HomeMy WebLinkAbout01-1131
J PETITION FOR PROBATE and GRANT OF LETTERS
(\ 0 11 Estate of Geneva W. Jacoby No. d.-/- 0 I ... //31
\-1 ~ also known as Geneva Ward Jacoby To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 239-46-9480 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(X), who is/alle{18 years of age or older an the execut or
in the last will of the above decedent, dated August 29
and codicil(s) dated none
named
,U-2Q..Ql.
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 105 South Queen Street, Borough of
Shippensburg
(list street, number and muncipality)
Decendent, then 70 years of age, died December 3 000 2001,
at Penn Hall Nursing Center, Chambersburg, PA 17201
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the wiil offered for probate; was not the victim of a killing and was never adjudicated
incompetent: none
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 535.000
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 75 .000
situated as follows: 105 South Queen Street. Borough
of Shippensburg. Cumberland County. PA
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters tes tamentary
(testamentary; administration c.I.a.; administration d.b.n.c.t.a.)
theron.
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LLFIRST TRUST COMPANY OF
PENNSYLVANIA
55 South Main Street
Chambersburg, PA 17201
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I S"
COUNTY OF CUMBERLAND J ~
The petitioner(s) above-named swear(~) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief 0 etitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will wel tr y minis er tI#estate according to law.
Sworn to or affirmed and ~~. tr. V')
before me this 13th Y~'
~ Dec~r 12- .... PENNSYLVANIA ~
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Mary: . Lewis ~
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~o. 21-2001-1131
Estate of
_ Geneva Ward Jacoby , Deceased
ajkja Geneva W. Jacoby
DECREE OF PROBATE A~D GRA~T OF LETTERS
~~
Mary c. Lewis / ~
FEES
Probate, Letters, Etc. ......... $ 410.00
Short Certificates( 3) . . . . . . . . .. $ 9.00
Renunciation ................ $
x-Pages (6) $ 18.00
JCP TOTAL _ $ 5.00
Filed . December. 13.th, 20.01. $. .4 4 2...00.
Jerry A. Weigle, Esquire #01624
ATTORNEY (Sup. Ct. J.D. No.)
WEIGLE, PERKINS & ASSOCIATES
126 East King Street
ADDRESS
Shippensburg, PA 17257
(717) 532-7388
PHONE
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When Letters are done put in Attorney Weigle's POX
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This is to certifY that the information here given is correctly copied from an origi~al certifIcate :of- death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records OffIce for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fee for this certificate, $2.00
P 7783327
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Date
21-2001-1131
,.. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME Of DECEDENT !f ". Mlddle,l'"
SEX
SfATIF1lIEJ\I\JM8f:A
SOCIAL SECURITY NUM8ER
W JACOBY
UNDER 1 YEAR UNDER 1 O,w
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DECEDENT'S USUAl OCCUM'I()N
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FRH(A'S NAME (Fnl.~. LaSl)
to. David Franklin
INFORMANT'S NAME (T~.,.,
R. Michael Jacob
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REGISTRAR"S SIGNAT\JRE AND N\J""BER
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Dr. John N. Benner 17201
o ,.1425 Philadel phia Aile.. Chambersburg. PA
DATE FilED {Moolh 0,.
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Page' 1 of 7
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21-2001-1131
LAST WILL AND TESTAMENT
I, GENEVA WARD JACOBY, presently residing at 105 South Queen Street, Borough of
Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition,
do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void
all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I direct my hereinafter-named Executor to engage the Eby Granite Works of
Newville, Pennsylvania, or its successor, to inscribe my name on the tombstone located at the Spring
Hill Cemetery, Shippensburg, Pennsylvania (beside the name of my beloved husband, C. Robert Jacoby)
marking the graves of the C. Robert Jacoby and myself.
THIRD. I give, devise and bequeath any real estate and vehicles that I may own at the time
of my death and all of the contents of my home known as 105 South Queen Street, Shippensburg,
Cumberland County, Pennsylvania 17257, unless otherwise specifically bequeathed under this my Last
Will and Testament, to my son, R. MICHAEL JACOBY, absolutely.
FOURTH. I give and bequeath my Micki-Moto pearl necklace to my daughter-in-law,
LUCENDA WAGNER JACOBY. It is an heirloom.
FIFTH. I give and bequeath all of my personal belongings located in my bedroom closets to
my daughter-in-law, LUCENDA WAGNER JACOBY, and to my friends, JANE RHINEHART and
KAREN RHINEHART, to be divided in an equitable manner. I further direct my herein-named
Executor to give any items not desired by the said Lucenda Wagner Jacoby, Jane Rhinehart and
Karen Rhinehart to the CUMBERLAND VALLEY ANIMAL SHELTER THRIFT SHOP, presently
located on East King Street, Shippensburg, Pennsylvania 17257.
SIXTH. I give and bequeath my opal glass candleholder (located in the den of my home in
my antique coffee table chest) to my friend, MAXINE MOHN.
SEVENTH. I give and bequeath all of my fiction books located III my home to the
SHIPPENSBURG PUBLIC LIBRARY.
EIGHTH. I give and bequeath the 125th Anniversary Church Program honoring
Vernon Dyer; the Testimonial Dinner program honoring Vernon Dyer, dated December 7, 1995; and the
1995 framed church choir picture, all of which are located in my home, to the MESSIAH UNITED
METHODIST CHURCH of Shippensburg, Pennsylvania, provided that these items be hung
permanently in the choir room of the church.
k2Q...~>'" ~7\... (SEAL)
( ~
WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
Page 2 of?
.
NINTH. I bequeath to MRS. MARLIN RHINEHART, my dearest friend, my
Lenox, holly pattern, cake dish (plate) and my Lenox, holly pattern, one-tiered cookie dish. They are
located in my dining room in one of my comer cupboards. In the event Mrs. Marlin Rhinehart should
predecease me, I then give and bequeath my said Lenox pieces to my son and daughter-in-law,
R. MICHAEL JACOBY and LUCENDA WAGNER JACOBY, or to the survivor thereof, for use
in their home.
TENTH. I give and bequeath the two (2) wooden paddles and the framed Acacia membership
certificate (which were presented to my beloved husband, C. Robert Jacoby, by the Acacia Fraternity)
that are located in the den of my home, to the SHIPPENSBURG CHAPTER OF THE ACACIA
FRATERNITY in memory of the said C. Robert Jacoby. In the event the Acacia Fraternity is non-
existent at the time of my death, I then direct this bequest to be destroyed.
ELEVENTH. I give and bequeath the sum of One Thousand Dollars ($1,000.00) to my friend,
ALAN RHINEHART.
TWELFTH. I specifically bequest the sum of Two Thousand Dollars ($2,000.00) to
DR. WILLIAM BASHOR for the care of my two Siamese cats, Samantha and Sabrena, with
my eternal thanks.
THIRTEENTH. In the event that my total estate exceeds the full sum of Two Hundred
Thousand Dollars ($200,000.00) after payment of all debts, bills, fees and taxes and after distribution of
all pecuniary and specific bequests herein, I then give and bequeath the rest, residue and remainder of
my estate at follows:
A. Four and one-half percent (4.5%) of my estate to my grandson,
STEPHEN MICHAEL JACOBY, given to him with love from his grandmother
and grandfather. Should the said Stephen Michael Jacoby be under the age of
twenty-one (21) years, I then give, devise and bequeath said beneficiary's share
under this paragraph 13th A of this my Last Will and Testament only to and
appoint as Trustee of this property, my son, R. MICHAEL JACOBY, and my
daughter-in-law, LUCENDA WAGNER JACOBY, or the survivor of the said
R. Michael Jacoby and Lucenda Wagner Jacoby, as Co-Trustees, nevertheless and
with the same trust powers contained in the trust established under paragraph
fifteenth of this my Last Will and Testament.
B. One and one-half percent (1.5%) of my estate to ACACIA FRATERNITY
HOUSING CORPORATION, presently located at 101 Stoney Brook Drive,
Newtown, Pennsylvania 19403, telephone number (610) 631-1418, answering
service 1-800-220-0743, for the upkeep of the fraternity house named in memory
of my beloved husband, Dr. C. Robert Jacoby, one of their founders. This
pecuniary bequest is to be used by the said housing corporation either to reduce
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(SEAL)
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
Page 3 of7
,
the principal debt on its current fraternity house mortgage obligation on the
fraternity house here in Shippensburg, Pennsylvania, or for necessary repairs to
said fraternity house in the sole discretion of my hereinafter named executor. In
the event that the Shippensburg Chapter of the Acacia Fraternity is not in
existence at the time of my death or in the event that the said Acacia Chapter here
in Shippensburg does not own or lease a fraternity house at the time of my death,
I then direct that this pecuniary bequest shall lapse and become a part of the rest
and residue of my estate;
C. One and one-half percent (1.5%) of my estate to SW ARSBORO
METHODIST CHURCH, presently located at Swarsboro, North Carolina,
phone (910)326-4822 (church office) or 910-326-4373 (church parsonage), in
memory of Geneva Ward Jacoby.
D. One and one-half percent (1.5%) of my estate to MESSIAH UNITED
METHODIST CHURCH, located at 30 South Penn Street, Shippensburg,
Pennsylvania 17257. It is my very strong hope and desire (but not demand)
that the church will use its share of the rest and residue of my estate to
begin the planning and construction of a church chapel in memory of
C. Robert Jacoby and Geneva Ward Jacoby.
E. Three percent (3%) of my estate to THE CUMBERLAND VALLEY ANIMAL
SHELTER, presently located at 2325 Country Road, Chambersburg,
Pennsylvania 17201, phone number (717)263-5791, in memory of Dr. and Mrs.
C. Robert Jacoby, to be utilized as follows:
1. One-half (112) of said three percent (3%) to be used for food and
necessary medical care for animals housed or to be housed and cared for at
this shelter; and
2. One-half (1/2) of said three percent (3%) to be used to help support the
shelter's prevention of cruelty to animals program.
F. Three percent (3~'o) of my estate to THE ANTIETAM HUMANE SOCIETY,
presently located at 8513 Lyons Road, Waynesboro, Pennsylvania 17268, phone
number (717)762-9091, in memory of Dr. and Mrs. C. Robert Jacoby, to be used
for food and necessary medical care for animals housed or to be housed and cared
for at this shelter;
G. Three percent (3%) of my estate to HARRISBURG HUMANE SOCIETY
(EAST SHORE), presently located at 7790 Grayson Road, Harrisburg,
Pennsylvania 17111, phone number (717)564-3320, in memory of Dr. and Mrs.
C. Robert Jacoby, to be used for food and necessary medical care for animals
housed or to be housed and cared for at this shelter; and
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(SEAL)
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
Pag640f7
.
H. Three percent (3%) of my estate to HUMANE SOCIETY OF HARRISBURG,
INC., WEST SHORE SHELTER, presently located at 710 Eppley Road,
Mechanicsburg, Pennsylvania 17055, phone number (717)697-8547, in memory
of Dr. and Mrs. C. Robert Jacoby, to be used for food and necessary medical care
for animals housed or to be housed and cared for at this shelter.
