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HomeMy WebLinkAbout02-0878 IN RE: IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION TYLER ROBERT MOWRY, A MINOR NO. a J-O~. 371 PETITION PURSUANT TO 20 P.S. &5101 AND NOW, comes Petitioner, Jann Jones, the parent and natural guardian of the minor, Tyler Robert Mowry and avers as follows: 1. Petitioner is Jann Jones, an adult individual with a current address of 5008 Pheasant Hollow Road, Mechanicsburg, Pennsylvania 17050. 2. Petitioner is the parent and naturai guardian of Tyler Robert Mowry, a minor born April 16, 1992, who resides with Petitioner at 5008 Pheasant Hollow Road, Mechanicsburg, Pennsylvania 17050. 3. The minor's Father, Terry R. Mowry, Jr. is deceased, having died intestate and insolvent on February 9, 2002. 4. Through his employer, United Parcel Systems, Terry R. Mowry, Jr. had a Group Life Insurance Policy with Prudential Financial. 5. Tyler Robert Mowry, along with his minor sister, Autumn Nicole Mowry, have been named as equal beneficiaries under the Group Life Insurance Policy of their Father, Terry R. Mowry, Jr. (A separate, identicai Petition on behalf of Autumn Nicoie Mowry is being filed simultaneously with this Petition). 6. The minor is to receive $6,250.00 in insurance proceeds from Prudential Financial. Attached hereto and marked Exhibit "A" are letters dated May 22, 2002 from Prudential Financial/Prudential Investments Annuity Services, confirming in writing that the minor is to receive $6,250.00 as part of the life insurance settlement, (which amount has accumulated to $6,301.84 as of May 22, 2002), and that the funds have been placed in an interest bearing Claim Settiement Certificate CS000005032 until the minor reaches the age of majority or until a custodian or guardian is appointed. 7. Pursuant to Section 5101 of the Probates, Estates and Fiduciaries Code, because the personal Estate of the minor has a net value of $25,000.00 or less, the proceeds of the life insurance may be held or disposed of by the parent maintaining the minor, as directed by the Orphans' Court of Cumberland County, the county where the minor presently resides. 8. Pursuant to Section 5102 of the Probates, Estates and Fiduciaries Code, this Court may authorize or direct Petitioner, as the parent and natural guardian, to execute the necessary instruments needed to carry out a Court Order regarding acceptance of the life insurance proceeds and deposit of same in a savings account on behalf of the minor. 9. Petitioner's intention is to utilize the minor's proceeds to pay any attorney's fees and costs reiated to this Petition; to pay one-quarter of the outstanding minor child's Father's funeral expenses in the amount of $1,477.50; and to deposit the remaining life insurance proceeds and any interest earned in an interest bearing Savings Account at Commerce Bank in the minor child's name and Social Security Number, which funds would be sequestered until the minor attains the age of majority or otherwise as authorized by Court Order. Attached hereto and marked Exhibit "B" is a copy of the outstanding Hetrick Funeral Home, Inc. bill, showing a balance owed of $5,910.00. The minor's paternai Grandfather is financiaily responsible for half of the balance. WHEREFORE, Petitioner, Jann Jones respectfuily requests this Honorable Court to issue an Order directing her, as the parent and natural guardian of the minor, Tyler Robert Mowry, to execute the necessary documents to have the life insurance proceeds in the amount of $6,250.00, and any interest earned, released from Prudential Financial. From the proceeds, Petitioner is seeking Court permission to pay any attorney's fees and costs related to this Petition and to pay $1,477.50 to the Hetrick Funeral Home, Inc. The remaining proceeds wouid be deposited into an interest bearing Savings Account at Commerce Bank in the name and Social Security Number of the minor, and the funds would be sequestered until the minor attains the age of majority or as authorized by Court Order. Proof of the sequestered account would be filed of record. Respectfuily submitted, Dated: 9/2- u I ()L Jill At rney ID# 58802 Purcell, Krug & Hailer 1719 North Front Street Harrisbur9, PA 17102 (717) 234-4178 Attorney for Petitioner, Jann Jones (misc. ~ones\petjtion) 2 - Prudential t$ Financial Prudential Investments Annuity Services PO Box 13379 Philadelphia, PA 19101 (888) 778-2888 www.prudential.com TYLER ROBERT MOWRY 5008 PHEASANT HOLLOW RO MECHANICSBURG P A 17050 Owner: TYLER ROBERT MOWRY Annuitant: TYLER ROBERT MOWRY Certificate Number: CSC000005032 May 22, 2002 Dear TYLER ROBERT MOWRY: . Please accept this letter as coufirmation that we have