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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
Date
AUG 16 2001'
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYL1d-NIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH 014 5 9 4
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't11EDICAL E]IAtNNEN/CORONEA (Item 27) Typo ar PrIM
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REGISTRM'SSIGNATURE AND NUMSEq~
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INIi
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131191 CHECK HERE
POVERTUC EDIT IS CLAIMED ^
RESIDENT DECEDENT FILE NUMBER
(TO BE FILtD IN DUPLICATE
WITH REGISTER OF WILLS) COUNTY CODE % ' • - YEAR g'S'-°:: ~M~O~'
1606 BRIDGE STREET
OF8IRTH NEW CUMBERLAND, PA. 17070
ioo-~U-G~n ~ IU1-1~3-
(IF APPIICABIE) SURVIVING SPOUSE'S NAME ILAST, FIRST AND MIDDLE INITIAL)
® 1. Original Return
^ 4. Limited Estate
® b. Decedent Died Testat
(Attach copy of Will)
AL4CORRESPONDENC~,' _
NAME
_ WILLIAM J. JO
uta l GO;J-L / 1 /
^ 2. Supplemental Return ^ 3. Remainder Return
(for dates of death prior to 12-13-82)
^ 4a. Future Interest Compromise ^ S. Federal Estate Tax Return Required
(for dates of death after 12-12-82)
e ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe De osif Boxes
(Attach copy of Trust) P
AND CONFIR~~ITIAL TAX ~NFQRMATION SHOULD SE,DIRECTED T0: `
COMPLETE MAILING ADDRESS
HNSON EXECUTOR 10314 LAKE CARROLL WAY
TAMPA, FL. 33618
1. Real Estate (Schedule A) (1 } 115 . O O O
2. Stocks and Bonds (Schedule B) (2) 16 4 , 3 5 6
3. Closely Held StocklPartnership Interest (Schedule C) (3) O
4. Mortgages and Notes Receivable (Schedule D) (4 } 0
5. Cash, Bank Deposits ~ Miscellaneous Personal Property
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b. Jointly Owned Property (Schedule F} (b) _ n
7. Transfers (Schedule G) (Schedule L) (7) ~
8. Total Gross Assets (total Lines 1.7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
E
h (9) 13 , 6 3 7
xpenses (Sc
edule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) r, r, 6 ~
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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based on
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(B) _ 292,559
(l t) 19 200
(12) 273.359
1131 0
273,359
pausal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse (15
Side. (Include values from Schedule K or Schedule M.) ) O x'-=
1 b. Amount of Line 14 taxable at b% rate (16) __ 7 r 3 5 9 x .06 = 16 , t} O 2
(Include .values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17) O x .15 = n
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ 17,250 + _
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
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21. If Line 18 is greater than Line 19, enter the difference on•Line 21. This is the TAX DUE
A. Enter the interest on the balance due on Line 21A.
B. Enter the total of Line 21 and 21A on Line 216. This is the BALANCE DUE.
Make Cheek Payable to: Register of Wills, Agent
)- ~ BE SURE TO ANSWERtALL CIUESTIONS-O~I REVERSE SIDE=AN
:Ities of perjury, I declare that 1 have examined this return, including accompanying schedules ar
rred and complete. I declare that all real estate has been reported at true market value. Declar
II i formation of which preparer has anv knowladno
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(18) 16, 402
(19) 17, 250
(20) 8 4 8
(21)
(21 A)
(21 B)
-~O R~CHECKMATH- :~ ~
statements, and to the best of my knowledge and belief,
ion of preparer other than the personal representative is
DATE
DATE
e
Act #48 of 1994 provides for the reduction of the tax rates imposed on~the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 3% (.03j will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02j will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1% (.O1j will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
BY PLACING AS CHECK MARK (rOj IN HE APPROPR ATE BLOCKS.
1. Did decedent make a transfer and:
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 on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration$ 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'. bank account at his or her deaths .............................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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REV-1502 EX+ (12.851 !
` SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
FILE N
NAOMI B. JOHNSON 1995-00142
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
REV-1503 EX+ (4.86) ~,
SCHEDULE B
COMMONWEALTH OF DENNSYLVANIA STOCKS AND BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
NAOMI B. JOHNSON 1995-00142
(All property (ointl
-own
d
ith Ri
h
f
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s
w
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t o
Survivorship must b• disclosed on Sehoduls F.)
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
~
• 700 SHARES AT&T CORP @ $50.500
2. 248 SHARES AIRTOUCH COMMUNICATIONS @ $27.125 35,350
727
6
3.
4 600 SHARES AMERITECH CORP NEW @ $41.875 '
25
125
. 400 SHARES BELL ATLANTIC CORP @ $52.125 ,
20
850
5.
6 200 SHARES CHECKERS DRIVE_IN RESTAURANTS @ $3.313 .
.
976
3
. 300 SHARES DQE, INC. @ $32.500 x
7. 400 SHARES NYNEX CORP @ $38.375 9.750
8. 248 SHARES PACIFIC TELESIS GROUP @ $29,750 15,350
378
7
9. 600 SHARES SBC COMMUNICATIONS @ $41.250 '
24
750
10. 400 SHARES U S WEST, INC. @ $37.750 ,
15,100
TOTAL (Also enter on line 2, Recapitulation) $ 16 4 , 3 5 6
REV-1508 EX+ (2.87)
,~. ~:
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
w trrt c yr
NAOMI B . JOHNSON FILE NUM
(All property jointly-owned with the Right of Survivorship must b~ disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION
1. PNC BANK (ACCT # 51-4003-2082)
2. MERIDIAN BANK (ACCT #32315194)
3. PNC BANK (ADJUST ACCT BALANCE}
4. PAINE WEBBER (ACCT # CW 10397 47)DEPOSIT IN TRANS
5. HOUSEHOLD FURNISHINGS
Please Print or Type
ER
1995-00142
TOTAL (Also enter on line 5, Recapitulation) $
(Attach additional 8y:" x 11" sheets if more space is needed.)
VALUE AT
DATE OF DEATH
1,770.62
4,787.10
16.03
1,629.16
5,000.00
13,202.91
REV-1511 EXi I7-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
NAOMI B. JOHNSON
Please Print or Type
3ER
1995-00142
AMOUNT
ITEM
NUMBER DESCRIPTION
~-• Funeral Expenses:
1• FLOWERS
2. CHURCH FOOD SERVICE
3. STONE & MURRAY FUNERAL HOME
B.
1.
2.
2.
3.
4
C.
1
2
3
4.
5.
6.
7.
8.
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
CHECK PRINTING COSTS, EXECUTOR'S BANK ACCOUNT
Attorney Fees
Family Exemption
Claimant THOMAS R. JOHNSON Relationship SON
Address of Claimant at decedent's death
Street Address ~_60Fi BR"rnr_F STREET
City NF.W ['iTMRFRT nT.Tn State ~_ Zip Code_ i ~n7n
Probate Fees
REGISTER OF WILLS, CUMBERLAND COUNTY, PA
Miscellaneous Expenses:
SETTLEMENT COSTS, SALE OF RESIDENCE
1,235..25
APPRAISAL FEE RE SALE OF:'.•RESIDENCE 250.00
BROKER's COMMISSIONS, SALE OF COMMON STOCKS 3,226.79
4,712.04
161.60
239.31
6,147.00
72.37
2,000.00
305.00
4,712.04
TOTAL (Also enter on line 9, Recapitulation) I $
13,637 32
- (If more space is needed, insert additional sheets of same size.)
