HomeMy WebLinkAbout04-0669 In Re: : IN TITE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
ETHEL M. BRINTON, : ORPHANS COURT DIVISION
an Alleged Incapacitated Person : NO. 2004- ~ ~.C:[
Petition for Adjudication of Incapacity and Appointment
of Plenary Guardian of the Estate and Person in
Accordance with 20 Pa. Cons. Stat. § 5511
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
1. Petitioner is Dorothy J. Jumper, the sister of Ethel M. Brinton, an adult individual of
7590 Wertzville Road, Carlisle, Pennsylvania.
2. Ethel M. Brinton was born on July 30, 1924, is 79 years of age and an unremamed
widow. Her last residence was at 21 North Hanover Street, Carlisle, Cumberland County,
PennsyIvania. She is currently residing at Manor Care Nursing Home, 940 Walnut Bottom Road,
Carlisle, Pennsylvania.
3. The following persons are the alleged incapacitated person's only living next-of-kin:
NAME ADDRRESS RELATIONSHIP
Crystal Arnold 501 Windy Hill Road granddaughter
Shermansdale, PA 17090
Tina Gaines 2129 Highway 25 N. granddaughter
Millen, GA 30442
Keith Windemaker 430 North Pitt Street grandson
Carlisle, PA 17013
Dorothy J. Jumper 7590 Wertzville Road, sister
Carlisle, PA 17013
4. To the extent known by petitioner, the assets of the alleged incapacitated person are
valued at approximately $5,000.00, comprising the following: $5,000.00 life insurance benefit
payable on the life of her son, Roger G. Windemaker.
5. Petitioner has no knowledge of the alleged incapacitated person's annual income
which includes Social Security Benefits of an unknown amount.
6. The alleged incapacitated person was not a member of the armed services of the
United States and is not receiving benefits from the United States Veteran's Administration.
7. The alleged incapacitated person suffers from complications from a stroke which has
resulted in her being unable to communicate or indicate comprehension of attempts to
communicate with her.
8. Because of her mental condition, the alleged incapacitated person is totally unable to
manage or even appreciate the significance of his financial affairs, property and business and to
make and communicate any decisions relating thereto, including the ability to communicate her
need for assistance in these areas.
9. Because of her impaired mental condition, the alleged incapacitated person lacks the
capacity to make or communicate any responsible decisions concerning her person and is unable
to even attend to her personaI hygiene or to keep herself properly nourished and hydrated or
communicate to others her need for assistance in these areas.
10. Because of the severity of her mental impairment, the assistance of other persons or
services would not enable the alleged incapacitated person to even participate in the making of any
decisions concerning her estate or person.
11. The severity of the alleged incapacitated person's mental condition mandates that a
plenary guardian of her estate be appointed to manage and handle all aspects of the alleged
incapacitated person's estate, specifically including, but not limited to: all issues relating to her
cash, checks, and any bank or savings accounts held in her name, her personal personal property,
any insurance of any kind, of which he is a beneficiary, any governmental and non-governmental
benefit plans to which she may be entitled, federal, state and local taxes, any claims made o'r to be
made on behalf of her or against her, and the execution of documents, entry into contracts and
payment of reasonable compensation or costs to provide services for him.
12. The severity of the alleged incapacitated person's mental condition mandates that a
plenary guardian of her person be appointed to handle all issues relating to the person of the
alleged incapacitated person, specifically including, but not limited to: her living arrangements, her
medical and psychiatric care, the administration of medication to her, and the employment and
discharge of physicians, psychiatrists, dentists, nurses, therapists and other professionals for her
physical and mental care.
13. Petitioner is not aware that the alleged incapacitated person signed any powers of
attorney or advance health care directives or in any other way designated anyone to serve as her
agent over any of her personal or financial affairs or as her surrogate over her medical care, or that
she designated in writing her wishes with regard to health care, including the use or refusal of life-
sustaining treatment. Petitioner is aware that the alleged incapacitated person's son, Roger
Windemaker, had been acting as her agent, but is unaware of any written directives. Roger
Windemaker died on May 28, 2004. Petitioner is aware that the alleged incapacitated person did
execute a last will and testament in which she appointed Roger Windemaker as her executor and
Petitioner as the alternate executrix.
14. The proposed plenary guardian of the person of the alleged incapacitated person is
Petitioner, Dorothy J. Jumper, the sister of the alleged incapacitated person, who resides as
aforesaid and whose consent to serve as plenary guardian of the person is attached hereto.
15. The proposed plenary guardian of the estate of the alleged incapacitated person is
Petitioner, Dorothy J. Jumper, the sister of the alleged incapacitated person, who resides as
aforesaid and whose consent to serve as plenary guardian of the estate is attached hereto
16. The occupation of the proposed guardian of the person and estate is that of retired.
17. The proposed guardian has no interest adverse to the alleged incapacitated person.
18. No other court has ever assumed jurisdiction in any proceeding to determine the
capacity of the alleged incapacitated person.
19. No other guardian has been appointed for the estate or person of the alleged
incapacitated person.
20. Petitioner has notified the granddaughter of the alleged incapacitated person, Crystal
Arnold, of her intention to seek to be appointed guardian. Crystal Arnold expressed no objection
to the proposed guardianship.
WHEREFORE, petitioner respectfully requests that this court award a citation directed to
Ethel M. Brinton, the alleged incapacitated person, with notice thereof to be ~ven to the alleged
incapacitated person in conformity with 20 Pa. Cons. Stat. § 5511, and to such other persons as
this court may direct, to show cause why she should not be adjudged a totally incapacitated person,
and Dorothy M. Jumper appointed plenary guardian of her person, and estate.
Respectfully submitted,
Frey & Tiley,
Attorneys for Petitioner
By: ~~~ff--~. ~"'~
Robert G. Frey, Esquire
Supreme Court Number 46397
5 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-5838
I verify that the statements made herein are true and correct and understand that false
statements herein are made subject to the penalties of 18 Pa. C. S. A. § 4904 relating to unswom
falsification to authorities.
Dated: July 8, 2004
Dorothy J. Jurril~
In Re: : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
ETHEL M. BRINTON, : ORPHANS COURT DIVISION
an Alleged Incapacitated Person : NO. 2004- E; (& ~ C[
PRELIMINARY DECREE
!
NOW,
this
n~, day of u ~'1' 2004, upon consideration of the annexed
petition, it is hereby ORDERED and DECREED that a citation is awarded directly to Ethel M.
