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Home My WebLink About08-26-09In Re: Estate of NAOMI R. RAMP, late of Carlisle Borough, Cumberland IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA County, Pennsylvania, Deceased ORPHANS' COURT DIVISION ~Q F...~~ ~t -c~~ C~~t~C~ No ~ . PETITION UNDER SECTION 3102 OF THE PRO~~Pj '' ~, , ESTATES AND FIDUCIARIES CODE FOR ~° ~`-' SETTLEMENT OF SMALL ESTATE ~=~ - ~ ~.y .}., -~F i '..~~....~ ~~ ,, ~' ; -_f --~ ": ~ .: ,~~,:~ KATHY L. BRIDGE, your Petitioner herein, files this Petition for Settlement of a Small Estate under the provisions of Section 3102 of the Probate, Estates and Fiduciaries Code and in support thereof avers as follows: 1. Your Petitioner, Kathy L. Bridge, is a competent adult whose mailing address is 4689 Spring Road Shermans Dale, PA 17090 and is a friend of the Decedent. 2. The Decedent, Naomi R. Ramp died testate on Apri16, 2009, and was domiciled at the time of death in Carlisle Borough, Cumberland County, Pennsylvania, with a last family or principal residence at 1000 West South Street, Carlisle, PA 17013. 3. Your Petitioner is the named executor of the Last Will and Testament of Naomi R. Ramp, dated September 15, 2000, which is marked Exhibit "A," and incorporated herein. 4. The death certificate is attached hereto and marked Exhibit "B." 5. The names, relationships and interests of all parties beneficially interested in the estate are: Shermans Dale Lions Club - $1,000.00 Shermans Dale Fire Company - $1,000.00 Shermans Dale Ambulance Association - $1,000.00 Rella Marie Smiley -Niece - $1.,000.00 Edward P. Bridge and Kathy L. Bridge -Friends -Remainder of estate HOLMAN 8~ HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 16 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17068 TEL. (717) 582-2410 FAX (717) 582-8178 6. The debt of $1,000 owed to Earl Arnold as set forth by decedent in Item 3 of her Last Will and Testament was paid in full by decedent on April 13, 2002; a true and correct copy of the final payment of said debt is attached hereto made a part hereof by reference and marked Exhibit "C". 7. The assets of decedent are as follows: Value Bank of Landisburg -Checking account $ 2,930.24 Conseco -Return of Premium 525.54 Total Assets $ 3,455.78 HOLMAN 8~ HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 16 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17068 TEL. (717) 582-2410 FAX (717) 582-8178 8. The estate is insolvent for Pennsylvania Inheritance Tax purposes; therefore, no separate schedule of assets and deductions for inheritance tax purposes will be filed. 9. Decedent established a burial account with Ewing Brothers Funeral Home through ForeThought Life Insurance Company; said funds totaling $7,425.49 were paid in partial satisfaction of the funeral expenses, with $502.20 being due as a Class 3 claim. 10. Notice has been received by the Commonwealth of Pennsylvania, Department of Public Welfare advising that the Commonwealth has a claim in the amount of $282,556.86 against the estate of decedent; a true and correct copy of the Claim Letter dated June 9, 2009 is attached hereto, made a part hereof by reference and marked Exhibit "D". 