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Home My WebLink About02-03-12/l~ ~ ~~ /~ . ,. . . F:\FQ.ES\CIiWS\13937 Myers ERete\13937.1.patition.edjudiation DECEDENT'S ESTATE ,,, ~` COURT OF COMMON PLEAS OF a~~ V IA w AN CUMBERLAND COUNTY, PENNSYL IVISION ~ ~' ' ORPHANS COURT D .-~. ~.. 4!C? ~: ESTATE OF DONALD G. MYERS, DECEASED No. 21-10-0739 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. INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Supreme Court I.D. No.: Name of Law Firm: Address: Telephone: Fax: Form OC-01 rev. iV. 13.08 Hubert X. Gilroy 29943 MARTSON LAW OFFICES 10 East High Street, Cazlisle, PA 17013 (717) 243-3341 (717)243-1850 Page 1 of 9 Estate of Donald G. Myers, Deceased 1. Name(s) and address(es) of Petitioner(s): Mark A. Myers 19 Partridge Circle Carlisle, PA 17013 65 Loreto Avenue Rochester, NY 14623 Kelly R. Myers Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: Is this the first accounting by this fiduciary? .................................... ®Yes O No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on June 15, 2010. ^ Letters Testamentary or ®Letters of Administration were granted to Petitioner(s) on July 26, 2010 Date of Will (if applicable): Date(s) of Codicil(s) (f applicable): Date of probate (if different from date Letters granted): Was a bond required? OYes ®No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ..................... ®Yes o No Dates of advertising of the grant of Letters: The Sentinel: September 11, 18 & 25, 2010 Cumberland Law Journal: September 17, 24 & October 1, 2010 rw,m oc-o~ rev. % ~s.oe Page 2 of 9 Estate of Donald G. Myers, Deceased 3. Was decedent survived by a spouse? ...................................... ®Yes o No If yes, name of the surviving spouse: Patricia A. Myers 4. Has the surviving spouse filed to take an elective shaze? ...................... ^Yes ®No (See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code) (See attached) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (if none, so state): Mazk A. Myers & Kelly R. Myers 6. Did decedent marry after execution of Will or Codicil(s)? ..................... ^Yes ®No Were any children bom to decedent after execution of Will or Codicil(s)? ........ oyes ®No If yes, give names and dates of birth: /~a~ne; 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 Welfaze? ....................................... oyes ^ No 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 Form OGO1 rov. io. 13.08 Page 3 of 9 Estate of Donald G. Myers, Deceased 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): nt r ~elationshin and Comments. ifanv r s Mark A. Myers Son None: Estate Insolvent 19 Partridge Circle Carlisle, PA 17013 Kelly R. Myers Daughter None: Estate Insolvent 65 Loreto Avenue Rochester, NY 14623 B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. C. State why a Petition for GuardianlTrustee Act Litem has or has not been filed for this Audit (see Pa. O.C. Rule 12.4). 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. 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 Admitted? WiU Claim Be Paid in Full? Fo-m Oao1 rev. iv. 13.08 Page 4 of 9 Estate of Donald G. Myers, Deceased Allstate Fire & Casualty Insurance, Co. 84.79 ®Yes ^Yes P.O. Box 3589 ^ No ®No Akron, OH 44309-3589 Associated Cardiologists 140.00 ®Yes ^Yes 865 Century Drive ^ No ®No Mechanicsburg, PA 17055 Camp Hill Emergency Physicians 646.00 ®Yes ^Yes P.O. B ox 13693 ^ No ®No Philadelphia, PA 19101-3693 Commercial Acceptance Company 1,350.00 ®Yes ^Yes P.O. Box 3268 ^ No ®No Shiresmanstown, PA 17011 Carlisle Cardiology Associates 45.6 ®Yes oyes 850 Walnut Bottom Road ^ No ®No Carlisle, PA 17013 Eastern Account System of Connecticut, 120.55 ®Yes ^Yes Inc,, ^ No ®No P.O. Box 837 Newtown, CT 06470 SRA Associates 1498.72 ®Yes ^Yes 401 Minnetonka Road ^ No ®No Hi Nella, NJ 08083 ERSolutions, Inc. 376.04 ®Yes ^Yes .800 SW 39~ Street ^ No ®No Renton, WA 98057 Johns Hopkins University 10,173.36 ®Yes ^Yes Clinical Practice Association ^ No ®No P.O. Box 64896 Baltimore, MD 21264-4896 Kantor & Tkatch Associates, PC 1,023.00 ®Yes ^Yes 205 South Front Street - 6's Floor ^ No ®No Harrisburg, PA 