Brinton, to show cause why she should not be adjudged a totally incapacitated person and a
plenary guardian of her person and estate appointed; the hearing therein to be held in Court Room
No. , Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania, on ~J)[,Q-~/
(~ff '1'3, 4oo~4) at ¢ ~' ~0 o'clock /~.M., ~,,c d}rrx~:~,~e~
At least twenty days' notice of the hearing shall be given to , the alleged incapacitated
person, by personal service of the citation, a copy of the petition and written notice in conformity
with 20 Pa. Cons. Stat. § 5511 and by service of notice upon Ethel M. Brinton, the alleged
incapacitated person's intestate heirs and to Ann-Marie E. Boyn Stouffer, the Admissions Director
of the HCR Manor Care Nursing Home, where the alleged incapacitated person resides, personally
or by registered mail.
IN RE: ETHEL M. BRINTON IN THE COURT OF COMMON PLEAS OF
An alleged incapacitated person CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-2004-0669
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with the Court to have you declared an Incapacitated Person. If the
Court finds you to be an Incapacitated Person, your rights will be affected, including your right to
manage money and property and to make decisions. A copy of the petition which has been filed by
Dorothy J. Jumper is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No. 1, Cumberland
County Courthouse, Carlisle, Pennsylvania, on Friday August 13 ,2004, at 9:30 AM. to tell the
Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your
behalf.
To be an incapacitated Person means that you are not able to receive and
effectively evaluate information and communicate decisions and that you are unable to
manage your money and/or other property, or to make necessary decisions about where
you will live, what medical care you will get, or how your money will be spent.
At the hearing, you have the right to appear, to be represented by an attorney, and
to request a jury trial. If you do not have an attorney, you have the right to request the
Court to appoint an attorney to represent you and to have the attorney's fees paid for you
if you cannot afford to pay them yourself. You also have the right to request that the
Court order that an independent evaluation as to your alleged incapacity.
If the Court decides that you are an Incapacitated person, the Court may appoint a
Guardian for you, based on the nature of any condition or disability and your capacity to
make and communicate decisions. The Guardian will bc of your person and/or your
money and other property and will have either limited of full powers to act for you.
If the court finds you are totally incapacitated, your legal rights ~vill be affectcd
and you will not be able to make a contract or gift of your money to other property. If the
court finds that you are partially incapacitated, your legal rights will also be limited as
directed by the Court.
If you do not appear at the hearing (either in person or by an attorney representing you)
the court will still hold the hearing in your absence and may appoint the Guardian requested.
Date:y-23-04 B''y. {- "~
Cler~;rphans' Court Division r:M:7/{ 117)~
Cumberland County, Carlisle, PA
My Commission Expires 1~ Monday,
January, 2006
In Re: : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
ETHEL M. BRINTON, : ORPHANS COURT DIVISION
:
an Alleged Incapacitated Person : NO. 2004-669
AFFIDAVIT OF SERVICE
AND NOW, this July 30, 2004, I, Robert G. Frey, Attorney for Dorothy Jumper, Petitioner in
the above-captioned matter, hereby swear that I have served a tree certified copy of the Pet/tion, with
Citation attached, in the above-captioned matter upon Ethel M. Brinton, by personal service on her
at her room at Manor Care, 940 Walnut Bottom Road, Carlisle, Pennsylvania, on Friday, July 23,
2004, and I further certify that I made known to her and mad to her the contents of the Petition at
that time. I further swear that true and correct copies of the Petition with Citation attached were
served by regular first class mail on July 27, 2004 on Ann-Marie Boyn Stouffer, HCR Manor Care,
940 Walnut Bottom Road, Carlisle, Pennsylvania 17013, Crystal Arnold, 501 Windy Hill Road,
Shermansdale, Pennsylvania 17090, Tina Gaines, 2129 Highway 25 N, Millen, Georgia 30442,
and Keith Windemaker, 430 North Pitt Street, Carlisle, Pennsylvania 17013. Copies of the
Certificates of mailing are attached hereto.
Robert G. Frey
Attorney for Plaintiff
5 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-5838
Sworn and subscribed to before me this
July 30, 2004
C
T~HA A. ~. ~T~RY PO~ [
I.S. POSTAL SERVICE CERTIFICATE OF MAILING ~ ~
MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL, DOES NOT
PROVIDE FOR INSURANCE--POSTMASTER
fee.
PS Form 3817, Mar. 1989
Afl x ~.~,~r~.;~n stamps
U.S. POSTAL SERVICE CERTIFICATE OF MAILING or m~t~c ~a~ and
PROVIDE FOR INSURANCE--POSTMASTER Post~ for ~rent
Receiv F~)m: ~ UN/~O
PS Form 3817, Mar. 1989
U.S. POSTAL SERVICE CERTIFICATE OF MAILING Affix fee here in stamp,
or meter postage am
IN RE: ETHEL M. BRINTON: IN THE COURT OF COMMON PLEAS OF
An alleged incapacitated: CB2~IBERI.d%ND COUNTY, PENNSYLVANIA
person : ORPHANS' COURT DIVISION
:
:
:
:
:
: NO. 21-2004-0669
DEPOSITION OF: George P. Bransoum, Jr, M.D.
TAKEN BY: Petitioner
BEFORE: Cheryl Farner Donovan, RPR-Notary
DATE: Thursday, July 29, 2004
scheduled for 11:00 a.m.
PLACE: Deponent's Office-Conference Room
George P. Branscum
850 Belvedere Medical Center
Carlisle, PA 17013
APPEARANCES:
THE LAW OFFICES OF FREY & TILEY
BY: ROBERT G. FREY, ESQUIRE
5 South Hanover Street
Carlisle, PA 17013
FOR - PETITIONER
ORIGINAL
CHERYL FARNER DONOVAN
Registered Professional Court Reporter
305 Bullshead Road
Newville, PA 17241
Phone (717) 776-3515
Courtroom & Free-lance Reporting · Experience Since 1975
1 INDEX
2
3
4
5 WITNESS DIRECT EXAMINATION
6
George P. Branscum, Jr., M.D. 3
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
1 Whereupon,
2 GEORGE BRANSCUM, JR., M.D.
3 having been first duly sworn, according to law, testified
4 as follows:
5 DIRECT EXAMINATION
6 BY MR. FREY:
7 Q Just for the record, Dr. Branscum, if I'm
8 unclear in any of my questions or if I do not ask a
9 question in a way in which you know how to answer, just
10 ask me to repeat and clarify the question.
11 Certainly use any documents, notes or records
12 you have that you feel might be helpful in responding to
13 my questions.
14 Could you state your name and business address
15 for the record, please?
16 A George P. Branscum, Jr., M.D., 850 Walnut Bottom
17 Road, Carlisle, PA.
18 Q And what is your practice, any specialties?
19 A Family practice with an interest in
20 Geriatrics.
21 Q And are you licensed to practice in
22 Pennsylvania?
23 A Yes.
24 Q And how long have you been practicing?
25 A About 27 years.
3
1 Q Have you treated or examined Ethel Brinton in
2 the past?
