HomeMy WebLinkAbout03-14-08 (2)
~-
~
15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
J
tJ
Decedent's Last Name
Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Last Name Suffix
MI
~pouse's Social Security Number
,}l<,,,,,
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
<:::)
2. Supplemental Return
c:::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
<::)
-
<::) 4a. Future Interest Compromise (date of
death after 12-12-82)
c::) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C=> 10. Spousal Poverty Credit (date of death c::) 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
8. Total Number of Safe Deposit Boxes
4. Limited Estate
<::::)
c::)
I J
-'J- ,.......1
First line of address ....-.
~
()
')
Second line of address
City or Post Office
State
ZIP Code
c:.
DATE FILEDv':;
Il1ECH/tNICS13U
/
SS?73S'
Correspondent's e-mail address:CeShie../ds3@etJh1etJ$t.II~t
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU OF PERS SPaN IBL FOR FILING RETURN
3?tTE d
110 O~
170S"S"
Side 1
L
15056051047
15056051047
--I
--.J
15056052048
REV-1500 EX
Decedent's Name: .JDHN.$IJAJ) HELeN s.
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5.
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested. . . . . . 7.
8. Total Gross Assets (total Lines 1-7). 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). .. 11
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . 12.
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)
. . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0eL
16. Amount of Line 14 taxable
at lineal rate X.O ~
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
. () 0
15.
5"1J'f/7
I 4
.00
16.
17.
. 0 0
18.
19. TAX DUE. . . . . . .
. . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
Decedent's Social Security Number
I,' I" 3).,;(3
1.
J.S" S 2 2 . () 0
8' 3 S z. I · J.. I
.00
. () 0
I J k' 0 s. ,,2.
7S 393.;' f
J.."Iq 5S'Cf.;J..3
518801.3'1
'314fD1.D'
!J'fIS.Jl(-
.3738t.f.a..O
5"'114/7.1'1-
. 0 ()
S-lf I 4 1 7. I 'f
2.
4.
.of)
~'f 3" 3.77
.00
.00
a4 3~ 3.77
c:::J
15056052048
--.J
REV-1500 EX Ppge 3
Dec~dm\t'A Complete Address:
DECEDENT'S NAME
File Number ).,1 - 07.... 3,8
H r: LEN S ~ JOf/AJS()N
STREET ADDRESS
'10 ~/l/ar /lye.
CITY
New eUI1f ~r/041d
STATE
{J/t
ZIP
/7070
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
~c{
J
3' 3. "17
f)
()
o
Total Credits ( A + B + C )
(2)
o
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
(3) 0
(4) 0
(5) fA'/, 36 3.77
~
(5A) I,. tJ / tf, '16
(5B) !~ 3 J?~"J13
~
Total Interest/Penalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, 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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
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;......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 IZI
c. retain a reversionary interest; or.......................................................................................................................... 0 [ZI
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. IZI 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.
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 three (3) percent [72 P.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 zero (0) percent
[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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 PS. 99116(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.
REV-1502EX + (1-97)
~
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ""l H
...J () NoS f} N,
HELeN S..
FILE NUMBER
;"1- t> 7-38
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
Sole 0 W/le-r~ J,.,;p of tt. II teLttl certa.I' n p j'e.ce. 6r re.a...l e$fa.J~
IMfJr"()/luI IUI'fA a. residenHal c{we,llj~ S;~o.Je a;f 90 {l;p/t~.r
4ve. !Jf.;tAi Cl-tmherlruu/, {L"wu Allen (tA/fl.) C.lkYl-\W/iU1c1
I ,
Chtinty, fJ~J1n~'fJv'(J;nral as 1.5 /VJ-cre klfy aM.d p{,(,rh'(;,uI4r~
dese}ltJ~d In !Iud cerfa/n deed dA.kd J)f:c. Zq, 1 q, (" ..frDI11
Lv !LiS J. ZfMJdDlJ~ Sr. and tiden J. Zt:Ufc:ioY/; h,s w /te, fo
l\1elvir1 j(,. jl)hnson .uuJ He.Je-11 SA Johnson, l?,'s wlk,
wh,'e-h ; & ree.orde-d ~ J>eed Bex;k ~~-J:"-8 u1 fC..e. 6Pr,CL
I- ~ RWJrcler rI 'lJuds ~ tH<<i /Pr eU/J1),erfa.nd ~~,
7k 5tW1 /IItly/n,e. ..Hkll5ht pl?d~~qut:l hlk SDIt/ w/k,;
tJkN 11/1"" sk kcalJtl ;% &t;/~ Mfd ~ St:J/u ~ () tvru!.-r
fiG ~u- '* t'lt/tt ~f d/5 (;hfH/Pl1lVeollh ,'ne/deAf ~
knlUtt/~5 ./;y fire e/l h rehl!5.
c tLrrtl1t IlS5~$St.tJ value. rpu Cl.(..mb. Co.
d.<6,d. "/25 rum" - f't\~/h'pI,'t-r =- J.lt.f
(.see tied Ifftd q~Ge5SIJ1t'lJt /IN"! '}tet" ~~).
As"",,~o 'Of=- j 37. 3lO. .~
J I
I
Ji
J 5 (, I SZ Z,tJt:J
TOTAL (Also enter on line 1, Recapitulation) $ 15" ji:/,2., ()o
(If more space is needed, insert additional sheets of the same size)
It '..
.5-2008 1Z:50DM FROM-TRICOUNTY ABSTRACT
17177613830
T-88Z P oez/ooz F-3Tl
J. Clb'C L VI 1
-Detailed Results for Parcel 13-25-0008-066. in the 2004 Tax Assessment Dzltabase
DistrictNo I)
P:m:d - ID l3-25 -0008-066.
)H,lpSuffix i
Huusc;-';o 90
Dir~ctioll
StT~et POPL/'.R AVENUE
Ownerl JOHNSON, HELEl\" S
I
ClO
Prop Type R
PropDcsc
LivA rea 1640
CurLl1ndVal 29000
CurlmpVal 108300
CurTOI'Val ]37300
Curl'rc1Val I I
Acrc:'lge .32
ClGrnStat I
I
TaxEx 1
SaleAnH I
Sald\1o
SaleD<1
Sal~Ce
SaleVr ,
DeedBkP:lge 0022F -00008
YearBlr ]9t1~
HF - file - Dat(. 11/17/2004
HF _Approval_ Status A
P-201-CT-Warranty Deed-Short Form-Act 1909-Arranged for Pho({)-Recording
Henry Hall, Inc., Indiana, Pa.
I.. .)
t!tbi~ .meeb,
MADE THE ,,27t:-/~fti day of
of our Lord one thousand nine hundred sixty-six.
