The URL can be used to link to this page

Home My WebLink About03-26-09IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA. ORPHANS' COURT DIVISION FILE NO: 21-07-1128 FIRST AND FINAL ACCOUNT OF Cynthia A. Gorski, Executrix For ESTATE OF PAUL M. MORROW Social Security #: Tax ID #: 242-12-0275 Date of Death: 26-6143771 Date of Incapacity, if any: November 30, 2007 Date of Executrix Appointment: None Date of First Complete Advertisement: December 13, 2007 Accounting for the period: December 21, 2007 November 30, 2007 to March 11, 2009 Purpose of Account: Cynthia A. Gorski, Executrix, offers this Account to acquaint interested parties with the transactions that hav e occurred during her Administration. It is important that the Account be carefully examined. Requests for additional information, questions or objections ca b di n e scussed with: Richard C. Snelbaker Snelbaker & Brenneman, P.C. 44 West Main Street Mechanicsburg, PA 17055 Phone #: 717-697-8528 Supreme Court I.D. No: 06355 l~ L~L~ -~ ,`- L~ _ ,.p - ~i LAW OFFICES 7 --1 SNELBAKER 8C BRENNEMAN, P.C. t+..7 c-a t_ 7 ~w~ iJ iO] CJ's :'~ (~,.3 __ ~' "3 Page 1 LAW OFFICES SNELBAKER BC BRENNEMAN, P.C. SUMMARY OF ACCOUNT PRINCIPAL Receipts Net Gain on Sales or Disposition Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Family Exemption Federal, State & Local Taxes Fees and Commissions Balance before Distributions Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Holdings INCOME Receipts Less Disbursements Balance before Distributions Distributions to Beneficiaries Income Balance on Hand COMBINED BALANCE ON HAND Pesons Interested in Distribution of Estate Proposed Distribution to Beneficiaries AffidavitNerification PAGE Page 2 3 3 3 3 3&4 4 4 4 4 5 5 5 5 5 6 7 8 $ 50,854.75 0.00 $ 50,854.75 $ 2,705.22 2,668.69 3,975.16 0.00 11, 002.25 5,360.00 25,711.32 $ 25,143.43 3,392.00 $ 21,751.43 $ 0.46 0.00 $ 0.46 0.00 $ 0.46 $ 21, 751.89 PRINCIPAL RECEIPTS Assets Listed on Inventory per copy of attached: (Valued as of Date of Death) $48,728.73 ADJUSTMENTS TO INVENTORY NONE 0.00 LAW OFFICES SNELBAKER EC BRENNEMAN, P.C. SUBSEQUENT RECEIPTS 12/3/2007 Henry Ford Hospital, pension payment (made in error returned 9/26/08) 4/22/2008 Royal Palm Insurance, refund on homeowners insurance 890.63 9/6/2008 West Shore EMS, ambulance refund 823.23 10/17/2008 Refund on flood insurance policy 176.46 12/7/2008 WREC, refund overpayment 123.00 1/14/2009 Commonwealth of PA, refund on Inheritance Tax 89'02 TOTAL PRINCIPAL RECEIPTS 23.68 $50,854.75 PRINCIPAL GAINS OR LOSSES ON SALES OR OTHER DISPOSITIONS NONE $0.00 NET GAIN/LOSS TRANSFERRED TO SUMMARY $0.00 DISBURSEMENTS OF PRINCIPAL DEBTS OF DECEDENT 12/24/2007 Dailey Harvey, medical expense -eye doctor $ 20 00 12/28/2007 Verizon, phone service . 12/31/2007 Country Meadows Community, nursing home care 1 29 1/10/2008 Mobile X-Ray Imaging, medical services 91.75 1/10/2008 Commerce Bank, payoff credit card debt 69.73 1/10/2008 Health South Rehab, medical services 307.44 1/10/2008 West Shore EMS, ambulance service 20.00 1/11/2008 Jackson, Siegelbalm Gastroenterologist, medical services 77 02 50 00 1/16/2008 M. Atfeh, cardiologist/medical services . 1/24/2008 East Penn Ambulance Service, ambulance services 146.94 74 96 1/28/2008 Health South Rehab medical services . , 2/29/2008 Burrick, Azizhan Internal Medicine medical i 1,000.00 , serv ces 4/14/2008 West Shore EMS, ambulance service 35.98 810.11 $ 2,705.22 FUNERAL EXPENSES 4/9/2008 Malpezzi Funeral Home, funeral services $ 2,668.69 $ 2,668.69 ADMINISTRATION EXPENSES 12/1/2007 WREC, electric service Florida $ 75 12!19/2007 Bill Weller, lawn care for Florida propert .73 y 12/24/2007 Hernando County Utilities utilities Florida 100.00 , 1/2/2008 Dick Williams, pool care 54.55 1/22/2008 Anthony Kanaris, real estate appraisal 245.00 1/24/2008 Hernando County Utilities utilities Florida 275.00 , 1/25/2008 Veterans benefit for December returned 38 92 1 /2 812 0 0 8 Bill Weller, lawn care for Florida property 115.00 2/26/2008 Accounting Associates, preparation Final Individual Taxes 80.00 50 00 2/28/2008 Hernando County Utilities, utilities Florida . 