Loading...
HomeMy WebLinkAbout04-0763 PETITION FOR PROBATE and GRA T OF LETTERS Estate of Lawrence I. Kemp No. · ' ~)~ ' also known as To: Register of Wills for the , Deceased County of Gumberland in the SocialSecurityNo. 083-07-9732 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the execut or named in the last will &the above decedent, dated and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Gumberland County, Pennsylvania, with h ia last family or principal residence at 325 Weale¥ Orive~ #102~ (list street, number and municipality) Decedent, then ~ ~ years of age, died 5/15/04 at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted atler execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ /?O,, ~o o (If not domiciled in Pa.) Personal properly in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith andthe grant of letters Testamentary thereon. (testamentary; administration ¢.t.a.; administration d.b.n.c.t.a.)  5 Hamilton Place Pine Brook NJ 07058 -o~ ~An drew M~f/'''~- OATH OF PERSONAL REPRESENTATIV E COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Cumberland SS '~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedant petitioner(s) will well and truly a~tinister the estate according to law. Sworn to or affirmed and subscribed ~-~- ~-- ~ before me this lqlab day of [ ~' ~ ~ Register ,~t,dr.'x I ~ Estate of Lawrence I. Kemp , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~'-~ \'-~ ~=~(~ (~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of Lawrence I. Kemp and Letters Testamentary are hereby granted to Andrew Mayer FEES David H. Radcliff, Esq. Probate, Letters, Etc ...... $ ,~ 3>''~, 0° 25483 ~ .~.~ .~. 6,~0 ATTORNEY (Sup. Ct. I.D. NO.) Short Certificates ( ~. ~. $ t2., oa, Renunciation ............ $ 20 Erford Road, Ste 200 D"-C ~ $ ,/orOO kemoyne PA '17043 ADDRESS PHONE OATH OF NON-SUBSCRIBING WITNESS Also known as , Deceased (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~-~ familiar with the signatur¢ of A/~oJte~ge~-~-, ~ ,testato~ of (one of the subscribing witnesses to) the codicil/will presented herewith and that ~ believes the signature on the codicil/will is in the handwriting of ,~/,ea..--e~c~, ~ ~/~ ~.t~ to the best of ~e~ ~ knowledge and belief. (Address) Sworn to or affirmed, md subscribed B~ore me this,'--~x- day pf ~ ~~A~~'~''/ ,20 ~ame) ~ ~ ~ (Ad~e~) "his is lo 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 permanen[ filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar No. ~'-,,,,,,,~ Dale of I, LAWRENCE I. KEF~, domiciled in Spartanburg County, South Carolina, eclare this to be my Last Will and Testament, hereby reVoking all wills and codicils heretofore made by me. ARTICLE I I direct that all of my just debts, my funeral expenses, and the cost of adm/nistration of my estate be paid out of the assets of my estate as soon as practicable after my death. ARTICLE II I direct that all estate and inheritance taxes and other taxes in the general nature thereof which shall become payable upon or by reason of my death with respect to any property passing by or under the terms of this Will or any codicil to it hereafter executed by me, or with respect to the proceeds of any policy or policies of insurance on my life, or with respect to any other propert included in my gross estate for the purpose of such taxes, shall be paid by my Executor out of the principal of my residuary estate. AR~ ICLE III I bequeath to my wife, A/24A R. KEMP, if she shall survive ~e, all my personal effects, and all tangible personal property including automObiles m~ned by me and held for personal use at the time of my death, but excluding cash on hand or on deposit, securities, choses in action or other intangibles. In the event my wife, ALMA R. KEMP, predeceases ~e, then I give a~d bec~eath the above described personal effects and tangible personal property in shares of equal value to my surviving children. In event o f ~ny disagree~nt in division, my ~xecutor shall have pOWer to make final and conclusive divisic~. ARPICLE IV A~i the residue of the proper~y which I may own at the time of my real or personal, tangible and intangible, of whatsoev~f~ature and w~l e- after the execution of this will, including all lapsed egacles_ and ~ises'~ ~. bequeath and devise in fee to my wife, ALMA R. KEMP, if she shall survive me. If my said wife, AIWA R. KEMP, shall not survive me, then I bequeath and devise the said property in fee and in equal shares to my surviving issue per stirpes. ARTICLE V I appoint my wife, ALMA R. F~/~p, to be Executrix, without bond, of this my Last Will. If my wife, ~ R. KEMP, shall predecease me, or for any reason shall fail to qualify as Executrix hereUnder, or having qualified, shall die or resign, then in such event I appoint my son-in-law, ANDREW MAYER, as Executor Without bond, of this my Last Will, and in such capacity my said son-in-law, ANDREW MAYER, shall possess and exercise all ~owers and authority herein conferred Upon my wife, A~ R. KEMP, as Executrix. If my Wife, /~ R. K~, and my son- in-law, ANDREW MAYER, shall predecease me, or for any reason both shall fa/1 to qualify as Executrix or Executor hereUnder, or having qualified shall die or resign, then in such event I appoint my daughter, J~NICE K. HUTCHI$ON, as EXecu- trix, without bond, of this my Last Will, and in such capacity my said daughter JANICE K. HUTCHI$ON, shall possess and exercise all power and authority herein conferred upon my wife, ALMA R. KEMP, as Executrix. I em~ower my Executrix fo do everything she deems advisable, even though it wOUld not he authorized or appropriate for fiduciaries but for this pOWer under