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Home My WebLink About02-0606 PETITION FOR PROBATE and GRANT OF LETTERS Estate of PAULINE A. JOHNSPN also known as Deceased. Social Security No. 189-18-6807 No. To: g.1-()~- ~(, Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition ofthe undersigned respectfully represents that: Your petitioner is 18 years of age or older and the Executrix named in the last will of the above decedent, dated February 19, 1990 and codicil dated [none]. James O. Johnson predeceased on 12/15/1996. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 659 Hamilton Street, Borough of Carlisle. Decedent, then 86 years of age, died Jun..21, 2002, at 659 Hamilton Street, Carlisle, PA. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was Qat 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 (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value ofrcal estate in Pennsylvania situated as follows: Carlisle Borough $ unestimated $ $ $ unestimated WHEREFORE, petitioner respectfully requests the prohate of the last will andcodicil(s) presented herewith and the grant of letters testamentary thereon. I\.ka.. Jeannine Kautz nka Jeannine Oi 384 Eddington Avenue Harrisburg, P A 17111 (717) 561-0858 ~ --------------------------------------------------------------------- -------------------------------------~---~----------------------~---- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best ofthe knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. " Sworn to or affirmed and subscribed before me this 2nd day of Jul , 2002. JJv,JU 17- 73--3 No. 21-2002-606 Estate of Pauline A. Johnson, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, July 2nd, 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED thatthe instrument(s) dated February 19, 1990 described therein be admitted to probate and filed of record as the last will of Pauline A. Johnson and Letters Testamentary are hereby granted to Jeannine Kautz nka Jeannine Gilreath. Will Book # Page ~c..~t2U ~//JJI'+J. Register of ~ills Mary C. LewkT FEES Probate, Letters, Etc. Short Certificates( 2) Renunciation x-Paqes (3) JCP TOTAL $ 115.00 $ 6.00 $ $ 9.00 $ 5.00 Carl C. Risch, Esq. (75901) ATTORNEY (Sup. Ct. J.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 Filed _July 2nd,2002 $135.00 .-..,.-- .- d I'...j C. r". I N CALL ATIORNEY CARL C. RISCH ON 7-2-02 F :\F1LES\DA T AFfLEIEST A TES\ 72461-letters.te$ 1l10'i.!!Q'j RfV\1IfV, This is to certify that the information here given is correctly copied from an original certitlcate of death dul~ fried with me as Local Registrar. The original certilicate will be forwarded to the State Vital Records Of lice for permanenr filIng, WARNING: It is illegal to duplicate this copy by photostat or photograph, No, "r'II""""'O'~~,,~, ,,""';'1>-\'~ OF Pf,f;----~ l'#~:t~" "c:;_.~" !:,j '. .. '-I -..?-;, ~ 'IIl:!:'. . Oi&':i Q ~" -~ ~,-,I_ ,In ..:t:..~ \ *~. . '.M;' ...'; *? ~a . -.. . !~~ ~~ /'-..::sl'" '. -f,? ,/""-'r,, ", ';jfE//1~\ """, '~~""~~~"H",'JJI!!' ~~. ~~.. &.~~ Local Registrar Fee for this certificate, $2.00 P 8481623 JUN 2 4 20UZ Date H10S.:OJA...2J87 COMMQNWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECOADS CERTIFICATE OF DEATH 'INT .. AGE(L"~ Pauline UHOElllY(AFl - ,.,. A. utCleR\ON Hooonl...... !TA;l'(r'u~" SEX socw..stc~'N~lIl '.Female . 189 - 18 - 6807 OATEOF~H,_.~.'''''') .. June 21,2002 '"' Ok !(Io.ME:OfOECEDEH1!h"~,l-""1 .~. Cumberland "" - ~.. -' ~IO 86 .. 8IRT~jC.Iy..-:l c~1Jg!':tlml Penna. P\.N;:EOFllERHIC"-""'l'_ _....'UC1<lI>Oon__1 C . "..-.0 E~O .;ill COUfllTYOFOU1H Cumberland Carlisle 659 Hamilton Street White k, CEOEHT'SuSUA U~ .~~1i?~ Own Home ~ (1'~"'~"1 ". ,Jt.O"".~_1n MAIITAl$VlI'US.~ NMirMwriM,-'-. --'" Widow SUAYIVlNG$POUSi 111_._"-_ O. Johnson nL Hb. ""g"59'Ha~m~h-~rre~."''""' .. Carlisle ,Penna. 17013 I'ArNER'SNAAlE (Fw.. IolJa.ities Arno Id ,,- 1Nf0000000000'StuME{tlS*.Teannine c. Gi Lr-ea th EPlNl'S ,eM,- ...""" - ~-- ,,. ... I.I€TNOD OF 01 IrION :='~C_icIIIO _......sw.O ...-.... tN. ....,..._......flII UOTHER'S,.,....,.,4F..,~~"-l Crull ..r~~fr"'~m':illrrrisburg PV(:I'OFDISPOSmON._"'~c..m......, .~;;m~f~~Ti8if8tns ". Carlisle ...- Pennsylvan~a n llCEKSEMl.JM9EI'l ou""", r;.'/vr' ,- '-- :_lInll-'" , i 'MSCo\SEI'.EFERI\E;\)'lOIo\E~E::tA>>lJiIE A1 ~d....- __.0 _qr- ""'""'0ltIM~_~..._."", ""'-.In.....~_~InF'IUITI 1NE000ERH ().Q'EPAONOUI'ICEOOEAO~.~~ 11.52 A June 21, 200~ M. . Z7,H.IITI: 1EnM<"'-<Ii.._.iftjurjo>l"'CO~_COI_1M_.o..""_"1M_"'dYIn9._..OtClioc",,",,",.,..,......_,,,_rllaiIUI. u..-,__",,__. L DUElOlOAASACQNS[QIJ(MCE{)F); DUElO(OAI,SACONSfOUENa:OF): - tb- o o ...."''"'"'" (,..."..,.tl.t~ TIUEOFIH.IUAY lNJlP'IVf(lWOFIK? OESCRlBIEHOWINJUAYOCCIJAAED. WlEAEAUTOPSV1'INDlNGS ..............'" ~Pl.ETlOf<lOFCAUSE "'''''''''' lolANNEROfDEATH o o ~_l;IoO","_ 0 ~OFINJUfIY'N._._.......la<tIWy._~. ...-......~ -. 