HomeMy WebLinkAbout03-02-15 (3) J . pennsylvania 15 0 5 61410 5
DEPAF�MENTOFflEVENUE
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 28o6oi INHERITANCE TAX RETURN /
Harrisburg, PA 17128-0601 RESIDENT DECEDENT Z� � O � � 10 U
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01152010 05291920
DecedenYs Last Name Suffix DecedenYs First Name MI
Girondi Eva _ R
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
p 4.Agriculture Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Kari E. Mellinger (717) 234-7828
First Line of Address
3513 North Front Street
Second Line of Address
City or Post Office State ZIP Code
Harrisburg PA 17110
Correspondent°S ema�i ada�ess: kmellinger@rjmarzella.com
,.,
REGkSTER OF WILL$�E OIyLY E-;-y
C::: �
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REGISTER OF WILLS USE ONLY _.." �j � <�!;7 t-�
DATE FILED MMDDYYYY ` -' -�,_i `x'� "`
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DATE FILE�D ST'ANI`P -�
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PLEASE USE ORIGINAL FORM ONLY
Side 1
(I��I�I�I��I�III�����I�I�I��I��)�I'I��I��I II�I���I�I���I I��I
� 1505614105 15056141�5 �
h
� 1505614205
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedenes rvame: Ev8 R. Girondi
RECAPITULATION
1. Real Estate(Schedule A). .. . .. . .. . .. . . . .. .. .. .. .. . .. . . . . . . .. . . . . .. .. . 1. 0.00
2. Stocks and Bonds(Schedule B) . . . . . . .. . . . . . . . .. . . . . .. .. .. .. . . . .. .. .. . 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 0.00
4. Mortgages and Notes Receivable(Schedule D). . . . .. .. .. . . . . . . . .. . . . .. . . . 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . . .. 5. 107,492.30
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . .. . 6. 0.00
7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .. .. . . 7. 0.00
8. Total Gross Assets(total Lines 1 through 7). . .. .. .. .. . . .. . . . .. .. . .. .. . . . 8. 107,492.30
9. Funeral Expenses and Administrative Costs(Schedule H).. . . . . . . . . .. . .. . . . . 9. 12,077.77
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I).. . . . . . . .. . . . .. 10. 0.00
11. Total Deductions(total Lines 9 and 10). . . .. . . . . . .. . . . . . . . .. . . .. . . . .. .. . 11. 12,077.77
12. Net Value of Estate(Line 8 minus Line 11) . . . . .. .. .. .. .. . .. .. . . . . . . . . .. . 12. 95,414.53
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. 95,404.53
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 0.00
(a)(1.2)X.0_ 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.045 95,414.53 16. 4,293.65
17. Amount of Line 14 taxabie
at sibling rate X.12 0.00 �7, 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 0.00 �g 0.00
19. TAX DUE . . . .. .. .. .. .. . .. .. . . .. .. . . . .. .. .. .. . . . . . . . . . . . . . .. .. . . . .. 19. 4,293.65
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF PERSON RESPO SIB OR FILING R TURN DATE
�' bz o 3 �/s
ADDRESS
1440 Amherst Court, echanicsbur , PA 17050
SIGN RE F P AR OTH P SPONSIBLE FOR FILING THE RETURN DATE
AD ESS
3513 North Front Street, Harrisburg, PA 17110
�I'�I'I I�����IIII��I�)�III��II�I II�II�I�I'II��I��I�I'��I I��) Side 2
� 1505614205 1505614205 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Eva R. Girondi
STREETADDRESS
1440 Amhert Court
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,293.65
2. Credits/Payments
A.Prior Payments 0.00
B.Discount 0.00
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 4,293.65
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decetlent make a transfer and: Yes No
a. retain the use or income of the properry transferred .......................................................................................... � �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
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 trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Ditl decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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)(1.1)(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 naturai parent, an
adoptive parent or a step-parent 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(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.
REV-iso8 EX+(o8-iz)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCETAXREfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Eva R. Girondi
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
� IRA=PSERS 7,089.90
2 Vanguard GNMA Account,Acct#9958606890 39,344.68
3 Wachovia Bank Checking,Acct#10092595664 5,251.72
4 Fulton Bank Checking,Acct#9903-64182 414.33
5 Survival Action Settlement(Less 40%of attorney's fees and costs) 55,391.67
TOTAL(Also enter on Line 5, Recapitulation) $ 107,492.30
If more space is needed, use additional sheets of paper of the same size.
