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Home My WebLink About04-0796PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Social Security No. Deceased. ~o: Register of Wills for the ,~2~ County of ~ f'~_nO~l~ the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your p~titioner(s), who is/are 18 years of age or older, app~~ for letters of administration on the estate of (d,b.n.; pendente lite; durante absentia; dutante minorltate) the above decedent. Decendent was domiciled at death in L cx-r~D ~¢Je._/c~lD Count>:,, Pennsylvania, with h f~5 last family or principal residence at D,/~c h a?a ~c~ ~ u~. P/q (list street, number and municip~ity) Decendent, then ~-ff years of age, died ~-'LZ/y ~ 'r4'9~ ~90 / at Decen.dent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled itt Pa.) Personal. property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: the following spouse (if any) and heirs: Petitioner. after a proper search ha-.q asccrtaincd that decedent left no will and was survived by ,_.. Relationship THEREFORE, petitioner(s) respectfully request(s) the grant of letters of' admmtstr, stton in:;th~ appropriate form to th~ undersigned. '.:" ; PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~4 U ~ T ~ T~ P-~ ~ ~ No. also known as To: Deceased. Social Security No. ~ 1~. ~ i 'ff.'~ ~"7 Register of Wills for the County of ~-~J-4~¢ ~,~a)~/)in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl~k~--c~ (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. for letters of administration on the estate of Decendent was domiciled at death in Q_~ck_),~ ~ ~/'~.~ County, Pennsylvania, with O h t.~ last family or principal residence at '~'~ ~-I~-CC~c~L~ ff---C~_T' (list street, number and municipality) Decen~ent, then .::~ years of age, died J ~ t_~ 7 ,-1-9- 2_ ~, Decendent at death owned property with estimated values as folllows: (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: Petitioner the following spouse (if any) and heirs: Name after a proper search ha_~__ ascertained that decedent left no will and was survived by Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters o~ adminis~ation appropriate form to the undersigned. ; ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF ~~~-~ ~ The petitioner(s) above-named swear(s) or affirm(s)that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ] . Sworn to or affirme_~l~ and subscribed before mef tl~is/ dO ~ .d~y~ ,~ '1, ' / ., ~, ,, I ~ .4 - No. Estate of , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW 19 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to in the estate of FEES Letters of Administration ..... $. Short Certificates( ) .......... $ Renunciation ................ $ $ TOTAL $ Filed ..................... A.D. 19 ATTORNEYASup. Ct. I.D. No.) IAADDRESS PHO~4E OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF C tN v~4 kB~ LPrA2_/~3 ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed c- before mr~ this /(-~, (:~ day of [ No. ~)q--{qLc Estate of ~Lin~(t~(~, (')'t~' L~¥ T~'~\tT-~ , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW AL~ Q L~ ,%~ :--)~'~ 1~~, in consideration of the petition on the reverse side hereof, s~.t~sfactory proof hsaving been presented,l~efore me, IT IS DECREED that is .~entitled to Letters of Administration, and in accor~ with suc~h finding, Letters of Administration are hereby granted to ('z~e'~J'3~- A ']-~':'~.~ c:'c~d Chrc~hr~c:~ Iv~r~r~/!ecrv,~ in the estate of FEES Letters of Administration ..... $ 14/. 0 0 Short Certificates( ) .......... $ 17~, 0 o Renunciation $ :~:~j~)o'" $ ia o o ....... - ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of No. also known as To: Register of Wills for the Deceased. County of in the Commonwealth of Pennsylvania Social Security No. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. h Decendent was domiciled at death in last family or principal residence at County, Pennsylvania, with (list street, number and municipality) Decendent, then at years of age, died , 19__ Decendent at death owned property with estimated values as folllows: (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: Petitioner after a proper search ha the following spouse (if any) and heirs: Name ascertained that decedent left no will and was survived by Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent, filing~/ t_..7~(o WAFINING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 1054503 No. Local t~egistrar ~--i~ ~ 'Date H1O5 144 Rev 1/91 TYP£1PRINT P~RMANENT B[ACKINK COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH #29-303 (Coroner) " Hunter ' T~¢~ 1" Male *' 479 - 31 - 9607 I~. July 7, 2004 3 ,-.I I ~r~ 12,20011 .......... Cumberland J C~p ~tll I Camp ~tll Shopping Center ~~~. ~'" .... - lb Ik, ' I~' ~8 ~CEOENI EVE~ I Christina M. Temes _ a~ [] 2,b. July 12, 2004 Severe Head Trauma ,..~,,. Pennsylvania ~ ',7~.~ ,,.~=~ Lower Allen ,,b. Cou~ Cumberland ,,. Christina M. Bruner 2~.33 Mallard Court Mechanicsbur~, PA 17055 ~b. FD-014889 ,~Malpezzi 8 Mmshat plm ~ay Madl~m!c~t~nq~ PA 1705~ 7:30 A u 26. July 7, 2004 [] ~, 2004 ~, [] ~o[q Pedestrian struck by ~__ __ ~__ ____ u ''~ ~~ot .~indle R~,Camp Hlllg 'U~mCAL~m~C~O.~ ~ M1chael L. Norris, Coroner *~.. ' ......................................................................... ~ . Mechanlcsburg, Pa. 17050 -- - ') .... I 7 '1 '- ' CHRISTINA M. TEMES, Plaintiff V. ROBERT A. TEMES, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 2002-1281 CIVIL TERM : :CIVIL ACTION - LAW : : IN CUSTODY ORDER OF COURT AND NOW, this / ~J"& day of.~ i~ ~'! L ,2002, upon consideration of the attached Custody Concilial[ori Report, it is ordered and directed as follows: 1. Mother, Christina M. Temes, shall have sole legal custody of Hunter Moore O'Riley Temes, bom March 12, 2001. child. Mother, Christina M. Temes, shall have primary physical custody of the 3. Father shall have periods of visitation and partial physical custody as the parties agree. 4. This Order is entered pursuant to Mother's request at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order s~control. BY THE (/OURT, / KeviffA. Hess, J. cc: Robert L. O'Brien, Esquire, counsel for Mother Robert A. Temes 8838 Dove Cove Drive Las Vegas, NV 89129 DUSAN BRATIC, ESQ. STEPHEN K. PORTKO, ESQ. BRATIC AND PORTKO Attorneys at Law 101 OFFICE CENTER, SUITE A 101 SOUTH U.S. ROUTE 15 DILLSBURG, PENNSYLVANIA 17019 July 20, 2004 FAX (717) 432-9706 (717) 432-2538 (717) 432-9220 Glenda Farner Strasbaugh Register of Wills and Clerk of the Orphans' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 VIA FAX AND (717) 240-7797 Re: Estate of Hunter Moore O'Riley Temes M~IL Dear Ms. Strasbaugh: Please accept this letter in confirmation of the discussions I had with representatives of your office. I represent Christina M. Temes the mother of Hunter Temes regarding an unfortunate accident that occurred on July 7, 2004. This morning I stopped by your offices with Ms. Temes in order to open up an estate for litigation purposes. I did bring a copy of the death certificate and I also brought along a copy of a court order dated April 19, 2002 by which the mother, Christina M. Temes had been awarded primary and physical custody of the child. The child was 3 years old. During the last 2 years there has been no visitation at all with the father who resides at 8838 Dove Cove Drive, Las Vegas, NV 89129. I also understand there have been substantial arrearages on the child support payments. Christina's extended family including both her mother and grandparents are located in central Pennsylvania. There is no Pennsylvania connections with the father's family as they all reside in other states. This is an administration for litigation purposes and there is no Will. I understand that it is your discretion, to whom you would issue Letters of Administration. I respectfully request that these Letters of