I. I give, devise and bequeath the remaining seventy-nine percent (79%) of my
estate and all other tangible personal property not otherwise specifically
bequeathed under this my Last Will and Testament to my son, R. MICHAEL
JACOBY, absolutely.
FOURTEENTH. In the event that my total estate does not exceed the full sum of Two
Hundred Thousand Dollars ($200,000.00) after payment of all debts, bills, fees and taxes and after
distribution of all pecuniary and specific bequests herein, I then give, devise and bequeath all of the rest,
residue and remainder of my estate, real personal and mixed, whatsoever and wheresoever situate, to my
son, R. MICHAEL JACOBY, on a per stirpes distribution basis.
FIFTEENTH. In the event that any beneficiary of this my Last Will and Testament is under
the age of twenty-one (21) years, I then give and bequeath said beneficiary's share to and appoint as
Trustee of any property which passes under this Will or otherwise, the ALLFIRST TRUST
COMPANY OF PENNSYL VANIA, N.A., and my daughter-in-law, LUCENDA WAGNER
JACOBY, AS CO-TRUSTEES, NEVERTHELESS, to invest and re-invest the same until the said
beneficiary reaches the age of twenty-one (21) years, with the following powers in addition to those
presently given by law:
A. The power to expend the income towards the health, support and maintenance,
and education, including a college (both undergraduate and graduate), trade,
business or technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the said Trustee, if the
income is insufficient, towards the health, support and maintenance, and
education, including a college (both undergraduate and graduate), trade, business
or technical school education, of the said beneficiary;
C. The power to sell any and all real estate, within the discretion of the said Trustee;
D. The power and obligation to distribute the balance of principal and interest, if any
remaining, when the said beneficiary reaches the age of 21 years, without the
necessity of a formal adjudication of the Trustee's Account in the Court of
Common Pleas of Cumberland County, upon the receipt of a good and valid
release; and
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(SEAL)
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
Page 5 of7
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E. The principal of the Trust and the income therefrom shall be free from the debts,
liabilities, and engagements of those beneficially interested therein, and shall not
be subject to assignment by him or her, nor to attachment or execution under any
legal, equitable or other process for the enforcement of judgments or claims of
any sort against them, either individually or collectively.
SIXTEENTH. Upon my passing, I would ask my good friend, ALAN RHINEHART (Trust
Officer for the Allfirst Trust Company of Pennsylvania, N.A., Western Region), to do the following with
respect to the care and feeding of my two (2) beloved Siamese cats, Samantha and Sabrena:
A. Contact my son, R. MICHAEL JACOBY, at (717) 848-6218 (home) or
(717)845-6634 (work). R. Michael Jacoby will be responsible to care for and
feed my cats at my home until they can be delivered into the personal care of
Dr. William Bashor.
B. Contact DR. WILLIAM BASHOR in order to make arrangements for
Dr. Bashor to pick up my beloved cats from my home and take them to his home
where he will provide loving care for them. Dr. Bashor's home phone is
(717)263-0760. His present home address is 164 Harvest Lane, Chambersburg,
Pennsylvania 17201. A cat carrier for transporting is in the basement.
SEVENTEENTH. I nominate, constitute and appoint ALLFIRST TRUST COMPANY OF
PENNSYL VANIA, N.A., presently located at East King Street, Shippensburg, Pennsylvania 17257, to
be the Executor of this my Last Will and Testament.
EIGHTEENTH. As a personal favor to me, I request that my friend and financial advisor,
ALAN RHINEHART, and my friend and legal advisor, JERRY A. WEIGLE, ESQUIRE,
make themselves available to give aid and advice to my son, R. Michael Jacoby, as needed by him
after my death.
NINTEENTH. I direct that my personal representatives shall not be required to give bond for
the faithful performance of their duties in any jurisdiction.
TWENTIETH. I hereby direct that all federal, state and other death taxes payable because of
my death, with respect to the property forming my gross estate for tax purposes, whether or not passing
under this Will, including any interest or penalty imposed in connection with such taxes, shall be
considered a part of the expense of administration of my estate and that such be paid out of the rest and
residue of my estate.
IN WITNESS WHEREOF, I, GENEVA WARD JACOBY, have hereunto set my hand and seal
to this my Last Will and Testament, writt~ ~~~ pages, the first four pages signed for
identification only, this /1..- ~ day of _ __ r1 ' 200 J.
~<'~~(\S-D(~\: (SEAL)
WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
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This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her
Last Will and Testament, in our presence, who at her request and in the presence of each other, we
believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as
witnesses.
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COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
SS
I, Geneva Ward Jacoby, the person whose name is signed to the foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last
Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
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Sworn or affirmed to and acknowledged before
me by. GENEVA WARD JA~OBY, the Testatrix,
this-.;JCfI"1 day of ~~'..f/ , 2001.
~.cfulfj2j
Notarial Seal
, Rhonda R. Wolford. Notary Public
hlppensburg Bero. C.umberland Cou
M Commission b.pilUS Jan, 20,2005
WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
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Page 70f7
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
we,A'/~~~ d
the witnesses whose names are signed to the foregoing mst ent, being duly quali 1 cording to
law, do depose and say that we were present and saw Geneva War Jacoby, the T s atrix, sign and
execute the instrument as her Last Will; that she signed willingly and that she executed as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix,
signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen
(18) or m~re years of age and of sound mind and under no constraint or undue influence.
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Sworn or affirmed to and subscribed before me
by
,2001.
and
witnesse~, this ,:::;i)lflday of
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L/!J1inL~ rf2 tU/ ~td
Notarial Seal
Rhonda R. Wolford, Notary Public
hippensburg BorG, Ci_:rnberiand Cou
Commissloi' .Jan, 20, 2005
WEIGLE, PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
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IN RE: ESTATE OF GENEVA W.
JACOBY a/k/a GENEV A WARD
JACOBY, late of the Borough of
Shippensburg, Cumberland
County, Pennsylvania
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NUMBER 21-01-1131
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Geneva W. Jacoby a/k/a Geneva Ward Jacoby
Date of Death: December 3,2001
Will No. 21-01-1131
To the Register:
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 December 20, 2001:
R. Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Lucenda Wagner Jacoby
656 Wheatlyn Drive
York, PA 17403
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Jane Rhinehart a/k/a Mrs. Marlin Rhinehart
3461 Gleneagles Drive
Chambersburg, P A 17201
C--
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Karen Rhinehart Coldsmith
1648 Scotland Avenue
Chambers burg, P A 17201
'-.0
Cumberland Valley Animal Shelter Thrift Shop
One East King Street
Shippensburg, PA 17257
Maxine Mohn
406 North Morris Street
Shippensburg, P A 17257
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
Shippensburg Public Library
73 West King Street
Shippensburg, P A 17257
Messiah United Methodist Church
30 South Penn Street
Shippensburg, P A 17257
Shippensburg Chapter of the Acacia Fraternity
101 Brookside Avenue
Shippensburg, P A 17257
Alan Rhinehart
13 7 West King Street
Shippensburg, P A 17257
Dr. William Bashor
164 Harvest Lane
Chambersburg, P A 17201
R. Michael Jacoby and
Lucenda Wagner Jacoby, Co-Trustees for
Stephen Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Acacia Fraternity Housing Corporation
101 Stoney Brook Drive
Newtown, PA 19403
Swansboro Methodist Church
ATTN: Mary Berry, Treasurer
655 West Corbett Avenue
Swansboro, NC 28584
Cumberland Valley Animal Shelter
2325 Country Road
Chambersburg, P A 17201
The Antietam Humane Society
8513 Lyons Road
Waynesboro, PA 17268
Harrisburg Humane Society (East Shore)
7790 Grayson Road
Harrisburg, P A 17111
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
-
Humane Society of Harrisburg, Inc., West Shore Shelter
710 Eppley Road
Mechanicsburg, P A 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
NONE.
December 20,2001
Name:
Address:
Weigle, Perkins & Associates
126 East King Street
Shippensburg, P A 17257
Telephone: (717) 532-7388
Capacity: Personal Representative
X Counsel for Personal
Representative
WEIGLE. PERKINS & ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
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STATE OF PENNSYLVANIA
IN RE: ESTATE OF
GENEVA W. JACOBY
REGISTER OF WILLS
CUMBERLAND COUNTY
ESTATE NO: 2001-01131
PA FILE NO: 21-01-1131
STATEMENT OF CLAIM
1. The estate of Thomas Pritchard smith presents for
filing against the above estate the statement of claim in the
amount of $120,000.00.
2. The basis for the claim is a refund of excess estate
distribution caused by the surfacing of additional paternal heirs.
3. The tax identification number of the claimant is 56-
6568271.
4. The name and address of the claimant is: Estate of
Thomas Pritchard Smith, c/o Carl S. Milsted, Administrator, P.O.
Drawer 766, Jacksonville, North Carolina 28541.
5. This claim is not contingent.
6. This claim is not secured.
Under penalties of perjury I declare that I have read the
foregoing and the facts alleged are true to the best of my
knowledge and belief.
Executed this
22nd day of February, 2002.
- (' ....1 -.1, ~I
CARL S. MILSTED, A mlnlstrator
the Estate of Thomas Pritchard
(SEAL)
of
smith
NORTH CAROLINA
ONSLOW COUNTY
I, Kn',s-h~ J-I iJj;t!a 1;/ J
the County and State aforesaid, do hereby certify that CARL S.
MILSTED personally appeared before me this day and acknowledged the
due execution of the foregoing instrument. J
WITNESS my hand and notarial seal, this the 9?~n~ day of
February, 2002. ~
a Notary Public in and for
My comi<isSion Expires:
();;2 Oi{) } (.(J
r
iJIllC CUM
COUNTY OF ONSLOW
My Gomm. Expires Q2JOlll2OOlS
..
ALEX WARLICK, JR.
CARL S. MILSTED
MARSHALL F. DOTSON, JR.
JOHN T. CARTER, JR.
WARLICK, MILSTED, DOTSON &
ATTORNEYS AT LAW
320 NEW BRIDGE STREET
P.O. BOX 766
JACKSONVILLE, NC 28541-0766
CARTER
TELE: (910) 455-1215
FAX: (910) 455-4702
February 22, 2002
Register of Wills
Cumberland County, P A
County Offices
Carlisle, PA 17013
Re: Estate of Thomas Pritchard Smith - Geneva W. Jacoby
Dear Sir or Madam:
Enclosed is Claim of the Thomas Pritchard Smith Estate for refund from Ms. Jacoby's Estate.
