HomeMy WebLinkAbout03-0700 PETITION
Estate of Clarence W. Johnson
also known as
'~ l
, Deceased.
FOR PROBATE and
No.
To:
Social Security No. 207-09-0843
GRANT OF LETTERS
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut or
in the last will of the above decedent, dated.,'. Novembor 83
and codicil(s) dated ..
in the
named
, ~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in O~rnl"~r] and County, Pennsylvania, with
h is last family or principal residence at 101 Mountail2 Road, Stumnorda] ~. pA 17003
(list street, number, Twp. or Boro.)
Decedent, then 91 >'ears of age, died &ugust 12 , ~ 2003 ,
at Holy Spirit Hospital, Camp_ Hill. PennsylvaniQ
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 4,000.00
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania
situated as follows:
$ 1~3,,333.GG
WHEREFORE, petitioner(s) respectfully request(s) the probate
presented herewith and the grant of letters Testamonta.ry
theron.
of the last will and codicil(s)
(testamentary; administration ¢.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA q~ ss
COUNTY OF Ctm~berlonct
tative(s) of the above decedent petitioner(s) will well a_nd truly adrrt~ni~er
Sworn to or affirmed and subscribed
before me this ~ 22nd day of { ' / -
~A~~/~ ~ 2003J . .
~nna M. 0~o, 1st ~ty' - /- ~g;~l
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
the estate according to law'.
21-2003-700
Estate Of
Clarence W. Johnson, a/k/a'
Wilbert Johnson Jr.
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
August 26th
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated Nov~a'nber 8th, 2001
described therein be admitted to probate and filed of record as the last will of
Clarence W. Johnson, a/k/a Wi~ert John~qon Jr.
and Letters Testamentary
are hereby granted to Earl H. Johnson
Xl~ 2003, in consideration of the petition on
FEES
Probate, Letters, Etc .......... $ 200.00
Short Certificates(4) .......... $ 1
~ . ~.-.P. og~i%. (. ~).. $ 6. O0
JCP $ 10.00
TOTAL __ $ 228.00
Filed A..u.~..s.t., .2.6.t.h. :..2.0.0..3: ..............
Mailed Letters to Attorney on
8/26/2003.
Willi~n C. DSs~Sno~w # 27737
ATTORNEY(Sup. Ct.I.D. N0.)
400 South State Road, Marysville.
ADDRESS
PA 17053
(717) 957'3474
PHONE
21-2003-700
LAST WILL AND TESTAMENT
OF
CLARENCE W. JOHNSON
I, Clarence W. Johnson, of 101 Mountain Street, Summerdale,
East Pennsboro Township, Cumberland County, Pennsylvania, being
of sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament, hereby
revoking all Wills and Codicils heretofore made by me.
ITEM I. I direct that all my debts and funeral expenses,
including my cemetery lot and grave marker and all expenses of my
last illness, shall be paid from my residuary estate as soon as
practicable after my death as part of the expense of the
administration of my estate.
ITEM II. I devise and bequeath all of my estate of every
nature and wherever situate as follows:
C o
10% to the Summerdale United Methodist
Church, of Summerdale Pennsylvania; and
30% to Earl H. Johnson of Lemoyne
Pennsylvania, and his issue per stirpes; and
30% to Edward Q. Allison, of Ohio, and his
issue per stirpes; and
30% to Donald E. Allison, of Massachusetts,
and his issue per stirpes.
ITEM III. I direct that any and all Inheritance, Estate and
Transfer taxes imposed upon my estate passing under my Will or
~therwise, shall be paid out of the principal of my residual
~state.
ITEM IV. I appoint Earl H. Johnson, Executor of this my
Last Will and Testament. In the event of his renunciation, death,
resignation or inability to act for any reason whatsoever, I
appoint Sandy L. Johnson, Executrix of this my Last Will and
Testament. I relieve my Executor/Executrix from the necessity of
posting security in connection with his/her duties as such in any
jurisdiction in which he/she may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand to this my
Last Will and Testament, which consists of. ~- pages, to each of
which I have affixed my signature this ~'-!day of ~)V, ,
two thousand and one (2001).
