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Home My WebLink About09-16-09 (3)1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 9 0 2 6 8 Harrisburg, PA 17128-0601 - RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 153 22 8440 02 26 2009 01 13 19.30 Decedent's Last Name Suffix Decedent's First Name MI YOUNGSMAN EDMUND W (If Applicable) Enter 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 X^ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) 6 Decedent Died Testate ~ (Attach Copy of Will) ~ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11 • 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 TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tele~one Numbe GARY L. JAMES ESQ. 717 53~~cZ3280~ -r",; Firm Name (If Applicable) -La ~ - : 1 ~ REGISTER OFiN~4S USE.ONLY~ JAMES, SMITH, DIETT . ERICK & CONNELLY, L r -~? a,, L: `~i - , First line of address ~ ~~ ~ --p `-• r ~ '- ' m ' ~ ~ 134 SIPE AVENUE ~ --i -t - ' ' _`"~ =. ri , rv ~ -+ .. Second line of address .v ,~- ~ • -' ~__~`7 City or Post Office HUMMELSTOWN State ZIP Code PA 17036 DATE FILED Correspondent's a-mail address: 91 j@ j S d C. C O m Under penalties of perjury, I declare th I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an complete. Declar lion of preparer other than the personal representative is based on all information of which preparer has any knowledge. NATURE N R PONSIBLE OR F ING RETURN ~~~~--~-'~~~ DATE ,l,3Ck.'rU+il>laL Diane Lynn Steenstra ~` '- ~- ~ `j ADDRESS 589 Lake Meade Drive, East Berlin, PA 17316 SIGNAT; LtftE OF PREPARER T ER T AN REPRESENTATIVE ~Tj'`-~x ~ , _ DATE _ _ Gary L. James Esq. ~,~` _ -~~ -~~-,~~ ADDRESS 6 ~ 134 Sipe v ue, H mmelstown, PA 17036 Side 1 1505607120 1505607120 J 1505607220 REV-1500 EX oe~ede~t'SName: Edmund W. Youngsman Decedent's Social Security Number 153 22 8440 RECAPITULATION 1. Real Estate (Schedule A) ................................................................................... ....... 1. 2. Stocks and Bonds (Schedule B) ........................................................................ ....... 2. 2 3 5, 16 7 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)... ....... 3. 4. Mortgages & Notes Receivable (Schedule D) ................................................... ....... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ......... ....... 5. 1 0 2 , 4 7 9 . 2 8 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ...... ....... 6. 7. Inter-~vos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ...... ....... 7, 4 2 2 , 13 0 . 9 5 g. Total Gross Assets (total Lines 1-7) ................................................................ ....... 8. 7 5 9, 7 7 7. 2 3 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 4 , 7 0 6 . 7 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 3 , 7 4 9 . 4 3 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11, 2 8 , 4 5 6 . 2 2 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 7 3 1 , 3 21.01 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. 7 3 1, 3 21.01 TAX COMPUTATION -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 .o0 0. 0 0 15• 0. 0 0 16. Amount of Line 14 taxable at linealratex .045 731, 321.01 16. 32, 909.45 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18• O. O O 19. Tax Due ..................................................................................................................... 19. 32, 909 .45 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0268 DECEDENT'S NAME Edmund W. Youngsman STREET ADDRESS 907 Gingko Grove CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5g) Make Check Payable to: REGISTER OF WILLS, AGENT 32,909.45 32,631.58 277..87 277.87 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 :.................................................................................. x^ ^ b. retain the right to designate who shall use the property transferred or its income :.................................... x^ ^ c. retain a reversionary interest; or .................................................................................................................. ^x ^ 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 yE;ar of death without receiving adequate consideration? ....................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his ~~r her death?......... ^ ^x 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 <~ 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. §9116 (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. §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. 31,000.00 1,631.58 Rev-1503 EX+ (8-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Youngsman, Edmund W. 21-09-0268 All property )ointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 118.601 shares of T Rowe Price Blue Chip Growth 21.29 2,525.02 Fund -held in the T Rowe Price Account number 670191131-1; valued per public listing 2 627.713 shares of T Rowe Price Dividend Growth Fund 14.31 8,982.57 - held in the T Rowe Price Account number 670191131-1; valued per public listing 3 1,982.9 shares of T Rowe Price Equity Income Fund - 13.58 26,927.78 held in the T Rowe Price Account number 670191131-1; valued per public listing 4 569.179 shares of T Rowe Price Health Sciences Fund 18.62 10,598.11 - held in the T Rowe Price Account number 670191131-1; valued per public listing 5 1,186.849 shares of T Rowe Price Mid-Cap Growth 29.55 35,071.39 Fund -held in the T Rowe Price Account number 670191131-1; valued per public listing 6 1,679.765 shares of Vanguard Equity Income Fund - 12.78 21,467.40 held in the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing 7 1,341.57 shares of Vanguard Life Strategy Growth 13.59 18,231.94 Fund -held in the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing Total of Continuation Schedule See attached page TOTAL (Also enter on Line 2, Recapitulation) 235,167.