17104-1619 Members 1°` 4835.06 ®Yes ^Yes P.O. Box 30495 ^ No ®No Tampa, FL 33630-3495 r-am oc-o~ rev. A. ts.os Page 5 of 9 Estate of Donald G. Myers, Deceased Mobile X-Ray Imaging, Inc. 945 East Pazk Drive, Suite 102 Harrisburg, PA 17111-2804 18.00 ®Yes ^ No ^Yes ®No NCO financial Systems, Inc. 195.25 ®Yes oyes 1804 Washington Blvd., Mailstop 450 ^ No ®No Baltimore, MD 2123 Sires XM Radio, Inc. 19.65 ®Yes ^Yes P.O. Box 33174 ^ No ®No Detroit, MI 48232 Attention: Listener Caze 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: 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, aze as follows: Date Payment Interest None made. Insolvent Estate 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guazdian, agent under power of attorney) or surety on the bond of a fiduciary? ............................ ^Yes ®No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awazds performed, or, in the alternative, how the decedent's estate will be dischazged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Form oGOt rev. m. f3.08 Page 6 of 9 Estate of Donald G. Myers, Deceased Petitioner(s) as to each question: B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? ........................ o Yes v No 15. If Petitioner(s) has/have knowledge that a shaze has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. 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. 17. A. List or attach a sepazate 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 Pazagraph 9 above? ................... v Yes o No 18. If a reserve is requested, state amount and purpose. amoanc: $ 2,508.60 Manson Law Offices, balance of attorneys' fees $ 180.00 Manson Law Offices, Account filing fee $ 2,000.00 Mazk A. Myers & Kelly R. Myers, Administrators' commission Pom- oc~o~ „„ % ts.oe Page 7 of 9 Estate of Donald G. Myers, Deceased 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 o No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? ........ ®Yes o No As to real estate only? .................................................. a Yes ®No Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distributee(s) Amount/Proportion No Income B. Principal: Proposed Distributee(s) AmoundProportion None Made Submitted By: Mark A. Myers, Administrator elly R. Myers, Administrator ~ odor rov. ~D ~s.oe Page 8 of 9 Estate of Donald G. Myers, Deceased Verlflcation of Petitioners The undersigned hereby verifies they are the Administrators of the Estate of Donald G. Myers and that the facts as set forth in the foregoing Petition for Adjudication/ Statement of Proposed Distribution which are within the personal knowledge of the Petitioners 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). A. My1a~, Administrator ~ of Donald G. Myers Estate of Donald G. Myers 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 foam Petition authorized by the Supreme Court, and that no changes to the form have been madg,6Fyond thee~es~nses herein. X. Gilroy, Fom- oror rov. A ts.os Page 9 of 9 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tames IQeinklaus, Direcfior of Sales and Mazketing, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SIIVT'INEL, a newspaper of general circulation in the Borough of Cazlisle, County and State aforesaid, was established December 13,1881, since which date THE SENTINEL has been regulazly 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 SEIVZTNEL on the following day(s): September 11, September 18 and September 25, 2010 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and chazacter of publication aze true. ~~~~~/lip, Sworn to and subscribed before me this ~~ \~~ Notary Public My commission expires: NOTARIAL SEAL BAMBIANN HECKENDORN Nohry Publk CARLISLE BOROUGH, CUMBERLAND CNTY My Commission Expires Jan 27, 2014 . f 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, viz: September 17 September 24 and October 1, 2010 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. Srss, Doaald Q., deed. Late of Middlesex Township. Administrators: Mark A. Myers and Kelly Myers c/o Martson Law Offices, 10 East High Street, Car- lisle, PA 17013. Attorneys: Hubert X. Gilroy, Es- quire, Martson Law Ofrces. Marie Coyne, 'tor SWORN TO AND SUBSCRIBED before me this 1 of October, 2010 Notary NOTARIAL SEAL DEBORAH A COLLINS Noah Pudic CARLISLE ~aou~t.