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HomeMy WebLinkAbout09-17-12 (2)J 1505618140 REV-1500 ~` (°'-'°) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po sox 2eosol INHERITANCE TAX RETURN County Code Year File Number Harcisbura PA 17126-0601 RESIDENT DECEDENT 2 1 1 1 1 3 5 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth Iv1MDDYVYY 2 0 1 1 0 6 0 1 1 9 3 6 Decedent's Last Name Suffix Decedent's First Name K E M P MI R O B E li T ~ (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Narne MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN (DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW © 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ^ prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required ® 6. Decedent Died Testate (Attach Copy of Will) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death ~ 1' 1. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T,4X INFORMATION SHOULD BE DIRECTED N ame TO: Daytime Telephone Number I V O V O T T 0 I I I 7 1 7 2~~-1~3 3 ~= 4 1 - First line of address M A R T S O N L A W O F F I C E S Second line of address 1 0 E H I G H S T R E E T City or Post Offce State C A R L I S L E p A Correspondent's a-mail address: N ZIP Code 1 7 0 1 3 I' _~r7 -• J cq ~ ~'. ` PI C ~ i USE Y !_ -,%!--> Cam. _.. =n TJ .y (.:~ iv f'.. ~ ' rrr -- ~ ~ c::.- -T7 DATE FILED ~nuer penaaies or penury, I tleGare }hat I have examined this return, mcludmg accompanying schedules and statements, antl to the best of my knowetlge and beliel it is true, correct antl complete. Declaration of preparer other than the personal representative is basetl on all informatlori of which preparer has any knowletlge. SIGNATURE O PERy~ RE PONSIBLE FOR FILING RETURN ~ic~~~~2 - p ADATE ADDRESS 7 ~/ Y'/ P.0- BOX 32383 BELLINGHAM WA 98228 SIG TURE QF ($~gER O^HER THAN REPRESENTATIVE l Val) DATE _ USE ORIGINAL FORM ONLY Side 1 L 1505610140 1!i05610140 J J 1505610240 REV-1500 EX Decedent's Social Security Number oecedenrs Name: ROBERT J. KEMP 5 1 6 4 6 2 9 5 7 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .. 1. 2. Stocks and Bonds (Schedule B) .................................... .. 2. 7 6 1 2 8 1, 1 5 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. , 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7 7 2 6 1 , D $ 7. Inter-Vivos Transfers & Miscellaneous ~gprobate Property (schedule G) u Separate Billing Requested ..... .. 7. 3 9 7 6 3, 5 6 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 8 7 8 3 0 5 , 7 6 9. Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 3 8 2 9 2 . 6 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ . 10. 7 8 5 2 . 8 5 11. Total Deductions (total Lines 9 and 10) .............................. . 11. 4 6 1 4 5 . 5 1 12. Net Value of Estate (Line 8 minus Line 11) ........................... . 12. 8 3 2 1 6 0 . 2 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... . 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) . . ................... . 14. 8 3 2 1 6 0 . 2 5 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.0 _ ~. ~ 0 15. O ~ ~ i6. Amount of Line 14 taxable . at lineal rate X .045 8 2 2 2 1 2. 6 4 16. 3 6 9 9 9. 5 7 17. Amount of Line 14 taxable at sibling rate X .12 ~. ~ 0 17. 0 ~ 0 18. Amount of Line 14 taxable at collateral rate x .15 9 9 4 7. 6 1 16. 1 4 9 2. 1 4 19. TAX DUE ...................................................... 19. 3 8 4 9 1. 7 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 15175610240 J REV-7500 EX Page 3 Decedent's Complete Address: File Number 21 11 1353 DECEDENT'S NAME ROBERT J.KEMP STREET ADDRESS P.O. Box 236 CITY STATE 21p Mechanicsbur PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 34,000 00 1,789.42 11) 38.491.71 Total Credits (A+B) (2) 35,789.42 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill In oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,702 29 Make check payable to: REGISTER OF WILLS, E~GENT :, ant .gNNJnIIItlWNiIUYfIiIWxuMNaimuwulxiwxuwxinxnwwvuwummxxmwu,,,ux„µx.xW~,..