HomeMy WebLinkAbout08-16-10DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
ESTATE OF THOMAS E. MOOD
No. 21-09-0480
DECEASED
PETITION FOR ADJUDICATION /
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
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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, {f 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: Lisa Marie Coyne, Esq.
Supreme Court I.D. No.: 53788
Name of Law Firm: Coyne & Coyne, P.C.
Address: 3901 Market Street, Camp Hill, PA 17011
171737-0464
Fax: (7171737-5161
Aorm OC-01 rev. l0. /3.06
Page 1 of 10
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Estate of THOMAS E. MOOD
1. Name(s) and address(es) of Petitioner(s):
Nnme.• ZOE A. BUHOSKY
Address: 3431 WILSON AVENUE
OREFIELD, PA 18069
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
NONE.
Deceased
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 MAY 18, 2009
Letters Testamentary or ®Letters of Administration were granted to Petitioner(s) on
MAY 22.2009
Date of Will (applicable):
Date(s) of Codicil(s) (f applicable):
Date of probate (zf different from date Letters granted):
Was a bond required? ®I'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: patriot News: June 5, 12, and 19, 2009
Cumberland Law Journal: June 12, 19, and 26, 2009
Form oc-oi rev. 10.13.06 Page 2 of 10
Estate of THOMAS E. MOOD
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 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 (f none, so state):
NONE.
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)? ........................................... Q 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 OGO/ rev. /0./3.06 Page 3 of 10
Estate of THOMAS. E. MOOD
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):
Deceased
in Interest
ZOE A. BUHOSKY
3431 Wilson Ave.
Orefield, PA 18069
Sister
1/2 Residual Estate
Wilberta E. Mood
105 S. 15th Street
Camp Hill, PA 17011
Sister
1/2 Residual Estate
Form OC-01 rev. 10.13.06 Page 4 of 10
Estate of THOMAS E. MOOD
NONE.
Deceased
C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for
this Audit (see Pa. O.C. Rule 12.9).
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-ol rev. 10.73.06 Page 5 of 10
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.
Estate of THOMAS E. MOOD ,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 Eath Claimant Amount of Claim Claim Will Claim
Admitted? Re Paid In
Full?
Nephrology Associates of Central PA $63.94 ®Yes ®Yes
P.O. Box 517 Class 3 Claim ®No ®No
Hazelton, PA 18201
Spirit Physician Services $623.00 Wes ~ Yes
~No ~No
205 Grandview Ave., Suite 210 Class 3 Claim
Camp Hill, PA 17011
DPW $25,674.57 ®Yes ~ Yes
P.O. Box 8486 Class 3 Claim ~No mNo
Harrisburg, PA 17105-8486
DPW $310,585.44 Yes Yes
P.O. Box 8486 Class 3 Claim ®No mNo
Harrisburg, PA 17105-8486
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.5. § 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.•
Farm oc-ol rev. 10.1.?.Oti Page 6 of 10
Estate of THOMAS E. MOOD ,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
NONE.
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? ................... 0 Yes m 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? .................. ~J 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-01 rev. 10.13.06 Page 7 of 10
Estate of THOMAS E. MOOD ,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.
,_._..._.. 400.00
p">P°se: For the preparation of final fiduciary income tax return for this Estate.
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? .......................... DYes ®No
As to real estate only? ........................................ ®Yes ~ No
Form OC-01 rev. 10./3.06 Page 8 of 10
Estate of THOMAS E. MOOD ,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 DuMbutee(s)
ESTATE IS INSOLVENT. A SCHEDULE OF
DISTRIBUTION IS ATTACHED ALONG WITH
ACCOUNTING.
B. Principal:
Proposed Distributee(s)
Amount/Proportion
AmoundProportion
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
Nam of Petitioner: OE A. BUHOS
Name of Petitioner:
Porm oc-ol rev. ]0.13.06 Page 9 of 10
Estate of THOMAS E. MOOD
Verification of Petitioner
(Verification must be by at least one petitioner.)
Deceased
The undersigned hereby verifies * [that r~e~she SHE is titre ADMINISTRATRIX
of the above-named name ofcorpora[ion 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).
S afore of Petitioner
* Corporate petitioners m¢st 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.
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gna a of Counsel for Petiti er
Form OC-01 rev. 10.13.06 Page 10 of 10
FIRST AND FINAL ACCOUNT~TG AND PROPOSED DISTRUBUTION
ZOE A. BUHOSKY, ADMINISTRATRIX
for
Estate of THOMAS E. MOOD, Deceased
21-09-0480
Date of Death:
Date of Esecntor Appointment:
Date of First Complete Advertisement of Letter:
Accounting for the Period:
May 18, 2009
05/22/09
06/05/09
5/26!09 to July 1, 2010
Lisa Marie Coyne, Esquire
Pa. Supreme Ct. No. 53788
Coyne & Coyne, P.C.