3 A Yes.
4 Q Do you recall when was your most recent visit
5 with her?
6 A Yesterday, the 28th.
7 Q And you have examined her on previous
8 occasions?
9 A Yes, when she was first admitted to Manor
10 Care.
11 Q And have you had an opportunity to review her
12 medical records?
13 A Yes, I have.
14 Q What did you observe concerning her mental and
15 physical condition?
16 A When she was first admitted to Manor she was
17 basically unresponsive, which was when she was
18 discharged from the hospital and sent to Manor;
19 that's what the attending physician at the hospital also
20 noted.
21 Yesterday she was more responsive, but still
22 disoriented as to time, person and place.
23 Q Based on that examination, what would be your
24 diagnosis and prognosis for her in the future?
25 A She has multiple infarct dementia from my
4
1 examination and review of her records.
2 The prognosis is she's going to slowly get
3 worse, unless she developed another acute episode,
4 another acute stroke, in which case she'll quickly get
5 worse.
6 Q What were her physical and mental limitations
7 and imparities?
8 A Physically, I'm not sure. I'd have to check
9 with the nurses at the Home. I don't believe she's
10 ambulating. She does eat. She does not require a feeding
11 tube. She has to be fed. And she's pretty much dependent
12 upon the nurses for care. She still can't do any of her
13 ADL's.
14 Mentally she's disoriented, really not capable
15 of making decisions on her own behalf.
16 Q I think you answered a number of my questions.
17 With regard to her finances, what affect do the physical
18 or mental impairments have on her ability to manage
19 her daily finances or make decisions concerning her
20 expenses?
21 A She's unable to manage her finances. She cannot
22 make decisions.
23 Q A hearing is scheduled concerning her capacity.
24 Would it be in her interest for arrangements to be made
25 for her to attend that hearing?
5
1 A No, it would not be in her best interest. She
2 would not understand what's going on and it would
3 only upset her by taking her out of her environment.
4 Q Okay. Thank you very much. That's all the
5 questions I have, unless you have anything else you wanted
6 to say?
7 A No.
8 Q Thank you.
9 (Concluded at 11:05 a.m.)
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
6
1 CERTIFICATION
2
3 I, CHERYL FARNER DONOVAN, a Registered
4 Professional Reporter and Notary Public, certify that the
5 foregoing is a true and accurate transcript of the
6 deposition of George p. Bransoum, Jr., M.D., who was first
7 duly sworn by me at the place and on the date hereinbefore
8 set forth.
9 I further certify that I am neither attorney nor
10 counsel for, nor related to or employed by, any of the
11 parties to the action in which this deposition is taken,
12 and further that I am not a relative or employee of any
13 attorney or counsel employed in this case, nor am I
14 financially interested in the action.
15
Registered Professional Reporter
17 Notary Public
18
19
Notary Public, Cumberland County
20 My Commission Expires July 23, 2006
21
22
23 (The foregoing certification of this transcript
does not apply to any reproduction of the same by any
24 means unless under the direct control and/or supervision
of the certifying reporter.)
25
7
IN RE: : IN TIIE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
ETHEL M. BRINTON, : ORPHANS' COURT DIVISION
AN ALLEGED INCAPACITATED :
PERSON : NO. 21-04-669 ORPHANS' COURT
IN RE: PRESENCE OF INCAPACITATED PERSON WAIVED
ORDER OF COURT
AND NOW, this 13th day of August, 2004, upon
consideration of the deposition of George P. Branscum, Jr., M.D.,
which has been marked as Petitioner's Exhibit 1, and which is
hereby admitted, the presence of the allegedly incapacitated
person, Ethel H. Brinton, is waived at this hearing on a petition
for an adjudication of incapacity based upon Dr. Branscum's
opinion that her presence would not be in her best interests,
that she would not understand what was going on, and that she
would be upset by being taken out of her present environment.
In the Court's view, this statement substantially
comports with the provision in Section 5511(a) (1) ef the Probate,
Estates arid Fiduciaries Code permitting the Court to waive the
presence of an allegedly incapacitated person where the Court is
satisfied, upon the deposition or testimony of or sworn statement
by a physician or licensed psychologist, that his or her physical
or mental condition would be harmed by his er her presence.
By the Court,
/
Robert G. Frey, Esquire
5 South Hanover Street
Carlisle, Pa 17013
For the Petitioner
IN RE: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ETHEL M. BRINTON, ORPHANS' COURT DIVISION
AN ALLEGED INCAPACITATED
PERSON NO. 21-04-669 ORPHANS~ COURT
IN RE: PETITION FOR ADJUDICATION OF INCAPACITY AND
APPOINT~4ENT OF PLENARY GUARDIAN OF THE ESTATE AND PERSON IN
ACCORDANCE WITH 20 PA. CONS. STAT. SEC ~.~p!~)N 5511 .
BEFORE OLER, J. ~
ORDER OF COURT ~
AND NOW, this 13th day of August, 2004, upon
consideration ef the Petition for Adjudication of i~capacity
and Appointment of Plenary Guardian of the Estate and Person
in Accordance with 20 Pa. Cons. Stat. Section 5511, and
following a hearing at which the presence of the allegedly
incapacitated person, Ethel M. Brinten, was excused by the
Court pursuant to Section 5511(a) (1) ef the Probate, Estates
and Fiduciaries Code, and the Court finding that Ethel M.
Brinton is totally incapacitated for purposes both of her
person and estate, she is so adjudicated, and Dorothy J.
Jumper, her sister, is appointed plenary guardian of her
person and estate.
The guardian is directed te file reports in
accordance with the provisions of the Probate, Estates and
Fiduciaries Code applicable to such guardianships. The
guardian is expressly authorized to expend from the
incapacitated person's assets the sum of $884.36 in legal
fees as supported by ~he FinOings o~ ~ac~ herein.
No bond shall be required of the guardian in this
case.
BY THE COURT,
J. Wesley Ol~rr}Jr., ~.~
Robert G. Frey, Esquire
5 South Hanever Street
Carlisle, PA 17013
For the Petitioner
:mae
IN RE: : IN THE COURT OF COHHON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ETHEL M. BRINTON, : ORPHANS~ COURT DIVISION
AN ALLEGED INCAPACITATED :
PERSON : NO. 21-04-669 ORPHANS' COUR?
IN RE: PETITION FOR ADJUDICATION OF INCAPACITY AND
APPOINTMENT OF PLENARY GUARDIAN OF THE ESTATE AND PERSON IN
ACCORDANCE WITH 20 PA. CONS. STAT. SECTION 5511
BEFORE OLER, J.