any statutory or other rule of law, including but not limited to the pOWers to: sell or otherwise dispose of any security or property, whether real or personal, either publicly or privately; delegate discretion; employ agents and attorneys and hold property in the name of a nominee; invest and reinvest in any property without limitation; account informally to the beneficiaries or to their natural quardians if any of them be m/nors; distribute in kind or in cash or partly in each even if shares be cO~osed differently; and make distributi~s to a person or persons designated ~y my Executrix as custodian for any beneficiary hereUnder who ~y be a m/nor, pursuant to the So~(ch Carolina Unifoz~ Gifts to Minors Act, as though the Executrix was a donor making a gift Under the Act to the m/nor pursuant to its terms on such date. EICLE VII During the administration of my estate, it shall not be necessary for my Executor at any time to have a guardian appointed for any beneficiary with respect to the disbursement of income or principal or other property to or for such beneficiary. My Executor may make any part or all of the payments directly to a beneficiary Or to some other person, firm or corporation for the benefit of such beneficiary. IN WITNESS WHEREOF, I sign, seal, publish and declare this instru- ment to be my Last Will and Testament this 3 ~ · day of December, 1981, at Tryon, North Carolina. The foregoing instrument, consisting of this and two (2) preceding typewritten pages, was signed, sealed, published and declared by LAWRENCE I. KEn, P, the Testator, to be his Last Will and Testament, in OUr presence, and we, at his request and in his presence and in the presence of each other, have here- unto subscribed our names as witnesses this f'~(~' , day of December, 1981, at Tryon, North Carolina. /~:"~/~'~.:~ ;.~ ::c/~.z.~._ ~siding ~t ".~.~.~,..61. C'. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: LAWRENCE I. KEMP Date of Death: August 15, 2004 Will No. 21-04-00763 Admin No. To the Register: I certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above-captioned estate on August 24, 2004. NAME ADDRESS JANICE K. HUTCHISON 3606 Rutherford Street Harrisburg, PA 17111 JOANN K. MAYER 5 Hamilton Place Pine Brook, NJ 07058 Date: ~'/~/~/~f/' RADCLIFF LAW OFFICE, p.C. / / ~ . RADCLIFF, ES~;/ 20 Erford Road, Suite 200 /" Lemoyne, PA 17043 (717) 236-9318 Capacity: Personal Representative X Counsel for Personal Representative STATE OF PENNSYLVANIA IN RE: ESTATE OF - Jo.N c. 'AL ER J. IN OF - CUMBE~ _ COURT: ESTATE NO. ~ S~TAT~_EMENT OF CLAIM 1. MBNA America hereby presents for filing against -- the mount of $ ~ the above estate this statement of claim in 2. The basis for the claim is MBNA ~ account number 5329020419033494 which was opened on 3. The tax ' · · ~dentlficat~on number &the claimant is ~ 4. The name and address of the claimant is MBNA A~1000 Samoset Drive, W~iim!neton. DE 19884~. 5. This c/aim ~ contingent. 6. Th/s claim ~ secured. 7. The last payment made on the account was $ 60.00 on 05/19/04. Under penalties of perjury, I declare that I have read the foregoing, and the facts aileged are true, to the best of my knowledge and belief. Executed this ~ day of~ a ' 2004 .~ ,7. KATRINA M. WOOTTEN MBNA America Claimant State Of Delaware, Coun IN _W~TNESS WHEP~Oty of NEW CASTLE F, I have set my hand and notanai day of seal this :-a ,, ~,~ ~ ~, 2004 My Commission Expires:~ff2~2~ OUO~£R OO, ~007 STATE OF PENNSYLVANIA 1N RE: ESTATE OF IN THE REGISTER OF WILLS COURT: JOHN C. PALMER~ JR. CUMBERLAND COUNTY ESTATE NO. 2104673 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 4~937.27. 2. The basis for the claim is MBNA account number 5329020419033494 which was opened on 04/08/83. 3. The tax identification number of the claimant is 510331454. 4. The name and address of the claimant is MBNA America~ 1000 Samoset Drivel Wilmington, DE 19884. 5. This claim IS NOT contingent. 6. This claim IS NOT secured. 7. The last payment made on the account was $ 60.00 on 05/19/04. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are tree, to the best of my knowledge and belief. Executedthis ~°~f dayof ~~ ,2004 ~' 2 r,~ , KATR1NA M. WOOTTEN MBNA America Claimant ~,~ State Of Delaware, County of NEW CASTLE ;~ .7 iN WITNESS WHEREOF, I have set my hand and notarial seal this ~ ~t day of/~'~/~Jl~( ~P~ ,2004 My Commission Expires: MY COMMIS$IOI~ EXPII~ES OCI'08EI~ 01], 2001 X165-1 CUSTOMER INFORMATION SYSTEM MD 08/25/04 * 5329020419033494 * USA 10:10:41 JOHN C*PALMERSJR CURBAL: 5021.18 CYCLE: 09 N CR LIN: 7200.00 STATUS: 5 CHANGED: 08/06/04 ***************************** JULY STATEMENT ***************************** POST ....... REFERENCE ....... TRAN ........ DESCRIPTION ....... BC ---AMOUNT--- PURCHASES AND ADJUSTMENTS 0706 0004895 0706 LATE FEE FOR PAYMENT D C 39.00 -- A REMINDER: IF YOU MISS TH DATE, YOU WILL LOSE THE PR .00 P~ATE ON CATEGORY A. AS A .00 COURTESY WE DID NOT CHANGE .00 TIME. .00 ***************************** JULY STATEMENT ***************************** CONGRATULATIONS! YOUR CREDIT LIMIT HAS BEEN ~ INCREASED TO 7200.00 PREV BAL - PAY + SALE + CASH + F/C + LATE CH BAL 4895.81 0.00 0.00 0.00 41.46 39.00 4976y PF10=PAGE FORWARD PF03=AUGUST STMT PAl=BEGIN AGAIN ~1 PFll=TRANSACTION SUMMARY PF09=JUNE STMT PA2=SYSTEM MENU IBR7 4-© 1 MBNAIS 192.168.14.10 0044CI2B 2/31 BEV 1162 EX(11 961 4ARRISBURS PA ' 7128 C60~ PENNSYLVANIA RECEIVED FROM; INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004614 MAYER ANDREW 5 HAMILTON PLACE PINE BROOK, NJ 07058 ACN ASSESSMENT AMOUNT CONTROL NUMBER told 101 $9,300.00 ESTATE INFORMATION: SSN: 083 07-9732 FILE NUMBER: 21 04-0763 