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Home My WebLink About01-0447 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Robert H. Jacoby a/so known as R. H. Jacoby No. To: cJ-I-CJ/- <197 Deceased. Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 189-18-4942 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, applies for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decedent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 3 West Mul.ber.ry Hill M., N Middletcn Tamship, P~ 17013 (list street, number, Twp. or Boro.) Decedent, then 78 years of age, died April 5 at 3 West Mulberry Hill Road, Carlisle, PA 17013 }{9{; 2001 , , Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 3 West Mulberry Hill Road $ 400,000 $ $ $250,000 Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship if 1956 S Residence In aIls Court Lakewood, CO 80227 Wilmin ton, DE 1980: Rd Dr D rfield, II 60015 THEREFORE, petitioner(s} respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. -- '" -- J__ ,-~ ~ g~~ .~~ ~_n s. Ja_ QG~ -g.g ~.= ~~ 'il"..... BO <IS c: 00 U'i /6 -~:J. g>- /3 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 55 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ . c-~ ~C)~~ Sworn to or affirme and subscnbed J before me this ~ day of L n S. J ac "\ ~ l' 2001 '7?')~t iJJA. t!O. ~~A ~, I , ~egiste l ...-. .;"" ..- ./ '.. . - " - ." ~ ... ::s .... ..." ~. fii L_ N 21-01-447 o. Estate of Robert H. Jacoby A/K/A R. H. JACOBY , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW MAY 7, 2001 J9;;2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Lynn S. Jacoby is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Lynn S. Jacoby ---------...-----.-- in the estate of Robert H. Jacoby ~t!.~ 1aM.tJ.1i ~ I RtJister of Wills ------ ) TIORNEY (Sup. Ct. 1.0. No.) r P Andrews, Esquire ID#15641 WA~r PnmTTOT ~rr~~r FEES Letters of Administration ..... $ 410.00 Short Certificates( ) 15. . . . . . .. $ 45.00 Renunciation ..?... 'BOND' . .. $~ JCP $- .LS:1j1j TOTAL _ $ 485.00 Filed J;IA~. ?'" . .. . .... . ... A.D. U2001 ADDRESS Carlisle, PA 17013 (717) ?Ll'3-012:3 PHONE rUT IN ATTORNEY TAYLORS FILE .MAY 8, 2001 / REV ')(86 This is to certify that the information here given is correctly copied fran: an original certificate of death dulZ filed with Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. H\05.801 Fee for this certificate, $2.00 p 7248399 No. ~ --:\k \3 ~y\ ~~ ....I......\~ ) I\: , N\. '_.. :Shc~b-. ~e04 '. 5+, " ~~) ~~~ ~l ~[ q~~-c\ ~,~~.. me as l.i'~~. ~b.).~~ Local Registrar APR 2 3 2001 Date H105.144 Rev. 1191 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (Coroner) :!PAINT IN IANENT :KINK SEX .. Male H Jacoby DATE OF BIRTH (Month. Dav. Year) BIRTHPLACE {Ci\>i and State or Foreign COU(ltrV) PLACE OF DEATH (Check only one see inSffUCliorls on other side) HOSPITAl..: InPli1~1D 1. ... FACILITY NAME (II not institution, give strHI and nomOerI g'~,D DKl ........ Ilveina Ct]~rland townahip? 11d.O =~=or MOTHER'S NAME (fiest. Mic;kIe, MaKlen Surname) It. Rose Leusenring INFORMANT'S MAILING AOORESS (Street. CilylTown, Stale. Zip Code) 2412 Graydon Rd., Wilmington, DE 19803 PlACE OF OlSPOSmON. Namf: 01 Cemetery, Cremalory LOCATION. CtfyfTown.. Stat., Zip Code or Other Place ,J..ak.eview Memorial Cemete NAME AND ADORESS OF FACILITY 0 UNDER 1 DAY Ho....rs Mlnut.. Hill Road OECEOEN"t"S USUAl.. OCCUPATION (~~~tiI~~U~r~r~ 1. Professor ".. oeceDeNT'S MAILING ADDRESS (Street. CitylTown, Slate, lip Codel 3 West Mulberry Hill Rd. Carlisle, Pa 17013 17a,S"te PI\. f1b. eo....n .... TIME OF DEATH Aprx . DATE PAQNOUHCEO DEAD (Month, DaV. Year) ... 10:00 P. ... .,. April 8.' 2001 27. PART I: ent" the d/IlNIft,lnjur* or comp4Icettonswhleh cauted the death, Do not enter In. mode 01 dying, JuCh as cardlec Of' ,..pratory arrest, shOck Of Mart failufe. Ultonlyone CIIU8C1 on each line. .. H ertensive Cardiovascular Disease DUE 10 lOR AS' CONSEOUENCE OF): b. CUE 10 lOR AS' CONSEOUENCE OF): c. oue TO tOR AS A CONSEOUENCE OF): d. WEAE AllTOPSY FINDINGS .u.ILABLE PRIOO 10 COMPLETION OF CAUSE OF OEJJH? MANNER OF DeATH ORE Of' lNJURY (Month. Dav, 'lttar) ~ D D ST~E FILE NUMBER SOCIAL SECURiTY NUMBER DATE OF DEATH (Month. DaV, Yearl April 5, 2001 3. 189-18-4942 RACE. Amenc.n Indian, ~, White. etc. IS"",ify, '0. White MARITAL STATUS. Married NeV$\' MarTled. Widowed, DiYorc:ed(Specity\ ..,oi vorced SURVIVING SPOUSE (II wife. give maiden name) f7C.CX Yes, deCedenlllved irI 1. Norllli, Mi-dd1.'eton ...p. - 23b. 230. WAS CASE REFERRED TO MEDICAL EXAMtNERICOROHER? zo. ....111 NoD 1~O'tlm_e PART II: OIher significant concIitione contributing to death, but l!nlerval between not resulting in the underlying cauu given in PART I. lOn_,1nd death I , ! D TIME OF INJURY INJURY AT WORK? Na1ural Homicide D D 30.. 3Gb. O Pu..CE OF INJURY. AI home, farm, street, factory, offiCe bullditlQ.etc.(Speclt'f) 30.. ... Pending hwnltgation Could not be determined NO~ Accident v..D NoD Sule... ... 2... 21b. CERTIFIER (Check onIv one) -CE.ATIF'fIHO PH"fStctAN (Physician certifying cause Of deBttl wflen another physiCian has pronounced death and completed Item 23) Totfwbestofrny knowtedgll,dUthocc.umd due to the CaUH(') and manner as atated. ,.,.,...,...........,....,..........".. -PRONOUNCING AND CERTUrYINQ PHVSIClAN {PhysiQan boIh pronol.Incing dNlh and certifying to cause of death) To thct beet of my~. dMth occurNd.t the Um., at_,.nd pa.ce, and due to the CWM(a) and m.nner.. alIIted,. . . . . . . . . . . . ....EDlCAL EXAMINEAlCOROHER On tM b" of ...mln~ 8nd/or lnveaflgetJon, In my OJtfnlOn, death occurred at the ttme, date, ,nd pille., and due to the eauH{a) and manner n Bated.. ..................,...,.............................................,........................... 3fa. AEGISTRAR'S SIGNATURE AND I~II~\IOI Coroner OATE SIGNED (Month. Dav. ~) D 310. 31.. April 11, 2001 NAME AND AOOAESS OF PERSON WHO COMPLEiED CAuse OF OE.<rH (ltem 27) T'/110 '" P,inl Michael L. Norris, Coroner ~ 6375 Basehore Road, Suite HI ~n Mechanicsburg, Pa. 17050 DATE FILED (MOf)th, Oa~ ~r) ... ~ ~~ In Re Estate of ~C) ~er-l- To the Register of Wills of The undersigned be issued to WITNESS Ly~vt I ,v1{ { s 21-01-447 RENUNCIATION l-l deceased. County, Pennsylvania. of hand this I 7 day of 4prl ( 'Z.Cl:) ( ,-1-9-_. ~~ Cf. EJ ~ '4i .i?1J' . ('. . 1 (Si nature) . I q S"(:; s, Ivrlc;//s CCJUrl- LA ke tu>oJ C6 8CJZZ 7 ) (Address) 7~ ()J ()~.) sf: ~ __ de ~ \ (ress) -' Jacohy I CUlM h~r/4 '-'t d /-0'+-"-} p~ tJ~ ~kf ( the above decedent, hereby renounce(s). the right to administer the estate and respectfully ask(s) that Letters o-+- 4cL<<1l ./1 (.5 fret II fS ~ -:s~co by I (Signature) (Address) APR-18-01 01:49 PM ANDREWS & JOHNSON 717 2430061 P.02 21-01-447 RENUNCIATION _ In Re Estate of Robcrt II. Jacoby, d~eased To the Register ofWiUs ofCumbcrland County. PeMsylvania. The undersigned, Linda Leigh Frost. daughter of Lhc above decedent, hereby ronoum::cs the right 10 administer the estate and respectfully asks that l.etters of Administration be issued to , 2001. SIGNATUk.:. "".J,...jv\,'~ iCED MEDALLION GUARANTEED FIRSTAR BA.NK. tjf. ~~~ (Cr\ T.e1, AUTHORIZED SIGNATURE (W~) X9007023 SC'CU~ITlES TRANSFER Acr". 'I'... "()N PROGRAMs" ~R ~ ~~t2fft-- Linda Leigh Frost 1'+69 AWII5LE.SIDE. bj<.ivE. PSE.1Z.FIEl..-D, 7CU-IAJOIS ~OOJ6 (address) . '~,..1 21-01-447 Power of Attorney STATE FARM FIRE AND CASUALTY COMPANY KNOW ALL PERSONS BY THESE PRESENTS: That STATE FARM FIRE AND CASUALTY COMPANY, an Illinois corporation, with its principal office in Bloomington, Illinois, does hereby constitute and appoint: John C. Anderson, Lori Baer, Teresa L. Brown, Ceola Campbell, Pamela Chancellor, Norma Christiansen, Ruth Davis, Kim Filter, Julie Freed, John Gibson, Christine~GOben, William L. Gordon, John R. Horton, Cynthia Johnson, Mary Johnson, Susan K. Johnson, Mary K. Kerfoot, DeAnna Kerrick, Juli. I ing, Tammy Koenig, G.F. Krawcyk, Janet R. Leake, Donna K. O'Crowly, Michael D. O'Donnell, James Platt, Debra Prater, Lynn Rak . i Redman, Aubrey Riddle, Linda Rieck, Suzanne M. Robertson, Alice Schuler, Michelle Shives, Trudy Spence, Heidi Stevens, Pe , Susan M. Wagoner, Karen Weber, Wilma L. Weinzierl, Kim Wietfeldt, Susan Wiggins of Bloomington, Illinois its true and lawful )-in-Fact, to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or other writings oblig I the nature of a bond as follows: Any such obligation in any amount I-::::~ This appointment is made under and by the authority of a resolution which was ~~ by the Executive Committee of the Board of Directors of State Farm Fire and Casualty Company on the 24th day of July, 1974, a~is'q~y authorized by the Board of Directors in Article II, Section 6 of the By-Laws of the Company, which resolution is: ",:" '\ Resolved, that the Executive Vice-President or a Vice-President of the C~anY is hereby authorized to appoint and empower any representative of the Company or other person or persons as Attorney-in-Fact ~xeQIte on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other writings obligatory in the nature of a ~ich the Company might execute through its duly elected officers, and affix the seal of the Company thereto. Any said execution Of.= .~. lGllment~n Attorney-in-Fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the r . ele~rs of the Company. Any Attorney-in-Fact, so appointed, may be removed for good cause and the authority so grante~~~ \ i1ev . ~ specified in the Power of Attorney. Resolved, that the signature of the Executive Vice-President or W:~Pr '. land the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of ttf~ ~letary,.' resident or Assistant Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such ~~r and ~y power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any SUCh~.. rso ex~~,.and sealed and certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attache~~ue to ~~}f and binding on the Company. IN WITNESS THEREOF, STATE FARM FIRE AND CA!f:CO. Mf.l... ,'A.N~as caused this instrument to be signed by its Vice-President, and its Corporate Seal to be affixed this 22nd day of July 1 :--)' (~-"<<:;" " This APPOINTMENT SHALL CEASE AND TE~ Ay.;"f~iICALLY AS OF DECEMBER 31, 2001, UNLESS SOONER REVOKED AS PROVIDED. _-""_--""""""\\ Q ~<( ./ ,",~!. /~,,,~.~~~.~~.t (~/:~. STATE FARM FIRE AND CASUALTY COMPANY ! ,t.... '". I (~~-~~~~; ,. : ~:' ~O"PO 141' .S ~ '.'(.-""~~' /&W. f' .~~ /"..:::-'~..__, ~ ~ / ~: . . :... ~ (<:;-. .~--;:; A ~/ j // C , ~ ~: ;: / :".....<:.>.) By". ;; /~..... I. ..... :"T ~~,....' \",~'" . ......~~~.. ~\~/ Vice-President ~, *eTO.. \\,.\.: ~~~ """........' c THIS POWER I N IMPRINTS ARE NOT PRESENT IN THEIR ENTIRETY .J STATE OF ILLINOIS COUNTY OF McLEAN On this 22nd day of Ju that he is Vice-President instrument; that he kno said instrument on be ~re me personally came W Donald SullNen to me known, who be;ng duly sworn, d;d depose and say E FARM FIRE AND CASUALTY COMPANY, the corporation described in and which executed the above eal of said corporation; that the seal affixed to said instrument is such Corporate Seal; and that he executed e corporation by authority of his office under the By-Laws of said corporation. "OFFICIAL SEAL" Ruth Davis Notary Public, State of Illinois My Commission Expires 4/13/02 I2t1Q~ Notary Public My commission expires April 13, 2002 CERTIFICATE I, the undersigned Vice-President of STATE FARM FIRE AND CASUALTY COMPANY, do hereby certify that the original Power of Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions asset forth are now in force. 3 rei.. fY7 /} Signed and sealed at Bloomington, Illinois. Dated this - day of I . ( a.L~ I t1'l ()O/ .,$'"_....................,'''''\\\\\\\ -= ...'- ~IlD 1:"$1' I, .iF ~,... .... ..... "-f I" j" .t.... "'~""~ 'I, :~.... c.Of\POR,,1"~\.S ~ ~ ~: ..... ~, ~ , ~. .~ ~ ~ ~.... SEAt ..:'~ i \ ~ ...... ........ .E "1 "0 ...... ,.