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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNlY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF JOANNE K. COOPER
, DECEASED
No. 2006-00094
PETITION FOR ADJUDICA TION I
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
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This form may be used in all cases involving the Audit of the Account of a Deced~~Estate.r-:'lf
space is insufficient, riders may be attached. Attach the spouse's election, if any; the paItH
required under items 8- J 9 inclusive; and any instrument pertinent to the adjudication.
INCLUDE A1TACHMENTS AT 11lE BACK OF THIS FORM.
Name of CmB1sel: Michael S. Travis
Supreme Court J.D. No.: 77399
Name of Law Firm: Attorney at Law
Address: 3904 Trindle Road. Camp Hill, PA 17011
Telephone: 717-731-9502
Fax: 717-731-9511
Furm DC-OJ rev. JO.13.06
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Page 1 oft 0
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Estate of JOANNE K.. COOPER
, Deceased
1. Name(s) and address(es) ofPetitioner(s):
Name:
Laurie J. Weller
Address:
108 May Drive No. 1
Camp Hill, P A l70ll
Identif}' any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . .. IZlYes [J No
If not, identify prior accountings, the accounting periods covered, and the date of
adj udication of the prior accounting.
2. Decedent died on December 26, 2004
121 Letters Testamentary or DLetters of Administration were granted to Petitioner(s) on
Date of Will (ifapplicable): May 10, 1993
Date(s) ofCodicil(s) (ifapplicable):
Date of probate (if different from date Letters granted):
Was a bond required? DYes IllNo If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... IZJ Yes D No
Dates of advertising of the grant of Letters: July 28, August 4 and 11,2006
(Cumb. Law Journal), July 21, 28 and August 4,2006 (patriot News)
FurmOC-Ol rev. 10.13.06
Page 2 of! 0
Estate of JOANNE K.. COOPER
. Deceased
3. Was decedent survived by a spouse'? . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Dyes IZ]No
If yes. name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............. Dyes DNo
~ee Section 2201 et seq. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
5. In the case of an intestacy, state the names of the decedent's surviving children or
surviving issue of deceased children (ifnone, so state):
6. Did decedent marry after execution of Will or Codicil(s)'? . . . . . . . . . .. DYes IZI No
Were any children born to decedent after execution of
Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Dyes [ZJ No
If yes, give names and dates of birth:
Name:
Date of Birth:
7. If required by the Medical Assistance Estate Recovery Act,
62 P.S. ~ 1412. was a request for a statement of claim sentto
the Department of Public Welfare? .............................. Il)Yes DNo
Form OC-OJ rev.10.JJ.06
Page 3 of 10
Estate of JOANNE K. COOPER
. Deceased
8. Written notice of the Audit as required by Pa O.C. Rules 6.3. 6.7 and 6.8 has been or will be
given to all parties in interest listed in item 9 below. all wtpaid creditors and all claimants
listed in item 10 below. In addition. notice of any questions requiring Adjudication as
discussed in item 14 below has been or will be given to all persons affected thereby.
A. If Notice has been given. attach a copy of the Notice as well as a list of the names
and addresses of the parties receiving such Notice.
B. If Notice is yet to be given. a copy of the Notice as well as a list of the names and
addresses of the parties receiving such Notice shall be submitted at the Audit
together with a statement executed by a Petitioner or cowtsel certifYing that such
notice has been given.
C. If any person entitled to Notice is not sui juris (e.g.. minors or incapacitated
persons). Notice of the Audit has been or will be given to the appropriate
representative on such party's behalf as required by Pa. O.C. Rule 5.2.
D. If any charitable interest is involved. Notice of the Audit has been or "'111 also be
given to the Attorney General as required wtder Pa O.C. Rule 5.5. In addition. the
Attorney General's clearance certificate (or proof of service of Notice and a copy
of such Notice) must be submitted herewith or at the Audit.