.,
/{ll'
in the year
BETWEEN LOUIS J. ZAYDaN, SR. and HELEN J. ZAYDaN, his wife, of the Borough of
New Cumberland, County of Cumberland and State of Per'l1sylvania, parties of the
first part,
Grantors ,
and MELVIN K. JOHNSON and HELEN S. JOHNSON, his wife, of State College, Pennsyl-
vania, parties of the second part,
Grantee s :
WITNESSETH, that in consideration of
- TWENTY-T1>lO THOUSAND and 00/100 - (~22,000.00)
in hand paid, the 1'eceipt 1vhereof is he1'eby acknowledged, the said grantor s do
and convey to the said grantee s ,
Dollars.
hereby grant
ALL that certain piece or parcel of land situate in the Borough of
New Cumberland (formerly Lower Allen Township), Cumberland County, Pennsylvania,
bounded and described as follows, to wit:
BEGINNING at a point on the western line of Poplar Avenue, which point
is Sixteen Hundred Twenty-five 0625) feet from the intersection of Poplar
Avenue with Fourth Street and which point is also at the southeastern corner
of land now or formerly of John C. Kilgore; thence along the western line of
Poplar Avenue south six (6) degrees, Thirty (30) minutes east Seventy-five
(75) feet to a point on the northern line of lands now or formerly of SUlart
Heagy, Inc.; thence along the same south Seventy-two (72) degrees Seven (7)
minutes West One Hundred Forty-nine and Ninety-eight One-hundredths (149.98)
feet to a point on the eastern line of other lands of Stuart Heagy, Inc.;
thence along the same north Eight (8) degrees, Forty-seven (47) minutes west
Seventy-four and forty-six One-hundredths (74.46) feet to a point on the
southern line of land now or formerly of J. C. Kilgore; thence along the
same North Seventy-two (72) degrees Seven (7) minutes east One Hundred Flfty-
three (153) feet to the point of BEGINNING.
UND]i:;R AND SUBJECT, nevertheless, to a Thirty (30) foot front setback
line measured from t he westerly line of Poplar Avenue.
BEING the same premises which Wilbur Fink, single man, by his deed
dated February 2, 1965, and recorded in the office of the Recorder of Deeds in
and for Cumbeiand County, Pa. in Deed Book "M" ,Vol. 21 ,Page 269,
granted and conveyed to Louis J. Zaydan, Sr. and Helen J. Zaydan, his wife, the
Grantors herein.
1 % ,;Odl blate Transfer Tax
~ 00
)dt~ /~.-~f~~.. Amt./.I.0. ~..
q~J f) .d/JU;;;d/"
Gumb. Co. DI,t. ('.01. Agt.
).lID Real Estate Transfer talC
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Date I?- :-!.'1.:-v. ~. Ji:.1. ~.....
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Cumbo Co. Dist. Co!. Agt.
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School Did. Cumbo Co., PaD
Township of ?fJ.lf:~.v;..4: Jt./l~.
Cumbo CO., PaD
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AND the said grantors hereby covenant and agree that they and each of them will warrant
GENERALLY the property hereby conveyed.
IN WITNESS WHEREOF, said grantors have hereunto set their hands and seals
the day and year first ab01'e written.
~i.""'I~~~~~:;:'!c:I::''''' I uu..)nUjUumc;n;;=m/}mmum e
) { . ()t'l~Jf.:(/,'.u~~ume
h_ h____hu ._,~f:ll,!-.,.:~-2-uli-~-~.'::l:.'~=~-! )\ ----iiE...-h ----- y..------ -. _____h.h_.._____.________________h_h_______ e
- m_ jJu_ .-- u u -- - .- .- ---------__ __h .___h -- _m ~ i~~--- -~ --- . ----~A-.----.- ~
~,
State of
PENNSYLVANIA
}ss.
day of Al-e eU-L-J''--GU
, 19 66, before me,
County of CUMBERLAND
On this, the
.~ tj d'L
a Notary Public
the undersigned office1', penonally appeared
his wife
LaJrS J. ZAYDrn{, SR. and HELEN J. ZAYDON,
known to me (or satisfactorily proven) to be the person s whose name s are subscribed to the
within instrument, and acknowledged that they exec'uted same for the l)urposes therein
contained.
IN WITNESS
R ,,_""f~,,(i
DOROOS>> I)F :h'.-'f Ci:t:,ar.RV.:l:l
('~:~ zz:.?~~~~9..~ 1 ~~
I-f2.L( L;/ / J.t!:'.(i.L~~/1- -.'
Secreta
WHEREOF, I hereunto s9-)my hand and ofjicial seal.
e -~ c- >, /') I
----~~-- _e~c~~rY_h__d;~ ___ 2=~4d~~Ld~__ ~
I ~lff".
NO -r l\ R~{ Pl~ 3 ~.._ i C <,; ,;:~11~,:d;,; t..
My CGn:UT:~f€i0il-1iJ<1iif.=,-rif!m.'itfy-2; -I %9- -- u__ -. --- - __h_ ---_f!~~+if:: _\;".,5':LD !~1
Carlisle, Pa. Cumberland Couilty Title ?l Otfide~':<),
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. . do here.by cer~Yy th~ty, t" e" ~,re5iS,e ,res~,d~,n,ce anfJ.comPlete&, $,',t,' offic,e adG"l,.ress,," I
of the 1lnthm named grantee '/,S (/ /) j., .-Cl.?p L //.-,. 0//-u; J //,/ ", '1./ /. . I {~c,_ .v,;, /,., "./
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BOOK/;Z'22 PAGE 9
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REV-1503 Ex + (1-97)
'l.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
-JtPHII.s{)tv; flE.t..l:/l/ S,
FILE NUMBER
:11-07- -oR
All property jointly-owned with right of survivorship must be disclosed on Schedule F,
ITEM
NUMBER
1.
.:l~
3.
DESCRIPTION
A-/YIIf!1f/Pi!lSc ONE ':/IVANCI,fL .4-fU!r: /Vb. OOOS; 87hl ..?h3 J 021
tJI'~ 1J,f- /Hl{IlI/~. 5; I"z. 7 3.1 SIU/HS (f) ~3.t:l6 = 6, ~ If''Z5'.2.1
/fAla?l~&sE CWE 1- TC /JI€E/J?/ll AI ~ Tu.RAI ~r. .N&'.
9/ ~o ~s,J 5S73 6 ooif
1.
I. S ~/'. CrPh1 sfl't-k. Fu/ITJII F/l1ruJ(:/a I &rp.
~"'K. etrh't.. 1-I;lS Y '1 3 :2. C..U;'P 3 ~ o;r7 l/ 0 0
a Ire. pr i Ct. pe-r s htut. = ~ t#. 2./ 't
It see. ~I/ Jl4/uah'", Cale. rd 9,1-. sek.iult. F)
~ .
~ 1'.1.1'1. ~fi sh::. I} O~3.loS' X y,- ,
(cleceAtnt held Dlle-half Jl'/ttJofst ers. -kl1onf ; n ~lUmblf w.tI" h.er
d hter, t-It1aa JDhnsol\-l3l-1'. !h,S S/7t-K WfU made.. Ill/. olf.-
hd-itlftrts.f ()wner.!~ h1 J'~ne!.. <<Of)". 7kreJvl't) +at o/iu- o/IL-hall
;nfettst fl{JfJt.UJ &11 sdtu/. G q~ t{ !Jft u,/fI,;n / ,YeAr ~f e!o.r:I)
5!J~. t!tHn. ~ F~/lDn li/1/UtC/R/ &I'p.
sfK. ct.th f.. H:l :J 7 t5l.D1o 0...ts I P same
Ol/t htdf ilJktfSf ~~ leitanc )/1 &lI1mtJl1 w,ft kr s~ ~4kr.