REV•151Z E%+ (1.93)
SCHEDULE 1
COMMONWEAUH OF PENNSYLVANIA DEBTS OF DECEDENT,
RESIDENT DECEDENT
INHERITANCETAxRETURN MORTGAGE LIABILITIES AND LIENS
ESTATE OF Please Print or Type
NAOMI B . JOHNSON FILE NUMBER
1995-00142
ITEM
NUMBER DESCRIPTION
AMOUNT
1' PAINE WEBBER - MARGIN ACCOUNT BALANCE
2. STATE OF PENNSYLVANIA - 1994 STATE INCOME TAX 5,000.06
220.00
3• FAMILY PHYSICIAN'S ASSOC. OF NEW CUMBERLAND
52.00
4• ROBIN GASPERETTI - TAX COLLECTOR
291.32
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed,. insert additional sheets of same size.) - 5.5 6 3 3 8
RE V.1513 E%+R.87)
ESTATE
' ~1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER
1995-00142
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
NAOMI B. JOHNSON
ITEM
NUMBS NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~- WILLIAM J. JOHNSON
10314 LAKE CARROLL WAY, TAMPA, FL.33618
2. EDWIN R. JOHNSON
122 OAK DRIVE, CAMP HILL,PA. 17011
3- ROBERT Z. JOHNSON
6109 GREENLAWN CT., SPRINGFIELD, VA.
4- JACQUELINE L. RUTH
1762 SANDALWOOD PL., THOUSAND OAKS, CA.
5. MARJORIE H. CAMPBELL
705 ELKWOOD DRIVE, NEW CUMBERLAND, PA.
6. ELEANOR J. MARTIN
39 S. 39TH STREET, CAMP HILL, PA. 17011
7. BETTE ANN KOHN
6801 N.W. 43RD PL., GAINESVILLE, FL.
8. JANICE E. JAMOUNEAU
55 HIDDEN SPRINGS RD., DILLSBURG, PA.
9. THOMAS R. JOHNSON
1606 BRIDGE ST., NEW CUMBERLAND, PA.
10. GLENN H. JOHNSON, JR.
439 E. 51ST ST, APT. 5B, NEW YORK, N.Y.
11. KENNETH C. JOHNSON
514 16TH STREET, NEW CUMBERLAND, PA.
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
SON
SON
SON
DAUGHTER
DAUGHTER
DAUGHTER
DAUGHTER
DAUGHTER
SON
SON
SON
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more space is needed, insert additional sheets of same size)
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
1/11TH
AMOUNT OR
SHARE OF ESTATE
S
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters Testamentary
No. 1995-00142 PA No. 2195-0142
ESTATE OF JOHNSON NAOMI
Late of NEW CUMBERLAND BOROUGH
Deceased
Social Security No. 168-50-2567
WHEREAS, on the 23rd day of February 1995 an instrument
dated
December 30th 1977
was admitted to probate as the last will of~JOHN5ON NAOMI
late of NEW CUb133ERLAND BOROUGH , CUMBERLAND County, who died on the
18th day of February 199.5 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to WILLIAM J JOHNSON
who has duly qualified as Executor(rix)
and has agreed, to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 23rd day of February 1995.
r + 28:712 11/a/77
WILL
OF
NAOMI JOHNSON
I, NAOMI JOHNSON, of Cumberland County, Pennsylvania,
declare this to be my will and hereby revoke all prior wills
and codicils made by me.
1. I bequeath and devise the following specific items of
personal property to the following persons, or if any such
person does not survive me, then per stirpes to his or her
issue:
Description of Property Name of Recipient
1967 Ford LTD Automobile Kenneth C. Johnson
Misc. Coin Collections Thomas R. Johnson
China Elinor J. Martin
Diamond Ring Marjorie H. Campbell
Birth Stone Ring Jacquline L. Huth
Chime Clock, Cedar Chest and
Maple Rocker Bette A. Kohn
2. I bequeath, devise, and appoint all of my remaining
property, of whatever nature and wherever situated, including
property over which I hold a power of appointment, to my
children, or, if if any of my children do not survive me, per
stirpes to his or her issue.
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3. if any beneficiary under this will shall die within
thirty (30) days after my death, he shall be deemed to have
predeceased me for all purposes under this will.