11. The Commonwealth of Pennsylvania has agreed to the payment of $551.58 after the deduction of the nursing home bill of $944.90, admin/atty fees of $530.00 and funeral costs of $1,256.51; a true and correct copy of the DPW Letter dated July 14, 2009 is attached hereto, made a part hereof by reference and marked Exhibit «E» 12. After receipt of the DPW July 14, 2009 letter, Ewing Bros. Funeral Home sent a revised billing indicating payment due of only $502.20, a true and correct copy of the revised funeral bill is attached hereto, made a part hereof by reference and marked Exhibit "F" 13. The names of all unpaid claimants and nature of each claim are set forth in order of priority pursuant to 20 PA.C.S.A. 3392: A. Class 1 -Costs of admi~'~nistration: 1) Register of Wily -Filing Fees $ 30.00 2) Holman & Holrr~an -Counsel Fees 500.00 3) Kathy L. Bridge -Executor's commission 172.79 B. Class 2 -Family Exemption 0 C. Class 3 -Claims 1) Costs of decedent's funeral and burial Ewing Brothers Funeral Hoine 502.20 2) Costs of medicines furnished to decedent within six months of death 0 3) Medical or nursing services performed for decedent within six months of death Sarah A. Todd Memorial Home 944.90 Pennsylvania Department of Welfare 28,683.04 4) Hospital services including maintenance provided to decedent within six months of death 0 5) Services performed for decedent by any of decedent's employees within six months of death 0 D. Class 4 -Cost of grave marker p 0 E. Class 5 -Rents for the occupancy of the decedent's residence for six months immediately prior to death 0 F. Class 6 -All other claims, including claims by the Commonwealth, Pennsylvania Department of Welfare 153,873.82 TOTAL $ 184,706.75 HOLMAN 8 HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 16 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17068 TEL. (717) 582-2410 FAX (717) 582-8178 14. Edward P. Bridge and Kathy L. Bridge, residuary legatees, consent to the filing of this petition and waive their ten days' notice of intention to file, as evidenced by the Consent attached hereto and marked Exhibit "G." 15. Shermans Dale Lions Club, Sherinans Dale Fire Company, Shermans Dale Ambulance Association, Rella Marie Smiley, Ewing Brothers Funeral Home, Sarah Todd Memorial Home and the Pennsylvania Department of Welfare have been given ten (10) days' written notice of intention to present the within Petition, as evidenced by a copy of the Notice attached hereto and marked Exhibit "H." WHEREFORE, your Petitioner respectfully requests that an Order be entered authorizing and directing Kathy L. Bridge as named Executor to: (1) Receive distribution of all accounts, held in the name of decedent in the total amount of $3,455.78. (2) Receive refunds from any insurance; (3) Pay in full the following claims in order of priority as set forth in 20 PA.C.S.A. §3392(1) and (3): Register of Wills -Filing fees $ 30.00 Holman & Holman -Counsel fees 500.00 Kathy L. Bridge -Executor's commission 172.79 (4) Distribute the remainder of the estate totaling $2,752.99 as follows in full satisfaction of all claims from said creditors pursuant to 20 PA.C.S.A. §3392(3): Ewing Brothers Funeral Home -Funeral and burial 502.20 Sarah A. Todd Memorial Home -Nursing home care 944.90 Pennsylvania Department of Welfare Claim 1,305.89 $2,752.99 (5) Perform such other duties of executor as required by the laws of the Commonwealth of Pennsylvania. HOLMAN & HOLMAN HOLMAN & HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 1fi EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17068 TEL. (717) 582-2410 FAX (717) 582-8178 Date: August 25, 2009 Robin Holman Loy Attorney for Plaintiff I.D. #49675 16 East Main Street, P. O. Box 97 New Bloomfield, PA 17068 (717) 582-2410 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. Cons. Stat. Ann.