The URL can be used to link to this page

Home My WebLink About02-0879 IN RE: IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION AUTUMN NICOLE MOWRY, A MINOR NO. ,;{/.Obl-cg79 PETITION PURSUANT TO 20 P.S. &5101 AND NOW, comes Petitioner, Jann Jones, the parent and natural guardian of the minor, Autumn Nicole 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 natural guardian of Autumn Nicole Mowry, a minor born August 19, 1987, 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. Autumn Nicole Mowry, along with her minor brother, Tyler Robert Mowry, have been named as equal beneficiaries under the Group Life Insurance Policy of their Father, Terry R. Mowry, Jr. (A separate, identical Petition on behalf of Tyler Robert 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 Settlement Certificate CS000005835 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 related 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 Sank 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 "S" is a copy of the outstanding Hetrick Funeral Home, Inc. bill, showing a balance owed of $5,910.00. The minor's paternal Grandfather is financially responsible for half of the balance. WHEREFORE, Petitioner, Jann Jones respectfully requests this Honorable Court to issue an Order directing her, as the parent and natural guardian of the minor, Autumn Nicole 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 Prudentiai 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 would be deposited into an interest bearing Savings Account at Commerce Sank 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. Respectfully submitted, Dated: 912 U 10 L ~mkl~ Jil . Wlneka, Esquire Arney ID# 58802 Purcell, Krug & Haller 1719 North Front Street Harrisburg, PA 17102 (717) 234-4178 Attorney for Petitioner, Jann Jones (misc.\jones\petition) 2 ----- Prudential ~ Financial Prudentia/lnvestments Annuity Services PO Box 13379 Phi/adelphia, PA 19101 (888) 778-2888 www.prudential.com AUTUMN NICOLE MOWRY 5008 PHEASANT HOLLOW RD MECHANICSBURG P A 17050 Owner: AUTUMN NICOLE MOWRY Annuitant: AUTUMN NICOLE MOWRY Certificate Number: CSC000005835 May 22, 2002 Dear AUTUMN NICOLE MOWRY: Please accept this letter as confirmation 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 CSC000005835 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 dccision 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 yourparent 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 of 8:00 a.m. to 8:00 p.m. One of our customer service representatives will be happy to assist you. si7erelY, . i /,' "'-"-/7/ ." -;;-- ,_..-. '4 iliv ,?,,? ( /:i:~~r',! Peter L JcilinsOJ1~/ Registered R{presentative Annuity Payment Services Enclosures: Contract W-9 ORD 86076 - Change in the Manner of Payment Business Reply Envelope EXHIBIT 1L A Prudential business Registered Representative Prudential Investment Management Services LLC A Prudential company Gateway Center Three -- 14th Floor Newark, New Jersey 07102-4077 107".' l'ln?_A~')A Prudential ~ Financial CLAIM SETTLEMENT CERTIFICATE NO. CSC000005835-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 AUTUMN NICOLE MOWRY Date of First Interest Accumulation AUGUST 19, 1987 FEBRUARY 9, 2002 Frequency of Accumulation FEBRUARY 9, 2003 Beneficiary: CLASS 1 : ESTATE OF AUTUMN NICOLE 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 ~ ___ ~.-ao. * Secr€'ta~' Date: February 9, 2002 CSC3 Prudential ~ Financial The Prudential Insurance Company of America Pruco Life Insurance Company Pruco Life Insurance Company of New Jersey All are Prudential companies Annuitant: AUTUMN NICOLE MOWRY Claim Settlement Certificate Number: CSC000005835-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 BV .11 L _ _ ~.~o._ -* S\O'U8!arv 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 whosemailingaddressisPOBox13379.Philadelphia.PA19101. 