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HomeMy WebLinkAbout03-0207IN RE: LAUREL ANN CAMPBELL A MINOR IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-03-C:~ O '~ ORPHANS' COURT DIVISION PETITION FOR GUARDIAN FOR THE ESTATE AND PERSON OF A MINOR CHILD 1. The Petitioners are Shawn A. Campbell and Susan K. Campbell, the parents of Laurel Ann Campbell, age 12 years, born June 16, 1990. The Petitioners and Laurel reside at 155 Kline Road, Shippensburg, PA 17257. 2. It is necessary that a guardian be appointed for the minor child as she is entitled to receive a distribution under annuities issued by Sun Life Financial through Thrivent Investments and/or the Last Will and Testament of her Great Grand Father, Robert P. BIo(~her, Cumberland County Estate Number 21-02-1011. These benefits amount to proceeds from life insurance of approximately $45,000.00, presently being held by Sun Life Financial. The proposed guardian has no interest adverse to that of the minor child. ~ 3. Information about the Petitioners: Shawn A. Campbell, age 37, natural father. Susan K. Campbell, age 39, natural mother. The Petitioners have no religious persuasion that is adverse to that of Laurel. WHEREFORE, Petitioners request that the court appoint Shawn A. Campbell and Susan K. Campbell as guardians of the estate of Laurel Ann Campbell. Respectfully submitted, O'BRIEN, BARIC & SCHERER Robert L. O'Brien; Esquire I.D. # 28351 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Consent To Appointment Of A Guardian Of The Estate And Person I, Laurel Ann Campbell, born July Court of Shawn A. Campbell and Susan Estate. 16, 1990, consent to the appointment by the K. Campbell to act as Co-Guardians of my Laurel Ann Campbell /- Consent To Serve As Guardian I, Shawn A. Campbell, consent to serve as Co-~u/a'~dian of the Estate of Laurel Ann Campbell. . .,,~~~;~.,. ~i ,/~ Shawn A. CamlJbeZ Consent To Serve As Guardian I, Susan K. Campbell, consent to serve as Co-Guardian of the Estate of Laurel Ann Campbell. 'Susan K. Campbell I verify that the statements made in the foregoing Petition For Appointment of Guardian of Estate of a Minor Child are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. ~~(1~.~/~4 -Shawn A. ~'a~l~bell ' Susan K. Campbell rlo.dir/estates/campbell FROM:~F)~,_,_~.~,_lWC'm~d HAP~ TMRN Sull Life Financial TO: 717~'4~357~;5 Novcmber 14, 2002 Thrivent Investments Attn: Richard Clapp 78 West Pomfret Street Carlisle, PA 17013 Regatta Platinum Fixed2Variable Annuity Col~tract Number 79-7900-219412 Robert P. Blocher Owner Robert P. Blocher Annuitant Dear Mr. Clapp, We were sorry to hear of the passing of our client, Robcrt P. Blocher. Please extend our sympathies to his family and friends. The Tax Reform Act of 1984 made some changes to the disposition of an annuity when thc contract owner passes away- These changes mandate that any contract issued on or after January 18, 1985 be paid out upon the death of any contract Owner , Alter review of beneficiary designation of th,~s contract, it has been determined that Ashley Campbell, Laurel Campbell, Livia Drumheller, Matthew Peters, and Andrew Millward are entitled to thc death benefit options. It is important that they consult a tax or legal advisor before making a decision. One of the following options may be elected: (I) hmnediate Lump Sum Minimum Death Benefit We have calculated the Minimum Death Benetit and will pay the greatest of the following options on the Death Benefit Date. This ~$ the date on which we receive, good order, all required documentation to process the Death Benefit. 