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HomeMy WebLinkAbout06-22-15 (2) pennsytvania 1505614105 oEpaarMENroF aEVEHUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY l^ I6 Z 8 O t 0 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) O 4.Agriculture Exemption(date of C:D 5.Future Interest Compromise(date of O 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) 7. Decedent Died Testate O 8.Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=:) 10.Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number I obt�i>zL � ti1-t- 'T3Z-MLI First Line of Address Second Line of Address City or Post Office State_ ZIP Code o JQ i Fi� I F Correspondent's email address: V11AA" �UM UP , AR-r- r1 x T—` REGISTERLOF WILLS USE ONLY. f> REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY j (D —TI .T C') s ' r Cz) DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 6 4� �iii�iiiii iim ilii iiia 0 1505614105 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Ke Decedent's Name: GIIr j g RECAPITULATION i\ 1. Real Estate(Schedule A). . .................. . ..... .......... .. ........ 1. b 2. Stocks and Bonds(Schedule B) . .. ............ .............. .......... 2. 1 It 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. O 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7)................ I da `4(, 2(Q, ZZ 9. Funeral Expenses and Administrative Costs(Schedule H)..... .... .......... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)..... .......... 10. 11. Total Deductions(total Lines 9 and 10)...... .... .. ........... .......... 12. Net Value of Estate(Line 8 minus Line 11) .......... .................... 12. ® � ®o 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. ( �' , �` 3 t V/ ! 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.0-6- 15. 16. Amount of Line 14 taxable --- at lineal rate X.OU 1 1 `�j�-7�3, R� 16. 17. Amount of Line 14 taxable -- at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 , 18. I 19. TAX DUE ... .. ........ ...........:...................... .......... 19.E � 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SI ATURE OF PE SON PO I LE FOR FILING RETURN DATE AD SS � SIGNAT OF RE RE ER AN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADD ESS 1 3OL G114..c ,_ �ilt �� Pd t.rlii4 r;a lrlrz�� 1 J111111111111111111111111iJJ 1111�i�J�11111111111111 Jill Side 2 0 6 4 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME STREETADDRESS h p { CITY F^ STATE , ZIP ��S �U1la Tax Payments and Credits: t1 1. Tax Due(Page 2,Line 19) (1) j ((). 2 2. Credits/Payments A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) (� 3. Interest (3) b 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) n 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. 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.......................................................................................... ❑ XI b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest .............................................................................................................................. ❑ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 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? .........:.............................................................................................................. ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,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[72 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 step-parent 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(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-1502 EX+(02-15) Ila pennsylvania SCHEDULE A ' DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: V l� FILE NUMBER: c brl A 12) All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' �4Z8 q larayui�r- S4 , P.rblA p 16-1 s5 _ T 2 i B la y- tv-e 3. En thk r h i n o-3,s I q., 0,4 t) -A -cv �Enal� -Pr if)�l�S JE 7. • TOTAL(Also enter on Line 1, Recapitulation.) $# q 4 -9 460321c� If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(02-15) pennsytvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: �riyrira .� , ktm pe R If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. bMhLp Ked" 4 X25 l�ret?rzv:li�.. �c S ( B. br,d 4, G UTq 14D N„ E-h-tA bn tVr, 644 ?A Ip7nS7 C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. Fr IiI):: M"t".1 r- Is-r CU 0CCkUrL-r 344E_ 88 s0 �1?2Z.gt4 A P, I f 1109 P%w ce �3&Z.c� 33 4 .29 TOTAL(Also enter on Line 6, Recapitulation) $ 2l r7 Q Z —&e9 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(02-15) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER �I b�+A Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. j Ij!I v v a n rm rx-L . }&Ys - . ) CnaLC4 Pn I'1 b2s- T5 0 . DD Wood1wh (t(h- ril'r 2, 13(a .0(D 66irvorI-es %313 4 RnitrALSineI0Vn-?