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I'ETITION FOR I'ROBA TE and GRANT 01,' LETTERS
No. ~J - 9!1-=-JOO
To:
ReglMer of Wills fur the
_____n_ '. /Jrn'tI,lw/. eoumy of Clunberland In Ihe
Sodtll Srctlr/t)' No. .-lgll -12-3057 Commllnwellllh or l'ennsyll'lInlll
The pelltlllnllf Ihe 1I11derslgned respeelflllly represenls thlll:
Your petltloner(s), who Islure I H )'ellrs of uge or older unlhe exeelll or
Inlhe IlIsl will of the IIhlll'e decedent, dilled -lip"! 1 '4.
IInd eodlcll(s) dilled
Esllllr of Edith M. GlrardJ.___
III.m kllOIl'1I liS
nllnbed
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hlale ,elenln' circumslAllces. e.ll. rc:ntludallnn. deall1 uf urctltor. rIC.)
Peeendenl wus domiciled III dellth In_Cumberland County, Pennsylvania, with
h~r lasl family or principal residence Ul 801 N. Hanover street. Carlisle,
( North Middleton Township \ , Pennsylvania
Uhl strcct, Ilumber ami mUIIl:lpulh)')
Dceendem, then 87 years of age, died November 19 ,19- 2004 ,
al Church of God Hane, 801 N. Hanover street, Carlisle, Ph 17013 ,
Excepl as follows, decedelll did nol marry, was not divorced and did nol huve a child born or adopled
afler e~eclltlon of Ihe will offered for probale: was nOllhe victim of II killing and was never adjudlcaled
Incompetent:
Dccendcnt at death owned properlY with estimated values as follows:
(If domiciled In Pa.) All personlll properlY
(If nol domiciled In Pa,) Personlll properlY In Pennsylvnnla
(If nOI domiciled In Pa,) Personal properlY In Counly
Value of real estate In Pennsylvania
situated as follows: N/ h
S 70,000.00
S
S
S
WHEREFORE, pelltioner(s) respeclfully requesl(s) the prohate of the lasl will and eodlcll(s)
presented herewith and Ihe granl of lelters teB tmlcn tary
(lcllnmc:nlary; admlnlm~ulon c.1.a.l odmlnlmu1,ion d.b.n.c.l.a.)
theron.
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E. Robert Elicker, II
20 stone Sprinq [~ne
~1I11p Iii 11, P^ 17011
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OATH OF I'ERSONAL REI'RESENTATIVE
COMMONWEALTH OF PENNSYLVANIA '1 ss
COUNTY 01' CUmberland f
The petltloner(s) above-named swear(s) or affirm(s) Ihal the stalemenlS In the foregoing pelltlon arc
tllle and correel 10 Ihe besl of the knowledge and belief of petilloner(s) and Ihalas personal represen-
lalive(s) of the above decedent petltloner(s) will ~UJY adminj'le1'e estale according 10 law.
Sworn to or affirmed and subscribed { , J {Lt4-- . ~
before me this 7th day of ~
~:~~ i9-2QO..4 i:
<<'~~T~lI'-, l.\I.-9 lief/isler ~
No.
Estate of
a1ith M. Girardi
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW December 7. I'J: 2001 In cOnllderatlon of the petition on
the reverse side hereof, satisfactory proof havlni been presented before me,
IT IS DECREED that the Inmument(s) dated l\Oril 24. llJlJn
described therein be admllted to probate and med of record as the last will of Frlith M. Girardi
and Lelters TeB taren tarv
are hereby granted to E. Robert Elicker, II
FEES
Probate, Letters. Etc, ....,..., S
Short Certlncates( ).......... S
Renunciation ................ S
174 f:."" U,,;W,
Re;bterOrWllls ~~~
E. Robert Elicker, II , // ~,
01572
S
TOTAL _ S
A TIORNEY (Sup. Cl. 1.0, No,)
20 stone spring Lane
came HilL PA 17011
ADDRESS
717-240-6535
Filed
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PHONE
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WARNING: Ills 1I100alto dupllcato this COllY by photostat or photoornph.
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COMUOHWEALnl 0' PENNSYLVANIA. DEPARTMENT 0' HEALTH. VITAL RECORDlI
CERTIFICATE OF DEATH
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('IfnOl~"llSlJ,f.lor.cuP""~
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III Clerk
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Church of God Home
ijOl N. Hanover St. ,Carlil!l1e,PA
'''''",,''''''''..flfnt.''_I.''I
tt Unknown
E. Robert Slicker, II
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LAST WILL AND TESTAMENT
m:
EDITH M. GIRARDI
I, EDITH M. GIRARDI, of Hampden Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, pUblish and declare this as
and for my Last Will and Testament, hereby revoking and making
void any and all wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses be
paid as soon as practicable after my death by my Executor
hereinafter named.
2. All the rest, residue and remain<l,ei, of my estate,
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real, personal and mixed, and wheresoever the same may be
C"
In
situate, I give, devise and bequeath in equal sha~s as follows:
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(a) Fifty (50%) percent to the ST. JOSEPH I~DIAN
\('J
SCHOOL, Chamberlain, South Dakota 57326j absolutely;
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(b) Fifty (50%) percent to the ST. LABRE INDIAN
SCHOOL, Ashland, Montana 59004, absolutely.
3. I hereby nominate, constitute and appoint my said
attorney, E. ROBERT ELICKER, II, as Executor of this my Last will
and Testament, and I further direct that no person serving as
Executor shall be required to post any bond to secure the
faithful performance of his duties in the Commonwealth of
Pennsylvania or in any other jurisdiction.
LAW O,.,.ICID
8NELDAKER 6 ELICKER
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last'Will and Testament written on two (2) pages
this d. i day of ~
, 1990.
f!.cU m. ~('SEAL)
Edith M. Girardi
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signed, sealed, published and declared by EDITH M. GIRARDI,
the Testatrix above named, as and for her Last Will and
Testament, in our presence, who, in her presence, at her request,
and in the presence of each other, have hereunto subscribed our
names as attesting witnesses.
~~LQ...J- /'11- -7~~ (SEAL)
J~_~. /I, ~-(71- (SEAL)
LAW O,,,Cl:lI
DNEL.DAKER A ELICKER
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COMMONWEALTH OF PENNSYLVANIA)
COUNTY
OF
: SS.
CUMBERLAND)
We, EDITH M. GIRARDI, JANET M. FORRY, and SUSAN A. McCOY,
the Testatrix and the witnesses, respectively, whose names are
signed to the attached or forgoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the
Testatrix signed and executed the instrument as her Last will and
Testament and that she had signed willingly, and that she
executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed the Will as witness
and that to the best of her knowledge the Testatrix was at that
time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
((,'d;J /n. j;~~
Testatrix
r? (/. tl...tI' ')t (. .:f ~v~
Witness .
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witnes
subscribed, sworn to and acknowledged before me by EDITH M.
GIRARDI, Testatrix, and subscribed and sworn to before me by
JANET M. FORRY and SUSAN A. McCOY, witnesses, this ~y~~ day
c~z:. r?
, 1990.
of
P~..".;. 7P K'~<LM
Notary Public
rs.:!.!I1<lI&1i'.1
C3~11.],1~i' E C.'X.cum. Noory Pt.<<-=
t.tl.,-Jl:'ln'j,:sD..qJ BOt()~'t~I, Cumbml.vd CaJr.ty
MyCc.rr:11I~nE~F(flJ.27.1OCJ4
MIM1Jb..'l', Pl.'flmytvattl<l A:"..."{)Cl.ltlOO 01 Not.lf1U'J
LAW or,ICI.
