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HomeMy WebLinkAbout01-23-13IN RE: ESTATE OF MARY E. MENTZER :ORPHANS' COURT DIVISION LATE OF BOROUGH OF CARLISLE :COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA NO. 21-12-0269 a ~~~ -~• _ ~ ~ ~. PETITION FOR SETTLEMENT OF A SMALL EST `" ~ ° ~~ PURSUANT TO 20 Pa.C.S.A. SECTION 3102 ~: ~ `~P ' ~ ' ~~~~' ; ,' ... ti.- ._ _ ~_ TO: THE HONORABLE JUDGES OF SAID COURT: ~ - -} ~, ... 6 __.., ` ~ t The Petition of Barbara A. Ickes respectfully represents that: a- ~ , , ~.. 1. Mary E. Mentzer died on January 31, 2012, a resident of the Borough of Carlisle, Cumberland County, Pennsylvania. 2. Petitioner, Barbara A. Ickes, whose address is 704 West Penn Street, Carlisle, Pennsylvania, 17013, is the Executrix of Decedent's Estate. 3. A Certificate of Grant of Letters Testamentary was issued to Petitioner by the Register of Wills of Cumberland County Pennsylvania, on March 1, 2012. 4. Decedent died with a Last Will and Testament dated May 24, 2007. 5. Decedent's Last Will and Testament provides that Petitioner, along with her siblings, Robert L. Mentzer and Martha K. Stake, are the sole heirs of Decedent's estate, with the Decedent's Last Will and Testament intending to have the residue of the Estate divided equally among the three of them. 6. At the time of Decedent's death, the only assets of which she was seized, and assets received by the estate after decedent's passing, were the following: (A) F&M Trust $7,367.17 Checking Account No. XXX5438 (B) F&M Trust Irrevocable burial account $8,479.77 r~ Certificate of Deposit No. XXXX9080 (C) Everence Financial $ 95.83 Health insurance premium refund TOTAL $15,942.76 7. The F&M Trust Irrevocable Burial Account referenced abo ve was paid directly to the Thomas L. Geisel Funeral Home, Inc., the funeral home handling the services for the Decedent. 8. The assets or funds available to the Petitioner in the Deced ent's Estate for use for payment of fees and expenses, therefore, totaled $7,462.99. 9. Petitioner has paid from the limited estate assets, the following debts associated with administration of the estate: (A) Probate fees paid and anticipated $ 141.50 (B) Attorney's fees to Griffie and Associates $2,000.00 (C} Personal Representative's Commission to Barbara A. Ickes $1,500.00 (D) Thomas L. Geisel Funeral Home $ 519.63 (Balance of funeral home expenses) (E) Salem Cemetery Association (grave opening) $ 500.00 (F) Pastor's fee $ 125.00 (G} Cumberland Law Journal (Advertising) $ 75.00 (H) The Sentinel (Advertising) $ 189.54 TOTAL $5,050.67 10. As such, Petitioner has paid all known debts associated with the administration of the estate from the limited estate assets. 11. After payment of all debts associated with the administration of the estate, Petitioner has $2,412.32 remaining from the estate assets. 12. The Commonwealth of Pennsylvania, Department of Public Welfare, has a claim against the estate for medical expenses and Medicaid expenses in the amount of $27,688.25, as evidenced by Exhibit "A", which is attached hereto and incorporated herein by reference. 13. Petitioner, after proper advertising of the Estate, and after serving as Power of Attorney for Decedent before Decedent's death, is not aware of any additional indebtedness of the Decedent. 14. Petitioner has proposed to the Department of Public Welfare that the remaining estate asset of $2,412.32 be distributed to the Commonwealth of Pennsylvania to satisfy the claim set forth in paragraph 12. 15. Despite corresponding with the Department of Public Welfare, Third Party Liability Recovery Section, on July 9, 2012, making this proposal, and no response was received from the Department. 16. Despite corresponding with the Department of Public Welfare, Third Party Liability Recovery Section, by correspondence dated October 17, 2012, which was forwarded by certified mail and received by the Department on October 22, 2012, the Department has failed and refused to respond to Petitioner's offer of settlement. 