OPINION and ORDER OF COURT
Oler, J., August 13, 2004.
At issue in the present case is whether Ethel
M. Brinton should be adjudicated an incapacitated person,
and, if so, whether her sister, Dorothy J. Jumper,
Petitioner herein, should be appointed plenary guardian of
her person and estate. A hearing was held in this matter
on Friday, August 13, 2004, before the undersigned judge.
The presence of the allegedly incapacitated person at the
hearing was excused by the Court in accordance with Section
5511(a} (1) of the Probate, Estates and Fiduciaries Code.
Based upon the evidence presented at the
hearing, including a deposition of George P. Branscum, Jr.,
M.D., and testimony of Dorothy J. Jumper, which, inter alia,
verified the contents of the petition, the following
Findings of Fact, Discussion and Order of Court are made and
entered:
FINDINGS OF FACT
1. The allegedly incapacitated person is Ethel H.
Brinton {date of birth, July 30, 1924), a domiciliary of
Cumberland Ceunty presently residing at the Hanor Care
Nursing Home, 940 Walnut Bottom Road, Carlisle, Cumberland
County, Pennsylvania. Her mest immediate prier address was
21 Nerth Hanever Street, Carlisle, Cumberland County,
Pennsylvania, where she rented an apartment.
2. Petitiener is Dorothy J. Jumper, an adult
individual and sister of the allegedly incapacitated person,
who resides at 7590 Wertzville Road, Carlisle, Cumberland
Ceunty, Pennsylvania.
3. The allegedly incapacitated person, Ethel H.
Brinton, is suffering frem the effects of multiple infarct
dementia; the precise date of the onset of this condition
does not appear in the record.
4. As a result of this condition, Ms. Brinten is an
adult individual whose ability to receive and evaluate
infermatien effectively and communicate decisions is
impaired to such a significant extent that she is totally
unable to manage her financial resources and tetally unable
te meet essential requirements fer her physical health and
safety.
5. The aferesaid condition may be irreversible.
6. Based upon the aforesaid conditien, the Court finds
it necessazy to establish plena£y guardianships with £espech
te the estate and person of Ms. Brinton; it is believed that
her assets are of minimal value.
7. In view of the absence of a more favorable
prognosis at this time, the duration of the guardianships
required must be said to be indefinite, pending further
Order of Court.
8. Dorothy J. Jumper, sister of the allegedly
incapacitated person, is found to be a person qualified
under 20 Pa. C.S. Section 5511(f) to serve as plenary
guardian of Ms. Brinton's person and estate.
9. Reasonable legal fees and expenses have been
incurred for the benefit of the allegedly incapacitated
person by Petitioner's counsel, Robert G. Frey, Esquire, in
the prosecution of this matter in the amount of $884.36.
10. The foregoing Findings ef Fact are made on the
basis of clear and convincing evidence.
DISCUSSION
The provisions respecting an adjudication of incapacity
are contained in 20 Pa. C.S. Section 5501 et seq.
Petitioner has substantially complied with these provisions,
and based upon the foregoing Findings of Fact, the following
Order of Court will be entered:
ORDER OF COURT
AND NOW, this 13th day of August, 2004, upon
consideration of the Petition for Adjudication of Incapacity
and Appointment of Plenary Guardian of the Estate and Person
in Accordance with 20 Pa. Cons. Stat. Section 5511, and
following a hearing at which the presence ef the allegedly
incapacitated person, Ethel M. Brinton, was excused by the
Court pursuant te Section 5511(a) (1) ef the Probate, Estates
and Fiduciaries Code, and the Court finding that Ethel H.
Brinton is totally incapacitated for purposes both ef her
person and estate, she is so adjudicated, and Dorothy J.
Jumper, her sister, is appointed plenary guardian of her
person and estate.
The guardian is directed to file reports in
accordance with the provisions of the Probate, Estates and
Fiduciaries Code applicable te such guardianships. The
guardian is expressly authorized te expend from the
incapacitated person's assets the sum of $884.36 in legal
fees as supported by the Findings of Fact herein.
No bond shall be required of the guardian in this
case.
BY THE COURT,
/s/ J. Wesley Oler, Jr.
J. Wesley Oler, Jr., J.
Robert G. Frey, Esquire
5 South Hanover Street
Carlisle, PA 17013
For the Petitioner :mae
IN RE: ETHEL M.
BRINTON, an
Alleged Incapacitated
PERSONAL
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
NO. 21-04-669 ORPHANS' COURT
ORDER OF COURT
AND NOW, this 28th day of March, 2005, upon consideration of the Petition for
Appointment of Substitute Plenary Guardian of the Estate and Person in Accordance with
20 Pa. Cons. Stat. ~5514, a hearing is scheduled for Wednesday, April 13, 2005, at 3 :00
p.m., in Courtroom No.1, Cumberland County Courthouse, Carlisle, Pennsylvania.
BY THE COURT,
,--'
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t ~.
r 'Wesley 0 J.
Robert G. Frey, Esq. {I
5 South Hanover Street
Carlisle, P A 17013
Attorney for Petitioner
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IN RE: ETHEL M.
BRINTON, an
Alleged Incapacitated
PERSONAL
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
NO. 21-04-669 ORPHANS' COURT
IN RE: PETITION FOR APPOINTMENT OF
SUBSTITUTE PLENARY GUARDIAN OF
THE ESTATE AND PERSON IN ACCORDANCE
WITH 20 PA. CONS. STAT. &5514
ORDER OF COURT
AND NOW, this 30th day of March, 2005, due to a conflict in the Court's
schedule, the hearing previously scheduled in the above matter for April 13, 2005, is
rescheduled to Monday, April 25, 2005, at 1 :30 p.m., in Courtroom No.1, Cumberland
County Courthouse, Carlisle, Pennsylvania.
BY THE COURT,
Robert G. Frey, Esq.
5 South Hanover Street
Carlisle, P A 17013
Attorney for Petitioner
:T.
Crystal Arnold
Tina Gaines
HCR Manorcare
Keith Windemaker
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In Re:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION
NO. 2004-669
ETHEL M. BRINTON,
an Alleged Incapacitated Person
Petition for Appointment of an Emergency Guardian
of the Estate for the Purpose of Medicaid Qualification
Pursuant to 20 Pa.C.S.A. ~ 5513
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
AND NOW, comes Crystal Arnold, Petitioner, by and through her attorneys, Frey & Tiley,
and makes the following petition for an emergency order:
1. Petitioner is Crystal Arnold, a granddaughter of Ethel M. Brinton, an adult individual
of 501 Windy Hill Road, Shermansdale, Perry County, Pennsylvania.
