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Home My WebLink About12-27-13 (2) 1505610105 REV-1500 EX(02-11)(R)41!j �sylvania OFFICIAL USE ONLY PA Department of Revenue P enn Y County Code Year File Number Bureau of Individual Taxes EP�PiN OFgEVEf11E PO BOX 280601 INHERITANCE TAX RETURN :�� Harrisburg,PA 17128-0601 RESIDENT DECEDENT �� e E ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 111/12/2013 03/29/1926 Decedent's Last Name Suffix Decedent's First Name MI Kempf �j j Frank �J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number Security — -er-- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) Q 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) OD 6.Decedent Died Testate . O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number y Frank J Kempf, Jr. !(717)764-3942 t G6TER OF W�CL'S USA Q :x7 r r C) First Line of Address___ m r\ ) TI `2174 Esbenshade RoadR -,x� C3 Second Line of Address ^� =0 -r I 3 L DATE Ptt ED n i City or Post Office State ZIP Code York ^� PA 31740 C;D _. Correspondent's e-mail address:FJKempf @COmCaSt.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is Vu rrect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG URE PER ON R NSI E FO FLING RETURN DATE 2 AQ)6F1ffSS 2174 Esbensh a Road ork, WA 17408 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Frank J Kempf RECAPITULATION 1. Real Estate(Schedule A). . ...... ... .................... . ...... ....... 1. 0.00 2. Stocks and Bonds(Schedule B) ........ .. .... .............. ..... ...... 2. 394,366.81 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)...... . ......... ...... . . . .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)... .... 5. 72,567.95 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7). . . . ... ..... .... .. ........ ... 8. 466,934.76 9. Funeral Expenses and Administrative Costs(Schedule H)......... .......... 9. 5,110.12 10. -Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... ..:.:::.... 10. - 13;137.20._ 11. Total Deductions(total Lines 9 and 10)........................ ......... 11. 18,247.32 12. Net Value of Estate(Line 8 minus Line 11) ................... .... . ... . .. 12. 448,687.44 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - an election to tax has not been made(Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . ........ .. ......... .. 14. 448,687.44 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_ 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 448,687.44 16. 20,190.93 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE . .... ....... ................. . ....... ......... ........... 19. 20,190.93 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Frank J Kempf STREETADDRESS 5225 Wilson Lane CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 20,190.93 Z. Credits/Payments A.Prior Payments B.Discount 1,008.20 3. Interest Total Credits(A+B) (2) 1,009.55 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2,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) 19,181.38 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. retain the use or income of the property transferred.......................................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest .............................................................................................................................. ❑ E d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ E 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death 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? .............................................................................................. ❑ 0 .......................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of d ath on r after July j,(1),94,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent 2 P.S. 9116 a 1.1 i . 