S/r;t/l. Wit!. IJ1drIL Hit &Ill- -hf/If ;11~.$f O/l)/Ilr/p..... fM JU/I.f., If, UJolf
~ ~ '~ -
ewe. ,lJr/a ::: /~.21 -,;. 9..sh. == "8/IJ.G;D -:- 2. =
VALUE AT DATE
OF DEATH
fl'7. tt;S.29
-0 -
,. 52,.83
~ifos. :z5"
-
~ 1'-1 s. 55
~
.2, J:},. ,~
5;
IIOOS" sh. t!bm. .sf,{ FkIIP" 17illll1cla,1 CDrp.
fi>tk c.erf:;{.. H ~/q58:? er.,s!P Sa-me
tH1e -Auff /l1kK~f Q5 fehqnt" ;" ~1H~n ~/tt Jw. sad ~h:k,r_
6-1u1t. W06 I'HMIe /t1~ tJnt- Mil ;deH5"f t:'/fIMrfkt nt ~ksf
J.1J OZtt>J ave. prkt. c /".2/ x to()S =- i" .:/.9/. oS" -;'2 _
d2~3 sA. ~AJ. 5fk. F~/lDn F/lJltnci~ Ct:Jrp.
sft certlf H,2tf1o'l2. (!u5,'p $1Lme..
&rle-hqfl /l1ktesf P5 ~ In CtJIHPU/71 1if)/~ kr sad ~J.vky.
~~ WI5 tWu:k ~ tH1l--half inlett5f PW/tt~It#p nt 7HM~ 2PO.f".
ewe. fJ"/ce c: ~/". 2/ )( 2113 = $1{., '2..' 3.33 -+ z : ,Set" t"fJAnAsket-J
,.
TOTAL (Also enter on line 2, Recapitulation) $ i 3; 5"2/. ,;zl
(If more space is needed, insert additional sheets of the same size)
~.2 St!IIn, 8." ~'o!.
..... I"
Rs.T. 0/= J6ftlV..s()~ #Gl8ll.s~
F/LCAlP" 2/-07-6J'
l:C'"
Z L{Z sh. ~/IJ. cJfI(. ~/'IZP" ~/JI/I1ul1l~4li()l1.s ~.
#P{/. 2'1; 2D'" ~,' as.vv h ~~ 7t) J . 1.
tUrt.lJrla = 31. "9 X Iz.Z' .::=
Abv. :l7; ~,,~ 1,/.3''1- j z ID .3'1, If
,..
.if ~3{). 96
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1. d3 sl &;no jf~.
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. .
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JOHAfJOtV,i N€LEAI rS.
FILE NUMBER
rZ/-() 7- 3g
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
:2.
,qq 7 Pi Y frlou TH SW riAl It: 1 P LfG-P t.JLJ If 8 vB ;1.7.).1 'I,
C E?clmv.nd.s. Com PriYtv1e flA~ Valu4h'M ~!02) J3Cj.()O?
(Ke..lle:>, 8Jue {3001< -Fair C1nd. VtLl. ::. .:l.J Odt),OtJ ftWe. -
(see C-.ofJ;CS 0/ j/trltltlhb/J cia/II a#ac he c/)
()h,'p t!nJttt:,)fy ~"1p - Pa,.f,~/ lekne/ ~; cMJur. PteIh,'UYh
191'3 t!?,ne,,;,'ew M"b,'Je H"~I ~;htl- bJJ'de.. (one ba-MNOJn)
'jerK ~. /k.$t-#shlmt Vt1-Jue Z fRo. "2
&U1Jty muIr/voller in elled d d. ~.eI. = I, ,U) J
(Se.t- h j,//I/~ u 1huJd)
f'eriZtJl1 /denehts {]e.nk-r ~ ,c;"a,J faonrutf dw.. t E.sfd
I?elulld ~11 stI/;sel'ip/;int t H4:/'I'/sJul} ~,'ot- AAu.J
Ifems ~f tJersMtI/fy
(see r'aluat/M IM/"/dd t eltt{~K 8r/c.ktr 1 auc-h'ol1eer
atfachui)
VALUE AT DATE
OF DEATH
J'
:2, o7q~ s-v
fA
11/'00
SOl'
7" fJ'CJ.tJ~
~
7t/' ./2
~ 1.. 9.tJo
~
31 ~otJ.oo
J,
4.
5.
6,
TOTAL (Also enter on line 5, Recapitulation) $ J 3J 8{)5'~ 6;;L
(If more space is needed, insert additional sheets of the same size)
~
., "
Ecimund< used Plymouth Voyager car appraisal. Used Plymouth car pricing.
~I:.\I( 0111', i.~IH">t
ISION IN I I..JOINI
01/23/200802:28 PM
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PRICING
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1997 Plymouth Voyager
3 Dr STD Passenger Van View 1 qq7 StvlPc,
Other years for this style :--2000 ': .! \ .~)
View: Pictures
Consumer Ratino 6.1 -=::J ~
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STEP 5 Review Edmunds.com Pricing Report
~1997 Plymouth Voyager 2 Dr STD
Passenger Van
National Base Price
ODtionai EouiDment
Power Door Locks
AM/FM/Cassette Audio System
Cruise Control
Sunscreen Glass
Air Conditioning
Rear Window Defroster
Roof Rack
Tilt Steering Wheel
Power Exterior Mirrors
Color Adlustment
Gray
Reoional Adiustment
for Zip Code 17055
Mlleaoe Adjustment
59,000 miles
Condition Adlustment
Average
Total
Certified Used Vellicle
14 Revi ews
. Get a Bad Credit CM Loan
PARTNER SPOTUGHT ~f'{A1~')I'.U' Vn/!HH
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, NOW,
AuW1huierO"
@Yl Tru.: fV\CtfkH Vdlu>E:@
Pr"icing
~ ~
Partv
$1,001 $1,607
$98 $176
$10 $18
$8 $15
$8 $15
$20 $36
$19 $34
$9 $16
$8 $14
$8 $14
$8 $14
$-2 $-3
$-11 $-17
$854 $854
$-303 $-478
[$1,637 $2,139
~
~
$2,347
$300
$31
$25
$25
$62
$58
$27
$24
$24
$24
$-5
$-680
$2,791-)
Price Another Vel1iclf>
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L!!llunc!~ I'sed Plymouth Voyager car appraisal. Used Plymouth car pricing,
01/23/200802:28 PM
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Page 2 of 2
"
Kelley Blue Book - Private Party Pricing Report - Plymouth, Voyager
Kelley Blue Book
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OUY A USED CAR
on Blue Book Classifieds""
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30 Miles or less ~'
ZI P Code 17055
To View Adsl Click
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on Dlue Dool( Classlficdsu.\
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_~~!~~~~2.~~_~___,-11
Both Nt'w iI nd Used ~ l
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.))1"1" ~ ilil:: ~
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fij) Estimated Payments
540 /"'0 @ (i 35D/o APR
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Iltt V / Iwww.koo.com/KRR/lJseelCars I PricingRe port .as flx?Ma nllfactll rerlel ~ .. .ue%7 c308680%7 ctrlle%7 c 308 747%7 ctrue&C onelil ion~ Fair&Qu izConelitions~
Condition <,.,,",.,"'-1111"
Value
Excellent
$2,710
$2,410
$2,020
Good
More Photos
Fair
-
-
NEXT STEPS:
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Average Consumer Rating (30 Reviews)
Read Reviews
(:r{Jr(;:r{Jr' 4 out of 5
Review This Vellicle
Vehicle Highlights
Mileage:
Engine:
Transmission:
Drivetrain:
59,000
V6 3.0 Liter
Automatic
FWD
Selected Equipment
Change Equipment
Standard
5 Passenger
Air Conditioning
Power Steering
AM/FM Stereo
Dual Front Air Bags
Optional
Rear Air
Power Windows
Power Door Locks
Tilt Wheei
Cruise Control
Cassette
Privacy Glass
Blue Book Private Party Value
Private Party Value Is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle is
501(1 "As Is" and carries no warranty (other than the contllluing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions. Tllis value may also be used to
derive Fair Market Value for insurance and vehicle donation purposes.