processed your claim for benefits. I appreciate the opportunity to assist you with this settlement. I encourage you to keep this letter and refer to it if you should need any further assistance. Claim Settlement Certificate CSC000005032 is enclosed. This certificate reflects the $6,250.00 retained on your behalf while the claim is being settled. Our Periodic Payment Center will retain this money until you reach the legal age of majority or until a custodian or legal guardian has been appointed. Interest will be credited annually while the funds remain in the account. This decision is based on our policy records. According to these records, you are a minor and no custodian or legal guardian has been appointed to you. Enclosed is Form W-9 which should be completed by your parent or guardian on your behalf. Please be sure to return the form to this office within 30 days from the date of this letter. It is important to note that if we do not receive your completed Form W-9 within 30 days, we are required to withhold federal income taxes from you payments. A reply envelope is enclosed for your convenience. If you have any questions or need further assistance, please contact your representative or the Prudential Annuity Service Center. You can reach us at (888) 778-2888, between the hours of 8:00 a.m. to 8:00 p.m. Eastern time, Monday through Friday. If you are using a telecommunications device for the hearing impaired (TOO), please call (800) 654-7637, between the hours of8:00 a.m. to 8:00 p.m. One of our customer service representatives will be happy to assist you. SinCe,'r ely" ' lit, ;Z )>t1;z<J{~J Peter L Johnson :' Registered Representative Annuity Payment Services Enclosures: Contract W-9 ORD 86076 - Change in the Manner of Payment Business Reply Envelope A Prudential business EXHIBit ,4 Registered Representative Prudential Investment Management Services LLC A Prudential company Gateway Center Three.. 14th Floor Newark, New Jersey 07102-4077 (973) 802.8624 - Prudential ~ Financial CLAIM SETTLEMENT CERTIFICATE NO. CSC000005032-A is the result of settlement of a contract issued by: The Prudential Insurance Company of America Original Insured Settlement Amount Group Number Certificate Number TERRY R MOWRY JR $6,250.00 76536 189589306 Annuitant Annuitant Date of Birth Certificate Date TYLER ROBERT MOWRY Date of First Interest Accumulation APRIL 16, 1992 FEBRUARY 9, 2002 Frequency of Accumulation FEBRUARY 9, 2003 Beneficiary: CLASS 1 : ESTATE OF TYLER ROBERT MOWRY ANNUAL Settlement of the above numbered contract(s) will be made as stated below: The settlement amount will be held at interest. While the Annuitant is living, interest will be accumulated effective on FEBRUARY 9, 2003 and at intervals of 12 months after that date. The Annuitant may withdraw the balance. Subject to our approval and to such conditions as may be agreed upon, the Annuitant may designate or change a Beneficiary. At the Annuitant's death, any balance will, without further accrual of interest, be payable in one sum as described in the Beneficiary section of this certificate. A Beneficiary receiving payments may withdraw the balance of his or her share. Signed for the Company By ..1.-- S-.'?..-o * Secretary Date: February 9, 2002 CSC3 --- Definitions We define here some of the words and phrases that may be used in this certificate. We, Our and Us - The company that issued the original contract(s). You and Your - The Annuitant under this certificate. Contract(s) - The original contract(s) that provided the settlement amount for this certificate. Insured - The word Annuitant means Insured. Balance On any date the balance is any unpaid amount with interest to that date. Claim Settlement This supplementary contract, including the special provisions, if any, and any endorsements Certificate attached, form the whole certificate. This certificate is evidence that contract proceeds have been placed under an annuity settlement. It is assumed that all statements made when making claim were made to the best of the knowledge and belief of the person(s) who made them. Change of Address To be sure your payments and important notices reach you without delay, you should notify your Service Office as far in advance as possible of any changes in your mailing address. Proof of Survival or Before we make a payment, we have the right to require proof that the Annuitant was living on Death the date the payment was due. If we ask for such proof, that payment and any later ones will not be due or payable unless and until we receive such proof in a form that meets our needs. If we do not receive such proof within 36 months of the date we first ask for it, we will cancel this