Administration be granted solely to the mother, Christina M. Temes because any and all proceeds would have to have court approval. In addition, when a distribution of proceeds takes place then notices would have to be given to any and all parties in interest in accordance with the Probate, Estates and Fiduciary Code and no proceeds would be distributed from the estate without the proper procedures being followed, both as to the distribution and to the closure of the estate. Glenda Farner Strasbaugh July 20, 2004 Page Two My office has already started an investigation into the liability aspects and damages of the case. Any and all appropriate estate and inheritance taxes would be paid to your offices since the mother does reside in Cumberland County. I would therefore appreciate your consideration to these matters. Thank you. Vert/truly yours, DB/dlg Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Marjorie A. Wevodau,.,, ~-~0'~ ...... ...... Of First Deputy Kirk S. Sohonage, Esquire Solicitor One Courthouse Square Carlisle, Pa. 17013 OFFICES OF July 23, 2004 METZGAR WICKERSHAM Ted Knauss, Esquire 3211 N. Front Street PO Box 5300 Harrisburg, Pennsylvania 17110 BRATIC and PORTKO Dusan Bratic, Esquire 101 Office Center, Suite A 101 South U.S. Route 15 Dillsburg, Pennsylvania 17019 RE: LETTERS OF ADMINISTRATION IN THE ESTATE OF CHRISTINA M. TEMES Gentlemen: I write in regard to your recent Petitions for Letters of Administration on behalf of your respective clients in the Estate of Hunter Moore O'Riley Temes, a minor, whose early demise is a horrific tragedy. As the minor child had no assets, for all intents and purposes the estate will be opened only for litigation. In a case such as this, as you know, the Register of Wills initially determines whether Letters of Administration should be issued, and if so to whom, primarily on the statutory preferences of the intestacy laws. Generally, the Register will not determine the right to administer an estate based upon the closeness of a relationship but rather she will base her decision upon the size of the interest in the estate. Also, the decision of the Register of Wills shall not be subject to review except for abuse of discretion. In light of the nature of the minor child's demise, the Register of Wills has determined that Letters of Administration should be issued for litigation purposes. Her next step, though, is to determine to whom such letters should be issued and in doing so she will consider the intestacy laws. As such, since the minor child had neither spouse nor issue the next parties in order of preference to receive letters would be his parents. In determining whether one parent should receive Letters of Administration over the other parent, absent incapacity, the Register will not consider the closeness of the respective parent's relationship with the minor child, instead the Register will consider the equal interest that each parent possesses in the minor child's estate. Ted Knauss, Esquire Dusan Bratic, Esquire July 23, 20O4 Page 2 Accordingly, without passing judgment upon the domestic relationship of the proposed administrators and the minor child, the Register of Wills determines that Letters of Administration shall be issued to the parents as Co-Administrators of the Estate of Hunter Moore O'Riley Temes, if that be their will. In this fashion, both interested parties can be involved in the whole probate and litigation process and shall have equal say in the same. Certainly, counsel for the respective parties will need to iron out some "technicalities" so that co-administration will operate effectively. But at this difficult time in the parties' lives, the Register believes that cooperation between them will be essential to resolving this matter and trusts that such a resolution can be achieved without the assistance of her office. Thank yOU. Very truly,your, Kirk S. Sohonage, Esquire Solicitor, Register of Wills Cumberland County, Pennsylvania KSS: ahg Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 12/06/2004 BP~ATIC DUS~dq 101 SOUTH U.S. ROUTE 15 DILLSBURG, PA 17019 RE: Estate of TEMES HUNTER MOORE O'RILEY File Number: 2004-00796 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 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 will become delinquent on 12/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge GLENDA FARiqER STP~ASBAUGH Clerk of the Orphans' Court Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 12/06/2004 TEMES ROBERT A 9 AlqlqADALE DRIVE CARLISLE, PA 17013 RE: Estate of TEMES HUNTER MOORE O'RILEY File Number: 2004-00796 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 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 will become delinquent on 12/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 12/06/2004 TEMES CHRISTINA MARIE 33 MALLARD COURT MECHANICSBURG, PA 17055 RE: Estate of TEMES HUNTER MOORE O'RILEY File Number: 2004-00796 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 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 will become delinquent on 12/05/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, GLENDA FARNER ~ Clerk of the Orphans' Court CERTIFCATION OF NOTICE UNDER RULE 5.6(A) NameofDecedent: ~lU/l,d-e/' m_/,~,~' OL'/~j/ ./-W'//Oe-O" DateofDeath: T-P- O~ Will No.: Admin No.: ~ Odz/- 0(7 ") ~' ~ To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature - _ Iqh~ne Address ?/) -o2 ~/'~ ' ~' ~ Telephone Capacity: 5~'--lYersonal Representative [] Counsel for personal representative RENUNCIATION IN RE: Estate of Hunter M. Ternes, deceased, c2 )-C)4.'1 C) lo TO the Register of Wills of Cumberland County, Pennsylvania. The undersigned Robert A. Ternes, father of the above decedent, hereby renounces the right to administer the estate and respectfully asks that Letters of Administration be issued to Christina M. Ternes. Witness his hand this ;;2. ~ day of C/ct-oJ..,er' ,2004. 'Rot;} Ct ~ .,;/ ----- Robert A. TemeSTSignature) c; 1 /I//Ve.,-,c1 co J e 0 r (Address) Co. r /.'SI e. Pc, I 70r<. COMMONWEALTH OF PENNSYj;.,V ANIA COUNTY OF c:.U/YRbe~ SS ON THIS, the ;}.(o day of OC",cb€f , 2004, before me, the subscriber, personally appeared Robert A. Ternes, known to me or satisfactorily proven to be the person whose name is subscribed to the within renunciation and acknowledged that he executed the same for the purposes therein contained. Witness my hand and notarial seal the day and year aforesaid. C~Lk Notary Public ~ ~ My Commission Expires: J -::) 0 -0 to o Co c.;::J:] . '7::U ;',~~~ (f) ;oc..:: '" = = cr. ,- :;:."" =:::: N en Q " :::! ....) N +" Notarial Sea) Cathy E. Fry, Notary Public South Middleton Twp" Cumberland County My Comml"ion Expires July 30, 2006 U '_Ad '--.",A-II C d~, 'c:\~Oi ; J,;.._ r /-0 ::'0 r:'l C) C) :iJ ,-_., , , f-'_ ("'''':;1 ;.,\ T1 ?') fn r) ....:r-l STATUS REPORT UNDER RULE 6.12 Name of Decedent: Hunter Moore O'Riley Ternes, Deceased Date of Death: 7/7/2004 Estate File No.: 2004-00796 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: The Estate was opened for litigation purposes. That litigation is still ongoing. 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. Did the personal representative state an account informally to the parties in interest? Yes No Date: ,1;J~6 d approvals of formal or informal accounts rt and may be att~ched to this report. Copies of receipts, releases, joinders may be filed with the Clerk of the Orphan's \-n. . Dusan Bratic, Esquire Name (Please type or Print) c'\ 101 South u.s. Route 15, Dillsburg, PA 17019 Address t~'~,'; 717 -432-9706 Tel. No. Capacity: Personal Representative X Counsel for Personal Representative ~ IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANI~ ) ;) '\.