2. Petitioner has filed a Petition to the above term and number to be appointed plenary
guardian of the estate and person of Ethel M. Brinton.
3. Ethel M. Brinton is a resident of HCR ManorCare Nursing Home In South
Middlteton Township, Cumberland County, Pennsylvania.
4. Ethel M. Brinton has expended her resources for her care and is unable to pay the
charges for her care from her resources.
5. HCR ManorCare has filed a request through the Commonwealth of Pennsylvania
Department of Welfare for Medicaid reimbursement of Ethel M. Brinton's costs, but that request
has been denied because no one had authority to complete and execute documents on Ethel M.
Brinton's behalf.
6. A hearing has been scheduled on the request for April 13, 2005 before the
Commonwealth of Pennsylvania, Department of Public Welfare, Bureau of Hearings and Appeals.
7. Petitioner is desirous of being appointed Guardian of the Estate of Ethel M. Brinton
without the requirement for a hearing in advance for the limited purpose of authorizing, completing
and executing documents and providing financial information necessary for obtaining Medicaid
reimbursement for Ethel M. Brinton for medical and nursing home care.
WHEREFORE, petitioner respectfully requests that this Honorable Court enter an Order
appointing Crystal Arnold as Emergency Guardian of the estate of Ethel Brinton for the purpose
of executing necessary documents and providing necessary information for qualifying Ethel M.
Brinton for Medicaid reimbursement.
Robert G. Frey
Attorney for Petitioner
5 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-5838
"nr;-cu-CUU:J\1 nU) I~:::lf
)cnutJer I ~ogar LL[
(FAX)717 909 5925
P. 0021002
Bur or Heorlngs'Ap~OI:l
2330 vorton Woy
.Second FloQr
I'ICrrlsburg PA 17110.99.<16
Chadwick O. Boga~
$chatj~r/bQ9a~ ~1c
441 F~ienQshi~ R~
Suite 102
~r~i~burg ~A 11111
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
Bureau of Hearings & Appeals
Phone: (717) 783-3950
Fax: (717) 1"12-27$
tlate Mench 23.2005
Appellant Name and Address:
. Etl'lQI Brlnton
Monoreare Carlisle
9.40 Wolnut Bottom Rd
CcIr1sle PA 17013
NOTICE .OF HEARING~ DATE AND TIME
Dear Ms. Brinton:
The heorln!i;l that wos orlglnclly scheduled for you hosoeen ccn~elled ond rescheduled becouse
the cppellonrs representotlve reQuested a rescheduling.
A 1oce.to-foce heorlns hos been'scheduled for you.
Your hearing will be conducted ot the dote, time and location below. Please nott1V this
offlce Immedlotely If you went to chonge to 0 telephone heorlng. We can coil you at 0
number that VClU I'rovlde or you con use the telephone at your CAO.
Case No: 210103143-001
AE: PA/FS 162
CATE OF NOTICE: 1/4105
Hearing Date: April 13. 2005 TIme: 01 :00 p.m.
Location: 2330 Varton WQY. .Second Floor. Harrisburg
AdmInistrative Law Judge (ALJ): Snown A. Bozortn
NOTE: 2330 Vartan Wov Is located east of North Progress Ave.. beiween 1.8' and l.lt:!glestoWl"l
Rd. CRt 39). If you need directions from 0 specIfic locot/on. pleose eoll (17) 783.3950.
.IMPORTANT: It you, or a representative far you. Is not available for the hearing, you w1/1lose the case. If, betore the nearlng,
you gllle me a reason for your unavailability and t"e Bureau ot HearIngs ancl Appeals deems the reason 10 be acceptable, the
hearing will be postponed. 'f the Bureau of Hearings and Appeals deems your reason to be unacceptable and you are not
alla/lable for the hearing, your appeal will be dIsmissed.
CONTINUED ON REVERSE
Please complete and sign the "REPLY TO BUREAU OF HEARINGS AND APPEALS" form below, cut on the dotted
line and retum as soon as possible In the postage-paid reply envelope to the Bureau ot Hearing and Appeals.
...._. .... _.._....._... _.._ ..... ...... .... _... __ .... ... ........... ......... - ............. .... "._ ........_ ..... ...... .._. ____ _......._. _...... a.a aa... ___a _
..... ..... ..._.... . ..._.
REPLY TO BUREAU OF HEARINGS AND APPEALS
Check all that apply:
D I will be available 10r tne hearing April 13.2005
at 01:00 J:l.m. with AW
Shown A. Bozarth
o I need an Inte"""eter. Language needed:
o My correc:t telephone number
o I am a person with a disability and I need an acccmmOdatlon to
partlclpale In tne hearing. The accommOdation I need Is:
o I will NOT be available 10r the hearing because:
SQREAU OF HE.i\RDlG AND APPEiUoS
2JJC V"'1\R'1';.N WAY
SECOND F~OR
HARRISBURG PA 17110-9946
D I wish 10 withdraw my appeal at tnls time (Only
the person who fUed the appeal or hlslher
authorized representative can withdraw the
appeal).
Signature
Oate
Ethel Brln'on
210103143.Q01
_,'PllfIA
PW 111ll.-~
an Alleged Incapacitated Person
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS COURT DIVISION
: NO. 2004-669
In Re:
ETHEL M. BRINTON,
EMERGENCY ORDER
<t/ 1. S u u..C$$QS
AND NOW, thisS lL,day of Apri ,2005, upon consideration of the annexed petition and
after hearing previously held following e notice, it is hereby ORDERED and DECREED that,
Crystal Arnold is appointed emergency~uardian of the estate of Ethel M. Brinton for the limited
purpose of authorizing, completing and executing documents and providing financial information
necessary for obtaining Medicaid reimbursement for Ethel M. Brinton for medical and nursing
home care. ~ e.e,. Z 0 P2 I c..,~, ~ 5".!:>- (L.{ .
This order shall be effective for no more than 30 days from this date.
A certified copy of this Order shall be served upon all persons named as next of kin in the
annexed petition and upon Manor Care Nursing Home by certified mail, return receipt requested.
By the Court:
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In Re:
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION
NO. 2004-669
ETHEL M. BRINTON,
an Alleged Incapacitated Person
FINAL DECREE
-rt;
AND NOW, this 2b day of April, 2005, upon consideration of the annexed petition and
after hearing previously held following due notice, it is hereby ORDERED and DECREED that,
Crystal Arnold is appointed successor plenary guardian of the person and plenary guardian of the
estate of Ethel M. Brinton.
