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Home My WebLink About09-13-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: James F. Boylan a/k/a: a1k/a: a/k/a: Date of Death: File No: ~ ~ ' ~ oZ -- ~ ` / - / (Assigned by Register) Social Security No: Age at death: 77 Decedent was domiciled at death in Cumberland County, pennsylvania (crate) with his/her last principal residence at 1700 Market Street. Como Hill 17011 Camn Hill Borout?h Cumberland Street address, Poat Office and Zip Code Cfty, Towuahip or Borough County Decedent died at Manor Care. 1700 Market Street. Camn Hill 17011 Camn Hill Boroueh Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 1,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsyh'ania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 1.000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Past Office and Zip Code City, Township or Borough ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated State relevant circumatancea (eg. renatrclatlon, death ojexecutor, eta) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorc divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. C'? Q NO EXCEPTIONS ~ EXCEPTIONS Couuty ~jl Codicil(s) rTl ~~ r'_'~ __ '~ =CJ .=not apab,~pto ap~ad lot have a child biota of ~. - `7 'J ?~ w ~~ p B. Petition for Grant of Letters of Administration (If applicable) a ~ c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. 0' NO EXCEPTIONS ®EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left na Will and was survived by the following spouse (if any) and heirs (attach additio»al sheets, if necessary): Name Michael Boylan Relationshi Brother Address Unknown because the decedent and brother were estranged. Theresa Conniff cousin 21 Railroad Street, Locust Gap, PA 17840 ~o-,nRw-oz rev. l0/11/20!/ Page 1 oft Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: } COUNTY OF official use only Petitioner(s) Printed Name Petitioner(s) Printed Address Lisa Marie Co e, Es . Co e & Co e, P.C., 3901 Market Street, Cam Hill, PA 17011 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the lmowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the dent, the 'ti ner(s) will 1 and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date ~'I - I ~ - ~ 2 me this ~ day of ,~I~ Date By' 1 ~ C ~ Date For the Register Date BOND Required: Q YES i0 To the Register of R'llls: FEES: Please enter my appearance by my signature below: Letters ...................... $ ~, L~~ (~ )Short Certificate(s)...... .~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ,,,,,,,, ........ Automation Fee ............... S,L~ , JCS Fee . ................ .... ~ 3, `~D TOTAL ..................... $ `~ n.~A;AR~- Attorney Signature: \ / V Printed Na e: Lisa Marie Coyne, Esq. Supreme Court ID Number: 53788 C~ e* Firm Name: Coyne & Coyne, P.C. C ~.? Address: fx7 ~.'~ f'1 _a -. ~ '~ f ~~ Phone: 717-737-0464 _ . . ~-, C`: ~ . Fax: 717-737-5161 : z~ Email: lira@cnvneandrn~mP rnm _ ~ A ~_ DECREE OF THE REGISTER Estate of .lames F. Bovlan File No: ~ j - ~ ~ '~' (~~~ a/k/a: I_ _ ~/ , AND NOW, ~ ~'~~ t~~~ ~ ~"~/ ,r , mil/ ~a, , in consideration of the foregoing Petition, satisfactory proof having been p esented before me, IT IS DECREED that Letters of Administration are hereby granted to Lisa Marie Coyne, ESq. in the above estate and (if applicable) that the instrtunent(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Q ~ ,~ Register of Wills Q~(~ ~ ~Y ` ~~~~ ~'~0 r"` ~ +:,2 Form Rw oz rev. 10/II/2o// I Page of 2 LOCAL~~~~~;5;;~~'S CERTIFICATION OF DEATH WARNtN ([tGS-A~~gaf<'~I~~upiicate this copy by photostat or photograph. ~.. Fee for this certificate, $6.00 P 15932465 ?