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Home My WebLink About05-08-09IN THE COURT OF COMMON PLEAS OF THE CUMBERLAND COUNTY, PENNSYLVANIA In Re: Estate of Dora K. Zook : PA No: 21-08-2007 _ No: 2008-00207 C N ° ~ ~- . ;=j ~ A _ , ri r= i C_ 7 :Orphans' Court Division ? ~m -< <~-~_ ±`~' ~- _ , , PETITION FOR APPROVAL OF SETTLEMENT ' JL= ~`' ~--' ~ ~., r~ -, `!j' NOW comes, Jeremiah Zook, Administrator of the Estate of Dora K. Zook and sets forth the following. 1. Dora K. Zook, an adult individual was born on February 6, 1951 and died on January 14, 2008. 2. At the time of her death, Dora K. Zook was a passenger in an automobile being driven by Anna Martin. Dora K. Zook died intestate survived by her husband, Jeremiah Zook. They had eight children, all of whom are adults, namely Gideon G. Zook, Christian G. Zook, Mary G. Smoker, Abner G. Zook, David I. Zook, Ivan G. Zook, Ruben G. Zook and Sylvia D. Beiler. Notice of estate administration has been given to all of the named children. 3. The car being driven by Anna Martin failed to stop at a posted stop sign and traveled into the path of an oncoming vehicle. Both Anna Martin and Dora K. Zook died as a result of injuries from the accident. 4. Anna K. Martin was insured by a policy of insurance issued by Infinity Preferred Insurance Company with a limit of $50,000.00. A copy of the declaration sheet is attached. 5. Infinity Preferred Insurance Company tendered payment of the $50,000.00 policy limit to the Estate of Dora Zook. 6. The spouse of Dora K. Zook, Petitioner, was appointed to administer the estate l on February 27, 2008. 7. No civil action has been filed. There are sufficient assets in the estate to pay inheritance taxes, debts and any creditors of the estate. 8. No attorneys fee are being charged. 9. Counsel requests approval for reimbursement of $117.00 advanced to the Register of Wills a probate fee. Counsel also requests approval for reimbursement of additional fees to the Register of Wills to file this petition and an inheritance tax return. 10. It is requested that the Court allocate 100% of the damages to the survivors' action. 11. Since all the potential heirs are adults; the administrator is the spouse of decedent and policy limits have been tendered, it is suggested that no hearing is required. Wherefore Petitioner prays your Honorable Court approve settlement in this matter, without hearing, allocating 100% of the award to the Estate of Dora K. Zook as a survivors' action. Dated: S 7 ~ Respectfully submitted, H. Anthony Adams, Esquire Attorney for Plaintiffs 49 West Orange Street, Suite 3 Shippensburg, PA 17257 (717)-532-3270 VERIFICATION I verify that the statements made in this petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: ~ ~~ H. ANTHONY ADAMS ' Infinity Value added' 5205 N. O'Connor Blvd., Suite 700 Irving, TX 75039 Underwritten by: Infinity Preferred Insurance Co., 1400 Provident Tower, One E 4th St, Cincinnati, OH 45202 Customer Service: (8 7) 953-2337 PERSONAL AUTO DECLARATION Claims Service: (800) 334-1661 POLICY NUMBER: 137-15187-0252-001 MARTIN, ANNA M POLICY PERIOD: 01/04/2008 TO 01/04/2009 PO BOX 253 NEWBURG PA 17240 This policy incepts on the date and time that the application for insurance is executed and shall expire at 12:01 a.m. on the last day of the policy period. The folbwing coverages and limits apply to each described vehicle as shown below. Coverages are defined in the policy and are subjed to the terms and conditions contained in the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. # Yr Make -Model Serial Number Com /Coll # Driver Name Driver Status 1 95 DODG CARAVAN 2B4GH2532SR398081 N/A / N/A 1 Anna Martin Adive COVERAGES -LIMITS OF LIABILITY PREMIUMS FOR VEHICLES THE COVERAGE IS APPLICABLE ONLY IF A PREMIUM IS INDICATED VEH 1 liodpy Injury Liabiity 550,000 each person 5100,1]00 each accident 95 Property Damage Liability y50,00D each accident 151 Medical Benefits 65,000 Limn 71 Uninsured Motorist '""" REJECTED'""' '""" REJECTED ""` Underinsured Motorist ""` REJECTED ""' ""` REJECTED "^"' PREMIUM BY VEHICLE: 317 TOTAL VEHICLE PREMIUM $ 317.00 POLICY FEES ENDORSEMENTS MADE A PART OF THIS POLICY: TOTAL POLICY PREMIUM $ 317.00 13757AF1ni (Duly Au d Representative) IF COLLISION COVERAGE IS PURCHASED, IT DOES APPLY TO A RENTAL VEHICLE USED AS A SUBSTITUTE AUTO. INSURED COPY AMEND DATE: 01/04/08 FORM 13752DEC02 Page 1 of 2 ENDORSEMENT: 4-1 Agency information: DYMOND INSURANCE AGENCY 9531 (717) 263-9053 1784 LINCOLN WAY EAST Chambersburg, PA 17201 Please mail all inquiries to: Infinity Value Added 5205 N. O'Connor Blvd., Suite 700 Irving, TX 75039 Please fax all inquiries to: 1-877-532-3379 ANY LOSS UNDER PART E IS PAYABLE TO NAMED INSURED AND LOSS PAYEE: LOSS PAYEE ADDITIONAL INTEREST Veh # Addlint # Name Veh # Addlint # Name Disclosure of the dollar amounts of all surcharges and each discount, as mandated by Pennsylvania statute or regulation, are listed below: DISCOUNTS /SURCHARGE DISCLOSURE DISCOUNTS Description: Amount: Applies to: Description: Amount: Applies to: Airbag Discount (2) -30.43 1 Passive ResVaint -12.53 1 Market Factor -102.00 1 Limited Tort -145.40 N!A SURCHARGES Description: Amount: Applies to: Description: Amount: Applies to: VIOLATIONS Drv# Violation: Violation Date: I Drv# Violation Violation Date: I Violation Premium Surcharge: $ 0.00 TORT OPTION: Limited Tort Page 2 of 2 T REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No . 2008- 00207 PA No . 21- 08- 0207 Estate Of : DORA K ZOOK (Fist, Midd/e, Lastl Late Of: HOPEWELL TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : WHEREAS, DORA K ZOOK /First, Middle, Lastl -- late of HOPEWELL TOWNSHIP CUMBERLAND COUNTY died on the 14th day of January 2008 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: JEREM/AH ZOOK who has duly qualified as ADMINISTRATOR(RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 27th day of February 2008. ~0~•~-n-a~. eg/ster o / s eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 2/27/2008 Cumberland County - Register Of Wills Receipt Time: 08:14:27 One Courthouse Square Receipt No.: 1051727 Carlisle, PA 17013 ZOOK DORA K Estate File No.: 2008-00207 Paid By Remarks: H ANTHONY ADAMS ESQ JA ------------------- ----- Receipt Distrib ution ------------- ----------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 90.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D Check# 12569 ---------------- $117.00 Total Received..... .... $117.00