The respective guardians shall file with this court a report within 12 months from the date of
this decree and at least annually thereafter which
(a) in the case of the guardian of the estate attests to:
(i) current principal and how it is invested;
(ii) current income;
(iii) expenditures of principal and income since the last report; and
(iv) the needs of Ethel M. Brinton, the incapacitated person, for which the guardian
has provided since the last report, and
(b) in the case of the guardian of the person attests to:
(i) current address and type of placement of Ethel M. Brinton, the incapacitated
person;
(ii) major medical or mental problems of Ethel M. Brinton, the incapacitated person;
(iii) a brief description of the living arrangements of Ethel M. Brinton, the
incapacitated person, and the social, medical, psychological and other support serviceS!Jle is
recelvmg;
(iv) the opinion of Crystal Arnold as to whether the guardianship should continue or
be terminated or modified, and the reasons therefore; and
(v) the number and length of times Crystal Arnold visited the incapacitated person
in the past year. J
~l) lao'r"]d s,.l."t\ ~<=- t--e"vL~uL ~ t~l~t-2-( I1r,?otcL.
A certified copy of this Order shall be served upon all persons named as next of kin in the
anne~ed petition and upon Manor Care Nursing Home by certified mail, return receipt requested.
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Estate of
also known as
Ethel M. Brinton
PETITION FOR PROBATE and GRANT OF LETTERS
No. 21-~ Q1-lGloQ
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
201.111-JlIl11
ocwl 8ecunty No.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the executors named
in the last will of the above decedent, dated Ma 14 1997
and codic' (s) dated N/A
c:,I t.S W. -.. -e Cl Lo D
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executor, etc.
Decedent was domiciled at death in Cumberland
the Decedent's last family or principal reSIdence at
South Middleton Townshi )
County, Pennsylvania, with
940 Walnut Bottom Road
Carlisle I'A 170lJ
1St street, num er an mumclpa Ity
Decedent, then 81 years of age, died AUllUst 6, 2005
at 940 Walnut Bottom Road Carlisle PA 17013
t:xcept as tallows, decedent did not marry, was not dIvorced and did not have a chIld born or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
Decedent was adjudicated incapacitated See Cumbertand County Orphans' Court Iile number 21-04-669. See also attache<
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
10,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters administration .:tIMI.c.t.a.
(testamentary; admInIstratIOn c.I.a.; admInistratIon d.b.n.c.l.a.)
thereon.
~ ) j) Signatur}'(s) of Petitioner(s)
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Crystal L. Arnold
Residence(s) of Petitioner(s)
501 Windy Hill Road #69
ShermanseJale, PA 17090
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REGISTER OF WILLS OF CUMBERLAND CUUNTY
OATH OF NONSUBSCRIBING WITNESS
-------.-.-----------------------
Estate of
Ethel M. Brinton
No.
~1-04 - tDlP9
Also known as
, Deceased
Robert G. Frey and Trisha Liess
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that the)
are familiar with the signature of Theresa L. Bentzel, (one of the subscribing witnesses to) the will pn
herewith and that each believes the signature on the will is in the handwriting of Krista King to the be~
of our knowledge and belief.
Sworn to or affirmed and subscribed before
me this ~j ay of
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Robert G. Frey ()
5 South Hanover Street, Carlisle, PA 17013
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REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUBSCRIBING WITNESS
Estate of
Ethel M. Brinton
No.
~1-04-L{/1
Also known as
, Deceased
Robert M. Frey
(each) a subscribing witness to the will/codicil presented herewith, (each) being duly qualified accordi
to law, depose(s) and say(s) that they were present and saw Ethel M. Brinton
the testatrix, sign the same and that they signed as a witness at the request of testatrix in her presence
(in the presence of each other) (in the presence of the other subscribing witness(es)).
~M.~
Robert M. Frey ,-
5 South Hanover Street, Carlisle, PA 17013
Register
NOTARIAL SEAl
TR.SHAA. L1ESS. NOTARY PUBLIC
BOROUGH OF CARLISLE. CUMBERLAND co.. PA
MY COMMISSION EXPIRES MAY 20, 2006
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RENUNCIATION
In Re Estate of Ethel M. Brinton, deceased
No.
d.1 -61 -I.Ao~
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned Tina Gaines, granddaughter of the above decedent, hereby
renounce(s) the right to administer the estate and respectfully ask(s) that Letters of
Administration C.TA, be issued to Crystal L. Arnold.
J
WITNESS my hand this L?-"" day of August 2005
Affirmed and subscribed before me this
.J..;). nc! day of ~. d-.eflS
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Tina Gaines
2125 Highway 25 North
Millen, GA 30442
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Notary Public ~Co. 4iL
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RENUNCIATION
In Re Estate of Ethel M. Brinton, deceased
No. Jd - 01-lPl.il
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned Keith Windemaker, grandson of the above decedent, hereby
renounce(s) the right to administer the estate and respectfully ask(s) that Letters of
Administration, C.T.A., be issued to Crystal L. Arnold.
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WITNESS my hand this ~(p day of August, 2005
Affirmed and subscribed befqre me this
~f.,+l.J day of ~ ('T,t.(J"I ,
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Notary Public
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Kei h Windemaker
430 N. Pitt Street
Carlisle, PA 17013
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NOTARIAl SEAl
TRISHA" lIESS. NOTARY PUBLIC
BOROUGH Of CAAUSlE. CUMBERlAND CO PA
MY COMMISSION EXPIRES MAY 20. 2006"
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This is to certify that the information here given is correctly copied from an original ccrtificatc of death duly filcd with me as
Local Rcgistra~. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
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AUG 1 0 2005
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATEFllE~"aER
SOCIAL SECURITY NUMBER
DATEOF DEATH (Month, o.r, V.....)
TYPE/PRlHT
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NAME OF DECEDENT (Fl...~ M"oddle. Last)
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INFORMANTS UAlLlNGADDRESS (Slraat, Cily/Town. stats. Zip Code)
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'MEOfCAL EXAMttER1CORONER
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l.:UMMUNWI<:ATLH Ul<' PI<:NNSYLVANIA
l.:UUNTY Ul<' l.:UMBI<:KLANU
The petitioner(s) above-named swear(s) or aftirm(s) that the statement in the foregoing peition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or afhrmed and subscribed )><; f' , D ~ fl Ll ~
be~t\ m'::h~i~ lo-\:.~cx..cday of urstai'L:J(rhold
~~~~tn~Arn. .<;~t~'1i~glSter 0
No. ~ \ - 0 1-lP lit
Estate 01" Ethel M. Brinton
Deceased
DECREE OF PROBATE AND GRANT Olf LETTERS
AND NUW f) lC. ~ , zJ)5 in consideration of the petition on the reverse side
hereof, satisfactory proof having been presented before me, IT IS DEl.:REED that the instrument(s) dated
May 14, 1997 , described therein be admitted to probated hied of record as the last will of
J<;thel M. Brmton ; and Letters are hereby granted to
l.:rystal L. Arnold
Filed
FEES
$
$
$
$
$
$
$
Total_ $
,20
Probate, Letters, Etc.