§ 4904 relating to unsworn falsification to authorities. Date: 5 11 0 ~, t~, d KAT Y BRIDGE HOLMAN 8 HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 16 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17088 TEL. (717) 582-2410 FAX (717) 582-8178 LAST WILL AND TESTAMENT OF NAOMI R. RANII' I, NAOMI R. RAMP, widow, of Carroll Township (mailing address: X685 Spring Road, Shermans Dale, Pennsylvania 170y0), Perry County, Pennsylvania, being of sound and disposing mild, memory and understanding, do hereby make, publish an~_ declare this as and for my Last W i I I and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executrix to pay all of my just debts and funeral expenses as ~ati)1"i ;.f~tE.',r rT1V ciP;~t!? a~ I?~a j/ ~?~ 1~ti',.i~;d r;~.!:zJi;:~~~; Lr? d~ SO. I Cii,''e:;i t1iuL iii.'y' fiiiieral ~erVrCts ~ e conducted by Ewing Brothers Funeral Home, 630 South Hanover Street, Carlisle, Pennsylvania and that my body be interred beside that of my husband, Herbert D. Ramp on our burial lot located. in West. Minister Cemetery in North Middleton Township near the Borough of Carlisle Pennsylvania. 2. I direct that all inheritance, transfer, succession, estate and death. taxes which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the assets upon which such taxes -are based are included in my probate estate. 3. I bring to the attention of my Executrix that I borrowed a total of $1,000.00 from my friend Earl Arnold in August, 2000, of which none has yet been repaid, and I direct that any amount remaining unpaid at the time of my death shall be paid to him as a debt due him. 4. I give, devise and bequeath the sum of $1,000.00 to Shermans Dale Lions Club, Shermans Dale, PA 1.7090, to be used for such purpose or purposes as said Club shall deem best. 5. I give, devise and bequeath the sum of $1,000.00 to Shermans Dale Fire Company, Shermans Dale, FA 17090, to be used for such purpose or purposes as the Fire Company shall deem best. 6. I give, devise and bequeath the sum of $1,000.00 to the Shermans Dale Ambulance Association, Shermans Dale, PA 17090, to be used for such purpose or purposes as said Association shall deem best. 7. I give devise and bequ.,at,~ thu surr~ of $1,OOO.i10 to my niece Rella Marie Smiley, of Spring Road, Shermans Dale, PA 17090, provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the same shall lapse and be added to the residue of my estate. 8. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my faithful friends Edward P. Bridge and Kathy L. Bridge, husband and wife, as tenants by the entirety, their heirs and assigns, of 4689 Spring Road, Shermans Dale, PA 17090. 9. I hereby nominate, constitute and appoint my faithful friend and neighbor, Kathy L. Bridge, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify or cease serving as such, then in such event I nominate, constitute and appoint her husband, Edward P. Bridge as alternate or successor Executor, and I further direct that neither of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (1) page, this ~'S ,t~(, day of September, 2000. ___~'~~~c~!4' ~i ~ °~-~'y11~ (SEAL) Naomi R. Ramp Signed, sealed, published, and declared by Naomi R. Ramp,. the Testatrix above named, as and for her Last Will ar~d Testament, in our presence, who, in her presence, at her request, and in the presence of each other., have hereunto subscribed our names as attesting witnesses. _ EXHIBIT "A" - ~ i '' ~ ~ ^~ ~- '~~~ 123 J 3 NAi.