HomeMy WebLinkAbout11-06-08REV-1500 EX + (8-00)
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COMMONWEALTH OF REV-1500 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN ----------
DEPT.280601 FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 6 6
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
z Johnson Esther, L. 1 9 0- 1 6- 7 4 7 1
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
v 07/07/2008 01/16/1924 REGISTER OF WILLS
LJJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
N/A
XD 1.OriginalRetum ~ 2. SupplementalRetum ~ 3. RemainderRetum Idaoeofdeamp~arrol2.1~-82)
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~ a ~ ~ 4. Limfted Estate ~ 4a. Future Interest Compromise {date ordealh aRer fz-12-e21 ~ 5. Federal Estate Tax Retum Required
v ii'm a 6. Decedent Died Testate (Anacn copy of wal) ~ 7. Decedent Maintained a Living Trust (Atracn copy orTmsff 0 8. Total Number of Safe Deposit Boxes
a ~ 9, Liiti~gation Proceeds Received ~ 10. Spousal Poverty Credit (~ ordeath netweeR f z-af-sf and ~-~-esl ~ 11. Election to tax under Sec. 9113(A) IAaacn Scn of
r- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
w NAME COMPLETE MAILING ADDRESS
o Shaun B. Adrian Es uire MacDonald, Illig, Jones & Britton LLP
ea FIRM NAME (If Applicable)
MacDonald Illi Jones & Britton LLP 100 State Street, Suite 700
p TELEPHONE NUMBER
814 870-7758 Erie PA 16507
1. Real Estate (Schedule A) (1) O.OO OFFICIAL ~ ONLY I
2. Stocks and Bonds (Schedule B) (2) _ ~ ~ .,_ ~,
14 384.92 ~ ° "~ i~Y~`> .
3. Closety Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 ~ t ~` i j
4. Mortgages 8 Notes Receivable (Schedule D) (4) O.OO ~ ~,. CT -~} `-~ ~
~ c`~ c :> ~
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 20 997.09 ~ Ca 7~' ' r~'
Z (Schedule E) ~-^n _
~. ~ ...
~ 6. Jointly Owned Property (Schedule F) (6) 0, 00 ~, ~-t c,.. > c ~~
Separate Billing Requested..!
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 124 153.79 ~___
F- (Schedule G or L) -
a
Q 8. Total Gross Assets (total Lines 1-7) (8) 159, 535.80
v
~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) _ 10, 567.54
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 22, 370.58
11. Total Deductions (total lanes 9 810} (11) 32 938.12
12. Net Value of Estate (Line 8 minus Line 11) (12) 126 597.68
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) O.OO
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 126 597.68
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
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H
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X
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
0.00 X 0.0 (15) 0.00
126,597.68 X .045 (1s) _ 5 696.90
0.00 x .12 (17} 0.00
0.00 x .15 (1s) 0.00
19. Tax Due
(1s} 5 696.90
20. ~ • • ~ - • • ~ •
decedent's Complete Address:
STREET ADDRESS
Thornwald Home
442 Walnut Bottom Road
CITY STATE PA ZIP 17013
Carlisle
Tax Payments and Credits:
1. ,Tax Due (Page 1 Line 19) (1) 5,696.90
2. Credits/Payments
A. Spousal Poverty Credit 0.00 ,
B. Prior Payments 5.800.00
C. Discount 284.84
Total Credits (A +B +C) (2) 6,084.84
3. InteresUPenalty if applicable _
D. Interest 0.00
E. Penalty 0.00
Total InteresUPenalty (D + E) {3) 0:00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) 387.94
5. If Line 1 + Lirie 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 +SA. This is the BALANCE pUE. (5B) 0.00
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 : ........................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ ^X
c. retain a reversionary interest; or ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ X^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................... ,. 0 ^
.........................................
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and st~ements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration Qf preparer other than the personal representative is based on aN information of which preparer has any knowledge.
SIGNATU11jE OF P~R$ON RESPQ~SIBLE FOR ING RETURN nerG
2716 Echo Lane
DD ~
one PA 16506
SIGNATURE OF PREPA OTHER THAN REPRESENTATIVE DATE
ADDRESS 100 State Street, Suite 700
Erie PA 16507
For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
(72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)).