~,.~~~,.~,..,..~,. ......................_..._........_..-_._.___..... 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 : ................................................................ ...... ^ b. retain the right to designate who shall use the properly transferred or its income : ......................... ...... ^ c. retain a reversionary interest or .......................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ................ . . ................................................................ ^ ..... 3. Did decedent own an'in trust for' orpayable-upon-0eath bank account or security at his or her death? .... ..... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................. ..... ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ~4ND FILE IT AS PART OF THE RETURN. !j~~"~EI~L~Nf~I11~I~IIB~N~~(HI'ININII~i~llplN~IlUllllliull(I~ifl011~INNInI~ifl110NINIi~ftII1111NVIII~IIibINII111111;IIVll~llllllllllllllhlllUOllll~llU(N~IIIIIIIIIIIiIIII111NIIN110lIIIIIIIMN41UlIUNM~111h~111~11111NIIIflIIII~IIfNlliliVllNfllll~flNiMi1i116NI1111~IdIII~IIINii For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of V~ansfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)j. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt 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 21 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 percent [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 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)j. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [7'2 P.S. §9116(a)(1.3)]. Asibling 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-1503EX + (8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT J. KEMP 2 f 11 1353 All property lointty•ovmed vdth right otsurvivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Wells Fazgo Account No. 7588-2037 144,323.07 See attached 1 a. Dividends on Item 1 See attached 510.90 2. Wells Fargo Account No. 3217-1104 See attached 361,431.62 2a. Dividends on Item 2 See attached 147.02 3. Wells Fazgo Acount No. 4644-5135 See attached 252,623.85 3a. Dividends on Item 3 See attached 402.54 4. 10 shazes IBM CUSIP 459200101 See attached 1,842.15 TOTAL (Also enter on line 2, Recapitulation) $ 761 281.15 (If more space is needed, insen additional sheets of the same size) REV-7509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY•OWNED PROPERTY ESTATE OF: FILE NUMBER: ROBERT J. KEMP 2.1 11 1353 H an asset was made Jointly owned wRhln one year of the decedent's date of death, h must. be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Michael D. Kemp P.O. Box 32383 Son Bellingham, WA 98228 e. Patricia A. Kemp C. JOINTLY-OWNED PROPERTY: 9127 25th Ave. NE Seattle, WA 98115 ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIALINSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FDRJOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 09/1982 AmeriChoice Fed. Credit Union 9916-0001 233.40 50. 116.70 2. A. 12/2010 AmeriChoice Fed. Credit Union 9916-0013 20,732.82 50. 10,366.41 3. A. 09/1981 617 shares IBM CUSIP 4592000101 113,660.66 50. 56,830.33 4. B. 12/1968 108 shares IBM CUSIP 4592000101 19,895.22 50. 9,947.61 If more space is needed, TOTAL (Also enter on Line 6, Recapitulation) S sheets of paper of the same size. 1 • 'REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON•PROBATE PROPERTY ROBERT 1. KEMP 21 11 1353 This schedule must be completed and filed H the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OFTHE TRANSFEREE,THEIR RELATIONSHIPTO DECEDENTAND THE DATE DF TRANSFER. ATTACHACOPV OF THE DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET °h OF DECD'S INT EXCLUSION TAXABLE 1. . AmeriChoice IRA shares account 9916-0020 10 444 99 EREST 100 00 pFAPPLIGaIE) VALUE Beneficiary: Michael D. Kemp, son, 100% , . . 