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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF Mary Elizabeth Beatty -, DECEASED
No. 2015-00288
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PETITION FOR ADJUDICATION/ _ " `�' =• cD
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C.Rule 6.9
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This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If
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.
INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel: Nancy Kocher,Executix, Pro Se
Supreme Court I.D.No.:
Name of Law Firm:
Address: 763 Vista Drive, Camp Hill, PA 1701.1
Telephone: 717-761-2746
Fax:
Form OC-01 rev.10.13.06 Page 1 of 10
Estate of Mary Elizabeth Beatty , Deceased
1. Name(s) and address(es) of Petitioner(s):
Name: Nancy Kocher,Executrix
Address: 763 Vista Drive
Camp Hill,PA 17011.
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
N/A
Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . . 0 Yes [I No
If not, identify prior accountings,the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on 03/1.6/2015
Letters Testamentary or MLetters of Administration were granted to Petitioner(s) on
03/18/201.5
Date of Will (if applicable): 08/15/2003
Date(s) of Codicil(s) (f applicable): N/A
Date of probate (f different from date Letters granted):
Was a bond required?Mes 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: 03/31/2015, 04/07/201.5, 04/14/2015
Form OC-01 rev.10.13.06 Page 2 of 10
Estate of Mary Elizabeth Beatty Deceased
3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F1 Yes 0 No
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . E]Yes E]No
(&e Section 2201 et M. 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):
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [3Yes 0 No
Form OC-01 rev.10.13.06 Page 3 of 10
Estate of Mary Elizabeth Beatty ,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. O.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,if any I Interest
Nancy Kocher Daughter, Executrix Residual beneficiary
763 Vista Drive and sole residual
Camp Hill,PA 17011 beneficiary
David B.Bayne Grandson Coin Collection
6 Prospect Circle
Atlantic Highlands,NJ 07716 Interest satisfied
Form OC-01 rev. 10.13.06 Page 4 of 10
Estate of Mary Elizabeth Beatty , Deceased
Name and Address of Each Party in Interest I Relationship and Comments,if an I Interest
Ann Schoeller grand daughter Silver tea service
6 Prospect Circle
Atlantic Highlands,NJ 07716 Interest satisfied
Scott B. Bayne grandson China and silverware
787 Oakwilde Way
Millersville, MD 211.08 Interest satisfied
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.
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).
D. If distribution is to be made to the personal representative of a deceased parry,
state date of death, date and place of grant of Letters and type of Letters granted.
Date of death was 03/16/2015. Letters of Testamentary granted on 03/18/2015 in
Cumberland County,Pennsylvania.
Form OC-01 rev. 10.13.06 Page 5 of 10
Estate of Mary Elizabeth Beatty 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
I Full?
N/A E]Yes El Yes
ONo No
E]Yes Yes
EINo E3No
E]Yes E]Yes
EINO F1 No
OYes M— Yes
E3No 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes MNo
Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E]Yes nNo
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-01 rev.10.13.06 Page 6 of 10
Estate of Mary Elizabeth Beatty , 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
06/20/2015 46,920.00
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? . . . . . . . . . . . . . . . . . . . Q 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.
1.4. A. Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
Petitioner believes that,pursuant to 20 Pa.C.S.A.s. 3543,the notice required under
Paragraph 8(B)above does not apply because all interests have been satisfied.
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . . . . . . [3 Yes M 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 Mary Elizabeth Beatty Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . Yes g]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.
N/A
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . OYes No
18. If a reserve is requested, state amount and purpose.
Amount
Purpose:
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? . . . . . . . . . . . . . . . . . . . . . . . . . . MYes MNo
As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ]Yes ONo
Form OC-01 rev.10.13.06 Page 8 of 10
Estate of Mary Elizabeth Beatty , 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 Distributee(s) Amount/Proportion
B. Principal:
Proposed Distributee(s) Amount/Proportion
Nancy Kocher(sole residual beneficiary) 100%
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
Name of Petitio r:Nancy Kocher, Executrix
Name of Petitioner:
Form OC-01 rev.10.13.06 Page 9 of 10
Estate of Mary Elizabeth Beatty Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that helshe she is title Executrix
of the above-named name ofcorporation estate 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 Pet' oner
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
Form OC-01 rev. 10.13.06 Page 1.0 of 10
The Patriot-News Co. °
2020 Technology Pkwy
Suite 300 Z1)( Vatr10t'WX(W5
Mechanicsburg, PA 17050 Now you know
Inquiries -717-255-8213
KOCHER, RICHARD S.
