1500�`'°�-11,��,'�,'
PA Department of Revenue P�nsylvar�ia OFFICIAL USE ONLY
Bureau of Individual Taxes �MTMENfOFIIEVEMYF County Code Ye� File Number
Po Box Zso6oi INHERITANCE TAX RETURN ;
Narr�sburg,PA i�i28-o6oi RESIDENT DECEDENT � � I ; ��� `1
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- ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYV Date of Birth MMDDYYYY
_ _. _ ._._ ____.__._ ----- � --- -___ .___ _.. _ ..___._..._. _...;
�
� , 04/30/2012 ; 11/13/1922 ,
__. __.--.------------- -.----.._.__.__---! -------_.___—____���.._ �_ ____._ ____�
Decedent's Last Name Suffix Decedent's First Name MI
�. __... .__. ._._ . ._ ___. _... ___. . .. ; � , ___._..._.__._.......---- _ ......._. __.. ._
'Jacobs _ -- _ __ ----___ _..._ ------. ._ -_--� �__--__-...-_-__:.__.__J �_~Louise ----------------- . _. _ ___I , H
1 I __.!
(If Applicable)Enter Surviving Spouse's Info�mation Below
Spouse's Last Name Suffix Spouse's First Name MI
__ __----_..._. __....__. ___._____-----_..___ __._. ._____._.____� �______---_____ _.___._,_------_..-----.----_A-------- ______- ---
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� __.� �_ _. ..__ ._.! !__.........._._....___............_._...._...___..___._.____.___..._._..... .....___. ___.., _"
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGI$TER OF WILLS
FILL IN APPROPRIATE OVALS BELOW �
� 1.Original Retum O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
� Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTiON MUST BE COMPLETED:ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
. _ .__.. .--_.-_._ __._.._ ..____ _.___._ ......... _------- _---..__---._._--- �_�._._.�_.__.- �__ _.__----.__.__--�---._._ _.----
'David A. Baric, Esquire � ;(717)249�6873 �:4; � �
° _ _- --_. ._ . . ._... _ . _ _._ ._ _ _ _ _---- -. __ _. - -------_---- — •--- —___ _ .._. ---
�-�-. �
REG� WILLS t�ONL'� �
� � t"" (� � i,� ;
First Line of Address � � � �' :� ;
_ _.______ _. _ . _
____.__ --_.--------- _...____ ____,__ .___._.
Baric Scherer LLC . "�� ' � �
_. _.. __ _._.. _. ._ __.__.._ _ .. ` -�t
� �
� � � :
. .......... .. . ...... . .......... .._. . . ... ......_ .__..... ......... .. � � �K4� .
. .................
Second Line of Address ' - �� � �� "� '
__._--------_.-_ ---- -_-�--. . ,�3 ;:�
.....____.. - - - --_----------, '^'-
19 West South Street ; ' '� ��� � �
_.._..._..---_.___.__ .____. --------__.._._. ... _ ..--_.� � DATE FILED� '
_... _ ._._. _.. _ ... .._ ____--- -
City or Post Office State ZIP Code `
_ ___. __..._ .______... -_-- _ . __ .. . _ _ � - ... , . ._ ___ _--- .... _. _- -- ..___ ___ ...
�.
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Carlisle ! ` PA !17013
. _ . __. __ _--.-.-___..._______...____ _ .___.__._-. _- : .__..._. : �___-_______._ _ _---- _ ._. -.-..
Correspondent's e-mail address:dbaric@baricscherer.com
Under penalties of periury,I declare that 1 have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG� RE F P ON ESPONSIBLE FOR FILING RETURN DATE�' �� ��
A RESS
300 Raad, il� Pe ylvania 17241
SIGN P E O �ESENTATIVE DATE
� aI 30 ,�
ADDRESS —
19 West South Street, Carlisie, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 15D5610105 �
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� 1505610205
REV 1500 EX(FI) DecedenYs Social Securiry Number
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�ecedo�r$Ne�: Louise H.Jacobs !
