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Home My WebLink About02-0473 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Irving W. Johnson alsoknownas 1. William Johnson No. ;lJ"O~-1.J73 , Deceased Social Security No. 017 -10 -4910 Deborah D. Kelly and Mark W. Johnson Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) rn A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors named in the last Will of the Decedent, dated 06/14/95 and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted aller execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: D B. Grant of Letters of Administration (c.I.a.; d.b.n.c.l.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) aller a proper search has/have ascertained that Decedent lell no Will and was survived by the following spouse (if any) and heirs: I Name RelationshiD Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 609 Cedar Ridge Lane, Upper Allen Township (list street, number, and municipality) Decedent,then~yearsofage,died 05/10 , 19.Ql,at Holy Spirit Hospital, Camp Hill, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 90,000.00 $ $ $ $ 100,000.00 situated as follows: 609 Cedar Ridge Lane, Mechanicsburg, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si nature T Deborah D. Kelly 526 W. Siddonsbur Rd., Dillsbur , PA Mark W. Johnson 66 Srnokestone Drive, The Woodlands TX 17019 77381 /7-~3-/q Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) ~'lA8lE PfllORlO if Cot.lPLETlOH OF CAUSE OFDEAJ"H? "'-",11I Accodoonl 0 "..0 NoD Suicl" 0 (MllIlm,Oav.~arl ",o~L lOCAfION(SIr__C~, Slal81 Hom",. 11,\ l~1 ~I~ P'ndingln"'S1igali<ln COI.IldllOCb!fd61"m,ned 2.. 2h. U ClRTlflER IChllCk OI'II~ onel 'CERTlFYING PHYSICIAN IPhr~oC""'c""~V~'g c,""se Wi (j,'~I!' ",.\"" ~"<.lll'c' ~I'"......,,,,,lo~~ l"une><"OO811 dedi!> ~nu ,-,x"I.J'dOO Ik," ~jl To u.. bonl 01 mV kno.....,... .,th oc:curr" d"a to lhe c."ae(I).nd m.......... "alad 'PAONQOHClNQ ANO CEATI,.YIHQ PHYSICIAN (Ptl~"",,,.,, IX'''' ;J"">OU'"'''~J ,'~"I!' ,ud ~",l<lv""l.u ~..u"" "l,'~"I"1 To the be.I 01 my kno"le6ga,..alh<>ccurrlld althe llme,d.I., ir>dpl.u, lInd du. to Ifl.eCauae( ,jandmann"lI....I,d 'MEDICAL EXAMINER/CORONER On Ihe b.ai, ol.,..mln.llon .ndlOf" inv.,Uglltion. in my opinio'n, de.lh occulted .IIhe lima, dala, and pl'CII, ."d dualo Ihe c.uae(al.nd J1a"UII'I"e'lI.al.led..,....... ...,..... .. .. ...... ...... .... ...... .. .... ..__ . .. . ... ._....... .... ......... Oath of Personal Representative Commonwealth of Pennsylvania Coun~of Cumberland The Petitioner(s) above-named swear(s) or affirrn(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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed c:i before me this 14 tltay of ~ ,~ ~1 May ~002~ Mark " C. /UV. 'e() For the Register MA C. LEWIS '.:i U'I No. 21-2002-0473 Estate of Irving W. Johnson. 1. William ,lohmmn Deceased Social Security No: 017 -10 -4910 Date of Death: 05/10/02 AND NOW, May 15th 2002. 'd' ,5ti: , In consl eratlon of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [!] Testamentary 0 Of Administration (c.I.a.; d.b.n.c.l.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Deborah D. Kelly and Mark W. Johnson in the above estate and that the instrument{s) dated 06/14/95 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Short Certificate(s). .6. $ 18.00 J2;:j; Wile , Es ui c. LEWIS Letters. . . . . . . $ 235.00 " ..................! ~.J.r.-. Attorn~: / Jan M. (j I.D. No: Renunciation. $ 9.00 Address: 06298 The Wiley Group One S. Baltimore St. Affidavits ( $ Extra Pages ( 3 ). $ Codicil. $ JCP Fee. $ Inventory. $ Other $ Di11sburg, FA 17019 5.00 Telephone: 717/432 - 9666 NOl'E: GIVE ONE SHORT TO EXECU'IDR - MARK JOHNSON REMAINDER TO A'ITOFNEY ON 5/15/02 TOTAL. $ 267.00 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) "'11';'(1\", "r.\' This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local R~gistrar. The original certificate will be fOlwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 8391064 No. ~4U4;'L ~L ~ Local Registrar 7Jlay. /3 r ;;{ <J () .::}. Date H105.143AevVB7 COMMONWEALTH Of PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH STATE Fill!: NUMBEA SOCIAL SECUAITV NUMBER i't'PElPAIIH ." PERMANENT BLACK INK NAME Of DECEDENT (forst Moddle. Lam) '" .. Irving William Johnson AOE (LaS! S..,tlaay) uNOER I YEAR UNDER I OM V.. Montftt ChlY* HQIn! Min"".. .. Male .. 