3901 Market Street
Camp Hill, PA 17011-4227
717-737-0464
Attorney For Estate
Page 1 '~ ~~
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. RECEIPTS OF PRINCIPAL
Fiduciary
Assets Listed in Inventory Acquisition
Valued as of Date of Death Value
Cash:
National Penn Bank Savings Acct. 620993720 $12,200.68 $12,200.68
Recei is Sub sent to DOD:
6/18/2009 Golden Living Resident Account $758.68
7/9/2009 Cuna Mutual $3,037.58
8/19/2009 Golden Living Refund 317.00 4 113.26
TOTAL RECEIPTS OF PRINCIPAL $16,313.94
DISBUILSEMENTS OF PRINCIPAL
Debts and Expenses:
Amount
5/26/2009 Zoe Buhosky (Reimbursement for Funeral Deposit, lunch) 3,089.77
5/28/2009 Myers-Hamer Funeral Home $2,620.00
6/1/2009 Zoe Buhosky (postage, mileage, honorarium, Register of Wills) $244.00
6/29/2009 Patriot News $123.38
7/6/2009 Cumberland Law Journal $75.00
8/29/2009 Register of Wills--additional probate $40.00
8/24/2009 Register of Wills--inheritance tax filing fee $15.00
7/11/2010 Filing Fee for Account and Confirmation 130.00 6,337.15
TOTAL DISBURSEMENT OF PRINCIPAL:
Total Receipts and Principal $16,313.94
Total Distributions of Principal 6 337:15
TOTAL NET ESTATE $9,976.79
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FIItST AND FINAL ACCOUNTING AND PROPOSED DISTRUBUTION
ZOE A. BUHOSKY, ADMINISTRATRIX
for
Estate of THOMAS E. MOOD, Deceased
21-09-0480
Date of Death:
Date of Executor Appointment:
Date of First Complete Advertisement of Letter:
Accounting for the Period:
May 18, 2009
05/22/09
06/05/09
5/26/09 to July 1, 2010
Lisa Marie Coyne, Esquire
Pa. Supreme Ct. No. 53788
Coyne & Coyne, P.C.
3901 Market Street
Camp Hill, PA 17011-4227
717-737-0464
Attorney For Estate
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RECEIPTS OF PRINCIPAL
__ Fiduciary
Assets Listed in Inventory Acquisition
Valued as of Date of Death Value
Casb•
_ National Penn Bank Savings Acct. 620993720 $12,200.68 $12,200.68
Receipts Subsequent to DOD:
6/18/2009 Golden Living Resident Account $758.68
7/9/2009 Cuna Mutual $3,037.58
8/19/2009 Golden Living Refund $317.00 $4,113.26
TOTAL RECEIPTS OF PRINCIPAL $16,313.94
DISBURSEMENTS OF PRINCIPAL
i
Debts and Expenses:
Amount
5/26/2009 Zoe Buhosky (Reimbursement for Funeral Deposit, lunch)
_
_ 3,089.77
-
5/28/2009 _
Myers-Hamer Funeral Home
$2,620.00 __
6/1/2009 Zoe Buhosky (postage, mileage, honorarium, Register of Wills) $244.00
6/29/2009 Patriot News $123.38
7/6/2009 Cumberland Law Journal $75.00
8/29/2009 Register of Wills--additional probate $40.00
8/24/2009 Register of Wills--inheritance tax filing fee $15.00
7/11/2010 Filing Fee for Account and Confirmation 130.00 6,337.15
TOTAL DISBURSEMENT OF PRINCIPAL: _ _ _ _
r
Total Receipts and Principal $16,313.94
Total Distributions of Principal 6 337.15
TOTAL NET ESTATE $9,976.79
Proposed I+~nal Distributions To:
Zoe A. Buhosky--Administratrix's Commission $ 800.00
Coyne & Coyne, P.C.-- Attorney Fees $ 2,577.00
Reserves $ 400.00
Spirit Physician Services (Total: $623.00) Payable: 2% $ 12.46
Nephrology Assoc. of Central PA (Total: $63.94) Payable: 1% $ 0.64
DPW Class 3 Claim (Total: $25,674.57) Payable 97% $ 6,186.60
DPW Class 5.1 Claim (Total: $310,585.44) $ -
$ 9,976.70
Zoe A. Buhosky -- residual heir Insolvent
Wilberta E. Mood -- residual heir Insolvent
Total Distribution
Zoe A. Buhosky, Administratrix of the Estate of Thomas E. Mood, deceased, hereby declares
an oath that she has fully and faithfully discharged the duties of her office; that the foregoing
First and Final Accounting is true and correct and fully discloses all the significant transactio s
occurring during the accounting period; and that all lrnown claims against the Estate have been
paid in full; that to her lmowledge, there are no claims now outstanding against the Estate;
and that all taxes presently due have been paid.
Zo A. Buhosky, Administratr
Sworn and subscribed before
me this ~_ day of
2010,
f
otary Public
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