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased childtwenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use o1 the decedent's siblings is 12% (72 P.S. §9116(a)(1.3)]. Asibling 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-1503 EX ~ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STACKS & BONDS
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,Lohnson. Esther. L 21 08 00766
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 859.314 shares of Franklin Equity Income Fund CL A, NAV of $16.74 per share 14,384.92
(OTC) CUSIP No. 353612 401
TOTAL (Also enter on line 2 Recapitulation) I S 14 384
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
IN RES DENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
,lohnson. Esther. L. 21 08 00766
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property pintly-owned with right of surv' orship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Decedent was a resident of a nursing home and except as reflected on 0.00
Schedule G owned limited personal belongings
2. Commerce Bank -checking account no. 537564692 20,834.43
3. (West End Lions Club -check for Lottery proceeds
4. IGoodville Mutual Casualty Company -refund of unearned premium
5. ~AARP -check for refund of unused member benefit
6. I Reiman Publications - 3 checks for refunds of prepaid magazine subscriptions
FOR INFORMATIONAL PURPOSES ONLY:
1. MetLife -insurance proceeds under policy no. 5-352-627M are payable to
the decedent's estate in the amount of $3,256.16. Pursuant to 72 Pa. Stat. Ann.
Section 9111(d) life insurance proceeds are not taxable.
25.00
68.00
6.44
63.22
0.00
TOTAL (Also enter on line 5 Recapitulation) I S 20 997 09
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
COM NHERV I~TANCEDTAX RETURNANIA MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Johnson. Esther. L. 21 08 00766
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..
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR REUTIONSHIPTO DECEDENTANC DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFORREALESTATE. VALUE OF ASSET INTEREST (~FAPPUCABLE) VALUE
1. ButlerWick Investments 124,153.79 .100. 0.00 124,153.79
' IRA Account No. 1054-0712
Balance: $124,153.79
Beneficiaries: equally among decedent's grandchildren
(Kevin R. Close, Carrie A. Karns, Phillip G. Close,
Sara L. Gordon, Laura M. Lochbaum and. Brent K.
Lochbaum)
2. Gift of jewelry (4 pieces) 2,599.00 100. 3,000.00 0
Transferee: Marcia M. Smith, daughter
Transfer Date: 07/06/2008
Transfer Value: $2,599.00
3. Gift of Jewelry (diamond dinner ring) 2,695.00 100. 3,000.00 0
Transferee: Carrie A. Karns, granddaughter
Transfer Date: 07/06/2008
Transfer Value: $2,695.00
4. Gift of Jewelry (2 pieces) 400.00 100. 3,000.00 0
Transferee: Sara L. Gordon, granddaughter
Transfer Date: 07/06/2008
Transfer Value: $400.00
TOTAL (Also enter on line 7 Recapitulation) ~ S
(If more space is needed, insert additional sheets of the same size)
124.153.
EV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Johnson. Esther. L. 21 08 00766
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home 8~ Crematory, Inc. -funeral expense 2,012.82
2. Franklin Granite Works -name plate for memorial marker 295.00
3. Fox Street Church of God -family meal following the funeral 50.00
a
B. ADMINISTRATIVE COSTS:
~, Personal Representative's Commissions
Name of Personal Representative (s) Willa M. SOIi 1 900.00
Social Security Number(suEIN Number of Personal Representative(s)
Street Address 2716 Echo Lane
c;q, Erie state PA Z;p 16506
Year(s) Commissbn Paid:
2, Attorney Fees MacDonald, Illig, Jones 8~ Britton LLP -legal fees 5,800.00
3. Fatuity Exemption: (If decedent's address is not the same as claimanCs, attach explanation) 0.00
Claimant None Claimed
Street Address
CttY State Zip
Relationship of Claimant to Decedent
4. Probate Fees -Register of Wills and Clerk of Records -filing fees 166.00
5 Accountants Fees 0.00
6. Tax Return Preparers Fees 0.00
7. The Sentinel -estate legal notice 75.00
8. Cumberland Law Journal -estate legal notice 118.72
9. MacDonald, Illig, Jones & Britton LLP -reimbursable costs for photo copies, 150.00
postage, FAX and long-distance telephone expense
TOTAL (Also enter on line 9, Recapitulation) I t
(If more space is needed, insert additional sheets of the same size)
10
r
REV-1512 EX + (8-98)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, '
IN RESIDENTEDECEDENTRN MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Vinson. Esther. L. 21 08 0 766
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. First National Bank - co-obligor under loan no. 42901490 originating on 10,931.00
03/10/2003 in the amount of $34,099.00 at 5.990% interest.
