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HomeMy WebLinkAbout11-01-06 (2) . REV .1100 IX . I-I * REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COUNTY CODE COMMONWEAlTH OF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 2110601 HARRISBURG, PA 171211-0601 .... Z w a w u w a DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) JACOBS, MARTHA A. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 06/29/2006 03/09/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I!! :.::CfI) uiii!:':: wIL8 :z:i..J UlLlII IL C ~ 1. Original Return o ~ o o 2. Supplemental Return o o o 4a. Future Interellt Compromise (dete of deeth after 12-12-a2) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12 1- 1 and 1-1-95 o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received OFFICIAL USE ONLY I SOCIAL SECURITY NUMBER 06 00600 YEAR NUMBER 211-22-6693 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w.... !!!:i ~ a IRM NAME (If applicable) 82 JOHNSON, DUFFIE, STEWART & WEIDNER ElEPHONE NUMBER 717/761-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o J: :5 :) .... i: C ld II:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) P. O. BOX 109 LEMOYNE, , PA 17043-0109 (1 ) 295,210.00 (2) None (3) None (4) None (5) 73,948.01 (6) None (7) None (9) (10) 17,849.63 1,053.98 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES OFFICIAL US~LY o c:::::) (~~ ~ ':::rC') ....::: ~;~; f=;::; I .,-; ':0 . cn/" ,--., ~Cj -0 ~ :::0 n'l o (:) ::0 i:.::J IT1 CJ C).C') ---;-\ -'1'1 11 C'") rn . ') ~~?, N .. U1 (8) 369,158.01 (11 ) 18,903.61 350,254.40 (12) (13) (14) 350,254.40 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 16.Amount of Line 14 taxable at lineal rate 350,254.40 .045 (16) 0 x ~ :) IL 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) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15,761.45 15,761.45 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1128 LAUREL AVENUE CITY I STATE PA IZIP 17011 CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 13,500.00 710.53 Total Credits (A + 8 + C) 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1 ) 15,761.45 (2) 14,210.53 (3) 0.00 (4) (5) 1,550.92 (SA) (58) 1,550.92 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.................................................................................. ~ I ~: ~::::~ ~h;e~~~i~~:~s:~~::s~~. .~.~~.I~. ~~~. ~~~.~~~.~.~.~ .~~~~~~~~~~..~.~.i.t.~.~~~~~~: :::: :::::: ::::::::::::::::::: :::::: 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?....................................................................................................................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... 0 ~ 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 examinad this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaretion of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS HAROLD O. JACOBS 524 N. THIRD STREET WORMLEYSBURG, PA 17043 ~'C ADDRESS 3 WHEATLAND DRIVE MECHANICSBURG PA 17050 ADDRESS P. O. BOX 109 LEMOYNE" PA 17043-0109 DATE lo'l'O-~ DATE /iP/Z6(DI. 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) (i)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) (ii)). The statute does not exemot 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. l -\ 1La~t Will anb me~tament OF ~@~~ MARTHA A. JACOBS I, MARTHA A. JACOBS, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my motor vehicle(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my sons, RAY E. JACOBS and HAROLD O. JACOBS to be divided between them in as nearly equal shares as may be practical as they shall agree, and if there be a disagreement' as to any item, such item shall be disposed of as part of my residuary estate. If either of my sons predeceases me, I give and bequeath the same unto my surviving son. }. -. 1 ) ) ". . (~\ ARTICLE III DEVISE OF REAL ESTATE AND BEQUEST I give and devise my real estate known as 530 North Third Street, Borough of Wormleysburg, Cumberland County, Pennsylvania, and the sum of Five Thousand ($5,000.00) Dollars unto my grandson, CHRISTOPHER ALLAN JACOBS, provided he survives me. ARTICLE IV DEVISE OF REAL ESTATE I give and devise my real estate known as 1128 Laurel Avenue and 1130 Laurel Avenue, Lower Allen Township, Camp Hill, Cumberland County, Pennsylvania unto my sons, HAROLD O. JACOBS and RAY E. JACOBS in equal shares if both survive me. If either of my said sons predeceases me, I give and devise said real estate unto my surviving son. If neither of