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, ��l�dE�I.�2.�L�[�SE A1�T� ��'�"�"I.�Ii�I�T'AGId�EI+���'
Tft� tt�dE�•signed, A�ff��d ��r���1i9 ��e, I��F�T�d���13r ��c3 �� �d����aF��r�t��- �a� �h�
E���te €af ��a ���°�a�adi, (hereir�aftee referr•ed to as the "�eleasQrs"), declare €k�at, for ai�d in
consideration af I�i���g�-��v� �'hous��� (��S,OQ�.0�3} ����a�°� (here�nafter referred ta as the
"settlement funds"), the receipt of which is h�reby�cknawledged on behalf�f the ��t�te mf�va
GirQndi, its heirs, Administrators, successors and assigns, do forever retease and discharge
li�anor C�.re of Carlisle PA, I.LC, IO�I�a�mr IIeal�hcare C�rp., I+a���orcaa-e �ae�l�h Services
Carlisle, Heafh C�re ��ad Retire�►e�at Corpor�tiQn of Aafla��ica, 1��.�►�r C�re af Amei•aca,
Inc., 1Vlanorcare, Ia�c., I�CR l�a�aor Caa°e, Inc., �ICR 1Vlano�° Care, tl�eir owners, officers,
directors, �xeczttive staff, rr►anagers, ag�nts, serva.nts, nursing sta�f, employees, insurers,
reinsurers, parents, subsidiaries, predeeessars, successars and assigns, and all other persons,
firms, corporations, associations, partnerships, affiliates, subsidiaries and entities whatsoever,
affiliated or associated with the above, whether named above or not (hereinafter collectively
referred to as "Releasees"), of and from any and all actions, causes of actions, claims, demands,
or damages of whatever kind or nature, includ'uzg any and all clairns which were the subject
matter of the lawsuit entitled, Alfred Girondi, Jr., Individually and as Adaninistrator for the
Estate of Eva Girandi v. James �Iarty, 1VI.D. Manor Care of Carlisle PA, LLC, Manor
Healthcare Carp., l0�danorsare health Services Carlisie, I-€eath Care and Retirearient
Corporation of America, Manor Care of Anaeriea, Inc., 1Vlanoreare, Inc., HCR 1VI�nor
Care, Inc., gICR Manor Care, Court of Common Pleas of Cumberland County, No. 11-5324,
which shall be dismissed with prejudice in accordance with the Rules of Court.
The ut�dersi��d (�eg•eby dectare �le� rep�°�se��t th«t a11 �laapns which h�v� or �r�a}� b�
asserted, znclt�ctirtg canditiop�s, �.����ch vaer� ar r�1ay �tave b�en �erman�nt at�c� �ndeftn�te a��
��huily�-�leased, af�d that in �naking t�iis Retease it �s understood an� agreed that the undersigr�ed
re�ied whcally upan their �udgme�t, beiief, and lc�lowledge of the nature, extent, effeet and
duration af said injuries or possible injuri�s and laa6ili�y therefore, a;�d that this Release is �nade
without relia�Ice upon any st�tement or represeni�tion by the Releasees or their representatives,
the making of any such statemer�ts or representations being specifcally denied.
The Releasors and their attorney further agree to satisfy any and all liens, inctuding those
asserted by Medicare and Medicaid. In arder to do sa, the Releasors and their attorney fi.irther
declare and agree to set �side and hold ia� trust a sufficient amcur�t frc�rr� the settlement funds to
satisfy �ny and ail liens asserted by Medicare and Medicaid and agr�e that th�se funds will not
be releas�d to any other persan until the liens have been satisfied fully from those funds. The
Releasors or their attorney will forvvard to defense counsel, upon receipt, documentation from
the lien holders confirming that the liens have been satisfied. The Releasors further agree to
indemnify, defend and hold harmless Releasees from any and all claims arising from any liens.
It is understood and agreed that this paragraph is intended to preclude any further claims or
actions against the Releasees seeking reimbursement for liens, and, in the event of any such
claims or actions, to make Releasors responsible, legally and financially, for any such claims or
actions.
It is expressly understood and agreed that this Release and Settlement Agreement is
intended to apply to and does apply to not only all now known injuries, losses and damages, but
further operates to release, acquit and forever dis�harge any and all claims or actions for any �
2
fur�h�r Iosses arld aarrtages ��i�ich �rise from or �re r��ated to, the occurrer�ce set fa��th in t1��
taws�it noted above.
