HomeMy WebLinkAbout01-04-08
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
INRE: ESTATE OF ANNARUNK,
DECEASED
11
of 2008
No.
PETITION FOR CITATION
TO GRANT LETTERS OF ADMINISTRATION
PURSUANT TO 20 Pa.C.S. & 3155
TO THE ORPHANS' COURT OF CUMBERLAND COUNTY:
Golden Living Center - West Shore Health and Rehabilitation ("Petitioner"), a
principal creditor of Anna Runk, respectfully represents that:
1. Petitioner operates a skilled nursing facility located at 46 Erford Road,
Camp Hill, PA 17011.
2. On or about July 22, 2005, Decedent was admitted to Petitioner's skilled
nursing facility pursuant to an Admission Agreement pursuant to which Petitioner
agreed to provide Decedent with skilled,pursing care and services in return for her
promise to make timely paYplent for that skilled nursing care and services.
3. As of the date of Decedent's death, as outstanding balance was owed to
the Petitioner for the skilled nursing care and services it provided to her, and Petitioner
was a principal creditor of Decedent.
4. Upon i~formation and belief and to the extent of Petitioner's knowledge,
on September 7, 2007, Anna Runk ("Decedent") died intestate. An original death
certificate is attached as Exhibit" A."
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5. Upon information and belief and to the extent of Petitioner's knowledge,
Decedent has the following surviving heirs or next of kin:
Name
Relationship
Address
Robert Runk
Son
P.O. Box 171
Dry Run, P A 17220
Mark Runk
Son
111 E Dunlap Ave.
Phoenix, AZ 85020-2807
Steven Runk
Son
1013 Oyster Mill Road
Camp Hill, PA 17011-1002
Susan Feagley
Daughter
14557 Mountain Green Road
Willow Hill, PA 17271-9703
Michael Runk
Son
P.O. Box 172
Willow Hill, PA 17271-0172
Albert Gartz
Brother
P.O. Box 607
Delta Junction, AK 99737-0607
6. Petitioner desires to have Shaun E. O'Toole, Esquire (" Attorney O'Toole"),
appointed by the Court to administer the Estate of Anna Runk for the purpose of
paying all debts owed by Decedent, qualifying the Decedent for the receipt of Medical
Assistance benefits, and distributing the balance of the estate pursuant to the intestate
laws of the Commonwealth of Pennsylvania.
7. Attorney O'Toole is a disinterested party who has no interest in the
outcome of the pending Medical Assistance appeal involving the Decedent.
8. In furtherance of this matter, Petitioner also requests the appointment of a
Limited Administrator Pendente Lite, pursuant to 20 Pa. c.s. 9 3160, solely for purposes
of appealing and preserving Anna Runk's eligibility for Medical Assistance benefits.
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9. The appeal regarding Anna Runk's eligibility for Medical Assistance
benefits is currently pending before the Bureau of Hearings and Appeals of the
Department of Public Welfare of the Commonwealth of Pennsylvania. 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. Runk's interests.
Otherwise, her eligibility for benefits may be lost.
WHEREFORE, Petitioner, Golden Living Center - West Shore Health and
Rehabilitation, respectfully requests that a Citation be issued pursuant to 20 Pa. C. s. 9
3155 upon the known heirs of Anna Runk to Compel the Production of a Will, if any,
and if no Will exists to Show Cause, if any there be, why Letters of Administration for
the Estate of Anna Runk, deceased, 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:,jo/ 200B
.
BY~~
Kirk S. Sohonage
Attorney J.D. 77851
(717) 909-8160
Maria G. Macus-Bryan
Attorney J.D. 90947
(717) 909-8640
417 Walnut Street, 4th Floor
Harrisburg, PA 17101
Fax No.: (717) 909-5925
Attorneys for Petitioner
DEC-20-2007(THU) 10:45
P. 005/005
VERlFICA TION
The undersigned hereby verifies that the stat~ments of fact in. the foregoing
Petition are true and correct to the best of my knowledge, information and belicl. I
understand that any false statements therein. are subject to the penalties contained in 18
Pa. C. S. S 4904, relating to unsworn falsification to authorities.
Dated:~
fO#1{ . D)'~
. verly F Nurs g Home Administrator
Golden Livrng Center - West Shore Health
and Rehabilitation
H105.905 REV.(6/06\
Thts is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records III accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
/7 :A~d: It is megal to duplicate this copy by photostat or photograph.
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No.