Yours very truly,
c~ ). (r~J)
Carl S~sted
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ALLFIRST TRUST COMPANY OF PA
55 SOUTH MAIN STREET
CHAMBERSBURG, PA 17201
_____n_ fold
ESTATE INFORMATION: SSN: 239-46-9480
FILE NUMBER: 2101-1131
DECEDENT NAME: JACOBY GENEVA WARD
DATE OF PAYMENT: 02/26/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/03/2001
NO. CD 000894
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $15,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$15,000.00
REMARKS: ALLFIRST TRUST
CHECK# 20287728
INITIALS: CW
RECEIVED BY:
SEAL
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ALLFIRST TRUST COMPANY OF PA
55 SOUTH MAIN STREET
CHAMBERSBURG, PA 17201
-------- fold
ESTATE INFORMATION: SSN: 239-46-9480
FILE NUMBER: 2101-1131
DECEDENT NAME: JACOBY GENEVA WARD
DATE OF PAYMENT: 08/06/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/03/2001
NO. CD 001483
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,422.49
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,422.49
REMARKS: ALLFIRST TRUST CO OF PA NA
CHECK# 20334625
INITIALS: CW
RECEIVED BY:
SEAL
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
~
Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate of Geneva W. Jacoby
No. 2101-1131
also known as
Date of Death 12/03/2001
,Deceased Social Security No. 239 - 46 - 9480
A11first Trust: Company of PA, NA,
Personal Representative(s) of the above Estate, deceased, verity that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of P:rinsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I !We verity that the statements made in this Inventory are true and correct. l!We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
Weigle & Associates
Jerry A. Weigle
P,~o",1 R'P'~';i ------, _
Signature: ~~~ !:C~fl.
A11first Trust Company of PA, NA
I.D. No.:
01624
Signature:
Address:
126 East King Street
Address:
55 South Main Street
Shippensburg, PA 17257
Chambersburg, PA 17201
Telephone:
7/;' I ~-3J-7J;!'
,
Telephone: 717/261~2822
Dated:
?/J1IV
, I
Description
Value
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Total:
611,910.92
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of l~ach item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992)
Estate of:
Date of Deat.h:
County:
INVENTORY
Geneva W. Jacoby
12/03/2001
Cumberland
CASH:
$11,000 A1lfirst Bank
Certificate of Deposit
#87008140751022
Accrued Interest
$11,000 A1lfirst Bank
Certificate of Deposit
#87008140751057
Accrued Interest
$15,000 Al1first Bank
Certificate of Deposit
#87008141240404
Accrued Interest
$30,000 Al1first Bank
Certificate of Deposit
#87008141185608
Accrued Interest
$70,000 Al1first Bank
Certificate of Deposit
#87008140921521
Accrued Interest
A1lfirst Bank Checking Account
#97322091 - Date of Death
Value
Accrued Interest
Al1first Bank Money Market
Fund Alternate Account
#0098219944 - Date of Death
Balance
Accrued Interest
Allstate Insurance Company -
Refund of Premiums
A11first Bank IRA Account
#8700029-3406001 - Date of
Death Balance
Accrued Interest
Capital Blue Cross/PA Blue
Shield - Refund of Medical
Insurance
1
11,000.00
57.77
11,000.00
61. 66
15,000.00
80.01
30,000.00
50.45
70,000.00
62.23
19,052.37
0.74
29,098.97
9.45
166.80
3,533.49
2.00
142.60
Estate of:
Date of Death:
County:
Geneva W. Jacoby
12/03/2001
Cumberland
Cash found in home
Comcast Cable - Refund
Hearst Corporation - Refund on
Magazine Subscription
Internal Revenue Service -
2001 Personal Income Tax
Refund
Internal Revenue Service -
2001 Personal Income Tax
Refund on amended return
PA Department of Revenue -
2001 Personal Income Tax
Refund
Received from Geneva W. Jacoby
POA Account
Accrued Interest
Seabury & Smith, Inc. -
Insurance Premium Refund
PERSONAL PROPERTY:
1982 Chevrolet Caprice CL
Sedan - Appraised Value
Lenox Cake Plate - Appraised
Value
Lenox One-Tier Cookie Dish -
Appraised Value
Miscellaneous Fiction Books -
Appraised Value
Opal Glass Candle Holder -
Appraised Value
Personal Property - Appraised
Value
2
46.05
5.00
1. 50
1,290.00
400.97
216.00
323,540.56
54.68
77.62
510.00
25.00
20.00
45.00
20.00
7,340.00
514,950.92
7,960.00
Estate of:
Date of Death:
County:
Geneva W. Jacoby
12/03/20'01
Cumberland
REAL ESTATE/PA:
~05 S. Queen Street,
Shippensburg, PA - Appraised
Value
89,000.00
TOTAL RECEIPTS OF PRINCIPAL...............
3
89,000.00
611,910.92
----------------
----------------
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OFFICIAL USE ONLY
REV~ 1500 EX + (6-00) REV-1500 /7- ai- /1
INHERITANCE TAX RETURN mE NUMBER
COMMONWEALTH OF PENNSYLVANIA 2101-1131
DEPARTMENT OF REVENUE RESIDENT DECEDENT
DEPT. 280601 COUNTY CODE YEAR NUMBER
HARRISBURG, PA 17128-0601
DECEDENT'S NAME {LAST, FIRST,AND MIDDLE !NITIAl) SOCIAL SECURITY NUMBER
0 Jacoby Geneva II. 239-46-9480
E
C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN OUPUCATEWlTH THE
E
0 12/03/2001 10/10/1931 REGISTER OF WILLS
E
N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
T
.E 1. Original Return _ 2. Supplemental Return y 3. Remainder Return ~~rci~t"c1rt_a~~_82)
APB 4. Limited Estate 40. Future Interest Compromise (date of death after 12- 12-82) 5. Federal Estate Tax Return Required
pRL X 6. - 8. Total Number of Safe Deposit Boxes
plO Decedent Died Testate _ 7. Decedent Maintained a LIving Trust
-= -
RAC (Attach copy ofWlll) (Attach copy of Trust)
OTK 09. 010. 0 11. Ejection to tax under Sec. 91 13(A)
ES LItigation Proceeds Received Spousal Poverty Credit
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
,...., " :}H,'i'
" , "
P NAME COMPLETE MAILING ADDRESS
C
0 0 Alan B. Rhinehart Vice-President & T.O.
R N FIRM NAME([f Applicable)
R 0 55 South Main Street
E E Allfirst Trust Company of PA, NA Charnbersburg, PA 17201
S N
T TELEPHONE NUMBER
717/?hl_?R?? .. .---
1. Real Estate (Schedule A) (1) 89,000.00 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or (3) None
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0) (4) None
R 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) 522,910.92
E (Schedule E)
C
A 6. Jointly Owned Property (Schedule F) (6) None
p
I 0 Separate Billing Requested
T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
U
L (Schedule G or L) .
A
T 8. Total Gross Assets (total Lines 1-7) (8) 611,910.92
I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 53,333.79
0
N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule l) (10) 128,825.11
11. Total Deductions (total Lines 9 & 10) (11) 182,158.90
12. Net Value of Estate (Line 8 minus Line 11) (12) 429,752.02
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 54.415.68
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 375,336.34
C
0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
M
P 15. Amount of Line 14 taxable at the spousal tax
T U
A T rate, or transfers under Sec. 9116(a)(1.2) 0.00 X .0 0 (15) 0.00
X A 372,271.34
T 16. Amount of Line 14 taxable at lineal rate X .0 45 (16) 16,752.21
I 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
0
N 18. Amount of Line 14 taxable at collateral rate 3,065.00 X .15 (18) 459.75
19. Tax Due (19) 17,211.96
20. .n l"i'Il;!I!;q!(::!I!;!l!::i~f:'tQIi!;Al!!::;~j;i!:!li!$t!~";,*,;l!!l~!I!li:!;~Ii;A!!i;ii!~!l~~'d~!;N,t;;"1
"
.THaiSEetlONNIlS'I'BE'C:OMlltmaJltt,coRRESPOHOENCE&CONFlO.ENllitAI:iTAlIINFOIlMATjONcSHOUtO BE:lilIREeTSD'"M '
q'
>.>,. BE SURE TO ANSWERJALL QUESTIONS ON'REVERSE,S10E:ANlil TO RECHECK MATH <: <:,..
",);;;,,,,.,,,<,,.,
CopyrIght (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX
-
.
Decedent's Complete Address:
STREET ADDRESS
105 S. Queen Street
CITY I STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
17,211.96
0.00
15,000.00
789.47
Total Credos ( A + 8 + C) (2)
15,789.47
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Totallnteresr/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERl>>AYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
1,422.49
0.00
1,422.49
'''''''''''''[['[~'t~~~[[~~~~~~[i~~~[[~i~[[8~~~[~m~~~i~~l8[~~m~~ii~~~[li~i~"~~' "X"
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or .
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an ~in trust for~ or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
i~'i~~'~ir~~~i~i~~'~il~~~"i~[~~~~ii"
Yes No
~~
D
D
D
[B
[B
[B
Under penalties of perjury. I declare that f have examined this return. 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.
SIGNATUR.%PERSON~. IBLEFO
~~ -
"-
SIGNATUR
A11first Trust Company of PA, NA
55 South Main Street
-----------------------------------------------------
Chambersbur , PA 17201
A11first Trust Company of PA, NA
55 South Main Street
DATE
~/Jlt>1--
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (al (1.1) (i)].
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. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)( 1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
,
REV-1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 105 S. Queen Street, Shippensburg, PA - Appraised Value 89,000.00
SCHEDULE A
REAL ESTATE
TOTAL (Also enter on line 1, Recapitulation) $ 89,000.00
(If more space IS needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97)
.' ,
REV-1503 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHEAITANCET/J:X. RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Geneva W. Jacoby
SSft 239-46-9480
12/03/2001
2101-1131
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
UNIT VALUE
NUMBER OF DEATH
TOTAL (Also enter on line 2, Recapitulation) 0.00
(If more space IS needed, insert additional sheets af the same size)
CopyrIght (e) 1996 torm software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
,
REV-1504 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacoby
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
SSjf 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest at the decedent,
other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $ 0.00
(If more space IS needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems.lnc. Form REV-1504 EX (Rev. 1-97)
,
REV-1507 EX + (1~97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETUFlN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacoby
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
SSIf 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 4, Recapitulation) $ 0.00
(Jf more space IS needed, Insert additional sheets of the same size)
CopyrIght (c) 1996 formso1tware only CPSystems, Inc:. Form REV-1507 EX (Rev. 1-97)
REV-1S08 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
10
11
12
13
14
DESCRIPTION
$11,000 A11first Bank Certificate of Deposit #87008140751022
Accrued Interest
VALUE AT DATE
OF DEATH
11,000.00
57.77
2
$11,000 A11first Bank Certificate of Deposit #87008140751057
Accrued Interest
11,000.00
61.66
3
$15,000 A11first Bank Certificate of Deposit #87008141240404
Accrued Interes't
15,000.00
80.01
4
$30,000 A11first Bank Certificate of Deposit #87008141185608
Accrued Interest
30,000.00
50.45
5
$70,000 A11first Bank Certificate of Deposit #87008140921521
Accrued Interest
70,000.00
62.23
6
A11first Bank Checking Account #97322091 - Date of Death Value
Accrued Interest
19,052.37
0.74
7
A11first Bank Money Market Fund Alternate Account #0098219944 _
Date of Death Balance
Accrued Interest
29,098.97
9.45
8
Allstate Insurance Company - Refund of Premiums
166.80
9
A11first BAnk IRA Account #8700029-3406001 - Date of Death
Balance
Accrued Interest
3,533.49
2.00
Capital Blue Cross/PA Blue Shield - Refund of Medical Insurance
142.60
Cash found in home
46.05
Comcast Cable - Refund
5.00
Hearst Corporation - Refund on Magazine Subscription
1.50
Internal Revenue Service - 2001 Personal Income Tax Refund
1,290.00
Total of Continuation Schedu1e(s)
332,249.83
TOTAL (Also enter on fine 5, Recapitulation) S 522,910.92
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems.lnc. Form REV-150B EX (Rev. 1-97)
, ,
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Item
If
Continuation of Schedule E
(Cash, Bank Deposits & Miscellaneous Personal Property)
Description
Value at Date
of Death
15
Internal Revenue Service - 2001 Personal Income Tax Refund on
amended return
400.97
16
PA Department of Revenue - 2001 Personal Income Tax Refund
216.00
17
Received from Geneva W. Jacoby POA Account
Accrued Interest
323,540.56
54.68
18
Seabury & Smith, Inc. - Insurance Premium Refund
77 .62
19
1982 Chevrolet Caprice CL Sedan - Appraised Value
510.00
20
Lenox Cake Plate - Appraised Value
25.00
21
Lenox One-Tier Cookie Dish - Appraised Value
20.00
22
Miscellaneous Fiction Books - Appraised Value
45.00
23
Opal Glass Candle Holder - Appraised Value
20.00
24
Personal Property - Appraised Value
7,340.00
332,249.83
, .