2W>. '"' ~. ~=~~,,":"(PIorso<:""<~_d___~_"'__ana<__2:JJ ,......_""....,..-,.... a..lhoec"fftId _.........,,-"Mi.,.""...._.. .""Ied...... ................,... -- ..... 0 NoD - .......- ~O ...0 ...... M.D., 'f'MlMOUNClNQANDet:'"'I'YINQI'HVSIClAH~""""'ll'~__CMltyo'IQ"'CMII'OOl""''''1 Tooe,._oI",.,~"""""'ol~,""."''''''''''''''''''II-._._._plan..'''''''''''"'''''<.UM(.I_m._.....Md.,. "MtCMCM. UAM\ltERiCOAONtR OrI_b..l..of,...m'n"'.llnandlOflnyUllg.lion.ItlIf1.,"l'lnl....,de~_..\""'t\,....lt.....n<lpl""',_d". to"'" "ouMi_'_ .........,..-......................................,......,......................,...............,.................. 11.. o ". :HUO\0~: ~\ aoo~ AEQISTRAA'S~ot"'~M<1l ~.~~ I~I ,&,1 ,01 c: o r CI} c: .~ ~g .~~ (]) c: ..-1 rl , :l \, "-J <tl a. 21-2002-606 LAST WILL AND TESTAMENT 1, PAULINE A. of the Borough of Carlisle, JOHNSON, Cumberland County, pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last will and Testament, hereby revoking any and all former wills or Codicils by me made. 1. I direct my just debts, funeral expenses, that all testamentary expenses and all inheritance taxes shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. 2. If my husband shall survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my husband, JAMES O. JOHNSON, absolutely. 3. In the event my said husband shall predecease or fail to survive me by more than thirty (30) days, then I give, devise and bequeath my estate as follows: A. I give the sum of One Thousa~d Dollars ($1,000.00) unto i my husband's son, CARL L. JOHNSON. I B. I give my grandmother's cloc to TARA KAUTz. C. I give my safe to JEANNINE K UTZ. D. I give my house located at 659 Hamilton Street, Carlisle, Pennsylvania, to JEANNINE KAUTZ and TARA KAUTZ. E. In the event that the said TARA !<AUTZ shall not have attained the age of majority, then such items of personalty and -1- LAW OFFICES - MARTS ON. DEARDORFF. WILLIAMS & OTTO Q) c ..... .-; ::l \l.::ro 0. real ty that have been left to her under the foregoing specific bequests shall be held by her mother, JEANNINE KAUTZ, until such time as TARA KAUTZ shall have attained the age of majority. F. All the rest, residue and remainder of my estate, both real and personal property, I give, devise and bequeath, in equal shares, unto JEANNINE KAUTZ, RICHARD JOHNSON, TERESA JOHNSON and BRIAN JOHNSON. 4. I nominate, constitute and appoint my husband, JAMES O. JOHNSON, as Executor of my estate. In the event my husband shall be unable or unwilling to serve in such capacity, then I appoint JEANNINE KAUTZ to act in such capacity. In the event the said JEANNINE KAUTZ shall be unable or unwilling to serve in such capacity, then I appoint TERESA JOHNSON to act in such capacity. 5. I direct that my Executor or Executrix shall not be required to file a bond to secure the faithful performance of his or her duties in any jurisdiction. 6. I authorize and empower my personal representatives, in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection -2- LAW OFFICES - MARTSO~, DEARDORFF, WILLIAMS & OTTO ., and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; and to execute and deliver such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,q-M day of FeJ:,ruar/ ,1990. Pa.L.J 4.. ~..~ Pauline A./ Johnson (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request have hereunto subscribed our names as witnesses thereto, in the presence of said Testatrix and of each other. ~~ -3- LAW OFFICES - MARTSON, DEARDORFF. WILLIAMS & OTTO COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, Pauline A. Johnson, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ;:.hAUf..:" h ~-.;-,.-- Pauline A.,;1o nson Sworn or affirmed to and acknowledged A. Johnson, the Testatrix, this 1'1111 day of before me by Pauline Fe'hru.'''1 ' 199,) COMMONWEALTH OF PENNSYLVANIA f!tA~,,) 0( 7;iLL:hAJ Notary Public _"_ .,__-' Ndr.;(lt: ~.It.l;JI ) Corrine L, My.'., Notary p' ,b1ic C..-tis!e 80<0, Cumberland County My Commission Ex!","" May 27, 1991 SS. COUNTY OF CUMBERLAND ) We, ])a.-n I'd K bo.rdo rf{' tJA-vot L V'j) V, to -!tv) J1L I the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Q)~ k: ~-, 0t "'<000 I~:;; ~ A^ ,~ "17M3 Addr ss If j 1.