DECEDENT NAME: KEMP LAWRENCE I DATE OF PAYMENT: 11 / 12/2004 POSTMARK DATE: 1 1/1 2/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/15/2004 TOTAL AMOUNT PAID: $9,300.00 REMARKS: A MEYER CHECK# 107 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY , Deceased No. 21 04 0763 Date of Death 8/1512004 Social Security No. 083-07-9732 Estate of LAWRENCE I. KEMP also known as 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 in the CommonweaMh of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents i1s fair value as of the date of the Deoedenfs death, and that Deoedent owned no real estate outside the CommonweaMh of Pennsylvania except that wI1ich appears in a memorandum at the end of this inventory. lIWe verify that the _ements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penallies of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attorney: David H. Radcliff. ESQuire 1.0. No.: 25483 Address: 20 Elford Road. Ste 200 Lemoyne Telephone: (717)236-9318 /7"~ (~~,~) ;4vtJ....2W P M"fC:W- Dated "~;l /o~ , PA 17043 Description Waypoint Bank - Checking Acct #1 00671171 - CertifICate Deposit #9600019101 Value $3,068.02 $92,130.21 95,198.23 PNC Bank - Checking Acel #5000978909 - Savings Acel #5004413622 $11,877.09 $36,666.01 48.543.10 1998 Grand Am Pontiac 5,000.00 Erie Insurance Group - Premium refund 69.00 Verizon - Refund 2.53 (Attach Additional Sheets if necessary) r, ".,,/c./iVieD \;'0 v I. :/, '~';\';Q':dO 1\:1 "0 ~"wn ~O '}.'d:l18 Total ~11: ~d ~ \ k'il\ ~UU1. 6.23 Quantum Imaging & Therapeutic Assoc - Refund 150,755.03 NOTE: The Memorandum of real es_ outside the CommonweaMh of Pennsylvania may, '!\ \I\'!, el,,'\IiI~1\~.ursonal representative, include the value of each Item, but such figures should not be extended into the total of th~lY;: ~~- RW-4 :\0 j'JI:lj'J \fL. Continuation of Inventory LAWRENCE I. KEMP 21 04 0763 PaQe 1 Description of Inventory Description Value Bethany Village - Refund 243.00 Bank of America - Refund 7.99 Patriot News - Refund 9.95 Personal property ( See attached listing) 275.00 Cash on Hand 1,400.00 Subtotal $ Grand Total $ 1,935.94 150,755.03 < ESTATE OF LAWRENCE I. KEMP S.S. # 083-07-9732 FILE NUMBER 21-04-0763 Personal Prooertv Bedroom set Lamps Sofa bed TV & stand Portable stereo Chairs Utility table Kitchen items Linens Miscellaneous knick knacks $ 100.00 10.00 20.00 55.00 25.00 20.00 10.00 20.00 10.00 5.00 $ 275.00 REV-1500EX+(8-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712s.<l601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT .... z W Q W o W Q w !;( ",-Ul 0"'" w..o ,,00 ofai .. < DECEDENT'S NAME (LAST, FIRST, AND MIDOLE INITIAL) KEMP LAWRENCE I. DATE OF DEATH (MM-DD-Yea-) DATE OF BIRTH (MM-DD-Year) 08/15/2004 01/23/1915 (IF APPlICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 1. Oliginal Retum o 4.LimiredEslate [Xl 6. Decede!1t Died Testate (_''''''''WI) o 9. Liligatioo Proceeds Received o 2. Suppiemenlal Retum o 4a. Future Interest Compromise (dale 01 death after 12-12-82) D 7. Decedent Maintained a Living Trust (AtIach copy ofTrustj D 10. Spousal Poverty Credit (daleofdealh between 12-31-91 iIld 1-1-95) OFFICIAL USE ONLY FILE NUMBER 21-040763 ""OOiiNiY"OOOr -YEAR- - - NUMBER-- SOCIAL SECURITY NUMBER o 8 3 - 0 7 - 9 7 3 2 THIS RETURN MUST BE FILED IN OOPUCATE WITH THE REGISTER OF WILLS SOCIAl SECURITY NUMBER D 3. RemainderRetum (daeoldealhprb'kl12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposn Boxes o 11. ElecIIon to tax under Sec. 9113(A)_,Soho} D. ALL CORRESPONDENCE AND CONFIDEN1lAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS 20 Erford Road, Ste 200 0.00 X _(15) 0.00 215,761.24 x .045 (16) 9,709.26 0.00 x .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 9,709.26 I- Z W o z o .. Ul w .. .. o o THIS SECTION MUST BE COM NAME David H. Radcliff FIRM NAME (W Applicable) Radcliff Law Office P.C. TELEPHONE NUMBER 717-236-9318 Lemo ne (1) (2) (3) (4) (5) z o i= oc( ...I :J .... ii: oc( o W D:: 1. Real Es1aIe (Schedule A) 2. StocI<s and Bonds (Schedule B) 3. CioseIy Held Corporation, Partnership or Sole-Propnetorship 4. Mortgages & Noles Receivable (Schedule D) 5. Cash, Bank Deposns & Miscellaneous Personal Property (Schedule E) 6. JoinUy Owned Properly (Schedule F) o Separate Billing Requested 7. lnter-V NOS Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Cos1s (Schedule H) 10. Deb1s of Decedent, Mortgage Liabiiitles, & Liens (Schedule i) 11. Tolal Deductions (total Lines 9& 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Chanlable and Govemmenlai BequeslslSec 9113 TrusIs for which an eleclion to tax has not been made (Schedule J) (6) (7) (9) (10) 14. Net Value Subjoctto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= oc( .... :J Q. :i o o >< c( .... 15. Amount of Line 14 taxable at the spousal tax rate, orbansfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable a1l1neal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable aI collateral rate 19. Tax Due 20. [g] CHECK HERE iF YOU ARc REQUEST,NG A REFUND OF AN OVERPAYMENT ,- PA 17043 OFFloW. uSE -0-".1.:. y <:~:.:.' C) (;;.n ::~g: /0;. :::A: -oC w -t) ':~.)C) '")--,'j 150,755.03 ~ ,'::.'~ '"i-"; (..) 54,493.621'~ ::.:, .;;. ~ W 32.650.13 , i I 1 ----_----.! (8) 237 .898. 