`cRLANO couNTr My Comn~htion Expfn~ Apr 28, 2014 " ! ~~ CRIEST, HIES, HERROLD, `SCHAUMA.NN, FEMOLLP 129 EAST MARKET STREET LAURENCE T. HII~AES, JR. YORK, PENNSYLVANIA 17401 BRANCH LOCATION JOHN 6. HERRQLD - SUZANNE H. DRIEST DAVID B. SCHAUMANN TELEPHONE (7'I7~ S46-SSJG WARRINGTON WAYS CHRISTOPHER A. FERRO FAX (71 1 O wELLSVILLE, PA 17385 HEATHER Z: REYNOSA FAX (71 ~ 845-3330 (REPLY TO YORK OFFICE) RU8SELL F. C~RIEBT (1953-1978) September 8, 2010 Hubert X. Gilroy, Esquire 10 East High Street Carlisle, PA 17013 RE: The Estate of Donald G. Myers Dear Hubert: I have reviewed your two (2) letters of September2, 2010. you want that confirmed. in writing, please forvrar an agreement or memo of understanding for her review and execution. As to the monies received from the government for back pay and vacation pay, by copy of this letter to my client, I am asking her to contact the govemmdnt to ensure that this is reported under Donald's social security number. Hopefully they. will provide her with confirmation. If not, we will have to pursue o#her avenues to secure that information. SHG/kao cc: Patricia A. Myers Ve ly yours, SU N E H. GRIEST IN RE: ESTATE OF DONALD G. MYERS, DECEASED LATE OF MIDDLESEX TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION N0.21-10-0739 ~jOTICE OF FILIN G FIItST AN D FIN AL ACCQUNT AND PETITION FOR ADJUDICATI ON/SCHED ULE OF PROPOSED DISTRIBUTION AND CALL F OR AUDIT OR C ONFIRMATION NOTICE IS HEREBY GIVEN that Mark A. Myers and Kelly R. Myers, Administrators of tbe Estate of Donald G. Myers, deceased, has this date filed the First and Final Account and $etitio~} for ~ju~~.ation/Sc~edule of Proposed Distribution in the above-captioned Estate in the Office of the Clerk of the Orphans' Court in and for Cumberland County, Pennsylvania, where the same is filed as public record and may be inspected. Copies of the Account and Petition are enclosed for your information. YOU ARE FURTHER NOTIFIED that any exceptions or objections to said Account or Petition must be filed in writing at the office of the Clerk of the Orphans' Court, Cumberland County Courthouse, Carlisle, PA 17013, aforesaid prior to the confirmation of said Account and Schedule of Proposed Distribution scheduled as set forth below. UNLESS written exceptions or objections are filed prior thereto, said Account will be presented by the Clerk of the Orphans' Court to the above-captioned Court in Court Room No. 1 of the. Cumberland County Courthouse, Carlisle, Pennsylvania, at 9:30 a.m. prevailing time, on Tuesday, March 6, 2012, at which time said Account will be confirmed and distribution ordered in accordance with the Petition for Adjudication/Schedule of Proposed Distribution. W Date of Notice: NOTICES TO: Mark A. Myers 19 Partridge Circle Carlisle, PA 17013 Kelly R Myers 65 Loreto Avenue Rochester, NY 14623 By: v s~+ -~ Hubert .Gilroy, Esquire 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorney for Estate of Donald G. Myers Associated Cardiologists 865 Century Drive Mechanicsburg, PA 17055 Camp Hill Emergency Physicians P.O. B ox 13693 Philadelphia, PA 19101-3693 Allstate Fire & Casualty Insurance, Co. P.O. Box 3589 Akron, OH 44309-3589 Commercial Acceptance Company P.O. Box 3268 Shiresmanstown, PA 17011 Carlisle Cardiology Associates 850 Walnut Bottom Road Carlisle, PA 17013 Eastern Account System of Connecticut, Inc., P.O. Box 837 Newtown, CT 06470 SRA Associates 401 Minnetonka Road Hi Nella, NJ 08083 ERSolutions, Inc. 800 SW 39~' Street Renton, WA 98057 Johns Hopkins University Clinical Practice Association P.O. Box-64896 Baltimore, MD 21264-4896 Kantor & Tkatch Associates, PC 205 South Front Street - 6'~ Floor Harrisburg, PA 17104-1619 Members 1" P.O. Box 30495 Tampa, FL 33630-3495 Members 1~` P.O. Box 40 Mechanisburg, PA 17055 Mobile X-Ray Imaging, Inc. 945 East Park Drive, Suite 102 Harrisburg, PA 17111-2804 NCO financial Systems, Inc. 1804 Washington Blvd., Mailstop 450 Baltimore, MD 2123 Sirus XM Radio, Inc. P.O. Box 33174 Detroit, MI 48232 Attention: Listener