~MI FAMG :*" ' "F~a . ua„ sr~niNC nano 9HENWW-. tJA:_F_. rh tYl)41G) ~)~ / /7 )„,,'L I ~' I1 fU~~ ~ __.-~~ L/IGUr 0~~++. .__. _. ___. {HY1kM lX.~tL/~-... 7 .~ u~L.~~ut~u~. ~` `~ 4~ ~ " S ' ~ + + J1J72h._ d2Cl 1t7 IIh SMER •N ! OYYK'[ A7i 547 ~ M L THE HANK OF LANpfSBUHG •l~CMNMIS pAl/I'/.l'l'b'~~'~ ~ .~,~.~ ~-,~.Q~ z~,~ _~ a.~~~._r ~' ~ f ~ gF16 ~~Qp' D i 23 ~~ +:0313 l 2 3~~ , IDDODD 2DODD. ~~:k.~..~1~'.-ffNY'a..Ar~wr~nw~-e -f.w~r>l7iwlrwlsia ~i~z~.~+ Check # i~~._3 for 5200.00 O5 j_14T02 ~en,"3 P~,,~ _.~ _..~ ._..-- 3 2 fi NAUMI RAMP ~ ~ ~S9E SPRING ROA6 ~6 i C ~1 n • ~. + ' ~ SHFJI-NNS f]IW&. PA 1JDBD c.,,~n... .___l.`[.4 /N.+4~+ ~` ~, _. ~' ', i by{~ i; 1'AY TOM[ _~~ .. ~t.-1;-1-----...... ~ _ ~ ~P ..7~, •"2ra ~~ + I O[D~R f7._._ _ 1. _ _._..__._ _ _ ~p p ~ 1 _'~^+) ~ 1 [ N5 DAL[ OF-lr,F TWE BA K OF LANDiS$URG t ~ $N[RM w1M.'Y AAl.l. rA. t70~0 ~ i .~..p ~a~r~ Qo ..._._ - ----M }} ~:D3i3121231: 369H614D~' Di26 QDDODD3525.~ f -- - - - ~ i Check # "126 for $35 .25 05T? 02 1 6a~,.! a w;/ ~; ~ CrY'_}k':,%l;..!?it; .cam ~ aa,~UPRi r~n~~ rn-•~ziz~ 1. ~? 3 ~~ t ~ ~ 3~~ F~.r u~'•tiIF~C. Itr7:~1~ 91•IF.I'SLQ.4tJ:1 f.),\..fc, i>>i 'tIf^,?11 ~ ~ asc,,xto f] / ~, ` ~, :. i r C`~tl~ LYE .. ~~ ~,:.-....,. ['1!~ ':( t~,( - ~tl~'~ Z ~ ~~ ~ i ~ '~ ~~~ :~ "' ^ l ~ ~ ' : . . . : .r . ;. ~ : ~G. .. ._~..L.:~ t,._~• __, a l'~r,::s:)1. ~;l 7 •i, f:ti;'> - ~r ±Pt.i_ArtS _ r. .:~.:,. V >~ ~. L~ 1: ti '::i %'~ 7'='•~' '~..; ~l i''!s; Z"}.t F. ~sl~i~11C OF 1..fkh1L71`:i(:IiJF~C?r , s::rsc%.rsti,rnr~s cr+,s,.~:. t~k, s'l~~ts ~s :? j L l ~: . ~ P ~t r ~ ~~ ~~ ca„Lp . n .~ ,t ... .sc r.s=~rt~i . ~- . . C. .-~. / r» ~~ _~ ~ ~~ L :~ ~ .k~ ~ ~ A '~` ~ ~~ ~ ~ :~ >,r t:~ r~ ~~ t~i t_I ~ C~r.~ Ca ~a>r~ C ` !-~":1f;~~R.Ya:1'7S:ip;.fl:iw~'di~=~!4':..w.u?•+X.•: ~'•:~r _....,. ,._.....!:..... -!;!CR11R~.Wbb}K :~!YN~~~fi~k4 ~ wMliAy;.~'~G~dltipCi.: i- ra vK4';•`• ,~ _.- r ~~~~.. x ~ ~, ., ~~~~. >•,:~}~ l'' EXHIBIT "C" ,,;. F COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 June 9, 2009 HOLMAN & HOLMAN ROBIN HOLMAN LOY ESQUIRE 16 EAST MAIN ST P 0 BOX 97 NEW BLOOMFIELD PA 17068 Re: NAOMI RAMP CIS SSN: Date of Death: 04/06/2009 Dear Attorney Robin Holman Loy: Please be advised that the Department of Public Welfare maintains a claim in the amount of $282,556.86 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $28,683.04, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $253,873.82, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Also please provide proof of funeral bill, proof of life insurance policy and copies of signature cards for bank accounts. Sincerely, Karin L. Tyler Claims Investigation Agent 717-772-6614 717-772-6553 FAX Enclosure EXHIBIT "D" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY CASUALTY UNIT P.O.BOX 84$6 HARRISBURG, PA 17105-8486 July 14, 2009 HOLMAN & HOLMAN ROBIN HOLMAN LOY ESQUIRE 16 EAST MAIN ST P 0 BOX 97 NEW BLOOMFIELD PA 17068 Re: NAOMI RAMP CIS #: 600165851 Incident Date: 04/06/2009 Dear Attorney Robin Holman Loy: Thank you for your letter of June 17, 2009. After careful review of the documents submitted under Section 3392 of Title 20, 3392 the Department will accept the following: total assets of the estate are #3,455.78 with funeral bill amount of $1,256.51, Nursing home bill amount of $944.90, Admin/Attorney fees of $530.00 and Executor fee. of 5 percent of assets; $172.79. This leaves a total due the Deparment of $551.58. Please submit payment via check made payable to the Department of Public Welfare. Sincerely, Karin L. Tyler Claims Investigation Agent 717-772-6614 717-772-6553 FAX -- EXHIBIT "E" -- Ewln~ :Brothers Funeral Name, Inc. 630 South. Hanover Street Ca.r(isle, P~ 17013- (7 17)243-242 l ~.pril 21, 2009 Kathy [.. l~3ri(l~;e 46$9 Sprit}; Rd. Sllernlans Dale, 1'!