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 1719 N FRONT ST HARRISBURG PA 17102 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 $6,30 I .84. If you have any questions, please call the Prudential Annuity Service Center at (888) 778-2888. You can obtain contract values, request fonns 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 linancial services. Sincerely, , ! " "'~,~J (1-- ~.(::~-:C(L, -'//vCL "'Lotetta Orce ~-- Customer Service Associate A Division of Prudential Insurance Company 0' America ------ HETRICK FUNERAL HOME, Inc. 3125 Walnut Street, Harrisburg, PA 17109 (717) 545-3774 Fox (717) 545-2325 Graham S. Herrick, licensed director, Stephen G. Hetrick, 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. State Board of Funeral Directors. STATEMENT OF FUNERAL GOODS AND SERVICES SEI ECTED Charges are only for tkose items that you Selected or are required. If we are required by law or by a cemetery or crematory to use any irems, 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 to pay for embalming. You do not have 10 pay for embalming you did not approve If you selected arrangements such as direa crema/ion. or immediate bun'al. If we charge for embalming we will explain. why helow. Legal, cemetery, cremafOty or other requirements com elling the Purchase of any items listed below: ;:; ~ GOODS AND SERVICES SELECTED TYPE OF SERVICE AUTHORIZED TO BE PROVIDED ~Traditional Full Service aViewing day of Service o Graveside seT\:ice only IJ No Viewing C Cremation C Immediate Disposition C Public Viewing 0 Anatomical Gift i:J Prillate Family Viewing o Memorial Service l--: Evening Viewing lJ Shipping Service U Receiving Service Package Arrangement -r,t,.J~:?"...f i:;:'N'f/~{S"""',I,'-f. Lo.J'~ ~';Cf.AJI\{- I ha fe, <"" . { 1(",-,",-.1 I",-~,-,,- $ ? 735 Charge for Services Selected: 'fAt,,; \'1 _ 30 (:) I. PROFESSIONAL SERVICES ~,"',",,\ ~z,~ y;-' Basic Services Fee. ............ $~ Embalming ..... .A.J.~'??;+-~... $~ Cremation ....... '" ...\J.. $_ Other Preparation of Body $~ Transfer of Remains to Funeral Home.... $~ Sub.Total of Professional Services (Bl) ...,.... $~ 2. A~~;~i~~NA~ S~~rI~~~l~1;_~C~\I~;;1~~ Funeral Service ....,.... $~ Memorial Service ............... $~ Graveside Service. . . . . . . . . . . $~ Sub-Total of Additional Services and Facilities (B2). . . . 3. AUTOMOTIVE EQUIPMENT Funeral Coach............... .......... $~ Lead/Clergy Car.................. ..... $ Flower Car... ...... ........ ........... $~ Family Car H., H _"" H'" H', H'" H' $ Other than local 20 mile Transportation. .. $_ Sub-Total of Automotive Equipment (B3)..... ..$~ Total of Professional Services, Additional Service And Facilities, and Automotive Equipment (B). . . '11 $~ C_ CHARGE FOR MERCHANDISE SELECTED ~ J>4>'!>S- ~~~'" ~\''D ~. $ 1~7-( Othe.r ~eceptacle , t"\ 1JIvt.I....prvu- Bloc.... Descnpuon $"~ Oute.r ~urial CO)1tainer, Descnptlon ~........... ~\"'-""~ $ (~/)a URN Description $ Acknowledgement Cards................... $ "I_I MefA~~~II::';';;(IO~'''H''H'''' $ 1" CASH ADVANCES MUST BE REIMBURSED PRIOR TO SERVICE DAY AGREEMENT: I agr~ tllat I hav~ inspected th~ goods 8,:,d servic~s !dccted abov~ and found them 10 be aCCUl'1lte and according to th~ arrangements I have selecled. I acknowledg~ =dpl of a copy of lhi! Stat~mem of Goods and SerYices Selected. It IS understood that the total charge!; !ho"'n aholle may be esumal~d and reflect only Ihal agreed ~pon allhe time of thisl.l!'reemelll. ^fly addilional item. of scrYice or merchandise ord~red or required aft~r lh~ time of tbi! arrangement shall be considered part of this agreement and Ihe COS! wtll he reflected on your FInal Slatement which we provide TERMS: This;" a ca.h transaclion due in full in 30 days, and in aU