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OC1968-0365 - ESTATE OF JACOBS
Testate Form/ PETITION SUR AUDIT IN THE ORPHANS' COURT OF WASHINGTON COUNTY Estate of ................ C.lYDE .. t! ..... JACQ.BS"" _________________________ _ ~ 3-6~'-36'5 No ..... ---·······--·-···-················------------------··········A. A. Fiduciary .............. ~d.og __ M ..... J9.c.o.b.s ........................ . ............................. ~~~f~t~!~---·············--·-----·······----· Deceased Date of Date of Decedent's deat'h ........ febr.v.o.ry. .. 5+ . .19..6fL .......................... Grant of Lettters ...... M~u.ch.Z, . .l9.68 .................................. . This is the ................................. Eir.st .. and.flnaL ................ account filed in this estate If there have been former accounts filed in this estate, list file 'number or number and term ................ ~~~~----------- Election to take Date Election Place of; Under or Against will. (cross out one) Filed .................................. Record ····------······------------·· Name of surviving spouse ............................ -----~-~-':l.<:J .. ~-~--~C?.~~~~------··········------·-------··--····························------···---········· List issue, where material: Not applicable Did decedent marry after execution of will? (indicate) Yes. No. Any children born after execution of will? (indicate) Yes. No. If answer yes, name them .............................. :---··········------------·-·····--··········--······--······--··-·----···-------·--------·---_____ _ Legatees Relationship Interest Fiduciary, if deceased or not sui juris Edna M. Jacobs Wife Entire List, if exceptions to above: Adeemed: Revoked: Lapsed: Abated: Give Cause: None If partial intestacy, give facts: Not applicable Notice to interested parties. Have all parties, having either vested or contingent interests and all crediors entitled to notice (Court Rule No. 9 paragraph C: Section 6: Subdivision c) received written notice of the filing of the account and of call of audit? Yes. No. If any exception give cause: ................ NQn~---·················· File copy of Notice Personal notice and date of mailing ........................................................................................................... , ... , ....... , .. ,., ..... , ... , ........ ,, .. ., .. . Is estate subject to the filing of a Federal Estate Tax Return?. ____________________ No_ _____________ , ___ , ___ , ________________________________ ,: ___ , Actual payment made on Pennsylvania Transfer Inheritance Tax. Amount $ .... .87.2 •. 49. ... ---------------------------------------· If the Will makes any portion of estate subject to a life-estate, give name and birth date of life tenant _____________________ _ Not appHcable ---------------------------------------------------------------------------------------------------------------------------------------·-------------------------------------------------· Give Names and addresses of all unpaid creditors who are legally entitled to notice, together with the amounts of such claims; state whether they are admitted to be correct; and whether the claim is denied. None Give reference to such parts of the will as require interpretation by the Court; a reference to all questions re- quiring adjudication, and a statement of any other facts deemed necessary for the preparation of the adjudication: None Balance for distribution per account, Itemize any additional debits not shown by account: $.J:4.,.522...5_Q ________________ _ Total additional debits (Add) $ _____ None -------------------·--·-------- Itemize any additional credits not shown by account: Total additional credits (Subtract) $ None -------------------------·------···· Balance for distribution $ . .l:4,.522 ... 50 ________________ _ If balance for distribution is not in cash, list each item held in kind, giving appraised Value (or distribution Value); ·' "-· .... Balance for distribution consist of cash. L..~. . ~~-~-~-------~-... ~ If F 'I E t' I · d b P t't' · I f R d· in the First & Final Ac,..."'"nt f'l d am1 y xemp 1on c a1me y e 1 1on, g1ve pace o ecor ·············································"""'"' .. l e .................... . If Family Exemption is claimed at audit, give name, relationship and basis for Claim: .......... ::::::-::-::-........................... . List any advancement or distribution on account that has been made, and nature and amount of same: None Suggested distribution of balance shown, both as to principal and income, attaching signed and itemized elections to take in kind if balance is not in cosh: residuary shares being stated in proportions: . Distribution to be made entirely to wife, Edna M. Jacobs. COUNTY OF WASHINGTON, SS: COMMONWEALTH OF PENNSYLVANIA The above named Fiduciary or representative thereof, being duly ...................... sworn ....... doth depose and say that the facts set forth in the foregoing petition are true And your petitioner will ever pray, etc. to the best oL ............. her ............ knowledge and belief. ---··············-qw.arn ....... ~----.... and subscribed be:~e me this ................ day of..... ~9 ....... . Signatu'e of Offic2/ ... 2/~ .. l?'.f/&/:~ ........ ,4~Jta~---·········· Title of Officer ............................................................... . Office expires ...................... · ........................................... . EVELYN, C. TELE~I:C. ~·otary Public ~·•••• ••••• ••••• •• •• ••• ••• •••• .. ··~ ·~ ~·· ••• ~' T '!'"'' "'" ""'"""'"' "'!''!' !''!'t'" "''!'"'"' ••• '"'""'~!"' ••• ••• '""'"""'"' CANONfBUkG. 1'··'-· . ~: " :o ,. · My Commissa:,n €APiiCS ;,::;i. lG,"l969 -~ # (J3-b$-36~ No ........................................................... A.A. ···~ Estate of CLYDE H. JACOBS ··------·-----------------·----·--------------------·---·- Deceased Fiduciary ............ EdmLM •.. Jg~Qbs.,. ................ . Executrix PETITION SUR AUDIT FROM WHERE DECEDENT LEFT A WILL Counsel of Fiduciary will submit herewith the following/ in conformity with Court Rules adopted effective December 31 1951 1 being rule No. 9: paragraph b-e; and divisions thereof: shown on pages 23-24. 1. Written praecipes of all Counsel in the case. 2. Copy of order appointing Guardian ad litem1 if pertinent. 3. Copy of Order appointing Trustee ad litem1 if pertinent. 4. Proof of service of above. 5. Letters Testamentary or Administration C. T. A or an attest copy of Will. 6. Copy of inventory and appraisement. 7. Proof of advertisement of grant of letters if not filed with account. 8. Certificate of liens in case any of the funds for distribution are from judicial sale of real estate. 9. Signed and itemized elections if any distribution in kind. 10. Copy of Federal Estate Tax return if es- tate is subject thereto. (\.[yvr ! ~--;.;;:;;;,;;; -.~::::\:t:U.~ ..... •• 1 .~· D -· l I I . L I 1 __ _ r~ .; r~ -:s ~~ ~J l"''' l11 4 : 1 -~ R:.··:;S!:"I L 1 li'.r.:~lQ HCCIS ru; C~ \:ILLS ---------------- f"l v.--· •......... -- 11 I iJ I, II H i LAST WILL AND TESTAMENT I, CLYDE H. JACOBS'· of the Borough of Canonsburg, Wash- ington county, Pennsylvania, being of sound mind, memory and un- lderstanding, do hereby make, publish and declare this to be my '!Last Will and Testament, hereby revoking and making void all form Wills or Codicils by me at any time heretofore made. FIRST: I direct and order that all my just debts and funeral expenses shall by my Executrix hereinafter named, be paid out of my estate as soon after my decease as shall by her be convenient. SECOND: I give, devise and bequeath all of my property, real and personal, wherever situated, and whether acquired before , or after the execution of this Will, to my wife, EDNA M. JACOBS, lin fee simple, as her own absolutely; provided, however, that if jmy said wife, EDNA M. JACOBS, fails to survive me or perishes in ja ~ommon disaster with me, then in either event, I give, devise and bequeath all of my property, real and personal, to my children ELIZABETH ANNE RIGGLE, HUGH ALEXANDER JACOBS and DAVID COOPER I JACOBS, equally, share and share alike. I I THIRD: I hereby name my wife, EDNA M. JACOBS, as Execu• !trix of this Will, and if she should die, resign, be disqualified, ll 'i 11 or unable or unwilling to act as such then I nominate my sons, li ljHUGH ALEXANDER JACOBS and DAVID COOPER JACOBS, to be co-executors .. ;I of this Will, in her place and stead. l IN WITNESS WHEREOF, I have set my hand and seal this 1 ' ;t:t: day of December, 1967. -~-' !! I I I I [i Signed, sealed, published and declared by Clyde H. Jacod I the above named Testator. as and for his Last Will and Testament, ! I . , I' I; ' " in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses this ~day of December, 1967. Certified to be a true and correct copy of original filed in Register of Wills office Washington County, Po . 1 :::0 P:-1 c-.C: c..~(..") -f> r ·.::! --,- ~'-. .... r l t .: n . ' (.) w .. --- CJ ~ffibuuit ®f 1fxrrutnr ®r .Abmiuistrutnr Sttatr nf Jrnnayluania, ~ au: C11nuuty nf Bau~ingtnn \ Personally before me, the undersigned authority, a ................ N.2.t9X.Y.. .. P.~.~.JJ.g;:: ............................... in and for said County and State, appeared ............................ ~9.!J.Q .. M..: ... J.9.~.9.~.L .................................................................. who, being duly sworn according· to law, deposes and says that she is the executor ooxa~iorxof the estate of C l.yde. . .l:i ..... Jacabs., ...................................................................................... deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of ........... ~.!.Y.~~ ... t!.: .. J9.9.2.~.L ...................... , deceased, except real estate outside the Commonwealth of Pennsylvania; that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death, based upon a just appraisement of each item made by the above named Executor A;Q;mqM~. day a~=~=-a ... :~b·:~~.:~-~.:~:~hi~.fl. .. -... l .~~;···· ···········-···-·· '··············-····- _EVELYN, C. TElESKO·, .. ~r:··, ··ubrc .... {!..¥1£~ ................ . CANONSBURG, WASHINGTor; co .• PA.. ADDITIONAL INSTRUCTIONS My Commission1e.xpirA<nMlllivt%to.mf)!Jnust be filed within three months after appointment of personal representative. 2. A supple~ental inventory must be filed within thirty days of discovery of additional assets. 3. 1 Original and 2 Copies and 2 RCRI-34, Under $10,000; 1 Original and 2 Copies and 2 RCRI-33, Over $10,000, including Copy of Will; 1 Original and 3 Copies and 2 RCRI-33, Over $50,000, in- cluding Copy of Will and copy of Federal Estate Tax Return. REFERENCE FOR ADDITIONAL COPY Act of 1947 P. L. 513 Sec. 5.2, 72 P. S. 4844.2 lluurutnrg au!l 1\pprai.armrut of the goods and chattels, rights and credits which were of ....... ~.!.Y.~.«:: ... t!.: ... ).c:!.~.~-~.~ .................................................... Jate of .. S9.~.?..~:.~.~.~-~.! ..................................................................... . Washington County, Pa., taken and made in conformity with the above affidavit. PERSONALTY: Proceeds of life insurance policy of Continental: National American Group REALTY: None DOLLARS CENTS 20,000 00 20,000.00 (:; 3 -0Z-3fo s- :rr.:S 3 f \ Inventory and Appraisement IN THE EST ATE OF ............................ ~.~.Y.P..~ ... tL ... .J.~.~.Q.~~ ....................... ~ Filed .......... .Z.f..:::: .. d.£. .. 5. ..... : .. ···· .. ····, ;?.:?_ :7-:.Jj L. n --.,-, ~ ·._:. .-I ("?~ -.:: ~ :-:>1 r-:: ro Ul I ' ' ' < ' l.,.J ,., ... ,. ;;.-: (...) ..... ~ -· .... .,_. p.j z::,. M. E. KUSTURISS ATTORNEY AT LAW 12 N. JEFFERSON AVE. CANONSBURG, PA.. .... 9 --r ,---;o~ l i ~ ;CJ 19 68 ........... . l j_ 1: i) •.. ~ "J [ . -. 1 ., f' 1 11 • 1 .1 .,_,,,...,.'