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HomeMy WebLinkAbout01-06-12 (P 4.~ -/ l /~ ~~°Y r~ _ DECEDENT'S ESTATE `~' ~ T --' ~-, ... __ .:--, ;: COURT OF COMMON PLEAS OF ; - r CUMBERLAND COUNTY, PENNSYLVANIA -~ - ° =~ , ORPHANS' COURT DIVISION f `'~'- ESTATE OF Mary Kathryn Anderson ,DECEASED No. 21-10-1078 PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9 This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication. INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Taylor P. Andrews, Esq Supreme Court I.D. No.: 15641 Name of Law Firm: Andrews and Johnson Address: 78 W. Pomfret St., Carlisle, PA 17013 Telephone: 717 243-0123 Fax: 717 243-0061 Form OC-0I rev. ]0.13.06 Page 1 of 10 ~/ Estate of Mary Kathryn Anderson ,Deceased 1. Name(s) and address(es) of Petitioner(s): Name: Michael B. Anderson Address: 305 Fireside Drive Camp Hill, PA 17011 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: none Is this the first accounting by this fiduciary? ..................... ~ Yes ~ No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on August 12, 2010 Letters Testamentary or OLetters of Administration were granted to Petitioner(s) on October 29. 2010 Date of Will (rf applicable): N/A Date(s) of Codicil(s) (if applicable): N/A Date of probate (f different from date Letters granted): N/A Was a bond required? ^Yes ~ No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... m Yes Q No Dates of advertising of the grant of Letters: CLJ: 7/29/11: 8/5 & 8/12/11 Carlisle Sentinal: 7/20 & 7/27/11; 8/3/l 1 FormOC-0/ rev. !0.!3.06 Page 2 of 10 Estate of Mary Kathryn Anderson ,Deceased 3. Was decedent survived by a spouse? ............................. Yes ~ No If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ............. ^ Yes ©No (See Section 2201 et sir . 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 (fnone, so state): Timmee Suhr Martin Allen Anderson John E. Anderson Michael B. Anderson Edward J. Anderson James Michael Anderson 6. Did decedent marry after execution of Will or Codicil(s)? ........... ^ Yes m No Were any children born to decedent after execution of Will or Codicil(s)? ........................................... ~ Yes ~ No 1f yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, was a request for a statement of claim sent to the Department of Public Welfare? .............................. ~ Yes ~ No Form OC-01 rev. 10.13.06 Page 3 of 10 Estate of Mary Kathryn Anderson Deceased 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Form OC-01 rev. 10. /3.06 Page 4 of 10 Estate of Mary Kathryn Anderson ,Deceased B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. None C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit (see Pa. O.C. Rule 12.4). N/A D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. N/A Form OGOI rev. 10. /3.06 Page 5 of 10 Estate of Mary Kathryn Anderson Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant Amount of Claim Claim Will Claim Admitted? Be Paid In Full? $290,912.41 ®Yes ©Yes Department of Public Welfare for QNo ®No Medical Assistance Lien ®Yes ©Yes ~No ^ No ®Yes ~ Yes ~No ^ No Yes ^Yes ~No ~No If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed payments. 11. Was family exemption claimed? ................................ Yes ~No Was family exemption allowed? ................................ Yes ~No Family exemption claimant's name and relationship: Name: Relationship: Form oc-ol rev. l0.13.06 Page 6 of 10 Estate of Mary Kathryn Anderson 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 Interest No tax due 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 m No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: None B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. Q Yes ~ No I5. 