Clarence W.
COMMONWEALTH OF PENNSYLVANIA :
: ss ::
COUNTY OF 1~~ :
We, Clarence W. Johnson, and ~>~~ ~'__ ~~and
~ ~. ~F~~'A , the testator and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testator signed and executed the
instrument as his Last Will and that he had signed willingly, and
that he executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence
and hearing of the testator, signed the Will as witness and that
to the best of their knowledge the testator was at that time
eighteen years of age or older, of sound mind and under no
constraint or undue influence.
Clarence WF~Jo_h~on, Tee tator
WitneSs '7 C ~ ~- //
Witness U
Subscribed and sworn to and acknowledged
before me by Clarence W. Johnson, Testator
and subscribed anD sworn Ko ~nd acknowledged
bqfore me ~y~ ~~ ~. I~~ and
~a~ ~. ~~ , witnesse~ this
~ da~ %f ~~~ , 2001.
NOTARIAL SEAl..
LEIGH ANN SNYDE2, f?.~t~%~ Pub:lc
My Commission Expirss
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 _ O3 0700
COUNTY COOE YEAR NUMBER
I-
Z
UJ
m,
Z
0
X
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Johnson, Clarence W.
DATE OF DEATH (MM-DD-YEAR)
08/12/2003
DATE OF BIRTH (MM-DD-YEAR
02/17/1912
SOCIAL SECURITY NUMBER
207-09-0843
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING ~,POUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
NA
~-~1. Odginal Return
E~4. Limited Estate
~---~ 6. Decedent Died Testate (A~ch copy of W~)
E~9. Litigation Proceeds Received
E~]2. Supplemental Return
E~] 4a. Future Interest Compromise (date of death alter 12-12,82)
E~]7. Decedent Maintained a Living Trust (A,ac, copy of Trust}
---]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
E~]3. Remainder Return (Uate of death pnor to 12-13,82)
F-'I. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
'--]11. Election to tax under Sec. 9113(A) (Attach Sch O)
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
William C. Dissinger
FIRM NAME {ffApplicable)
Dissinger and Dissinger
TELEPHONE NUMBER
(717) 957-3474
COMPLETE MAILING ADDRESS
400 South State Road
Marysville, PA 17053
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Properb/ (5)
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6)
E~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probata Prope~ (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses &Administrative Costs (Schedule H) (9)
10. BeLts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
112,000.00
0.00':
0.00
o.oo'
5,695.061
0.00
(8)
20,688.81
0.00
(11)
(12)
117,695.06
20,688.81
97,006.63
(13)
(14)
9~700.63
87,305.62
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) 0.00 x .0 0 (15)
16. Amount of Line14 taxable at lineal rate 0.00 x .0 0 (16)
17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
18. Amount of Line 14 taxable at collateral rate 87,305.62 x .15 (18)
0.00
0.00
0.00
13,095.84
19. Tax Due (19)
13,095.84
· · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH
Dei:edent's Complete Address:
STREET ADDRESS
101 Mountain Street
ClTYsummerdale I STATEpA I ZIP 17093
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pr[or Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
0.00
(1)
Total Credits ( A + B + C ) (2)
0.00
0.00
Total Interest/Penalty ( D + E ) (3)
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)
13,095.84
0.00
0.OO
0.00
13,095.84
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 13,095.84
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING OUESTIONS BY PI_~ClNG 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; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
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 penailJes 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 Irue, correct and complete.
Declaration of preparer other than th~ personal representative is based on all information of which preparer has any knowledge.
