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HomeMy WebLinkAbout07-24-09~~it the Orphans' Court Division of the Court of Common Pleas of Cumberland County COMMONWEALTH OF PENNSYLVANIA No. 2007-01068 Estate of SANDRA L. ADAMS ,Deceased Late of Hampden Township, Cumberland County, Pennsylvania FIRST AND FINAL ACCOUNT of PAULA D. POTTEIGER, ADMINISTRATRIX Date of Death: November 6, 2007 Letters Granted: November 21, 2007 First Complete Advertisement of Grant of Letters: December 7, 2007 Account Stated to: July 15, 2009 SUMMARY & INDEX Pages PRINCiP_A_ L_ Receipts 2 $ 15,485.27 Net Gain or (Cuss) on Conversions 3 Adjustad Balance $ 15.485.27 Bess Dh;,oursements 5 2.954.08 Balance before Distributions $ 12,~53~.19 Dist~ibUiions to Beneficiaries 5 Principal Balance Remaining INCC"v1F Receipts 6 $ 33.36 Less Disbursements __ ~~_ Balance before Distributions $ 38.36 Less Distributions to Benefaaries 7 - Income Ba!ar~:e Remaining COMBirvE,'. BALANCE REMAINING !N'JESTPP,LNTG CAFIIAI. CHANGES AFFIDAVIT OF ACCOUNTING PART`r scHFDU~ t: or t~RO~o~r-n ~ uar. o!srPir;unoNS Exhibit A (at Page 12) 12,531 19 38.36 12,569.55 Purpose et Acco,.nt: FaWa D F'otteiger, offers this account to acquaint interested parties with the transactions that have. occurrad during his adminitration. the a~ coon! also indicates the proposed distribution of the estate it is irnporant that the account be carefully examined. Requests for additional irrforr;eticn or quesacns or obyactians .:an be discussed with. 5helty J. KunFei, Esq Wion Z~tIG & Seii;eit 109 Locust Strest Harrisburg, PA 1710 (717)L3o-931 Page 1 `i 1a~1~~~~ J ~, ~~~y~ ~ }~I COMPOSITION OF NET BALANCES Total Principal and Income Combined Market Value July 15, 2009 Account Value Cash Members 1st Federal Credit Union Savings Account 25.00 Members 1st Federal Credit Union Investment Savings Account 15,447.70 TOTAL PRINCIPAL AND INCOME COMBINED - 15,472.70 PRINCIPAL RECEIPTS Per Inventory Filed Per Copy of Inventory attached to the Petition for Distribution as Exhibit "C" 15,472.70 Adjustments to Account Values Adjustment to Members 1st Savings for interest 12.57 TOTAL PRINCIPAL RECEIPTS 15,485.27 Page 2 CONVERSIONS INTO CASH 11/21/07 MEMBERS 1ST Savings Account # 283160-00 Proceeds 25.00 Inventoried at 25.00 11/21/07 Members 1st Investment Savings Acct# 283160-05 Proceeds 15,447.70 Inventoried at 15,447.70 TOTAL TRANSFERRED TO SUMMARY Gain Loss Page 3 PRINCIPAL DISBURSEMENTS 11/21/07 Cumberland County Register of Wills -Probate Fee 88.00 11/21!07 The Cumberland Law Journal -Estate Advertisement 75.00 12/1/2107 The Sentinel -Estate Advertisement 174.58 01/02/07 Members 1st FCU -Estate Check fees 8.50 02/18/08 Wion Zulli & Seibert -retainer Sandra L. Adams Estate 1,608.00 04/18/09 Cumberland County Register of Wills -Inventory Filing Fee 30.00 05/13/08 Wion Zulli & Seibert -retainer Sandra L. Adams Estate 840.00 07/24/09 Cumberland County Register of Wills -Account Filing Fee 50.00 07/24/09 Cumberland County Register of Wills -Advertising Fee 80.00 07/24/09 Wion Zulli & Seibert -Certified Mail fees 90.00 TOTAL DISBURSEMENTS 2,954.08 PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES NONE Page 5 INCOME RECEIPTS Members 1st FCU E 12/31 /07 01 /31 /08 02/28/08 03/31 /08 04/30/08 05/31 /08 06/30/08 07/31 /08 08/31 /08 09/03!08 10/31 /08 11 /30/08 12/31 /08 01 /31 /09 02/28/09 03/03/09 04/30/09 05/31 /09 06/30/09 state Checking