~ € 2 SEP 13 d~ 9~ 3~' ~,.JI-.... :~~. ORPI-~Iv`5 t/Ui~~~ (~.IMBERIAN~ ~., Certification Number :;s Inoslu REV ttnme TvPEw DIADK INN t. Nrr d Detadere s ~ n.r IAknray) 77 Mgrr I Irya I Nave This is to certify Chat 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 p~ennanent filing. ~ ~~t~~c,II~DIvII-~x• N01~ 2 0/ Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Sae inetruetlona and examples On reverse) STATE FILE NUMBER Z. Sa 5. SaAtl Sapry Number 1. Dra d Oaani (Mara, dry, ;,,,,_~_....,._ - 206 - 26- 7803 Novrwelno- Oct. 6, 1932 Mt.Carmel, Pa, ~ anK tA> canq a D.em ee rwP, a De.m ea FsdNy Arnie (n na kMnrr, p« Aber ur ambep ^ MwlraO ^ ER~~ ^ DOA Nara Nar ^ Rerrrca ^ Onwr - SPaa In rr, w«Ar OE.r Olpy,a rr ^ rro 10. Raw: Mrdcr r ~' ~ Cumberland Camp Hill Manor Care Marwn,PUrbRirn,a>c,) Ida n.D«.awr.Inaa arwkrr mope raD•naaw tzwroeweweaearti 18Dmr,EAratlr Whi. Iar a wok Imtla IyiYieeaylnhrry u.s. Mrs Fare pip, + Secairry (( P rN ~ (+I+icangaadl 1~. ~N^~,dea/ Madr 15. a~mw,o spoor. IN wre, p~. mr ®Yr ^No 1S. DawaufsMinpAddnw (Beset dy/Irwn, cola, zlpalae) Dredellre qa Deceaue N 1700 Market St. i1cdid pe1~°+'°~ D° acre ne.^vea Drre,e L;,re~ ''' Cam Hill Pa. 1 701 1 +r^•~r ^t1Th~r7 anal Tow~a +7d [~N°,Dwedue LArd aahr p' ,~~a Camp Hill U t8. Fetlrr'e Name (FNeI, nitlae, rr, euAk) 19. Marie Nrr ~Fkr, nedde, mrar eunane) Ln 20e. knonrnre NYr (Tyr /Print) Janet E Pull 25h. Ir~bmaire Mernq Addeea (Sbesl, aY / Iwm, err, ib Aida) 2,a r.nr a DleaeelAr ~ $1 a.mrw ^ Dartlan zro. ar a DlWOauw (Mrm, dry, yrp z,•. Prw a DrPwMw (wrw a 1 ' 1 e Pa . 1 7 01 3 ^ Bpltl ^ Ramwr non Srr r Irr Clamellr a Drallen AanalAr w'^~Y~ ~Y adMr pawl 2,0. Lewtlon (Gry/rwn, Wr, xb ante) aFraelswiw °' ~c0101'nI,~rr^NO Nov, 22 2009 Hollinger FH/Crematory Inc. Mt.Holly Spgs Pa 1706 . . _ nb. Llwrre Manber rdc. Name rd Mdmr a FaaMy ~ FD-011932-L 501 N. Baltimore Ave. IYe.29ec a1y trai oueyrp zA. re tlr lrra ,arma,o.rarnrmna,ar end m for Inc. Mt.Holl S rin s, Pa. 17065 r na rvenrr r Yma a darn r Ww acrd (aprm° roar) away rra d each. z5a Licure tie,ter zsc Ikr slpra lMaal. rri roep Ilrr 2axs wr ty aerplraa M Paver z<. Tyne a prm 2s. Dar PrerlaaKed Dar (roan. rY.Wrl wno panlewr arm. zs. wr Cw Rraned r Maacr Eras 1 cad,. Ia . Rerr tMr mr ,]ameYr a Darlbna 1 l:ZoAM. Novz bc ^ e~ ~ (J aO~~ Yr ^No Irm 27. Pr I: 61er Ir CAUSE OF DEATN (Sw MrrMWne m0 rxrmpW) ~PPnWmer rrrrF. 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Drams now nay anmad r eeAbM Prr D aaprlw IA~ a Oew a Deem? ~ Ne1atl ^ FAOneaea 32e Prw a May: now. FemL Sort Fain, ^ rr ~ Na ^ yr ^ No ^ Mara ^ Pr1a~e ImwdOaAr aza. 7kw a MAY Dmw moo, es Isaa~AN sze. May r wake szr. n rrrupnruw Inter (bk•aY/ sz ^ soar ^ cwa rea w Depnrrd r p. Iccarn a M+r (suet ay 1 mwn, err) ^ r« ^ Ne ^ oawr+ ^ P°ee«ger ^ PederrW, . ssw c«sw (agar a,y ar) ~- snewr • ~+Anq PNAerre (Plryraen aaykq c..• a arm Mien rglna rrrrMaeee,aaamran.a error ~~~'pe~~~ene r•maara °rryey ra rrnrr rrr ~~~ sib. Sgrlun end rre a c.dArr ` `Nam / ~ ,~~-''~~ __-__-_ • ~aeW rdwNylny P6yerlae lPlnelar U°m ___ rosreraarrrwrey,,ereoeae,eerm. a~rr•m.rwnAyngaa...aae.m) an. eer r ______________ ^ ~ ~ rwre. ssaows , ,a pew,raArrlMruaap)rMmrwwrrnaa---- • ANewl HrMiwlCemrrr oem.brra a 4raMonm.rr,wrl - ------ QS OO+i-0 & L{- L , m nanowreyalnr.nyrr,,,rmrro~r.rrnowamrnrrr,rr,rapr.,erawrNr o rrkbtr O 00 9 eeueya)remwwratare_ ^ 3/ Wrr rd Aer a ~ ~ ~ "'aee8ye ems. °"a o~~~ ~ L ~kc , er vAacanarre cr.ea Deem (Irm Ta)Tyw/Pee M a2 h e-P ( 4rrL S 1p U °r° Rr" crrm rr rp ' ~~ ' ~ xv~ l~l . ~ I I 1.7. I I l a I . . r 35 / N N e ~ . c s s 19,, c avr~5 'er ld 7//O DrPetdAr PemYt Na`:_ ~ ,' ^ `ti:'f n X57 ESTATE OF JAMES F. BOYLAN ATTACHMENT TO THE PETITION FOR GRANT OF LETTERS B. Petition for Grant of Letters of Administration 1. Decedent died intestate with no children. 