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 [72 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 decedents lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frank J Kempf 2013-01251 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' AEP American Electric Power 77.05 3,663.51 CMRE Costamare Inc. 900 16,681.50 CTL Centurylink 400 12,620.00 CVX Chevron Corp. 900 3,974.21 GE General Electric 359.149 9,688.05 HON Honeywell International 58.102 5,050.80 JNJ Johnson&Johnson 44.349 4,148.62 MSFT Microsoft Corp. 107.495 4,020.05 NSC Norfolk Southern Corp. 20.714 1,788.35 NVS Novartis AG 22.707 1,774.90 PPL PPL Corporation 104.565 3,163.10 SDRL Seadrill LTD. 150 6,795.75 T AT&T Inc. 104.493 3,672.42 YUM Yum Brands Inc. 55.07 3,922.49 Subtotal-stocks 84,224.88 Mutual Funds GFACX American GR FD of America 1,141.96 47,254.29 MCDVX Blackrock Equity Dividend 3,082.28 70,337.68 NECZX Loomis Sayles Strat Inc. 2,534.058 41,457.19 PTTCX Pimco Total Return 5,512.30 59,753.28 PUBCX Pimco Unconstrained Bond 4,604.36 51,568.86 PICEX Virtus Insight Emerging mkts.2,008.03 18,192.77 Subtotal-Mutual Funds 288,564.07 TOTAL(Also enter on Line 2, Recapitulation) $ If more space is needed,insert additional sheets of the same size REV-15o3 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frank J Kempf 2013-01251 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. EFT Ishares MSCI EAFE Growth 81.393 5,621.40 EWJ Ishares MSCI Japan 155.13 1,834.42 EWS [shares MSCI Singapore 124.205 1,682.35 EWY Ishares MSCI south korea 28.37 1,766.46 1XC Ishares Global Energy 46.208 1,961.87 JGV Nuveen Global Value Opp.97.338 1,295.57 MSF Morgan Stanley Emerg mkts fund 95 1,420.25 VEA Vanguard FTSE developed mkts.92.864 3,748.46 Subtotal-Exchange Traded Funds 20,980.58 Dividends due at date of death JNJ Johnson&Johnson 29.27 PTTCX Pimco Total Return 52.88 MSFT Microsoft 30.10 NSC Norfolk Southern Corp 10.77 AEP American Electric Power 38.50 CVX Chevron Corp 33.00 HON Honeywell International 26.15 CTL Centurylink 216.00 AFL Aflac,Inc. 18.45 NECZX Loomis Sayles Strat Inc 142.16 Subtotal-Dividends due at date of death 597.28 TOTAL(Also enter on Line 2, Recapitulation) $ 394,366.81 If more space is needed,insert additional sheets of the same size REV-1508 EX+(o8-i2) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Frank J Kempf 2013-01251 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CD 40431 GFR5 HSBC BK USA N A MC Lean VA 3% 55 shares 54,591.35 r�arraleyt�velssetfs Ta>�able-F-r ;ISt-Ba" 7. 7A TOTAL(Also enter on Line 5, Recapitulation) $ 72,567.95 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frank J Kempf 2013-01251 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Rolling Green Cemetery, Grave opening 1,495.00 St.Theresa parish,funeral refreshments 235.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: Z• Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4, Probate Fees: 498.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. mailing costs 6.76 broker's commissions 2,697.84 Estate Notices 177.02 TOTAL(Also enter on Line 9, Recapitulation) $ 5,110.12 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) -j- ]pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frank J Kempf 2013-01251 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 OnlniCare King of Prussia,Prescriptions 769.14 Bethany Village,Skilled Nursing Care 12,368.06 TOTAL(Also enter on Line 10,Recapitulation) $ 13,137.20 If more space is needed,insert additional sheets of the same size. Wealth Management 4507 North Front Street Suite 201 Harrisburg,PA 17110 tel 717 255 6666 fax 717 255 6651 M o rg a n Sta n ley toll free 800 676 0673 December 16, 2013 Frank J. Kempf, Jr. Frank, The value for Frank J. Kempf s taxable account on his date of