HomeMy WebLinkAbout01-0007
REV-1500EX+(6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
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COUNTYCOOE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
Johnson Bell Jane
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
1 92- 3 0 - 1 970
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/22/2000 08/03/1938
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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00 1, Original Return
o 4, Limited Estate
o 6, Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AlIachcopyofTrust)
o 10. Spousal Poverty Credit (date of death betwe€n 12-31-91 and 1-1-95)
03. Remainder Retum (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11, Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST$E COMPLETED. ALL CORRESPONDENCE ANbCOIIIFIDENTIALl'A)(It'jIl-ORMA:TION$IlI)UlP$EPIRECTEDtO:
NAME COMPLETE MAILING ADDRESS
H. Anlhon Adams Es uire 128 E. King Street
FIRM NAME (If Applicable)
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Suite A
TELEPHONE NUMBER
717 -532-3270
PA 17257
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Scheduie OJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (Iotal lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
20,460.37
(6)
(7)
(8)
20,460.37
(9)
69,712.50
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11, Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11)
(12)
(13)
69,71250
-49,25213
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
-49,25213
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rale
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X_(15)
X_(16)
X .12 (17)
X .15 (18)
(19)
0.00
0.00
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL Qu nONS ON RJWERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
121 Walnut Bottom Road
CITY I STATE I liP
Shippensburg, PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
000
Total Credits (A +B +C) (2)
3. InteresUPenalty if appiicable
D. Interest
E. Penalty
TotallnteresUPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This IS the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
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; ..... ............................. .. .................................... 0 [ZJ
b. relain the right to designate who shall use the property transferred or its income; ................................. ...... 0 [ZJ
c. retain a reversionary interest; or ........................ ................................. ..................... D [Z]
d. receive the promise for life of either payments, benefits or care? ................... ...................... 0 [ZJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............. ....................................... ............... D [Z]
3. Did decedent own an "in trust for" or payable upon death bank account orsecurity at his or her death? .... . .......... 0 [ZJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.. .................................. ............... ........ 0 [Z]
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 01 perjury, I declare that I have examined this return, includin9 accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete
Declaration of preparer other than the personal representative IS based on all InformatIOn of which preparer has any knowiedge,
SIGNATU OF PERSO ES NSI FOR FILING RETURN DATE
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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 fa the e of the surviving spouse is 3%
[72 PS 99116 (a) (11) (I)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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. 99116(a)(I.2)].
The tax rate imposed on the net value of transfers to or for the use of Ihe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) 172 P.S. 99116(a)(1)].
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. 99116(a)(I.3)]. A sibling is defined, under Seclion 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508fX+(1-9,l)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Johnson BetlY Jane
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.
FILE NUMBER
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
19,402.82
2.
Orrtown Bank
Checking Account
Accl: 103002223
Refund from Shippensburg Health Care Center
1,057.55
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
20460.37
REV.1511EX+{1-971
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FilE NUMBER
Johnson Bellv Jane
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, Inc. 28.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Boyd J. Johnson, III 1,500.00
Social Security Number(s) I EIN Number of Personal Representative{s)
Street Address 111 Sandbank Road
City Shippensburq State Pa Zip 17257
Year(s) Commission Paid: 2001
2. Attorney Fees H. Anthony Adams, Esquire 1,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 91.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Sprint (telephone bill) 36.89
8. Pharmcare (prescription) 370.00
9. Emergency Medical 274.26
TOTAL (Also enter on line 9, Recapitulation) $ 3800.15
(If more space IS needed, Insert additional sheets of the same size)
REV-1S12 EX+(l-~71 .
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Johnson Bettv Jane
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
65,912.35
1.
Commonwealth of Pennsylvania
Department of Welfare
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
65 912.35
REV-1513EX+(1;97I,
~l.. .._1.1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
.Inhnonn Beth, .I~n"
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Boyd J. Johnson,1I1 Son 1/2
111 Sandbank Road
Shippensburg, PA 17257
2. Bradley J. Johnson Son 1/2
132 Noble Avenue
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
. .
LAST WILL AND TESTAMENT
I, BETTY JANE JOHNSON, of 312 Meadow Drive, Shippensburg, Southampton Township,
Franklin County, Pennsylvania, being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void all wills by
me at any time heretofore made.
FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be
convenient after my decease. It is my desire to be buried wearing a long nightgown and no shoes.
SECOND. I give, devise and bequeath all of my estate, real, personal and mixed, whatsoever and
wheresoever situate, in equal shares, as follows:
A ONE SHARE to my son, BOYD 1. JOHNSON, III, on a per stirpes distribution basis.