It is understood and agreed that tl�is �e�ttement is a c�mpromise of a �aubtful and
disp�tea claiin, and t1�at the payment gnade is nQt to be canstru�d as an adinissio�l of lial�ility an
the part af the parties hereby released, and that said Rel�asees deny liability and intend inerely ta
avoid litigation and b�ay their peace. Further, it is understood and agreed that Releasors will fle
all necessary d�cuments seeking court approval of this settlement, and that no fimds will be paid
without express approval by a court of competent jurisdicti�n.
It is further understood and agreed and made part hereof, that the undersigned, their
family, representatives and attorriey(s) fi�rther ackriowledge and agree that the terms, conditions
of this settlement, including any payments made hereunder, shall re�nain strictly confidential and
shall not be discl�sed or made known to any third person or party unless such disclosure is
required by law or to satisfy any and all liens.
It is further understood and agreed that this is the complete Release and Settleflnent
Agreement, and that there are no written or oral understandings, or agreements, directly or
indirectly connected with this Release and Settlement that are not incorporated herein. Further,
this agreement shall be binding upon and inure to the benefit �f the successors, assigns, heirs,
executors,Administrators, and legal representatives of the Releasors and Releasees.
Alfred Garoa�di,Jr., Indivisluaply and as Administrator for the Estate of Eva Girondi
hereby declares that the terms of this Release and Settlement Agreement have been completely
read; and has discussed the terms of this settlement with the legal counsel of his choice, Robin J.
Marzella, Esquire, and that said terms are fully understood and voluntarily accepted for the
3
purp�se�f makitag a f�lI and �na( camprornis� of arzy�nd ai1 clair�s on accau��t of tl�e darnages
and Iosses mer�tioned ab�ve aa�d fi�rther for�he express p�rpose of precludir�g forev�r any f�rthex
or�dditic�nal suits by Releas�rs.
C'AIT�'I�I�I, 12�AD �EFO�E SIGI�II�TG r �
�1`�T W��'PdE�s�'I-I��OF,we have hereunto s�t our hand a��d seal this �l ��day of
— ,2013.
� ��
�
�.�c—Cl�.-�,c _r) �-C��.,�.2 �
r�l�r��d Gi�oaadi,Jr.,�nd'avidually��id as
Admin�str�tor for the E�tate of Ev� �aronai
r �.��
On thi��� day of ;��1`�'�%'_ , 2013, befo�e me,
a Notary Public,personally appea�d Richard Kazimer to me
known as the persons who executed the foregoing Release and
who acknowledged to �e that they voluntarily executed the same.
'� �' �; � �
��J `� �� � �� ���
�
NOTARY PUBL�
COMMONWEALTN OF PENNSYLVNdip
NOTA IAL SEAL
RACHEL A TINGLER
NWary PubNc
HARRISSURG CITV,DAUPkiN COUNTY
My Qommtadon�xpirea May 8,2017
4
P.O.Box 61013 (117)234-8484(Harris6urg)
Narrisburg,PA 11106-7013 (800)237-7328(Nationwide)
website - http://�+W Psecu.com
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THE FAIR MARKET VALUE, (FMV
OF YOUR IRA WILL BE REPORTED
TO THE INTERNAL REVENUE
SERUICE
ANNUAL IRA—SUt1MQRY
EUA R GIRONDI FOR GALENDAR YEAR 2009
�— PAGE 02
�APYE = ANNUAL PERCENTAGE YIELD EARNED
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IRA TYPE: TRADITIONAL CONTINUED 6r�.0i
� IRS WITHHOLDING . 0.00
IROLLOVERS 41.80
i NOM TAXABLE DIVIDENDS 7�pgg,90
�. FAIR MARKET VALUE 621.92
2010 RMD
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._ . __ I — �
5004511
OY02 000 054 6 ------------------------- 'I
— --Js I '� I �
DECEMBER 31, 2009
i �
v�ll�l�d0 Vanguard GNMA Fund _
Admirai Shares
.�A R GIRONDI i
ALFRED J �IRONDI 8 �" ACCOUNT VALUE • CHECK
RITA ANN GIRONDI p 5118,034.03 CONFIRMATION
f JT T�N WROS .�.�
1440 AMNERST CT �� FUND NUMBER 536
MECHANICSBURO PA 17050-8348 ACCOUNT NUMBER 9958606890
CHECK NUMBER 19943985
ACCOUNT SERVICE
CALL 1-800-2847245
Trade Transaction Doilar Share Share Shares
Date Descri hon Amount Price Amount Owned
BEGINNING BALANCE 12,867.428
10/30 Income dividend cash 390.14 0.000 12,867.428
11/12 Sell electronic bank transfe -20,000.00 10.82 -1,848.429 11,018.999
__.__.11«Q._:. )ncame.divi end cash.___._ �__�_._ ____ 335.42 0.000 11,018.999
12/30 ST cap gain .052 �572.99 �10.66 4 —�53.7 ` 11;072:'75� ' ' --`
12/30 LT cap gain .02 220.38. 10.66 20.674 11,093.424
12/31 Income dividend cash 295.25 0.000 11,093.424
PAID THIS Income + Short-term + Long-term = TOTAL
CALENDAR Dividenda Oalna Gains DIST818UTION3
YEAR
5,441.37 572.99 220.38 6,234.74
THf CURRENT DISTRIBUTION LJSTED ABOVE WAS PAYABLE ON JANUARY 4,2010. eese
I I11111 IIIII illll Iilll 111lI Iilll IIIII IIIII IIIII Ilili iilll Ililll IIII Illl IIII -
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i 1010092595664 ` CROtiNN CLASSICBKG ` 15,735.8i i2/28 - � —
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WACNOVIA BANK,N.A., CAMP HlLL page 1 of 5
JI
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; ��7�� 1057 0033 40317 Y
J
LISTEfVING 15 JUST THE BEGINNING.'"