10,444.99 See attached 2. AmeriChoice IRA 9916-0080 3,842.70 100.00 3 842 70 Beneficiary: Michael D. Kemp, son, 100% , . See attached 3. AmeriChoice IRA 9916-0081 3,346.68 100.00 3 346 68 Beneficiary: Michael D. Kemp, son, 100% , . See attached 4. AmeriChoice IRA 9916-0082 20,322.92 100.00 20 322 92 Beneficiary: Michael D. Kemp, son, 100% , . See attached 5. AmeriChoice IRZ 9916-0083 1,806.27 :f 00.00 1 806 27 Beneficiary: Michael D. Kemp, son, 100% , . See attached _ TOTAL (Also enter on Line 7 RE:rapitulation $ 39 763.56 If more space Is needed, use add'Nonal sheets of paper of the same size. 'REV-151,7 EX+ (1 D-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ROBERT J. KEMP 2l 11 1353 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers-Buhring Funeral Home, Shippensburg, PA 4,060.00 2. Expenses for funeral services in Montana 1,675.60 3. Michael D. Kemp, reimbursement for travel expenses from WA to PA to arrange cremation 819.49 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) o(Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP p, Attorney Fees: Martson Law Offices 3. Famiy Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address Cdy State _ Relationship of Caimant to Decedent 4. Probate Fees: Cumberland County Register of Wills 5 Accountant Fees: 6. ~ Tax Rehm Preparer Fees: 7. Filing fee, Inheritance Tax return 8. Additional Probate fee 9. Michael D. Kemp, reimbursement for administration expenses 10. EVP stock valuation 11. Computershaze, stock transfer fees TOTAL (Also enter on Line 9, Recapitulation) ~ E ZIP 29,680.00 83.50 15.00 540.00 763.75 1.55 653.77 If more space is needed, use additional sheets of paper of the same size. REV-7512 Ex+17 p_08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ROBERT J. ICEMP 21 1 I 1353 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. US Treasury 201 l 1040 tax due 6,690.38 2. US Treasury 2009, 1040 interest and penalty due 3. PA Department of Revenue, 1022 PA40 tax due 4. US Treasury, 2010, interest and penalty due If more space is needed, i TOTAL (Also enter on Line 10, Recapitulation) ~ sheets of fhe same size. 36.82 1, 112.00 13.65 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: ROBERT J. KEMP ~ I ~ ~ ~ NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Indude ouVight spousal distributions and transfers under Sec. 9116 (a) (1.2).1 1. Michael D. Kemp Lineal 819,512.64 P.O. Box 32383 Bellingham, WA 98228 Sch F, 1-4; Sch G, 1-5 2. Patricia J. Kemp All of estate residue Collateral 9,947.61 9127 25th Ave., NE Sch F, Item 4 Seattle, WA ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET AS APPROPRIATE II. , . NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAk:EN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVE',R SHEET. 6 If more space is needed, use additional sheets of paper of the same size. LAST WILL AND T&8TA1dENT BE IT REMEMBERED THAT I, ROBERT J. KEMP, a resident of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married and that I have two sons, KEVIN C. KEMP and MICHAEL D. KEMP. II I direct that all my just debts and funeral expenxa shall be paid from my residuary estate as soon as practicable after my deceax. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction impoxd, shall be paid from my residuary estate as a part of the expenx of the administration of my esU~te. IV 1 have intentionally provided that my son, KEVIN C. KEMP should receive no funds or benefits from my estate. V 1 give, devix and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, to my son, MICHAEL D. KEMP, per stitpes. ~ -_ ^.