HomeMy WebLinkAbout05-24-13 . � 1505610101
REV-1500 EX`°'.,°, �
OFFICIAI.USE ONLY
PA Departmenf of Revenue Pennrylvanfa County Cotle Yesr F'tle Number
eureau of Individual7axes INHERITANCE TAX RETURN
po eox zso5oi RESIDENT DECEDENT '2 I 1� L�r� S �
Harrisburq PA i7i28-o6oi
ENTER DECEDENT INFORMATION BELOW
Social Securiry Number Date of Death MMDpVVYV Da[e ot Blrth ��dDDVVYY
12l15/2Q12 08/11(1921
DecedenCs Last Name Suffix DecedenPs First Name MI
STRUZKA JR ANDREW M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffz SPouse's First Name MI
STRUZKA MILDRED A
Spouse�s Social Security Number
THIS RETURN MUST BE FILED IN DUPLIGI�TE WITH THE
211-14-7112 REG137ER OF WILL,S
FAL IN APPROPRIATE OVALS BELOW
� 1. Origlnal ReWm O 2. Supplemental Retum Q 3. Remalnder ReWm(date o(death
prior l0 12-1&&2)
p 4. Limlted Estate O 4a. FuN�e Interest Compromise(date of p 5_ Federal Estate Tax Retum Required
death 2iter�2-12-Fi2j
(p 6. �ecedent Died Testate O 7. Decedent Maintained a Living Trusi ____. R. Total Number ef Sa(e Deposit Boxes
(Attacn Copy of W01) (Aitach Copy of Tnist)
p 9. Lrtigation Proceeds Received O 10. Spousal Poverty Credit(dale of death O it Eh>ction to tax under Sec. 9��3(A)
between h2-3}-gi and 1-1-95) (Attach Sch. O)
CORRESPONDENT-� THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND WNFI�EN7IAL 7AX INFORMA710N SHOULD BE DIRECTED 70:
Name Daytime Telephone Number
THOMAS E FLOWER (717)243-5513
o -- __......_'�',..... --;�- _ ---
REGIST��F WI�S�ti$E ONLY
C � �i� �„
'� T — µ.
p =?,
First line of address r'� -- O `-`- :;;,. ..
,-' n�
FLOWER LAW, LLC - ' �J' ___
Second line of atlAress ' ' ' - . �
...,.i. ., _. _.? ,.. :
10 W. HIGH ST I `
City or Post Offce State ZIP Code i. >--�TE F�LED;��,
CARLISLE PA 17013-2922 ° ,_ � �
CorrespondenPs e-mail address: TOM(o�FLOWER-LAW.COM
Undar pen2lties oi perjury,I declare that I have examined thls retum,including aceompanyinq scl�edules anA statements_and to the best of my knowledge end belief,
it is true.co«ect antl complete.Declaration of preparer ot�er than the personal representative is basetl on all information of�Nhich preparer has any knowledge.
SIGNATURE f PERS/O/�1/f�SPONSIBLE POR LING RETURN DAT
//—,L!/��,���..-� .�hGt..,! 5�2�} /�
ADDRESS
GERALDINE M. CONVERSE, 1901 Sleepy Hollow Road South ParF;, PA 15129
SIGNATtlfjE OF PREPA6TcG� �'H,ER THAN REPRESEN7ATNE ., 9A i
��/
VI Y�VA ( � f- ° /�
A�DRE55
FLOWER LAW, LLC; 10 W HIGH ST, CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 150561�101 150Ei61�101 � r � ,
i�—�
�;'
