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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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ESTATE OF Gertrude E. Graffius , DECEASELI' y~ _
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No. 2008-00835 ;\, a
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PETITION FOR ADJUDICATION / rn '
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa O.C. Ruie 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 arty; the papers
required under items 8-19 inclusive; and arty instrument pertinent to the adjudication.
INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel N/A
Supreme Court I.D. No.:
Name of Law Firm:
Address:
Telephone:
Fax:
Form OC-Ol rev. !0.13.06 Page 1 of I O
Estate of Gertrude E. Graffius
1. Name(s) and address(es) of Petitioner(s):
Name:
Jeffrey W. Ciraffius
Deceased
address: 30 W. Broadway
Ked Lion, PA 17356
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 Q No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on June 26, 2008
® Letters Testamentary or Q Letters of Administration were granted to Petitioners} on
Aueust 13.2008
Date of Will (if applicable): December 29. 1990
Date(s) of Codicil(s) (if applicable):
Date of probate (if different from date Letters granted):
Was a bond required? []1'es m 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: December 12, 2008; December 17, 2008
F~~oc-oi rev. 1~l3.06 Page ? of l0
Estate of Gertrude E. Graffius
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 [] Na
(See Section 2201 et s_q. 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 (if none, so state):
Donna L. Amig
Patty L. Plummer
Jeffrey W. Graffius
6. Did decedent marry after execution of Will or Codicil(s)? ........... ®Yes m No
Were any children born to decedent after execution of
Will. or Codicil(s)? .......................................... Yes Q No
If yes, give names and dates of birth:
Name:
Date of Birtk:
7. If required by the Medical Assistance Estate Recovery Act,
52 P.S. § 1412, was a request for a statement of claim sent to
the Department of Public Welfare? ......... . .................. ^Yes ~ No
~.a,T, vc-0t rte. ~ n. r 3.06 Page 3 0~ 10
Estate of Gertrude E. Graffius
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 creditars 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 affecteri 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 certifi; ing that such
notice has been given.
C. [f 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 :~.2.
D. If any charitable interest is involved, Notice of the Audit has been ter will also be
given to the Attorney General as required under Pa. O.C. Rule 5.5. [n 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 Petitioners} haslhave notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will or
Codicils} 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 ear-h party's
interest(s):
,Name and Address ojEach Party in Interest ~ Relationship and Comments, if am ~ Interest
Donna L. Amig Daughter 1 /3
107 Valley View Rd.
New Cumberland, PA 17070
Patty L. Plummer Daughter l /3
305 W Washington St.
L rbana, IL 61801.
Form OC-01 re.'. 1(t. !3. (M Page ~ OY~ 1 ~
Estate of Gertrude E. Grafftus
__, 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.
f none)
C. State why a Petition for Guardian/Trustee Ad Litem has or has not Keen filed for
this Audit (see Pa. O.C. Rule 12.4).
No need to file: There are no minors involved.
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,
(none)
f~~~~~ oc-or r~~. in. ~3.0~ Page 5 of t
Estate of Gertrude E. Graffius __, Deceased
1 t). 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 ClaJmant Amoaatt ofClaim Clarrn
Admrttea`' yl `tll ('lainl
ile Puic~l in
i~uli?
(no unpaid claimants) ^Yes ^Yes
^No ^ No
^Yes ^ ~"es
^No ^ No
^Yes ^ ~'es
^No ^No
^Yes ^Yes
^No ^ No
If the estate is insolvent, attach a schedule setting forth the order of prefertxnce under
2U Pa.C S. § 3392 and the proposed payments.
)1. Was family exemption claimed? .............................. ^Yes ®tic
Was family exemption allowed'? ..... ........................ . ^Yes ~ N~=
Family exemption claimant's name and relationship:
14'ame
Relationship:
~,>rn~ C1C-lil reo. I r1. ; 3.+~6 Page ~ of ~ { 1
Estate of Gertrude E. Graffius
Deceased
1'. The amount of Pennsylvania Transfer Inheritance Tax and additional Penn~vle aria Estate
Tax paid_ the date(s) of payment{s), and the interests} upon which paid, artj as follows:
L~nte Payment Interest
March 25, 2009
1,350.00 0.00
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
of attamey} or surety on the bond of a fiduciary? ................. ^Yes Q ~i«
If yes, provide the name of the estate, indicate whether an account has 't:~een 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 adrnin~stration 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 ^ tic
5. 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 ~~ttachment,
together ~~ith anv relevant supporting documentation.
:~~, oc-~l ret~. ~ ~~. ~ 3.aa Page 7 of l tt
Estate of Gertrude E. Graffius
deceased
t;. Had the decedent been adjudicated an incapacitated person? ........ [`] Yes 0 Ne
If yes, attach a coAe of the Order if available; otherwise state the Court. terna_ number,
date, anal name of Hearing Judge.
1 ~7. A. List or attach a separate list of additional receipts and disbursements ~i~~ce 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 ^ N~;
18 If a resen~e is requested, state amount and purpose.
:{mr~!tnr: ~.QU
Pt~rpc~,vr:
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`? ....................................... ^Y ~s ^ N:~
if so, attach a copy of the notice.
~ ~?. Is the Court being asked to direct
the filing of a Schedule of Distribution? ....................... ^Yes /^ Nc~
.As to real estate only? .............. . ..................... ^Yes ^?ti4~
.:;,rm, !~("-/,!/ rt~,r. Ira ~.i.!~ }'agC' ~ ~)t I l~
F.sta.te of Gertrude E. Graffius
_._ _,. ~~eceasea~
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the pars ies entitled
anti suggest(s) that the distributive shares of income and principal (residuary share~~, +~eing stated
in proportions, not amounts) are as follows:
A,. Income:
Proposed L)istributee(s)
(none}
AmcunvPro~~orn w>
B. Principal:
Proposed Distributee(s) Amound/Pr«pornor;
i3onna l.. Amig 1 /3
Path L. Plummer 1 /3
..leffrey W. Graffius 1 /3
Submitted By:
("fill petitioners must sign.
Add additional lines if necessary).
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Name of P~titi ner: Jeffrey W. Graffiu~>
Name of Petitioner:
~>~°ro~ t~C-(ll rs'r Jti ~ ~_(1b Pi~ge ~ ~)~ ~ ~'
F: ,-fate of (1~rtrude E. Graffius _~___ __, '~ecease~.~
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * that ~re~s~ne is n,~e ____.
cif the above-named .~.,e o~
andj tiaa~ t6~e facts set
ti~rth in the foregoing Petition for Adjudication /Statement of Proposed Distributi~~n which are
+-Within the persorsal knowledge ofthe Petitioner are true, and as to facts based on tl~~e in~~~rmati~n
fit ethers, the Petitioner, after diligent inquiry, believes them to be true; and that ,~s,~ fals,e
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating !.~~ uns~~om
=4~isitication t~ authorities).
'" i;:arpor~ue petitioners must complete bracketed inforntntion.
,~
,1
Signature o'~-Petitioner
Certification of Counsel
'The undersigned counsel hereby certifies that the foregoing Petition for .-~~ijudicati~:~n%
5r:atement of imposed Distribution is a true and accurate reproduction of the fo~-n i'etiti~ar~
~~t~thorized by the Supreme Court, and that no changes to the form have been mad;. bc:LOnd the
responses herein.
Ni A _
Signature of Counsel i~or P~~~ti a ic~ner
rm (7f -fi( rer 1 /), IS. t)<- ~'a~~1 ~ ~~ {1T O
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Statement of Estate Account Audit
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA.
ORPHANS' COURT DIVISION
Grant of Letters No. 2008-00835
FIRST AND FINAL ACCOUNT OF
Jeffrey W. Graffius, Executor
For:
ESTATE OF GERTRUDE E. GRAFFIUS, DECEASED
Date of Death: 06/26/08
Date of Incapacity, if any: None
Date of Executor's Appointment: 08/13/08
Date of First Complete Advertisement: 11/28/08
Accounting for the period: 06/26/08 to 05/20/10
Purpose of Account:
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The Executor offers this Account to acquaint interested parties with the transactions that
have occurred during the Administration. It is important that the Account be carefully
examined. Requests for additional information, questions or objections can be discussed
with:
Jeffrey W. Graffius
30 W. Broadway
Red Lion, PA 17356
717-645-9762
1
PRINCIPAL RECEIPTS
Decedent's Balance (at the time of death): ~-I7t~,t~O
lr~terest vielded to date: ~:'3' (3t)
l~~;al I~stat~;
:Mile of Residence Property (on 09/28i~~):
`~:xttlement l'a~out: ~+: 4`,?4~3.C)~~
l ax Escroti~ : ` '.6~ ~I t~0
~';rsonal Itenat;
~.ile cif ~'ehic°~~: ; `,~'., ~~)t),t~~~
1 )TAL t RIiVCTPAL RECEIPTS: ~ ~.~iBC).Cf~)
2
DISBURSEMENTS OF PRINCIPAL
~:.rrieral Services
i~ ~~~rleral Nc~lr~e° '". ~ ~ ~ t~C~
.__ __.-.
1 ?=~=TAI_`l~Ig~3~lIZ_SEMENTS OF PRINCIPAL: ~ ~~ ~ ~:-Ct
PRINCIPAL. BALANCE ON HAND
~~.~tate I3ani~in~
"`~.iVin~s l~ticot~nt {as ofO5120110) `~ ;'.~~~~'~.~~t~
~. ~~:cking .~cc:tl>unt (as of OSi20/10) ~ i4i;s 0
i ~)'I'AI. l'RINd"IPAL BALANCE ON HA1VT0: ~ ' ~ tl~_+
DIS~[~RIBUTIOI~IS ~F P~RINCIP~,L T~ BENEFICi~~~t CE4
~~ I3Cy~1tiG~ L .~`~rnig (L`3) § '=.~~-It~~% ~t3
+". ,x Patt~° l_.. ?~~~~irrlmer (I; 3) ~ z?,~~~?~r (~~~1
1,~: J~.f~i~<~k- ~~ Lraffius (Il3) ~ (~.~~t~~,.t3~)
i t~;I"A3__:~~5_I=It~BUTIONS O~ I'RINCIPAI_TO BENEFICIt1RIES: `~ ~ .~ ` " Cif}
VERIFICATION
,te~tf`-~e~ ~%~ Graffius, Executor of the Will of Gertrude E. Graffius, ~~ :~ t~seci.
~a~:~reby~ dec3ar~~ under oath that he has fully and faithfully discharged the dkz2 es co;~h;~;
~?s3~~ce: that ~th< foregoing First and Final Account is true and correct and ii~l; ~a~scioses
;i signit~cant rransactians occurring during the accounting period; that alk ~. ic~~~n ~;l~i~~r~s
a~~;ain~t the ~~~ate have been paid in fiiIl: that, to his knowledge, there are a=:~~~ ti~a~z~7ti
~a~atst~~nding r~~3ainst the estate; that alf taxes presently due from the Estate rra ~~w been pai~3:
a~~id that the ~;r~nt of Letters Testamentary and the first complete advertise~r~_;r~3y ther~x~~'
=a.~;urred rnor; than four manths before the filing of the foregoing First a~~~= ~ ;r7ax
">.c;~o~ut~t.
Thiv~ ~t~~tement is made subject to penalties of 18 Pa. C.S.A.. Secti~~ '•~d;~~ ~-~~latiac
ans~or~n laisii'ication to authorities.
~~~ l ~
Ci
~atate Notice
~ l'etation for Adjudication of the Estate of Gertrude Fllc~ ~ ~~-ra~=f~usfl
4~'ong ~~itlz tf Statement of Estate Account Audit is being filed ~~ ' t~~c
srphan<.~ C'~~~~r~ at the Cumberland County, PA court house. Tl~~ ~;:l~a~i~~ date
'~~~~ filing is ~vlay 21, 2010 and the Judge"s decision is to be iss~.~e~ ~~~~ .~~~nc
~', 20 ~ ~~. 1~cluded with this notice are copies of the Petition anal I~~~
`~~:atement c~~' Account, which covers the time period £rom June ~?u ~~.O~v~~~ ~o
~l~~y zo, ~ft~~.
'This notice is being sent to lJonna L. Amig and Patty i~.. l~i~~ri-~rr~~st-.
Sincerely,
.leffre~~ VV. Graffius, l/xecutor
30 W. Broadway
lied Lion, PA 1736
Hate: May 20, 2010
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
s~;RAFFIL`~~ JEFFREY ~,~,'
~30 ~V BROADWAY
!~ED 10"v. PA ? 7356
ACN
ASSESSMENT r~~,~0~'~'`ti~'~
CONTROL
NUMBER
ES?,~T~ i ~F(1F'Pv1ATlOa`~J: SSN 167-?4-8439
FILE NUrfBE~: 2108-0835
~Er~D_r4r r~Lr~~E: GRAFFIUS GERTRUDE ELLEN
', cArE of ~A'r~r~lIENT 03;'25/2009
~--
'~ PosrMA"~~~ ~a-rE:
t)3,~25/2009
co~NTY CUMBERLAND
ofarE of ~Ef;~-H: 06,'26/2008
TOTAL AMOUNT PAID:
?~1,:~50 ~.:
REMAR=:S
~CHL
NECI<# 502
INITIALS: JN
RECEIVED BY:
GLENDA FARNE~i ~l~~RASBA.~C~N
REGISTER Of= V~iL_
TAXPAYER