HomeMy WebLinkAbout03-18-11DECEDENT'S ESTATE
' 'r COURT OF COMMON PLEAS OF
~!~ ~~~~ COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF 1 ITt(J Q~F. ~. .ItY(~-~4 DECEASED
No. a~fa~~~S
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, if any; the papers
required under items 8-19 inclusive; and any instrument pertinent to the adjudication.
INCL i1DE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel:
Supreme Court I.D. No.:
Name of Law
Address:
Telephone:
Form oc-o/ rev. !0./3.06 Page 1 of 10 /
Estate of /I/~Z.ClK~. W ~ ~, l'71/LI9Gf~ __ _ ,Deceased
1. Name(s) and address(es) of Petitioner(s):
~i1
Name: /`~ ~ p ~/l
Address: t ~ ~/~ U ~'C ~ ~~~-
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and Account and state reason:
Is this the first accounting by this fiduciary? ....................... L9'Yes ~ No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on m ~}'y ~ ~, ~~
D'~,etters Testamentary or ^ Letters of Administration were granted to Petitioner(s) on
.-~ ~
Date of Will (if applicable): J ~~ , ~6 , (q ~
Date(s) of Codicil(s) (if applicable): ~~~
Date of probate (f different from date Letters granted): i/~.~G ~~, a'O ~U
Was a bond required? ^ Yes ~No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... Imes ^ No
Dates of advertising of the grant of Letters: ~~.~/ 1~(_ a-I .A~ 2~' ,'~ 1Q,~7titi.
~,~ a ~~ Za~Q CCT, a-~ a~rp ~ ~~ A..r~ ~-to ~ 2 at o ~~c ~2Z~~'~ pC~
Form OC-01 rev. 70.13.06 Page 2 of 10
Estate of
Deceased
3. Was decedent survived by a spouse? ............................. ^ Yes
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............. ^ Yes ^ No
(See Section 2201 et sue. 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):
6. Did decedent marry after execution of Will or Codicil(s)? ............ ^ Yes loo
Were any children born to decedent after execution of ~
Wil] or Codicil(s)? ........................................... ^ Yes ~.Pd"o
If yes, give names and dates of birth:
Date of Birth:
Name:
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
I~Q.~ ~J~E,R'~.~.-
Form OG01 rev. 10.13.06
Page 3 of 10
Estate of
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.
List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will or
Codicil(s) or as intestate heirs if there is a complete or partial intestacy:
A. State each party's relationship to the decedent and the nature of each party's
interest(s):
Name and Address o Each Par rn /merest Relatlonshi and Comments, i an /merest
~~ ~i~»'-i R.olro
t~a~~l-u~+, P~- ~ fs~r~3
s~~ ~£`~
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Form oc-o/ rev. /0.13.06 Page 4 of 10
Estate of
Deceased
....~... ,.r, u. rmerest rte~anonsnt ana t,omments, i an Interest
~~~
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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.
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).
~~P~~~~~
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.
t~-~Pl~~tll
Form OC-07 rev. /OJ3.06 Page 5 of 10
Estate of
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.
1 `~~ I`~~
Name and Address of Each Claimant Amount o(Claim Claim
Admit(ed? Wil! Claim
Be Paid In
Full?
^ Yes D Yes
^ No ^ No
0 Yes ^ Yes
^ No 0 No
^ Yes ^ Yes
^ No ^ No
0 Yes ^ Yes
^ No D No
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. § 3392 and the proposed payments.
11. Was family exemption claimed? ................................ ^ Yes l9'1Vo
Was family exemption allowed? ................................ ^ Yes ^ No
Family exemption claimant's name and relationship:
Name: Relationship:
Farm oc-ol rev. 10.73.06 Page 6 of 10
Estate of
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 /nterest
la, a~3. ~~ r~-(,(.. l~
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 ltriQo
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:
1~ or~~.
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. ^ Yes ^ No
rte- ~Pp~
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 OGO/ rev. /0.13.06 Page 7 of 10
Estate of
Deceased
16. Had the decedent been adjudicated an incapacitated person? .......... ^ Yes m~11t
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.
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Para(gr~aph 9 above? ............. D Yes ^ No
I`~ ~~
18. If a reserve is requested, state amount and purpose.
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 ~~
As to real estate only? ........................................ ^ Yes ^ No
For,„ oc-or rev. 10.73.06 Page 8 of 10
Estate of
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)
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B. > nncir~ - C~d~l~
Proposed Distributee(s)
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~h~a~e~- _e~yC~c
Amount/Proportion
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Submitted By:
(Al! petitioners must sign.
