HomeMy WebLinkAbout04-28-06
lEV-1500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 1
o 5
00702
COUNTY CODE
YEAR
NUMBER
I-
Z
W
o
W
U
W
o
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
'Jacobsen, Clarence
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
07/28/2005 07/17/1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
051-18-7056
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
f-
:.::~1Il
U 0::'::
w c..u
J: 00
U O:...J
c..1O
c..
<(
[!],
04
[!]6
Original Return
Limited Estate
o 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required
o 7. Decedent Maintained a Living Trust (Attach copy oITrust) ~ 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (date of death between 12-31.91 ard 1-1-95) 0 11. Election to tax under se~.' 9113(A)(AllaCh Sch 0)
Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
f-
Z
W
Cl
Z
o
c..
III
W
0:
0:
o
U
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Andrea C Jacobsen
FIRM NAME (If Applicable)
TELEPHONE NUMBER
355 E Baltimore St
Carlisle, PA 17013
1. Real Estate (Schedule A)
(1)
105,000.00
OFFI6IfJ. USE Ot-ll. Y
(717) 245-0527
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4)
z
o
i=
~
::J
l-
ii:
<(
u
w
c::
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
132,095.77
2,261.57
-...l
(5)
8. Total Gross Assets (total Lines 1-7)
239,357.34
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
(8)
12,526.94
1,764.85
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
12. Net Value of Estate (Line 8 minus Line 11)
(12)
14,291.79
225,065.55
11. Total Deductions (total Lines 9 & 10)
(11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J) (13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
225,065.55
z
o
i=
<(
I-
::J
a.
:E
o
U
X
<(
I- 20. D
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 _(15)
16. Amount of Line 14 taxable at lineal rate 225,065.55 x .0 ~(16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
10,127.95
10,127.95
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO.ANSWERALLQUESTIONSONREVERSE SIDE AND RECHECK MATH < <
5W4632 1.000
Decedent's Complete Address:
STREET ADDRESS
355 S Sporting Hill Rd
CI1Y I STATE I ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. 'credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
10,127.95
9,405.00
495.00
Total Credits (A + B + C) (2)
9,900.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + 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)
.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
227.95
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(58)
227.95
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D
b. retain the right to designate who shall use the property transferred or its income; . D
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [!]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 pre arer other than the personal representative is based on all information of which preparer has any knowledge.
SI(;1.::2) ~ P SON RESPONSIBLE FOR FILING RETURN
ADDRESS !
355 E ~imore St Carlisle, PA 17013
SIGNATURE OF PREPARE O. llib~~~RESENTATIVE
12 -,,----
Yes
No
o
o
o
o
~
~
DATE
'j 'l1
'lee b
DATE
ADDRESS
157 S. Hanover St.
04/27/2006
Carlisle, PA 17013
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%
[72P.S.99116 (a) (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. 99116 (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. 99116(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. 9 9116(1.2) [72 P.S. 9 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. 9 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.
5W4633 1.000
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
REV-1502 EX + (6-98)
ESTATE OF
FILE NUMBER
Clarence Jacobsen
21-05-00702
"
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
105,000.00
Residential Real Estate
421 Dogwood Ct. Carlisle, PA 17013
5W4695 1.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
105,000.00
R EV-1508 EX + (6-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Clarence Jacobsen
FILE NUMBER
21-05-00702
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 DESCRIPTION
1. Checking Account - M&T Bank # 1195689
2. Money Market Account - American Home Bank # 0000110795
3. Certificate of Deposit - American Home Bank # 290001554
(Includes Accrued Interest $ 179.00)
4. Refund from Country Meadows Retirement Community
VALUE AT DATE
OF DEATH
1,051.00
30,790.92
100,179.00
74.85
5W46AD 1.000
TOTAL (Also enter on line 5. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
132,095.77
REV-1509 EX + (6-98)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Clarence Jacobsen
FILE NUMBER
21-05-00702
>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. ,Andrea C Jacobsen
355 E Baltimore St
Carlisle, PA 17013
Daughter
B.
c.
JOINTL Y -OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NJMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR
NUMBER TENANT JOINT JOINTLY-I-ELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 03/2004 Commerce Bank Checking 4,523.15 50.00 2,261.57
Acct# 0536775323
TOTAL (Also enter on line 6, Recapitulation) $ 2,261.57
5W46AE 1.000
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Clarence Jacobsen
FILE NUMBER
21-05-00702
Debts of decedent must be reported on Schedule I.
'<.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
.1.
FUNERAL EXPENSES:
Ewing Borthers Funeral Home
Memorial Service and Reception Expenses
11,601. 84
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
395.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
300.00
7.
Miscellaneous Administrative Expenses
(postage, fax Copying Etc.)
230.10
5W46AG 1.000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
12,526.94
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clarence Jacobsen
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-05-00702
Re,port debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1. '
2.
3.
4.
5.
6.
7.
8.
9.