Vehicle Condition Ratings
Check Vehicle Title Hlstor-y
Page ] of 3
'*
Kelley Blue Book - Private Party Pricing Report - Plymouth, Voyager
01/23/200802:21 PM
.
,
, .
To View List, Click
Excellent
"''''''~''''''''..'''I
WL-.h_h_H.....
$2,710
\t'll~(t 1.1.lh
. Looks new, j~; in excellent mectlilnicaJ condition am] needs no
r~concJjtjonjn9.
I'lever hod any paint or body work and is free of rust.
Clean title history ilnd will pass il smog anel safety inspection.
En~Jinc compartment IS. cleem, with no fluifJ leaks and is free of
(lny wear or visible defects,
. Complete and verifiable service records.
Less ttliln 5'Y.) of all used vehicles fall into tllis calerJory.
VIEW i\I/OIIIER VElIlClE
_~~!'.~.~~~~1
<"'('!f:U t~'lu(wJ.
Or Searcll by Category
Or Ch1lnge ZIP Code
Good
:':'j~O~:t
$2,410
. Free of ilny major defects.
. Clei.Hl title history, the pClints, hocly, anel interior hClve only
minor (if any) blemishes, and there (Ire no major mechiinical
problems.
. Little or no rust on this vehicle,
. Tires match ane! have substantial tread weal len.
. A '\lood" vehicle will need some reconditioning to be solei at
retail.
Host consumer owned vehicles fall into this catefJory.
Fair
""~""~"'l'
www
$2,020
. Some mechanical or cosmetic defects and needs servicing but is
still in reasonable running condition.
. Clean title history, the paint, body and/or interior need work
performed by 11 professional.
. Tires may need to be replaced.
. There may be some repairable rust damage.
Poor
~.
L.
N/A
. Severe mechanical and/or cosmetic defects and is in poor
funning condition.
. H(lY have problems ttlat cannot be readily fixed such as ~~
t1amaged frame or a rusted-through body.
. Branded title (saivage, f1oorJ, etc.) or unsubstantiated mileage.
Kelley Biue Book (Ioes not attempt to report a value on a "poor" vehicle
because the value of these vehicles varies greatly. A vehicle in poor
condition may require an independent appraisal to determine its volue.
* Pennsyivania 1/23/2008
Accurate Condition Appraisal Change Condition
Accurately appraising the condition of a vehicle is an important aspect in
determining its Blue Book value. T1Iking our 16 question condition quiz
will ensure you know the correct condition rating.
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(9 200S Kelley Blue Book Co., lnc. All rights reserved. Jao.Apr 2008 Edition. The
specific information required to determinE the value for this particular vehicle was
supplied by the person generating this report. Vehicle valuations are opinions and may
vary from vehicle to vehicle. Actual valuations will vary based upon market conditions,
specifications, vehicle condition or other particular circumstances pertinent to this
particvlar vehicle or tilE transaction or the parties to tile transaction. T/lis report is
intended for the ;ndividual use of the person generating tills report only and s/iall flot
be sold or transmitted to another party. Kelley BJue Book assumes no responsibility
for errors or omissions. (v.OB014)
http://www.klob.com/KBB 1 UsedCars 1 PricingRe port .aspx?Ma nufactu rerld ~. .l1c%7 c3 08680%7ctruc%7c3 08 747%7 ct rue&Cond ilion ~ F air&Qu izCond ilia", ~
Page 2 of 3
,Kelley Blue Book - Private Party Pricing Report - Plymouth, Voyager
01/23/200802:21 PM
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Motorcvcle Value5
ill! p: Ilwww.kbb.com/KBB/UsedCars/PricingRel1ort.asl1x?Ma nufactu rerld = .. .ue%7 c3 086 80%7 ctrue%7 c3 08 7 47%7 ctrlle&C and ition = Fa ir&QlI izConditions =
Page 3 of 3
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DEPOSITS MAY NOT BE AV~LABLE FOR IMMfDI TE WITHDRAWAL
THIS DEPOSIT IS ACCEPTED SUBJECT TO VER/FIC N AND UNDER THE;
PROVISIONS OF THE UNIFORM COMMERCIAL CODE AND THE RULES AND
RE;GULATIONS OF THIS BANK.
CASH/CURRENCY ~
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07I02I07PI'i!6:13 001900 DEPOS3622-88191 'S13S.120328.002
.
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THE PATRIOT-NEWS
PO Box 2265
Harrisburg, P A 17105
Check Date: OS/24/2007
Invoice Number
010045159,2007-05-22
SUBSCRIBER REFUND
Vendor Number: 9999999999
Invllice Date Voucher ID
OS/22/2007 00029412
Gross Amount
29.00
Check No.