017 - 10 81 PLACE OF OE.Q"H (Ci'ec~ Of'Iyr....e -- >l!tl ,(191(lICt.oo~on <lIi'&! ~I<let HOSP~ lopal_~ COUNTY OF DEATH ... CUmberland DECEDENT'S USUAl OCCUPATION (~l~=~~~~.:':';l::df 11.,P.dninisb::ati.w PBs:i.stalt lIb. Naval DECEDENT'S MAlllNG ADDRESS (Str..... C'l'IfTown $late. Z,pCOdel 609 Cedar Ridge Lane Mechanicsburg PA 17055 j o ~ < " [ : Cl/A oue~(OAASACONSEauENCE Of): . ~I tuQp ou (OA AS A CONSEIiUENCtOf}' J~i?P~' I eo.. OU TO A CONSEQUENCE Of) WERE AlITOPSY fINDINGS """ltABlE PRIOR ro COMPLETIOH OF CAUSE OF DEATH? MANNER OF DEATH if o o [J NlUural ...0 Accodelll 0 SuK:~ 0 Could""l:blitdt""mlned Peodi"llln"'Sligauon '.Ilpl~'~.,j II",n.'J! 'PRONOUNCING AND CERTIFYING PHYSICIAN (I-'t>Y,,",'dn 1.,,1, ;>1"'''''''",'''') "~,,,j, .1' "l """,rY"l<IIO~''''''"'' ," ,1<1",101 To Iha ~I of my knowlHQ.. d..,h occ...t" 111M tlm.a, dlll,.nd pl.c., .nd du. 10 tha c.....j.'.od m.nn.r.1 .1.led "MEDICAL EXAMINER/COAONER On the b.ala 01 u.amJnaUon .ndlCl" In",...Uglhon, in my op'nio'n, d.ath cx:curred allhe time, datI'. and place, ..nd due 10 the cluselal eoo mannafUlt.fed '" "'G;g::":::N:.B'i( ~~~i2J .--~---- l;! ,I 1~1 ~,alJ White MARITAL SWUS. Ma".-.cl SUflVll/1NG SPOUSE Nev..Marf_,W~, (It,od.QI....f'RaCIO\n_1 OivorA<ItS~J Widowed Upoer Allen ... ,"'- ... '''PPrOxirMt. :=....s~; , i ...p PART II: OIharsiglllllclnlcondilionlconllobutinglOdUth.llUt not ....ullinll in U. undarIylng u... grv... in FWn' I TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCUAAED loc.vION(S'r_C~ Slalel 21-2002-473 IDast lIill ann ID-esmm.ent OF IRVING w. JOHNSON BE IT REMEMBERED, that I, IRVING w. JOHNSON, of 609 Cedar Ridge Lane, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my two children, DEBORAH D. KELLY and MARK W. JOHNSON, in equal shares, per stirpes. ITEM 3 : I appoint my daughter-in-law, DIANE W. JOHNSON, as guardian over any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to ~:\NESS: , '~\ It-. cJ~ lr~n {)J~~/; L ~RV~ It/,P~SEAL) J~SON -1- another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education, (including college education, both graduate and undergraduate), without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor's parent or to any person taking care of the minor. ITEM 4: I direct my hereinafter named Co-Executors to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my daughter, DEBORAH D. KELLY and my son, MARK W. JOHNSON, as Co-Executors of this my Last Will and Testament. ITEM 6: I direct that my Co-Executors, Guardian or their successors shall not be required to give bond for ~TNESS: .\, . r <: 'f'-d... \/I./) LJ -^--, ( " r4{;~' [jjtZ~~ -2- the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /t../-I!J day of 9u./l. K. . , 1995. rW{TNESS: ~- l~ ii, / ',! (-L'IA ~ ~l- /' 7,,1 L' p. [lia-k<~ -3- COMHONWEALTH OF PENNSYLVANIA : SS COUNTY OF YORK We, IRVING W. JOHNSON, JAN M. WILEY, ESQUIRE and JANICE E. SHAMBAUGH, 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 Testament and that he had signed willingly (or willingly directed another to sign for him), 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 this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this /'1 #J. day of ~ .1995. 5 - l .!lj~2.I1:t.A NOTARY PUBLIC MY COMMISSION EXPIRES: Notarial Seal .. Dawn Gladfelter. Notary PlbIIc My eoCarroil "IWp.. York CoUnty .. mmission Expires May 17. 1997 I lIt'1I1I~lI1iA~ofNolarlii I August 8, 2002 THE WILEY GROUP AttonlCYS at La'\V Wiley · Lenox · Colgan · Marzzacco . P.c. Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 In Re: Estate ofIrving W. Johnson a/ka/ I. William Johnson Number 21-02-0473 Dear Register: Enclosed please find a check from the Estate ofIrving W. Johnson a/k/a I. William Johnson in the amount of$5,985.00 for prepayment of inheritance tax. This payment is being made on an estimated estate as follows: $140,000.00 @4.5% for a total tax of$6,300.00 less the 5% discount of$315.00 equals the payment of$5,985.00. Please return a receipt to my office in the envelope provided. Thank you for your assistance. Sincerely, ~ ~ Yvl. CAJ~~ /s dn - ~ M. WILEY, ESQUIRE JMW/sdg encl. jan M. Wiley. David j. Lenox. Timothy j. Colgan · Christopher j. Marzzacco . Christine j. Taylor 1 South Baltimore Street · Dillsburg, PA 17019 . Phone: (717) 432-9666 . (800) 682-4250 . Fax: (717) 432-0426 Offices in Harrisburg. York. Carbondale COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THE WILEY GROUP ONE S BALTIMORE STREET DILLSBURG, PA 17019 -------- fold ESTATE INFORMATION: SSN: 017-10-4910 FILE NUMBER: 2102-0473 DECEDENT NAME: JOHNSON IRVING W DATE OF PAYMENT: 08/09/2002 POSTMARK DATE: 08/08/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/10/2002 NO. CD 001502 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,985.