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RECAPITULATION
1. Real Estate(Schedule A). ............................................. 1. � ^ 77,301.00 j
.. _�..._��.._.._..._._..__�......_......_.__.._.._.__._...__..._..___.�;
2. Stocks and Bonds(Schedule B) ....................................... 2.� i
�._..._.__._�_____.� - - --- - -; -
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.� �
_._____...__.
i
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4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 6,274.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vfvos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Unes 1 through 7)............................. 8. 83�575.00
9. Funeral Expenses and Administraave Costs(Schedule H)................... 9. 30,331,80 ;
.._.�._._...�.__�
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 53,216.70 M
11. Total Deductions(total Lines 9 and 10)................................. 11. 83,548.50 j
-_--i
12. Net Value of Estate(Une 8 minus Line 11)......... . .................. 12. 26.50 �
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which �
an elec�on to tax has not been made(Schedule J) ........................ 13. �
�..._..._.�...,
14. N�t Value SubJect to Tax(Line 12 minus Line 13) ........................ 14.' �T� �.26.50 I
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable .
at the spousal tax rate,or
transfers under Sec.9116 ----_�_-____.__._...--.--.--- - --- --.--------_._____._.._.___..._..
�a)�1.2)X.0_ 15.
16. Amount of Line 14 taxable �� �
at I�nea1 rate X.0 45 26.50 �g. 1.19
17. Amount of Line 14 taxable �M� �� ��M�� �
at sibling rate X.12 17•
18. Amount of Line 14 taxable
at collateral rate X.15 18. 1.00 .
.._.._______._.��.__._�_._._._...._..____.._._._� ,
19. TAX DUE............................ ........................... 19. 1.19 �
- ��
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 15p5610205 150561�205 �
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REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Louise H.Jacobs
STREET ADDRESS
253 Wainut Street
��Ty STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1.19
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
�3)
4. If Line 2 is greater than Une 1+Line 3,enter the difference. This is the OVERPAYMENT.
Fill in ovai on Page 2�Une 20 to request a refund. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1.19
�
. Make check paya.ble 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.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did deoedent own an"in tn�st 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 propeity,which
oontainsa beneficiary designation? ...................................................................................................................:.... ❑ � �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan.1,1995;the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or.after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9916(a)(1.1�(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are s411 applicable even if the suroiving 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 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)j.
• The tax rate imposed on the net value of transfers io or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in(72 P.S.§9116(a)(1)]. —
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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• REV-1502 EX+(01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
��,�T,��,�, REAL ESTATE
rt�sweNr oecE�ur
ESTATE OF: � FILE NUMBER:
Louise H. Jacobs 21-12-0581
All reil prop�rt�l owned�oldr or u a b�nsnt in a�mmon mu�t b�roporEed at tsir msrkat valua Fair market value is defined as the price at which property
would be exchanged between a wiilirg buyer and a willing seller,neitl�er being compelled to buy or sell,both having reasonable knowl�ge of the relevant facts.
Re�i propert�tl�at i:jointl�-own�d with�i�ht ot wrvivor:htp mwt be dbdaed on SdNdule F.
Attach a copy of the setdement sheet if the pmperty has been soid.
NUMBER Indude a wpy of the deed showing decedent`s irrterest if owned as tenant in common. V OF DEATH�
� DESCRIPTION
1• f253 Wainut Street 77,301.00.
, �Carlisle,Pennsylvania 17013
;
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TOTAI.(Also enter on Une 1,Recapituladon.) : 77,301.00
If more space is needed,use additional sheets of paper of the sa�size.
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REV-1$08 EX+(11-30) '
� ennsylvania SCNEpVLE E
P /�/�
DEPARTMENT OF REVENUE vMSH� BANK DEPOSITS &MISC.
INHERITANCE TAX RErURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: � FILE NUMBER: �
Louise H.Jacobs 21-12-0581
Include the proceeds of IiGgation and the date the proceeds were received by the estate.
Ali property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VAtUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. Orrstown Bank checking account . � 206.00
2, Orrstown Bank savings account 1,714.00 .
3. sale of personal property 4,287.00
4, Comcast refund 67.00
TOTAL(Also enter on Line 5, Recapitulation) � 6,274.00
If more space is needed,use additional sheets of paper of the same size.
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• IZEV-1511 EX+(10-09)
� pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Louise H. Jacobs 21-12-0581
Decedent's debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: __ _ _ ..���....�....�,...� �,��,�,�
1. :Hoffman Roth Funeral Home -
, � 8,939.00
_.___._ _ -
_
_�a_. - - ------ .�.�.,:._.r __ _ _ �_ _�_
_ � _ __ u._..m.. ----- �
;?.� jMemaial Chedc � � 50.00
+� - — �- - --;- - --; ��...�
i.� -
�-1 fi �_u-_�_-� -- - ---- �- - - -_.,_.�_� � �
� + -- - - -- �
_,.�_� _,..._._. .__ y.._�...� .:� .- _ �- ._- - - �_� _ .� ._ _,
��..n..._1 �...:_�.�.. _.�.��.���z.�� - = �-_ �-�.__ �4.�.��s_ a.� - -
. .��.._._.v._.�_�__s_�_�,.� _- ._--�_�_. __i
_:._�.� _.__.. ._._ __..�. ____.«...�__..__. —.__ ------�--�----- •----.�_.--.._�.�...___ _ ._ _..__.__ _,_.._�.�----
� , _ �___�-- �
�1__-__f 1 .- --- __ __ ._ .