death (11/12/2013) was: $466,337.48 Stock Positions Symbol Description Shares Date of Death Value AEP American Electric Power 77.05 $3,663.51 "FL Afla lnC CMRE Costamare Inc. 900 $16,681.50 CTL Centurylink 400 $12,620.00 CVX Chevron Corp. 900 $3,974.21 GE General Electric 359.149 $9,688.05 v / HON Honeywell International 58.102 $5,050.80 JNJ Johnson&Johnson 44.349 $4,148.62 MSFT Microsoft Corp. 107.495 $4,020.05 NSC Norfolk Southern Corp. 20.714 $1,788.35 NVS Novartis AG 22.707 $1,774.90 PPL PPL Corporation 104.565 $3,163.10 SDRL Seadrill LTD. 150 $6,795.75 T AT&T Inc. 104.493 $3.672.42 YUM Yum Brands Inc. 55.07 $3,922.49 Exchange-Traded Funds Symbol Description Shares Date of Death Value EFT Ishares MSCI EAFE Growth 81.393 $5,621.40 EWC Ishares MSCI Canada 56.49 $1,649.80 EWJ Ishares MSCI Japan 155.13 $1,834.42i'f EWS Ishares MSCI Singapore 124.205 $1,682.35 (� 1 EWY Ishares MSCI south korea 28.37 $1,766.46 IXC Ishares Global Energy 46.208 $1,961.87 JGV Nuveen Global Value Opp. 97.338 $1,295.57 MSF Morgan Stanley Emerg mkts fund 95 $1,420.25 VEA Vanguard FTSE developed mkts. 92.864 $3,748.46 Investments and services are offered through Morgan Stanley, LLC. Incorporated,member SIPC. Morgan Stanley Smith Barney LLC.Member SIPC. Wealth Management 4507 North Front Street Suite 201 Harrisburg,PA 1711.0 tel 717 255 6666 fax 717 255 6651 Morgan Stan ley toll free 800 676 0673 Mutual Funds Symbol Description Shares Date of Death Value GFACX American GR FD of America 1,141.96 $47,254.29 n!7 MCDVX Blackrock Equity Dividend 3,082.28 $70,33 1 7.68 NECZX Loomis Sayles Strat Inc. 2,534.058 $41,457.19 d�1 PTTCX Pimco Total Return 5,512.30 $59,753.28 PUBCX Pimco Unconstrained Bond 4,60436 $51,568.86 PICEX Virtus Insight Emerging mkts. 2,008.03 $18.192.77 Certificates of Deposit Symbol Description Shares Date of Death Value 40431GFR5 HSBC BK USA N A MC Lean VA 3% 55 $54.591.35 Cash and Bank Deposit Symbol Description Shares Date of Death Value AATF Bank Deposit 17276.60 $17,976.60 Please call with any questions you may have. Take Care, Michael E. Kempf Financial Advisor Investments and services are offered through Morgan Stanley,LLC. Incorporated,member SIPC. Morgan Stanley Smith Barney LLC.Member SIPC. w ASBURY STATEMENT Page: 1 of 2 117 B� � 1"tj �� ,��. ��: E630785 nvoice# Accoun## � Date_ 23434 12/06/2013 Anticipate More 325 Wesley Drive Mechanicsburg,PA 37055 Due Date, Amount Due Amount Paid 12113/2013 -$6,44210 Jr.Frank J Kempf - -�� ` F "� � `� 2174 Esbenshade Road Resident Name York, PA 17407 Kempf,Frank J Your designated amount will be paid by electronic funds withdrawal from your bank account. Bethany Village-The Oaks 12/0612013 Date Description Units Unit Net Balance From -1 Through. I I I Cost I Char es I Credits RESIDENT RESPONSIBILITY 10/31/2013 Balance Forward $12,368.06 11101/2013 11130/2013 Room and Board -6,822.00 -$6,822.00 11101/2013 11/01/2013 Ancillary Supplies 1.00 Each 7.75 7.7 -$6,814.25 11/01/2013 11/01/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.00 12.0 -$6,802.25 11/01/2013 11/01/2013 Catheter Care 1.00 Day 7.76 7.7 -$6,794.50 11/02/2013 1110212013 Ancillary Supplies 27.00 Each 0.8 22.2 -$6,772.25 1110212013 11102/2013 Incontinence Care-ModlHeavy 1.00 Day 12.0 12.0 -$6,760.25 11/0212013 11/02/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,752.50 11/03/2013 11/03/2013 Ancillary Supplies 30.00 Each 0.5 15.1 -$6,737.37 11/03/2013 11103/20/3 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,725.37 11/43/2013 11/03/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,717.62 1003/2013 11/12/2013 Nutritional Supplements 25.00 Each 1.0 27.0 -$6,690.62 11104/2013 11104/2013 Ancillary Supplies 1.00 Each 7.7 7.7 -$6,682.87 11104/2013 11104/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,670.87 11104/20013 