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DEBORAH 0 KELLY & MARK W JOHNSON C/O THE WILEY GROUP CHECK# 114 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $5,985.00 MARY C. LEWIS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY , Deceased No. 21 - 02 - 00473 Date of Death 5/10/2002 Social Security No. 017-10-4910 Estate of Johnson, Irving W. also known as Johnson, 1. William Deborah D. Kelly Mark W. Johnson The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposije each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Jan M. Wiley, Esq. Signature: I.D. No.: 06298 Signature: Signatur . Address: 1 S. Baltimore St. Dillsburg, P A 17019 Address: 526 W. Siddonsburg Rd. Dillsburg, PA 17019 Telephone: 717/432-9666 Telephone: 717-432-8601 Dated: I ....{(, - 0 3 Personal Property Redemption of US Savings Bonds: 6,288.44 Waypoint Bank Checking Account #1800032052 14,779.07 Waypoint Bank Savings Account # 18600 10 185: 1,364.93 Malpezzi Funeral Home (refund): 700.00 Sale of 1999 Crown Victoria: 12,000.00 Blue Shield (refund): 380.99 Total Personal Property $35,513.43 (Attach additional sheets if necessary) Total Personal Property and Real Estate $138,765.58 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued . Deceased No. 21 - 02 - 00473 Date of Death 5/1 0/2002 Social Security No. 017-10-4910 Estate of Johnson, Irving W. also known as Johnson, 1. William Real Estate Sale of property situate @ 609 Cedar Ridge Lane, Mechanicsburg, P A: 102,000.00 Tax proration due estate: 1,252.15 Total Real Estate $103,252.15 2 /,/." /,/' //- J -(I' "-- -~ - >.../- ~ BUREAU ;F INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 11128~0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLDWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JAN M WILEY ESQ WILEY GROUP 1 S BALTIMORE ST DILLSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-24-2003 JOHNSON 05-10-2002 21 02-0473 CUMBERLAND 101 *' REV-lS47 EX AFP (01-03) IRVING W Amount Remitted PA 17019 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ it{V'= iS4T'Ex-AFP--COY:03Y-NOT-ic'E--cirYN'H'EifiTAN-CE-TA'X-APPRAis'EifENT-:--AiXoWAirCE-'(rri----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JOHNSON IRVING W FILE NO. 21 02-0473 ACN 101 DATE 03-24-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E> 6. Jointly Owned Property (Schedule FJ 7. Transfers (Schedule G) 8. Total Assets (l) (2) (3) (4) (5) (6) 0) 103.252.15 6,288.44 .00 .00 29,224.99 .00 50,151. 02 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 61,157.90 (9) (10) 6.430.63 (1l) (12) (l3) (14) 10. 11. 12. 13. 14. Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paymen t. 188,916.60 f.7.0;88 0;3 121,328.07 .00 121,328.07 NOTE: If an assessllent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of &b. returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X 00 .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 121.328.07 X 045 = 5,459.76 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00 19. Principal Tax Due (19) = 5,459.76 TAX CRF'DITS: PAYM~NT K"-CEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-09-2002 CDOO1502 272.99 5,985.00 TOTAL TAX CREDIT 6,257.99 BALANCE OF TAX DUE 798.23CR INTEREST AND PEN. .00 TOTAL DUE 798.23CR . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) /?-b3- /.,:v ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-IU7Ell AFP (ol-US) Recorof'C! Regisk JAN M WILEY ESQ WILEY GROUP 1 S BALTIMORE ST DIL LSBURG .OJ MAY 16 __ ~TE V!'ii~STATE OF DATE OF DEATH FILE NUMBER Al~TY ACN 04-28-2003 JOHNSON 05-10-2002 21 02-0473 CUMBERLAND 101 IRVING W Allount Rellitted Clerk! PA 17019 Cumberland FM MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ilEV=i6ifj-EY-AFP--niY--03Y------...--iNifERITANc'E--YAiniTXfEM'E-N'Y-O-F'-AC-coUi,rfu...--------------------- ESTATE OF JOHNSON IRVING W FILE NO.21 02-0473 ACN 101 DATE 04-28-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-17-2003 PRINCIPAL TAX DUE: ................................ 5,459.76 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-09-2002 CD001502 272.99 5,985.00 04-07-2003 REFUND .00 798.23- TOTAL TAX CREDIT 5,459.76 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 " IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J w CERTIFICATION OF NOTICE UNDER RULE 56 (aJ Name of Decedent: Irving W. Johnson a/k/a 1. William Johnson Date of Death: May 10, 2002 Estate Number: 21-02-0473 To the Register: I certity 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 May 29, 2002. Name Deborah D. Kelly Mark W. Johnson Address 526 W. Siddonsburg Rd., Dillsburg, P A 17019 66 Smokestone Dr., The Woodlands, TX 77381 Notice has now been given to all persons entitle Date: May 29, 2002 Name: Jan M. Wiley, Esquire Address: One S. Baltimore St. Dillsburg, P A 17019 Telephone: (717) 432-9666 ~ M Capacity: Counsel for personal Rep. " p - , r .