BNELDAKER a ELICKEA
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~ COMMONWEALTIi OF
. PENNSYLVANIA
( ..:. "1' DEPARTMENT OF REVENUE
, . io; DEPT 280601
, " . HARRISBURG, PA 11128,0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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oreEOOjJ 5 NM.IE IlASl FIIlST_ AND MIDDLE 1t-iIlIAI)
Girardi Edith M,
DAlE Of DEATH IMY,DD,VE,nl I OATE Of D,'ITH ,MMDD,YE,nl
11/19/2G04 101/03/1917 ,
I'f "PlICADlEI SU~VIVINO SPOUSE'S MME IlAST, flnST. AND ~lIDDlE INITlAll
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{iJ 1 ()fllJ~lal Return
D4UmiICdE$til!O
~J 6. Oocodenl O~d Tustate \......." wvt 1II"'.l
[J 9 lih!llhon Plocecds R8(f.~\cd
[J 2 Supplemontal Relum
[J .0 rulUfC Inleresl Compromiso '...llldJil...... 111"'1
o 7. Ducudenl M;!inlained I living Trult jAlltIll1lVf uf ll\oWl
LJ 10 Spouul Po~eltrCledlllcltlfDl"'''''''''"fl'l J'9'....l-l ~l
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FILE NUMBER
21 94
0900
CllloN"ll.XIl 'FAA
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M,l.l!lflt
SOCIAL SECURITY NUMDER
188.12.3057
THIS RETURN MUST BE FILED IN DUPLICATE WITH TIlE
REGISTER OF WILLS
SOCiAl SECURITY NUMDER
o 3 Remaindo'Roluml.u."....~llwtllJa11
o 5 Fedoral Estate Tal Return Rcqulr~
II Tobl Numbe, of Sale DeposlI DOlCS
o 11. Eletlion 10 ta_ under Se(; 911 31^) l"lIdISdlIlI
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THIB BECTION MUST BE COMPLETED. ALL CORREBPONDENCE'AND CONfIDENTIAL'TAX I FORMATION BHOULD BE DIREOTEO TO:
NAME COMPLETE MAllINO ADDRESS
,E, Robert Elicker, II. Attorney 20 Slone Spring Lane
fiRM NAME 1"._' Camp Hill, PA 17011
'TELEPtiONE NUMDER
(717) 240.8535
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151 77,901.37 ij 7! .'1
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111 0.00
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191 9,654.34
1101___,____,__180.00 .-
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1 Real Est.1le {Schedulo AI
2. Stocks and BondS tS(tlcdule 81
3 Clo~ty Ilald Corporation, Paflnel5hlp Of SoIo.Proprietorltlip
4 Mortg3ges & Notcs Re<:elvablo (Schedule 0)
5 Ca~h. Bank Deposils & Mlstc:nancous Personal Property
ISth,~u" EI
6 J...,y Ownod Property ISth,dul. FI
o Separalc Odling Requc~lcd
1Inlcr.vl\'Os Tr3nslcfl & Mlscdancous Uon.Pfobalu Pro~crty
(Schedule 0 or II
e Tol.ll O,on "n.ls (Ictill llncs 1,11
9 Fllnerul Elpcnses &. h!nMllilrallYo Co,l~ ISthcduto III
10 Dellis 01 DOfJ,ldenl. MOfI~J~o Llilblhlios, & Uona (Schedulo II
11 Tol.1 Dedu,lIo"s ltolilllincs 9 & 10j
12 N.I V,Iue of EII,le (lino 8 tnlnus Line II)
13. Chilfllablo and Ocrvllrnmental Boque'''ISuc 9113 Tru$l, lor ....hich an ulucbon 10 lu has not boo"
made ISc.hI.tdu1c J)
1". N,I V,lut Subi'" to Tn (lino 12 minus Uno 131
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SEe INSTRUCTIONS ON REVERSE SIDE fOR APPLICABLE RATES
15, ArT,Dunl 01 Uno 14laublo Dllho spousall.n
rale, Of lI,nl101s undef See 9116 (aXI 21
, ,0
16 Amo\Jf\1 01 Uno 14 taaatllo at I.ncal folIe
, 0
11. Amuunt 01 Line 14lalablo OIl sitlling rale
1I .12
18. Mounl 01 Uno 14t31ubk! 01 col1.1tcrill ralll
II .15
19 Tn Out
200
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONB 0 REVERSE SIDE AND RECHECK MATH · ·
77,901.37
(11) 9,834.34
(12) 88.067.03
1131 68,067,03
(ll) 0.00
115)
(16)
1111,___
1181
119)
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Decedent's Complete Address:
RAESS
The Church of God Home
801 North Hanover Slrael
CITY Carllslo '
SIAIEpA
liP 17013
Tax Payments and Crodits:
I I,,, DUO (Pago llino 19)
2 Crodl15lPlIymcnls
A spou.al Po,orty Crod,1
D Pr"r PajmonlS
C Discount
(I)
Tolnl Crod," (A + D + C ) (2)
3
Inloro.UPonally Ilapplocablo
o Inlo,o.'
E, Ponally
(3)
(4)
(5)
4,
Totallnle1O.VPenally ( 0 t E )
II line 21s grealer Ihan line 1 + line 3, enlor Ihe d,llo1Onco, This Is \he OVERPAYMENT,
Chock box en P.go 1 L1no 20 '0 requesl. "fund
5,
If line 1 + llno 3 is grealot Ihan line 2, onlor Ihe d,lforenco, This Is Ihe TAX DUE.
A, Enler Ihe ,"1"0.1 on 1110 la, duo, (SA)
D, Enter Iho lotal of line 5 + SA, This Is Iho BALANCE DUE. (5B)
Make Check Payable 10: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWiNG QUESTiONS BY PLACiNG AN "X" IN THE APPROPRiATE BLOCKS
1. Old docedonl mako a Unn.lor and: Yos No
a, rotain tho use 0' Income ollho property I,an.lo.od:..",,,.,,,,,,.,.,,,,,,.,,,,,,,,,,,,,,.,,.,,,,,,,,,,,,,,,..,,,,,,,,""...."""".."", 0 IKI
b, rolain Iho tighllo doslgnato l'lho shall use Ihe property Iran.lo.od or its Incomo:",,,,,,,,,,,,,,,,,,.,,,,.,,,,,,,,,,,,,,,,,, 0 IKI
c. rotaln 8 rovorsionary mterost; or................"...."...,...,......"..............................,...."...............,........,...,.",.......,,,,, 0 [i]
d, rocclvolhe promise lor life 01 ellhor paymenls, benel,ls or caro? ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,, 0 [i]
2, If dealh occuttod after Oocomber 12. 1982, did decodenllran.for prDpeny IVilhin one year 01 doalh
IVilhDUI receiving adoquato con.,derallon? ",,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"",,,,,,.,,,,,,,.,,,,,,,,,,,,, 0 IKI
3, Old decedenl Cl'Nn an "in llUsl fo~ or payable upon death bank accounl or seeunly 01 his or her dealh?""""""" 0 IKI
4. Old decodenl Cl'Nn an Individual Reliremonl Accounl, annuity. or othe, non,probale property IVhIch
conlalns e benefIciary de.ignalion? """",,,,,,,,,,.,,,,,,..,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..,,,,,,,,,,...,,..'"""'.."...",,,,,,,,,,,,,,,,,,, 0 [!J
iF THE ANSWER TO ANY OF THE ABOVE QUESTIONS is YES, YOU MUST COMPLETE SCHEDULE G AND FiLE IT AS PART OF THE RETURN,
Ul"dIrptl\lLl.orPt".y.ldldat.tIIlltllY".I/l'I~thi\"lum.IncIud&ng.~ld'ItclIJelandll&ttmtntI.II'ld"'lhIb1'loI",.,~anctb...r..IIM,eooKtandc:omplell
Dtdatlban d~" otlII Chan IhI ptf1CInII ftpftltftllMllblMclonall1lorm'1lOI\ of_Nth pt~" ha. ant WMtedot.