~, 1.7000 rC'he I?ur~era( Service for Nao~t~i I~. Ramp We su~ccrely apprcciale the cotftdence you have placed in us a.iid will continue to assist you in every ~vay we can. Please ~c~! t~rce to contact lts if you lxave any questions in regard to this staternerit. .~ 'lI-~::; I~C)LLOWIN(~ IS AN 1"0'I3M:IGCD STA'T'EMENT UI~ Z'1-1E SC1tVi(~1.5, C~ACIi,I'IIt;S, AlJ1'UMOTIVE: L;(~IJII'IvIC1N1~, AND MI:I.tCIIANDIS[-~ TCIA`I' YUU SII,IC'1'CD WIIE,N MAI{ING 7'IIE C'UN.ERAI.. ARRANGIMEN'I'S. 1. PitOi{C+;SS(ONAi~, SEItV1CES Services c>1.' Funeral Director/Sta1~f , . $458U.U0 I~UN1~.1~AL kIUME SI.I~VIC;E CIiAItGES $4580.00 S[,Lf;C"I'I±.D MERC:EIANDISE: 20G NG Copped-lanaul~;rtone Cask. $85U.OU #S il.rtzericau UI3C;. . $ 1395,00 7`IIE CUS'I' UI? U[Jli. SERVICCS, EQUIPMENT, ANll MLRCH.ANQISE '1'IIA'I` YUIJ E~IAVE SLLCC'FCD $6&25.00 Cash Ach~ances Opening Grave. $I495,U0 C:;tergy/IVCass Uf(cring, $85.00 Certifies{ Copies of`the Deaah Certificate . $L2.U0 'T'he Sentinel Obit . . . $6I.8U "l'he I-Iairdre;sser , . $40.00 7'U'1'Al., CAS1-1 A.DVANCI?.S ANll SPECIAL CEIARGES . $1.818:80 'Total .L.ota.l Cost . . $8643.$0 SU[3=1'U7'AL $86403.80 ,-~ '~ Y 1NI'C~I~1[., YAYMI3N'T' / DISCUUN`l' / CItLii~I1'S 7425.49 ":- t '~~~'~`'~-j~'~~ '' 'C'U'C`AG AMUUN'I' DUI`; f~~~:`31.. "I-hc unpaid Balance over 3() days is sul~jectec{ to a I .SU `% service charge per martth - I8.OU00' ~> per annum. ~r,.r.~c~..~ ~,!"cw~',~.f' p ~.~ .,~i,i, f ~ .cam ,~~ ,~ ~"~, K.. r~ k 6r ~J w ~a 9!/ z ~G f~ ~E~',a-0/~ .~.~ Cpl .~~'.a ,._ EXHIBIT "F" ~ ~;; G:1 ~~ ~~ _-_ d.--..----~. __..~. . __ __ ;_. ~~ _....~ ._ .~ .. .. ,........_._...~,.w ...~____~..~._...~_..._~._.._._........,..._...__ ......__.__.-..~_..._... _.. __ 630 youth Hanover St.; Carlisle, PA 17013 Since 1853 Seymour A. Ewing, F.D. Phone: (717)243-2421 Fax: (717)243-7553 E-Mail: adman@since1853.com William M. Ewing, F.D. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Chaves aro only fordhose items that you selected or that are required. If we are required by law or by a cemetery or a crematory to use any items, we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You.do not have to ppa)- or embalming you did not approve if you selected arrangements such as cremation or inunediate burial. If we charged for cmbalning we will explain why below. For the Service of: Naomi R. Ramp Date of Death April 6, 2009 Charge to : Kathy L. Bridge 4689 Spring Rd. Shermans Dale PA Name Address City State A. CHARGE FOR SERVICES SELECTED: Traditional Package Itemized Services Other Clothing _ 1. PROFESSIONAL SERVICES $ _0_ Services of Funeral Director/Staff , ........ .$ 4,580.00 $ -0- Embalming ..................:....... .5. -0- Cremation Urn................... ..