_._....�.�....._..�:_..o._�.`�.—R_--- .�:__._._ ._:,_. _._...�a._ _:...- — -----��.:�s--r�.��.�._�a_� _�, .� . ._ ,�_.J
B. ADMINISTRATIVE COSTS:
L Personal Representative Commissions: 6,510.00
Name(s)of Pe�sonal Representative(s) Kirk E. Jacobs and Brian L. Jacobs �"�"'�`�""'
Street Address 300 Creek Road
ciry Carlisle state PA ZIP 17013
Year(s)Commission Paid: 2013
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6,510.00
2. Attomey Fees:
3. Family Exempdon:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant None
Street Address
City State ZIP
Relationship of Claimant to Decedent
- .���..o
4• Probate Fees: 323.50
��r
5. Accountant Fees: � �
:�:�
6. Tax Retum Preparer Fees:
�. ��..........�..,�..*...:�..�*.;►#,���;�*,�:SEE ATTACHED SHEET:,�.,�.*�,►�.,�.*.�►.�*:�.*...:*.�:....�,►*.��:� � �
_ _ -- -..� �_.� - — ..� _....�.._ .�.
—,, --—---- - - - - -- ,. --_ ..�.., ----- ,
� � � ��
r:, �- . _.�. : _ : . _ . _._.� _�,� .,..___ �. .__ __ .y�.
.��, --e.�.,_�_..._..,��..,�,.,�r�.�_,__ . __. ._,�._. .��.,- _--� --
�s�...d�,�.�.�.,..�.V:_.:,�_,.�_,._�_, _- _
__: .:_ . _ _ . _ _ _._ - _ _ _ .. . _ _ _
�
_w_, ___�..�_._�....�_..............__�__._ _------_�,�_ �___��. .___�. �v =- ---,�._...�.___.-�.�_:__ ._,�._._ ,�..�.__.._._.�_�-- �,,,,�,� _
� � �
__.. .�_� __, __ _._ __ _,_ __. _�.:_ _.� ._� � ,_ .�-- --
_ _
..-....� ------- -- �,_�__.�_�.� ------ --- �-�---.�_.�._._�... --- -- - ----., --L.�.=�__ _.��.� ---���� ����
_.., _ _ . . . . .. _._ . __ _ _ _._
-_. - ---=-..�._ �_�� . ._�__.�__. _ _�_,_. ._. . ._ ...�� �.._ _�.:._._rt. _ u..._ __..., _.._ �.___. ..._..__�a_ �.,
_ �. � �
, �
TOTAL(Also enter on Line 9, Recapitulation) 30,331.80
If more space is needed,use additional sheets of paper of the same size.
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Estate of Louise H. Jacobs
File No.: 21-12-0581
SCHEDULE H CONTINUED
7. School real estate taxes $ 1,632.00
8. Comcast $ 613.00
9. PP&L $ 313.00
� 10. Peerle.ss Insurance $ 355.00
11. UGI $ 239.00
12. UGI Service $ 29.00 �
13. Carlisle Water& Sewer $ 145.00
14. County/Township real estate taxes $ 745.00
15. Herman Plumbing $ 61.00
16. Quicken Loan payments $ 3,374.00
17. Utility bills $ 250.00
18. The Sentinel (legal advertising} $ 168.30
19. Cumberland Law Journal (legal advertising) 75.00
TOTAL: $ 7,999.30 �
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• REV-1512 fX+(12-12)
pennsylvania SCH E DU LE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT, .
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&tIENS
RESIDENT DECEDENT
� ESTATE OF �t�MUMB�R
Louise H.Jacobs �'t-12-0581
Report debts incurred by the decedent prior to death that remained unpaid at the date o�i��ath,including unrelmbursed medicai expensea.
REM VAIUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Ascension Point Recovery Services LLC(Sears Gold Mastercard) 7,351.03
� � . . . � � ... . .. � .. � .. . � . . . ..,. . .. .�...:�-. ... ... ...: . ...... ... ., ..:.� � . ..