~ , T y Q ci ~; Fn ~~~ n~ a ' ~~T 2' , GJ `n I nominate, constitute and appoint my son, MICHAEL D. KEM:P, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, [, ROBERT J. KEMP, have xt my hand o~ this LAST WILL this 9th day of November, 2011. . _ ~- ~, s ROBERT J. ICEMP Signed, xaljed, published and declared by the above-named ROBERT J. KEMP, as and For his Last Will end Testament, in the prexnce of us, o, a.t his request and in hid prexnce, and in the prexnce o[ each other, hereunto subscribed our napnea as witnesses. ~~~ ACI{NOWLEDp1~ENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND as. 1, ROBERT J. KEMP, Testator, 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 ttry LAST WILL; (that I signed it as my free and voluntary act for the purposes therein expressed. ROBERT J. KEMP Sworn or affirmed to and acknowledged bb5e~fo'rc me by ROBERT J. KEMP, Testator, this 9~. day of ~llO DL1r.b.c.. , 2011. ~n~.~ terry Public NOTARVLL SERI. DIANE M SMDN NmD,y PuDlla MECNANICSBa)6 EORO, CUMpEpLANI)CtAy AS)'19AViT My Commbgpn EKpIrN Jun tr, pp)= PENNSYLVANIA ss. COUNTY OF CUMBERLAND , We, ~U~'l2C[. ,4. G-IRGZ,r~/ ~ and~SCIIJA~~?iol ha/,! b the witnesses whose names are signed to the attach or foregoing instrument being duty qualired according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL, that ROBERT J. KEMP signed willingly and that he executed it as his f land voluntary act for the purposes therein expressed; that each of us in 'heating and sight of the Testator signed the Will as witnesses; and that to th at of our knowledge, the Testator was at the time 18 years of~e,~r pto{e, o and mind and under no constt'airrt or undue influence. ~~ `~l71~Y1? i1wL ~/Y/.~// Swor+}~q; affirmed to and ac owledged before Ime this `4~ day of ~JD a , 2011. \. Notary NoTAaIAt au~ DIANE M EMlix Esrate Valuation Robert Kemp Date of Death: 12/17/2011 valuation Date: 12/17/2011 Estate of: Robert Kemp Processing Date: O1/Zfi/2012 Account: 7508 2037 Report Type: Date of Death Number of Securities: 12 File ID: 7588-2037 Shares Security or Par Description High/Ask Low/Bid Mean antl/oc Adjustments Oiv and Int Accrual Security V s alue li 9952.53 Bank Deposit Sweep (CASH) Accrual 9,452.53 0.02 _ -. 2?000 PLAINSCAPITAL BK LUBBOCK TX (72663QVM8) Financial Times Interactive Data DTD: 07/09/2010 Mat: 07/09/2012 0.858 12 /16/2011 100.40625 A/B 12/19/2011 100.39520 Mkt Int: 07/09/2011 to 12/17/2011 1(10.400725 22,088.16 Nate: Put Option on DOD 82.98 3! 30000 GE CHP RETAIL BK DRAPER UTAH (361595NW7) Financial Times Interactive Data DTD: 07/02/2010 Mat: 07/02/2013 1.88 12/16/2011 101.96875 A/B 12/19/2017 101.47910 Mkt Int: 07/02/2011 to 12/17/2011 101.473925 30,992.18 No[e: Put Option on DOD 248.55 41 20000 GE CAP FINL INC (36160XXY8) Financial Times Interactive Data DTD: 10/?1/2011 Mat: 10/21/2013 1.18 12/16/2011 99.90625 A/B 12/19/2011 99.93120 Mkt Int: 10/21/2011 to 12/17/2011 99.918725 19,983.75 Note: Put Option on DOD 39.36 51 15000 WELLS FARGO BK N A CA (94986TDU8) Financial Times Interact i.ve Data DTD: 07/08/2010 Mat: 07/08/2019 18 12/16/2011 12/19/2011 97.87500 A/e 97.87500 Mkt Int: 07/08/2011 to 12/17/2011 97.875000 19,681.25 Note: Put Option on DOD 66.58 6) 185.051 CAPITAL INCOME BLDR FD (190193103) SH BEN INT Mutual Funtl (as quoted by NASDAQ) 12/16/2011 98.67000 Mkt 98.670000 9,006.93 7) 115.731 EURO PAC GROWTH FD (298706102) SH BEN INT Mutual Fund (as quoted by NASDAQ) 12/16/2011 34.85000 Mkt 39.850000 9,033.23 8) 309.712 GROWTH FD AMER INC (399879106) COM Mutual Fund (as quoted by NASDAQ) 12/16/2011 28.25000 Mkt 28,250000 8,749.36 91 338.233 INVESTMENT CO AMER (961308108) CL A Mutual Funtl (as quoted by NASDAQ) 12/16/2011 26.95000 Mkt 26.950000 8,946.26 10) 127.001 SMALLCAP WORLD FD INC (831681101) COM Mutual Fund (a5 quoted by NASDAQ) 12/16/2011 32.52000 Mkt 32.520000 4,130.07 Page 1 This report was produced with EstateVa 1, a product of Estate Valuations s Pricing Systems, Inc. If you have questions, please contact EVP Systems at (618) 313-6300 oz www.evpsys. com. (Revision 7.2.1) =.