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II THE !tATTER OF
IN THE COURT OF COMOI PLEAS
CUJlBERUID COUlTY PEINSYLVAlIA
ORPHAN'S COURT DIVISION
No. 507 Orphans 1978
Sara It. Vhittinqton
An Inco.petent
PETITIOI TO CHANGE Bt:IEnClARY 01 LU'E IISURAICE POLlCIES
1. Petitioner, Bonita J. Stahl, Guardian Officer at
Selinsgrove Cenler, was appointed Guardian of the Estate of
Sara M. Whittington by this Honorable Court. on November 17, 1978.
2. Sara M. Whittington is a resident of the
Selinsgrove Center, Selinsgrove, Pennsylvania, having been
admitted to said facility on December 18, 1968.
3. The Incompetent's marital status is she never
married, and her military status is never served in the armed
forces.
4. The Incompetent's next-oE-kin and their relationship
to the Incompetent are:
Mrs. Florence Whittington (mother)
100 B. Sout.h Fi rst Street
Lemoyne, Pennsylvania 17043
5. The Incompetent's monthly income consists of a Social
Security benefit of $175.00.
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6. 'l'he J llcompet.ent. I s ~3l:fet.s cons i st of Conserved
Social Security Income of $1875.15 held by her Guardian.
7. The Petitioner also holds t.he following life
insurance policies:
a. American General Life and Accident. Insurance Co.
policy number 117831985, face value $2000.00, cash value $57.90.
b. American General Life Insurance Company policy number
79366340, face value $1000.00, cash value $264.13.
c. A.erican General Life Insurance Co.pany policy number
78266624, face value $1000.00, cash value $341.62.
d. The Knight.s Life Insurance Company, for.erly American
General Life and Accident Insurance Coapany, policy number
W0749355, face value $315.00, cash value $91.43.
e. The Nat.ional Life & Accident Insurance COII.pany,
policy number 3817443452, face value $375.00, cash value $224.15.
8. Selinsgrove Center bills the Incompetent at. t.he rate
of $115.00 a month.
9. The beneficiaries on t.hese policies are eit.her the
mother, Florence Whit.tingt.on, or the father, A1dine Whit.t.ington.
The father died August 18, 1987.
10. It is the desire of the guardian to consider these
policies in place of a $1200.00 irrevocable burial reserve. In
order t.o ensure that the funds will be available for burial, a
change of beneficiary t.o t.he "Estat.e of Sara ". Whit.t.ingt.on" would
be needed.
11. Sara Whitt.ingt.on is current.ly on Medical Assistance.
Among other benefits of being "edical Assistance eligible is t.he
fact. that approximat.ely 55, of Sara's daily per diem of $192.00 is
paid by Medical Assistance for Sara's st.ay here. Whenever a
Medical Assist.ance recipient has life insurance policy(s) with a
face value of more t.han S1500.00, any cash value over $1000.00 of
the F~licy(s) is considered an availalbe resource for billing
purposes. This limit.s the monies available to Sara to meet her
personal needs.
BOOK 121 PhCE 804
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13. Currently Sara Whittington is paying premiums of
$246.72 per year on the above policies. Since Sara has only
$60.0,0 per month to use for her personal needs, payment of the
premiums reduces Sara's available assets.
14. As guardian 1 propose that The American General Life
Insurance policy numhers: OOW0749355, 00,78266624, and 0079366340"
be changed t.o reduced paid up policies. This will provide more
monies for Sara WhitLingLon's personal needs. See Exhibit 'IA" for
the new reduced values.
WHEREFORE, Petitioner, Bonit.a J. Stahl, Guardian Officer,
requests this Honorable Court authorize the guardian to change the
beneficiary on the life insurance policies to "Estate of
Sara l'1. Whittington" and c:hange the three American General Life
Insurance policies to reduced paid-up policies.
BY:
{Jd1kt- ~.};kId .
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BOOK 121 P~r,E 805
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COJlJlO'''tAL T8 OF . PEI.Sn. VAil A
eOUlTY OF SlYDER
AFFIDAVIT
Imnit.a.J. Stahl, Petitioner in this maLt.er, being duly
8worn according t.o law, do depose and st.ate that. 1 am t.he GuardiflO
Officer At Selinsgfove Center and that the fact.s set. forth in t.he
forego i ng Peti l.i on are t.rue and correct. to t.he best of my
knowledge, information and belief.
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GilARDI AN . FI . R
BOOK 121 P~r.E 806
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~~Ch THE
'Ifi..~ American General
W GROUP
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* American General Life and Accident Insurance Company
Harrisburg Office
OiSlricl Of/ice Code PA02/938
POBox 4507
Camp Hill, Pennsylvania 1 7011
Selinsgrove Center
Route 522, Box 500
Selinsgrove, Pa. 17870
Attention : Ms. Bonita St~hl
March 28,1988
David Thoma.
Manager
761-0435
Re: Sara Whittington
Policies: OW0749355, 078266624, 079366340
Dear Ms. Stahl:
In response to your letter dated March 17th, it is possible to convert the
poliCies to paid up policies. #OOW0749355 would have a reduced death benefit
of $160. #0078266624 would have a reduced death benefit of $906, and
#0079366340 would have a reduced death benefit of~$450. If th1!S is what is
desired to do, we would first have to change the ownership of the policies.
Currently, Sa":'a is the owner of her own policies. If she is mentally incompetent
in order to make any policy changes, the ownership should be changed.
If you would like the ownership of these policies to be changed to you since
you are Sara's guardian, thi s c~n be done. The beneficiary then also can be
changed to Sara's Estate. If this is what you would like to be <llone, the
attached forms should be completed. After ownership of the policies is
changed, the policies than could be changed to reduced paid up )01ic1es if you
so desire to do this.
You also stated that you would be making the )premiUm payments on
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these policies. Have the premium receipt books been turned over to you?
Payments sh~uld be mailed to this location.
I'm sure you may have questions on these matters, ahd I would
appreciate it if you would call me B.t your convenience so any chfU18es can
be handled correctly and promptly.
Sincerely,
~p~<--
EXHIBIT A
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