~ ....;........ STATUS REPORT UNDER RULE 6.12 (/ ~K Name of Decedent: Y Vi n tJ W. J 0 h nS,o() /1/ k/ t7 Date of Death: 05 -10 -{):;;J Will No. ;7 ( - OJ - ()() if 73 Admin. No. .r. (/ }t//ltVrYJ ....J ohn5(Jr] Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes V No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, jOinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: / - /u-O,~ -::J a I) fv1, z". it /.f'{.~ Es g U j y-e Name (Please type ort rint) Ufle. S. fief /-I--imcrt" 5-) Address ~;//5 burtj PI1 /7()/9' (717) tf3~-1{11/(" Tel. No. Capacity: Personal Representative ~Counsel for personal representative Row .IMlO+""'" . .w 17-lo3-/~ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 02 00473 COUNTY CODE YEAR _____~UMBER __ OFFICIAL USE mJlY COMMOfoNo'EALl1-I OF PENNSYlVANIA DE?ARThlIEHT C* REVENUE CEPT.2aIMlO1 HARRISIlURG,PA 1112&-OllO1 i w ~ DECEDENT'S NAMe (LAST, FIRST, AND MIDDlE INITIAl) Johnson, Irving W. DATE OF DEATH (MM-OO.YEAR) DATE OF BIRTH (MM-DD-YEAR) SOCIAL SECURITY NUMBER 017-10-4910 THIS RETURN MUST BE FILED IN DUPUCATE VYlTH THE 05/10/2002 0711211920 REGISTER OF WILLS ~~---_._----~-~._- I SOCIAL SECURITY NUMBER I -------rra- Remainder-Return (date of death pncK to 12-13-iiil- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) ~!~1' OnginalRetum' 0 ,,:I" 0 4. limited Estate 0 "~,, W i ~ 181 6. Decedent Died Testate (Attach copy 0 ll..1Il or Will) 1< i 0 9. litigation Proceed. Re<:eived 0 13. Charitable and Governmental BequestslSec 9113 Trusts tor which an election to tax has not been _I made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable atthe spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 2. Supplemental Return 4a. Future Interest Compromise (dale of death after 12-12-82) 1. Decedent Maintained a Living Trust (Attach copy of Trullt) 10. Spousal poverty Credit (date of death between 12 HI1 and 1-1-95 o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposjt Boxes o 11. Election to tax under Sec. 9113(A) (Attach Scn 0) ~~~~~,.10!; '''\Ii i~ OZ "f( ME Jan M. Wiley, Esq. IRM NAME (If appliCable) The Wiley Group ElE:PHONE NUMBER 717/432-9666 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) Z o " ~ ;:! I 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposils & Miscellaneous Personal Property (Schedule E) 6. Joinlly OWned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expense. & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabililies, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 67,588.53 121,328.07 (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) (13) (14) 121,328.07 (15) Z ~ ;! ~ ,. 8 g 121,328.07 x .045 (16) 5,459.76 16.Amount of Line 14 taxable at lineal rate (17) x .12 17. Amounl of Line 14 taxable at sibling rate (18) 18. Amount of line 14 taxable at collateral rate x .15 , It 19. Tax Due (19) 5,459.76 20. 181 CHECK HERE IF YOli ARE REQUESTING A REFUND OF AN OVERPAYMENT Copyright 2000 Ionm software only The Lackner Group, Inc. Fonm REV-1500 EX (Rev. 6-00) Decedent:' Complete Address: STREET ADDRESS 609 Cedar Ridge Lane .,-r=-:;----- ------ --- ZIP 17055 CITY rTATE PA Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CredilslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 5,985.00 272.99 Total Credits (A + B + C) 3. InteresVPenalty if applicable D. Interesl E. Penalty TolallnlerestlPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enler the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to reques1 a refund 5. If Line 1 + Line 3 is grealerthan Line 2, enter the difference. This is Ihe TAX DUE. A. Enter the interest on the tax due. B. Enler Ihe total of Line 5 + SA. This is Ihe BALANCE DUE. Make Check Payable 10: REGISTER OF WILLS, AGENT (1) _~~,459.]i (2) 6,257.99 ---..------ (3) __ 0.00 (4) 798.23 (5) (5A) (5B) 0.00 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;....................................,.......................... ................ ~ I 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 dealh occurred atter December 12, 1982, did decedent transfer property wilhin one year of dealh wnhoul receiving adequate consideration?....,..."".........................................,......,.. ........ ...................,.................. . 0 o HHHm ~ 3. Did decedent own an "in trusl for" or payable upon dealh bank accounl or security al his or her dealh?HH' 4. Old decedenl own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..",... .......... ......... ...... ....., ............................................................ ~ ~ o 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 pefjury, I declare that I have examined this return, including accompanying schedules and statemema, and to the be${ of my ~ and beief, it is true, COrred aM complete. Oed8ration of ~ otI1el" than the personal representative is based on 81 information of which preparer NIB any Jo:I1owIadge. .._n ___" SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS DATE Debo b D. Kelly 526 W. SiddonsburR Rd. DiIIsburg, P A 170 I9 ADDRESS 66 Smokeslown Dr. The Woodlands, TX 77381 R T N REPREseNTATIve ADDRESS \o'V\. G-J I S. Ballimore St. DiIIsburg, P A 17019 H le ~b ~ -------oAre-- .'-- 1- j~-D.3 --'--- -DATE -- I ~ 1/..1 -b3 For dales of death on or after July 1, 1 994 and before January 1, 1995, the lax rate imposed on ll1e nel value oflransfers 10 or for Ihe use olthe 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 tt'ie net value oftranafers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (il)]. The statute does not exemot a lransfer to a surviving spouse from lax, and ll1e statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dales 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 adoplive parenl, or a stepparent of Ihe child is 0% [72 P.S. ~9116 (a) (1.2)). The tax rale imposed on the net value of Iransfers 10 or for Ihe use of the decedent's lineal beneficiaries is 4.5%, excepl as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9115 (a) (1)]. The tax rale imposed on the net value of lransfers to orforthe use oflhe decedent's 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. 21-2002-473 . funst lIill cmb ID.e5mmenl OF IRVIIlG w. JOHllSOIl BE IT RJlI{ElIBERED, that I, IRVIIlG W. JOHllSOIl, of 609 Cedar Ridge Lane, Mechanicsburg, cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last will and Testament, hereby revoking and making null and void any and all wills and Testaments and writings in the nature thereof by me at any time heretofore made~ ITEK U I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2= All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my two children, DEBORAH D. KELLY and MARK W. JOHNSOH, in equal shares, per stirpes. ITIlK 3: I appoint my daughter-in-law, DIAIlE W. JOHIISON f as guardian over any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to ~~NESS' . /~" kf". cJ Y-.., (~M,{lJ~dl L ~RV~~ /i/'~~SEAL) J~SON -1- another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education, (including college education, both graduate and undergraduate), without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor's parent or to any person taking care of the minor. ITEM " I direct my hereinafter named Co-Executors to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against'my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues~ ITEM 51 I appoint my daughter. DEBORAH D. Kl!LLYand my son, MARX W. JOHNSON, as Co-Executors of this my Last Will and Testament. ITEM 6: I direct that my Co-Executors, Guardian or their successors shall not be required to give bond for ~~' ( r~<< ' vv,.L)~ 1 { }j(j1t~kJu7 ~1b,~~" I . "7N -2- the faithful performance of their duties in any jurisdiction. IN WITHBSS WHBRBOF, seal this I<(~~ day of I have hereunto set my hand and LfuJl i , 1995. ~. NESS: , ~.Ij~ Gf<", r:JL,...k<~ ~ ~"~' IRVIN ll. SON -3- COIOtOIlllBALTH OF PElIllSYLVAIIIA SS COUllTY OF YOlU{ We, IRVDlG W. JOHllSON, JAIl II. WILBY, ESQUIRE and JAKICB E. SHAMBAUGH, 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 Testament and that he had signed willingly (or willingly directed another to sign for him), 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 this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (28) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this /~I.b day of 7t;::; , 1995. :5: ; -.!I,uf"I1J1I NOTARY PUBLIC MY COMMISSION EXPIRES: Nooml_ .. t>awn-.'-YNlio QoroIThp.. VOIkC<ul!y MyCommssial~esMay17.1rm ~.. . SCHEDULE A REAL ESTATE I I I 1 Cot.NOHWEAl. TH Of' PENI&Svt.I/AtAA lNiERlTANCE TAX RETURN RESIDENT OECEOEHT ESTATE OF . I FILE NUMBER Johnson, Irvmg W. I 21 .02 .00473 ._.._ All real properlY 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 wilfing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of survivorship must be disclosed on schedule F. -~ ------ VALUE AT DATE OF DEATH 102,000.00 ITEM NUMBER 1 DESCRIPTION Sale of property situate @ 609 Cedar Ridge Lane, Mechanicsburg, P A: 2 Tax proration due estate: 1,252.15 TOTAL (Also enter on Line 1, Recapitulation) 103,252.15 "'<", "'.......,... M 0 ;.., 0 B N . 2S02-ll2&5 .... A', B, TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING (I. URBAN DEvelOPMENT 1.0FHA 2.oFm'" 3.00eoNV. UNINS. 