B. ONE SHARE to my son, BRADL Y 1. JOHNSON. In the event that the said BRADL Y J.
JOHNSON, should predecease me or is not living on the sixtieth (60th) day following my
death, I then give, devise and bequeath his share to my son, BOYD 1. JOHNSON, III, on a
per stirpes distribution basis.
It is my specific intent and desire to exclude my daughter, BERRIE JEAN HOOVER, from
a share of my estate, because I have otherwise provided for her during my lifetime.
THIRD. In the event that any beneficiary of this my Last Will and Testament is under the age of
twenty-five (25) years, I then give and bequeath said beneficiary's share to and appoint as Trustee
of any property which passes under this Will or otherwise, my son, BRADL Y J. JOHNSON, AS
TRUSTEE, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches
the age of twenty-five (25) years, with the following powers in addition to those presently given by
law:
c (SEAL)
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET _ SHIPPENSBURG, PA. 17257
A. The power to expend the income towards the health, support and maintenance, and
education, including a college (both undergraduate and graduate), trade, business or
technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the said Trustee, if the
income is insufficient, towards the health, support and maintenance, and education,
including a college (both undergraduate and graduate), trade, business or technical
school education, of the said beneficiary;
C. The power to sell any and all real estate, within the discretion of the said Trustee;
D. The power and obligation to distribute the balance of principal and interest, if any
remaining, when the said beneficiary reaches the age of Twenty-five (25) years, without
the necessity of a formal adjudication of the Trustee's account in the Court of Common
Pleas of Franklin County, upon the receipt of a good and valid release;
E. The principal of the Trust and the income therefrom shall be free from the debts,
liabilities, and engagements of those beneficially interested therein, and shall not be
subject to assignment by him or her, nor to attachment or execution under any legal,
equitable or other process for the enforcement of judgments or claims of any sort against
them, either individually or collectively;
F. In the event the above-mentioned Trustee is unable to accept the position of Trustee, I
then name, constitute and appoint ORRSTOWN BANK, as Trustee, with the same
powers hereinbefore stated.
FOURTH. I nominate, constitute and appoint my son, BOYD J. JOHNSON, III, to be theExecutor
of this my Last Will and Testament; ifhe be unable to fulfill the dutes of Executor, I then nominate,
constitute and appoint BRADL Y J. JOHNSON to be the Executor of this my Last Will and
Testament.
FIFTH I direct that my personal representatives shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
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(SEAL)
MARK, WEIGLE: AND PERKINS _ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 17257
IN WITNESS WHEREOF, I, BETTY JANE JOHNSON, have hereunto set my hand and
seal to this my Last Will and Testament, written on three pages, the first two pages signed for
identification only, this J ~ day of c\'~t ' 1998.
B":\;J~,~,",,,,- ~1.''"l'''tr'l
(SEAL)
This instrument was by the Testatrix, on the date hereof, signed, published and declared by
her to be her Last Will and Testament, in our presence, who at her request and in her presence and
in the presence of each other, we believing her to be of sound and disposing mind and memory, have
hereunto subscribed our names as witnesses.
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MARK, WE.IGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 17257
COMMONWEALTH OF PENNSYLVANIA
: SS.
COUNTY OF CUMBERLAND
I, BETTY JANE JOHNSON, whose name is signed to the 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.
YiJtu] ~"'~~~4\4 err)
Sworn or affirmed to and acknowledged
before me.;,bY BETTY JANE JOHNSON, Testatrix
this j rl day of upn I ,1998 1 "
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MARK, WEIGLE AND PERKINS _ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSeURG, PA. 17257
COMMONWEALTH OF PENNSYLVANIA
: SS.
COUNTY OF CUMBERLAND
We, Q~ C). C:;...k~ and, /((.(I/A? fVtd._/w
the witnesses whose names are signed to the foregoing inst~ment, being duly qUalifie~)cording
to law, do depose and say that we were present and saw BETTY JANE JOHNSON, Testatrix, sign
and execute the instrument as her Last Wi!!; that she signed willingly and that she 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 the time eighteen (18) or more years of age and of sound mind and under no constraint or undue
influence.
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MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET _ SHIPPENSBURG, PA. 17257
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY - PENNSYLVANIA
JJJ~/ PETITION FOR GRANT OF LETTERS
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(Estate of Betty J. Johnson
.,also known as Betty Jane Johnson
No.
