HomeMy WebLinkAbout03-28-08
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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
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ESTATE OF Diane Marie Coppens
, DECEASED
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No. 2007-00347
PETITION FOR ADJUDICATION /
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 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: Karl M. Ledebohm, Esq.
Supreme Court I.D. No.: 59012
Name of Law Firm: Karl M. Ledebohm, Esq
Address: P.O. Box 173
Telephone: 717-938-6929
Fax: 717-932-0317
Form DC-OJ rev. 10.13.06
Page 1 of 10
Estate of Diane Marie Coppens
, Deceased
1. Name(s) and addressees) ofPetitioner(s):
Name:
Daniel J. Coppens
Address:
813 North Walnut Street
Mechanicsburg, P A 17055
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
None
Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . . IZl Yes 0 No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on March 17. 2007
o Letters Testamentary or IZlLetters of Administration were granted to Petitioner(s) on
Date of Will (if applicable):
Date( s) of Codicil( s) (if applicable):
Date of probate (if different from date Letters granted): April 11, 2007
Was a bond required? DYes IZl No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... IZl Yes 0 No
Dates of advertising of the grant of Letters: Cumberland Law Journal on April 20,
27 and May 4, 2007. The Sentinel on April 16, 23 and 30, 2007.
Form OC-Ol rev. 10.13.06
Page 2 of 10
Estate of Diane Marie Coppens
, Deceased
3. Was decedent survived by a spouse? . . . . . . . . . . . . . .. . ., . . . . . .. . . " (ZJYes D No
If yes, name of the surviving spouse: Daniel J. Coppens
4. Has the surviving spouse filed to take an elective share? ............. D Yes IZJ No
(See 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 (if none, so state): None
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . ., DYes D No
Were any children born to decedent after execution of
Will or Codicil(s)? .... ....... ................... ............. DYes D 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? .. . . . . . . . .. . . . . . . . . .. . . . . . .. .. DYes D No
Form DC-OJ rev. 10.13.06
Page 3 of 10
Estate of Diane Marie Coppens
, Deceased
8. Written notice ofthe 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 ofthe Notice as well as a list of the names and
addresses ofthe 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 ifthere 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 Partv in Interest
Relationship and Comments, if anv Interest
Catherine Kubeika
Schuylkill Manor Nursing Home
1000 Manor Road
Pottsville, P A 17901*
Mother of Decedent Ms. Kubeika does not
possesses an interest
since net value of
Estate is less than *
*C/O John Kubeika,
Attorney-in-fact for Catherine
Kubeika
920 Magnolia Drive, Enola, P A
*$30,000.00.
17025
Form OC-OI rev. 10.13.06
Page 4 ofl 0
Estate of Diane Marie Coppens
, Deceased
Name and Address of Each Party in Interest
Relationshio and Comments, if anv
Interest
B. Identify each party who is not sui juris (e.g., minors or incapacitated persons).
For each such party, give date of birth, the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identify the next of
kin of such party, giving the name, address and relationship of each.
None
C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for
this Audit ($ee 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. 10.13.06
Page 5 of 10
Estate of Diane Marie Coppens
, 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?
Discover Bank $614.56 IZ)Yes IZ) Yes
Michael Mehan, Authorized Agent DNo DNo
175 South Third Street
Columbus, Ohio 43215
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. ~ 3392 and the proposed payments.
11.
Was family exemption claimed?
............ ....................................................
IZJYes DNo
IZ)Yes DNo
Was family exemption allowed?
.................. .............. .... .............. ..............
Family exemption claimant's name and relationship:
Name: Daniel J. Coppens
Relationship: Spouse
Form OC-OJ rev. 10.13.06
Page 6 ofl 0
Estate of Diane Marie Coppens
, Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . D Yes IZl 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? ............. DYes D 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? ........................................ DYes DNo
If so, attach a copy of the notice.
19.
Is the Court being asked to direct
the filing of a Schedule of Distribution?
DYes IZlNo
As to real estate only? ........................................ DYes IZ]No
Form DC-OJ rev. JO.13.06
Page 8 of 10
Estate of Diane Marie Coppens
, Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that helshe h.p-"
of the above-named .td.I~ ll!UJI']ltl"afitlJl ~~t~~k
IS title
A-cltn ,'J\ ;.; ~.otAo r-
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).
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Signature of Petitioner
". 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 fo have been made beyond the
responses herein.
Form DC-OJ rev. 10.13.06
Page 10 of! 0
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, Esquil'e, 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 sRid 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:
April 20, April 27, and May 4, 2007
Affiant further deposes tl1at 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, pLlce and chc1racter of publication are true.
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SWORN TO AND SUBSCRIBED before me this
4 day of Mav, 2007
Coppens, Diane M., dec'd.
Late of Mechanicsburg.
Administrator: Daniel Coppens,
813 N. Walnut Street, Mechanics-
burg, PA 17055.
Attorney: Karl M, Ledebohm,
Esquire, P.O. Box 173, New
Cumberland, PA 17070-0173.
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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 THE SENTINEL, a
newspaper of general circulation in the Borough of Carlisle, County and State
aforesaid, was established December 13th, 1881, since which date THE 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 THE SENTINEL on the following day(s)
April 16, 23, 30, 2007
COPY OF NOTICE OF PUBLICATION
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EXECUTOR'S NQI!g
ESTATE OF DIANE M. COPPENS
LATE OF MECHANICSBURG, PENNSYLVANIA,
DECEASED
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
publication are true., l
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Letters of Administration on said estate having been
, granted to the undersigned, all persons indebted
thereto are requested to make immediate payment,
and those having claims or demands against the same
will present them without delay for settlement to Karl M.
Ledebohm, Esquire, P.O. Box 173, New Cumberland,
PA 17070-0173.