2. Phillips&Cohen Associates Ltd.(GE Capital Retail) 13,960.70'
3. American Info Source(Bank of America) 2,738.45
4. Chase 24,593.29
5. Lowes 2,031.47
6. Chase(AARP) 2,541.76
_ _ _ _
TOTAL(Also enter on Line 10,Recapitulation) � 53,216.70
If more space is needed,insert additional sheets of the same size.
, � � °+ ' , ' .
• REV-1513 EX+(01-10) � �
� pennsylvania � SCHEDULE � �
DEPARTMENT OF REVENUE
' UVHERITANCETAXRETURN BENEFICtARIES �� �
RESIDENT DECEDENT '
ESTATE OF: ' . FILE NUMBER:
. . � , .,
Louise H. Jacobs 21-12-0581 � .'
� ' � " RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER�.�:�. I�AME AND ADDRESS OF PERSON(S)RECENING PROPER7Y Do Not Liat Trusbea(a) OF ESTATE �
� I TAXABLE DISTRIBUTIONS[Indude outright spousal distributions and transfers under
• � � Sec.9116(a)(1.2).)
-�-—.�..�..--�..� ___�_ _�.� _-----
-- - -�..�..��� .�._._ _ _....�., __- - - _ _ ___ : ..�,
} _ _ - ----- _ .�
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-,�, -,..._.�.
. 1. ;Kirk E.Jac;obs � son 50%
.
_. _ . ._ __ _ _ : _ _ ��-,���.,r__.�.s,�.��..._�_ _�
; 300 Creek Road
_. . __. ._ _,_. . :_ , . ___ ._ _ _ ._ __ __
_ _�__, .�...__._..__ ___.___�__.��....��__._4�a____..___�_�.�.___�_..__�..::__ .._:_. ._ :-, - - _. _. ___
_ .;
�Newville,Pennsylvania 17241
,
, ._ __.____ _._.._ __ _ _ __ _ -- _ --_.... _._-__ : __.. ..__ _. _ _ _ _. � -
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:
2.� �:Brian L.Jacobs . � son ' 50%
�_�.___J .�........�.-...�.....�.....,_..J.,...,�__........__.._._.....'_"_"'_'__._-..�a__.__"_u��..+.�._.��...�... .. .�.n..:.__�..�-��_,.__"__._�__._...:...� �..,.�._...._.. .. ..._.._..._....._.__ __'.__
' ........ . .:_._.. _."""._.' __..:...........:..__. ... ....___.. _.__,.._".__'._._—'_......__.._...__:, ..._.... .:.._...... ...... , ".`."."_.. . ..... ._ ._ . ... _ - _ " _
.. . v�^n,•Rxz�-��-�-r
�253 Walnut Street _. ,
_.. �� ��_ _ ._ --- �._�.��- � �_ LL.__ _— . __
. ' _. �Cariisle,Pennsylvania .17013 _�__ �__�_..�.__. .. _.__ _.__,�,. _�,.,_- �-. _ _ _ . ._; . .
�-. �
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.�..._._._:._.J .:..."_ _ _."_.'_ ..... . . ... . . ..� . ..
_..._.._... � ._.. .... ...:... _.._.-.._....._. ..._ . � . . . . .. . . .. _ _ __ ...____ ___........ _. ._.... _ ._...._- -�T��
. ._: ..�... _.._ ... .... - . .__. ..... . . . . .
. .. .. . .. .—._—. ._ .__. __ _ ' .. . . �
. .... ...� . . _
.__,... �_.. _._..__. . -...�_ ��..�.-�.�.�....�..�...v� . _ .. ..
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.._. ...._ _.._�..� .�—_, ,__. - .. - . � ��
...._.._....� ....._ ___—...__"._ .._:_.._._ ..__..-.. . ... . . .. . _.�....___..�..�..__.. _..Y . . . . ... . . ...... . .... .
.
... .___......_.._ _'___i...__ .�._..____ .`_._..�_._.
' ..._.. .._.. ...� . . .� a
��^ ��
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. -
II NON TAXABLE DISTRIBUTlONS '
A. SPOUSAL DISTRIBUTIONS UNDER SECTlON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
_._�..�___ �.--:. - . ---- ----���_._._._��---=---- --. _--,.--�. ___._._..
.:_r_ -- ---..-_ �.,_,.�.-�- ,
, . _ __.__ ._, . . , �
1 `
__ _ _ _ - � - --- -._-�_--�_.�.�. __-- -
__, ._.._�..��_.___ ._ __ __ __ . -
�__.��_ __-_�. ___-�.___._ ___�.__ -- --= . . .-=-� „���--.�.-=...�,.:-.
