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Home My WebLink About10-30-06 --.J 15056051047 REV-1500 EX (06-05) PA Department of Revenue * Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year J. I J(j)L, File Number {1 hj Date of Birth 156 36 5842 Decedent's Last Name o 7 0 5 2 006 Suffix 1 222 1 946 Decedent's First Name MI K E M P J R H A R R y' (If Applicable) Entp.r Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name 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 RE'turn c:> 2. Supplemental Return c:> 3. Remainder Return (date of death prior to 12-13-82) c:> 5. Federal Estate Tax Return Required c:> 4. Limited Estate c:> c:> 6. Decedent Died Testate c:> (Attach Copy of Will) c:> 9. Litigation Proceeds Received c:> 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 8. Total Number of Safe Deposit Boxes c:> 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDEN" - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RON A L D Firm Name (If Appli':able) FIe K ES 7177765864 REGISTER OF WILLS USE ONLY HOW A R D SAC C 0 U N TIN G First line of addres:' C') 8 W EST BIG S P R I N G A V E Second line of address (.-) , ) r'. (,~ ( ~~) City or Post Office State ZIP Code DAT(FIL~D '~-'''::' NEW V ILL E P A 1 7 241 r.', Correspondent's e>11ail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and cQl1plete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF PER'SON RE DATE e /f:et/t5~.l:::? ~~ / ?CJ G-::? -t'& ADDRESS 8 W BIG SPRING AVE, NEWVILLE, PA 17241 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ...J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME . HARRY T KEMP JR STREET ADDRESS 501 WINDY HILL RD LOT 71 CITY I STATE I ZIP SHERMANSDALE PA 17090 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 404.72 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Total Credits ( A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 404 . 72 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 404.72 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;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Kl c. retain a reversionary interest; or.......................................................................................................................... 0 [] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 K1' 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 e9 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 Kl 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 death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. 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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty-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 zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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. -.J 15056052048 REV-1500 EX Decedent's Name: HARRY T KEMP JR RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . .. . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-ProprietorsniD \ Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . ........... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) <=> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <=> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. Decedent's Social Security Number 1 5 6 3 6 5 8 4 2 - - - - I 2 4 7 0 -I 1 - . - 2 2 4 5 - 0 0 2 3 1 - 3 4 1 3 4 7 6 - 3 4 . 8 9 9 3 7 7 - 8 9 9 3 · 7 7 9. Funeral Expenses & Administrative Costs (Schedule H).. .... . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Scheoule 1.1 . .. .. .. .. .. 10. 11. Total Deductions (total Lines 9 & 10).. .... . . .... . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . ....... . .. ................. 12. 13. Charitable and Govemmental Bequests/See 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. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPL.ICABL.E RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 tax~le at lineal rate X.O ~ · 17. Amount of Line 14 taxable at SIDling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 - 15. 16. 18. 19. TAX DUE..... . . . ....... ..... .. . .... . .... . . . .,. . . . . . . . . ....... .... 19. 20. FIL.L. IN THE OVAL. IF YOU ARE REQUESTING A REFUND C . ""ER:'AYMENT Side 2 L 15056052048 tl 4 0 4 -7 2 . - 4 0 4-7 2 c::> 15056052048 -.J REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HARRY T KEMP JR FILE NUMBER 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 CASH 5,770.11 2 MOBILE HOME 3,000.00 3 AUTO 1,200.00 4 AUTO 2,500.00 I TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 12,470.11 REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HARRY T KEMP JR FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. EWING BROTHERS FUNREAL HOME 1785.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative( s) Social Security Number(s)/EIN Number 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's Fees 6. Tax Retum Preparer's Fees 7. LETTERS OF ADMINISTRATION 380.00 80.00 TOTAL (Also enter on line 9, Recapitulation) $ 2 245 . 00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HARRY T KEMP JR Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical exoenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 173.31 'C',0JK CHARGES 2 uTILITIES 197.94 3 RENT 240.49 4 MOBILE HOME EXPENSE REQUIRED FOR SALE 309,.58 5 MOBILE HOME TAXES 310.02 f/ '4{ TOTAL (Also enter on line 10, Recapitulation) $ 1231. 34 (If more space IS needed. Insert additional sheets of the same size) - - n ~....... ~ ~ t-I n t<:l HOCil en c: H t-I !:"O en t<:l 88 'U ::r:~ ~O ~O f-' t<:l I-Ij -...I o en ::E: ......IOH W c::: t-I I ~ t-I w~en wt<:l ex> -...I - - - - - - - - - . ! nl-'::r:: ~N8 l::d'!"J' t1 "'" ...~ HQlJ"" encmt<:l t-I~~ t<:l 'U ~ 'UHen :t>'Z~ (fl ......8 -...It<:l O~ ...... wn o c::: ~ 8 of- '!" >f" ;~ - ,;,. ~ ;f ., , ...0MMONWEAl TH OF PENNSYLVANIA uEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HARRY T KEMP SR 8 W BIG SPRING AVE NEWVillE, PA 17241 n______ {old ESTATE INFORMATION: SSN: 156-36-5842 FILE NUMBER: 2106-0975 DECEDENT NAME: KEMP HARRY T JR DATE OF PAYMENT: 11/02/2006 POSTMARK DATE: 10/29/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 07/05/2006 NO. CD 007384 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $404.72 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 119 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $404.72 GLENDA FARNER STRASBAUGH REGISTER OF WIllS