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 OC-Ol rev. 10.13.06 Page 7 of 10 Estate of Mary Kathryn Anderson Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... ®Yes ~ No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. Order attached. Docketed at 21-04-0889 Cumberland County Orphans' Court 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. None B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ............. ~ Yes ~ No 18. If a reserve is requested, state amount and purpose. Amounl: ~'~~ rurpose: None requested 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? .......................... DYes mNo As to real estate only? ........................................ Yes ®No Form OC-01 rev. 10.13.06 Page 8 of 10 Estate of Mary Kathryn Anderson ,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(sJ AmoundProportion There is nothing left to distribute B. Principal: Proposed Distributee(sJ Amount/Proportion There is nothing left to distribute Submitted By: (All petitioners must sign. Add additional lines if necessary): Name of Petitioner: Michael B. Anderson Name of Petitioner: Fore, oc-oi rev. ro.13.n6 Page 9 of 10 Estate of Mary Kathryn Anderson Verification of Petitioner (Verification must be by at least one petitioner.} Deceased The undersigned hereby verifies * [that r,e~she is rare of the above-named name of corporation and] that the facts set forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn falsification to authorities). Signature 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. FormOGO! rev. 10.!3.06 Page 10 of 10 Supplement to Petition for Adjudication Estate of Mary Kathryn Anderson 9. List of intestate heirs: Name & Address Ralatinnchin Intaract Timmee Suhr daughter 1/6 th of residue 170 Stonehedge Lane, 0 in this estate Mechanicsburg, PA 17055 John Eric Anderson Son 1/6th of residue 6312 Chesterfield Road, 0 in this estate Mechanicsburg, PA 17050 Edward James Anderson Son 1/6th of residue 37 Mallard Ct., Mechanicsburg, 0 in this estate PA 17055 James Michael Anderson Son 1/6 th of residue 692 Beaver Dam Road, East 0 in this estate Berne, NY 12059 Martin Allen Anderson Son 1/6 th of residue 953 Pin Oak Dr., Antioch, TN 0 in this estate 37013 Michael B. Anderson Son 1/6 th of residue 304 Fireside Drive, Camp Hill, 0 in this estate PA 17011 10. Schedule of preference of claims: [Note letter from DPW regarding release of lien on real estate attached] Costs of Administration $39,018.70 The Family Exemption $0.00 Costs of funeral, burial, medical services in last 6 months $40,426.05 Cost of gravemarker $905.00 Rents in last 6 months $0.00 Claims by Commonwealth $13,685.79 Other claims $0.00 Total: $94,035.54 PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, vlz: Julv 29 August 5 and August 12 2011 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Anderson, Mary Kathryn, decd. Late of Lower Allen Township. Administrator: Michael B. Ander- son, 304 Fireside Drive, Camp Hill, PA 17011. Attorney: Taylor P. Andrews, Es- quire, 78 West Pomfret Street, Carlisle, PA 17013. ,~ ,~ ~-- Li a Marie Coyne, Edito SWORN TO AND SUBSCRIBED before me this 12 of August, 2011 ,~ ) P.. ,~ ; ~ ~ , Notary NOTARIAL SEAL DEBORAH A COLLIhS Notary Pubiic CARLESLE BOROUGH, CUP~BERLAIJO COUNTY (~y Commission Expires Apr 2B, 2014 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Jackie Cox, Sales