78 10.315.63 11,821.91 (11) (12) (13) 22,137.54 215,761.24 (14) 215.761.24 >> BESURE ALl. QUESTIONS ON REVERSE SIDE AND RECHECK TH < < D d t' C I t Add ece en s ample e ress: STREET ADDRESS 325 Weslev Drive CUY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 9,709.26 9 300.00 485.46 Tofal Credits (A +8+C) (2) 9,785.46 3. InteresVPenalty il applicable D. inferest E. Penalty T otallnterestlPenalty ( D + E ) (3) 4. II Line 2 is greater than Line 1 + Line 3, enter fhe difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a relund (4) 5. If Line 1 + Line 3 is greater than Line 2, enterfhe difference. This is the TAX DUE. (5) A. Enter fhe interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT I PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. refain fhe use or income of the property transferred; ........................................................................... 0 ~ b. retain fhe right to designate who shall use the property transferred or its income; ........................................ 0 ~ c. retain a reversionary interest; or ...................................................................................................... 0 ~ d. receive the promise lorl~e of either payments, benefifs or care? ............................................................. 0 ~ 2. If death occurred after December 12,1982, did decedent transfer property wifhin one year 01 death without receiving adequate consideration?...... ........................... ............................... ........................... ... 0 ~ 3. Did decedent own an 'in trusffo~ or payable upon deafh bank account or security at his or her death? ................. ~ 0 4. Did decedent own an Individual Retiremenf Accounf, annuity, or of her non-probafe property which contains a beneficiary designation? .................................................................................................. .... 0 ~ 0.00 76.20 0.00 0.00 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 pe!jUlY, I declcre that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaralion of preparer other than the personal representative is ba$ed on all information of which preparer has any knowledge. SIGNATURE OF N S R FI ETURN ATIVE PA 17043 I For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on fhe net value of translers to or lor fhe 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, fhetax rate imposed on fhe net value oltranslers to or lor the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (il)). The statufe does not exemot a transfer to a surviving spouse from tax, and fhe statutory requirements for disdosure of assefs and filing a tax retum are still applicable even ~ fhe surviving spouse is fhe 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 01 age or younger at deafh to or lor fhe use of a natural parent, an adoptive parenf, 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 fhe use offhe decedent's IineaJ beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). The tax rate imposed on the net value of transfers to or forfhe use of fhe decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Sectioo 9102, as an individuaJ who has at least one parent in common v.ifh fhe decedent, whether by blood or adoption. REV-1508 EX+ (6.98) * SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KEMP LAWRENCE I FILE NUMBER 21 04 Indude the proceeds of 1~9ation and the dale the plOceeds were received by the estate. All plQtlOrty joinlly-ownod with right of survivorship must be disclosed on Schedule F. 0763 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. DESCRIPTION Waypoint Bank Checking Acet #100671171 Waypoint Bank Certificate Deposit #9600019101 PNC Bank Checking Acct #5000978909 PNC Bank Savings Acet #5004413622 1998 Grand Am Pontiac Erie Insurance Group - Premium Refund Verizon - Refund Quantum Imaging & Therapeutic Assoc - Refund Bethany Village - Refur!ld Bank of America - credit adjustment Refund - Patriot News Personal Property (See attached listing) Cash on Hand VALUE AT DATE OF DEATH 3,068.02 92,130.21 11,877.09 36,666.01 5,000.00 69.00 2.53 6.23 243.00 7.99 9.95 275.00 1,400.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same SIZe) 150755.03 Personal Property Bedroom set Lamps Sofa bed TV & stand Portable stereo Chairs Utility table Kitchen items Linens Miscellaneous ESTATE OF LAWRENCE I. KEMP S.S. # 083-07-9732 FILE NUMBER 21-04-0763 knacks $ 100.00 10,00 20.00 55.00 25.00 20.00 10.00 20.00 10.00 5.00 $ 275.00 REV.1509 EX + (6-98) .. SCHEDULE F COMMONWEAlTH OF PENNSYLVANIA JOINTL V-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT . ESTATE OF FILE NUMBER I I ?1 nd n7f\"'l ff an asset was n ade joint within one year of the decedenfs date of death. it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Janice K. Hutchison 3606 Rutherford Street Daughter Harrisburg, PA 17111 B c I JOINTL Y.OWNED PROPERTY: LETTER DATE INCLUDE NAME 0 DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOlNT MADE :i:^NCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DEWS VALUE OF NUMBER TENANT JOINT IDENTlFYIN NUMBER ATTACH DEED FORJOlNTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 12/1/97 3804.903 sh Scudder Grwth & Inc Fd 73,948.29 50. 36,974.15 2. A. 7/06/01 PNC Bank C ert Deposit #31600242352 35,038.94 50. 17,519.47 TOTAL (Also enter on line 6, Recapitulation) $ 54493.62 (If more space Is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) * SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KEMP LAWRENCE I. FILE NUMBER 21 04 0763 This schedule must be completed nd filed nlhe answer to any of questions 1 through 4 on the reve... side of the REV-I500 COVER SHEET is yes, DESCRIPTION OF PROPERTY ITEM INClUDETHE~EOFTHETRANSFEREE ~~ RaATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THEOATEOFTRANSFER ATTACH A OFTHE DEED FOR REN.. ESTATE VALUE OF ASSET INTEREST VALUE (lFAPPLICAllLE) I. Waypoint Bank Cert Deposit # 17100017331 32,650.13 100. 