!, .J ... ..J -~. /j. • ,r,,i' ~USSELL I iA;<t;:o f.Eli!0iD\ o;;-\":ILLS I ~ ~ ~ ~ STATE OF PENNSLYVANIA, } WASHINGTON COUNTY, SS: The within named Accountant being duly sworn according to law, depose and say that the above account as stated is true and correct as ............. she ___________________________ .. verily believe. . . ;4- Sworn and su'bscnbed before me th1s ------------------------ ElYN, C. TElESKO, Notary Public CANONSBURG. WASHING10f' CO., PA .. My Commission expires Mar. 10, 1969 Washington County, ss: ' ..... ' 0 I ~ J ~ <:.> <:.> < ·-: ... , I ..... , :::>i ~ ui Q)i ~ I'« en! Xi 0 wj co: ' 0! "" ~ en: E-< Ui co: < Ol E-< ~! rJl -,! U: I i ~ -: C,j :i! Oi ~! c; -,: •-: '-.3! wi LL.j i! Oi -ci ~, >-i Ci Oj ~; ...Ji ui ~: Zi V>: ... , Oi ·-: ci LL.: w! z -~lh~-'------- I do certify that I have given legal notice to all persons concerned of the filing of the within account in the manner pre- scribed by Statute and Rule JI Court,}}~ e"jenced by proofs thereof filed to No. . ... /.tf ... ~-g .. /z..if. __________ , Witness my hand and official seal this .... ~.? _________________ _ day of.Jf~---------------------------------------19.4_(_ -------~-Y.?f~--------- Register of Wills I ~~ ..... .... \ i 0 ::I 8 Q) !o ..c:: .. ..... ~ 0 ..... D l ........ '0 ~ Q) ..... l':l Q) '0 VJ 1"Q Q) , .. ·"I .... iS -~ ,, J,l I p. -· w 1:: :o iK 5 i~ <:.> .-' ' ... 'I <:.> :oo <lS 'l=:l _,-~LS <lS S' l':l d : ;§ .... a .9 Q) : ..... -~ -VJ 0 <lS .b.o "'--..... Q) s Q) I" ~~ .... -~ ;;:: l':l 0 ~ <:.> '0 : l':l : .... < ,-; .B ..... "": . ., . ;, THE FIRST AND FINAL ACCOUNT OF EDNA M. JACOBS, EXECUTRIX OF THE ESTATE OF CLYDE H. JACOBS, Deceased, late of 266 North Central Avenue, Canonsburg, Washington County, Pennsylvania. The Executrix is charged as follows: . Inventory and Appraisement filed August 19, 1968 ......................... $ 20,000.00 ' ·' I T ota I Assets of Estate $ 20,000 00 Total Amount of Credits claimed by Account 5,477.50 Balance due $14,522.50 I , .,. , -·--. ,,(. The Executrix claims the following credits: Date No. Name of Payee Remarks Amount 4 'I 168 1 Dean Maker -Moving services rendered $ 100.00 ' 3/51 68 2 Russell Marino -Letters of Administration 19.50 3 113168 3 Washington County Reports -Legal advertising 12.50 I 3 113168 4 The Da i I y Notes Legal advertising 12.50 I - 3/13168 5 W. Leonard Griffith Funeral Home -Funeral bill 766.00 3/13/68 6 Oak Spring Cemetery -Burial Lot 210.00 3113/68 7 Everlasting Memorial -Headstone 670.00 3/13/68 8 Canonsburg General Hospital -Last illness 482.00 3/13/68 9 Zuver Florist -Flowers 25.00 3/13/68 10 Harold Slone, M.D. -Medical services last illness 20.00 3113/68 11 Mrs. Gilbert -Nursing services last illness 21.00 3113168 12 Rev. Conboy & Skuce -Church services 30.00 8 115/68 13 M. E. Kusturiss -Attorney 1S Fee I, 000.00 8/15 168 14 Edna M. Jacobs -Family exemption 1,.000. 00 8115168 15 Oak Spring Cemetery-Opening and closing grave 90.00 8/15 168 16 Edna M. Jacobs -Executrix commission I, 000.00 8115168 17 Russell Marino-Filing Inventory and Appr. 3.00 8115/68 18 Russell Marino -Filing the Account 16.00 ' ~:-' \;r H."'. IN RE: ESTATE OF CLYDE H. JACOBS, Deceased -' PROOFS OF PUBLICATION z-_ . !, • , ... C::) (_ ) (;_<,) ::::0 C) (. P!:U C) --~c:: -; ( ,, u;?g ' ;-:~-~ -· ....... , . f'J -.... · ... ,~- 8----i ;~~'~ 2!: ~-~--; ;-;;::;:::: 0 r--o !_,.) C/) .. I ·----,--w ---..1 ,, MICHAEL E. KUSTURISS ,, < ) ' \ ATTORNEY AT LAW 12 N • .JEFFERSON AVE. CANONSBURG, PA. L~ ~-.... I • I I ,,~ .... ) : "' I ___ L: t -I •• j''\ ~ "'"'--- I i : . I ) r• -..,. '1-)-r··r il • 1 "Jo ,) -~ • .J ,i, t • .,) r:: :1: ~·j· (1:-.~ r· rt1tl, 1 ~::::~ ) .. ~·h: ._ t. 1, jl,l\ ~ ·,., ~ ,r.""' ;~:;Tl<n c;--\.·J~LS . '" 3.[• 14 r ;,1 r . : ··~~ .· r;· ~-: r : ~ .. --~--~' \ \ Washington County Reports ~HXM~~ Washington, Pennsylvania (PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION) PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16, 1929, P. L. 1784 Sec. 3, paragraphs (3) and (25). CoUNTY OF \V ASHINGTON l STAT!! OF PENNSYLVANIA ( SS. Personally appeared before me, a Notary Public in and for said County and Commonwealth, CHARLES C. KELLER, who, being duly sworn, deposes and says: that he is the Editor of the WASHINGTON COUNTY REPORTS, the official legal periodical for said Washington County, publis'hed weekly having its place of business at Washington, Washington County, Pennsylvania, and is act- ing as its agent in t'his behalf; that the said WASHINGTON COL'NTY REPORTS was established on March 31, 1920, and was designated as the official legal publication for Washington County, Pennsylvania, by order of the several courts of said County, dated November 11, 1920; that the printed notice or adver- tisement attached hereto is a copy of a notice or advertisement, exactly as printed or published, which appeared in the said legal periodical in its regular issues on the following dates: ...... ~~~~.~ ... ?.!.t .... ?..?.t....!.9..9.?. ............................. . April 4, 1968 ~hat the a~fi<mtr.er t!1e-.£Qrl?orati~n in behalf ?f. which he is acting is not int~rested!~l;•mr m the subJect m~~e~~ottce or advertlii'ng,and th.l'},t all of the allegations of · this affidavit as ~Ll:J char~~f t/!r~; Sworn to and su~e-t: .................. ~ ........ Edit~; ... 4J.h.~-;·jay of..~P.;:~·~···························• 196.~ ... . .......... ~ .... (1,~··············· KATHERINE C. YARD, Notary lfj?ffiY Public Washington, Washington Co.,. a. My Commission Expires November 1, 1969 Estate Notices The Register of Wills has granted letters, testamentary or of administration, in the following estates. Notice is hereby given to all persons indebted thereto to make payment without delay and to those hav- ing claims or demands to present t:hem for settlement to the Executors or Admin- istrators or their Attorneys . • • • • • • • • • • • • • • • • • JACOBS, CLYDE H., Dec'd. Late of Canonsburg, Washington County, Penna. Executrix: Edna M. Jacobs, 266 North Central Ave .. Canonsburg, Pa. 15317 Attorneys: M. E. Kusturis~. 