$ -0- Ott?er preparation of body (Description)_ $ -0- _ ................................... S . -0- $ -0- SUB-TOTAL OF PROFESSIONAL SERVICES... .. ..... Al $ 4,580.00 $ -0 TOTAL MERCHANDISE SELECTED . ...... .... B $ 2,245.00 2. FACILITIES AND SERVICES C. SPECIAL CHARGES Use of facilities and services for Forwarding of remains to Viewing (Visitation/Wake)............... . ~ -0- $ Use of facilities and services for (Funeral Home) -0- Funeral Ceremon y ~ ' ' ' ~ ' ' ~ $ ' ' -~- Receiving of remains from Use of facilities and services for $ _0_ Memorial Service ......:........ . .. . .. . g , , -0- (Funeral Home) Use of equipment and services for Immediate Burial :.. . ... . .... . . . . . .. $ -0- Graveside Service .......... . .......... . ~ .. -0- Direct Cremation.................. . $ -0- Other use of facilities $ _0_ SUB-TOTAL OF SPECIAL CHARGES ...... .... C $ -0- .................................. $ ... 0 D. CASH ADVANCED: SUB-TOTAL OF FACILITIES/EQUIPMENT ..... ....... A2 $ 0.00 Opening Grave .................. ..$ 1,495.00 -- Cemetery Equipment ............. ..$ -0- Lotand Deed .................... ..$ -0-, 3. AUTOMOTIVE EQUIPMENT Newspaper Notices -Out-of-town , . , , ..$ -0- Vehicle to transfer remains to .Funeral Telephone & Telegrams ........... ..$ -0- Local .............................. . $ -0- Airfare......................... ..$ -0- Hearse (Casket Coach) Clergy/Mass Offering .. . .... . ..... . . .$ 85.00 Local .............................. . $ -0- Pallbearers............:........ ..$ -0- Limousine Certified Copies of the Death Certificat e $ 12.00 ---- Local ..... . ..... . ................... . $ -0- Police Escort.................... . ..$ -0- FamilyCar Flowers,,,,,,,,,,,,,,,,,,,,,,,, ,,$ 125.00 Loeal .............................. ..$ -0- Vault Service Charge ............. ..$ -0- Flowercar or floral disposition ~ The Sentinel Obit (Estimate). , , , , , , . . , $ 100.00 Local ..........:........ , .......... .. $ -0- :The Hairdresser $ 40.00 -,.,.~- Lead car/Clergy _ Local .............................. .$ -0- $ 0 Car For pallbearers $ -0- Local ............................... . $ -0- $ -0- Out of town transportation ........:..... ..$ -0- $ -0- $ -0- $ -0- _ $ -0- SUB-TOTAL OF ADVANCES ....... ..... ...... D $ 1.,857.00 We char e ~ou~or our ~ervi es in obtaining: f Le ~ SUB-TOTAL OF AUTOMOTIVE EQUIPMENT... ........A3 $ 0.00 (speci y as a vance rtems . TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT .................................... A $ 4,580.00 B. CHARGES FOR MERCHANDISE Casket ..............................$ 850.00 (Description) 20G NG CoaoerHammertone Cask. Outer Receptacle .. ...................$ 1,395.00 (Description) #5 American OBC SUMMARY OF CHARGES: A. Professional Services, Facilities and Equipment and Automotive Equipment ..................... .. $. 4,580.00 B. Merchandise ................... ....$ 2,245.00 C. Special Charges ................ ...$ -0- D. Cash Advances ................ ...$ 1,857.00 TOTAL OF ALL SELECTIONS ................. $ 8.682.00 $ _0_ PAID AT TIME OF OR PRIOR TO Outer burial container .................. . (Description) Alternate Container ARRANGEMENTS ........................... $ 0.00 i Acknowledgement cards . , .... , . , BALANCE DUE ... . ............ . . . .. . . . .. . . . ........$ -0- $ 8.682.00 ~ Re aster Books _ REASON FOR EMBALMING g O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ $ ~ Required for traditional funeral with viewing. / Memorial folders .......................$. -0- Prayer cards ..........................$. -0- If any law,.cemetery or crematory requirements have required the purchase of any of the items listed above the law or requirement is explained below. Temporary grave marker .................