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DECEDENT'S ESTATE
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF CLAIRE C. LINDSEY
. DECEASED
No. 21-06-0695
PETITION FOR ADJUDICATION I
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If ~
space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers
required under items 8- J 9 inclusive; and any instrument pertinent to the adjudication.
INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel: Christopher E. Rice
Supreme Court 1.0. No.: 90916
Name of Law Finn: Mattson Law Offices
Address: 10 East High Street
Telephone: 717-243-3341
Fax: 717-243-1850
Form oc-O/ rev. /0.13.06
Page 1 of 10
~
Estate of CLAIRE C. LINDSEY
. Deceased
1. Name(s) and address(es) ofPetitioner(s):
Name:
John A. Lindsey
Carole A. Kuhn
Address: 4447 Dunmore Drive
412 Chestnut Street
Harrisburg, PA 17112
Mt. Holly Springs, P A 17065
Identify 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? . . . . . . . . . . . . . . . . . . . .. III Yes [J No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on 7/29/06
[J Letters Testamentary or [JLetters of Administration were granted to Petitioner(s) on
8/4/06
Date of Will (if applicable): 6/19/06
Date(s) of Codicil(s) (if applicable): None
Date of probate (if different from date Letters granted): 8/4/06
Was a bond required? [JYes III No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... IlIYes [J No
Dates of advertising of the grant of Letters: Cumberland Law Journal 8/25, 9/1 & 9/8
2006: The Sentinel 8/17, 8/25 & 8/31, 2006
Form OC-Ol rev. 10.13.06
Page 2 of 10
Estate of CLAIRE C. LINDSEV
. Deceased
3. Was decedent survived by a spouse? ............................. []Ves IZINo
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............. []Ves D No
(s.u. Section 2201 IU. sea. 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 (if none, so state):
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . .. DVes IZI No
Were any children born to decedent after execution of
Will or Codicil(s)? .. . . . . .. . . . . .. . . . . . . . . .. . . . . .. . . . . . . . . . . . . . DVes IZI 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 sent to
the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IZIVes D No
Form OC-OI rev. 10.13.06
Page 3 of 10
Estate of CLAIRE C. LINDSEY
A
. 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 unpaid 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 counsel 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 will also be
given to the Attorney General as required under 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 under 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 and A.ddress of Each Pam in Interest ReIiIlioMhiD and Co_II if anv Interest
John A. Lindsey Son 1/3 of estate residue
4447 Dunmore Drive
Harrisburg, P A 17112
Richard A. Lindsey Son 1/3 of estate residue
485 South Spring Garden Street
Carlisle, P A 17015
Form OC-Ol rev. 10.13.06
Page 4 of 10
_.~._--~--~.....-
Estate of CLAIRE C. LINDSEY
. Deceased
N(IIM tl1Id Address of Each PartY in Interest Relatio1l8hiD and Commenl8 if tl1flI Interest
Carole A. Kuhn . Daughter 1/3 of estate residue
412 Chestnut Street
Mt. Holly Springs. P A 17065
B. Identify each party who is riot sui juris (e.g.. minors or incapacitated persons).
For each such party. give date of birth. the name of each Guardian and how each
Guardian was appointed. If no Guardian bas been appointed, identify the next of
kin of such party. giving the name. address and relationship of each.
C. State why a Petition for Guardianffrustee Ad Litem has or has not been filed for
this Audit (~Pa. O.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-OJ rev. /0./3.06
Page 5 of 10
Estate of CLAIRE C. LINDSEY
. Deceased
10. Other than the claim for the family exemption, list the names of all known claimants and
the amount of their claims and state whether each claim is admitted.
Name and Address 01 Each Claimant AmOU1lt olClaim Claim Will Claim
Admitted? Be Paid In
FuJI?
None ClYes Cl Yes
ClNo ClNo
ClYes Cl Yes
ClNo ClNo
ClYes Cl Yes
ClNo ClNo
ClYes Cl Yes
ClNo ClNo
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. ~ 3392 and the proposed payments.
II.
Was family exemption claimed?
ClYes IZINo
ClYes ClNo
Was family exemption allowed?
Family exemption claimant's name and relationship:
Name:
Relationship:
Form OC-OJ rev. 10.13.06
Page 6 of 10
Estate of CLAIRE C. LINDSEY
. Deceased
12. The amount 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
Pfl)'ment
Interest
10/27/06
4,000.00
2/6/07
5/16/07
1,827.41
403.52 2.65
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
ofattomey) or surety on the bond ofa fiduciary? . . . . . . . . . . . . . . . . . . . [JYes lZI No
If yes, provide the name of the estate, indicate whether an account has been filed and
confinned 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. Descn"be in detail any questions requiring adjudication and state the position of the
Petitioner( s) as to each question:
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. [J Yes [] No
15. IfPetitioner(s) haslhave knowledge that a share has been assigned, renounced, disclaimed
or attached, provide a copy of the assignment, renunciation, disclaimer or attachment,
together with any relevant supporting documentation.
Form DC-OJ rev. 10.13.06
Page 7 of 10
Estate of CLAIRE C. LINDSEY
. Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . [] Yes IZI 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.
None
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? ............. []Yes [] No
18. Ifa reserve is requested, state amount and purpose.
Amount:
Purpose:
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. []Yes []No
If so, attach a copy of the notice.
19.