12 N. Jefferson Ave., Canonsburg, Pa. 15317 ~ I l THE DAILY NOTES CANONSBURG, PA. PROOF OF PUBLICATION In compliance with the Newspaper Advertising Act of May 16, 1929, P. L. 1784, Sec. 3. paragraph (3) and (25). State of Pennsylvania } County of Washington ss. Personally appeared before me, a Notary Public in and for said county and state, ____________ k!~P-~_! _____ ~_! ____ p~y _______________________ , who being duly sworn, deposes and says: that ______ §__h~----------is the Q_QQ_~~~-~.P~ the Notes Publishing & Printing Co., a Penn- -sylvania corporation, and its agent in this behalf: that the said company is the pub- lisher of The Daily Notes, published daily except Saturday and Sunday, having its place of business at Canonsburg, Washington County, Pennsylvania; that rthe said Daily Notes was established August 1, 1875; that the printed notice or advertisement, attached hereto is a copy of a notice or advertisement, exactly as printed or published, which appeared in the said newspaper in its regular issues on the follow).ng dates: · March 14 March 21, March 28, 196~ -------------------------------------------'-----------------------------------------------.-----------------------------------------······························· .. ··· that the affiant or the corporation in behalf of which ----------~-~-e-.. _ is acting is not inter- ested in the subject matter of said notice or advertising and that all of the allegations of this affidavit as to tthe time, place and character ~e publication are true. --------.-----------------------------------------------------------~--~~ Sworn to and subscribed before me this 8 lBloo~epep 14th March 6 '-~--~-:-~-{Z;_u----~. 2. ~~--~r;;};,_,;~-~~S?*.~Y19~u~ A L • • .(7~:~~ ' - ' .'t>;llh',..' .. II' j : .. y Coml .o~•Cd E~~·.-·~ '\1arch .. w, i :.Ji • r-EXECUTRIX NOTICE, . ~ Estate· of Clyde H. Jacobs deceas-. ed, late of Canonsburg, Washing- \ ton County, Penna. LETTERS TeRtam0ntary upon the above e~tate having hf'Pll • ·.!.ra·ntt>f1 to the undC'J~:--ig·neLl, notice; I is lwreb>· given to tho"c indehtcd tllf'reto to make imnwdiate pa:c- ,n1ent, and to those ha\·ing clailn~ ! or dPnHlnds to pre~cut then1 for ~settlement_ '[i;(lna :\(: :rae'ohs, I•Jxeeutrix 2!Hi :\'orth Centr:,tl ,\Yenue Canon~lntrg, l'a.~ :Hi;H7 <· • ___ , J ' ~l. 1·: .. Ku"1 uris" Attonwv 12 Xorth .Jeff0r~on .\ Yen~ie C'anon::;burg, 1-'a. l :>:J 17 ' 1 Mar"h H, f_1'-, _2_8,~1-!lf~:~~---===d I_ ___ / ·• 1 1Jn tqr ®rpqans' O!nurt of musqiugtott O!ounty In the matter of the Audit of Account in ) ~~state or .... CLYDE .H. .... JAC.O.BS ........................... .. .:\0. ) ' TO THE A1'DI'TI:-..'G JUDGE: ;;;;-_.~....._-=- I~ntcr. ... ·• .. --·--------- ' -------~---------··r········ .. ····· ~LB.-Counsel shall, hy sep:~rate paper, present a concise Rtatement of each l'laim, with supporting calculation of any interest claimed. Obje(:tions to an ·a<:count as filed, shall be concisely stated in a . separate paper. Counsel suggesting proper distribution shall file a separate concise statement in that regard. + / 19 .. 68 , A.A. ·-.. --· ....... -· ....... ~ 68 ., 19 ...... ~ :;.1 ... - --~ = : --~ .,;o.._..F-"7i ~ No. 1968 A.A. IN RE: Audit of Account in Estate of CLYDE H. JACOBS AUDIT PRAECIPE FOR APPEARANCE FOR EDNA M. JACOBS, Executrix s-1-:· .. .'' .. , c::: :j . : . -, ,_ ~ -·. ' (.' v 1-I.'! ( T ( ;;;. • • ~~ . . c ' '· l,--I . ' ·-' r • I I . . M. t:. KUSTURISS ATTORN!:'! .\T LAW 12 N. JEH :..<::.01-t AVE.. CANONSBUR6, PAt ..,. 1Ju tlJr .. OOrpqans' Q1nurt nf6~~~]!ingtnn <ltnunty ESTATE OF No _______________ Of 19 ____________ , A.A. ____________________ g_~_y<?:~--:rr~ __ _;[~~~-t?.~-~----------------- Deceased. In the matter of the .. X~t~t __ ?.-?._<?: __ :f._~~§._L ___ _ Edna M. Jacobs, Account of ___________________________________________________________ _ Executrix ADJUDICATION AND DECREE And noW--------~=~-~-~-~=~--------------------------/;1. __ , 19~~----, this matter came on for hearing, audit and distribution at this session and testimony taken; and thereupon, upon due consideration thereof the balance for distribution in •the hands of the Accountant is determined to be $.14_,._5_22 .... 5_0 _____________________________________ and the account is accordingly confirmed; and it is orde,red, adjudged and decreed that the said balance be paid out by the Accountant in accordance with the schedule of distribution hereto attached and made a part hereof, unless exceptions hereto be filed sec. reg. or an appeal be taken herefrom sec. leg. Balance per account---------------------------------------------------------------------------------· Balance·------------------------------------------------------------------------------------------------------ Deduct Clerk's Costs & Receipts _________________________________________________________________ _ M. E. Kus turiss AttorneY-----------------------------------------------------------------------------------------------------· Edna M. Jacobs, widow, residue, / 0 ...... 0 ~ f'> ~ r;r n :J z n ..-: -+ 0 -+ 9 t:Y 0 c :T ("- ..... (1) ........ (1) :J :n = 0 -+ 3 \ <>;;,? ~-, t:Y ...... 0 0 t"' ..... ...... ~ ..... [.... ; ~ (1) ~ .... ...... 0 0 ...... ..... ...... ..... :T (1) tt~ - ' ...... .. -. -' Q II> ! ,.'"'I b --·· "--t !• = (.. , ..... L' ~ ;> t-•J = • ....J r_:: t:Y :-o s ~ ~ ~ ~ ~ ~ ~ ~ \ - IN THE ORPHANS' COURT OF WASHINGTON COUNTY, PENNSYLVANIA IN RE: ESTATE OF CLYDE H. JACOBS, Deceased ) In the matter of the First and Final Account ( of EDNA M. JACOBS, EXECUTRIX ) ( ) NO. 63-68.;.365 PAY TRANSCRIPT AND NOW, this day of December, 1968, the undersigned hereby acknowledge to have received from Edna M. Jacobs, Executrix of the above captioned Estate, the sum of money set opposite their respect names, being the amount awarded them at the audit of the above Estate, and I do further waive the right to file exceptions as to the adjudication and the right of appeal from the adjudication, and agree that the Executors may forthwith make distribution in accordance with the terms of the adjudication. •. ·,., ,,.. __ . .. ,.., ··-~--:.