Account Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest 1.05 3.25 2.82 2.29 2.29 2.21 2.18 1.96 2.02 2.02 1.96 2.03 1.96 2.03 2.03 1.83 2.03 1.22 1.18 TOTAL INCOME RECEIPTS 38.36 Page 6 INCOME DISBURSEMENTS NONE INCOME DISTRIBUTIONS TO BENEFICIARIES NONE PAULA D. POTTEIGER, AD INIS ATRIX Page 7 In the Orphans' Court Division of the Court of Common Pleas of Cumberland County COMMONWEALTH OF PENNSYLVANIA No. 2007-01068 Estate of SANDRA L. ADAMS ,Deceased Late of Hampden Township, Cumberland County, Pennsylvania AFFIDAVIT OF ACCOUNTING PARTY COMMONWEALTH OF PENNSYLVANIA ) ss. DAUPHIN COUNTY ) PAULA D. POTTEIGER, ADMINISTRATRIX ,being duly sworn according to law, deposes and says that he is the Accountant in the Estate above named, and that the FIRST AND FINAL ACCOUNT stated to July 15, 2009 contains according to the best of my knowledge and belief a true statement of all my receipts and disbursements on account of the Estate and of all moneys or other property belonging to the Estate which have come into my hands or been received by any other person by my order or authority for my use and that I do not know of any error or ommission in the account to the prejudice of any creditor of, or person interested in, the Estate; and that the Grant of Letters of Administration and the first complete advertisement therof occurred more than four (4) months before filing the First and Final Account. PAULA D. POTTEIGER, ADMINI T ATRIX Sworn to and Subscribed~efore me this -~~ ~~ day of t ~~-- v7 ~« ~It ~~. -lr~.~ ~ Notary Public CG~9~Ns1~1!ly~A' -f tl~ ~~r~;'n1SYLVT,~.i3F~ ~. ~ sr, nsRi ~r,~~L p f, ', , , l Viy ~Jr f"iia~il:'s~4.si'(), Li2~rlTirl GoUnty R m _Pa~}~ ~',~mr~isuion i=x~ires March 19, 2010.._.,..] Page 8 In the Orphans' Court Division of the Court of Common Pleas of Cumberland County COMMONWEALTH OF PENNSYLVANIA No. 2007-01068 Estate of SANDRA L. ADAMS ,Deceased Late of Hampden Township, Cumberland County, Pennsylvania SCHEDULE OF PROPOSED DISTRIBUTION DISBURSEMENTS TO CREDITORS PURSUANT TO 20 Pa. C.S. § 3392 Balance for distribution as per FIRST AND FINAL ACCOUNT Dated July 15, 2009 $ 12,569.55 Distribution 20 Pa. C.S. § 3392 11- -Costs of Administration Wion Zulli & Seibert - Paula D. Potteiger - Administratrix Fee 20 Pa. C.S. § 3392 121 -Family Exemption John P. Adams -Spouse of Decedent 20 Pa C S § 3392 (3) -Funeral and Burial. Medical w/in 6 Months of DOD Proposed Percentage Distribution to Class (3) Creditors: Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 Longsdorf Cemetery St. Stephens Evangelical Lutheran Church 30 W. Main Street New Kingstown, PA 17072 Subtotal (Proposed Payment in Full) (Proposed Payment in Full) $ 1,052.00 1,000.00 $ 3,500.00 Available Balance $ 7,017.55 0.7386 Amount of Bill Proposed Payment $ 5,452.48 4,026.99 $ 475.00 $ 350.82 $ 5,927.48 4,377.80 Page 1 SCHEDULE OF PROPOSED DISBURSEMENT TO CREDITORS PURSUANT TO 20 Pa. C.S. § 3392 Balance for distribution as per FIRST AND FINAL ACCOUNT Dated July 15, 2009 Amount of Bill Distribution Sanford & Roumm Rheumatology $11.34 1845 Center Street Camp Hill, PA 17011 Women's Cancer Center $44.37 3901 N. Front Street Harrisburg, PA 17110 Quantum Imaging and Theraputic Associates $74.74 629D Lowther Road Lewisberry, Pa 17339-9222 Rehab Medicine $34.02 5124 East Trindle Road Mechanicsburg, PA 1 Suite 211 West Shore EMS $954.10 205 Granview Avenue Camp Hill, PA 17011 Holy Spirit