HomeMy WebLinkAbout07-18-14 DECEDENT'S ESTATE
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ESTATE OF Patricia Ann Miller , DECEASED� c.,�
No. 21-11-1277
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 insu�cient, 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 A T THE BACK OF THIS FORM.
Name of Counsel: Keith O. Brenneman, Esquire
Supreme Court I.D. No.: 47077
Name of Law Firm: Snelbaker& Brenneman, P.C.
Address: 44 West Main Street, Mechanicsburg, PA 17055
Telephone: 717-697-8528
Fax: 717-697-7681
Form OC-Ol rev. 10.13.06 Page 1 of 10
�
Estate of Patricia Ann Miller , Deceased
1. Name(s)and address(es) of Petitioner(s):
rvame: Barbara A.House,Administratrix,D.B.N.
Address: �40 Autumn Ridge Drive
Montgomery,IL 60538-2934
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
None
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 lune 25, 2011
� Letters Testamentary or �Letters of Administration were granted to Petitioner(s)on
Anril 4. 2013
Date of Will (if applicable): N/A
Date(s) of Codicil(s) (if applicable): N/A
Date of probate (if different from date Letters granted): Same
Was a bond required?�Yes �No If yes, state amount: 40,000.00
Are proofs of advertising of the grant of Letters attached? . . . . . . . . . �Yes �No
Dates of advertising of the grant of Letters: Cumberland Law Journal, August, 17, 24
31, 2012 & The Sentinel, August 1 l, 18, 25, 2012
Form oc-oi rev. lOJ3.06 , Page 2 of 10
Estate of Patricia Ann Miller , Deceased
3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes 0 No
If yes, name of the surviving spouse: James W. Miller(Date of death 2/6/2013)
4. Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . ❑Yes �No
(See Section 2201 et s�. 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 (if none, so state):
Barbara A. House
140 Autumn Ridge Drive
Montgomery, IL 60538-2934
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . . . �Yes � No
Were any children born to decedent after execution of
Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes � No
If yes, give names and dates of birth:
Name: 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mYes � No
Form OGOI rev. lOJ3.06 Page 3 of 10
Estate of Patricia Ann Miller , 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 l4 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. [f 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 lnterest I Re(ationship and Comments,r any I /nterest
Estate James W. Miller Executrix of Estate of 100%of residue
C/O Barbara A. House, Exec. James W. Miller and
140 Autumn Ridge Drive daughter of the
Montgomery, IL 60538-2934 Decedent
FormOC-01 rev. l0.13.06 Page 4 of 10
_ " _
Estate of Patricia Ann Miller , Deceased
Name and Address o Each Par in Interest Relatronshi and Comments,r an Interest
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.
N/A
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).
N/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.
Estate of James W. Miller, date of death 2/6/2013 Letters of Administration
D.B.N., were granted to Barbara A. House on Apri14, 2013 by the Cumberland
County Register of Wills, Cumberland County Pennsylvania.
Form OC-01 rev. 10.13.06 Page 5 of 10
Estate of Patricia Ann Miller , 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 oJ'Claim Claim Wi!!Claim
Admitted? Be Paid/n
Full?
Commonwealth of Pennsylvania 88,939.87 �Yes �Yes
Department of Public Welfare �No �No
Bureau of Program Integrity
Division of Third Party Liability
Class 3 claim in the amount of �Yes �Yes
$26,356.97 and Class 5.1 claim in the �No �No
amount of$62,582.90
�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.
11. Was family exemption claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-0/ rev. 10.I3.06 Page 6 of 10
- - _ _ .
_ _
Estate of Patricia Ann Miller , 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 /nterest
08/28/2013 1,123.41 0.00
12/5/2013 47.99
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:
None
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.
N/A
Form OC-0! rev. lOJ3.06 Page 7 of 10
Estate of Patricia Ann Miller , Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . � Yes � 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 receipts and disbursements since the closing
date of the Account.
None
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . ❑Yes 0 No
18. If a reserve is requested, state amount and purpose.
Amount: 22'3.24
P"'p°Se: Filing fee for First and Final Account, Petition and certified mail costs.
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes �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
Form OC-0/ rev. 10.13.06 Page 8 of l 0
Estate of Patricia Ann Miller , 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 Drstributee(s) Amount/Propor[ion
See Accounting
B. Principal:
Proposed Distributee(s) Amount/Proportion
See Accounting
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
,
�
Na e o Petitioner: Bar ara A. House, Administratrix, D.B.N.
Name of Petitioner:
Form OC-Ol rev. J0.13.06 Page 9 of 10
Estate of Patricia Ann Miller , Deceased
Veritication of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * �tllat he/she she is t;�re Administratrix, D.BN.
of the above-named name ofcorporatron Estate of Patricia Ann Miller 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).
�_.. ,
S�gnature of etit ner
*Corpo�ate 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 Counsel for Petitioner
Form OC-01 rev. 10.13.06 Page 10 of 10
PItUOF OF�!'U�+�+�"'�;"��"C"�E
�� ��'���1a�
(Under Act No. 5$7,a�������=�'-�"178�
COMMONWEALTH OF PENNSYLVANIA : ss.
COUNTY OF CUMBERLAND '
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 Car1a1 colurts as the official legal aforesaid,
was established January 2, 1952, and designated by the lo
periodical for the publication of all legal notices, and haotice or J bl cra ion�attac�hed hereto i�s ly
issued weekly in the said County, and that the printed n p
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
Au ust 17 Au ust 24 and Au ust 31 2012
Affiant further deposes that he is authorized to verify this statement by�ed n the ubject
Law Journal, a legal periodical of general circulation, and that he is not interes
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.
��
is Marie Coyne,Ed tor
SWORN TO AND SUBSCRIBED before me this
31 dav of Au�,ust 2012
Notary
Miller,Patricia Ann a/k/a Patricia
Ann Reeder,dec'd.
Late of Middlesex Township.
Administrator:Jaxnes W.Miller,2 �
Trinity Drive, Apartment 111, NOTARfRL SEAL
Dillsburg,PA 17019. DEBORAN A COLLINS
Attorneys: Keith O. Brenneman, Notary PubliC
Esquire,Snelbaker BcBrenneman, CUMBERLAND COUNTY
P.C.,44 W.Main Street,P.O.Box CARLISLE BOROUGH, �28 2014
318,Mechanicsburg,PA 17055. My Commission Expires Ap
'.
I'�
(<
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Jackie 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 13�", 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):
August 11, 18&25, 2012
COPY OF NOTICE OF PUBLICATION
� � ' " ,';
�� �� �KmMIMI$tRATOR S. TI , .,
Le�o�'A`�mipi�s�tlah'on tH�e�statedat PI�TRICIA ANN MII:L�R,alao s;
knoWl�s ,PA �C�PB��S��g^aEhB�etbae Mgr�tea i ine��tlier�i9nea' Affiant further deposes that he/she is not
,Cyml�s�nc��� , ,: �= a�
A����q Q�, ' e�m:�enrga'w'�,a,des�dcq�a�a��ueaWui.maae ,� interested in the subject matter of the
� �"���;��c�a�ly„an�mdse ha�ing claims.will presentth�m for , � aforesaid notice or advertisement, and that
�s#�8�rent� � , ��
'.'Jemes W.Mfller;Adminfsuato'��: all allegations in the foregoing statement as
2�riNty Drive,
�`� : om$b�g PA 7oi'�-; to time,place and character of publication
`� a ue.
Ke�t�0 prenneman Esquire � �
�5+ny��b� �nan.R G r ; , 1
}I'���, .'�X '/A ;}._ �. ' � 4 1� 4 .�` � /
M��� '�� Ma e . k ��. �
� � �p`�',���;� 's, �
Attomeys"fot°. n�TFalbf . , : '�ti
Sworn t and subscr' ed before me this
� . _ Z�IZ
�����
Notary Public
My commission expires:
NOTARIAL SE�,L�����,����,�
BAMBI ANN HEGKE��IDOR��!
Notary Public �
�
CARLISLE BOROUGH, C�"'::Jr�L�PJD CPJTY �;
i�yCommission �=;:plre�... � � <'�.��t�
20 Pa. C.S .A. Sec. 3392
§3392 . Classification and order of payment.
If the applicable assets of the estate are insufficient to
pay all proper charges and claims in full, the personal
representative, subject to any preference given by law to claims
due the United States, shall pay them in the following order,
without priority as between claims of the same class :
(1) The costs of administration.
(2) The family exemption.
(3) The costs of the decedent ' s funeral and burial, and the
costs of inedicines furnished to him within six months of his
death, of inedical or nursing services performed for him within
that time, of hospital services including maintenance provided
him within that time, of services provided under the medical
assistance program provided within that time and of services
performed for him by any of his employees within that time.
(4) The cost of a gravemarker.
(5) Rents for the occupancy of the decedent ' s residence for
six months immediately prior to his death.
(5 . 1) Claims by the Commonwealth and the political
subdivisions of the Commonwealth.
(6) All other claims .
(Feb. 21, 2006, P. L. 45, No. l7, eff. imd. )
2006 Amendment. Section 2 of Act 17 prcvided that Act 17
shall apply to the estate of a decedent who dies on or after the
effective date of Act 17 .
Cross References . Section 3392 is referred to in section
7755 of this title .
SNELBAKER F� BRENNEMAN, P.C.
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
44 WEST MAIN STREET
MECHANICSBURG, PENNSYLVANIA 17055
KEITH O.BRENNEMAN P.O.BOX 318
R.ICHARD C.SNELBAKER-OF COUNSEL 7V-697-8528 FACSIMILE(717)697-7681
July 18, 2014
T0: Commonwealth of Pennsylvania Certified Mail No.
Department of Public Welfare (7010 1670 0001 0650 3081)
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
Attention: Elvetta E. Knox
P.O. Box 8486
Harrisburg, PA 17105-8486
Estate of James W. Miller
Barbara A. House, Executrix
140 Autumn Ridge Drive
Montgomery, IL 60538-2934
Re: Estate of Patricia Ann Miller, Deceased
Estate No. 21-11-1277
NOTICE TO PARTIES IN INTEREST
The undersigned, as Attorney for Barbara A. House, Administratrix,
D.B.N. of the Estate of Patricia Ann Miller, Deceased, hereby gives
notice to each of the above named persons pursuant to Rule 6. 3 of the
Pennsylvania Supreme Court Orphans' Court rules as follows:
1 . She has filed this date in the office of the Clerk of
Orphans ' Court and Register of Wills of Cumberland County,
Pennsylvania, at Carlisle, PA, the First and Final Account of her
administration as such Administratrix, D.B.N. , together with a
Petition for Adjudication, true copies of which are enclosed herewith.
2 . Said Account and Statement will be presented to a judge of
the Orphans' Court Division of the Cumberland County Court of Common
Pleas at the Cumberland County Court House, 1 Court House Square,
Carlisle, PA 17013, on August 26, 2014 at 9: 30 o' clock A.M. ,
prevailing time, at which time said Account will be confirmed and
distribution ordered unless written objections are filed prior
thereto.
3. You have the right to file written objections to said
Account and Statement prior to the confirmation as scheduled above.
Very truly yours,
1����
Keith O. Brenneman
KOB: sks
Enclosures
z���� �a-
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA.
ORPHANS'COURT DIVISION
FILE NO: 21-11-1277
FIRST AND FINAL ACCOUNT OF
Barbara A. House,Administratrix, D.B.N.
For
ESTATE OF PATRICIA ANN MILLER
Social Security#: 204-26-9861
Tax ID#: 45-6705073
Date of Death: June 25, 2011
Date of Incapacity, if any: None
Date of Administratrix Appointment: April 4, 2013
Date of First Complete Advertisement: August 11, 2012
Accounting for the period: June 25, 2011
June 6, 2014
Purpose of Account: Barbara A. House,Administratrix D.B.N., offers this Account to acquaint
interested parties with the transactions that have occurred during her Administration.
It is important that the Account be carefully examined. Requests for additional
information, questions or objections can be discussed with:
Keith O. Brenneman
Snelbaker& Brenneman, P.C.
44 West Main Street
Mechanicsburg, PA 17055
Phone#: 717-697-8528
Supreme Court I.D. No: 47077
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BRENNEMAN, P.C. T� ���
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Page 1
�
SUMMARY OF ACCOUNT
PRINCIPAL PAGE
Receipts 3 $20,279.97
$20,279.97
Less Disbursements/Claims paid or to be paid upon confirmation of account:
Class(1) Claims: 3 $4,431.39
Class(2) Claims 3 $16,048.00
Class (3) Claims 3 $0.00
Ciass (4) Claims 3 $0.00
Class(5) Claims 4 $0.00
Class(5.1) Claims 4 $0.00
Class(6) Claims 4 $0.00 $20,479.39
Balance before Distributions _$199.42
Distributions to Beneficiaries 4 $0.00
Principal Balance on Hand -$199.42
For Information:
Investments Made 4
Changes in Holdings 4
INCOME
Receipts 5 $199.42
Less Disbursements 5 $0.00
Balance before Distributions $199.42
Distributions to Beneficiaries 5 $0.00
Income Balance on Hand $199.42
COMBINED BALANCE ON HAND $0.00
Listing of Unpaid Creditors 6
Listing of Persons Interested in Distribution 6
Estate
Affidavit Page 7
LAW OFFICES
SNELBAKER EC
BRENNEMAN, P.C.
Page 2
PRINCIPAL RECEIPTS
Assets Listed on Inventory per copy attached: $20,279.97
(Valued as of Date of Death)
ADJUSTMENTS TO INVENTORY 0.00
SUBSEQUENT RECEIPTS 0.00
TOTAL PRINCIPAL RECEIPTS $20,279.97
DISBURSEMENTS OF PRINCIPAL
There are insufficient funds to pay all claimants/creditors; therefore the proposed
payments and disbursements are based upon the parameters as provided
in 20 Pa.CS§3392
CLASS (1) CLAIMS-COSTS OF ADMINISTRATION
10/11/2012 Wells Fargo, service charges on bank account $ 67.23
The following items are to be paid upon confirmation of the accounting:
8/28/2013 Register of Wills, filing fee for Inventory and Inheritance Tax 30.00
Return
8/28/2013 Register of Wills,Agent, Inheritance Tax 1,123.41
""" Snelbaker& Brenneman, P.C., costs advanced 360.76
a. Register of Wills, Agent, balance due on 47.99
Inheritance Tax
b. Cumberland Law Journal, advertising 75.00
Administrator's Notice
c. The Sentinel, advertising 232.02
Administrator's Notice
d. Certified mail fee 5.75
""" Snelbaker& Brenneman, P.C., attorney fees 2,213.25
"'"" Barbara A. House, reimbursement for following expenses: 413.50
a. Surety Bond with State Farm 210.00
b. Register of Wills, probate fees 203.50
""*" Reserve for filing fees for Final Accounting and certified mail 223.24
TOTAL CLASS (1) CLAIMS TO BE PAID: $ 4,431.39
CLASS (2) CLAIMS- FAMILY EXEMPTION
NONE $0.00
CLASS (3) CLAIMS-COST OF FUNERAL AND BURIAL,AND THE COSTS OF MEDICINES
FURNISHED WITHIN SIX MONTHS OF DEATH
""" Commonwealth of Pennsylvania, Department of Public Welfare
partial payment of Class(3)claim for medical expenses in the
amount of$26,356.97 provided to the Decedent $ 16,048.00
TOTAL CLASS (3) CLAIMS TO BE PAID: $ 16,048.00
LAW OFFICES
SNELBAKER 8C CLASS (4) CLAIMS-COSTS OF GRAVE MARKER
BRENNEMAN, P.C. NONE
��.��
Page 3
CLASS (5)CLAIMS- RENTS FOR OCCUPANCY OF THE DECEDENT'S RESIDENCE
NONE $0.00
CLASS(5.1) CLAIMS-BY COMMONWEALTH AND THE POLITICAL SUBDIVISIONS
OF THE COMMONWEALTH
Commonwealth of Pennsylvania, Department of Public Welfare $0.00
Class(5.1)claim for medical expenses in the amount
of$62,582.90 will be unpaid
$0.00
CLASS(6) CLAIMS-ALL OTHER CLAIMS
NONE $0.00
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
NONE $0.00
PRINCIPAL BALANCE ON HAND
FIDUCIARY
VALUE AT ACQUISITION
6/06/2014 VALUE
Savings Bonds $0.00 $ 3,560.64
Cash $ 19,258.75 $ 16,719.33
"""* Less expenses to be paid subsequent to $ (19,258.75)
confirmation of First and Final Account as
as listed on page 3 of accounting
TOTAL PRINCIPAL BALANCE ON HAND $ - $ 20,279.97
INFORMATION SCHEDULES
PRINCIPAL INVESTMENTS MADE
NONE $0.00
CHANGES IN PRINCIPAL HOLDINGS
NONE $0.00
LAW OFFICES
SNELBAKER 8C
BRENNEMAN, P.C.
Page 4
RECEIPTS OF INCOME
10/11/2012 U.S. Savings Bonds, interest $ 199.42
$ 199.42
DISBURSEMENTS OF INCOME
NONE $0.00
DISBURSEMENTS OF INCOME TO BENEFICIARIES
NONE $0.00
LAW OFFICES
SNELBAKER 8C
BRENNEMAN, P.C.
Page 5
" UNPAID CREDITORS:
1. Commonwealth of Pennsylvania
Department of Public Welfare
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
Attention: Elvetta E. Knox
P.O. Box 8486
Harrisburg, PA 17105-8486
Class(3)claim for balance of unpaid medical expenses $ 10,308.97
Class(5.1)claim for unpaid medical expenses $ 62,582.90
** PERSONS INTERESTED IN DISTRIBUTION OF ESTATE:
1. Estate of James W. Miller $0.00
C/O Barbara A. House, Executrix
140 Autumn Ridge Drive
Montgomery, IL 60538-2934
LAW OFFICES
SNELBAKER Sf
BRENNEMAN, P.C.
Page 6
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
Barbara A. House, being duly sworn according to law deposes and
says: that she is the Administratrix, D.B.N. of the Estate of Patricia Ann Miller,
Deceased; that she is the Accountant herein; that the foregoing is a true and complete
accounting of her administration of said Estate; that the attached list or
or schedule(']contains the names, addresses and amounts due unpaid creditors
who have given proper notice of their claims; that the attached list or schedule[""]
contains the names and addresses of all persons interested in the distribution of
said Estate; and that the facts set forth herein are true and correct to the best
of her knowledge, information and belief. �
t � I�'�� � R�t t` /�
, r il
ara . Ho e, ministratrix, D.B.N.
Sworn to and subscribed before
me this ��3_day of �C,t n 2._. , 2014
� C� �� � U�.,
COMMONWEALTH OF PENNSYLVANIA
Notarlal 5eal
5indra K.Showers,Notary Public
MeGhAhlcsburp Boro,Cumberland County
Cntnmi�Itx� res Nov.22,2015
7i9N 9F NOTARI
LAW OFFICES
SNELBAKER 8C
BRENNEMAN, P.C.
Page 7
�urY
INVENT�RY
REGISTEI� OF' WILLS OF Cumberland _ C011N�'�Y, PEN�ISYLVANIA
COMMONWEALTH OF PENNSYL.VANIA
COUNTYOF Cumberland SS File:Numbcr '1'11'1277
Barbara A. Ho�,��e_,_�m�n���tratri}- D B N
Personal Representative(s)of the Estate of patricia Ann Miller
deceased,depose(s)and say(s)that the items appearing in the following inventory include a I I of the ersonal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation pl ced opposite each item of said
inventory represents its fair value as of the date of the decedent's death, arid that Deced�nt own no�-real estate outside of the
Commonwealth of Pennsylvania except [hat which appears in a memorandwn at the en�ofthis inv m�'ry.
I verify that the statements made in this lnven- � � ,� ��.,i p �
_ ,,-y�� ����,f? �-��: ` l:; �✓'�L
tory are true and correct. 1 understand that false state- - - _ . „
ments herein are made subject to the penalties of Barbara A.�QUSgs, Administ atrix D.B.N.
18 Pa.C.S. § 4904 relating to unsworn falsificalion to 4��t���ee
authorities. Toms River, NJ p8757
Rttorney-- (��ame) Keith O. Brenneman, Esquire _ ('iupreme C urt 1.D. No.) 47077
(Addre,ss) Snelbaker& Brenneman, P.C.44 West Main Street, Me:chanicsburg. PA 17055
(Telephone) �17-697-8528 _
DATE OF DEATH IAST RESIDENCE DECEDENT'S SOC.SEC.N0.
06/25/20l I Claremont Nursing Home, IU00 Claremont Drive,Carlisle,PA 17013
rIGURES MUST E3E TOT.ALED
I. U.S. Savings Bond,39 EE:boniis 3,560.64
2. Residue from the Estate of James P. Miller, Decedent's son 16,719.33
c� -
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(,4t1ac/r ad�itional sl:eets us needed)
TOT L: 20,279.97
NOl�E The Memorandum of real estatc oufside the Commonwcalth of Pennsyhania may, a� tne clection of the personal r�presentative include the value of each
itcm,�ut such tigures should not be catended into the total of the Inventory (See?0 Pa.C_'.S.§.�J01("6J)
Fo�m RW-09 rer. 10.I J.06 i
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