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacoby
SCHEDULE F
JOINTL V-OWNED PROPERTY
55/1 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
c.
JOINTLY-OWNED PROPERTY,
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECO'S VALUE OF
account number or sImilar identifying number.
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'SINTERES
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
T
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSysterns,lnc.
Form REV-1509 EX (Rev. 1-97)
. ,
REV-1S10 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacoby
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
SSlf 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY % OF
ITEM RELAt~8~~~I~ t~'b~~~5g~lt;W:J~4~~A;'~1fF t~~~ASFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH ACOPYOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
,
TOTAL (Also enter on line 7. Recapitulation) $ 0.00
(It more space IS needed. insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems.lnc.
Form REV-1510 EX (Rev. 1-97)
. ,
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETA:X RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAl EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Geneva W. Jacoby
SSff 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
1 Foge1sanger-Bricker Funeral Home - Funeral Expense 2,244.00
B. ADMINISTRATIVE COSTS,
1. Personal Representative's Commissions 24,357.33
Name of Personal Representative(s) Allf irst Trust Company of PA, NA
Social Security Number(s) I EJN Number of Personal Representative(s)
Street Address 55 South Main Street
City Chambersburi; State PA Zip 17201
-
Year(s) Commission Paid:
2. Attorney's Fees Weigle & Associates 24,357.33
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
-
Re!ationship of Claimant to Decedent
4. Probate Fees Register of Wills 442.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Borough of Shippensburg - Water and Sewer Expense 121.00
2 Bridge Street Realty, LLC - Appraisal of Real Estate 300.00
3 Cumberland County Register of Wills - Short Certificates 15.00
4 Cumberland County Register of Wills - Filing Fees 500.00
5 Dan Hershey Auctioneering Service - Appraisal of Personal 125.00
Property
6 GPU Energy - Utility Expense 126.84
Total of Continuation Schedule(s) 745.29
TOTAL (Also enter on line 9, Recapitulation) $ 53,333.79
(If more space IS needed, Insert addItIonal sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1511 EX (Rev. '~97)
. .
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Item
It
Description
Continuation of Schedule H-B4
(Probate Fees)
Amount
1
Weigle, Perkins & Associates - Reimbursement for Probate
442.00
442.00
, ,
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Item
II
Continuation of Schedule H-B7
(Other Administrative Costs)
Description
Amount
7
Larry Weaver - Snow Removal Expense
40.00
8
Seabury & Smith, Inc. - Liability Insurance
110.65
9
Tanner Home & Energy - Utility Expense
409.24
10
The News-Chronicle - Publishing Letters
83.90
11
Weigle, Perkins & Associates - Reimbursement for Cost of
Advertising and Proof of Publication
75.00
12
Weigle & Associates - Reimbursement for Deed Filing
26.50
745.29
REV-1512 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCET/!t\X RETURN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacoby
SCHEDULE I
DEBTS OF DECEDENT,
MO'RTGAGE LIABILITIES, AND LIENS
SSft 239-46-9480
12/03/2001
FILE NUMBER
2101-1131
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
Borough of Shippensburg - Sewer and Refuse Expense
AMOUNT
124.06
2
GPU Energy - Utility Expense
38.75
3
HCR-Manorcare - Balance due
594.00
4
Menna-Haven Nursing Home Inc.
Nursing Home Expense
7,302.09
5
Menna-Haven Nursing Home Inc.
Pharmaceuticals
436.50
6
Snoke's Florist - Flowers
20.00
7
Sprint - Balance due
182.01
8
Tanner Home & Energy
Utility Expense
127.70
9
Thomas Pritchard Smith Estate - Refund of Overdistribution
120,000.00
Mrs. Jacoby was a Beneficiary of the Estate of
Thomas Pritchard Smith who died 7/3/00, a Resident
of North Carolina. The Executor of the Estate had
distributed the bulk of the Assets of the Estate
where it was discovered that there were additional
heirs and therefore it was requested that this
amount b~ returned.
Attached is a copy of the letter requesting the refund
as well as a copy of the claim that was filed with
the Register of Wills, Cumberland County against the
Estate.
TOTAL (Also enter on line 10, Recapitulation) $ 128,825.11
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1512 EX (Rev. 1-97)
ALEX WARLICK, JR.
CARL S. MILSTED
MARSHALL F. DOTSON, JR.
JOHN T. CARTER, JR.
WARLICK, MILSTED, DOTSON &
ATTORNEYS AT LAW
320 NEW BRIDGE STREET
P.O. BOX 766
JACKSONVILLE, NC 28541-0766
CARTER
TELE: (910) 455-1215
FAX: (910) 455-4702
February 22, 2002
Mr. Alan B. Rhinehart
Vice President
Allfrrst Trust
P.O. Box 459
Chambersburg, P A 17201-0459
Re: Estate of Thomas Pritchard Smith - Geneva W. Jacoby
Dear Mr. Rhinehart:
Enclosed is Claim of the Thomas Pritchard Smith Estate for refund from Ms. Jacoby's Estate.
Yours very truly,
tl.o.....L-
Carl S. Milsted
CSM/khw
enclosure
cc: Register for the Probate of Wills and Granting Letters of Administration &c.
STATE OF PENNSYLVANIA
IN RE: ESTATE OF
GENEVA W. JACOBY
REGISTER OF WILLS
CUMBERLAND COUNTY
ESTATE NO: 2001-01131
PA FILE NO: 21-01-1131
STATEMENT OF CLAIM
1. The estate of Thomas Pritchard smith presents for
filing against the above estate the statement of claim in the
amount of $120,000.00.
2. The basis for the claim is a refund of excess estate
distribution caused by the surfacing of additional paternal heirs.
3. The tax identification number of the claimant is 56-
6568271.
4. The name and address of the claimant is: Estate of
Thomas Pritchard Smith, c/o Carl S. Milsted, Administrator, P.O.
Drawer 766, Jacksonville, North Carolina 28541.
5. This claim is not contingent.
6. This claim is not secured.
Under penalties of perjury I declare that I have read the
foregoing and the facts alleged are true to the best of my
knowledge and belief.
Executed this
22nd day of February, 2002.
(
~n~t ,g.~
CARL S. MILSTED, Administrator
the Estate of Thomas Pritchard
(SEAL)
of
Smith
NORTH CAROLINA
ONSLOW COUNTY
I, Krr~*f- ~ W,tla+ud
the County and State aforesaid, do hereby certify that CARL S.
MILSTED personally appeared before me this day and acknowledged the
due execution of the foregoing instrument. d
WITNESS my hand and notarial seal, this the ;:(:;;0 day of
February, 2002. ~
(J~
a Notary Public in and for
My C?mitission Expires:
u;;) Obln!o
, I
II allfirst
Allfirst Trust
55 South Main Street
P.O. Box 459
Chambersburg. PA 17201-0459
717 261 2819
August 5, 2002
Commonwealth of Pennsylvania
Department of Revenue
Dept 280601
Harrisburg, P A 17128-0601
RE: Geneva W. Jacoby Estate
File Number 2101-1131
Dear Sir:
As executor of the above referenced estate I am writing this separate letter to explain why
several bequests included in Mrs. Jacoby's will were not included on the Inventory and
PA Inheritance Tax Return.
Item Fourth - the Micki-Moto pearl necklace was never found. An extensive search of
the house was made several times.
Item Fifth - The clothing had no monetary value. Furthermore, almost all of it was given
to the Cumberland Valley Animal Shelter Thrift Shop, a charitable organization.
Item Eighth - These items had no monetary value. Furthermore, the bequest is to a
charitable organization.
Item Tenth - These items had no monetary value. Furthermore, the bequest is to a
charitable organization.
If you should need any further clarification of any of these items, please feel free to
contact me.
Very truly yours, /
~~~)~ ---
Alan B. Rhinehart
Vice President
.,"~~"
REV-1S13 EX... (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Geneva W. Jacoby
NUMBER
I.
SSff 239-46-9480
FilE NUMBER
2101-1131
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not list Trustee(s) OF ESTATE
12/03/2001
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under See. 91 16{aX1.2)]
Dr. William L. Bashor
164 Harvest Lane
Chambersburg, PA 17201
Friend 2,000.00
Cash Bequest
2
Alan B. Rhinehart
137 West King Street
Shippensburg, PA 17257
Friend
1,000.00
Cash Bequest
3
Maxine Mohn
406 North Morris Street
Shippensburg, PA 17257
Friend
Opal Glass
Candleholder
20.00
4
Mrs. Marlin Rhinehart
3461 Gleneagles Drive
Chambersburg, PA 17201
Friend
Lenox One-Tier
Cookie Dish
20.00
Lenox Cake
Plate
25.00
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTiON TO TAX is NOT BEiNG MADE
1
B. CHARITABLE AND GOVERNMENTAL DiSTRIBUTIONS
Shippensburg Public Library
73 West King Street
Shippensburg, PA 17257
Renounced
Bequest of
Fiction Books
in Item
Seventh of Will
Total of Continuation Schedule(s)
54,415.68
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyright (c:) 2000 form software only The Lac:k:ner Group, Inc:.
54,415.68
Form REV-1513 EX (Rev. 9-00)
. .
