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ESTATE OF
DECEDENT'S ESTATE
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CUMBERLAND COUNTY, PENNSYLVANIA , _
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ORPHANS' COURT DIVISION c~.~
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Michael D. Politzer-Hardy ,DECEASED `~
No. 21-12-0377
PETITION FOR ADJUDICATION /
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. RULE 6.9
This form maybe used in all cases involving the Audit of the Account of a Decedent's Estate. If
space is insufficient, riders maybe 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:
Bradley L Griffie
34349
Griffie 8~ Associates, P.C.
200 North Hanover Street
Carlisle, PA 17013
Telephone: 717-243-5551
Fax:
E-mail: bgriffie@griffielaw.com
Form OC-O1 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. P89B 1 Of 'I O
Estate of Michael D. Politzer-Hardy ,Deceased
1. Names} and address(es) of Petitioner(s):
Mame: Geneva PolitZer
Address: d9 Kanwnnrl Ovanua
Carlisle, PA 17013
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and Account and state reason:
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 02/17/2012
^Letters Testamentary or
0 312 912 0 1 2
® Letters of Administration were granted to Petitioner(s) on
Date of Will (rf applicable):
Date(s) of Codicil(s) (rf applicable):
Date of probate (if different from date Letters granted):
Was a bond required? ^Yes ®IVo If yes, state amount:
Are proofs of advertising of the grant of Letters attached? .......................................... ®Yes ^ No
Dates of advertising of the grant of Letters:
04/1312012 04/20/2012 04/27/2012
04/06/2012 04/13/2012 04/20/2012
Form OC-O1 Rev. 10.13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page Z Of 'I O
Estate of Michael D. Politzer-Hardy ,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? .........................
(,egg Section 2201 gt egg. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
^ Yes ^ No
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):
6. Did the decedent marry after execution of Will or Codicil(s)?.......
Were any children born to decedent after execution of
Will or Codicil(s)? ........................................................
If yes, give names and dates of birth:
Name:
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
^ Yes ® No
Date of Birth:
® Yes ~ No
Form OC-O1 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 3 OT 'I O
Estate of Michael D. Politrer-Hardy ,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):
in
Politrer, Geneva
42 Kenwood Avenue
Carlisle, PA 17013
Mother
100% of net
distributable estate
Form ~C-~~ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Pege 4 Of 1 O
Estate of Michael D. Politzer-Hardy ,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 GuardianlTrustee Ad Litem has or has not been filed for
this Audit (~ PA. O. C. Rule 12.4).
NIA
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
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Estate of Michael D. Politzer-Hardy ,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
A milted? Wll Claim
8e Paid in
Full.
Above
Attachment
Total
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?
Family exemption claimant's name and relationship:
Name: Geneva Politzer Relationship: Mother
® Yes ^ No
Form OC-O1 Rev. 10.13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 6 Of 1 O
Estate of Michael D. Politrer-Hardy ,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
04/2712012
Payment Interest
1,200.00
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 ~ 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:
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? ............................................................ ® Yes ^ No
15. 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-O1 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, inc. Page 7 of 10
Estate of Michael D. Politzer-Hardy ,Deceased
16. Had the decedent been adjudicated an incapacitated person? ........................................... ^Yes ® No
If yes, attach a copy of the Order if available; otherwise state Court, term, number,
date, and name of Hearing Judge.
17. A. List or attach a separate list of additional receipts and disbursements since the closing
date of the Account.
Date Description Amount
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.
Amount:
Purpose:
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? ................................................................................ ^Yes ® No
As to real estate only? ......................................................................................................... ^Yes ^ No
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Estate of Michael D. Politzer-Hardy ,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 DisMbutee(s)
Politzer, Geneva
B. Principal:
Proposed Distributee(s)
Politzer, Geneva
Amount Proportion
0~%
Amount Proportion
0~%
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
e of Petitioner: Geneva Politer
Name of Petitioner:
Name of Petitioner:
Form OC-01 Rev. 10.13-2006 Copyright (cj 2006 form software only The Lackner Group, Inc. Pege J Of 1 O
Estate of Michael D. Politzer-Hardy ,Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * ![that ne~sne ~is M~ fxz'~`~.+..1^u~
of the above-named name ofoorporation n~ ~ ~ , e ~,~~ ~ ,~„
antl] 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).
S~pature of Petitioner Geneva Politzer
Signature of Petitioner
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.
i
i C s or Petitioner
riffs
Form OC-O1 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 10 of 10
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:
Aril 13 A~ri120 and April 27 2012
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.
r
Li a Marie Coyne, Edi r
SWORN TO AND SUBSCRIBED before me this
27 of April, 2012
Polit:zer-Hardy, Michael D., deed. Notary
Late of South Middleton Town-
ship.
Administratrix: Geneva Politzer
c/o Bradley L. Griffie, Esquire,
Griffie & Associates, 200 North
Hanover Street, Carlisle, PA _
NOTARIAL SEA
17013, (717) 243-5551, (800) 347- DEBORAH A COLLINS
5552.
Attorneys: Bradley L. Griffie, Es-
i
t
.Notary Public
CUMBERLAND COUNTY
CARLISLE BOROUGH
es.
a
quire, Griffie 8s Assoc ,
My Commission Expires Apr 28, 2014
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Taclcie 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 13th, 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):
Apri16,13 & 20, 2012
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 character of publication
are
My commission expires:
before me this
NOTARIAL SEAL
BAMBI ANN HECKENDORN
Notary Public
CARLI5LE BOROUGH, CUMBERLAND CNTY
illy Commission Expires Jan 27, 2014
Notary Public
In re: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Michael D. Politzer-Hardy :ORPHAN'S COURT DIVISION
Late of South Middleton Township N0.2012-00377
Cumberland County, Pa., deceased PA N0.21-12-0377
n fi~
FIRST AND FINAL ~ r
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ACCOUNT OF ,
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Geneva Politzer, Executrix ~t~
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Estate of Michael D. Politzer-Hardy a `= ~
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late of South Middleton Township, Cumberland County ~ --, ~--
Pennsylvania, deceased n ~ `"
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CERTIFICATE OF CLERK
The above Account was filed on , 2012, last advertised April 27,
2012, according to law, and is presented herewith to the Court of Common Pleas, Cumberland
County, Pennsylvania, Orphans' Court Division for confirmation.
Date
Clerk
ORDER OF COURT
2012, no exceptions or objections having been filed to the account
or to the proposed schedule of distribution, the within account and schedule of distribution are
confirmed and distribution is directed in accordance with the schedule of distribution.
BY THE COURT,
J.
Date of Death: February 17, 2012
Gross value of estate: $25,502.64
Distribution amount of estate: $12,379.28
Last advertising: Apri127, 2012
1
- - _ ~~
In re: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Michael D. Politzer-Hardy :ORPHAN'S COURT DIVISION
Late of South Middleton Township N0.2012-00377
Cumberland County, Pa., deceased PA N0.21-12-0377
DATE OF DEATH: February 17, 2012
LETTERS GRANTED: March 29, 2012
FIRST COMPLETE ADVERTISEMENT Apri120, 2012
OF GRANT OF LETTERS
DISTRIBUTION OF ESTATE INCLUDED IN ACCOUNTING
DISTRIBUTION AMOUNT IS $12,379.28
GROSS VALUE OF ESTATE IS: $25,502.64
ACCOUNTING FOR THE PERIOD March 29, 2012 through November ~, 2012
Purpose of the Account: Geneva Politzer, Executrix, offers this accounting to acquaint interested
parties with the transactions that have occurred during her administration.
The Account also indicates the proposed distribution of the Estate.