STATEMENT OF RCCOUNTS
� 9903-64182 X
STATEMENT PERIOD
FROM THROUGH
, 12-01-09 12-31-09 7
EVA R GIRONDI PAGE 1 OF 1
i RTTA ANN GIRONDI
, ALFRED J GIRONDI 0 ENCLOSURES
VILLAGE OF BRANDYVJINE
1440 AMHERST CT �
MECHANICSBURG PA Z7050-8348
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Fl7L-l"bN FUND-'' - -- ._.------------- . 9�0`3=6-4�28Z '—
i -_-A�Z.bUNT�- - ---_-_--
i PREVIOUS DEPOSITS/ CHECKS/ SERVIC£ �NDING
; STATEMENT BALANCE CREDITS 1 DEBITS 4 FEES BALANCE
' 1,242.77 .21 .00 .00 1,�42.98
�
i ACCOUNT/INTEREST INFORMATION
! INTEREST PAID THIS YEAR 2.46
i
, DATE ACTIVITY DESCRIPTION REFERENCE �C�DITS/ DEBITS/ BALANCE
�' 12-01 BEGINNING BALANCE X�2�2.��
12-31 INTEREST CREDIT .21 1,242.98
12-31 ENDING BALANCE 1.242.98
' �`�� ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM 12-01-09 THROUGH 12-31-09 �`^� �
ANNUAL PERCENTAGE YIELD EARNED .24�
AVERRGE DAIL1' C4LLECTED BALANCE 1,242.77
INTEREST EARNED .21
SERVICE FEE BALANCE INFORMATION FROM 12-d1-09 THROUGN 12-31-09
AVERAGE LEDGER BALANCE 1,242.77 AVERAGE COLLECTED BALANCE 1,242.77
MINIMUM LEDGER BALANCE 1,242.77 MINIMUM COLLECTED BALANCE 1�242.77
EFFECTIVE DECEMBER 12, 2009 - OUR FUNDS AVAILABILITY POLICY
HAS �HANGED." FUNDS DEPOSITED INTO YOUR ACCOUNT WILL
GENERALLY BE AVAILABLE ON THE FIRST BUSINESS DAY AFTER THE
DAY WE RECEIVE THE DEROSIT.
(
DIRECT FULTON BANK, N.A.
INQUIRIES TO: PQ BOX 50�t
�AST PETERSSURG, PA 17520-0544 Fm��B�„�,r.�
TELEPHONE: 717-581-3000 OR 1-800-FULTON4 tdembcxF.D.LC.
rmt�m,S.cem
Page I
REV-1511 EX+ (08-13)
��� ' SCHEDULE H
� � �pennsylvania
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Eva R. Girondi
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A• FUNERAL EXPENSES:
1' Neill Funeral Home Bill
10,700.20
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
Z� Attorney Fees: 1,306.67
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: 70.90
5• Accountant Fees:
6• Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 12,077.77
If more space is needed, use additional sheets of paper of the same size.