-e of Death: 12 /17/2011 Estate of; Robert Remo _•:at icn Date: 12/17/2011 ~ arccess ing Date: 01/26/^_012 Report Type~uDate7of8Death Number of Securities: 12 Fi 1e 1D: 7588-2037 Shares Security ;;ees a,d/or Div and Int Security or Par Description igh /ASY. __... 3_.. .,d; csr-er.ts Accruals Value __. 72.471 VANGUARD INDEX FDS (922908108) 500 PORTFOLIO Mutual Fund (as quoted by NASDAQi 12/16/2011 __- _ - _ _ 112.860000 8,179.08 -= 3.50.72 WASHINGTON MUT ZNVS FD INC (939330'06) COM Mutual Fund ;as auoted by NASDAQ) 12/16/2011 _-._-_ rg,t ?7.960000 9,630.77 Div: 0.235 ~..: 12/16/3"011 Rec: 12/16/2011 Pay: '_. __. ____ 78.91 ---= :ante: - -- -- $149,323.07 'otal: 5144, 833.9'1 5510.90 Portfolio Endr.otes ^?HR. vf2 Page 2 This report was produced with EstateVal, a product of Estate Valuations 6 Pricing Syst [:rtes, Zne. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7,2.11 Estate Valuation Robert Kemp Date of DeaUi: 1?/17/2011 Valuation Date: 12/17/3011 Processing Date: 01/26/2012 1) zl 31 4) 5J 6) 7) 81 91 101 Estate of: Robert Kemp Account: 3217-1104 Report Type: Date of Death Number of Securities: 15 Eile ID: 3217-1109 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Atlj ustments Accruals Value 16935. 33 Bank Deposit Sweep (CASHI 16,935.33 Accrual 850 INTERNATIONAL BUSINESS MACNS (959200101) COM New York Stock Exchange 12/16/2011 188.01000 181 .91000 H/L 12/19/2011 189.69000 182 .25000 H/L 184.215000 ;6000 WELLS FARGO BK N A (9997480091 Financial Times Interactive Data DTD: 10/07/2009 Mat; 09/08/2013 09 12/16/2011 108 .25000 A/8 12/19/2011 108 .50000 Mkt 108.375000 Nate: Put Option on DOD :0000 WELLS FARGO BK N A CA (94986TEO97 Financial Times Interactive Data DTD: 08/06/2010 Mat: 08/07/2019 18 12/16/2011 97 .75000 A/B 12/19/2011 97 .75000 Mkt 97.750000 I nt: OB/0~6/2011 to 12/17/2011 Note: Put Option on DOD 23000 WELLS FARGO HK N A CA (99986TEH6) Financial Times Interactive Data DTD: 09/08/2010 Mat: 09/08/2019 09 12/16/2011 99 .62500 A/B 12/19/2011 99 .62500 Mkt 99.625000 25000 WELLS FARGO BK N A CA (99986TEZ61 Financial Times 2ntezact ive Data DTD: 11/05/2010 Mat: 05/06/2016 0& 12/16/2011 89. 25000 A/B 12/19/2011 88. 87500 Mkt 89.062500 Note: Put Option on DOD 304.047 CAPITAL INCOME BLDR FD (190193103) SH BEN INT Mutual Fund las quoted by NASDAQ) 12/16/2011 48. 67000 Mkt 9E3. 670000 172.295 EURO PAC GROWTH FD (298706702) SH BEN INT MuCUa1 Fund (as quoted by NASDAQ) 12/16/2011 39. 85000 Mkt 35,.850000 509.99 GROWTH FD AMER INC (3998791061 COM Mutual Fumd las quoted by NASDAQ) 12/16/2011 28. 25000 Mkt 28.250000 922.79 INCOME FD AMER INC (453320103) CL A Mutual Fund (as quoted by NASDAQI 12/16/2011 16. 54000 Mkt 1fi.590000 D.De 156,582.75 19,507.50 19,550.00 72.88 21,763.75 22,265.63 19,797.97 6,002.74 19,265.97 15,262.95 Paqe 1 This report was produced with EstateVal, a product of Estate Valuations 6 Pricing Systems, Inc. If you have questions, please gontact EVP Systems at (BiB) 313-6300 or www.evpsys.com. (Revision 7.2.1) ~~~~~,~ ~ z~~a Date of Death: 12/17/2011 Estate of: Robert Kemp Valuation Date: 12/17/2011 Processing Date: 01/26/2012 Account: 3217-1109 Report Type: Date of Death Number of Securities: 15 File ID: 3217-1109 SiLa res Security i9e a.n and/or Div and Int Security __ rar Description =_gh /AS Y, Loy..; B.S Adjustments Accruals Value -- SL4.57 INVESTMENT CO AMER 1961308108) CL A Mutual Fund (as quoted by NASDAQ) 12/16/2011 26.45;00 i9kt 26.450000 13,610.38 -- '_=6.262 SMALLCAP WORLD FD INC (831681101) COM Mutual Fund (as quoted by NASDAQ) 12/16/2013 "x2.52000 Mkt 32.520000 7,032.89 -- 850 FLAHERTY u CRIaN/CiYMR PFD SEC (338478300) cola sHs New Ycrk 5tocl: Exchange 12/16/2023 17.68000 17.94000 B/L 123 19/2011 17.73000 _7. S600G F./L 17.597500 19,957.88 -'~ - - -=Ce:SOCe: .RED?