settlement as of the date of our request. We will pay any death benefit that would have then been payable as if the Annuitant had died on the date of our request. Misstatement of Age If the Annuitant's stated date of birth is not correct, the amount of any payments already made will be adjusted. The adjustment will be made as follows: (1) Any overpayments, with interest at 5% a year, will be deducted from any payment(s) due then or later; (2) Any underpayments, with interest at 5% a year, will be added to the next payment we make after receiving proof of the correct date of birth. Withdrawal If you have this right and would like to make a withdrawal, send your certificate to your Service Office along with your signed request that includes your certificate number. Ownership and Control Unless we endorse this contract to say otherwise: (1) the owner of the contract is the Annuitant; and (2) while the Annuitant is living the owner alone is entitled to (a) any contract benefit, and (b) the exercise of any right and privilege granted by the contract or by us. Beneficiary(ies) You may be able to name or change a beneficiary. This is explained in the special provisions attached to this certificate. Any request must be in writing and in a form that meets our needs. It will take effect only when we file it at your Service Office. The interest of anyone who is being removed will end as of the date of the request, even if you are not living when we file it. When a beneficiary is designated, any relationship shown is to the Annuitant unless otherwise stated. To show priority, we may use numbered classes, so that the class with first priority is called class 1, the class with next priority is called class 2, and so on. When we use numbered classes, these statements apply to beneficiaries unless otherwise stated. 1. One who survives the Annuitant will have the right to be paid only if no one in the prior class survives the Annuitant. 2. One who has the right to be paid will be the only one paid if no one else in the same class survives the Annuitant. 3. Two or more in the same class who have the right to be paid will be paid in equal shares. ----- Prudential ~ Financial The Prudential Insurance Company of America Pruco Life Insurance Company Pruco Life Insurance Company of New Jersey All are Prudential companies Annuitant: TYLER ROBERT MOWRY Claim Settlement Certificate Number: CSC000005032-A CHANGE IN THE MANNER OF PAYMENT 1. This Certificate is amended to provide that (a) if the interest frequency is not annual, it is changed to annual; and (b) each annual interest payment due after the date of this endorsement will be added to the principle and not paid out. Any interest amounts that we add to the principle are subject to the same provisions and conditions that apply to the principle. 2. But: (a) if a life income settlement starts at a later date, we will use the life income rates in Ordinary contracts that we issue on the due date of the first payment to compute that part of the life income payment that comes from the interest that has accumulated under this certificate. (b) We or the Annuitant may choose that the interest be paid periodically as of the next annual payment due date on or after the date that choice is made. 3. All provisions of this Certificate that do not conflict with this rider still apply. Endorsed or acknowledged for the Company B',," llo-- S-.~a. * ::::8cr8181i,i Date: FEBRUARY 9, 2002 ORD 86076 --- 4. If none survive the Annuitant, we will pay in one sum to the Annuitant's estate. Example: Suppose the class 1 beneficiary is Jane and the class 2 beneficiaries are Paul and John. We owe Jane the balance if she is living at the Annuitant's death. We owe Paul and John the balance if they are living then but Jane is not. But if only one of them is living, we owe him the balance. If none of them is living we owe the Annuitant's estate. Before we make a payment, we have the right to decide what proof we need of the identity, age or any other facts about any persons designated as beneficiary. If beneficiaries are not designated by name and we make payment(s) based on that proof, we will not have to make the payment(s) again. Service Office This is the office we designate to service your certificate. Your Service Office is the Periodic Payment Center whose mailing address is POBox 13379,Philadelphia, PA191 01. We will notify you of any changes. ---- ENDORSEMENTS (Only we can endorse this contract.) Annuity Contract. Prudential ~ Financial Prudential Investments Annuity Services PO Box 13379 Philadelphia, PA 19101 (888) 778-2888 www.prudential.com PURCELL DRUG AND HALLER A TIN JILL WINEKA 1719N FRONT ST HARRISBURG PAl 