HomeMy WebLinkAbout02-06-06
REV-I500fX(6-00,
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REVs1500
~NHER~TANC!E TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
en ER EDN rn
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OF~~ClAl USE O~:..H..:V
FILE NUMBER
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YEAR
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NUMBER
01. Original Retum
D 4. Limited Estate
0' 6. Decedent Died Testate (AIIach copy of WI)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (dale of daalh aftar 12-12-/12)
D 7. Decedent Maintained a Living Trust (AItachcopy 01 Trusl)
o 10. Spousal Poverty Credit (dale ofdealh balw8an 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Return (dale of daalh prior 10 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Allam Sch 0)
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OFFICIAL USE ONLY
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TELEPHONE NUMBER
/7- 19
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(1)
(2)
(3)
(4)
(5)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line B minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(7)
(9)
(10)
(8)
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(11)
(12)
(13)
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14. Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0 _ (15)
7 ILl' \3 J.... x.O is- (16)
(14)
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16. Amount of Line 14 taxable allineal rate
17. Amount of line 14 taxable at Sibling rate
x .12 (17)
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(19)
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1 B. Amount of Line 14 taxable at collateral rate
x .15 (18)
20.0
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19. Tax Due
Dec.edent's Complete Address:
STREET ADDRESS
.
CITY
HN((C
STATE Pit
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C ) (2)
3. Interest/Penally if applicable
D. Interest
E. Penally
Total Interest/Penally ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
ZIP I '7 () 0
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)..;) a, t/. _
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedenl make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 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 securily at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuily, or other non.probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
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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 f perjury, I declare thai I have examined this relurn. including accompanying sclIedules and statements, and to the best of my knowledge and belief. rt is true, COffeet and complele.
Declaration of parer other tha \he I re esenlalive is based on all information 01 which preparer has any knowledge.
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of transfers to or for the use of the surviving spouse is 3%
17 ()S()
DATE
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net val
[72 P.S. 99116 (a) (1.1) (in.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)l.
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 twenly-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 39116(a)(1.2)].
The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) (72 P.S. 99116(a)(1)).
The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116(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.
~EV.1502 EX+ (12.85) '*
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL EST ATE
FILE NUMBER
ESTATE OF
ED N ;q {n I< E m fJ E R ~ I - D 5- () '7 f 7
(Property jointly-owned with Right of SurvivorshiF' must be disclosed on Schedule Fl All real estate should be reported at fair market value
which 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.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
PER.SO N/lt..- f-;ESi1JEtJ(~E:
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m E c /-1 11 f\f f C 5 BUR G {Jitt 1705- 0
85.000
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TOTAL (Also enter on line 1, Recapitulation)
$
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REV.1SC6 EX- (1.971
..
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EDtJit
FILE NUMBER
rJ- / - D-5- - () 7/7
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly+owned with the right of survivorship must be disclosed on Schedule F.
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ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
PNe.- CHECkiNG 11 ec.o uj\Ji
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IS 75;-
1- 75: -
RENT RE13ATE
{JERSONAL
PlZoPERT'/
500.. --
TOT At (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
E:o N A
kE (Yl PER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
1.
COCkL I AI FUMER!-i L /fu mE
;) 0 1'0 C f-l ES'J Nor Sf
J)/"-LsJ3URc, VA 170 lei
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
FILE NUMBER
,j.. 1- 05 - D '0 7
Year(s) Commission Paid:
Attomey Fees
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant ::p 0 N ;:) L- )) K E" /1) (J IE ((
Street Address J J f..c, Tn 7 Ii L L END Ie
City IJ1&C H/1 AI (C 5' 11 L.J 'KG State P fl Zip 17D[j6
Relationship of Claimant to Decedent S.0 N
2.
3.
4.
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Probate Fees I'-- I::: C 0 re..,1/ -- f'\ 0 j--' c'-/ i .....J
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cltR-c{[)LE
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,sEAl/IAlE-1.-
5.
Accountanfs Fees
6.
Tax Retum Preparer's Fees
7.
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LocuE'S CK.EDn C/'9l2p
7/1?ItIN ]/oc-tcRS'
UTtL I TIES
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TOTAL (Also enteron line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
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LASi Will AND TESTAMENT
OF
EDNA M. KEMPER
KNOW ALL MEN BY THESE PRESENTS, That I, EDNA M. KEMPER, of the
Township of Upper Allen, County of Cumberland, and Commonwealth of Pennsylvania,
do make, publish, and declare this instrument to be my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
FIRST: I direct the Executor hereof to pay all my just debts, funeral expenses
and costs of administration as soon as conveniently may be done after my death. I
further direct the Executor hereof to pay all inheritance, estate, transfer and succession
taxes which may be levied or assessed upon any property which is included as part of
my gross estate for the purpose of any such tax.
SECOND: I give, devise and bequeath unto my Son, DONALD B. KEMPER, the
rest, remainder, and residue of my estate provided that he survives me by a period of
thirty (30) days.
THIRD: In the event that my Son, DONALD B. KEMPER, does not survive me
by a period of thirty (30) days then in that event, I give, devise and bequeath all the
rest, residue and remainder of my estate in equal shares to my Grandchildren,
REBECCA E. KEMPER and SHELLEY C. KEMPER, per cCJ,pita. I rei
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FOURTH: In the event that any of my said Grandchildren have not attained their
twenty-second (22) birthday, then in that event I give, devise, and bequeath unto PNC
BANK (hereinafter "Trustee") in trust for the benefit of my Grandchildren any gift, devise
or bequest to which they are entitled under this my Last Will and Testament until they
attain their twenty-second birthday. The principal and income of this trust is to be
utilized for the health, education, and welfare of my said Grandchildren. I hereby give
the Trustee the power and authority to utilize the funds in this trust in accordance with
their best judgment as to the needs of my Grandchildren.