(Balance due: $21,862.01) 50% of balance: $10,931.00
2. AT8~T -balance due on account 47.38
3. ~ButlerWick -annual investment fee
4. Millenium Pharmacy Systems East -balance due on account
5. Thornwald Home -balance due on resident account
TOTAL (Also enter on line 10, Recapitulation) I ;
(If more space is needed, insert additional sheets of the same size)
35.00
310.96
11, 046.24
370.58
REV-1513 EX + (Q-nm
SCHEDULE J
COMMONWEALTH OF PENNSVtVAN1A BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF PILE NUMBER
n r
RELATIONSHIP TODECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright sppoousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Sara L. Gordon Granddaughter 1/6 of Residue
125 Clearview Place
Carlisle, PA 17013
2. Brent K. Lochbaum Grandson 1/6 of Residue
6424 Seal Cove
Fort Worth, TX 76179
3. Phillip G. Close Grandson 1/6 of Residue
114 Elm Street
Franklin, PA 16323
4. Kevin R. Close Grandson 1/6 of Residue
208 Manor Drive
Franklin, PA 16323
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. None 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None
~ 0.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 0.0~
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheriitance Tax Return Resident Decedent
Johnson, Esther, L. 21 08 00766
Decedent's Name Page 1 File Number
Schedule J -Beneficiaries -1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
5. Carrie A. Karns (formerly Close) Granddaughter 1/6 of Residue
2337 Horsecreek Road
Oil City, PA 16301
6. Laura M. Lochbaum Granddaughter 1/6 of Residue
98 1/2 East Main Street
North East, PA 16428
~~~~° ~~~ ~ ~ ~r~~
I, ESTHER LEORA JOHNSON, of the Borough of Sugarcreek,
Venango County, Pennsylvania, with a mailing address of P. 0. Box 151,
302 Walnut St., Reno, Pennsylvania, being-of sound mind,-memory and
understanding, do make, publish and declare this- my' Last Will and
,, Testament, hereby revoking and making null and void any and all wills,
codicils, papers testamentary and writings in the nature thereof at any.
time heretofore made and executed by me.
FIRST: I direct my Executrix or Executor, ,hereinafter named,
to-pay all my just debts, funeral expenses, administration expenses and
all estate, inheritance and other death taxes as soon after my death as
shall be convenient, out of the assets listed in Paragraph Second
(whether or not the asset upon which such taxes or expenses are paid
are one of those listed in said paragraph Second, the remainder of
which shall be disbursed, as set forth therein).
SECOND: I give, devise and bequeath the net proceeds from the
following assets (after payment of all the items set forth in paragraph
First above) to my grandchildren, SARA L. GORDON, Apt. J, 600 N.
Baltimore Ave., Mt. Ho11y Springs, PA 17065, BRENT K. LOCHBAUM, 5512
Creekwood Dr., Ft. Worth, TX 76109, PHILLIP G. CLOSE, 114 Elm St.,
Franklin, PA 16323, KEVIN R. CLOSE, 208 Manor Dr., Franklin, PA 16323,
CABBIE A. CLOSE, 208 Manor Dr., Franklin, PA 16323 and LAURA M.
LOCHHP,UM, 11735 Shadduck Rd., North East, PA 16.428, in equal shares,
1
share and share alike. If any grandchild of mine predeceases me, then
their share shall lapse, and shall instead be distributed to my
remaining children living at the time of my decease
A. My Franklin Fund, together with any interest or
dividends accruing thereto, at the time of my death.
B. My Neuberger-Berman IRA-Focus Fund, together with
any interest or dividends accruing thereto, at the time of my
death.
C. My IRA Account which is through Butler-Wick.
D. Any other assets of a liquid nature which I may own
at the time of my death, either in addition to, or in
substitution for the assets specifically listed, aforesaid.
THIRD: I give and bequeath the following specific items OF
PERSONAL PROPERTY:
A. To my granddaughter, CABBIE A. CLOSE, my diamond
dinner ring, absolutely.
