HomeMy WebLinkAbout08-28-15 ex�oani 1505610143
_J REV-1500 nM OFFICIALUSEONLY
Y1
PADeparlmentofRevenue p¢nnsylvania co�n�rcoae vea� rnenumee.
Bureau of Indlvitlual Taxes �F°"^'T"•0°"�"°u°F
ao eox2eosai INHERITANCE TAX RETURN y 1 15 0 6 5 4
Harriseurg.vnn128-osOt RESIDENTDECEDENT
ENTER OECEDENT INFORMATION BELOW
Social5ecunlyNumber Da[eofDeath Da�eofBitlh
05 27 2015 04 28 1926
Decetlenfs Lasl Name Suffix Decetlenfs Firs�Name MI
JACOHS IRENE
(Ii Applicable)Ente�Surviving Spouse's Information Below
Spouse's Last Nam¢ Suffix Spouse's Firs�Name MI
Spouse's Social Securiry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW RemainCer aewm(Da�e M oeaN
� 1. OnginalReWm ❑ 2. SupplemenlalReWm ❑ 3 pnor�ol2-13E2)
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i
CORFESVON�ENT-THIS SELTION MUST BE COMPLETED.ALL LORRESPONDENCE AND CONFIOENTIRL TNt INFORMATION SHOULO BE DIREGTED TO:
Name Uaylime Telephone Number
WILLIAM R BUNT ESQ 717 582 8195
REGIS�R OF WILLSFSE ONL�
C � � � f*1
� i'l
First Line of Mtlress � � c_ '� O
f t �_ � G-J :o ':.
109 S CARLISLE STREET . - N
w
Secontl Line of Rddress . ,.��
PO BOX 336 � "
DATE FILED� '�
CityorPoatOlfice Stata ZIPCotle r.. -_
m
NEW BLOOMFIELD PA 17068 � �� ''�� �
C'J -�1
o spontlent'se-mailaddress: W�b�Pa.�B[
Unslru¢.ca1tIM0 iom�pl . I�lare(ionojeexami kner5ihsnmepersonalaepresenlallvelsbaselEonntllllmo�imation'o%wM1wicnprepererlM1xsenyknovAeE9�Ilet.
i rr Preparer
SIGNS OFGE ONRE N519LEPoRFlLINGRENRH O TE
Donald A Jacobs ZG��
oaess
37 rly oad, EllioNsbur P -17024
SIGNAiVREOFPREPA R FEGflESEMATIVE
William R Bunt Esq
nooaess
Law Office o illiam R. Bunt
109 S. Carlisle Street, New Bloomfield, PA 17068
Side 1
L 15U5610143 1505610143 � �
ADDITIONAL Personal Representatives
Jacobs, Irene S127/2015
Under penalties of perjury, the undersigned declare that they have examined this return,
including accompanying schedules and statements, and to the best of their knowledge and
belief, it is true, correct and complete. /
2 Signalure �
�
Name Samuel M.Jacobs
Adtlress 402 Mumper Lane
Ciry, State,zip Dillsburg PA 17019
Date
3 Signamre
Name
Atldress
Ciry,Stah,Zip
Date
4 Slgnature
Name
Address:
Ciry, State,Zip
Date
5 Signature
Name
Atldress:
Ciry, SWte,Zip
Date
6 Signature
Name
Address:
Ciry, Slate,Zip
Date
J 1505610243
REV-1500 EX
�eceEenfs Social Securiry Number
o�aamaHa��. JACOBS, IRENE
RECAPITULATION � � � � �
1. RealEsfate(ScheduleA)..... ........__. ..........._. ........__.. 1.
2. S�ocksandBontls(SchetluleB) .......___ ____. 2. 559 � 500 . 21
.........__.
3. ClosetyHeltlCorpora�ion.PartnershiporSole-Propnetorship(SchetluleC)......._. 3.
4. Mort9a9es8No�esReceiva�le(Schedule0l.....________........_____..........____. <.
5. Cas�,Bank Deposils&Miscellaneous Persanal Property(Schetlule E).............._ 5. 5 5 , 4 0 3 . 5 2
6. Join�ly Ownetl Properry(Schetlule F) ❑ Separate Billing Requestetl.......___ 6. 9 0 , 3 4 4 . 4 2
]. Inter-Vivos Transfers&Miscellaneous Non-Pmba�e Property 4 0 4 � 2 5 5 . 8 1
(Sche�uleG) ❑ Separa�eBillingReqvestetl______. �.
e. Total Gross Aasels potal Linw t throu9�])__..______........______.........._____ e. 1 . 1 0 9 . 5 0 3 . 9 6
9. FuneralExpensesantlAtlminisUa[iveCosts�Sche4uleH�................._________.. 9. � � 29 • � 67 . 06�
10. DebtsofDecetlent,MotlgageLiabilitiesandLiens(Schedulel)_____.__.............. 10. 37 . 10
11. Total Detluctlona Qotal Lines 9 antl 10)._..... _____._ ��, Z 9 , 8 0 4 . 1 6
12. Ne[ValueofESWle(LineBminusLinell)____..............______....................___. 12. 1 . 079 . 699 . 80
�3. ChantableantlGovemmentalBequestsl5ec9113Tmstsforwhic�
an eleGion to tax has not been matle(Schetlule J)___._.............__________....... 13.
14. Ne[Value Svb�ect ro Taz(Line 12 minus Line 13)....._..___....................._..__... 14. 1 , 0 7 9 , 6 9 9 . 8 0
TAX GOMPUTATION-SEE INSTRUGTIONS FOR APPLICABLE RATES
15. Amount ot Llne 14 tarable
a��he spousal Wx rate,or
tronsfers under Sen 9116
(aHt2)x.00 15.
16. Amounl of Line 1 a�axable �6. 4 8 , 5 8 6 . 4 9
at lineai rate X .045 1 , 0 7 9 � 6 9 9 . 8 0
1]. AmountofLinel4tarable
atsiElingra�eX .t2 ��'
18. Amoun[of Line 14 tasable
atcollateralrateX .15 18'
�e. ruc oue ........ .. .....___. .____ .._....___ ie. 4 8 . 5 S 6 . 4 9
20. FILLINTHEOVALIFYOUAREREOUESTINGAREFUNDOFANOVERPAYMENT. ❑
Side 2
L 1505610243 15�5610243 J
REV-1500EXPa9e3 FileNumber 21 - 15 - 0654
DecedenYs Complete Address:
�ENT' AM
Jacobs, Irene _ _ ._ . .