SIG~~~r;~':;;ETURN
ADDRESS
20 Slone Spring Lane, Camp Hili. PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
,/. DATE
If "Lc:/.#c,-
DATE
ADDRESS
:,;'.;-:.,:;. j;.~..~">~~~ t:.::,';\ ~-,;''--,; .' '. ;."';':
1,,;
For datos or death on or after July 1, 1994 8fld beloro JMuary 1. 1995. 1M tax rate imposed Ol1lhe nol valuo oftranslors 10 or for the use ollhe surviving spouse is 3%
172 P,S, 59116 (a) (1.1) (il!
For dales 01 death on or after January 1, 1995, tho la' ,ale Imposod on Ihe nel value of Uan.lers 10 or for Ihe use of the surviving spou.e b 0% 172 P,S, 59116 (a) (1.1) (Ill!,
The statute ~Le.mmQI a transfer 10 8 surviving spouSO Irom lax, and tho statutory requirements for disclosure 01 nssols and rding a lax return are SI~1 applicable even II
tho surviving spouse is the only benefICiary,
For dales 01 dealh on 0' after July I, 2000:
Tho lax rale Imposed on thO nol value of lransfers from a deceased child twenty-one years of ago or younger al death to or for tho use of a n.1lural paronl, an adoptive parent,
ora slepparenl ollhe child b 0% 172 P,S, 59116(0)(1.211,
The la' rale imposod on Ihe nel value ollranslers 10 or for tho use 0' Ihe decodenfs lineal beneficiaries Is 4,5%, e'ceplas nelod In 72 P.s. ~9116(1.2) f72 P.S, ~9116(a)(I)J,
The la. tale Imposed on Iho nel valuo olltan.I,,, 10 or for Ihe use olllle decoden!'s ',~ings is 12% 172 P,S, 59116(a)(1,3)J, A slblin9 Is defmod, under See~on 9102, as an
IndIVidual who hn! al Icast one parent in common With tho doccdcnl, whol~er by blood or adoplion.
R[VIOOK[X'IOOK) .
COMMONWlAL1H Of- PI;NNSYlVANI^
INIlEIUtANCE TAlC HE tUft"
nE!lIDEN'llECEOENI
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
"i
ESTATE OF
Edith M. Girardi
Indude the proceed. of IjUg.ticn tnd the dill the procelda wlr. received by th. "1I1e.
All prop.,ly lolnll~'own.d with rlghl of lurvlvor.hlp mUll b. dl.clolld on Ich.dule F.
ITEM
HUMBER
DESCRIPTION
., ..',
FILE NUMBER
21.94.0900
VALUE AT DATE
OF DEATH
10,687.37
47,93
2,450,84
1,003.79
0,17
60.094.40
0,00
1,802.54
83.94
194,74
1,535,65
I, Certificate of Deposll, PNC Bank, Account # 31200246206
accrued Interest
2. Checking account, PNC Bank, Account # 5080470585
3. Savings account, PNC Bank, Account # 5003177613
accrued Inleresl
4, Savings accounl. PA slale Bank, Account # 21301130
5. Donated tangible personal property In her room at Church of God Home, Carlisle, PA 10 other resldenls of
home
6, Refund on prorated monthly fee. Church of God Home, Cerl/sle, PA
7, Personal eccount balance. Church of God Home, Carlisle, PA
6. Reimbursement for medical expensBs . Church of God Home, Carlisle, PA
9. Lump sum death benefit. Unlled States Treasury
TOTAL (Also enler on line 5. Recapitulation) $
(II more .pac,ls nceded,ln,ert .ddiUonlllheel. of Ih. same Ill')
77,901.37
,
~.._...._......- -. - ...
" -
HLV HllOl..(IIO Ull,.9./'Jl.,o
--
SCHEDULE G
INTER-VIVOS TRANSFERS &
Mise, NON-PROBATE PROPERTY
COMMONWI:^L HI Of PLt-4NS'ftV^"I^
IMtUUlANCE lAX Ht 'URN
IU!SIOENT U[CI:UENf
ESTATE OF
Edith M, Girardi
FILE NUMBER
21-04-0900
IIIi. .chedule mUll bt 'omp/eled end "led IIlhe .n.... I. enr.' que.tion. llI1,ough 4 on 111. "",.. .lde Dr !he REV'I!DO COVER SHEET I. rll.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH " OF DECO'S EXCLUSION TAXABLE
INCU,q 'ttI ~ 01 flC '~"llln, '...'" "11..&110'-,"", lO PlCfOl'" oUCl
NUMBER IHlDAfIOf"lfWNU ""AC""C""'orrHlOUD'~Il("",.tAfl VAlUE OF ASSET INTEREST ..--., VAlUE
I, Federel Employees' Group lire Insurance paymant life
5,009,45 100 Wmn::a 0,00
~
I
TOTAL (Also anler on lina 7 Recapilulalion) S 0,00
(II more space I, needed. Insert add.!lonallheell 0' the lamellze)
.
/lEV.'S" EX. II"...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETUAN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Edith M, Girardi
FILE NUMBER
21-94-0900
ITEM
NUMOER
A,
Dlblt of dlced.nl mUll b. ,.porl.d on Sell.dull'.
OESCRIPTION
AMOUNT
1,
FUNERAL EXPENSES:
Hoffman Roth Funorat Home. 219 North Hanover Streot, Co~isle, PA 17013
Bu~al expenses and marker, Greenwood Memorlat Park, 5820 Greenwood Rd" Lower Burrell, PA 15088
UPS, Shipping charges lor remains
1,669.08
2,050.00
24.29
2,
3.
TOTAL (Also enler on line g, RecapilulaUon) S
III more .pace Is needed,lnsert addillonal Iheel. of Ihellm. Ilze)
9,654.34
Rlv"I1H"11l0ll *'
COMtolc:>>M'ULfH 01 pttmSYl\lANIA
1tf1[R11AHCE fA.l. RETURN
RUIOlNI OCCU){Nt
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Edith M. Glrordl
FILE NUMBER
21.94.0900
ITEM
NUMaER
,
R.port debttlncurr.d br Ihl dlcedent prior to death vrhlch r.maln.d unplld .. 01 thl datt of dulh,lncludlng unfllmbu,..d m.dlcal..p.n....
VALUE AT DATE
DESCRIPTION OF DEAlIt
orl, Currla & Hecht, Oral & Maxillofacial, P,C" Carlisle, PA 17013,teelh exlraclion
180,00
TOTAL (Also enler on line 10, Racapitulation) $
(II mot'e 'PIC' IS needed,lnHl1lddition.IIMII. of thlllme Ille)
180.00
REYI~13U.tI9001
*'
SCHEDULE J
BENEFICIARIES
COMMOm,lALtlt or IILN~~YlVAAIA
INII(RlTANCE f.u R[TUHN
IlESlOtNf DtCCOENl
FILE NUMBER
21-94-0900
RELATlO~ISHIP TO DECEDENT AMOUNT OR SHARE
00 Not L1.t Tru.lu(.) OF ESTATE
ESTATE OF
Edith M. Girardi
NUMBER NAME AND ADDRESS OF PERSONISI RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS lindud' ou~llhl,poUl.1 d,.!libulion', 'nd ~,",IOI' undOl
See, 1116(.) (1,211
ENTER OOLlARAMDUNTS FOR DISTRISUTlDNS SHOWllABOVE ON LINES IS TIlRDUGH lB. AS APPROPRIATE, ON REV.lSOO COVER SHEET
II NON.TAXABLE DISTRIBUTIONS:
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 1113 FOR WIlICH AN ELECTION TO TAX 15 NOT BEING MADE
B, CHARITABLE AND OOVERNMENTAL DISTRIBUTIONS
:m of r-lr"'ny estate
lEt' l-' ":J"1. h 2 of Will
1.
