HomeMy WebLinkAbout04-29-14 1505610105
REV-1500 EX(e2-11)(Ft) ii
i
PA Department of Revenue Pennsylvania
USE ONLY
Bureau of Individual Taxes County Code Year Fie 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
0713012013 0211011933
Decedent's Last Name _ Suffix _ Decedent's First Name MI
WIDRA JR. JOSEPH J
(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
ClD 1-Original Return C=) 2.Supplemental Return C:7 3. Remainder Return(Date of Death
Prior to 12-13.82)
C= 4.Limited Estate C=) 49.Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required
death after 12-12.82)
Cp 5,Decedent Died Testate C=> 7,Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received C=> 10.Spousal Poverty Credit(Date of Death C= 11. Election to Tax under Sec.9113(A)
Between 12.31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
EDWIN J. FEUCHTENBERGER (717)226-4970
REGISTER OF WALLS USE eNLY `
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First Line of Address _ _ .2T _7 p
129 BEETEM HOLLOW ROAD
DID = c-s
."'7. D r"- fV I O rrI
Second Line of Address !-?7 CLr .3 v
C7
..._.. .. .__ DC7 'nt
City or POST Ofica State ZIP Code Em ell,
NEWVILLE PA 17241 v :;u cn rte— m
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N -rl
Correspondent's a-malt address:CHARFEUgEMBAROMAIL.COM
Under penalties of perjury,I declare that I have examined this return,Including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and mplete. G rata of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SI RE F ON RE R FILING RE URN DATE
a 04/23/2014
ADDRESS
129 BEET M HOLLOW ROAD, NEWVILLE, PA 17241
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1105610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: WIDRA, JOSEPH J. JR.
RECAPITULATION
1. Rea!Estate(Schedule A}. ............................................ 1. 0.00
2. Stocks and Bonds(Schedule 8) ....................................... 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 94,044.19
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00
7, Inter-Was Transfers&Miscellaneous Non-Probate Property
(Schedule G) C) Separate Billing Requested........ 7. 0.00
$: Total Gross Assets(total Lines 1 through 7)............................. 8. 94,044.19
9. Funeral Expenses and Administrative Costs(Schedule H)... .:.............. 9. 14,663.64
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 59,589.95
11. Tate!Deductions(total Lines 9 and 10)...........................
tt. 74,253.59
12. Net Value of Estate(Line 8 minus Line 11)..... ......................... 12. 19,790.60
13. Charitable and Governmental Bequests/Sec 9113 Trusts 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. 19,790.60
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 19,940.60
(a)(1.2)x.0� 15. 890.58
16. Amount of Line 14 taxable ......_._..,,..._.__._ .....,�.......__........._.......... .. . _.�.....-_....__. _.._...._... ._
at lineal rate X.0_ 16.
17. Amount of tine 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE....................._.................................. 19. 890.58
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=)
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
WIDRA, JOSEPH J. JR.
STREETADDRESS
121 WALNUT BOTTOM ROAD
CITY STATE ZiP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 119) (1) 890.58
2. Credits/Payments
A.Prior Payments 600.00
B.Discount 31.58
Total Credits(A+B) (2) 631.58
3. Interest
(3)
4. If Una 2 is greater than tine 1+Une 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If tine/+Une 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 259.00
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.__..._.................................. ❑
c. retain a reversionary interest..............................................._.......:............_...............----.............................. ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. if death occurred after Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?...........:.............................................._...............-............_-........---... ❑ N -
3. Did decedent own an'in trust for'or payable-uponAeath 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 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 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 A)(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 stepparent 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(x)(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-rSo8 EX.(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: - FILE NUMBER:
WIDRA, JOSEPH J. JR. 2013-00871
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, ORRSTOWN BANK CHECKING ACCOUNT 92,049.33
2 ACCRUED INTEREST ON ITEM#1 3.03
3 PPL-REFUND OF OVERPAYMENT 102.08
4 SHIPPENSBURG HEALTH CARE CENTER-REFUND OF OVERPAYMENT 1,889.75
TOTAL(Also enter on Line 5, Recapitulation) $ 94,044.19
If more space is needed,use additional sheets of paper of the same size.