Hospital $993.61 503 N 21st Street Camp Hill, PA 17011 Susquehannna Surgeons $33.12 532 North Front Street Wormleysburg, Pa 17043 Camp Hill Emergency Physicians $27.34 P.O. Box 13693 Philadelphia, PA 19101-3693 Spirit Physicians $92.29 205 Grandview Ave.Suite 210 Camp Hill, PA 17011 Pathology Associates $25.93 4520 Union Deposit Road Harrisburg, PA 17111 Pinnacle Health Hospital $1,049.03 P.O. Box 2353 Harrisburg, Pa 17105-2353 Pinnacle Health Hospital $234.29 P.O. Box 2353 Harrisburg, Pa 17105-2353 Subtotal This Page Total Funeral Expenses and Priority Medical Expenses Calculation of Percentage Proposed to Priority (3) Creditors $ 7,017.55 Proposed Payment $8.38 $32.77 $55.20 $25.13 $704.66 $733.84 $24.4Ei $20.19 $68.16 $19.15 $774.77 $173.04 $3,574.18 $2,639.75 $7,017.55 0.73856042 Page 2 SCHEDULE OF PROPOSED DISBURSEMENT TO CREDITORS PURSUANT TO 20 Pa. C.S. § 3392 continued 20 Pa. C.S. § 3392 (6) -All Other Claims Includins Claims of the Commonwealth Proposed Percentage Distribution to Class (6) Creditors: Amount of Bill Proposed Payment MSHMC Physicians $ 243.22 $0.00 Billing Center P.O. Box 854 Hershey, PA 17033 Central Medical Equipment Co. 35 Sarhelm Road Harrisburg, PA 17112 Capital One c/o Estate Information Services, LLC 2323 Lake Club Drive, Suite 300 Columbus, OH 43232 Capital One c/o Estate Information Services, LLC 2323 Lake Club Drive, Suite 300 Columbus, OH 43232 Sears/Providian c/o NCO Financial Systems, Inc Probate Department, # 450 1804 Washington Boulevard Baltimore, MD 21230 Providian c/o Commonwealth Financial Systems, Inc. P.O. Box 18036 Hauppauge, NY 11788-8836 Exxon/Mobil Credit Card Center P.O. Box 688940 Des Moines, IA 50368-8940 Total $ 126.00 $0.00 $ 4,234.18 $0.00 $ 380.17 $0.00 3054.86, $0.00 $ 2,271.65 $0.00 $ 44.95 $0.00 $ 7,300.17 $0.00 Page 3 STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION The above distribution is proposed in accordance with the intestate laws of the Commonwealth of Pennsylvania. ~~ PAULA D. POTTEIGER, ADMI ISTRA RIX COMMONWEALTH OF PENNSYLVANIA ) ss. COUNTY OF DAUPHIN ) PAULA D. POTTEIGER, ADMINISTRATRIX ,being duly sworn according to law, deposes and says that she is the Administratratrix and the Accountant in the Estate above named, and that the facts set forth in the Statement of the Reasons for the Proposed Distribution are true and correct. ~. ~~ ; ~ PAULA D. POTTEIGER, ADM IST ATRIX Sworn to nd Subscribed b re,me this ~~~1~` day of ~ ~c~ Notar ubiic I ~ .. '.-' {SJilifV a' y,~ r~„. , ~s-g C ;~~,~{n Count I ~ Page 4 In the Orphans' Court Division of the Court of Common Pleas of Cumberland County COMMONWEALTH OF PENNSYLVANIA No. 2007-01068 Estate of SANDRA L. ADAMS ,Deceased Late of Hampden Township, Cumberland County, Pennsylvania SCHEDULE OF DISTRIBUTION Schedule of Distribution in accordance with Adjudication dated , of J., upon the First and Final Account of Paula D. Potteiger, Administratrix. Balance for distribution as per FIRST AND FINAL ACCOUNT Dated July 15, 2009 Distributions to Beneficiaries per Account CERTIFICATION OF SCHEDULE OF DISTRIBUTION I hereby certify that the foregoing Schedule of Distribution is correct and in conformity with the inrestate laws of the Commonwealth of Pennsylvania. Attorn r Accountant DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Sandra L. Adams No. 2007-01068 DECEASED PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9 r•, ~ .. _, ' 1 . ~ , c. r ~-~ - c: ~ '" ~ - _ t .