40 44 3/10/2008 WREC, electric service Florida . 32.95 Page 3 3/14/2008 Johnson & Sasser, attorney services in Florida 3/17/2008 WREC, electric service Florida 3/19/2008 Dick Williams, pool care 3/20/2008 Hernando County Utilities, utilities Florida 3/25/2008 Conseco refund transferred to bank account under Morrow Family Revocable Living Trust 3/27/2008 Bill Weller, lawn care for Florida property 4/1/2008 Joseph James Jewelers, jewelry appraisal 6/2/2008 Household goods which were given to family friends (fishing equipment $10.00 and gold clubs $50.00) 8/14/2008 Proceeds from sale of household goods transferred to bank account under Morrow Family Revocable Living Trust 8/29/2008 Register of Wills, filing fee for Inheritance Tax return 9/6/2008 Henry Ford Hospital, pension, refunded paid to decedent in error 1/22/2009 Accounting Associates, preparation of Fiduciary Taxes 3/11/2009 Filing fee for First and Final Account and Inventory '`"'` Snelbaker & Brenneman, P.C., costs advanced: a Register of W'll $0.00 $0.00 I s, probate fee 140.00 b. Cumberland Law Journal, Executrix Notice 75.00 c. The Sentinel, Executrix Notice 174.58 d. Register of Wills, short certificates 16.00 $ 3,975.16 FAMILY EXEMPTION NONE FEDERAL STATE & LOCAL TAXES 2/22/2008 Register of Wills, Agent, estimated tax payment 8/29/2008 Register of Wills, Agent, PA Inheritance Tax FEES AND COMMISSIONS """ Cynthia A. Gorski, Executrix commission ~"' Snelbaker & Brenneman, P.C., attorney services TOTAL DISBURSEMENTS OF PRINCIPAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. TO: Cynthia A. Gorski Household goods retained in kind TO: Nancy A. Pawelczyk Household goods retained in kind TOTAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIE Page 4 $ 9,000.00 2,002.25 $ 11,002.25 $ 2,400.00 2,960.00 $ 5,360.00 200.00 9.96 160.00 61.00 210.00 90.00 95.40 60.00 475.00 15.00 890.63 50.00 145.00 405.58 $ 25,711.32 792.00 792.00 2,600.00 2,600.00 S $ 3,392.00 PRINCIPAL BALANCE ON HAND Cash Household goods retained In-kind *"~ Less items listed on page four of Accounting FIDUCIARY VALUE AT ACQUISITION 3/11/2009 VALUE 27,517.47 45,276.73 0.00 3,452.00 -5, 765.58 TOTAL PRINCIPAL BALANCE ON HAND $ 21,751.89 $ 48,728.73 INFORMATION SCHEDULES PRINCIPAL INVESTMENTS MADE NONE CHANGES IN PRINCIPAL HOLDINGS NONE LAW OFFICES SNELBAKER EC BRENNEMAN. P.C. RECEIPTS OF INCOME 12/31/2007 Commerce Bank, checking account #537669624, interest 3/25/2008 Bank of America, checking account #1428744541, interest Commerce Bank, checking account #537670580, adjustment to accrued interest not paid TOTAL RECEIPTS OF INCOME DISBURSEMENTS OF INCOME NONE TOTAL DISBURSEMENTS OF INCOME DISBURSEMENTS OF INCOME TO BENEFICIARIES NONE TOTAL DISBURSEMENTS OF INCOME TO BENEFICIARIES $ 0.09 0.42 -0.05 $ 0.46 $0.00 $0.00 $0.00 $0.00 Page 5 UNPAID CREDITORS: NONE ** PERSONS INTERESTED IN DISTRIBUTION OF ESTATE: 1 ~ Cynthia A. Gorski, Co-Successor Trustee for Morrow Family Revocable Living Trust 1363 Shuman Drive Carlisle, PA 17015 2~ Nancy A. Pawelczyk, Co-Successor Trustee for Morrow Family Revocable Living Trust 18500 Hannan Road New Boston, MI 48164 LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. Page 6 PROPOSED DISTRIBUTION TO BENEFICIARIES Cynthia A. Gorski, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Paul M. Morrow, Deceased, to wit: $ 21,751.89 in accordance with the Last Will and Testament of said Decedent as follows: 1 ~ The Morrow Family Revocable Living Trust 100% of Residue Cynthia A. Gorski and Nancy A. Pawelczyk, Co-Successor Trustees TOTAL DISTRIBUTION: LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. Page 7 $ 21, 751.89 $ 21,751.89 