2. At the time of the Decedent's death, Cumberland County Aging & Community Services had guardianship over the Decedent. (See Exhibit "A" -Letter dated December 15, 2009). 3. Susan Seitz, cousin of the Decedent and only relative in contact with the Decedent at the time of death, sent a letter to the Pennsylvania Department of Public Welfare requesting the Department administer the estate. (See Exhibit "B" -Letter dated January 21, 2010). 4. The Decedent has a brother, Michael Boylan, but was estranged from the brother at the time of death. (See Exhibit "B"). 5. The Pennsylvania Department of Public Welfare is the principal creditor of the estate. 6. Petitioner has been nominated by the Pennsylvania Department of Public Welfare to administer the estate pursuant to 20 Pa.C.S.A. 3155(b)(4). (See Exhibit "C" - Letter dated February 12, 2010). 5. The only known family member of the decedent that was not estranged from the decedent is: Theresa Conniff 21 Railroad Street Locust Gap, PA 17840 n ~.~ C ~ rv ~,~ Z~ r~ `~1 4 ~,% ~~ W _.~; 4 C7 ~.-~' --r-i _~ ~ l1? _ ~:_ C.~ ~..] L~ ~• \, CUMBERLAND COUNTY ~E~i'~~~ & COMMUNITY SERVICES LL~G9 Q~~ ~ ~ A~1 ~ I ~ ~! 2 ~~ CASUALTY UNIT/ One Team ...OneMirrion ~3TATE RECOVERY December 15, 2009 Ms. Barb Aschenbrenner Division of Third Party Liability Estate Recovery Program P O Box 8486 Harrisburg, PA 17105-8486 Dear Ms. Aschenbrenner: 16 WEST HIGH STREET, SUITE 100 CARLISLE, Pr1 17013 (717) 240-6110 OR 1-888-697-0371 EXT 6110 FAX: (717) 240-6118 Gary Eichelberger Chairman Richard L. Rovegno Vice Chairman Barbara B. Cross Secretary Terry L Barley Director The Cumberland County Aging and Community Services was the guardian of James F. Boylan, DOB10-6-32, James Boylan was a resident of Manor Care-Camp Hill nursing home and was on Medical Assistance from May 2008 until January 14, 2009. At that time he became private pay as a result of monies. returned to him in the form of restitution from a criminal case. His MA Record # was 21-0117692. His checking account has a balance of $13,758.78. His account is with the M&T and the number is 9846711183. The known outstanding• bills are as follows: Heartland Pharmacy, 7010 Snowdrift Rd, Allentown, Pa 18106 for $54.29 State Pension check for $498.57 does not appear to have been stopped or reversed. Closest known relative is a cousin, Theresa Conniff, 21 Railroad Street, Locust Gap, PA 17840. If you need any other information, please feel free to call me. Sincerely, ~` ~~~~ Janet Paull Aging Care Manager EMAIL US AT aging@ccpa.net OR VISTT OUR WEBSITE AT' www.ccpa.net/aging C X~~~ ~~f COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY CASUALTY UNIT P.O.BOX 8486 HARRISBURG, PA 17105-8488 January 21, 2010 THERESA CONNIFF 21 RAILROAD ST LOCUST GAP PA 17840 Re: JAMES BOYLAN CIS #: 840200963 Incident Date: 11/20/2009 Dear Ms. Conniff: :'~ ~. ,..':'f. :~ : ~~. :;:. C ~ P;;~ ~: L. ~~~~~TS~~, , .~ ~ r... , . y` !