100% of the accumulated value on the date we recei ve the death notification and election option paperwork in good order. Accom~t value on the 7th contract rumiversary m~mediatcly preceding the date of death of the Annuitsa~t, adjusted tbr any pm'chase payments or withdrawals since the most recent 7tI) contract anniversary. Cash Surrender Value (CSV) on the date we receive the certified death certificate and elected option paperwork in good order. This includes any applicable surrender penalties aa~d Market Value Adjustment (MVA-applies to fixed sertcs on!y), We will process the death benefit on the Death Benefit Date:. The Death Benefit Date i.~ tt~e date on which we receive, tn gt~od order, all required documentation 4 list, q/ required documentat~on.[oh TO: 717~4-357~_=,  BEN,LIFEBEN~i~tuthbr To: CLAPP RtCHARD~iuthbro ~om o.¢om cc: alina.gu~u~thnvent, com ,, Subj.: PENDING DEATH C~IM - BL~ER 1111~2~2 02:39AM " ~") / Death claim 0157527 on ROBERT P BLCCHEA ha3 now be~n rev~e~.ze~. Our records sbow the beneficiaries below for in~urance and/or annuity con'tracts. Any Income Contracts (~SC) or Mull]al }"u.nds ~o not included. PL~Sg NOTE T~T IF MOR~ TH,~q ONE BENEFICIARY IS LISTED FOR THE S~E CONTACT ~UMBER, THEY A~ NOT NECESSARIL'f N~ED FOR THE k~OUNT. PLEASE CALL OR E~IL M~ IF IOU DO NOT KNOW ~[.]E PROPORTIONS AND NEED THAT INFO~TION, BENEFICIARY ASNLEY MARIE C~.FBELL LAUREL ANN CAMPBELL /LiVIA DROMHELLER .MATHEW PETERS ~,.ANDREW J MILLWALD RELATIONSNiP GRANDDAUGTR GRANDDAUGTR GRANODAUGTR GRANDSON GB.ANDSON CONT~%CTS WHER~ NAMED B33221'/0 B3322!72 B3322170 B3322172 B3322170 B3322172 B332~7D B3322172 B3322i70 B3322172 Below is a 3l~rnmary of the total payable under ~ach contract and initial calculation of 'the taxable gain. As }'ou ~ncw, the gain on anr~uity ccntracts is taxable as ordinary j. nsome to the beneficiary, and we must report ]'t to the IRS. Additional will be calcolated at the time o~ settleK~en5 and is also taxable. / CONTRACT PRODUCT T~ VALUES TOTAT.. BENEFIT TOTAL T~.ABLE NUMBER TYPE STATUS AS O~' ~OUNT GAiN B33221'70 ANNUITY NON-QUAL 11/09/2~'..02 59,268.86 9,26~3.96 .%9,268.86 9,265. B3322172 ANNUIT~ NON-QU~ If a b=neficiary would like '~o dufer ~he taxabl~ i~comu from annuity, please r~fer ~o LBS,-Life Renefits-Tax Oefurzal Option on Annuity Death Claims for a listitg of the available options. Please contact me %f Vou would like cdditional in~c. rmation regarding the options or a letter. ~or '[he beneficiary that explains the options. For annuities listed with 8 taxable 9akn of $0.00, please call for updated val'ue~ ALINA GUTTU FHONE: 888-422-5737 opt ~, ext 8-241C .LUTHERAN BROTHERHOOD Claimant's Statement, Part 1 Deceased's Information 1-800-990-6290 Customer Interaction Center N,~me o! Deceased- Last , ,,,~ Fi fst City ~la~e Zip Cc~ 3oc Sec ~ Bi~th Oate Data of De,th Ca use ~ Deol h If illness, when did deceased first complain or give indication of last illness~ D,~c: ..~.'.~...:..~.~.~.:.~ .............. When did deceased first consult a medical practitioner for the last illness or injury? Date: ....................................... On what date did deceased last attend to usual work? oat~: .......................................... N~me a~d Add~s~s of all do~tors who attended dele]sad du~i~9 the last three years, including t~e last iii.ess or l~lury: (nleose attach any addition~l nome~.) gates of At~enclance Dates D~le~ of Attendance AUTHORIZATION FOR INFORMATION REGARDING DECEASED PERSON: I authorize these persons or institutions: Any physician or other medical practitioner (for example, psychologist, chiropractor, social worker, etc.); any hospi- tal, clinic, pharmacy or other medical or medically related facility or association (including the Veterans Administra- tion); any employer past Or present; an~ educatonaL vocational or rehabilitation organization o~ program; ar.), insurance or reinsurance company, financial institutior, worker's compensation company, or consumer reporting agency; an)' accountant, tax preparer, or attorney; or any government agency (for example, Social Security Adminis- tration, Public Retirement System, Railroad Retirement board, etc.). TO give the following: Inlormation as to diagnosis, treatment and prognosi~ with respect to any physical or psychological condition or sub- stance abuse (including drug and/or alcohol use, AIDS, NIL/ or AIDS Related Corn,plax (ARC), and any communicable ............ /.....::.....,, ......................... ':....~'..~.. Signature of C~ :'"': ............. 2~8J-1 disease or disorder). Examples of the information to release inciode charts, notes, x-rays, operative results, psycholog- ical tests, tab ~nd medication records, etc. information of a non.medical nature incIuding such things as education, employment history, earnings, finances, and eligibility for other benefits. To Lutheran t~rotherhood or Its authorized represen- tative for the purpose of evaluating my claim. I authorize Lutheran Brotherhood to release any such information to the followin9 persons or organizations: reinsuring companies, person5 or organization5 performing business, legal, medical or insurance services related to my claim, or any other public or private entity ~s may be lawfully required I understand d3at I or my autl~orized representa~ive have a right to receive a copy of this authorization, tha~ a copy of this authorization shall be as valid as the or §in~l, and thb authorization will be valid for the duration of this claim. ,/i0' ) ~EEt- 87- ~083 0}: 15 FR'.L- '1: DUNCAN HaRU'lq~t ? 1 ?;Eq3T8.30 73: -i?~ 73'49_'5 T55 P. 3/ 6 Sun Life Financial November 14, 2002 Thrivent Investments Atto: Richard Clapp 78 West Pomfret Street Carlisle, PA 17013 RE: Regatta Platinum Fixed/Variable Contract Number 79-7900-28163 Robert P, Blocher Owner Robert P. Blocher Ammitant Dear Mr. Clapp, We were sorry to hear of the passing of our client, Robert P. Blocher. Please extend sympathies to his family m~d ~hends. The Tax Reform Act of 1984 made some changes to thc dispos:tion of an annuity when the contract owner passes away. These changes mandate that ~my contract i~sued on or after Janua~ 18, 1985 be paid out upon the death of any contract Owt~er After review of beneficiary designation of this comract, it ha.q been determined that Ashley Campbell, Laurel Campbell, Livia Dm~nheller, Matthew Peters, and Andrew Millward are entitled to the death benefit options. It is important that they consult a tax or legal advisor before making a decision. One of the Ibllowing options may be elected: (1) hnmediate Lump Sum Minimum Death Benefit We have calculated the Minimum Death Benefit and will pay the greatest of the lbllowing options on the Death Benefit Date. Tl~is is the date on which wc receive, in good order, all reqmred documentation to process the Death Benefit. 100% of the accumulated value on the date we receivc the death notification anti election option paperwork in good order. Account value on the 7t~' co~tmet atmiversapy immediately preceding the date of death of the Annuitant, adjusted for any purchase pa'ymet~ts or withdrawals since thc most recent ?th contract ,-tlllliversgry. Cash Surrender Value (CSV) on thc date we receive the certified death certificate and elected option paperwork i.t~ good order. This includes any applicable ~un'ex~der penalties and Market Value Adjustment (MVA-applies to fixed .series only). We will.proce,~'s tile death benefit on the Death Ben.<:l~; Date. 77~e Death Benefit Date is the date on which we receive, in good order, ail required documentation. ,4/ix~ q/" required documentation.follows. Sun Life Financial Novem0er i4, 2002 Tlmvent rmvestments Attn: Richard Clapp 78 West Pomfret Street Cra'lisle, PA 17013 RE: Regatta Platinum Fixed/Viriablc Annuity Contract Number 79-7900-2816 t 0 Robert P. Blecher Owner Robert P. Blocher Annuitant Dear Mr. Clapp, We were ~orry to hem' of the pass£ng of oar ctient, Robert P. Blochcr. Please exte,',d our sympathies to his hmily and friends. The Tax RefOrm Act of i 984 tnade some changes to thc disposition of an annuity