.Discount Taken
0.00
0900010087
Paid Amount
29.00
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Questions regarding this check contact the AP Dept 717/255-8260
Check Number
09000]0087
Date
OS/24/2007
Total
Gross Amount
Total
Discounts
Total
Paid Amount
$29.00
$0.00
11-0 ~OOO .008711- 1:0 2 . ~O ~ ~ 7 ~I: (;0 ."'8 7 ~ .5811-
Our Address for Correspondence
'. <r _
Verizon's Benefits Center
100 Half Day Road
Lincolnshire, IL 60069
For Information Call
Verizon's Benefits Center
1-877-275-8947
Estate of Helen Johnson
90 Poplar Avenue
New Cumberland PA 17070
0000000747 (1 OOO/box Rev 01)
Description
This Pay
Pay On:
Check Number: 2 0 0 0 05 6 5 0 6
0000000747 (1 OOO/box Rev 01)
0000 000747 (1000/box Rev 01 )
Payable Date 5/16/2007
~
Ver'70"
Account:
028823800A1
~.~";"'""-~...~~~qJ!,.-""~.~<:""""""",,,,,,~,e..'V'.,;:y~,-~~~......!'6~,..'"!:<~~~~~~~~:7-,~
66.763/531
..::-:--''::'':'='_.::::-:'~'':'::-~~~'r~~=:~~'~lO~''''~~''''~'----~~~''''-'.-=-<.,..,.e..,,__:.io\l'~~
Pay to the Order of
I
Estate of Helen Johnson
90 Poplar Avenue
New Cumberland PA 17070
Amount
I.
**$706.12**
VOID AFTER 90 DAYS
Wachovia Bank, N.A
FOR: 12/1/2006
Benefit Check
~~) ~ ~\~~ <--
AUTHORIZED SIGNATURE
III 2 0 0 0 0 5 b SOb III ': 0 5 :l . 0 . 5 b .': 20 7 g gOO . :l 7 . b 7 III
.
,
'.
Chcck Date: OS/24/2007
Invoice Number
010045159,2007-05-22
SUBSCRIBER REFUND
THE PATRIOT-NEWS
PO Box 2265
Harrisburg,PA 17105
Vcndor Number: 9999999999
Invoice Date Voucher ID
OS/22/2007 000294] 2
Receive your payments faster' Ask how! Call us (866) 2//-2620 opt 3
Questions regarding this check contact the AP Dept 7/7/255-8260
Gross Amount
2900
Check No. 09000 I 0087
Discount Taken Paid Amount
000 2900
Check Number
Date
OS/24/2007
Total
Paid Amount
09000]0087
Total
Gross Amount
Total
Discounts
$29.00
$000
$29.00
'.. .. .
Our Address for Correspondence
Verizon's Benefits Center
100 Half Day Road
Lincolnshire, IL 60069
For Information Call
Verizon's Benefits Center
1-877-275-8947
Estate of Helen Johnson
90 Poplar Avenue
New Cumberland PA 17070
0000000747 (1 OOO/box Rev 01)
Description
This Pay
Pay On:
Check Number: 2000056 50 6
JOOO 000747 (1 OOO/box Rev 01)
t V~vVVJ\JVUI
uJ!.r.......'L..VVI
.l>L'I.VV
J>U.UU
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"
APPRAISAL
Personal Property of J-IELE,I..,/ s. TDHlvS6/'.J' .-E5T~17! /\Et(.. C"/'1I3Ef'?-L-l/vCl Pi,
Appraised by Chuck E. Bricker AU094-L
Date
ITEM VALUE ITEM VALUE
HlOSE/ft;L-d C C A.... f tE-,<./ r s ASST:
Ft/~Jv/ TVfL~ J- S /vIA L-L <::. 'loot. /; t
REv 1:;0'" EX.;- (1.9!l ~
"'~..,
~ .,.-'
COMMONWEALTH OF PENNS\ LV ANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF oJ Of-IN~otJl HELEN S.
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
~f-o 7-3g
If an asset was made joint within one year of the decedent's date 01 death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. L;nD/a. ~t1t.. J'&An!,tJ/I-eu
B.
c.
8' /YJAyfleld i;J 4.
Me.en4l1ic~bu'jJ fA (iOS~
d~l-yttZr
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DE CD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. ItJ jq/bJ ,: lJ.'nn BanK Cheek/Iff At.d.1YP. 3'.t~- '13~ 1)()1. ~5' -'t>4, f I, S-IJ/f..'~
J339G"
(~~e J/AIJlIJPQI/ letter trl!aclteP!)
:l. A. "/:1.'//8'1 flSECU ~itJ//nf....r~. /Y" ~/7'1 "322.3
(51) Pr:nciI'4/ ..'/,"'" 'I&' fttf ~o9.o1 'f ~ 651. 07 ~I)~ ?..2, 3 2?; s,
InnHst H,b9 I
(See Yflltltlf/~11 Ie Ittr fI ~ chtrl )
3. A. J/'f/~ !l-lfJerJ!'ri,st! I)N~ niJatu,'a/ ~ wYli ND.
I)()()$ F7h //7:J. if 0,;J!
~'l/feAts j/Ill",~ aJ ;;/1"111.$: , ~
~ "... ~~, ~~:Z.lJ,{
SlJ .sit. (!,IHCtI sf h; 'fO.02. 10 3'T. /5 ~ 39, Sf c: II 97J; 7S- Sl),Z
;. ~ ~ 'Jl!
~ 1.f23sJ, 13.e1/ St'). ,,/ LJ3.~ ID Af3.2S' ave. Jf~."(, = (o3, 3053..07
/3:1. S/'. L"cGttlt II; ~;?"o 10 1.1..g. 1AAIt.~ doSe =: "O'lOIS'b
,
eaJ,n;1I A-ut. ;2,9'12. i3
* 1~1=() /JUTe.' 13,fSt!P ON DIrTt;;; of OI'GJl/IA" ANi> VIO,} 'liS. 2.1
'J{JINTZu<.E, ?J.Ili ~7J.Ierc Pl//f-lIA-tF' VA-I-UE ot:
'?}liS I'fM..OJ{Nr /f-/J1'E1ff2S ~If/ S~Ef) ~.
~II/'It u. e.rI ) ~
TOTAL (Also enter on line 6, Recapitulation) $ 7 ~ '39 3, z &'
.-
(II more space is needed, insert additional sheets of the same size)
(
Selle-]), I; M1tfr/
1f571i'TE; ~F ~/Y..fP~ HELy( s:
If, ,4 .
,,jt/bS a~{, sh.tJo/JI. ~/R. Fu.,/fpn Fi'NUtt;,'rJ Csrp.
Slk C!tA:If Hfi 37S/'I C!it.s/,uH 3boZ1110 0
". r
,:;::; ;;: ~::~~ ~: ~:~~ Jav..- ~W t ZZw =
S:A.
r, /e / ()~ /; S- sh. (!om. sf/( "Hvlfvn F/lJdJtc l'a/ c,rp.
Sf}:'. cerh't. H~SI!;'7J~ CLlStP.s4.me
e
ave. pr/# = 1,.21~ .~!;.::.
(sa scht., (;. -Gr ~l~r "N-h4/1' YaIJ,ie.)
~,A 'h/tJ'I 50 sh. C()m .srkH&JhJ11==r'naJ1c,'a" Cor-p.
...
.sfK Ct,.f,t- . H 22t{. "10 . r!Lt~/P SaM!.
,'I 50
ave. (1JI'U;t :- / '. 2 I X =
7,/1-. R/II/()~ t ()()().rI,.(!onJ. . SIK.FUlfon r;'~/al C!J,rp.
sfkC!P'fr't H.2/B8foO CitSlfJ JAme
ave.'fJr/c! = ~(,.Zl x~ P()O =
g-,A.