Frank Yeropoli
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
4203955
DEe 20 Z007
Date
H105-143 REV 1112006
TYPE I PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Inlltnlctlon. end exemple. on reverse)
088865
STATE FILE NUMBER
5. Age (Lasl Birthday)
6. Dale 01 Birth Month, de ,
( and &tale or
2673
4. Date 01 Death (Month, day, year)
September 7, 2007
1. Name of Decedent (Firsl, midcIe, last, sutIIx)
Anna Marie Runk
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7.
onel
Other:
66
July 8, 1941
Elizabeth, NJ
OOlhef. Spec:ifyc
10. Race: Americarllndian, Black, 'M1ite, etc.
ISpeciIJiJ
I ~
8b. COUnty of Death
Cunberland
Set Facility Name (11 not institution, give 51ree! and nurnbef)
Golden Living Retirement
11. Decedenfs Usual Occ tion Kind 01 work done
KindofWortr.
Seamstress
. 16. Oecedent'sMaifingAddress (Street,cityl Iown,stale, zipcodel
14557 Mt. Green Road
. Willow Hill, PA. 17271
18. Father's Name (First, mIdde, last, suffix)
Albert Gartz
20&. Informant's Name (Type I Pml)
Robert Runk
12. Was Decedent ever in the
U.s. Armed FOrce5?
o Vos IKI No
Ilecedont's
Actual Residence 17a. State
13. _s E<lucatioo (Spec:ifyon~hIg1oslgmlo_"'l
EIeme"la'Y I U'Y (0-121 CoI~(l"orS+1
14. Marttal Stalus: Married, Nevel' Married,
W_, _ (SpociM
Divorced
PA
Didllecedont
Livens
Townsllip'
17e, [;I Yes, Decedent UvGd in
17d. 0 No, Oecedenlll\ted within
Aclual Lm1s ~
'F'.mn..!-!-
Top.
17b. County
'F'...,nklin
ClylBoro
Q
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19. Mother's Name (Fltst, midde, maiden sumamel
Edna Stachura
2Ct>._s_g-"'(SlIeeI,dlyltown,_,~_1
21132 Parson Road Run
17220
21d. LocatIon (City floWn, stale, zip code)
Doylesoorg,PA. 17219
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Items 24-26 must be completed by person
wtlopronoll1C8&cIeath.
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CAUSE OF DEAnt (11oo 1_ ond ..._l
1temZ7. Part I: Enterlhe~ dIte8ses, lIluOes,orcomplicatlons-thatdl9CllyC8UltdIhede8th. DO NJTentert8l11linal events such as cardiac arrest
respiratory arrest, or ventricular ItbrIation wtthout showing the elioIogy. List my one cause on eectI Hne.
1/14'/1 / .f;~""
.LI!ck..~/' 'f ~..,/;,^-
ApproxknaIe interval: Part II: Enter other llilI'IIfIc8nI cmdIIonI tordl'iblb1o to dMIh,
Onset to Deet!l but noI resulting in 1he uncIertyIng CIU88 gMtn in Part t
=~=I"""'-:
e.
308. Was an Autopsy
PlI1ormed?
d.
3Ob.__F_
.__toCompletion
~ Causo ~ Ooolh?/
o Vos [!(No
31. OfOeath
No1uool 0-
O-O-"ll'<W0Stig81ion
OS,",de OCooldNolbolle1onnin8d
at prepnt within pest year
o Pf8gll8n1._~_
o Nol_,,",-,"",wttNn42days
~daolh
o Nol-,"",.,",_43daysto'YOOI
boIoroda8lh
o Unlrnownl__lhepos1yoo'
32c.~~,~~)SlIeet,FacloIy
_~islcondltions,I,""
IeedInoIoi1ecauseli8tedonlinea.
EnTor Iho UNIlERI.YINO CAUSE
~~1""::i.n"'l'mrlhe
Dileto("'''~CI
b. :;.-'.;) 1\0-
Due to (or as 8 consequeoct of):
c,
Due to (or as a consequence ot):
OVos No
32d. TiTle 01 Injury
32g.l0cati0n ~ I~,~ (Sbeot. dIy 1 town, ....I
M.
330. Certifier (ChOCk on~ one)
. CertlfyIntIpIly'_I""""""""'il'''llCO"",Ofdallhwhon_'_hos",_daolhllndoompletodltom231
To thI bitt of my knowledge, cIIIIh occUfI'Id due to the ClUll(I) nI mini*' allltld.............. -............ -...........................................................
~-: =~~~=ti~.:r:::.c.~:~~=~':).~ mlMlfllllatld........... _ __ __ _........ _ __..... 0
. MIdk:8I ExItrnintr f CorOI*
On the bull 01 uamInItIon MId I 01' Investigltlon, In ~y optnlon. dMItl 0CCUl11Id -' the tIrnt, cII;ie. and ptece, and due to the ClUH(I).-.cIll'IInnel" n.-cL 0
12 IRI.2.I.!, I~ I
Disposition Permit No
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