~ •.i ' -z .... - ~~ ~~ ,~ ,.:~ _. .. - F `, ~ ~~i .a::- 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, rf 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: Supreme Court l.D. No.: 64485 Name of Law Firm: Wion, Zulli & Seibert Address: 109 Locust Street, Harrisburg, PA 1710] Telephone: (717) 236-9301 Fax: (717) 236-6100 Shelly J. Kunkel, l~'orni OC-0! rer. 10.13.06 Pagel Of 1 ~ Estate of Sandra L. Adams 1. Name(s) and address(es) of Petitioner(s): n'anre_ Paula D. Potteiger ,1~~~.eSS 30 Faith Circle Carlisle, PA 17013 Deceased Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: Is this the first accounting by this fiduciary? ..................... /® Yes Q No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. ?. Decedent died on November 6, 2007 ~ Letters Testamentary or /©Letters of Administration were granted to Petitioner(s) on November 21.2007 Date of Will (if applicable): Date(s) of Codicil(s) (if applicable): Date of probate (if different fi^om date Letters granted): Was a bond required? ©Yes /©No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... ®/ Yes Q No Dates of advertising of the grant of Letters: The Sentinel: December 5, 12, 19.2007 The Cumberland Law Journal: December 7,14,21, 2007 F~o~~r~roc-or ,~e,~. ~n.t3.o6 Page 2 of 10 Estate of Sandra L. Adams Deceased 3. Was decedent survived by a spouse? ............................. /DYes ~ No If yes, name of the surviving spouse: John P. Adams 4. Has the surviving spouse filed to take an elective share? ............. Yes Q No (See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code) [f 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 slate): Paula D. Potteiger 30 Faith Circle Carlisle, PA 17013 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)? ........................................... ^Yes ^/ No If yes, give names and dates of birth: Name: Date of Birth: 7. [f 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? .............................. 0/ Yes ~ No ra~~», oc-ni ,~e,~. ~n.13.o~ Page 3 of l 0 Estate of Sandra L. Adams Deceased 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): Warne and Address of Eacdi Party in Interest ~ Relationship and Commen John P. Adams 504 Quail Court Mechanicsburg, PA 17050 Surviving Spouse ~ Family Exemption Paula D. Potteiger 30 Faith Circle Carlisle, PA ]7013 Daughter Administratrix Fee F~,~»~ oc-nl rein. ln.l3.n~ Page 4 of 10 Estate of Sandra L. Adams Deceased 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 (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. NiA F~~~-n~oc-oi r~e~~. in.r3.a6 Page 5 of 10 Estate of Sandra L. Adams ,Deceased 0. 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 [G'il! Claim Adntit~ed? 6e Paid In Full' See Attached List of Creditors Yes 0 Yes lf~~'~b~+ ~`~ ^No ^No ^Yes Q Yes ONo ^ No ^Yes Q Yes ~No Q No ^Yes DYes ONo Q 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. 1 1. Was family exemption claimed? ................................DYes ONo Was family exemption allowed? ................................ 