Will
Renunciation
Short l.:ertihcates ( 2.)
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Automation Fee
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5 South Hanover Street
l.:arlisle, Pennsylvania 17013
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LAST WILL AND TESTAMENT
OF
ETHEL M. BRINTON
I, ETHEL M. BRINTON, widow. of 21 North Hanover Street, in the Borough of
Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and Testament
hereby revoking and making void any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executor or Executrix to pay all of my just debts and
funeral expenses as soon after my death as may be found convenient to do so. I direct my
Executor or Executrix to select an appropriate funeral director for my burial, and that my body be
interred beside that of my husband, Junior C. Brinton, on his burial lot located in Kutz's Church
Cemetery in Middlesex Township, Cumberland County, Pennsylvania.
2. All of the rest, residue and remainder of my estate, real, personal and mixed and
wheresoever the same may be situate, I give, devise and bequeath to my son, Roger G.
Windemaker, his heirs and assigns, of 21 North Hanover Street, Carlisle, Pennsylvania, provided
he shall survive me by a period of ninety (90) days, but should he fail to so survive me, then to
my sister, Dorothy J. Jumper, her heirs and assigns, of 7590 Wertzville Road, Carlisle,
Pennsylvania.
3. I hereby nominate, constitute and appoint my son, Roger G. Windemaker, as Executor
of this my Last Will and Testament but should he predecease me or fail to qualify or cease serving
as such, then in such event I nominate, constitute and appoint my sister, Dorothy J. Jumper, as
alternate or successor Executrix, and I further direct that neither of them shall be required to post
any bond to secure the faithful performance of his or her duties in the Commonwealth of
Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will
and Testament written on one (1) page, this 14th day of May, 1997.
~' , "^. !3ru7l..~
Ethel M. Brinton
(SEAL)
Signed, sealed, published and declared by ETHEL M. BRINTON, the Testatrix above-
named, as and for her Last Will and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto subscribed our names as attesting
witnesses.
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Page 1 of 1 Pages
Cu~berland County - Register Of Wills
One Courthouse Square
~~_ __,.i .' __I ,...... nil" '101-'
~aLL~OLC, rn LIUL~
Phone: (717)240-6345
Date: 02/01/2006
ARNOLD CRYSTAL
501 WINDY HILL RD #69
SHERMANSDALE, PA 17090
RE: Estate of BRINTON ETHEL M
File Number: 2004-00669
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 11 for decedents dying on
or after July 11 19921 the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.71 shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
03/12/2006
Your prompt attention to this matter will be appreciated.
Thank You.
SincerelYI
k10..~ /..~ If ~~. . l)
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GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Counsel
Judge
I ,
! I
Cumberland County - Register Of Wills
One Cou~thouse Square
Carlisle, .?A :LIe:!..:;
Phone: (717)240-6345
Date: 02/01/2006
FREY ROBERT G
5 S HANOVER STREET
CARLISLE, PA 17013-3385
RE: Estate of BRINTON ETHEL M
File Number: 2004-00669
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on
or after July I, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
03/12/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sin7:ely,
.@~~ !~;it1j J&dh~~
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Personal Kepresencaclve(s)
Judge
C:..---
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ethel M. Brinton
Date of Death:
August 6.2005
Will No.
Admin. No. 21-04-669
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes () No (X )
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: November 30, 2006
3. If the answer to No.1 is Yes, state the following:
(a) Did the personal representative file a tmal account with the Court?
Yes () No ( )
(b) The separate Orphans' Court no. (if any) for the personal
representative's account is:
(c) Did the personal representative state an account informally to the parties
in interest? Yes ( ) No ( )
(d) Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to
this report.
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Date: March 29. 2006
Robert G. Frey
5 South Hanover Street
Carlisle. Pa 17013
(717) 243-5838
Capacity: ( ) Personal Representative
( X) Counsel for Personal Representative
\ :
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IN RE: EST A 'fE OF
BRINTON ETHEL M
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-2004-0669-
NOTICE OF FAILURE TO FILE CERTIFICATION
Personal Representative: ARNOLD CRYSTAL
Counsel for Personal Representative: FREY ROBERT G
Date of Grant of Original Letters: 12/2/2005
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, is hereby given that you have ten (10) days to file the Certification
Report. If the required 5.6 form is not filed in accordance with Rule 5.6(e) the Court will be
notified of such delinquency and the undersign will request that a Court conduct a hearing to
determine whether sanctions should be imposed upon the delinquent personal representative or
counsel for the delinquent personal representative.
Date: 3/29/2006
~~tlJ4ML;rl
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Ethel M. Brinton
Date of Death:
August 6, 2005
Will No.
Admln.No.
21-04-0669
To the Register:
I certify that notice of (beneficial Interest) estate administration Irequlred by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to th, following
beneficiaries of the above-captioned estate on: April 20, 2004.
Name
Crystal Arnold
Keith Wlndemaker
Tina Gaines
Address
501 Windy Hili Rd., Lot 69, Shermansdale~ PA 17090
430 N. Pitt Street, Carlisle, PA 17013
2125 Highway 25 N., Millen GA 30442
Notice has now been given to all persons entitled thereto under Rule ~.6)a)
except NO EXCEPTIONS
Date: 413012006
-~.~
Signature " CJ"
Name: Robert G. Frey
Address: 5 South Hanover Street
Carlisle. Pennsylvania 17Cln
Capaclty:_Personal Representative
--X.Counsel for Personal Represen*atlve
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15056041114
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisbur , PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN _q l
RESIDENT DECEDENT ex
OFFICIAL USE ONLY
County Code Year
File Number
Cif
()
Date of Birth
201-18-3818
08062005
Decedent's Last Name
Suffix
Decedent's First Name
MI
BRINTON
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
ETHEL
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST 8E :"l:"ED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW
W 1. Original Return 0 2. Supplemental Return
o 4. Limited Estate 0 4a. Future Interest Compromise (date of
death after 12-12-82)
REGISTER OF WILLS
W 6. Decedent Died Testate
(Attach Copy of Will)
CJ 9. Litigation Proceeds Received
o
o
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
o
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11 Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT G. FREY
Firm Name (If Applicable)
717-243-8-5338
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FREY & TILEY
REGISTER 0 ILLS USs:m.JL Y
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First line of address
5 SOUTH HANOVER STREET
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Second line of address
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CO
City or Post Office
State
ZIP Code
DATE FILED
CARLISLE
PA
17013
Correspondent's e-mail address:RFREY@FREYTILEY.COM
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct and com lete. Declaration of re arer other than the ersonal re resenlative is based on all information of which re arer has an knowled e.