ADDRESS ' vt- ~'
7074 Par Street, Lemoyne, PA 17039
DATE
SIGNA'[.URE OF PREPARER OTHER~A"N REPp, ESENTATIVE
ADDRESS ( .....
400 South State Road, Marysville, PA 17053
DATE
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 exemet 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 twen¥one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Clarence W. Johnson
Ail 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 VALUE AT DATE
NUMBER DESCRIPTION o OF DEATH
1. 112,000.00
Real Estate located at 101 Mountain Street, Summerdale, East Pennsboro
Township, Cumberland County, Pennsylvania (Sold on 12/23/03).
TOTAL (Also enter on line 1, Recapitulation) $ 112,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Clarence W. Johnson
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship m.ust be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4,
5.
Account #49506579 with M & T Bank.
1987 Olds Ciera Station wagon.
Proceeds of miscellaneous personnel property sold at auction.
Refund from Hallmart Insurance.
Refund from Verizon
TOTAL (Also enter on line 5, Recapitulation)
2003.00
650.00
2774.73
257.17
10.16
5,695.06
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHE. RITANCE TAX RETURN
RESIDENT DECEOENT
ESTATE OF
Clarence W. Johsnon
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule
ITEM
NUMBER DESCRIPTION
FUNERAL EXPENSES: ,,
Bo
9.
10.
11.
12.
13.
14.
15.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Persm~l Repmse~lative(s) Ead H. Johnson ·
Social Security Number(s)/EIN Number of Personal Representative(s)
$1metAddmss 7074 Par Street
c~y Lemoyne state
Yea,'(s) Coenmission Paid: 2004
A~mey Fees
Family Exemplion: (If decedenrs address is not the same as ctaimanrs, attach explanation)
Claimsnt
PA , Zip 17039
Sb'ee{ Address
city
Relationship o~ Claimant to Decedent
State ,, Zip
Probate Fees
Accountant's Fees
Tax Re~um Prepm*er'e Fees
The Patriot-News
Cumberland County Law Journal
PPL
NlState (homeowners insurance)
Earl H. Johnson, II (trash removal)
Earl H. Johsnon, I1 (trash removal)
John Mutzabaugh (trash removal)
East Pennsboro Township (sewer)
PPL
TOTAL (Nso enter on line 9, Recapitulation)
AMOUNT
Prepaid
7,061.70
7,061.70
0.00
228.00
0.00
0.00
122.35
75.00
130.81
25.25
100.00
75.0O
400.0O
96.00
66.63
20,688.81
(If more space is needed, insert additional sheets of the ~T~e size)
SCHEDULE H - Continued
16.
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Verizon
Earl H. Johnson, II cleaning)
Earl H. Johnson, II cleaning) °
Verizon
AllState
PPL
AllState
Suburban Propane
Earl H. Johnson, II trash p~ckup)
AllState (car insurance)
Suburban Propane
Cigic's Garage (car inspection)
Cost of Settlement on Real Estate
Auctioneer Commission on sale of real estate
Earl H. Johnson, II
(Reimbursement for payment of snow removal)
15.67
100.00
100.00
15.62
38.40
64.96
25.25
9.57
100.00
76.84
50.08
146.00
2006.81
2240.00
257.17
REV-l$13 EX* (g-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Clarence W. Johnson
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, and transi'ers under
Sec. 9116 (a)(1.2)]
Earl H. Johnson, II
7074 Par Street
Lemoyne, PA 17039
Edward Q. Allison
1511 South Kohler Road
Orrville, OH 44667
Donald E. Allison
10 Skye Line Drive
Sutton, MA 05190
"nephew
nephew
nephew
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
NONE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Summerdale United Methodist Church
203 Second Street
Summerdale, PA 17093
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)
30%
30%
30%
10%
499 Mitchell Road, Millshoro, DE 19966 Mail Code DE-MB-12
Dissinger & Dissinger
Attorneys At Law
400 South State Road
Marysville, PA 17053
Phone (888) 5024349
F ax (302) 934-2955
February 12, 2004
Re: Estate of Clarence W Johnson
Social Security: 207-09-0849
Date of Death: August 12, 2003
Dear Sir or Madam:
Per your inquiry dated January 29, 2004, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
.1.