B. It is my will that the items of personal property
which I have listed and have given to my Executrix, Willa M.
Soli, be distributed by my Executrix, or Executor, as the
case may be, in accordance with such list, which I may, from
time to time, amend.'
FOURTH: ALL the rest, residue and remainder of my estate of
whatsoever ykind and wheresoever situate, whether real, personal or
mixed, I give, devise and bequeath to my grandchildren, SARA L. GORDON,
Apt. J, 600 N. Baltimore Ave., Mt. Holly Springs, PA 17065, BRENT K.
LOCHBAUM, 5512 Creekwood Dr., Ft. Worth, TX 76109, PHILLIP G. CLOSE,
2
114 Elm St., Franklin, PA 16323, KEVIN R. CLOSE, 208 Manor Dr.,
Franklin, PA 16323, CABBIE A. CLOSE, 208 Manor Dr., Franklin, PA 16323
and LAURA M. LOCHBAUM, 11735 Shadduck Rd., North East, Pa 16428; in
equal shares, share and share alike. If any grandchild of mine
predeceases me, then their share shall lapse, and shall instead be
distributed
FIFTH; I hereby .nominate, constitute and appoint my
daughter, WILLA M. SOLI, to be the Executrix of this my Last Will and
Testament. However, in the event that my said- daughter shall
predecease me, or shall be or become unable or unwilling to serve as my
Executrix, I hereby nominate, constitute and appoint my son, RICHARD W.
CLOSE, JR., t0 be the Executor of this my Last Will and Testament.
Said Executrix or Executor shall serve without giving bond for the
faithful performance of their duties as said fiduciary.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this, my Last Will and Testament, on the 30th day of March 2000.
^~ r~
(''
S EORA HNSON
Signed, sealed, published and declared by ESTHER LEORA JOHNSON, the
above-named Testatrix, as and for her Last Will and Testament, in our
presence, and we, at her request and in the presence of the Testatrix,
ESTHER LEORA JOHNSON, and in the presence of each other, have: hereunto
subscribed amour names as witnesses thereto.
~~~CUtci ~- I ~C,u o f ~, Q/ Q~ ~f z Z
Mary Stewart
`~/ of ~' ~~~``
Vir nia D. Proper
.~ ~ /~~
3
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF VENANGO
I, ESTHER LEORA JOHNSON, and We, Mary E. Stewart
and Virginia D. Proper• the testatrix and the witnesses
respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her Last Will and
Testament, and that she had signed willingly. and that she executed it
as her free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the
testatrix, signed the Last Will and Testament as witnesses and that to
the best of their knowledge the testatrix was at the time eighteen
years of age Or older, of sound mind and under no constraint or undue
influence.
ESTHER LE RA JO ON
~~~ C, 2ec
Mary E Stewart
~_ ~
Virg' is D. Proper
Subscribed, sworn to and acknowledged before me by ESTHER LEORA
JOHNSON, the testatrix and sworn to before me by witnesses, Mary
E. Stewart and Virginia D. Proper this
30th day of March 2000.
....
NOTARIAL SEAL NOt y Public
FRANK R. RIDDLE, NOTARY PUBL+~
FRANKLIN, VENANGO COUNTY
MY COMMISSION EXPIRES APRIL 18, 2002 ~. My COmm1SSiOn expires '
4
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REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 2008- 00766 PA No . 21- 08- 0766
Estate Of : ESTHER LEORA JOHNSON
(First, Middle, Lastl
Late Of : CARL/SLE BOROUGH
CUMBERLAND COUNTY
Deceased
Soci a1 Security No : 190-16-7471
WHEREAS, on the 21st day of July 2008 an instrument dated
March 30th 2008 was admitted to probate as the Iasi will of
ESTHER LEORA JOHNSON
(First, Midd/e, LasU
late of CARL/SLEBOROUGH, CUMBERLAND County,
who died on the 7th day of July 2008 and,
WHEREAS, a-.true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills ~n and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
W/LLA MSOLI '
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to Iaw, all of which
fully appears of record in my office a t CUMBERLAND COUNTY COURT HDUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 21st day of July 2008.
r 1.~: , ~c -zc
eg/ster o I/ls i
L, . _ ~~ ,
eputy
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE,- LAST)