~ ~, We were recently notified that you are the closest known relative of the decedent. Enclosed is our standard subrogation letter and the statement of.' claim listing medical expenses paid on behalf of the decedent. The only known asset is a checking account. If you are willing to become executor of~ the estate, you would be entitled to an executor's fee of somewhere between $650 - $700 plus reimbursement for any estate costs you would pay out-of-pocket. The remaining balance in the checking account would be payable to the Department of Public Welfare. If you are not willing to handle this estate, we will hire an attorney to handle it on the Department's behalf. In this case, you would not receive any payment. Please advise in writing as to how you wish to proceed. Feel free to call me if you have any questions. Sincerely, t ~~~ ,. Barbara I. Aschenbrenner TPL Program Investigator /~.~ p ~ 717-772-6617 ~ ,/ ~ ~r~`~s~i-~ ~/~ 717 - 7 7 2 - 65 5 3 FAX ~ ~(!•, s ~, i ~- G~ ~~p~ ~~~ ' ~~ ~~ ~~ -,~e1-_ ~/~~ ~ ~~ ~ J` C~~~m/ ~ ~ ~~~ Coyne & Coyne Lisa Marie Coyne 3901 Market Street Camp Hill, PA 17011-4227 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ,~~. PO BOX 8486 ~ ;~ , u /S HARRISBURG, PA 17105 % . ~ ~\ ~G ~; / ^ /I ~~ ~ / %!` / February 12 , 2 010 ~i F v v ~,. ~,~~ r ~~ a~ FB1~~ v~s~ O,O/~~ RE: JAMES BOYLAN CIS: 840200963 SSN: 206-26-7803 DOD: 11/20/2009 COUNTY: CUMBERLAND Dear Ms. Coyne: The Department of Public Welfare is responsible for the implementation and operation of Pennsylvania's Medical Assistance Estate Recovery Program. (62 P.S. §1412.) The Medical Assistance Estate Recovery Program is a federally-mandated program requiring recovery of Medical Assistance payments from the estates of deceased individuals age 55 and older who received nursing home care, home and community-based services or related hospital and prescription drug services on or after August 15, 1994. To facilitate the operation of the Program, the Department must recover Medical Assistance payments from estates that remain unadministered throughout the Commonwealth. The Department's regulations authorize the Department to refer these cases for administration to attorneys who practice in this area. Such a referral does not create an attorney-client relationship with the Department and you may not file legal papers as the Commonwealth's attorney. However, you are authorized to seek appointment as the personal representative of the estate pursuant to 20 Pa. C.S. 3155(b)(5) as our nominee. In a previous conversation with you, you have agreed to assist in administering estates for the Department. We are forwarding you an unadministered estate with all the attached information we have in our file. If, after reviewing this file, you determine that you do not wish to handle this estate, please return the entire file to me. A reasonable administrator's commission and an attorney's fee may be charged to the estate as administration expenses, but may not exceed a combined fee of $1,000, or 6g of the gross assets of the estate, whichever is greater. The Department will require an itemization of your fee and your administrative costs for our records. ~~ ~x ~.~~~ You may receive additional estate referrals in the future from the Department. If you do not wish to receive future referrals, kindly notify the Department. Thank you for your attention and cooperation with the Department in this matter. If you have any questions, please do not hesitate to contact me. Sincerely, Barbara Aschenbrenner TPL Investigator 717-772-6617 717-772-6553 FAX Enclosure