4.oVA 5.oeONV. INS. 6, FILE NUMBER: 1-7. LOAN NUMBER: SETTLEMENT STATEMENT GLl199-02 1581817245 B. MORTGAGE INS CASE NUMBER: e. NOTE: This form is furnished to g/vfJ you e stlJlementof actual settlemenf costs. Amounts paid to 8M by the sett/~ment agent 8rB mOWll. ltems marked "{POcr W!l/lf paid outside /he closing; they 818 shawn here for lnfunnatiomil' purposes and Sill ~/ncJuded;n the tota/a 1.03118 1~.PF00'Gll1~"';-- D. NAME MID AODRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF lENDER: MATIHEW D. GUNSKlsnd EST. OF IRVING W, JOHNSON CHASE MANHATTAN MORTGAGE KIMBERLY E. GUNSKI 609 CEDAR RIDGE CORP. 609 CEDAR RIDGE LANE MECHANrCSBURG, PA 17055 6000 FREEDOM SQUARE DR. MECHANICSBURG, PA 17055 INDEPENDENCE, OH 44131 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1619811 l. SmLEMENT DATE: 609 CEDAR RIDGE lANE TR~OUNTY ABSTRACT SERVICE MECHANICSBURG, PA 17055 August 13, 2002 CUMBERWID County, Pennsylvania PLACE OF SElTLEMENT 1 S BAlTIMORE ST OILLSBURG, PA 17019 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF 5EU.ER'S TRANSACTION lQQ. GROSS AMOUNT DUE FROM BORROWER: 400, GROSS AMOUNT DUE TO SEllER: 101, Conlract Sales Price. 102 000.00 401. Contract Sales Price 102 000.00 102. Personal P 402. Personal PrODl!!rtv 103. settlement Char 10 Bonower Une 1400 4 16.66 403. 104. 404. 105. 405. J1rliU~tments Fcr-Itoms Paid B Seller in ~V81lC1J 'ustments For Items Paid B $ellBr in Bdvsnce 106. Ci fTown Taxes 08113102 10 01/01103 102.35 400. C' own Taxes 08113102 to 01/01103 102..3 101. CQUn Taxe. to 407. COUf\ TilXl!$ to 108. SCHOOL TAX 08113102 10 07101103 1113.03 408. SCHOOL TAX 08113102 to 01/01103 1113.03 109. HOMEOWNERS DUES 08113102 to 09.101102 36.77 409. HOMEOWNERS DUES 08113102 to 09101102 35.77 110. 410. 11,. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 107,468.81 420. GROSS AMOUNT DUE TO SELLER 103,252.15 200. AMOUNTS PAlO BY OR IN BEHA'- F OF BORROWER: 600. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. D II or earnest mone 12,000.00 501. ExC8$8Oe it See Inslructions 2.02. Pri \ Amoun\ of New Loan S 81,600.00 502. SetUsment Chllf s to Seller Line 1400 2,525.17 203, ExIsllJl loan s \liken s~to 503. ExlslinlJioari(sllakensubi8cttlJ 204. 504. Payoff of firsl Mortgage 10 WAYPOINT BANK/50093114 43,937.62 205, 51*. Pa o second Mo .0 206. 506, De osit. retai\'l8d se\\!!r 12000.00 2f17. 507. 208. 508. 209. 509. A ustments For {terns U aidB SeNer 'ustments For Items U BidB SeHer 210. ca;rrown Taxes to 510. CiMTOWll Taxes 10 211, Cou T 8XO$ 10 511. CouiltvTaxes to 212, SCHOOL TAX 10 512. SCHOOL TAX 10 213. SEWER JULY Al1G SEPT. 0710110210 08113102 4tH. 513. SEWER JULY AUG SEPT. 07101/0210 08113/02 46.7~ 214. 514. 215. 515. 216. 516. 217. 517. 218, 518. 219. 519. 220, TOTAL PAID BY!FOR BORROWER 93,646.74 52". TOTAL REDUCTJON.AMDUNT DUE SELLER 58,509.53 300, CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SEllER: 301. Gross Amount DLIe From Borrower ine 120 107468.81 601. Gron A.mount Que To Seller Une 42 103252.15 302. leu Amount Paid Mor Borrower (Urle 220 [ 93,645.741 602. Less Reductlons Due Seier Lin8 520 58,509.5 303. CASH [ X FROM){ TO) BORROWER 13,822.07 503: CASH ( X TO)( FROM) SEllER 44.742.62 The undersigned hereby acknowledge 1'eCe\P\ of a completed c:opy of pages 1&2 of this a!alemen! & any attachments referred to herein. r HAVE CAREFUllY REVIEWED THE HUD-1 SETIlEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUe. AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY T"'TI"'~~~1~~~.7A?~T So'" ~~ e . KIM~td1J::-l fJukt TO lliE BEST OF MY K WLEDGE, THE \:;IUO-'1 S~EMENT TI!:MENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH ER C' 0 AND BEEN DIS 30 BY THE UNDERSIGNED AS PART OF THE SEmEMENT OF THIS lRANSACTION. _ E1T MENT OFFICER ttlement Agent WARNING~ IT ISlA CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMlLAR FORM. PENAL TIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: rm.E 18 U.S. CODE SECTION 1001 & SECTION 1010. L SETTLEMENT CHARGES Al COMMISSION aged on Price $ '" % f'1\1DFflON PA.CFROW JilIis10n of Commission line 700 &$ FoHows: aoRROWER'S ,au"" $ 10 """AT RJNDS AT , .$ '0 'ETTlaOEHf Srnu;OEHT 103. ummis5ion Paid al SettlBIllent 704, TRANSACT FEE 10 BOO.ITEMS PAYABLE IN CONNECTION WITH LOAN 801, LOlln Or inl!ltiof\ Fee '4 10 S02. loan Dltlcount % .. 803. Appnlisal ee to C RAL P NN MTG. PO $250B '04. kR_ '0 805. L.ender's Inspection Fee \0 806. Mort a e Ins. .Fee to 807. Assumption Fee to aoB. lAX RELATED SERVICE FEE 10 CHASE MANHA rrAN MORTGAGE CORP. 69.00 609. UNDERWRITING FEE to CHASE MANHA ITAN MORTGAGE CORP. 175.00 810. MORTGAGE BOKER'S FEE 10 CENTRA PENN MORTGo\GE COMPANY 750. 