NEiL UNERAL HOIlJ1E 7��i � i�at�.u�,�0���
3 " MARKET STREET
CAMP H{LL, PA 17011
r��-7s7-s�Zs INDIVIDU2iI, CASH RECEIPT
nxrF: /�G�V /�(� t�ccouNT�a. /y/!__1_Sl_������ 7��,��
ACCT/GONTlt.lv��IE
�� C I����_I �ccricc�vTx.Nc�. s
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12F.CEIZ'ED F120�I/Y �I���(1 �� CK�/C.G.:'1PPK0�:1I.# ��
C.C.'fYAis
DESCRLPTIO\
TRliST N�. $
C�/i.�CC1: �
����:�� ❑ �_as�� �o�oa ao
BY � �(.i( '�.C/! � CRLll'f CARD � DEI3TT TC)3'�I. �
GE\'S(HA{3/OR) TH�NK YOU
R1ute-Ca�tumer Cop;� Yelloc�-Conaacc File Pink-Gontrol Copy
--''—_— -- _—. .— — — — — -— — --------- --—-
-- -- -- — — — — --
---�—----- - - $2j995.Q0 $2,99L:00 �
Basic Profiessionai Service Fee Incl lncl —
i ransferring Remains to�uneral Home incl incl ___
Funeral VehiclelHearse incl ]nci —
Service Vehicle �nc� Incl __
Total Package Offerings $2,995.00 $2,995.00 __
Care and Preparation of Remains
Embaiming �795.00 �795.Od __.
Total Care and Prepara�on of Remains $795.00 $795.00 __
Use of Facilities and Related Services
Religious Facility Funeral Ceremony $495.�0 $495.00 ___
Total Use of Facilities and Related Services $495.OU $495.00 ___
Other Goods and Seroices
Flowers $417.70 $417.70 __.
Memorial Package $85.0p $85.00 ___
Total piher Goods and Services $5p2.70 �saz.�o ___
Merchandise
GOLDEN PEARL $2,395.OQ 52,395.00 �
The Eagle Sentinei Vault $1,395_00 $i,395.00 —
Time Sheet
Date Work Performed Attorney Time
12/21/11 Dept of Rev— Inh. Tax Return CVS .3 (18)
02/03/12 ROW—Status Report CVS .3 (18)
02/13/12 Rec'd TS'ed Status Report CVS .1 (6)
O1/03/13 ROW—Status Report CVS .3 (6)
O1/23/13 Rec'd TS'ed Status Report CVS .1 (6)
09/OS/13 Ltr to Client—Notice of Estate CVS .3 (18)
09/OS/13 R. Girondi—Notice of Estate CVS .3 (18)
09/OS/13 ROG—Cert. of Notice CVS 3 (18)
09/10/13 Rec'd TS'ed Cert. of Notice CVS .l (6)
09/29/13 Cumberland Law journal CVS .6 (36)
O1/6/14 Status Report CVS .3 (18)
1/14/14 Rec'd TS'ed Status Report CVS .1 (6)
1/30/14 Reviewed tax forms from son CVS .6 (36)
07/22/14 Ltr req. Estate info. From son KEM .3 (18)
07/28/14 Reviewed asset/debt information KEM .7 (56)
12/29/14 ROW— Status Report KEM .2 (12)
O1/07/15 Rec'd TS'ed Status Report KEM .1 (6)
1/27/15 Inheritance Tax Return KEM .8 (48)
1/28/15 Finalize Tax Return—Send to KEM ,7 (42)
Client for signature
Total: 6.5 hours
KEM= $200/hr
CVS=$200/hr $1,306.67
REV-1513 EX+ (01-10)
� pennsylvania SCHEDULE )
DEPARTMENT OF REVENUE
INHERITANCE TAX REfURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Eva R. Girondi
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RE oT otSL st T�ustee(S�NT AMOOF E�ATE ARE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• Alfred Girondi,Jr. Son 50%
2. Rita Girondi Daughter 50%
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 TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
A ' . A6
BRrY
I, GLENDA F,4RNER STRA SBA UGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 19th day of February, Two Thousand and Ten,
,T;ot+-�,-, Tcc�r�n��cniT�pv
__ .. . _ ,
in common form were granted by the Register of
said County, on the
es ta te of EVA R G/ROND/ , �a te of HAMPDEN TOWNSHIP
(Fi�st,Middle,Lasfl
in said county, deceased, to ALFRED JOSEPH G/RONDI JR
(First,Middle,Lastl
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 26th day of April
Two Thousand and Ten.
Fi 1 e No. 2010- 00160
PA File No. 21- 10- 0160
Da te of Dea th 1/15/2010
S. S. # 195-07-8891
:rJ..�' � �C� �,
R gister Of Wills
�-_ l�.l�. -'�..) l� ' �- '~�Q,9�.k'
Deputy
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
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