~,;' .', ESTATE OF HUNTER MOORE O'RILEY TEMES ::,\J ORPHANS' COURT DIVISION ESTATE NO. 2004-00796 PETITION FOR REVOCATION AND REISSUE LETTERS ADMINISTRATION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: 1. The petitioner is Robert A. Temes, an adult individual residing at 9 Annendale Road, Cumberland County, Carlisle, P A 17013. 2. Christina M. Temes, an adult individual residing at 33 Mallard Court, Mechanicsburg, Cumberland County, P A 17055. 3. Relevant to this complaint Robert A. Temes and Christina M. Temes were married on March 22, 1999 and divorced on January 22, 2003. They were the parents of Hunter Moore O'Riley Temes who was the child born during the marriage on March 12,2001. 4. At all times relevant to this complaint Robert A. Temes was the father of Hunter Moore O'Riley Temes who became deceased on July 7, 2004. 5. At the time and prior to the time of Hunter Temes' demise, he was in the custody of his natural mother, Christina M. Temes and resided with her. A copy of the Order signed by Judge Kevin A. Hess on April 19, 2002 is attached hereto as Exhibit A. Said order was not modified. 6. At the time the estate was opened, Robert A. Temes co-petitioned for Letters of Administration and was awarded said Letters of Administration as a Co- Administrator along with the natural mother, Christina M. Temes. Since that time Robert A. Temes has decided not to participate in the administration of the estate. 1:..,:' 1") (...) On January 26, 2005 Robert A. Temes personally appeared before Glenda Farner Strasbaugh, the Register of Wills for Cumberland County and requested the Register of Wills to remove him from the appointment as a Co-Administrator. This Renunciation was signed by Robert A. Temes on October 26, 2004 and notarized on October 26, 2004. A copy of the actual Petition for Renunciation filed with the Register of Wills Office by Robert A. Temes is attached as Exhibit B. 7. The Register of Wills informed the petitioner and petitioner's counsel for the Estate that removal to serve as a Co-Administrator would require a leave of court. 8. Said Petitioner Robert A. Temes wishes to remove himself as the Co-Administrator of the Estate and requests leave of Court to do so. Wherefore, he prays the Court will allow him the leave to remove himself as Co- Administrator of the Estate of Hunter Moore O'Riley Temes and directs the Register of Wills to remove him as Co-Administrator of the Estate of Hunter Moore O'Riley Temes and to issue revised letters of Administration to Christina M. Temes, the natural mother and natural guardian. Dated: ,) /7 !o~ , I C & PORTKO usan Bratic, Esquire ID # 19249 101 South U.S. Route 15 Dillsburg, P A 17019 (717) 432-9706 Attorney for Petitioner VERIFICATION I, Christina M. Ternes, hereby acknowledge that I am the Petitioner in the foregoing action and the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to authorities. Dated: 3/7 jOu I I ~.~~ - Christina M. Ternes INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF HUNTER MOORE O'RILEY TEMES ORPHANS' COURT DIVISION ESTATE NO 2004-0796 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Petition to Remove Robert A. Ternes as Co-executor of the Estate of Hunter Moore O'Riley Ternes was furnished by U.S. Mail, first class, postage prepaid on this Lth day of March 2006, to: Christina M. Ternes 33 Mallard Court Mechanicsburg, P A 17055 Robert A. Ternes 9 Annendale Road Carlisle, P A 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphan's' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 Dated: ,3 h Iu b , { I & PORTKO :~ san Bratic, Esquire ID # 19249 101 South U.S. Route 15 Dillsburg, P A 17019 (717) 432-9706 Attorney for Petitioner cc: C A.f; .:;J.i/1 ~ -rr:'.~-<::, if / :;p, / () :;- CHRISTINA M. TEMES, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2002-1281 CIVIL TERM ROBERT A. TEMES, Defendant : CIVIL ACTION - LAW : IN CUSTODY ORDER OF COURT i O.J..i.. r J AND NOW, this ~ day of , 2002, upon consideration of the attached Custody Concilia on Report, it is ordered and directed as follows: 1. Mother, Christina M. Ternes, shall have sole legal custody of Hunter Moore O'Riley Ternes, born March 12,2001. 2. Mother, Christina M. Ternes, shall have primary physical custody of the child. 3. Father shall have periods of visitation and partial physical custody as the parties agree. 4. This Order is entered pursuant to Mother's request at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. J. cc: Robert L. O'Brien, Esquire, counsel for Mother Robert A. Ternes 8838 Dove Cove Drive Las Vegas, NV 89129 ~;~~~~ RENUNCIATION IN RE: Estate of Hunter M. Temes, deceased, cJl- b~ JJ 9(0 TO the Register of Wills of Cumberland County, Pennsylvania. The undersigned Robert A. Temes, father of the above decedent, hereby renounces thc right to administer the estat~ and respectfully asks that Letters of Administration be issued to Christina M. Ternes. Witness his hand this ~ L.. day of ~~r' .2004. 'Kat-.J 4-~ ~ R hen A. Ternes (Signature) C; tJ /l/A-!~~eI Q J e 0 r (Address) Cc,f J,:5/e Pc,. /701.<. COM.MONWE~TH~FPENNSYLV~ COUNTY OF L~e.~ S5 ON THIS, the _.J:k day of Oe:\-cbef- , 2004, before me, the subscriber, personally appeared Robert A. Ternes. known to me or satisfactorily proven to be the person whose name is subscribed to the within renunciation and acknowledged. that he executed the same for the purposes therein contained. Witness my hand and notarial seal the day and year aforesaid. o Co ~:~~ ~J ~~ P ';~:~~ '.1r.:;>o ,..,~ " ) --r'. ~:,).;~~ . :\':! ,-~ ~ = <= <:.1"' ,- ;:.... :":'2:. ::,U '":1 ('r I ['.'"1 C? ':..:., <~) ", ;,; ::0 :~-.) ;-;-~~ . ,- \ -::-: r~2k_ Notary Public"," ~~ My Commission Expires: ,- 3 () - 61.o N 0' NOUItlal Seal c~ B. Fry, Notary l'IIblie SOlIdI Middlellal) Twp., C111J1berl1Dld CouRt)' My Cr.uunluiofJ a..p~s JulY 3<1, 2006 '""i II ::'.,..4c-1;':;,w:' .4-1 i ~" c1::>- o.--'Qi.. ; -" L f. ."t;..I N N .0:- r', 'I r-., f-, ,'OJ:, .:: .?-~ r-= nl ':'/)0 -r, :c! - BRATIC AND PORTKO Attorneys at Law 101 OFFICE CENTER, SUITE A 101 SOUTH U.S. ROUTE 15 DILLSBURG, PENNSYLVANIA 17019 DUSAN BRATIC, ESQ. STEPHEN K. PORTKO, ESQ. (717) 432-9706 (717) 432-2538 FAX (717) 432-9220 March 8, 2006 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphan's' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, PAl 7013 Re: Hunter Moore O'Riley Ternes, Deceased Date of Death: July 7,2004 Dear Ms. Strasbaugh: Our office represents The Estate of Hunter Moore O'Riley Ternes. Enclosed please find an original and several copies of the Petition for Revocation requesting Robert A. Ternes be removed as the Co-Executor of the Administration of the estate and issue revised Letters of Administration for filing and presentation to the Judge of the Court, including one for your office as indicated on the Certificate of Service. Also enclosed please find the following: 1. 4 self addressed stamped envelopes for service of signed Order 2. A check in the amount of$15.00 for filing fees 3. 1 self addressed stamped envelope addressed to our office for the return of the stamped-in copies. After filing please return the extra stamped-in copy to our office using the envelope provided. Thank you. Very truly yours, r--- ~ C____ Debora . Graham Paralegal DLG Encl ~(( A\ t{\~~ ~ b~ --i' <.--' RECEIVED MAR 1 ':i 2006 BY: y IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF HUNTER MOORE O'RILEY TEMES ORPHANS' COURT DIVISION ESTATE NO. 2004-00796 ORDER AND NOW, on this ~ Day of t\It ?~ L L, , 2006, upon consideration of the within Petition of Robert A. Ternes IT IS HEREBY GRANTED AND ORDERED Robert A. Ternes be granted leave to be removed as the Co-Administrator of the Estate of Hunter Moore O'Riley Ternes and that Letters of Administration be reissued to the natural mother, Christina M. Ternes. BY THE COURT: J. ~!J ) ~; ~ :..