HomeMy WebLinkAbout10-30-14 (2) I'; ��� : BEFORE THE CLERK OF THE
� : ORPHANS' COURT OF THE
: COURT OF COMMON PLEAS OF
ESTATE OF : CUMBERLAND COUNTY,
DAVID L. HITTIE, : PENNSYLVANIA
deceased : No. 21-14-0967
PROOF OF NOTICE GIVEN TO
THE PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
PURSUANT TO SECTION 1412 OF THE
PUBLIC WELFARE CODE
To The Clerk of the Orphans' Court:
Attached hereto for filing in your office are the following:
1. Copy of notice given to the Pennsylvania Department of Public Welfare pursuant to Section
1412 of the Public Welfare Code.
2. Letter from the Pennsylvania Department of Public Welfare indicating that the Pennsylvania
Department of Public Welfare will not seek any recovery for medical assistance benefits
paid.
Date: October 29, 2014 i�`�V����G-y
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Christopher M. Vedder,Esquire
Sup. Ct. I. D. #38497
Morris&Vedder '�=.� �
32 N. Duke St., P�J Box 14� �� �
York, PA 17405 � � �� "' `�
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Estate Recovery Form Page 1 of 1
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Home� Estate Recovery Statement of Claim Request
Estate Recovery Statement of Claim Request
STATEMENT OF CLAIM RE UEST FORM
DECEDENT'S FIRST NAME: David �
DECEDENT'S MIDDLE INITIAL• �'
DECEDENT'S LAST NAME: Hittie
----...-------------------------- ------------
DECEDENT'S LAST KNOWN STREET ADDRESS: 125 Channel Drive
(PRIORTO ENTERING NURSIN6 HOME)
DECEDENT'S LAST KNOWN CITY: Cariisle
-—_._.__.
DECEDENT'S LAST KNOWN STATE: PA'
DECEDENT'S LAST KNOWN ZIP CODE: 17013 -DECEDENT'S LAST KNOWN Zip Code Plus Four: v
_..___.....
DECEDENT'S SOCIAL SECURI7Y NUMBER: 178-40-7678 (###-##-####)
DECEDENT'S DATE OF BIRTH: O8/07/1948 (MM/DD/YYYY)
DECEDENT'S DATE OF DEATH: 06/14/2014 (MM/DD/YYYY)
GROSS AMOUNT OF DECEDENT'S ESTATE: $ 1000.00 (up to$1,000,000)
PERSONAL REPRESENTATIVE'S FIRST NAME: Robin '���vrn
PERSONAL REPRESENTATIVE'S MIDDLE INITIAL; M'�
PERSONAL REPRESENTATIVE'S LAST NAME: Hittie � ^�~���
�._._.�..___........__._.._. _.----_....._.�_.._.__�____.��..�... _
PERSONAL REPRESENTATIVE'S STREET ADDRE55: 125 Channel Drive
PERSONAL REPRESENTATIVE'S CITY: Carlisle � � �
PERSONAL REPRESENTATIVE'S STATE: IPA
PERSONAL REPRESENTATIVE'S ZIP CODE: 17013 -PERSONAL REPRESENTA7IVE'S Zip Code Plus Four:V
PERSONAL REPRESENTATIVE'S PHONE NUMBER: (7�7)385-4793 ((###)###-####)
_.___.----------.___-----
PERSONAL REPRESENTATIVE'S E-MAIL ADDRE55:
ATTORNEY'S FIRST NAME: _...__._........--------...__.._.__._..__.
Christopher
ATTORNEY'S MIDDLE INITIAL: M
_.....__-----------__._..__...
ATTORNEY'S LAST NAME: Vedder
--------------__-- -----------..._..-------—
ATTORNEY'S STREET ADDRESS: 32 North Duke Street
P.O. Box 199 �
ATfORNEY'S CITY: York� �A� mm V
ATTORNEY'S STATE: PA' �
ATTORNEY'S ZIP CODE: 17405 -ATTORNEY'S Zip Code Plus four:��
..._..._.._.______._,
ATTORNEY'S PHONE NUMBER: (717)843-9815 ((###)###-####)
ATTORNEY'S E-MAIL ADDRE55: cmvedder@morris-vedder.com
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https://www.humanservices.state.pa.us/dpwsecure/EstateRecoveryForm.aspx 10/10/2014
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PA ONLINE SEI2VICE5 u PA STATE AGENCIES u
, Tom Corbett.Governor�Beveriv Mackereth.Actino Secretarv
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Home( Estate Recovery Statement of Claim Request
Estate Recovery Statement of Claim Request
Your claim has been submitted.
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�►'� pennsylvania _ -
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DEPARTMENT OF PUBLIC WELFARE
C�CT 2 Q 2014 '
October 15, 2014
CHRISTOPHER M VEDDER ESQUIRE
23 N DUKE ST
YORK PA 17401
Re: David Hittie
SSN: ###-##-7678
Dear Attorney Vedder:
Pursuant to your letter dated October 10, 2014, the Department's, Estate Recovery
Program, has reviewed the information you provided regarding the above-referenced
individual.
It has been determined that this individual did not receive any type of assistance
during the questioned period.
Therefore, according to the information you provided, the Department's Estate
Recovery Program will not seek any recovery from this estate. If your client applied for
Medical Assistance and had an application and/or hearing pending at the time of death,
please advise us and provide any additional information that may affect a recovery by our
Department.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely
�?
��_ � Y��
Vince A. Porter
Recovery Section Manager
(717)772-6604
Bureau of Program Integrity � Division of Third Party Liability � Recovery Section
PO Box 8486 � Harrisburg, Pennsylvania 17105-8486