1/.3/Pf: 8S!)Sh, tJ/J1II.,sfK. Ye,.iZ.LJnuC()ntmun/~h'''l.sL~
6fK (!~h'f VZS'IS2.tJ'I . Cttsl/fjd3lf3 Y It) L/
aye 'fJr/c~ = ~7:6e
(111~y/"" /),' ~3S:VO /~ 3~7() 1 fI<
I' , ;: 4-Yl!. 3tl6,J' i 55$"
"('27/~~ A/ 3'f,cf2. k .PI./!
(Jte stltul. C' (i;r p&r ON--0glf raja! ).
F/UG"NO. ill-t:)7~J>
-t
L/j d. q7. 02.
S1Jt
~
I os 3. {,S" Sl:J0
I. . . .. . . u.
~
8/0, W ..${/~
,
~/ 1~31t51
.,
S.2'. i3
f
'fO$, :$"
~ ~
I{" ZIOd)tJ .s-oJ. J;/tJ$oo
.,
1.1., .311, c.;/J
S'f)J,
;. ~ 15S',10
,
" PSE(~
March 13,2007
Charles E Shields, III
Attorney At Law
6 Clouser Road
Mechanicsburg, P A 17055
RE: Helen S. Johnson, Deceased.
PSECU Acct # 0176163223
Dear Mr. Shields:
The account was opened on November 24, 1989. The Share accounts were held jointly by
Helen S. Johnson and Linda R. Jonson-Bex.
The Visa Loan was held individually by Helen S. Johonson.
The following are the Date of Death Balances for Ms. Johnson's account with PSECU:
Account
Date of Death Balances
Interest
Savings
(S 1)
$ 4,647.48
$ 11.59
Loans:
Visa Loan
(L9)
$ 313.84
If you have any questions, please contact me at (717) 234-8484 or toll-free at (800)
237-7328, then press 6, extension 3120.
S."reIY, ~
'-K~0-1Vy.)
Roxann Myers
Service Advisor
PSECU
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . 717.234.8484 . 800.237.7328
. i/iUiliIlSjl\ddl8:;:; PO Co;: 67013, Hallisburg, P/\ 171067013.717.777.2100 (TOO) . 800..172.'967 (TOO)
ThIS uedij union is feder'olly insured by the t"-lotlonol Credit Union Administration. Equal Opportuni1y Lendel www.psecu.com
.
.
>
.
Fulton Bank
LISTENING.
March 9, 2007
Charles E. Shields, III
6 Clouser Road
Comer of Trindle and Clouser Roads
Mechanicsburg, Pennsylvania 17055
Dear Mr. Shields:
RE: Helen S. Johnson, deceased November 25,2006
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Checking # 3622-23395, open 10/14/2003, balance $3,009.68 (any
accrued interest would not have been payable had the account been
closed on the date of death) joint with Linda R. Johnson Bex.
The decedent also has 1,383 shares of Fulton Financial Corporate
Stock, in her name only. Please contact Fulton Financial Advisors
at (717) 291-2546 if you require additional stock information.
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
Very tmly yours,
\ol~~~~
Karen D. Hillegls (j
Credit Inquiry Processor
Cf)~Jr-Ff)!]-I!\;~'r,f f-,;
, ur~t" h.~t~~ ~ ~KL
This j"~orma~:fl'l if' J. ~ :..L ..,J -.~ -. .w. ' .
.. III td lh,f .,;,) i\J~n;;;:-!!...: ';i", .'; G1~;d":f (F b\tf~"n~"s ....O.l..,.l.,..r:c-y
~:in a~~~~:'~'~i~~;):~~.~~!~sii~~~,.7:!:,.,,~.~.- '.0.;".',.;,' c', ;~(';C C~n~i~j:~t;;1 l~:~u~:~[;:
. . or CHIY of its of-ficers.
.l\n}l aprn'~ln hn:~jn (;)(pr;::~;:'D0 L:; ;;;U,~di,;C.i' tc= cLanee \vith~;tr~ nr,tlc(:.
POBox 4887 Lancaster, PA 17604
fultonbank.com
1-800-FULTOf'.j-4
REV.1510 EX . (1.97}
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
.
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
J PH /'1.50 t1I, 1/ ~=l- eN S.
FILE NUMBER
:Z1-07~t6
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
A.
A-hlEItIP((lbF I=/AlAfY'C/ItL SFI/!,V/CES, /N~.
,;()A II-ecft/o, {)/O! 01/ ~3fDl 1 ()o2
- fl 11 ~ ~
s: :/53. 6'l/:; ~hs. @ 8. 72tJ ='~S; K/3, SO
8eneh'c.illry is LIJ//JA .IN/IV.! tW .r5~ daLt1hftr
df decedent.
;r "d,'v. /J1 u1Ua.! f:'und /fc d. AJo.
&/1 3ill.{ tJ91 933 002
7rMSfr M /Jealh -Ptvytt- L/tYlJlf JIf//JISP,v te~
d(u{fthfer rI c/~eeD/trd.
I 11 16
1{./~31. k9pShfll8$ (i) /'()f)= if,63/.~9
(e '-Sh rnM\~ Fa-A) Cu.s If' 7bF,''1/ 3 J o~
Ij'xd Ifefirement A-nnu.1y vfl- Post /qiS
A-w /liP. 9.30 ~18" 5/0 $.3 ~ f)o'f
fJa.ytt - L/NLJI!. dt;h'JlI.J()AI-;&I::~ dCU4'Jhft-y t!J{
tJt.c.eJmt.
'it
t,fa1 Vllhu. NO, fal#~,07
~.
e.
~.
ONE-Hit-iF PF AhlE1(lfJIlISE ONE F/AlAHMIH.
A(!~r: Nt), 000$ 8762 117.2 .If 0:2/
SEE I:NTIlY 3. A. bN SellEiJ t:. ~ IJATE of
A ..rrwIUJ 4Ur; 01= /(/NItJ( "1J.IIS /S tJIIIE--NAtF
pI:: mE NIIPLF JlAlI-f t. 7H /$ tJI'IE-/lIH.F 1$
I'Elwc &1tlJ/IJE/!,flJ ~ A GIFt" 1J1/fIJF PI/rIlIN
ollF YEIHf pt l>.tJ.P.
E.
()NE -IIALF ~F "5 .sha~ Pi' &1J1. s.~eJ< 8f
F u.t..~1f) F//IIAA/C/A-L C!P1lfJ. ;:;:'r elein; Is oAld
VtL!l.tcd';on data see :L-/c-m 3 011 .s~. 13.