Type of Account
Account Number
Ownership (Names oj)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Check#,g Accotmt
49506579
Clcnwwe W dohm'o~7
03/28/73
S2, 003. O0
,5 0.00
.... 'S-,_;~50'O- ......................................................................
For further account information, closures and/or reimbursement of funds please call the Summerdale Plaza Office at #717-255-226l.
Please be advised, there was no safc deposit box found for the above decedent.
Records Management
OMB No. 2502-0265
SETTLEMENT STATEMENT Titlepro for WindowsTM
ASSURED LAND TRANSFERS, INC.
301 Market Street a. TYPE OF LOAN
PO Box 109 [] 1. FHA [] 2. FMHA [] 3. CONV.UNtNS.
Lemoyne, PA 17043-0109 [-]4. VA ~']5. CONV. INS.
(717) 761-4720 6. FILE NUMBER:
1
7.
LOAN
NUMBER:
136864 I
MORT. INS. CASE NO.:
9430-11
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER
Mickey Shuler Earl H. Johnson, Executor of the Estate of Clarence Cash
Johnson
332 Belle Vista Drive
Marysville PA 17053
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Assured Land Transfers Inc. I. SE'I-rLEMENT DATE:
101 Mountain Street '
Summerdale, PA 12/23/2003
Tuesday
East Pennsboro Township PLACE OF SETTLEMENT: 301 Market Street 01:00 AM
Cumberland County, PA Lemoyne, PA 17043
J, SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. Gross Amount Due From Borrower 400. Gross Amount Due to Seller
101. Contract sales price 112,000.00 401. Contract sales price 112,00Q0£
102. Personal Property ~402. Personal Property
103. Settlement Charges (line 1400) 2,077.25 403.
104. 404.
105. '~,05.
Adjustments for items paid in advance by seller(s) Adjustments for items paid in advance by seller(s)
106. City/Town tax 12/23/03 to 12/31/03 2.51 406. City/Town tax 12123103 to 12/31/03 2.51
107. County/City tax 12/23/03 to 12/31/03 6.09 407. County/City tax 12/23/03 to 12/31/03 6.09
108. Assessments 408. Assessments
109. SchooITax 12/23/03 to 06~30~04 810.18 409. SchoolTax 12/23/03 to 06~30~04 810.1B
10. Sewer/Refuse 4th Quareter 12/23/03 to 12/31/03 8.44 410. Sewer/Refuse 4th Quareter 12/23/03 to 12/31/03 8.,~.
11. 411.
12.
412.
120. Gross Amount Due from Borrower 114,904.47 420. Gross Amount Due to Seller 112,827.22
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
~01. Deposit or earnest money 12,000.00 501. Excess deposit (see instructions)
202. Principal Amount of new loan(s) §02. Settlement charges to seller (line 1400) 2,834.0?'
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. ~04.
205.
505.
206.
207. 506.
~08. ~07.
;~09. 508.
509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. City/Town tax 510. City/Town tax
21 1. County/City tax 511. County/City tax
212. Assessments 512. Assessments ~
213. School Tax --
214. 513. School Tax
215. 514.
216. 515.
516. ~
217. ~
~18. - 517.
~19. ~,1~. - ..... _
519.
220. Total Paid By/For Borrower 12,000.00 520. Total Reduction Amount Due Seller 2,834.03
300. CASH AT SE I [LEMENT From/To BORROWER 600. CASH AT SE I ~ LEMENT To/From SELLER
301. Gross Amt. due from borrower (line 120) 114,904.47 601. Gross Amount due Seller (line 420) 112,827.2~
:302. Less Amt. paid by/for borrower (line 220) 12,000.00 _602. Less reduction in Amt.due Seller (line 520) 2,834.03
102,904.47 603. Cash[] TO [] FROM Seller 109,993.19
Buyer or Borrower's Signature
Seller's Signatur~
L SETTLEMENT CHARGES
700. Total Sales Commission based on Price: $
Division of Commission at: $
Total
701.
