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Home My WebLink About11-03-10DECEDENT'S ESTATE COURT OF COMMON PLEAS OF n N ~ _~~ CUMBERLAND COUNTY, PENNSYLVANIA ~~ _ ~ ; r - ORPHANS' COURT DIVISION m-an "c x ,' ~a~rn ~ t 0`T~ ~' `i IRENE H. MACIEJEWSKI , DECEASE ESTATE OF D ~ ~ °? ~' ~{ • :> No. 21-10-0382 "' 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. INCLUDE 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 Telephone: 717-737-0464 Fax: 717-737-5161 For,,, oc-o~ Yw. ~0.~3.06 Page 1 of 10 Estate of IRENE H. MACIEJEWSKI ] . Name(s) and address(es) of Petitioner(s): Nnmer Delphine I. Albert Address: 5265 Meadowbrook Drive Mechanicsburg, PA 17050 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: 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 March 30, 2010 Letters Testamentary or ^ Letters of Administration were granted to Petitioner(s) on April 9.2010 Date of Will (if applicable): March 7, 1995 Date(s) of Codicil(s) (if applicable): Date of probate (if 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: patriot News and Cumberland Law Journal: April 23, 2010; April 30, 2010; May 7, 2010 Firm oc-ol rev. 10.13.06 Page 2 of 10 Estate of IRENE H. MACIEJEWSKI 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_g. 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): N/A 6. Did decedent marry after execution of Will or Codicil(s)? ........... ~ Yes Q 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 F~,~,,, oc-ol rev. 10.13.06 Page 3 of 10 Estate of IRENE H. MACIEJEWSKI 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): and Address of Each Party in Interest Delphine I. Albert daughter 5265 Meadowbrook Drive Mechanicsburg, PA 17050 Joan Gruszecki daughter 86 St. Amelia Drive Tonowanda, NY 14150 Interest 1/3 of the residual estate 1/3 of the residual estate Fo,-„r oc-o1 rev. 10.13.06 Page 4 of 10 Estate of IRENE H. MACIEJEWSKI Name and Address Diane Clarke 2150 Salisbury Street York, PA 17408 in Interest ~ Relationship and daughter Deceased /nterest 1 /3 of the residual estate 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 parry, state date of death, date and place of grant of Letters and type of Letters granted. N/A Form OC'-0/ rev. 10.13.06 Page 5 of 10 Estate of IRENE H. MACIEJEWSKI ,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 F.crch Claimant Amount of Claim Claim Will (Maim Admitted? Bc Pnid In Full ~ Department of Public Welfare $20,597.77 Yes ~ Yes Division of Third Party Liability Class 3 Claim ~No ~No P.O. Box 8486 Harrisburg, PA 17105-8486 Department of Public Welfare $186,054.75 mYes ~No ~ Yes ~ No Division of Third Party Liability Class 5.1 P.O. Box 8486 Claim Harrisburg, PA 17105-8486 Yes ~ Yes ~No ~ No Yes ~ 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? ................................ DYes ~No Was family exemption allowed? ................................ Yes ®/ No Family exemption claimant's name and relationship: Name: Relationship: Faun OC-0! rev. /0. / 3.06 Page 6 of 10 Estate of IRENE H. MACIEJEWSKI 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: Dnte Pnyment 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? ................... ~ Yes 0 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 OGOI rev. 10.13.06 Page 7 of 10 Estate of IRENE H. MACIEJEWSKI Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... ~ Yes 0/ No If yes, attach a copy of the Order if available; otherwise state the Court, term, nw~t~ber, 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? ............. LYJ Yes ~ No 18. If a reserve is requested, state amount and purpose. Amount: 1 ,000.00 P"'"P°`~ For preparation of decedent's final income tax returns and the 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? .......................... Yes 0 No As to real estate only'? ........................................ Yes ~ No Form oc-oi ,-w io.i 3.0~ Page 8 of 10 Estate of IRENE H. MACIEJEWSKI 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) PAYMENTS FOR DISTRIBUTION AS ATTACHED. B. Principal: Proposed Drstributee(s) Amount/Proportion Amount/Proportion Submitted By: (All petitioners must sign. Add additional lines if necessary): .~ ~ ~ ~. Name of titioner: Delphine I. Albert Name of Petitioner: Form OGO! rev. 10.13.06 Page 9 of 10 PROPOSED SCHEDULE OF DISTRIBUTION OF NET ESTATE: 'Total Receipts and Principal .Total Distributions of Principal TOTAL NET ESTATE Final Distributions To: __ Reserves Delphine I. Albert -Executor's Commission Coyne & Coyne, P.C. (Final Attorney Fees) DPW Class 3 Claim $20,597.77 DPW Class 5.1 Claim $165,456.98 _ Delphine I. Albert -residual h_eir_ 'Diane Clarke -residual heir 'Joan Gruszecki -residual heir '.TOTAL DISTRIBUTION ~43,~ ; 1.9-1 -$2J03.94 $39,328.00 -- -- __, __ __ _ r- _ - _~ - _ _ __ t_$1,000.00 __$2,500.00 i _ ~- $1 000.00 .-- -- _~_ $20,597.98 __- $ i 4,23u.o2 $0.00 $0.00 $0.00 $39,328.00 ~~~~~~~ The Patriot-News Co. 2020 Technology Pkwy ` Suite 300 ~IVlechanicsburg, PA 17050 Inquiries - 717-255-8213 COYNE & COYNE ATTENTION: LISA MARIE COYNE 3901 MARKET STREET CAMP HILL PA c~e~latriot News NOw you know D ~G~p ~ 1 MAY 2 4 2010 i 17011 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Marianne Miller, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0002058866 ran on the dates shown below: April 23, 2010 Apri130, 2010 May 07, 2010 Sworn to an inscribed before me this 7 d o May, 2010 A.D. f , ~ f`~_ Notary Public ~pNtA ~M~~pL,R~ 0 ~ NSfI. sr-errN ~ ~p~Y,~Pn"rAUn~Y t 11~ ~, ~No 6° ~1N0tarles {~ Assam fiber, Penr~°° /~t5~ ~~ PROOF OF PUBLICATION OF NOTICE ~'~ ~~~ O</ LN CUMBERLAND LAW JOURNAL, '~~ (Under Act No. 587, approved May 16, 1929), P. L.1784 ~>O COMMONWEALTH OF PENNSYLVANIA ; COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borou was established January 2, 1952, and designated by the local courts as the o fici~al 1eate aforesaid, periodical for the publication of all legal notices, and has, since January 2, 1952, beenare ularl issued weekly in the said County, and that the printed notice or publication attached hereto is y exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the sub'ect matter of the aforesaid notice or advertisement, and that all allegations in the foregoing J statements as to time, place and character of publication are true. Maciejewski, Ireae H., deed. Late of Upper Allen Township. Executrix: Delphine I. Albert c/o Lisa Marie Coyne, Esquire, Coyne & Coyne, P.C., 3901 Market Street, Camp Hill, PA 17011- 4227. Attorneys: Lisa Marie Coyne, Es- quire, Coyne 8s Coyne, P. C., 3901 Market Street, Camp Hill, PA 17011-4227. a Marie Coyne, E for SWORN TO AND STJBSCRIBED before me this 7 day of May 2010 _ ~ ` Notary NOTARIAL SEAL DEBORAH A COLLINS CARLISLE BOROIIOH CUM 18ERLANp CpUN~r My conuna~on Expires Aa 2a, 20~~ Estate of IRENE H. MACIEJEWSKI Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that h~isM~ she is ,«<~ Executrix Of the above-named nnme ofcm-pororion Deceased 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). Signature f Petitioner * Corporate petitioners must complete braelceted 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. f r. ~~~ Sign ture of Counsel for Petiti ner I..tSl~ M.~~~ ~7+vt1, t:1C~ 1'~ _ ~~~rtYr-e- C~'_ fJ~+_ .S 37~Er Form oc-oi rev. io.ii.o6 Page 10 of 10 CERTIFICATE OF SERVICE I, Lisa Marie Coyne, Esquire, of Coyne & Coyne, P.C., hereby certify that true copy of the foregoing Notice of Confirmation of Account and First and Final Account and Schedule of Distribution was served this date upon the below-referenced individuals at the below listed address by way of first class mail, postage pre-paid: Department of Public Welfare Division of Third Party Liability Estate Recovery Program ATTN: Patricia Nace, Investigator P.O. Box 8486 Harrisburg, PA 17105-8486 Delphine I. Albert 5265 Meadowbrook Drive Mechanicsburg, PA 17050 Joan Gruszecki 86 St. Amelia Drive Tonowanda, NY 14150 Diane Clarke 2150 Salisbury Street York, PA 17408 Dated: /VDY. 3 ?.