~,:i ~ IN RE: ESTATE OF HUNTER MOORE O'RILEY TEMES IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV ANl1- ,,"""') , ;. c,;,"'. ORPHANS' COURT DIVISION ESTATE NO. 2004-00796 :J C) PETITION FOR REVOCATION AND REISSUE LETTERS ADMINISTRATION l") (...) TO THE HONORABLE, THE JUDGES OF THE SAID COURT: 1. The petitioner is Robert A. Temes, an adult individual residing at 9 Annendale Road, Cumberland County, Carlisle, P A 17013. 2. Christina M. Temes, an adult individual residing at 33 Mallard Court, Mechanicsburg, Cumberland County, PA 17055. 3. Relevant to this complaint Robert A. Temes and Christina M. Temes were married on March 22, 1999 and divorced on January 22, 2003. They were the parents of Hunter Moore O'Riley Temes who was the child born during the marriage on March 12, 2001. 4. At all times relevant to this complaint Robert A. Temes was the father of Hunter Moore O'Riley Temes who became deceased on July 7, 2004. 5. At the time and prior to the time of Hunter Temes' demise, he was in the custody of his natural mother, Christina M. Temes and resided with her. A copy of the Order signed by Judge Kevin A. Hess on April 19, 2002 is attached hereto as Exhibit A. Said order was not modified. 6. At the time the estate was opened, Robert A. Temes co-petitioned for Letters of Administration and was awarded said Letters of Administration as a Co- Administrator along with the natural mother, Christina M. Temes. Since that time Robert A. Temes has decided not to participate in the administration of the estate. \J~/ On January 26, 2005 Robert A. Temes personally appeared before Glenda Farner Strasbaugh, the Register of Wills for Cumberland County and requested the Register of Wills to remove him from the appointment as a Co-Administrator. This Renunciation was signed by Robert A. Temes on October 26, 2004 and notarized on October 26, 2004. A copy of the actual Petition for Renunciation filed with the Register of Wills Office by Robert A. Temes is attached as Exhibit B. 7. The Register of Wills informed the petitioner and petitioner's counsel for the Estate that removal to serve as a Co-Administrator would require a leave of court. 8. Said Petitioner Robert A. Temes wishes to remove himself as the Co-Administrator of the Estate and requests leave of Court to do so. Wherefore, he prays the Court will allow him the leave to remove himself as Co- Administrator of the Estate of Hunter Moore O'Riley Temes and directs the Register of Wills to remove him as Co-Administrator of the Estate of Hunter Moore O'Riley Temes and to issue revised letters of Administration to Christina M. Temes, the natural mother and natural guardian. BRA C & PORTKO Dated:,) /7 !or;, , I L---- usan Bratic, Esquire ID # 19249 101 South U.S. Route 15 Dillsburg, PA 17019 (717) 432-9706 Attorney for Petitioner VERIFICATION I, Christina M. Ternes, hereby acknowledge that I am the Petitioner in the foregoing action and the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa.C.S. 94904, relating to unsworn falsification to authorities. Dated: 3/7 IOu I I ~-~ Christina M. Ternes IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF HUNTER MOORE O'RILEY TEMES ORPHANS' COURT DIVISION ESTATE NO 2004-0796 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Petition to Remove Robert A. Ternes as Co-executor of the Estate of Hunter Moore O'Riley Ternes was furnished by U.S. Mail, first class, postage prepaid on this Lth day of March 2006, to: Christina M. Ternes 33 Mallard Court Mechanicsburg, P A 17055 Robert A. Ternes 9 Annendale Road Carlisle, PAl 70 13 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphan's' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 Dated: 3 h h b I ( I & PORTKO san Bratic, Esquire ID # 19249 101 South U.S. Route 15 Dillsburg, PA 17019 (717) 432-9706 Attorney for Petitioner (1(' . (' L _ . - -' ~ 1\...1 I ~+, t1 t.:.. j;",'r...< ~ if / :2. ~/ 0':;- CHRISTINA M. TEMES, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2002-1281 CIVIL TERM ROBERT A. TEMES, Defendant : CIVIL ACTION - LAW : IN CUSTODY ORDER OF COURT iOJ.L r J AND NOW, this -1-L!-!1 day of , 2002, upon consideration of the attached Custody Concilia on Report, it is ordered and directed as follows: 1. Mother, Christina M. Ternes, shall have sole legal custody of Hunter Moore O"Riley Ternes, born March 12, 2001. 2. Mother, Christina M. Ternes, shall have primary physical custody of the child. 3. Father shall have periods of visitation and partial physical custody as the parties agree. 4. This Order is entered pursuant to Mother's request at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. J. cc: Robert L. O'Brien, Esquire, counsel for Mother Robert A. Ternes 8838 Dove Cove Drive Las Vegas, NV 89129 . ~ ~~ ve ~(t';'J RENUNCIATION IN RE: Estate of Hunter M. Ternes, deceased, TO the Register of Wills of Cumberland County, Pennsylvania, cJ 1- O~ .. t'J 9 (0 The undersigned Robert A. Terncs!' .fath~r of the above decedent, hereby renounces the right to administer the es~ and respectfully asks that Letters of Administration be issued to Christina M. Temes. Witness his hand this ~ G" day of L!?Gl:i:J,er I , 2004. foo~Ct~~ R hen A. TcmeS(Signature) ~ t1MM.#-A/clt~ Ie 0 r ( Address) Cc,r/,51e: Pc:.. COMMONWE~TH at PENNSYL.. v ANlA COUNTY OF c.~e.~ 55 17D/~~ ON THIS, the _~ day of OC--\-obu-- , 2004, before me, the subscriber \ personally appeared Robert A. T emes. known to me or satisfactorily proven to be the person whose name is subscribed to the withi.t1 renunciation and acknowledged that he executed the same for the purposes therein contained. Witness my hand and notarial seal the day and year aforesaid. C~ ct_ Notary PublIc ~ ~~ My Commission Expires: J - 3 0 -- (J l.o No&.InaJ Seal Cpd)y n. fry, Notary hblic SoD MidrDetloJ) Twp.. Cambet1snd CouMy My CommlAfot\ Ebtpires Jaly 90, 2006 I. t.>,...;.o<\. t-t '~'.'" "1 i r .. . . ~ IT '-. 'e-(?;t., 1~Qh o :':=0 }~~~ ~.J ~~ P :;~':,~~ :..:J ~.:'~ !=~ ~:.~'~~ ,. .--4 :~\';! ("-V c;::) c;:::) <:J" 1 c_ :;::."" :';!'; -tJ .-: 1 tr) ("~' l.'~? '~.";; <-J "':', X) ~:~.~~~ ;w~~~ ~.,. \ ~:;7 ~ ~. i-~ I::;:.: .-': fq r~rn 'J)O -., N 0' I"-..) N ~ 1 --4 ~} .::"'~~ BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF HUNTER MOORE O'RILEY TEMES DECEASED NO 21-04-0796 DECREE OF THE REGISTER OF WILLS AND NOW, this 17th day of March, 2006, upon consideration of the Petition to Revoke and Reissue Letters Administration filed by Robert A. Ternes, Co-Executor in the Estate of the above-named Decedent, and the Order of lWesley Oler, Jr., Judge dated 3/16/06 IT IS HEREBY DECREED that Letters of Adminstration which were granted to Robert A. Ternes and Christina M. Ternes on August 24,2004 are hereby revoked. IT IS FURTHER DECREED that Letters of Administration are granted to Christina M. Ternes in the Estate of Hunter Moore O'Riley Ternes. . Glenda Farner Strasbaugh, Register of Robert A. Ternes Christina M. Ternes . ' Dusan Bratic, Esquire (.,.) ~ In Re: Estate of Hunter Moore O'Riley Ternes ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-04-0796 CERTIFICATE OF SERVICE OF ORDER ORDER DATED: 03/17/06 JUDGE'S INITIALS: GFS TIME STAMP DATE: 03/17/06 INRE: Decree of the Register of Wills ---...-.-.----------.--------.-------------.-----------~~_..__.~--~-------_.~._------_...._~-----~--_._._------------.-------- SERVICE TO: Robert Ternes Christina M. Ternes Dusan Bratic. ESQ METHOD OF MAILING: [8] USPS DRRR D Hand delivered D Other: _ ENENVELOPE(S) BY: [8] Petitioner D Judge D Clerk of Orphans' Court DATE OF MAILING: 03/17/06 - --......-.----.-.-----------.-.-.-.-.-.-.-.-------.-------.----------------.--.------------------------------_..._-~-------_..._~--------_._-_.-._--._--------------.-.--- --------~---- SERVICE TO: METHOD OF MAILING: D USPS DRRR D Hand delivered D Other: _ ENVELOPE(S) BY:D Petitioner o Judge o Clerk of Orphans' Court DATE OF MAILING: - .....-..."...-----.------.-----.-------------.----------~~_._..._,---------_.__._------------ -------------------,.-.