<j: 111\\\-."0.. \\." --..:=- \\\"",...................... Ullo(}f\ fYt .Walki n<t Vice-President If you have a question concerning the validity of this Power of Attorney, call (309) 766-2090. FB6-9043A.26 (11/00) Printed in U.S.A. 21-01-447 FB-9062 Bond No. 9B-KN-B051-B BOND OF EXECUTOR, ADMINISTRATOR OR GUARDIAN STAll .AIM .. fNIUUNCI .. STATE FARM FIRE AND CASUALTY COMPANY BLOOMINGTON, ILLINOIS }ss COURT OF COMMON PLEAS COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF THE OF ROBERT H JACOBY [8J Estate D Guardianship [8J Deceased D Incompetent D Minor Bond of D Execut [8J Administrat or D Guardian D KNOW ALL PERSONS BY THESE PRESENTS: That we, LYNN S JACOBY , as Principal, and State Farm Fire and Casualty Company, a corporation of Illinois, as surety, are held firmly bound unto the Commonwealth of Pennsylvania, in the penal sum of EIGHT HUNDRED THOUSAND AND NO CENTS----------- ____________n____________________________________________________ Dollars ($ 800,000.00 ), for the payment of which we jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, that if the above bound principal shall faithfully discharge the duties of his, her, their trust as ADMINISTRATOR , of the estate of (EXECUTOR, ADMINISTRATOR, GUARDIAN, ETC.) ROBERT H JACOBY according to law, then the above obligation is to be void, else to remain in full force. Dated, signed and sealed with our seals this 3RD day of MAY ,2001. ^9~~ incipal ~ By: Approved this day of Attest: COMMONWEALTH OF PENNSYLVANIA I swear that I will faithfully discharge the duties of my trust as of the person and estate of ROBERT H JACOBY (EXECUTOR, ADMINISTRATOR, GUARDIAN, ETC.) according to law; so help me God. Subscribed and sworn to before me, the ~ -^9~rQ, day of FB-9062 (Pennsylvania) U.S.A. Printed in Name of Decedent: Date of Death: Will No: To the Register: E CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Robert H. Jacoby April 5,2001 21-01-0447 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 10, 200 I: Lynn S. Jacoby 2412 Graydon Road Wilmington, DE 19803 Linda Leigh Frost 1439 Ambleside Drive Deerfield, IL 60015 Peggy D. Jacoby 1956 S. Ingalls Court Lakewood, CO 80227 Notice has now been given to all persons entitled thereto under Rple 5.6(a) except: No exceptions. l Date: May 10, 200 I Taylor P. Andrews, Esquire 78 West Pomfret Street Carlisle, P A 17013 Phone: 717-243-0123 Capacity: Counsel for personal representatives '\,. / b--c2c:22?- /'--~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ,i DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-18-2002 JACOBY 04-05-2001 21 01-0447 CUMBERLAND 101 '02 FEB 25 TAYLOR P ANDREWS ESQ ANDREWS & JOHNSON 78 W POMFRET ST G.8fr. CARLISLE fAUljl19~l3 n11 i'\i i :57 '* REY-1547 EX AFP 112-001 ROBERT H Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =iS4-j-Ex--AFP-n2"=OoY-NOYicE--oF-YNHEifiTANCE-YA;rjrppRA-isEiiENT~--Ar.l-owAircE-oR-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JACOBY ROBERT H FILE NO. 21 01-0447 ACN 101 DATE 02-18-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 259.900.00 790.116.91 .00 .00 258.311.50 .00 89.367.41 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 81.362.35 1.116.26 (11) (2) (3) (14) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 1.397.695.82 8?478 61 1.315.217.21 .00 1.315.217.21 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due (5) 717.292.31 X 00 = .00 (6) 597.924.90 X 045 = 26.906.62 (7) .00 X 12 = .00 (8) .00 X 15 = .00 (9)= 26.906.62 rAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 03-05-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 26.906.62 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 260.35 TOTAL DUE 27.166.97 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE ... D....IIN11 ~.... D"U"D~" ~Tn.. n.. TWT~ ..nDM ..nD TN~TDII"TTnN~ 1 '" /6-0202/;>- /0 Rt; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-415 EX AFP (12-001 Recc 02-18-2002 JACOBY 04-05-2001 21 01-0447 CUMBERLAND 201 ROBERT H .02 FEB 25 PJ 1 :58 TAYLOR P ANDREWS ESQ ANDREWS & JOHNSON " 78 W POMFRET ST l,l;;:Ir;. .' CARLISLE p~l~'9t1r3':1 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR FILES ..... Rifv:483--EX--AFP--(i2~-OO)-----.ii-NiificE--OF--jETifRMiN-ATiiiN-AN-j-A!fSESS-MENir---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF JACOBY ROBERT H FILE NO.21 01-0447 ACN 201 DATE 02-18-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 26.906.62 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 26.906.62 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE nlll: A DI'I'IINn _ ~I'I' DI'Ul'D~F ~TD~ OF TMT~ FORM FOR TNSTRUCTTONS. 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ANDREWS TAYLOR P 78 W. POMFRET STREET CARLISLE, PA 17013 __n~___ fold ESTATE INFORMATION: SSN: 1 89-18-4942 FILE NUMBER: 21-2001- 0447 DECEDENT NAME: JACOBY ROBERT H DATE OF PAYMENT: 01/04/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/05/2001 NO. CD 000719 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $26,906.62 I I I I I I I I TOTAL AMOUNT PAID: $26,906.62 REMARKS: TAYLOR P ANDREWS ESQUIRE CHECK# 1039 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /(P - Z2 ~ - ) j... (.. OFFICIAL USE ONLY FILE NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 w <( ~t:CI) tl"'''' wo..tl J:OO tl"'-' 0.'" 0. <( 21 -01 -0447 COUNTY CODE NUMBER YEA' .... Z W Q W () W Q DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Jacob , Robert H. DATE OF DEATH (MM-DD-VY) DATE OF BIRTH (MM-DD-YY) A rll 5,2001 Janua 20, 1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME P yD. Jacoby SOCIAL SECURITY NUMBER 189-18-4942 THIS MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I- Z W CI Z o 0. <Jl W '" '" o tl o 2. Supplemental Return 4. Limited Estate 0 4a. Future interest Compromise 6. Decedent Died Testate 0 7. Decedent had livIng Trust o 3. Remainder Return liJ 5. Fed. Est. Tax Return Req'd _0_8. Total number of SDB's Ta or P. Andews, Esquire FIRM NAME: Andrews & Johnson TELEPHONE NUMBER 717 243-0123 Taylor P. Andrews, Esq. Andrews Jil~hnson 78 ~. po\fjf't St. ~ Carlisle,' 17013 :tl~ (D, .n I"'" z o i= S :J .... ii: 04: () W II:: (1) (2) (3) (4) (5) (6) $259,900.00. $790,116.91 $0.00 $0.00, $258,311.5 $0.00 3l N N Cl:l 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3.Closely Held Corporation, Partnership or Sole-Prop. 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E} 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administration Costs (Sch H) 10. Debts of Decedent, Mortgage liabilities, & Liens 11. Total Deductions (total lines 9&10) 12. Net Value of Estate (Line 8 minus Line \ \) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (\4) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amnt of Line 14 taxable at the spousal rate, or transfers under Sec.9116(a)(1.2) 16. Amount of Line 14 taxable at linea! rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate \9. Tax Due 20 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .1.: ':};18' .. '.':'$11: ?'.':!l.'\:. (7) $B9,367.41 (8) $1,397,695.82 $81,362.35 $1,116.26 (11) $82,478.61 (12) $1,315,217.21 (9) (10) $1,315,217.21 z o ;:: ;l: ::> 0. ~ o <J ~ $717,292.31 $597,924.90 $0 $0 X.o_ x.045 x.12 x.15 (15) (16) (17) (18) (19) $0.00 $26,906.62 $0.00 $0.00 $26,906.62 :'.ij@1#~Jh~@@%~N1MttJHH: Decedent's Comolete Address: STREET ADDRESS 3 Mulbenv Hill Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credo B. Prior Payments C. Discounts (1) Total Credits (A+B+C) (2) 3. InteresVPenalty if applicable D.lnlerest E. Penalty 4. TotallnterestlPentalty (O+E) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (3) (4) 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (SA) (5B) $26,906.62 $0.00 $0.00 $26,906.62 $26,906.62 B. Enter the tolal of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT :@H##lJtt&t.dg%MM1Y:Mj#.r,g%t@.&,]Ht.f.t';in::1[mmmmttr@mm%tlWM@Mtm~M~Umm5B#.tH@UiliUm@fu\~MMt'W:W~mm~1mmmmm@HtmJmHM@mmmt]:tW PI-EASE ANSWER THE FOl.I-OWlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BI-OCKS 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 transerred or its income' c. retain a reversionary interest: or d retain the promise for life of either payments or care? 2 If death occurred after December 12, 198:2, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or securrty at his or her death? 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary disignation? CJ CJ CJ CJ CJ CJ ~ ~ ~ ~ ~ ~ ~ CJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Um1er penalties of pe~Uly, j dec\3le that I ha'Ie examined this ratum, 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. SIGNATURE OF PERSON. RE~NSIBLE FOR FILING RETURN C:::::::-g.A. '-f06 ADDRESS 24 r on oad, SIGNATURE,..efi" P R N RE .~I', , ADDRESS' I ) 78 W. Pomfret St., Carlisle, PA 17013 DATE I - '-1- :zoo 2.- DATE / - <t -2",10 L For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net yalue of transfers to or for the use of the surviving spouse is 3% [72P,S Sec. 9116(a)(1.1)(I)J For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Sec; 9116(al(1 ,1}(iill The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filin9 a tax return are still applicable !!Yen if the surviving spouse is the only beneficiary For dates of death on or after July 1, 2000 The tal< rate imposed on the net Yalue of transfers from a deseased child twenty--one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the c:hild is 0% [72 P.S. Sec. 9116(9.)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4,5%, except as noted in 72 P,S, Sec. 9116(1,2) [72 P,S, Sec.9116(a)(1) The tax rate imposed on the net value of transfers to or for the use of the deeedenfs siblings is 12% {72 P.S, Sec,9116{a)(1.3)] A sibling Is tleflned, under Section 9102, as an indiyidual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Robert H. Jacoby (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value with is defmed as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to sell, both having reasonable knowledge of the relevant facts. ITEM DESCRIPTION NUMBER 21-01-0447 VALUE AT DATE OF DEATII I Honse and lot at 3 W. Mulberry Hill Road, North Middleton Township, Carlisle Post Office, Cumberland Couuty, PA 17013 Sold in arms length transaction to nnrelated bnyer for sales price of $259,900 Settlement on 9/10/2001 [Settlement sheet is attached] $259,900.00 TOTAL (also on line 1, Recapitulation) $259,900.00 SEP-10-2001 15:28 cor.trnll,IEAL TH HARR I SBIJR'J P.01/0.2 :CJolMOIf'ol'EALTH UJ.JO TInE INSURANce CCHPAllY \. Settlement S~~ce~enc I. TYPe of t,o.9n :.. [lFKA 2. (lPf\'\W>. J. [X]Conv. Unins. 1.1 lvJ. S. ( IConv. Ina. :.Noce: This fo~ 1s !urn~ehed co give lho~. It.~31 l1IA:!:'ked "(p.o.cl" "'ere paid :he t.,;,t.alB. ).Name and Address of 8orrover TOlll:!ph B. Chap~~ and z.t1chelle 11.. Ch.:1pie 1 ,. File Nutl\bcr I you 4 statement of 4ctu~1 'cttle~ent cooto. Amounco pai4 co ~nd by ehQ Dettlem~nt agent a~~ outai1e t.h. clo~~n9; they are shown here for inform~t.ion31 purpo~e~ And Arc noe includ~d in 717 23;2 6507 U.S. Department of HOUGing and Urb~n ~velop~ent OMB No. 2Sn2-Q26S T1cle Insurance Mo.D3011i5CP 1'.Loan Number I 4294.S0BREL I a . HorcgJ,gB Im;ur.lnce Case tlo. I le.Nam8 and ~d~e38 ot Seller I Lynn $. J.coby. ~~inlacr8tor of the I Estate of Rob~rt H. Jacoby. d~p.aied I I I I , J.Propercy ~cacion ] W~st Mulborry Hill Road ~Qr~h Middlecon Townahic. CUmbcrl~nd ~~ur.ty, PA J. SL~Y OF BORROW[R'S TRANSACTION lQO. G~05S l\MOUN'T DUE FROM BOMOW'ER; 101.C~ncract 9alea pri:e l02.Per9onal property lOl.Settlement eh.r9~' to borrower (line 14001 2S9SiOO.00 11~7J.2J Ip.N6Me ~~d Addre~~ ot Lcnde= I We11a r~r9o Ho"-e Horcgage. Inc. I PO flox 51)7 I Des Moines, rA 50JO'5137 I I I H.Sett1emenc ^9~nt CCMMON'Wf'J\.L TJ.l: wm TITLe INSL1RANCE CCMPAUY place of e.~~lcmcnc II.Swttlemont O~tc 17 SOUTH ~~ SQ. SUIT~ 2-h. HARRISBURG, FA 17101 L1nd. K. Tr~vely LY-T K. 5~~Y OF SELLER'S ~~SActIo~ 400. GROSS I\MOUNT DLl[ TO SELLER Sepco~~er 10. 2)01 ~Ol.Contr&cc ~aln. priee 402.PerGon31 property 'l.0l. 25HOO.OO A':hu'5Cfllent.9 t:)!' lteme D.lid by seller 1n ..".;lvar.cl'l 10'.City/town tax~B 09/10/01 to 12/31/01 l01.Ccun~y t&xe~ to l~Q.SCHOOL T~ 09/10/01 to 0'/)0/02 2210.:37 nor, .n ~~,u'tmen~~ !cr i~e~g paid by seller in advancft 40'. Cic.y/town t.lXe9 0$/10/01 CQ 12/31101 224.81 101.co~n~y ~axe3 "'Oe.SCHooL TAX 00 09/10/01 co 06/30/02 2106.11 120. aROSS AAomrr DUE FROM ROP-ROWER ~DO. AMOL~S PAIn BY QR I~ BCUALF OF flOP~O~~R 201.Deposit of earnest ~on~y 202.Prine!pAl amount ot new loan!al 203.Exi~clr.g loan(al 20G.Lender Oirecc 8ill Credle. 2D'.A~don Rem.d1.t~cn Credit 214204.2;' 2000.00 2JJHO.OO 7894.85 62S.QO 4 ~ O. ~RlJSS k~Ol'll:.rr DUE to SeLLER 500. REDUCTIONS !N Ar~ONT DUE TO SELLeR S01.E~cess Deposit laee inatructionn) S02.Settle~enc charges to geller fline 11001 SOJ.Exi9cing loan(al 506. SO'.R4don Remediation C:edit 26<230.'H U7tl2.71 (,25.00 Ad,uscmcnc.~ fo= itQm~ unp~ld bv D~11Qr 210.C1Cy/tOWn taxes to 211. COu.l"\cy caxeg to ^d1ustmentG for itamo unp~ic bv aoll_r SlO.City/t.own t.xc>> to S11.County taxc~ to 220. TOTAL FArO BY/FOR BOilROW~R 30'). TOT1J.. AT SETT"'..f:M:ENT FROM/TO BORRO\4'ER l01.Gross amount due from borrower f11ne 1201 )02.~~ft ~mount.n ~~td bv/fo~ borTOv~~ (llnc 22~! ]03. CASH ((XX] FRt.lMI ({ J TOI 90AAOWt:R 'l4442~. 65 2H201.21 24""'29.85 ~" "74.36 520. TOTAL REDUCTION AMOUNT DUE SeLLER 600. CMH AT SC!'1'LCHENT To/pROM 9tLLER 6al.Groca amou~t due to 8eller 111n4 4201 602.L~a~ reductlone in ~mount due seller fline S2~1 G03. asH I (x:x:.l TOI (( PROHI SELLER 22101.11 262230 H 22101.71 2H,e2J.27 FOR1<l Hi U-il81 HUD-l ()-Q6\ RESPA. HIl4.:3oS-2 SEP-10- 200 1 15:29 D.10174SC'P CIJI'1r10r II,JEAL TH HARR I SBURG 717 232 6507 P.02/02 L. !lCTTLrMEm CHARGes Paqe 2 of Form Approved OMS ~o. p,a"ro fROM BORROWER'S POND.::; AT 2S02.r.l2l'i5 P~IO FROM SELLrR'S FmlDC AT SeTTLEMENT 100. T07~ SAL~S/BROKER'S COMMISSION bsged ~n price S 259gao.00 . Division of comm1s;lonl11ne 100l Ole foll~w~: 101.S 7822.00 to Jade Gaughen RuItor tRA 102. S 7172.00 to Till! Prudentia.l TholTlp21cl"l Wood Rea.l EetJ,ce '03 .CCln\lTll~gion Paid At. Se~tleflenl: '04. S to 800. ITEMS PAYABLE IN CQt~CTtON WITH IOI.Loan Or~9.n~tlon Fee 1.00 , !02. Loan Oiscount. " 11 I03.Apprais41 rcc l01.Credit Reporc iOS.Lender's Inapection Fee !08.PrOCCGDir.g ree j09.Flood ~one 08cermin.cion rsa i:O.Tax Serv1cit Fee '.OOt - 155H.OO SEl"TLEHErrt lS5H.OO LONJ to Well~ Fargo ~ome Mortgage. Inc. :;'))9.10 co to Lendtlr21 Se::vtee. Inc. to SMS MQ:~gage Servlceo 325.00 15.00 u~ll~ rargo Uoma Morcgagc. Inc. wells pargo Heme: M~%t;4ge, Inc. W~llB Fargo Home MO~tgage. Inc. 235.00 16.,)0 lOO.Of) 9QO, ITCMS ReCUIRED BY LENDER TO BE PAtD IN ADVANCE J01.Interest from 09/10/01 to 10/01/01 GS 13.26 '01.1 Interest trom co ~5 902.Ho:~g~ge I~9~rance Pre~iu~ for mo. to ~1)).Ha:~rd Insu=ance Fremium for r=s.tO /ci.y IdlY 908.