9. List all parties (charitable and non-charitable) of whom Petitioner(s) haslhave notice or
knowledge. having or claiming any interest in the estate as beneficiaries wtder the Will or
Codicil(s) or as intestate heirs if there is a complete or partial intestacy:
A. State each party's relationship to the decedent and the nature of each party's
interest(s):
Name a>UJ Address u[ Each Party in Interest
Rela/i()J/shm a>UJ Cumments. if any Interen
COwtty of Cumberland
Claremont Nursing Home, c/o
Steven !IIlontresor, Esquire
1700 Bent Creek Blvd, Ste 140
Mechanicsburg, PA 17050
Creditor claim $69.010.00
p~'ment:$34,772.42 *
(after reduction for reserve)
Shalonis Funeral Home
206 Maple Ave
Mmysville, PAl 7053
Creditor $ 1,326.12
payment: $ 1,326.16
* in full satisfaction of lawsuit Claremont v. Weller, ~b. 2005-4126
Furm OC-()] rev. W.H.06 Page 4 of 10
Estate of JOANNE K. COOPER
. Deceased
Ntmle and Address of Each Party in Interen
Rdatiomhiv and Commenl8, if am>
Interest
Laurie 1. Weller
108 May Drive, No. I
Camp Hill, P A 17011
daughter
named beneficiary
under will
100% residual
Payment: $0.00
(insolvent)
B. Identify each party who is not sui juris (e.g., minors or incapacitated persons).
F or each such party, give date of birth, the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identifY the next of
kin of such party, giving the name, address and relationship of each.
C. State why a Petition for Guardianrrrustee Ad Litem has or has not been filed for
this Audit (~ee Pa. a.c. Rule 12.4).
D. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters and type of Letters granted.
Form DC-01 rev. 10.13.06
Page 5 of 10
Estate of JOANNE K. COOPER
, Deceased
10. Other than the claim for the famil)' exemption, list the names of all known claimants and
the amount of their claims and state whether each claim is admitted.
N_ tmd Addnt$$ if Each Claimant Amulll'll if Claim Claim Will Claim
Admitted? Be Paid In
Full'
Cotmty of Cumberland 69,010 llJYes DYes
Claremont Nursing Home, c/o []No IZJNo
Steven~ntressor , F,squire
1700 Bent Creek Blvd. Ste 1 40
Mechanicsburg, PA 17055
Shalonis Funeral Home lZJYes I2JYes
206 Maple Ave 1,326.12 []No DNo
Mmysville, P A 17053
Dyes DYes
ONo DNo
Dyes DYes
[]No DNo
If the estate is insolvent, attach a schedule setting forth the order of preference tmder
20 Pa.C.s. ~ 3392 and the proposed payments.
11.
Was family exemption claimed?
DYes l'Z]No
Dyes IZlNo
Was family exemption allowed?
Family exemption claimant's name and relationship:
Name:
Relutiumhip:
Furm OC-01 rev. 10.13.06
Page 6 of 10
Estate of JOANNE K.. COOPER
, Deceased
12. The amotmt of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate
Tax paid, the date(s) ofpayment(s), and the interest(s) upon which paid, are as follows:
Date
Payment
Interest
nJa
0.00
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent tmder power
of attorney) or surety on the bond of a fiducial)'? . . . . . . . . . . . . . . . . . .. DYes It] No
If yes, provide the name of the estate, indicate whether an acCOtmt has been filed and
confirmed absolutely and all awards performed, or, in the alternative, how the
decedent's estate will be discharged for the decedent's fiduciary administration of the
estate.
14. A Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
Claim of Claremont Nursing Home and Shalonis Funeral Home are of equal class and
order of pa)'ment pursuant to 20 Section 3392 and will be paid as a percentage of claim.
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. Dy es ~ No
15. IfPetitioner{s) haslhave knowledge that a share has been assigned, renounced, disclaimed
or attached, provide a copy of the assignment, rentmciation, disclaimer or attachment,
together with any relevant supporting documentation.
Form OC-Ol nN. JO.13.fJ6
Page 7 of 10
Estate of JOANNE K. COOPER
. Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . DYes IZ1 No
If yes, attach a copy of the Order if available; otherwise state the Court, term, number,
date, and name of Hearing Judge.