J./- D /- Oaf} 7
, Deceased
Social Security No. 192301970
Boyd J. Johnson, III
Petitioner(s). who is/are 1 B years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or
Decedent, dated 4/3/98 and codicil(s) dated
none
named in the Last Will of the
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 after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a" d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
(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 121 Walnut Bottom Road, Shippensburg, PA
(list street, number and municipality)
Decedent, then 62 years of age, died December 22 ,2000, at Shippensburg Health Care Center
(Location)
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 of real estate in Pennsylvania ................ ..................
Total.. ..............................................
$ ~~ 000 .C)O
$
$
$
$d9 6co cx-.~
Real Estate situated as follows:
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 appropriate form to the undersigned:
Signature
Typed or printed name and residence
111 Sandbank Road Shi
PA 17257
RW-1 /(;-lfP7:;<
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner( s) and that, as personal representative( s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this
3rd
day of
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Lewis all ~
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DECREE OF REGISTER
Estate of -Betty Jan~ Johnson
also known as -::.. ~e~ty J . "t<?,hnson
Social Security No: 192301970
Deceased
No.
21-2001-0007
Date of Death: 12/22/00
AND NOW, ,T,mwny 3 2001
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I:&l Testamentary 0 of Administration
, in consideration of the Petition on the
((c.l.a, d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
are hereby granted to Boyd J. Johnson, III
in the above estate and that the instrument(s), if any, dated April 3, 1998
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $ 50.00
Short Certificates(s) ....3......... $ 9.00
Renun~ation .......................... $
Extra Pages (4 ) ............... $ 12.00
$
$
$
$
$
Signature
I.T.R.......................................
JCP Fee .................................
5.00
Attorney: H. Anthony Adams, Esquire
I.D. No: 25502
Address: 128 E. Kin~ Street
Shippensbur~
Telephone: (717)-532-3270
DATE FILED: January 3,2001
Inventory ...... ...... ....... .............
Other ......... ...... ......... ........ ......
PA 17257
76.00
TOTAL .............................$
This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
Fee f(lr this certificate, $2.00
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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21-20001-0007
N 2ffJ7
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
t.
BETIY J. JOHNSON
su
.. Female
!T~. 'II.! NUMWA
SOCIAL SECURITY NUMBER
.. 192 - 30
DATE OF OEATH,MonUl, UIIV. ''''tar,
.. December 22, 2000
NAME Of DECEDENT (f.w!II. MIddIe.l.U11
AOE (laal BIf1tldayI UNDER 1 YEAR
Monttl. Days
62 v..
UNDER 1 OM
Houn I ..!nut.
SlIn'HrlACI (C~ tAd
State or Foreqn COlInlfvt
PlAC OF OlEAI'H (C"<<:1l only Me -- .. Ifl8fruellOflS OIl OIMf ..oAt
HO"'''''
Inp..... []
g-~",,)o
C..ouHTY OF Of.:AI'H
,,,,.
...
-
......
Cumberland -' "..0 ::...-=.:::::'"
MOTHER'S NAUE (f.-lit. Middle. M8lderl Surnamel
11. Carrie Baer
....'frr.~~~~f8SRs;;-:.8;Sh"'rPife~bu r g, PAl 7257
-
PlACE OF D1sPOSfTK)N. Neme ofCtfftetery, CremalOty LOC.(l1()N . CIt'f'ITown. Slale, lip Code
or 01'* Pa.c.
Spring Hill Cemetery
210.
MMITAL STATUS. M.med
,....,., Married. Widowed.
ntvon:.d (Soeclfyl
1.. Divorced
I1c.Kl ..... dIIcedInl: ....Irl
RACE, AI'I'IWteM IndI_". AlKtI.. Wh... <tk:
''''''''''''I
,..White
SURV1V1NQ SPOUSE
1" ...... QNe tnallMn I'W1"IeI
.. Cumberland
DECEDENT'S USUAL OCCUPAIlON
l~work~_:io~::ft.?If:)'
l1froduction Worker 1U~istle
DECEDENT'S MAtLlNO AOOAESS (Str... CltyfTorwn. sr... lip Codel
121 Walnut Bottom Road
Shippensburg, PA 17257
II.
FAJ'HER'S NAME (First Middle. Lasfl
II. Howard Leedy
INFOAMAHT'S NAME (TypIWPf'tnl)
Boyd J. Johnson, III
METHOOQF DISPOSITION
O ...... [Jl: C_loo 0 ..........~...I.D
_ 00... (Sooc",
210.
Co.