(6 1000.ReSERVES PEPOSITP.D WITH LEN't'EP. 100l.HAzard Insur~nce . f1Io..$ 400.00 per ""'. Ho.oo loo2.Mor~9a9c 1n~uranee fRo.iS per ""'. l003.CltY prcp~rty tAxes me.GiS pcr mo. l001.Couney property tAXes 12 mo,Q$ 215.41 pcr mo. 29u.n 1~OI.^i9reg~~e Accourttirtg ~jusem~nt -160.00 1100. TITLE CHARGES 1101.Settlement or eloo~n9 feB 1102.AbStract or title gearch 110J.T~tle exaMination ll04. Title In!lurance binder 1106. U~t~ry ree lincludes above items No.: 11GB.Title Inscrsnee l!neludee above iteN8 No. 11119.tender'3 covengc: S 1110.Owner's CQve~age $ 1112.ENC~RSEMENT PA 300 111).FNCORS~NT PA ~OO IALTA 8.11 1114.E~~RSEMENT Ph 100 co. 111S.EXPRESS MAIL Closing Packet co co co co tc LJ.ncl~ K. T:::"1\tl!1y I 10.00 5.00 J................I.~.~......~... co COMMONWEALTH 1101 . 111:111 233910.00 25HOO.oO to COt-t1OUWEJ\Lrn LN-'D TI'I"'"...E to CD.'I.t"lONWF.1\L tH t.A!ID T rTLE t.o COMHONMEAL11( LAND 'TITLE t.o COHNDNWEALTH LAND TITLE Ll\ND TITLE H28.7S I................ .............. I....~.~......... .............. . , I................l.............. 50.011 50.00 50.00 15.00 1200. GOVERNMEln" RECORD INC AND 1201.Pecording feos; ~.d S 1202.City/coun':y tOlx/namp,a; Deed S 12CJ.St~t~ t~x/~t4~~ Deed S 'I'RANSFEft CHhR.::a:S 27.~O Mo~tgage S 2S9~.OO Hb~tg8g~ S ~53~.CO MOrts~ge $ Releases S 5~. 50 81.00 2519.00 :2599 00 1300. ADD:TrO~AL SETTLEMENT CHARGES 1~u2.PeGC InGp~c~~~n 1)~3.Initl~t~on Fc~ 1)'4.Heme I~peee1ort/Radon TC9t IJ}5.Tr~ns~ct~on rS8 13Gh.Final Bil11ng/W~ter ~ S~w~r 1]Q7.2001 Co. k Tvp. Ta~e9 IJOB 20~1 School taxee ~~ All Ame~ican Peat Control cc Me~~o~brook Farms Ho~.~wners A~~A. to:' Env~orqutl8t to Thq frud.nci~l Thonpaon Wood R~a] Entat~ to ::.J.~l~!Jle Suburb~n Aut.h. t~ Robin K. Zollenberger. Tax Collector to Robin X. Sollcnber~~r. TAX Call~ctor 35.00 1nQ.00 HO.OO 125.00 1f4.::H 822.51 2671.20 l~OO.tOTAL SC~LEMEt~ CKARG~5 l~n~er.d FORM 91~ 11.181 21.762.H on l:~~w ~OJ, SEctION J AND 502. ~ectioo K! S8~ p&3e 3 for certiflcAtion ~nd 8J.gnat~reB 1l.!l73.2,3 Page 3 of Form Approved OMB No. 2502-0265 Title Application No: D3Q4745CP CERTIFICATION I direct and authorize the Company to make the distributions indicated for my account on the attached HUD-l Settlement Statement, recognizing that the Company is not responsible for the accuracy or validity of disbursement amounts or the completeness of disclosure of charges made by others. Disbursements made hereunder are guaranteed by the company. Funds deposited with the Company in connection with the settlement are not held in trust, and interest or other valuable consideration may be earned and retained by the Company on such settlement funds .--- I further certify I have carefully reviewed the HUD-l Settlement Statement and to accurate statement of all r/ceipts and disbursements made on my that I have received a copy of the HOD-I Settlement Statement. ~ , 0' fo^. Borrowers Address Statement "'!-" ' I "dVt:!"" prepared is i;bu~~ccordance with a true and accurate account of this transaction. I have caused or this statement. q/fO I 01 a crime to knowingly make fals statements to the United States on this or any other similar form. penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. Date Form 471 {Rev. n/a7) SCHEDULE B STOCKS AND BONDS ESTATE OF Robert H. Jacoby FILE NUMBER 21-01-0447 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH Q!y CUSIP# Exch @ I 200 AT&T Corp 1957109 NYSE $15.66 $3,132.00 Dividend; rec dt: 3-30-01; pay dt: 5-1-01 $7.50 2 500 Bolder Technologies Corp 97519102 OTC $0.01 $5.00 3 600 Bristol Myers Squibb 110122108 NYSE $54.94 $32,964.00 4 200 Canadian Pacific Limited 13645TlOO NYSE $17.33 $3,466.00 5 112 Chiron Corp. 170040109 OTC $42.47 $4,756.64 6 100 CIBA Specialty Chemicals Holding Inc. 17162W206 NYSE $30.00 $3,000.00 Dividend; rec dt: 3-20-01; pay dt: 4-27-01 $49.91 7 400 Ciena Corp 171779101 OTC $39.03 $15,612.00 8 510 Coles Myer Ltd 193870409 NYSE $26.25 $13,387.50 9 400 Colgate Palmolive 194162103 NYSE $54.40 $21,760.00 10 100 E.I.DuPont DeNemours & Co. 263534109 NYSE $42.93 $4,293.00 II 1,493 Duff & Phelps Utility & Coporate Bond Trust 26432KI08 NYSE $13.76 $20,541. 79 12 100 Ecogen Inc. New 278864202 OTC $0.18 $18.00 13 200 Energy Research Corp 35952HI06 NMS $23.67 $4,734.00 14 1,000 Escagenetics 29605310 I NMS $0.22 $220.00 15 400 Evercel, Inc. 299759100 NMS $6.25 $2,500.00 16 1,200 FuelCell Energy Inc. 35952HI06 NMS $23.67 $28,404.00 17 400 Genzyme Corp. General Division 372917104 NMS $44.13 $17,652.00 18 21 Genzyme Corp. Com-Molecular Oncology Division 372917500 NMS $7.49 $157.29 19 27 Genzyme Corp. Biosurgery Division Tracking stock 372917104 NMS $44.13 $1,191.51 20 1,000 Gulf Canada 40218L305 NMS $5.33 $5,330.00 21 400 Guilford Pharmaceuticals, Inc. 401829106 NMS $16.31 $6,524.00 22 400 Horizon Pharmicies 439902107 AMEX $5.33 $2,132.00 23 100 Internet Studios.com Inc. Com new NMS $39.15 $3,915.00 24 300 Isis Pharmaceuticals, Inc. 464330109 NMS $8.52 $2,556.00 25 1,200 Johnson & Johnson 478160104 NYSE $43.77 $52,524.00 26 800 Eli Lilly & Co. 532457108 NYSE $76.30 $61,040.00 27 500 Lions Gate Entertaimnent Corp. 535919203 AMEX $1.71 $855.00 28 200 Longs Drug Stores, Corp. 543162101 NYSE $31.05 $6,210.00 Dividend; rec dt: 3-13-01; pay dt: 4-10-01 $28.00 29 100 Lubrizol Corp 5492711 04 NYSE $31.70 $3,170.00 30 500 Macrochem Corp. - Del. 555903103 NMS $5.34 $2,670.00 31 41 MIPs Technologies, Inc. CI B 604567107 NMS $18.81 $771.21 32 612 Novartis AG - Sponsored ADR 66987VI09 NYSE $40.34 $24,688.08 33 4,425 pfizer Inc. 717081103 NYSE $40.32 $178,416.00 34 357 Pharmacia Corp. REORG NYSE $50.48 $18,021.36 35 300 Phillips Petroleum Co 718507106 NYSE $54.67 $16,401.00 36 500 Rayovac Corp. 755081106 NYSE $18.15 $9,075.00 Subtotal $572,178.79 SCHEDULE B STOCKS AND BONDS (Cont'd) ESTATE OF FILE NUMBER Robert H. Jacoby 21-01-0447 (All property jointly--owoed with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH Snbtotal from prior page: $572,178.79 Q!y CUSIP# Exch @ 37 100 RIO Tinto PLC sponsored ADR NYSE $69.95 $6,995.00 Dividend; rec dt: 3 -9-0 I; pay dt: 4-9-0 I $154.00 38 500 Rite Aid Corp. 767754104 NYSE $6.14 $3,070.00 39 100 Roche Holding Ltd. 77195104 NMS $67.47 $6,747.00 Dividend; rec dt: 4-5-01; pay dt: 5-7-01 $57.23 40 300 Safegnard Scientifics Inc. 786449108 NYSE $3.96 $1,188.00 41 1,600 8chering Plough Corp 80660510 I NYSE $35.63 $57,008.00 42 300 Silicon Graphics Inc. 827056102 NYSE $3.26 $978.00 43 65 Syngenta AG Sponsored ADR NYSE $10.66 $692.90 44 602 Texas Instruments, Inc. 882508104 NYSE $30.53 $18,379.06 45 200 Ultralife Batteries Inc. 903899102 NMS $5.19 $1,038.00 46 500 Vari-L Compaoy 922150107 OTC $2.00 $1,000.00 47 1,433 Verizon Communications NYSE $48.25 $69,142.25 48 36 Waste Management, Inc. Del 941 06L 109 NYSE $23.61 $849.96 49 200 Western Gas Resources, Inc. 958259103 NYSE $33.75 $6,750.00 Dividend; rec dt: 3-30-01; pay dt: 5-14-01 $10.00 50 300 Winstar Communications, Inc. 97551507 OTC $0.53 $159.00 52 31,521 Vanguard Prime Money Market Fund $31,521.43 53 accrued dividends $22.07 54 555 Morgan Growth Fund - IRA $8,008.51 55 4,168 Muriel Siebert & Co. Prime Fund $4,167.71 56 40 Arapahoe Chemicals, Inc. $0.00 $0.00 57 100 Calgene, Inc. $0.00 $0.00 58 400 Chloride Group Limited ADR 170262208 $0.00 $0.00 59 3,000 ETTC Environmental Treatment and Technologies 670839109 $0.00 $0.00 60 255 F & E Resource Systems $0.00 $0.00 61 3,000 OHM Corporation 670839109 $0.00 $0.00 62 150 Scientific Control 808706105 $0.00 $0.00 63 200 Story Chemical 869810101 $0.00 $0.00 64 140 8yntex Corporation $0.00 $0.00 65 100 RTZ Corporation $0.00 $0.00 66 25 United Financial Group $0.00 $0.00 TOTAL (also on line 2, Recapitulation) $790,1l6.91 FROM : PAT MCFRDDEN CFP FAX NO. 2154964872 + Dec. 28 2001 05: 42PM P2 .. Legg Meson Wood We/ker,/noorporaled 873 Lsncester Avenue, Bryn Mewr, PA 19010.3379 610.527.7350 M~mbef NlIw YCltk Sloct Exchstlgt, IlIclM*lrdu~r SIPC December 28, 2001 Mr. Taylor P. Andrews Andrews & ,Johnson 78 W. Porofret Street CarlisleP A 17013 Re; Estate of Robert Jacoby Dear Mr. Andrews, After considerable research, we have determined the following securities had no market value on 04/0512001; Arapahoe Chemicals. Inc. Calgene lnc Chloride Group Limited ADR Ciba Giegy AG ADR ETIC Environmental Treatment and Technologies Corp. (now OHM Corp) F&E .Re~ource Systems Technoloey lnc OHM Corporation Sandoz Ltd ADR Scientific Control Corporation Story Chemical Corporation Syntex Corporation The RTZ Corporation PIc United Financial Group, Inc. Please do not hesitate to can me if you need further information regarding these securities. This quotation hl:\& been taken from AD? Power Partner and other applicable research SOurCes:. This quotation has been carefully checked but the accuracy is not guaranteed.. All capital chang.. may not be reflected '" the aoove qU01;e. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Robert H. Jacoby (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER 21-01-0447 VALUE AT DATE OF DEATH I $21,266.01 2 3 4 5 6 7 8 PNC Bank Checking Account 50-0186-3345 [copy of bank statement confinning balance attached] 1st Bank of Lakewood, CO Acconnt 340-470-0759 [copy of bank statement confinning balance attached] $2,555.83 Banca Unione Di Credito, Geneva, Switzerland Account 16545.322 210,115.42 CHF exchange as of 4/5/2001 I Swiss Franc [CHF] = $1.699083 [copy of bank statement confinning balance attached] $123,664.01 1995 Chevolet Truck [Kelly's blue book value - attached] $8,365.00 Household furnishings at 3 Mulberry Hill Road, Carlisle, P A [Appraisal attached] $1,939.00 Coin collection [Appraisal either attached or submitted under separate cover] $92,872.00 Stamp collection [inventory of stamps attached. Valued by Administrator with valuation books] $4,480.15 Checks received but not deposited at death: OHM Corp. - interest BP Amoco - Chevron - retirement Public Employees Retirement Assoc. American Historical Society - refund Novartis AG - dividend Novartis AG - dividend Social Security ck for March $240.00 $221. 79 $449.17 $737.06 $88.65 $89.31 $168.52 $1,175.00 TOTAL (also online 5, Recapitulation) $258,3 I 1.50 [nterest Checking Accou _ Statement 0.PNCBAN< For the period 03/15/2001 to 04/13/2001 ROBERT H JACOBY Primary account number: 50-0186-3345 Page 2 of 2 Robert H Jacoby E:t For 24-hour cllstomer service: Call: '-888-PNC-BANK interest Checking Account Summary I.ccount number: 50~0186-3345 Account link ~ number: 0189184942 Jalance Summary Please see the Activity Detail section for additional information. Beginning balance Deposits and other additions Checks and other deductions Ending n~"'nce Gl,2G6.0i) Charges and fees :!$,I45.1:J 69.04 1,948.16 Average monthly balance 21,795.33 .00 rransaction Summary Checks paid! withdrawals Bank card/POS Account Information transactions assistance calls Teller transactions 16 o 0 3 Total ATM transactions PNC Bank MAC Other MAC ATM ATM transactions transactions Other ATM transactions o o 0 o laterest Summary As of 04113, a total of $36.12 in interest was earned this year. Annual Percentage Yield Earned (APYE) Number of days in interest period Average collected balance for APYE Interest Earned this period 0.43% 21,795.33 30 8.02 "ctivity Detail IJeposits and Other Additions )ate )3, 15 U '29 14 '13 There were 3 Deposits and Other Additions totaling $69.04. Amount 35.00 2G.02 8.02 Description Deposit Reference No. Deposit Refl"l'ence No. Interest Payment 029836345 028857612 Checks :heck lumber IU 114 115 ill) 118 * II ~I t.:W 111 Date Reference Amount paid number 1-46.00 03./23 02I~96090 17.95 0:V22 027717205 680.00 03'19 02--10l9..117 500.00 0:t'27 025029626 -19.00 03/20 022700302 29.tlll 03,/20 027--1S69(,--1 .i..L3j eO):'j,':11 025272--171 20.80 03,/23 0211,9l;312 Check Date Reference number Amount paid number 422 90.00 03/22 02772--1668 423 49.00 03/27 02--167--1521 424 T 150.00 0:1/23 02S001.,6'i1 425 23.00 O:~/29 02210'JOl1 426 20.00 04/04 02--171;O,90 427 27."15 04/0:1 027SJ(;527 ,12;) S5.50 04/()~) n'.!747~)I':'9:; -119 14.95 04/13 0222~13i'53 ~ Gap in check sequence -Tn Teller Cashed Check There were 16 checks listed totaling $1.948.16. Daily Balance Detail )ale U:15 ):1 '19 1~1"20 Balance 23,],,0.13 22.500.13 22,-121.47 Date 03/21 O:~'/22 CU' "23 Balance 22,:~76,62 ')9 <)68 67 21:95187 Date 0:V27 O:l/29 0.1/02 Balance 21,402.87 21,405.89 21,320.39 Date 04/03 04/04 04/13 Balance 21,292.94 21 ~2.94 C21,- G.Ol..;/ I.