ORRSTOWNBANK
A Tradition of Excellence
ORRS P.O.BOX 250
Shippensburg,PA 17257
Date 7/15/13 Page
Temp-Return Service Requested
Primary Account 103009259 4
Enclosures
I"II�IIIIrludrl�r�rLluhllr�1�11111r�L1'11�1111'�'�1ill'���
003736 0.6500 AT 0.384 TR00016
Joseph Widra
231 High Mountain Rd
Po Box 155
Walnut Bottom PA 17266-0155
C H E C K I N G A C C O U N T S
Account Title Joseph J Widra
50+ Interest Checking Check Safekeeping
Account Number 103009254 Statement Dates 6/17/13 thru 7/15/13
Previous Balance 541.44 Days In The Statement Period 29
1 Deposits/Credits 91, 986.86 Average Ledger 16,105.58 -
2 Checks/Debits 479.47 Average Collected 12, 937.00
_ .__—_-Service Fee _ ._____._�. - - .ao_ --interest—Earned-
interest Paid .50 Annual,,,Percentage Yield Earned=,,- 0.05%
Current Balance 92, 049.33 2013 Interest Paid .52
Deposits and Additions
Date Description 'kmount
v, 7/11 Deposit - 91, 986.86
7/15 Interest Deposit .50
n
0
0
,o - CHECK SUMMARY ---
cDate Check No Amount Date Check No Amount
.". 6/24 1661 300.00 7/05 1662 179.47
g * Denotes missing check numbers
0
0
0
Daily Balance information
°o vv's Date Balance Date Balance . Date Balance
6/17 -"1 .61.97 7/15 92,049.33
on 541.44»:3 7/05
6/24 241.44° 7/11 -92, 04 8.83
N t0
C n
O r
REV-1511 EX+ (08-13) ,
Spennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERRANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENrDECEDENT
ESTATE OF FILE NUMBER
WIDRA, JOSEPH J. JR. 2013-00871
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME 9,089.18
FUNERAL MEAL 125.00
HONOR GUARD-HONORARIUM 80.00
PASTOR TIM WHEELER-HONORARIUM 140.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 4,000.00
Name(s)of Personal Representative(s) EDWIN J. FEUCHTENBERGER
Street Address 129 BEETEM HOLLOW ROAD
City NEWVILLE state PA ZIP 17241
Year(s)Commission Paid: 2014
150.00
Z. 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: 318.50
5. Accountant Fees:
6. Tax Return Preparer Fees: 500.00
7. CUMBERLAND LAW JOURNAL-ADVERTISING ESTATE 75.00
ORRSTOWN BANK-ESTATE CHECKS 16.00
SHIPPENSBURG POST OFFICE-PROOF OF MAIL RECEIPT 1.66
THE SENTINEL-ADVERTISING ESTATE 168.30
TOTAL(Also enter on Line 9, Recapitulation) $ 14,663.64
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ (12-12)
pannsylvania SCHEDULE I
OEPARTMENTOF REVENUE DEBTS OF DECEDENT;
INRER TANCETAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VVIDRA, JOSEPH J. JR. 2013-00871
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
REM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. COMMONWEALTH OF PENNSYLVANIA-ESTATE RECOVERY CLAIM 50,654.38
2 SHIPPENSBURG HEALTH CARE CENTER-BALANCE DUE 7,596.82
3 TUCKER-ARNSBURG-LEGAL SERVICES PROVIDED PRIOR TO DOD 885.00
4 DCM SERVICES ON BEHALF OF AMERICAN EXPRESS-CREDIT CARD BALANCE DUE 332.75
5 WALNUT BOTTOM POST OFFICE-PAST DUE RENT AND FEE TO CLOSE BOX 121.00
TOTAL(Also enter on Line 10, Recapitulation) $ 59,589.95
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
. pennsytvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
VVIDRA, JOSEPH J. JR. 2013-00871
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).)