~/, \~ (d 1<. '" P;' 70/3 S}>'orn or affirmed to and subscribed before me this 1'1/1\day of J-chr4c<r'j ,19<10 . ~7A/ti2.U~')'~ "/n.JP/l-4/ Notary Public NotatialSeal Corrina l. Myers, Notary P'lblic Car6sle 8oro. Cumberland County My Commission F.xplres M.:lY 27, 1991 LAW OFFICES - MARTS ON, DEARDORFF, WILLIAMS & OTTO e~:.JL Carl C. Risch CCRlvlo Enclosure F:\FILES\DA T AFlLE\ESTA TES\7246I-row.l INFORMATION. ADVICE. ADVOCACy'M #. (1 " J' F: \FJLESIDA T AFlLEIEST A rES\ 7246] -notice_err CERTIFICATION OF NOTICE UNDER RULE 5,6(a) Name of Decedent: Pauline A, Johnson Date of Death: June 21, 2002 File No. 21-02-0606 To the Register: I certify that notice of estate administration required by Rule 5,6(a) ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about September 9, 2002, Carl L Johnson 1205 Guildford Road Glen Bumie, MD 21061 Tara L Kautz 384 Eddington Avenue Harrisburg, P A 17111 Richard C. Johnson 31 Quigley Avenue Egg Harbor Township,NJ 08234 Jeannine Gilreath 384 Eddington Avenue Harrisburg, P A 17111 Tresa Johnson Vaughn 203 Oak Knoll Road New Cumberland, PA 17111 Brian A Johnson 403 Longbow Road Mount Airy, MD 21771 Notice has now been given to all persons entitled thereto under Rule S,6(a) , Date: September 9, 2002 Signature Name ~:..Q. Carl C. Risch, Esquire MARTS ON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative 1 ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RISCH CARL C 10 EAST HIGH STREET CARLISLE, PA 17013 -----~-- fold ESTATE INFORMATION: SSN: 189- 18-6807 FILE NUMBER: 2102-0606 DECEDENT NAME: JOHNSON PAULINE A DATE OF PAYMENT: 09/17/2002 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 06/21/2002 NO. CD 001625 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,800.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JEANNINE C GILREATH C/O CARL C RISCH ESQUIRE CHECK# 509 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $2,800.00 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT Of REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 AEV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RISCH CARL C ESQUIRE C/O MARTSON DEARDORFF ET AL 10 EAST HIGH STREET CARLISLE, PA 17013 ____u__ told ESTATE INFORMATION: SSN: 189-18-6807 FILE NUMBER: 2102-0606 DECEDENT NAME: JOHNSON PAULINE A DATE OF PAYMENT: 01/06/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/21/2002 NO. CD 002017 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $98.23 I I I I I I I I TOTAL AMOUNT PAID: $98.23 REMARKS: CARL C RISCH ESQUIRE C/O MARTSON DEARDORFF ETAL CHECK# 518 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS Rf:'i .1500"EX.+ [lI.jl~i w ~ ::.:=~1I.l u~'" W~U ,,00 U~~ ~m ~ < INHER,RTAENVCE-1T5AXOORETURN 1cL- -u COMMONWEALTH OF PENNSYLVANIA 'FILE NUMOER OEPAR6~;~T,~iVENUE RESIDENT DECEDENT I 21 02 ~~~S8UB9~!~_~______.. L_ _GQ!,JNn:CODL__.Y~_~_. , DECEDENT--;SNAME-(LAST. fiRST, AND MiDDU=-'IN1TI-~)~=-~::=:::::-::=:~--==--:-:-=-==---====---=-====--=::--:-'::=:=::~~==='- SOClAlSECURIYY-NUMB-ER I JOHNSON, Pauline A. I 189-18-6807 .-.----+- -- -------.-. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~-- 1. Orjgi~-;I--R~h;;;- -.--------- ---1:r2~Supplem;,taJ Return --~-~--~---.---_. o 4. Limited Estate 0 4a. Future Inleresl Compromise (date of death after 12-12.82) ~ 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Atlach ofWiI!) copy of Trust) o 9 litigation Proceeds Received 0 10. Spousal Poverty Credit (dale Of death between 0 11.Election to tax under Sec. 9113(A) (Allach Sch O) '_n__ _ --':-.-,,------c-:-:--;:-c-::'""........ ..... . "_".., ..__12-~~~~.1__and1~1~95}. ...____...__........ ..... .... __..._~.;______._:_-_:_:__:;_:_____,..____-~-_______.~ 1.T/:I1$$S\l~IOIif/.lliS'f!'!!i!l(l!lI.l_~ic~~.~liIt!lll'_i!!I'{l!i!!~~l!(lQ~\?~mcl\lllfQI!f.IA__U~\?~.llll'leC~eD''tQ: NAME 'COMPLETE MAILING ADDRESS Carl C. Risch . ~ z w c w u w c DATE-OF -DEAni (MM-OD-YEARj- DATE OF BIRTH (MM-DO-YEAR) 06/2l!2002 0110211916 ; (IF APPLICABLE) SURVIVING SP-OUSE'-SNAMETLAST,F1RST AND MlDOlEINITIALj---- ~ z w c z o ~ ~iRM-NAME-iifapplicablej------~--------~---- Martson Deardorff Williams & Otto I -----i TELEPHONE NUMBER ----'----'---~~~.., " Of'T;C'f.,i ,,',. G"<'- I L,... I .J 3 00606 NIJ_~~~_ ,_ _.._.~E.GISTER_OFWILLS SOCIAL SECURITY NUMBER o o o 3, Remainder Return (datElof death prior \0 12-11-B2) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Ten East High Street Carlisle, PA 17013 1. Real Estale (Schedule A) 717/243-3341 =--::-.-~c=-'-'==-'-'--'=::--.::...----=.::::-:=-----==----------:=:-~-:-::...---=:-::-----~~---~-----=--------=---::-c=--",--:==_::=-==--:=.=..::::c_:=:----:__::_ CH'iCI", U:',i' )~Il." z o ~ :l ~ ~ ~ ~ w ~ 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedulo D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Properly (Schedule F) o Separate Billing Requested 7. InterNivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines g & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) 72,000.00 -~--._---- (2) None (3) None ---.. ._~------~---' ._--._- (4) None --'-~-_._---- (5) 15,695.38 (6) None ~_._---~---..~-, (7) None (8) (9) 19,789.76 (10) 110.84 _.1 87,695.38 (11) 19,900.60 67,794.78 (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) (13) (14) 67,794.78 SEE INSTRUCTIONS ON REVERSE SIDE FOR A.PPLICAB~E RATES 3,050.77 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3,050.77 20.0 .>>iiJ~'~i!D!f!l7~Milt~~i'lI~l~!liI~~'J~_~II;I~-" fii1!t<.;-- --. Copyright 2000 form software only The Lackner Group, Inc. 