DATE OF DEATH
VALUE OF ASSET
-J-
'f~ P/3. Sf)
'I
~ ~31.6'f
I
I 'to, hfc'2.07
t
S~ J4~,~1
~ S~'.33
%OF
DECO'S
INTEREST
J 00 tD
/00/0
100rD
100%
I tJ{) Jo
IJAlF-II/It.F 01: f&, 5 .5 k$ "f ~IY/. s;fr;eJ; ~ ,
Ft.iL~AJ r//VAAJ~/4i. c:?e>~ ~r- de'/4//S iUJd 5:)(#.~3 /bolo
J/ItIJUtf/I1h ~ rSt!e 2:1ent $,/1., hi S"dtuI F:
( c,.,yf,~)
TOTAL (Also enter on line 7, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
F
EXCLUSION
(IF APPLICABLE)
-0-
-0-
-0 -
f
3. O()(),OD
'/
-0-
-0-
TAXABLE VALUE
,...
Lf.~ 6'/3.SlJ
?'
If)ftJ3/. b?
f1tfO, ftJ'~.o7
~
5 1,1 :IJt:l,~1
&.<',8"3
~.z.', tf3
$ J. 4 q, 5"59. J 3
1
.
.
... ~_ l.till
S~H€D. G; (;I)'L{,
~$7: 0/= ~N#J't7~ II(;L~ s:
G. tJNE-.flt4{.J: I)F3SS s/lltrt$ ,.1 C,111. .shr.-k..
II f~Z'1I &/NiHtWICII--7itJA/.J, hM. .%,. aI~k
AWl VAluaA~1I tida 6u.zkm 5'.A:6It sci.ul F
I
I
j
I
n .i
i
i
I
'"
ft" I:J- f". 70
!=/tSNo. .;U-o 7-6?
I t;o to
If.
-0 - ~ IS S. 7 ~
REV-1511 EX+ (12-99)
~ . Y;;~r'~
~ . ~~>>;.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
tJ()I-IN~~~ Ht;L.E/V.5.
FILE NUMBER
~/- /) 7-3 ~
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
MC1.ll'e"t~; t:v..nu~1 HbMt 6F MecM)1;c.~bur"j
ve"ytl6 F~/QtnJ 6/ ~1lIf 11///, /Pr v/ewl/lj
~ 3J 518'1. SO
?}o1.37
;l.
B. ADMINISTRATIVE COSTS:
4.
5.
6.
7.
t.
IP.
1. Personal Representative's Commissions
Name of Personal Representative(s) /..,'nela V54e ;J;;hIJSol1- &"
tJAIVEJ>
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 0 IJ1 Offield III d.
City Mee.nan ic 5bu~
Year(s) Commission Paid:
State ~ Zip '"7 f) 5$
2.
Attorney Fees C ha.r-I U k. Sh : e..1 d.s 'JlL
!'Ilf, SO/) .C)O
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
/II {/ ONE
A!tJ;,/c
I: L..I (;- / J5L F
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees aA.U1 ()t"iUil1fLl lEoS-U.e. vf ShfJtf cer-t,'f,'t::4-h"J
Accountant's Fees ""t. ~ I I J, ! /I. ". II
_ ) Sfeven nt/MeJ TlJG~ I {) Ullltp If'll
Tax Return Preparer's Fees
<!
I~o. 00
1 ,So. 00
1.
!l-dlttt ;.5/,;n Carl/sle ~nf/fI~/
II-dJle/'h5;;~ 1/1 (!/.(miur/MlrJ Law J;ur/lal
":,'//n! -;::'11 htr; raY1u t:v; ~k"Jf
I/-It/,'.f,Pl1al fJrt?hJe fee.
~
~:Zt),{)()
~
, 0 l. qq
~]s. 00
If ( s. /)0
(su &tlh'n. sh~d)
TOTAL (Also enter on line 9, Recapitulation) $ 31; 4ft, 9, 0(,
(If more space is needed, Insert additional sheets of the same size)
, )
p' Z thJd.
. . I
. "
i 5eJ.!~/). I{ Chff~
EST f)j: r/~III(S/~ flEZE/!/ J.
/1. II ceo "!;4. Insur. (l-/oIDcowne.rs .1 nslA,Y.)
1:2. LtJNe; II//er; ~f/' - frp5h.
(3. LnJ,./! /ltIl . 7N P - V'(e:.tt / Est. 7Nxes
If. lkrtlrh ~ AIM tumhllhl-d - Juut,r
/5, 1ft
I{ /f;/Im hider ~-
1. PPt
I .
It. & ~ hJ~ a.
/'1., PIt
I
:Iv. 1 ~d/l1 /tIahr ~.
),J.. ,oPt
--1
2~. i 1& 4h1 hJ"hr &
:J.J i PIt.
,,~.! .~ /fm fr~.. 6 .
1s: ;Jft
.1t. tA Ah1 /Va,fllT e.,.
),1 IfJL
J.t. Ilt 4At lVaIv ~.
Jt ItJt..
3D, IA. Jm IvrJv (!,.
J/. . fJpL
.3~ fh. ~Naltr tv.
33. ffL
3'1. At IJ.M wafer Co.
35', (JfJL
..3~. f14 Am /;JaMr~.
!J~ pPt...
3i. ' fJ ~ ftlcJtr &.
39.: fJpL
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if 9f~ 7t:J
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~7 9.3tt
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f 39.62
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79. 0 I
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( (J . ~ f!.M+'d.
,
s tiuI. f/ w'cl
.I~57 ()F JOflAJ.JolV; HElLo/VS.
'-13, t?e.jJ1V~ -Ii C-hvrl~ E. SiJ:Ws IiI.
k,. a.n kbS'ftur CJ/ rifle.
4'1., Ll-WPK 4/IU]
'If. i 3,~.; fltan'ny A-te/ ~//
'16.1 ~/c.t~l?lrad tu/!ft/t{(!,{]/u~l /r;,./(uAn, $Ys~ unit! Jdlc!.
r1.! /kl+rlz fi NUt! CUMhw-/-vI, cfwu-
'iC.1 Har/rsni/e;t;J$/I./'.
"/9. tBr;afJ ~/JJee./ ;f'lI)Ul'4-/~f /vinci 4nt4fe/ ilur~p.f free.
5"0.1 ~,.k ~ W eIa/1Yl ~
SJ. I Ytl'J ~11
1
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SJ. I L,uJ~ tliIen -r~'r,(JlRl1,'e 1(;_/JtdI.u)~/ ~ ~~
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5~ lM~f -~~
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51. ~ ~ JtJafh
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bl. v<.e~M1l,tr$rrvmt ti C/uArJesE. Sh,'eJd~ 1ii..k- Id14k~;a, fh~ ,d:..
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frdrk,dC[ IUI' 111m
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UlseUulit.
Tax:
Totd! :
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Cllailge:
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I 511
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" GLENDA M. WETHINGTON
TRI-COUNTY ABSTRACT SERVICE
3414 CHESTNUT ST.
CAMP HILL, PA 17011
~#-~3~
Invoice
Date
Invoice #
1/30/2008
08-159
Bill To
SHIELDS, CHARLES E. 1lI, ESQ
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
P.O. No. Terms Project
Net 30
Quantity Description Rate Amount
] CUMBERLAND COUNTY SIXTY YEAR SEARCH: JOHNSON: 90 POPLAR 135.00 135.00
A VENUE, BOROUGH OF NEW CUMBERLAND
Charles E.Shields,1I1
Attorney-At-Law
6 Clouser Road
Mechanicsburg, PA 17055
Citizens Bank
5182
3-7615/360
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Pay **One Hundred Thirty-five And 00/1 00 Dollars************************************************
$135.00
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02/12/08
to the
Order of TRI-County Abstract Service
3414 Chestnut Street
Camp Hill, PA 17011
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Authorized Signature
II- 00 5 . B 2 II- I: 0 ~ b 0 7 b . 50 I: b 2 . 5 5 5 . 2 l, B II-
Total
$135.00
Page No.