my sons survives me, I direct that this devise of real estate shall lapse. ARTICLE V REST, RESIUDE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, in equal shares unto my sons, HAROLD O. JACOBS and RAY E. JACOBS, or the then-living issue, per stirpes, of either who predeceases me. 2 I J ARTICLE VI UNIFORM TRANSFERS TO MINORS In the event that any beneficiary of my Will shall not have reached the age of twenty-one (21) years at the time for distribution of his or her share, distribution of said share may be made in the discretion of my Personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A 9 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the time such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. ARTICLE VII POWERS OF PERSONAL REPRESENTATIVE My Personal Representative(s) shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. 3 \../F .iJ "- l -- r, r~ \ .1 B. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. C. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. E. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. F. To compromise any claim or controversy. G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax'refunds and the payment of such taxes as my Personal Representative and/or Trustee shall deem appropriate, without obligation to adjust the distributed share of any person thereby affected. ARTICLE VIII I name, constitute and appoint my sons, HAROLD o. JACOBS and RAY E. JACOBS, Co-Executors of this my last Will. If either should fail to qualify or cease to so act, I direct that the other Executor shall carry out the duties of administration of my Estate without the necessity of the 4 , '1 j \, I . ~ t , appointment of another Co-Executor. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 9l!5.. day of ~ ' 2002. ~ ~ ~ ' ~~~ HA A. JA~S (SEAL) Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 5 \, i J i I I~ 'J , I ) , . . ACKNOWLEDGMENT COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND SS We, MARTHA A. JACOBS, and &l1I11t1'111f~t fJ/J;~lkltlw,~~e Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his /her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~~fs~' . ~!J 14r-- Witness Subscribed, sworn to and acknowledged before me by MARTHA A. JACOBS, Testatrix, and t?~ q m~ and ;YJJ~; Ikt 9tee ~ witnesses, this ~ day of iilqf ' 2002 l . l'-lotarlal Seal ! NIna June DavIs, Notary Publi' I Lemoyne Boro, Cumberland CO! _~vGo",mlsSI~.Explres Oct 31. '.tD~ I , ----_.._,,1 . ,J:..,." >c\r1fi:} "1 J r~ J --; ~r;;tt& ~ Notary Pub!" 6 . -\ 1\- '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. FILE NUMBER 21 - 06 - 00600 All real properw 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 wilnng 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Real Estate - 1128 - 1130 Laurel Avenue, Township of Lower Allen, Cumberland County, PA. 146,550.00 (Deed Book - H, Volume 19, Page 254). Assessed Value - Copy of 2006 Real Estate Tax Notice attached. 2 Real Estate - 526 North Third Street, Borough of Wormleysburg, Cumberland County, PA. 80,000.00 (Deed Book E, Volume 22, Page 516) Sale Price - Copy of Settlement Statement attached. 3 Real Estate - 530 Third Street, Borough of Wormleysburg, Cumberland County, 68,660.00 PA. (Deed Book B, Volume 24, Page 932). Assessed value - Copy of 2006 Real Estate Tax Notice attached. TOTAL (Also enter on Line 1, Recapitulation) 295,210.00 TAX. PAYER WEST SHORE SCHOOL DISTRICT LOWER ALLEN TOWNSHIP REAL ESTATE TAX SENT TO THE TAX CLAIM BUREAU 12/31/06 DISCOUNT NET PENALTY ~~~~~~61~9_22~3240799227 1128 LAUREL AVENUE RANA VILLA SPRING TERRACE ,/"-~~-.. ~ ,E CHECKS PAYABLE TO: BONNI= K MI.llER~ TAX COLLECTOR LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE CAMP HILL PA 17011-5938 (717) 915-1515 EXT 1701 MONt TUES & THURS 9 AM - 4 PM CL05EO WED, FRI S HOLIDAYS CLOSED VACATION WEEKS OF AUGUST 7-11 ~ SEPTEMBER 18-22 OfFICE CLOSED DEe 4TH-JAN 3RO 2:006-2007 JULY 01, 2006 TAX NOTICE UNPAID TAXES WIll BE THESE TAXES ARE DUE AND PAYABLE 1::, PAY ABOVE JACOBS MARTHA A 1128 lluREl AVENUE CAMP HIll PA 17011 (0;. I?l-....0., ...!.~\r'.. \\. ~. tl d, '''.- ~'~>'U ~ J OMB NO. 2502-0265 on A B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.DFmHA 3. DcoNV. UNINS. 4.DvA 5. DCONV. INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked -[poe)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Lloyd C. Rowe Estate of Martha A. Jacobs ((II \\ 1310 Potato Valley Road 526 N. 3rd Street \.....r~ <.:::~.