HomeMy WebLinkAbout06-21-07 (2)
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
IN RE: LINDA CAMPBELL,
DECEASED
REGISTER OF WILLS
NO. ct \ () '\ <Jl.o ()\
PETITION FOR CITATION
TO GRANT LETTERS OF ADMINISTRATION
PURSUANT TO 20 Pa. C. S. & 3155
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The Petitioner, HCR ManorCare - Carlisle ("Petitioner"), a princ~mdit~ of <,~~ S~~
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Linda Campbell, respectfully represents that: )1Z-l ~ i_~, I -1
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TO THE REGISTER OF WILLS OF CUMBERLAND COUNTY:
1. Linda Campbell ("Decedent") died intestate on March 19, 2007. A Death
Certificate is attached hereto as Exhibit" A."
2. Upon information and belief, Decedent was survived by a husband,
Richard Campbell, who resides at 240 N. 36th Street, Camp Hill, P A 17011; a son, James
Campbell, who resides at 1620 E. Jefferson Street, #127, Rockville, MD 20852; a
daughter, Nichole Campbell, who resides at 719 N. 2nd Street, Apt. 5, Harrisburg, PA
17102; and a son, Corey Campbell, who resides at P.O. Box 9271, Aspen, CO 81612.
3. Petitioner was a principal creditor of Decedent.
4. Petitioner desires to have Shaun E. O'Toole, Esquire, appointed by the
Court to administer the Estate of Linda Campbell for the purpose of paying all debts
owed by Decedent, qualifying the Decedent for Medicaid benefits, and distributing the
balance of the estate pursuant to the intestate laws of the Commonwealth of
Pennsylvania.
5. Attorney O'Toole is a disinterested party who has no interest In the
outcome of medical assistance involving the Decedent.
6. In furtherance of this matter, Petitioner also requests the appointment of a
Limited Adminsitrator Pendente Lite, pursuant to 20 Pa.C.S.A. 3160, solely for purposes
of appealing and preserving Linda Campbell's eligibility for medical assistance benefits.
7. Petitioner requested that the Bureau of Hearings and Appeals reopen the
appeal for Linda Campbell and that request was granted on June 19,2007. Because a
hearing will be scheduled in this matter in the near future, it is essential that the
appropriate legal representative is available to represent Ms. Campbell's interests.
Otherwise, her eligibility for benefits may be lost.
8. Petitioner desires to have Shaun O'Toole, Esq., appointed as
Administrator Pendente Lite, pursuant to 20 P.a.C.s.A. 3160, for the Estate of Linda
Campbell for the limited and sole purpose of appealing and pursuing medical
assistance benefits for the time period that she was a resident at Petitioner's skilled
nursing facility.
2
WHEREFORE, Petitioner HCR ManorCare - Carlisle respectfully requests that a
Citation be issued to the heirs of the decedent to show cause, if any, why Letters of
Administration for the Estate of Linda Campbell should not be issued to Shaun E.
O'Toole, Esquire, and in the interim that Attorney O'Toole be appointed as
Administrator Pendente Lite.
Respectfully submitted,
SCHUTJER BOGAR LLC
Date: ~ ~ ~l- r1OO1-
BY~~"
Cha ick O. Bogar
Attorney ID 83755
Mariclare L. Hayes
Attorney ID 201289
(717) 909-5922
305 N. Front Street, Suite 401
Harrisburg, PA 17101
Attorneys for Petitioner
3
H105.905 REV.(6/06)
This is to certify that this IS a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
/? ~:A~?: R Is illegal to duplicate this copy by photostat or photograph.
vro ~ Cf~~ lf~ol.
Frank Yeropoli
State Registrar
No.
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Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
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H105-143 REV 1112006
TYPE I PRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
- 0304
1, Name 01 Decedent (First, middle, last, suffixl
Linda Jo
5. Age (Last Birthday)
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59 Y~.
8b. County of Dealh
Cumberland
6. Date of Birth (Month, day, ar) 7. Birthplace (City and state or for 8a. Place ot Death (Check on one)
Hospital: Other:
7-1-1947 Darby, PA O,npatien, OER/Otrtpa'ient OOOA IKlNursingHome OResi<lenee OQthe,.Spe6ty,
Sd. Facility Name (If not institution, give street and number) 9. Was Decedent of Hispanic Origin? 29 No 0 Yes 10. Race: Amelicen Indian, Black, While. etc.