___ _ � ..__.._ _.�.� , _ - -
_. _ --
___ .._. - --__ :. _.. ___.... : _ _._ . --_:�;
_ ,
._�__._...�.__.____. __ ___----_. .____ _____ ____------ ��
_ ._, _:__ ._ _ .. _.v_.._ .�_,--- -.:.. ._ - -
----____—__�_ __ ---- __F.,.�_� ..�_. . _.._.
_ _�w� _ --------------- ._
----_._._.._.. _. �,
____..,__,_.. ----- .-��.�.,.�.
--__-- _ _ ___ _ ____ --_.._.___ _. .
�_. __
:- ° -
.
_
.
_ __. _.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: �
1 --_ �. __ .___ _ _ __- - _ _ _
- ------_.,___:_ _..._ __
. _ _, _ .._._�._���m.-:��,�,�:.�..,.�
_ �
__. ._ ___.. _._._..� _ _.�_.._ _. _ � � ..,. T,�,..�.,�._..�,,.�,....t.- .
. _. . .. _ _
:�..���--��� ~�
.
�r,". , ,
, �
. _ _._ _ _ _:._ _ _---- --- --.: _ ___ _ .__
_ .,.�-.�.,,,.--,�.�,�,_.,._-�.---°--� _
.,
� —
_ ., _. �� �
�� �
. ,,..� . .,A,s _._ __
_ _ �
_...,. :-m..-_–..,�.�.��2.�,�-.�.--„s
TOTAL OF.PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. �� �
.: . ., , _
.__ .�.: . �_ �.__�___
If more space is needed,use addiaonat sheets of paper of the same size.
o y
� �
•
• LAST WILL AIJL� TEST.AMENT OF IAUISE H. JACOBS
I, IAUISE H.. J.ACOBS, of the �orough of Carlisle� Cumberland �
County, Pennsylvania, declare this instr�nent to be my Last TiJill
and Testament, in manner and form following:
1. I hereby expressly revoke all t�ills and Codicils hereto- _
fore made by me.
2. I hereby direct my Executor to pay �11 my just debts,
funeral and administrative exnenses out of my estate, as soon as
practicable after my death.
3. Should my husband, Kenneth F. Jacobs, survive me for R
period �f thirty days f_ollawing my death, I devise and bequeath
the remainde� of my estate to Kenneth E. Jacobs,
4. Should my husband� Kenneth F. Jacobs� predecease me or
die on or before the thirtieth day following my death, I devise
and bequeath the remainder of my estate to my issue living on the
thirty-first day following my death, per stirpes.
5. I nominate and appoint Commonwealth National Bank�
Carlisle, Pennsylvania, Trustee of the share of any beneficia�r .
who maS� 'be under the age of twenty-one years. The income and/or
principal of said trust may be accumulated or expended for the
maintenance, education And support of such beneficiarq as my
Trustee in its sole discretion may determine; and mq Trustee, in
the expenditure of income and/or nri.ncipal for such purposes,
may, at its discretion, apply the same directly without tl�
intervention of a guardian or pay the same to any person having
the care or control of said benef iciary or with whom the bene-
ficiary resides, without duty on the part of the Tx•ustee to
supervise or inquire into the application of the funds by anq .
person to whom atiy payment is so made. The balance of such
income and/or nrincipal shall be paicl to such beneficiaxq upon
�. � w
._...._............_.. . . .__....._. . .. ". I
...._........._..'._.. .. .. '. . . . .
. �
reaching the age of twenty-one years or to such beneficiary's
estate in the event �f death prior thereto.
6. I nomin�te and appoint my husband, Kenneth F. Jacobs,
as F.�cutor of this my Last T�Till Rnd Testa�ent; and as substitute
Executors I :nominate and appoint my sons, Kirk F. Jacobs and
Brian L. Jacobs.
7. I direct that my personal representative and �'ru.s�ee,
as well as their successors, shall not be x�ec!��ired to file bond
or security in anq jurisdiction.
IN LJITI�IF,SS t��HL'F.FOF� I have hereunto set my hand anc� sea�.
this Z3� day nf � - � , 1978.
� -
,,
� �
�;�o�-c.�';c.., • CSEAL)
uise .. co s
WI'TNFSS:.
.,� ` � :
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.__._......___ _ - ----_,.