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) --_._-~--.._-._-- z 67,794.78 .045 (16) 0 16.Amount of Une 14 taxable at lineal rate x ~ -----_._------~----- ~ ~ ~ 17, Amount of Line 14 taxable at sibling rate x .12 (17) '" 0 u ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) -.--.-.---..-.--------- 19. Tax Due (19) Form REV-1500 EX (Rev. 6.(0) Decedent's Complete Address: STREET ADDRESS 659 Hamilton Street CITY Carlisle . . -;51';'; TE .p;: ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,050.77 .__._.~,8_00.00 152.54 Total Credits (A + 8 + C) (2) 2,952.54 3. Interest/Penalty if applicable D. Interest E. Penalty 8. Enter the total of line 5 + SA. This is the8ALANCE DUE (3) 0.00 (4) (5) 98.23 (SA) (58) 98.23 TotallnteresllPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Une 3 is greater than line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable fa: REGISTER OF WILLS, AGENT l\\.i~~"" EI!l ~. _ _1II11l111~ftIIW'~__nim~II!\li\ll\W 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;...........................................................n..............., ~ I ~.' ~::::~ :~e~~~~i~~:~s:~::s~:~. ~~~~'..~.~~.~~~.:.~~:.~:.,t.~.~.~~~~~.~. ~~.i~.i.~.~.~,~~~..............................:::::::::::::~~".'. d. receive the promise for Jjfe 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?.................. ......... ............................... .n............................ _...................... 0 ~ 3. Did decedent own an Min trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..............................n................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE 384 Eddington Avenue ..JIa,!is~ur&P A }7111- -ADDRESS I,;) -.:J 1-0 d- - --- ---, -DATE T N REPRESENTATIVE AODRESS- -DATE Ten East High Street Carlisle, PA 17013 \ "'L- 1.'"'\ - (Y1.. 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 .8. ~9116 (a) (1.1) (ii)l. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty~one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is 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 (al (1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P:S. ~9116 (a) (1..3)1. 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. . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DeCEDENT ---- ---------..--- -.-_________..._____...._..__. ________ u_ _____.__ .._ _______ ______ ESTATE OF JOHNSON, Pauline A. ---.. ~.._-------._-------- - - -.----~.---._------_.._--..------.-._._~__.__._. ______________ ____.___.......__...__H___ FILE NUMBER 21 - 02 - 00606 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pric, at which property would be excl1anged between a willing buyer and a wining 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. _._n__..____.._________" ______________..____________________ ._____.__~__ _____ .__.___..___. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 72,000.00 - Residence situate at 659 Hamilton Street, Borough of Carlisle, Cumberland County, P A, known as parcel No. 06-20-1800-046, being described in Deed dated July 3 1964, and recorded in Cumberland County, PA, Deed Book "G", Volume 21, Page 635, and being conveyed to James O. Johnson and Pauline A. Johnson his wife. The said James O. Johnson died December 15, 1996, vesting title entirely in decedent herein. Value is actual sale price. See Settlement Statement attached as Exhibit "A". TOTAL (Also enter on Line 1, Recapitulation) 72,000.00 '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEl\l TH OF PENtlSYL\!A!-olIA. INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHNSON, Pauline A. FILE NUMBER 21 - 02 - 00606 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 13.252.02 Citizens Bank, Checking #192-108-8975 2 Capital Blue Cross, refund of premium 501.15 3 Agway Petroleum, refund of credit balance 100.00 4 Commonwealth of Pennsylvania, 2001 real estate tax rebate 482.00 5 Grandmother's clock, appraised value 10000 6 Safe, appraised value 50.00 7 Household furnishings 750.00 8 Real estate taxes (proration) 460.21 TOTAL (Also enter on Line 5, Recapitulation) 15,695.38 *' SCHEDULE H FUNERAl.. EXPENSES & ADMNSTRATIVE COSTS , FILE NUMBER 21 - 02 - 00606 AMOUNT 3,619.00 246.98 2,945.00 5,135.00 135.00 75.00 3.00 7,630.78 19,789.76 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHNSON, Pauline A. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION . FUNERAL EXPENSES: ! Ewing Brothers Funeral Home, Carlisle, P A 2 'Georges' Flowers, funeral flowers B. ! ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Jeannine Kautz Gilreath Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 384 Eddington Avenue City Harrisburg Stale P A Zip 17111 Year(s) Commission paid 2002-2003 Attorney's Fees Martson Deardorff Williams & Otto (estimated) 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County State Zip 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Cumberland Law Journal, advertising Letters Testamentary 2 Register of Wills, Short Certificate Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) *' ScheWIe H FlIleI'llIExpenses & PdnirisIraIive Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DeCEDENT __..._____u_. ESTATE OF JOHNSON, Pauline A. 3 The Sentinel, advertising Letters Testamentary 4 Cleaning and trash removal supplies 5 Calvin Hunter, trash removal 6 I PPL, electric service pending disposition of real estate 7 Carlisle Borough, water/sewer service pending disposition of real estate 8 Darlene L. Moyer, 2002 real estate taxes 9 Coldwell Banker, conunission on real estate sale 10 Coldwell Banker, transaction fee II REIMAX Sterling, commission on real estate sale 12 County of Cumberland, I % of realty transfer tax 13 Register of Wills, filing fee, Inheritance Tax Return 14 Reserved for additional probate, filing fees and miscellaneous expenses FILE NUMBER 21 - 02 - 00606 Page 2 of Schedule H 90.59 100.00 100.00 154.58 77.65 707.96 2,545.00 125.00 2,495.00 720.00 15.00 500.00 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVA.NIA. INHERITANCE TAX RETURN RESIDENT OECEDENT -- -'-'~--'---"--'-------'- - ..---.---...---------- -'---"-- -----"--"-' --..------ --.---------------- - _._._~----- --. ._-._--'- --------- .__L ESTATE OF JOHNSON, Pauline A. I FILE NUMBER 21 - 02 - 00606 --- -----~- -- - ----------. - -- --.--- Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 DESCRIPTION Sprint, final bill, telephone service PPL, June bill, electric service Carlisle Borough, June bill, water/sewer service TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 43.73 45.67 21.44 110.84 REV-1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ___n_____'n_ __.____ ESTATE OF JOHNSON, Pauline A. I FILE NUMBER 21" 02 - 00606 RELATIONSHIP TO DECEDENT Do.HotUstr~_ AMOUNT OR SHARE OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Carl L. Johnson , 1205 Guildford Road, Glen Burnie, MD 21061 : Stepson I 1,000.00 2 Tara Kautz 384 Eddington Avenue, Harrisburg, PA 17111 Stepgreat-granddaught Grandmother's clock, er ,one-half real estate 3 Jeannine Kautz Gilreath 384 Eddington Avenue, Harrisburg, PA 17111 , ! Stepgranddaughter Safe, one-half real 'estate, one-fourth \residue 4 Richard Johnson ; 311 Quigley Avenue, Egg Harbor Township, NJ 08234 , I ! Stepgrandson I lOne-fourth residue 5 Teresa Johnson Vaughn 203 Oak Knoll Road, New Cumberland, P A 17070 I Step granddaughter One-fourth residue Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate, on Rev 1500 cover sheet I II. NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE]f *' SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ---~---,---,.__._--_., ---~ -L.__ ESTATE OF JOHNSON, Pauline A. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE D;STRIBUTIONS - - f\nclulieoutright spousaldiSti.butio-ns.-andtranSfers under I. Sec. 9116(a)(1.2)) 6 Brian Johnson 403 Longbow Road, Mt. Airy, MD 21771 FILE NUMBER 21.02.00606 RELATIONSHIP TO DECEDENT ~ ~'?!_!:~!it Troll't~~~1 Step grandson I , AMOUNT OR SHARE OF ESTATE :One. fourth residue Page 2 of Schedule J NDV-21-2002 14:14 FROM:DUNCAN HARTMAN 7172497800 10:7172431850 P.2/3 .' I .---,- ~."._. ---.-..,--- ,-- A. H,U.O SETTlEMt'NT8TATEMENT S.LOAN TYPE: ." OUA FILE 'if: RE02-321 LENDER: Members First FCU C.Thiti form. is furnished. to give you A statement of f!c"tu.l eettlelPent coet8~ Amounts paid. to "nd by the stitt18ment Agent An shown. It61me. marked ~.o.c. were paid Q'U.teide closing. 0, NAME OF BORROWER: E. NAME OF SELLER: Patricia. L. Ron Estate of Pauline A. Johnson - G, PROPERTY LOCATION: H, SETTLEMENT AGENT: I SETTLEMENT OA TE' 659 Hamilton Slreet, Carlisle, PA 17013 DUNCAN &. HARTMAN, P.C. FTiday 22 - NoY-02 \ IRVINE ROW I Carlisle Borough Cumberland County CARLISLE, P.o.. 17013 11:00a.m. J, SU_MMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TR~N.SACTION 100 GROSS AMOUNT DUE FROK BORROWER 400 GROSS AMOUNT DUE TO SELLER 101 COt'ltt:4C:t't, sal.6 P~iCl. $72,000,00 401 Contraot: 81!l1.a p~ 10. "", $72,000,00 -""' ..-.- 10' Personal property 0,00 402 l?~t:tJOT\.Q..l ~rope.rty 0,00 - "-- lOJ Settltllrnent Char'il9e: (Une HOO) 1700.25 .., 0,00 . 104 40' ,_.- ", Adjue:tmlints items prepaid by sellttrt -~-,,-- J\djus:ttaen"t.8 It/ilmQ. pr",pcd,oj by p..l1ca:t. .0' Locel t",xilt:l to n..ov,c-02. 33.50 '08 J.OO.lil.~ t.IlIX.~ to 31...D*0-02 J....... 33.50 4.06 Aae'lil8a1lil.6r.t.8 --,-,,-,'-,",., -, ..~ _.~, -'-"-'~'''-~-''''-'~'-~ .- .~--_._-' 107 lUIQQDllmontlll to 40' Sohoo1 taj(.~ to 30-JUn-03 426,72 '08 SchOQl tex.15 to 30-Jul\-Q3 426.72 40' -...-." "9 40' 120 GROSS OUE FROM BORROWER 74160.46 420 GROSS DUE TO SEl.LEF\ 72460,21 " . 200 AMOUtlTtl PAto BY OR PO, BOR!OWER '" REDUCTIONS " MOUNT DUE TO 8ELLE~ 2., PQP<;>Qi1;. or E",rrHoll1: Mon.y 1000.00 SOl Ex"e~~ depOlli~ .~....,-~,.""._..,-- ._.....~~_._,_.. 202 ..W Kortq..gQ A.oo.<>1,1n....: MQmh1o.rll l"irllt 52000,00 '" Sollttl<l1m~ll.t c~";:~~"~.,,.,,_. S922,06 w"".,.,,"~.