17. By correspondence dated December 4, 2012, Petitioner, through counsel, has provided a copy of the within Petition to the Department of Public Welfare, Third Party Liability Section, indicating that upon notification of the date of receipt of that correspondence which includes a copy of this Petition, which documents were sent by certified mail, Petitioner will wait an additional thirty (30) days and then file the within Petition. 18. A copy of the original certified mail sent on October 17, 2012, which was received by the Department on October 22, 2012, it attached hereto and incorporated herein by reference as Exhibit "B," along with the certified mail card evidencing receipt. 19. A copy of the certified mail card evidencing receipt of the correspondence dated December 4, 2012 and a copy of this letter were forwarded by counsel for Petitioner evidencing receipt of documents on December ~, 2012 by the Department of Revenue is attached hereto and incorporated herein by reference as Exhibit "C." 20. As the Department of Public Welfare has refused to respond to the correspondence of counsel requesting cooperation in settling the Department's claim, it is appropriate under the Pennsylvania law for the court to approve the request of the Petition herein requiring the Department of Public Welfare to accept disbursement of the sum of $2,412.32 as payment in full satisfaction of the Department's claim, pursuant to ~5 Pa. Code §258.8. 21. There are no assets of Decedent nor of the Decedent's estate from which any additional distributions can be made and, as the estate debts exceeded the estate assets, this is an insolvent estate. 22. There are no additional claimants or creditors of whom the Petitioner has knowledge who have not received full compensation other than the Commonwealth of Pennsylvania, Department of Public Welfare, as hereinbefore described. 23. As this is an insolvent estate, no Pennsylvania Inheritance Tax Return was due, but an Inheritance Tax Return was filed and has been confirmed as per the Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax which is attached hereto and incorporated herein as Exhibit «D» 24. Notice of the intent to file this Petition was given by certified mail, return receipt requested, with a copy of this Petition, to the Commonwealth of Pennsylvania, Department of Public Welfare, Third Party Liability Recovery Section, more than forty-five (45) days prior to filing of the Petition. WHEREFORE, Petitioner requests your Honorable Court to approve settlement of this estate with payment of debts associated with administration of the estate as noted in paragraph 9, with payment of $2,412.32 to the Commonwealth of Pennsylvania, Department of Public Welfare, in full satisfaction of its claim as described in paragraph 13 and with no disbursements to the named heirs. Respectfully submitted, Br le . Grif e, Esquire ey fog etitioneN Attorney ID#34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717)243-5551 ~~'~ pennsyLvania ~i DEPARTMENT OF PUBLIC WELFARE April 17, 2012 GRIFFIE & ASSOCIATES BRADLEY L GRIFFIE ESQUIRE 200 N HANOVER ST CARLISLE PA 17013 Re: Mary Mentzer CIS # : 820311071 SSN: ###-##-2084 Date of Death : 01/31/2012 Dear Attorney Griffie: Please be advised that the Department of Public Welfare maintains a claim in the amount of $27.688.25 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 $27,688.25, 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 .00, 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, ~`~ , ~~ . ~~ ~~~ ~ 1~~~~~~~ ~. Angela D. Carter Claims Investigation Agent 717-772-6612 717-772-6553 FAX Enclosure J Q W J W Q F- J J Q Bureau of Program Integrity (Division of Third Party Liability ~ Recovery Section PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486 ^ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^-Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Address,/e~d to: ~~~ _0 - Q~~~SIcTn c~-~-)fi~r~~ ~c~cl~~ U J Pp Qua ~ ~~~ ,r~ ~~ ~ /~~ ~ 7/~ ~ 2. Article Number (Transfer from service label - A. Signature X ^ Agent • ^ Addressee B eceitved~b~y (~ir~c{;p~-+~ C. Date of Delivery !!