St, Joseph's Indlen School, Chamberlain, SO 57326
?
~.
51, LabrB Indian School, Educational Association, P.O, Box 216, Ashland, MT 59003
:m of l"""l~.my estate
lEt' l ~".':J"1.11 2 of Will
TOTAL OF PART 11_ ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REY,l500 COYER SHEET $ 100% of estate
llf more 'pace II needed,lnurt Iddillonallheel' of the lime Ilze)
I,
~.
~
f;'
,;,
~
~~;
Inventory of the reulullll personul cst lite of
Edith M. Girurdi, deeeused
Personallv
I.
Certificate of Deposit, I'NC Bunk, Accollntll 31200246206
accrued interest
2,
Checkinguccollnt, I'NC Bnnk, Accollntll 5080470565
3.
Snvings nccount, PNC Bnnk, Account II 5003177613
accrued interest
4,
Savings account, PA Stnte Bank, Account II 21301 130
5,
Donated tnngible personnl property in her room at Church
of God Home, Carlisle,l'A to other residents ofhollle
6.
Refund on prorated monthly fee - Church of God Home, Carlisle
PA
7,
Personal account balance - Church of God Home, Carlisle, I'A
8.
Reimbursement for medical expenses - Church of God Home,
Carlisle, PA
9,
Lump sum death benefit- United Stutes Treasury
Totnl personnlty
NO REAL ESTATE
N
15 M "
(J~ .. . '":~
l>'~ ,,:', - [1: ,:
p :' ::z:: II-t'<:. ;
_~l' c- OCI..
C) r.'_, .......u '.,
cr.'" ,,: \0 ~" ,I
.. -.--,
kl\,j N .,!;1~:;1
f~)': ~. ~. -
8'-') :~ Uft:L
1;.J -, ~B
1.t.11-1'_ ,,,.,
0:: ,:>
C"
......
10,687,37
47,93
2,450,84
1,003,79
,17
60,094.40
,00
1,802.54
83.94
194.74
1.535.65
S77,90L37
t.....
~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUM.ERLAND
III
E. Robert Elicker, II
-..-.. -.". . _.,,-- ---- .. ..- - - - ,...--~ " ...._.__.__.-._._.__.__.-.-~.--~.._. --_._.._-~--.,_.- .".- -_.......~........-
b.lng duly _,_.swo~l}__,.._".._ .ccordlng 10 I.w, d.po... .nd ..y. Ih.1 h. !I:I_~~!:~~,':..~~ _ __....._
-,. -'--.u___u '..-....,".-...,.... ,___, 0' Ih. E.I.t. 0' .~.lt!LM'-!;,1;!,.@f& _'___
lat. 0' ..North Middleton Township " ",_ .,..... __...., Cumb.rl.nd Counly, P." d.c....d .nd Ih.t the
within is .n Inv.nlory m.do by, -J;...J1o.bJtl:,t...f,.uC!H~];', 1.1._ _ _,.....__, Ih. ..Id_ E~or
., Ih. .nll.. ..1.1. 0' ..Id d.c.d.nl. con.Istlng 0' .11 Ih. p.rson.1 prop.rly .nd ...1 ..1.1., oxc.pt r..1 ..t.l. ouhld.
th. Commonwealth 0' P.nn.ylv.nl., .nd Ih.1 the IIgur.. oppo.lte o.ch Itom 0' tho Inv.ntory ..pr...nllt'. '.Ir v.lu.
.. ., the d.lo 0' d.cod.nt'. do.'h.
- .nd .ub.crlbod bo'o" mo,
f. .t>'7~
~ (" :>
----V!lI:o.~til4~1.__.__
E.",IYi' "'J..lnhl"'f~
E. Robert ECKer, ,L
-:l..,C3~-
~
--..------.---
20 Stone Spring Lane
Camp ~~, PA 17011
Addr...
0.1. 0' O..th _ .-,-UL.__
o.Y
November__..___ 2004
Month YUt
INSTRUCTIONS
I, An Invontory mo.t bo 1II0d within throo monlh. .ltor .ppolntmenl of person.' r'pre..nt.tlv.,
2, A .uppl.ment Inventory mu.1 b. 'iled within Ihlrly d.y. 0' discovery 0' .dditlon.' ....ts,
3, Addltlon.1 .heels m.y b. .tt.ch.d .. to person.lty or re.lty
4, SOl Arlicl. IV, Flduci.rlo. Act 0' 1949,
0-
'rl
.c:
I en
c:
)
0
E-<
c: .,;
~ I 0
0 w .... ..
~
0 ~ '" I- 01 ..
w g 'rl ~ ..
'" a.. 'e 'tl u
0 0 .. II
I e w 'tl C '" ,...
J: '" ra 'rl .. ..
... I- a.. ..J u. I-< :E .; a.. E
'" Z .1j 0 'rl a.. 0
I U. ..J :I:
UJ 0 c( t? .c: ,::
~f > Z '" .... c(
N .
~ 0 . I-< c I
c :E 0 ~
VI Z 0
0 '" Z U . .
Z w c( .c: ...
a.. ."
.... c
'rl - ..
~ 'tl ;:
W, 0 ..
..,
. e ." ...
. .! 0
.. ~ 0
..J U it CD
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAM
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIDNS AND ASSESSNENT OF TAM
BUREAU DF INDIVIDUAL TAMES
INIERlTANeE tAX DIVISION
PO lOX 28060.
HARRISBURG PA 17121-0601
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-11-2005
GIRARDI
11-19-2004
21 94-0900
CUMBERLAND
101
Anount Realtt.d
E R ELICKER
20 STONE SPRING
CAMP HILL
LN
PA 17011
-
REV-15" EX AFP (05"051
EDITH
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS .....
1l4V.WI;,),,"fi'Wjl.M~'lm1''Il'/ItM''lII!'.UllMftrr~M!l!'.'''''l' AWIIA'Y\fII!lW1'~'')fCtW'~mM'llrr''.'"....'''''''
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GIRARDI EDITH M FILE NO. 21 94-0900 ACN 101 DATE 04-11-2005
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expans../Ada. Coat./Hi.c. Expans.. (Schedule H)
10. Debts/Hartg.ge Liabiliti.s/Llans (Schedule II
11. Total Deductions
12. Nat Valu. of Tax R.turn
15. Charitable/Dovern.ant.l Dequa.tsl Hon-alactad 9113 Trust. (Schedule J)
14. Nat Valu. of elt.t. Subjeot to Tax
NOTE:
TAX RETURN WAS' I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schedule AI
2. stocks and Bond. (Schedule DJ
3. Clo..ly Held stock/Partnership Inter..t (Schedule C)
4. Hortg.ga./Not.. Receivabl. (Schedule DI
5. Ce.h/Bank D.polite/Hiac. Peracnel Property (Schedule E)
6. JointlY Owned Prcperty (Schedul. f)
7. Tran.ferl (Schedule 0)
8. Total A...t.
I~ an assassmant waa issued previOUSly, lines
re~lect ~igures thet include the totel Df 6bh
ASSESSMENT OF TAX:
15. AMount of Line 14 .t Spcusal rat. 11S1
16. Anount of Lin. 14 taHable .t Linaal/Cla.' A rat. (16)
17. Anount of Line 14 at Sibling rat. 1171
18. Amount of Line 14 taHabla .t Collat.ral/Claaa Brat. (18)
19. Principal TaK DUD
NUNBER
INTEREST/PEN PAID (-I
DATE
~
9,654,34
180.00
1111
1121
1151
1141
14, 15 end/or 16, 17, 18 and
returns assessed to date.
I CHAND ED
III
121
151
141
151
161
17J
.00
.00
.00
.00
77 ,901. 37
.00
.00
(Sl
HOTE, To insure prop.r
credit to your account,
subnit the upper portion
of thia forn with your
taH paYMent.