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Item
#
Continuation of Schedule J, Part I
(Taxable Bequests)
Name and Address of Beneficiary
Relationship
Amount or
Share of Estate
5
R. Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Son
6
R. Michael Jacoby and
Lucenda Wagner Jacoby
f/b/o Stephen Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Grandson
Real Estate
89,000.00
Automobile
510.00
Personal
Property
7,340.00
Fiction Books
45.00
79% share of
Residue
260,535.70
4.5% share of
Residue
14,840.64
. ,
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Continuation of Schedule J, Part II-B
(Charitable and Governmental Bequests)
Item
If
Description
Amount or
Share of Estate
2
1.5% share of
Residue
4,946.88
Acacia Fraternity Housing Corporation
1800 Ling1estown Road
Suite 103
Harrisburg, PA 17110
3
Swarsboro Methodist Church
Attn: Mary Berry, Treasurer
665 West Corbett Avenue
Swarsboro, NC 28584
1.5% share of
Residue
4,946.88
4
Messiah United Methodist Church
30 South Penn Street
Shippensburg, PA 17257
1.5% share of
Residue
4,946.88
5
The Cumberland Valley Animal Shelter
2325 County Road
Chambersburg, PA 17201
3% share of
Residue
9,893.76
6
The Antietam Humane Society
8513 Lyons Road
Waynesboro, PA 17268
3% share of
Residue
9,893.76
7
Harrisburg Humane Society
East Shore
7790 Grayson Road
Harrisburg, PA 17111
3% share of
Residue
9,893.76
8
Humane Society of Harrisburg, Inc.
West Shore Shelter
710 Eppley Road
Mechanicsburg, PA 17055
3% share of
Residue
9,893.76
54,415.68
. .
REV-1514 EX + (9~OO)
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
This schedule is to be us~d 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Copy 1/1
o Will
o Intervivos Deed of Trust
o Other
NAME(S) OF
LIFE TENANT(S)
DATE OF BIRTH
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
lnteresttablerate- 031/2% 06% 010%
3. Value of life estate (Line 1 multiplied by Line 2)
$
0.00
0.00000
o Variable Rate
0.0 %
$
0.00
NAME(S) OF
ANNUITANT(S)
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
TERM OF YEARS ANNUITY IS
PAYABLE
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
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% 0 6% 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
0.00
o Monthly (12)
o Other ( )
o
0.00
0.00
0.0
%
0.0000
0.0000
0.00
0.00
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, 17 and 18.
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1514 EX (Rev. 9-00)
. ,
REV-1S14 EX +(9-00)
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Copy 1/2
o Will
o Intervivos Deed of Trust
o Other
NAME(S) OF
LIFE TENANT(S)
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
TERM OF YEARS LIFE ESTATE IS
PAYABLE
Term of Years
Term of Years
Term of Years
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% 0 6% 0 10%
3. Value of life estate (Line 1 multiplied by Line 2)
$
0.00
0.00000
o Variable Rate
0.0 %
$
0.00
NAME(S) OF
ANNUITANT(S)
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
TERM OF YEARS ANNUITY IS
PAYABLE
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
3. Amount of payout per period
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate - D 3 1/2% D 6% D 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
0.00
o Monthly (12)
o Other ( )
o
0.00
0.00
0.0
%
0.0000
0.0000
0.00
0.00
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, 17 and 18.
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1514 EX (Rev. 9-00)
. >
REV~ 1514 EX + (9-00)
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
This schedule is to be us~d for all single life, joint or successive lite 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Copy If3
o Will
o Intervivos Deed of Trust
o Other
NAME(S) OF
LIFE TENANT(S)
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
TERM OF YEARS LIFE ESTATE IS
PAYABLE
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 031/2% 06% D 10%
3. Value of life estate (Line 1 multiplied by Line 2)
$
0.00
0.00000
D Variable Rate
0.0 %
$
0.00
NAME(S) OF
ANNUITANT(S)
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
TERM OF YEARS ANNUITY IS
PAYABLE
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
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% D 6% 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
0.00
o Monthly (12)
OOlher( )
o
0.00
0.00
0.0
%
0.0000
0.0000
0.00
0.00
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, 17 and 18.
(It more space is needed, insert additional sheets of the same size)
Copyright{c) 2000 form software only The Lackner Group, Inc.
Form REV-1514 EX (Rev. 9-00)
, ,
. >
REV-1647 EX + {9-00}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETJ()( RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
(Check Box 4a on Rey-1500 Cover Sheet)
ESTATE OF
Geneva W. Jacoby SS# 239-46-9480 12/03/2001
This schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession
and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
FILE NUMBER
2101-1131
nWiII nT,ust nOthe'
I. Beneficiaries .
NAME OF AGE TO
BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right. n Limited riqht of withdrawal
n Unlimited riQht of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest $ 0.00
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) . .$ 0.00
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%. 00% ,$ 0.00
(also include as part of total shown on Une 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 06%, 04.5% .$ 0.00
(also include as part of total shown on Une 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) . .$ 0.00
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Une 18 of Cover Sheet) . .$ 0.00
7. Total Value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) $ 0.00
(If more space is needed, insert additional sheets of the same size)
CopyrIght (c) 2000 form software only The Lackner Group, Inc.
Form REV-1647 EX (Re..... 9-00)
, ,
. .
REV - 1648 EX (9-00)
SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLVANIA
INHEAITANCETAX DIVISION
(AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91)
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46_9480 12/03/2001 2101-1131
This schedule must be completed and filed it you checked the spousal poverty credit box on the cover sheet.
t:F'AFllI::"~:l!l:4liCIIl911l1mNkQJ;h_$SSJ
1. Taxable Assets total from line 8 (cover sheet)
1. 611,910.92
2. 0.00
3. 0.00
4. 0.00
S. 0.00
6.. 0.00
6b.
6e.
6d.
6. 0.00
7. 611,910.92
B. 0.00
2. Insurance Proceeds on Ufe of Decedent.
3. Retirement Benefits
4. Joint Assets with Spouse
5. PA Lottery Winnings.
6a. Other Nontaxable Assets: List (Attach schedule if necessary).
6. SUBTOTAL (Lines 6a, b, c, d).
7. Total Gross Assets (Add lines 1 thru 6).
8. Total Actual liabilities
9. Net Value of Estate (Subtract line 8 from line 7) .
If line 9 is greater than $200,000 - STOP. The estate is not eli
Income:
a. Spouse.
b. Decedent.
c. Joint.
d. Tax Exempt Income.
e. Other Income not listed above.
f. Total.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(11) 0.00
1. TAX YEAR' 191998 2. TAX YEAR' 191999 3. TAX YEAR' 192000
1.. 0.00 2.. 0.00 3.. 0.00
lb. 0.00 2b. 0.00 3b. 0.00
le. 0.00 2e. 0.00 3e. 0.00
ld. 0.00 2d. 0.00 3d. 0.00
le. 0.00 2e. 0.00 3e. 0.00
11. 0.00 21. 0.00 31. 0.00
+ (21)
o . 00 +(31)
0.00
0.00
~ 3 )
0.00
4b. Average Joint Exemption Income.
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part Ill.
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.
1.
2. Multiply by credit percentage (see instructions) .
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 2A on Page 2 .
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 2A on Page 2.
Copyright (c) 2000 form software only The Lackner Group, Inc.
2.
3.
4.
s.
Schedule (Rev,9-00)
-
, .
.. ;, REV-1649 EX .. (1/97)
.
COMMONWEALTH OF PENNSYLVANIA
INHEAITANCETIV( RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
00 not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance &
Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies .to the Trust III Trust (marital. residual A, 8, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirement of Section 9113{A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered. in whole or in part as an asset on Schedule 0,
then the transferor's personal representative'may specifically identify the trust (all or a fractional portion or percentage) to be included in the election
to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included
as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or
similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on
Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving
spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION VALUE
Part A Total 0.00
PART 8: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Part B Total 0.00
FormREV-1649 EX (Rev.1~97)
.
. .
.
~ REV-1649 EX + (1/97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance &
Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust #2 Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
It a trust or similar arrangement meets the requirement of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative 'may specifically identify the trust (all or a fractional portion or percentage) to be included in the election
to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included
as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or
similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on
Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving
spouse under a Section 9113 (A) trust or similar arran ement.
DESCRIPTION VALUE
Part A Total
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is bein
DESCRIPTION
0.00
made.
VALUE
Part B Total
0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1649 EX (Rev. 1-97)
-
. ~ I II
l... . REV-1649 EX +(1/97)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance &
Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust #3 Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirement of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election
to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included
as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or
similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on
Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
PART A; Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving
spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION VALUE
Part A Total 0.00
PART 8: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
Part B Total
0.00
(If more space is needed. insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc.
Form REV-1649 EX (Rev. 1-97)
1/
J 7- j.~-d
OFfiCIAL USE ONLY
f\EV-1500 EX + (6-00)
CAPB
HpRL
EplO
CRAC
KOTK
ES
C P
o 0
R N
R D
E E
S N
T
C
o
M
P
T U
A T
X A
T
I
o
N
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
D
E
C
E
D
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Jacob Geneva W.
DATE OF DEATH (MM-DD- YEAR)
2101-1131
DATE OF BIRTH (MM-OD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
239-46-9480
THIS RETURN MUST BE ALED IN DUPlICATEWlTH THE
NUMBER
12/03/2001 10/10/1931
IF APPLlCABL SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. OrIginal Return
4. Limited Estate
X 6. Decedent Died Testate
3 date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
X 2. Supplemental Return
4a. Future Interest Compromfse(date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach copy of Trust)
D 10. Spousal Poverty CredIt 0 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
"i'l'BISS);cnOIfMllS;'tBEl::ON~llEitED!;~ CORRESPONDENCE&; CMF1D'ENil"1iJf'jIIlCll~Ii:f"1l10NISHoUI1l)iBEDlI'I'ECTEll!1O~' ~
NAME COMPLETE MAILING ADDRESS
(Attach copy of WllI)
D 9. Litlgatlon Proceeds ReceIved
Alan B. Rhinehart, Vice-President & T.O.
FIRM NAME (if Appllcable)
Al1first Trust Com an of PA, NA
TELEPHONE NUMBER
55 South Main Street
Chambersburg, PA 17201
R
E
C
A
P
I
T
U
L
A
T
I
o
N
- 8
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8) 21,039.03
(11) 0.00
(12) 21,039.03
(13) 3.471.45
(14) 17,567.58
(1)
(2)
(3)
None
None
None.
OFFICIAL USE ONLY
(4)
(5)
None
21,039.03
(6)
None
None
None
None
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116{aX1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
(15)
(16)
(17)
(18)
(19)
.0 0
,0 45
,12
.15
0.00
790.54
0.00
0.00
790.54
17,567.58
x
X
X
X
Copyright (cl 2000 form software only The Lackner Group, Inc.
FormREV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
105 S. Queen Street
CI1Y I STATE I ZIP
ShiDDensbur~ PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
790.54
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
790.54
0.00
790.54
':::'::::::::imm~:ti!~~ii~~~!~~:i~~~i:~i~t~~!i~i~m~~~:~~:i~i~~m~~ii~~2ili~:~ii~~i!!i~:!!iii~""~:;~'''~~:~'6~''~"ll~~'~LOCKS
1. Did decedent make a transfer and:
8. retain the use or income of the property transferred;
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or .