Care F:1FII.651CIiwu\13937 Mya. E.tate\13937.1.aaountfoemei IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION FILE N0.21-10-0739 FIRST AND FINAL ACCOUNT OF MARK A. MYERS AND KELLY MYERS, ADMINISTRATORS OF THE ESTATE OF DONALD A. MYERS, LATE OF MIDDLESEX TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA Social Security Number: Tax ID Number: Date of Death: Date of Incapacity, if any Date of Executor's Appointment: Letters Advertised: ' el - Cumberland Law Journal - Accounting for the period: 202-36-5400 27-7031199 6/15/2010 None 07/26/2010 9/11, 9/18 & 9/25 2010 9/17, 9/24 & 10/012010 06/15/2010 - 01/10/2012 Purpose of the Account: Mark A. Myers and Kelly Myers, Administrators, offer this account to acquaint interested parties with the transactions that have occurred during the administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Hubert X. Gilroy, Esquire MARTSON LAW OFFICES 10 East High Street Carlisle, PA 17013 (717) 243-3341 Supreme Court No. 29943 +~v ~ ~ ~_. ~~~ ~ c ~ j'~? SUMMARY OF ACCOUNT Page No. PRINCIPAL Principal Receipts Principal Distributions Principal Disbursements Debts of Decedent, paid Funeral Expenses, paid Administration Expenses, paid Fees and Commissions paid & reserved Total disbursements & Distributions Debts of Decedent, unpaid Balance Before Distributions Distribution to Beneficiary Principal Balance on Hand INCO~ Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Income Balance on Hand COMBINED BALANCE ON HAND 3 3 3 4 4 4 4 4 5 PRINCIPAL RECEIPTS -134,455.80 -2,365.78 -10,825,77 -610.90 -13.768.85 Assets Listed in Inventory (or Inheritance Tax Return) (Valued as of Date of Death) R st Residence located at 180 Wagners Drive, Middlesex Twp. Cumberland Co., PA Fiduciary Acquisition Value 162,027.10 -162,027.10 21,517.56 0.00 0.00 2.22 ~.~ 0.00 0.00 0.00 116,020.80 -2- personal Effects 1969 Smoker boat and trailer, sale price 200.00 2004 Ford F150 pick up truck 9,355.00 2006 Saturn View vehicle 7,600.00 2009 Polaris snowmobile 1,480.00 Other US Savings Bonds (2), redemption proceeds 103.16 Metro Bank checking 357.68 Proceeds from divorce escrow settlement 13,792.59 Defense Logistics Systems, vacation and sick pay due at time of death 8,904.08 Highmark Blue Shield, payments issued for Lower Allen and West Shore 1,997.65 EMS ambulance services Highmark Blue Shield, medical reimbursements 114.28 Subsequent Receipts US Treasury 2010 1040 refund 2,091.00 PPL, refund 8.65 Interest transferred to principal 2.22 TOTAL PRINCIPAL RECEIPTS 162,027.10 PRINCIPAL DISTRIBUTIONS Real Estate, Wells Fargo Bank, N.A., foreclosure 116,020.80 Santander, 2004 Ford F150 pick up truck, vehicle surrendered 9,355.00 Members ls`, 2006 Saturn View vehicle, vehicle surrendered 7,600.00 Sheffield Financial, 2009 Polaris snowmobile, vehicle surrendered 1,480.00 TOTAL PRINCIPAL DISTRIBUTIONS 134,455.80 PRINCIPAL DISBURSEMENTS DEBTS OF DECEDENT Metro Bank, outstanding check on date of death 23.41 PPL, pending foreclosure on real estate 344.72 -3- Lower Allen EMS, paid with Highmazk proceeds specifically issued for 1,218.00 ambulance services West Shore EMS, paid with Highmazk proceeds specifically issued for 779.65 ambulance services Total Debts of Decedent FUNERAL EXPENSES 2,365.78 Parthemore Funeral Home 10,549.17 Emanuel Cemetery, grave mazker 276.60 Total Funeral Expenses 10,825.77 ADMINISTRATION EXPENSES Probate fee 255.50 Short Certificates 16.00 Legal Advertising, Cumberland Law Journal 75.00 Legal Advertising, The Sentinel 198.16 Postage 5.54 Additional Probate Fee 50.00 Certified mailing, Savings Bonds 5.70 Duplicate title for boat 5.00 Total Administrative Expenses 610.90 FEES AND COMMISSIONS Martson Law Offices, partial attorneys' fees 9 2 Total Fees and Commissions to date 8,980.25 RESERVED FOR FUTURE DISBURSEMENT Martson Law Offices, balance of attorneys' fees 2,608.60 Martson Law Offices, reserve for Account fling fee 180.00 Mark A. Myers and Kelly Myers, Administrators commission ~,.t .Q,QQ Total Reserve 4,788.60 TOTAL PRINCIPAL DISBURSEMENTS 27,571.30 PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES None ~ -4- TOTAL PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES 0.00 RECEIPTS OF INCOME Susquehanna Bank, interest on divorce escrow account $ 2.22 TOTAL RECEIPTS OF INCOME $ 2.22 1 ~ ul ~M 1 1 I Transferred to Principal $ 2.22 TOTAL DISBURSEMENTS OF INCOME $ 2.22 UNPAID CREDITORS Allstate policy # 918264425, premium balance due on caz insurance 84.79 Associated Cazdiologists, account # 278179 140.00 Camp Hill Emergency Physicians, account # HYP36939312 646.00 Joseph P. Cazdinale, D.O., account # myerdo-02, Commercial Acceptance 1,350.00 Company, debt recovery agent # 674281 Cazlisle Cazdiology account # 515733 45.60 Comcast, account #09547373920029, Eastern Account System of 120.55 Connecticut, Inc., debt recovery agent #24378343 Dell Financial Services account # 687945012966031314, SRA Associates, 1,498.72 Inc., debt recovery agent Dish Network # 8255909703123098, ERSolutions, Inc., debt recovery agent 1,367.58 # F-35507568 Johns Hopkins University Hospital, account # 30-4585859 10,173.36 Kantor & Tkatch Associates, PC, account # MYED006 1,023.00 Members ls` Visa 4672 0900 0020 2877 4,835.06 Mobile X-Ray Imaging, account # 331860 18.00 Verizon account # 09047753300001, NCO Financial Services, debt recovery 195.25 agent # NG0942 -5- XM Satellite Radio, account #110118710899 19. 5 TOTAL UNPAID CREDITORS 166,510.50 M A. My ,Administrator Kelly R. Myers, Administrator Estate of Donald G. Myers -~- VERIFICATION We, Mark A. Myers and Kelly R. Myers, Administrators of the Estate of Donald G. Myers, deceased, hereby declares under oath that he has fully and faithfully dischazged the duties of their office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all taxes presently due from the Estate have been paid; and that the grant of Letters of Administration and the first complete advertisement thereof occurred more than four months before the filing of the foregoing First and Final Account. This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. Mazk A. Myers ~7 Kelly .Myers Dated: ~'"~7~~~- -7- VERIFICATION We, Mark A. Myers and Kelly R. Myers, Administrators of the Estate of Donald G. Myers, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of their office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all taxes presently due from the Estate have been paid; and that the grant of Letters of Administration and the first complete advertisement thereof occurred more than four months before the filing of the foregoing First and Final Account. This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. M A. My Kelly R. Myers Dated: l`~/- ~ ~ -7- IN THE COURT OF COMMQN PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION FII,E N0.21-10-0739 FIRST AND FINAL ACCOUNT OF MARK A. MYERS AND KELLY MYERS, ADMINISTRATORS OF THE ESTATE OF DONALD A. MYERS, LATE OF MIDDLESEX TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA SCHEDULE OF PROPOSED DISTRIBUTION Mazk A. Myers and Kelly R. Myers, Administrators of the Estate of Donald G. Myers, deceased, state that no payment will be made to the Unpaid Creditors listed in the First and Final Account, nor will any distribution be made to any heirs due tot he insufficient funds in the Estate. k A. M rs, Administrator Kelly R. Myers, Administrator Sworn an ubscribed to before me this 31st day of c i . ~G G~~` Notary Public ~,Vt~.t~ ~~ NOrf O~ public Victaria~ County M l~l~m~sion cic D~na~p°~~ 20, 2014 -8- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION FILE N0.21-10-0739 FIRST AND FINAL ACCOUNT OF MARK A. MYERS AND KELLY MYERS, ADMI1vISTRATORS OF THE ESTATE OF DONALD A. MYERS, LATE OF MIDDLESEX TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA SCHEDULE OF PROPOSED DISTRIBUTION Mark A. Myers and Kelly R. Myers, Administrators of the Estate of Donald G. Myers, deceased, state that no payment will be made to the Unpaid Creditors listed in the First and Final Account, nor will any distribution be made to any heirs due tot he insufficient funds in the Estate. M A. Mye ,Administrator e ly R. Myers, Administrator Sworn and subscribed to before me this ~_ ~Y of ~~ _ ~ ~~_ Notary Public .LAMES ROS.SET1~ y Public - Ebb o~ Nlaw Yri~ No. 01-ROe1a/401 -f~uaUAsd inEilsCd~ MyCgntgiNion Expires 040~1lAi! -8-