HomeMy WebLinkAbout07-16-09IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
PENNSYLVANIA
ORPHANS' COURT DIVISION / - p
Estate of Mazlene E. Stein, No. a U~Q - l~/So
Deceased
Petition for Settlement of Small Estate
Pursuant to section 3102 of the Probate, Estates and Fiduciaries Code, the undersigned
petitioner respectfully represents that:
1. The name and address of the petitioner is:
Mazgo E. Stein
111 Barnwood Place
Harrisburg, Pa 17112- 3385
2. The relationship of the petitioners to the decedent is: Sister
3. The decedent died on: November 12, 2008
4. The decedent was domiciled at time of death in Cumberland County,
Pennsylvania, with a last family or principal residence at:
Claremont Nursing Center
1000 Claremont Road
Cazlisle, Pa (Middlesex Township)
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5. The decedent's social security number is: 173- 32- 6782 -~ v ~ ;~ ~ <;_~
6. The death certificate is attached hereto. ::' c~3 ~ o+ ^; '~
7. The decedent died: ~~ z -_• -rl
W s"~
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X (a) intestate ~ :'J
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-~y
^ (b) testate
If the decedent died testate:
^ (i) the will has been probated, and a copy is attached hereto.
Letters have been issued to:
1
^ (ii) the will has not been probated and the original will is
attached hereto. [If not attached; explain.) The personal
representative(s) named therein is (are):
8. The name(s), relationship(s), and interest(s) of all parties beneficially interested in
the estate aze:
5ui Juris
Name Relationship Interest es or no
Margo Stein Sister Yes
Moms E. Stein Brother Yes
9. A spouse's elective shaze: N/A
X (a) has not been claimed
^ (b) has been claimed. [Give details.)
10. If the decedent died testate, the decedent:
^ (a) was not married or divorced after the date of execution of the will
^ (b) was marred or divorced after the date of execution of the will.
[Give details.)
11. If the decedent died testate, the decedent:
^ (a) did not have a child or children born or adopted after the date of
execution of the will
^ (b) had a child or children born or adopted after the date of the
execution of the will. [Give the name and date of birth or adoption
of each such child)
2
Name
Date of Birth or Adoption
12. The decedent died owning property (exclusive of real property and property
payable under section 3101 of the Probate, Estates and Fiduciaries Code) of a gross
value not exceeding $25,000, which is itemized below. [Include account numbers and
registration numbers, etc. If a bequest is deemed, explain.)
Item
PCA fund Claremont Nursing Home
Refund from Olewiler Funeral Home
Sovereign Bank Check Account #2781718602
Amount
$141.00
$389.98
3 249.10
Total $3,780.08
13. An itemized statement of all claims against the estate is set forth below:
(a) The following person(s) claim(s) the family exemption under section 3121
of the Probate, Estates and Fiduciaries Code by virtue of being a member
of the same household as the decedent:
Amount of
Name Relationship Items Claimed
None Claimed
Total
(b) The following person(s) claim(s) reimbursement for debts, expenses, and
other claims (including inheritance tax, if applicable) they have paid with
their own funds:
Claiming Date of
Natute of
Debt or
None
(c) The following claims remain unpaid:
Claimant
Pa. Dept of Welfare
Jane M. Alexander, Esq.
Jane M. Alexander, Esq.
Nature of Claim
Medical Assistance
Filing Fee for Petition to Settle a small est.
Professional Services Rendered
Amount
$191,917.97
$45.00
$265.00
Total
14. X (a) All claims are undisputed.
^ (b) The following claims ate disputed: [Give details)
$192;227.97
15. The petitioner has paid or will cause to be paid all Pennsylvania inheritance tax
due on all property to be awarded under this petition. (2008)
16. All parties beneficially interested in the estate, other than the petitioner, including
all holders of claims that are denied, or in the case of an insolvent estate, all holders of
claims who will not be paid in full, have: N/A
X (a) signed the joinder in this petition which is hereto attached; or
^ (b) been mailed at lease ten (10) days written notice of the date, time,
and place of the Orphans' Court audit session at which the petition
will be ruled upon by the Court, a copy of which notice is attached
hereto.
17. Your petitioner proposes:
(a) that the following claims be paid: [Refer to section 3392 of the Probate,
Estates and Fiduciaries Code to establish priority among claims, if
necessary.)
Claimant Nature of Claim Amount
me M. Alexander Reimbursement of fees and professional. $310.00
Services, in re administration of estate.
. Dept of Welfare $3,470.08
Total $3,780.08
(c) the balance, if any, be distributed as follows:
4
(c) the balance, if any, be distributed as follows:
Item
No balance remaining
Amount
Total $0.0
~ ~ ~M/k/ ~. R~N.C.1/YV
Margo .Stein, Petitioner
M.
preme Court L13. No.: 07355
8 S. Baltimore Street
O. Box 421
Dillsburg, PA 17019-0421
(717)432-4514
Verification
The undersigned petitioners hereby verifies, subject to the penalties of 18 Pa. C.S.A.
§4904 (relating to unsworn falsification to authorities), that the facts set forth in the
foregoing petition which are within his lrnowledge are true, and, as to the facts based on
information received, after diligent inquiry, he believes them to be true.
Date: _/ ~ UN (.C.S'U ~ ~ , D~ ~-1
~. ,
Margo Stein, Petitioner
Joinder
I/We, the undersigned, being parties other than the petitioner beneficially interested in the
estate of the foregoing decedent, do hereby certify that I/we have read the foregoing
petition and join in the prayer thereof.
Pennsylvania Department of Welfare by
Morris E. Stein
~-~(i l l~J~ C
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DNISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX BaB6
HARRISBURG, PA 17105-8086
April 26, 2009
JANE M ALEXANDER ESQUIRE
148 S BALTIMORE ST
DILLSBURC PA 17019
Dear Attorney:
Re: MARLENE STEIN
CIS #: 820152777
SSN: 173-32-6782
Date of Death: 11/12/2008
This letter is to advise you that according to the information you
provided to our office regarding the assets of the above-referenced estate,
the Department of Public Welfare will accept the balance, namely $3,281.08
remaining in the estate for payment of our existing claim.
Please have the check made payable to the Department of Public Welfare
and forwarded to my attention at the above address.
Your cooperation in resolving this matter is appreciated.
Sincerely,
/~
Kelly J. Chestnut
TPL Program Investigator
717-214-1861
717-772-6553 FAX