HomeMy WebLinkAbout09-01-09ESTATE OF IN THE COURT OF COMMON PLEAS
JOHN FORREST MASON :CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
N0.21-09- Q ~ ~ ~
PETITION UNDER SECTION 3102 OF THE PROBATE,
ESTATES AND FIDUCIARIES CODE FOR
SETTLEMENT OF SMALL ESTATE
TO THE HONORABLE JUDGES OF SAID COURT:
Opal M. Mason, your Petitioner, 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 that:
(1) Your Petitioner, Opal M. Mason, is a competent adult residing at 10 East Front
Street, Apt. A, Shiremanstown, Pennsylvania 17011, and is the spouse of the
above decedent.
(2) John Forrest Mason, spouse of the Petitioner, died on August 19, 2009, at the age
of 84 years, but prior thereto lived and was domiciled at 10 East Front Street, Apt.
A, Shiremanstown, Pennsylvania, Cumberland County, Pennsylvania. He died
without a Will and no Letters of Administration have been issued. A copy of
decedent's Death Certificate is attached hereto as Exhibit "A."
(3) John Forrest Mason had no probate estate when he died other than the following:
An outstanding insurance claim with United Healthcare Insurance Company in
the amount of $16,384.00. Copies of correspondence from United Healthcare
Insurance Company are attached hereto as Exhibit "B."
(4) Your Petitioner avers that there are no creditors of the decedent and no claims
unpaid known to your Petitioner.
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WHEREFORE, your Petitioner respectfully requests that an Order be made authorizing
United Healthcare Insurance Company to pay outstanding Claim #91739-220083-1 to Opal M.
Mason, pursuant to Section 3102 of the Probate, Estates and Fiduciaries Code.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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Roger . I in, Esquire
Supr a urt I.D. No.6282
IRWIN & McKNIGHT, P.C.
60 West Pomfret Street
Carlisle, PA 17013
(717) 249-2353
Opal M. Mason, being duly sworn according to law, deposes and says that the facts
contained in the foregoing Petition are true and correct to the best of her knowledge, information
and belief.
/'F r
'~ (SEAL)
al .Mason
Sworn d subs ed be ore me
this ~~ day of S , 2009.
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Notarial seal
Karen S i+,lcel, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Dec. 8, 2011
Member, Pennsylvania Association of Notaries
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1786474ASF0012001
MR. JOHN F. MASON
APT A
10 FRONT ST
CAMP HILL, PA 17011-6363
DEAR MR. MASC}N-:
-Claim Unit
Post Office Box 740819
Atlanta, GA 30374-0819
JUNE 26, 2008
MEMBERSHIP #: 014482147
CLAIM #: 91739-220083-1
THANK YOU FOR YOUR PARTICIPATION IN THE AARP HEALTH CARE OPTIONS
PROGRAM. WE ARE WRITING TO INFORM YOU THAT WE ARE IN THE PROCESS OF
REVIEWING YOUR CLAIM(S) FOR SERVICES PROVIDED BY CHURCH OF GOD HOME ON
JUNE 5, 2008 TO JUNE 30, 2008. YOU WILL RECEIVE OUR STATEMENT(S)
EXPLAINING OUR CONSIDERATION OF THESE SERVICES SHORTLY.
THANK YOU FOR YOUR PATIENCE. IF YOU HAVE ANY QUESTIONS, PLEASE CALL US
TOLL-FREE AT 1-800-523-5800. OUR CUSTOMER SERVICE REPRESENTATIVES ARE
AVAILABLE WEEKDAYS FROM 7 A.M. TO 11 P.M., AND SATURDAYS FROM 9 A.M. TO
5 P.M., EASTERN TIME.
SINCERELY,
CHERYL KENNEY
CLAIM EXAMINER
CLAIM DIVISION
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Coverage insured by United HealtlzCare htstrrance Company (for New York residents, United Healthcare Insurance Compa~ty of New York)
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United Healthcare Insurance Company
2046474ASF0089901
Claim Unit
Post Office Box 740819
Atlanta, GA 30374-0819
JULY 24, 2009
THE ESTATE OF JOHN F. MASON MEMBERSHIP #: 014482147
APT A CLAIM #: 91739-220083-1
10 FRONT ST
CAMP HILL, PA 17011-6363 _
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DEAR SIR/MADAM:
I AM WRITING TO INFORM YOU OF THE STATUS OF YOUR CLAIM FOR THE SERVICES
PROVIDED TO YOU BY CHURCH OF GOD ON JUNE 13, 2008 TO AUGUST 19, 2008.
I AM CURRENTLY REVIEWING THIS CLAIM. YOU WILL RECEIVE OUR STATEMENT(S)
EXPLAINING OUR CONSIDERATION OF THESE SERVICES SHORTLY. THANK YOU FOR
YOUR PATIENCE.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL US TOLL-FREE AT 1-800-523-5800.
OUR ,CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE WEEKDAYS FROM 7 A.M.
TO 11 P.M., AND SATURDAYS FROM 9 A.M. TO 5 P.M., EASTERN TIME.
SINCERELY , L~~,~, ~~
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ELIZABETH MOSSMAN ~ ~~
CLAIM EXAMINER ~ ~ «
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Coverage insured by United Healthcare Insurance Company (for New York residents, United Healthcare Insurance Company of New York)
A proud provider to HeaItF1 Care
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United Healthcare Insurance .Company
2186474ASF0076501
THE ESTATE OF JOHN F. MASON
APT A
10 FRONT ST
CAMP HILL, PA 17011-6363
INSURED: JOHN F. MASON
DEAR MRS. MASON:
Claim Unit
Post Office Box 740819
Atlanta, GA 30374-0819
AUGUST 7, 2009
MEMBERSHIP #: 014482147
CLAIM #: 91739-220083-1
WE WISH TO EXPRESS OUR CONDOLENCES TO YOU OVER THE LOSS OF JOHN F.
MASON.
PLEASE SEND US A CERTIFIED COPY OF EITHER THE LETTERS TESTAMENTARY OR
THE LETTERS OF ADMINISTRATION. ONCE THIS INFORMATION IS RECEIVED, WE
WILL BE ABLE TO CONSIDER ANY OUTSTANDING CLAIMS. PLEASE USE THE
ENCLOSED ENVELOPE TO SUBMIT THIS INFORMATION ALONG WITH ANY ADDITIONAL
CLAIMS.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL US TOLL-FREE AT 1-800-523-5800.
OUR CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE WEEKDAYS FROM 7 A.M.
TO 11 P.M., AND SATURDAYS FROM 9 A.M. TO 5 P.M., EASTERN TIME.
SINCERELY,
ELIZABETH MOSSMAN
CLAIM EXAMINER
CLAIM DIVISION
Coi~erage inrtrretl h~• United Healthcare L~surance Conrpam~ (for ?Vei~• York 1•esidents. United HealthCme In.rtrrance C~~mpam- of ,Ve1r York)
A proud provider to Health Care
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