__._~._-------,-,----------_._..._-----~-------_._- nLWl\J \lL~ Margie A. Wev dau First Deputy rk of Orphans' Court Clerk of the Orphans' Court In Re: Estate of Hunter Moore O'Riley Ternes ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-04-0796 CERTIFICATE OF SERVICE OF ORDER ORDER DATED: 03/1 7/06 JUDGE'S INITIALS: JWO TIME STAMP DATE: 03/17/06 INRE: ORDER SERVICE TO: Robert Ternes Christina M. Ternes Dusan Bratic. Esq METHOD OF MAILING: [8J USPS DRRR D Hand delivered D Other: _ DATE OF MAILING: 03/17/06 SERVICE TO: ENENVELOPE(S) BY: [8J Petitioner D Judge D Clerk of Orphans' Court METHOD OF MAILING: D USPS DRRR D Hand delivered D Other: DATE OF MAILING: ENVELOPE(S) BY:D Petitioner D Judge D Clerk of Orphans' Court Margie A. Wev dau First Deputy C rk of Orphans' Court Clerk of the Orphans' Court IN TIlE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANlA IN RE: CHRISTINA M. TEMES Administratrix of the Estate of HUNTER MOORE O'RILEY TEMES Petitioner ORPHANS' COURT DIVISION REGISTER OF WILLS ESTATE NO. 2004-00796 PRTITION FOR A PPROV A I, OF SRTTI,RMRNTS NOW COMES, CHRISTINA M. TEMES, Administratrix of the Estate of Hunter Moore O'Riley Ternes, Decedent, by and through her Attorney, DUSAN BRA TIC, ESQUIRE of BRATIC & PORTKO and hereby requests Petition for Approval of Settlement and states the following in support thereof. 1. Your Petitioner, CHRISTINA M. TEMES, was named Administratrix on the 17th day of March, 2006 to Estate Docket No. 21-004-00796 at the Register of Wills, Cumberland County, Carlisle, Pennsylvania. A true and correct copy of the Decree of the Register of Wills is attached hereto as Exhibit A. 2. Your Petitioner, CHRISTINA M. TEMES, was the Natural Mother and Guardian of the Decedent, HUNTER MOORE O'RILEY TEMES, who was 3 years old at the time of his death. 3. The proposed settlements arise out of the death of HUNTER MOORE O'RILEY TEMES caused by a motor vehicle accident on the 7th day of July 2004. The accident occurred in the parking lot of the Commerce Bank at 32nd and Trindle Roads, in Camp Hill, Cumberland County. At the time of the accident, the decedent was standing behind his mother's parked car waiting for his mother to position his child safety seat, when the front of Christina's car was stuck by the vehicle being operated by Karen Bruner, the Decedents' maternal grandmother. The impact propelled Christina's car over the curb, of the Commerce Bank parking area, causing it to run over Hunter. As a result of the impact, Hunter incurred fatal injuries. 4. The impact of the vehicle operated by Karen Bruner also caused Christina Ternes to be thrown to the ground and to sustain the following injuries; .-',.r, Thoracic Outlet Syndrome on the left, which will require surgi,~,~~~e!~~; u Left rotator cuff tendonitis and possibly a tear, which may reqJrre~iig@itwair; Neck strain and sprain; a) b) c) 6.(' . I ,lJH I"") '::1 . II i.1I L6 9GUl d) Crepitation and burning in her left hand with moderate but significant thumb index weakness on the left: and c) Temporomandibular Joint injuries, which will require lifelong care. 5. The Decedent, HUNTER MOORE O'RILEY TEMES, is survived by the following heirs: a) His natural mother and guardian, CHRISTINA M. TEMES who resides at 33 Mallard, Mechanicsburg, Cumberland County Pennsylvania; and b) His father, Robert A. Ternes, who resides at 1964 S 2100 E, Gooding, Idaho 83330. 6. The Decedents' parents are divorced. Custody was granted to CHRISTINA M. TEMES by Court Order and signed by Judge Kevin A. Hess on April 19, 2002. Said order was not modified. A copy of said Order is attached hereto as Exhibit B. 7. Notice of the institution of this action pursuant to Pa. Rules of Civil Procedure ~2205 has been given to both heirs at their respective addresses as follows: Cristina M. Ternes Decedents' natural mother and guardian 33 Mallard Court Mechanicsburg, P A 17055 Robert A. Ternes Decedents' natural father 1964 S 2100 E Gooding, Idaho 83330 8. The parties have engaged the services of Dusan Bratic, Esquire, of Bra tic and Portko and have agreed to pay him a fee of 30% of the gross proceeds received. The balance of the Wrongful Death and Survival Action would be paid, after payment of inheritance taxes and estate costs, as follows: Fifty percent (50%) to the mother Cristina M. Ternes, and Fifty percent (50%) to the father, Robert A. Ternes. APPROV Al .OF SETTI.EMF.NT WITH THE MOTORIST MUTUAl, INSlJRANCF, GROlJP 9. All ofthe aforesaid averments contained in paragraphs 1 through 8 are realleged and 2 incorporated by reference herein. 10. At the time of the accident GEORGE SHOEMAKER owned the vehicle driven by KAREN BRUNER, the Decedents' grandmother, which hit the Petitioner's vehicle causing the Decedents' demise. Mr. Shoemaker was insured through an automobile insurance policy through THE MOTORIST MUTUAL INSURANCE GROUP bearing Policy Number 2332-06-359308- 05A. 11. Under the terms of the MOTORIST MUTUAL INSURANCE GROUP policy there is TWO HUNDRED TWENTY FIVE THOUSAND DOLLARS ($225,000) available in insurance coverages to the Estate of Hunter Moore O'Riley Ternes representing the value of policy limits. 12. Your Petitioner, CHRISTINA M. TEMES and THE MOTORIST MUTUAL INSURANCE GROUP have reached a settlement agreement whereby THE MOTORIST MUTUAL INSURANCE GROUP has agreed, on behalf of GEORGE SHOEMAKER and KAREN BRUNER, to pay the sum of TWO HUNDRED TWENTY FIVE THOUSAND DOLLARS ($225,000) in full settlement of the all claims to THE ESTATE OF HUNTER MOORE O'RILEY TEMES after receiving court approval. 13. At no time has the Defendant admitted liability in this case. Therefore, the settlement is a settlement of a disputed claim. 14. The settlement of this policy is in full satisfaction of any Wrongful Death and Survival Actions. 15. Your Petitioner, CHRISTINA M. TEMES, requests that the Court approve the TWO HUNDRED TWENTY FIVE THOUSAND DOLLAR ($225,000) Policy Limits settlement with THE MOTORIST MUTUAL INSURANCE GROUP and that the net proceeds of this settlement be allocated towards the Wrongful Death Action at 75% and allocated at 25% to the Survival Action. 16. Your Petitioner, CHRISTINA M. TEMES, requests that this Court approve the proposed settlement and that she be authorized to sign a Release to THE MOTORIST MUTUAL INSURANCE GROUP in settlement of all claims as set forth therein including any Wrongful Death and Survival Actions which could be brought against the policy owned by GEORGE 3 SHOEMAKER and KAREN BRUNER. 17. The father, ROBERT A. TEMES, natural heir joins in this Petition in the enclosed consent, which is attached hereto as Exhibit C. A PPROV A I. OF SF,TTI.F.MRNT WITH SAFF. AIJTO INSTJRANCR COMPANY 18. All of the aforesaid averments contained in paragraphs 1 through 17 are realleged and incorporated by reference as if more specifically plead herein. 19. At the time of the accident KAREN BRUNER, the Decedents' maternal grandmother, owned a vehicle which was insured under a separate automobile policy issued in her name alone through SAFE AUTO INSURANCE COMPANY bearing Policy Number PAOOI98999A-00. 20. Under the terms of the policy there was FIFTEEN THOUSAND DOLLARS ($15,000) in liability coverages for the vehicle in question. 21. Your Petitioner, CHRISTINA M. TEMES, believes that SAFE AUTO INSURANCE COMPANY will reach a settlement agreement whereby the SAFE AUTO INSURANCE COMPANY will pay, on behalf of KAREN BRUNER, the sum of FIFTEEN THOUSAND DOLLARS ($15,000), which are the policy limits, in full settlement of the all claims to THE ESTATE OF HUNTER MOORE O'RILEY TEMES after court approval. 22. At no time has the Defendant admitted liability in this case therefore. The settlement is a settlement of a disputed claim. 