^ ALL INC TR IV 1092508100) ~" E'o~k Exchange -- - - -- 12.26000 =.l000O H/L ---- --- 12.23000 ?.06000 R/L - -- - 1'1..162500 3,296.04 --~~ _.. .~ ,... 12/32/2011 Rea 12/14/2011 Pay: 12/3 9/2G 1 21.27 _~, "_392.8;- __ _?a 97ffi6E. --``6" -9 11.ca000 11.10000 A/B '-2!-~~`~-- 11.30000 10.96000 A/B - ,_7- 17..200000 15,599.89 =nt: -'~~- - ---. _.!07/2011 Re C. 12/09/2011 Pay: 12/25/2011 52.79 :ntdl ~Ia 1LE: -oral Accrua_: 5361,931.62 Total; :361,57g,6c 5197.02 Portfolio Endnotes Titled: ROBERT KEMP PO BOX 32383 BELLINGHAM WA 98228-c 383 Account was opened on 02/25/2008 Page 2 This report was produced with Estateval, a product of Estate Valuations s Pricing Systefns, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.11 Estate Valuation Robert Kemo Dale of Death: 12/17/2011 Valuation Da [e; 12/17/2011 Processing Date: 01/26/2012 9) 5) 6) 7) 81 9) 10) Estate of: Robert Kemp Account: 4699-5135 Report Type: Date of Death Number of Securities: 37 File ID: 9644-5135 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Ad'iustments Accruals Value 31079.61 Bank Deposit Sweep (CASH) 31,079.61 ACC rudl 80 ABBOTT LABS (002824100) COM New York Stock Exchange 12/16/2011 59 .96000 59 .63000 H/L 12/19/2011 59 .92900 59 .16000 H/L 54.669750 60 ALTRIA GROUP INC (022095103) COM New York Stock Exchange 1?/16/2011 29 .97000 28 .97500 H/L 12/19/2011 29 .63000 29 .29000 H/L 29.391250 96 BANK OF AMERICA CORPORATION (0605051091 COM New York Stock Exchange 12/16/2011 5 .42000 5 .16000 H/L 12/19/2013 5 .22000 9 .92000 H/L 5.180000 Div: 0.01 Ex: 11/30/2071 Rec : 12/02/2011 Pay: 12/2 3/2011 90 BECTON DiCKIDISON 6 CO (07588 7109) CUM New York Stock Exchange 12/16/2011 71. 45000 70. 05000 H/L 12/19/2011 71. 28000 70. 50000 H/L 70.82000C Div: 0.45 Ex: 12/08/2011 Rec: 12/12/2011 Pay: 12/3 0/2011 80 BP PLC (055622104) SPONSORED ADR New York Stock Exchange 12/16/2011 91. 76000 91. 26000 H/L 12/19/2011 91. 15000 90. 40000 H/L 91.14250C Div: 0.42 Ex: 11/02/2011 Rec: 11/04/2011 Pay: 12/1 9/201 1 92 CHEVRON CORP NEW (166769100 COM New York Stock Exchange 12/16/2011 100. 86000 99. 59000 H/L 12/19/2011 101. 33000 99. 50000 H/L 100.320000 80 DIAGEO PLC (25243Q205) S PON ADR NEW New York Stock Exchange 12/16/2011 89. 67990 83. 52000 H/L 12/19/2011 89. 38000 83. 55000 H/L 84..032475 130 DISNEY WALT CO 1254687106) COM DISNEY New York Stock Exchange 12/16/2015 35. 74000 35. 15000 H/L 12/19/201T 35. 55000 39. 51000 H/L 35.237500 Div: 0.6 Ex: 12/14/2011 Rec: 12/16/2011 Pay : 01/18/2012 150 EMERSON ELEC CO (291011109) COM New York Stock Exchange 12/16/2011 50. 09000 48. 87000 N/L 12/19/2011 99. 29000 97. 73500 H/L 40.971250 0.10 9,373.58 1,760.48 497.28 0.96 2,832.80 18.00 3,291.90 33.60 9,229.99 6,722.60 4,580.88 78.00 7,345.69 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.1) ~„'~~ ~_ ___ _ __ __ _ _ _ _ 6scate of: Robert Kemp -:=_== -' -.__~. i_!?6/2Ci2 Account: 9699-5135 - Report Type: Date of Death Number of Securities: 37 File ID: 4694-5135 5.^.ares Security :!ear. aad/or Div and Int Seccrit cr Par Descri tion - - Y P He cc/AS!: _.,« __~ _ 'astnents Accruals Va lce --. 100 ENERGY TRANSFER PRTNRS L P (29273RIZ 9 ; UNIT LTD PARTN New York 'Stock Exchange 12/16/2011 45.""<2000 - - - ; H/L 12/19/2011 95.20000 ... c`55s ::4/L 49.89625( -- 100 EXELON CORP (30161N101) COM New York Stock Exchange 12/16/2011 93.SSOGC __,-ppp0 H/L 12/19/2011 92.97990 ::.97000 H/L 92.79997° -- 92 EXXON MOBIL CORP (302316102) COM New York Stock Exchange 12/16/2011 80.91000 ?9.88000 H/L I?/19/2011 80.9600 -?. 36000 H/L 80.157500 19) 70 FEDEX CORp 131926X106) COPS New York StocV: Exchange 12/16/2011 86.37000 83,92000 H/L 12/19/2011 85.92000 80.91100 H/L Dia: 0.13 E::: 12/09/2011 Rec: 12/13/20 11 Pay: 01/03 /20i2 89,155250 15! 120 GENER.