- .,~_.... '" 1!x.l.ating lOAI'Jt:i 'eaK&n 8ub~Q?t <0 '" Ex:18dn9 loans tdken -'-' '. 2" '04 0,00 '" Or"nt A9r"'QmQnt-R..dov.lo~m.nt A.u'ehorlty 3000.00 50s 208 credit ior Radon . Re.pd.rlJ , 550,00 ,., ~roQd'j;t ior Rfl.don . ftlilpai.re 1SS0,CO 2" '" --- A.d.ju~'t..nts tor itema unpaid by Ileller ,.. 210 LO<ll!;l TlIxel!l to 22-Nov-0.2 0.00 Adjustn\9nta for it,;.ms unp4id by sel1l9'r ,,-- 21' .a.lJ~llIgam.nt:.IiI <0 510 Looal taxes 22..Nov-O.2 000 2" s(:lhool TaX&8 <0 22-'Nov-02 0.00 511 ASS911sm&ntll to ,. 2" 512 toe-hoal t,s)C:CUI to 22~~ov-Q~ 0.00 2" 513 -..- 217 514 220 TOTAL PAID BY BORROWER 57550.00 '" TOTAL REDUCTIONS SELLllR 7472.06 .,...-.....- SOO CASH FP.OM/-ro BORROWER 600 CA:GH TO/PROM S~r..I..I:lR SOl QrQlJ1J ~mOl,1n"t d"" f~oRl !x>:r;1:Ql'''.,,," 74160,46 '" q~OIU. (lW,Qo;II\t to 1-$11$):' 72460.2.1, ,., [,1il'(J8 <Ilm(;n~fl"t8 p,,!.r;l by/foJ: borrowoar 57550,00 '01 jtQQuc"ione to ...eJ,ler 747206 ~'cJ{~f!L€"l~,!(:!qLi;l",OI'l1'l6~!i!1;l~2""'."'."".-....."i2",' $16,610,46 'iiosl:)'AsHi't6:(FROiAiisEti;.5Ai> $64.988.15 -..........."".....''''^-.. .... ,. .".."........ ". ... ".......... I hav~ earefully r~viQw~d thg HUO-l SQttlQment Statem$n~ and to the be$t of ~y knowledg~ ~nd beliet, i~ 1s a true and a~eurate atdtemant of all receipte and dieb~~Bement5 made on my 4e~oun~ or on my behalf and I have received a oopy of th1e RUD-l for my reco~de. Patricia L. Ross Estate of Pauline A Johnson r II + It iA/1 1::/ J-...b' . r-r NDV-21-2002 14: 15 FROM: DUNCAN HARTMAN 7172497800 TO: 7172431850 P.3/3 PAGE #2 HUD DISCLOSURE/SETTLEMENT STATEMENT PAID BY BORROWER P AID BY SELLER 700 TOTAL REALTOR'S COMMISSION 7% X $72,000.00 ;~ 701 Listing Agency: Coldwell Sanker HSG $2545.00 702 Selling Agency: RE/MAX Sterling $2495.00 70:3 Transaction Fee: Coldwell Banker HSG 1~ -- 600 ITEMS PAYABLE IN CONNECTION WITH LOAN .- 801 Origination Fee Members Flfst FCU 0.00 802 Loan Discount Members First FeU 60:3 Appraisal Fee Members First FeU 804 Cradit Report Member. First FCU -- ...- 805 Und..rmiting F'.... !l.~ Document Preearation Fee ___'n ~.._._~~"._..~~_.,'.. ,__._ B07 Flood Certification B08 Tax Service Fee B09 Lende, Administration fee: -.'-' 810 Overnight Mall Charges: Duncan & Hartman, P.C. 0.00 0.00 900 ITEMS LENDER REOUIRES TO BE PAID IN AOVANCE .. -- 901 Interest from 22-Nov-02 to 01 -Dec-02 ,'._, """"_u"__ 902 Mortgage insurance .....- 909. Hazard insurance -- 904 -- 1000 RESERVES DEPOSITED WITH l.ENDER ~. Escrows collected: # mos. due: X $ per mo.: -- 1001 Hazard in$l.,.lrance 0 0.00 0.00 1002 Mortgaae insuranoe - - 0 0.00 0.00 1003 County/Locai taxes 0 0.00 000 -- 1004 School taxes 0 0.00 0.00 .. ._,._~.._._" 1 005 Aggregate Adjustment 1100 TITLE CHARGES 1101 Settlement or olosina lee: , , 02 Abstract or title search: - -----...J 11 03 Title Review: 0.00 0.00 -- 1104 Title insurance binder: . 1100 Documant prepa ration: - 1106 Notary fees: Notary 6,00 -. 1107 Attorney's ~~es: Martson, Deardorff, Williams & Ono - 0.00 POC .... (includes above Item numbers}: 1108 Title Insurance: WILLIAM A. DUNCAN, AGENT FOR FIOELiTY NATIONAL TITLE 840.75 (includes ai?ove item numbers):1101-1104 ~ Endorsements 100 SOO e.l $150 1109 Owner's coverage $72,000.00 $690.75 -. - 1110 Lender's coverage $52,000.00 1111 Insured Closing letter Fidelity N~tional Title -'-' 0.00 1200 GOVERNMENT RECORDING AND TRANSFER CHAAGES 0.00 1201 Deed '.-' 40.00 Mortgage 66.50 10B.50 ,- , 202 Release/Satisfaction 0.00 Agreement 27.00 27.00 0.00 1202 County/Localtransler tax (1 %) -~_. .- ..... 720.00 1203 Pa. State lransfertax (1%) J2~ 1300 AODITIONAL SETTlEMENT CHARGES 1301 Radon testing: POC $370.00 Biechler & T(ltery, Inc. POC "-'--'.~' 1302 Pest inspection: POC $35.00 Blechler & Tillery, Ine, POC 0,00 ~ ,_0..___ 130:3 Water 8< Sewer Reading: #941-A Ca rHsle Borough ~._,- 37.06 1304 Homeowners AS$oeiatton Fee i4001'o1'AfsE;1''t(eMI;J~''cHAR"Ges::' . ..."'r..,....,...",...,....,.,,,..~_A_..c'.."_ <: . 1790..~5 5922.06 (alSo entered on line 103 for Borrower; line 502 for Seller) .: CITIZENS BANK Account Number Account Title Tuesday, August 27,2002 192-108-8975 PAULINE A JOHNSON -------_.._------~.~---.~. ---~._-_._---- .-- --~--_..--~------_._--_._._------_. ~._----- ------..__._-~_._------_.._.._...- Date Opened: 01/30/1981 Principal Balint from Last as of 000 Posting to 000 $13,251.75 $0.27 Account Type: DO Account Bal as of 000 $13,252.02 YTD Int to 000 $16.72 .__,_______.. .___...n....__.______.__.. ___..____.___~_____ __________.___._______.____.__________________...___ c' "'H. E Ik-..-.<- ( 0L. I Page 2 of 2 c: o C" U) ..E ~g .1..: (lJ c: ..... .