-;, -j Form RCC-33 . ' ' --' COMMONWEALTH OF PENNSYtVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS / RESIDENT DECEDENT COUNTY OF --Wa-shi-ngton·-··-············· ....... , ...... ,, ................ . IMPORTANT: This return must be complete.d in detail and filed in duplicate, with will attached, with the Register of Wills of the County where decedent resided; Return is due within one year after date of death, unless an extension is granted by the Secretary of Revenue, (Section 703 of the Inheritll,nce __ an!f Est;ate Tax A,ct of 1961.) Late of IN THE MATTER OF THE ESTATE OF } AFFiDAVIT OF ................... C.~.Y..P..~ .. _.tL ..... JA.~-Q~S..,., .. ----·-·-...... ,, ....... ,., ...... , .. _................ EXECUTOR (State full name of decedent) ....... , .... _ .......... , .......... --------------·----· __ .. ..W.<:J.~hi.JJgtqn_ ............. , ...... , ..... county NbXU®i~~X ................................................................................................................................................ Executor of the estate of the above-named decedent being duly sworn, depose S and sayS Decedent -died .. ,, .. ____ ... .f.e.brvqry._ (Month) (Jiay) ,., .. , 19_ .. ,9.6_ ,.,.,,J testate leaving a last will, copy of which is hereto attached. } (Y 1:11r) l XA¢)4)1(1')6~ Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. M . E. KYstvr:Jss, ___ Attomeyqt ~qw, .J,.4. .. _N9.rth )E:lffE!TSC?rl AYE!ri':JE!, Canor1sburg 1 Pennsyly(lnia~. 15317 That as such ... Jgna)y\ ':.)9..~9.-~.L. deponent is familiar with the affairs of said estate and the property con- < t•:xecu tor-~!1(!)(~~)(>}11 stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:- NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT None That the contents of said safe deposit box or boxes are itemized under Schedules ___ of this return, with the exception of the following, for the reasons hereinafter set forth: That Sc.hedule A attached hereto and made part hereof sets forth full v and in' detail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of decedent. That Schedule 8 attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, ',and t~-the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death; all wearing apparel, jewelry, silverware, pic- tures, books, works of art, household furniture, horses, carriages, automobiles, boats, and'any and all other personal chattels of whatsoever kind or nature, left by decedent, together with the fairly estimated market value thereof; all bonds and mortga!!:es held by decedent and of all claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be less than the face value, it sets forth briefly the reasons for such depreciation-as to each item; all moneys-payable to the estate from life insurance policfes carried by decedent; all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent; and all the corporate stocks and dividends due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of dece- dent's death and other investment securities owned by the decedent at the time of death, with the market value thereof at such time. '. In the case of securities of close or family corporations, the values reported are as far as possible substantiated by financial statements of the corporations, showing the assets and liabilities thereof as of the'date of death. The schedule also sets forth the interest of decedent at the time of death in any co-partnership or business, and in support of the value of such interest there is annexed to said schedule, financial statements showing the assets and liabilities of said co-partnership or business. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement) together with a statement setting forth the character of the business, its location, and such other facts pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest therein must be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transf'ers of'property, real or personal, within two years of decedent's death, in contemplation of decedent's death, or intended to tftke effect in possession or enjoyment at or af'ter death, said schedule sets f'orth the nature and value of such property, to whom transferred, the relationship of the transferees to the decedent, the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a co~y of the deed, trust agreement or other instrument creating the trust. TherA is also set forth in said schedule a list of all property, real and personal, with its value, which passes at decedent's death by virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another, with a copy of the instrument creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death, the nature of their res- pective interests, their relationship, if any, to the decedent, together with the ages at the time of decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also contains a statement show~ng which of the beneficiaries named in the decedent's will, if any, died prior to decedent, the dates of their death, their issue, andthe relationship of such issue to the beneficiary. That Schedule E attached hereto and made a part hereof sets forth all property, real and per- sonal, owned by the decedent jointly with another or others, including intangible, standing in the name of the decedent and others, plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty, plus the name, address and relationship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth f'ully and in detail all debts and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts and claims owing anrl unpaid at time of '\ . death; taxes accrued charge.able for period prior to decedent's death (except. those allowed under Section 651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga- tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re- quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that the amount of tax assessed can be reassessed in accordance therewith. That the totals of the appropriate columns in Schedules "A", "B", "C", "E", and "F" as directed therein,. have been carried forward and properly registered in the Summary. Subscribed and sworn to b ore me this ... ./...Cf ................. . .................. . ....................... ~.9..9. ... N.9.r.!.h ... ~.~r.tr.9.LAY..~.D..'::'.~ ............. ~ ............ , . (Street Number) CANONSBURG. WASHII\GTC•,·· CO., PA .. ................. ~9DQ.D.~Q.Y..~.9.1 .... .P.9 .. : .... !.:5..~.!7. ......................................... . My Commission expnes Mar. lC, 1969 (City or Town and State) NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business, that the data and statements required under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. ----------~--------------------------------------------~· RCC-34 (l-6.4j COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLE,CTIONS' TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" -iEAL PROPERTY ------------------------------------~------------------------------------------------r---Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Where property heid as joint tenant or tenancy by entireties, report on Schedule "E". Property ht-ld by the de.cedent as tenant in common with another or others, should .be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located In the Commo!,'lwealth of Pennsylvania should be (1) (2) (3) described by lot and block number, street and street number, together with DEPARTMENT a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION conveyance by which the decedent took title; if a farm state number of a-FOR YEAR OF ESTIMATED CAUTION cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE {Do not write of decedent. Taxes, assessments, accrued interest on mortgages, etc.,are DEATH In this space) to be listed on Schedule "F" and must not be deducted from this schedule. N 0 N E Insert this total opposite "real property", Schedule "A" in the X X X X X "As Reported" column on the last page of this return. I RCC-3p QOMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E", Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and fUrnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank, . . stocks, ·mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed estate of or income from any property held in trust under the will or agreement of another, even though located outside of the State, at the time of death, should be listed in this schedule. Item No. ITEM List and describe fully Proceeds of Life Insurance Pol icy of ( ontinental National American Group, Policy #sRI85874 Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. UNIT VALUE X X ESTIMATED MARKET VALUE 20,000.00 20,000.00 DEPARTMENT VALUATION (Do not write in this space) RCC-3t cmmoN'\'K\LTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX ~~SIDENT DECEDENT SCHEDULE "C" TR..I\.NSFERS (1) Did decedent, within two years of death, make any transfer of any material part O..f.his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) ~0 (2) Did decedent, within two years of death, transfer property from himself to himself and another or others (including a spouse) in joint ownership? (Answer yes or no) No (3) If the answer to (1) or (2) above is in the affirmative state: (a) Age of decedent at time of transfer ------ (b) State of decedent's health at time of making the transfer. (Note 1). (c) Cause of decedent's death. (Note 1). (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or after his death? (Answer yes or no) No (a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no) _______ _ (b) What was the transferee's age at time of decedent's death? _____ __ (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) No (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or no) _____ _ (6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others ______________________________________________ ~------- (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit of care of transferor? (Answer yes or no) No (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? (Answer yes or no) No (9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) ~0 NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION N 0 N E Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. MARKET VALUE (Estimated) DEPT. VALUATION (Dept. Only) Cf)M\It)\'VF\LTH UF 1'ENN~YIXANL\ :~\ \:\~~: 'Flt I~l1FltlTt\NCE T~\S m~~ IlW\'1' l!EC:EDENT SCHEDULE "E" JOINTLY OWNED PROPERTY I\STRrCTIO!\S: This schertule must disclose all property, real and personal, owned by the rtecedent jointly with another or others, including intangibles, standing in the name of the decedent and others. List real estate first, as entireties, or joint tenants, giving brief description, as indicated tmder Schedule "A"~ plus the date and place of record of instrument effecting vestiture, but do not include entireties or out of state real estate value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-awners to the decedent. Description of Property, Date of Acquisition, N~me! Address and Relationship of Co-Owners, and Place ; of Record of Instrument, where Real Estate. ~ Unit I perce~tage I Value Share _j Estate Valuation I I ! I N 0 N E i I i I I I I i I I I I I I I I I I Insert this total opposite "Jointly Owned Property", Schedule ''E" l.n the "As Reported" column on the last page of this return. I I ! I I I I I I I I l I I I I i I I I I L DEPARTllENT VALUATION CAUTION-Do not Write In This Space. Value of Entire Property I I I I I I I I I I Value of Decedent's Interest ( h RCC-37, h2-63) C'Ol\1!\10N\\'EALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT BENEFICIARIES AND ADDRESSES State full names and addresses of all who ave an interest, vested, contingent or other- wise, in estate) Edna M . Jacobs SCHEDULE "D" BENEFICIARIES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF illegitimate children DECEDENT OF BENEFICIARY are involved, set STATE YES IN ESTATE forth this fact.) OR NO BIRTH Wife Yes Entire estate Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE SUMMARY Real Property .................................... (Sch"A")· . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Personal Property .......................... . Transfers ..... Gross Taxable Estate . f-. z :"0 ~ .. ~ :Cil <:1S ::2 . ., (I) V') -~ ;;... ~ lXI :~ 0 Cl CJl .... u• < IX< <( ~ ~ •• 0 ~ lil < lil :X: :X: ~ I: t-< ~ t-< f-4 ..,-: ~ :r: .. , t... 0 h 0 f-4 w z CJl 0 ~ ~ ~ _..._.. 0 ~ 1: u 0 IX< ·.c ~ cc f-4 b f-4 "' < ·~ -'§ ""· ~~ ~ .. m c: '-' 0 :I th ...0 c: If) s:::: ...... 0 ...c: If) c: 0 0 u ~ ...... 0 ..... .C· 0 v :: .... 0 -:-:: ...l u .. .. (Sch. "B") . (Sch. "C") ~ <( r:ll -< C'tS r::r: 1: ~ C'tS ~ ...:: <-;..., "' ~~J 1: ,... 'Z Q::; ~ ~ ...... !-0 r::r: ..c: 0 ..:::: :-:: ~ (I) '"-l ;.. r::r: ,.... 1: 0 E ,... 1: 0 u ( 1 ) (As Reported ) $ NQn~ $ ~~~-~-q~~o~ $.. Non.e .. $ $ $ ... ~9.,.9.99~99 . -I L --0 -~ I t l I' I I -•/ I' I'"> ~J Ml •. -.J 11 . . "' I ~ "'i /ll I r;•·r"'r •• -~>) •. )' !.L :1.~\:':INO fJ.u:v I :.1; CF \.'ILLS "•' . •" - ' I , ' 1 ·' . --) 25 1'\ -,. ..... -..1 ( 2) (As Determined) $ . o(/d 000-oo $ ......... / ..... . $. $. $. $ c?'q 600 ao .• ~ '•n::c-39 (6-67) ,·:or.~MONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT JACOBS, CLYDE H • FILE # 63-68-365 February 5, 1968 SUMMARY FILE # 63-68-365 flEPOHT OF INHERITANCE TAX APPRAISER I. the undersigned # 63 Washington duly appointed Inheritance Tax A.ppraiser in and for the County of , Pennsylvania, do respectfully report that I have appraised property as reported in the foregoing return at the values set forth the last column to the right in Schedules "A" 1 "B", "C" and "E". the real and personal opposite each item in Dated: 09-03-68 02-05-68 REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for Washington County, Pennsylvania, do r-espectfully report that I have allowed deductions in the amounts claimed b;y deponent, except as to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum allowed as a deduction. /) ~ Dated: 09-03-68 f'CL~/~~~ REGISTER OF WILLS INVENTORY VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Joint-Held Property (Schedule E) $ $ $ ---------------- TOTAL GROSS ASSETS LESS Debts and Deductions (SCHEDULE F) CLEA~ VALUE OF ESTATE Valuation of life estates or annuities .......• ESTATE TAX ASSESSMENTS FOR USE OF REGISTER ONLY $ ~ 20,000.00 20,000.00 ·- 5,1...5$. 59:,~ 14.541.50 ·-- ------ COMPUTATION OF TAX Tax on $_________________ ~% ~~---------- Tax on S ·:79-\~~ ~ Tax on !1: 14,%.1.50 ~~%_---..:87:::.L.::2~ • .::t.~L9_ Tax on $ ___ lfl7S $ Exemptions=?========(':') Total Estate _____ _ TOTAL TAX Less tax previously paid BALANCE Less 5% of tax if paid within 3 months after death 3ALANCE OF INHERITANCE TAX DUE Add interest at rate of 6% from to $ ____ _ $ ======~= $ ------ $ ======•= AMOUNT OF ESTATE TAX ASSESSED $ _____ _ Estate tax paid BALANCE DUE Add interest at rate of 6% from to FQH USE OF REGISTER ONLY $ ~----- TOTAL TAX BALANCE PAID ADJUSTMENTS 20,000.CJ:?_ 20,000.09_ 5.458.59 14.541.59_ ======~======~ As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. % ________________ _ $ ______ _ $ ______________ _ $ ______ _ $-~-----$ NOTE: Where subsel}uent adjustments are made to the above computation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation. I Will Administration ~ No. IN THE Year ........... . MATTER OF THE APPRAISEMENT OF THE ESTATE OF C.:LJDE H ~ c1AG9.B.$. Deceased Late of . . CAI\l\.)N$aV!i.G. County of WASHIN:TIOON Commonwealth of Pennsylvania REPORT AND APPRAISAL , ,, I Fonn RCC-2 D&TE ............ ?.~llt.~.J!!!>~L.:l, .... ~.2.~.?.. l ... . i-, " • DEPARTMENT ·oF REVENUE ,. COMMONWEALTH OF PENNSYLVANIA . "' RESIDENT INHERITANCE TA:X APPRAISEMENT COUNTY ....................... W.§l:.~.h..~.~?..l?: ........ . BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA. I 7 I 2 7 63-68-365 FILE NO .................................................................................. . Whereas, ..................................... C..lyd.e ..... H ...... J.a..c.Ob.$. ............................................................ late of ........................ qi:L:r!:9.~.1J.:u..r.g .................................................. . in the County of .................................. W.?.:.~.h.~Y,Jg~9.P ............................................................... Commonwealth of Pennsylvania, having died on the ....... .. .................... 2 .... ~11: ............................................. day of ............. !'.~?~~l. ................................... 19.§.? .... , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ............................. W.~.~.~ .... G.llilP.~.Y. ................................................................ , an appraiser duly appointed according to law, having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement: In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs 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 collateral rate on any such future interest. Unit Appraisement Description of Asset Values Made for Inheritance Tax Purpoaes $ REALTY: NON .. .r!J NON.t!; P.ERSONALTY: As per Schedule 11j11 20,000 00 TRANSFERS: NONE NON~ JT. HELD: NONE NONB Total 20,000 DO form~;vi.:hb~"; !~~h~w~ ~cc:'j!~~~: ~; 0~~~b~ :~~~~~~·~2~?: ···,S'·············;?~z ... ,··s;;;;,, ..... &Z ............. ··::: ...... . ~~6df.:.Add:... r. . -~~.... ... . .. ................... , Penna. (Post Offiee) I I ' ' ~A$H~~QTQ!J County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of C.:l,.YD.~ .. H~ .. .:TAC.Q£.39 .. . Deceased. Late of CAJ:~QlJS BU H.G. . ... . . . ...... .......... .. . .......... . Date of Death, ....... f~p;r.-q~y.5,. :L9.6.S ................ . Appraisement Docket Vol., ............. .3.7 ................................ . Page, .......... .9$::~5 ...................... No ...... 6.3~.68~3.65 .......... . Filed in Register's Office, $~pt..~ .... .3. ......... 196.