7102 Contract #: CSC000005032 CSC000005835 Client: TYLER ROBER MOWRY AUTUMN NICOLE MOWRY May 22, 2002 Dear Ms. Wineka: Your recent request for information on the above-mentioned contracts has been referred to me for a reply. I hope the following information proves helpful. The value of contract CSC000005032 as of May 22, 2002, amounts to $6,301.84. The value of contract CSC000005835 as of May 22,2002, amounts to $6,301.84. If you have any questions, please call the Prudential Annuity Service Center at (888) 778-2888. You can obtain contract values, request forms and duplicate statements, and conduct certain financial transactions 24 hours a day 7 days a week with our automated phone system. The Service Center is open Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. If you are using a telecommunications device for the hearing impaired, you may call (800) 654-7637, Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. Thank you for choosing Prudential for your insurance and financial services. Sincerely, ~.itLLttL"~>0C( ~Lotetta Orce Customer Service Associate A Division of Prudential Insurance Company of America HETRICK FUNERAL HOME, Inc. 3125 Walnut Street, Harrisburg, PA 17109 (717) 545.3774 Fax (717) 545.2325 Graham S. Herrick, licensed director, Stephen G. Herrick, supervisor Nathan A. Bitner, licensed director Funeral Expense Agreement This is an explanation of charges as well as a sales agreement presented in accordance with the regulations of the Pa. Slate Board of Funeral Directors. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you Selected or are required. If we are required by law or by a cemetery or crematory fa use any items, we will explain the reasons in writing below. If you selected a funeral which may require embalming, such as a funeral with a viewing, you may have lO pay [or embalming. You do nO! have to pay for embalming you did nOl approve If you selected arrangements such as direCl cremation or immediate burial. If we charge for embalming we will explain why below. Legal, cemetery, crematory or other requirements com elling the purchase of any ilems lisled below: Reason for Embalming: -r; Q-. Funeral Services for f? hi ( 'Date of Death ~_ '1- a;L Dare of Service GOODS AND SERVICES SELECTED TYPE OF SERVICE AUTHORIZED TO BE PROVIDED &Traditional Full Service 8.,.Viewing day of Service o Graveside service only 0 No Viewing o Cremation c-:: Immediate Disposition C Public Viewing U Anatomical Gift o Private Family Viewing [] Memorial Service C Evening Viewing 0 Shipping Service o Receiving Service Package Arrangement 1!l4Cf.:.,.......1 h-iA.H...-II(S......,f._ I...NI~ ~';c......,l.~ J h", fe'd>f .-/ fVNe~1 4,,,,,,,... $ ;'735 Charge for Services Selected: 1Af1'. ki _:3 0 b I. PROFESSIONAL SERVICES 1)",,",,\' i~?' Basic Services Fee ......,... $~ Embalming .......AJ.hf:>~...... $~ Cremation .."..,........\J",.... $_ Other Preparation of Body $~ Transfer of Remains to Funeral Home.. $~ Sub-Total of Professional Services (BI) """.. $~ 2. A~i~::fo~NA~ S{1~~I~~;~\~ON~_~t~I~~~;~ Funeral Service . $~ Memorial Service $_ Graveside Service .. ..... ...... $~ Sub-Total of Additional Services and Facilities (B2). . _ 3. AUTOMOTIVE EQUIPMENT FuneralCoach......................... $ ~."~ Lead/Clergy Car....... _............... $_ Flower Car..... ....................... $~ Family Car............................ $ Other than local 20 mile Transponation. .. $_ Sub~Tota1 of Automotive Equipment (B3)....... $ ~ Total of Professional Services. Additional Service And Facilities, and Automotive Equipment (B). . . '11 $~ C. CHARGE FOR MERCHANDISE SELECTED ~:71. '!> <;" ~~~'" Sk",\'''G ~. $ J~7<' Othe.r ~ceptacle ~ l"'\ \7\1.)( I Sprvl.l...13llL. Descnpuon $-=----- Oute.r ~urial COJltainer\ t. "0"0 DcscnptJOD &-r~_ _IIIJ<'/.. $~ URN Description $ Acknowledgement Cards.. ....... .......... $~ Me;;:~ ~1::,~(lii6)"'"'''''' $ -~ l CASH ADVANCES Ml!ST BE REIMBURSED PRIOR TO SERVICE DAY AGREEMENT; I aVec' that I have inspected lhe goods and savites ill:lected above and found them to be accurate and according 10 lhe arrangements I have selected., I acknowledge receipt of a CQpy _of thi~ Slalemenl of Goods and Service-< Selected. It i_s understood that the total charges shown above may be estimaled a~d ~f1ect only that agreed upon at the ume of lhis agreement. Any additIonal Items of SCrvlCe or merchandiill: ordered Or requlI'ed after the time of lhis arrangement shall be considered part of lhls "ireemen! and the Cost w,lI be reflected on your Final Statement which we provide. TERMS: This is a ca.h tran.oction due in lull in 30 days. and in all evem. becomes past due and delinquem after the 30 day. date. A penalty of ] 5% pet