-r-dj ny S�jr+1 Sb,to Rtv� �t I bTr- I DO .60 FVACM L LUn�fvm $3.S'? B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 17- 6. Z6. Tax Return Preparer Fees: 7. Cul s 24$ . q MISC, ItS Tt7f— Q!ZTS (sTAvy\f s , P cn,e�-� 2 $4 W 10 TOTAL(Also enter on Line 9, Recapitulation) $ • 3 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+(02-15) Q7pennsytvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. oSd i 2 0960-1\11w ��� K�mi�- � 1 2 Livor, V G-U,;u ob—D 3' Rvapt E , Vempeg 30 ,0 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ tJ If more space is needed,use additional sheets of paper of the same size. U:\lifeplanportfolio\clients\Kemper,GlodaMill.revised.doc February 25,2014 LAST WILL AND TESTAMENT OF GLORIA B.KEMPER I, GLORIA B. ]KEMPER, of Enola, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. FAMILY. 1.1 Identification of Family. I declare that I am a widow and that I have three (3) children whose names are DONALD LEROY KEMPER, LINDA K. GUTH and ROBERT E. KEMPER. 1.2 Definition of Family Terms. As used in this Will,the terms "my child" or"my children" refers to all my natural children and adopted children, now living or hereinafter born. As used in this Will, the term "issue" refers to all lineal descendants of the indicated person of all generations, with the relationship of parent and child at each generation determined by the definition of"child/children" set forth in this paragraph. 2. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of(1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 3. SPECIFIC BEQUESTS. I hereby devise and bequeath the following items of personal property: 3.1 I leave my personal residence located on Lot 1 of the Final Minor Subdivision Plan of Gloria B. Kemper, also known as 428 Lafayette Street, East Pennsboro Township, Enola, Cumberland County,Pennsylvania,to my son,DONALD LEROY KEMPER. 3.2 I leave Lot 2 of the Final Minor Subdivision Plan of Gloria B. Kemper, located in East Pennsboro Township, Enola, Cumberland County, Pennsylvania, to my daughter, LINDA K. GUTH. 1 Q.ati d Gloria B. Kemper ` U:Uifeplanportfolio\clients\Kemper,GlodaMill.revised.doc February 25,2014 4. DISPOSITION OF TANGIBLE PERSONAL PROPERTY. I direct my executor to divide my tangible personal property into two parts. The first part shall contain all items that my executor determines, to be of no present or future value or use to my children. The second part shall contain the balance of the property. My executor shall dispose of the first part by sale, abandonment, destruction, or gift to any charity or person. The proceeds of any sale shall be added to my residuary estate. All property in the second part I give to my children, in substantially equal shares, to be divided among them as they shall agree. If no agreement is reached within (60) days after my death, all property in the second part shall be divided among all my children in such manner as my executor shall direct. The decision of my executor shall be conclusive and binding on all persons interested in my estate. 5. DISPOSITION OF RESIDUARY ESTATE. All of the rest, residue and remainder of the property that I own at the time of my death, both real and personal, and of every kind and description, wherever situated, to which I may be legally or equitably entitled at the time of my death(my"residuary estate"),I leave as follows,per stirpes: 5.1 Forty percent(40%)to my son,DONALD LEROY KEMPER. 5.2 Thirty percent(30%)to my daughter,LINDA K. GUTH. 5.3 Thirty percent(30%)to my son, ROBERT E. KEMPER. The distribution of my residuary estate as set above shall be adjusted further with regard to any Florida properties that I may own at the time of my death titled along with any of my children, so that any child not titled on the Florida properties at said time will receive their proportionate share of the appraised value of the Florida properties that they would have received had.they also been titled on said deeds though a distribution from my residuary estate. 6. IN TERROREM. If any devisee, legatee or beneficiary of any gift under this Will directly or indirectly objects to the probate of this Will or contests this Will or any part thereof or exercises or attempts to exercise any right of election to take any part of my estate against the provisions of this Will,then any such objecting or contesting devisee, legatee or beneficiary shall be treated for the purposes of this Will as if he or she had predeceased me, and any devise, legacy or bequest of any kind intended for him or her shall be void and of no effect. 