32,650.13 Janice K Hutchison - Benefici ry I 2. Amanda Hutchison 1,100.00 O. 1,100.00 0.00 (Cash gift within one year of d+ath - July 2004) 3. Ian Hutchison 1,100.00 O. 1,100.00 0.00 (Cash gift within one year of dtath - July 2004) 4, Liz Mayer I 2,100,00 0, 2,100.00 0.00 (Cash gift within one year of d~ath - July 2004) ! 5. Alexis Mayer 100.00 O. 100.00 0.00 (Cash gift within one year of d~ath - July 2004) TOTAL (Also enteron line 7 Recapitulation) $ 32650,13 (If more space is needed, insert additional sheets of the same size) REV-15ll EX + (12-99) .* SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER "'''''0 I I ?1 04 n17R'l Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Neill Funeral Home 274.00 Obituary Notices 250.00 Memorial Service 150.00 B. ADMINISTRATiVE COSTS: 1. Personal Representative's Commissions Name of Personal F !epresentative (s) Social Security Nun ~e~s)IEIN Number of Personal Rep..sentative(s) St..et Add..ss City State Zip Year(s) Commissio Paid: 2. AtIomey Fees Radcliff aw Office, P.C. 9,136.96 3. Famity Exemption: (If decode ts address is not the same as daimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Clai ~ant to Decedent 4. Probate Fees 263.00 5. Accountants Fees 6. Tax Return Preparer's Fees 7. Filing fee - Invento y & PA Inheritance Return 30.00 8. Check printing fee estate account 16.40 9. Legal Advertising - Cumberland Law Journal 75.00 10. Legal Advertising - The Sentinel 95.27 11. Register of Wills - dditional Probate 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 10315.63 (If more space Is neecled, insert additional sheets of the same size) REV-1512 EX + (6-9a) .. SCHEDULE. COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER I AWREI\lr.E I. 21 04 07R<\ Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. U.S. Treasury - 2004 fe ~eral income tax 3,217.00 2. PA Dept Revenue - 20( ~ income tax 145.00 3. East Pennsboro Ambul nce 89.00 4. Holy Spirit Hospital 22.26 5. Value of four checks is ued by decedent prior to death but cleared after decedent's death 8,348.65 I I I , TOTAL (Also enter on line 10, Recapitulation) $ 11821.91 (If more space is needed. insert additional sheets of the same size) REV"5'3EX+<" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF "'.....n , NUMBER L II. 1. 2. SCHEDULE J BENEFICIARIES :1 FILE NUMBER ?1 1M RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NAME AND ADDRESS OF ERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS ~nclude ~tI;ght spousal distributions. and translers under See 9116 (a)(1.2)] Janice K. Hutchison 4606 Rutherford Street Harrisburg, PA 17111 Joann K. Mayer 5 Hamilton Place Pine Brook, NJ 07058 Lineal Lineal n7"" AMOUNT OR SHARE OF ESTATE 107,880.62 107,880.62 ENTER DOLLAR AMOUNTS FOR 0 STRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UN[ ER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. I I B. CHARITABLE AND GOVERNMEtTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOIrAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, Insert additional sheets of the same size) I-- I .1 .,':\ ,'" i ,I I -j '- I i I I I I;-Ie:: ;C::'Ci:.un~) '/J;;;~) 1[: ZId Ll snv PO. J'J --, -:lcj2H ":"\"'1.(,,-,,;:; , - -'~_I"....cj.,::! 3[cts1 3IDIill ctub illtslctttttttl of LAWRENCE I. KEMP ***It I, IAWRENCE I. KEMP, domiciled in Spartanburg County, South Carolina, clare this to be my Last Will and Testament, heieby' revoking all wills and c dicU.s heretofore made by me. ARTICLE I I direct that all of my just debts, my funeral expenses I and the cost o administration of my estate be paid out of the assets of my estate as soon as p acticable after my death. ARTICLE II I direct that all estate and inheritance taxes and other taxes in the g neral nature thereof which shall become payable upon or by reason of my death w th respect to any property passing by or under ~the terms of this Will or any c 'cil to it hereafter executed by me, or with respect to the proceeds of any ~ p 1icy or policies of insurance on my life, or with respect to any other property i cluded in my gross estate for the purpose of such taxes, shall be paid by my E ecutor out of the principal of my residuary estate. ARTICLE III I bequeath to my wife, AlMA R. KEMP, if she shall survive me, 11 my personal effects, and all tangible personal property including automobiles ned by me and held for personal use at the time of my death, but excluding ash on hand or on deposit, securities, Choses in action or other intangibles. n the event my wife, l\LMA R. KEMP, predeceases me, then I give and bequeath the ve described personal effects and tangible personal prop-erty in shares of equal alue to my surviving children. In event of any disagreement in division, my xecutor shall have power to make final and conclusive division. ARl'ICLE IV AJ.l the residue of the property which I may own at the til':\e of my ath, real or personal, tangible and intangible, of whatsoever nature and where- oever situated, including all property which I may acquire or become entitled to fter the execution of this will, including all lapsed legacies and devises, I , ;';\' .-':Y),',; :': :J:'~ < ,';,-2J :):\ :~K~~ .... .".,.,.i\ . "'~:;,'''';;:!:'~ :;,;j~J :\.{tl, ., iJ ,<6}.;~L ," " "{ , --::-/::.jb . ,~.:~~ "';';! :-:-~j "1 . :~I ',! ";-- ;., bequeath and devise in fee to my wife, AIHA R. Km-~, if she shall. survive me. If my said wife, ALMA R. 'KEMP, sha!.1 not survive me, then 1: bequeath and devise the said property in ~ee and in equal shares to my surviving issue per stirpes. .ARl'ICLE V ".' .,..-'t._';toi,,;;-;.',~~,.. I appoint my wife, ALl.{A R. 'KEMP, to be Executrix, without .bond, of this . . '-'-.' " -' my - Last ~Will~-."-'-If my wife,' ALMA R. 