$. -0- OBC by cemetery 3urial clothing ...:.................... $^ -0- ! agree !hat I have examined the terms of goods and services selected above and found them to be correct and according to the arrangements I have requested and I acknowledge a copy of this Statement of Funeraf Goods and Services selected. I represent that I have sufficient funds available for payment of total price for goods and services selected. I also agree to make payment of $ 8.682.00 within 30 days. I agree to be jointly and sev?rally liable with anyone who signs below. A late charge of 1.5% per month amounting to 18% per year will be applied to the unpaid balance beginning 30 days fr m ;he date of this agreement. I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agre ..ent. Those costs Aga include attorney's fees, court costs and other costs. Any additional services or merchandise ordered or risque ted after t e ate of this a ree /./Jn~/'~ be c nsidered part of this agreement and the cost the eof w' I be effected on the final bill or statement. tJ~ ) / (Pure sec) (S I) .__ a (Purchaser) (Licensed. Fria irector) CONSENT The undersigned, being parties interested in the Estate of NAOMI R. RAMP, Deceased, hereby consents to and join in the foregoing petition to settle the Decedent's estate and also waives the 10 days' written notice of the intention of petitioner to present this Petition to the Court. Date: ~ Z~ Edward P. Bridge, Res uary Legatee Date: ~~Z~ o ~ ~~~- Kathy L. ridge, Residuary Legatee - EXHIBIT "G" - HOLMAN & HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 18 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA 17068 TEL. (717) 582-2410 FAX (717) 582-8178 In Re: Estate of NAOMI R. RAMP, late of Carlisle Borough, Cumberland County, Pennsylvania, Deceased IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. AFFIDAVIT OF SER VICE COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF PERRY Before me, a Notary Public, in and for the said County and State, personally appeared ROBIN HOLMAN LOY, Esquire, who, being duly sworn according to law, deposes and says that she served a Petition for Settlement of Small Estate by forwarding a copy of said Petition by First Class Mail, from the Post Office, New Bloomfield, Pennsylvania, to the following: 1. Shermans Dale Lions Club, P. O. Box 76, Shermans Dale, PA 17090 2. Shermans Dale Fire Company, 5462 Spring Road, Shermans Dale, PA 17090 3. Shermans Dale Ambulance, P. O. Box 142, Shermans Dale, PA 17090 4. Mrs. Rella Marie Smiley, 4740 Spring Road, Shermans Dale, PA 17090 5. Ewing Brothers Funeral Home, Inc., 630 South Hanover Street, Carlisle, PA 17013 6. Sarah A. Todd Memorial Home, 1000 West South Street, Carlisle, PA 17013 7. Commonwealth of Pennsylvania, Department of Public Welfare, Bureau of Financial Operations, Division of Third Party Liability, Estate Recovery Program, P. O. Box 8486, Harrisburg, PA 17105-8486 HOLMAN & HOLMAN Robin Holman Loy / Attorney for Plaintiff I.D. #49675 16 East Main Street, P. O. Box 97 New Bloomfield, PA 17068 (717) 582-2410 HOLMAN 8 HOLMAN ATTORNEYS AT LAW ROBIN HOLMAN LOY 18 EAST MAIN STREET P. O. BOX 97 NEW BLOOMFIELD, PA ,7088 TEL. (717) 582-2410 FAX (717) 582-8178 Sworn and subscribed to before me thi~OMMONWEALTH PENNSYLVANIA 17th day of June, 2009. TqR EAL CAROL V. MEGE~ Notary Public Bloomfield Borough Perry County salon Ex~res February 232012 Notary Public EXHIBIT "H" ^