-f \ '- ~ 0, LAST WILL AND TESTAMENT I, PAULINE A. of the Bo~ough of Ca~lisle, JOHNSON, Cumbe~land County, Pennsylvania, being of sound and disposing mind and memo~y, do he~eby make, publish and decla~e this to be my Last Will and Testament, he~eby ~evoking any and all fo~me~ Wills or Codicils by me made. 1. I di~ect fune~al expenses, all my just debts, that testamentary expenses and all inheritance taxes shall be paid f~om my ~esidua~y estate as soon as practicable afte~ my decease and as pa~t of the administ~ation of my estate. 2. If my husband shall su~vive me by thirty (30) days, then I give, devise and bequeath all of my estate, both ~eal and pe~sonal p~ope~ty, unto my husband, JAMES O. JOHNSON, absolutely. 3. In the event my said husband shall p~edecease o~ fai I to survive me by mo~e than thi~ty (30) days, then I give, devise and bequeath my estate as follows: A. I give the sum of One Thousand Dolla~s ($1,000.00) unto my husband's son, CARL L. JOHNSON. B. I give my g~andmothe~ls clock to TARA KAUTZ. C. I give my safe to JEANNINE KAUTZ. D. I give my house located at 659 Hamilton Street, Carlisle, Pennsylvania, to JEANNINE KAUTZ and TARA KAUTZ. E. In the event that the said TARA KAUTZ shall not have attained the age of majority, then such items of personalty and -1- LAW OFFICES - MARTS ON, DEARDORFF. WILLIAMS & OTTO real ty that have been left to her under the foregoing specific bequests shall be held by her mother, JEANNINE KAUTZ, until such time as TARA KAUTZ shall have attained the age of majority. F. All the rest, residue and remainder of my estate, both real and personal property, I give, devise and bequeath, in equal shares, unto JEANNINE KAUTZ, RICHARD JOHNSON, TERESA JOHNSON and BRIAN JOHNSON. 4. I nominate, constitute and appoint my husband, JAMES O. JOHNSON, as Executor of my estate. In the event my husband shall be unable or unwilling to serve in such capacity, then I appoint JEANNINE KAUTZ to act in such capacity. In the event the said JEANNINE KAUTZ shall be unable or unwilling to serve in such capacity, then I appoint TERESA JOHNSON to act in such capacity. 5. I direct that my Executor or Executrix shall not be required to file a bond to secure the faithful performance of his or her duties in any jurisdiction. 6. I authorize and empower my personal representatives, in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected wi th the protection -2- LAW OFFICES - MARTSON. DEARDORFF, WILLIAMS & OTTO and p~ese~vation of my estate; to mo~tgage o~ pledge any ~eal o~ pe~sonal p~ope~ty fo~ming a pa~t of my esta te o~ to join in o~ secu~e the pa~tition of same; to comp~omise any claims o~ demands of my estate against othe~s o~ of othe~s against my estate: to make dist~ibution in kind and to cause any sha~e to be composed of cash, p~ope~ty o~ undivided f~actional shares in p~ope~ty diffe~ent in kind from any othe~ share; and to execute and delive~ such instruments as may be necessa~y to ca~ry out any of these powe~s. IN WITNESS WHEREOF, I have he~eunto set my hand and seal this /q+lt day of Fe..-brudt'1 ,1990. P au.L~ a.. 4,LL>----. Pauline A/'Johnson (SEAL) SIGNED, SEALED, PUBL ISHED AND DECLARED by the above-named Testat~ix, as and fo~ he~ Last Will and Testament, in the p~esence of us, who at her ~equest have hereunto subsc~ibed ou~ names as witnesses the~eto, in the p~esence of said Testatrix and of each othe~. ~~ -3- LAW OFFICES - MARTS ON, DEARDORFF, WILLJAMS & OTTO COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, Pauline A. Johnson, Testatt"ix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last will; that I signed it willingly; and that I signed it as my free and voluntary act fot" the put"poses thet"ein expt"essed. &A,L" ~ ~~_____ Pauline A."~o nson Sworn ot" affit"med to and acknowledged A. Johnson, the Testatt"ix, this If~day of befot"e me by Pauline Fef:,n",/''j , 199,) COMMONWEALTH OF PENNSYLVANIA (JLJjI/u~./) 0( 7Y~h'>> Notary Public _ ___' N,-~!~ji~; ;,:.>6.11 ) Corrino L Myers, Notary p,tJljc Cerlisle Boro. Cumberland County SS. My camm..~icn E.""... M,'Y V, 1\l9\ COUNTY OF CUMBERLAND We, ])"u,,'d K. bu.rdorff t1.,'\.d Lv';) V, iOtto,J1L, the witnesses whose names at"e signed to the attached ot" fot"egoing instt"ument, being duly qualified accot"ding to law, do depose and say that we were present and saw the Testatt"ix sign and execute the instrument as het" Last will; that the Testatt"ix signed willingly and that the Testatrix executed it as het" ft"ee and voluntat"y act for the purposes therein expressed; that each of us, in the heat"ing and sight of the Testatt"ix, signed the Will as wi tnesses; and that to the best of our knowledge the Testatt"ix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. cv~ ~ Q-. Id- >ddm. I~~;;'; ~;'13 Ad~ I~j r:!" ~. f'- I <; e P# 70/3 Sjiorn or affirmed to and subscribed before me this I 1 !I\, day of f-Gbrf4o.ry ,1990 . f!A->)''''~,,),~ >J?t'/UV Notary Public Notarial Seal ~ Corrina L. Myers, Notary po ,b1ic Carlisle Boro. Cumberland County My Commissicn Ex.,:Sres May 2:7,1991 LAW OFFICES - MARTS ON, DEARDORFF, WILLIAMS & OTTO /.....]..--:>....