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HomeMy WebLinkAbout05-25-78 -,; ~I '" ~ ... ~ - f .., s-l! .... :=> z " co ~ '" .;r Z \oJ ~ ,... N :::l '"' '" ~ " :::: .... .... '"' \oJ ,... >- '" .... ~ ~ .... N ~ <'l 0 ~ ~ :E N .... " " 0: CJl r;...., '"' " :;: CO ,.. ci 0 ." l: l: .,,; 8 " " ::: ~ :<: " .., " ~ <C - <5 ,; Eo- E: .~ 'E ~ ~ c- " ~ z " ..., ..c :::. ~ ~ ~ <>.. ... ~ <>.. .., " ., ~ \oJ "' " t<< " 0 ,," :e: " " " '" '-' " <=l -.J :: Eo- i " z t; "'" ... ." ." - l: ~ "I; ~ ~ " '" ~ L:J ~ " .. " <; e .... ... El .. :::: :5 <l "'" - ." ,.. ... 1: " ., ~ <>: "" ~ "" Q... " 1 ~ ~ ::! l;: ~ " " <;- ~ 1: ~ " " - .... <<: ';; " ~ Cl l; S Q " ~ C <>.. L:J z <<l ~ .S ';;: ~ " u ~ '" :.: ::. - .., ~ L:J - ... " '5 ,," ." <<: Z ~ "" ~ :: \oJ " ii:; " e B " Q " c.. .n \oJ ~ RCC-2 (2-64) July 24. 1978 . . . . COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 FILE NO. Whereas, Gertrude D. Jacobs late of Borou~h of Camp Hill in the County of Cumberland Commonwealth of Pennsylvania, having died on the 23rd day of February 19~, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Th f I Ira K. Gleim . d I . t d rd' t I ere ore, , . an appraIser u y appom e acco Ing 0 aw, having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement: In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any estate for Ufe or for years, the Commonwealth hereby expressly reserves the right to appralse and assess transfer Inheritance taxes at the lawful collateral rate on any such future Interest. Ducrlptlon of A..et Unit V.I"e. Appnllement Mede for InheritanCI Tu PurPO'" Real Property Personal Property Joint-Held Property $ None 19,544 29 997 65 Transfers None TOTAL ASSETS $20,541 94 Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con. formity with law on this 24th day of ~.IA _ k. J~_. 197~. AppraileT (....m....... _0 tlarrisourg (PaR omee) , Penna. Inheritance Tax Division RCC-81 (5-73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBU RG 17127 IN YOUR REPLY PLEASE REFER TO '* NOTlCE..Q.F riLING Dr APPRAISEMENT JOu.. Dress ~ac6Ds 531 .Bosler Avenue Lemoyne. PA 17043 (Executor or Administrator) In Re: Estate af Gertrude D. Jacobs Cumberland Caunty - Fi Ie Na. 21-78-0158 Dear Mr. Jacobs: Yau are hereby notified thgt the Original appraisement in the estate of Gertrude D. Jacobs has been fi led in the office of the Register of Wi lis of Cumberland County on Julv 24 , 191!L, Said oppraisement reflects the following voluations: Reol Estate Personal Property T ronsfers Jointly Owned Total None 19.544.29 None 997.65 $20.541.94 As to such tax that is paid within three months from date of death, a five (5%) percent discount is allowable. .As to any tax thot remains unpoid after nine (9) months (fifteen months when deoth occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when death occurred prior to December 22, 1965) from date of death, interest at the rate of six (6%) percent per annum is chorged. Any party in interest who is aggrieved by this notice moy object thereto within sixty days after receipt of soid notice os provided by Section 1001 of the Inheritance and Estote Tox Act of 1961, 72 P. S. 2485.1001, P. L. 373. Dote July 24, 1978 Signed Title Chief Appraiser v- --. Note: This is not a bi II. . ~.M E ' "'iJ1~ tt~-~~ ';f ~1:~ .. ...If.: - ~ l"1t-. -.-. ~:: "~:-t .5:::-~ ~ ~-"--~~ "., ---, CommonwealthAh. - - National Bank ~ April 28, 1978 Ball & Skelly 127 State Street P.O. Box 1108 Harrisburg, PA. 17108 Re: Estate of GertrudeD. Jacobs '. Dear Mr. Murren: In reply to your letter dated Ap~ ~7, 1978 on the above estate, the checking acc~t #152-50208l-2~e balance as of February 23, 1978 is $1.995.30.~is account is jointly held with Gertrude D. Jacobs or , John D. Jacobs, opened before 12-12-69. If you have any questions, please feel free to contact us. Very truly yours, ~~Jc-dL- Robert Talalai .Assistant Vice President and Credit Officer RT/cg , ~ .: The Commonwealth National Bank. 10 South Market Square. Harrisburg. Pa. 17108 (717) 564-9500 RCC-3B * . COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY lNSTRLlCTIONS: This scherlule must disclose all property, real and personal, owned by the rlecedent jointly wi th another or others, including intangibles, standing in the name of the decedent and others. List