23. The settlement is proposed in full satisfaction of any Wrongful Death and Survival Actions as well. 24. Your Petitioner, CHRISTINA M. TEMES, requests that the Court approve a FIFTEEN THOUSAND DOLLARS ($15,000) policy limits settlement with SAFE AUTO INSURANCE COMPANY and that the net proceeds of this settlement be allocated towards the Wrongful Death Action at 75% and allocated at 25% to the Survival Action. 25. Your Petitioner, CHRISTINA M. TEMES, requests that this Court approve the 4 proposed settlement and that she be authorized to sign a Release to the SAFE AUTO INSURANCE COMPANY in settlement of all claims as set forth therein including any Wrongful Death and Survival Actions which could be brought against KAREN BRUNER. A PPROV AI, OF SETTI.EMF.NT WITH NATIONWTnR INSTJRAN(;E (;OMPANV 26. All of the aforesaid averments contained in paragraphs 1 through 25 are realleged and incorporated by reference as if more specifically plead herein. 27. At the time of the accident CHRISTINA M. TEMES was insured through an automobile insurance policy through NATIONWIDE INSURANCE COMPANY bearing Policy Number 5837D504312477555. 28. Under the terms of the policy there are FIFTEEN THOUSAND DOLLARS ($15,000) policy limits in underinsured motorist coverages for the vehicle owned by Christina M. Ternes. 29. Your Petitioner, CHRISTINA M. TEMES, and the NATIONWIDE INSURANCE COMPANY have reached a settlement agreement whereby NATIONWIDE INSURANCE COMPANY has agreed to pay the sum of the policy limits of FIFTEEN THOUSAND DOLLARS ($15,000) in full settlement of the underinsured motorist claims to THE ESTATE OF HUNTER MOORE O'RILEY TEMES after receipt of court approval. 30. The settlement is in full satisfaction of any Wrongful Death and Survival Actions as well. 31. Your Petitioner, CHRISTINA M. TEMES, requests that the Court approve the FIFTEEN THOUSAND DOLLARS ($15,000) settlement with NATIONWIDE INSURANCE COMPANY and that the net proceeds of this settlement be allocated towards the Wrongful Death Action at 75% and allocated at 25% to the Survival Action. 32. Your Petitioner, CHRISTINA M. TEMES, requests that this Court approve the proposed settlement and that she be authorized to sign a Release to NATIONWIDE INSURANCE COMPANY in settlement of all claims as set forth therein including any Wrongful 5 Death and Survival Actions which could be brought against the Petitioner, CHRISTINA M. TEMES. 33. The Decedent, HUNTER MOORE O'RlLEY TEMES had no debts or assets in his own right. Most expenses associated with his demise have now been or will be paid and fully covered. The only outstanding claims that remains is the cost of the funeral bill and payment of inheritance taxes and attorney's fees, which the Administratrix will proceed to pay in accordance with the law. WHEREFORE, Petitioner, CHRISTINA M. TEMES prays this Honorable Court to approve the proposed settlement as set forth herein and to authorize her to settle the Wrongful Death Action and Survival Action for HUNTER MOORE O'RILEY TEMES, against all parties and sign Releases for any claims against THE MOTORIST MUTUAL INSURANCE GROUP, SAFE AUTO INSURANCE COMPANY, and NATIONWIDE INSURANCE COMPANY for the sums aforesaid and under the terms and conditions of said Releases. Dated: Wi oj; C & PORTKO D san Bratic, Esquire Attorney LD. No. 19249 101 Office Center, Suite A 101 U.S. Route 15 South Dillsburg, PAl 7019 (717) 432-9706 Attorney for Petitioner 6 p d RECEIVED MAR 1 '!l 2006 BY: fly' ~ IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF HUNTER MOORE O'RILEY TEMES ORPHANS' COURT DMSION ESTATE NO. 2004-00796 ORDER AND NOW, on this ~ Day of 1\11?~ L~ ,2006, upon consideration of the within Petition of Robert A. Temes IT IS HEREBY GRANTED AND ORDERED Robert A. Temes be granted leave to be removed as the Co-Administrator of the Estate of Hunter Moore O'Riley Temes and that Letters of Administration be reissued to the natural mother, Christina M. Temes. BY THE COURT: J. \. ~. n:J . ",,,.J "" I. _... .:-.J -">0'; /.....:~ ;.,) ... -..... I I "'.' i L~<;7 (' ,,,", . r: ! .: ..: l'l ;; .. J :,I~V :J ~ 'vl ,',Ll I- ." :.l,<'~~ ,_ --"-"~-'~"..:,.."'t-;" .~.() 3J;JJr:j Qj~jc'~.JJ=c BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF HUNTER MOORE O'RILEY TEMES DECEASED NO 21-04-0796 DECREE OF THE REGISTER OF WILlS AND NOW, this 17th day of March, 2006, upon consideration of the Petition to Revoke and Reissue Letters Administration filed by Robert A. Ternes, Co-Executor in the Estate of the above-named Decedent, and the Order ofJ.Wesley Oler, Jr., Judge dated 3/16/06 IT IS HEREBY DECREED that Letters of Adminstration which were granted to Robert A. Ternes and Christina M. Ternes on August 24, 2004 are hereby revoked. IT IS FURTHER DECREED that Letters of Administration are granted to Christina M. Ternes in the Estate of Hunter Moore O'Riley Ternes. Glenda Farner Strasbaugh, Register of Robert A. Ternes Christina M. Ternes Dusan Bratic, Esquire ;-,..) :~~~ , :....--., ..."'j: --ij - ~:-) :.'-} ...-1..1 G) -===" REGISTER OF WILLS CUMBERLAND County, Pennsylvania ~ CERTIFICATE OF GRANT OF LETTERS No. 2004- 00796 FA No. 21- 04- 0796 Es ta te Of: HUNTER MOORE TEMES (Firsr, Middle. Lasr) a/k/a: Late Of: HUNTER TEMES LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceas.ed Social Securi ty No: 479-31-9607 WHEREAS, HUNTER MOORE TEMES (Firsr. Middle. Last) a/k/ a HUNTER TEMES late of LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY died on the 7th day of July 2004 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I r GLENDA FARNER STRASBAUGH , Register of wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: CHRISTINA MARIE TEMES who has duly qualified as ADMINISTRATOR(RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOFr I have hereunto set my hand and affixed the seal of my office on the 25th day of August 2004. /1/ /- . (/~ C! I ..'" ,S2>JLtAca <'L QYaU/Vj.;J(;t~f/L(fU Register of wns V) Z a:, rJ r;. /f;iL L L d/'PUty * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ill :r: rn :r:1- ~ ~ (9\.1. Gl ~ ~i:: ::>0 t/l < ~ s <( ~ 6 ...... t-< r-< tZl \0 ffiffi~€~~ ffi ~ ~g;S 0 \J:) C2-J::>g~C? 0 ~~~u~@ N 0\ I- () 0 () O'"~ ~ t..:' t"- o (/) ~ 0 ?;oW 0 bOzO~~ ...... 0 Q)...... . 0:: (/) - 5 t/l ..- t-< ~~P-l~:>-O~ ~ "'t" w::1~86ct 0 en E-'~ tZlU ~ I ~ 8:J~ffi~~ ...... z-<( L: N o::~:r:-g-S~ t-< :E <(u.o...roOt/l ~ ~ p:::~~ u. 0::: -.:: () :e ~ ~::;sp.., <(ooGl..-ro ~ ~~ 00:: ~ () 5 E-' au 0 ZW :::l S ~ wI- () Z -J~ 0+-: i:i (9(9 0 tr:: Q) .- ill Q) Q) co .- ;:) .- 0::: co (/) (/) .- .!!!. ill (/) ill '~"""- Jr';r..<: if / :p, / /J :;- CHRISTINA M. TEMES, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA V. : NO. 2002-1281 CIVIL TERM ROBERT A. TEMES, Defendant : CIVIL ACTION - LAW : IN CUSTODY ORnER OF COURT J OJ.L. r J AND NOW, this..LJ...!.!J. day of ,2002, upon consideration of the attached Custody Concilia on Report, it is ordered and directed as follows: 1. Mother, Christina M. Ternes, shall have sole legal custody of Hunter Moore O'Riley Ternes, born March 12,2001. 2. Mother, Christina M. Ternes, shall have primary physical custody of the child. 3. Father shall have periods of visitation and partial physical custody as the parties agree. 4. This Order is entered pursuant to Mother's request at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. J. cc: Robert L. O'Brien, Esquire, counsel for Mother Robert A. Ternes 8838 Dove Cove Drive Las Vegas, NV 89129 . g . e ~X;J f-J.:lU4/ "Ltll:Jb _ J_.:I_: 4~_ ~l::l1:l-':l::l4-1:l951 GOODING TRANSPORT CONSENT AND JOINDER OF ROBERT A. TEMES TO PETITION FOR APPROVAL OF SEITL:BMEl\TTS I, ROBERT A. TEMBS, natural father or HUNTEll MOORE O'lUl..EY TEMES. have rca4 the Petition for Approval orSettlcmCftts that i. bciD& filed by Cbrison. M. Tem., the JWural mother md Adminilttattix of the Estate of HUNTER. MOORB O'JULEY TBMES. I agree with the {.as set forth in the Petition and reque.st that CHRISTINA M. TEMES be authorized to oompJete settlemonts and sign To)easea with THE MOTORIST MUTUAL INSURANCE GROUP, SAFE AUTO INSURANCE COMPANY aDd NATIONWIDB INSURANCE COMPANY, as outlined in tile six page Pdition. A fae.Unile copy of this Consent and Joinder with my aianarurc .hould be coasidercd as valid as an original. /h~ nth d., Lt :1.00(,- Date ~ t--:' - ......----' ,Ir-r--c-/ - L~ en A. T(VOea .". PAGE 81 P.15/17 . VERIFICATION I, Christina M. Ternes, hereby acknowledge that I am the Petitioner in the foregoing action and the facts stated therein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to authorities. Dateil p Y /u0 ~ Lfl~ Christina M. Ternes IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: CHRISTINA M. TEMES Administratrix of the Estate of HUNTER MOORE O'RILEY TEMES Petitioner ORPHANS' COURT DIVISION REGISTER OF WILLS ESTATE NO. 2004-00796 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Petition for approval of settlements H~oore O'Riley Ternes was furnished by U.S. Mail, first class, postage prepaid on thi~th day of March 2006, to: Christina M. Ternes 33 Mallard Court Mechanicsburg, P A 17055 Decedents' natural mother and guardian Robert A. Ternes 1964 S 2100 E Gooding, Idaho 83330 Decedents' natural father Glenda Farner Strasbaugh Register of Wills & Clerk of Orphan's' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, PAl 7013 Dated: ~;; f I fJ6 I Dusan Bratic, Esquire ill # 19249 101 South U.S. Route 15 Dillsburg, P A 17019 (717) 432-9706 Attorney for Petitioner _ ~fl RECEIVED MAR 2 7 Z006 ry '" ~. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, P IN RE: CHRISTINA M. TEMES Administratrix of the Estate of HUNTER MOORE O'RILEY TEMES Petitioner ORPHANS' COURT DIVISION REGISTER OF WILLS ESTATE NO. 2004-00796 ORDER AND NOW, this 3.\ cs4 day of .;11 1/ L L , 2006 upon consideration of the Petition for Approval of Settlement. The Court being satisfied that the proposed settlement is in the best interest of the parties concerned, it is hereby ORDERED and DECREED that the Petitioner, Christina M. Ternes, Administratrix of the ESTATE OF HUNTER MOORE O'RILEY TEMES is hereby authorized to sign Releases with THE MOTORIST MUTUAL INSURANCE GROUP, SAFE AUTO INSURANCE COMPANY and NATIONWIDE INSURANCE COMPANY in settlement of claims against the Defendant Karen Bruner and benefits under policies as indicated within the said Petition. The Administratrix, CHRISTINA M. TEMES is hereby authorized to settle claims for Wrongful Death and Survival Actions in which Christina M. Temes and Robert A. Temes may have and that Releases with THE MOTORIST MUTUAL INSURANCE GROUP, SAFE AUTO INSURANCE COMPANY and NATIONWIDE INSURANCE COMPANY shall be incorporated in the settlement of the above claims under the terms contained therein. The allocation of the net proceeds shall be 75% to the Wrongful Death Action and allocated at 25% to the Survival Action. BY THE COURT: J. , ;....} o -:1 . ,.-. 7t J r: _ u j .~ f:""';' [~_. ,;'.J In Re: Estate of CHRISTINA M. TEMES ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-0796 CERTIFICATE OF SERVICE OF ORDER ORDER DA TED: 03/31/06 JUDGE'S INITIALS: JWO TIME STAMP DATE: 04/03/06 INRE: ORDER RE:PETITION FOR APPROVAL OF SETTLEMENTS SERVICE TO: CC TO DUSAN BRACTIC PHOTOCOPY TO ROBERT A TEMES; CHRISTINA M TEMES; BRACTIC AND PORTKO METHOD OF MAILING: [8J USPS DRRR D Hand delivered D Other: _ ENENVELOPE(S) BY: [8J Petitioner D Judge o Clerk of Orphans' Court DATE OF MAILING: 04/04/06 SERVICE TO: METHOD OF MAILING: D USPS DRRR D Hand delivered D Other: _ ENVELOPE(S) BY:D Petitioner D Judge D Clerk of Orphans' Court DATE OF MAILING: ~t~" 7J11lf!F3' COLI: N M. MYERS ./ Deputy Clerk of Orphans' Court Clerk of the Orphans' Court BRATIC AND PORTKO Attorneys at Law 101 OFFICE CENTER, SUITE A 101 SOUTH U.S. ROUTE 15 DILLSBURG, PENNSYLVANIA 17019 DUSAN BRATIC, ESQ. STEPHEN K. PORTKO, ESQ. (717) 432-9706 (717) 432-2538 FAX (717) 432-9220 March 30, 2006 Holly McClintock Commonwealth of Pennsylvania Department of Revenue Inheritance Tax Division PO Box 280601 Harrisburg, P A 17128 VIA FAX ONLY (717) 783-3467 Phone: (717) 787-1794 Re: Hunter Moore O'Riley Ternes, Deceased Date of Death: July 7, 2004 Estate No. 2004-00796 Dear Ms. McClintock: cr. Our office represents Christina M. Ternes, Administratrix of the Estate of Hunter Moore O'Riley Ternes, Decedent. Pursuant to our telephone conversation of this date, I have enclosed a copy of the proposed Petition to Settle and accompanying Order as required by Judge Wesley Oler. Please provide our office with a letter setting forth your concurrence of the Wrongful Death and Survival Action allocation, to be attached to the Petition for Court approval of the settlement distribution, as required by the Register of Wills of Cumberland County pursuant to 20 Pa.C.S. S3323(b )(3). Our total expenses are expected to be less than $6,000 in this matter. Please provide our office with a confirming letter via fax and mail as soon as possible. Thank you. Very truly yours, (~(-') - \ --- , - ~ l.r:'Graham Paralegal DLG Encl WEB ADDRESS www.state.oa.us BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION Po Box 280601 HARRISBURG, P A 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE March 30, 2006 Deborah L. Graham, Paralegal Bratic & Portko 101 Office Ctr., Ste. A 101 S. US Rt. 15 Dillsburg, PA 17019 Re: Estate of Hunter Moore O'Riley Temes File Number: 2104-0796 Date of Death: 7/7/04 Court Number: Cumberland Co. ,i cr', Dear Ms. Graham: The Department of Revenue received a petition concerning the approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It was forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the petition, the 3-year-old-decedent died as a result of a motor vehicle accident. The heirs to the decedent's estate are his parents. Therefore, any proceeds paid to settle the survival action would pass to the decedent's parents and would be subject to a zero percent inheritance tax rate. 72 P.S. 99116(a)(1.2). Accordingly, regardless of the allocation of the subject proceeds, there would be no inheritance tax consequences. Please be advised that based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the proceeds of this action, 750/0 to the wrongful death claim and 25%) to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and, although subject to the imposition of a zero percent inheritance tax rate in this instance, they must be reported on decedent's Pennsylvania inheritance tax return. 42 Pa. C.S.A. 98302; 72 P.S. 999106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending the hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Finally, the approval of this allocation is limited to this estate and does not reflect the position that the Department may take in any other proposed distribution of proceeds of a wrongful death/survival action. Sincerely, :9J, fJfC~c L Holly A. McClintock Trust Valuation Specialist PHONE: 717-787-1794 · FAX: 717-783-3467 · EMAIL: hmcclintoc@state.oa.us BRATIC AND PORTKO Attorneys at Law 101 OFFICE CENTER, SUITE A 101 SOUTH U.S. ROUTE 15 DILLSBURG, PENNSYLVANIA 17019 DUSAN BRATIC, ESQ. STEPHEN K. PORTKO, ESQ. (717) 432-9706 (717) 432-2538 FAX (717) 432-9220 April 5, 2006 Glenda Farner Strasbaugh Register of Wills & Clerk of Orphan's' Court Cumberland County Courthouse 1 Courthouse Square Carlisle, p/\ 17013 O;""t Attention: Margie Re: Hunter Moore O'Riley Ternes, Deceased Estate #: 2004-00796 Dear Margie: Enclosed please find the original letter from our office to the Department of Revenue dated March 30,2006 along with their original response letter from Holly A. McClintock, dated March 30, 2006 to be attached to the original signed Petition. Thank you for all your assistance regarding this matter. Very truly yours, .... Deb~kh L. Graham Paralegal DLG Encl REV-1500 EX i (ti-00) COMMONWEALTH OF RE -1500 oFFicInLUSeoNLv PENNSYLVANIA Y DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 4 0 7 9 x _ COUNTY