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate co~sideration? . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes No
~~
D
D
D
[RJ
[RJ
[RJ
Under penalties of perjury, I declare that I have examined this return, 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.
SIGNATUR/} PERS;'RE~~E FOR:::::_ _ _~~~;_~~;;_ _~;~_~~ ~~_~;:~~~ _ ~_~ _ ~~_'_ _ ~~_ _ _ _ _ _ _ _ _ __
~ ~~~ Chambersburg, PA 17201
SIGNAT";J;Ee;Rj"ERTH.^N REP ESENTA;M _ _ _~~~;_~~;;_ _~;~_~~ ~~_~;:~~~ _ ~_~ _ ~~_'_ _ ~~_ _ _ _ _ _ _ _ _ __
~h~?",t'~b':'''1?' .PA 17201
:";':';":';iiiii!!:::im:mmmiW:iHHHni:[i:i:;i::'::' . .,....""""'ii::W!Wi'
DATE
<1/1/03
DATE
tI/1//)J
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (;l].
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. 9116 (a) (1.1) OJ)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
AEV~ 1508 EX .. (1-97) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Geneva W. Jacoby SS# 239-46-9480 12/03/2001 2101-1131
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
Interest Estate Thomas Pritchard Smith
VALUE AT DATE
OF DEATH
21,039.03
TOTAL (Also enter on line S. Recapitulation) $ 21,039.03
(If more space IS needed, Insert additional sheets of the same size)
Copyright (cl 1996 form software only CPSystems, Inc. Form REV-15G8 EX (Rev. 1-97)
REV-1513 EX + (9.00) .
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Geneva W. Jacobv SS# 239-46-9480
12/03/2001
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal dlstrlbut!ons, and
, transfers under Sec. 9116(aX1.2)]
R. Michael Jacoby
656 Wheat1yn Drive
York, PA 17403
1
2
R. Michael Jacoby and
Lucenda Wagner Jacoby
f/b/o Stephen Michael Jacoby
656 Wheatiyn Drive
York, PA 17403
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Grandson
FILE NUMBER
2101-1131
AMOUNT OR SHARE
OF ESTATE
79% share of
Residue
4.5% share of
Residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Acacia Fraternity Housing
Corporation
1800 Linglestown Road
Suite 103
Harrisburg, PA 17110
Total of Continuation Schedule(s)
1.5% share of
Residue
315.59
3,155.86
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
3,471.45
Form REV-1513 EX (Rev. 9.00)
Estate of: Geneva W. Jacoby
Soc Sec #: 239-46-9480
Date of Death: 12/03/2001
Continuation of Schedule J, Part II-B
(Charitable and Governmental Bequests)
Item
iF
Description
Amount or
Share of Estate
2
Swarsboro Methodist Church
Attn: Mary Berry, Treasurer
665 West Corbett Avenue
Swarsboro, NC'28584
1.5% share of
Residue
315.59
3
Messiah United Methodist Church
30 South Penn Street
Shippensburg, PA 17257
1.5% share of
Residue
315.59
4
The Cumberland Valley Animal Shelter
2325 County Road
Chambersburg, PA 17201
631.17
3% share of
Residue
5
The Antietam Humane Society
8513 Lyons Road
Waynesboro, PA 17268
631.17
3% share of
Residue
6
Harrisburg Humane Society
East Shore
7790 Grayson Road
Harrisburg, PA 17111
631.17
3% share of
Residue
7
Humane Society of Harrisburg, Inc.
West Shore Shelter
710 Eppley Road
Mechanicsburg, PA 17055
631.17
3% share of
Residue
3,155.86
~ /'/-026- /y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ALAN B RHINEHART
ALLFIRST TR CO PA NA
55 S MAIN ST
CHAMBERSBURG PA 17aO~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
; COUNTY
ACN
09-23-2002
JACOBY
12-03-2001
21 01-1131
CUMBERLAND
101
'*
REV-1547 EX AFP 101-02l
GENEVA
W
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--foY=02Y-NC)T-iCE--OF-'j;""NHERifAifCE-TA)r'A.-ppR'A.ysEifiNT-:--Ail-owAifcE-ifi------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF JACOBY GENEVA W FILE NO. 21 01-1131 ACN 101 DATE 09-23-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
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 (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
372,271.34 X 045 = 16,752.21
.00 X 12 = .00
3,065.00 X 15 = 459.75
(9)= 17,211.96
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)
89,000.00
.00
.00
.00
522,910.92
.00
.00
(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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
53,333.79
128.825.11
(11)
(2)
(3)
(4)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
611,910.92
18:7.158 90
429,752.02
54,415.68
375,336.34
~"._n. n_v_~. , (+) AMOUNT PAID
DATE NUI1BER INTEREST/PEN PAID (-)
02-26-2002 CDOO0894 789.47 15,000.00
08-06-2002 CDOO1483 .00 1,422.49
TOTAL TAX CREDIT 17,211.96
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B [collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B [collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND [CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS I AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1313). Applications are available at the Dffice
of the Register of Wills, any of the 23 Revenue District Dffices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or
speaking needs: 1-800-447-3020 [TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" [REV-1501) for an explanation of administrativelY correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent [5%) discount of
the tax paid is allowed.
The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six [6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 n .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 n .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
..
REGISTER OF WILLS, CUMBERLAND COUNTY
G~~
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Geneva W. Jacoby a/k/a Geneva Ward Jacoby
Date of Death:
December 3, 2001
Will No.:
21-01-1131
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion ofthe administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes !Xl 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 representative file a final account with the Court?
Yes X No 0 Confirmed by the Court 1-14-2003
b. The separate Orphans' Court No. (if any) for the personal representative's
accountiS:~2002
c. Did the personal representative state an account informally to the parties
in interest? Yes 0 No @
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the 0 han Court
and may be attached to eport. r
qr-
Date: 11/18/03
Jerry A. Weigle, Esquire
Name
WEIGLE & ASSOCIATES, P.C.
126 East King Street
Shippensburg, PA 17257
Address
717-532-7388
Telephone No.
Capacity: 0 Personal Representative
W Counsel for personal representative
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-1131
ESTATE OF GENEVA WARD JACOBY, DECEASED
--------------------------------------
--------------------------------------
FIRST AND FINAL ACCOUNT OF
Allfirst Trust Company of Pennsylvania, NA, Executor
================================================================================
Date of Death: December 3, 2001
Date of Executor's Appointment: December 13, 2001
Date of First Advertisement of Letters: December 28, 2001
Accounting for the Period: December 3, 2001 to
October 21, 2002
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
Purpose of Account: Allfirst Trust Company of Pennsylvania, NA, Executor,
offers this account to acquaint interested parties with the transactions that
have occurred during this administration.
It is important that the account be carefully examined. Requests for
additional information or questions or objections can be discussed with:
Allfirst Trust Company of Pennsylvania, NA
8 West High Street
Carlisle, PA 17013-2923
Or
Jerry A. Weigle
Attorney Identification No. 01624
Weigle & Associates
126 East King Street
Shippensburg, PA 17257
SUMMARY OF ACCOUNT
Estate of Geneva Ward Jacoby, Deceased
For Period of 12/03/2001 through 10/21/2002
Page
Proposed Distributions
to Beneficiaries
20-22
PRINCIPAL
Receipts:
Per Inventory Filed 3-4
Net Gain (or Loss) on Sales
or Other Disposition
5
Less Disbursements:
Debts of Decedent 6
Funeral Expenses 6
Administration Expenses 7
Federal and State Taxes 8
Fees and Commissions 8
Reserves 8
Balance before Distributions
Distributions to Beneficiaries
9
Principal Balance on Hand
10
For Information:
Investments Made
Changes in lnvestment Holdings
11-12
INCOME
Receipts:
This Account
13 -14
Net Gain (or Loss) on Sales
or Other Disposition
Less Disbursements
18
Balance Before Distribution
Distributions to Beneficiaries
Income Balance on Hand
19
COMBINED BAL~~CE ON HAND
2
Current
Value
Fiduciary
Acquisition
Value
310,545.48 310,545.48
--------------- ---------------
--------------- ---------------
128,825.11
2,244.00
1,909.13
16,422.49
12,357.33
36,857.33
611,910.92
0.00
611,910.92
--------------- ---------------
198,615.39
413,295.53
109,960.00
303,335.53
9,087.24
0.00
---------------
9,087.24
1,877.29
7,209.95
0.00
7,209.95
310,545.48
---------------
---------------
.. " -....
RECEIPTS OF PRINCIPAL
AS PER INVENTORY AS FILED:
CASH:
-------------------------
$11,000 Allfirst Bank
Certificate of Deposit
#87008140751022
Accrued Interest
$11,000 Allfirst Bank
Certificate of Deposit
#87008140751057
Accrued Interest
$15,000 Allfirst Bank
Certificate of Deposit
#87008141240404
Accrued Interest
$30,000 Allfirst Bank
Certificate of Deposit
#87008141185608
Accrued Interest
$70,000 Allfirst Bank
Certificate of Deposit
#87008140921521
Accrued Interest
Allfirst Bank Money Market
Account #0098219944 - Date of
Death Balance
Accrued Interest
Allfirst Bank Checking Account
#97322091 - Date of Death Value
Accrued Interest
Allfirst Bank IRA Account
#8700029-3406001 - Date of
Death Balance
Accrued Interest
Allstate Insurance Company -
11,000.00
57.77
11,000.00
61.66
15,000.00
80.01
30,000.00
50.45
70,000.00
62.23
29,098.97
9.45
19,052.37
0.74
3,533.49
2.00
166.80
Capital Blue Cross/PA Blue 142.60
Shield - Refund of Medical Insurance
Cash Found in Home 46.05
Comcast Cable - Refund 5.00
3
Fiduciary
Acquisition
Value
Geneva W. Jacoby POA Account
Accrued Interest
323,540.56
54.68
Hearst Corporation - Refund on
Magazine Subscription
1. 50
Internal Revenue Service -
2001 Personal Income Tax Refund
1,290.00
Internal Revenue Service -
2001 Personal Income Tax
Refund on Amended Return
400.97
Pennsylvania Dept of Revenue -
2001 Personal Income Tax Refund
216.00
Seabury & Smith, Inc. -
Insurance Premium Refund
77.62
PERSONAL PROPERTY:
1982 Chevrolet Caprice CL Sedan - 510.00
Appraised Value
Lenox Cake Plate - 25.00
Appraised Value
Lenox One-Tier Cookie Dish - 20.00
Appraised Value
Miscellaneous Fiction Books - 45.00
Appraised Value .
Opal Glass Candle Holder - 20.00
Appraised Value
Personal Property - 7,340.00
Appraised Value
REAL ESTATE/PA:
105 S. Queen Street,
Shippensburg, PA -
Appraised Value
89,000.00
TOTAL RECEIPTS OF PRINCIPAL. . . . . . . . . . . . . . .