811. MESSENGE:R/COURIER E to CHASE NHATTAN MOR GAGE CORP. 14.00 812. FLOOD DETERMINATION to FOSl INITIAL 11.00 813. fLOOD CERT 10 FDSI LIFe OF LoAN 7.00 81 . ADMIN! TRATION FEE to CENTRA/... PENN M RTGAGE l,;OMPANY 100.0 815. VI SP PREMIUM BY CHASE C P NN MORTGAGE COMPANY $1326.00 POC 816. 817. 616. 819. 820. BOO. ITEMS REQUIRED BY LENDER TO BE PAlO IN ADVANCE 901.lnterestFrom 08113102 to 09101102 '" $ 1.4.530000fdlW ( 19 days %) 276.07 02- s e Insurance remlum or months to 903. Hanmllnwrance Premium lor 1.0 years to STATE FARM INS POC $241 B 904. !lO'. 1000. RESERVES DEPOSITED WllH I...ENDER 1001. HBl8rd Insurance 3.000 moot" $ 20.09 cer month 60.27 1002. s e Insurance months $ r month 1003. CiMfown Taxes 7.000 months $ 22.08 oer month 154.56 1004. Coun Taxes months $ , month 1005. SCHOOL TAX 3.000 momns @ $ 105.14 per month 315.42 1006. months $ r month 1007. months , n 1008. AGGREGATE ADJUSTMENT months r-month -a6.41 1100. TITLE CHARGES 1101. Setuemenlor Closino Fee to 1102. CLOSING PROTECTION LEITER to FIRST AMERICAN mLE INSURANCE COMPANY 35.00 1103. TIlle Examinalion 10 1104. Tille Insurance Binder to 1105. DOGIJlT'lent P .... to 110Et NOlarvFees to CASH 8.00 1107. Atlomey's Fees 10 JAN P..t WILEY, ESQUIRE 150.00 incJudes 8bo~ Hem numlJers: 108. ltle In \nBl'lce to TRI-COUNTY A TRACT S RVI AGENT P LNO. .7 Includes &boVlil item number1:: ) 1109. Lender's Coverage $ 8t,6oo.00 POL: 1110. er'sCoverage $ 102,000.00 868.75 1111. ENDORSEMENTS 100, 300, 8.1 PUD 10 TRl.COUNlI S CT SERVICE 200.00 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. ReCOrding Fees: Deed $ 30.50; Mortgage $, 60.50; ReMnses $ 91.00 1202. Cil COUI'l Tax/Slam s: .... 1 020.00' Mort . 1,020.00 1203. Stale TaxJS\a r. Revenue Stamos 1020.00; ,",ormaae 1 020.00 1204. JULY/AUG HOMEOWNERS I\SSOC. to CEDAR RIDGE HOMEOW ERS ASS UNIT 609 120.00 1205. SEWER-APR, MAY, JUNE 2002 to UPPER ALLEN lWP. AC 408024 105,00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 10 1302. Pest Ins 'on '0 1303, 2002-1)3 SCHOOl RE TAXES 10 MARL-IN ^- YOHN TAX CO!... -4224 0792024 1261.67 1304. TAX CERT FEE I. MARLIN A. YOHN, TAX COL 4.00 1305. OVERNIGHT FEE to TRI-COUNTV ABSTRACT SERVICE 14.5Q 1400. TOTAl SETTLEMENT CHARGES fEnter on Lines 103 SectIOn J anti 502, SlItctlon.,K) 4,216.66 2,525.17 ByIlgfirlg".loIlt'dllll""'....Iho~kll18$~recejploI.wm".llladeopYotP8ll"'2otlhlsllwlp<llJ<lb). //", /); 7~ .~ "'Z ~ [0 ",., Certltled to be a true copy. / SETTlEMENT OFFICER . Settlement Agent y (Gll1~Jr.ll1~?I]:;' . SCHEDULE B STOCKS & BONDS I I I L II FILE NUMBER 21 - 02 - 00473 COWoIONWE#L tH Of' PENNS't\..\IAN1A INHERITANCE "TAl( RETURN RESIDeNT DECEOeNT ESTATE OF Johnson, Irving W. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM I NUMBER 1 Redemption of US Savings Bonds: I UNIT ':LU; 1VALUE AT DATEOF . DEATH r------i . 6,288.44 I I I I DESCRIPTION I I I I J___ I I I I I I I I l-----J- TOTAL (Also enter on line 2, Recapitulation) 6,288.44 ....... ~03~OOOO~O~ OO~~5~33qp OOO~ " . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMQt.MIEPL11-\ OF PENNS'1\.\I-'N1A. NiERITANCE TAX REllJRN RESIDENT DECEDENT I FilE NUMBER i 21 - 02 - 00473 ESTATE OF . Johnson, Irvmg W. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survlvol1lhlp must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH I Waypoint Bank Checking Account # 1800032052 14,779.07 2 Waypoint Bank Savings Account #1860010185: 1,364.93 3 Malpezzi Funeral Home (refund): 700.00 4 Sale of 1999 Crown Victoria: 12,000.00 5 Blue Shield (refund): 380.99 TOTAL (Also enter on line 5, Recapitulation) 29,224.99 - ~ ~lWaYRqi!lt LOOK FOR US. WE'LL GET YOU THERE. 08/07/2002 TIiE WILEY GROUP 1 S BALTIMORE ST DILLSBURG P A 17019 The information which you requested on the account(s) of IRVING JOHNSON (Social Security Number 017-10-4910) is/are as follows: 1860010185 SAVINGS 08/06/99 1363.96 .97 1364.93 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established 1800032052 CHECKING 07/09/99 14778.58 .49 14779.07 SOLE Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name ofJ oint Owner, if any Date Ownership Was Established Additional Information Requested WE NE/jU !ZEC&It/El) Yf/1l1Z {;R/6-/tJ/lL ,eEltIJ{J( S~erelY, Lhwu. KA~Q~~ SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG. PENNSYtYA.NIA 17105-1711 T_II a::...eo.e LDt:'::_'^/AVon'''IT ILt::::U:::.c::_O::JQ_7IC:At::\. 