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DECEDENT'S ESTATE ~fi~; ~, ~ `~ ~~ x ' ~~
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COURT OF COMMON PLEAS OF ~ ~ .. ~ ~ - ~_
~.y, r,,,~nts~r~~ COUNTY, PENNSYLVANIA - .
ORPHANS' COURT DIVISION
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ESTATE OF ~ ~ `
v~ ~- ~ ,DECEASED
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:
~~ ~~
Supreme Court I.D. No.: ~~ ~[ ZZ,~i
Name of Law Firm: ~ ~
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Address:~~.~ /~I . I ~ _-~ ~-t- - -~~~ `~~~.r.-. ~ ~~ ~ l ~. ,., ~ 1~? . ~ _
Telephone: ~- .- ` ~ ~ ~
Fax: ~1~~-~ ,\
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Form OC-01 rev. 10.13.06
Page 1 of 10
Estate of `
~ `` ~~ ~- ,Deceased
1. Name(s) and address(es) of Petitioner(s):
Name: ~~l
Address: ~ o~~ ~~ , (~~~-
`.
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? ,,,,,,,, , , , , , , , , , , , , , ,, -~7 Yes ^ No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on ~ ~..~ ~ 1
'Letters Testamentary or ^ Letters of Administration were granted to Petitioner(s) on
Date of Will (f applicable): [ ~ > > - -~
Date(s) of Codicil(s) (f applicable): ~'' ~' ~~ ~~ ~~ ~~. ., ~~ c~~ ~_
Date of probate (if different from date Letters granted): ~~ /~
Was a bond required? ^ Yes l~ No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... ^ Yes ~10
Dates of advertising of the grant of Letters: ~ ~ ~.~ ~~ ;~,/~ ~ I
Form OC-01 rev. 10.13.06 Page 2 of 10
Estate of ~'( ~~ ~ ~~~ _ ,Deceased
3. Was decedent survived by a spouse? ............................. ^ Yes ~io
If yes, name of the surviving spouse: fit`/~~
4. Has the surviving spouse filed to take an elective share? ............. ^ Yes ^ No
(See Section 2201 et sue, 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 (rf none, so state):
~~,
6. Did decedent marry after execution of Will or Codicil(s)? ............ ^ Yes ~10
Were any children born to decedent after execution of
Will or Codicil(s)? ........................................... ^ Yes ~'~lo
If yes, give names and dates of birth:
Name:
f~v~
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 ~(.. ~^ y~~ 4~ ~ ~~ 1s~ L ,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 ju~is (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):
Name and Address of Each Parry in Interest
and Comments,
Interest
~ ~
~.~~~~~~
Form OC-01 rev. 10.13.06 Page 4 of 10
Estate of J ~~, ~~~ `~~' cr, ~ ~ i`~,~ ,Deceased
C~o,~~
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).
~`~/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.
r,r/A
Form oc-o] rev. ]0.13.06 Page 5 of 10
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.
Estate of ~. ~ :~ ~ E'_ ~ ~ ~ ,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.
C~t~ e . `
~ ~ L ~ i ~Yr~ ~~~ ' ~~ ~~?~
Name and Address of Each Claimant Amount of Claim Claim Will Claim
Admitted? Be Paid In
Full?
^ Yes ^ Yes
^ No ^ No
^ 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.
1 1. Was family exemption claimed? ................................ ^ Yes ~10
Was family exemption allowed? ................................ ^ Yes ~o
Family exemption claimant's name and relationship:
Name:
Relationship:
Form oc-nl rev. 10.13.06 Page 6 of 10
Estate of ~_ ,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
-~ ,~
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 ~Idl~o
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:
~i~ ~
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-01 rev. 10.13.06 Page 7 of 10
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Estate of ~ ~~ ,Deceased
16. Had the decedent been adjudicated an incapacitated person? .......... ^ Yes L-d'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 separate list of additional receif~ts and disbursements since the closing
date of the Account.