CODE YEAR ~- -~ NUMBER-! DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER H Z Temes, Hunter Moore O'Rile 4 7 9- 3 1- 9 6 0 7 W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U 07/07/2004 03/12/2001 REGISTER OF WILLS l1J 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F ~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of deathpnortol2-13-82) Q ~ a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (dace otdeatn after tz-iz-az) ~ 5 Federal Estate Tax Return Required W o0 ~ a m ~ 6 Decedent Died Testate (Attach copy or wiq ~ 7. Decedent Maintained a Living Trust tanaon copy of trust) . _ 8. Total Number of Safe Deposit Boxes a X 9 Ldigation Proceeds Received ~ 10. Spousal Poverty Credit (date o(deatn between 12-31-st and c-t-ss) ~ 11. Election to tax under Sec. 9113(A) (Attacn scn o) F THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS o Dusan Bratic, Es 101 South U.S. Rou te 15 ~ FIRM NAME (If Applicable) ~ Bratic & Portko p TELEPHONE NUMBER 717-432-9706 Dillsbur PA 17019 1. Real Estate (Schedule A) (1) OFFICIAL USE ONLY ~ j 2. Stocks and Bonds (Schedule B) (2) I 3. Closely Held Corporation, Partnership orSole-Proprietorship (3) j r-.a o 4. Mortgages & Notes Receivable (Schedule D) (4) `~ ? ~ ~ ~' I 5. Ca;,h, Bank Deposits & Miscellaneous Personal Property (5) . 40,357.86 ' ~ ~; I (Schedule E) _ T ~ ~ ~ -, ~ I - Z , - ~ 6. Jointly Owned Property (Schedule F) (6) _ -~~ ~..1 ~ ) Q ^ Separate Billing Requested -~ I , `y, "~ LJ I i ~-y.~ 4"'t _A ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Pro bate Properly (7) ~--~ .~: j F- Q. U w fY (scneoule ~ or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net \/alue of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been madE; (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 0 Q F- a xU Q f- 15. Amount of Line 14 taxable at the spousal tax 39,010.28 0 rate, or transfers under Sec. 9116 (a)(1.2) X _ 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate (15) 0.00 X (16) X .12 (17) X .15 19. Tax Due _F3 --t .. .~ (8) w 40,357.86 1.347.58 (11) 1, 347.58 (12) 39,010.28 (13) (14) 39,010.28 (18) (19) 0.00 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < [~ecedent's Complete Address: STREETADD~ESS 33 Mallard Ct CITY Meclhanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penally Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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. (5A) (1) 0.00 0.00 B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................... ........ ^ Q b. retain the right to designate who shall use the property transferred or its income : ................................ ........ ^ ^X c. retain a reversionary interest; or .............................................................................................. ........ ^ d. receive the promise for life of either payments, benefits or care? ..................................................... ........ ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ........ ^ Q 3. Dld decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ........ ^ X^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................... ........ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Under penalties of perjury, 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI ATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE MVVRCJJ /cam'%~ ~~3pL~-- ~r /~''- r7C~~ SIGNATU~ZE OF FREPARER OTHER THAN REPRESENTATIVE DATE _~-C~ ~ AUDRE~- `" %' << . i ~~ ~ ; ~, ~ ~~J . ~ ~ ~ GY 1 c,1 s ~ s -2~ _.+~ ~ s E~) . l ~ s b ~ ~ ~~ ~~ i ~~ ~ t 1 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 3% [72 P.s. §9116 (a) (1.1) (q]. 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 0°f° [72 P.S. §9116 (a) (1.1) (ii)]. The statute does got 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 deattl 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 0% [72 P.S. §9116(a)(1.2)]. The tax rate impo:;etl on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate impo:;ed on the net value of transfers to or for the use of the decedent's siblings is 12°!° [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an Individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-~50& EX+(t-9T, SCHEDULE E COMPdONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. .NHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Temes. Hunter Moore O'Rilev 21 04 07 6 include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Litigation Proceeds (75°lo attributed to wrongful death -not the estate & 25% to estate 40,357.86 as survival action -see attached letter from Dept. of Rev.) Total recovered $240,000 less attorney fees & costs = $161431.45. See attached sett{ement statements. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) EV-i511EX * (1-57j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Temes. Hunter Moore O'Rilev 21 04 0796 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Maipezzi Funeral Home (Total $4210.30 x 25% _ $1052.58) 1,052.58 B. ADMINISTRATIVE COSTS: ~, Personal Representative's Commissions Name of Personal Representative (s) Christina M. Temes Social Security Number(s) / EIN Number of Persona! Representative(s) Street Address 1717 English Drive C;ry Mechanicsburg state PA zip 17055 Year(s) Commission Paid: 2 Attorney Fees 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 Register of Wills $45 to open estate. 45.00 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. Reserve for additional probate fees & inheritance tax return filing. 250.00 TOTAL (Also enter on fine 9, Recapitulation) f $ 1 347.58 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + Ic~_nm SCHEDULE J COMMON/VEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RE=SIDENT DECEDENT ESTATE OF FILE NUMBER Temes H unter Moore O'Rile 21 04 796 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Christina M. Temes Mother 50% 1717 English Drive Mechanicsburg, PA 17055 2. Robert A. Temes Father 50% '1964 South 2100 East Gooding, ID 83330 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TI~TAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DUSAN BRATIC ESQ BRATIC 8. PORTKO 101 S US RTE 15 DILLSBURG PA 17019 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NP,TICE OF INHERITANCE TAX APPRAISEt~~1F-r-:.pLLDWANCE OR DISALLOWANCE OF D~IUCt,EQ~S ~~j~Ik'~S~SESSMENT OF TAX REV-1547 EX AFP (01-09) 2009 MAR 20 PM p~9~r~ 03-16-2009 ESTATE OF TEMES HUNTER M CL~~I~ nt DATE OF DEATH 07-07-2004 ~R~A~~~ rQU~LE NUMBER 21. 04-0796 Cl1M~E~~,~4~i~ ~~OfA~NTY lO1BERLAND APPEAL DATE: 05-15-2009 (See reverse side under Objections) Amount Renitted~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------- ----------------------------------------------------------------------------- REV-1547 EX AFP CO1-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF TEMES HUNTER M FILE N0. 21 04-0796 ACN 101. DATE 03-16-2009 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED 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) .00 NOTE: To insure proper (2) .00 credit to your account, 00 submit the upper portion (3) of this form with your (4) .00 tax payment. (5) 40.357.86 (6) .00 (n .00 ($) 40,357.86 APPROVED DEDUCTIONS AND EXEMPTIONS: 1r347 .58 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (LO) .00 11. Total Deductions (11) 1 .347.58 12. Net Value of Tax Return C12) 39,010.28 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule ,1) (13) .00 14. Net Value of Estate Subject to Tax C14) 39,010.28 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 39, 010 .28 X 00 _ . 00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 = .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 _ .00 19. Principal Tax Due (19)= .00 Tex ro enrTC. PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ry ~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST.. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)