HomeMy WebLinkAbout03-01-13In Re: Estate of FREDA J. HARRY,
deceased
Late of N. Middleton Township
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Orphans' Court Division C,
No. ~ ~~ - p~~5
Petition for Settlement of Small Estate Pursuant to 20 Pa. Cons. Stat£~ ~° ~ rn
TO THE HONORABLE, THE JUDGES OF THE SAID COURT: m ~
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The petition of LESTER HOCKLEY respectfully states that: z ~' ~ ~' ~'
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1. Freda J. Har
ry ("Decedent") died intestate, on January 31, 2013i°a~eside n~ of ~e~:,
Claremont Nursing & Rehabilitation Center, in North Middleton Tow
asl`ilp, Cu mberlyd~
County, Pennsylvania. ~ ~ ~
2. The Petitioner is Lester Hockley, Decedent's brother, whose address is 89 McAllister
Church Road, Carlisle, PA.
3. Decedent's only other living heir is her sister, Mildred L. Baughman, of 269 W. Ridge
Street, Carlisle, PA. (Mildred L. Baughman's joinder and consent to this petition is
attached.)
4. Decedent was widowed and had no children.
5. No one is entitled to claim the Family Exemption.
6. Decedent's funeral was prepaid, and she had no private creditors at the time of her
death.
7. Decedent has no federal tax liability.
8. Decedent received Medical Assistance benefits and the Commonwealth of Pennsylvania
Department of Public Welfare has an acknowledged Class 3 claim for reimbursement of
benefits paid for medical costs during the final 6 months in the amount of $30,255, and
an acknowledged Class 5.1 claim for reimbursement of benefits in the amount of
$244,827.98.
9. Decedent's assets consist of $1,061.14 on deposit in a resident trust account at
Claremont Nursing & Rehabilitation Center, $4,176.38 on deposit in M&T Bank checking
account number 950362742 and a $555.46 refund of health insurance premium.
10. Petitioner does not claim an executor's commission.
11. Petitioner claims attorney fees in the amount of $1,000 as an estate administration
expense, with priority over creditors' claims.
12. Petitioner claims $30 in filing fees to the Register of Wills as an estate administration
expense, with priority over creditors' claims.
13. Petitioner desires to collect the decedent's funds on deposit, pay his attorneys and
disburse the balance to the Department of Public Welfare, in partial satisfaction of its
claims.
WHEREFORE, Petitioner prays the Court award the Estate of Freda J. Harry, deceased, to
the Commonwealth of Pennsylvania Department of Welfare and issue an appropriate Order to
enable petitioner to collect Decedent's funds on deposit at Claremont and at M&T Bank, and
make disbursement of the same as hereinabove set forth.
Respectfully Submitted,
Flower Law, LLC
By~ ,~
Thomas E. Flower
S.C. # 83993
Flower Law, LLC
10 W. High St.
Carlisle, PA 17013
717-243-5513
In Re: Estate of FREDA 1. HARRY,
deceased
Late of N. Middleton Township
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Orphans' Court Division
. No.
Verification
I, Lester Hockley, hereby verify that the statements made in the foregoing petition are true
and correct, to the best of my knowledge, information and belief. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S.A. § 4904, relating to unsworn
falsification to authorities.
DATED: o'L `o~-~- l 3 By: i~~~°iI
Lester Hockley
In Re: Estate of FREDA J. HARRY,
deceased
Late of N. Middleton Township
In the Court of Common Pleas of
Cumberland County, Pennsylvania
Orphans' Court Division
N o.
Consent and Joinder to Petition to Settle Small Estate
M~~vQ~
I, Lowse Baughman, hereby join in the petition of Lester Hockley to settle the Estate of
Freda J. Harry and 1 consent to the relief requested therein.
Dated: ~ ~ ~ ~ ~~,2013 By: ~ • fjGi/~~~~:1'~-~`t--
p1twR~ Louise Baughman
In Re: Estate of FREDA J. HARRY, In the Court of Common Pleas of
deceased Cumberland County, Pennsylvania
Orphans' Court Division
late of N. Middleton Township No.
CERTIFICATE OF SERVICE
On this 1st day of March, 2013, I, Thomas E. Flower, hereby certify that I served a
true and correct copy of the foregoing Petition, upon the Pennsylvania Department of
Public Welfare in care of Katie J. East, Program Investigator, Division of Third Party
Liability, by placing a copy of same in the United States Mail, first class, postage prepaid,
addressed as follows:
Katie J. East, TPL Program Investigator
Pa. Department of Public Welfare
Bureau of Program Integrity, Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
Dated: 3 ~
By:
Thomas E. Flower
S. Ct. #83993
FLOWER LAW, LLC
10 W. High St.
Carlisle, PA 17013
(717) 243-5513
Counsel for the petitioner
pennsylvama
DEPARTMENT-0F PU9LFC WELFA R'.E
February 20, 2013
THOMAS E FLOWER, ESQUIRE
lOWHIGHST
CARLISLE PA 17013
Re: Freda Harry
CIS #: 520216598
SSN: ###-##-8679
Date of Death: 01/31/2013
Dear Mr. Flower:
Please be advised that the Department of Public Welfare maintains a claim in the
amount of 5275,083.23 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 530,255.25, 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 S244.827.98. 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,
Katie J. East
TPL Program Investigator
717-772-6713
717-772-6553 FAX
Enclosure
Bureau of Program Integrity i Division of Third Pally Uability I Recovery Section
PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486
H IOS,ppS RF.V (9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It Is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P ~.9211~97
Certification Number
Typ@/Print In
P•rman•K
BI ck 1 k
This is to certify that 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 permanent filing.
.1~~t-~.c~~pcxn~x' FED 1 /2013
Local Registraz Date Issued
COMMONWEALTH OF P[NNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH ~
1. O@i•tlant'a Lapl Nam@ (Fire[. Mldtll@, lea[, 9V[Ra) 2. E!a H. Sed•1 EICV r
rKy Number 4. D•N e1 Death (MO Day Spa M°
Fra a Harr F '176-18-8679 n
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a Months Days NPYrs Mlnutu Pina
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l 91 yrs. Fab_ 26F
192
1 >b. BlKhplaw (COUrWy)
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7.1 b ri e.. Resldenw (ZIP Cod@) ~ 7 Q ~ 3 ~ No, d.iedent Ilwa within limes or dty/boro.
9. Ewr In US Armed forces 10. Manta StKYL at Tma e1 Death MaKled i owe 11. EurvMng Spouaa's Nam@ (IT wife, {Na name prior tp Rrst maMa{e)
Q Yes ®No Q Unknown Q Dlwrced Q Newr Mardad Q Unknow
12. Father's Name (Fire, Mlddh, Vs[. SVMK) 19. Mother's Nama Prbr<o Flrrt M•Mage (FIKt, MI dla, Las!)
v Hoclcl Lottie McElwee
14a. In rman[ [Name 144. R•letlonfhlp tp Decadent 14e. InfermanNS Mellin{ Address wt arM Number, C1ty, Etat•, Zip Coda)
Lester Hoc]c1e Brother 89 McAllater Church Rd_ Car11ffi1e PA
............ ......................................... .......................................... ..... S[...~ST..................!4.. on y one .............................. ..................... ...................................
.............
If Death Oaumd In • Hwphal: InpMeM IP Oea[h Occurred Somewhere OMK Then • HospMl: 1] hospice Faclihy ~ Cecedant's Noma
Ema Ream/Out tlem Dead on Arrlwl NurNn Hpme/LO -Term Cart Fadl Other (Spec )
iEb. Faellhy Neme H net Inatltu[lan, FM s[r..t antl nV mbar) 15c. CRy Or Town, Eti<a, antl Zlp Coda ISd. County Deat
h Aisle PA 170'13 Cumberland
~, SBa. MK DbpwltlOn Burial CrcmKlOn 16b. Date W ONpealtlen 16c. Place of Dlapoalt On Nam@ of wmalary, crematory, Or KMr place)
Q R•mewl from StKe Q Donaflon
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16tl. LOCKIen of D13pwhlOn (City or Town, S[Ka, end Zlp) 1 a. St{nature Puwrcl rvica Liwnsea or Person In Charge M In[arment 1> . Uwns• Number
Mt _HO11 S rin a PA 17065 ~.,[_. FD-077589-L
1>u Nama arW ComPleq Adtlr•N Ot FVneM1I Fadllty VVgg
n ~~ o11Ba ti~nrs APA~'17065
~ 18. Oe en[ f E ucatlon - eck [ha bw that bast ucrlbes the 19. Decedent of Mlspenle OH{In - Check C a 20. Dec an[ a Raw - Check ONe OR MORE rcwi to Indlwb whK
highest tleirae or lawl of schael wmplKed @[ [ha time of death. bw that best describes whether the Nwdent M deeetlen[ wnaldered hlmaeH or hers•H t° M.
Q {eh {rcda or lass Ia Spanlah/Hhpanic/Latlnb. Check M. "NO" Whha Q Korean
dlPlom., 9th -11tn {rce. bw If d@c•tlen[ Is not Spenlsh/MlspanlULatlne. Black or AMwn Am•riwn
Q Q VlKnemese
Q Hi{h sFROOI OeduKe Or GED wmPIKad not Spanish/HlsPan14LKino
O AmeHCen Indian ar Alaaka Na[N@ Q Oth@r gylan
Soma call
Q e{a credl[, but no degree Q Y•s, MaKlwn, MaKlcan AmeHCSn, Chlwno Q Aslen Indian Q NRNa HawNlan
Q Aawcla[a dgrca (@-g- A.s, AS) Q Vas, Puerto Rlon Chlnesa
~ Q Guamanian Or Ch•morro
Q Bachelor's tlMrce le.{. Bq, AB, BE) Q Yea, Cuban Q Filipino Q Samoan
'
Q Maatar
s da{rca (e.{. MA, MS, MEng, MEd, MEW, MBA) Q Ves, Kher Epanbh/HlspenlrJLKlnO Q J•Panese Q Other PacMC Islander
O Doctorab (@.{. PhD, EdD) or Professional tle{rce (Specify) O OMer IEpecHy)
e. . MD D DVM
21. Dec entY In{ a ace 9@ -DUI{nation -Chick ONLY ON{ to Indluu robe[ the deceden[ eansidercd nlmsaH or her»I(<o b@. 22a. DacadanYs Uwa1 Oceupatlen - Indicate LVPe of work
'B~WhM Q lapanea@ Q Samwn dens tlurin{ moat o/w°rkin{ IIM1
DO NOT USE RFf10.ED
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Q ack pr AMCen Amerlc•n Q Korean Q OMer PacHlc Hlander
~ Americo Indian Or Alaska NaHw Q Vlatnamaaa Q Dense Know/Not Eur@ Laborer / As 8 amb 1 er
p Allan n.dlen O oen.r Allan p R@waed zzb. Kme w e°am. me..a[.y
p Chines p N•Hw Hewalbn p Dmar lsPedry)
pFlllplna QGeamanian or CAamor.0 Hughes Aircraft Man.
BY P{RgON WMO a1tONOVNC{E OR a. to Pronounw Dea M Day r {nKUrc ° erion ronounc n{ at n y w •n app • 3t wnu Num r
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rar[ ( U 1 1 1 L t[(~ 25. Was Medical laaminer or Corowr CenOKed] Q Yea No
CAUSE OF DEATH
APPmaimm
26. Parf 1. En[@r th. chain of .r.nL-dlwaf@a, Injurl.s, pr wmpllwtbnhthK dircCtW waled [he death. DO NOT.rH@r terminal @wnta aVCh a[ urdlaC errcs[ In<eMl:
rcapirc<ON erroat, or yentKeulsr flbrill•Nen wi[M1qu[ showln{ Me etlola{y. DO NOT AB/B~REVIATE. Enter onW Ona cause on • Iln@. Add addhlonal line[ IRn~cusary OnaK <O Death
IMMEDIATE GUEE ------> a. ~ r fn 'Yjli/f{Ii (1 ~~
(Final dlia•fe or condition Due to (Vr as a can a an of): ~
rasuhln{ In duty) ,~ ' ,
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1/any, Iwd1n{ eo Lha rouse
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(dlsaue Or Injury Ma<
initiated [he •yanta rcaul[ing d.
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26. part 11. Eller other but np[ reaching In the un erhdng cacao {Nan In P•K 1 2]. Wes an eutePry M ad]
Yes
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[° cpmpbb tM ceuw eI deethl
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38. H Female: 90. Dld TObacw UN CoMributa M Death 31. Manner o D••th
Not Prc{nan<whhln past cart
Q Pre{naM at <Im@ W tl@Kh Q Yu Q Probably
Q No U
k Na[urcl Q Homldda
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Q Net pr.{n@n[, bu[ Prgnan! wRl,In 12 tlaya Of deatY n
nown
~ Attidant Q Pendin{ Inwrtl{aLen
Q NK Pregnant, but pre{nant 43 tlaYS to 1 War babrc death
32. Date of Injury (MO/Day r) (Spell Month) Q EVICIde Q Ceultl net be tletermined
O Unknown If pregnant whhin the past year 39. Tme pf INury
34. Plau OT Inlury (@.g, home; wnatnrf[Ipn site: farm; acheeH 35. Location Of Injury (EtrcK and Number, CM. EbH, Zip Cede)
36. INury K W° 97. If TranapartatlOn Inlury, EPacIN' 3p. D@serlbe Hew INury Owurre
Q Ve[ Q Driver/Operator Q Pedea[rlan
Q Np Q Passsn{er O O<M1ar (EPaclly)
39a. CaKMer (Check only °n@):
$GKIlying phwlden - TO the beat of my knowNdge, duth eaurrad des t0 M@ wuse(a) and manner slated
Q Pr°nouncln{ B bKHyln{ phYSiclan - Ta Me WK of my knawled{a, deKh otturretl at the [Imo, dKe, and platy, antl due <° [he uuae(s) and manner mtad
O M@dleel Evminer/Coroner- On t @ baala mina[lon, antl/or Inws[I{ation, in my opinion, tlaKh Ottur
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DIipO[ItIOn P@rmlt NO. REV D%/2D11