~ ELECCRIC CO (369604103) GOb) New Yor4: Stock Exchange 12/16/2011 17.09000 16.91000 H/L 12/19/2011 17.10000 16.79000 H/L 16.972500 16) 250 HEWLETT PACKARD CO {g28236103) COM New Yolk Stock Exchange 12/16/2011 26.67000 25.83000 H/L 12/19/2011 26.07500 25.02000 H/L Div: 0.12 !Ex: 12/12/2011 Rec: 12/19/2011 Pay: 01/04/2012 25.896750 lli 109 HONEYWELL INTL INC (43851fi106) COM New York Stock Exchange 12/16/2011 53.71000 52.53000 H/L 12/19/2011 53.63000 52.10000 H/L 52.992500 18) 93 INTERNATIONAL BUSINESS MACHS (959200101 ) COM New York Stock Exchange 12/16/2011 186.01000 181.91000 H/L 12/19/2011 184.69000 182.25000 H/L 189,.215000 19! 74 JOHNSON 6 JOHNSON (978160109) COM New York SGOCk. Exchange 12/16/2011 64.37000 63.55000 H/L 12/19/2011 69.28000 63.36000 H/L 63.890000 20) 150 JPMORGAN CHASE & CO (46625H100) COM New York Stock Exchange 12/16/2011 32.60000 31.80910 H/L 12/19/2011 31.90000 30.42000 H/L 31.682275 9,989.63 9,280.00 7,379.99 5,890.87 9.10 2,036.70 6,979.69 30.00 5,776.18 17,132.00 9,727.86 4,752.34 Page 2 This report was produced with EstateVal, a product of Estate Valuations b Pricing Syst erns, Inc. If you have questions, please contact EVP Systems at (8181 313-6300 or www. evpsys.com. (Revision 7.2.1) ~^ --. :?!17/2011 =-ate o.": RoCert fie 12717/2011 Acco unt: 4694-5135 _~e: 01/26/2012 3epor[ Type: Date of Death Number of Securities: 37 File ID: 4694-5135 ____es Security ;; r Div antl Int Security __ ,r Description -_ahi=si _ _•. ~_~ = - =_-:er.ts Accruals Value -- 35 kIMBERLY CLARK CORP (9943681031 COM New York Stock Exchange 12/16/2D11 71.62 CCO - _- - 12/19/2011 71.65020 -_._,. ,_ :._ 71.353750 2,997.38 Div: 0.7 Ex: 12/07/2011 Rec: 12 /09/2011 Pay: :_. ., ._.__ 29.50 -- 41 KRAFT FOODS INC (50075N109) CL A New York Stock Exchange 12/16/2011 ~ 36.90.'^= 00 H/L 12 /19/2b11 36.9000^ ....'40 UO H/L 36.505000 1,496.71 -- 56 MACYS INC (55616P109) COM New York Sock Exchange 12/16/2011 31.99000 33.59D 00 H/L 12/19/2011 31.33550 ;.;2000 H/L Div: 0.1 Ex: 12/13/2011 Rec: 12/15/2011 Pay: C'./.3 i>;:= 31.189975 5.60 1,746.36 -- . .3U i4CDONALDS CORP (580135101) 00:7 Ne'»~ 'fork Stock Exchange 12/_6/20"-1 98.62000 97.06000 H/L --%-9/20_1 98.36990 96.98000 H/L 97.762475 12,709.12 -= 63 >'R-i..E ...C i59156R108) Sroc r. Exchange --~!~-E/23'--- ~ 30.68000 30.05000 H/L ---5- -~-= 30.39000 28.93000 H/L 30.062500 1,893.94 .c. 70 iiICROSOF'1' CORP (599916104) CO2: 'he NASDAQ Stock Market LLC 12/i6/20'~.li 26.17000 25.63000 H/L '_2/19/2011 26.12000 25.96000 H/L 25.895000 1,809.15 271 145 PEFS ICO INC (713448108) COM P:eo: Yor4: Stock Exchange 12/16/20111 65.40000 64.62000 H/L 12/19/2011 65.17000 69.20000 H/L 64.647500 9,902.89 Div: 0.515 Ex: 11/30/2011 Rec: 12/02 /2011 Pzy: 01/0 3/2012 74.68 28) fi0 PHILIP MORRIS INTL INC (718172109) COM New YoxkStock Exchange 12/16/2051 76.63000 75.2900D H/L 12/19/2011 76.81000 75.79000 H/L ' '76.130000 9,567.80 291 120 PROCTER (. GAMBLE CO (792718109) COM New YorkStock Exchange 12/16/2011 65.62990 69.82000 H/L 12/19/2011 65.59000 64 .79D00 H/L 65.194975 7,823.90 301 200 PDSLIC SVC ENTERPRISE GROUP (7995731061 COM New York Stock Exchange 12/16/2011 32.01000 31.22000 H/L 12/19/2011 31.6900D 30.60000 H/L Div: 0.3425 Ex: 12/07/2011 Rec: 12/09/2011 Pay: 12/30/2011 31.367500 68.50 6,273.50 Page 3 ahis report was protluced with Estateval, a product of Es[ate Valuations s Pricing S ystems, Znc. If you have questions please contact EVP Systems at (8181 313-6300 or www. evpsys.com. (Revision 7 .2.1) , _z 0.: Rabe r[ fiemo Account; 9694 5135 < a- ryoe: Da'_e of Death ?1;:mber of Secuxit ies: 37 File ID: 9694-5135 -- _- ^---_ ---: -. ter: and Inc Security _ ,_ - __: -. :~ . - 3_... .~._..__ .,crua is Value E6.532500 CC? New 'York S- .... ~.:ch_^.._ ~ _ _ _ i^/16/201-- _ _ .,2 .639000 __ __ _RAVELER9 COMPANIES iNC (_-:_-~_..:. - _O'f ~.a Yoxk ,Stock Exchange 1 !16/2011 =- _- - -~ _ _J 19/2011 =-.