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Horne &mp!rtw~ments
C75 'Wehsviiie Rd.
'Welisville, PA 17365
(7171 432..51::6
r(~r-r ..,--
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PROPOSALSUBMITTEDTO ~
L//L.<;~/'~,4 L56<<
STREET
PHONE
JOB NAME
JOB LOCATION
JOB PHONE
We hereby submit specifications and estimates for:
/'
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We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
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dollars ($
).
Payment to be made as follows:
All matenal is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents or
delays beyond our control. Owner to carry lire, tornado and other necessary insurance. Our
workers are fully covered by Workman's Compensation Insurance.
Authorized
Signature
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Note: This proposal may be
withdrawn by us if not accepted within
days.
Acceptance of Proposal - The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature
work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
. ,
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TAX CLAIM BUREAU OF YORK
28 E. Market St., Room 110, York, PA 17401-1577
JOHNSON MELVIN
90 POPLAR AVE
NEW CUMBERLAND PA 17070
~-~~._.__._~-----_._~._._-_._-
I RECEIPT NO: 201525
i DATE: 06-FEB-08
I
I,PAID:
, PAID ON ACCOUNT:
I BALANCE DUE:
$150.41
PARCEL NO:
SCHOOL DISTRICT:
MUNICIPALITY:
RECEIVED OF:
ASSESSED OF:
27-000-RF-0001.00-M0012
WEST SHORE SCHL - 27
FAIRVIEW TOWNSHIP
~
L-____.~_~_.____.___.__~______.~~._
REAL EST ATE TAXES
2007
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12.H~
11.001
!
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80.381
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122.19\
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0.66
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89.081
,
12.22
1.00
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15.001
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0.001
1 50.4 1
**** PAl D ****
fihL
CUSTOMER'S ORDER NO. I DEPARTMENT \ DATE
'7-21-0~
NAME L, (\ 6c-\ --;-- "
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ADDRESS n . I~e.
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CITY, STATE, ZI{, . C UVVlloer- b", J f\
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SOLD BY I CASH I C.OD. I CHARGE I ON ACCT. I MDSE RETD \ PAID OUT
QUANTITY DESCRIPTION PRICE AMOUNT
1
2 19 x l-DWA lY\c- I ~ h lCX)! S eC(sC;./\ ~L0 ~KiCD
3
4 , Lec:,f cl (>C{ lA U. ) 2t\D'l S Ctl5Ci\ 1..0<) 2L~i\)b
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6 'Sv\Cl' /) \ 7..001 - a \"S C>;.~\ 2. l{b ioo
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11
12
13
14
15
16 :
17
18
19
20
RECEIVED BY
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{ r:.^~~I\llNe.
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B(adams
5805
KEEP THIS SLIP FOR REFERENCE
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I TERMS: ,
All charges paid within 5 days of delivery will receive the CASH price.
I The net charge amount is due within 15 days of the statement date. I
. A finance charge of 1.5% per month will be added to all accounts over 30 days,
Annual percentage of 18%. I
! Unless specified otherwise, each account shall have a credit limit of one delivery of
I' oil, Therefore, each previous delivery must be paid in full before the next delivery or I
within 15 days of the statement date, whichever comes first.
I' THIS INVOICE HAS BEEN ACCURATELY COMPUTED AND AUTOMATICALLY 1
PRINTED BY A MIDCOM COMPUTING METER, VOLUME TEMPERATURE
I. COMPENSATED TO 600F I
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JACKSON SIDING AND WINDOW
845 CLUBHOUSE ROAD
17403
717-891-7365
Building Maintenance
Residential&Commercial
January 7, 2007
Estate of Hellen Johnson
90 poplar rd.
New Cumberland pa.
Misc. Home repairs and clean up of property .
1. Clean leaves and braches around house and clean spouting out.
Haul away all debris.
2. Scrape all ext. window and door frames, prime and paint.
3. Repair loose spouting and down spouting.
4. Replace damaged aluminum facia on both gable ends.
5. Replace rotten wood on windows sill before painting.
Clean up all and disposal of all construction debris.
Total due: $ 2875.00
'JOHNSON,EST OF HELEN S account # -> 204-232 .00 fc
~ MAYFI~LD ROAD .00 90
MECHANICSBURG, PA 17055-0000 credit code A .00 60
D H 000-0000 limi t 500 .1 .00 30
D 90 POPLAR AVENUE B 766-0697 ch ------------ .... 191.95 cur
D NEW CUMBERLAND,17070 C/O L JOHNSON-BEX ~e, 191.95 bal
STAY OFF DRIVEWAY last dely 1/02/2008
status CAL W zone 037 sort 320 disc .0500 cleaned 6/27/2007
grade 2 info D E data OC budget usable 250
tank 275 map 21A04 co 02 paid -z-
available 293 srce cont 0 start -z-
k factor 10.00 sf .75 month -z- new 8/09/1979 rent exp 0/15
**** **** **** transactions below **** **** ****
F 1/02/08 105691 344.90 100.0 units 2@ 3.4490 k .Op
F*10/19/07 102162 284.90 100.0 units 2@ 2.8490 k .Op
F* 5/15/07 100251 249.90 100.0 units 2@ 2.4990 k .Op
F* 3/05/07 97144 254.90 100.0 units 2@ 2.5490 k .Op
F* 1/10/07 92699 267.68 109.3 units 2@ 2.4490 k 13.7
. f'+11/16/66 89590 378.85 151.6 units 2@ 2.4990 k 12.6
F* 5/30/06 85724 303.00 130.1 units 2@ 2.3290 k 10.5
F* 3/06/06 82729 441. 35 189.5 units 2@ 2.3290 k 9.1
F* 1/16/06 77869 597.16 256.4 units 2@ 2.3290 k 9.8
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF oJo HN~O IV; HELEN S.
FILE NUMBER
:J../ - () '1-38
ITEM
NUMBER
1.
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses"
VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 10, Recapitulation) $ 51 'l J fill/If
(If more space is needed, Insert additional sheets of the same size)
REV-1513 EX+ (9-00) .
\,\ .k
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
JOHNSONj HEtliN ,5,
:LJ-07-6~
ESTATE OF
FILE NUMBER
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. LI !J/J/f. RA-r; JbIiNJO#- ~EX
2? /VIa.yf/e./d Rd.
fYIech4n~eshlAr8" fJA /105'.s
NUMBER
I
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AMOUNT OR SHARE
OF ESTATE
100 10
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
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