lY
B. Has notice of the additional receipts and disbur:>ements 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 nc-tice of the j
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 G~'No
As to real estate only? ........................................ ^ Yes ~'No
Form OC-01 rev. 10.13.06 Page 8 of 10
r
Estate of c~'y ~ ~ ~ `) ~ ,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(s) Amount/Proportion
A ~
1 ~ ^ ~ ~ ~, ~ ~ ~~ 1 V~ ~ Lt ~ V~~t
B. Principal:
Proposed Distributee(s) Amount/Proportion
Submitted By:
(All petitioner r~s~ ign. ~ ,
Add additional lines if necessary):
~M _1 ~ ~ ~
Name of Petitioner:
Name of Petitioner:
Form OC-01 rev. 10.13.06 Page 9 of 10
t ~
Estate of L ~ - ~ c~JL ,Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that he~she ,~ r~ is ~~tre .~
of the above-named name of corpora~~~'~~'~- ~,j-- '~~~ f~~i/`,j( 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.
Signature of ounsel for Petitioner
Form OC-01 rev. 10.13.06 Page 10 of 10
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~= IN RE: ) IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF MARY SUE DICK, )
Deceased ) ESTATE N0. 21-11-1048
FIRST AND FINAL ACCOUNT
OF DONALD R. HOWE, CO-EXECUTOR, AND
PENNY ARCHER, CO-EXECUTRIX
FOR THE PERIOD
26 SEPTEMBER 2011 TO 31 DECEMBER 2012
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Date of Death: 26 September 2011
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I Date of Receipt of Funds by personal representatives: 5 October 2011
Letters granted to personal representatives: 5 October 2011
l Date of notice to heirs: 1 November 2011 ~
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Date of Advertising:
Cumberland Law Journal 9, 16, and 23 December 2011
~,~ Carlisle Sentinel 1, 8, and 15 December 2011
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'~ Accounting for period 26 September 2011 to 31 December 2012
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~° Purpose of Account: The personal representatives offer this Account to acquaint interested parties with
~~
the transactions that have occurred during the administration of the above estate.
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It is important that the Account be carefully examined. Requests for additional information, questions,
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or objections can be discussed with: ~' __:~. ~` ; ;
a..i ..~ .. ... v
Samuel L. Andes ~ i i,,~ ~~ ~~
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Attorney-at-Law ~ ~ ~ ~ °M1
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525 North 12th Street
P.O. Box 168 _,,; :-:
Lemoyne, PA 17043 ~ ~-. ; , e'
(717) 761-5361 ~ ~~ .~ r ,:,a ~:,b
{ Supreme Court ID 17225 '~~~' ~.~
4
IN RE:
ESTATE OF MARY SUE DICK,
Deceased
) IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-11-1048
FIRST AND FINAL ACCOUNT
OF DONALD R. HOWE. CO-EXECUTOR. AND
PENNY ARCHER, CO-EXECUTRIX
FOR THE PERIOD
25 SEPTEMBER 2011 TO 31 DECEMBER 2012
~,
j SUMMARY OF ACCOUNT
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I. Principal and Income Received:
is
~' I (A) Tota{ Capital Receipts
~,
I (B) Total Income Generated by Assets
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Total Received:
II. Disbursements Made:
;;
I! (A) Funeral Expenses
,,
II (B) Debts Paid
!~ !I (C) Administrative Expenses
~;
11 (D) Specific Devises
Total Disbursements
Page 3 $1,882,556.68
Page 3 $22,970.38
Page 3-4 $1,630.04
Page 4 $615.23
Page 4-5 $615,743.08
Page 5 $114,999.99
$1,905,527.06
732 988.34
Balance Left For Distribution: $1,172,538.72
I. PRINCIPAL AND INCOME RECEIPTS
A. Total Capital Receipts
The accountants charge themselves with receipt of the following assets valued as of the date of death:
Balance in Smith Barney Investment Account at date of death: $1,746,273.52
Metro Bank Checking Account Balance at date of death $30,011.38
One-half of balance in joint checking account (with Donald $15,564.14
Howe) at Metro Bank at date of death:
Death benefit paid by Aviva Annuity $85,811.14
Country Meadows Flome refund $2,817.30
Met Life stock proceeds (less tax) $1,826.00
Erie Insurance (renters policy refund) $57.00
?_010 income tax refund 196.20
Total $1,882,556.68
B. Income generated by assets during probate:
Total increase in value of portfolio during probate $32,645.05
LESS: Decline in value of portfolio during probate ($9,677.25)
Interest earned on cash funds held in bank 2.58
Tota! net gain on investments during probate $22,970.38
II. DEBTS AND EXPENSES:
The accountants paid the following expenses and debts during the administration of the estate:
A. Expenses related to funeral and burial:
Dealers Florist $366.60
Comfort Inn guest rooms $724.19
Pastoral fee for memorial service $200.00
Travel expenses for attendees $300.00
Chesterfield Inn -reception food 39.25
Tota I
B. Debts owed by decedent paid during probate:
Capital Self-Storage $69.96
Donald Howe and Samuel L. Andes (fees for power of attorney $45C.00
documents)
Continuing care (medical prescriptions) $6.70
Mobile X-Ray Imaging $41.94
Azizkhan Internal Medicine $17.90
Pinnacle Health (emergency room care) 28.73
Tota!
C. Estate Administration Expenses:
fees and commissions paid for liquidation and management of $39,754.19
Smith Barney account
PA Department of Revenue -inheritance tax (less discount for $458,285.88
early deposit)
Cumberland County Register ofWills -probate fee $1,818.50
Postage for Aviva Annuity claim $7.12
Postage for Met Life claim $5.79
Mumma Jewelers (jewelry appraisal) $100.00
PA Department of Revenue (2011 income tax for credit shelter $338.00
trust)
PA Department of Revenue (2011 personal income tax for $264.00
decedent)
PA Department of Revenue (fiduciary income tax for estate) $310.00
U.S. Treasury (fiduciary income tax for estate) $264.00
Michael Cox, CPA -tax preparation and accounting fees $3,100.00
$1,630,04
$615.23
Donald Howe -purchase of calculator $37.93
Harlan Clark -purchase of checks $39.54
Michael Cox, CPA -accountant's fees for final tax returns $2,500.00
Interest paid on inheritance tax $133.19
Samuel L. Andes -attorney's fees $35,500.00
Donald R. Howe -executor's fee $38,000.00
Penny Archer -executrix's fee $33,000.00
Register ofWills -final accounting fee and advertising $1,030.00
Alphagraphics -photocopy expense $600.00
U.S. Postal Service -postage for mailing account $600.00
U.S. Pcst Office -postage to deliver jewelry items 54.94
Tota
D. Specific Devises:
Pamela Middleton $5,000.00
Barbara Egerman $21,666.67
Lois Rich $21,666.67
Evan Dick $555.55
Olive Dick $555.55
Ivy Dick $555.55
Gisela Dick $20,000.00
Lawrence Howard $20,000.00
Willa Kravitz $20,000.00
Julia and Joseph Hallman ~5,000.0~
$615,743,0$
Tota I $114,999.99
RECAPITULATION
I. PRINCIPAL AND INCOME j
A. TOTAL CAPITAL RECEIPTS $1,882,556.68
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i
B. TOTAL INCOME 22 970.38
TOTAL RECEIVED: $1,905,527.00
II. DISBURSEMENTS
A. FUNERAL EXPENSES $1,630.04
B. DEBTS $615.23
C. ADMINISTRATIVE EXPENSES $615,743.08
D. SPECIFIC DEVISES $114,999.99
TOTAL DISBURSED; 732 988.34
BALANCE LEFT FOR DISTRIBUTION $1,172,538.72
VERIFICATION
Donald R. Howe, Co-Executor of the Will of Mary Sue Dick, Deceased, hereby declares under oath that he
ar.d the co-executrix, Penny Archer, have 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 known claims against the estate have been paid in full, that to his knowledge there
are no claims outstanding against the Estate, that all taxes presently due from the Estate have been paid, anal
that the grant of Letters Testamentary and the first complete advertisement thereof occurred more than four
months before the filing of the foregoing First and Final Account.
The undersigned further verifies that the Grant of Letters and the first complete advertisement thereof
occurred more than four months before the filing of this Account.
This statement is made sub;,ect to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn
falsification to authorities.
Dated: ~ -'~-.`? .. P "~ ~e~ ''r ~>~~_.-~'':, _
Donald R. Howe
IN RE:
ESTATE OF MARY SUE DICK,
Deceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-11-1048
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PROPOSED SCHEDULE OF DISTRIBUTION ~ ~ ~;'
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The accountant proposes the final distribution of t -,
he estate assets as follows:
Distributee
Percentage of
Amount ,
Net Estate - -= ~`~'
Mildred Howard 10% $117,253.87
Lawrence Howard 4% $46,901.55
Willa Kravitz 4% $46,901.55
Lois Rich 4% $46,901.55
Gisella Dick 4% $46,901.55
Barbara Egerman 4% $46,901.55
Madeleine Nicklin 2% $23,450.77
Jane Piepes 2% $23,450.77
Linda Griesemer 9% $105,528.48
Brenda Weiler 9% $105,528.48
Marie Smith 4% $46,901.55
Anita J. Winkler (from Marilyn Kocher, deceased) 1% $11,725.39
Michelle Siverly (from Marilyn Kocher, deceased) 1% $11,725.39
Ivan Kocher (from Marilyn Kocher, deceased) 1% $11,725.39
James Kocher (from Marilyn Kocher, deceased) 1% $11,725.39
Elizabeth Archer-Myers 2% $23,450.77
Jeffrey Archer 2% $23,450.77
Michael Howe 2% $23,450.77
Laurie Thompson 2% $23,450.77
Penny Archer 14% $164,155.42
Donald Howe 14% $164,155.43
Dana Freeman 1% $11,725.39
Vanessa Howard 1% $11,725.39
David Kravitz 1% $11,725.39
Heather Doyle 1% $11,725.39
Total Distribution: $1,172,538.72
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"~ IN RE: ) IN THE COURT OF COMMON PLEAS OF
?;3
i
CUMBERLAND COUNTY, PENNSYLVANIA
;~ ESTATE OF MARY SUE DICK, )
Deceased ) ESTATE NO. 21-11-1048
CERTIFICATE OF SERVICE
'f The undersigned, as counsel for the personal representatives of the above estate, hereby
certifies that he served a copy of the attached notice, with a copy of the First and Final Account and the
s
proposed Schedule of Distribution, on the parties listed on Schedule A which is attached hereto and
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made a part hereof, by depositing the same into the U.S. Mail, first-class postage prepaid, addressed as
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'P listed on Schedule A, on ,30 ~"/~N~tla,Qy 2013.
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Samuel L. Andes I
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Attorney for Personal Representatives ~
525 North 12~~ Street j
~~ Lemoyne, PA 17043 ~~
(717) 761-5361
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IN RE: ) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF MARY SUE DICK, )
Deceased ) ESTATE N0. 21-11-1048
NOTICE TO PARTIES IN INTEREST
TO: HEIRS, BENEFICIARIES, AND OTHER PARTIES HAVING AN INTEREST IN THE ABOVE ESTATE:
You are hereby notified that Donald R. Howe and Penny Archer, co-executor and co-executrix of
the Estate of Mary Sue Dick, deceased, have filed their First and Final Account for the estate, in which
they have listed the assets and income received during the administration of the estate, the
administrative and other expenses paid, including taxes, the debts of the decedent, and the previous
distributions to specific devisees. A copy of that First and Final Account is attached to this notice.
You are further notified that the said Donald R. Howe and Penny Archer are prepared to make
final distribution from the estate in accordance with the proposed Schedule of Distribution, a copy of
which is also attached to this notice.
The Account is scheduled for confirmation by the Court of Common Pleas of Cumberland
County, Pennsylvania, at 10 a.m. on Friday, 5 March 2013, at the Cumberland County Court House, in
Carlisle, Pennsylvania.
Any party wishing to file objections to the Account must do so by filing those objections with the
court five (5) days prior to the call of the Account for confirmation on 5 March 2013.
It is anticipated that final distribution to the beneficiaries of the estate will be made ~,vithin
twenty (20) days after the Account is confirmed.
If you have any questions about the Account, the proposed Schedule of Distribution, or any
other matter relating to the estate, please contact the undersigned.
.-~
Dated: ~~ ~ a•, ~ ~~j
Samuel L. Andes
Attorney for Personal Representatives
525 North 12th Street
Lemoyne, PA 17043
(717) 761-5361