-_.._ __. :.,.~ _,_ 57 .202500 __-: 0.91 Ez: 12/07/2011 Rec. 1.". .; _.__ '- __ _: _.__ -_. '.ark Stock Exchange .=.:1;201.- ___ __ _ - _ 3/L __ _r X2011 -~. 5____ '-. __. __ "'./L 18 .861200 .5 .-. ... ~ .'_ =.iTY FDS l45890C606) _ __ _ _:_{ AM A - a. Fond (as quoted by NASDAQ) __ __ _Gii =.__.OG i+t~ _ .1900.-_ _. __-..:J _- -='.2 INVT TR (543916969) - - - - - i:iCM F _ =-: d (as quoted by NASDAQ) __ _ _-,_ =.53000 hikt 4 .53000C _" --.-_ --_-- --' ' PORTFOLIO LP (302777752) _-=r-_:=77EQ6FCM Portfoiia .......ores 4,923.91 18.50 5,263.00 5,720.25 91.00 7,255.23 12,126.17 10,231.79 22,295.28 5252,623.85 5402_ 54 Page 9 This report was produced with Est ateVal, a product of Estate Valuations d Pricing Sy°stems, Inc. Zf you have questions, pleasecontact EVP Systems at (818) 313-6300 or ur.,w.evpsys.com. (Revision 7.2.31 Estate Valuation Date of Death: 12/17/2011 Estate of: Robert J. Kemp Valuation Da':e: 12/17/2011 Account: 13946.E Processing Date: 03/06/2012 Report Type: Date of Death Number of Securities: 3 File ID: 13996.2. kemp. ibm Shares Security Mez.n and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 10 INTERNATIONAL BUSINESS MACHS (459200101; IBM) COM NYSE 12/16/2011 188.01000 181.91000 H/L ,,, 12/19/2011 189.69000 182.25000 H/L D , IE9 .215000 1,892.15 2) 617 INTERNATIONAL BUSINESS MACHS (459200101; IBM) /~ NYSE COM f~"~` ~/ 12/16/2051 188.01000 181.91000 H/L 12/19/2051 189.69000 182.25000 H/L ~L 1E9.215000 !~ 113,660.66 31 108 INTEANAT IIONAL BUSINESS MACHS (959200101; IBM) f NYSE 12/16/2011 188.01000 181.91000 H/L ra.L 12/19/20I1 184.69000 182.25000 H/L r~ 1E 4.215000 19,895.22 Total Value: Total Accrua:L Tot a:L $135,398.03 50.00 5135,398.03 Page 1 This report was produced with Estat eVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.9.1) AmeriChoice FEDERAL C R E D I T U N I O N Building Relationships For Life January 18, 2012 Michael Kemp PO Box 32383 Bellingham, WA 98228 Re: Estate of Robes J Kemp Mr. Kemp, The decedent had dne member number 9916 titled Robert J Kemp. This account included: Regular Savings (s ffix 0001) -opened 09/13!1982 with JT Michael D Kemp Share Draft (suffix10013) -opened 07/10/1995; JT Michael D Kemp added 1:U13/2010 'IRA Share (suffix 0020)-opened 04/14/1983 60 Month IRA Share Certificate (suffix 0080) -opened 04/14/2008 60 Month IRA Share Certificate (suffix 0081) -opened 0411 5 /2 009 36 Month IRA Share Certificate (suffix 0082) -opened 04/12/2010 36 Month IRA Sha1'e Certificate (suffix 0083) -opened 0411 3/20 1 0 Date of death balances are as follows: Balance 0001 - $ 233.40 0013 - $ 20,732.82 0020 - $ 10,444.99 0080 - $ 3,842.70 008] - $ 3,346.68 0082 - $ 20,322.92 0083 - $ 1,806.27 Accrued Dividends $ 0.03' .Sc~c~r..-E~... $0.00 $ 15.00 Y.v..-..+ I + 7' $ 25?0 / /~ $ 18.60 ,Sr~o~.~.~-~ C~, /.c..r-~ /-S $ 63.70 $ 5.12 The abuve baialces inciudc the accrued dividends. Mr. Kemp did not have a safe deposit box with AmeriChoice. I have included Mr. Kemp's most recent statement. Please feel free to ciontact me directly with any questions you may have. Sincerely, f Bonnie R.Seagravas Operations Speciafi'st Phone (717)591-1282 Fax (717) 697-3713 Email bseaeraves(~;americhoice.or¢ Main Office: 3175 6umhle [3ee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) (97-3474 • Fax: (717) 697-3713 `/~' Website: www.americhoice.org •T.. ~ Eywl, Moen LE~N~p ER l:kFOOr UNIONS' REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 34.000.00 Discount: 1.789.42 Interest Table Year Days. Delinquent this time perlod Balance Due this year Interest this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throw h 1991 1992 1993 throw h 1994 1995 throw h 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 throw h 2012 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: