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DECEDENT'S ESTATE
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COURT OF COMMON PLEAS OF ~~ ,
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ESTATE OF Rose A. Lemke DECEASE? ~ ~ ~ ~ `~~ `~~`
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No. 21-08-1117
PETITION FOR ADJUDICATION /
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
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, if 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: L. PETER TEMPLE, ESQUIRE
Supreme Court I.D. No.: 17573
Name of Law Firm: LARMORE SCARLETT LLP
Address: P. O. BOX 384, KENNETT SQUARE, PA 19348
Telephone: 610-444-3737
Fax: 610-925-4894
Form OC-01 rev. 10.13.06 Page 1 of 10
Estate of Rose A. Lemke ,Deceased
1. Name(s) and address(es) of Petitioner(s):
Name: John D. Lemke, Executor
Address: P• O. Box 384
Kennett Square, PA 19348
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
None
Is this the first accounting by this fiduciary? ..................... Yes No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on October 31, 2008
Letters Testamentary or Letters of Administration were granted to Petitioner(s) on
November 12.2008
Date of Will (f applicable): NnvPmhPr 5 ~nm
Date(s) of Codicil(s) (f applicable): Nine
Date of probate (f different from date Letters granted)
Was a bond required? Yes ~ No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... Yes No
Dates of advertising of the grant of Letters: necemher 4 and 5. 2~(lR~ 1~ecemher 1 1
and 12, 2008; December 18 and 19, 2008
Form OC-Ol rev. 10.13.06 Page 2 of 10
Estate of Rose A. Lemke ,Deceased
3. Was decedent survived by a spouse? ............................. Yes No
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............. ~ Yes No
(See Section 2201 et sic. of the Probate, Estates and Fiduciaries Code)
If 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 (f none, so state):
N/A
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. If 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? .............................. Yes No
Form OC-Ol rev. 10.13.06 Page 3 of 10
Estate of _Rose A. Lemke ,Deceased
8. 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):
Name and Address ojEach Party in Interest ~ Relationship and Comments, if any ~ Interest
John D. Lemke Son 1/5 personal property
P. O. Box 802771 and 1/5 residue
Dallas, TX 75380
Constance Arnold Daughter
286 Walter Road
Cochranville, PA 19330
1 /5 personal property
and 1/5 residue
Form OC-01 rev. 10.13.06 Page 4 of 10
Estate of Rose A. Lemke
Name and Address of Each Party in Interest
Timothy A. Lemke
130 Spring Drive
Dillsburg, PA 17019
Son
and C
Deceased
Interest
1 /5 personal property
and 1/5 residue
Philip C. Lemke Son 1/5 personal property
4290 Sunshine Blvd. and 1/5 residue
St. James City, FL 33956
Christopher T. Lemke Son 1/5 personal prop
20 Rvmen Lane and 1 /5 r_ Pa; c3uP
Palm Coast, FL 32164
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.
N/A
Form OC-01 rev. 10.13.06 Page 5 of 10
Estate of Rose A. Lemke
File No. 21-08-1117
Petition for Adjudication #9
Grandchildren who received $2,500.00 each under Item III of Will. Bequests have been paid and
released and they have not been given notice of this Account.
John S. Lemke Grandson $2,500.00
802 Cresside
Richardson, TX 75081
Kristin A. Shelby Granddaughter $2,500.00
1049 Cochran Drive
Mesquite, TX 75149
Andrew L. Arnold Grandson $2,500.00
710 Saginaw Road
Oxford, PA 19363
Todd W. Arnold Grandson $2,500.00
43 Berkshire Road
Landenberg, PA 19350
Amy A. Hunt Granddaughter $2,500.00
18536 Kent Ave.
Hagerstown, MD 21748
Peter Lemke Grandson $2,500.00
130 Spring Drive
Dillsburg, PA 17019
Molly Lemke Granddaughter $2,500.00
130 Spring Drive
Dillsburg, PA 17019
Hans D. Lemke Grandson $2,500.00
6454 Anderson Ave.
Hanover, MD 21076
Nichole V. Campbell Granddaughter $2,500.00
4290 Sunshine Blvd.
St. James City, FL 33956
Timothy Ian Lemke Grandson $2,500.00
1508 Echo Road
Durham, NC 27707
Estate of Rose A. Lemke
Deceased
10. 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 Will Claim
Admitted? Be Paid In
Full?
None Yes Yes
~No No
Yes Yes
~No No
Yes Yes
No No
DYes Yes
~No 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.
11. Was family exemption claimed? ................................ ^Yes No
Was family exemption allowed? .................... ........... ^Yes ~No
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-01 rev. 10.13.06 Page 6 of 10
Estate of Rose A. Lemke ,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:
Date Payment Interest
February 17, 2009 17,791.26 .00
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:
None
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. Yes No
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.
Form OC-Ol rev. 10.13.06 Page 7 of 10
Estate of Rose A. Lemke ,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 No
18. If a reserve is requested, state amount and purpose.
Amount: 25'000' 00
Pureose: Pending PA Inheritance tax approval and fiduciary tax preparation
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? .......................... Yes No
As to real estate only? ........................................ Yes No
Form OC-Ol rev. 10.13.06 Page 8 of 10
Estate of Rose A. Lemke
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)
John D. Lemke
AmountlProportion
1/5 residue
Constance Arnold 1/5 residue
Timothy A. Lemke 1/5 residue
Philip C. Lemke 1/5 residue
Christopher T. Lemke 1/5 residue
B. Principal:
Proposed Distributee(s) AmountlProportion
John D. Lemke 1/5 residue
Constance Arnold 1/5 residue
Timothy A. Lemke 1/5 residue
P i ip e e rest ue
Christopher T. Lemke 1/5 residue
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
~~
Name o Petitioner: John D. Lemke, xecutor
Name of Petitioner:
Form OC-Ol rev. 10.13.06 Page 9 of 10
. ,
Estate of Rose A. Lemke
Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that heishe he is title Executor
of the above-named name of corporation Estate 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 18 Pa. C.S. § 4904 (relating to unsworn
falsification to authorities).
Si of Petitioner
* Corporate petitioners 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.
Si nature of unsel for Petitioner
Form OC-Ol rev. 10.13.06
Page 10 of 10