Is the Court being asked to direct
the filing of a Schedule of Distribution?
lZIves []No
As to real estate only? ........................................ []v es IZI No
Form DC-OJ rev. 10./3.06
Page 8 of 10
Estate of CLAIRE C. LINDSEY
. Deceased
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distrib\ltive shares of income and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. Income:
Proposed Distributee(s)
John A. Lindsey
Richard A. Lindsey
Carole A. Lindsey
B. Principal:
Proposed Distributee(s)
Same as A
Amount/Proportion
1/3 of estate residue
1/3 of estate residue
1/3 of estate residue
AmountlProportion
Submitted By:
(AU petitioners must sign.
Add additional lines if necessary):
Name of Petitioner: John A. Lindsey
Name of Petitioner: Carole A. Kuhn
Form OC-OJ rev. /0./3.06
Page 9 of 10
Estate of CLAIRE C. LINDSEY
. Deceased
Verification of Petitioner
(Verification must.be by at least one petitioner.)
The undersigned hereby verifies * [that he/she is title
of the above-named IUlme of co~ration and) that the facts set
forth in the foregoing Petition for Adjudication / 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 inquiry, 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).
QJ2k~
Signa of Petitioner
* Corptmlte petitioners must complete bNclcetetl ;n/ormtltion.
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 have been made beyond the
responses herein.
CR..~ r. 12-
Signature of Counsel for Petitioner
Form OC-OI rev. 10./3.06
Page 10 of 10
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Current Value Fiduciary
05/15/2007 Acquisition
or as noted Value
TO: Carole A. Kuhn
Proposed distribution 2.313.10 2.313.10
2.313.10 2.313.10
TO: John A. Llndsev
Proposed distribution 2.313.09 2.313.09
2.313.09 2.313.09
TO: Richard A. L1ndsev
Proposed distribution 2.313.10 2.313.10
2.313.10 2.313.10
Total 6.939.29 6.939.29
15
F IFILESIDA T AFILE\EST A TES\3470.2.nolice.be(
(
NOTICE OF ESTATE ADMINISTRATION
Tms NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM TmS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the
decedent's will. If the decedent died without a will, whether you will receive any money or property will
be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND,
CARLISLE, PENNSYLVANIA
In re Estate of Claire C. Lindsey, deceased,
Estate No. 21-06-0695
TO:
John A. Lindsey
4447 Dunmore Drive
Harrisburg, PA 17112
Carole A. Kuhn
412 Chestnut Street
Mt. Holly Springs, P A 17065
Richard A. Lindsey
19 Barkwood Lane
Clifton Park, NY 12065
Please take notice of the death of Decedent and the grant of letters to the personal
representative(s) named below.
The Decedent, Claire C. Lindsey, died on the 29th day of July, 2006, at 485 South Spring Garden
Street, Cumberland County, Pennsylvania.
Decedent died --2L- testate
intestate.
The personal representatives of the Decedent are:
John A. Lindsey
Carole A. Kuhn
4447 Dunmore Drive, Harrisburg, P A 17122
412 Chestnut Street, Mt. Holly Springs, PA 17065
(717) 671-8671
(717) 486-3068
The Will has been filed with the Office of the Register of Wills of Cumberland County, 1
Courthouse Square, Carlisle, P A 17013, 717-240-6345.
CL~ ~. ~
Christopher E. Rice, Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
Ten East High Street, Carlisle, P A 17013
(717) 243-3341
_ Personal Representative
~ Counsel for personal representative
Date: August 14,2006
Signature
Name
Address:
Capacity:
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Tammy Shoemaker, Classified Advertising Manager, of The Sentinel, of the County
and State aforesaid, being duly sworn, deposes and says that lHE SENTINEL, a
newspaper of general circulation in the Borough of Carlisle, County and State
aforesaid, was established December 13th, 1881, since which date lHE SENTINEL has
been regularly issued in said County, and that the printed notice or publication
attached hereto is exactly the same as was printed and published in the regular editions
and issues of lHE SENTINEL on the following day(s)
August 17, 24, 31, 2006
COPY OF NOTICE OF PUBLICATION
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L. PII..ffIOnJ,.___. . .....~...... ........1hem~..... .~.blt.Indebted.. Iould
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havInj~ WIlt PAlM. ..' .'nt nt lie..,. for -tiem..lll'luo.=".
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Affiant further deposes that he / she is not
interested in the subject matter of the
aforesaid notice or advertisement, and that
all allegations in the foregoing statement
as to time, place and character of
~~kt<-
-
.....~ ~
- -
Sworn to and subscribed before me this
31st. day of August 2006.
C~LIl~rt~
Notary P c
My commission expires: q/,Iof
COMMONWEALTH OF PENNSYLVANIA
NoIarlaI Seal
ChrisIna L Wdfe. NoIary Public
CaItIsle Boro. Cumbeltand Coonly
My CcmmIssion Expns Sepl1. 2008
Member. Pennsylvania Association Of Notaries
f~'.--
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
55.
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 and State 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:
August 25, and September 1, 8, 2006
Affiant further deposes that he is authoriz~ 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.
Uadlley, ClaIre c., dee'd.
Late of Carlisle.
Executors: John A. LIndsey and
Carole A. Kuhn, c/o Martson
Deardorff Williams & Otto. Ten
East High Street. Carlisle. PA
17013.
Attorneys: Christopher E. Rice,
Esquire. Martson Deardorff Wil-
liams & Otto. Ten East High
Street. Carlisle. PA 17013.
SWORN TO AND SUBSCRIBED before me this
8 day of September. 2006
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