77 ,901.37
9.834 34
68,067.03
68,067.03
,00
19 will
.00
,00
,00
,00
.00
,00
.00
,00
,00
191
1101
.00 X 00 .
.00 X 045.
.00 X 12 .
.00 M 15 .
119)111
ANOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION DF ADDITIONAL INTEREST,
IF TDTAL DUE IS LESS THAN tl, NO PAYNENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRN FOR INSTRUCTIONS,I
RESERVATION I
PURPOSE OF
NOTlCEI
PAY"ENT.
REFUND (CA)I
OBJECTIONS.
ADNIN-
ISTRATIVE
CORRECTlONSI
DISCOUNT.
PENALTY.
INTEREST I
Eltata. of d.c.dant. dvlng on or b.fora Dlc..b.r IZ, 1982 -- I' anv futurl Int.rl.t In .h. ..t... I. .ran,'.rr.d
In po.....lon or .nJay..nt to CI... I Icoll...rall b.n.flel.rl.. of th. d.c.d.nt aft.r .h. 'Mplr.tlon 0' any ..tat. fer
llf. er for y..r., the Ce..onw.alth h.r.by a.pr...lv r...rv.. the right to .ppral.. .nd ...... tran.f.r Inharlt.nc. ,....
.t th. I.wful Cl... I lcoll.t.r.l) r.t. en any .uch 'utur. Int.r..t.
To fulfill th. r.qulr...nt. of S.ctlon Zl40 of the Inh.rltanc. .nd E.tat. T.. Aet, Act ZS of 2000. 172 P.S.
SacUen 9140).
D.t.ch the tep pert Ion of thl. Hotlc. and .ubalt with your payaant to the R.gI.tar of Will. prlntad on the r.var.. .Idl.
"-"ah ch.ck or .onlV order payabla to. REGlSTEH.U"\\'ILLStAnE~l'.
f.llur. to p.y the t.x, Int.r..t, and p.n.lty due "V r..ult In th. ,lllng of . II.n of racerd In the approprl.ta county,
or tha IlIuanca of .n Orphan'. Ceurt citation.
A rafund of a tax cr.dlt, which wa. not raqua.tad en the Tax Raturn, .ay b. r.qua.t.d by cOlplatlng an
"Appllc.tlon 'er R.fund of penn.vlvanla Inharltanc. and E.t.t. Tax" (REV-ISIS). Application. ar. av.llabl.
onlln. .t vww.r.v.nu...tat..ol.U', anv Ragl.t.r of Will. or R.v,nu. DI.trlct Offlc., or frol the D.p.rt..nt'.
24-hour an.w.rlng ..rvlca for 'or.. ord.r.. I-DOO-S62-Z0S0, ..rvlc.. for taMplyar. with .paelll h.arlng and/or
.p.aklng naad.. 1-800-447-5020 ITT onlv).
Any party In Int.ra.t not ..tl.,I.d with tha appral...nt, allewanc. or dl.allevana. of d.ductlen. Dr ........nt of t.x
(Including dl.count Dr Int.r..t) a. shewn on thl, Notlca aav ebJlct within 60 dava of the data of racalpt of this notlc.
bv filing on. of tha followlngl
AI Prot..t to the PA D.part..nt 0' Rav.nu., loard of APP..ls. Vou I'V ebJ.ot bv ,lllng a pret..t online .t
vww.boardofaoo..l...t.t..ol.u. on or b.for. th. a.plratlon 0' the .I.tv-dav app..1 p.rlod. In ord.r for
an II.ctronlc prot..t to b. v.lld, vou IU.t r.ellv. a conflr..tlon nu.b.r and proc....d d.tl 'rol tha
loard of APP..ls w.b.lt.. You .av al.o ..nd a wrltt.n prot..t to PA DIP.rt..nt of R'v,nu., loard of App..I.
P.O. Bo. Z81021, Ilarrhburg, PA 17128-1021. p.UUon. .av not b. laud.
I) Ellctlon to h.v' the .att.r d.t.r.ln.d at the audit of the account of thl p.r.onal r.pr...ntatlv..
C) App.al to the Orphan.' Court.
F.otual .rror. dl.cov.rad on thl. ........nt should b. .ddr....d In writing tal PA O.p.rt..nt 0' R.v.nu.,
Burllu of Individual Tall'" ATTNI po.t Alln..ant R.vl.w Unit, P.O. 10. 280601, Ilarrhburg, PA 17128-0601
Phon. (717) 787-6505. S.a p.g. 5 of th. booklet "In.tructlon. for 1nh.rltanc. Tax Raturn 'or. R..ld.nt
O.c.dant" IREV-1S01) for an ..p1anatlon of .d.lnl.tr.tlvely ccrr.ctabl. .rror..
If InV ta. du. I. p.ld within thr.. (5) cal.ndar .onth. a,t.r tha dae.d.nt.. d..th, a flv. p.rclnt IS%) dllcount of
the ta. paid I. allowed.
Th. IS% ta. a.n'ltv non-partlclp.tlon p.n.ltv I. co.put.d on the tot.1 0' the ta. and Int.r..t .......d, and not
p.ld bafor. Jlnuarv 18, 1996, th. flr.t dav a,t.r th. .nd of the t.x .en..tv p.rled. Thl. non.partlelp.tlon
p.nalty I, app..I.bl. In tha .... ..nn.r and In the the .... tl.. p.rlod a. you would app.al th. ta. and Int.r..t
th.t h.. b..n .......d .. Indlc.t.d on thl. notlc..
Int.ra.t I. charg.d b.glnnlng with flr.t dav of d.llnquuncv, or nln. (91 .onth. and on. (I) dav fro. th. data 0'
d..th, to th. data 0' p.va.nt. Ta... which b.c..a d.llnqu.nt bafor. Januarv I, 1982 b..r Int.r..t .t th. rat. 0'
.Ix 16%) p.rc.nt p.r annua c.1cul.t.d at . dally rat. of .000I6~. All t..a. which b.ca.. d.llnqu.nt on .nd .ft.r
Janu.rv I, 1912 will b..r Int.r..t at . rat. whIch will vary fro. cal.ndar v..r to caJ.ndar v.ar with that r.t.
announced bv the PA D.part..nt of Rav.nuI. Th. appllcabl. Int.r..t r.t.. for 1982 through ZOOS .r..
Int.r..t D.llv Intarllt Oalh Int.rut
Rata Factor V..r R.t. F.ctor V.ar Rat.
-mr- =m Tml-19'1 -nr ':'mI'!n" nn --w-
16lC .OOOUD 1992 9X .000247 za02 6:C
1l:C .0IlOSDl 199!aI99,. 7:C .0110192 zaos S:c
U:C .000556 1995al998 9:C .000Z47 200" 4%
SOX .000274 1999 7lC .01111192 ZOIlS S%
lOX .00027" ZDOO 7X .0110192
V..r
I'm
1985
1984
1985
19116
1987
Oal1v
factor
,'1l1lmr
.000164
.000157
.000110
.000157
....Int.r..t 1. calculat.d .. fol10wII
INTEREST a BALANCE OF TAX UNPAIO X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
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b.vond th. data of the ........nt. If pav..nt II aad. aft.r th. Int.ra.t caaput.tJon d.t. shown on th.
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Q
IN THE MATTER OF THE PERSON I
AND ESTATE OF EDITH M. I
GIRARDI, an alleged I
incapacitated person I
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
94-0900 ORPHANS' COURT
IN REI PETITION FOR APPOINTMENT OF EMERGENCY GUARDIAN
FINDINGS
Consistent with the mandates of the Decedents,
Estates, and Fiduciary Code, and specifically 20 Pa. C.S.A.