~TO: PAGE FOR 24-HOUR TELEPHONE BANKING, CALL 303.274.5000 TO APPLY FOR A LOAN OR OPEN AN ACCOUNT, CALL 303-238-9000 IF OUTSIDE METRO DENVER, CALL 1-800-964-3444 G, LAKEWOOD PO BOX 260400 LAKEWOOD CO 80226-0400 1-0340 1...111...111......11.,11.11....11.....111..1....111..1,.1..11 ROBERT H JACOBY PO BOX 618 CARLISLE PA 17013-0618 340-470-0759 4-27-2001 22.12 N/A 'iimi~q99I:lNfjj':~!.!MM~~~mm~~mi'fi!~l'!~~ii"fi!~~II;I:';!:I1mi~!:!~~~,~~~,~ii~~~~~,l'!!:I1'jiiimimiii'i'''''''''''' i'iiimimm'im,,! ,.".._.._.'_._n__............"...."..... ...".".."..........--------.--....--... ..__.m.........,,",........................... ......_.....m_nmn........._......... .".....'n'._.________.__.__........ .......",.......".....-..--------. m._._m_n_n............".......'........ .. ..m.._.__.___nm.__U.............. .............-.......-.------..... SEE REVERSE SIDE FOR IMPORTANT INFORMATION mimi:,mm~~~!!:iiiifi!i~i!!li~fi!P.fi! ,....1 3,055.83 4.36+ 500.00- 2,560.19 CLOSING BALANCE FROM PREVIOUS STATEMEN1............................................................... DATE: 3-28-2001 1 DEPOSITS AND "THER ADDITIONS TOTALING................................................... 1 CHECKS AND OTHER WITHDRAWALS TOTALING................................................ CLOSING BALANCE FOR THIS STATEMENT............................................................................ DATE: 4-27-2001 ~~~ ~:~~;~~~"RIUU .............~.:..=.=.:.:.~.~....:.~~:::::::::::... 4-05-i~01 J INTEREST EARNED .................................................................................... 4.36 ANNUAL PERCENTAGE YIELD EARNED ......................................... 2. 00y. I' ii",i,iJ~g~~~,i~~II~~g~,~!1i;l:!Qi~~~~~,iiim~ii . ....... j'mmmmm:mmm,iiiimiiimmm[mm~mimmlmm,:mi,mmimim "",:""""::,:,::::::::Im,:::,::::,:,::",,,,,,,,,,,", 'i~im~l:!~~'ii~~~~I!!l'!li~~g~li~1i!IM!: I~! CHECK3.......AMOUNT...OATE CHECK3.......AMOUNT...DATE CHECK3.......AMOUNT...OATE 897 500.00 4-05 Ii"""" ~!;~$i~~,~~P,~TH!!;~:i~Q!fjjt~~i I . '11001[ """""""",,,,,,,,,,,,,,:,,,,,,,,,,::,,,,,,,,,,,,,,,,,,,,,,,, [ii~i~i~i~~::]::j:::jmm~:g::i::~:m:i::~:[i~[:E g(::[j[ ...._..._.__.__m__....._.......,..,..,..... .,.."..,..,..,.....,..__..__m__....'..... ...........,....,.............-----. m_...__m._.m__............... .....".....,................. ..................-. m mi~ m.: - .....................,........................-. ........- .............................. ,.,...",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..,,, ...........................----...----.--.....--.....-.. DATE..........AMOUNT..OESCRIPTION 4-27 4.36 INTEREST EARNED 1,~mmm~~!~1\1!li!:l~~~~1~ii~14,MM~~ljmm!m,i :::,'::':!,':::,i.'mmmimmmmmmml ,:mm::mmmmmmmillimiilm DATE..........BALANCE mmmmmmmmffilmimmm""i"::"::::::''''::'''' mmmm..... I,m. in:ii::'iii!!::;::\]:ijii1:i::mmmimmmm OATE..........BALANCE mlmimmmmiilimiiiiii'il OATE...........BALANCE "'" J-"_~ \:i\ji~liMm~:m:m; 3-29 3,055.83 4-05 2,555.83 4-27 2,560.19 j:l1\~"'D"mQl!lmiitippQD!!!1f:m EiALANC""m",'::::,:"........... :iililii,mmimmllli:I\~~" = mti!!!!!!Dti!m::mipI$RPI$!!!~A~l$mii~~I$!mll\ ......,.1 _'" ..............--, ...........;;..... _ _ ...... ............. .."li..... I'i':':::' RAtE 'DiscLoSURE ,7;:,{:RfiTE ...,..,~".. EFFECTIVE DATES 3/29 THROUGH 4/27 --- $500 UP TO $20,000 --. ----- $20,000 AND UP ------- RATE 2.71 % APY 2.75% ",::,::::::",::""::::,,::::,:,,",,,,::',,::i',::,'::mmmmmmmmmmmmm,l,mmm,iiiiimiiiii~ilmm, mimimi,miiim,il RATE 1.98% APY 2.00% I., i:lPWARE'We.. DOiNG?, ...,.....,."."..,...,..,..,... .....,.,...... ...................,........ .....,_.......____..______.m__.mm__...........".".".........."..,..'__.,. .. ........."..,....,.."..,...__.......__..m..__.m____................. ...m._____.m__mm_____.____.........,_"..,..'.....'..m.......m__.....___.m.. ....".".,..,..,..........,.....__'__..__m__....__..................".'........."''''0'' .............,.,..,.......,.........._'...m__________............................... .. .....................,.........--........--...------......-....--... ...................,.............--.....--.. ................................. ........,.........."."......."-,,... .......,...,......._,........__..____..m...m._____..'..__. ........,.".,.......,......,.."........,.....--. .................................,....,..,.. - WE ARE WORKING VERY HARD TO MAINTAIN THE HIGHEST LEVEL OF CUSTOMER SERVICE POSSIBLE. BUT IF WE MAKE A MISTAKE, OR YOU RECEIVE POOR SERVICE FROM ANY OF OUR EMPLOYEES, WE WANT YOU TO LET US KNOW. PLEASE CALL ONE OF OUR CUSTOMER REPRESENTATIVES AT 303-231-2000 (OUTSIDE METRO DENVER: 1-600-230-1060) WITH ANY QUESTION OR COMPLAINT. WE WILL DO OUR BEST TO SOLVE YOUR PROBLEM. IF OUR SERVICE HAS BEEN ESPECIALLY GOOD, WE'D LIKE TO HEAR ABOUT THAT TOO. WE WELCOME ANY SUGGESTIONS YOU MIGHT HAVE ABOUT NEW PRODUCTS OR WAYS WE COULD IMPROVE OUR SERVICE TO YOU. THANK YOU FOR BANKING WITH US! BANCA UNIONE 01 ~REOITO KREOIT UNION BANK . BANQUE UNION DE CREDIT CREDIT UNION BANK JACOBY ROE f TEL. 022 / 909.67.11 CODE TVA 187054. 1211 GENEVA, 02.05.2001 REF.: 09022971 PAYMENT NO. 22971 CERTIFICATE OF DEPOSIT BUC - CAYMAN Securi ty no.: 04.05.2001 000000643765.000 05.06.2001 Nominal Price Rate value CHF 100,000000 2,25000 % 210.000,00 % Amount CHF 210.000,00 Commissions Charges CHF CHF 90,42 25,00 Net amount CHF 210.115,42 Interests to maturity date CHF 406,87 (subject to encashment) Without your instructions five working days prior to maturity, your Certificate of Deposit will be renewed for the same period. Securities: to safekeeping account 1645322.NR.00 Debit to your account 1645322.01.DP.00 Through: MR ROBERT H. JACOBY Yours faithfully, BANQUE UNION DE CREDIT Advice without signature ExchangeRate.com - Exchan<- Rate - Currencies - Graphs - IntematiOlmt Currency - Forei.. Page 1 of2 . "I I m...~ ....................m................................................................................................................................................ fr.~:. eXchangeRate.com "%"~j i P > ';I,'ii~ 'h ~ ~<,' ~<. 0.;,.' XR uickealculator'''' U.S.A.-USD$ 1~-~--s~L'~~t---~~ ........Itl ... HOT!! XR For Your Web.ite™ XR 200+Calculator™ XR Quiz Challenge XR Quiz Scoreboard Shop @ XR Store ™ Register With XR CURRENCY INFO XR World Rates 1M XR Past Rates ™ XR Charts.. Graphs™ XR Currency Photos™ XR Central Banks™ FAQ SMART TRAVELLERS XR Travel Warning.™ XR Country Info ™ Shop @ XR Store ™ FOR BUSINESS Data Feeds SEARCH Travel It Finance LMM:. ~~ FridaYI December 7, 2001 Home >> XR Past Rates™ >> Switzerland ~~~~ert I_~~_~_~_~_~_~~.~,~~_"_~____~_~~,~_~__,~_~~_~~_:,'5~~ ~:~~~~: !2oo':lIAPrJt1 or Last 30 Days: I ~~:nvert IU.S.A: -USDotlar~ USD I....... .. ':'",:' iJI.'.o..... III r~.IMJ~rJ~1 Date Displaying Period: Apr 2001 Switzerland, Swiss Franc, CHF U.S.A., US Dollar, USD I 1 U.S.A., US Dollar, USD 1.727439 1.713849 1.706362 1.710130 1.707975 1.702847 1.702934 1.726057 1.735111 1 .724498 1.714176 1.709216 1.709888 1.716975 1.711538 1.695318 1.701948 1 .699083 1.701674 1.720613 1.734973 I 1 Switzerland, Swiss Franc, CHF 0.578892 0.583482 0.586042 0.584751 0.585489 0.587252 0.587222 0.579355 0.576332 0.579879 0.583371 0.585064 0.584834 0.582420 0.584270 0.589860 0.587562 0.58 553 . 87657 0.581188 0.576378 Apr-30 Apr-27 Apr-26 Apr-25 Apr-24 Apr-23 Apr-20 Apr-19 Apr-18 Apr-17 Apr-16 Apr-13 Apr-12 Apr-11 Apr-10 Apr-09 Apr-04 Apr-03 Apr-02 Content, information, data, material, services, or products comprising this web-site may not be published, broadcast, rewritten or redistributed without written permission from ExchangeRate.com Inc.. The information supplied by this web~site is believed to be accurate, but ExchangeRate.com Inc. does not warrant or guarantee such accuracy. Users are always advised to verify information with their financial and accounting advisors or with the appropriate government agencies before relying on any such information. Information contained in this web. site is intended for your personal, non-commercial use. All other uses are expressly unauthorized and prohibited to the maximum extent allowed by law. Thanks For Visiting ExchangeRate.Com ~~' BUtf 7 Finao<;iai Massage Boards at oncal ill Yahoo! Flnanc& ill MotleyFoO!/ I searchj ill R.tgin!l Bull ill ~ . I I ........ mangos. le..time'" .. ./past Jates.html?letter=&cont= All&cid=220&year=200 1&month=04&currency=239&action=Su 2/7/0 1 Kelley Blue Book Used Car V es Page 1 of2 New Car Pricing i Build a Car 1 IncentivES i ~w"'-~-'"l My Car's Value l Us<!<l Car _it I .KeUey __ Book kbb,com - guiding the car buyer Blue Book's unique , J ' t' J ~.---.. l RUlLD MAKE J LOCATE 'DEALER'S " " L!Ol.!~~~~._ pO~PARI~J.~~~O~~ ~'!!~!,~!:,IE,", BUy '. .... Click on the image above to visit this advertiser Blue Book Private Party Report Pennsylvania' December 10, 2001 1995 Chevrolet 1500 Pickup Short Bed Buy a New Car Buva Used Car List Your Car For Sale Online Financing Ouote Insurance Ouote Warranty Ouote Payment Calculator Engine: V8 5.0 Liter Trans: Automatic Drive: 2 Wheel Drive Mileage: 66,000 Equipment Cheyenne Air Conditioning Power Steering AM/FM Stereo Cassette ABS (4-Wheel) Pickup Shell/Cap Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left.. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. http://www.k.../kw.kcur?kbb;341933&;p&723;Chevrolet; 1995%20 1500%20Pickup&7;CT;A 12/1 010 1 . Kelley Blue Book Used Car' es Page 2 of2 $8,365 Private Party Value Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value Get Invoice & MSRP on New Cars Copyright @ 2001 by Kelley Blue Book CO'I All Rights Reserved. Nov.Dec 2001 Edition. The. information in this report was printed from the Kelley Blue Book Web site (www.kbb.com) and is intended for the personal use of the customer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omissions.(v.Ol111) SUlLO I MAKE. ! LOCATE __ i OEA\..ER'S I mH;w~ YOURCAR ~~~l!~!~~YL!.~~ ~..- A. http://www.k.../kw.kc.ur?kbb;341933&;p&723;Chevrolet; 1995%20 1500%20Pickup&7;CT;A 12/1 010 1 . '.. '. B~~ ROWE: ~~ ~~~~t 08 . AU 2276L R. D. 4, Box 353 . Carlisle, P A 249-2677 249-1978 Auction Is Action Call "ROWE"For Satisfaction May 29, 2001 TO: Taylor Andrews Attorney 78 West Pomfret st. Carlisle, Pa. 17013 FOR: Lynn S. Jacoby Administrator FROM: Benny E. Rowe Auctioneer/Appraiser 2505 Ritner Highway Carlisle, Pa. 17013 REF: Robert H. Jacoby Estate, 3 West Mulberry Hill Road, Carlisle, Pa. Personal Property Appraisal at Current Auction value. - . PAGE 2 2 Door Bookcase 2 Step End Stands 3 Cushion Sofa Rug Dropleaf Coffee table 2 Brass Table Lights 1930's Floor Light CAptains Chair Lamp Stand Wing back Chair Brass Floor Light Stereo $ 125.00 50.00 175.00 40.00 75.00 20.00 35.00 55.00 25.00 95.00 15.00 N/V BASEMENT/GARAGE Wine Making Accessories Misc. Small Tools Metal Shelf T V Stand 2 Door Bookcase Misc. Tools Wheelbarrow Step Ladder Bicycle 65.00 30.00 12.00 8.00 90.00 110.00 8.00 12.00 6.00 10.00 UPSTAIRS Maple bed 2 Drw Stand Table Light Captains Chair Brown Reclining Chair 7 Shelf Bookcase 4 Shelf Bookcase Cabinet- 2 Louver Doors Lamp Stand- One Door/One Drawer Queen bed 2 Drw Wall table Windsor style Chair Table Light One Drawer Night Stand Provincial Chest of drawers 65.00 35.00 5.00 8.00 90.00 85.00 65.00 90.00 65.00 125.00 110.00 55.00 5.00 55.00 75.00 TOTAL $1939.00 ~. ~-=--- Benny E. Rowe Q) ;;; 1ii w '"''' .c 0 8- ",t! ....,~ .0 :I: 0 t::o. 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ClO> ..."'-0"'-!:l~18111'" ~~~~~~ t;{;;t;)~~~ .... {;; a C'l .... o a C'l '" Ol 01 D. SCHEDULE G T ANSFERS EST ATE OF FILE NUMBER Robert H. Jacoby 21-01-0447 This schedule to be completed and filed if the answer of the question on the reverse of the cover is yes ITEM DESCRIPTION EXCLUSION TOTAL VALUE DECD.% DOLLAR VALUE NUMBER OF ASSET !NT OF DECD. INT I TIAA-CREF annuity - successor $89,367.41 life annuitant is wife, Peggy D. Jacoby Federal Fonn substitute 712 attached with valuation TOTAL (also on line 7, Rocapituhrtion) $89,367.41 "# j , Ii Teachers Insurance and Annuity Association College Retirement Equities Fund 730 Third Avenue, New York, NY 10017-3206 212490-9000 I 800842-2733 SUBSTITUTE FORM 712 This statement has been prepared as a substitute for U.S. Treasury Department Form 712 which does not apply to our annuity contracts/certificates since they have no life insurance features. Type of ContracUCertificate I c~~~c~~~~~c;te Number I Date Contract/Certificate Issued Immediate Annuitv March 1, 1988 Name of First Annuitant Date of Bh-th Date of Death Robert H. Jacoby January 20, 1923 Avril 5, 2001 Name of Second Annuitant Date of Birth Date of Death Pel!:l!:V D. Jacobv October 10, 1924 Name of Decedent Date of Birth Date of Death Remaining Investment in Contract $3,963.62 VALUE OF CONTRACT AT DECEDENT'S DEATH D [!] $ , value of accumulation (Deferred Annuity). $ 89,367.41 , present value of life annuity to surviving annuitant or beneficiary(ies). D The payment(s) made on was the final installment due the decedent. The annuity(ies) was terminated without any further value. The information below will only be provided to the Executor of the Estate upon receipt of the Letter of Appointment. BENEFICIARY(IES) ENTITLED TO PAYMENT AT DEATH OF LAST SURVIVING ANNUITANT NAME RELATIONSHIP 1. 