annum (I .25% momhly) will be charged for unamicipated lale payment effective on the Hstday. , ,_ , . WARRANTIES: The only warranty of the merchandisc sold m connection wnh t111~ agreement i. the e~prcss written warranty (,f any), provtded by lhe manufacturer. The funeral director makes no wllfranty (cxpres""d or implied) with telpect 10 any funeral merchandi"". AUTHORIZATION: I or We authorize and ratify prior conscot 10 the funeral director 10 take pClS""ssion of the body. give care to and carry out the arran,emenll hereto specified and allr~d 10. I or We represent our""lvt'!! as lite perron(.) having the legal rillhtto auanlle for lhe final dispo.ition or lhe above named decedent, and do hereby IIflUl! aurhority to the funeral director to supply lhe services and merchand"e as listed aoove, I or We guarantee lhe paymem of Ih.. Conlact accordtng to the above terms. and also iIIree to pay any anorney f~ or legal iudgement imposed upon WcoUl'Ctionof{hecO$lofthis~erviceagreemenl. Oral Permission To Embalm: The above named decedem ~ Was gramed 0 W'as refused by J'ltD{r. d . on ;J I 'j I ( approx. . Relation.hlP FINAL ACCEPTANCE: I or We accept and approve, the above selections and terms, and acknowledge that the ge effe.s:(~el I I IO~ andouter burial contamer price list effectlve ( I, ,I.;)~.were made available prior t" e!;tion ). 1!UA. A"/)I.(/ :JIlt!'''' ~i, 'i Siln.lurcofl'urch..e, IDa / j ~~Th: ' /~~"'Y'""~""""" Accepted By /~7:a-~ A. B. $~ Register Book........................... $~ Prayer Cards...................... (~';' :.:~ $ CrucifIx. . . . . . . . ; ;'.f1lT--- Temporary Grave Marker. . . . . . . . .. $_ Memorial Board Rental....... .'.... $_ Casket Rental.................. $_ Clothing..... ............. $_ Flag Case... ....................... $_ Other $_ Total of Merchandise Selected (C). ...$ P)..:'-7-<'- D. Special Charges Forwarding Remains to $- Receiving of Remains from $- $- $- ....$- Immediate Burial. . . . . . . . . . Direct Cremation Total of Special Charges(D).. E. Cash Advances Opening of Grave. . . . Cemetery Equipment. . Clergy/Mass Offering ... ~~~~~~ 'c~~i;s' ~f D~~~h C~r~ifi~~t~' n.'Q): Newspaper Notice. . . . . , . . . , . . . . . . . . . . . . . Cemetery Lot and Deed.......... '....... Pallbearers............... , Airfare ......................... Vault Service Charge. . . , Honor Guard .................... Organist............................... . Other $~ $...Mi9D ~ F;,~. $~ $- $- $- $- $ $ .,,0 $- $- For YOllr convenience, we will advance the cost of the foregoing items; however, any error made by any supplier of services shall be the sole responsibility of that supplier and our funeral home is relieved of liability therefore by acting as your agent. .... $ 900 $ %3> $- $~ D. SPECIAL CHARGES.............. $_ Total of Funeral Home Charges.............. $~ E. Cash Advances........................ $~ Total of Funeral Home Charges and Cash Advan,:es ..<.................... Total of Cash Advances (E) . . . . . . . . . . . . . . . . . A. PACKAGE ARRANGEMENTS. . . . . . . . . . . B. ADDITIONAL SERVICESIFACILlTIES . . C. MERCHANDISE ................. . $69.ID ~~. ~~)r/.I"~ Tule aHIBI'I' .. VERIFICATION I verify that the statements made in the Petition Pursuant to 20 P.S. S5101 are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: q Iz. s'l v L , " ()['i 0 1 ZOO? IN RE: IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION TYLER ROBERT MOWRY, A MINOR NO. 21.0.2- 878' ~ ,j O~ AND NOW, this 1/ '" day of a , 2002, based on the Petition of Jann Jones, the parent and natural guardian of the minor, Tyler Robert Mowry, this Court hereby GRANTS the Petition and authorizes Jann Jones to execute all necessary documents in order for the life insurance proceeds, and any interest earned, being held at Prudentiai Financial on behalf of the minor be released to Jann Jones. It is further ordered that upon receipt of the life insurance proceeds and any earned interest, Jann Jones is directed to: 1) Pay $1 ,477.50 of the proceeds to Hetrick Funeral Home, Inc.; 2) Pay any attorney's fees and costs related to this Petition; 3) Place the remaining monies in an interest bearing Savings Account at Commerce Bank under the name and Social Security Number of the minor, Tyler Robert Mowry, with a notation on the records of the Commerce Bank Savings Account that no withdrawals may be made until the minor attains the age of majority, except as otherwise authorized by Court Order; 4) File of record evidence of the marking of the restrictions on the Commerce Bank Savings Account within ten days of the Account being opened. BY THE COURT: Distribution: Jill M. Wineka, Esq., 1719 North Front Street, Harrisburg, PA 17102 I