real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule "A", plus the date and place of record of instrument effecting vestiture, but do not include entireties or out of state real estate value 1n estate valuation column. Personal property should be listed as in Schedule "B", ]lIus date of acquisition, and the name, address and relationship (if any) or co-owners to the decedent. Description of Property, Date of Acquisition, Name unit percentage Estate Address and Relationship of Co-Owners, and Place Value Share Valuation of Record of Instrument where Real Estate. DEPARTMENT VALUATION CAUTION-Do not Write In This S ace. Value of Entire Property Commonwealth National~, checking account #152-502081-2, jointly held with Gertrude D. Jacobs and John D. Jacobs - balance as of Feb. 23, 1978 - $1,995.30 ~ 1/2 997.65 Insert this total opposite "Jointly Owned Property", Schedule WE" in the "As Reported" column on the last page of this return. 997.65 Value of Decedent's Interest 9?11;S ~ ...., oS _ E.<- u;: c '2.!l E .- ~ =' E-o "0 C. " <: e. ~8:o o " '5in1:: " ~ 0 ~Efr ~ c:: SUMMARY ...(Sch. "A") (Sch. "B") ....(SCh. "e") Real Property ............... .......... Personal Property....... ........ ......... Transfers .................... .......... ................. Scedule "E" - Jointly-owned .................................,_............ Gross Taxable Estate ex> '" en' .-< t- "0 Z " ~ til ~ '" '" .. <- "" " < cil" til '" ~ ..c::' '" l/) U'l .oc tJl - .-< 0 ;::l' < I -< 0 "0 " ~ ex> c: ~ III 0, c. '" A. ....., " "" 0 ....., 0' III " A. I , !:! "" !:! , co' ..... ~ < -< ..... .-<' til Q. QJ: :.. i= i= .-4: ~ N' til l- ....., ~. S Q i:: ::: ... -< Q) ~. Z <0 0 l- "0 ;I: , " 0( % l- U'l 2 ;::l, 0.. t'-o til Po' 0 ~ I- ~ 0 1:: E. 0 ~ " Q) Ill, - 0 .9 c: [j 0 A. ;; til ;; ;..l !: ~ :. ~ .b 0 ~ " ~ -< ~ .c. 0 '" 0 g E --, ~ E :; .;: j 0 0 - u u (I) (As Reported) o 1.~.~..5.~.~. 29 $ $ $ S $............. L.2,~.~S.~~,:..~4.. o 997.65 (2) (As Determined) S $. . $ ....... ..... $.. S.. ."", ,......... .. ,. , S RCCT37 (:r2-63J COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT . SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESSES , RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise in estate) forth this fact.) OR NO BIRTH John Dress Jacobs 531 Bosler Avenue , Lemoyne, PA 17043 Son Yes 11-19-13 Total , ( h Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE ~' . " ,,~,~;:~~;..:. ;.~ -'- ..1 .:.:' '., . ~ ~}i :~- f . ~ .. -1.." - ".,'.. , .~. . " ., -" ".',- - .,:'" . _..;';..~'....'iL4', .._,::....:...:.>:..~;;'",.,_.c..,_,._""-----_._ . -'-'---~._~- ----.. -- -~ .~ ~._-,------...-.~_. -_.~...:. LAST WILL AND TESTAHENT I, Gertrude Dress Jacobs, widow of George Wolfe Jacobs, residing at 157 South Fourth Street, Stee1ton, Pennsylvania, do make and publish this, my last will and testament, hereby revoking and making void all former wills b~ me at any time heretofore made: To my son George Willis Jacobs I give and bequeath all of my household goods and furnishings. All the rest and residue of my estate, real and personal, not hereinbefore given and disposed of, I give, devise, and bequeath to my two sons, George Willis Jacobs and John Dress Jacobs, share and share alike. And I do constitute and appoint my two sons, George Willis Jacobs and John Dress Jacobs, Executors of this, my last will and testament; and I direct neither Executor aforesaid shall be required to give any bond, and that if, notwithstanding this direction, any bond is required by any law, statute, or rule of court, no sureties be required thereon. In witness whereof, I, Gertrude Dress Jacobs, the Testatrix, have to this set my hand and seal, this .1..b ~ day of September, A.D. one thousand nine hundred and sixty-two. Signed, sealed, published and ~ declared by the above-named Ger- ,,(J. ~n ~ trude Dress Jacobs, as and for ~ )lf~AA..d.# . ~SEAL). her last will and testament, in ~ the presence of us, who have hereunto subscribed ~. our names at her request as witnesses thereto, ~ in the presence of the said Testatrix, and of ~ each other: ~ ~~:J'~~~ 1J2Z:U'h'~~)l~,~ J?</'d~. .I. J1r h..( ~61/ t......"..~7 NcL }k~-f/. .- -'--...,.--,.~.,,_. ~---"--~ ~ . c . 