~_ J1'~~991iIJ~~~J~iVVl111 ~T 2 2 2 D. Is delivery address different from item 1? ^ Yes If YES, enter delivery address below: ^ No 3. S rvice Type ertified Mail ^ F~cpress Mail Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 707 X220 ~~~2 2526 6445 PS Form 3811, August 2001 Domestic Return Receipt J Q W J W Q H J J Q 102595-02-M-1540 ^ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: i 'i ~ ~ ~ ~1n.-~ Q ~l ~ S L~ o~.~- ~i~~1 P.©. ~~x ~3~~ to ~{ar riS 1~u Q~ ~ `~ D l 5 ~'~ ~ y 2. Article Number 7 0 0 7 (Transfer from service labeq ~__ __~ . PS Form 3811, August 2001 Domestic Return Receipt A. Signature X ^ Agent ~ ^ Addressee B eiv~~y ((P~r~t~mo)_ ~ C. Date of Delivery D. Is delivery address different fro 1 If YES, enter delivery address below: ^ No 3. Service Type Certified Mail ^ Express Mail ^ Registered ~ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 0220 0002 2522 8603 Q W J W Q H J J Q 102595-02-M-1540 NOTICE OF INHERITANCE 'TAX pennsylvan~a ~ ~ APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES _ INHERITANCE TAX DIVISION ^F DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-08-2012 ESTATE OF MENTZER MARY DATE OF DEATH 01-31-2012 FILE NUMBER 21 12-0269 COUNTY CUMBERLAND BRADLEY L GRIFFIE ACN 101 200 N HANOVER ST APPEAL DATE: 12-07-2012 C A R L I S L E P A 17 013 - 2 4 2 3 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --) RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP C12-11~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE 0F: MENTZER MARY - FItE N0.:21 12-'D 269 ACN: 101 DATE: 10=08-2012 '° TAX RETURN WAS: C)O ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) ~ .0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) C2) .0 0 credit to your account, .0 0 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) C3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) •0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 7,4 6 2.9 9 6. Jointly Owned Property (Schedule F) C6) .0 0 7. Transfers (Schedule G) C7) .0 0 8. Total Assets C8) 7 , 462.99 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) Cg). 5,5 5 0.6 7 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 27,688.25 C11) 33,238.92 11. Total Deductions C12) 25, 775. 93- 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Tr usts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax C14) 25,775.93- 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. ASSESS MENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 04 5 = .0 0 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 .0 D 18. Amount .of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0 19. Principal Tax Due C19)= .0 0 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 W BALANCE OF TAX DUE .00 'INTEREST AND PEN. .00 a TOTAL DUE .00 IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS. VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relatinb to unsworn falsification to authorities. DATE: BARBARA A. ICKES IN RE: ESTATE OF MARY E. MEI~TTZER LATE OF BOROUGH OF CARLISLE ORPHANS' COURT DIVISION COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA NO. 21-12-0269 CERTIFICATE OF SERVICE ..;R~ I, Bradley L. Griffie, Esquire hereby certify that I did, the =~ day of December, 2012, cause a copy of the within Petition for Settlement of Small Estate to be served upon the Department of Public Welfare, Estate Recovery Program by certified mail, return receipt requested, at the following address: Angela D. Carter, Claims Investigation Agent Department of Public Welfare Bureau of Program Integrity Division Estate Recovery Program PO Box 8486 Harrisburg, PA 1710-8486 And by regular mail to the named heirs of the estate at the following addresses: Martha K. Stake Robert L. Mentzer 18 Carter Place 1884 Leafmore Road Carlisle, PA 17013 Chambersburg, PA 17202 ~~ DATE: ~ ~.. .3 1=~ ri e, Esquire net Petitioner Attorney ID# 34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717)243-551 (800)347-552