7. POWERS OF ADMINISTRATION. 7.1 Grant of Powers. My executor, in the administration of my estate, (my "fiduciaries") shall have the powers and authorities set forth in this Article 7. These powers and authorities may be exercised by my executor in his sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, 2 Q � , Gloria B. Kemper U:\Iftplanportfolio\clientsNKemper,GloriaMill.revised.doc February 25,2014 but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 7.2 Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate or trust, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property. 7.3 Transfer of Assets. My fiduciaries shall have the power to sell,transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate or into the trust corpus at or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciaries deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. If anyone is residing in any of the properties that I own at the time of my death, they either need to vacate within three(3)months of my death or enter into a short-term lease with my Estate and pay reasonablee market value rent until the property is sold at which time they must vacate the property so as not to impair the marketability of the property. 7.4 Investment. My fiduciaries shall have the power to invest and reinvest any property in my estate or in the trust corpus in preferred and common stocks, bonds, notes, common trust funds(including any managed by any corporate fiduciary), interests in investments,trusts,mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciaries deem advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 7.5 Power to Borrow. My fiduciaries shall have the power to borrow money for any purpose, for any periods of time, and on any terms and conditions as they deem advisable (including the power to borrow from any corporate fiduciary), and to pledge, mortgage, or otherwise encumber any property in my estate or in the trust corpus to secure repayment of any loan, as well as the power to renew existing loans either as maker or endorser. 7.6 Power to Hold Property in Nominee Form. My fiduciaries shall have the power to hold any property in the name of a nominee or in bearer form. 7.7 Distribution in Cash or in Kind. My fiduciaries shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, 3 . q o +�. fov Gloria B. Kemper U:Uifeplanportfolio\ciients\Kemper,GloriaWILrevised.doc February 25,2014 or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind,without notice to or consent by any beneficiary. 7.8 Distribution to Minors and Persons Under Disability. My fiduciaries shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciaries' judgment is incapacitated. The distributions or payments shall be made in any one or more of the following ways: (1)directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciaries. 7.9 Continuation or Liquidation of Business. My fiduciaries shall have the power to continue•or to permit the continuation of any business, incorporated or unincorporated, in which I may have any interest at the time of my death for any period of time, or to liquidate the business on any terms as they deem appropriate. This power includes, but is not limited to (1) the power to invest additional sums in any business, even to the extent that my estate or the trust corpus may be invested largely or entirely in the business, without liability for any loss resulting from lack of diversification; (2) the power to act as or to select other persons to act as directors, officers, or employees of any business, to be compensated without regard to being a fiduciary under this Will; and (3) the power to make any other arrangements in regard to any business as my fiduciaries shall deem proper. 7.10 Emulovment of Agents. My fiduciaries shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciaries deem advisable in the administration of my estate. 7.11 Commissions. My fiduciaries shall have the power to take reasonable commissions on account at any time during the administration of my estate or of the trust without the approval of any beneficiary or of the court, but subject to allowance or disallowance on the settlement of the final accounts of my fiduciaries. 7.12 Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 4 Gloria B. Kemper�� U:\Iifeplanportfolio\Gients\Kemper,Gloria\WILrevised.doc February 25,2014 8. PAYMENT OF DEATH TAXES. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 9. EXECUTOR. 9.1 Appointment. I name, constitute, and appoint my son, DONALD LEROY KEMPER, as executor of my estate. 