STREETADDRE55 � �
4905 Trindle Road _ _
CITV � . _. . . .��. .. . STATE —._. .LP
Mechanicsburg PA 77050
Tax Payments and Cradits:
1. iaxoue(Page2,Line19) 11) .48,586.49
2. Cretlits/Paymen�s
A, PnorPaymen�s 46,000.00
B. Discount 2�421.05
TotalCretlps�A �e) (2) 48,421.05
3- mterest �3) 0.00
q. Ii Line 2 is grea�er lhan Line 1 �Line 3,enter the tliHerence. This Is t�e OVERPAVMENi (4) _
CM1eck boz on Page 2,Lina 20 to reques[a refuntl
5. It Line 1 +Line 3 is grea�er I�an Line 2,enterttie tliflerence. Thls is ihe TA%DUE (5) _ �s$.44
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
L �idCecetlentmakeatransferantl'. Yes No
a. relain0eusearincomeofiheP�Perty[rdnsterteB ...____..... __._........ .........._._ .... ,x.
b. retaint�enghtrotlesignatewhoshallusethepropertytransfemetloritsincome;.....__..................____. �'�` �z'�.
c. retainareversionaryinterestoc. ... _........... . ......___..... ..._............. .......___. _� 'x
tl. raceive�M1epromsePorlifeofei�M1erpayments,benefl�sorcare? ........_ ......_.. . �i �x
2. If tleath occurretl after Dec. 12. 1982. tlitl tlecetlent transfer pmperty wi[�in ane year of deat� wi�hout
receivingatle9ua�econsitleratlon? _........... __........__ .__...... _._............. x. J
3. DitltlecetleMownan"intms�tof orpayableupontleathbankaccoun�orsecu�ityathisorhertleat�?..___. _ LI
4. Ditl tlecetlenlown an intlividual retiremenl accoun�,annuity,or o�her non-pm�ate propetly whlch
containsabenefidarytlesignationv __...___. ___..... ............... ._............_. . i'. ..J
IF THE ANSWER TO ANY OF THE ABOVE OUESTION515 YES,YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
Por tlales of tleaM on or afler July 1.1994 antl before Jan.1,1995,ihe tax rate imposetl on ihe net value of Uansfers to or(or the use of t�e surviving
spousels 3 percent�/2 P.S.§9118(a)(1.1)Q)].
For tla�es ot tlea�h on or after January 1,1995,ihe tax rate imposed on Me net value of Vansfers�o or for ihe use of the surviving spouse is 0 percen�
�12P.5.§9118�a)(1.1)(iij]. Thesta�u�etloesmtexemp�aVansfertoasunivingspousefrom�ax,antlUestaW�oryrequiremenlsfortlisclosureof
assets and filing a tax retum are still applica�le even if t�e surviving spouse is the only beneficiary.
For dates of tlea�h on or aker July 1,2000:
•The tax ra�e imposetl on ihe nel value of transfers Gam a tleceasetl child 21 years of a9e or younger at tlea�h lo or for the use oi a naWral parent,an
atloptive paren�,or a stepparent of Ne chi10 is 0 percent[]2 P.S.§9116(a)(j 2J].
•The lax rate imposed on ihe net value of Vans(ers�o or(or Ihe use of��e tlecetlenfs lineal bene(ciaries is 4S percen�,except as noteG in
�]2 P.S.§9116(a)(1)�.
•Thetaxrateimpasetlonlhenetvalueo(Vansferstoorforiheuseofihedecetlenfssiblingsis72percent[12PS.§9116 a)(13). A
sibling is defnetl onder Sec�ion 9102,as an intlivitlual who has at leas�one parent in common wM t�e decedenl,wfiether y�loo o�atlop�ion.
PEV-0WJE%��6M)
� SCHEDULE B
��� STOCKS 8 BONDS �.
._ . �..— __.. _ .—. . _ . — ._. —. — .
— � —�� - � i FILE NUMBER
ESTATEOF Jacobs, lrene 21 - 15-0654
NI propertyjointly-ownetl with ripht ol survivorahip mus[be tlisclased on Schedule F.
ITEM � DESCRIPTION � UNIT VALUE ��, VALUE AT DATE OF
NUMBER . OEATH
1 PNC Investment account no 005956856 � � 103.542.37
iSee attached letter
2 I Merrill Lynch Wealth Management account no. 872-86364 I 221,395.67
See attached statemenL �
3 Merrill Lynch W ealth Management account no. 8 72-3861 6 I 234,56217
�, See attached statement �
� TOTAL(Nso anter on line 2, Recapitulation) I 559,500.21
��.,g;y,� pennsylvania SCHEDULE E
1.►1 °�°"°'"`"�°`R`�E"�E CASH, BANK DEPOSITS AND MISC. I
INMERITRNCE TM RETVPN
aesioe��oeceoe�r PERSONAL PROPERTY I
— — —� — . . — --� L_ __ .. . —.. --
- �- � �-�� FILENUMBER
ESTATEOF Jacobs, lrene .2� - i5-ossa
Include the proceeds of liligalion and the dale Ihe proceeds were received by lhe estate. PJI propertyjolntly-owned with the righl of
survivorship musl be disclosed on schedule F.