5512.1, the Court makes findings with regard to the following
specific factsl
1. The alleged incapacitated person suffers from
degenerative dementia which manifests itself in a virtually
complete loss of short-term memory, which results in inability
on her part to recall the necessity to eat or to take medication
for a high blood pressure condition. She is surrounded by
intolerable living conditions. She has lost weight and would
not eat unless food were brought to her. She is not oriented as
to date nor can she retain information necessary to function in
her own homa.
2. While she is, obviously, a gentle and very
pleasant person who does not present a threat to anyone, her
incapacities impair greatly her ability to make decisions
necessary not only to her welfare, but to her very survival.
3. There ara no relatives in the area who are
available to assist Miss Girardi nor are there friends willing
and able to do so. While Mr. Robert Elicker, Esquire, has a
Power of Attorney, this is insufficient to assist Miss Girardi
in the management of her daily affairs.
4. The appointment of a plenary guardian is
necessary based on the nature of Miss Girardi's incapacity. The
. '
I
.
record of this case would suggest that Miss Girardi is coherent,
but her short-term memory is virtually nonexistent.
5. The duration of the guardianship is
indefinite in light of the testimony that her condition is
irreversible.
ORDER OF COURT
AND NOW, this 26th day of October, 1994, Robert
Elicker, Esquire, is appointed plenary guardian of the Person
and Estate of Edith Girardi, with all the powers and duties of
said position in accordance with the Decedents, Estates, and
Piduciary Code of Pennsylvania.
By the Court,
. A, J=L.
Anthony DeLuca, Esquire
Por Office of Aging
Rebecca R. Hughes, Esquire
For Edith Girardi
mal
;.
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IN THE MATTER OF THE PERSON
AND ESTATE OF:
Edith M. Girardi,
AN ALLEGED INCAPACITATED
PERSON
:
:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. qoo ORPHANS' COURT 1994
ORDER OF COURT
AND NOW, this <ilIAc day of (~at~tL{A..J
, 1994, upon
consideration of the within Petition, it is hereby ordered that the
E. Robert Elicker, II, Esquire be appointed as Emergency Plenary
Guardian of the person of Edith M. Girardi and that he shall serve
in that capacity until ~u.- t7t'Ll't.- ,~( (I/fU/t-t:
A Hearing in this matter shall be held(. on the t( tJ, b{ day of
&t.-t/-Lv\- 1994, at';: 30 n .m. o'clock, in Courtroom No.
,
t/ at the Cumberland County Courthouse, Carlisle, Pennsylvania.
tfuc e (ltL )J.tl(1/LI!~ &7" j :.w a.jJ~~:(/J1..& ~ /~ '/Le;p~{.ALV}'(~"C
e.ud 177, ~t1.d- L,LO. BY THE COURT,
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IN THE MATTER OF THE PERSON
AND ESTATE OF:
Edith M. Girardi
AN ALLEGED INCOMPETENT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
94-
ORPHANS' COURT
PETITION FOR APPOINTMENT OF EMERGENCY GUARDIAN
AND NOW COMES THE PETITIONER, The Area Agency On Aging, County
of Cumberland,
16 West High street, Carlisle, Pennsylvania who
prays this Court to grant the Petition and appoint E. Robert
Elicker, II, Esquire, as Emergency Plenary Guardian of the person
of the alleged incapacitated person, Edith M. Girardi, for the
following reasons:
1.
That the alleged incapacitated person is Edith M. Girardi, 77
years of age, who resides at 2 East Chestnut Circle, Camp Hill,
Cumberland county, Pennsylvania.
2.
That Edith M. Girardi is an unmarried woman whose only known
next of kin is a sister by the name of Elizabeth Lagune, age 80,
who has alzheimer's disease and resides at 103 Jefferson Avenue,
Lower Burrell, Pennsylvania.
3.
That there has been no family contact with the sister,
Elizabeth Lagune, in twenty-five (25) years.
4.
That no person is providing residential services to the
alleged incapacitated person, Edith M. Girardi.
5.
That the Petitioner requests that E. Robert Elicker, II,
Esquire, be appointed Emergency Plenary Guardian of the person of
Edith M. Girardi.
6.
That the proposed Emergency Plenary Guardian of the person of
Edith M. Girardi has no interest adverse to the alleged
incapacitated person but does have a power of attorney from Edith
M. Girardi which permits him to handle her business affairs.
7.
That Edith M. Girardi, has, for at least four (4) months, been
incapable of managing and caring for herself.
8.
That Edith M. Girardi exhibits symptoms of mental incapacity,
including but not limited to, absent-mindedness, eccentricity and
senility.
9.
That Edith M. Girardi's mental incapacity prevents her from
managing and caring for the affairs of her person and estate.
10.
That less restrictive alternatives are not available in this
matter because of her condition.
11.
That Edith M. Girardi's condition has deteriorated in that:
A. Her appearance and hygiene have gotten worse;
B. She is unkempt and disheveled;
C. She appears disoriented and confused;
"-.;,.r:;">';;.;",,,-~- .
o. She is unable to eupply adequate food for herself
and care for her home; and
E. She is unable to take her medication in the manner
prescribed.
12.
That a psychiatric evaluation has been conducted of Edith M.
Girardi which has resulted in a diagnosis of primary degenerative
dementia.
13.
That a recommendation made by Maurice J. Lewis, M.D., of
Susquehanna Internal Medicine Associates, pc., reflects that Edith
M. Girardi has a degree of cognitive impairment which requires 24
hour supervision to insure her safety.
14.
That the Petitioner has been advised that Edith M. Girardi has
the following physical conditions:
a. Hypertension;
b. Hyperlipidemia;and
c. Arthritis
15.
That less restrictive alternatives are not available because
there is no one able to care for her.
16.
That the approximate gross value of the estate of Edith M.
Girardi is approximately $145,000.00 and that she has monthly
income of approximately $1,700.00 from retirement and savings.
,
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That the Petitioner believes and, therefore, avers that a
Plenary Guardian of the person of Edith M. Girardi should be
appointed.
18.
That Edith M. Girardi has never had a Guardian of her person
previously.
19.
That no previous application has been made for the Order
herein asked for, or fer a similar Order.
20.
That no other Court has ever assumed jurisdiction in any
proceeding to determine the incapacity of Edith M. Girardi.
21.
That failure to appoint E. Robert Elicker, II, Esquire as
Emergency Plenary Guardian of the person of Edith M. Girardi will
result in irreparable harm to the person of Edith M. Girardi.
WHEREFORE, Petitioner prays that this Honorable Court appoint
E. Robert Elicker, II, Esquire, to be the Emergency Plenary
Guardian of the person of Edith M. Girardi.
Respectfully submitted,
A~~~UC:~~~
113 Front street
P.O. Box 358
Boiling Springs, PA 17007
(717) 258-6844
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VERIFICATION
I hereby verify that the facts and information set forth in
the foregoing Petition are true and correct to the bsst of my
knowledge, information, and belief. I understand that any false
statements contained herein are subject to the penalties of 18 Pa.
C. S. section 4904, relating to unsworn falsification to
authorities.
Dated:
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COMMONWEALTH OF PENNSYLVANIA
OFFICE OF ATTORNEY GENERAL
May 1 0, 2005
TOM CORBETT
ATTORNEY GENERAL
Charitable Trusts and
Organizations Section
14th Fir., Strawberry Sq,
Harrisburg, PA 17120
Telephone: (717) 783-2853
Facsimile: (717) 787-1190
E, Robert Elicker, II, Esquire
20 Stone Spring Lane
Camp Hill, PA 17011
RE: Estate of Edit M. Glrardi/ No. 21-94-0900
Dear Mr, Elicker:
This will acknowledge receipt of your notice pursuant to Supreme Court Orphans'
Court Rule 5,6 regarding the above-captioned matter.