4
514,950.92
7,960.00
89,000.00
611,910.92
--------------
--------------
GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL
12/31/01
$15,000 Allfirst Bank
Certificate of Deposit
#87008141240404
Net Proceeds
Fid. Acq. Value
15,000.00
15,000.00
01/03/02
$70,000 Allfirst Bank
Certificate of Deposit
#87008140921521
Net Proceeds
Fid. Acq. Value
70,000.00
70,000.00
04/11/02
$11,000 Allfirst Bank
Certificate of Deposit
#87008140751022
Net Proceeds
Fid. Acq. Value
11,000.00
11,000.00
08/08/02
$11,000 Allfirst Bank
Certificate of Deposit
#87008140751057
Net Proceeds
Fid. Acq. Value
11,000.00
11,000.00
09/30/02
$30,000 Allfirst Bank
Certificate of Deposit
#87008141185608
Net Proceeds
Fid. Acq. Value
30,000.00
30,000.00
TOTAl, GAINS AND LOSSES/PRINCIPAL...... . . . . .
LESS LOSS.............................
NET GAIN OR LOSS..... . . . . . . . . . . . . . . . . . . . . . .
5
Gain
0.00
0.00
0.00
0.00
0.00
Loss
----------------------------
0.00
0.00
0.00
0.00
--------------
--------------
12/11/01
12/11/01
12/20/01
12/20/01
01/09/02
01/11/02
01/14/02
01/17/02
01/22/02
01/24/02
02/12/02
02/26/02
03/11/02
03/22/02
12/14/01
DISBURSEMENTS OF PRINCIPAL
DEBTS OF DECEDENT
-----------------
Menno-Haven Nursing Home -
Nursing Home Expense
Sprint - Telephone Expense
GPU Energy - Utility Expense
Tanner Home & Energy -
Utility Expense
Menno-Haven Nursing Home -
Pharmaceuticals
Snoke's Florist - Flowers
Sprint - Telephone Expense
Sprint - Telephone Expense
Borough of Shippensburg -
Sewer & Refuse Expense
Borough of Shipp ens burg -
Sewer & Refuse Expense
HCR-Manorcare - Balance Due
Sprint - Telephone Expense
Sprint - Telephone Expense
Thomas Pritchard Smith Estate
Return of Over distribution
7,302.09
40.08
38.75
127.70
436.50
20.00
40.27
21.56
42.00
82.06
594.00
40.05
40.05
120,000.00
FUNERAL EXPENSES
TOTAL DEBTS OF DECEDENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fogelsanger & Bricker Funeral Home -
Funeral Expense
2,244.00
TOTAL FUNERAL EXPENSES..............................
6
128,825.11
2,244.00
12/27/01
12/28/01
12/31/01
01/08/02
01/09/02
01/14/02
Oi/22/02
02/04/02
02/07/02
02/08/02
02/20/02
02/21/02
03/14/02
03/21/02
04/03/02
04/08/02
08/05/02
ADMINISTRATION EXPENSES
-----------------------
Weigle, Perkins & Associates -
Probate Costs - $442.00 and
Advertising Costs - $75.00
517.00
Cumberland County Register of wills -
5 Short Certificates
15.00
Dan Hershey Auctioneering Service _
Appraisal of Personal Property
125.00
Seabury & Smith, Inc. -
Liability Insurance/Casualty Coverage
7.63
Bridge Street Realty, LLC -
Appraisal Fee - 102 S. Queen Street
300.00
Tanner Home & Energy -
Utility Expense
161.55
GPU Energy - Utility Expense
44.27
Seabury & Smith, Inc. -
Liability Insurance
103.02
The News-Chronicle -
Cost of Advertising and
Proof of Publication
83.90
Larry Weaver - Snow Removal Expense
40.00
GPU Energy - Utility Expense
40.10
Tanner Home & Energy -
Utility Expense
116.39
GPU Energy - Utility Expense
42.47
Tanner Home & Energy -
Utility Expense
131.30
Weigle & Associates -
Reimbursement for Deed Filing
26.50
Borough of Shippensburg -
Sewer & Refuse Expense
121.00
Cumberland County Register of wills -
Filing and Recording Fees -
PA State Inheritance Tax - $15.00;
Inventory - $19.00
34.00
TOTAL ADMINISTRATION EXPENSES...;...................
7
1,909.13
02/25/02
08/05/02
09/03/02
FEDERAL AND STATE TAXES
-----------------------
Cumberland County Register of Wills -
Payment on PA State Inheritance Tax
Cumberland County Register of Wills -
PA State Inheritance Tax Balance Due
15,000.00
1,422.49
FEES AND COMMISSIONS
TOTAL FEDERAL AND STATE TAXES.......................
Weigle & Associates -
One-Half Attorney's Fee
12,357.33
TOTAL FEES AND COMMISSIONS..........................
RESERVES
Allfirst Trust Company of PA, NA -
Executor's Fee
Cumberland County Register of wills -
Filing Fees
Weigle & As~ociates -
Reserve for Balance of Attorney's Fee
24,357.33
500.00
12,000.00
TOTAL RESERVES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TOTAL DISBURSEMENTS OF PRINCIPAL....................
8
16,422.49
12,357.33
36,857.33
198,615.39
--------------
--------------
Dr. William Bashor
01/14/02
R. Michael J'acoby
01/15/02
03/13/02
04/05/02
07/26/02
07/26/02
Maxine Mohn
02/26/02
Alan Rhinehart
01/07/02
Mrs. Marlin Rhinehart
01/17/02
01/17/02
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
Specific Bequest as per Item Twelfth
of the Last Will and Testament
of Geneva W. Jacoby, Deceased
1982 Chevrolet Caprice CL Sedan - 510.00
Appraised Value -
Distributed in Kind
Advance Partial Distribution 10,000.00
105 S. Queen Street, 89,000.00
Shippensburg, PA - Appraised
Value - Distributed in Kind
Miscellaneous Fiction Books - 45.00
Appraised Value - Delivered in Kind
Personal Property - Appraised 7,340.00
Value - Delivered in Kind
Opal Glass Candle Holder -
Appraised Value Distributed in Kind
Specific Bequest as per Item Eleventh
of the Last Will and Testament
of Geneva W. Jacoby, Deceased
Lenox Cake Plate -
Appraised Value -
Distributed in Kind
25.00
Lenox One-Tier Cookie Dish -
Appraised Value -
Distributed in Kind
20.00
TOTAL DISTRIBUTIONS TO BENEFICIARIES......
9
2,000.00
106,895.00
20.00
1,000.'00
45.00
109,960.00
--------------
--------------
.. '..
PRINCIPAL BALANCE ON HAND
Description
Current Value Fiduciary
Acquisition
or as Noted Value
ARK Money Market Portfolio
303,335.53 303,335.53
--------------- ---------------
303,335.53 303,335.53
--------------- ---------------
--------------- ---------------
10
CHANGES IN INVESTMENT HOLDINGS - PRINCIPAL
$11,000 Allfirst Bank Certificate of
Deposit #87008140751022
------------------------------------
12/03/01
04/11/02
inventoried
matured
$11,000 Allfirst Bank Certificate of
Deposit #87008140751057
------------------------------------
12/03/01
08/08/02
inventoried
sold
$15,000 Allfirst Bank Certificate of
Deposit #87008141240404
------------------------------------
12/03/01
12/31/01
inventoried
matured
$30,000 Allfirst Bank Certificate of.
Deposit #87008141185608
------------------------------------
12/03/01
09/30/02
inventoried
sold
$70,000 Allfirst Bank Certificate of
Deposit #87008140921521
------------------------------------
12/03/01
01/03/02
inventoried
matured
11
Cost
11,000.00
(11,000.00)
0.00
--------------
--------------
11,000.00
(11,000.00)
0.00
--------------
--------------
15,000.00
(15,000.00)
0.00
--------------
--------------
30,000.'00
(30,000.00)
0.00
--------------
--------------
70,000.00
(70,000.00)
0.00
--------------
--------------
. "
105 S. Queen Street, Shippensburg, PA
-------------------------------------
12/03/01
04/05/02
inventoried
distributed in kind
89,000.00
(89,000.00)
0.00
--------------
--------------
1982 Chevrolet Caprice CL Sedan
12/03/01
01/15/02
inventoried
distributed in kind
510.00
(510.00)
0.00
--------------
--------------
Lenox Cake Plate
12/03/01
01/17/02
inventoried
distributed in kind
25.00
(25.00 )
0.00
--------------
--------------
Lenox One-Tier Cookie Dish
12/03/01
01/17/02
inventoried
distributed in kind
20.00
(20.00)
0.00
--------------
--------------
Miscellaneous Fiction Books
12/03/01
07/26/02
inventoried
delivered in kind
45.00
(45.00)
0.00
--------------
--------------
Opal Glass Candle Holder
12/03/01
02/26/02
inventoried
distributed in kind
20.00
(20.00 )
0.00
--------------
--------------
Personal Property
12/03/01
07/26/02
inventoried
delivered in kind
7,340.00
(7,340.00)
0.00
--------------
--------------
12
'. '
. "'"
RECEIPTS OF INCOME
INTEREST
$11,000 Allfirst Bank Certificate of
Deposit #87008140751022
------------------------------------
04/04/02
05/08/02
Interest 12/4/01 - 3/4/02
59.70
173.32
$11,000 Allfirst Bank Certificate of
Deposit #87008140751057
------------------------------------
04/04/02
04/29/02
05/06/02
05/08/02
06/03/02
07/01/02
08/02/02
08/08/02
Interest 12/4/01 - 3/4/02
63.72
330.72
61.66
184.99
63.72
61.66
63.72
0.80
$15,000 Allfirst Bank Certificate of
Deposit #87008141240404
------------------------------------
12/31/01
$30,000 Allfirst Bank Certificate of.
Deposit #87008141185608
------------------------------------
05/08/02
OS/24/02
06/25/02
07/26/02
08/23/02
09/25/02
Interest 12/4/01 - 12/29/01
465.25
168.16
173.77
168.16
173.77
173.77
$70,000 Allfirst Bank Certificate of
Deposit #87008140921521
------------------------------------
01/03/02
05/08/02
Interest 12/4/01 - 12/29/01
15.96
311. 17
13
233.02
830.99
19.63
1,322.88
327.13
, "
Allfirst Bank Money Market Account
#0098219944
----------------------------------
05/08/02
Interest 12/4/01 - 5/7/02
Allfirst Bank Checking Account
#97322091
------------------------------
01/11/02
05/02/02
Interest 12/4 - 12/11/01
Interest 1/10 - 5/1/02
Allfirst Bank IRA Account
#8700029-3406001
-------------------------
01/14/02
Interest 12/4/01 - 1/1D/02
ARK Money Market Portfolio
--------------------------
01/02/02
02/04/02
03/01/02
04/01/02
05/01/02
06/03/02
07/01/02
08/01/02
09/03/02
10/01/02
334.74
647.25
588.08
541.38
398.66
447.33
439.13
435.88
425.46
395.83
TOTAL INTEREST INCOME. ....................
