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Home My WebLink About05-07-14 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COiJNTY,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: Dorothv M.Deaven File No: ,��f Lj.�� a/k/a: (Assigned by Register) a/k/a: a/Wa: Social Security No: Date of Death: December 18,2012 Age at death: 84 Decedent was domiciled at death in Cumberland County,Pennsvlvania (srate)with his/her last principal residence at 770 Poplar Church Road East Pennsboro Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at Hol�pirit Hospital Camp Hill 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 $4,432.34 If not domiciled in Pennsylvania. . . . . . . . . . . . . . . . . .. . . ... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. . . . . . .. .. . . ... . . . . . . . .. Personal property in County $ Value of real estate in Pennsylvania... . ..... .. . . . . . .. . . .. .... . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . $ TOTAL ESTIMATED VALUE. . . . $4,432.34 Real estate in Pennsylvania situated at: n/a (Attach additional sheets,rf necessary.) Street address,Post Office and Zip Code City,Township or Borough County � A. Petition for Probate and Grant of Letters Testamentarv Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated and Codicil(s) thereto dated State relevant circumstances(e.g.renunciation,death ofexecutor,etc.) Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not divorced,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 did not have a child born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. � � �'�"°` Q NO EXCEPTIONS Q EXCEPTIONS C c � ?.7 � � � c3 � ■B. PetitionforGrantofLettersofAdministration (Ifapplicable) � � c} --�'c ��, ° c.t.a.,d.b.n., d.b.n.c.t.a.,pendente lite, du�ant�PYb��tia, durant2�7hi e�e'ritate ,.,, „�� 's f Y� If Administration,c.t.a. or c�b.n.c.t.a.,enter date of Will in Section A above and comu�te`'��st�of heirs k' �� Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorc�h�b�n e�lished zas.�efined in 23 Pa.C.S. §3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.r� � :�.._� �j -� "-i W � fr7 •NO EXCEPTIONS O EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(iff�i )and heir�(attach additional sheets, ifnecessary): Name Relationship Address onna Deaven AUGHTER 145 E.Main Street, ls`Floor,Mechanicsburg,PA 17055 Form RW-02 rev.10/11/2011 Page 1 of 2 Oath of Personal Representative official use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Petitioner(s)Printed Name Petitioner(s)Printed Address LISA MARIE COYNE, ESQUIRE 3901 MARKET STREET, CAMP HILL, PA 17011 w.; N n rn rn ::o cn 't39c CO Cn <, o The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correct tmtkOe6of th7ftowiedgMnd belief of Petitioner(sland that as Personal Representative(s)of th ceden, Petition •)will well and truly ad imis(Z�thewestat;aowrdmgZ law. Sworn to S med subscribed before ! ��— Datet 7��.ZU1 me th rf _ / � _Dat- By: - _!� , _ Date F t Register Date BONDRequired:OYES !NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters . . . . . . . .. . . . . . . . . . . . . . $ Attorney Signature: (� ) Short Certificate(s). . . . . . 0 ( )Renunciation(s).. . . . . . . . ( ) Codicil(s). . . . . . . . . . . . . ( )Affidavit(s).. ... .... . . . Bond.. . . . . . . . . . . . . . . . . . . . . . . Prin Name: L75A 1SARIE COYNE Commission, . . . . . . . . . . . . . . . Supreme Court they . . . . . . . . ID Number: 53788 D TIM- . . . . . . Firm Name: COYNE&COYNE PC _ . . . . . . . . Address: 3901 MARKET STREET . . . . . . . . CAMP HILL,PA 17011 - Automation Fee. .... . . ..... . . . Phone: 717-737-0464 JCS Fee. . . . . . . . . . . . . . . . . . . . . Fax: 717-737-5161 TOTAL. . . . . . . . . . . . . . . . . . . . . S Email: Lisa(alcovneandcoyne com DECREE OF THE REGISTER 1� Estate of DOROTHY DEAVEN File No: f aWa: AND NOW, /M i OW 13 _ 201 in consideration of the foregoing Petition, satisfactory proof having presented before me,IT IS DECREED that Letters Administration __are hereby granted to Lisa,Marie Coyne _ in the above estate and'(if applicable)that the instrument(s) dated Ad A described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent. Register of Wills Form RW-02 rev.Joirinarin - Page 2 of 2 ESTATE OF DOROTHY M. DEAVEN ATTACHMENT TO THE PETITION FOR GRANT OF LETTERS B. Petition for Grant of Letters of Administration 1. The decedent died intestate on December 18, 2012 at Holy Spirit Hospital at the age of eighty-one (84) years. 2. At the time of her death, decedent was domiciled in Cumberland County, Pennsylvania with her principal address being 770 Poplar Church Road, Camp Hill, East Pennsboro Township, Pennsylvania. 3. Decedent owned personal property at the time of her death valued at$4,432.34. 4. At the time of her death, the decedent was an unremarried widow and had one child: Donna Deaven. 5. Donna Deaven resic�es at 145 East Main Street, lst Floor, Mechanicsburg, Pennsylvania. 6. Donna Deaven does not wish to serve as administrator of her mother's estate and has requested the Pennsylvania Department of Public Welfare to administer the Estate. (See Exhibit"A"—Letter from Donna Deaven). � 10. The Pennsylvania Department of Public Welfare is the principal creditor for the Estate and has a total claim of$45,715.04 against the Estate. 11. The Pennsylvania Department of Public Welfare has nominated the Petitioner as the person to administer the Estate. (See Exhibit"B"—Letter to Petition from Pennsylvania Department of Welfare). !�) �,. O � n � � rn � � � � � s3� -� � --�c v:; � � _.` ."� A,. f_" � i"r1 �, ,� f',.� �� ,':3 � `��. �f� �.°��. .,.�3 � � � �, ..� ,� "�1 G:J � _ `�°1 Q � � �-= G"7 , � W � rn � � � � o cn Exhibit A ' � '' //� . . f" ,�,C,�'L,�(:.�,�,� �,l ��('( � � � � � r _ 1 ' ,� �� 7� �`�-z�ZL-�� 7 ) � % �_.�l `�L- L�'{., � �� i�,�L��t,�� L{� _ "�Z'� ' �,�L'�i�""/li-� J , G � ,(:�L�- J %�"L`�' L �� ' -l /(,{�2�.r��1 �.�" `��.;t�1�_yC4.�J�"� �� " � , , � _{�r ,''+ -i ' � t \ .� � �- . / -� f � l l.�� '� ' ,,/'r;l�,. ..�_L I 1 �` '^ N I _ '` � J . � ' ;�� . '_ ; -. ;� ' ' `� ' r� i,. �;- �� '� �'a i�' . , �, ' '=�- �<� . T_ _ � �-- � � `� �J---� �f ° . �` � •r .7�+ � _ _/ t ,� t� �->-��-�� _ J•�, �� --- --- -- -_ � _____- � / C�� I�% Y'�i; � t. �\) f,. L�.��G (i L . , r(� � + \ I I `.1 ��.. ��l Q.i I`1 `_3_�}�,.�� 1 1 5 r �`J�iv y� . � � t f � �I�• �' Lv`,f , i L `�Y) .:�� 1 �� i L�LI 1 � � ��- �,��(- �'� � / � , I i J 1�. C ��i �s�"t'V �' �lc'. �bZt�'tr I, ��-'�•,i"� ,r � (��!�C ; �;.�r�i,�,n �" ;:,-,�.� i ' .. � �� . , -�- ,L �, �� Copy from DPW PEAP system Exhibit B . � . � � � C� Q `�, ,_ti �� . a � � ��t � � • pennsylvania D�c � � Zut� � ' � DEPARTMENT OF PUBLIC WELFARE �. By,�_. � �`�"=_;1 December 10, 2013 , COYNE & COYNE PC ATTORNEYS AT LAW 3901 MARKET STREET � CAMP HILL PA 17011-4227 Re: Dorothy Deaven CIS #: 380168694 Incident Date: 12/18/2012 Dear Sir or Madam: The Department of Public Welfare is responsible for the implementation and operation of Pennsylvanla's Medical Assistance Estate Recovery Program. (62 P.S. §1412.) The Medlcal 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 i5, 1994. To faciEitate the operation of the Program, the Department must recover Medical Assistance payments from estates that remain unadministered throughout the ' Commonwealth. The Department's regulatlons 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 shall not fle legal papers as the Commonwealth's attomey. 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 conversatlon with you, you have agreed to assist in adrninistering estetes 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 6% � of the gross assets of the estate, whichever is greater. The Department will require an i itemization of your fee and your administrative costs for our records. - i . � Bureau of P�ogram Integrity J pivis(on of Third Party UabiUty� Recovery Sedion f PO Box 8486�Hairisburg,Pennsylvania 17105-8486 � _ � � �� pennsylvania ; DEPARTMENT OF PUBLIG WELFARE You may receive additional estate referrals in the futu�e from the Department. If you do not wish to receive future referrals, kindly notify the Department. Thank yo� far your attention and cooperation with the Department in this matter. If you have any questions, piease do not hesitate to contact Ms. Marianne Meckley at 717-772-6246. Si cerel --� R covery Section Bureau of Program In[eg�ity�Dlvision of Third Party Uabifi[y� Recovery Section PO Box 8486 � Hartisburg,Pennsylvanla 171Q5-8486