~ Harrisburg, PA 17112 Wormleysburg, PA 17043 U G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-1284840 I. SETTLEMENT DATE: 526 N. 3rd Street Wlon, Zulli & Seibert Wormleysburg, PA 17043 September 6, 2006 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 109 Locust Street Harrisburg, PA17101 J. suMMARY OF BUYER'S TRANSA :;TION K.::'fUMDAR-V OF SELLER'S TR) NSACTION 100. r.Rnss AMUlJN 'DLJI'! "'NUM allVC'D. 400 I':!:Dnc:u:!: ' nllJ; Tn J;lJ;1 I J;R. 101. Contract Sales Price 80,000.00 401. Contract Sales Price 80,000.00 102. Personal Property 402. Personal Prooertv 103. Settlement Chames to Buyer (Line 1400) 1,607.25 403. 104. 404. 105. 405. nr:A advance 106. CountvlTWP Taxes 09/07/06 to 12/31/06 126.77 406. CountvlTWP Taxes 09/07/06 to 12/31/06 126.77 107. School Taxes 09/07/06 to 07/01/07 651.30 407. School Taxes 09/07/06 to 07/01/07 651.30 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 82,385.32 420. GROSS AMOUNT DUE TO SELLER 80,778.07 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or eamest money 10,000.00 501. Excess Deooslt (See Instructions) 202. Principal Amount of New Loan(s) 502. Settlement Charces to Seller (Line 1400) 1,701.75 203. Existina loan(s) taken subiect to 503. Existlno loan(s) taken subiect to 204. 504. Payoff of first Mortgage 205. 505. Pavoff of second Mortaaae 206. 506. 207. 507. (Deoosit disb. as oroceedsY 208. 508. 209. 509. Adiustments ror Items unDald Bv ::)eller AiJfuSlmeiifSFor7fems UnDaid Bv Seller 210. CountvlTWP Taxes to 510. CountvITWP Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. ; 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BUYER 10,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,701.75 300. CASH AT SETTLEMENT FROMITO BUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Buyer (Line 120) 82,385.32 601. Gross Amount Due To Seller (Line 420) ! 80,778.07 302. Less Amount Paid BylFor Buyer (Line 220) ( 10,000.00) 602. Less Reductions Due Seller (Line 520) ( 1,701.75 303. CASH ( X FROM) ( TO) BUYER 72 385.32 603. CASH ( X TO) ( FROM) SELLER I 79,076.32 i The undersigned hereby acknow~cei~ed copy of ~~es 1 &2 of this statement & any attachments referred to herein. Buyer. ---- rc. '-' Seller Estate of Marth . acobs ~.... --Rowe (/ /-,..... . " '" BY, '2f? ~ 7- .<../ (9 ~ HUD-l (3-86) RESPA, HB4305.2 Pace 2 0" L SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ ail D/~ PAID FROM PAID FROM Division of Commission (line 700) as Follows: BUYER'S SELLER'S 701.$ to FUNDS AT FUNDS AT 702.$ to SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 800. ITEMS PAVAAI ~ IN CONNECTION WITH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. MortQaae Ins. App. Fee to 807. Assumption Fee to 808. 809. 810. 811. goo. ITEMS ED BY LENDER TO BE PAID IN 901. Interest From to @ $ /day ( days %) 902. Mortaaae Insurance Premium for months to 903. Hazard Insurance Premium for years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance $ per 1002. MortQaae Insurance $ per 1003. CountyfTWP Taxes $ per 1004. School Taxes $ per 1005. Assessments @ $ per 1006. @ $ per 1007, @ $ per 1008. ail $ per 1100. TITLE CHARGES 1101. SetUement or Closing Fee to 1102. Abstract or Title Search . to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Notary Fees to 11 07. Attorney's Fees to (includes above item numbers: ) 1108. Title Insurance to Commonwealth Land Title Insurance Comoanv 738.75 (includes above item numbers: ) 1109. Lender's Coverage $ 1110. Owner's Coverage $ 1111. 1112. 1113. 1200- GOVERNMENT R NG AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 38.50; Mortgage $ ; Releases $ 38.50 1202. City/County Tax/Stamps: Deed 800.00' Mortaaoe 800.00 1203. State Tax/Stamps: Deed 800.00; Mortgage '800.00 1204. 1205. 1300. ADDmONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. SewerfTrash Charges to Borough of Wormleysburg 30.00 85.00 1304. 2006/07 School Taxes to William A. O'Donnell, TC 47191590101 816.75 1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) /""1 ./"""'\ 1 ,607.2 5 1,701.75 By signing page 1 of this statement, the signatories acknCMAedge receipt of a <:orr4llete~:Z ..:~s ~. '/I~~tA. o' 'l!" & Seibert 0 e t Agent ( I 526 N 3RD ST - ROWE I 4 ) -- --~ Est -- stieR E'''' sc traoI. --'0 IS f\~ Ie T- -,- -. - -. --,- .. m_ -- -- - ----------* --i& ---*~-*: * ... -* I JUL Y 01, 2006 WCRMLEYSBURG RGROUGH 2006',2:::,07 *010928 * REAL ESTATE TAX ..