763 VISTA DRIVE
CAMP HILL PA 17011
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Marianne Miller, being duly sworn according to law, deposes and says:
That she is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the
Commonwealth of Pennsylvania,with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the
Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday
Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State
aforesaid;that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949,
respectively,and all have been contouously published ever since;
That the printed rmioe or publication which is securely attached hereto is exactly as printed and published in their regular
daily and/or Sunday/Comm Weeldy editions which appeared on the date(s)indicated below. That neither she nor said
Company is interested in t,"te subject mer of said printed notice or advertising, and that all of the allegations of this statement as
to the time, place and characler of pulmocation are true; and
That she has persaraD age at the facts aforesaid and is duly authorized and empowered to verify this statement on
behalf of The Patriot-dews CoL afixesaiid by YkWe and pursuant to a resolution unanimously passed and adopted severally by the
stockholders and board of akeckxs of the said Company and subsequently duly recorded in the office for the Recording of Deeds
in and for said County of Dm#iiin in is Book'W,Volume 14, Page 317.
PUBLICATION COPY Ttft ad# 0002331271 ran on the dates shown below:
March 31,2015
ESTATE MOXXIE
t_ettersTestorrenivYit►iheEsio*at April 07, 2015
ary ElFtwbeth l9eatfy[aTRfa 8e� ' w_
tatty),late of Lower AllenTowoship, April 14, 2015
imberland County,Pen syhrarft
ceased,were granted to the
dersianed and all persons indebted to ,
Id Estate are requested to make' - A . . . . . . . . . . . . . . . . . . .
imedlate payment and those having
rims wl11 present some without delay
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j63 Viscy to Drive, mpeN ll,PAi70li i . subsci4bed before me this 15 day of April, 2015 A.D.
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N,tary Pub)i
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
A lda:c Le__o:e,Notary Public
r._'_a__a Tre.,CLtrbe:land County
Wy - isix Expires July 16,2018
.U53CIATION OF NOTARIES
IN THE COURT OF COMMON PLEASE OF CUMBERLAND COUNTY, PA
ORPHANS' COURT DIVISION
FILE NO. 2015-00288
FIRST AND FINAL ACCOUNT OF
Nancy Kocher, Executrix
For
Estate of Mary Elizabeth Beatty, DECEASED
Date of Death: 03/16/15
Date of Executor's Appointment: 03/18/15
Date of First Complete Advertisement: 03/31/15
Accounting for the period: 03/18/15 to
08/03/15
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SUMMARY OF ACCOUNT
Receipts 237,675.42
Less Disbursements
Debts of Decedent $ 544.60
Funeral Expenses 3,465.00
Administration Expenses 1,082.41
Taxes 46,958.51 (52,051.10)
Balance before Distributions $ 185,624.32
Distributions to Beneficiaries (5,500.00)
Residual Principal Balance $ 180,124.32
Residual Distribution to Nancy Kocher $ (180,124.32)
Balance $ -0-
The other residual beneficiary named in the will, Elizabeth Beatty, is deceased and has no
children, leaving Nancy Kocher as the sole residual beneficiary.
2
PRINCIPAL RECEIPTS
03/20/15 Money Market Account#50-0579-8499 PNC $ 2,049.83
04/17/15 Refund of Bethany Village entrance fee 223,279.64
06/18/15 Reimbursement by long term care insurer 6,832.40
03/18/15 Silver Tea Service (Testamentary) 2,500.00
03/18/15 China and silverware (Testamentary) 1,000.00
03/18/15 Coin Collection (Testamentary) 2,000.00
03/24/15 Refund of overpayment by Ortho Institute of PA 13.55
TOTAL PRINCIPAL RECEIPTS $ 237,675.42
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DISBURSEMENTS
Debts of Decedent
05/08/2015 Medicine Shoppe $ 544.60
Unreimbursed prescription drug charge
Funeral Expenses
03/19/2015 Myers Harper Funeral Home 3465.00
Cremation, grave opening, coroner's fee
And shipping of remains
Administration Expenses
03/18/2015 Cumberland County Register of Wills 920.50
Probate
03/20/2015 Patriot News 162.26
Estate notice — letters of testamentary
Taxes
06/11/2015 Register of Wills
Pa. Inheritance tax
Pre-payment 46,920.00
Discount 2,469.47
Overpayment 2,431.73
Net taxes paid 46,958.74
TOTAL DISBURSEMENTS $ 52,051.10
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DISTRIBUTIONS TO BENEFICIARIES
05/22/2015 To Scott Beatty Bayne (per Will)
China and Silverwear $ 1,000.00
5/22/2015 To David Beatty Bayne (per Will)
Coin Collection 2,000.00
5/22/2015 To Ann Bayne Schoeller (per Will)
Silver Tea Service 2,500.00
TOTAL DISTRIBUTIONS TO BENEFICIARIES $ 5,500.00
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VERIFICATION
Nancy Kocher, Executrix of the Will of Mary Elizabeth Beatty, 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 have been paid in full; that, to her
Z;u,Ltanding against the Estate; that all taxes
presently due from the Estate have been paid; that the grant of Letters
Testamentary and the first complete advertisement thereof occurred more that
four months before the filing of the foregoing First and Final Account.
I understand that this statement is made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.
Nancy Koch Date
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