ITEM � DESCRIPTION VALUE AT DATE OF
NUMBER __ DEATH
— — _ _
1 Jewerlry-see attached appreisal � � 15,336.42
2 PNC Bank-savings accouN no. 5004795827 24.940.04
See atlached letter
3 Nationwide-see at[ached letter 15,127.06
_ . _ —_ . . _ - _
� � TOTAL(Also enter on Lina 5, Recapitulation) 55,403.52
nev.�we eu�m.io� I
�:;;:;� pennsylvania . SCHEDULE F
�,� CEGPR�MENTOFREVENOE
���Ea�ra�E��aE*�R� JOINTLY-OWNED PROPERTY
aEsioENroecEOErvr
ESTATE OF � � � � ,FILE NUMBER
Jacobs, Irene '� 21 - 15-0654
If an asset was matle joint wilhln one year ot the tlecedenPs tlate o!tleath, it must be reportetl on schetlule G. �
SURVIVINGJOMTTENANT(S)NAME A��RE55 � RELATIONSHIPTOOECEDENT
Samuel M.Jacobs 402 Mumper Lane son � �
A Dillsburg, PA 17019
Donald L. Jacobs � 3748 Erly Road son �
B Elliottsburg, PA 17024
JOINTLYOWNEDPROPERTY—es�ayQantlen�0 oau�mbeOr.Attachtlaetlaforonlluheltl ea�DALUEOFA�S�S z IINT;00%I
ITEM��ETTER DATE I qr [iT 0 k DECD'S oarEoroEnrN
FOR JOINT�� MADE vnwe or
NUMBER �Yi g I i y- oECEOErrt's r�rEREs�
TENANT JOINT _ —
– - � � 100.02
1 A, B � O6127/2014 ' Welis Far o account no. zxzxxx5665 ,
ISee aQached statement '
2 A, B O6/27/2014 Wells Fargo account no. xxxxxxxxx8804 �� 9,392.�5 100% 9,39275
See attached statement ���� �
3 �, A, B 'I O6/27/2014 Wells Fargo account no. xzxxxxxxx5648 eo,e5ts5 100%I� 80,851.65
� , I See attached slatement �
II . . _ . — . _ . ... .. _ __
� �� TOTAL�Also enler on line 6, RecapiWlalion) 90,344.42
IAST WILL AND TESTAMENT
OF " ,�,
— c � ' n
r- T L � n
IRENE JACOBS =' �, L '��: `�
.-� -,i
�
T i
I, Irene Jacobs, of Upper Allen Township, Cumbedand Coenly.PEnnS�Ivania;�ISeing
w ��
of sound mind, memory and understanding, do hereby declare this to be rt�lastM�l and
Testament, revoking all fortner wills or writings in the nature thereof and any codicils
thereto made.
FIRST: I direct my hereinafter named Executor or altemate Co-Executors, as
the case may be, to pay all of my just debts, funerel e�enses, costs of administration and
inherRance taxes out of the corpus of my estate as soon after my decease as is practica6le
to do so.
SECOND: I give, bequeath and devise all oi my estate, real, personal and mixed
and wheresoever situate unto my husband, Abraham Jacobs.
� THIRD: In the event that my husband, Abraham Jacobs, predeceases my
�
� ' decease, then and in that event, I give, bequeath and devise all of my estate, real,
�
personal and mixed and wheresoever situate unto my iwo sons, Donald A. Jacobs and
Samuel M. Jacobs, in equal shares, share and share alike.
In the event that either of my children above named predecease my decease,
leaving a child or children to survive the same, then and in that event, I give, bequeath and
WILLIAM R. BIIM
cNmsrni�,caossea devise the share of said deceased child's share of my estate unto the child or children of
AIIO�rvEVS Ai tqW
�ovs.co���mee, said deceased child, in equal shares, share and share alike.
rvaw�aamnaid.va.
i�oea
iel.pl�$02-Bro5
FA%pl])581-]51�
In the event that either of my children above named predecease my decease, failing
to leave a child to survive the same, then and in that event, I give, bequeath and devise the
share of said deceased child's share of my estate unto my remaining child.
FOURTH: Any person who shall have died within thirty (30) days of my death, or
under such circumstances that the order of our deaths cannot be established 6y proof,
shall be deemed to have predeceased me.
FIFTH: I name, constitute and appoint my husband, Abraham Jacobs, as the
Executor of this my Last W ill and Testament.
In the event of the renunciation, death, resignation or inability of my husband,
Abraham Jacobs, to act for any reason whatsoever, as the Executor of my estate, then and
in that event, I name, constitute and appoint my sons, Donald A. Jacobs and Samuel M.
Jacobs, as the altemate Co-Executors of this my Last Will and Testament.
My Executor or altemate Co-Executors, as the case may be, are hereby excused
trom the posting of any bond or security notwithstanding any provisions of the law to the
contrary.
IN W ITNESS W HEREOF, I have he�eunto set my hand and seal to this my Last W ill
and Testament this 30`" day ot August, 2001.
%.
�/�o„<,e� X4'/b�d6EAL)
�
WILLIAM R. BUNT
CHRYSiALL.PROSSER
AiIORNFVS Ai LAW
1 W 5.Caillfle Stteet
„aw�m��d.Po. Page 2 of 4 pages
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Signed, sealed, published and declared by the above named Testatrix, as and for
her Last W ill and Testament, in our presence, who, in her presence, at her request and in
the presence of each other, have hereunto set our names as attesting witnesses.
� .s� ��—
WILLIAM R. BUM
CHRVSiAI L PROSSER
AIIORNEVS Ai tAW
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new eaom��,aia.co. 9 P 9
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ACKNOWLEDGMENT AND AFFIDAVIT
Commonwealth of Pennsylvania :
SS
County of Perry .
We, Irene Jacobs, the Testatrix in, and William R. Bunt, Esquire and Kim M. Smith,
the witnesses to the Last W ill and Testament of Irene Jacobs, the atlached or foregoing
instrument, who have signed the instrument, having been du�y qualified according to law
do depose and say:
(a) that I, Irene Jacobs, the Testatrix do hereby acknowledge that I signed
and executed the instrument as my Last W ill and Testament, and that I signed it willingly
and as my free and voluntary act for the purposes therein expressed.
(b) that we, William R. Bunt, Esquire and Kim M. Smith, the witnesses,
were present and saw the Testatrix sign and execute the instrument as her Last W ill and
Testament; that the Testatrix signed willingly and executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the will as a witness; and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind �n�r no onstraini or undue influence.
� �1�r�
Itene Jaco s, Testatri
William R. Bunt, Esquir Witness
�� ���'-�
KipTi M. Smith, i[ness
Swom to or aNirmed and acknowledged
before me this 30'" day of August, 2001.