evellls'becomrs past due and drlinquelll after the 30 days dale, A penalty of IS% per annum (1.2S% mOlllhly) will be charged for unanticipated late paymem effective On Ihe 31st day. WARRANTIES: The only warranty of Ihe merchandisc sold in connection with thi! agr~ement is the express written warranly (if any), provided by the manufacturer. The funeral director make!; IlO warranty (nprrsscd or implied) with n:!pecttoany funeral merchandi... AUTHORIZATION; r or We aUlhorlze and raufy pnor consent to the funeral direclor to lake P'?"sessinn of Ihe body. give care to and carry out the arranft'menu hereto specified and agreed to. 10rWerepleSelllourselvesastheperSOn(S)l\allinglhelegalrighltoarrangefor the final dispos'!l'J.noflhe abnve named decedent. and do hereby grant aUlhority to the funeral director to supply the services and merchandl$~ as listed above. I Or We guarante~ the payment of thts contact accordmg to the above lerms. and allO agree to pay any anorney fee Or legal judgement Imposed upon thecolJectionoftbecO&t of this scniceagreement. Oral Permission To Embalm: The above named de~em ti Was gramed !J Was refu.ed by AD-if..d '. on d l'j I tapprox. ' R~I."on.h,p FINAL ACCEPTANCE: r or We accept and approve, the above selections and terms, and acknowledge that the ge effective I 1 I 10 and outer burial COntamer pnce list effective I f I A29,..were made available prior t9- ection /\!(~, 'n})i/ :2/'r./':>- I $;1I;"ur<ofl'un:hou, I D. J . . ~. tatememTo; ,~-Z'I' "'00 .) B - =-- ",J'<.'f"t'~d"1'? Accepted Y 'Ji.- ..... iEXHllllY /!) ,,,', A, B. $~ Date of Death ~ - q - 0:1- Dare of Service Register Book. Prayer Cards. . Crucifix ...... Temporary Grave Marker..... Memorial Board Rental. . . . . . . Casket Rental Clothing......... . Flag Case. . . Other Total of Merchandise Selected (C). D. Special Charges Forwarding Remains to $~ .......".;...;$- "'f'~h ,,$~ $- $- $- $- $- ".$~ $- Receiving of Remains from $- $- $- .,,$- Immediate Burial Direct Cremation. . Total of Special Charges(D). . . E. Cash Advances Opening of Grave. . . $~ Cemetery Equipment. . . . . . . . . . $~ Clergy/Mass Offering $ FAN. "~ Flowe" ",,","," "(" '"', $_ Certified Copies of Death Certificate ./P.). $~ Newspaper Notice.....................,. $~ Cemetery Lot and Deed ................. $~ Pallbearers........... ........... $~ Airfare ...................... .......... $_ Vault Service Charge... .......... $~ Honor Guard ............ $~ Organist................................ $~ Other $_ For your convenience, we will advance the cost ofthe foregoing items; however, any error made by any supplier of services shall be the sele responsibility of that supplier and our funeral home is relieved of liability therefore by acting as your agent. Total of Cash Advances (E).......... '.......... $~ A, PACKAGE ARRANGEMENTS"" _""" $ 3&,'- B, ADDITIONAL SERVICESIFACILITIES " $_ C, MERCHANDISE""""".".."""" $~ D, SPECIAL CHARGES H'"""""", $ ..,,$~ $ 9/P0 Total of Funeral Home Charges... E. Cash Advances. . . . . . . . . . . Total of Funeral Home Charges and Cash Advan,;es ..0:............... ..... "" $ffML I VERI FICA TION I verify that the statements made in the Petition Pursuant to 20 P.S. 35101 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 c; Iv 1(; L OCT 0 1 IUCI? ;r IN RE: IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION AUTUMN NICOLE MOWRY, A MINOR NO. ~I-OJ..- 'tIC} AND NOW, this ~~ ~ day of , 2002, based on the Petition of Jann Jones, the parent and natural guardian of the minor, Autumn Nicole 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 Prudential 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, Autumn Nicole 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: J. Distribution: Jill M. Winel<a, Esq., 1719 North Front Street, Harrisburg, PA 17102 ---