' � 15056101�5
REV-1500 EX
Dece.denYs Social Securiry Number
oecede�rs Name: ANDREW M. STRUZKA, JR
RECAPITUTATION
1. Real Estate(SChedule A). . . .. . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . 1.
z. stocks a�d sonds(scned�ie e� . . . . . z. 15,217.06
3. Closety Held Corporetion, Partnership or Sole-Proprietorship(ScheAule C) . . . . . 3.
4. Morlgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 2,79325
6. Jointly Owned Property(Schedule F) O Separate Billing Requesled . . . . . . . 6.
7. Inter-Vivos Transfers&Miscelianeous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7). . . . . . . _ . . . . . . . . . . . . _ . . . . . . 8. 1$,010.31
9. Funerai Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . 9. 14,734.00
10. Debts of Decedent, Mortgage Liabilitles, and Liens(Schedule p . . . . . . . . . . . . . . 10. 0.00
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 11. 14,734.00
12. Net Value of Estate(Line 8 minus Line 1 I) . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 12 3,276.31
13. Charitable and Governmen[al Bequests/Sec 9113 Trusls 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. 3,276.31
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount ot Line 14 taxable
at the spousal tax ra[e,or
transfers untler Sec 9116
(a)(i2)xo0 3,276.31 ts. 0.00
16. Amount of Line 14 taxable
at lineal rate X .0_ 0.00 �6. 0.00
17. Amount of Line 14laxabie
at sibiing rate X .12 0.00 �� 0.00
18. Amount o!Line 14 taxable
at collateral ra[e X .15 0.00 �g 0.00
19. TAX DUE . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610105 1505610105 J
REV-1500 EX Page 3 File Number
� DecedenYs Complete Address: ��� ' � � `='r�
DECEDENT'SNAME
ANDREW M. STRUZKA, JR
STREETADDRESS
417 WALNUT STREET
Cf�Y STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2.Line 13) (1) 0.00
2. CreditslPayments
A.Prior Payments
B.Discount
Total Gedlts(A+B) �2)
3 Interest
(3)
4. If Line 2 is greater than Lne 1 �Line 3,enter ihe diflerence. 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 Llne 2,enter the difference.Thls Is the TAX OUE. (5) Q00
Make check payable to: REGISTER CF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE�4PPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retaintheuseorinwmeofthepropertytransferred _.__.. ........_. .___.. __.._. ❑ ix]
b. retaintherighttodesignatewhoshallusethepropertytransferredoritsincome�..............._._..._.........._____ [] �
c. retain a reversionary iNeresk or..___. ..._.__. ..._.._. _...._. ..........._ __.. U LX�
d. receivethepromiseforlifeofeitherpayments.beneftsorcare?._. ._..__... ...___..... ._._.�. � �X�
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 lrust for"or payable-upon-death bank account or security at his or her death?___._.__ �: �
4. Did decedent own an individual retirement account,annuity or olher non-probate property,which
containsabenefciarydesignation? .__.. ......._ ......._._. .._........... ._ ____. ❑ LX]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 15 YES,YOU MUST COMPLETE SCHEDULE G AMD 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 nel value of transfers lo or for the use of ihe surviving spouse is
3 percent[72 P.S.§9116(a)(1,1)(i)].
For dates of death on or affer Jan. 1, 1995, the tax rate imposed on the nei 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, antl the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only benefciary.
For dates of deaih on or after July t.2000:
. The tax rale 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 nalural parent, an
adoptive parent or a stepparent of the child is 0 percent[12 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value of hansfers to or for the use of the decedent's lineal benefciaries is 45 percent, except as noted in
72 PS.§9116�12)p2 PS.§9116(a)(1)J.
. The tax rate imposetl on lhe net value of transfers to or for the use of the decedenYs siblin�,3s is 12 percent(72 P.S. §9116(a)(1.3)] A sibling is definetl, under
Section 9102,as an individuai who has at least one parenl in common with the decedent,whether by blood or adoplion.