-, --'/ /- /";:;' -t--::- 'v IlUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX CARL C RISCH MARTSON ETAL 10 E HIGH ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-03-2003 JOHNSON 06-21-2002 21 02-0606 CUMBERLAND 101 *' ~EY-1547 EX AFP (OI-D5l PAULINE A Amount Rell1 H:ed PA 17013 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 ... R.f,,=iS4rEx-AFP--foFci3Y-NoTicE--oF-iNHEifii'ANcE-TAX-APPR7iisEiiENT~--AL'i'-OWAiicE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JOHNSON PAULINE A FILE NO. 21 02-0606 ACN 101 DATE 03-03-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total ~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rata (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Aaount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due T X C TS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedul. B) 3. Closely MaId Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. JointlY Owned Property (Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 72.000.00 .00 .00 .00 15.695.38 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad~. Costs/Misc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern..ntal Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax (9) (10) 19,789.76 11 0 . 84 IllJ (12) (13) (14) NOTE: .00 X 67,794.78 X .00 X .00 X NUMBER CD001625 CD002017 INTEREST/PEN PAID [-) 147.37 .00 AMOUNT PAID 2,800.00 98.23 DATE 09-17-2002 01-06-2003 PAYMENT MUST BE MADE BY 03-21-2003*. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax paYllent. 87,695.38 19.QOO 60 67,794.78 .00 67,794.78 00 = 045 = 12 = 15 = .00 3.050.77 .00 .00 3,050.77 (19)= 3,045.60 5.17 .00 5.17 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS TMAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX '~ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CARL C RISCH MARTSON ETAL 10 E HIGH ST CARLISLE . ~ i A..ount Rellitt.d '* JEV-l!i4:7 Ell .F' tDl-UJ 03-03-2003 JOHNSON 06-21-2002 21 02-0606 CUMBERLAND 101 PAULINE A PA 17.013 Sill MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ icV :i'i:'Z'i'-~y--iiii.-fi);-:n~'--NnTi~~--ni"T-Nw;D-fTiii';-~"T-AY-'i-iiiAi'qiMFNT---Ai'i":"~':'::-:~"--"------- TO: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT Of REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MARTSON ETAl 10 E HIGH STREET CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 189-18-6807 FILE NUMBER: 2102-0606 DECEDENT NAME: JOHNSON PAULINE A DATE OF PAYMENT: 03/12/2003 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 06/21/2002 NO. CD 002279 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5.17 I I I I I I I I TOTAL AMOUNT PAID: $5.17 REMARKS: MARTSON ETAl CHECK# 11416 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS \". 1'/1- '?S-0 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DfPT. Z80601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * ~EV~ln1 EX iF' (Ul~05l CARL C RISCH MARTSON ETAL 10 E HIGH ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2003 JOHNSON 06-21-2002 21 02-0606 CUMBERLAND 101 PAULINE A A..ount Re..itted PA 1701.3 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper eredit to your account, subllit the upper portion of this for.. with your tax pay.ent. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REv:ic.oTiif-AF'p--foFo3Y------...-iNHERITANCE-TAir-si'AYiiiifN"T-oTACCouiff--...--------------------- ESTATE OF JOHNSON PAULINE A FILE NO. 21 02-0606 ACN 101 DATE 03-31-2003 THIS STATEHENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATEO ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, ANO, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-03-2003 PRINCIPAL TAX DUE: ... 3,050.77 PAYMENTS CTAX CREDITS), PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 09-17-2002 CDOO1625 147.37 2,800.00 01-06-2003 CD002017 .00 98.23 03-12-2003 CD002279 .00 5.17 TOTAL TAX CREDIT 3,050.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADOITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTEO AS A "CREDIT" ICR), YOU HAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) D /o~ REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: PAULINE A. JOHNSON Date of Death: June 21, 2002 File No.; 2002-00606 Social Security No.; 189-18-6807 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, r 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 x 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. I is Yes, state thefollowing: a. Did the personal representativefile afinal account with the Court? Yes No x 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 x No d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. [See attached] '" Signature: Name: Address: QQttQC1Q.:..D Carl C. Risch, Esquire MARTS ON DEARDORFF WILLIAMS & OTIO Ten East High Street Carlisle, P A 17013 (717) 243-3341 Counsel for personal representative Date; August 21, 2003 ,-. (-:J '-:J ,-,..\ F:\f(LES\DA T AFlLE\EST A TES\ 7246_lsrep r'l ~:.:J