2. 3. 4. THE UNDERSIGNED OFFICER OF TIAA-CREF HEREBY CERTIFIES THAT THIS STATEMENT SETS FORTH CORRECT AND TRUE INFORMATION. Signature Title Date 7~A~ Manager, Individual Services April 27, 200 I ":):\"::;.;~:-,::::;:}' .j" CREF Certificate No: OT46062-3 Robert H. Jacoby, deceased ;~ -:i'~ .<:,.....-; ~~"" - ..': );~3\):;~i"t,:~~,_:,. .51:~1;~~, p:~~~W.-ilJ}."lIA~fP~~~" :,_ "':;'::>><';;~:\'<' ' .. "",::,'1f5hi.H :', ,,'. \",.~c"'-'~::~'::"-;';'::;;~',~'U-i!::!a>tTi~~,,;~C>:,'~'T;:;;t,,:, TOTAL .OVERPAYMENt,WR{CR'EF,'f;$696;7m:-;- Your reduced future payments, starting with the June I, 200 I payment and continuing through approximately the September I, 200 I for CREF payment: Payment Over Payment to recover Total Payment Your Regular CREF Stock one -half Income is a variable income payable monthly beginning as of October 1, 2001 and continuing through your remaining lifetime. Number of Annuity Units Per Payment Current Value of One Total Initial Payment Annuity Unit 3.162 x $220.4222 = $696.97 fiJliyeai';l' Y'";,,,;,'c SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Robert H. Jacoby (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) 21-01-0447 A. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: 1 Hoffman Roth Funeral Home $5,620.00 2 Lakeview Memorial Park $2,185.00 3 Miscellaneous Expenses: $250.00 Administrative Costs: 1 Personal Representive Commissions $20,000.00 Social Security Number of Personal Representative: 2 Attorney fees to Andrews & Jobnson $20,000.00 3 Family Exemption Claimant Relationship: Address of Claimant at decedent's death: Street: City: State & Zip 4 Propate Fees to Register of Wills $2,395.00 Miscellaneous Expenses: 1 Electric bills $139.72 2 Phone bills $167.30 3 Gaslheat $516.73 4 Water/Sewer $328.84 5 Cleaning $1,462.39 6 Waste disposaJ $3,189.90 7 Yard care/brush cutting $643.10 8 Repairs $205.83 9 Insurance $662.41 10 RE Taxes $1,168.79 11 Advertising $172.07 12 SaJes expenses [realtor +] $18,823.00 13 Appraisals $385.00 14 Postage and shipping $2,111.28 15 Travel $695.51 16 SDB $140.00 17 PennDot title expenses $81.00 18 Stationary supplies for inventory purposes $19.48 19 20 21 TOTAL (also on line 9, Recapitulation) $81,362.35 B. C. SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Robert H. Jacoby 21-01-0447 ITEM NUMBER DESCRIPTION AMOUNT Discover $621.36 2 Capital Tax Collection Bureau - per capita tax $16.90 3 Department of Revenue - 2000 income taxes $428.00 4 Mid Penn Urology $50.00 TOTAL (also on line 10, Recapitulation) $1,116.26 SCHEDULEJ BENEFICIARIES ESTATE OF FILE NUMBER Robert H. Jacobv 21-01-0447 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE I Peggy D. Jacoby Wife $30,000 + 1/2 of balance 1956 S. Ingalls Court, Lakewood, CO 80227 c:7"~ 2 Linda Leigh Frost Daughter 1/,/ of [estate less $30,000] 1439 Ambleside Dr., Deerfield, IL 60015 3 Lynn S. Jacoby 0'1 ~Graydon Rd., Wilmington, DE 19803 Son 1/4(of [estate less $30,000) ~'II2-. c:7""-'7 ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: None $0 TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, R<:capitula1ion) $0 "",,""""',-971. COMMONWEALTH 0' PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev.1500 Cover Sheet ESTATE OF --r I l2. 10 rf. H FILE NUMBER ..Ja.coto!, 0 ~. ,;2/-01 -O'lY7 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust 0 other LIFE EStATEJNTEREstCALCllLAtlON NEAREST AGE AT DATE OF DEATH NAME(S) OF LIFE TENANT S D. .JO.co . DATE OF BIRTH 16-1D-Z,-/ 77 TERM OF YEARS LIFE ESTATE IS PAYABLE IRTLife or 0 Term of Years _ o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable $ 2. Actuarial factor per appropriate table Interest table rate - 0 3 1/2% 06% 0 10% 0 Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) $ g '7 ~ 7 t.f- I ..c.".,i',:'.,:.... ,::.::"i',:i'ii',,":?\::~~:lfO:ERI!$lilfil~Ql!1A:mlt':~'~ (:r.~.Y:;;,i' ii',i',Xi:."...... . !',;c',yr.."., <'-0;\"'::';';;'; ," ,,,,:J>.s,,/<,,;'~>.'>':1v~Y :...;/",.',.':~"; NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUIT ANTIS) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE o Life or 0 Term of Years - o Life or 0 Term of Years - o LifeorD Term of Years - o Life or 0 Term of Years - 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter conresponding (number) Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) ~ Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate 0 3 1/2% 06% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is : Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period, calculation is : (Line 4 x Line 5 x Line 6) + Line 3 $ (.;,9&.97 "'6:37~. fo'-l 15~3&7. "t I I NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) /~-d~~--13 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT R€:c DATE ESTATE OF DATE OF DEATH FILE NUMBER All :21 COUNTY ACN '02 1-1AR-1 TAYLOR P ANDREWS ESQ ANDREWS & JOHNSON 78 W POMFRET ST CARLISLE C2n, PA 17b-Hnbv" t-* REV-I'D? EX AFP 101-02> 02-25-2002 JACOBY 04-05-2001 21 01-0447 CUMBERLAND 101 AlIOUIlt Rellitted ROBERT H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, sUbllit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'ifj-E3t-AFP-foY--02Y-----...-iNifERITANC"E--YAX-Si'i,fEMENY-cfF'-ACrcoUiff--.i.--------------------- ESTATE OF JACOBY ROBERT H FILE NO. 21 01-0447 ACN 101 DATE 02-25- 2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-18-2002 PR I NCI PAL TAX DUE: ..........................................................................................................................................................._........................................................ PAYMENTS (TAX CREDITS): 26,906.62 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-04-2002 CDOOO719 .00 26,906.62 TOTAL TAX CREDIT 26,906.62 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 !Ii SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), .. - ""'- . -PP...... ",co:: DI'UI'RSI' SIDE OF THIS FORM FOR INSTRUCTIONS. ) j "\ V 1.( LIt( Date of Death: koLer+ '-f -~- STATUS REPORT UNDER RULE 6.12 H, 3aCc> ~y ( 'LotJl Name of Decedent: Will No.: Admin. No.: ~I -00 Vlf 7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes JK1 No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal ~r. esentative file a final account with the Court? Yes _ No 1&:1 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal ,!;fresentative state an account informally to the parties in interest? Y es ~ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with th rk of the 0 ans' Court and may be attached to this report. Date: ~-t;9 Sign ure ?yhr p A~~$ Name 76 W~ 1bwl Frd 5f Address (br-(l> (.e f P4- t f () ( 3 7t7 r2lf3 -or Z p Telephone No. Capacity: Cd Personal Representative JBl. Counsel for personal representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/10/2003 LYNN S JACOBY 2412 GRAYDON ROAD WILMINGTON, DE 19803 RE: Estate of JACOBY ROBERT H File Number: 2001-00447 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 4/05/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc:) File Counsel Judge /6 c2:.2cR-"- /.3 \ ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER All :1 8 COUNTY ACN '* REY-75' EX AFP (01-021 '01 JUN-2 TAYLOR P ANDREWS 1tSQ ANDREWS & JOHNSON 78 W POMFRET SlCSn, CARLISLE Cl~a~am~ 05-26-2003 JACOBY 04-05-2001 21 01-0447 CUMBERLAND 202 ROBERT H Allount Rellitted )'1 F'A MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ..... RE-v:;3E;-Ex--AFP--[oi~ii2i-----j(i-No-iicEf-OF:-nETEfRMIN~iIO-N-AN-n-ASfsEssiiENir---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF JACOBY ROBERT H FILE NO.21 01-0447 ACN 202 DATE 05-26-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 26.906.62 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 26.906.62 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE nul" A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN EST ATE OF ROBERT H. JACOBY. DECEASED THIS AGREEMENT made this ! 3~ FebrtJ (;)n..\ day of JaBtlary', 2003, by and between LYNN S. JACOBY, as Administrator of the Estate of ROBERT H. JACOBY, Deceased and as Son of ROBERT H. JACOBY and heir of the Estate of ROBERT H. JACOBY; PEGGY D. JACOBY, Surviving Spouse of ROBERT H. JACOBY, and Heir of the Estate of ROBERT H. JACOBY; and LINDA LEIGH FROST, Daughter of ROBERT H. JACOBY, and Heir ofthe Estate of ROBERT H. JACOBY; WHEREAS, ROBERT H. JACOBY, a resident of Pennsylvania, died on April 5, 2001, without having a will; and WHEREAS, on May 7, 2001, the Register of Wills in and for Cumberland County, Pennsylvania, did constitute and appoint LYNN S. JACOBY as Administrator of the estate of ROBERT H. JACOBY, filed to Estate No. 21-01-0447; and WHEREAS, pursuant to the intestate law of Pennsylvania, the Estate of ROBERT H. JACOBY, who was survived by the above named surviving spouse and two children, is to be divided by payment of the first Thirty Thousand ($30,000.00) Dollars to PEGGY D. JACOBY as surviving spouse, and the balance ofthe estate is to be divided with PEGGY D. JACOBY receiving one-half, and LYNN S. JACOBY and LINDA LEIGH FROST receiving equal shares of the remaining estate; WHEREAS, the Administrator has proceeded with the administration ofthe estate consisting of the assets set forth in the First and Final Account and Schedule of Proposed Distribution, a true and correct copy of which is attached hereto, and made a part hereof and marked as Exhibit A; and 1 WHEREAS, the only parties remaining in interest in the Estate are the above-named parties; and WHEREAS, the parties desire that the Administrator shall not be required to file an Account with the Register of Wills of Cumberland County, Pennsylvania and that the net estate of the decedent be distributed without the necessity of filing a formal account to avoid expense, delay and publicity of a formal accounting, but should instead be distributed in accordance with the Schedule of Proposed Distribution attached hereto and made a part hereof, and included with the Accounting as Exhibit A, attached hereto. NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements recited herein, and intending to be legally bound hereby, LYNN S. JACOBY, PEGGY D. JACOBY, and LINDA LEIGH FROST, the beneficiaries of the estate of ROBERT H. JACOBY do hereby formally agree as follows: 1. Each has fully and carefully reviewed the First and Final Account and Schedule of Proposed Distribution of LYNN S. JACOBY, Administrator of the Estate of ROBERT H. JACOBY, and finds them to be true and correct and acceptable and further acknowledge that they have received a copy of this Family Settlement Agreement and Final Release. 2. In order to avoid expense, delay and publicity involved in the filing of a formal Account and Schedule of Proposed Distribution, no accounting to the Court is necessary and they do hereby agree and consent to distribution being made without filing a First and Final Account and Schedule of Proposed Distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Court of Common Pleas of Cumberland County, Pennsylvania 2 3. They do hereby release, remise, quitclaim and forever discharge the Estate of ROBERT H. JACOBY, and LYNN S. JACOBY, Administrator of the Estate, his heirs, executors, administrators, and assigns, from all manner of acts, suits, claims, accountings, debts and demands whatsoever which they, their heirs and assigns, may at any time hereafter have against the Administrator, or the estate or assets thereof. 4. LYNN S. JACOBY, PEGGY D. JACOBY, and LINDA LEIGH FROST, do hereby covenant and agree that they wilI contribute their share of the Estate to satisfy any claims, debts, demands, suits, or causes of action that may be successfully brought against the Estate or the Administrator after the execution of this Family Settlement Agreement and Final Release. 5. The parties hereto agree that they will at all times in the future and wherever necessary, appropriate or convenient, make, execute and deliver to the Administrator or as otherwise directed by the Administrator, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention of this Family Settlement Agreement and Final Release. 6. The parties hereto agree that this Family Settlement Agreement and Final Release constitutes the entire understanding among the parties hereto and no other representations or statements of any kind, written or oral, have been made to them by the Administrator or any other person or party on their behalf. 