'II..V"'l:IV do&:^ 71"7 /J::UC:_A~nn . '''^''n.nu:::llln....il''l+h::..''1t- t"""m 'w SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY I l I FILE NUMBER 21 - 02 - 00473 COMMONWEAL TtI OF PENNSYLVANIA INHcRITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Johnson, Irving W. ITEM NUMBER This schedule must be com leted and filed If the answer to an of DESCRIPTION OF PROPERTY Include the I'I$ITMt of the transferee, their relatiOnship to decedenllW'ld the date of transfer. A.tlal::h 8. copy of the. deed for relll esta~. uestlons 1 throu TAXABLE VALUE DATE OF DEATH % OF VALUE OF ASSET DECO'S INTEREST 1 Federal Employees Retirement System: 3,245.92' 100% 3,245.92 1,284.00 45,621.10 2 Unpaid Compensation: 1,284.00 100% 50,151.02 3 , Thrift Savings Plan: 45,621.10. 100% 1--- I : "',...,... ...,_ h '. _,ol ~ F ed-e-rtLl ~ 0 v -1-. - ih r I -r+ .:sa (/i r7 q5 Plan. NOTICE TO CHECK RKCIPIENT TRKASURY-FINANCIAL MANAGEMENT SERVICE TFS FOJUI !039IRov.1 VENDOR 1.0. NUMBER: U,S, TRKASURY REG, FINANCIAL CENTER: CHECK NUMBER 017104910 DEBORAH D KELLY USDA.NFC TSP SERVICE OFFICE P.O. BOX 61135 NEW ORLEANS,LA.70161.1135 3091.5626489 $**22810.5 10-09.0; AGENCY SCHEDULE NUlIBEI J FEDERAL RETIREMENT THRIFT SAVINGS PLAN DISTRIBUTION ~ OF PROCEEDS FROM ACCOUNT OF DECEASED 000022856~ Q PARTIC IPANT: IRVING W JOHNSON SSN: 0171 0491 0 AGENCY TELEPHONE NUMBE ~ TIB EIN: 52.1529691 YOUR SSN:197405465 ~ PARTICIPANT'S ACCOUNT BALANCE.............$ 53,578.99 504.255-6001 ~ YOUR SHARE OF ACCOUNT BALANCE.............$ 26,789.49 ~ LESS: FEDERAL INCOME TAX WITHHELD.........$ 3,978.94 ~ JijJg~~~' ~. . ON ~"'E JlliE' !;; N IN E R C 0 9. .,. '" '" .. '", "- L VENDOR NAME: AGENCY NAME 1 AND BILLING ADDRESS KANSAS C!TY, MO CHECK AMOUNT CHECK DATE THIS NOTICE IDENTIFIES THE INVOICE. PURCHASE ORDER OR SIMILAR DOCUMENT NUMBERS TO WHICH THE ENCLOSED CHECK RELATES. FLEASE DIRECT ANY INQUIRIES TO THE AGENCY AT THE ADDRESS INDICATED ABOVE. OR BY TELEPHONE IF A NUMBER 15 PROVIDED. . SCI-EDl1.EH FLtBW..EXPENSES& AlM<IS1RATlVE Cu:::i I ~ ~lHOfPENNSYlVANIA N1ERlTANCE TAXRETURH ReSIDENT DECEDENT ESTATE OF J hns I' W o on, rvmg . Debts of decedent must be reported on Schedule I. ITEM I NUMBER. DESCRIPTION A. I FUNERAL EXPENSES: I Malpezzi Funeral Home: , FILE NUMBER I 21 - 02 - 00473 , I AMOUNT -.---+--------.- 4,708.60 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Securily Number(s) I EIN Number of Personal Representative(s): Slreet Address City Slate Zip Year(s) Commission paid Attorney's Fees Wiley, Lenox, Colgan & Marzzacco, P.C. 2. 9,500.00 3. Family Exemption: (If decedent's address is not the same as c1aimarrt's, attach explanation) Claimant Street Address Cily Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills: 267.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other AdmInistrative Costs Real estate settlement charges: 2,525.17 2 Cumberland Law Journal: 75.00 Total of Continuation Schedule(s) i I I 44,082.13 t-------- I 61,157.90 TOTAL (Also enter on line 9, Recapitulation) *' COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SchecUe H FlIlllIaI~ lrS& Ami! Mcdive Costs conliIJed ESTATE OF J hns I. W o on, rvmg . --3~Sentinel: I 4 i Waypoint Bank (payoff mortgage): 5 I Register of Wills (filing fee): I I I I I .____L I FILE NUMBER I 21 ~02-00473 Page 2 of Schedule H 116.5] 43,937.62 28.00 . . '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ~THOFPENNSnVANLA lNHERITPHCETAX~ RESIDENT DECEDeNT -L-. I FILE NUMBER . I 21-02-00473 ESTATE OF Johnson, Irving W. Include unrelmbursed medical expenses. ITEM NUMBER I Internists of Central PA (last illness): DESCRIPTION AMOUNT 30.00 2 Internal Revenue Service: 3 Sewage payment: 4 AT&T: 5 Verizon: 6 Liberty Mutual (fire & auto insurance): 7 PP&L (electric): 8 Cedar Ridge Homeowners Assoc.: 9 United Water: 10 Waypoint Bank (mortgage payment) 11 Internal Revenue Service: 12 Holy Spirit Hospital (last illness): 13 PA Neuro. Assoc (last illness): 14 ConnerlRich Assoc. (last illness): 15 House Painting: 16 Messiah Village (last illness): 17 Internists of P A (last illness): 18 West Shore EMS (last illness): 19 Moffitt Group (last illness) 38.26 46.74 49.59 49.41 376.41 179.92 240.00 9.18 648.91 1,039.00 87.22 22.48 126.98 800.00 778.90 76.55 1,614.08 217.00 TOTAL (Also enter on Line 10, Recapitulation) 6,430.63 REV-1IU EX+ (t-OO) . . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Johnson, Irving W. , FILE NUMBER I 2] -02-00473 NUM~ER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO _ ~.:~~DENT I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Deborah D. Kelly 426 W. Siddonsburg Rd. Dillsburg, PA 17019 daughter 2 Mark W. Johnson 66 Smokestone Dr. The Woodlands, TX 77381 son I 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ; TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET AMOUNT OR SHARE OF ESTATE one-half one-half