I have reviewed your First and Final Accounting and Statement of Proposed
Distribution as Executor of the Estate of Edith M. Girardi, Deceased and have no
objections, At your earliest convenience, kindly forward executed copies of the charities
receipt and releases.
Please be advised that this review was conducted pursuant to the parens patriae
function of this office and has no bearing on any matter unrelated to that function, Be
further advised that this no objection is based on the Information submitted to the Office of
Attorney General and therefore is conditioned upon Its accuracy submissions or omissions.
JLD/srh
Sincerely,
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on, oWning ~'" N
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Deputy Attorney General : ~; ;,~:: ~:
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n.ELEASI~
Fr. Stephen HuCfstetter,SCJ
I. ~i>>/l<D~~lMill:}l., SCJ, Director. St. Joseph's Indinn School, of
Chnrnberlnin, South Dnkotn. ncknl1wledge tllllt I IIIn nuthorized to net in the clIpncity ns
heretofore stntcd on behnlfofSt. Joseph's Indian School, 10 receivc funds on its behulf
lInd to rcleuse the executor nnd nllomey inthc estnte of Edilh M, Girurdi upon receipt of
funds from the Estnte pursunntto the Will of Edith M, GlIrnrdi.
I ueknowledge thntupon receipt ofa chcck from the Estnte of Edilh M. Glrnrdi in
the amount of Thirty Six Thousund Nine lIundred Fifty Fil'e nnd 36/100 ($36,955.36)
Dollurs, I remise, release, quit elnimand forever disehurge the suid executor and allomey,
E, Robert Elicker, II, his hcirs, nssigns and successors fwm nil actions. suits, puyments,
neeounts, reckonings, clnims und demnnds whntsoel'er in the mntter of the Estate of Edith
M. Girnrdl from the dnte of birth ofEdilh M, Girnrdi to the dny of the dnle ofthesc
prcscnts.
IN WITNESS WHEREOF, 111I11'c hereunto sctmy hnnd nnd senlthc
?~th dnyof April ,2005.
WITNESS:
t~
(SEAL)
~~Ik ~ Fr. Stephen Huffstetter, SCJ
for and on behnlf of St. Joscph's Indinn
School
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STATE OF SOUTH DAKOTA
: 55:
COUNTY OF Brule
On this, the 25th day of April
2005, before me, the undersigned officer, personnlly appeared 1Mt~~ltS~
Fr. Stephen Huffstetter, SCJ
director, St. Joseph's [ndinn School, known to mc (or satisfactorily proven) to be the
person whose name is subscribcd to the within instrument, and acknowledged that he is
authorized to sign the release for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
~1A\O #~Avf
tary Public t?
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RELEASE
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I, JAMES M. McDONALD, CPA, finnnce director, St. Lnbre Indlnn School,
Educntionnl Associntlon, of Ashlnnd, Montnnn, ncknowlcdge thnt I nm nuthorizcd to nct
in thc cnpncity ns hcrctoforc stnled on bchnlf of Sl. Lnbrc Indinn School, Educntlonnl
Assoclnlion, to rccelve funds on its behnlfnnd to relense thc exccutor nnd nttorney in the
estnle of Edith M, Girnrdi upon receipl of funds from the Estnle pursunnt to the Will of
Edith M. Gnrnrdi.
I ncknowledge thnt upon receipt of n check from the Eslnle of Edith M, Girnrdl In
the nmount of Thirty Six Thousnnd Nine Hundred Fifty Five nnd 35/100 ($36,955,35)
Dollars, I remise, release, quit claim nnd forever discharge the said executor and attorney,
E. Robert Ellckcr, II, his heirs, assigns and successors from all actions, suits, payments,
accounts, reckonings, claims and demands whatsoever in the matter of the Estate of Edith
M, Girardi from the date of birth ofEdllh M, Girnrdl to the day of the date of these
presents,
IN WI'6SS WHEREOF, I have hereunto set my hand and seal the
0'2 S day of ,+/U' ( , 2005.
WITNESS:
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STATE OF MONTANA
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COUNTY OF ((.(J se/:::llt d
On this, the OZ 5" tJ.. day of +n:J
2005, before me, the undersigned officer, personally appeared JAMES M.
McDONALD, CPA, finance director, St. Labre Indian School, Educational Association,
known to me (or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that he is authorized to sign the release for the
purposes therein contained,
In witness whereof, I hereunto set my hand and official seal.
(SEAL)
SUSAN SCHIPMAN
NotaIy Public lor \he SIal8 of Montann
ResIding at Ashland, MT
CommIssIon ExPires: Apr1l13. ~
~:STATE NO, 11.94.0900
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I'IItST AND FINAL ACCOUNT AND STATBMBNT 01' 1'llOl'OSHlJ
DISTIUIIUTlON 01' AND IIY E. IlOllI!ItT BLICK 1m, II BXBCUTOIt
OF TIIB I!STATB AND UNDI!It Till! LAST WILL AND TI!STAMIlNT
01' 1l00TII M. GIRARDI, DIlCIlASED, LATll OF TIIB TOWNSIIII'
01' NORTII MJlJDLBTON, CUMIIEItLAND COUNTY,I'IlNNSYLVANIA
Il, Itobert llIieker, IIllxeeutor us aforesaid and Accountant herein,
livers as follows:
DATil 01' IJECIlDIlNT'S DIlATII:
DATU LBITIlItS TIlSTAMBNTAItY ISSUED:
DATBS BXBCUTOR'S NOTICB ADVI!RTISED:
Cumberland Law Journal
The Sentinel
FlltST AND FINAl. ACCOUNT
November 19, 2004
December 7, 2004
December 24, 31, 2004, January 7,
2005
December 15, 22, 29, 2004
I'~:RSONALTY - PIUNCII'AL ACCOUNT
DEIIITS
The Accountant charges himselfwilh the receipt of the Decedent's personalty,
goods and ehollels os set forth below:
PERSONALTY -I'IUNCII'AL ACCOUNT
CREDITS
I, PNC Bonk, Certificate of Deposit
aeemed interest
2, PNC Bonk, checking occoont
3. PNC Bank, Savings account
aecmed interest
4. PA State Bank, Savings aeeoont
5. Chorch of God lIome, promted refund for
November 2004
6. Chorch of God lIome, rcfund from personal account
7. Federal Bmployees' Group Life Insllrnnee payment
8. United States Treosory, Federal Bmployees' IlIlllp slim
death payment
9. Tangible personal property items and clothing dllnated to
Church ofOod lIome
TOTAL,I'EItSONALTY,I'IUNCII'AL ACCOUNT, DEli ITS:
S 10,687.37
47.93
2,450.84
1,003.79
.17
60,094.40
1,997.28
83.94
5,009.45
1,535.65
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S 82,910,82
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The Accountant claims credit for the payment of the following Items from
Decedent's Personalty I'rinelpol Account:
I. Continning Care RX, tinol hili, dn.gs
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2. Drs. Currie & IIcchl, tccth cxlrocllon
3. IlofTmon RolIll'uncrollloll1e, Crcll1otlon scr\'lccs und urn
4, Grecnwood McmorlnlPork, opcn/closc Ilro\'c ond Ilru\'c morkcr
5. RClllslcrofWllIs, probolc fccs
6, Cumbcrlond Low Jountol, nd\'crtisinllleltcrs
7, Thc Scnllncl, ud\'ertlslnlllcltcrs
8. UPS Slorc, shipping churgcs
9, Rcglslcr of Wills, n1ing fces for Inhcrilonce lox relurn
ond counly In\'cnlory
10. Rcglslcr of Wills, short ccrtificUlc
II. Grccnowoll ond Compony, prcporollon of IInol incomc lox rclunts
12. E. Robert Elickcr, II, oltontey fccs