7. This Family Settlement Agreement and Final Release shall inure to the benefit of and shall be binding upon the parties hereto, each of them, their heirs, executors, administrators, successors and assigns. 3 8. The laws of the Commonwealth of Pennsylvania shall govem this Family Settlement Agreement. IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have set their respective hands and seals the day and year first above written. WITNESS: S)r",-,,~(\ Ct 1~4 b~ (UiuLA Q J~ L~ C:>G-^9~~ LYNN S. JACO , ~dmmlstrator Estate of ROBERT H. JACOBY .-~ -4 9~~ LYNN S. JACO , R., Heir and beneficiary ofthe Estate of ROBERT H. JACOBY neficiary of the ~A'-f~ fi~ ~ LINDA LEIGH FROST, Heir and beneficiary ofthe Estate of ROBERT H. JACOBY 4 STATE OF DELAWARE COUNTY OF ~~lA. ) ) ON THIS, the ~ day of --.::::r~ ,2003, before me, the undersigned officer, personally appeared LYNN S. JACOBY known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained in his capacities as Administrator and as Heir. IN WITNESS WHEREOF, I have set my hand and official seal. (SEAL) BEL QUI NOTARY PUBUC My CornmIsaIon expires Dec. 13. 2003 STATE OF COLORADO ) COUNTY OF ) ON THIS, the rgtb-daYOf te.6rtO~ ,2003, before me, the undersigned officer, personally appeared PEGGY D. JACOBY, kno to me (or satIsfactonly proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. JENNIFER GILL NOTARY PUBLIC STATE OF COLORADO ~vU Not Public (SEAL) '-- 'AV Cnmmi!><;hr I=voires 5/2412005 5 STATE OF ILLINOIS ) COUNTY OF CLb~ ) ON THIS, the ,?"" day of ~AJ.t( ,2003, before me, the undersigned officer, personally appeared LINDA LEIGH FROST, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. (SEAL) ",-"~;-""./~'-.;j,,,,,,""'~'.'J!""r...!'..~~~"~"'--"'-" InOFFICIAL SEAL" , RODNEY H. PIERCEY ~ NOTARY PUBLIC, STATE OF ILLINOIS ~ . MY C(,\~M!5SI0r,: fXPIi~FS 6/29i2COS 6 IN RE: ESTATE OF Robert H. Jacoby DECEASED IN THE COURT OF COMMON PLI;AS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0447 FIRST AND FINAL ACCOUNT OF LYNN S. JACOBY ADMINISTRATOR OF THE ESTATE OF ROBERT H. JACOBY LATE OF NORTH MIDDLETON TOWNSHIP,CUMBERLAND COUNTY, PENNSYLVANIA Date of death: Letters Granted: Advertisement of Letters: The Sentinal: Cumbo Law Journal: ACCOUNT STATED AS FINAL April 5, 2001 May 7, 2001 May 14, 21, & 28,2001 May 18, 25, & June 1, 2001 Purpose of Account: Lynn S. Jacoby offers this account to inform interested parties of the transactions that have occured during this administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Taylor P. Andrews, Esq. 78 W. Pomfret St., Carlisle, Pa. 17013. Phone 717-243-0123 PRINCIPAL Receipts Gains/(Losses) from conversions Less Disbursements Balance Before Distributions Distributions to Beneficiaries Principal Balance Remaining SUMMARY & INDEX Paqe No. 2 3 4 5 $1,356,416.29 ($84,729.12) ($125,227.27) $1,146,459.90 ($855,406.96) $291,052.94 INCOME Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Income Balance Remaining 6 7 $28,921.36 $2,322.00 $26,599.36 $0.00 $26,599.36 COMBINED BALANCE REMAINING $317,652.30 EXHIBIT j D B A 12/30/02 PRINCIPAL RECEIPTS Realtv: 3 West Mulberry Hill Rd., Carlisle, PA 1995 Chevrolet Truck Household Furnishings PNC Checking Account 1st Bank of Lakewood, CO Account 340-470-0759 Checks received but not deposited at death: OHM Corp. - interest BP Amoco - Chevron - retirement Public Employees Retirement Assoc. American Historical Society - refund Novartis AG - dividend Novartis AG - dividend Social Security ck for March Allstate insurance claim on homeowners insurance Refund - Wayside Gardens Discover Card - cash back bonus award Sales tax refund check from Comm of PA Banca Unione Di Credito, Geneva, Switzerland Account 16545.322 Coin Collection Stamp Collection 200 AT&T Corp Dividend; rec dt: 3-30-01; pay dt: 5-1-01 500 Bolder Technologies Corp 600 Bristol Myers Squibb 200 Canadian Pacific Limited 112 Chiron Corp. 100 CIBA Specialty Chemicals Holding Inc. Dividend; rec dt: 3-20-01; pay dt: 4-27-01 400 Ciena Corp 510 Coles Myer Ltd 400 Colgate Palmolive 100 E.I.DuPont DeNemours & Co. 1,493 Duff & Phelps Utility & Coporate Bond Trust 100 Ecogen Inc. New 200 Energy Research Corp 1,000 Escagenetics 400 Evercel, Inc. 1,200 FuelCell Energy Inc. 400 Genzyme Corp. General Division 21 Genzyme Corp. Com-Molecular Oncology Division 27 Genzyme Corp. Biosurgery Division Tracking stock 1,000 Gulf Canada 400 Guilford Pharmaceuticals, Inc. 400 Horizon Pharmicies 100 Internet Studios. com Inc. Com new Page 2 - Principal Receipts Amount $259,900.00 $8,365.00 $1,939.00 $21,266.01 $2,555.83 $240.00 $221.79 $898.34 $1,474.12 $88.65 $89.31 $168.52 $1,175.00 $518.97 $130.60 $16.94 $36.65 $123,664.01 $92,872.00 $4,480.15 @ $15.66 $3,132.00 $7.50 $0.01 $5.00 $54.94 $32,964.00 $17.33 $3,466.00 $42.47 $4,756.64 $30.00 $3,000.00 $49.91 $39.03 $15,612.00 $26.25 $13,387.50 $54.40 $21,760.00 $42.93 $4,293.00 $13.76 $20,541.79 $0.18 $18.00 $23.67 $4,734.00 $0.22 $220.00 $6.25 $2,500.00 $23.67 $28,404.00 $44.13 $17,652.00 $7.49 $157.29 $44.13 $1,191.51 $5.33 $5,330.00 $16.31 $6,524.00 $5.33 $2,132.00 $39.15 $3,915.00 12/30/02 300 Isis Pharmaceuticals. Inc. 1,200 Johnson & Johnson 800 Eli Lilly & Co. 500 Lions Gate Entertainment Corp. 200 Longs Drug Stores, Corp. Dividend; rec dt: 3-13-01; pay dt: 4-10-01 100 Lubrizol Corp 500 Macrochem Corp. - Del. 41 MIPs Technologies, Inc. CI B 612 Novartis AG - Sponsored ADR 4,425 Pfizer Inc. 357 Pharmacia Corp. 300 Phillips Petroleum Co 500 Rayovac Corp. 100 RIO Tinto PLC sponsored ADR Dividend; rec dt: 3-9-01; pay dt: 4-9-01 500 Rite Aid Corp. 100 Roche Holding Ltd. Dividend; rec dt: 4-5-01; pay dt: 5-7-01 300 Safeguard Scientifics Inc. 1,600 Schering Plough Corp 300 Silicon Graphics Inc. 65 Syngenta AG Sponsored ADR 602 Texas Instruments, Inc. 200 Ultralife Batteries Inc. 500 Vari-L Company 1,433 Verizon Communications 36 Waste Management, Inc. Del 200 Western Gas Resources, Inc. Dividend; rec dt: 3-30-01; pay dt: 5-14-01 300 Winstar Communications, Inc. 60 Zimmer Holdings, Inc. 31,521 Vanguard Prime Money Market Fund accrued dividends 4,168 Muriel Siebert & Co. Prime Fund Total Receipts of Principal Page 2 - Principal Receipts $8.52 $87.54 $76.30 $1.71 $31.05 $31.70 $5.34 $18.81 $40.34 $40.32 $50.48 $54.67 $18.15 $69.95 $6.14 $67.47 $3.96 $35.63 $3.26 $10.66 $30.53 $5.19 $2.00 $48.25 $23.61 $33.75 $0.53 $28.05 $2.55600 $105,048.00 $61,040.00 $855.00 $6,210.00 $28.00 $3,170.00 $2,670.00 $771.21 $24,688.08 $178,416.00 $18,021.36 $16,401.00 $9,075.00 $6,995.00 $154.00 $3,070.00 $6,747.00 $57.23 $1,188.00 $57,008.00 $978.00 $692.90 $18,379.06 $1,038.00 $1,000.00 $69,142.25 $849.96 $6,750.00 $10.00 $159.00 $1,683.00 $31,521.43 $22.07 $4,167.71 $1,356,416.29 12/30/02 r CONV~RSIONS Date Asset 7/9/01 Sale of AT&T wireless fractional shares 10/15/01 Sale of CPL fractional shares 12/31/01 Sale of AT&T wireless [less cost of sale] 1/18/02 60 shares of Zimmer Holdings, Inc. 4/25/02 600 shares of Bristol Myers 800 shares of Eli Lilly & Co 2200 shares of Pfizer, Inc. 5/13/02 1200 shares Johnson & Johnson 5/20/02 1600 Sherring Plough Corp. 7/1/02 1452 shares Verizon 9/10/02 500 shares Bolder Tech. Corp 10 shares Ecogen, Inc. 5 Internet Studios.com 500 shares Vari-L Co, Inc. 200 shares Winstar Communications, Inc. 1000 shares Escagenetics 400 shares Horizon Pharmacies 150 shares of Scientific Control 25 shares of United Financial Group 1/28/02 Increased value of Swiss Bank account Sale Price $5.92 $38.19 $833.76 $1,801.00 $17,398.90 $54,934.00 $78,230.51 $70,736.51 $39,480.32 $52,779.09 $0.39 $1.29 $2.19 $329.99 $0.85 $4.99 $0.39 $0.14 $0.02 Cost Basis $0.00 $0.00 $0.00 $1,683.00 $32,964.00 $61,040.00 $88,704.00 $52,524.00 $57,008.00 $69,142.25 $5.00 $18.00 $3,915.00 $1,000.00 $159.00 $220.00 $2,132.00 $0.00 $0.00 Unrecognized Loss in value from 000 value to Date of Distribution value of stocks distributed in kind: 8/21/02 Gain on sale of coins to Delaware Valley Collectors TOTAL GAINS/(LOSSES) ON CONVERSIONS: ESTATE COMPOSITION PNC Accounts: Performance Money Market Account Interest Checking Account Legg Mason Account TOTAL Page 3- Asset Conversions Gain/(Loss) $5.92 $38.19 $833.76 $118.00 ($15,565.10) ($6,106.00) ($10,4 73.49) $18,212.51 ($17,527.68) ($16,363.16) ($4.61 ) ($16.71) ($3,912.81) ($670.01 ) ($158.15) ($215.01 ) ($2,131.61) $0.14 $0.02 $4,214.95 ($35,350.27) $342.00 ($84,729.12) $283,559.30 $32,988.34 $1,104.66 $317,652.30 12/30/02 PRINCIPAL DISBURSEMENTS Amount 16-May-01 Sprint Carlisle Suburban - water/sewer UGI PP&L Discover Allstate Allstate Jack Gaughen Andrews & Johnson 65 short certificates 04-Jun-01 The Sentinel UGI Lynn S. Jacoby for: Carlisle Suburban - water/sewer Lakeview Memorial Park State Farm - for bond Peggy Jacoby's Rx. Hoffman Roth Funeral Home Andrews & Johnson 12-Jun-01 Sprint Rowe Antiques Cumberland Law Journal PP&L 02-Jul-01 Andrews & Johnson 06-Jul-01 PP&L UGI York Waste Disposal Discover 27-Jul-01 Double Gold Inc. - hazardous waste disposal Gwenn Drum Lynn S. Jacoby for: SDB for valuables Funeral music etc. Postage Register of Wills Travel Stationary supplies for inventory Bond refund Mid Penn Urology Andrews & Johnson short certificates 06-Aug-01 Andrews & Johnson 10-Aug-01 Sprint PP&L Capital Tax Collection Bureau 24-Aug-01 Waste Management 27-Aug-01 Pa Dept of Revenue Public Empl Retirement system 30-Aug-01 Com of PA PennDOT 10-Sep-01 UGI Andrews & Johnson 18-Sep-01 Lynn S. Jacoby for: Gwenn Drum A touch of green Sears - truck battery Page 4 - Principal dis. $93.08 $146.90 $394.18 $58.83 $583.70 $379.00 $177.40 $100.00 $195.00 $97.07 $27.56 $4,225.26 $5,620.00 $2,435.00 $30.04 $85.00 $75.00 $11.30 $650.00 $20.64 $81.80 $27.45 $37.66 $1,018.97 $235.00 $480.58 $50.00 $150.00 $562.50 $22.09 $21.60 $16.90 $350.00 $428.00 $614.22 $58.50 $3.76 $1,203.00 $1,205.91 12/30/02 Postage Supplies Meals Supplies Fred House SOB for valuables York Waste Disposal 14-Sep-01 Bullard Spahr Andrews & ... 26-Sep-01 PP&L UGI 01-0ct-01 Andrews & Johnson 02-0ct-01 Sprint 04-0ct-01 Lynn S. Jacoby David Frost Safety Kleen 11-0ct-01 Greenmont Moving & Storage Equitable Life Assurance Com of PA PennDOT Allstate 08-Nov-01 Andrews & Johnson 04-Dec-01 Andrews & Johnson 10-Sep-01 Settlement Sheet Disbursements: Realtors' Commission Notary Transfer tax Carlisle Suburban Real Estate Taxes Real Estate Taxes Radon Remediation Real Estate Taxes Real Estate Taxes 27 -Dec-01 Rocky Mountain Appraisers LLC 04-Jan-02 Register of Wills - filing fee In tx Register of Wills - inheritance tx Andrews & Johnson Allstate - auto insurance Lynn S. Jacoby 03-Feb-02 Andrews & Johnson 12-Feb-02 Ballard Spahr Andrews and Ingersoll, LP Register of Wills 08-Mar-02 Andrews & Johnson 28-Mar-02 State Farm - for bond Andrews & Johnson 17-Jul-02 Delaware Valley Coin Company Andrews & Johnson 02-Aug-02 Andrews & Johnson 04-Sep-02 Andrews & Johnson 01-0ct-02 Andrews & Johnson 22-Mar-02 Refund of homeowners insurance premium 17-Apr-02 UGI refund 22-Nov-02 Andrews & Johnson Pa Dept of Revenue 02-Jan-03 Alma Boettcher David Frost Dorothy Crump Gary McGinn $27.45 $443.03 $27.35 $9.43 $1,122.75 $22.09 $51.57 $546.50 $2,785.00 $1,992.06 $29.95 $22.50 $106.01 $787.50 $187.50 fees for administration services fees for administration services fees for administration services fees for administration services $15,594.00 $5.00 $2,599.00 $84.94 $822.57 $2,677.20 $625.00 ($224.87) ($2,106.11 ) $300.00 $15.00 $26,906.62 $6,147.25 $88.49 $141.11 $435.00 $621.91 $455.00 $250.00 $1,528.00 $75.00 $3,000.00 $303.00 $625.00 $168.41 $225.00 ($231.00) ($3.76) $7,662.50 $35.67 $450.00 $1,268.75 $450.00 $412.50 Page 4 - Principal dis. 12/30/02 Reserves: Janet Jacoby fees for administration services Lynn S. Jacoby fees for administration services Peggy Jacoby fees for administration services Ruth McGinn fees for administration services Vicki Jo Bright fees for administration services Final Administration expenses, taxes, etc. TOTAL DISBURSEMENTS OF PRINCIPAL $5,12500 $7,237.50 $300.00 $125.00 $900.00 $10,000.00 $125,227.27 Page 4 - Principal dis. 12/30/02 DISTRIBUTIONS TO BENEFICIARIES Peggy D. Jacoby: 30-May-01 Check 17-Sep-01 Check 20-Dec-01 Check 19-Apr-02 Check Coins distributed in kind [as per attached statement] 06-Sep-02 Check from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Linda Leigh Frost: 20-Dec-01 Check Coins distributed in kind [as per attached statement] 06-Sep-02 Cash from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Lynn S. Jacoby: 27-Dec-01 Check 06-Sep-02 Cash from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Coins distributed in kind [as per attached statement] Stamp Collection 1995 Chevrolet Truck Total Distibutions to Beneficiaries: Page 5 - Distributions $5,000.00 $15,000.00 $10,000.00 $20,000.00 $2,678.00 $150,000.00 $190,862.92 $21,235.55 $15,000.00 $8,732.00 $75,000.00 $99,443.97 $6,843.07 $15,000.00 $75,000.00 $98,918.07 $7,511.23 $26,337.00 $4,480.15 $8,365.00 $414,776.47 $205,019.04 $235,611.45 $855,406.96 12/30/02 INCOME RECEIPTS First Bank of Lakewood, CO: interest earned after 000: $22.76 Muriel Siebert & Co, Prime Fund dividends paid after 000 $45.95 Vanguard Prime Money Market Fund dividends paid after 000: Distribution from IRA at 9863710486 $559.48 $2,000.00 Post 000 Dividends from Reinvestment programs: Duff & Phelps Utility and Corporate Bond Verizon Communications Direct Invest Canadian Pacific Johnson & Johnson $839.92 $1,107.17 $99.99 $1,326.00 Dividends received before stocks transferred to Legg Mason: AT&T Bristol Myers Squibb Company Canadian Pacific Railway Ltd Chloride Group P.L.C. Coles Myer Limited ADR Colgate Palmolive Duff & Phelps Utility & Corp Bond Trust Dupont Equitable Life Assurance Fairmont Hotels & Resorts Fording John Hancock Lilly Longs Drug Stores Lubrizol Corp. Pan Canadian Energy Pfizer Pharmacia Phillips Petroleum She ring Plough Texas Instruments Verizon Western Gas Resources $20.42 $165.00 $3.54 $18.40 $499.48 $63.00 $107.92 $35.00 $35.94 $0.44 $1.13 $130.24 $224.00 $28.00 $26.00 $3.88 $486.75 $91.04 $102.00 $256.00 $19.19 $411.09 $10.00 Income received through Legg Mason account: dividends in 2001 : interest in 2001 : dividends in 2002: interest in 2002: distribution of Monsanto stock Misc. $3,983.86 $319.17 $6,485.67 $1,307.68 $1,105.27 $1,075.00 Interest earned on Estate Accounts at PNC: Account 50-0186-3345 Interest Checking 50-0312-0799: 2001 $7.83 $115.18 Page 6- Income In 12/30/02 2002 through 12/11/02 Performance Money Market Account 50-0385-1516 2001 2002 through 10/7/02 $10163 $1,440.16 $4,240.18 Total Receipts of Income $28,921.36 Page 6- Income In 12/30/02 INCOME DISBURSEMENTS 02-Apr-02 U.S. Treasury - w req 4 extension 08-Apr-02 Pa Dept of Revenue w req 4 extension 06-Aug-02 Pat Rosendale, CPA 11-0ct-02 IRS refund Pa Dept of Revenue refund TOTAL INCOME DISBURSEMENTS Page? - Income Out $2,000.00 $150.00 $500.00 ($288.00) ($40.00) $2,322.00 12/30/02 STATE OF DELiWARE COUNTY OF ~W~1"-- Lynn S. Jacoby ,being duly sworn according to law, deposes and says that the Account and Proposed Schedule of Distribution as stated are true and correct, and that the Grant of Letters and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. 4J .A I:).~ Sworn and subscribed to before me this.1... day of January, 2003 I . . NOTARY PUBUC My Comm/8aion ExpIres Dec. 13. 200S IN RE: ESTATE OF Robert H. Jacoby DECEASED IN TI-IE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0447 SCHEDULE OF PROPOSED DISTRIBUTION Combined Balance for Distribution $1,173,059.26 Remaining as Per First and Final Account: $317,652.30 TO: Peggy D. Jacoby Previously Distributed [see P.5] $414,776.47 From above remaining balance $186,753.16 $601,529.63 TO: Linda Leigh Frost Previously Distributed [see P.5] $205,019.04 From above remaining balance $80,745.78 $285,764.82 TO: Lynn S. Jacoby Previously Distributed [see P.5] $235,611.45 From above remaining balance $50,153.37 $285,764.82 TOTAL DISTRIBUTIONS $1,173,059.26 STATEMENT OF REASONS FOR THE PROPOSED DISTRIBUTION The Decedent, Robert H. Jacoby, died intestate. Under Pennsylvania's intestate law, the surviving spouse of Robert H. Jacoby is entitled to receive the first $30,000 of the estate plus one-half of the balance. The balance of the estate is divided equally by the children of Robert H. Jacoby. Peggy D. Jacoby is the surviving spouse, and Linda Leigh Frost an Lynn S. Jacoby are the only two children of Robert H. Jacoby. c-G --^>. q~ Lynn S. Jacoby, Adminls. or Sch. of Prop. Dist. 12/30/02 InRe: Estate of Robert H. Jacoby : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-01-0447 ~ AND NOW, this1A dayof ,2003, in consideration of the attached Petition, Lynn S. Jacoby, Administrator of the Estate of R rt H. Jacoby, is hereby discharged from the duties of the office of Administrator, and both Lynn S. Jacoby and State Farm Insurance Company as surety on his bond as Administrator are both released from future liability for acts ofLynn S. Jacoby as Administrator of the Estate of Robert H. Jacoby, deceased. BY THE COURT, J. " ~",.- ;;.....1 ' ~ '--' \....; c, ~.; w ~ ,,::-.,. lJ'l InRe: Estate of Robert H. Jacoby : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-01-0447 PETITION FOR DISCHARGE OF ADMINISTRATOR TO THE HONORABLE JUDGES OF SAID COURT: The Petition of Lynn S. Jacoby, through his counsel, Taylor P. Andrews, Esq. respectfully represents that: 1. Petitioner qualified as Administrator of the Estate of Robert H. Jacoby, deceased, by decree of the Register of Wills of Cumberland County dated May 7, 2001. 2. Petitioner has undertaken and concluded the administration of the above referenced estate. He has paid all claimants and filed all required tax returns. Distribution has been made in accordance with a Family Settlement Agreement dated February 13,2003, an original of which has been filed with the Register of Wills of Cumberland County at the above numbered estate, and a copy of which is attached hereto as Exhibit 1. 3. The entire estate has been distributed to the parties entitled thereto and no other property belonging to the estate has been received or remains to be accounted for. 4. Surety on Petitioner's bond as administrator is State Farm Insurance Company on bond in the amount of $800,000.00, filed with the Register of Wills. 5. The only parties in interest in the distribution of this estate were Lynn S. Jacoby, Peggy D. Jacoby, and Linda Leigh Frost, each of whom have acknowledged receipt oftheir distributive share by the Family Settlement Agreement referenced above. WHEREFORE, Petitioner asks the Court to enter an Order discharging Petitioner, Lynn S. Jacoby from the duties of the office of Administrator and that both he and State Farm Insurance Company be released from future liability from the acts ofLynn S. Jacoby as Administrator of the Estate of Robert H. Jacoby, deceased. Respectfully submitted, ANDREWS & JOHNSON Tay r . Andrews, Esq. 7 t Pomfret Street 'sle PA 17013 ( 17) 243-0123 Supreme Ct. Id#: 15641 ST ATE OF DELA WARE COUNTY OF I, Lynn S. Jacoby, verify that the statements made in this Petition are true and correct and to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. S 4904, relating to unsworn falsification to authorities. Date: -~ u II '2 'Z.. Zoos / ~O.A9~~ Lynn S. Jacoby l~\q Sworn and subscribed before me this~ day of July, 2003 t(:~~.U0 ~\~~ - '-<0-.'\~\ ['0\ \::,. f.. \M: ~\\\\ ~ . Notary Public ,,--;(\ \\\" '\\'O~~\\'\, t~ \'\:j.\~'C\. \\.'- MEUSSA DUFF NOTARY PUBUC-OELAWARE My CornrnIPIon &pIres Nov. e, 2003 FAMIL Y SETTLEMENT AGREEMENT AND FINAL RELEASE IN ESTATE OF ROBERT H. JACOBY. DECEASED THIS AGREEMENT made this 13~ Febrv day of Jami~2a03, by and between LYNN S. JACOBY, as Administrator of the Estate of ROBERT H. JACOBY, Deceased and as Son of ROBERT H. JACOBY and heir of the Estate of ROBERT H. JACOBY; PEGGY D. JACOBY, Surviving Spouse of ROBERT H. JACOBY, and Heir of the Estate of ROBERT H. JACOBY; and LINDA LEIGH FROST, Daughter of ROBERT H. JACOBY, and Heir of the Estate of ROBERT H. JACOBY; WHEREAS, ROBERT H. JACOBY, a resident of Pennsylvania, died on April 5, 2001, without having a will; and WHEREAS, on May 7, 2001, the Register of Wills in and for Cumberland County, Pennsylvania, did constitute and appoint LYNN S. JACOBY as Administrator of the estate of ROBERT H. JACOBY, filed to Estate No. 21-01-0447; and WHEREAS, pursuant to the intestate law of Pennsylvania, the Estate of ROBERT H. JACOBY, who was survived by the above named surviving spouse and two children, is to be divided by payment of the first Thirty Thousand ($30,000.00) Dollars to PEGGY D. JACOBY as surviving spouse, and the balance of the estate is to be divided with PEGGY D. JACOBY receiving one-half, and LYNN S. JACOBY and LINDA LEIGH FROST receiving equal shares of the remaining estate; WHEREAS, the Administrator has proceeded with the administration of the estate consisting of the assets set forth in the First and Final Account and Schedule of Proposed Distribution, a true and correct copy of which is attached hereto, and made a part hereof and marked as Exhibit A; and 1 j .0 S EXHIBIT I WHEREAS, the only parties remaining in interest in the Estate are the above-named parties; and WHEREAS, the parties desire that the Administrator shall not be required to file an Account with the Register of Wills of Cumberland County, Pennsylvania and that the net estate of the decedent be distributed without the necessity of filing a formal account to avoid expense, delay and publicity of a formal accounting, but should instead be distributed in accordance with the Schedule of Proposed Distribution attached hereto and made a part hereof, and included with the Accounting as Exhibit A, attached hereto. NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements recited herein, and intending to be legally bound hereby, LYNN S. JACOBY, PEGGY D. JACOBY, and LINDA LEIGH FROST, the beneficiaries of the estate of ROBERT H. JACOBY do hereby formally agree as follows: 1. Each has fully and carefully reviewed the First and Final Account and Schedule of Proposed Distribution of LYNN S. JACOBY, Administrator of the Estate of ROBERT H. JACOBY, and finds them to be true and correct and acceptable and further acknowledge that they have received a copy of this Family Settlement Agreement and Final Release. 2. In order to avoid expense, delay and publicity involved in the filing of a formal Account and Schedule of Proposed Distribution, no accounting to the Court is necessary and they do hereby agree and consent to distribution being made without filing a First and Final Account and Schedule of Proposed Distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Court of Common Pleas of Cumberland County, Pennsylvania 2 3. They do hereby release, remise, quitclaim and forever discharge the Estate of ROBERT H. JACOBY, and LYNN S. JACOBY, Administrator of the Estate, his heirs, executors, administrators, and assigns, from all manner of acts, suits, claims, accountings, debts and demands whatsoever which they, their heirs and assigns, may at any time hereafter have against the Administrator, or the estate or assets thereof. 4. LYNN S. JACOBY, PEGGY D. JACOBY, and LINDA LEIGH FROST, do hereby covenant and agree that they will contribute their share of the Estate to satisfy any claims, debts, demands, suits, or causes of action that may be successfully brought against the Estate or the Administrator after the execution of this Family Settlement Agreement and Final Release. 5. The parties hereto agree that they will at all times in the future and wherever necessary, appropriate or convenient, make, execute and deliver to the Administrator or as otherwise directed by the Administrator, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention ofthis Family Settlement Agreement and Final Release. 6. The parties hereto agree that this Family Settlement Agreement and Final Release constitutes the entire understanding among the parties hereto and no other representations or statements of any kind, written or oral, have been made to them by the Administrator or any other person or party on their behalf. 7. This Family Settlement Agreement and Final Release shall inure to the benefit of and shall be binding upon the parties hereto, each of them, their heirs, executors, administrators, successors and assigns. 3 8. The laws of the Commonwealth of Pennsylvania shall govern this Family Settlement Agreement. IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have set their respective hands and seals the day and year first above written. WITNESS: ~ ({~~"~ rp~~ Q. 3-~L:l c=>cs-^ 9~~ LYNN S. JACO , ~dministrator Estate of ROBERT H. JACOBY ~(\ -49~~ LYNN S. JACO , R., Heir and beneficiary of the Estate of ROBERT H. JACOBY neficiary of the A~' ~L A-,~ ~ LINDA LEIGH FROST, Heir and beneficiary of the Estate of ROBERT H. JACOBY 4 STATE OF DELA WARE COUNTY OF ~~u.. ) ) ON THIS, the ~ day of ~ ~ ,2003, before me, the undersigned officer, personally appeared LYNN S. JACOBY known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained in his capacities as Administrator and as Heir. IN WITNESS WHEREOF, I have set my hand and official seal. (SEAL) BEL GUl NOTARY PUBUC MyCommlsalon expires Dec. 13,2OOj STATE OF COLORADO ) COUNTY OF ) ON THIS, the fgll;-dayOf LeOltO~ ,2003, before me, the undersigned officer, personally appeared PEGGY D. JACOBY, kno to me (or satlsfactonly proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. JENNIFER GILL NOTARY PUBLIC STATE OF COLORADO ~~ Not Pubhc (SEAL) 'AV Cnmmi~<;h" ~voires 512412005 5 STATE OF ILLINOIS ) COUNTY OF C-Q; ~ ) ON THIS, the 1311( day of -~AJ.tf ,2003, before me, the undersigned officer, personally appeared LINDA LEIGH FROST, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. (SEAL) Q'~~'-"-'~" "OFFICIAL SEAL" S RODNEY H. PIERCEY ~ NOTARY PUBLIC, STATE OF ILLINOIS ~ , MY COMMISSION EXPiRES 6/29/2005 ' ~"."',:'.;F'';..._J --i '...: '.-'-__....... 