Director, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13~, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): July 20, Tuly 27 and August 3 2011 COPY OF NOTICE OF PUBLICATION ~~ EsrarE NOTICE Affiant further deposes that he/she is not Letters. of Administration for the Estate of MARY KATHRYN ANDERSON, interested in the subject matter of the deceased, of Lower Allen Township, Cumberland County, Pennsylvania, aforesaid notice or advertisement, and that have been granted to the undersigned. All persons indebted to the Estate are requested to make immediate payment, all allegations In the foregoing statement as and those having claims against the Estate are requested to present them t0 tlme, place and character of publication for settlement without delay to: Michael B. Anderson aT0•tl;Ue. 304 Fireside Drive ~ /// i Camp Hill, PA 17011 ( ~/ ~ / f ~~~ ° ii `, Counsel: Taylor P. Andrews, Esquire `~ ~ ~, *1( ~{ ' J 78 West Pomfret Street ~ Cadisle, PA 17013 I Sworn to d subscribed before me this IZ~~ a~a ~ C~u~-~-zD( Notary Public My commission expires: NOTARIAL SEAL BAMBI ANN HECKENDORN Notary Public CARLISLE BOROUGH, CUMOERLAND CNTY idly Commission Expires Jan 27, 2014 .: ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8466 November 15, 2010 ANDREWS & JOHNSON TAYLOR P ANDREWS ESQUIRE 78 WEST POMFRET STREET CARLISLE PA 17013-3216 Re: Mary Anderson CIS #: 370180039 SSN: ###-##-5243 Date of Death: 08/12/2010 Dear Attorney: Please be advised that the Department of Public Welfare maintains a claim in the amount of $290,912.41 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $33,771.05, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $257,141.36, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~~-f ` '- Patricia Nace Claims Investigation Agent 717-772-6616 717-772-6553 FAX Enclosure '9~d L~, ~tl.I ~ ~v~~s T"I`u -~.t~ ~IS~I Ityt (;.~ r~i~~~ G '3 ~. rJrt~ ~M Corarsotrlva:ru.YN OF pcNtasrivnrtu. OEpARThSElfl' OF PUBLIC WELFt~iF 6URtAU t5F PROGF.RM INT~GFrfrY bM3lCt(V (IF THiRO PA(tl`Y LtAL It iN CASUALTY UNtT P.n.6o7G B4~ t1PRezE5t3U(~G, PA 17105-sgex' ~1arc}~ ~~, 2t11~ AI~}17~ih~15 ~= SOt~1+780~1 3'13YL{)R P At~T}~R~WS ES¢USIi~, 7'fi ~rdE61' ~'OT~FftET S'~~t~~`t' cA~II~LE ~A 1703.3-321G Ede: Mary Anderson CIS ~ : J7018(1039 lnciderit Dates asJl~I2014 Dear Attorney; I harre reviewed 't_.11C tax rE'.turn and sttsC~'itr(Pnfs. T,he DepsrtYY~t'~t only allows executor fee of ti~ so this would bo 59691.9 nat $~i30U.0~1. This a.ould ma}>e tYte amount dva~,lahle for the Class 5.1 as $13r 6fi.~,.79 and the tonal due tc~ C(PW as $47,456.$4. Could. you al.^~o gleas~ .:end the prt~p~rty s~tr~.ement sheet and t~~e bills/ret:eipts for the repairs of $1C1, 95~.OQ 'ea me fr re~riett+ when t2iey are availal~lt= . Please contact me i~ ,you nave ar~y questi..ons. SiriCerely, ~atxi.Cia 1~~C2 C~.aims ZCrvCStigaiiol't Agent 73.7-772-6616 717-772~655~ FAh IN RE: : DIARY KATHERINE ANDERSON: An incapacitated person. On Petition of John E. Anderson 1N THE COURT OF COMMGN PLEAS OF CUMBERLAND COUNTY, PENNSYLVANLA ORPHANS' COURT DNISION NO. 21-04-0889 FINAL ORDER Off' COURT APPOINTING PLENARY GUARDIAN AND NOW, this 12th day of November, 2004; a hearing in this case having been held on November 12, 2004, at 9:30 a.m., in Court Room Number 3, Cumberland County Courthouse, Carlisle, Pennsylvania, and it appearing to this Honorable Court that Mary Katherine Anderson was personally served with a Citation and Notice of this hearing on October 26, 2004, and that the physical or mental condition_of Mary-~Katherine~Anderson would be harmed by her presence at the said hearing, and further finds from the testimony: 1. That Mary Katherine Anderson suffers from the effects of Alzheimer's Dementia, which totally impairs her capacity to receive and evaluate information effectively~and~to make and communicate decisions concerning her management of financial affairs or to meet essential requirements for her physical health and safety. 