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. c h I
�
C�i0N4fFAJ�TH OF PENNSYLVANIA s
: SS. .
COUNTY OF CiJMBE�I�ND .
I, Louise H. Jacobs, Testatrix� whose name is signed to the
attached or foregoing instr�ent, having been duly qualified
according to law, do hereby �cknowledge that I signed and execute
the instr�ment as my Last GT�ill; tt�at I signed it willinglq� and
that I signed it as my free and voluntary act for the purposes __
therein expressed.
S�aorn or aff irmed to and ack owledged f.ore me, by Louise
H. Jacobs, Testatrix� this 'y,3 Y� day of �e� , 1978.
U
� �� .
esta
...-�`�
. `� V�,,..r.A,.�„r,_.. � . �����.�
JANICE E. HERTZLER, NOTARY PUBUC _� �
Cumberland 'i'.ounty Carlisie, Pa.
My Commission Expires January 27, 1979
CONIA�ON4IEALTH OF �'NNSXLV�ANIA :
:: SS.
COUNTY OF CtJMB EP,I,A.�TD :
�,�e, Tom H. Aietsch and P�oger M. Morgentha7., the witnesses
whose names are si�,med to the attached or foregoing instrunent,
being duly qual�f i.ed according to law, do depose and saq that we -
were present and saw Testatrix, Louise H. Jacobs,. sign and
execute the instrianent as her Last Will; tha� she signed wi?lingl
and that she' exe cxited it as her free and voluntary act for the
purposes therein expressed; that both of us in the hearing and
sight of the Testatrix signed the will as witnesses; and that to
th� best of our knowle dge the Testatrix was at that time 18 or
more years of age, of sound mind and under no constraint or undue
influence, -
Sworn or affinaed to and �ubscritpd to before me �y Tom H.
Bietsch and Roger M. rTorgenthal, witne�sses� this ��� �"✓. day
of � , 1978.
� _
. ��� Y � ,
� ness
� � �
,r1
�.tness
.�—, ,
ANICE E. HERTiLER, NOTARY P'IJS�I� • ,�
�.�-
C an Carli e � C�-��-�-�� L �t IQ _-��
Cumberasnd o ty sl � Pa.
Commission Expires January 27� 1979
- 3` -
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„„ �'W��a'• 2S 1 d�W�o� p �"1 lP'�v � � ►ti'��• ","" • " OMB Approval No.2502-0265
`• �
• • ' •• • � A. Settiement Statement ( UD-1) FINAL
.
1.[]FHA 2.Q RHS 3.�Conv.Unins. 6'Fik Number: 7.Loan Number: 8.Matgage Insurance Case Number:
2012�4MJACOBS 217073
4.�VA 5.Q Conv.Ins.
C.Nob:This fam is fumished to�ive you a stat�nt of actual settlsment coats.AmouMs paid to and by the aetllemeM apsMs are shown.I�ms marked
"(p.o.c)"ws►e paid ouWde the dosina they are shown here for inforrt�adonal purposes and aro not lnduded in ths totals.
D.Name 8 Address of Borrower: E.Name 8 Address of Seller. F.Name 8 Address of Lender: :
Ki►k E.Jaoobs,Lind2 F.Jacobs M�nbers 1st FCU
300 Creelc Road,NewviUe,PA 17241 5000 Louise Drive,P.O.Box 40,
Mechanicsburg,PA 17055
G.Property Location: H.Settlement Agent: I.Settlement Date:OU22/2013
253 Walnut SVeet Baric�LLC Disbursement Date:0'V22/2013
Ca�lisle,PA 17013 19 West South SVeet,Carlisle,PA 17013 -
Ca�lisle Borough
Teleptwne:717-249�6873 Fax:717-249-5755
Plaoe of Settlement: TitleExpress
19 West Soutli Street,Carlisle,PA 17013 Printed OY22/2013 at 1'k00 am
bY AlF
102. Pe�onal 402. Petsonal
103. Seplennent dtarpes Fo borrower(Wie 1400) 3,236.35 403.
104. d ii�t loen#3300490822 b Quicke 404.
Loans 7 981.51
d ekuit . L.Jaoobs 124, . �05.
ior Ii� �h�dvana for irn� �r in adwnce
106. C�y/town taxes ro 406. cdylrown taxes to
107. CouMy taxes to 407. Caunry taxes to
108. Assesements to 408. Assessrnents to
109. Schoot ta�c ptoration due badc Estate of L.Jacobs 715.40 �09.
110. 410.
111. 411.
112. 412.