702.
703. Commission paid at Settlement
704.
Paid From
IBorrower's
IFunds At
Paid From
Seller's
Funds At
Settlement Settlement
800.
801.
802.
803.
804.
805.
806.
807.
808.
809.
810.
811.
900.
901.
902.
903.
904.
905.
1000.
Items Payable in Connection With Loan
Loan Origination Fee
Loan Discount
Appraisal Fee to
Credit Report to
Inspection Fee to
Mortgage Insurance to
Assumption Fee to
Items Required By Lender To Be Paid In Advance
Interest from
Mortgage Ins. Premium 0 Months to
Hazard Ins. Premium 0 Years to
0 Years to
0 Years to
Reserves Deposited With Lender For
/Day
1001.
1002.
1003.
004.
1005.
1006.
1007.
1008.
1100.
1101.
1102.
1103.
1104.
1105.
1106.
107.
1108.
1109.
1110.
1111.
1112.
1113.
1200.
1201.
1202.
1203.
1204.
1205.
1300.
301.
1302.
1303.
1304.
1305.
1400.
Hazard Insurance 0 Months @ $ /Month
Mortgage Insurance 0 Months @ $ /Month
City/Town Taxes 0 Months @ $ /Month
County Taxes 0 Months @ $ /Month
Assessments 0 Months @ $ /Month
School Taxes 0 Months @ $ /Month
0 Months @ $ /Month
0 Months @ $ /Month
Title Charges
Settlement or closing fee
Abstract or title search
Title Examination
Title Insurance Binder
Document preparation
Notary fees
Attorney's fees
(includes above items No.:)
Title Insurance
(includes above items No.:) 1101-1104 and 1108 Basic
Lender's coverage $
Owner's coverage $ 112,000.00
Assured Land Transfers, Inc.
Government Recording and Transfer Charges
Recording Fees: Deed $ 38.50 Mortgage $
City/County tax/stamps: Deed $1,120.00 Modgage $
State tax/stamps: Deed $1,120.00 ' Mortgage $
Additional Settlement Charges
2003 School Taxes to
Tax Certification to
Release $
Recorder of Deeds
Alicia D. Stine, Treasurer
Alicia D. Stine, Treasurer
Total Settlement Charges (enter on lines 103 & 502, Sections J & K)
2,077.25
Padies agree that no liability is assumed by Settlement Agent for the accuracy of information I'urnished by others as shown on the HUD-1 Settlement Statement.
I have carefully reviewed the HUD-1 Settlement StateHmUenDt CanEdRtTJFt~CeAb?sOt NofOmFyE~nUoYwEleRdSgeANanDdSbEelLieLfE' irt iSs a true and accurate statement of all receipt~ and
disbars ada ccount by me in this transaction. I further cedi~ that I have received a copy of the HUD 1 Settlement Statement
-
~uyer or BZwer's Signature ~'~' ~'~
Seller's Signature ·
Buyer's Address & Phone:
Seller's New Address &,~none:
1,120.00
1,712.03
2,834.0_.~
The HUD-1 Settlement Statement which I have prepared is a lrue and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this
statemenL
'"eme,,,Agent
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Admin No.
To the Register:
Clarence W. Johnson
August 12, 2003
2003-00700
I certify that notice of beneficial interest required by Rule
5.6(a) of the Orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on
Summerdale United
Methodist Church
Earl H. Johnson
Edward Q. Allison
Donald E. Allison
16 Mondale Circle
Hummelstown, PA 17036
7074 Par Street
Lemoyne, PA 17039
1511 South Kohler Road
Orrville, OH 44667
10 Skye Line Drive
Sutton, MA 01590
Notice has now been given to all persons entitled thereto under
Rule 5.6 (a) except: NONE.