AFFIDAVIT /VERIFICATION CYNTHIA A. GORSKI, Executrix under the Last Will and Testament of PAUL M. MORROW, Deceased hereby declares under oath that she is fully and faithfully discharged the duties of her 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; to her knowledge, there are no claims 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. This statement is made subject to penalties of 18 pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. / ... Cynthia A. Gorski, Executrix ,, ,~/ Dated: ~'r'~C „~~f~r ~ 7 ~'- h 'x Subscribed and sworn to by CY+N~HIA A. GORSKI b fore me this ~_ day of 2 ~ , 2009 C.~, r Notary Public ~' cOMOV~or~,rv~ALTr~ nF ~EN~e_,vLt<ANOA SBfi~r~i K. "~`e7'"i~l'S, 9'v0~t?~,' ~..ii??C•°, M1I~';~ ~c,ra,ri~ ~ i:wx ~ ~ , {4E~m~er, Pence ylv, a7ia ~,,,u.,.;~~4c.n ~i i~;s, pies LAW OFFICES SNELBAKER EC BRENNEMAN, P.C. Page 8 DECEDENT'S ESTATE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Paul M. Morrow No. 21-07-1128 DECEASED PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9 ~_ -~ - _~ f -- ~~. --.~ F.i r ; ;` ~; `T=; ~~_ . -~' -~ r ~ - ~ ~'~ - . . I'' _ ~ , 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. INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Richard C. Snelbaker Supreme Court I.D. No.: 6355 Name of Law Firm: Snelbaker & Brenneman P.C. Address: 44 West Main Street, Mechanicsburg, PA 17055 Telephone: 717-697-8528 Fax: 717-697-7681 Form OC-0/ rev. /0.!3.06 Page 1 of 10 Estate of Paul M. Morrow 1. Name(s) and address(es) of Petitioner(s): Name: Cynthia A. Gorski, Executrix Address: 1363 Shuman Drive Carlisle, PA 17015 Deceased Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: N/A Is this the first accounting by this fiduciary? ..................... ~ Yes ~ No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on November 30, 2007 c.~ 4.? Letters Testamentary or ~ Letters of Administration were granted to Petttt~n~,r(s) on _ ., ' ' December 13. 2007 --_~ ~--~ ~ _ Date of Will (fapplicable): `-~ ~' May 8, 1991 ' -°~ ~" - Date(s) of Codicil(s) (fapplicable): N/A "' ~ ~ ~ ~~' Date of probate (if different from date Letters granted): Decemher 1 ~ ~nm r~~ ~ ,` Was a bond required? ~;,JI'es ~ No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... Q Yes ~ No Dates of advertising of the grant of Letters: Cumberland Law Journal -December 28, 2007, January 4, 1 I, 2008 -The Sentinel -December 21, 28, 2007 & Jan 4, 2008 FormOC-01 rev. 10.3.06 Page 2 of 10 PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. 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 weelkly 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 tike following dates. viz: December 28, 200 7. January 4 and January 11 2008 Afflant further deposes that 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 subiect matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publicatior. are true. ~!, ~, ;. Lisa Marie Coyne; Editor SWORN TO ANL~ SLJBSCRIBBL~ before me this 1 i day of Januar ~~200~ ~ ,, ,. ,~ F - ~~.. ~_., ----___ Notary ~,_____ Morrow, Paul M., deed. Late of Hampden Township. NO'TlgRlpi 5EP,1 Executrix: Cynthia A. Gorski, ~EBC1C?G;H k CUCllf~ta 1363 Shuman Drive, Carlisle, PA Notary Public 17015. ~ CARLISLE EORG, CUMBERLAI~(C) COUNT4' Attorneys: Snelbaker & Bren- neman, P. C., 44 West Main Street, ~Y Commission Expires Apr 2c9, 201 C~ P.O. Box 31$, Mechanicsburg, PA 17055-0318. PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Trot/ Whitesel, Classified Advertising; Manages 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 13~, 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) December 21, 28, 2007 and Tanuarv 04, 2008 COPY OF NOTICE OF PUBLICATION EXECUTRIX NOTICE Letters Testamentary on the Estate of PAUL M. MORROW, Deceased, late of Hampden Township, Cumberland County, Pennsylvania, have been granted to the undersigned. All persons knowing themselves lobe indebted to said Estate