13. Rescl'\'e for occounlonl fccs for finolfiduclnry income lox relunts,
filing fces ond mlscelloneous cosls
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS:
PERSONALTY -INCOME ACCOUNT
DEBITS
The Accounlont chorgcs himsclfwllh the rcceipt ofthe following
income from the In\'eslmcnl ofPersonully Prlnclpol:
I. Intcrest- PNC Bonk Certlficote of Deposit
2, Intcrest- PNC Bonk sovings occount
3. Intcrest- PA SIDle Bonk, sovlngs occount
TOTAL,PERSONALTY, INCOME ACCOUNT, DEBITS:
PERSONALTY -INCOME ACCOUNT
CREDITS
The Accounlonl c10lms credit for the poyment ofthc following Itcms
from thc Personolly Incomc Account:
TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS:
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<f~o,,:-~j'?:f,$J~~~!i~""Z;K""~~'::.:
180.00
1,669.08
2,050.00
231.00
75.00
107.99
24.29
30.00
4.00
175.00
4,000,00
1.000,00
S 9,585.5 I
S 16.37
.34
568.69
S 585.40
NONE
NONE
NO ItEAL ESTAn:
IU:CAI'I'J'U1.A TION
PERSONALTY:
PRINCIPAL ACCOUNT:
Debits
Crcdlls
$ 82,910.82
$ 9.585.5 I
Dnlnnee
$ 73,325.31
INCOME ACCOUNT:
Debits
Crcdlls
$ 585.40
S-...:.ll.:
Dnlnnce
S 585.40
NO REAL t:STATE ACCOUNT
TOTAL FOR D1STRIOUTION:
$ 73,910,71
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COMMONWIlAL TII 0" I'IlNNSYL VANIA
SS:
COUNTY 01' CUMBIlRLAND
Il. Robert Illleker, II, being duly swom uccordlng to IlIw deposes IInd suys: thllt he Is the Ilseculor
of the Ilstute and under the Lust Wlllllnd Tcslllment oflldith M. Ginmll, Deceased: thllt he is thc
Accountllnt herein: thllt the foregoing Is II true IInd complete IIccounting of his udministrutlon of suld Ilslule;
thlllthe uUached list or schedule (.) contains the nllmes, IIddresses IInd umounts due unpllid creditors who
hllve given proper notice of their claims: thllt Ihe nllllehed list or schedule (..) eontulns the nllmes und
uddresses ofull persons/endUes interested in the distribution ofsllid Ilstllte: IInd thut the fllcts set forth
herein lire lrue and correct to the best of his knowledge, Infonnlltlonllnd bcllef.
!:4i.ioJ 4
Il, Robertlllicker, II, Ilseculor
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Sworn 10 and subscribed befor71.A n
melhls cJ.Dr dllyof 'I-I~
2005.
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L"- 1/"",,;,IS<<1I J
nridr.:1 All" Corn1mn. Notllry PubU;
Cllrlt~'e UtI"'. Cum~rJ,md CUlIlll)'
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· UNI'AID CIU:IlI1'OItSI
NONIl
.. .:NTITn:S INTJ.:IU:Sn:J) IN nrSTlUIIUTION Oil .:Sl'An:1
I, St, Joseph's Jndlnn School
Chnmberlnln, SO 57326
2, St. Lnhrc Jndlnn School, Ildocnllonnl AssoeJnllon
1'.O,nox216
Ashlnnd, MT 59003
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STAn:MENT m'l'ltOl'OSED mSTlUlIUTION
E. Robert Elicker, II, Exeeutur and Aecounlanl herein, proposcs to
dlstrlbuta Ihe balance of the Uslate ofEdllh M. Girardi. Deceased, 10 wit:
$73,910,71 In accordance wllh the Lost Will and Testol1lent ofsuld Dccedent
us follows:
I, St. Joseph's Indian School $ 36,955.36
2. St, Lnbre Indian School, Uducallonal Association 36.955.35
TOTAL DISTIUnUTJON
$ 73,910,71
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COMMONWI!ALTIIOJlPI!NNSYLVANIA
COUNTY 011 CUMUl!ltLANI>
ss:
Il. Robert I!Ileker,lI, belnll duly XWOrll IIccllnllllllllllllW, depoxex 111111 XIIYX tllllllhe Olelx xcI forth
IlIlhe forelloillll SllIlelllenlofPrufloxed I>ixlrlhullllllllre lrue 111111 correcllolhe bexlofhlx knowledlle,
illforlllllliollllll" hellef,
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I!, Rohert Illlcker, II, Execulor
Sworn 101111" sobscrlhed be ore l11e
Ihlx C).?;I- dnyof 2005.
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October 13, 1994
Cumberland County Office Of Aging
Attn: Priscilla Whitman
Human Services Building
16 W. High Street
Carlisle, PA 17013
RE: EDI'lli GIRARDI
Dear Ms. Whitman,
Edith Girardi has been a patient in this practice since 1988. She has been treated for
hypertension, hyper1ipi~emia and arthritis. Over the past 2-3 years, she has been noted
to have progressive dementing illness causing gradual impairment of her memory. She was
subsequently evaluated by Dr. Ali Ahmed and Dr. Shiv Aggarwal, whose diagnosis was a
primary degenerative dementia.
I feel that at this point, the patient is incapacitated due to her cognitive impairment
and requires 24 hour supervision. She is unable to care for herself due to the severity
of this impairment.
If I can be of any further assistance, do not hesitate to contact me.
Very ii~ncerelY'
t.(.
Maurice .
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M.D., F.A.C.P.
.. PElInONER'S
II EXHIBIT
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Medical Arl, Building . Suil.508 . 890 Popl"r CllIlr.J, R,nd . c'mp I-W, Prllln 17011 . (717) 761.3875
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E, ROBERT ELICKER, II
AlIorney lit Lllw
20 Stone Spring Lllne
Cllmp lIiII,l'A 17011
717-240-6535
December 7, 2004
Heather J, Vance-Rittman
Deputy Allomey General
Charitable Trusts and Organizlltions Section
141h Floor, Strawberry Square
Harrisburg, P A 17102
RE: Estate of Edith M. Girardi, 1994-00900, Cumberland County,
Pennsylvania
Dear Ms. Vanee-Rillman:
I am executor of the above referenced cstatc: thc Will has becn filed with thc
Rcgister of Wills of Cumberland County (a copy of which is cnclosed) providing for
bcquests to St. Joscph's Indian School and St. Labre Indian School, A copy oflcllcrs arc
enclosed front thc schools showing their addrcsses and thc name of 0 contact person that I
can communicatc to as I proceed with the selllcment of thc estate.
Lellers tcstamentary were issued to mc on Deccmber 7, 2004. My uddrcss is os
stated abovc in thc Icller-hcad, It is my understanding thut upon completion of the final
account and schedule of distribution, a copy should be provided to your office.
Very truly yours,
E, Robert Elicker, II
Allorney at Law
Enclosure: Lellers and Will
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CEIn'IFICATION 011 NOTICE UNUEIt IWLE 5.6(0)
Name of Deccdent:
Edith M, Girnrdi
Date of Dcath:
November 19, 2004
WlII No.:
1994-00900
To thc Rcglster:
I certify that notice of (benenchlllnterest) estate admlnlstralloll requlrcd by
Rule 5,6(a) of the Orphans' Court Rules was served on or mailed to the following
benefielarles of the above-captioned estate on December 7, 2004:
St, Joseph's Indian School, Chamberlain, SO 57326
Atlention: Deacon David Nagel, SCJ
Director
St. Labre Indian School, Educational Association, P,O, Box 216, Ashland, MT 59003
AUenlion: James M. McDonald, CPA
Financial Director
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Date
[)J&ta.L-t
Signature
E, Robert Elicker, II
Atlorney at Law
20 Stone Spring Lane
Camp Hill, PA 17011
Telephone (717) 240-6535
Personal representative
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