HomeMy WebLinkAbout10-10-07
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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
f! u~ b.lalO'N D COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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ESTATEOF DJfNif.J p, M~t"'~ ,DECEASED
No. J-tJO 7 oOb.3 7
PETITION FOR ADJUDICATION /
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 8-19 inclusive; and any instrument pertinent to the adjudication.
INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel:
Supreme Court J.D. No.:
Name of Law Firm:
Address:
Telephone:
Fax:
Form OC-OJ rev. JO.13.06
Page 1 of 10
Estate of J) ItN , 1,. L
D. iUtttArcly .
, Deceased
1. Name(s) and addressees) ofPetitioner(s):
DAN I ""l D. M 0\Ard'1//2...
(/
I&i/~ L~w-tll L~AJ t.
I1J -c. tV ell..., IJ~ ~ &'N (J J fJ~ / /() 70
Name:
Address:
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and Account and state reason:
Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . . .. ~s 0 No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on JOAJ 11(<"/ 7. /lnp 7 .
I
n;ters Testamentary or 0 Letters of Administration were granted to Petitioner(s) on
Date of Will (if applicable):
1tfN (..(.4 (\.)
/1tf1 \ t.t?o7
,
Date(s) of Codicil(s) (if applicable):
Date of probate (if different from date Letters granted):
Was a bond required? 0 Y es ~o If yes, state amount:
Are proofs of advertising of the grant of Letters attached? . . . . . . . .. 0 Yes 0 No
Dates of advertising of the grant of Letters:
Form DC-01 rev. 10.13.06
Page 2 of 10
, .
Estate of
]) AAJ I f- L D,
1M <!Cu 0
, Deceased
3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . .. . . . . . . . . .. 0 Yes ~
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............. 0 Yes ~
(See Section 2201 et seq. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
5. In the case of an intestac~ state the names of the decedent's surviving children or
surviving issue of deceased children (ifnone, so state):
AJ)t
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . . .. 0 Yes ~o
Were any children born to decedent after execution of
Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes ~
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? .............................. 0 Yes ~
Form DC-OJ rev. JO.13.06
Page 3 of 10
, .
Estate of
J)HNI2..-L lJ, Jt1~~l/lrl;--
, Deceased
8. Written notice of the Audit as required by Pa. a.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. a.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. a.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) has/have 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 Address of Each Party in Interest RelationshiD and Comments. if any
Interest
$ t.t 1, c, A) AJ e- L - S' ~~ 54 ".,~ 41 /) t!l-1/ttfJ ilv 12-
91., W. Tiz..'~ol-c U I t7
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Form OC-O 1 rev. J 0.13. 06
Page 4 of 10
Estate of
])I1N,~t
/). ttAltl4('J;-
, Deceased
Name and Address of Each Party in Interest Relationshiv and Comments. if any
Interest
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It ~ (, t. () W~ /1 La4/ 1:- J 'V
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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 Guardian/Trustee Ad Litem has or has not been filed for
this Audit (see 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 OC-01 rev. 10.13.06
Page 5 of 10
Estate of
j)4,IU)~L
p,
;H~u,~
~
, 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 of Each Claimant Amount of Claim Claim Will Claim
Admitted? Be Paid In
Full?
DYes DYes
DNo DNo
DYes DYes
DNo DNo
DYes DYes
DNo DNo
DYes DYes
DNo DNo
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. 9 3392 and the proposed payments.
11.
Was family exemption claimed?
DYes
Cl-N"o
Was family exemption allowed?
DYes
~o
Family exemption claimant's name and relationship:
Name:
Relationship:
Form DC-OJ rev. 10.13.06
Page 6 of 10
Estate of
IJ,If-N I ~L J) _ 111 ~I! "" yly
, 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
Payment
Interest
~-I/-O/
7 7j<t. 7 3
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
of attorney) or surety on the bond ofa fiduciary? . . . . . . . . . . . . . . . . . .. 0 Yes ~
If yes, provide the name of the estate, indicate whether an account 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:
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. 0 Yes 0 No
15. IfPetitioner(s) has/have 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 OC-OJ rev. JO.13.06
Page 7 of 10
Estate of
j) 11-1\.1' f.., t
D.
If1 t{\((j;;.-
V
, Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . .. 0 Yes ~o
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.
5'e ~ F"IL~.[- + :F;yJa L II-I"C etA It I- / F~
7;)~ C'l!"~l"A/-I-' ~ 2. ~Q/(-e
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? ............. BYes 0 No
18. If a 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? ........................................ 0 Yes D No
If so, attach a copy of the notice.
19.
Is the Court being asked to direct
the filing of a Schedule of Distribution?