0/ Yes ^No Family exemption claimant's name and relationship: ~tiran,e: John P. Adams nerauonsh;p: Surviving Spouse r~~~»,oc-or ,~~,~ ro.r3.o6 Page 6 of 10 Estate of Sandra L. Adams 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: Dnte Payntern /merest None Paid -Insolvent Est 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 ~ 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: Petitioner seeks confirmation from the Court for distribution in full to Administrative Expenses and Family Exemption, and pro rata distribution (73.86%) of the remaining available funds to Class 3 creditors. No funds remain to pay Class 6 creditors. B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. ®Yes [] No Each creditor provided with audit notice, account, and proposed distribution schedule 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. r~~,~,,, o~-or ~~~,~ ro i3 n6 Page 7 of 10 Estate of Sandra L. Adams 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. None B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? . ............ ^Yes 0 No 18. If a reserve is requested, state amount and purpose. ilmou~»: 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? ........................................ ^Yes /~No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? .Proposed. Distribution ... Yes INo attached As to real estate only? ........................................ ^Yes ~ No FormOC-0/ res. !0.!3.06 Page g Of l0 Estate Of Sandra L. Adams 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(s) ~ moon Ii Proportion See attached Proposed Schedule of Distribution B. Principal: Proposed Drstrrbutee(s) .9 mo un a/Propoi't i ofi Submitted By: (All petitioners must sign. Add additional lines if necessary): .., - F ~ ~\j~~ Tom."•.• /. _.,"`~. Name of Petitioner: Paula Potteiger, Administratrix Name of Petitioner: toYn,oc-o~ re~~. rn.~3.n6 Page 9 of 10 Estate of Sandra L. Adams Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies ~ [that i,eis~,e Of the above-named name of corporation Deceased 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 7 8 Pa. C.S. § 4904 (relating to unsworn falsification to authorities). ~~±,~--- Signature of Petitioner * Corporate petitior:ers 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. Y~ Signature of ounsel for Petitioner IS title Form OC-O! rer. 10.13.06 Page ~ ~ ~~ -10 List of Creditors Name and Address of Creditor Amount of Claim Claim Admitted Will Claim Be Paid in Full? Malpezzi Funeral Home $5,452.48 Yes Pro Rata 8 Market Plaza Way Mechanicsbur , PA 17055 Longsdorf Cemetery $475.00 Yes Pro Rata St. Stephens Evangelical Lutheran Church 30 W. Main Street New Kin stown, PA 17072 Sanford & Roumm Rheumatology $11.34 Yes Pro Rata 1845 Center Street Cam Hill, PA 17011 Women's Cancer Center $44.37 Yes Pro Rata 3901 N. Front Street Harrisbur , PA 17110 Quantum {maging and Theraputic Associates $74.74 Yes Pro Rata 629D Lowther Road Lewisberry, Pa 17339-9222 Rehab Medicine $34.02 Yes Pro Rata 5124 East Trindle Road Mechanics Suite 211 West Shore EMS $954.10 Yes Pro Rata 205 Granview Avenue Cam Hill, PA 17011 Holy Spirit Hospital $993.61 Yes Pro Rata 503 N 21st Street Cam Hill, PA 17011 Susquehannna Surgeons $33.12 Yes Pro Rata 532 North Front Street Wormle sbur , Pa 17043 Camp Hill Emergency Physicians $27.34 Yes Pro Rata P.O. Box 13693 Philadel hia, PA 19101-3693 Spirit Physicians $92.29 Yes Pro Rata 205 Grandview Ave.Suite 210 Cam Hill, PA 17011 Pathology Associates $25.93 Yes Pro Rata 4520 Union Deposit Road Harrisburg, PA 17111 EXHIBIT A List of Creditors (2) -10 List of Creditors (continued) Name and Address of Creditor Amount of Claim Claim Admitted Will Claim Be Paid in Full? Pinnacle Health Hospital $1,049.03 P.O. Box 2353 Yes Pro Rata