Add additional lines if necessary):
~_~ ~;
N e of Petitioner:
Name of Petitioner:
Form oc o~ rev. 10.13.06 Page 9 of 10
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Estate of _ '1 ~''.~-W(,,~ ~' ~ ~ ~` ' '~ ~~ ,Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that neishe is
of the above-named name ofcorporah'on 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).
gnature of Petitioner
* Corporate petitioners must complete bracketed information.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein.
Signature of Counsel for Petitioner
Form OC-01 rev. 10.13.06 Page 10 of 10
33a, D ~~, ~ 9
COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF THEODORE W. CHYLACK, DECEASED
N0.21-10-0649
E_._,
FIRST AND FINAL ACCOUNT OF n
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Theodore J. Chylack, Executor ~? cx.,
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For coo-„
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ESTATE OF Theodore W. Chylack
Deceased ~
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Date of Death: May 18, 2010
Date of Executor's Appointment: June 25, 2010
Date of First Advertising: July 14, 2010
Accounting for the Period: June 25, 2010 to March 15, 2011
Social Security Number: 186-22-3546
Purpose of Account: Theodore J. Chylack, Executor, offers this Account to acquaint interested
parties with the transactions that have occurred during his administration. This Account also
indicates the proposed distribution of the estate. It is important that the account be carefully
examined. Requests for additional information or questions or objections can be discussed with:
Theodore J. Chylack
42 Pinetree Drive
Audubon, PA 19403
(610)666-5803
SUMMARY OF ACCOUNT
Page
Proposed Distribution to Beneficiaries l2
Principal
Receipts 3
Less Disbursements
Administration Cost 4
Debts and Payables 4
Federal and State Taxes 4
Fees & Commissions 5
Funeral Expenses 5
Distribution of Principal to be made
to Beneficiaries 6
Principal Balance on Hand 7
For Information:
Investments Made g
Income
Receipts g
Less Disbursements 10
Distributions of Income to be made
to Beneficiaries 11
Proposed Distribution to Beneficiaries
$ 274,402.00 + $536.20 12
2
TOTAL
Value
$ 274,938.20
$ 332,038.09
$ 974.56
$ 29,950.40
$ 14,064.95
$ 9,961.18
2 685.00
$ 57,636.09
$ 274,402.00
$ 274,402.00
$ 650.82
$ 650.62
$ 114.62
$ 536.20
$ 274,938.20
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory Value
(Valued as of Date of Death)
Cash and Cash Equivalents
Cash
Pennsylvania State Employees Credit Union -checking
$ 330,113.09
Tangible Personal Property
Automobile
2001 Chevrolet Monte Carlo
Miscellaneous
Clothing and household goods
$ 1775.00
(Sold for Blue Book value)
$ 150.00
TOTAL INVENTORY $ 332,038.09
3
DISBURSEMENTS OF PRINCIPAL
Administration Cost
06/25/10 Register of Wills, Probate Fee $ 218.50
07/08/10 Cumberland Law Journal, Legal advertising $ 75.00
08/10/10 Register of Wills, Filing Fee $ 15.00
07/12/10 The Sentinel, Legal advertising $ 146.06
08/26/10 Register of Wills, Additional Probate Fee $ 225.00
03/14/11 Register of Wills, Inventory Fee $ 15.00
03/14/11 Register of Wills, Fee for First and Final Accounting
and Advertising Fees 280.00
TOTAL $ 974.56
Debts and Payables
06/25/10 Sandoe's Mini Storage, Arrearage on storage locker $ 174.90
06/25/10 U-Haul van rental to remove papers and
household goods $ 155.55
06/25/10 Gas and tolls to remove papers and
household goods $ 63.60
06/27/10 Postage $ 8,80
07/01/10 Enterprise van rental to continue removal of
papers and household goods $ 88.39
07/01/10 Gas and tolls to continue removal of papers and
household goods $ 59.65
07/08/10 Milage and tolls to complete removal of papers
and household goods $153.03
08/31/10 Reimburse Pa. State Employees Retirement System
for overpayment of pension $ 606.08
09/03/10 Payments for transportation for Decedent's
radiation treatments $ 150.00
09/16/10 PNC Bank, Check printing fee $ 10.00