(a) The trust created under this Fourth Paragraph of my Last Will
and Testament shall terminate when REBECCA E. KEMPER reaches the
age of 22, and the trustee is directed to distribute the principal and income
then remaining in the trust as set forth in Paragraph THIRD of this my Last
Will and Testament.
FIFTH: The trustee shall have the following powers:
(a) To exercise all powers granted to trustees by the common law
or any applicable statues (as they exist at this date or are subsequently
amended), to the extent that they increase the powers granted to trustees.
If, however, those powers are in conflict with the provisions of this Will, the
terms of this Will shall prevail;
(b ) To retain any property becoming a part of the trust estate,
including non-productive property, without having to account for the loss
of income;
(c) To convey, sell, transfer, exchange, partition, mortgage, pledge,
lease, assign, or otherwise dispose of, hypothecate, or deal with any and
all properties in the trust estate;
(d) To borrow or lend money for such purposes and on such terms
and conditions as the Trustee deems appropriate;
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(e) To invest and reinvest any assets, funds, properties, or income
of the trust estate in such properties or investments (whether income-
producing or not) as the Trustee deems appropriate; and
(f) To accept from any source any property acceptable to the
Trustee to be held as part of any trust hereunder. The trustee also is
authorized (but not directed) to accept from the Executor, at the
termination of the administration of any estate of which any trust
established herein may be the beneficiary, the assets delivered by the
Executor to the Trustee on the basis of the accounting therefor as
submitted by the Executor, without requiring an audit or other independent
accounting of the acts of such Executor. No Trustee hereunder shall have
any duty, responsibility, obligation, or liability whatsoever for, or any duty,
responsibility, obligation, or liability whatsoever for failure to rectify the
acts or omissions of said Executor.
SIXTH: No Trustee shall be responsible or liable for any loss to the Trust
estate that may occur by reason of depreciation in value of the properties at any time
belonging to the trust estate nor for any other loss to the trust estate that may occur,
except that each Trustee shall be liable for his or her own negligence or willful
misconduct.
SEVENTH: Any Trustee may resign by filing a written instrument duly
acknowledged of record in the Deed Records of Cumberland County, which filing shall
deprive immediately any such resigning Trustee of all powers as Trustee hereunder
except those powers appropriate to the administration of the trust during the time
required for the transfer of the Trust assets; provided, nevertheless, that at least thirty
(30) days prior to such filing, the resigning Trustee shall give written notice thereof to
those persons who could in the discretion of the Trustee receive income from the Trust
estate and are at such time sui juris. No purchaser from, or other person dealing with,
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any Trustee is obligated to examine such Deed Records, any such person acting in
good faith shall be protected in all transactions with any Trustee, whether or not any
such resignation has taken place. If the original Trustee and all successor Trustees
named herein, or if any other successor Trustee shall resign, or otherwise cease or fail
to serve, the president judge of Cumberland County, acting in his individual capacity
and not his judicial capacity, shall appoint a successor Trustee:
Any national or state bank, trust company or other financial institution in
the United States having trust powers and a capital and surplus of One
Million Dollars ($1,000,000.00) or more shall qualify as a successor
trustee.
EIGHTH: Upon the appointment and qualification of any successor Trustee, the
same duties shall devolve upon, and the same rights, powers, authorities, privileges,
and discretions shall inure to him, her or it as to the Trustee originally designated
hereunder; and all rights, powers, authorities, privileges, and discretions shall be
exercised without the supervision of any court.
NINTH: I appoint my said Son, DONALD B. KEMPER, to be Executor of this
my Last Will and Testament. I do hereby give to the Executor hereof full power,
discretion and authority at any time or times to sell, at private or public sale, mortgage,
lease pledge, exchange or otherwise deal with or dispose of the property comprising my
estate as deemed best, to settle and compound any and all claims in favor of or against
my estate as deemed best and, for any of the foregoing purposes, to make, execute
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and deliver any and ail deeds, mortgages, contracts, leases, bilis of sale or other
instruments necessary or desirable therefor.
LASTLY: I direct that no fiduciary appointed by this, my Last Will and Testament,
shall be required to give bond and that if, notwithstanding this direction, any bond is
required by any law, statute or rule of court, no surety shall be required thereon.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, consisting of five (5) typewritten pages on the margin of which (except this
page) I have affixed my initials this I ftJ'1.., day of '1;M.L<"~~...r-- ' A.D. 199..2.
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Signed, sealed, published and declared by EDNA M. KEMPER, the above-
named Testatrix, as and for her Last Will and Testament, in the presence of us and
each of us, who at her request, and in her presence, and in the presence of each other,
have hereunto subscribed our names as attesting witnZ
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County of Cumberland
ss.
Commonwealth of Pennsylvania
ACKNOWLEDGMENT AND AFFIDAVIT
We, EDNA M. KEMPER, the testatrix, and the undersigned witnesses to the Will,
the attached or foregoing instrument, having been qualified according to law do depose
and say:
(a) that I, the testatrix, do hereby acknowledge that I signed the instrument as
my Will, that I signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b) that we, the witnesses, were present and saw the testatrix sign the
instrument as her last Will. that she signed it willingly and as her free and
voluntary act for purposes therein expressed; that each of us in the
hearing and sight of the testatrix signed the Will as a witness and that to
the best of our knowledge the testatrix was at that time 18 or more years
of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed before me by EDNA M. KEMPER, testatrix, and Mark D.
Schwartz and Andrea Klinedinst, witnesses, this 18th day of November, 1997.
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Mark D. Schwartz (Witness)
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EDNA M. KEMPER'
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David . Knauer
Attorney 1.0. No. 21582
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Andrea Klinedinst (Witness)
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