WILLIAM R. BUNi � �
CHRVSiAL L PROSSER
ArtORNEVS Ai lAW
IOOS.Ca�i9e51ree1 �M��
�aw ewomnaa.Po. "��„'�w,�}.��,� Page 4 of 4 pages
noca �dmin4n(�a lwin a.1006
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fA%()t]150'1-15'll
��ry ie, zois
Emie Irwin
ernie.irainGDonc com
RE: 0059b6856/Jacobs-INDIVIDUAL
DearErnie:
The value ot the above-referencetl account on May 27, 2015 was:
. i . ... .. ��I�� .. . . �� DOD Prfw DOD YNw j
_ _ — —
�_.�_ � , , . ._
'� 1.000 FEDERA7ED PRIME CASH OBLIGATIONS CL SS '� QPRXp i103 542 370 $ 103,542.37
- —_ . ._ _—__ — .�—�.. . _
� � �� . . . � $ 103,542.37
— _ .
_ . .-� � __ _�—__ _ . .
''� Grentl Totsl(Market Value+pccrued Interest� _ '�, E 103,542.37
' Money Market Funds-Closing price on Ihe date of death or the last business day prior to death.
N you have any questions, please contact ISG at 800-622-708fi.
Sincerely,
PNC Investments, LLC.
Brokerage Operations Service&Support
AE/AO
7he summaries, prices,quotes and/or sGtlstics contalned herein have been obtained from sources believeU to
be reliable but are not necessarily complete and cannot be guaranteetl. They are providetl for Informatlonal
purposes only. Past peNormance tloes not guarentee future rasulfs.
1of1
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� eweCers
5255 Simpson Ferry Rd. Mechanicsburg, PA 17050
(7ll) 766-7771 david@hendersonjewelers.com
Estate Appraisal
Prepared for: The Estate of Irene]acobs Uo�m lambs
402 Mumper Lane
Dillsburg,PA 17019
This report was prepared]une 17, 2015.
The price of inetals is as follows: gold $1,176.30 per ounce
platlnum $1,073.75 per oun[e
palladium $728.50 per ounce
siNer$16.11 per ounce
The folbwing equipment was used in preparinq this report:
Binocular Mittoscope or minimum SO�c magnifier
Dial Gauge
Table Gauge
Electronic Scale
Refiactometer
Polariscope
Color Master Stones
Mechaniral Diamond Balance
Long Wave Ultraviolet
Electronic Gold Tester or Touth Stone and Acids -----_. .
_
The gemologis[was David A. Henderson, Gemol i of t� he ica tpE�of qmen , m@r 35
This appraisal report was prepared for � gs on . . � . ` � ���
Fair market values based on recent auctlon rices w-etli r a r- `�
P -prfces for i e items were used ro -�-.�
dMermine the values given.The conditlon of gems and mountings arid presen[demand for such items was
factored in when arriving at these values.
Triis jewelry appraisal dces no[represent an offer to buy rror dces Henderson &Co. ]ewelers have a stake in
these items.
Item #1
GOLD TYVISTED BANGLE BRACELEi
This yellow gold bracelet is stamped 18 ka2t. Six twis[ed tubes formed[ogether wlth a twis[make up
Me body of this banqle. Caps, hinge and hidden [ongue dasp with safery complete Me D�e.The
diameter is 914 mm.The condition of the bangle was excellent at time of e�camination.TOWI weight of
the bangle is 18.1 dwt. / 28.2 gr
ES7ATE VALUE..................................................$577.00
Item 7t2
CHARM BRACELEf WITH 23 CHARMS
The heavy double link charm bracelet chain is sterling, as are 17 of the charms. Four of the remaining
charms are 14 karat yellow gold, 1 is gold filled (200 pin), and 1 (nugget) is of undetermined high karat.
Total weight of the bracelet with diarms is 58.6 dwt. / 91.4 gr. (approx gold weight is 3.5 dwt J
ESiATE VALUE........................................$377.00
Item #3
MDQCAN 50 PESO COIN NECKLACE
The coin weighs a total of 41.67 g2ms, 37.5 gr. i5 pure gold 4.17 gr. alloy. The 18 karat(stamped)
yelbw gWd frame weighs 20.73 gr. The min is suspended on a heary weight ornate gold chain in 18
karat yellow gold.The chain weighs 83 gr.
ESTA7E VALUE..................................$9146.00
Item #4
EIGHT$TERLiNG AND TURQUOISE RINGS
Most of these rings are stamped with the makers mark, wme are not. AI�are fairly common simple
designs.All are smaller designs.
ESTATE VALUE.....................................................$250.00
Item #5
A. TURQUOISE AND SILVER BANGLE
This bangle consists of three half round ands of silver forming a°C"cuff. A larqe freeform bezel
set turquoise accented witt�a feather and scrolls on a 50 mm x 90 mm plate completes the
bangle.
B. THREE STStAND LIQUID SILVER AND TURQUOISE NUGGET NECKLACE
C. HAND MADE SILVER BEAD NECKLACE W1TH 5 TURQUOISE DROPS
Three sizes of rounded beads and long tapered beads make up this 18 3/a inch long nxklace
D. SHELL AND MULTI STONE FElISH NECICLACE
Silver caps and multi tone fetishes are sVung on a strand of thin shell seed beads. Total lergth is
28 (nches.
ESTATE VALUE............................................$300.00 for the lot
Item 1k6
A. 1944 10 karat(stamped) yellow gold dass ring. Wei9ht 3J dwt./ 5.8 gr.
ESTA7E VALUE................................................$86.51
B. 1942 10 karat(stdmped)yel�ow gold class ring. Wilkes-Barre. Weight 5.6 dwt. / 8.8 gr,
ESiATE VALUE..............................................$130.91
C. SMOKEY QUARTZ RING
A pale grey-brown smoky quartz, oval faceted is held by four prongs in this by-pass style ring.
The mounting was cast in 14 karat(stamped)yellow gold. Condi[ion of the n�g was good at time
of examination (Abrasion of the stone from wear is visible).Total weight of the ttrountlnq and
gem is 3.8 dwt./ 5.9 gr.
ESTATE VALUE.....................................3135.00
D, SMOKY QUARTZ RING
This ring has a pale grey-brown smoky quar� held by four prongs and surrounded by a Flat rope
design. Conditlon of the ring was good a[time of examinatlon.To�l weight of the moun[ing and
gem is 4.2 dw[. /6.5 gr.