William C. Dissinger
Capacity:
400 South State Road
Marysville, PA 17053
(717) 957-3474
Personal Representative
X Counsel for Personal
Representative
DISSINGEI _D
ISSINGER
Camp Hill Offices: 717.975.2840/voice · 717.975.3924/fax
Marysville Offices: 717.957.3474/voice · 717.957.2316/fax
February 19, 2004
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Re:
Estate of Clarence W. Johnson
21-2003-700
Dear Sir or Madame:
Enclosed, please find two (2) executed Inheritance Tax
Returns and a check in the amount of Thirteen Thousand Ninety-
five dollars and Eighty-four cents ($13,095.84) made payable to
Register of Wills, Agent. Also, enclosed is another check for
Fifteen dollars ($15.00) made payable to the Register of Wills,
the fee for filing the Inheritance Tax Return. Please file the
returns of record and apply the check to inheritance tax.
If you have any questions, please contact me at my office.
Very ,~iy '~iours,
~/ ' ,
Attorney at Law
WCD:las
encl: 4
cc: Earl H. Johnson, II
File 3-03-209
Attorneys at Law
28 North Thirty-Second Street · Camp Hill, PA 17011
400 South State Road · Marysville, PA 17053
COMMONWEALTH OF PENNSYLVAI~JA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
DISSINGER WILLIAM C
28 NORTH THIRTY-SECOND ST
CAMP HILL, PA 17011
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 0O3611
........ fold
ESTATE INFORMATION: SSN: 207-09-0843
FILE NUMBER: 2103-0700
'DECEDENT NAME: JOHNSON CLARENCE W
DATE OF PAYMENT: 02/27/2004
POSTMARK DATE: 02/26/2004
COUNTY: 'CUMBERLAND
DATE OF DEATH: 08/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $13,095.84
R'EMARKS:
SEAL
CHECK# 122
TOTAL AMOUNT PAID:
$13,095.84
INITIALS' JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF ZNDZVZDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. 280601
HARR/SBURG, PA 17128-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLOWANCE OR DZSALLONANCE
OF DEDUCTXONS AND ASSESSNENT OF TAX
REV-15~7 EX &FP ¢01-05)
'04 /~PR 2O
WILLIAM C DISSINGER
DISSINGER & DISSINGER
400 S STATE RD ~x:.: -
HARYSV Z L L E PA,tI~
DATE
ESTATE OF
DATE OF DEATH
FILE NUNBER
COUNTY
ACN
04-19-2004
JOHNSON
08-12-2005
21 05-0700
CUHBERLAND
101
Amount Rem J.t'l:ed
CLARENCE W
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTXCE OF INHERITANCE TAX APPRAXSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF JOHNSON CLARENCE WFZLE NO. 21 05-0700 ACN 101 DATE 04-19-2004
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATXON CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAXSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Par~nersh/p Interest (Schedule C) ($)
4. Hortgeges/Notes Receivable (Schedule D} (4)
5. Cash/Bank Depos/ts/H/sc. Personal Property (Schedule E) ($)
6. Jo/ntly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. TotaZ Assets
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expenses/Adc. Costs/H/sc. Expenses (Schedule H) (9)
10. Debts/Nortgage Liabilltles/L/ens (Schedule Z) (10)
11. Total Deduct/ohs
12. Net Value of Tax Return
15.
14.
Cher/table/Governeental Bequests; Non-elected 9115 Trusts (Schedule J)
Ne~ Value of Estate Subject to Tax
112~000.00
.00
.00
.00
5~695.06
.00
.0O
(8)
20,688.81
.00
NOTE: To insure proper
credi~ ~o your account,
sube/t the upper port/on
of th/s fore w/th your
tax payment.
