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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
He-(Ch -A-• 5ChacJ
ESTATE OF , DECEASED
No. 2012-00813
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PETITION FOR ADJUDICATION/ �, �''', c�
STATEMENT OF PROPOSED DISTRIBUTION Cn
PURSUANT TO Pa. O.C. Rule 6.9 �=' �' rn rn m a
C: 7� ZE ri
This form may be used in all cases involving the Audit of the Account of a Decedent's Estate If rn
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space is insufficient, riders may be attached. Attach the spouse's election, if:any; the pcors U'
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: THOMAS E. FLOWER
Supreme Court I.D. No.: 83993
Name of Law Firm: FLOWER LAW, LLC
Address: 10 W.HIGH ST, CARLISLE, PA 17013
Telephone: (717)243-5513
Fax: (717)241-4021
Form OC-01 rev.10.13.06 Page I of 10
Estate of CUMBERLAND , Deceased
I. Name(s) and address(es) of Petitioner(s):
Name: DENNIS J.SCHAD
Address: 310 SHATTO DRIVE
CARLISLE,PA 17013
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? . . . . . . . . . . . . . . . . . . . . . P1, Yes No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on JULY 11, 2012
Letters Testamentary or Letters of Administration were granted to Petitioner(s) on
JULY 26. 2012.
Date of Will (if applicable): AUGUST 30, 1996
Date(s) of Codicil(s) (if applicable): N/A
Date of probate (if different from date Letters granted): N/A
Was a bond required?E]Yes Q No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? . . . . . . . . . 0 Yes El No
Dates of advertising of the grant of Letters:LAW JOURNAL: 02/06/15, 02/23/15 &
02/20/15; THE SENTINEL: 01/28/15, 02/04/15 & 02/1.1/15
Form OC-01 rev. 10.13.06 Page 2 of 10
Estate of CUMBERLAND , Deceased
3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0Yes 0 No
If yes,name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . OYes Q No
(See Section 2201 et sit. 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):
N/A
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . . . CJ Yes ✓! No
Were any children born to decedent after execution of
Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ®-1 Yes `0 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No
Form OC-0/ rev.10.13.06 Page 3 of 10
Estate of CUMBERLAND , 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
MICHAEL SCHAD SON 1/4
256 Hidden Spring Lane
Langhorne, PA 19047
DENNIS SCHAD SON 1/4
320 Shatto Drive
Carlisle, PA 17013
Fonn OC-01 rev.10.13.06 Page 4 of 10
Estate of CUMBERLAND , Deceased
Name and Address of Each Part},in Interest I Relationship and Comments.if any I Interest
STEPHEN SCHAD SON 1/4
4335 Somers Ave
Oakford, PA 19053
TIMOTHY SCHAD SON 1/4
1.27 Limestone Drive
Reading, PA 19606
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
Form OC-01 rev. 10.13.06 Page 5 of 10
Estate of CUMBERLAND , 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?
PA DEPT OF HUMAN SERVICES 7,695.58 Yes El Yes
DIVISION OF 3rd PTY. LIABILITY [:]No WNo
ESTATE RECOVERY SECTION
E]Yes 0Yes
E]No E]No
Yes El Yes
E]No O No
Yes El Yes
E]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 RINo
Was family exemption allowed? . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes RINo
Family exemption claimant's name and relationship:
Name: Relationship:
Form OC-01 rev.10.13.06 Page 6 of 10
Estate of CUMBERLAND , 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
0.00 0.00
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? . . . . . . . . . . . . . . . . . . . Yes [0 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? . . . . . . . . . . . . . . . . . . E]Yes 0 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 CUMBERLAND , Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . E3 Yes M 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: N/A
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OYes 0 No
If so, attach a copy of the notice.
19. Is the Court being asked to direct
the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . DYes WlNo
As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [WsYes MNo
Form OC-01 rev.10.13.06 Page 8 of 10
Estate of CUMBERLAND , 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 Distribuiee(s) Amount/Proportion
NONE.
B. Principal:
Proposed Distributee(s) AmoundProportion
NONE.
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
Name of Petitioner:DOONIS J. SCHAD
Name of Petitioner:
Form OC-01 rev.10.13.06 Page 9 of 10
Estate of CUMBERLAND , Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that he/she is title
of the above-named name ofcorporation 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 Petition
*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.
<J_kq7/__
Signature of Counsel for Petitioner
Form OC-01 rev. 10.13.06 Page 10 of 10
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
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 Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
February 6, February 13, and February 20 , 2015
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
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.
Lisa Marie Coyn/, Editor
SWORN TO AND SUBSCRIBED before me this
20 day of February, 2015
Schad,Helen A.,'dec'd. Notary
Late of the Borough of Carlisle.
Executor: Dennis J. Schad c/o
Flower Law, LLC, 10 West High
Street, Carlisle,PA 17013.