09/22/10 Ambulance service, Camp Hill Fire Co. $ 100.00
09/22/10 Postage $ 8.80
12/07/10 Elaine Junstrom, Home health care services, as per
Americare Home Care Services Inc., rates $ 17,998.56
12/23/10 Diane J. Helm, Home health care services, as per
Americare Home Care Services Inc., rates $ 10,373.04
TOTAL $ 29,950.40
Federal and State Taxes
08/11/10 Register of Wills, Agent PA Transfer Inheritance Tax $ 12,283.78
09/03/10 Pennsylvania Department of Revenue, Deficiency
in state income tax 1 781.17
TOTAL $ 14,064.95
4
Fees & Commissions
03/14/11 Theodore J. Chylack, Principal commission $ 9,961.18
Funeral Expenses
09/03/10 Myers Funeral Home, Inc. $ 2,850.00
TOTAL DISBURSEMENTS OF PRINCIPAL
$ 57,636.09
DISTRIBUTIONS OF PRINCIPAL TO BE MADE TO BENEFICIARIES
25% to Marie Elaine Harrington
25% to Lawrence Chylack
25% to John Chylack
25% to Theodore J. Chylack
TOTAL DISTRIBUTIONS OF
PRINCIPAL TO BE MADE
TO BENEFICIARIES
$ 68,600.50
$ 68,600.50
$ 68,600.50
$ 68,600.50
$ 274,402.00
6
PRINCIPAL BALANCE ON HAND
Cash and Cash Equivalents
Estate Premium Money Market Fund Account,
PNC Bank $ 274, 402.00
PRINCIPAL BALANCE ON HAND $ 274,402.00
PRINCIPAL INVESTMENTS MADE
07/16/2010 Estate Premium Money Market Fund Account,
PNC Bank
Accrued interest
$ 330,113.09
$ 650.82
RECEIPTS OF INCOME
Interest Income
Estate Premium Money Market Fund Account #8608886643,
PNC Bank
07/16/2010 to 3/15/2011
TOTAL RECEIPTS OF INCOME
$ 650.82
$ 650.82
9
DISBURSEMENTS OF INCOME
03/14/2011 Theodore J. Chylack
Executor's income commission $ 19.52
03/15/2011 United States Treasury
Fiduciary Income Tax for 2010 $ 75.12
03/15/2011 Pa. Department of Revenue
Fiduciary Income Tax for 2010 $ 19.98
TOTAL DISBURSEMENTS OF INCOME $ 114.62
10
DISTRIBUTIONS OF INCOME TO BE MADE TO BENEFICIARIES
25% to Marie Elaine Harrington
25% to Lawrence Chylack
25% to John Chylack
25% to Theodore J. Chylack
$ 134.05
$ 134.05
$ 134.05
$ 134.05
TOTAL DISTRIBUTIONS OF
INCOME TO BE MADE
TO BENEFICIARIES $ 536.20
11
PROPOSED DISTRIBUTION TO BENEFICIARIES
25% to Marie Elaine Harrington
25% to Lawrence Chylack
25% to John Chylack
25% to Theodore J. Chylack
TOTAL DISTRIBUTIONS OF
PRINCIPAL AND INTEREST
TO BE MADE TO BENEFICIARIES
$ 68,734.05
$ 68,734.05
$ 68,734.05
$ 68,734.05
$ 274,938.20
12
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COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
March 15, 2011
RE: ESTATE OF THEODORE W. CHYLACK, DECEASED
N0.21-10-0649
To: All Parties in Interest
AUDIT NOTICE
The First and Final Account of Theodore J: Chylack, Executor under the Will dated June
16, 1990 of Theodore W. Chylack, Deceased, has been filed with the Clerk of Courts' of the
Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania,
and will be called for audit before the Honorable J. Wesley Oler, Jr. on April 26, 2011 at 9:30
a.m. in Room No.l, Cumberland County Court House, One Courthouse Square. Your interest in
the estate consists of a 25% interest.
The Court will be asked to approve the account as stated ans to make awards in
accordance with provisions of the will of Theodore W. Chylack, Deceased. A copy of the
account is enclosed.
It is not necessary that you or your counsel appear at the audit. However, if you have any
objections to any items in the account, or if you disagree with the position taken on any claim, it
is necessary that you appear at the time and place stated above in person or by counsel:
otherwise, the Court may assume you have no objection and may approve the account as stated.
If you have any questions regarding the contents of this letter, the account of the Executor
or will of Theodore J. Chylack, Deceased, please contact the undersigned.
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LIST OF PARTIES RECEIVING NOTICE OF AUDIT
Marie Elaine Harrington
26 Miami Road
Norristown, Pa. 19403
Lawrence Chylack
519 Delp Road
Souderton, Pa. 18964
John Chylack
26605 S. Nicklaus Dr.
Sun Lakes, Az. 85248