1\- I, I. 1\ ..1..;..,___-- '1' . '-'UI!IIIIUIIft'Cdlln71"\... . National Bank i;:- ~ ~~..""" April 17, 1978 Philip J. Murren, Esquire Ball and Skelly P.O. Box 1108 Harrisburg, Pa. 17108 RE: ~state of George W. Jacobs Estate of Gertrude D. Jacobs Dear Mr. Murren: In response to your letter of April 14, 1978, please be advised that the only heirs of George W. Jacobs that we have been able to locate were his mother, Gertrude D. Jacobs and his brother, John B. Jacobs. We are not aware of any other family members or intestate heirs. As you know, the beneficiary of his estate was his friend, Phyllis Klinedinst. Please keep us informed regarding the possible testamentary gifts to the Estate of George Jacobs from the Estate of Gertrude D. Jacobs. Sincerely yours" . AJif [ JI!d Robert E. Sherk Trust Manager RES/af " The Commonwealth National Bank. Elizabethtown Office. Elizabethtown. Pa. 17022 17171367.1116 H106 112 600M REV, 9.75 (100 Carl. per boOk) (FEE FOR THIS CERTIFICATE $.200) -. WARNING. It 10 ..... to J~."la tIlIo _ Ily p_ or ........... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL STATISTICS 62642 N~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH Reglotered No. __._ ~~~ _____.__m___~..----.2..tL~-------....-~,;;,----...--....----.. ~~.. ...is:.__7....-J.,....!lJ..a" A cd.n _Jl;uN"-a .._.~/f) A . ;- A . _ ._...L2..___ "\MII_ SINet / Otr Of to_ ~ .... .~-:. J,/J:/....~ ___.__.:!J4.::t.d '-.- Oate of Death _ _ . 7:;_r-.L..~..2..2_.._____..__SodaI Security No. LZ.J.__,__:-.2_..,,__L'i___U__.JI.ace_.m~ -.-- Marital Statu, _m?,1..&t..l4___h~. . .f( ..Sn-..122. ~_____..___.Date of Birth.___~-.i.LT..I2-.(..~.-----......-- ~___..~ f,-t;. ...J BlrthPIaCe._.__)~.---.iL.-_---..-- II Veteran. which War ____m______.________._mm__.._______m____m_m___.Yeteran.' SerIal No. ..______m___m__m__..___m.....__ MEDICAL CIlRTlPICATB Interval Between P.rt I. Death w.. caused hy: Omet and Death Immediate Couse (.)m-..__.._...__~~L______-1-.__._~.m---..--.--.-----_.-..-- ------. Due To (b)____..____._____._..._______.____.__________________--.-.-------------.--------...-----..-.- --'- Due To (c).______.._____..____...__.____.__..___..____m___.._________------------.-----...---------.-------..----.-.--- ...---. . Part 11. OTHER SIGNIPICANT CONDmONS: CODtributlng to death but DOl related to the immediate cauoe gIYID ID Part I (.) -...-...-......-..-.....-.....-.....-....-....--.-......-._._.._.__.._..._......_-_._..~-_......_......_._..._..-.......-..--.-..-.--..-.------........ Ateldetlt. Suicide or HomIdde .._....__________,....___~__._cmHow did IDjury OCCUJ' m___.______________m__.__ ~ ~~tIe~~m.th (M.D. 0.0.. Coroner) _._..-(lA.a..L..---..-..iv..-..-~---..-----. Addreu___$._~l1m...---:E-~f.::..:-.~--.J2i-- ----m~p_--.2~-m4:--'---_..-----. This is to cer:tify that. the inf,?rmation here given is correct~y copie,d .from ~n original certificate of death duly filed with me as Local RegiJtrar_ Tbe orl1l'na1 certificate will be forwarded to the State V,tal S'abstics Office for permaaent filing. /(~__~. A'OJ~Y. _~_.!..:::..il..L.2... Local "'11frat of Vitol StoHlttu ~...r--, _'1J..l___ 0 -~__J.1:J_--.-..0 A -. /. I :..,..../2 . S~~ atr.~.T~~.~ ..___.______m.7} ~-.::.,l: .: z...:, 1;0/;2-...--.-------..19.2-7.. m_____L~_.__19.:z.7 CertlflcaHIMl RCC- 36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX *~ SCHEDULE "C" T RAN SFEIlS RESIDENT DECEDENT (1) Did decedent, within two years of'death, make any transfer of any material part of' his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) ~O (2) Did decedent, within two years of death, transfer property from himself to himself and another or others (including a spouse) 1n joint ownership? (Answer yes or no) No (3) If the answer to (1) or (2) above Is In the affirmative state: (a) Age of decedent at time of transfer (b) State of decedent's health at time of' making the transfer. (Note 1). (e) Cause of decedent's death. (Note 1). (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefo~~hich was to take effect in possession or enjoyment at or after his death? (Answer yes or no) !