2. That there are insufficient supports available to assist Mary Katherine Anderson in 1 such decisions and that there exists no other less restrictive alternative mechanism for decision- making. That based on the total incapacity of Mary Katherine Anderson to receive and evaluate information and to make or communicate decisions, a plenary Guardian of the Person and a plenary Guardian. of the. Estate. are, required on a permanent. basis.. NOW, THEREFORE, based on the clear and convincing evidence supporting the foregoing findings it is OffDERED, ADJUllGED and DECREED that MARY KATHERINE ANDERSON be and is hereby adjudged a totally incapacitated person and JOHN E. ANDERSON is appointed PlenaryPermanent Guardian of the Person and~.Estate. As Plenary Permanent Guardian of the Person, John E. Anderson, has the authority to access all of Mary Katherine Anderson's medical records, including but not limited to psychiatric records, and to make all decisions regarding her health care, placement decisions, medical treatment, and life support. As the Plenary Permanent Guardian of the Estate of Mary Katherine Anderson, John E. Anderson has the authority to make all of the decisions concerning her financial affairs. An Inventory must be filed within I~ ~ ~~ ~- t ~ (~ ~ 1 days. A report by the Guardian shall be filed within 12 months- and annually thereafter, Bond is hereby waived. Mary Katherine Anderson, an incapacitated person, has the right to appeal this Order of Court by filing Exceptions within ten (10) days of this date or to Petition this Court for a review hearing to modify or terminate the guardianship herein established. 2 ti If Mary Katherine Anderson was not present at this hearing on appointment of a guardian, then petitioner shall serve upon and read to Mary Katherine Anderson the Statement of Rights, a ccpy cf which is Attached to this ORDER as Exhibit "A", and file proof of such service with this Court within ten (10) days. BY THE COURT: 7 ~ , 151 ,~--~~~~~. ~ ~~-%~ i~? Judge -, I .;~, , .. .. + ~ ..I, y 1 ~(/~r I~ 3 ~+ r IN ~~ IN THE COURT OF COMMON PLEAS MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION An incapacitated person NO. STATEMENT OF RIGHTS UPON APPOINTMENT OF A GUARDIAN AN ORDER HAS BEEN ENTERED WHEREBY YOU HAVE BEEN ADJUDICATED AN INCAPACITATED PERSON AND UNABLE TO CARE FOR YOURSELF AND/OR MANAGE YOUR PERSONAL AFFAIRS. YOU HAVE THE RIGHT TO FILE EXCEPTIONS TO THE COURT'S DECISION WITHIN TEN (10) DAYS OF THE DATE OF THE COURT'S ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL BECOME FINAL. IN THE EVENT THAT YOU FILE EXCEPTIONS AND THEY ARE DENIED, YOU HAVE A RIGHT TO FILE AN APPEAL TO THE SUPERIOR COURT WITHIN THIRTY (30) DAYS OF THE DATE OF THE DENIAL OF THE EXCEPTIONS. IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME TO MODIFY OR TO TERMINATE THE GUARDIANSHIP IF THERE IS A CHANGE IN YOUR CAPACITY OR IF YOUR GUARDIAN FAILS TO PERFORM HIS DUTIES IN ACCORDANCE WITH THE COURT'S ORDER. IF YOU WISH TO APPEAL THE ORDER OR TO PETITION THE COURT TO~ MODIFY OR TERMINATE THE GUARDIANSHIP, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY. IF YOU DO NOT HAVE AN ATTORNEY, THE COURT MAY APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY APPOINT FOR YOU MAYBE PROVIDED AT NO COST TO YOU. 4 EXHIBIT "A" IN RE: ESTATE OF MARY KATHRYN ANDERSON DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL,IJ.