120. Ow f�o�1 Borrow� 12t�51l.75 410. �/yuowk Dut b 8dMr
,'�:'�c;;�_;�s=�:.
,.i"�-�
a��, t (see'
202. Piir�ipel smount o#new ban(s) 108,3�.00 502. Setllement c�arges to seNer(line 1400)
203. s taken ' to 503. s taken su to
204. 504. Pa df d�st ben
Z05. 505. Pa of second ban
206. Credit br Appraisal 425.00 506.
207. 5W.
208. �•
209. `�•
tor M�ms s�INr for� sN�r
. taxes to 51 . �rlbMm ta�ces to
211. Ccunty te�ces 0122/2(113 to 01/221Z013 511. County taxes 01/2?J2013 to 01/22/2013
212. Aasessrtients to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. • � 516.
217. 517.
218. 518.
219. 519.
�. ToW BorrowK 101,745.00 �l0. ToW R�uctlon A�o�at Dw S�t 9.00
.;:,��•. :...-�:-«=
,:.,�.`�,��•,3::;�f.
301. Groes anw�uM dus from bor[o�wer(Nne 120} 1�,519.75 601. Gross amount due to�Ner(�ne 420) 0.00 -
302. ���P�bY/for borrow�er(ane 220) 108�745.00 602. Less neduaions in arnouM due seller(line 520) 0.00
30.1. C�h � F►oa� ❑To 8omaw�r 1l�774.75 6g3. Caih �To ❑ From SNIu 0.00
tlw lam Wa�R a cwnnMY wMtl 0116 antrW rnW�r.Ns mMpaMWMY h a�w+4 Ws dwlaun s nrndray.Tl�ia is aaiy�w m pov�ue IM P�+a.f�lPA cowna uaKrJion uM YramrYm arinp tlw �-
iMbnMnl P�
Prevfous editions are obsolete Page 1 0 4 HUD-1
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� : . ^�.x��3;"�<.�,u-'�.^-: �^t[.`.�,.�.�.;���',�''��'�.�.?���:��`��K.r�.'� ���I'. . IF� � .� �
• �I.W �� ��r� � .�i•
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s: ` 'i'�iea�.,
703. Corrrr�iasion paid at settlement
: ;.� ,�: ,�<: {.�� ., 4�,,,�,���� ``:�,. <� �.
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. x}?;, ',.'z�'�� s r c .f{ A ti.{�,.,�, �{i?i. ..r,_3.., a�.."1'' xF_.��.:.
. �� C'� rYlll{Q. � . , W.W (IIYIII f►�'
. Yau aed�a d�arge(Points)for tl�e speat'�c interest ra�chosen i (from GFE#2)
. Yaur adjusted origrciaUa►charges (from GFE A) 455.00
�� APP�� to' (fran G E�t3) 425.
�• � �o from GFE#3
806. Tax servioe to from GFE#�3
807. Ffood o�ion to from GFE#3
806. to
+,,� ;, ��f , �
� 1 1 . ( ) , -
- , 902. Maurance months to frdn GFE#3
903. Horneoiwner's insurance months to from GFE�k11
904. ►ranths to from GFE M11
� r s. �'•:.,? '�,v�,r�'-;1 K"4 y:'� . (Y'3,:; .
1001.k�tld depo�fot yqu esaow aocoum (from GFE#9)
1002.Homeowners insurance months S Irnonth
,003. �,ra►�ce m«►ths s �ma►th
�oa. � �►u,$ s n„«►m
�005. rtanths s Nnonth
�oos.n� ►�«,n� s o.oa�n a
�oo�.n�re��� a
:s:r�,,�.�: .;�.,.� : -
� ,.
J-� .ct '..i'! .Z:.:
1 . insuranoe from GFE�4 .
1102.Sediement at dosing fee to 3
1103.Owners t�le insurarxe from GFE#5 1,025.00
1104.Lender's Utle ins�rarwe . s225.00
1105.Lender's tlEle poGcy I�nit;108�320.00 Lende�'s Policy
1106.Ownera�de pdicy Nmil s124,568.00 Owner's Pdicy
1107.Agent"s palion d the lotal tltle N�sivar�oe premium a998.75
1108.Unde�mflers pation d the total tide insuranoe premium =Z51.25
1109.
��,: g��
.ir^^::..'�`�.. .��. .;�••5.,fl .� �'z' .Z.�'��>�ti w�':''��� r�y�:.�: F .