I. EDWIN J.FEUCHTENBERGER STEPCHILD 113
129 BEETEM HOLLOW ROAD,NEWVILLE,PA 17241
2 KATHY L.FEUCHTENBERGER STEPCHILD 1/3
2136 DUCKWALK COURT,WALDORF,MD 20602
3 WILLIAM J.FEUCHTENBERGER STEPCHILD 1/3
131 BEETEM HOLLOW ROAD,NEWVILLE,PA 17241
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 TAXIS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
i.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ 19940.60
If more space is needed,use additional sheets of paper of the some size.
{ I I
747
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October 30, 2013
Pennsylvania Department of Public Welfare
Estate Recovery Division
P.O. Box 8486
Harrisburg,PAt7105=-8486 _._ "'----,
.1 .,.
Estate of Joseph J. Widra
CIS#540281821
Date of Death: 7/30/2013
To om It May Concern:
Please be advised that I am in receipt of the enclosed estate recovery claim for the above
referenced decedent. After reviewing the documentation received from Shippensburg
Health Care center, I respectfully ask for clarification on a few items. Page 4 of Notice
ID#9011836425 indicates a home maintenance deduction of$720.10 for the months of
June 2012 through October 2012, totaling$3600.50. I have no record of receiving these
funds, either as POA for Mr. Widra, or in my current role of Executor. Were these funds
received by the nursing home,as the statement of activity they provided to me does not
reflect this.
I have enclosed the documentation pertinent to this claim for your review. Thank you for
your assistance in this matter.
Fely
r 1
. Peuchtenberger
Executor, Estate of Joseph J.Widra
Enclosures
� I
LAST WILL AND TESTAMENT OF JOSEPH J. WIDRA
a.k.a. JOSEPH JAMES WIDRA JR.
I, JOSEPH J. WIDRA a.k.a. JOSEPH JAMES WIDRA., JR., married man, currently of
PO Box 155, Walnut Bottom, Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this my Last Will and Testament,
hereby revoking and making void any and all prior Wills and Codicils by me at any time heretofore
made.
1.
I direct the payment of all my just debt and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate,real,personal and mixed, whatsoever
and wheresoever situate, I give, devise, and bequeath to my three (3)following named
stepchildren, to wit: KATHY LEE FEUCHTENBERGER, EDWIN J.
FEUCHTENBERGER and WILLIAM LEE FEUCHTENBERGER, in equal shares,
stiroes.
ar-
3
FOR PURPOSES OF CLARIFICATION: My stepdaughter,VICKIE LYNN
WALLICK, has been left out of this, my Last Will and Testament,by design and not by
accident. She is not to inherit from my Estate directly nor indirectly,Perstkpitalty, by
representation, or by ascent, or by descent through her relationship to any other beneficiary in my
Will or through my Will or by means of intestacy, in any other mode or manner whatsoever..
Additionally, she is not to have any rights to serve as an Executor or Administrator of my Estate.
4.
It is my intention that beneficiaries named before or after the date of this Will on my life
insurance, annuities, individual retirement accounts(IRAs), in Trust for or joint bank account
and any other assets for which I may designate beneficiaries will receive such investment and
that my Will provisions shall not control such investments.
5.
In the event that anyone shall undertake to contest this, my Last Will and Testament, in any
6.
I nominate, constitute and appoint my stepdaughter, KATHY LEE
FEUCHTENBERGER, to be the Executrix of this my Last Will and Testament. In the event
that she is unable or unwilling to act as Executrix,I appoint my stepson, EDWIN J.
FEUCHTENBERGER, to be Executor in her place and stead. In the event that he is unable or
unwilling to act as Executor, I appoint my stepson,WILLIAM LEE FEUCHTENBERGER, to
be Executor in his place and stead. I further direct that they shall not be required to file bond or
other security in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.this lky�* day of
A.D. 2012.
(SEAL)
JO PH . WED
a.k. . JOS PH J IES WIDRA, JR.
Signed, sealed, published and declared by the above-named JOSEPH J. WIDRA ak.a.
JOSEPH JAMES WIDRA, JIL, as and for his Last Will and Testament, in the presence of us,
who at his request and in his presence, and in the presence of each other,have hereunto
subscribed our names as witnesses.