'KEMP i shall predecease me I or for any reason ' . shall fail. to qualify as Executrix hereunder, or having qualified, shall die or resign, then in such event I appoint my son-in-law, ANDREW MAYER, as Executor, without bond, of this my J.ast Will, and in such capacity rrrj said son-in-law, ANDREW MAYER, shall possess and exercise all powers and authority herein conferred upon my Wife. ALMA R. KEMP, as Executrix. I.f my wife. AlMA R. KEMP, and my son- in-la.w, ANDREW MAYER. sha.ll predecease me I or for any reason both shall fail to qualify as Executrix or Executor hereunder, or having qualified shall die or resign, then in such event I appoint my daughter, JANICE K. HUTCHISON, as Execu- trix, without bond, of this my Last Will, and 1n such capacity my said daughter, JANICE K. HUTCHISON, shall possess and exercise all power and authority herein conferred upon my wife, AIMA R. KEMP, as Executrix. ARTICLE VI ~ I empower my Executrix to do everything she deems advisable, even though it would not be authorized or appropriate for fiduciaries but for thi~ ower under any statutory or other rule of law. including but not. limited to the ewers to: sell or otherwise dispose of any security or property, whether real r personal, either publicly or privately; delegate discretion; employ agents and ttomeys and hold property in the name of a nominee; invest and reinvest in any roperty without limitation; account infonnally to the beneficiaries or to their atural guardians if any of them be minors; distribute in k.ind or in cash or artly in each even if shares be composed differently; and make distributions to person or persons designated by my Executrix as custodian for any beneficiary ereunder who may be a mnor, pursuant to the South Carolina Uniform Gifts to "nors Act, as though the Executrix was a donor making a qift under the Act to e minor pursuant to its terms on such date. page Two ARTICLE VII During the administration of my estate, it shall not be necessary for my Executor at anytime to have a guardian appointed for any beneficiary with respect to the disbursement of income or principal or other property to or -for such benefici.ary. . My Executor may make any part or all of the payments direct1.y to a beneficiary or to some other person, firm. or cox:poration for the benefi t of such beneficiary. IN WITNESS WHEREOF, I sign, seal, publish and declare this instru- ? ..,J v day of December, 1981, ., ment to be my Last Will and Testament this at Tryon, North Carolina. ~~~/ (SEAL) The foregoinq instrument, consisting of this and two (2) preceding typewritten pages, was siqr.edt sealed. pub1ished and declared by LAT"ffiENCE I. KJ::MP, the Testator, to be his Last Will and Tes tament r in our presence t and we, at his request and in his presence and in the presence of each other, have here- ,d"'r<../ unto subscribed our names as witnesses this _~ day of December, 1981, at ryan, North carolina. ~f-/~" ' tn, {.-(i'de residing at <7'(1""" ..lj, c, U<::.l .I residing at r!&--c;udu,J~, <2- . ~clL+k residing at -rP1. "V /V_c. page Three COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96j RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RADCLIFF DAVID H 20 ERFORD ROAD SUITE 200 lEMOYNE, PA 17043 ___U~n fold ESTATE INFORMATION: SSN: 083-07-9732 FILE NUMBER: 2104-0763 DECEDENT NAME: KEMP lAWRENCE I DATE OF PAYMENT: 07/15/2005 POSTMARK DATE: 07/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/15/2004 NO. CD 005566 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $126.95 I I I I I I I I TOTAL AMOUNT PAID: $126.95 REMARKS: CHECK# 116 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS REV-1500 EX + (lS-OO) *' COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712~1 DECEDENT'S NAME (lAST, RRST, AND MlIJIJlE INITIAL) I- Z W C W o W C REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT KEMP LAWRENCE I. DATE OF DEATH (MM-IJO.V...) DATE OF BIRTH (MM-DlJ.V...) 08/15/2004 01/23/1915 (IF APPlICABLE) SURVMNG SPOUSE'S NAME (lAST, FIRST, AND MlDOLE INITIAL) OFFICIAl USE ONLY FILE NUMBER 21-040763 ""C&iirYcooe -YEAR- --NiiiiER-- SOCIAL SECURITY NUMBER o 83- 0 7 - 9 7 3 2 TItIS RETURN WST lIE FLED II DUPlICATE WIIH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER \!! "S... U"''' w"U ",00 ufiil .. c o 1. Original Return o 4. Lini1ed Esfafe o 6. Decedent Died Testate _'cop,ofWol) o 9. LiIigation Prooeeds Received 00 2. SUpplemental Return o 48. Future InferestCompmmise (dalaoldghak12.12-82j o 7. DocedentMamtalnedaUvingTrust_'_ofT""'i o 10.SpousaIPovel1yCred~I""of__ml.91"".1.95) o 3. RemainderRetum (dalaoldealhpriorb12-1W) o 5. Federal Esfafe Tax Return Required _ 8. Total Number of Sale Deposit Boxes o 11. Election to tax under Sec. 9113(A)__",o) z o i= ~ ::J l- ii: <( o w II:: z o i= <( I- ::J Q. :::E o o ~ I- !i: w o z o .. ... w '" '" o U THIS SECTION MUST BE NAME David H. Radcliff FIRM NAME (ff AlJIlIk:abIe) Radcliff Law Office P.C. TELEPHONE NUMBER 717-236-9318 PLElED. AU. CORRESPONDENCE AND CONFIOEN1IAI. TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS 20 Elford Road, Ste 200 1. Real Esfafe (Schedule A) 2. Stocks and _ (Schedule B) 3. Closely Held Corporation, _ip or SoIe-PIOpI_.1p 4. ~ & Noles Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7.lnIer-Vivos Transfer.; & MisceIIaneoos Non-Probate Property (Schedule G Ol' L) 8. Tolal Gross Assets (total Lines 1-7) 9. Funeral Expenses & Admill_ CosIs (Schedule H) 10. Debts ofDecedenL Mor1gage Uabllities, & Liens (Schedule I) 11. T.... Deduc:tions (toIal lines 9 & 10) 12. Net Value of E_ (Line 8 millus Line 11) Lemo ne (1) (2) (3) (4) (5) PA 17043 OFFICIAL USE ONLY -, I I (') '" :.