DYes
~o
As to real estate only? ........................................ D Yes ~o
Form DC-OJ rev, JO,/3.06
Page 8 of 10
Estate of
J) J1-/J/ I ~ L- lJ ,
111 (!~"f V~y/
/
, 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:
Proposed Distributee(s}
L. ; tV C (l.- lL III tJ /L yo s
S IJ 2-~ AI Ai ~ L- $e, OS .s ~ ..., ",4
V 1'1- IV" t:a L D. /f('Cw~Jv JIL
/
B. Principal:
Proposed Distributee(s)
Amount/Proportion
If I 1~2. S-z...
'-I ) S--2.. · S-2....
,
'IL/5:1-~ S3
.
Amount/Proportion
Submitted By:
(All petitioners must sign.
Add additional lines ifnecessary):
j)J,j.1?t(l~~.
Name of Petitioner:
Name of Petitioner:
Form OC-OJ rev. JO.13.06
Page 9 of 10
Estate of
VJfIU I ~ I.
)).
;# r'u v 01':1-
{/
, 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 name of corporation
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).
S8~ti~~
* Corporate petitioners must complete bracketed information.
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.
Signature of Counsel for Petitioner
Form OC-OJ rev. 10.13.06
Page I 0 of 10
1> ~/l.R&/~~?~
Decedent's Estate
Court of Common Pleas of Cumberland County, Pennsylvania
Orphan's Court Division
Estate of Daniel D. McCurdy, Deceased
No. 2007-00037
First and Final Account of
Daniel D. McCurdy, Jr., Executor
For
Estate of Daniel D. McCurdy, Deceased
Date of Death:
Date of Executor's Appointment:
Date of First Advertising:
Accounting of the Period:
Social security Number:
January 7, 2007
January 11, 2007
January 8, 2007
January 11, 2007 to
October 9,2007
174-20-0943
Purpose of Account: Daniel D. McCurdy Jr., Executor, offers this Account to
acquaint interested parties with the transactions that have occurred during his
administration. This account also indicates the proposed distribution of the estate.
It is important the account is carefully examined. Request for additional
information or questions or objections can be discussed with:
Daniel D. McCurdy Jr.
1646 Lowell Lane
New Cumberland, P A 17070
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Proposed Distribution to Beneficiaries
Principal
Receipts
Less Disbursments
Principal on-hand
Income
Receipts
Debts of Decedent
Funeral Expenses
Administration Expenses
State Taxes
Fees and Commissions
Combined balance on hand
Affadavit
Summary of Account
Page Value as of 10-9-07 Fiduciary Acquisition Value
$26,661.23
$3,442.64
$8,673.89
$730.29
$788.73
$572.82
$14,208.37
$12,452.86
$4.71
$12,457.57
Receipts of Principal
Assets Listed in Inventory
Fiduciary Acquisition Value
Cash
Members 1 st Credit Union Chk Acct
Members 1 st Credit Union Savings Acct
Members 1 st Credit Union Money Mgmt Chk Acct
$10,492.40
$528. 18
$9,745.65
Tangible Property
Rifle
Treadmill
Bed
1999 Buick Regal
Table Stands
Chairs
VCR
Stereo
TV
Clothes
$200.00
$25.00
$100.00
$5,227.00
$50.00
$75.00
$7.00
$20.00
$50.00
$141.00
Total Inventory
$26,661.23
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Receipts of Income
Interest
Wachovia Bank, Account #1010160093548
1-12-07 - 10-9-07
Proposed Distributions to Beneficiaries
Per article second(A) of will:
To: Suzanne l. Sassaman
Cash
Per article second(B) of will:
To: Linda K Nokes
Cash
Per article second(C) of will:
To: Daniel D. McCurdy Jr.
Cash
Total
$4.71
$12,457.57
$4,152.52
$4,152.52
$4,152.53
$12,457.57
Commonwealth of Pennsylvania:
County of Cumberland:
Daniel D. McCurdy, Jr., Executor of the Estate of Daniel D. McCurdy
declares under oath that he has fully and faithfully discharged the duties of his
office; that the foregoing First and Final account is true and correct and fully
discloses all significant transactions occurring during the accounting period; that
all known claims against the Estate have been paid in full; that, to his knowledge,
there are no claims now outstanding against the Estate; that all taxes presently due
from the Estate have been paid; and that the grant of Letters Testamentary and the
first complete advertisement thereof occurred more than four months before the
filing of the foregoing First and Final Account.
fJJJ. :IJ1~,
Daniel D. McCurdy, J .
Executor
Subscribed and sworn to by
Daniel D. McCurdy, Jr.
this )0 day of October, 2007
~l:~
Notary Public
COMMONWEALTH Of PENNSYLVANIA
NOTARIAL SEAL
ROBERTA E. BIESECKER, Notary Public
Camp Hill BQto, Cumberland County
. M\. r.ommission Expires JUly 23, 2009
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