Attorneys: Flower Law, LLC, 10
West High Street, Carlisle, PA COMMONWEALTH OF PENNSYLVANIA
17013. NOTARIAL SEAL
DEBORAH A COLLINS
Notary Public
CARLISLE KORO..CUMBERLAND CNTY
My Commission Expires Apr 28.2018
PROOF OF PUBLICATION
State of Pennsylvania, County of Cuinberland
Cathy Clark, Advertising 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 13th,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
January 28,2015 and February 4, 2015 and February 11 2015
COPY OF NOTICE OF PUBLICATION
NOTICE OF GRANT OF LETTERS TESTAMENTARY —
Letters Testamentary in the Estate of HELEN A.SCRD;d ceased,late of I' Affiant further deposes that he/she is not
the Borough of Carlisle,Cumberland County,Pennsylvania,have been
granted to the undersigned. interested in the subject matter of the
All persons knowing themselves to be indebted to the said estate will make aforesaid notice or advertisement,and that
payment immediately,and those having claims will present them for
settlement to: all allegations in the foregoing statement as
Dennis J Schad,Executor to time,place and character of publication
c/o FLOWER LAW,LLC
10 West High Street a true.
Carlisle,PA 17013
Sworn to and subscribed before me this
11�vl dau- d ' h( U-somu LM - A
U. f n65
Notary Pu lic
My commission expires:
Notarial seal
Bethany M.Holtry,Notary Public
cadisie Bolo,Cumberland coanty
My Comm6won Expires Sep-26.2015
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
THE ESTATE OF HELEN A. SCHAD, No. 2012-00813
deceased
Late of Carlisle Borough
CERTIFICATION OF NOTICE
I hereby certify that written notice of the date,time and place of presentation of the First and
Final Account for the Estate of Helen A. Schad for audit has been given by first class mail on
August 12, 2015, to every unpaid claimant who has given written notice of a claim and to every
other person known to have or to claim an interest in the estate as beneficiary, creditor, heir or next
of kin pursuant to Pennsylvania Orphans' Court Rule 6.3.
Date: 7—Z/ C\ J V D
Thomas E. Flower, Esquire
Attorney I.D.No. 83993
Flower Law, LLC
10 West High Street
Carlisle,PA 17013
(717) 243-5513
FLOWER LAW, LLC
10 W. HIGH STREET
CARLISLE, PA 17013
James D. Flower, Jr. (1953-2013) PHONE: (717)243-5513
Thomas E. Flower FACSIMILE: (717)241-4021
August 11, 2015
Department of Human Services
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
Attention: Elvetta E. Knox
In re: The Estate of Helen A. Schad
CIS #750315729
NOTICE OF ACCOUNT
Dear Creditor:
This letter will advise you, as required by law, that the First and Final Account of Dennis
J. Schad, Executor of the above-referenced estate, has been filed for Audit with the Orphans'
Court Division of Cumberland County Court of Common Pleas, in Carlisle, Cumberland County,
Pennsylvania. The Account, which does not include a Schedule of Proposed Distribution, will be
presented for audit, confirmation and distribution on October 13, 2015, at 9:30 a.m.
A copy of the Account is enclosed.
If you have no objections to the Account, or the matters set forth within the Account,no
action is required.
However, if you should have any objection to the transactions shown in the Account, or
omitted from the Account, you must file with the Clerk of the Orphans' Court Division,prior to
the date and time of audit, and in writing, objections thereto in conformity with the Cumberland
County Orphans' Court Rules. In the absence of timely written objections, the Court will assume
that you, as beneficiary, have no objections to the Account and the right to object will be waived.
However, if you should have any questions or objections, we would appreciate your
contacting us so that we can attempt to resolve any problems informally.
Very truly yours,
FLOWER LAW,LLC
Thomas E. Flower
Enclosure
List of parties receiving notice of the filing of the within Account:
MICHAEL SCHAD
256 Hidden Spring Lane
Langhorne, PA 19047
DENNIS SCHAD
320 Shatto Drive
Carlisle, PA 17013
STEPHEN SCHAD
4335 Somers Ave
Oakford, PA 19053
TIMOTHY SCHAD
127 Limestone Drive
Reading, PA 19606
PA DEPT OF HUMAN SERVICES
DIVISION OF 3rd PTY. LIABILITY
ESTATE RECOVERY SECTION
2 �151,�13
First and Final Account
of
Dennis J. Schad,executor
Estate of Helen A.Schad,deceased
File No.: 2012-00813
Date of Death: July 11, 2012
Date of Executor's Appointment: July 26, 2012
First Complete Advertisement of Grant of Letters: February 6, 2015
Accounting for the Period: July 11, 2012-June 15,2015
Receipts of Principal:
Funds on deposit: M&T Bank checking acct.#3740136126 $ 2,857.93
Total principal receipts: $2,857.93
Debts:
Department of Human Services, MA estate recovery' ( 1,577.43) $1,280M ::0>
M
c ca M c->.
Funeral and Administration Expenses:,
M o o
Bucks County Courier Times, Obituary: $ 50.00 0
St. Charles Bormeo Church,funeral service: $500.00
Probate fee:
$ 85.00
Tax return filing fee: $ 15.00 -' ; W rn
Attorney fee: $375.00 -y clt o
Account filing and advertisement fees: $255.50
Total expenses: ($1,280.50) 0.00
There was no income and no distribution to beneficiaries. No executor's fee is claimed.
Requests for additional information or questions or objections can be discussed with:
Thomas E. Flower, Esquire
FLOWER LAW, LLC
10 West High Street
Carlisle, PA 17013
(717) 243-5513
1 The total amount of DPW's claim is acknowledged to be $7,695.58.
COMMONWEALTH(JFPENNSYLVANIA)
: 33.
COUNTY OF CUMBERLAND)
Dennis J.Schad, Executor under the Last Will and Testament of Helen A. Schad, deceased,
hereby declares under oath that he has fully and faithfully discharged the duties of his 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, which are shown as
paid in the foregoing account, have been or will be paid in full;that,to his knowledge,there are no
claims nom/outstanding against the estate, except that all
taxes presently due from the estate have been pod
Dennis J.Schad,
or
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Sworn toand subscribed before nme
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this_��_ day of 2015.
~
,-__j Notary Public
Ci.)MMONWEALTH OF PENNSYLVANIA
NOTA I L SEAL
Thomas E.Flower,NotarY Public
Carilgle Soto,Cumberland County
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