will make payment immediately, and those having claims wilt present them for settlement to: Cynthia A. Gorski 1363 ShumarrDrive Carlisle, PA 17015 Executrix SNELBAKER & BRENNEMAN, P. C. 44 West MainBtreet P. O. Box 318 Mechanicsburg, PA 17055-0318 Attorneys 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. Sworn to and subscribed before me this 04th. day of Tanuary, 2008. f ~ /' Notary Pul~~xc My commission expires: ~~~~,~~~' COMMONWEALTH OF PENNSYLVANIA Notarial Sea! Christina L. Woke, Notary Public Cariisle Boro, Cumberland County MY Corrtrnissiorl Expires Sept. 1.2006 Member. Pennsylvania Association Of Notaries Estate of Paul M. Morrow Deceased 3. Was decedent survived by a spouse? ............................. Yes ~ No If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ............. Yes ~ No (See Section 2201 et sue. 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): N/A 6. Did decedent marry after execution of Will or Codicil(s)? ........... ~ Yes ~ No Were any children born to decedent after execution of Will or Codicil(s)? ........................................... Q Yes ®/ 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? .............................. Yes ~ No Form oc-or ,ev. gyn. ~3.n6 Page 3 of 10 Estate of Paul M. Morrow 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) 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): Forri~ oc-o~ ,ev. ~0.~3.06 Page 4 of 10 Estate of Paul M. Morrow N/A Deceased 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). N/A 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. N/A Form OC-01 rev. /0. /3.06 Page 5 of 10 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. Estate of Paul M. Morrow 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? None Yes ~ Yes ~No ~No DYes ~ Yes ~No ~ No Yes ~ Yes ^No ~ No DYes ~ Yes ~No ~ No 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? ................................ Yes ®/ No Was family exemption allowed? ................................ Yes ONo Family exemption claimant's name and relationship: Name: Relationship: Form oc-ol rev. /0.13.06 Page 6 of 10 Estate of Paul M. Morrow Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows: Date Payment Interest 2/20/08 9,000.00 8/29/08 2,002.25 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 of a fiduciary? ................... ~ Yes 0 No 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: N/A B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. 0 Yes ~ No 15. If Petitioner(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. N/A For„ oc-oI rev. Io.I3.o6 Page 7 of 10 Estate of Paul M. Morrow Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... ~ Yes ~ 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. N/A B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ............. ~ Yes ~ 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 ~No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? .......................... Yes ®/ No As to real estate only? .......................... Yes ~No .............. Form oc-o~ rev. ~o. ~s. 06 Page 8 of I 0 Estate of Paul M. Morrow 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(sf Amount/Proportion See accounting B. Principal: Proposed Distributee(s) See accounting Amount/Proportion Submitted By: (All petitioners must sign. Add additional lines if necessary): `., r C .L ~~ct- G_~,y ~ Name o Petitioner: Cynthia A. Gorski, Executrix Name of Petitioner: Formoc-or rev. io.~3.06 Page 9 of 10 Estate of Paul M. Morrow ,Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that heishe she is tare Executrix of the above-named ~..~c.~~~ Estate of Paul M. Morrow 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). ,. - r-. _, ; L Signatu e 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 form have been made beyond the responses herein. Signature of Counsel for Petitioner FoYm oc-nr rev. rn.r3.o6 Page 10 of 10