17. A List or attach a separate list of additional receipts and disbursements since the closing
date of the Account.
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? ............ . Dyes It] No
18. If a reserve is requested, state amount and purpose.
Amuttnt: 500.00
Purpose: to cover any contingencies and correspondence and or miscellaneous fees
including counsel fees regarding distribution of funds once the account is
adjudicated.
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
parties in interest? ........................................ IZfy es DNo
If so, attach a copy of the notice.
19.
Is the Court being asked to direct
the filing of a Schedule of Distribution?
lZJyes DNo
As to real estate only? ........................................ [JY es IZlNo
FurmOC-OJ rev.l0.JJ.06
Page 8 of! 0
Estate of JOANNE K.. COOPER
, Deceased
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares of income and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. Income:
Propused Distributee(s)
Amount/Propurtiun
n/a
B. Principal:
Propused Distributee(s)
Amuunt/Propurliun
Shalonis Funeral Home
$ 34,773.42 (after reserve)
1,326.12
County of Cumberland/Claremont Nursing Home
$
Laurie 1. Weller
$
0.00
Submitted By:
(AU petitioners "",., sign.
Add additional lines ifnecessary):
~C).~
Laurie J. Weller (Cooper)
Name of Petitioner:
Name of Petitioner:
FunH OC-OJ rev. JO.J3.06
Page 9 of! 0
Estate of JOANNE K.. COOPER
. Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The mdersigned hereby verifies .,. [that flels.1re she
is title Executrix
of the above-named name if curpuratiun estate and] that the facts set
forth in the foregoing Petition for Adjudication I Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true. and as to facts based on the information
of others. the Petitioner. after diligent inquil)'. believes them to be true; and that any false
statements herein are made subject to the penalties of 18 Pa C.S. ~ 4904 (relating to unsworn
falsification to authorities).
~Q;;~
gnature of Petiti er
* Cot'JH1'llle petitiOllen ..... cortlplete brtlelreteil ilIformtltioll.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication!
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court. and that no changes to the form h made beyond the
responses herein.
/"/":
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4Signature of Counsel for Petitioner
Furm OC-()J rev. lo.13.tJ6
Page 10 of 10
/
I
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16,1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County andState aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
VIZ:
July 28, August 4, and August 11,2006
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Cooper. Joaune K.. dee'd.
Late of Camp Hill.
Executrix: Laurte J. Weller.
Attorney: Michael S. Travis, Es-
quire. 3904 Tr1ndle Road, Camp
Hill, PA 17011.
SWO TO AND SUBSCRIBED before me this
11 day of August. 2006
NOTA lAL SEAL
LOIS E. SNYDER. Notary Public
Carlisle Bora, Cumberland County
My Commission Expires March 5, 2009
..
'-
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
-
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the
laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market
Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-
News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market
Street, in the City, County. and State aforesaid; that The Patriot~News and The Sunday Patriot-News were
established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever
since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared in the 21st and 28th day(s) of July and the 4th
day(s) of August 2006. That neither he nor said Company is interested in the subject matter of said printed notice
or advertising, and that all of the allegations of this statement as to the time, place and character of publication are
true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION
COPY
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Terry'" I','"~ ,"lcry ;)utllic \'
~Itv Of H.", 'e>" .", ;.)oupl'hO Coull\}
II!'!' ".,nIS"" "1"t'Sju"E6..~~
alia " :es
NOTlc;&
&.tate-~JoaliMJ(. CooNr , QeceaMd.
I..lter. 0' Admlril.tratlon on the a~" .
tate 1I11 betn lIranttcL all Ptl'lOn. In .
dtbth. Estate art rtQUftttd ta make
I , PGvm.ntand tho.. hqvlnll any
claim., o"ln.' lame will preHnt th.m
wItheM clelay In wrltlnll to: Mlcha.1 S.
Trail'" &1<<1., 3904 Tr'lndl. Road, Ccm1p Hill:
PA 17011.
MICHAEL S. TRAVIS
A TIORNEY AT LAW
3909 TRINDLE ROAD
CAMP HILL, PA. 17011