fiEV-i5o3 E%.b-ill
' � pennsylvania SCHEDULE B
DEGAPiMENiOF PEVENIiE
����� INHERRANCE TAX RETURN STOCKS & BONDS
RESIDENT�ECEDENT
ESTATE OF FILE NUMBER
ANDREW M. STRUZKA, JR. 21-13-0450
All property jointly owned with right of survivorship must be disclosed on ScYiedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPiION OF DEATH
1' 24 SHARES MINDSPEED TECHNOLOGIES, INC.@ 3.9525 94.86
2 107 SHARES OCCIDENTAL PETROLEUM CORP.@ 76.095 8,142.17
3 112.623 SHARES VIRTUS BALANCED FUND-A(PHBLX)@ 14.73 1,658.94
q 184.445 SHARES VIRTUS GLOBAL OPPORTUNITIES FUND-A(NWWOX)@ 102 t,gg1,34
g 196.661 SHARES VIRTUS TACTICAL ALLOCATION FUND-A(NAINX)@ 9.656 � ggg gg
g 158.599 SHARES VIRTUS STRATGIC GROWTH FUND-A(PSTAX)(a 9.715 1,54079
TOTAL(Also ent2r on �ine 2, Recapitulation) $ 15,217.06
IF more spare is needed, Insert additlonal sheets of the same size
REV-1508 E%+(v-io)
�' pennsylvania SCHEDULE E
���� ocvnArnEr+ror aevcnue CASH� BANK DEPOSITS & MISC.
'""Ea�T^"�E T"%1iF101tJ PERSONAI. PROPERTY
aesioeNl oECEnENr
ESTATE OF: F2LE NUMBER:
ANDREW M. STRUZKA, JR 21-13-0450
Include Che proceeds of Iltigation and Che date the proceeds were received by the esta[e.
All property jointly owned with right of survivorship must be discbsed on Schedule R
ITEM VALUE AT DATE
NUMBER DESCR[PTION OF DEATH
�. CASHINOPPENHEIMERINVESTMENTACCOUNT#A090041060 1,658.44
p MILLENIUM PHARMACY SYSTEMS, REFUND 463.81
3 STATE FARM WSURANCE,PAYMENT OF CLAIM 480.00
4 CASH 191.00
�
%
�
�I
(
I
i
i
TOTAL (Also enter on Line 5, Recapitulation) $ 2.79325
If more space is needed, use additional sheets of paper of the same size.
&PV45ti Fk�� �.SJ-09)
' �`i�,! pennsylvania SCHEDULE H
L'►i °E°"��"t"'°,'A�°�"�� FUNERAL EXPENSES AND
mHencraNCeraxaEruaN ADMINISTRATIVE COSTS
RESIDENT�ECEOENT
ESTATE OF FILE NUMBER
ANDREW M. STRUZKA, JR 21-13-0450
Decedent's debts must be reported on Schedule[. �
ITEM ——
NUMBER DESCRIP?e0N _ _______ AMOUNT
A. FUNERALEXPENSES:
�
` EWWG BROS. FUNERAL HOME,PROFESSIONAL SERVICES,CASk;ET, FUNERAL AND
TRANSPORT TO BURIAL SITE IN WEST ALEXANDER,WASHINGTON COUNTY 7,961.00
e. ADMINISTRATIVE COSTS:
!. PersonalRepresentativeCommissions: 1,350.00
Name(s)of Personal RepresentatNe(s) GERALDINE M CONVERSE
Street Address 1901 Sleepy Holiow Road
�ity South Pa�k Stare PA Z�p 15129
Vear(s)Commissioo Paitl: 2013
2, nttornev Fees�. 5,000.00
3. Fam(ly Exemphon: (If decedenPs address is not Ihe same as daimant's,attach explanatlon.)
Claimant
Street Address
�-�tY State ZIP
Relationshlp ofQaimantto Decetlent
4� Probate Fees: 158.50
5. Acmun[ant Fees:
6. Tax Return Preparer Pees:
� PUBLICATION OF ESTATE NOTICES 264.50
_ _ TOTAL(Also enter on Line 9, Recapitulation) $ 14,734.00
If more space is needetl,use atlditional shee[s of paper o`the same size,
RPV-1513 EX+(OL-LO)
,�i pennsylvania SCHEDULE ]
�i7 �,tNAN,ME��roFR��E��,�
wHea�TnNCe rnx aEruarv BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANDREW M. STRUZKA, JR 21-13-0450
RELAT[ONSHIP TO DKEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trust�ee(s) OF ESTATE
I TAXPBLE DISTRIBUTIONS [Include whight spousal distri6ution5 and transfers under
Sec 9116(a)(L2).j
1. MIDRED A. STRUZKA SPOUSE 100°/a
ENTER DOLNR AMOUNTS fOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 16 OF REV-1500 COVEIt SHEET,AS AGPROPRIATE.