ESfATE VALUE........................................$145.00
Item #7
A. PEARL NECKLACE
One endless rope of akoya cultured pearls, knotbed on silk. The pearls are 7 to 7.5 mm, very
good luster, lightly spotted and dark cream rose'color.
The mpe is 33 inches long.
ESTATE VALUE............................................$225.00
B. FRESH WATER PEARL RING
7riis wire wrap look ring in 14 karat(stamped)yeAow gold is set with a baroque fresh water
cultured pearl. The mountl�g was cast and the pearl sFrows some abrasion.
ESTAIE VAUIE.............................................$75.00
C. FRESH WATER PE4RL EAR RINGS
Three fresh water cultured peads in natural wlors are set In each of tfiese light weight ear clips.
The mountings are yellow gold stamped 14 karat.
ESTATE VALUE....................................575.00
Item #8
DIAMOND AND RUBY RING
This ring was Wst in 18 karat (sUmped) whfte gold. A modifled Thai Princess style ring set with 9
marquise rubies and 16 round diamonds. All are prong set. Cqndkion of the ring was fair at time of
�aminatlon (Two diamonds are chipped, some rubies are abraded and several prongs are thin).
RUBIES: Nine 6enuine Rubies, Marquise Cut(heat treated)
Dimensions: 1 -7.5 mm x 3.5 mm
8-Sto5.5mmz3mm
Co�ar: medium light pinkish red
Clariry: moderate m heavy irxlusions
DIAMONDS: Sixteen Round BrilliaM Cut
Diameters and Weights as follows
8- 2.5 mm, .O6 wrat each, .q8 ct. t.w.
8- 3 mm, .1�ct. ea.. .80 ct. t.w.
Total diamond weight is approxima[ely 1.28 �ardts.
Clariry: I,to Iz
Color: I-J
ESTA7E VALUE..........................................$500.00
Item #9
DIAMOND SOLITAIRE RING
This two tone mountlng features a single round diamorrd in a whfte gold four prong setting and a wide
yellow gold shank. The shank is wide and fiat measuring up to 7.7 mm wide at the top and 2.3 mm thick.
At the back Me shank tapers to 3.7�mm wide and .9 mm thick. Condition of Me rirg was good at time of
euamination.Total weight of the mounting and diamond is 3.8 dwt./ 6.0 gr.
DIAMOND: One Round Brilliant Cut Genuine Diamond
Diameter: 8.05 mm to 8.12 mm, averaqe 6.085 mm
Depth: approximately 4.8 mm, 59.5°h
Weight: 1.91 carat by formula
Table: 5.1 mm, 63%
Crown: 1 mm, 12.4°h
Pavilion: 94.5%
Clariry: Wsi
Color: G-H
CommenCs: The girdle of this diamond is faceted and medium to thick.The culet is very small. Symmetry
and polish are very good. Some abrasion is visible under magnifcation.Two naturals are visible as set.
ESTATE VALUE.....................................................$6,500.00
Item #10
DIAMOND SOLI"fAIRE RING AND ENHANCER
Solitaire Ring
The solitaire is a mid 20�'tenNry design with an illusion head holdirg the round diamond.The ring has a
medium heavy rounded shank.This white gold ring is stamped 14 karat. Conditlon of the ring was good
at time of ezaminatlon (The diamond is bose in the settin9).Total weight W[he mountlng and diamond
is 1J dwt. / 2.6 gr.
DIAMOND: One Round Brilliant Cut Genuine DlamorM
Diameter: 4.4 mm
Weight: 33 wrats approximately
Clarity: VSi
Cobr. H
Enhancer Ring
This double shank ring was cast in 14 karat white gold (stamped). Fourteen round diamonds are prong
set in the ring. 5even in each side of the ring forming a chevron [o wrap aiound the engagement nng.
Condition of the ring was good at time of e�camination. Total weight of the mounting and diartwnds is 3.4
dwt./ 5.4 gr.
Diamonds: Fourteen Round Bnlliant Cut Diamonds
Diameter: 2.3 to 2.5 mm
Weight: .04 to .06 wrat each, approximately .60 c[. t.w.
Clariry: SI to Ii
Color: H-I
EESrATE VALUE...............................................$500.00
Item #11
LADY'S SEIKO U15ALLE WATCH
lasalle is an obsole[e li� rw longer produced by Seiko. The watch is yelbw base metal with a quaitr
movement.
ESTATE VALUE........................................$75.00
item u12
A. THIN OMEGA NECKLACE WITH NJISTED FRONT
The ne[klace is mnstructed from 14 karat(stamped) yelbw gold.The wid[h of the nedclace
is 2.54 mm and R is 15 V: inches long.The front 6 Yz inches consists of Mree interwoven
strands.To41 weight ot the netklate is 16 dvrt. / 24.9 gr.
ESTATE VALUE............................................$500.00
B. MATCHING (above nxklace)THREE STRAND BRACELET
One 7 �/. inch long bracelet to match the above necklace.Total weight 11.9 dwt. / 16.5 gr.
ESTATE VALUE............................................$375.00
C. HINGED BANGLE
This bracelet was mn5[ructed from three gold tu6es inter[wined. CondRion of the bratelet is
fair.Total weyht of the bangle is 5.2 dw[. / 8.0 gr.
ES7ATE VALUE........................................5164.00
D. TRADITfONAL HINGED BANGLE
This i5 a traditlonal engraved 8.74 mm wide bangle in 14 karat yellow gold. Condition of
bangle at time of ezaminatlon was fair.Total weight of the bangle is 6.4 dwt. ) 10 gr.
ESTATE VALUE.........................................$200.00
A:� . rU �7 _. , ,'6' 4:. 'CE4 °. I
� � ! V L
August '.1, 2015
w'iUism R Bunt
Attomev a' Law
Y 0 ➢os 335
]09 S Carlisle 9t
New Bloomfleid, PA 19068
RE: Irene B Jacobs
SSN: 265-20-4097
DOD: OS-27.20]5
�ear Mr. Hunt:
In response to your �equest foc Date of Deafh (DOD)balauce6 fo�the eustomer norcd above, our
��:o�ds show the following:
5avipg5 Account �
account#5004795827 Established: O1-18-2006
IRENEBJACOBS
DOD balance: $ L1,939.50 t 054 accmed i�terest
I�teres[paid 01-07-2015 thru OS-27-2075 $ 627 Y'TD
Investment Acwunt
The decedent maintained Investment Account d 5956656 - For fiirther info[ma6oq you may call Ne
B�okerage�Deparrment at 1-500-7GLF111.