~' ~v "~ v" Lisa Marie Coyne, Esq re 390 Market Street amp Hill, PA 1 70 1 1-4227 (717) 737-0464 FIItST AND FINAL ACCOUNTING /~-~~ /pIPp~OS~(~ /~lST12/ /3uT/d~ DELPHINE I. ALBERT, EXECUTRIX for a _- -, ,•, ., o ~, Estate of IRENE H. MACIEJEWSKI, Deceased ~ ~ ~ _ 21-10-0382 ~~~ < ~' 'y~, J~O ~ ~ ~ __ . ' ~~~ .'~ CM? Date of Death: March 30, 2010 '~ ~ Date of Executor Appointment: Date of First Complete Advertisement of Letter: Accounting for the Period: 04/09/10 04/23/10 March 30, 2010 to October 31, 2010 Lisa Marie Coyne, Attorney 3901 Market Street Camp Hill, PA 17011-4227 717-737-0464 Attorney For Estate Page 1 q B C D E" F 1 ~ RECEIPTS OF PRINCIPAL I 2 i _-T 3 _ - - - _ -- ~ - _ --- I vento Li t d i A I Fiduciary i I _.. --- Ac9uisition 4 n s e n ry _ _ _ _ _ ssets _ - 5 Valued ns of Date ofDenth Value 6 ~ -_ - __ _- - -_- __ _- - - _ _~ _ - - ~ -- . _ _ _:_ 7 Cash: I _ 703-2 Account No 164 ki k Ch i l B N 120 81 $4 8 . . ng an ec ona at Adams County - --- , ~ . 9 -.. - -- 10 C ---- _ _ Tangible Personal Proaerty and Receipts Subsequent to DOD• __ - - 11 __ ~--- 4/20/2010 Refund from Funeral Home _ Y r $661 54 i - - t __ 12 5/3/2010 i Inheritance from the Estate of Edward Przybylski -- $37,241.524 13 ,Misc. Interest - _ - __- __ 8.07 ' 42 031.94 - _ ~ _-..._~~ -._ 14 -- TOTAL RECEIPTS OF PRINCIPAL $42,031.94 15 - .' 16 DISBURSEMENTS OF PRINCIPAL -- __ _ __ 17 18 Debts and Exgenses. 19 Amount 20 5!12/20101 Delphine Albert - reimbursement_for probate. and funeral expenses $294.20, 21 sement umberland Law Journal - le al adve 5/15/2010 _ _ $75.00 -_ ~ 22 5/22/2010 _ g ~ Patriot News - le al advertisement - _ _- - - g -~-- - $1 0 -~- 23 7/6/2010 - Register of Wills - mhentance tax film fee i 15.0 $ 24 7/10/2010 Register of Wills -additional probate fee ~ $115.00 . 25 - _ -__ -_ _ - - _ Filin Fee for Account and Confirmation ~- _ 8 ----- ~ __ 130.00 ~- $766 441 _ 1 _ _ _ 26 - __- _- - ~_--_ - T- _ - r 27 _ ~ Attorney's Fees. ~ 28 7!8/20101Coyne &Coyne PC (partial) _ _ _ __ _ - --- - 1 937.50 ~, 1 9~, 37.50 __ __ 29 fi --~;TOTALDISBURSEMENTOFPRINCIPAL: -- ~ -~ - - $2,703.94 - -- . _- - 31 - - ~ -- -- .._ -- - r - r ~ , 32 .. r-- Total Receipts and Principal _ . - -- -- - - ._i- . - - -- $42,031.94 ---~__ .. -- 33 p - Total Distributions of Pnnci al --- -- _ 2 703:94; ~- 34 _-. __ __ _ - _ - - _ ---- -- - -- $39.328.00', _ __---- .,_ - + 35 _ TOTAL NET ESTATE __ _ -- - -_ __ _- - _ _ --t 36 - _ ~ _- __~ .._ -- ~ __ - 37 Proposed Final Distributions To: '~ 38 Reserves -. - .- - _ _ - - $1,000.00 -_ ~ - - - -- - --r _ 39 - _-- -_ _ Delphine I. Albert -Executor's Commission $2,500_00+, 4 40 __ ,Coyne &Coyne, P.C. (Final Attorney Fees) $1,000.00 -- 41 -_ _ - DPW Class 3 Claim $20,597.77 $20,597.98, 42 'DPW Class 5.1 Claim $165,456.98 $14,23002' 43 Delp_hine 1. Albert residual heir $0.00' 44 ,Diane Clarke -residual heir _.._ _-- $0.001 -_ -. --- ---t- --- .._ 45 loan Gruszecki-residual heir - - _ _ - - ~ 0.00, 46 - 47 TOTAL DISTRIBUTION $39,328.00 48 _ _ 49 - - - -_ p d, hereby declare an oath Del hire 1. Albert, Executrix of the Estate of Irene H. Maciejewski, decease 50 'that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final 51 Account is true and correct and fully discloses all the significant transactions occurring during the _ _ __ _ 52 _ accounting period; and that all known claims against the Estate have been paid in full; that to his _ __' -- 53 -_ -- - knowledge, there are no claims now outstanding against th e; and that all taxes presently d 54 have been paid. 55 _ _ - _ _ _ -- -- - I -I - _ __ _ _ ~ elphine Albert, Executrix 57 58 I Sworn and subscribed before __~__ - ; ----_--- me thisY day of _ ---- --- --- - .. _ _ ~ _ ~ _- 60 -, - ~ ~I'>J 2010 _ ~. - - _---- 62 No r Public 1~~ ' Q ~lNWEA _OF p:EN 8 l..~K !I{ 1`A fAk $EAl ~~~ ~~~+ lii~tiu~r ptas~fbC ~ffln #gwe~hilp.. Curttberls"n;r~ ~~ frk ,_ ti