DESCRIPTION
Liability for Security Deposit Payable
Comcast Cable
Chase Mastercard
West Shore Ambulance
Kilmore Eye Associates
Sprint
Wissota Traders
Bon-Ton Charge Account
AT&T
VALUE AT DATE
OF DEATH
700.00
18.93
162.10
500.50
20.00
~7.99
180.90
17.96
66.47
5W46AH 1.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,764.85
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clarence Jacobsen
NUM~J::R
I
1.
2.
3.
4.
5.
6.
7.
8.
9.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Andrea C Jacobsen
355 E Baltimore St Carlisle, PA 17013
John Jacobsen
10 Laura Ln Saratoga Springs, NY 12866
Charles Jacobsen
3148 Manor Ave Walnut Creek, CA 94596
Elisabeth Jacobsen
317 A Second Ave New York, NY 10003
Johanna Jacobsen
3512 Knight Rd Whites Creek, TN 37189
Courtney Jacobsen
9527 Evanston Ave North Seattle, WA 98103
Paul Jacobsen-Rains
355 E Baltimore St Carlisle, PA 17013
Emily Jacobsen-Rains
355 E Baltimore St Carlisle, PA 17013
Jessi Jacobsen
3148 Manor Ave Walnut Creek, CA 94596
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-05-00702
AMOUNT OR SHARE
OF ESTATE
Daughter 25% Remainder
Son 20% Remainder
Son 20% Remainder
Daughter 20% Remainder
Granddaughter 3% Remainder
Granddaughter 3% Remainder
Grandson 3% Remainder
Grandaughter 3% Remainder
Grandchild 3% Remainder
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
5W46A11.000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
L...UIV'IVIUI\JVVtAL I H Ur t-'tNN::;YLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
~
JACOBSEN ANDREA C
,355 EAST BALTIMORE ST
CARLISLE, PA 17013
___n___ fold
ESTATE INFORMATION: SSN: 051-18-7056
FILE NUMBER: 2105-0702
DECEDENT NAME: JACOBSEN CLARENCE
DATE OF PAYMENT: 10/25/2005
)STMARK DATE: 10/25/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/28/2005
NO. CD 005932
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $9A05.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: EST OF CLARENCE JACOBSEN
CHECK#1005
SEAL
INITIALS: CM
RECEIVED BY:
TAXPAYER
$9A05.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2005-00702 PA No. 21-05-0702
Es ta te Of: CLARENCE JA COBSEN
(First, Middle, Last)
Late Of:
HAMPDEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 051-18-7056
WHEREAS, on the 5th day of August 2005 an instrument dated
March 26th 2002 was admitted to probate as the last will of
CLARENCE JA COBSEN
(First. Middle, Last)
la te of HAMPDEN TOWNSHIP, CUMBERLAND County,
who died on the 28th day of July 2005 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills ~n and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
ANDREA C JACOBSEN
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 5th day of August 2005.
( :Jlhn AA ~04/W... J,~,bl)" j I-~
Register of Wills
~ C} -Ol~
Deputy
**NOTE** ALL NAMES ABOVE APPEAR. (FIRST, MIDDLE, LAST)
,<-,
J,&lSTW[J .1,,1 &lJ-ltj) 'TEST&Vvt ENT
O:F
:-:
('J
C.LaXw'/CEJ'aC01)SD--I
I, CLARENCE JACOBSEN, of Carlisle, Cumberland County, PenrisylvanHJ:,
___, --I .
declare this instrument to be my Last Will and Testament, in manner and formfollowing;::-
C"J
FIRST:
I hereby expressly revoke all Wills and Codicils heretofore made by
me.
SECOND: I hereby direct my Executrix to pay all my funeral expenses and
taxes, as soon as practicable after my death.
~:";--l
-:f,,:~
.
C../l
'--,c')
--:-, --'-\
- ---;--,
----)
,-,1
THIRD:
I request a simple, inauspicious funeral in a manner I have made
known to the Executrix. I direct that my remains be interred as closely as possible to
those of my beloved wife.
FOURTH: From time to time, I have provided a certain financial assistance to
various beneficiaries of this my Last Will and Testament. None of that financial
assistance shall be considered an obligation by the donee to my estate or as an advance,
but rather as a gift made during my lifetime, unless an obligation of payment has been
evidenced by a Note or Mortgage.
FIFTH: I hereby give and bequeath all my personal property to my children,
CHARLES J. JACOBSEN of Walnut Creek, California, JOHN J. JACOBSEN of
Saratoga Springs, New York; ANDREA C. JACOBSEN of Carlisle, Pennsylvania and
ELISABETH JACOBSEN of New York City, New York, as they can agree or, if they
v..
cannot agree, as the Executrix shall determine. All items of personal property not taken
by one of the beneficiaries herein shall become a part of my residuary estate. All the rest,
residue and remainder of my estate I hereby give, bequeath and devise to the following
beneficiaries and in the following proportions:
CHARLES J. JACOBSEN of Walnut Creek, California, or, if he does not survive
me to his spouse: twenty percent (20%) of my residuary estate;
JOHN J. JACOBSEN of Saratoga Springs, New York, or, if he does not survive
me to his spouse: twenty percent (20%) of my residuary estate;
ANDREA C. JACOBSEN of Carlisle, Pennsylvania, or, if she does not survive me
to her spouse: twenty percent (20%) of my residuary estate;
ELISABETH JACOBSEN of New York City, New York, or, if she does not survive
me to her partner: twenty percent (20%) of my residuary estate;
My Executrix: fivepercent (5%) of my residuary estate; and
My surviving grandchildren: fifteen percent (15%) of my residuary estate, in equal
shares.