OTHER INCOME
Geneva W. Jacoby POA Account
----------------------------
01/07/02
05/15/02
Interest 12/4 - 12/11/01
145.83
0.04
State Employees Retirement System
---------------------------------
05/02/02
TOTAL OTHER INCOME........................
TOTAL RECEIPTS OF INCOME....... . . . . . . . . . . .
14
3.00
3.04
208.12
6.04
12.36
4,653.74
7,613.91
--------------
--------------
145.87
1,327.46
1,473.33
--------------
--------------
9,087.24
--------------
--------------
. "
05/01/02
10/21/02
DISBURSEMENTS OF INCOME
State Employees Retirement System -
Reimbursement of December Check
1,332.06
Allfirst Trust Company of PA,
NA - Income Commission
545.23
TOTAL DISBURSEMENTS OF INCOME..................
15
1,877.29
--------------
--------------
"
INCOME BALANCE ON HAND
Current Value
Fiduciary
Acquisition
Value
Description
or as Noted
ARK Money Market Portfolio
7,209.95
7,209.95
--------------- ---------------
7,209.95 7,209.95
--------------- ---------------
--------------- ---------------
16
.. --
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Current Value
or as Noted
Fiduciary
Acquisition
Value
Aca.cia Fraternity Housing Corporation
-------------------------------------
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (B) of
the Last will and Testament of
Geneva W. Jacoby, Deceased
4,808.18
4,808.18
-------------- --------------
4,808.18 4,808.18
The Antietam Humane Society
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (F) of
the Last Will and Testament of
Geneva W. Jacoby, Deceased
9,616.36
9,616.36
-------------- --------------
9,616.36 9,616.36
The Cumberland Valley Animal Shelter
------------------------------------
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (E) of
the Last Will and Testament of
Geneva W. Jacoby, Deceased.
9,616.36
9,616.36
-------------- --------------
9,616.36 9,616.36
Harrisburg Humane Society (East Shore)
--------------------------------------
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (G) of
the Last Will and Testament of
Geneva W. Jacoby, Deceased
9,616.36
9,616.36
-------------- --------------
9,616.36 9,616.36
Humane Society of Harrisburg, Inc., West Shore
----------------------------------------------
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (H) of
the Last will and Testament of
Geneva W. Jacoby, Deceased
9,616.36
9,616.36
-------------- --------------
9,616.36 9,616.36
17
.J"
R. Michael Jacoby
ARK Money Market Portfolio -
Residual Principal and Income Cash
as per Item Thirteenth(I) of
the Last Will and Testament of
Geneva- W. Jacoby, Deceased
253,230.95
253,230.95
Less Advance Cash Distribution
on 3/13/2002
(10,000.00)
(10,000.00)
-------------- --------------
243,230.95 243,230.95
R. Michael Jacoby and Lucenda Wagner Jacoby,
Trustee for Stephen Michael Jacoby, a Minor
Birth Date 3/10/02
-----------------------------------~--------
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (A) of
the Last will and Testament of
Geneva W. Jacoby, Deceased
14,424.55
14,424.55
-------------- --------------
14,424.55 14,424.55
Messiah United Methodist Church
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (D) of
the Last will and Testament of
Geneva W. Jacoby, Deceased
4,808.18
4,808.18
-------------- --------------
4,808.18 4,808.18
Swarsboro Methodist Church
ARK Money Market Portfolio -
Residual Principal and Income Cash -
as per Item Thirteenth (C) of
the Last Will and Testament of
Geneva W. Jacoby, Deceased
4,808.18
4,808.18
-------------- --------------
4,808.18 4,808.18
-------------- --------------
310,545.48 310,545.48
-------------- --------------
-------------- --------------
18
. J.
AFFIDAVIT
Allfirst Trust Company of Pennsylvania, NA, Executor under the Last
will and Testament of GENEVA WARD JACOBY, deceased, hereby declares under oath
that it has fully and faithfully discharged the duties of its office; that the
foregoing Account is true and correct and fully discloses all significant
transactions occurring during the accounting period; that all known claims
against the Estate have been paid in full; that, to its knowledge, there are no
claims now outstanding against the Estate; that all taxes presently due from the
Estate have been paid; and that more than four months have elapsed since the
first complete advertisement of the granting of letters in this Estate.
Subscribed and sworn to
~
6 day
before me this
of N~IjtM.. b1V
I 2002.
)t...~~.~
/~ otary pubhc
Notarial Seal
Gwendolyn E. Killian, Notary Public
Carlisle Bora, Cumberland County
My Commission Expires Nov. 22, 2004
Member, Pennsylvania Association of Notaries
19
It is hereby certified that written notice stating the date,' time and place of the
presentation of the First and Final Account in the above estate and the statement of
proposed distribution and stating the last day to file objections to the account and
statement of proposed distribution and including a copy of the statement of distribution
was given at least twenty-eight (28) days prior to the date fixed to every unpaid creditor
who has given written notice of his claim to the Accountant and to every other person
known to the Accountant to have or claim an interest in the estate as creditor,
beneficiary, heir or next of kin.
Trust Company of Pennsylvania, Executor
By: Thomas E. Morkin,Vice President
IN RE: ESTATE OF GENEV A WARD JACOBY,
Dc~ceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21-01-1130
NOTICE
This is to advise you that Allfirst Trust Company of Pennsylvania, Executor under
the will of Geneva Ward Jacoby, deceased, has filed the First and Final Account of the
administration of the said decedent's estate in the Office of the Register of Wills of
Cumberland County, Pennsylvania. The said Account and Proposed Schedule of
Distribution will be presented to the Court of Common Pleas of Cumberland County,
Pennsylvania, Orphans' Court Division, of Carlisle, Pennsylvania, in the Courtroom of the
Cumberland County Courthouse, Carlisle, Pennsylvania, on January 14, 2003, at 9:30 a.m.,
for confirmation.
Copies of the said Account and Proposed Schedule of Distribution are enclosed
herewith.
This notice is sent to you as an interested party, in accordance with the Rules of
Court. Any exceptions or objections to the said Account or Proposed Schedule of
Distribution may be filed prior to, or at that time and date, by any Party of Interest.
Yau are not required to appear at the audit. However, if you do not appear in person
or by counsel, the Court will assume that you agree with the accounting and the distribution
proposed by the accountants.
November 7, 2002
Very truly yours,
WEIGLE & ASSOCIATES, P.
,
Notices tl~:
R. Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Messiah United Methodist Church
30 South Penn Street
Shippensburg, P A 17257
R. Michad Jacoby and
LucendaWagner Jacoby, Co-Trustees for
Stephen Michael Jacoby
656 Wheatlyn Drive
York, PA 17403
Acacia Fraternity Housing Corporation
1800 Linglestown Road, Suite 103
Harrisburg, P A 17110
Swarsboro Methodist Church
A TTN: Mary Berry, Treasurer
655 West Corbett Avenue
Swarsboro, NC 28584
Cumberland Valley Animal Shelter
2325 Country Road
Chambersburg, P A 17201
The Antie:tam Humane Society
8513 Lyons Road
Waynesboro, PA 17268
Harrisburg Humane Society (East Shore)
7790 Grayson Road
Harrisburg, PAl 7111
Humane Society of Harrisburg, Inc., West Shore Shelter
710 Epplt:y Road
Mechanicsburg, PA 17055
Commonwealth of Pennsylvania
Office of the Attorney General
Charitable Trusts & Orfanizations Section
21 South 12thStreet,3f Floor
Philadelphia. PA 19107-3603
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1 162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ALLFIRST TRUST COMPANY OF PA
55 SOUTH MAIN STREET
CHAMBERSBUR(i, PA 17201
h__h__ fold
ESTATE INFORMATION: SSN: 239-46-9480
FILE NUMBER: 2101-1131
DECEDENT NAME: JACOBY GENEVA WARD
DA TE OF PAYMENT: 04/11/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/03/2001
NO. CD 002431
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $790.54
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 20412361
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$790.54
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
\, 1?-d2b-/-lj
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NO.
COUNTY
ACN
06-03-2003
JACOBY
12-03-2001
2101-1131
Cumberland
501
ALAN B RHINEHART
ALLFIRST TR CO PA NA
55 S MAIN S1'
CHAMBERSBURG PA 17201
REV-1S47 EX (12-97) PC
GENEVA W
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
. - REV:1547 EX -(Oif-97YPC - - - -" -" - - - - - - Notic"e -6-F -'N i'fe RIT ':Nce" TA)( AP-PR-Ais-eMeNT: "A"LLOWA-tilCE- OR -" _" _ _ _" _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _" _ _ _ _ _ __
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF JACOBY GENEVA W FILE NO. 2101-1131 ACN 501 DATE 06-03-2003
TAX RETURN WAS: ~ ACCEPTED AS FILED 0 CHANGED
RESERVATION CONCERNING FUTURE INTEREST _ SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION 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
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 0.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00
11. Total Deductions (11) 0.00
12. Net Value of Tax Return (12) 21,039.03
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 3,471.45
14. Net Value of Estate Subject to Tax (14) 17,567.58
NOTE: If an assessment was issued previously, lines 14,15 and/or 16,17 and 18 will reflect figures
that include the total of ALL returns assessed to date.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
0.00
0.00
0.00
0.00
21,039.03
0.00
0.00
(8)
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 taxable at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
21,039.03
(15) 0.00 X .00 0.00
(16) 17,567.58 X .045 790.54
(17) 0.00 X .12 0.00
(18) 0.00 X .15 0.00
(19) 790.54
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-11-2003 CD002431 0.00 790.54
TOTAL TAX CREDIT 790.54
BALANCE OF TAX DUE 0.00
INTEREST 0.00
TOTAL DUE 0.00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADIIITIONAL INTEREST.
(IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B
(collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to
appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 21 of 1995. (72 P.S. Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order
payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania
Inheritance and Estate Tax (REV-1313). Applications are available at the Office of the Register of Wills or any of the 23 Revenue District Offices, or by
calling the special 24-hour answering service numbers for forms ordering: In Pennsylvania 1-800-362-2050, outside Pennsylvania and within local
Harrisburg area (717) 787-8094, TDD# (717) 772-2252 (Hearing Impaired Only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance or disallowance of deductions, or assessment of tax (including discount or interest) as
shown on this Notice must object within sixty (60) days of receipt of this Notice by:
--written protest to the PA Department of Revenue Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative OR
--appeal to the Orphans' Court.
ADMINISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, A TIN: Post
Assessment Review Unit, Dept. 280601 Harrisburg, PA 17128-0601 Phone (717) 787-6505. See pane 3 of the booklet "Instructions for Inheritance Tax
Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death a five percent (5%) discount of the tax paid is allowed.
PENAL TV: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before
January 18,1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the same
time period as you would appeal the tax and interest that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes
which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes
which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Interest Daily Interest Daily Interest Daily
Year ~ Factor Year ~ Factor Year ~ Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment
is made after the interest computation date shown on the Notice, additional interest must be calculated.