Pleue note th¢[[his offme provides date of death 6alences for deposi: ecwunts (IItP.s, CDs, Chxkmg nnd
Savings). W e do uot proeess anp fioanciel hans.ctioos or proiide statemen4. If you oeeS assistance wi@i
a�ry of these items,please call 7-888-PNC-HANK {1-6 8 8-7 6 222fi5) or smp by yow locvl PNC Bank braneh
ott7ce.
Sinceeely,
t��ational Financial Services Centex
PVC Bazilc, N.A.
'vtember FDIC
Page 1 of 2
A��_. '7. 2)'; 2�� ' 2°N OS 6ANK kc p'oc ^<
■S`��� �8t19YiW��E'
� is on your sicie
�
DONALD A JAC095 -� August 1>, 2015
� REFERENCE NUMBER:00613865
Dea�M�,lacrobs:
7hank you for confacting Natlonwide Funds.We understand thls Is a dlfficult tlme for you and are sorry For
yourloss.
The following table shows the value of the account as of the close of buslness on May 27, 2015;
DatC�. " �• iN,ymherp(,Sh'B[es :.Net?92setVdl�la ,-�ipta V,�1ue�`�;§
OS/27/2015 1,549.904 $9•76 515,127,06
Please wnslder thls letter the wrltten conFlrm2tlon �hat was req�ested.
If you need additional assistance, please feel (ree to call one of our shareholder servlces representatives.7hey
are available Monday through Frlday Gom 9 a.m. to 8 p.m. ET at 800�846-0920.
�—S7ite"1933"NattbFWi71€F�7FiNshasgOM€d315aY€RSrdeTsthYo3ghall"t�p€FSF�6P56fttfC7�frb n�nFs�SH---.—
circumstances.We are dedlcared lo providingthe long-term inVes[ment solutlons and qualiry servlce you
need as you work toward your flnanclal goals. -
Slncerely,
�oCl mcl�ok,.�r.l�
Andl McConnlck
NaUonWldePunds �
CC; NATIONWIOE SECURITIES lLC �
NnliomviJe Funds Aistri6uleA by Nnl�om��lde Pnnil Dl:tr@utoCs LLC,memberFINRA,KingoCPnusin,Pn.
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Fax Server 8/17/2015 4 : 4Z :29 PM PAGE 2/002 Fax Server
♦
� a @
�� � ,�`�..,.�i.,-
Augus[ 10, 2015
Donald A Jacobs
Fax Number-(717)582-7150
Voya Insurance and Annuity Compa¢y
Decedenr. Lene Jacobs
Contrac[Number: I105576-OW
Claim Code: 01010 �
Dear 7acobs,
Thank you for your recen[inquiry cegazding the annuity con[rac[listed above. Please fiud
ehe conpac[informa[ion below.
Death BeneEt Value $176,052.80 as of OS/27/2015
� If you have ques[ions regazding [Lis iuformation,please con[ac[our Cus[omer Service,
available Monday—Thursday, 830 a.m. [0 630 pm.,Eas[ern Time, and Friday, 830
a.m [0 530 p.m,Eastern Time.Call 800-366-0066 and press 3 [o identify yourself as a
beneficiary.When prompced, en[er fhe five digi[Claim Code above and press#. Your
cal! will be addressed by a claims specialisC.
Sincerely,
Cusmmer Suvicc
Armuiti¢t arc in'ueQ bY VoyaA.rwm¢e ardAruwiy CompanY(M+Momev.lAl arW 6imibund bY nirc�rcd ServicuGGC. Ba�h
ron�pmiie.r me members oJfAe VqaTMjai.dlY nfvampmiiu."
lW/VK
Fax Server 8/17/2015 4 : 37:45 PM PAGE 2/002 Fax Server
�a.����8�,<.=.
August 1Q 2015
Es[a[e of Irene Jacobs
� Atm: Donald A Jacobs,Excew�or
Fax Number-717-582-7150
Voya Insurance and An�uiry Company
Decedene Irene 7acobs
Conn'act Number: C010710-GG
Claim Code: 01010
Deaz Mr. Sacobs,
Thank you for your rzcent inquiry regazding the annuiry con[rac[lis[ed above. Please find
the confrac[infortnation beLow.
Death Benefit Value $21,677.01 as of 0527/2015
If you Lave ques[ions regazding[his iuformation,please con[act o�Customer Service,
availabte Monday—Thursday, 830 a.m. m 630 p.m.,Eastem Time, and Friday, 830
a.m. [0 5:30 p.m,Eas[ern Time.Call 8003660066 and press 3 [o identify yourself as a
beneficiary.When prompted, enter[he five digit Claim Code above and press#. Your
call will be addressed by a claims specialis[.
Sincuely,
Customer Service
nMw�iee arc i.ssued M vom lu..ance urwnruwiy eomt�y fnei Mo;ne.,rn)adeu�rib�iee by nirc«.G sem�u u.e. baeh
mmnavex re�mbers Ime✓oYaTMf�!Y 7co.,��,e..
IOOIVK Q
Fax SerVeY 8/17/2015 4 : 39:29 PM PAGE Z/002 FaX SeTveT
�� ���>��
August 10, 2015
Estate of Irene 7acobs
A[tn: Donald A Jacobs,Excecumr
Fax Number-(717)582-7150
Voya Insurance and Annuity Company
Decedent Irene7acobs
Contract Number: C039874-GG
Claim Code: 01010
Deaz Mr. Jacobs,
Thank you for your recen[inquiry regazding the annuiry cou[rac[lis[ed above. Please find .
[he contrac[informa[iou below.
Dea[h Benefit Value $40,631.50 as of 0527/2015
If you Have quesCions regarding this informa[ioq please contact our Cusromer Service,
avaitable Monday—Thursday, 830 a.m. [0 630 p.m.,Eas[ern Time, and Friday, 830
a.m. to 530 p.m.,Eas[ern Time. Call 800366-0066 and press 3 [o identify yourself as a
beneficiary.When promp[ed, en[er t6e five digit Claim Code above and press#. Your
caLL will be addressed by a claims specialis[.