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1503 EX+ (6.98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Youngsman, Edmund W. 21-09-0268 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 8 886.137 shares of Vanguard Life Strategy Moderate 13.29 11,776.76 Growth Fund -held in the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing 9 1,836.058 shares of Vanguard Wellesley Income Fund - 16.81 30,864.13 held in the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing 10 687.648 shares of Vanguard Wellington Fund -held in 21.91 15,066.37 the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing 11 1,929.361 shares of Vanguard Windsor II Fund -held in 27.81 53,655.53 the Vanguard Account number 9900231747; valued per letter dated July 8, 2009 and public listing TOTAL (Also enter on Line 2, Recapitulation) 235,167.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 E7(+ (8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Youngsman, Edmund W. 21-09-0268 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. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank Checking Account # 6213463651 -valued per letter dated April 14, -1,010.65 2009 2 Citizens Bank Savings Account Number 6248117816 -valued per letter dated April 3,547.21 14, 2009 Accrued interest on Item 2 through date of death 0.38 3 Commerce Bank Checking Account Number 513127027 -valued per Netter dated 15,335.46 April 7, 2009 Accrued interest on Item 3 through date of death 0.19 4 Commerce Bank Savings Account # 616177963 -valued per letter dated April 17, 4,456.67 2009 Accrued interest on Item 4 through date of death 0.79 5 ING Direct Orange Savings Account Number 60931201 -valued per letter dated 6,586.08 March 19, 2009 6 ING Orange Savings Account Number 116771797 -valued per letter dated April 29, 1,000.35 2009 7 2004 Buick LeSabre -valued per Kelley Blue Book fair condition 6,550.00 8 Personal Property 1,500.00 9 Messiah Village -refund of acquisition fee 60,410.80 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 102,479.28 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF (FILE NUMBER Youngsman, Edmund W. 21-09-0268 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G j INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Youngsman, Edmund W. 21-09-0268 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 CCIVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % CIF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Fidelity Investments Life Insurance Company 12,454.43 12,454.43 Contract Number 321616200 -valued per letter dated April 6, 2009; beneficiary is the Edmund W. Youngsman Living Trust dated April 19, 1996 2 Prudential Annuity Contract # E0099927 -valued 7,121.14 7,121.14 per letter dated March 30, 2009; beneficiary is the Edmund W. Living Trust dated April 19, 1996 3 42.36 Charles Schwab Cash -titled in the 42.36 42.36 Edmund W. Youngsman Living Trust dated 04-19-1996; held in the Charles Schwab Brokerage Account Number 3045-5547; valued per public listing 4 4,160.1631 shares of IBM Corp -titled in the 367,217.60 367,217.60 Edmund W. Youngsman Living Trust dated 04-19-1996; held in the Charles Schwab Brokerage Account Number 3045-5547; valued per public listing Accrued dividend on Item 4 through date of 2,080.08 2,080.08 death 5 1,498.887 units of Schwab 1000 Index Fund - 33,215.34 33,215.34 titled in the Edmund W. Youngsman Living Trust dated 04-19-1996; held in the Charles Schwab Brokerage Account Number 3045-5547; valued per public listing TOTAL (Also enter on Line 7, Recapitulation) 422,130.95 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+(~p_gg) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF I FILE NUMBER Youngsman, Edmund W. 21-09-0268 ~,..,.~ .................................r.........,.....,............. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 3,625.12 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees James, Smith, Dietterick 8c Connelly, LLP 20,000.00 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 116.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 965.67 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 24,706.79 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE (COSTS continued ESTATE OF FILE NUMBER Youngsman, Edmund W. 21-09-0268 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman-Roth Funeral Home & Crematory Inc -funeral expense 3,625.12 H-A Subtotal 3,625.12 Other Administrative Costs 2 Cumberland Law Journal -estate advertisement 75.00 3 FIA Card Services -Visa late fee 31.04 4 James Smith Dietterick 8~ Connelly LLP -reserve for estate administartion expenses 500.00 5 John R. Zimmerman -messenger service 48.35 6 Runkles -car registration 102.50 7 The Sentinel -estate advertisement 208.78 H-B7 Subtotal 965.67 Copyright (c) 2002 forrn software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Youngsman, Edmund W. 21-09-0268 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Boscovs -credit card 10.40 2 Citibank -Visa 170.98 3 FIA Card Services -Visa 551.15 4 Hershey Medical Physicians -medical expense 42.89 5 M.S. Hershey Medical Center -medical expense 1,068.00 6 Messiah Village -rent 1,561.93 7 MSHMC Physicians Group -medical expense 293.51 8 Verizon -phone service 50.57 TOTAL (Also enter on Line 10, Recapitulation) I 3,749.43 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Edmund W. Youngsman 02/26/2009 153-22-8440 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Nicole Darr 1541 Stanton Street York, PA 17404 2 Evan D. Dykstra c/o Scott and Lori Dykstra 1861 Leslie Road Annapolis, MD 21409-6047 3 Jacob Y. Dykstra c/o Scott and Lori Dykstra 1861 Leslie Road Annapolis, MD 21409-6047 4 Lori J. Dykstra 1861 Leslie Road Annapolis, MD 21409-6047 5 Spencer J. Dykstra c/o Scott and Lori Dykstra 1861 Leslie Road Annapolis, MD 21409-6047 6 Diane L. Steenstra 589 Lake Meade Drive East Berlin, PA 17316 7 Kelly Steenstra 589 Lake Meade Drive East Berlin, PA 17316 Granddaughter 5% of residue Grandson 5% of residue Grandson 5% of residue, $45,000 bequest for education Daughter 37.5% of residue Grandson 5% of residue Daughter Granddaughter 37.5% of residue 5% of residue 34,316.05 34,316.05 79,316.05 257,370.38 34,316.05 257,370.38 34,316.05 Total 731.321.01 1