$ .. Amount of tax due, DEPARTMENT OF REVENUE Received, • Examined and Approved, Wrote abo.ut Appraisement, Appeal j1'om Appraisement, Entered and chi1rged, I ,. Form RC C ·10'-R I DEDUCTIONS ALLOWED IN OFFICE OF TME REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS THE SUM OF ............ $ ;;:;'71{[;/.~rQ OF VVashington couNTY .. £~~~fl' DATE ~VED $] ;~c;:;;~;c?k7~@ G/t ~~-~I)J Register of Wills, Ageot ESTATE OF Cly:de H. Jacobs L.ATE OF Canonsburg, Penns)!:lvania ....-/,""' DATE OF FILING APPRAISEMENT ~0~.3 ' 1968 OAT&: OF DEATH /~d ~,· /YG/ DATE NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCHEIII: 4/1/ :>8 1 Dean Maker Movina services rendered 100 00 _3L5J :t8 2 Russell Marino Letters_o_f A rim in ic:trnt inn 19 .'10 -343 68 3 Wash innton Countv Reoorts Leaal advertisinn 12 50 3/13 68 4 The De~ i I y Notes Legal advertising 12 50 3/13/ 8 5 Vi.. LeQcard Gri.ffith Funeral Home Fu neraJ hi II 71111 !00 3/13/.63 6 Oak Spring Cemetery Burial Lot 210 00 __3LL3/63 7 Everlasting Memorial Headstone 670 00 __3/-L3/6:B 8 CanonsburQ General Hospital Last iII ness 482 00 3/13/6~ 9 Zuver Florist Flowers 25 OD 3/13/6~ 10 Harold Slone, M.D. Medical services last illness 20 (0 3/13/6~ II Mrs. Gi I bert Nursing services last illness 21 ~0 313/6f 12 Rev. Conboy & Skuce Church services 30 ~0 Y-15/6~ 13 M. E. Kusturiss Attorney 1s fee I, 000 00 _8.,Ll5/-6~ lA Frlna M ,,..,..,.,.(..,. Familv exemotion I 000 00 ~6~ 15 Oak Sorinn Cemeterv Ooenina and dosina nrnve 90 no 8/15/6p 16 Edna M. Jacobs Executrix' commission I 000 00 5 458 50 }sa: couNTY OF __ WLY.J.,a~sJhu.'umi!,JgJ.L:to~.~.~n~.~-.. ____ _ COMMONWEALTH OF PENNSYLVANIA I, --------EL.Jd..u[)wa....._MIJU.. . ...._.,£Jld0l.<C.!>!O.!::!.bsiL_ ____________ H£REBY CERTIFY, THAT. TO THE BEaT OF MY KNOWLI!:OGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE srATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES OP" AoMINISTRATio,.· suBMITTED To THE ESTATE oF Clyde H · Jacobs DEcEAsED. As DEDUCTIONs F"OR ---I'E;~~· /lA.4.c~2n......L....I-7J~~~~~Xl./::___cL. s.l ---=<----DAY 01' INHERITANCE TAX PURPOSES. CANONSBURG. WASHINGTOI\ CO., PA •• My Commission expacs Mar. 10, 1969 - I I ' \ ,. '; r-D J .~:I 1!. : ?c.~ --;.:; \\ (• .. \. ~- \ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Form RCC-4-RI-3-66 ~9 COMMONWEALTH OF PENNSYLVANIA RESIDENT DECEDENTS No. 978889 OFFICIAL RECEIPT Transfer Inheritance ·and Estate Tax File No. 63-68 ... 365 Date S0pter.ther 12 19 68 Office REGISTER OF WILLS •. t-1ASHINOTON Pa. UASHINGTON County, ss: Received from Edna M. ,J acohs (Executorn~f'fmof the estate o,Lf ------!CQ;Lt. v~_lln\!lE~· -!!~! a,.....-,.,.J·r -.Att .. ~C~O~D~S~----------------- who died Fe'b. 5 19---Ga, the sum of InNHT Uttlmy;r..ED SEYE~!TY .-1!'10 a:ld 49/100 ... Q.ollars, being TRANSFER INHERITANCE TAX and/or ESTATE TAX due the Commonwealth as follows: Appraisements Made and Filed Real Estate Date Valuation $, ______ _ $. _____ _ Total Personal Property Date Valuation 9-3-68 $ 20,000.00 $, _____ _ Total Total Gross Assets Less Debts and Expenses of Administration Clear Value of Estate Valuation of Life Estates or Annuities $ _____ _ $ 20,000.00 $. 20.000.00 $ 5-4SS.SQ 14_.541 .. 50 $. --- Date 19__ $, _______ _ ________ 19__ _!!~:$============= Estate Tax Assessments Date 19__ $, ______ _ ________ 19__ ~$ ============= NOTE: In accepting the transfer inheritance tax on future estates prior to the death of the life tenant or tenant for years, as evidenced by this receipt, it is understood that the Com-monwealth shall not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the life tenant or tenant for years whenever it appears that such additional tax may be legally due and collectible for any reason whatsoever. ¥000 [p[LO ©£ lf[ 3?-98-5 NOTE: This Triplicate Receipt to be retained by the Register of Wills and filed in numerical sequence for audit purposes. Computation of Tax Tax on $ ------------5% $-------- 10% $------- Tax on $ ----lt--.41=---=s=o----:65?'~Y.VV ·, $ 872,. 4 f) Tax on$ 14 , ;;J · • ~r&!U\! Tax on $ 15% $ ---------- Exemptions * $ =============. Total Estate $ ----------- Total Tax $ 872 .. 49 Less Tax Previously Paid (if any) $ =========== Balance $ ----------------------- Less five per centum of tax if paid within 3 months after date of death $ ============ Amount of Estate Tax Assessed under the Act of May 7, 1927. $ ---------- Add interest at the rate o % from ________________ _ to ----------------$====:===== $ 872.49 Total " As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue under Act of May 28, 1956, P. L. 1757, effective June 1, 1957, as amended by Act No. 381, approved July II, 1957, and Act No. 207, 1961, Section 302. S E A'f~• J" );) /.l ( .~ • fl . 1., .. -.,.,.,.-c:;_..-._~/2-·*"·t·>'·t.-c) Register of-Wills MOORE BUSINESS FORMS, INC., ELMIRA, N.Y. FORM RCC-4-RI TRANSFER INHERITANCE and/or ESTATE TAX, RESIDENT DECEDENTS. RECEIPT 37 98 s Docke Page Une: ___ _ CLYDE H .. JACODS Estate OL--____________ _ OFFICE OF REGISTER OF WILLS b'ASRINOTON, ---~~-.~~~~~.---~Pa. ~eptember 12 68 ·Dateo ___________ l9 __ SIGNED AND SEALED AS PROVIDED BY SECTION 1201. ACT APRIL 9. 1929. P. L. 343 AS AMENDED BY ACT MAY 15, 1945. P. L. 528 RUSSBLL tt~niNO Register of Wills 1201 (g), Act of April 9. 1929. P. L. 343. as amended, viz:-"'To receive from Registers of Wills all duplicate re- ceipts for taxes paid to them by executors or adminis- trators and to charge the Registers receiving the money with the amount receipted for. The original of each such receipt shall be signed and sealed by the Register of Wills and transmitted to the executor or administrator, whereupon it shall be a proper voucher in the settlement of the estate. In no event shall the executor or adminis-trator be entitled to a credit in his account by the Register unless the receipt is so signed and sealed by the Register of Wills." Fill in below name and address of person to whom tax receipt is delivered: I ATTY .. M. E. KUSTURISS To ~l~:z~r;"-.-_~J:Ef'l'?'· f!'.m~·.t:~l'l'l., i~1slflio"t-.J.,..._* .....,a:-1'v~n...,·Nt'F.u"T:...s----- 1531'7 L _j