4. I grant to the fiduciaries named herein and their
successor or successors, the following powers in addition to
and not in limitation of such powers as they may hold by
law:
(a) To invest any funds of my estate in any
stocks, bonds, notes or other securities or
property, real or personal, notwithstanding that
such investments may not be of the character
allowed to fiduciaries by statute or general rules
of law, it being my intention to give them the
broadest investment powers possible.
(b) To sell or otherwise dispose of any
property, real or personal, at any time forming a
part of my estate, for cash or upon credit, in
such manner and on such terms and conditions as
they may deem best, and no persons dealing with
them shall be bound to see to the application of
any moneys paid.
(c) To manage, operate, repair, improve,
mortgage or lease for any term any real estate at
any time held or owned by my estate.
(d) To borrow money for the payment of taxes
or for any other proper purposes in the administra-
tion of my estate.
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(e) To distribute in cash or in kind, upon
any division or distribution of my estate.
(f) In general, to exercise all powers in
the management of my estate which any individual
could exercise in the management of similar
property owned in his own right, upon such terms
and conditions as to them may seem best, and to
execute and deliver all instruments and to do all
acts which they may deem necessary or proper to
carry out the purposes of this my will.
5. Any amounts which are payable from my estate to a
minor may at the discretion of my executor be paid either to a
parent or guardian of such minor, to the person with whom such
minor is residing, or directly to such minor, or may be applied
for the use or benefit of such minor.
6. I direct that all bequests, legacies and devises and
all shares and interests in my estate shall not be subject to
attachment, levy, execution or sequestration of any debt,
contract, obligation or liability of any legatee, beneficiary
or devisee.
7. I direct that all estate, inheritance and succession
taxes that may be assessed in consequence of my death, of
whatsoever nature and by whatever jurisdiction imposed, shall
be paid out of the principal of my general estate to the same
effect as if said taxes were expenses of administration, and
all property includible in my taxable estate, whether or not
passing under this will, shall be free and clear thereof.
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8. i appoint as executor of my estate my son, William J.
Johnson. My executor shall also serve as the guardian of the
property of any minor beneficiaries under this will, under any
insurance policies on my life, and with respect to any other
property passing as a result of my death, it being my intention
to make this appointment effective in all cases where it is
permitted under the laws of Pennsylvania. No fiduciary named
herein shall be required to furnish bond or other security for
the proper performance of his duties hereunder.
IN WITNESS WHEREOF, I, NAOMI JOHNSON, herewith set my hand
to this, my last will, typewritten on five (5) sheets of paper
including the self-proving attestation clause and signatures of
witnesses, this '3o day of~~C~--Q-~,-1977.
~6Ls+-y+~~.~'a-~i2.Ge-st,-- ( SEAL )
NAOMI JO SON
We, Naomi Jo neon, W. Jeffrey Jamouneau, / ~,~~f C._
~v, and t.c.~ce1<J ., the testatrix and the
witnesses, re ect vely, whose na es are signed to the fore-
going instrument being first duly sworn, do hereby declare to
the undersigned authority that the testatrix signed and ex-
ecuted the instrument as her last will and that she had
signed willingly (or willingly directed another to sign for
her), and that she executed it as her free and voluntary act
for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed
the will as witness and that to the best of his knowledge the
testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
TESTATRIX:
CL-c'+)-~-N/
NAOMI JOHNS
WITNESS:
~==
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.. '
J~ 4 ~~
,~ ~j
WITNESS:
~~W~
WITNESS:
Subscribed, sworn to and acknowledged before v
me by Naomi Johnson, the testatrix,
and subscribed a~Q sworn to before me by
u ?C. L • kJ , and
~,.,J , witnesses,
th s ~G' day of 1977.
. ~ ~ ~L
~~~~
Notary Publ c
~KA$FN UL?.liFl, N07ARY PUBLIC
hiy Comai:sion Exy'uu Aup. I6, 198!)
Nur~6urp, (I~ EA L ) Dawhin County
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e~ ~.