It is important that the Account be carefully examined. Requests for additional information, questions
or objections can be discussed with:
Bradley L. Griffie, Esquire
Attorney for Petitioner
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
2
PRINCIPAL ASSETS RECEIVED
REAL ESTATE
None
STOCKS AND BONDS:
1. Oppenheimer Funds
Account No. 8394
83.316 shares @ $59.78/share
Subtotal
CASH AND BANK DEPOSITS:
1. F&M Trust Checking
Account No. X2800
Subtotal
JOINTLY_HELD PROPERTY
1. F&M Trust Checking
Account No. ~~1383
(1 /2 value)
Subtotal
PERSONAL PROPERTY AND VEHICLES•
None
INTER-VIVOS TRANSFERS:
None
$4,980.63
$ 19,757.15
$ 764.86
$ 4,980.63
$19,757.15
$ 764.86
3
ADDITIONAL RECEIPTS:
None
NON-PROBATE ASSETS:
None
GAINS AND LOSSES ON LIQUIDATIONS AND OTHER DISPOSITIONS•
GAINS:
1. Interest earned $ 1.26
F&M Trust Checking No. XXXX2800
Subtotal
LOSSES:
1. Oppenheimer Funds (-)$22.49
Loss from DOD
Subtotal
NET GAINS OR LOSSES ON LIQUIDATIONS
INTEREST ACCRUED ON ESTATE CHECKING ACCOUNT:
None
Subtotal $ .00
Total Principal of Estate with Adjustments
1.26
(-)$ 22.49
(-)$ 21.23
$ 25,481.41
4
DISBURSEMENTS OF PRINCIPAL
DEBTS OF DECEDENT:
1. Final fee to F&M Trust as Trustee $ 878.25
2. Legal fees to Griffie & Associates (Estate Planning) 330.00
3. ATG Rehab Mid-Atlantic (medical) 262.50
Subtotal $ 1,470.75
FUNERAL EXPENSES:
1. Hoffinan Roth Funeral Home, Inc. $ 2,024.72
Subtotal $ 2,024.72
ADMINISTRATIVE EXPENSES AND COSTS:
1. Attorney's fees to Griffie & Associates $ 3,000.00
2. Probate fees 265.50
3. Advertising-Cumberland Law Journal 75.00
4. Advertising-The Sentinel 189.54
5. Personal Representative Commission (Geneva Politzer) 1,500.00
6. Family Exemption 3,500.00
7. Vital Records 45.00
Subtotal $ 8,575.04
TAXES:
Pennsylvania Inheritance Tax $ 552.85
Discount (- 29.10
Subtotal $ 581.95
Total Disbursement of Principal $12,652.46
5
PRIOR IN KIND DISTRIBUTIONS AND NON-PROBATE ASSETS DISTRIBUTED
None
INTERIM DISTRIBUTIONS
None
Total Principal of Estate with Adjustments $25,481.41
Less Disbursements of Principal - $12,652.46
TOTAL $12,828.95
NET ASSETS/PROCEEDS AVAILABLE FOR DISTRIBUTION
TOTAL $12,828.95
PROPOSED DISTRIBUTIONS TO TESTAMENTARY BENEFICIARIES
AFTER ACCOUNT CONFIRMATION
Geneva Politzer $12,828.25
Total Share of Distribution 100%
TOTAL PROPOSED DISTRIBUTION OF
PRINCIPAL AND INCOME: $12,828.25
6
Geneva Politzer, Executrix of the Estate of Michael D. Politzer-Hardy, deceased, hereby declares
under oath that she has fully and faithfully discharged the duties of her office; that the foregoing
First and Final Account and Schedule of Distribution is true and correct and fully discloses all
significant transactions occurring during the accounting period, that all known claims against the
Estate have been paid in full, that, to her knowledge, there are no claims now outstanding against
the Estate; and that all taxes presently due from the Estate have been paid.
Sworn and subscribed to before me
this day of p~~y.~,~~ , 2012
~~.~~ ~,~
e va Politzer, E ecutrix
NOTARIAL SEAL
ROBIN.I. BASSi:TT, Notary PubNc
CARLISLE BOROUGH, CUMBERLAND CO.
Commission Expires Apr.17, 2015
I hereby certify that written notice of the filing of this Account, and of the date, time and place
when the same will be presented to the Court for confirmation and of the last day to file written
objections to said Account, has been given to every unpaid claimant and to every other person
known to the accountant to have or claim an interest in the estate as creditor, beneficiary, heir, or
next of kin.
7
J.