~ c-...;, <;.,1 c_ c: l'~- f" \..0 , -=C) ---:-';["J1 . ,', (:-) ,C> ) -::TJ ,~ -.m :-j C'J --:-:;CY T' _ -1-, ~ c'""j - ;oTl :,--),., (6) 2,800.00 (""") ,- 'i:-) ~ "':-_J ;,,< 0.00 :-:- ., (7) ';.1; n'~ C.l 0.0 (9) (10) ---,~--- U-j (8) 2,800.00 0,00 0.00 13. CIla_and Governmental BequestslSec9113 TrustsfOl'wflich an election tl tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE IISTRUCTlONS ON REVERSE SIDE FOR APPlICASLE RATES 15. Amount of Line 14 taxable at 1he spousal tax rate, or transfer.; under Sec. 9116 (aX1.2) (11) (12) 0.00 2,800.00 (14) 2,800.00 0.00 X _(15) 0.00 2,800.00 X .045 (16) 126.00 0.00 X .12 (17) 0.00 0,00 X .15 (18) 0.00 (19) 126.00 16. Amount 01 line 14 taxable at 6neal rate 17. Amount 01 line 14 taxable at sibling rate 18. Amount of line 14 taxabte at coIIateml rate 19, Tax Due > > BE SURE 10 ANSWER ALL Ci-lC:i\ HERE:. C TOJ ARE REQUESTI~~() e:.. R[FUND Of: AN OVERPAYMENT ON REVERSE 20. D AND RECHECK MATH < < ~enrs Comnlete Address: STREET ADORESS 325 Weslev Drive CITY Mechanicsbura I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2, CreditsIPayments A, Spousal Poverty Credit 6, Prior Payments C, Discount (1) 126,00 126,95 Total Credits (A +6 +C) (2) 126,95 3, Inte<esVPenally if applicable D, Interest E, Penally 0,85 TotallnteresVPenally (D +E) (3) 0,85 4, If Une 2 is greater than line 1 + Une 3, enlerthe differenoe, This is the OVERPAYMENT. Check box on Pagel Line 20 to request. refund (4) 0.10 5, If Une 1 +Une 3 is greater than Une 2, enter the differenoe, This is the TAX DUE. (5) 0.00 A, Enter the interest on the tax due, (5A) 6, Enter the total of Une 5 +5A, This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN"J{" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use orinoome of the property transferred; ........................................................................... D 00 b, retain the righttodesignale who shall use the property transferred or its inoome; ........................................ D lID c, retain a reversionay Inte<est; or ...................................................................................................... D lID d, receive the promise for life of either payments, benefits or care? ............................................................. D lID 2. If death oocurred after December 12, 1982, did deoedent transfer property within one year of death without reoeiving adequate consideration?............ .........,.............................................,............... .........,. D lID 3. Did deoedentown an 'in trust for' or payable upon death bank account or security at his or her death? ................. D lID 4, Did deoedent own an Individual Retirement Aooount, annuily, or other non.pnobale property which contains a beneficiary designation? .........................."...,..........................................."..,................"..... lID D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS 20 Efford Road, Suite 200 Lemo ne NJ 07058 DA "7}" or PA 17043 For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfelS to or for the use of the surviving spouse is 3% [72 P.s. S9116 (a) (1,1) (i)], For dates of death on or after January 1, 1995, the tax rate imposed on the net valueoftransters to or for the use of the surviving spouse is 0% [72 P,S, ~9116 (a) (1,1) (ii)]. The statute does oot exernol a lralsfer to a surviving spouse from tax, and the staMory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the onty beneficiary, For dates 01 death on or after July 1, 2000: The tax rate imposed on the net value oIlralsfers from a deceased child twooly-one yeas 01 age or younger at death to or for the use 01 a natural parent, an adoptive parent, or a steppaent 01 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 01 the deoedenfs tineal beneficiaries is 4.5%, except as ooted in 72 P.S. S9116(1.2) [72 P.S. S9116(a)(1)]. The tax rate imposed on the net value oIlralsfers to or for the use 01 the deoedenfs siblings is 12% [72 P.S. S9116(a)(1.3)], A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) .. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KEMP LAWRENCE I RLE NUMBER 21 04 Include It1e proceeds of Illigalioo and the date the proceeds were received by It1e estate. AI -'Y ~ _ rtghtofsumvonhip II1UIl be dloc:_ on Schedule F. 0763 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 2,800.00 2004 Federal Income Tax Refund TOTAL (Also enter on line 5, Recapitulation) $ (If"""" space is needed, insert additional sheets of It1e same size) 2 800.00 REV_,5,3EX+<* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER I(I'MP I :1 ?1 rIA n7R:l RElATIONSHIP TO DECEDENT ~OUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE L TAXABLE DISTRIBUTIONS [-~h\r _, and transfers under Sec. 9116 (a (1. )] 1- Janice K. Hutchison Lineal 1,400.00 4606 Rutherford Street Harrisburg, PA 17111 2. Joann K. Mayer Lineal 1,400.00 5 Hamilton Place Pine Brook, NJ 07058 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 TAXIS NOT BEING MADE 1- B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAl OF PARrII - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ .. (If more space IS needed, Insert additional sheels of the same SIze) 08-08-2005 KEMP 08-15-2004 21 04-0763 CUMBERLAND 101 APPEAL DATE: 10-07-2005 ( See reverse side under Objections) AIIount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REY:is47-Ex-AFP-io3:osj-NoTIcE-OF-INHERITANCE-TAX-APPRAIsEHENT:-ALLowANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LAWRENCE I FILE NO. 21 04-0763 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA RECORDeD C~F:?r~T::~~H::XT:~E:E '~'='''TIAl''Plt,USEIIEIl:I", ALLOWANCE OR OISALLOWANCE .... .: '.., 'OF' DEoUcnONS AND ASSESSHENT