NOTE:
117,695.06
(11) 20 .&88.81
(1~) 97,006.65
(~$) 9,700.65
(14) 87,505.62
Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17,
re~lect ~Lgures that include the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. Aeount of L/ne lq at Spousal rate
16. Amount of L/ne 1~ taxabXe at L~neal/Class A rate
17. Aeount of Line 14 at S/bl/ng rate
18. Amount of L/ne 14 taxable e~ Collateral/Class B ra~a
19. PrLnc/pal Tax Due
TAX CREDITS:
PAYHENT RECETPT' DTSCOUNT
DATE NUNBER INTEREST/PEN PAZD (-)
02-26-2004 CD005611 .00
18 and 19 will
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
('ts), .00 x O0 = .00
(].6), .00 x 045= .00
(17) . O0 x 12 = . O0
(~8) 87,505.62 x 15 = 15,095.84
(~9)= 15,095.84
AHOUNT PAID
13,095.84
TOTAL TAX CREDIT I 15,095.84
BALANCE OF TAX DUEl .00
INTEREST AND PEN. .00
TOTAL DUE .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.)~
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Comeonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laeful Class B (collateral) rate an any such future interest.
To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
far Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications are available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special 24-hour
ansaering service for fores ordering: 1-800-362-2050; services for taxpayers eith special hearing and / or
speaking needs: 1-800-~47-50Z0 (TT only).
Any party in interest not satisfied mith the appraisement, allowance, or disallomance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice oust object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-65D5. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dscadant's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This nan-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the data of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .00016~. AIl taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by tho PA Department of Revenue. The applicable interest rates for 1982 through 200~ are:
Interest Dally Interest Daily
Year Rate Factor Year Rate Factor
1981 201 .0005~8 ~'~J~6-1991 111 .000301
1985 167. .000~38 1992 91 · OOOZq7
198q 117. .000301 1993-199~ 7Z .DO019Z
1985 131 .000356 1995-1998 91 .0002~7
1986 lOZ .O00Z7~ 1999 77. .OOO19Z
1987 iOZ . O O0 Z7~. 2000 7X .000192
--Interest is calculated as folloes:
INTEREST = BALANCE OF TAX UNPAID
Interest Dally
Year Rate Factor
~ 9Z .O00Z~7
ZOOZ 6Z .O0016~
2003 57. .000137
200~ ~Z .000110
X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/13/2005
JOHNSON EARL H
7074 PEAR STREET
LEMOYNE, PA 17043
RE: Estate of JOHNSON CLARENCE W
File Number: 2003-00700
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/12/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~A~~~
REGISTER OF WILLS
cc: File
Counsel
Judge
oJ
STATUS REPORT U1\1DER RULE 6.12
Name of Decedent:
C/qVeVlCe W. :rol.,V\50Y\
ItlXjU~+ J21 ~OO~
0;00 3- 0070 C)
Date of Death:
~\ \ e..
WrltNo.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I repOli the
following with respect to completion of the administration of the above-captioned estate:
1. State whytfier administration of the estate is complete:
Yes [3' No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lithe answer to No.1 is Yes, state the following:
a. Did the personal ~~tative file a final account with the Court?
Yes _ No L1'
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: --I:Y. A-
c. Did the personal ~ntative state an account informally to the parties
in interest? Yes l.:::1 No 0
LL
C'
L1.J
C)_
rl~_
L; __ '
c_;,"
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
<md may boa_hoi to this report. @: 1
Date:~/{)S .~C~~~~
Si~ /'
W;\!iCtrY) ~. ni5.sir"l~ .
Name
"'100 S. S~-te ~J
.JrIOf. vY.Sv L/ /jO (Ji+ 17{)55
Address
717 -9.!J-7- 3 L/ 7 Lj
Telephone No.
N
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Capacity: Q P~al Representative
Ld"Counsel for personal representative
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