~O (a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no) (b) What was the transferee's age at time of decedent's death? (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end bef"ore his death: (a) The possession or enjo~ent of or the right to income from th~ property transferred? (Answer yes or no) ~o (b) The right to designate the persons who~~hall possess or enjoy the property transferred or income therefrom? (Answer yes or no) NO (6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit of care of transferor? (Answer yes or no) ~ 0 (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to al ter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer yes or no) No (9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) NOTE 1: The anSwers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or & ITEM DESCRIPTION MARKET VALUE (Es Urns ted) NONE Insert this total opposite "Transfers., Schedule .e. in the "As Reported" column on the last page of this returlli DEPT. VALUATION (Dept. Only) Irunu fh.,nu The HA fAt R II S Savings Association 205 PINE STREET. HARRISBURG. PENNSYLVANIA 17'05 OFFJCES Ar.. Cod. 717/:236.4041 DOWNTCWN' COLONIAL PARK' cAMp HILL' LEBANON. UNION DEPOSIT CAPITAL CITY. NEW CUMBERLAND April 20, 1978 BALL & SKELLY Philip J. Murren 127 State Street P. O. Box noB Harrisburg, Pa. 1710B -- , Re: Gertrude D. Jacobs Estate Dear Hr. }lurren: As of February 23, 1978, the day of Ms. Jacob's death, the balance in her Optional passbook account paying ~%, compounded daily, was $18,101.14. The interest due on this account up to the day of her death was jUlfo.81. This brings the total of her account to $18,241.95~of the day of Ms. Jacob's death. ..- This account was opened on January 5, 1978 and was held in Ms. Jacob's name alone. Enclosed you will find a legal transfer paper and signature cards which must be signed by the executor or executrix of the Estate before we can authorize any activity on this account. The executor or executrix must also present us with a death certificate and a short certificate as authorization for us to allow them to withdraw.from the above account. If you have any further questions, please feel free to contact me in the Savings Department at 236-4041. Very truly yours, .~.-LJ<_l.~ (Mrs.) Sandra E. Myers " Savings Counselor SEH:sem Encl. ~ DNf., ~rWgl ~~ ~ JEWELRY APPRAISAL JEWELERS SINCE te.' REGISTERED JEWELER - CERTIFIED GEMOLOGIST AMERICAN GEM SOCIETY 36 NORTH THIRD STREET HARRISBURG. PA. 17101 JEWELRY APPRAISAL E. G. HOOVER CO. Appraisal For; JOHN D. JACOBS 531 BOSLER AVENUE LD10YNE. PENNSYLVANIA 17043 April 20. 1978 Item 1........... Ladies 14 karat yellow gold ring mounting set with one (1) genuine opal and twelve (12) round single cut diamonds. Each diamond weighs approximately .03 carats. are good color and poorly cut. The opal is heart shape. body color is blue displ~ medium to strong opalescence. Value lP725.oo ~ Item 2..........Ladies 14 karat yellow gold ring mounting set with two (2) round brilliant cut diamonds and one (1) synthetic emerald doublet. One diamond weighs approximately .32 carat and the other weighs approximately .30 carat. color grades A.G.S. II. clarity grades imperfilct and are poorly cut. Value lP525. 00 V- State tax is applicable ThIs .Il.PjralS3l const1tut~ our carefull3' studied opinion of g'the retall replacement cost throueh OUl' faclllt1t:ll o the dlstreu Well nature value of the artlele(a) deacribed above m.ofar .. the mount1ngC.) have permitted observation. We aeume no llab1Uty witb respect to any aet10n that may be taken on the basLs of th1! -.J>.pralsal J2:tiJ~ 'fl. U);{J.SE{#U) EfL AppralRr RCC~35. COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX '* RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY INSTRUCTIONS: This Schedule must disclose all tangible ondintangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent Jointly with another or others must be listed lUlder Schedule wE-. Intangible personal property, titled In the name of the decedent, but payable at death to another or others, including but not limited to P.D.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and furnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and In bank, stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or riduciary in said capacity, partnership interests, interest in any undistributed estate of or income rrom any property held in trust under the will or agreement of another, even though located outside or the State, at the time of death, should be listed in this schedule. Item No. ITEM List and describe rully UNIT ESTIMATED VALUE IW\XEr V ALIJE DEPARTIIENT VALUATION (Do not write in this space) 1 1 - Ladies 14 karat yellow gold ring, set with one opal and twelve diamonds $725.00 vV' '1~5 (JQ 1 2 1 - Ladies 14 karat yellow gold ring, set with two diamonds and one emerald doublet 1 525.00 vV' 0cJ5 ch:J (Items 1 and 2, see appraisal by E. G. Hoover Co.) 3 Harris Savings Association, Savings Account #5-75636 18,241.95 .....'" J~ ,21-/!. 