*. * * TAX NOTICE UNPAID TAXES WILL Be SENT TO THE TAX CLAIM BUREAU 12/31/06 ACCOUNT # 47191590102 THESE TAXES ARE DUE AND PAYABLE DISCOUNT NET PENALTY 47-; 1 <'/-1590-10 2 530 THIRD STREttff i ~- PAY ABOVE JACOBS MARTHA A 1128 LluREl AVENUE CAMP HIll FA 17011 TAX PAYER ASSMT 68,660 MAKE CHECKS PAYABLE TG: ~IlLIAM A..O'CONNELl PO BeX 200 WGRMlEYSBURG, PA 17U43-0200 (717) 7"3 7~"0974 JULY E AUG'~TUE$ ;:. w,::D[tPM-6PM 5EPT-JAN 15 lUES ONLY 4PM-6PM ~ORMlfYSBURC BORG OFFICE 20 MARKET STREfT, WOR~LEYSBURG ClOS~D JAN 15 TO FEB 15 CLOSED TUESDAY NOY 7 & NOV 21 .,r ,::::::\ ,\\ /7 I; . 1 \"1 L,"/ tJ *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . JACOBS, MARTHAA. FILE NUMBER 21 - 06 - 00600 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Household Goods - Appraised Value 1,011.00 2 1988 Chevrolet Corsica Sedan - Date of death value 575.00 3 Susquehanna Valley Federal Credit Union 12.227.32 Checking Account No. 10833-40 - Date of death balance. 4 Susquehanna Valley Federal Credit Union 3,470.26 Savings Account No. 10833-00 - Date of death balance, plus accrued interest. 5 Susquehanna Valley Frederal Credit Union 56,243.35 Money Market Account No. 10833-35 - Date of death balance, plus accrued interet. 6 West Shore A.L.S. - refunds 157.08 7 Senior Blue - premium refund 264.00 TOTAL (Also enter on Line 5, Recapitulation) 73,948.01 * SCI-EDUl.E H F\.IERAl.. EXPENSES & ADNINISTRATIVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 - 06 - 00600 ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Myers Funeral Home - funeral expenses 8,250.00 2 Rice Memorials - Marker Lettering 125.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attomey's Fees Johnson, Duffie, Stewart & Weidner 7,550.00 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 Register of Wills - Cumberland County 406.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal - Advertising Letters 75.00 Total of Continuation Schedule(s) 1,443.63 TOTAL (Also enter on line 9, Recapitulation) 17,849.63 *' Schedule H Funeral Expenses & Mrinistndive Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. FILE NUMBER 21 - 06 - 00600 2 The Patriot-News - Advertising Letters 123.18 3 Register of Wills - File Inventory and Inheritance Tax Return 30.00 4 Claude Wolfe - Appraisal of household goods. 150.00 5 Recorder of Deeds - 1% Transfer Tax - Sale of 526 N. Third St. 800.00 6 William A. O'Donnell, Tax Collector - School District real estate taxes due at sale of 526 N. Third Street. 165.45 7 Borough of Wormleysburg - SewerlTrash charges - sale of 526 N. Third Street. 85.00 8 William A. O'Donnell, Tax Collector - tax certification - 526 N. Third St. 15.00 9 Reserve for close-out costs 75.00 Page 2 of Schedule H w SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. FILE NUMBER 21 - 06 - 00600 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Verizon - telephone service - decedent's account - 1128-1130 Laurel Ave. 43.60 2 UGI - gas service - decedent's account - 1128-1130 Laurel Ave. '43.71 3 PA American Water Co. - water service - decedent's account -1128-1130 Laurel Ave. 37.40 4 PP&L - electric service - decedent's account - 1128-1130 Laurel Ave. 208.22 5 Lower Allen Township - Sewer/Refuse - decedent's account - 1128-1130 Laurel Ave. 94.05 6 Martin Lally - Lawn Maintenance - decedent's account - 1128-1130 Laurel Ave. .70.00 7 Check that cleared after death - Susquehanna Valley Credit Union - Checking Acct. No. 557.00 10833-40 - Check No. 3014 - Holy Spirit Hospital- $50.00; Check No. 3018 - Home Care- $507.00 - services to decedent. TOTAL (Also enter on Line 10, Recapitulation) 1,~S3.98 .EV-1513 EX+ (1-00) * SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. I FILE NUMBER 21 - 06 - 00600 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not Llat TruatM{a) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Harold O. Jacobs Son One-half - Tangible 524 N. Third Street, Wormleysburg, PA 17043 personalty; One-half real estate - 1128-1130 Laurel Ave.; One-half Residue 2 Ray E. Jacobs Son One-half Tangible 3 Wheatland Dr., Mechanicsburg, PA 17050 personalty; One-half real estate - 1128-1130 Laurel Ave.; One-half residue. See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET .' .. * SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JACOBS, MARTHA A. I FILE NUMBER 21 - 06 - 00600 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not list TNIteItS) I. trAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 3 Christopher Allen Jacobs Grandson Real Estate - 530 N. 92 Beard Road, Enola, PA 17025 Third St., Worm leysburg; $5,000.00 cash bequest. Page 2 of Schedule J .