II NON-TAXABLE DISTRBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELEQION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON=iAXABLE DISTRIBUTIONS ON LINE ]3 OF REV-1500 COVER SHEET. $
If more space is needed,use atlditional sheets of paper of the same size.
LA�T 4/ILL AND TESTAhIE[�iT OP AND2E4J M. ;TRllZKA, JR.
I, ANC°&?d M. STRU3CA, JR., of the Horeugh o£ Cgrlisle,
Ciunberland County, Petmsylvania, declam this instrunent to be
my Lact 6lill znd TestBnent, in manner and form following: �
1. I hereby expressLy revol.e z11 'dills aiul Codicils hereto-
fore made by me. .
�� 2. I he�by direct my Esewtrix to pay all my just debts,
funeral and administrative ex�nses out of my estate, as soon as
practicable a£ter my death.
3. Should my wife, Mildred Struzka, survive me for a
neriod oi thirty days followi.ng my death, I devise and bequeath
Che remainder of my estate to tlildred StruzYa..
4. Should my wife, MiLdred Struzlca, predecease me or die
on or before the thirtieth day follewing my death, I devise and
bequeath the reetainder of my estate to my stepdaugliter, Geraldin
btarie Gressi, if she is then Living, and to her issue, if anp� pe
�. stirpes, if she is not then livin�.
5. Shoiild my wife, 11i1dred StruzLca, predecease me or die on
�,, or hefore the thirtieth day follocring my death, and should neithe .
my stepdaughter, Geraldine blarie Grassi, nor any of her issue be
then Living, I devise artd tequeath the rnmainder of my estate to
. Dauohin Peoosit Trust Conpan}�, Carlisle, °etmsYlvan;.e, in tnut, .
to paP the sum of Two I{undrnd Fifty Lo7lars ($2.5�.00) quarterly
to my stepson, P.. Chester Grassi, ior the texm of hi_s life; and
upon 6is death the prinr.i.pal and/or incorue remaining to his i.ssee, .
if any, per stirpes; and in lieu thereof, to my iaeice, ^ets�
Linder.
6. t nominate and appoint Dau�hin Trust Conpany, Carlisle,
Penneytvania, tn�stee o1' the sl-.are of any benefiriary who may be
a minor. The i.nwme and/or principal of said tnist may be accimu
lated or er.pended for the maintenance, education and support of
. � cech beneficiary as my tnistee in its sole discreti:on ma;� deter-
mine; and my trustee, in the espenditure of income end/or principal
� For such �urposes, may, at its discretion, apply the seme directly
without the intervention o£ a E;uardian or pay the :;ame to any
� person having the care or control of szid Aeneficiery- or w ith whan
the beneficinry resides, �rithout duty on the part of the tr�stee .
to sunervise or inquire iinto the application of the £unds by any
person to whom any payment is so made. The baLance of such income
ar:d/or principal sha11 be naid to sur_h beneficiary upon reaching
mejority, or to such beneEiciary's �state in the event of death
pri_or thereto.
7. I nominate and appoint my oiife, idildred Struzka, as
Executrix of this my Last WS11 azid Testat�ent; and as substitute
£xecutors I nominate and appoint in or�er o£ preference, first,
my stepdaugM er, �eraLdine Nlarie Grassi; and second, Dauphin
Dr_posit Trust Compeny.
8, I direct that my personal representative and tnistee, as
we11 as t4eir succesaors� sha11 not be required ta file bond or
szcurity in any jurisdiction.
IN WITNF,SS LiHEAEOF, I have hereunto set my heind and seal
this 21� day of June, 1972.
G/�,.-,�,z�.�%�t;.�.�/ia�(SFaL)
�drew k. truz
Signed, sealed, puo:ished and declared by tkw. above n.med �,
Y'estator, Andrew il. Strv:.ka, Jr., as and 'Eor his Tast (1i11 -and ..
Testanent, in our presenre, who, in his presence, at his mquest, l
and in the presence of each other, have hereunto :=ubscribed our
names as attesting witnesses. I -
� � ��
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