(II yes, specify Cuban, (Speci1}1
Claremont Nursing Home Me>Ocan.PuertoRican,etc.) White
most of wor1<i life. 00 001 slate retired 12. Was Decedent ever in the 13. Oecedenfs Education (Specify only highest grade completed) 14. Marital Status: Married, Never Married.
Kind of Business I Industry U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Specify)
DYe, G9No 12 Married Campbell
. 16. Decedent's Mailing Address (Street. city I town, state, zip code)
1000 Claremont Road
Carlisle, PA 17013
::mnce 17a.State Pennsylvania
17b.County Cumberland
Did Decedent
Uve in a
Township?
17c. 0 Yes, Decedent lived in
17d. ~ No, Decedent Lived wiItlin
AcIuallimJlsof
Twp.
Carlisle
City/Boro
18. Fa\tler's Name (Rrsi. middle, last, suffix)
Charles Miller
19. Mo1I'ler's Name (FiTSt, middle, maiden surname)
Frances Williamson
208. Informant's Name (Type I Print)
Richard Lee Campbell
21a. Method of Disposition
2Ob. lnfom\ant's Mailing Address (Street. city / town, state, zip code)
240 North 36th Street, Camp Hill, PA 17011
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21c. P\ace of Disposition (Name of cemetery, crematory or other place)
21d. Location (City I town, slate, zip code)
Cremation Society of PA Harrisburg, PA 17109
22c.Name.ndAdd,..,ofF8Ci'Auer Memorial Home and Cremation Services, Inc.
4100 Jonestown Road, Harrisburg, PA 17109
~ems 24-26 """ be completed by penon
who pronounces death.
Connie Strayor, R.N.
24. Time of Death 25. Date Pronounced Dead (Month, day, year)
12:45 aM. March 19, 2007
RN 513144L
230. Date S_ (Monlt1. day. yee~
March 19, 2007
23b. License Number
26. Was Case Referred to Medical Examiner f Coroner for a Reason Other than Cremation or Donation?
o Yea IilNo
OYea gg No
DYe, ONo
31. Manner of Death
IE _ral 0 Horn<ide
o Accident 0 Pen<fing Investigatioo
o Suicide 0 Cou~ No( be Dete""ned
Approximate intem\: Part 11: Enter other sioni6canl conditions r.nntributina to d9ath, 28. Did Tobacco Use Contribute to Death?
Onset to Death but not resulting in the undertying cause given in Part I. 0 Ves 0 Probably
IKl No 0 Unknown
29. " Female:
il Notp.egnantwlthmpastyea<
o Pregnan'et'rnoofclea~
o Notp.egnant,butp<egn.ntwithin42days
01 death
o Not pregnant, but pregnant 43 days to 1 year
betoredeath
o Unknown ~ pregnant within the past year
32t. = ~J~~: :7s~~) Street, Fadory,
CAUSE OF DEATH (See Instruction. end ex.mpln)
Item 27. Part I: Enter the ~ - diseases, injuries, or complications - that directly caused !he death. 00 NOT enter terminal events such as cardiac arrest,
respiratory arrest, or ventricular fibrillation without showing !he etiology. Ust only one cause on each ~ne
~~=)<fise:;
ais'conditiona.KBllj.
to cause Iiste<l on line a.
Enter UIllleALYlNGCAUSE
~re:~N1~~e
b.
Inanition
Doe to (or as B consequence 01):
Senile Dementia
Due to (or as a consequence of):
- Alzheimer's Type
a.
Due to (or as B consequence 01):
308. Was an Autopsy
Performed?
d.
30b W... Autopsy Findngs
AvaUable Prior to Completion
01 Cause of Death?
32d. Time of Injury
M.
321. If Transportation Injury (Specify)
o Driver I Operator 0 Passenger DPedestrian
O\tl., . Spe6~'
33b.SignatureandTrtleofCerti
32g. LocatiofI of Injury (Stree!. city I town, state)
338. Certifier (check only one)
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=:~~:=ge~~tan~~i::"-:~~n~~~.::;~~:~~a: mlnner nltllecL _.... _ _................_ _.. _ 0
~: =s~X:.nd f or Investlgltlon, In my opinion, death occurred It the time, dele, and place,.oo due to the cause(s} Ind manner II stated_ 0
3-19-2007
33e. license Number
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MD - 042694
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Di_itionPe,mitNo O{~ b 11L
34. Name and Address 01 Person Who Completed C 01 Death (Item 271 Type I Print
Ernest M. Josef, M.D.
1830 Good Hope Road, Enola, PA
17025