120L GoremrneM rec�rdkig diarges S (from GFE�7) 158.00
1Z02.Deed .00 Nbrt 596.00 Release s _
1203.Tra�er taxes $ (from GFE�8)
�aoa.c�►rcown�►�� o�a a s
1Z05.St�te Taxlstan�Ws Deed S i
�zos. o�s s
� �� : �
� .�sV.�..i:�.- 6�r4y:
1 .' rd!C8f1 ( �
1 • ebr Md 1 to of Carlisle 5168.64 P.O.C.S'
1 . 1 ownaF� to Carliste 7 .51
1304. to
1306.: to
3 . 0.00
'Peid Oulsfde d doain9 bp(B�roiwer,(S�Ilet,(L)ender,(IMvestor,Bro(K�r•"Cre�it by lender shown on pege 1."'Credit by seller stiown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
�
.
. ��.
._.. .
• •, �`.`;
►
• 455.00 455.00
O.OQ 0.00
' 455.00 455.00
0.00 0.00
_ .;�.�.�..
-. .158.00
425.00 425.00
663.00 583.00
-1
.14 1 .
1,362. 255.00
� 0.00 1,025.00
Lwn TMtp�
i108,320.00
7.years
4.37509�
;540.83 indudes
����
Q Inlerest
❑Mort9a9e Insurance
X�No. ❑Yes,it can rise to a maximurn� 96.The tirst diange
wiA be on I I and cen change again everY pears after I l . Every change
da�,Irau in�est r�e can inaease or decxease by %.Over the Iffe d tlie ban,your
interest ra�e is guaranteed to nevet be lauu than 96 or hiplMr than 96.
Xn No. ❑Yes,il can rise to a max�wm of S .
Q No. ❑Yes,the firsst inaease can be on 1 I and ttie monthly
amount owed can rise to E .
The ma�cimum it can ever rise ro is S .
Q( No. ❑Yes,your mauimum prepayrt�ent penaltr is s .
QX No. ❑Yes,you have a balbon pa�rment d i due in
years on ! / . �
• �X You do not have a montl�ly escxow pa�rment for itert�,such as property taxes
and hortieowner's insurance. You must pay tl�ese items�rectly yourself.
❑You have an additianal monthly esaow payment of S
tl�at resufts in a total iniaad monthly�owed d i .This indudes principal,interest,
any mortgage insurance and any items checiced below:
❑Property taxes ❑Homeowner's insurance
�Flood insurance ❑
❑ ❑
Nob: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Previous editions are obsolete Page 3 0 4 HUD-1
i
Y
, �• � � � ' MUD CERTIFICATION OF BUYER AND SELLER
� 1 have cartfuNy reviwrsd the HUQ1 Settlsment Statement and to the best of my knowleclye and belief,it is a true and accuratt sta�nt of aN roceipts and
� di�bwse�menb�on my account or by me a�thi�transacdon.l iurther esRify Mat 1 hsve rocxired a
rocx ed copy of th�HUD-1 S�qMnNM S�meni
�-
� % �
Kirk E.Jacobs Li a F.Jacobs
Ths HlJD�1 SNtNment S�i�rrisnt which I have propared is s true and axurabs accow�t of thla transactbn 1 have cau�ed or wi�csuse ths funds t�bs
d' in aoco►danoe with this statement
�-
�
i C/� �
�� 1 �ta 13
SETTLEMENT A�ENT DAT
WARNING IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
Prevlous editions are obsolete Page 4 0 4 HUD-1
�
�
v �
� �M • Name of Borrower: Name of Seller: F�e Number:
0
� Ki�k E.Jacobs 1012�14/JACOBS
Linda F.Jacobs
011Z?J'1013 at 11:00 am
I�e:This p��displays an ibmization of the chary�s shown on line 1101�the HUD-1 S�m�nt 8tat�m�M.Th�p�p�
omp�ni�s btrt is not a part of ttw HUD-1 Sfttlemerrt Statam�r�t.If a discropancy exisb,tlt�i�famation o�the HUD-13eldement
dlsm�nt spplNs.
1101. �d�$ ��� to
�r �c�n s ,o.00 e«�o�
�t F� to Baric Sd�erer LLC s Z0.00 Borrower
Subbohl 30.00
11Q2.Sel�ement or dcsinD fee to s 0.00
1104.Lender's ti�e it�aurenoe to Baric Sc�terer LLC 225.00 g�p� -
;,• . _._,,... ., _ ...�... _ -
�" "� a,��f-y�a£< �;
Previous edltfons are obsolete Page i of i MUD-i
I.