I hereby direct that the gifts as set in this, the residuary clause of my Last Will and
Testament, are unrestricted. Nevertheless, I have no objection to any of the beneficiaries
of this my Last Will and Testament donating any portion of his/her share which he/she
may desire as a charitable gift in the memory of EMMA E. JACOBSEN.
SIXTH: I hereby nominate, constitute and appoint ANDREA C. JACOBSEN
to be the Executrix of this my Last Will and Testament. In the event ANDREA C.
JACOBSEN cannot or will not act as Executrix for any reason, I then nominate, constitute
~, and appoint JOHN J. JACOBSEN as Executor. No personal representative shall be
required to file bond in this or any other jurisdiction.
2--6
IN WITNESS WHEREOF, I hereunto set my hand and seal this
of
ft~
day
,2002.
C!vt~, J~~
Ii
ClarEfhce Jacobsen
3
Wi(~_~
J(~'0r7~~
Witness
/1
// d....--.-, /i
" ~ ' .
,...j, I " ! / )/)
'/ I' '( I I
" /<',' \ ',. I I I
[,e /Ltrl !) I f l/uJl~
Notary Pu~l .. (!
iJ
~, COMMONWEALTH OF PENNSYLVANIA
55.
COUNTY OF CUMBERLAND
We, Carol J. Lindsay and Sharon Simpson
the witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testator, CLARNECE JACOBSEN, sign and execute the instrument as his Last Will; that
he signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator signed the Will
as witnesses; and that to the best of our knowledge the Testator was at that time 18 or
more years of age, of sound mind and under no constraint or undue influence,
Sworn or affirmed to and subscribed to before me by Carol J. Lindsay
and Sharon Simpson witnesses this 26th day of
March
,2002.
/' \~
I' "
rJ& ":.,
NCffAf1IAL SEAL
RE~EE l, MUFl~AY, Notary Publle
Carlisle Bore, Cumberland Co,. PA
My Commission Expires December 13,2005
'- COMMONWEALTH OF PENNSYLVANIA
55.
COUNTY OF CUMBERLAND
\, CLARENCE JACOBSEN, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do her13by
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.
Sworn or affirmed to and acknowledged before me, by CLARENCE JACOBSEN,
Testator, this '1 G day of 911-tt~ ,2002.
() v;.? I j?
~\.~ jxr~~
If
Clarence Jacobsen, Testator
Notary pub+rc
i 1
iJ
NOTARIAL SEAL
RENEE l. MURRAY, Notary Public
Carlisle Bora, Cumberland Co., PA
My Commission Expires December 13, 2005
4
Ray "Buz" Wolfe, CRS
Broker/Partner
WOLFE &
SHEARER
REALTORS
William L. Shearer, Jr., CRS
Broker/Partner
-
-
-..
)
33 South Pitt Street
Carlisle, PA 17013
717.243.1551
800.377.3027
fax 717.243.0472
www.wolfeshearer.com
"
RESIDENTIAL
COMMERCIAL
APPRAISALS
INDUSTRIAL
CONSULTING
INVESTMENTS
August 4, 2005
Andrea C. Jacobsen
355 East Baltimore Street
Carlisle, PA 17013
Re: Clarence Jacobsen Property
421 Dogwood Court, Willow Crossing
South Middleton Township
Dear Andrea -
At your request, I have personally inspected the above referenced property for the purpose of
providing you with an opinion of a present day fair market value range. Please be advised that this is not a
formal appraisal, but rather a market anaylsis being provided per your request.
Based upon a physical inspection of the property, coupled with a review of information obtained
from the Cumberland County Assessors Office and a review of comparable sales which have occurred in
the Willow Crossing subdivision, I believe that the property would have a present day fair market value in a
range of$105,000 to $115,000.
Current market conditions are extremely favorable and the attached list, obtained from Central
Pennsylvania Multiple Listing Services, illustrates good activity within the subdivision of the subject
property. Since this property is tenant occupied, it would be reasonable to expect a sale at the lower end of
the value range with a tenant in place. The ability to sell the property to an owner occupant, where entry
level buyer activity is extremely heavy, would likely yield a price at the higher end of the value range.
Please let me know, Andrea, ifI can be of additional assistance. As always, it is my pleasure to
work with you.
Q:-
Ray L. Wolfe, Jr.
Broker/Partner
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B060 1
HARRISBURG, PA 17128-0601
KtV. IlbL t)\III-~bJ
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
JACOBSEN ANDREA C
355 EAST BALTIMORE ST
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 051.18.7056
FILE NUMBER: 2105-0702
DECEDENT NAME: JACOBSEN CLARENCE
DATE OF PAYMENT: 04/28/2006
POSTMARK DATE: 04/28/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 07/28/2005
NO. CD 006620
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $227.95
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$227.95
REMARKS:
CHECK# 1021
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS