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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND_ COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
M
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MARIANNE GRISCOM ,DECEAS c> o
ESTATE OF --a " x� 1
21-10-0203 CUD
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No. ? 7
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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. ff
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.
INCLUDE ATTACHMENTS AT THE,BACK OF THIS FORM,
Name of Counsel: Charles E. Shields III
Supreme Court LD.No.: 38513
Name of Law Firm:
Address: 6 Clouser Road,Mechanicsburg,PA 17055
Telephone: (717) 766-0209
Fax: (717) 795-7473
Form OC-01 rev.10.13.06 Page 1 of 10
Estate of MARIANNE GRISCOM ,Deceased
1, Name(s)and address(es)of Petitioner(s):
Name: Colleen M.Seace
Address: 799 Forest Lane
Dauphin,PA 17018
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? . . . . . : . . . . . . . . . . . . . . . 0 Yes No
If not,identify prior accountings,the accounting periods covered,and the date of
adjudication of the prior accounting.
2. Decedent died on January 19, 2010
Letters Testamentary or Letters of Administration were granted to Petitioner(s) on
March 2. 20 10
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):
Was a bond required?E]Yes 0 No If yes,state amount:
Are proofs of advertising of the grant of Letters attached? . . . . . . . . . M Yes M No
Dates of advertising of the grant of Letters: Sentinel: 4/28, 5/5, and 5/12/2010
Cumberland Law Journal: 4/30, 5/7 and 5/14/2010
Form OC-01 rev.10.13.06 Page 2 of 10
Estate of MARIANNE GRISCOM ,Deceased
3. Was decedent survived by a spouse? . . . . . . . . . ... . . . . . . . . . . . . . . . . . . Yes No
If yes,name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? . . . . . . . I . . . . . ElYes Ej No
(See Section 2201 et sea.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):
Robert Griscom
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:
ft"
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
NOTE: Decedent was less than 55 years of age so no
notice was required.
Form OC-01 rev.10.13.06 Page 3 of 10
Estate of MARIANNE GRISCOM ,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 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. Q.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 Party in Interest i Relationship and Comments,ifany Interest
Robert J. Griscom Son Sole Heir
c/o Ellen Halvorsen
PO Box 497
Ship Bottom,NJ 08008
For,n OC-01 rev.10.13.06 Page 4 of 10
Estate of MARIANNE GRISCOM ,Deceased
Name and Address of Each Party in Interest Relationship and Comments,if any Interest
e
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.
None.
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.
N/A
Farm oC-01 rev.10.1.3.06 Page 5 of 10
Estate of MARIANNE GRISCOM ,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 of Claim ClaimWill Claim
Admitted? Be Paid In
Full?
James A. Lenker, District Judge $66.50 0Yes ` .i Yes
Magisterial District Court 12-1.-01 ONo ONo
2125 Paxton Church Road
Harrisburg,PA 17110
Chase Cardmember Service $14$61.27 OYes El Yes
PO Box 15153 MN. RINo
Wilmington,DE 19886-5153
Citi Platinum $213.61 Yes OYes
PO Box 6500 No ONo
Sioux Falls, SD 57117
Discover Card $581.83 ZYes Q Yes
PO Box 71084 E]No ONo
Charlotte, NC 28272-1084
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? . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . E]Yes RjNo
Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes ONo
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-OI rev.10.13.06 Page 6 of 10
J
Estate of MARIANNE GRISCOM ,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 of Claim Claim Will Claim
Admitted? Be Paid In
Full?
Metro BanIcCenter $219.23 R]Yes E]Yes
Attn: Deposit Services E]No R]No
3801 Paxton Street
Harrisburg,PA 17111
E]Yes i._...? Yes
E]No O No
E]Yes D Yes
E]No El No
OYes El Yes
E]No E]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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes 0No
Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E]Yes oNo
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-01 rev.10.13.06 Page f§of 10
6a
Estate of MARIANNE GRISCOM 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
None Due
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? . . . . . . . . . . . . . . . . . . . E]Yes R]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,except in so far as there could be any dispute as to the prorations,we are not aware
of any such disputes at present.
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . . . . . . [Z]Yes [3 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
Estate of MARIANNE GRISCOM ,Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . Yes [Z 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 No
18. If a reserve is requested,state amount and purpose.
Amount:
Purpose: None.
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? . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . E]Yes E]No
If so,attach a copy of the notice.
19. Is the Court being asked to direct
the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . E]Yes R1No
r As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . QYes [Z]No
Form OC-01 rev.10.13.06 Page 8 of 10
Estate of MARIANNE GRISCOM ,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 Distribulee(s) Amormt/Proportion
None.
B. Principal:
Proposed Distributee(s) ArnoundProportion
None,
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
e-a-c--P,
Name of Petitioner: Colleen M.Seace
Name of Petitioner:
Form OC-01 rev,10.13.06 Page 9 of 1.0
Estate of MARIANNE GRISCOM ,Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that helshe she is rime Administratrix
of the above-named name of corporation Estate of Marianne Griscom 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
COLLEEN M. SEACE
*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 Counsel for Petitioner
CHARLES E. SHIELDS III
Form OC-01 rev.10.13.06 Page 10 of 10
r `
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA.
ORPHANS' COURT DIVVISION
FILE NO. 21-10-0203
FIRST AND FINAL ACCOUNT OF
COLLEEN M. SEACE,ADMINISTRATRIX
For
ESTATE OF MARIANNE GRISCOM
Date of Death: 01/19/2010
Date of Incapacity, if any: None
Date of Administratrix's Appointment: 03/02'/2010
Date of First Complete Advertisement: 05/14/2010
Accounting for the period: 01/19/2010
04/15/2014
PURPOSE OF ACCOUNT: The Administratrix offers this Account to acquaint interested
parties with the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for additional information,
questions or objections can be discussed with:
Charles E. Shields III
6 Clouser Road
Mechanicsburg, Pennsylvania 17055
Phone Number: (717) 766-0209
Supreme Court I.D. No. 38513 rn
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1
SUMMARY OF ACCOUNT
PRINCIPAL RECEIPTS PAGES
Real Estate 3 $ 0.00
Common Stocks 3 0.00
Other Personalty 3 20,892.20
$ 20,892.20
Less Disbursements:
Administration Expenses 4 $ 647.94
Fees and Commissions 4 7,028.80
Family Exemption 4 0.00
Funeral Expenses and medical cost 4- 5 4,929.88
Priority Tax Payments 5 511.19
Expenses to Maintain and secure assets 5 - 6 1,870.45
Less Reserve for additional tax
Accounting issues 6 500.00
Sub-Total Disbursements 6 $ 15,488.26
INCOME
` Receipts of Income 8-9 $ 0.00
Less Disbursements 9 0.00
Income Balance on Hand 9 $ 0.00
COMBINED BALANCE ON HAND 9 $ 5,403.94
Debts of Decedent/Proposed Distribution $15,942.44 $ 5,403.94
BALANCE AFTER PAYMENT OF APPORTIONED $ 0.00
NON-PRIORITY DEBTS
2
PRINCIPAL RECEIPTS
Real Estate
None $ 0.00
Common Stocks
None $ 0.00
Personalty
(* INFORMATIONAL NOTE: The figures below are updated and adjusted to reflect
additional information received after the date of the Inheritance Tax Return.)
1. Sale of Fairmont Mobile Home, 1988,
VIN #63972, including several additional items
of personalty contained therein, to Phyllis E. Lieb,
of 210 Burnt Hill Road, Cherry Hill,NJ 08003 $ 17,500.00
2. Overdrawn Metro-Bank Checking Account
No. 536 738 529 0.00
3. Sale of Volvo Sedan, 1996,
VIN #YV1LS5 720T 229 9360 to David DeGrandchamp 2,500.00
4. Refund on Erie Insurance Auto Policy 139.00
5. Refund of overpayment on Erie Insurance Policy 35.00
6. Sale of Miscellaneous Personalty by Derfler's
Auction, Pine Grove, Pennsylvania on May 7, 2010 415.20
7. Sale of small, upright freezer on Craig's List 80.00
8. Refund Aegis Security Ins. Co. —Mobile Home 163.00
9. Deposit of Checks for cleaning work 60.00
$ 20,892.20
3
DISBURSEMENTS OF PRINCIPAL
INFORMATIONAL NOTE: ESTATE IS INSOLVENT. FOR CONVENIENCE OF YOUR
HONORABLE COURT AND CREDITORS, DISBURSEMENTS ARE SET FORTH
HEREINBELOW ACCORDING TO LEGAL PRIORITIES OF PAYMENT, AS FOLLOWS:
COSTS OF ADMINISTRATION
GENERAL:
Reimbursements to Charles E. Shields III
Probate fees and original issue of short certificates $ 83.50
Photocopies, certified mailings to creditors, etc. (estim.) 95.00
Advertising in Cumberland Law Journal 75.00
Advertising in Carlisle Sentinel 134.44
Total reimbursements to Charles E. Shields III $ 387.94
Reimbursements to Colleen M. Seace
Additional probate fees 30.00
Filing Fee to Register of Wills for Inheritance Tax Return 15.00
Filing Fee for Accounting with Orphans' Court 215.00
Total reimbursements to Colleen M. Seace $ 260.00
Total Reimbursements $ 647.94
FEES AND COMMISSIONS
Colleen M. Seace, Administratrix $ 2,500.00
Charles E. Shields III, attorney's fees 3,000.00
David Seace, lawn mowing, personal trips to attend to
Mobile Home, prep sale, shoveling snow, etc, 750.00
Janet Brackbill, H&R Block, Accountant 675.00
Rob Derfler, Auctioneer's Commission 103.80
$ 7,028.80
FAMILY EXEMPTION
No one eligible $ 0.00
FUNERAL EXPENSES AND MEDICAL SERVICE
EXPENSES WITHIN SIX(6) MONTHS OF DEATH
1. Auer Cremation Services of Pennsylvania, Inc.
for cremation, etc. $ 1,830.00
2. H. T. Hall, Inc., Spring Lakes,NJ for
Lettering to Monument Marker 630.00
4
3. Funeral Meal at Grantville, Pennsylvania 733.88
4. Burial Meal at Spring Lake Manor 480,00
5. Parish Family of St. Catherine & St. Anne,
Cemetery, for opening grave, honorarium to priest, etc. 800.00
6. Pinnacle Health 456.00
$ 4,929.88
PRIORITY TAX PAYMENTS
1. U.S. Treasury Personal Income Taxes 2009 $ 60.00
2. Cumberland County Tax Claim Bureau 190.96
3. School Taxes on Mobile Home 200.55
4. U.S. Treasury—Income Taxes 40.00
5. PA Department of Revenue—Income Taxes 12.00
6. West Shore Tax Bureau—Income Taxes 7.68
$ 511.19
ADMINISTRATIVE EXPENSES ASSOCIATED WITH
MAINTAINING AND SECURING ASSETS IN
PREPARATION FOR SALE AND LIQUIDATION
1. Mobile Home Park Rental Payments to
RVG Management and Development Co.
a. Regular Payment $ 359.23
b. Regular Payment 359.23
C. Final Payment 440.38
2. Capitol City Oil 202.59
3. PPL, Electric Billing 277.41
4. Spectrum Utilities Solutions, Water Billing 15.22
5
5. Comcast for Communication Purposes 187.91
6. PPL 28.48
$ 1,870.45
RESERVE: FOR DEALING WITH TAX ACCOUNTING ISSUES $ 500.00
SUBTOTAL OF ALL PRIORITY AND PRE-DEATH PAYMENTS $ 15,488.26
6
RECEIPTS OF INCOME
TOTAL RECEIPTS OF INCOME $ 0.00
DISBURSEMENTS OF INCOME $ 0.00
PRELIMINARY RECAPITULATION
PRINCIPAL BALANCE $ 20,892.20
DISBURSEMENTS FROM PRINCIPAL $ 15,488.26
BALANCE OF PRINCIPAL ON HAND $ 5,403.94
INCOME BALANCE ON HAND $ 0.00
COMBINED BALANCE ON HAND $ 5,403.94
7
CLAIMS OF PRIVATE NON-GOVERNMENTAL AND NON-SECURED CREDITORS
FOR DEBTS OF DECEDENT
[These are to be paid at the rate of$0.338966 on the dollar. This is based on the percentage of
funds left versus face amount'of these debts which follow. The face amounts are given in the
first column and the proposed payment amounts are given in the second column in brackets.]
Balance due on fine to James A. Lenker,
Magisterial District Judge, Dist. Ct. 12-1-01,
2125 Paxton Church Road, Harrisburg, PA 17110 $ 66.50 [$ 22.54]
Chase Freedom Credit Card $ 14,861.27 [$ 5,037.47]
Citi Platinum Credit Card $ 213.61 [$ 72.40]
Discover Credit Card $ 581.83 [$ 197.22]
Metro-Bank overdraft and net balance due $ 219.23 [$ 74.31]
TOTAL CLAIMS/PROPOSED DISTRIBUTION $ 15,942.44 [$ 5,403.94]
3Ca—U (SEAL)
COLLEEN M. SEACE,Administratrix
of the Estate of Marianne Griscom,
Deceased
8
VERIFICATION
COLLEEN M. SEACE,Administratrix of the Estate of Marianne Griscom, deceased,
hereby declares under oath that she has fully and faithfully discharged the duties of her 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
having a priority payment status have been paid in full that,to her knowledge, there are no
claims outstanding against the Estate other than those unsecured claims set forth herein;that all
taxes presently due from the Estate have been paid; and that the grant of Letters of
Administration and the first complete advertisement thereof occurred more than four months
before the filing of the foregoing First and Final Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to
unsworn falsification to authorities.
Q-4--C-P (Seal)
COLLEEN M. SEACE
Dated: '7 A��/
9