96- 4 Blue Ridge Haven West (Refund on nursing home services for February, 1978) d)7. 9'1 27.99 ......v 5 PA Blue Shield (Refund Quickel-Connor medica services) /5. tl () 93~- 1/ 15.00 V" V 9.35 ,/ 6 PA Blue Cross (Refund for quarterly payment) Insert this total opposite "Personal Property., Schedule .B- in the "As Reported" column on the last page of this return. -$ /t,PfL/. .21 x X 19,544.29 RCC-34 (40-73) COM~ONWE"'L TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY *' Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Property held by the decedent os tenant .in common with another or other, should be identified os to quantum of interest and the estimated value should be that of the decedent's interest only. (Property held os joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E. ") The r.al property located In thl Commonwealth of Penn.ylyanla should be (1) (2) (Jl d..crlb.d by lot and block number# .treet and street number, together with DEPARTlllENT a gen.ral de.crlptlon of the property, with a ref.rence to the record of the ASSESSED VALUE VALUATION conveyance by which the d.cedent took title; If a form .tate number of a- FaR YEAR OF ESTllllA TED CAUTION cr..; also .tot.ment of mortgoge encumbrance. upon each parcel at death of decedent. Taxe., a.....m.nhlr accrued Int.re.t on mortgage., etc.,ate DECEDENT'S lllARKET VALUE (Da nat write to be lI,ted on Schedule uFu and mu.t not be deducted from thl. .chedule. DEATH In thl. .pace) ~ NONE Insert this total opposite "real property", Schedule "A" in the X X X X X "As Reported" column on the lost poge of this return. ~ In the case of securities of close or family corporations, the values reported are as far as possible substantiated by financial statements of the corporations, showing the assets and liabilities thereof as of the dRte of death. The schedule also sets forth the interest of decedent at the time of death In any co-partnership or business, and in support of the value of such interest there is Annexed to said schedule, financial statements showing the assets and liabilities of said co-partnership or Qusiness. A copy or the co-partnership agreement, (if oral, a statement setting forth the nature of tne agreement) together with a statement setting forth the character of the business, its location, and such other facts pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest therein must be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transfers of property, real or personal, within two years of decedent's death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or after death, said schedule sets forth the nature and value of such propert)', to whom transferred, the relationship of the transferees to the decedent, the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take effect in possession or enjo)~ent at or after death, there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating the trust. Ther'~ is 'also set forth in said schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by virtue of the exercise by decedent, ~ither individually, orjolntly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another, with a copy of the instrmnent creating such power attached to the schedule. That Schedule 0 attached hereto and made part hereof sets forth the nRmes and addresses of all persons beneficially interested in this estate at the time of decedent's death, the nature of their res- pective interests, their relationship, if any, to the decedent, together with the ages at the time of decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also contains a statement showing which of the beneficiaries named 1n the decedent's will, if any, died prior to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary. That S~hedule E attached hereto and made a part hereof sets forth all property, real and per- sonal, owned b)' the decedent jointly with another or others, including intangible, standing in the name of the decedent Rnd others, plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty, plus the name, Rddress and relationship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid; family exen~tion, where applicable; costs of administration of this estate; counsel fees and fudiciary's commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts and claims owing anrl unpaid at time of death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section 651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga- tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest, that if the a.mount actually paid in settlement of any fee, commission or debt is less than the estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules "A", "a", "e", "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this ................................. 6~~~.~-------- .....Qn.!?.9.!>l!i.LAy..'?..!:!lJ.?.............._......_..................._.. (Street N umbe1') ........~.~.I?.?..Y.~fiJ.L..~.J.I._....~.?.9..~.~.................................... (City or Town and St4te) NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or f'amlly corporations or an interest in any co-partnership or business) that the data and statements required under the paragraph above relating to Schedule ~B" are attached. Also make certain that column #1 in the "Summaryft has been properly completed as above-directed. .........._....??!:Iq/~a: ~:.~..;MCJ,y'..7.w..... 19......?.~.. ..............~~ARYPD9n~.r/~... Mv Com:ni!;!M LX;')!flt :';ril 9. 1981 Ua;li,~ur::( PI\ V..u~h;n COllnl"il . RCC...U't4-07!ll . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS MAY 2 5 19 COUNTY OF CUMBERIAND RESIDENT DECEDENT IMPDRTANT, This return mUlt be completed in detail and filed in duplicate. with all attached, with the Re,isler of Wills of the County where decedent residedj Return is due within nine months after date of death. unless an extension is &ranted by the Secretary of Re.enue. (Section 703, of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF GERTRUDE D. JACOBS (STATE FULL NAME OF DECEDENT) } AFFIDAVIT OF EXECUTOR ~ County Lat. of Cumberland Pennsylvania } Dauphin ~ .., JOHN DRESS JACOBS Executor Stat. of County of ~ of the ..tat. of the above-named decedent being duly swam, deposeS and sayS Decedent died February 23, (MONTH) Nome and addr... of ottorney or } other authorized r.pr....ntoliv. to whom all corr..pondence .hould be mailed. . 19-...Z.!L. t..lol. leaving a lo.t will, copy of which I. hereto attaChed.} (YEAR) (DAY) Ph1l1p J. Murren, Ball & Skelly, p. O. Box 1108, Harrisburg, PA 17108 That as such Executor deponent is familiar with the affairs of said estate and the property constituting \ EXECUTOR-ADMINIST RA TOR) the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another; or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following: - NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT RENTED A S."FE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT That 'the contents of said safe deposit box or boxes are itemized under Schedules wi th the exception' of the following, for the reasons hereinafter set forth: of this return, That Scherlule A attached hereto and made part hereof sets forth fully and in de,tail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the colunms provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of decedent. That Scherlule B attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases;~ all bonds, posta'} savings, treasW'y certificates or notes and other evidence of indebtedness of the United States to the de. cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision there or, or or any foreign country, which are owned at the time of death; all wearing apparel, jewelry, si\verware, pictures, books, works of art, household rurniture, borses, carriages, automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, .Ieft by decedent, together with the fairly estimated market value thereuf; all bonds and mortgages held by decedent and of all claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face value and estimated fair market value thereof, and if such estimated fair-market value be less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's death and other investment securilies owned by the decedent at the time of death, with the.market value there. of at such time.