6 IN RE: ESTATE OF Robert H. Jacoby DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0447 FIRST AND FINAL ACCOUNT OF LYNN S. JACOBY ADMINISTRATOR OF THE ESTATE OF ROBERT H. JACOBY LATE OF NORTH MIDDLETON TOWNSHIP,CUMBERLAND COUNTY, PENNSYLVANIA Date of death: Letters Granted: Advertisement of Letters: The Sentinal: Cumbo Law Journal: ACCOUNT STATED AS FINAL April 5, 2001 May 7,2001 May 14, 21, & 28,2001 May 18, 25, & June 1, 2001 Purpose of Account: Lynn S. Jacoby offers this account to inform interested parties of the transactions that have occured during this administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Taylor P. Andrews, Esq. 78 W. Pomfret St., Carlisle, Pa. 17013. Phone 717-243-0123 PRINCIPAL Receipts Gains/(Losses) from conversions Less Disbursements Balance Before Distributions Distributions to Beneficiaries Principal Balance Remaining SUMMARY & INDEX Paqe No. 2 3 4 5 $1,356,416.29 ($84,729.12) ($125,227.27) $1,146,459.90 ($855,406.96) $291,052.94 INCOME Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Income Balance Remaining $28,921.36 $2,322.00 $26,599.36 $0.00 6 7 $26,599.36 COMBINED BALANCE REMAINING $317,652.30 EXHIBIT j :8 II A 12/30/02 PRINCIPAL RECEIPTS Realtv: 3 West Mulberry Hill Rd., Carlisle, PA 1995 Chevrolet Truck Household Furnishings PNC Checking Account 1st Bank of Lakewood, CO Account 340-470-0759 Checks received but not deposited at death: OHM Corp. - interest BP Amoco - Chevron - retirement Public Employees Retirement Assoc. American Historical Society - refund Novartis AG - dividend Novartis AG - dividend Social Security ck for March Allstate insurance claim on homeowners insurance Refund - Wayside Gardens Discover Card - cash back bonus award Sales tax refund check from Comm of PA Banca Unione Di Credito, Geneva, Switzerland Account 16545.322 Coin Collection Stamp Collection 200 AT&T Corp Dividend; rec dt: 3-30-01; pay dt: 5-1-01 500 Bolder Technologies Corp 600 Bristol Myers Squibb 200 Canadian Pacific Limited 112 Chiron Corp. 100 CIBA Specialty Chemicals Holding Inc. Dividend; rec dt: 3-20-01; pay dt: 4-27-01 400 Ciena Corp 510 Coles Myer Ltd 400 Colgate Palmolive 100 E.I.DuPont DeNemours & Co. 1,493 Duff & Phelps Utility & Coporate Bond Trust 100 Ecogen Inc. New 200 Energy Research Corp 1,000 Escagenetics 400 Evercel, Inc. 1,200 FuelCell Energy Inc. 400 Genzyme Corp. General Division 21 Genzyme Corp. Com-Molecular Oncology Division 27 Genzyme Corp. Biosurgery Division Tracking stock 1,000 Gulf Canada 400 Guilford Pharmaceuticals, Inc. 400 Horizon Pharmicies 100 Internet Studios.com Inc. Com new Page 2 - Principal Receipts Amount $259,900.00 $8,365.00 $1,939.00 $21,266.01 $2,555.83 $240.00 $221.79 $898.34 $1,474.12 $88.65 $89.31 $168.52 $1,175.00 $518.97 $130.60 $16.94 $36.65 $123,664.01 $92,872.00 $4,480.15 @ $15.66 $3,132.00 $7.50 $0.01 $5.00 $54.94 $32,964.00 $17.33 $3,466.00 $42.47 $4,756.64 $30.00 $3,000.00 $49.91 $39.03 $15,612.00 $26.25 $13,387.50 $54.40 $21,760.00 $42.93 $4,293.00 $13.76 $20,541.79 $0.18 $18.00 $23.67 $4,734.00 $0.22 $220.00 $6.25 $2,500.00 $23.67 $28,404.00 $44.13 $17,652.00 $7.49 $157.29 $44.13 $1,191.51 $5.33 $5,330.00 $16.31 $6,524.00 $5.33 $2,132.00 $39.15 $3,915.00 12/30/02 300 Isis Pharmaceuticals, Inc. 1,200 Johnson & Johnson 800 Eli Lilly & Co. 500 Lions Gate Entertainment Corp. 200 Longs Drug Stores, Corp. Dividend; rec dt: 3-13-01; pay dt: 4-10-01 100 Lubrizol Corp 500 Macrochem Corp. - Del. 41 MIPs Technologies, Inc. CI B 612 Novartis AG - Sponsored ADR 4,425 Pfizer Inc. 357 Pharmacia Corp. 300 Phillips Petroleum Co 500 Rayovac Corp. 100 RIO Tinto PLC sponsored ADR Dividend; rec dt: 3-9-01; pay dt: 4-9-01 500 Rite Aid Corp. 100 Roche Holding Ltd. Dividend; rec dt: 4-5-01; pay dt: 5-7-01 300 Safeguard Scientifics Inc. 1,600 Schering Plough Corp 300 Silicon Graphics Inc. 65 Syngenta AG Sponsored ADR 602 Texas Instruments, Inc. 200 Ultra life Batteries Inc. 500 Vari-L Company 1,433 Verizon Communications 36 Waste Management, Inc. Del 200 Western Gas Resources, Inc. Dividend; rec dt: 3-30-01; pay dt: 5-14-01 300 Winstar Communications, Inc. 60 Zimmer Holdings, Inc. 31,521 Vanguard Prime Money Market Fund accrued dividends 4,168 Muriel Siebert & Co. Prime Fund $8.52 $87.54 $76.30 $1.71 $31.05 $31.70 $5.34 $18.81 $40.34 $40.32 $50.48 $54.67 $18.15 $69.95 $6.14 $67.47 $3.96 $35.63 $3.26 $10.66 $30.53 $5.19 $2.00 $48.25 $23.61 $33.75 $0.53 $28.05 Total Receipts of Principal Page 2 - Principal Receipts $2,556.00 $105,048.00 $61,040.00 $855.00 $6,210.00 $28.00 $3,170.00 $2,670.00 $771.21 $24,688.08 $178,416.00 $18,021.36 $16,401.00 $9,075.00 $6,995.00 $154.00 $3,070.00 $6,747.00 $57.23 $1,188.00 $57,008.00 $978.00 $692.90 $18,379.06 $1,038.00 $1,000.00 $69,142.25 $849.96 $6,750.00 $10.00 $159.00 $1,683.00 $31,521.43 $22.07 $4,167.71 $1,356,416.29 12/30/02 r CONVERSIONS Date Asset 7/9/01 Sale of AT&T wireless fractional shares 10/15/01 Sale of CPL fractional shares 12/31/01 Sale of AT&T wireless [less cost of sale] 1/18/0260 shares of Zimmer Holdings, Inc. 4/25/02 600 shares of Bristol Myers 800 shares of Eli Lilly & Co 2200 shares of Pfizer, Inc. 5/13/02 1200 shares Johnson & Johnson 5/20/02 1600 Sherring Plough Corp. 7/1/02 1452 shares Verizon 9/10/02 500 shares Bolder Tech. Corp 10 shares Ecogen, Inc. 5 Internet Studios.com 500 shares Vari-L Co, Inc. 200 shares Winstar Communications, Inc. 1000 shares Escagenetics 400 shares Horizon Pharmacies 150 shares of Scientific Control 25 shares of United Financial Group 1/28/02 Increased value of Swiss Bank account Sale Price $5.92 $38.19 $833.76 $1,801.00 $17,398.90 $54,934.00 $78,230.51 $70,736.51 $39,480.32 $52,779.09 $0.39 $1.29 $2.19 $329.99 $0.85 $4.99 $0.39 $0.14 $0.02 Cost Basis $0.00 $0.00 $0.00 $1,683.00 $32,964.00 $61,040.00 $88,704.00 $52,524.00 $57,008.00 $69,142.25 $5.00 $18.00 $3,915.00 $1,000.00 $159.00 $220.00 $2,132.00 $0.00 $0.00 Unrecognized Loss in value from 000 value to Date of Distribution value of stocks distributed in kind: 8/21/02 Gain on sale of coins to Delaware Valley Collectors TOTAL GAINS/(LOSSES) ON CONVERSIONS: ESTATE COMPOSITION PNC Accounts: Performance Money Market Account Interest Checking Account Legg Mason Account TOTAL Page 3- Asset Conversions Gain/(Loss) $5.92 $38.19 $833.76 $118.00 ($15,565.10) ($6,106.00) ($10,473.49) $18,212.51 ($17,527.68) ($16,363.16) ($4.61) ($16.71) ($3,912.81) ($670.01) ($158.15) ($215.01) ($2,131.61) $0.14 $0.02 $4,214.95 ($35,350.27) $342.00 ($84,729.12) $283,559.30 $32,988.34 $1,104.66 $317,652.30 12/30/02 PRINCIPAL DISBURSEMENTS Amount 16-May-01 Sprint Carlisle Suburban - water/sewer UGI PP&L Discover Allstate Allstate Jack Gaughen Andrews & Johnson 65 short certificates 04-Jun-01 The Sentinel UGI Lynn S. Jacoby for: Carlisle Suburban - water/sewer Lakeview Memorial Park State Farm - for bond Peggy Jacoby's Rx. Hoffman Roth Funeral Home Andrews & Johnson 12-Jun-01 Sprint Rowe Antiques Cumberland Law Journal PP&L 02-Jul-01 Andrews & Johnson 06-Jul-01 PP&L UGI York Waste Disposal Discover 27-Jul-01 Double Gold Inc. - hazardous waste disposal Gwenn Drum Lynn S. Jacoby for: SOB for valuables Funeral music etc. Postage Register of Wills Travel Stationary supplies for inventory Bond refund Mid Penn Urology Andrews & Johnson short certificates 06-Aug-01 Andrews & Johnson 10-Aug-01 Sprint PP&L Capital Tax Collection Bureau 24-Aug-01 Waste Management 27-Aug-01 Pa Dept of Revenue Public Empl Retirement system 30-Aug-01 Com of PA PennDOT 10-Sep-01 UGI Andrews & Johnson 18-Sep-01 Lynn S. Jacoby for: Gwenn Drum A touch of green Sears - truck battery Page 4 - Principal dis. $93.08 $146.90 $394.18 $58.83 $583.70 $379.00 $177.40 $100.00 $195.00 $97.07 $27.56 $4,225.26 $5,620.00 $2,435.00 $30.04 $85.00 $75.00 $11.30 $650.00 $20.64 $81.80 $27.45 $37.66 $1,018.97 $235.00 $480.58 $50.00 $150.00 $562.50 $22.09 $21.60 $16.90 $350.00 $428.00 $614.22 $58.50 $3.76 $1,203.00 $1,205.91 12/30/02 Postage Supplies Meals Supplies Fred House SOB for valuables York Waste Disposal 14-Sep-01 Bullard Spahr Andrews & ... 26-Sep-01 PP&L UGI 01-0ct-01 Andrews & Johnson 02-0ct-01 Sprint 04-0ct-01 Lynn S. Jacoby David Frost Safety Kleen 11-0ct-01 Greenmont Moving & Storage Equitable Life Assurance Com of PA PennDOT Allstate OB-Nov-01 Andrews & Johnson 04-Dec-01 Andrews & Johnson 10-Sep-01 Settlement Sheet Disbursements: Realtors' Commission Notary Transfer tax Carlisle Suburban Real Estate Taxes Real Estate Taxes Radon Remediation Real Estate Taxes Real Estate Taxes 27-Dec-01 Rocky Mountain Appraisers LLC 04-Jan-02 Register of Wills - filing fee In tx Register of Wills - inheritance tx Andrews & Johnson Allstate - auto insurance Lynn S. Jacoby 03-Feb-02 Andrews & Johnson 12-Feb-02 Ballard Spahr Andrews and Ingersoll, LP Register of Wills 08-Mar-02 Andrews & Johnson 2B-Mar-02 State Farm - for bond Andrews & Johnson 17-Jul-02 Delaware Valley Coin Company Andrews & Johnson 02-Aug-02 Andrews & Johnson 04-Sep-02 Andrews & Johnson 01-0ct-02 Andrews & Johnson 22-Mar-02 Refund of homeowners insurance premium 17-Apr-02 UGI refund 22-Nov-02 Andrews & Johnson Pa Dept of Revenue 02-Jan-03 Alma Boettcher David Frost Dorothy Crump Gary McGinn $27.45 $443.03 $27.35 $9.43 $1,122.75 $22.09 $51.57 $546.50 $2,785.00 $1,992.06 $29.95 $22.50 $106.01 $787.50 $187.50 fees for administration services fees for administration services fees for administration services fees for administration services $15,594.00 $5.00 $2,599.00 $B4.94 $822.57 $2,677.20 $625.00 ($224.87) ($2,106.11 ) $300.00 $15.00 $26,906.62 $6,147.25 $88.49 $141.11 $435.00 $621.91 $455.00 $250.00 $1,528.00 $75.00 $3,000.00 $303.00 $625.00 $168.41 $225.00 ($231.00) ($3.76) $7,662.50 $35.67 $450.00 $1,268.75 $450.00 $412.50 Page 4 - Principal dis. 12/30/02 Reserves: Janet Jacoby fees for administration services Lynn S. Jacoby fees for administration services Peggy Jacoby fees for administration services Ruth McGinn fees for administration services Vicki Jo Bright fees for administration services Final Administration expenses, taxes, etc. TOTAL DISBURSEMENTS OF PRINCIPAL $5,125.00 $7,237.50 $300.00 $125.00 $900.00 $10,000.00 $125,227.27 Page 4 - Principal dis. 12/30/02 DISTRIBUTIONS TO BENEFICIARIES Peggy D. Jacoby: 30-May-01 Check 17-Sep-01 Check 20-Dec-01 Check 19-Apr-02 Check Coins distributed in kind [as per attached statement] 06-Sep-02 Check from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Linda Leigh Frost: 20-Dec-01 Check Coins distributed in kind [as per attached statement] 06-Sep-02 Cash from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Lynn S. Jacoby: 27-Dec-01 Check 06-Sep-02 Cash from Legg Mason Account 06-Sep-02 Stocks from Legg Mason [as per attached statement] 30-Sep-02 Check from Legg Mason Account Coins distributed in kind [as per attached statement] Stamp Collection 1995 Chevrolet Truck Total Distibutions to Beneficiaries: Page 5 - Distributions $5,000.00 $15,000.00 $10,000.00 $20,000.00 $2,678.00 $150,000.00 $190,862.92 $21,235.55 $15,000.00 $8,732.00 $75,000.00 $99,443.97 $6,843.07 $15,000.00 $75,000.00 $98,918.07 $7,511.23 $26,337.00 $4,480.15 $8,365.00 $414,776.47 $205,019.04 $235,611.45 $855,406.96 12/30/02 INCOME DISBURSEMENTS 02-Apr-02 U.S. Treasury - w req 4 extension 08-Apr-02 Pa Dept of Revenue w req 4 extension 06-Aug-02 Pat Rosendale, CPA 11-0ct-02 IRS refund Pa Dept of Revenue refund TOTAL INCOME DISBURSEMENTS Page? - Income Out $2,000.00 $150.00 $500.00 ($288.00) ($40.00) $2,322.00 12/30/02 STATE OF DEL1fWARE COUNTY OF ~wc.1""" ) Lynn S. Jacoby ,being duly sworn according to law, deposes and says that the Account and Proposed Schedule of Distribution as stated are true and correct, and that the Grant of Letters and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. =c:s -A ~~~ Sworn and subscribed to before me this -1.. day of January, 2003 I .- NOTARY PUB~C My Commls8ion ExpIrea Dec. 13. 2001 IN RE: ESTATE OF Robert H. Jacoby DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0447 SCHEDULE OF PROPOSED DISTRIBUTION Combined Balance for Distribution $1,173,059.26 Remaining as Per First and Final Account: $317,652.30 TO: Peggy D. Jacoby Previously Distributed [see P.5] $414,776.47 From above remaining balance $186,753.16 $601,529.63 TO: Linda Leigh Frost Previously Distributed [see P.5] $205,019.04 From above remaining balance $80,745.78 $285,764.82 TO: Lynn S. Jacoby Previously Distributed [see P.5] $235,611.45 From above remaining balance $50,153.37 $285,764.82 TOTAL DISTRIBUTIONS $1,173,059.26 STATEMENT OF REASONS FOR THE PROPOSED DISTRIBUTION The Decedent, Robert H. Jacoby, died intestate. Under Pennsylvania's intestate law, the surviving spouse of Robert H. Jacoby is entitled to receive the first $30,000 of the estate plus one-half of the balance. The balance of the estate is divided equally by the children of Robert H. Jacoby. Peggy D. Jacoby is the surviving spouse, and Linda Leigh Frost an Lynn S. Jacoby are the only two children of Robert H. Jacoby. Sch. of Prop. Dist. 12/30/02