OF TAX 001:; lei 10. -5 ;,01 Ii: "4 LU""J j ,-;,.,;..; r.., 1. ,J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CO. ,T\: DAVID H RADCLIFF RADCLIFF LAW OFFICE 20 ERFORD RD STE 200 LEMOYNE PA 17043 ESTATE OF KEMP *' REY-1547 EX AFP (06-05) LAWRENCE I TAX RETURN WAS: I X) ACCEPTED AS FILED ) CHANllED DATE 08-08-2005 I~ an assesSBent was issued previously, lines 14, 15 and'or 16, 17, 18 and 19 will r~lect ~i9ures that include the total o~ abb returns assessed to date. ASSESSMENT OF TAX: IS. A.aunt of Line 14 at Spousal rat. (IS) 16. A.ount of Line 14 taxable .t Line.l/Class A rat. (16) 17. A.ount of Li~ 14 at Sibling rat. (17) 18. ~ount of Ll~ 14 taxable at Collateral/Class B rate (18J 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks end Bonds ISchodul. B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. "ortgages/Notes Receivable (Schedule D) 5. Cash/Bank DepositslHisc. P.~sonal P~ope~ty (Schedule E) 6. Jointly Ownod Property ISchodul. F) 7. Transfe~s (Schedule 6) 8. Total Assets 11) (2) (3) 1<+) IS) (6) (7) .00 .00 .00 .00 150.755.03 54.493.62 32,650.13 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. CostslHisc. Expenses (Schedule H) 10. DebtslHo~tgage LiebilitieslLlens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Ch8~iteble/Gove~nMental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) 110) 10,315.63 11.821.91 I1ll 112) 113) 11<+) NOTE: .00 215,761. 24 .00 .00 X 00 = X 045 = X 12 = X 15 = AMOUNT PAID 9,300.00 76.20- DATE 11-12-2004 08-01-2005 _BER CD004614 REFUND INTEREST/PEN PAID 1-) 485.46 .00 )- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 119)= NOTE: To Insu~e p~ope~ credi t to you~ account, sub.l t the uppe~ po~tion of this fo~. with you~ tax pay.ent. 237,898.78 :1?137 1i4 215,761. 24 .00 215,761. 24 .00 9,709.26 .00 .00 9,709.26 9,709.26 .00 .00 .00 IF TOTAL DUE IS LESS THAN 81, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREDIT" ICR), YOU HAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS.) 09-26-2005 KEMP 08-15-2004 21 04-0763 CUMBERLAND 101 APPEAL DATE: 11-25-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 9~r_~~9~~_r~!~_~!~~______~___~~!~!~_~9~~~_~9~!!9~_~9~_r9~~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LAWRENCE I FILE NO. 21 04-0763 ACN 101 :'"rr....,-.'r'~-i..\ BUREAU OF INDIVIDUAL,'tAIlJ;S ....... INHERITANCE TAX DIYISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX 'APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX 2r~~ C-,": J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN DAVID H RiADCLIFF RADCLIFF LAW OFFICE 20 ERFORD RD STE 200 LEMOVNE PA 17043 ESTATE OF KEMP REY-1547 EX AFP (06-05) LAWRENCE I TAX RETURN WAS: (X J ACCEPTED AS FILED CHANGED DATE 09-26-2005 IT an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reTlect Tigures that include the total oT Ahh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule AJ (lJ 2. Stocks and Bonds (Schedule BJ (2J 3. Closely Held Stock/Partnership Interest (Schedule CJ (3J 4. Hortgages/Notes Receivable (Schedule DJ (4J 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 .00 .00 .00 .00 2.800.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 (11) (12) ll3) ll4) (9J llOJ NOTE: 115J 116J lllJ ll8J .00 218,561.24 .00 .00 X 00 = X 045 = X 12 = X 15 = 119J= NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 2,800.00 nn 2,800.00 .00 218,561.24 .00 9,835.26 .00 .00 9,835.26 . ""'nc,.. ",C\.C.1.., (+J AMOUNT PAID DATE ... NUMBER INTEREST/PEN PAID (-) 11 12-2004 ""'" CD004614 489.47 9,300.00 07-15-2005 CD005566 .38- 126.95 08-01-2005 REFUND .00 76.20- TOTAL TAX CREDIT 9,839.84 BALANCE OF TAX DUE 4.58CR INTEREST AND PEN. .00 TOTAL DUE 4.58CR · 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 FORH FOR INSTRUCTIONS.) ~ tt:u- C)C) 00:: L 1 I STATUS REPORT UNDER RULE 6.12 Name of Decedent: LAWRENCE I. KEMP Date of Death: 8/15/2004 Will No. 2004-00763 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans I 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 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 I 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 of formal or informal accounts may be filed with the Clerk of the Orphans I Court and may be attached to this report. Date: ,/zct) I I ~r"~~ Signature ~ David H. Radcliff. Eso. Name (Please type or print) 20 Erford Road, Ste 200 Lemoyne PA 17043 Address o CJ (717 ) 236- 9318 Tel. No . ," C"'i .:.,-- Capacity : Personal Representative 0.- X Counsel for personal representative r- I." Gr COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE rr- ~ ('\[CI'""I= ';'- BUREAU OF INDIVIDUAL TAXES 1""'C(':(\o,\)\-D :,,It \ IV_ \~ \ INHERITANCE TAX INHERITANCE TAX DIVISION jlL.J.}l~- t; STATEMENT OF ACCOUNT PO BOX Z8D6Dl .. HARRISBURG PA 171Z8-D6Dl '* ni:' 'lei';;) ^o 0'1'\' ':1: D1 -La r., \,; DAVID H RADCLIFF i'l RADCLIFF LAW OFFICE 20 ERFORD RD STE 200 LEMOYNE PA 17043 REV-16D7 EX AFP [03-05) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-31-2005 KEMP 08-15-2004 21 04-0763 CUMBERLAND 101 LAWRENCE I Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -+ NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. +- RETAIN LOWER PORTION FOR YOUR RECORDS --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF KEMP LAWRENCE I FILE NO. 21 04-0763 ACN 101 DATE 10-31-2005 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: 09-19-2005 PAYMENTS (TAX CREDITS): PRINCIPAL TAX DUE: 9,835.26 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-12-2004 CD004614 489.47 9,300.00 07-15-2005 CD005566 .38- 126.95 08-01-2005 REFUND .00 76.20- 10-17-2005 REFUND .00 4.58- TOTAL TAX CREDIT 9,835.26 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 eCJ