when the contract owner passes away These changes mandate teat any coBt]act issued or'; or alter January 18, 1985 be paid out upon the death of any contract Owner. After review of beneficiary designation of this contract, it has been determined teat Ashley Campbell, Laurel Campbell, l.,ivia Drumhcller, Mattl, ew Peters, and Andrew Mi!tward are entitled to the deart~ benefit options. It is important that they consult a tax or legal advisor before making a decision. One of the tbllowing options may be elected: (/) Immediate Lump Sum Minimum Death Benefit We have calculated the Minimum Death Benefit ai~d will pay the greatest oF thc following options on the Death Benefit Date. This is the date on wilicii we receive: m good order, ail reqmrcd documentation to process the Death Benefi~ 100% of the accumulated value on thc date we receive ,fl~e death notification and election option paperwork in good order. · Account value on the 7'i' contract anniversary immediately preceding the date o'F death of the Annuitant, adjusted 'for any purghase payments or withdrawals since the most recent 7th contract anniversary. · Cash Surrender'Value (CSV) on fl~e date we receive the ccrufied death certificate a~:d elected option paperwork in good o~der. This includes any applicable surrender penalties and Market Value Adjustmcnt (MVA-applies to fixed series only)~ We will procesx the death benefit on the Death. Bene~ tt Dr~. The .Death Benefit Date the date on which we receive, m good order, all required documet~ta,.ion, ..,4 livt esi required documentatim* .tbllows. LAW OFFICES O'BRIEN BARIG & SCItERER 17 WEST SOUTH STKEET CARLISLE. PENNSYLVANIA 17013 IN RE: LAUREL ANN CAMPBELL A MINOR IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-03- ~0"'1 ORPHANS' COURT DIVISION AND NOW, this ORDER OF COURT '~day of //~~J~, 2003, upon review of the Petition for Guardian for the Estate of a Minor Child this Court sets a hearing for A.M._....._/P.M., the ,,~ I.~- day of ..~~. , 2003, in Courtroom #.~_, Cumberland County Courthouse, Carlisle, PA 17013. BY THE COURT, IN RE: APPOINTMENT OF A IN THE COURT OF COMMON PLEAS OF GUARDIAN FOR THE ESTATE OF : CUMBERLAND COUNTY, PENNSYLVANIA LAUREL ANN CAMPBELL, A MINOR. ORPHANS' COURT DIVISION NO. 21-03- ~d -O~COURT AND NOW, this ~,, ay of ~1~""~% , 2003, upon consideration of the Petition For Guardian For The Estate Of A Minor Child, Shawn A. Campbell and Susan K. Campbell are appointed Co-Guardians of the Estate of Laurel Ann Campbell with respect to life insurance proceeds payable to Laurel Ann Campbell as well as funds payable to her from her Great-grand-father's estate. The appointments shall be subject to the following conditions: .. ---ctl;-:?'_'_::'_ ' t-' ....,o Jo ,,...~-:...-.,,.t., ~- 2. That the proceeds be deposited in one or more savings accounts in the name of a Trust for the child, in banks, building and loan associations, savings and loan associations or credit unions, deposits which are insured by a federal governmental agency, provided that the amount deposited in any one such savings institution shall not exceed the amount to which amounts are thus insured, or in one or more accounts investing only in securities guaranteed by the United States government or a federal governmental agency managed by responsible financial institutions. The Guardians are authorized to deduct the costs and attorney fees associated with this proceeding from the funds received. 4. The Guardians shall be responsible to file the reports mandated by 20 Pa. C. S. Section 5521(c) on each occasion that a report is due by statute. No withdrawals shall be made from any such account while the Trust remains in effect, except as authorized by a prior order of court. Proof of deposit shall be promptly filed of record. The Trust shall terminate when Laurel Ann Campbell attains the age of eighteen (18) years. BY THE COURT, P.J.