11/04/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,663.12 11/0512013 11/05/2013 Ancillary Supplies 1.00 Each 7.7 7.7 -$6,655.37 11/05/2013 11/05/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,647.62 11/0612013 11/06/2013 Ancillary Supplies 1.00 Each 7.7 7.7 -$6,639.87 11106/2013 11/06/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,627.87 11/06/2013 11/06/2013 Catheter Care 1.00 Day - 7.7 7.7 -$6,620.12 11/07/2013 11/07t201 1 Ancillary Suppues 1.00 Each 7.7 7.7 -$6,612.37 11/07/2013 11107/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,600.37 11/07/2013 11/07/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,592.62 11/08/2013 11/0812013 Ancillary Supplies 1.00 Each 7.7E 7.7 -$6,584.87 11/08/2013 11/08/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,572.87 11/08/2013 11/08/2013 Catheter Care 1.00 Day 7.7E 7.7 -$6,565.12 11/09/2013 11/09/2013 Ancillary Supplies 107.00 Each 0.3 41.2 -$6,523.85 11/09/2013 11109/2013 Incontinence Care-Mod/Heavy 1.00 Day 12.0 12.0 -$6,511.85 r ASBURY STATEMENT Page: 2 of 2 BET .iC 4 1 r,,_ sy y Invoice# Account# Date / i'f L 1�`tt E �; 630785 23434 12/06/2013 Anticipate More 325 Wesley Drive Mechanicsburg, PA 17055 Due Date Amount Due Amount Paid 12/13/2013 -$6,442.10 Jr. Frank J Kempf 2.174.F-sbens-!ade Road. Resident Name York, PA 17407 Kempf, Frank J Your designated amount will be paid by electronic funds withdrawal from your bank account. Bethany Village-The Oaks 12/06/2013 Date Description Units Unit Net Balance From I Throu h d I I Cost I Charges I Credits RESIDENT RESPONSIBILITY _ 1.1/09/2013 1 1/09/2013• Catheter Care- _ - -_ -_ . 1XO,Day ., _ - 77! - 7.7 11/10/2013 11/10/2013 Ancillary Supplies 1.00 Each 7.7E 7.7 -$6,496.35 11/10/2013 11/10/2013 Catheter Care 1.00 Day 7.7E 7.7 -$6,488.60 11/11/2013 11/11/2013 Ancillary Supplies 1.00 Each 7.7E 7.7 -$6,480.85 11/11/2013 11/11/2013 Catheter Care 1.00 Day 7.7 7.7 -$6,473.10 11112/2013 11/12/2013 Ancillary Supplies 1.00 Each 7.75 7.7 -$6,465.35 11/12/2013 11/12/2013 Catheter Care 1.00 Day 7.75 7.7 -$6,457.60 11/13/2013 11/13/2013 Ancillary Supplies 1.00 Each 7,75 7.7 -$6,449.85 11113/2013 11/13/2013 Catheter Care 1.00 Day 7.75 7.7 -$6,442.10 Please contact Dana Renaut 717-591-8029 OR drenaut @asbury.org with billing questions.Thank you! TOTAL TOTAL RESIDENT RESPONSIBILITY -$6,442.10 D LAS'S WILL AND TESTAMENT or PRANK J. WIPF I, PRANK J. IMVP, of New Cumberland,* County of Cumberland and State of Pennsylvania, being of sound minds memory and understanding,, do hereby make, publish and declare this as and for my Last Will .and 'Testument hereby revoking and making void any and all other wills by me at any time heretofore made. 4 A.6 I direct: that my Executrix heteinaftet named shall. pay all my just debts and funeral, expenses as soon an conveniently may be done after my decease. All the rest, residue and remainder of my estate, whether real, personal or mi;xed,$ and .wh+eresoe'ver s tua.te,i I hereby give, devise and bequeath unto my wife, PATRICIA S. ICWFO if she ,survives me by a period of thirty days. If my said wife d®es not survive me by a period of thirty days6 then this gift to her shall be divested, and 't then give,, devise and bequeath my entire estate junto my children in equal: shares per stirpes. D No fiduciary acting under this Will shall be required to past bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, t., Frank J. Eempf,, the Testator, have unto this, my Last Will and Testament,, set my hand and seal this � � day of , A* D., 1970. - (SQL) SIGNED, SEALED, PUBLISHED and DECLARED by Frank J. Kempf, the above-named Testator, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names as witnesses at his request, in the presence of the said Testator and of each other. S/JON F. LaFATIER