DECEDENT'S
ACTUAl..
REStOE'NCE
-""""""'"
onoltl..~,
17.. sa...
II.
Shippensburg
-
-
PERSON ACTING AS SUCH
Shippensburg,
.'d. Cumberland Count
LICENSE NUM8ER
01 I 776-L
NAYE AND ADDReSS OF MeIUrv
elsanger-Bricker F .H. ,Inc. ,P .0.
LICENSE NUMBER
m. RN 3d.J 300 L
Box 336, Shbg. ,PA
PA
17257
"__ 24-28",,* be c:ornpteted by
.,.,.,. who pronouncn dIIelh.
IllllEDlATI. CAUSI! (f'na1 """-J-
~or condlhon .
'lMUlIIno on dMIh)_
Pl\ATN: OttIer'ignIfIeant~contributlnqlO~.'''.but
nor I'ftUltInQ in the ~ c-... g;v.n in FWfT I
ou AS A. CONSEOUENCE Of)"
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(MOl'lltlOey. '\leaf)
TIME Of' INJURV
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>C.
LAST WILL AND TESTAMENT
I, BETTY JANE JOHNSON, of 312 Meadow Drive, Shippensburg, Southampton Township,
Franklin County, Pennsylvania, being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void all wills by
me at any time heretofore made.
FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be
convenient after my decease. It is my desire to be buried wearing a long nightgown and no shoes.
SECOND. I give, devise and bequeath all of my estate, real, personal and mixed, whatsoever and
wheresoever situate, in equal shares, as follows:
A. ONE SHARE to my son, BOYD 1. JOHNSON, III, on a per stirpes distribution basis.
B. ONE SHARE to my son, BRADL Y 1. JOHNSON. In the event that the said BRADL Y 1.
JOHNSON, should predecease me or is not living on the sixtieth (60th) day following my
death, I then give, devise and bequeath his share to my son, BOYD 1. JOHNSON, III, on a
per stirpes distribution basis.
It is my specific intent and desire to exclude my daughter, BERRIE JEAN HOOVER, from
a share of my estate, because I have otherwise provided for her during my lifetime.
THIRD. In the event that any beneficiary of this my Last Will and Testament is under the age of
twenty-five (25) years, I then give and bequeath said beneficiary's share to and appoint as Trustee
of any property which passes under this Will or otherwise, my son, BRADL Y 1. JOHNSON, AS
TRUSTEE, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches
the age of twenty-five (25) years, with the following powers in addition to those presently given by
law:
(SEAL)
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 172S7
A. The power to expend the income towards the health, support and maintenance, and
education, including a college (both undergraduate and graduate), trade, business or
technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the said Trustee, if the
income is insufficient, towards the health, support and maintenance, and education,
including a college (both undergraduate and graduate), trade, business or technical
school education, of the said beneficiary;
C. The power to sell any and all real estate, within the discretion of the said Trustee;
D. The power and obligation to distribute the balance of principal and interest, if any
remaining, when the said beneficiary reaches the age of Twenty-five (25) years, without
the necessity of a formal adjudication of the Trustee's account in the Court of Common
Pleas of Franklin County, upon the receipt of a good and valid release;
E. The principal of the Trust and the income therefrom shall be free from the debts,
liabilities, and engagements of those beneficially interested therein, and shall not be
subject to assignment by him or her, nor to attachment or execution under any legal,
equitable or other process for the enforcement of judgments or claims of any sort against
them, either individually or collectively;
F. In the event the above-mentioned Trustee is unable to accept the position of Trustee, I
then name, constitute and appoint ORRSTOWN BANK, as Trustee, with the same
powers hereinbefore stated.
FOURTH. I nominate, constitute and appoint my son, BOYD J. JOHNSON, III, to be theExecutor
of this my Last Will and Testament; if he be unable to fulfill the dutes of Executor, I then nominate,
constitute and appoint BRADL Y J. JOHNSON to be the Executor of this my Last Will and
Testament.
FIFTH. I direct that my personal representatives shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
\y~~~ ~
(SEAL)
MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA. 172S7
IN WITNESS WHEREOF, I, BETTY JANE JOHNSON, have hereunto set my hand and
seal to this my Last Will and Testament, written on three pages, the first two pages signed for
identification only, this] ~ day of ~~t ,1998.
B ~ 1'f'I'> -- ~'">i' ~
(SEAL)
This instrument was by the Testatrix, on the date hereof, signed, published and declared by
her to be her Last Will and Testament, in our presence, who at her request and in her presence and
in the presence of each other, we believing her to be of sound and disposing mind and memory, have
hereunto subscribed our names as witnesses.
SJa::d G. C~
i//( ([17,~/~ ,A/ttl r-L~-/
/
MARK. WEIGLE AND PERKINS _ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA. 17257
COMMONWEALTH OF PENNSYL VANIA
: SS.
COUNTY OF CUMBERLAND
we,Q~ 0' C~ and/fnliAt/Vt:c':4f
the witnesses whose names are signed to the foregoing instrument, being duly QUalifie0cording
to law, do depose and say that we were present and saw BETTY JANE JOHNSON, Testatrix, sign
and execute the instrument as her Last Will; that she signed willingly and that she 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 the time eighteen (18) or more years of age and of sound mind and under no constraint or undue
influence.
(~\ . (....
~,A ()', C~~
J /"( // . A 1/
. it ( . f/t:--f' II v ( r:r I<zy
I
Sworn or affir~o and subscri~.ed
before me by -. J1 cPo ~
~~~n~::~:\hi/ ~~~yy;tJI
r1f r I I , 1998.
./1 ~ .,....,
\~V-J1-t .
!7 I
' //[0
~~3fl
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 172S7
COMMONWEAL TH OF PENNSYL VANIA
: SS.
COUNTY OF CUMBERLAND
I, BETTY JANE JOHNSON, whose name is signed to the 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.
~ ~~~4brl
Sworn or affirmed to and acknowledged
before mjbY BETTY JANE JOHNSON, Testatrix
this 3 rt.~~ay of {l.pn I ,1998. ! '1
y{t~a_ 1/ {Jc~tJ
~~
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA. 17257
\., / ~-/9 %~ /.;:2/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Reco~ r..""~."
. . ; \ '.:-.'
. . '~~~'-
Reg:ste'
of
""o'iils
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-17-2001
JOHNSON
12-22-2000
21 01-0007
CUMBERLAND
101
'01 Ole 27 AlO:1 0
H ANTHONY ADAMS
STE A
128 EKING ST
SHIPPENSBURG
ESQ
*'
REY-1547 EX 'FP 'lZ-OIl
BETTY
J
Allount Rellitted
Clerk.'.. 'Jdrt
PA 19~%ljbe,:d: ,.,,=::;, PA
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 ~
ifEV'= i5'47-:EX-AFP-(' i"2-:0(jr-Ncffic:E--OF-YNHEififANCE-TAX- APPRA-is:EMENT~--ALrOWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF JOHNSON BETTY J FILE NO. 21 01-0007 ACN 101 DATE 12-17-2001
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 F)
7. Transfers [Schedule GJ
8. Total Assets
Cl)
(2)
(3)
(4J
(5)
(6)
(7)
.00
.00
.00
.00
20,460.37
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule IJ
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
69,712.50
.00
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forI! with your
tax paYllent.
20,460.37
nlJ
Cl2)
Cl3)
(4)
69.712 liD
49,252.13-
.00
49,252.13-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: If an assessment was issued previOUSly, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
Cl9)=
.00
.00
.00
.00
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. 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" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
f--
L~
----~
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent:
Betty J. Johnson
Date of Death:
December 22, 2000
Will No: 2001-00007
Admin. No.
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the
Orphan's Court Rules were served on or mailed to the following beneficiaries of
the above captioned estate on: 1/11/01
Name
Address
Boyd J. Johnson, III
111 Sandbank Road
Shippensburg, PA 17257
Newark, DE 19713
Bradley J. Johnson
132 Noble Avenue
Carlisle, PA 17013
Berrie Jean Hoover
98 Springfield Road
Shippensburg, PA 17257
Notice has now been given to all persons entitled thereto under Rule 5.6
(a) except: None.
~~
H. Anthony Adams, Esquire
128 E. King Street
Shippensburg, PA 17257
Telephone: (717)-532-3270
Counsel for Personal Representatives
Date: 1/12/01
STATUS REPORT UNDER RULE 6.12
.
- /;.
C....-
Name of Decedent: Johnson. Bettv Jane
Date of Death: 12/22/00
Will No.
Admin. No. 2001-00007
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:
I . 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. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
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 No X
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: 2/1/02
~\~~
Signature
N
H. Anthony Adams. Esquire
Name (Please type or print)
12R E King Street
Shiooensbura PA 17257
Address
Q..
((71) 7)-532-3
Tel. No.
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Capacity :
Personal Representative
X
Counsel for personal
representative