SI~~ATURE~OF ~~~, ~~ONS~ FOR FILING RETURN DA~E _
ADDRESS
Side 1
L
15056041114
15056041114
--.J
--.J
15056042115
REV-1500 EX
Decedent's Social Security Number
Decedent's Name ETHEL BRINTON
RECAPITULATION
201-18-3818
1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . .
1. NONE
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. NONE
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .
3. NONE
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . .
4. NONE
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
14869.00
6. Jointly Owned Property (Schedule F) DSeparate Billing Requested.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) DSeparate Billing Requested.
6. NONE
7. NONE
8. Total Gross Assets (total Lines 1-7) . .
8.
14869.00
9. Funeral Expenses & Administrative Costs (Schedule H) . . . . .
9.
33112.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . 10.
27664.00
60776.00
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . 13.
-45907.00
14. Net Value Subjectto Tax (Line 12 minus Line 13). . . . . . . . . . . . . . . . . . . . . .. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O L
16. Amount of Line 14 taxable
at lineal rate X.O 4 5
17. Amount of Line 14
taxable at sibling rate X . 12
18. Amount of Line 14 taxable
at collateral rate X . 15
0.00
-45907.00
19. TAXDUE....
15. 0.00
16. 0.00
17. 0.00
18. 0.00
. . . . . . . . . . . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
D
Side 2
L
15056042115
15056042115
--.J
REV-1500 EX Page 3
Decedent's Com
DECEDENT'S NAME
ETHEL BRINTON
STREET ADDRESS
201-18-3818
lete Address:
File Number
21-04-669
21 NORTH HANOVER STREET
CITY
CARLISLE
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits ( A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due.
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . .
Yes
.....0
o
o
o
o
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 0
o
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No
o
o
o
o
o
o
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for
the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for
disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for
the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half
(4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling
is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
217
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ETHEL BRINTON
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-04-669
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv jointly-owned with riaht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 M& T Bank checking account no. 15004200922208
2 Life insurance benefits receivable on life of Roger Windemaker
VALUE AT DATE
OF DEATH
3,935
10,934
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14,869
217
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
ETHEL BRINTON
21-04-669
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Crystal Arnold
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 501 Windy Hill Road
City Shermansdale State Pa Zip 17090
Year(s) Commission Paid: 1,500
2. Attorney Fees 1,500
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 108
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Pennsylvania Department of Public Welfare, medical expenses within last 6 months 29,989
8. Filing Inheritance tax return 15
TOTAL (Also enter on line 9 Recaoitulation\ $ 33 112
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ETHEL BRINTON
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-04-669
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Pennsylvania Department of Public Welfare, medical expenses incurred more than 6 months age
27,664
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27,664
I!M&TBank
499 Mitchell Street, Millsboro, DE 19966
December 15,2005
Frey & Tiley
Attomeys At Law
5 South Hanover Street
Carlisle, PA 17013
RE: Estate of Ethel M. Brinton
Date of Death: August 6, 2005
Social Security Number: 201-18-3818
Dear Mr. Frey:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type........................... Savings Account
Account Number....................... 15004200922208
Ownership (Names oj).............. Ethel M. Brinton
Opening Date......................... ..06/02/97 (account closed 12/05/05)
Balance on Date ojDeath.........$3,934.38
Accrued Interest
$
0.14
TotaL.................................... ..$3,934.52
The above named decedent did not have a safe deposit box.
For any additional information on the above accounts, including ownership and
closures please contact our High Street Carlisle branch at 717-240-4536.
Sincerely,
UO:,UI',j) Zj,Z: !4ffc)
Charlene Warrington, Records Management
1-888-502-4349
.-:----' .
*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105-8486
December 13, 2005
FREY & TILEY
ROBERT G FREY ESQUIRE
5 SOUTH HANOVER STREET
CARLISLE PA 17013
Re: ETHEL BRINTON
CIS #: 170171476
SSN: 201-18-3818
Date of Death: 8/6/2005
Dear Attorney Frey:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $57,652.52 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $29,988.78, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $27,663.74, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
~
rtJ~'IiJ.ru<<- ~~""",J!,
.J .
Barbara I. Aschenbrenner
TPL Program Investigator
717-772-6617
717-772-6553 FAX
Enclosure
12-04-2006
BRINTON
08-06-2005
21 04-0669
CUMBERLAND
101
APPEAL DATE: 02-02-2007
( See reverse side under Objections)
Amount Remitted I 1
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
~Y!_~~~~-~J~-~J~~------~-_!~!~!~_~9~~_~!!J~_E9!_!9~_!~~!P~__~___________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ETHel M FILE NO. 21 04-0669 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
1\ ilr.:c~J(O,i OF INHERITANCE TAX
qf-CORow.MIS~NX ~ ALLOWANCE OR DISALLOWANCE
! "Qcr::('.l;~~"~~\!:~NS AND ASSESSMENT OF TAX
\ It_\.lh.../ ;~, .....
10nb DEe -8 PH 12: 06
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ROBERT G FREY
FREY & TILEY
5 S HANOVER ST
CARLISLE
CLERK OF
Q~rC~U~I;):,9Q~T ?f\
CU:\,"',,"" , '..
;,.-
PA 17013
ESTATE OF BRINTON
'*
REV-1547 EX AFP (06-05)
ETHel
M
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
DATE 12-04-2006
I~ an assessment was issued previoUsly, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. A.ount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. A.ount of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
X S:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
14,869.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/A~. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
33.112.00
(9)
(10)
27.664.00
Ul)
(12)
(13)
(14)
(Schedule J)
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
DATE
I
+
INTEREST/PEN PAID (-)
AMOUNT PAID
NUMBER
NOTE: To insure proper
credit to your account.
~it the upper portion
of this fo~ with your
tax pa~t.
14.869.00
60.776 00
45.907.00-
.00
45.1907.00-
(9)=
.00
.00
.00
.00
.00
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. ~.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DU
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
· IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ethel M. Brinton
Date of Death:
August 6.2005
Will No.
Admin. No. 21-04-669
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ( X) No ( )
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: November 30, 2006
3. If the answer to No.1 is Yes, state the following:
(a) Did the personal representative file a [mal account with the Court?
Yes () No (X )
(b) The separate Orphans' Court no. (if any) for the personal
representative's account is:
( c) Did the personal representative state an account informally to the parties
in interest? Yes ( X) No ( )
(d) Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached to
this report.
Robert G. Frey
5 South Hanover Street
Carlisle. Pa 17013
Date: June 1. 2006
(717) 243-5838
Capacity: ( ) Personal Representative
( X) Counsel for Personal Representative
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