~NIA ~f~ ORPHANS' COURT DIVISION '~; -~ ;-7 NO. 21-2010-01078 ; : ; m ~, .~- ~_ ,_, --, c.:~ - , ~> FIRST AND FINAL ACCOUNT OF MICHAEL B. ANDERSON ADMINISTRATOR OF THE ESTATE OF MARY KATHRYN ANDERSON LATE OF LOWER ALLEN TOWNSHIP,CUMBERLAND COUNTY, PENNSYLVANIA -,, - cJ ., ;,-:>;- c.,. Date of death: August 12, 2010 Letters Granted: October 29, 2010 Advertisement of Letters: The Sentinal: July 20, 27; August 3, 2011 Cumb. Law Journal: July 29, August 5, 12, 2011 ACCOUNT STATED AS FINAL Purpose of Account: Michael B. Anderson offers this account to inform interested parties of the transactions that have occured during this administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Taylor P. Andrews, Esq. 78 W. Pomfret St., Carlisle, Pa. 17013. Phone 717-243-0123 SUMMARY & INDEX PRINCIPAL Page No. Receipts 2 $94,035.54 Less Disbursements 3 $94,035.54 Balance Before Distributions $0.00 Distributions to Beneficiaries 3 $0.00 Principal Balance Remaining $0.00 INCOME Receipts 4 $0.00 Less Disbursements 4 $0.00 Balance Before Distributions $0.00 Distributions to Beneficiaries 4 $0.00 Income Balance Remaining $0.00 COMBINED BALANCE REMAINING $0.00 Page 1 1/3/2012 PRINCIPAL RECEIPTS (Value as of Date of Receipt unless otherwise indicated) Real Estate: 3903 Gettysburg Rd., Cainp Hill [Lower Allen Twp] Cumberland County, PA Tangible Personal Property: Misc persona] property [4 items of furniture] Cash and Securities: PNC Bank burial reserve Utility refunds Reimbursement of prepaid taxes received at settlement on sale of real estate Total Receipts of Principal Amount $88,900.00 $112.00 $4,772.68 $52.00 $198.86 Page 2 -Principal Receipts PRINCIPAL DISBURSEMENTS 10/28/2010 Register of Wills -for letters $279.50 Gilbert Dailey Funeral Home $4,000.00 Romberger Memorials -granite marker $905.00 East Harrisburg Cemetery and Cremation Services $2,555.00 Clergy for service $100.00 3/25/2011 Secured loan from Redevelopment authority $16,665.00 Real Esate Sales Commission $5,529.00 Recording fee $27.00 Transfer Tax $889.00 Seller assist to buyer $4,250.00 4/1/2011 DPW -toward medical assistance lien of $290,912.43 $47,456,84 Register of Wills -filing fee Inheritance Tax return $15.00 Cumberland Law Journal $75.00 Carlisle Sentinal $189.54 1/6/2012 Michael Anderson - Admininstrator's fee $4,691.84 Taylor P. Andrews, Esq. attorney fee $6,258.82 Andrews & Johnson -reimburse for fee for amended ltrs $19.00 Register of Wills for filing account $130.00 TOTAL DISBURSEMENTS OF PRINCIPAL $94,035.54 DISTRIBUTIONS TO BENEFICIARIES None TOTAL DISTRIBUTION OF PRINCIPAL TO BENEFICIARIES $0.00 Page 3 -Principal dis. None Total Receipts of Income None INCOME RECEIPTS INCOME DISBURSEMENTS Total Disbursements of Income to Beneficiaries Michael B. Anderson, Administrator $0.00 WV.VV Page 4 1/3/2012 COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) Michael B. Anderson ,being duly sworn according to law, deposes and says that the Account as stated is true and correct, and that the Grant of Letters and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. Michael B. Anderson Sworn nd subscribed to before me this _~day of ~c~,-~J^r~~ ti ~d ~ ~ ~ ~9 /' Ili COMMONWEA{-fli OF PENNSYLVANIA NOTARIAL SEAL SHELLY SEXTON Notary Public Carlisle Bono, Cumberland Courny My Oomm~sion Expires gpri128, 2015 Page 5 1/3/2012