9.2 Bond Not Required. The individual named in Section 9.1 shall be required to furnish a bond for the faithful performance of his duties as executor. 10. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me, a person shall not be deemed to have survived me or another person if he or she dies within sixty (60) days of my death or of the death of the other person. 11. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 12. INTERPRETATION. 12.1 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person acting as my executor, co-executor, or administrator, as the case may be. 12.2 Number and Gender. If required by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine,feminine, or neuter. 12.3 Headings. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 5 Gloria B. Kemper U:Uifeplanportfolio\clients\Kemper,GloriaMill.revised.doc February 25,2014 12.4 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting .of seven (7) typewritten pages which bear my signature for the purpose of identification,this at day of February, 2014. GLORIA B.KEMPE , Testatrix Signed, sealed, published and declared by the above-named Testatrix, GLORIA B. KEMPER, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. 2331 Market Street, Camp Hill, PA 17011 Witness Address 2331 Market Street, Camp Hill,PA 17011 Witness Address 6 + U:\Iifepianportfolio\cfrents\Kemper,Gloria\Will.revised.doc February 25,2014 COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) I, GLORIA B. KEMPER, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO AND ACKNOWLEDGED BEFORE ME BY GLORIA B. KENIPER, THE TESTATRIX,THIS 9T' DAY OF FEBRUARY,2014. COMMONWEALTH OF PENNSYLVANIA GLORIA B.KEMPIER,TE TATRIX Notarial Seal Jennifer S.K.Gross,Notary Public Camp Hili Boro,Cumberland County My Commission Expires Sept 11,2016 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES (:N:O:3T0BLIC COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) WE, 'r AND THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN(18)OR MORE YEARS OF AGE,OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS DAY OF FEBRUARY,2014. ,9\'0N\K\ 1�4� L- SS WITNESS NO PUBLIC COMMONWEALTH OF PENNSYLVANIA_._ Notarial Seat Jennifer S.K.Gross,Notary Public 7 Camp Hill Soro,Cumberland Coultty My Commission Expires Sept 11 2016 MEMBER,PENNSYLVANIA ASSOaATWN Of NWARM BUREAU OF INDIVIDUAL TAXES Pennsylvania Inheritance Tax R _ pennSyLVanla PO BOX 280601 DEPARTMENT OF REVENUE HARRISBURG PA 17128-0601 Information Notice And Taxpayer Response ------ BE"_1543 E%DocEXEL (0842) FILE NO.21 ACN 14161017 DATE 11-10-2014 Y Type of Account Estate of GLORIA B KEMPER Savings SSN Checking Date of Death 10-28-2014 Trust 'DONALD L KEMPER i County CUMBERLAND Certificate 925 WERTZVILLE RD ENOLA PA 17025-1837 {MEMBERS IST FCU provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.407508 Remit Payment and Forms to: Date Established 01-18-2011 REGISTER OF WILLS Account Balance $3,445.88 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 1,722.94 Tax Rate X 0.045 Potential Tax Due $77.53 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A F�No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B ❑The information is The above information is correct, no deductions are being taken, and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C El The tax rate is incorrect. ❑ 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.) of the deceased. (Select correct tax rate at right, and complete Part F_� 12% 1 am a sibling of the deceased. _ 3 on reverse.) ❑ 15% All other relationships (including none). D F—]Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. EV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation) $ PART Tax Calculation 3 PART If you are making a correction to the establishment date Line 1 account balance Line 2 or percent taxable Line 3 Y 9 � ) ( )� p � ), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%, 3 owners=33.33%, 4 owners =25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicatinga different tax rate, lease state I al, g ` \\\ ` pOtfCI Use ly AAF ` your relationship to the decedent: v vis v V �C'7c� m£le1�'nt 1. Date Established 1 gg` \ \\\ 1 \ PDQ v y vy 1A 2. Account Balance 2 $ �� 3. Percent Taxable 3 X 4- 000` vvv vy ver �` O vvv vAV v� a �� A 4. Amount Subject to Tax. 4 $ vvv vv v y ov 1 \ � AA ao ��j\ ` 5. Debts and Deductions 5 - ` �vv � � ` 6. Amount Taxable 6 $ vv v 10' O \ \ R 7. Tax Rate 7 X �v y� `�yt v ti0v \\ \\ ° \ W 051 ` 8. Tax Due 8 $ \\ ` \ \\ \,\\ ° Discount(Tax x .95) 9 w �\ .. \ .. .. ._ JIM'— Step :.... \:\ 9. With 5/° X v_�v., v v�� �� a� v Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020