Sincerely,
Cuerome[Suvice
am.Etesareu.e.edbyvop/nm.m�aardnmuiryComyrmy(Pr.rMoines,lA)andEiatributedbyDireaeEServme,r(1,C. Bo�h
�omym.ie.raremembee.e I«VOYaTMfmilY l��^W�ies."
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Fax Server 8/17/2015 4 : 40:42 PM PAGE 2/002 Fax Server
�a:f����3^`C�..
August 10, 2015
Estaee of Irene 7acobs
At[n: Donald A Jacobs,Excecu[or
Fax Number-(717)582-7150
Voya Insucance and Anuairy Company
Decedenr. Irene Iacobs
ContracWumber: C039R76-GG
Claim Code: 01010
Dear Mr.Jacobs,
Thank you for your reeen[inquiry regazding rhe annuity conL�c[listed above. PLease find
[he couvact informa[ion below.
Death BenePit Value $4Q631.50 as of OS/2"7/2015
_ If you have quesCions regazding tkiis informa[ion,please contac[our Cusromer Service,
available Monday—Thursday, 830 am. to 6:30 p.m.,Eas[ern Time,and Friday, 830
a.m. ro 530 p.m.,Fas[em Time.Call 8�0366-OD66 and press 3 [o idenflfy yourself as a
beneficiary. When prompced, entex[he fivt digi[Claim Code above aud press#. Your
call wIll be addressed by a claims specielis[.
Sincerely,
Custome[Servire
Armu�issarciumd6yVoyalnm�wc<aMArvw+ryCompmry(LktMoinet,(A)ardQisnlbwedby[NreneiSwice+LLC Bofh
companivarcmemberz 1[M1eVOYaTM7 ilY lcarpm�ies."
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Fax Server e/17/2015 4: 43:49 PM PAGE 2/002 Fax Server
�\� #'s"�^���r
�,..,.
�August 10,2015
Esta[e of Irene Jacobs � .
Atm: Donald A Sacobs, Excew[or
Fax Number-717-582-7150
Voya Insurance and Annuity Company
Decedent Irene 7acobs
Co��ac[Number: C038196-GG
Claim Code: O1010
Deaz MrJacobs,
Thaolc you for your recen[inquiry regarding the anuuity con[ract listed above. Please find
[he con¢act informa[ion bnlow.
Deatk�Benefi[Value $40,631.50 as of 0527/2015
If you have ques[ions regazding this informa[ion,please con[ac[our Cusromer Service,
available Monday—Thursday, 8:30 a.m [0 630 p.m.,Eas[em Time, and Friday, 830
a.m. [0 5:30 p.m.,Eastun Time. Call 800-366-0066 aud press 3 to identify yourself as a
beneficiary.When prompted,enter the five digit Claim Code above and press#. Your
call will be addressed by a claims specialis[.
Sincerety,
Cus[omer Suvice
Arx.nGesareiumdbyVoya/wu eaMnvwiryCwnpmiY(�+Moinu,/A)vrW6imi6weQbYnimctedSw:rez(LC. eoA
romya�iu me membe�t ol��VOY ryf^�Y 7compmiie�.••
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Fax Server e/17/2015 4 :46:53 PM PncE 2/Oo2 Fax Server
�F������:..
August 1Q 2015
Donald A Jacobs
Pax Number{7ll)582-7150
Voya Iusurance and Annuiry Company
Deceden[: IreneJacobs
Contract Numbec C039881-GG
Claim Code: 01010
Deaz Mr.Szcobs,
Thank you for your recen[inquiry regarding rhe annuity contrac[lis[ed above. Please find
Che coutracC infonna[ion below.
Death Benefic Value $40,631.50 as of OS/27/2015
If you have questions regazding this information,please contact our Customer Service,
available Monday—Thursday, 830 a.m. to 6:30 p.m.,Eascern Time, and Friday, 830
a.m. [0 530 p_m.,Fas[em Time. CaLI 800366-0066 and press 3 m iden[ify youcseLf as a
beueficiary.W6en promp[ed, en[er[he five digit Claim Code above and press#. Your
call wiLl be addressed by a claims specialis[.
Sincerely, �
Customer Service
Amvi(k.rareiuneE6yVoyaluu.m�reaMArv�uiryCompany(DUMoines,UJarW6i.rfri6uted6yDircne65ervimLLC Both
ro�ywie.are�mber,lm�Voya�7�!Y fco,�,oa,.;es...
100/VK
REVd510 E%�(W-0B)
�y;}.. pennsylvania
M�ti� P.a.ME�.oFRE�E��E SCHEDULEG
���EA�=.��E��*REr�A� INTER-VIVOS TRANSFERS 8 �
ResioF�.oECEoenr MISC. NON-PROBATE PROPERTY
_ ___
ESTATEOF JaCobs, Irene 'IFILENUMBER
, 21 - 15-0654
_ _. .. ___ _`.__.
This achedule must be comple[ed and filed if the answer[o any oi questions 7 through 4 on page 2 is yes.
ITEM� oEscniaroHorP o [n1v� � �� �'� a,rEoroEnrH �oF uc�usion TAXABLEVALUE
NUMBER Incude��enameolPe�q � .I � IImn5�0 4 eEenl '�, yq�UEOFq55ET I�TEREST (IFAPPLILPBLE)
anO�M1Btle�BMl9n51ec A� � 0Y � � dee01 es�ale. �.
. _. _ . _.— . ...—._—.._... ...N __..
1 Decedent made a gift of$14,000. in January of 2015 �, i<.000.o0 3.000.00 '�. 11,000.00
ro he son, Donald L. Jacobs �'
2 Decedent made a gift of$14,000. in January of 2015 �II ta.000.o0 3,000.00 11,000.00
to her daughter-in-law, Linda Z. Jacobs ��
3 Decedent made a gift of$14,000. in January of 2015 �<,000.00 ��. 3,000.00 11,000.00
to son, Samuel M. Jacobs '
4 Decedent made a gifl of$14,000. in January of 2015 i<,000.00 3,000.00 11,000.00
to daughter-in-law Beverly J. Jacobs '�
5 Voya annuities as per the exhibis attached hereto and I 384255.Bi 360,255.81
incorporated herein by reference thereto. Note: All i
beneficiaries were children or grandchildren. Annuiry
date of death values as per exhibits are:
$176,052.80; $21,671.01; $40,631.50; $40,631.50;
$40,631.50 and $40,631.50.