Daniel Coppens, Administrator
813 North Walnut Street
Mechanicsburg, PA 17055
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Sworn to and subscribed before me this
01st day of May 2007.
My commission expires: q III o-'t
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Chlistlna L. Wolfe, Notary Public
CaItisIe Boro, Cumberlatld County
My Canmission Expires Sept. 1, 2008
Member. Pennsylvania t\ssociation Of Notaries
FIRST AND P ARITAL ACCOUNT OF DANIEL J. COPPENS.
ADMINISTRATOR FOR THE ESTATE OF DIANE MARIE COPPENS.
DECEASED
Date of Death: March 17, 2007
Letters of Administration advertised:
Letters of Administration: April 11, 2007 Cumberland Law Journal: April 20, & 27
& May 4, 2007
Inventory filed: April 11, 2007 The Sentinel: April 16, 23 & 30,2007
Estate No.: 2007-00347
PRINCIPAL ACCOUNT RECEIVED-REAL ESTATE
1. Real estate situate in Cumberland County, Pennsylvania
known as 813 North Walnut Street, Mechanicsburg.
Total Principal Account Received - Real Estate
$104.851.94
$104,851.94
PRINCIPAL ACCOUNT RECEIVED - PERSONAL ESTATE
2. 2006 Kia Sportage (Purchase Price)
$21,800.00
3. MISCELLANEOUS CLOTHING
120.00
4. WEDDING RING AND BAND
300.00
5. FINAL PAYCHECK FROM PINNACLE HEALTH
1,817.78
6. REFUND FROM THE LOMIS COMPANY
189.09
7. REFUND FROM THE LOMIS COMPANY
46.00
8. UNLIQUIDATED WRONGFUL DEA TH/NEGLIGENCE
CLAIM PENDING
( A SUPPLEMENTAL ACCOUNTING WILL BE FILED
AS NEEDED)
unknown
Total Principal Account received
$24,272.87
$129,124.81
Total Principal Account received - real and personal estate
1
DISBURSEMENT ACCOUNT
1. Malpezzi Funeral Home - funeral expenses $7,874.72
2. Gingrich Memorials- Grave marker expense 810.00
3. FINAL LIVING INCOME TAX RETURNS TO JOHN COX, CPA 190.00
4. INHERITANCE TAX REVIEW TO TOM FLOWER, ESQUIRE 80.00
5. ESTATE PUBLICATION FEE TO THE SENTINEL 164.44
6. ESTATE PUBLICATION FEE TO CUMBERLAND 75.00
LAW JOURNAL
7. FEE TO REGISTER OF WILLS TO FILE FIRST & 180.00
PARTIAL ACCOUNT AND ADVERTISE
8. Family exemption to Daniel J. Coppens $3,500.00
9. Legal fees to Karl M. Ledebohm, Esq. 4,000.00
10. Chambers Hill Fire Swatara EMS 50.00
11. OSL DBA ORTH INSTITUTE OF PA 286.00
12. QUANTUM IMAGING & THERAPEUTIC ASSOCIATES 170.00
13. Quest Diagnostics 49.00
14. PharMerica 747.56
15. Hetrick Center PC 17.27
16. Pinnacle Health Hospital 657.00
17. Riverside Anesthesiologists 700.00
18. 2007 Countyffwp. Real Estate Tax for property at
813 North Walnut St., Mechanicsburg, PA 17055 1,196.31
19. 2007-2008 School Real Estate Tax for property at
813 North Walnut St., Mechanicsburg, P A 17055 423.57
20. Interest payments on mortgage loan set forth in item 1
2
above for April through December 2007.
21. Interest payments on vehicle loan for 2006 Kia Sportage to
Chase Auto Finance
22. Homeowner's insurance to State Farm Fire and Casualty
Company for property at 813 N. Walnut Street, Mechanicsburg, PA
17055
23. CHASE AUTO FINANCE, MAILCODE AZ 1196
201 NORTH CENTRAL AVE., PHOENIX, AZ 85004
(LIEN ON 2006 KIA SPORT AGE)
24. Probate fees to Cumberland County Register of Wills
25. Mortgage to Chase Home Finance on 813 North Walnut
Street, Mechanicsburg, P A to be assumed by Daniel J.
Coppens, surviving spouse of Diane Marie Coppens
26. Total Disbursement Account
RECAPITULATION
1. Total Principal Account Received
2. Total Disbursement Account
3. Balance for distribution
3
2,241.91
791.28
330.00
18,720.42
310.00
61,018.94
$104,583.42
$129,124.81
$104.583.42
$24,541.39
PROPOSED SCHEDULE OF DISTRIBUTION
Balance available for distribution
To: DISCOVER BANK ACCT. #6011 0021 80674095
C/O MICHELE MEHAN
WELTMAN WEINBERG & REIS CO. L.P.A
175 SOUTH THIRD STREET, SUITE 900
COLUMBUS, OH 43215
To: Daniel J. Coppens
813 North Walnut Street
Mechanicsburg, PA 17055
(Share to which Mr. Coppens is entitled to under
20 Pa. C.S.A. Section 2102(3))
Total balance to be distributed
4
$24,541.39
614.56
23,926.83
$24,541.39
BASIS FOR DISTRIBUTION
The proposed schedule of distribution is based upon 20 Pa. C.S.A. Section 2102(3)
governing the intestate share of surviving spouse where there are no issue of Decedent
and Decedent is survived by her mother, Cathy Kubeika. Since the value of the Estate
available for distribution is less than $30,000.00, the said Cathy Kubeika does not possess
an interest in Estate at this time.
Respectfully submitted,
.1~t:~~
Daniel J. Coppens, Administrator and
Accountant
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