Harrisburg, Pa 17105-2353 Pinnacle Health Hospital $234.29 P.O. Box 2353 Yes Pro Rata Harrisburg, Pa 17105-2353 MSHMC Physicians $ 243.22 No No Billing Center P.O. Box 854 Hershe , PA 17033 Central Medical Equipment Co. $ 126.00 No No 35 Sarhelm Road Harrisburg, PA 17112 Capital One $ 4,234.18 Yes No c/o Estate Information Services, LLC 2323 Lake Club Drive, Suite 300 Columbus, OH 43232 Capital One $ 380.17 Yes NO c/o Estate Information Services, LLC 2323 Lake Club Drive, Suite 300 Columbus, OH 43232 Sears/Providian $ 3,054.86 Yes NO c/o NCO Financial Systems, Inc Probate Department, # 450 1804 Washington Boulevard Baltimore, MD 21230 Providian $ 2,271.65 c/o Commonwealth Financial Systems, Inc. Yes NO P.O. Box 18036 Hau au e, NY 11788-8836 Exxon/Mobil $ 44.95 Yes NO Credit Card Center P.O.Box 688940 Des Moines, IA 50368-8940 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 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 05, 12,19, 2007 COPY OF NOTICE OF PUBLICATION ~~ NOTICE IS HEREBY GIVEN that Letters of Administration in the Estate of SANDRA L. ADAMS late of the Township of Hampden, Cumberland County, Pennsylvania, (died November 6, 2007) having been granted to the undersigned, all persons indebted to the said estate are required to make immediate payment and those having claims will present them without delay to: Paula D. Potteiger, Administrator 30 Faith Circle, Carlisle, PA 17013 OR Shelly J. Kunkel, Esquire W10N, ZULLI & SEIBERT 109 Locust Street Harrisburg, PA 17101 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 19th. day of December, 2007. C Notary Pub My commission expires:!/t/~v COMMOf~NJiALTH OF PENNSYLVANIA __._ Notarial Seal Christina L. Wolfe, Notary Public Carlisle Boro, Cumberland County My Commission Expires Sept 1,2008 Member. Pennsylvania Association Of Notaries PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Linder 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 weekly 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 the following dates, viz: December 7 December 14 and December 21, 2007 Affiant 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 subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. r Marie Coyne, SWORN'T~O AND SUBSCRIBED before me this 21 day of December. 2007 Notary Adams, Sandra L., decd. Late of the Township of Hamp- den. Administratrix: Paula D. Potteiger, 30 Faith Circle, Carlisle, PA NOTARIAL SEAL 17013. DEBORAH A COLLINS Attorneys: Shelly J. Kunkel, Es- Notary Public quire, Wion, Zulli & Seibert, 109 CARLISLE BORO, CUMBERLAND COUNTY Locust Street, Harrisburg, PA My Commission Expires Apr 28, 2010 17101. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVfSION OF THfRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 December 18, 2007 WION GULLI & SEIBERT PO BOX 1121 HARRISBURG PA 17108- 112 Re: SANDRA L ADAMS SSN: 288-40-4517 Dear Attorney Kunkel: Pursuant to your letter dated December 06, 2007, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced estate. It has been determined that the above individual did receive medical assistance. However, the medical assistance received is not recoverable in accordance with Act 49, 62 P.S. §1412. Therefore, according to the information provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If you have any questions, please feel free to contact me. Sincerely, .1 ,~ ~~ Carole A. Procope Recovery Section Manager (717)772-6604