,�, __. . __ _ __... .. I '.. . .
TOTAL(Also enter on Ilne 7, Recapitulation) 404,255.81 �
REV95H E%��14Y8)
� pennsylvania l p��pp��� ry����HpQw,1
, DEGARTMENTOiREVENVE ry��pyyUrpw]GJM\D
INXERItPNCETMRETURN . �1y���C}S]I�7wLI�M1C
RESI�EM DECEOENi F1LII�I�N I�MI IYC V W I J
—� �� � � --� FILENUMBER �
ESTATE OF JaCobs, Ifene 21 -15-0654
� DecedenPs debts must be nported on 5<hedule L � .
ITEM � - � �� — �� � AMOUNT
NUMeER FUNERAL EXPENSES: DESCRIPTION —
. . — . —.___ _ -__._-
A 1 '� Malpezzi Funeral Home-funeral 12,620.14
2 I Gate of Heaven Cemetery-greve opening 1,090.00
B. ADMINISTRATIVE COSTS:
�. �. PersonalRepresentative'sCommissions
Name oi Personal Representative(s)
SVeetAdtlress
Ciry State Zip
Vear(s)Commission Paitl '
2 . Anomey'sFees WilliamR. Bunt 12,000.00
3, Family Exemp�iort. Qf tlecetlenfs address is not ihe same as claimanfs,atlach explanation)
Claimant
Stree�Address
' City State Zip
Rela�ionship of Claimant to Decetlent
4. Proba�eFees WilliamR. Bunt 865.50
5. . AccountanfsFees
5. I�li rax rtewm areparers Fees Gift and Associales-reserved for tiling inwme taxes 500.00
�. O�her AdminisVative Costs
� �' Diamond Pharmacy-medicine 67 40
See attached ' 2,624.02
.. ___ . _.—__ .
� TOTAL(Also enter on line 9, Recapltulation)� 29,767.06
'�. Sd�rkle H
� Fu�erd E�'ses& �
COMMONWEPLTH OF GENNSYLVPNIA �y������/��y i
INHERITPNCETNRETVRN ♦YI�pYY11KlAALl� I
RESI�EM GECE�ENi . . I .
..- . . _. .. _-.
- � �� 'FILE NUMBER �
ESTATE OF Jacobs, Ifene 21 - 15-0654
�� � z I Henderson & Company-jewelery appraisal � 360.00 �
3 Linda Edstrom-caregiver 855.02
4 Griswold Home Carecaregiving agency 630.00
5 Pauline Abah-caregiver 629.00
e Danielle Ferrell-caregiver 150.00
Page 2 of Schedule H
js;;., pennsylvania �� SCHEDULE I
Zi� °E'"aT"E"�°`R`�E"�E DEBTS OF DECEDENT, MORTGAGE
ir�HEAi,nNce,uiaE,uR�
aesoeN.oECEoenr LIABILITIES 8 LIENS �
— —>
.._.. - - . .__
— —-� � � � � FILE NUMBER
ESTATEOF �acobs, lrene 21 - 15-0654
Repon debls incurretl by lhe deceden�pnor to dealh ihat remained unpaitl al Ihe tlate of death, including unreimbursed medical expenses.
NUM ER � DESCRIPTION � AMOUNT
� 1 Chase Bank-credit card balance � � 37.10
� � � � TOTAL(Also enter on Line 10, Recapitulatlon) � 37.10
REVASV E%��01-00� I
�.F�!i4-, pennsylvania ''�. SCHEDULE J
�1 ocvnRrueHroraEVExue BENEFICIARIES
NHERRPNCETp%RETORN
RESIpEM DECEOENT
ESTATE OF � � � I FILE NUMBER
Jacobs, Irene 21 - 15 -0654
l RELATIONSHIP TO �HARE OF ESTATE AMOl1NT OF ESTATE
NUMBER NAMEANDADDRESSOFPERSON(S) I DECEDENT � (Wortls) I (SSS)
RECEIVINGPROPERTV I D o1WRm�tlq�)
— —. _. __ ..- _. _. ..—_.
i� TAXABLEDISTRIBUTIONS[indutleou�n9hispousal .
disMbuYons,antl hansfers
� untler5ec.9118(a)(12)� � �
1 Donald A. Jacobs Son '. one-half of estate
3748 Erly Road
�' Elliotlsburg, PA 17024
2 Samuel M.Jacobs Son one half of estate
402 Mumper Lane
Dillsburg, PA 17019 , ��
Enter tlollar amoun45br tlistribu�ions shown above on lines 1I5lhrough 18 on Rev 1500 cover sheep as appmpriale. �
�I NON-TAXABLEDISTRIBUTIONS'.
A SPOUSAL DISTRIBUTIONS 11NDER SECTION 9113 FOR W HICH AN ELECTION TO TAX IS NOT TAKEN �
�I B.CHARRABLE ANO GOVERNMENTHL DISTRIBUTIONS �
TOTAL OF PART II-ENTER TOTAL NON-TA%ABLE DISTRIBUTIONS ON LINE 13 OF REV4500 COVER SHEETI. 0.00
���b .^���
��
� �V� ��`'y_,��"�5
- , �
WILLIAM R. BUNT
ATTORNEY AT LAW
P. O. Boz 336
709 $OUTH CPRLISLE STREET
NEW BLOOMFIELD, PA 17068
re� (717) 582-8795
FPX (7'I%) $EY-7$P7
August 26, 2015
Lisa M. Grayson, Esquire
Register of Wills
Cumberland County Courthouse
1 Courthouse Square, Suite 102
Carlisle, PA 17013
RE: Estate of Irene Jacobs
No. 21-15-0654
DearAttorney Grayson:
I enclose herewith two (2) copies of the Pennsylvania lnheritance Tax Return with
regard to the above referenced estate. If you have any questions with regard thereto,
please contact me.
Very truly yours,
Wil R. Bunt
Enc.
Cc: Mr. Donald Jacobs
Mr. Samuel Jacobs
WRB/as �, — �
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