HomeMy WebLinkAboutOC1971-1120 - ESTATE OF BRITTForm for Guardian or Trustee
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Estate of ~.~~~~~~Ei:.~.t2..
a minor
For _.
minor-incompetent-lite tenant
Date of tt:Ust .November 9,1971 .or guardIanshIp ..
If there have been former accounts
filed in this estate,list:
Filed at No !.!.?9._of 19 ~.!..
Fiduciary .f..~.!".~.~....!:l:~~.!.£g~1 ...~~!}1....~...J..r..~.§!g.9..~.."..
...........__.¥.~.?b.~E.g.~.~D.1._..r..§!-..~."Q.~~E~!.~g .
Place o~record WashingtonofappoIntment ..
Reason for filing this account...~~.~9.E ~~;;:~.~.~.:'!:~~~~~~;L?E.~:~y..~..
All persons having any interest,vested or contingent (including claimants),in the fund now before the Court,
with the nature of their interests are:
Sue Ann Britt
All of said parties have received notice as required by the Court Rules except as follows:
N/A
The fund now before the Court is subject to the following taxes:
NONE
Set forth any legal problems requiring adjudication by the Court or difficulties that must be met in distribution:
NONE
Balance for distribution per account,Principal $?}?2.~.?.~.~.7...
Additional debits not shown in account:
(Indicate whether income or principal)
.NONE
Additional credits not shown in account:
(Indicate whether income or principal)
NONE
Balance for distribution
Income
.;
Total additional debits
Total additional credits
Principal $?~.~.?~.~..:.?.?..
$??.?..20...................................
$Q.!.QQ .
$g..~.9.9..
Income
Total
$....;.......,....}!5.20 .......................................
$?~.L~~9..~..?.?.........................
If the balance for distribution is not in cash,list items'held in kind with carrying value designated,and if this is
a distribution account,file elections to take in kind for all items so listed:
General Electric Co.6.25%Notes Due 1979 $5,028.30
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Set forth accountants suggestion as to manner and form of distribution to be made,awards to'be stated in pro-
portions unless specific amounts or items are designated by instrument under which estate is being distributed:
On June 9,1972,Sue Ann Britt,Grantor,and First National Bank &Trust
Co.,Washington,Fa.,Trustee executed a Revocable Living Trust Agreement,a
copy of which is appended hereto as Exhibit A,to provide for further manage-
ment of the.Estate of Sue Ann Britt.On June 9,1972,the assets of the within
minor's estate were transferred to the above referenced Revocable Living Trust,
a Receipt for which is appended hereto as Exhibit B.On March 13,1974 Sue Ann
Britt revoked the said Revocable Living Trust Agreement,withdrew the remaining
assets of said trust and executed a Receipt and Release and Waiver of Accounting.
Said Revocation and Receipt and Release and Waiver of Accounting are appended
hereto as Exhibit C and D respectively.
Consequently,your accountant suggests that the estate be distributed
to:
First National Bank &Trust Co.,Washington,Fa.
Trustee,Under Agreement of Sue Ann Britt
Dated J~ne 9,1972.100%
COUNTY OF WASHINGTON,
COMMONvVEALTH OF PENNSYLVANIA,
The above named Fiduciary or representative thereofLIt..·,being duly r:doth depose and say that the
facts set forth in the foregoing'petition are true to the
best of...H.L~knowledge and belief.
~55
And your petitioner will ever pray,etc.
First National Bank &Trust Co.,...............................................................................................................................
Washington,Fa•...............................................................................................................................
,Jl.~.:.~mJJ1Jf.~~.
Trust Officer
NOTARiA'...SEAL
MICHELLE M.SAWC!-iUCK.Notai)'Public
Washington.Washington C<:.unty
My Commi"sion Exoires ,Jan.I,1991
JIrtition l'1tr hilit
IN THE
ORPI-IANS'COURT
OF WASHINGTON COUNTY
FORM USED FOR GUARDIAN-INCOMPETENTS
-OR TRUSTEES
No•....!.L?.Q of 19 ]1....
ESTATE OF ~.~.~A:~E.~.E;!;.~.~.1 ?:~.~.!:.?.E .
FOR ..
minor-incompetent-life tenant
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Counsel for the accountant shall submit herewith the
following,if pertinent:
1.Will or trust instrument-attested.
2.Inventory.
S:Signed elections of items to be taken in kind-
if distribution account.
4.Stipulation or certificate by minor approving
account.
5.Praecipe for those represented.
6.Brief-for any question of law raised.
John W.McIlvainet Esq._········ ·..·..··C~~i'··f;;;..·;~~~~t~t~..··...,.,q
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REVOCABLE LIVING TRUST AGREEMENT
THIS AGREEMENT,made this
19~,by and between SUE ANN BRITT of Fayette
day of :LJ .-('\..,f,
e/County,Pennsyl-
vania,(he.reinafter called the "GRANTOR")and FIRST NATIONAL
BANK &TRUST CO.,Washington,Pennsylvania,(hereinafter called
the "TRUSTEE").
The Grantor hereby transfers to the Trustee the property
described in the attached Schedule "A",and the Trustee agrees
to hold,administer and distribute the aforesaid property,togethe
with any other property added hereto,in accordance with the
following provisions.
ARTICLE ONE
A.During the lifetime of the Grantor,the Trustee shall
pay the net income from the trust to the Grantor,or for her
benefit,in quarter-annual or other convenient installments,
or shall deposit the same to any account of the Grantor,as she
shall direct by instructions in writing.In addition,the Grantor
shall have the right to withdraw all or any part of the principal
of the trust at any time.However,during any period in the
Grantor's life in which she is in the opinion of the Trustee
incapacitated,the Trustee,in its sole discretion,may use
so much of the net income and so much of the principal as it
deems necessary for the support,comfort and welfare of the
Grantor.
B.Upon the death of the Grantor,this Trust shall
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MLvS/fbl 5/17/72
terminate and the Trustee shall deliver all assets then held by
it hereunder to the Grantor's issue,per stirpes,or if no issue
survive the Grantor,to her heirs according to the Intestate
Laws of Pennsylvania as in effect at the time of the Grantor's
death.
ARTICLE TWO
A.While in the hands of the Trustee,neither the principal
nor the income of any trust hereunder shall be liable for the
debts of any beneficiary nor shall the same be subject to seizure
or attachment by any creditor of any beneficiary under any writ
or proceeding at law or in equity,and no beneficiary shall
have any power to sell,assign,encumber or in any manner to
anticipate or dispose of his or her interest in such trust or
in the income produced thereby.
B.Upon the death of any income beneficiary of the Trust
any accrued or undistributed income shall be held and accounted
for,or distributed,in the same manner as if it had been re-
ceived and accrued after the beneficiary's death.
ARTICLE THREE
If any beneficiary shall be under twenty-one (21)years
of age at the time any share of principal is distributable to
him or her,such share,although vesting absolutely in such
minor,shall be retained in trust,and the Trustee may,in its
discretion,accumulate the whole or any part of the net income
of such share,or may pay,distribute or apply at any time the
whole or any part of the net income and principal,including
accumulated income,to or for the support,welfare and education
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MLvS/fbl 5/17/72
of such beneficiary,either directly or by making payment to
the guardian or other legal representative of such beneficiary,
or to the person with whom he or she resides,without liability
on the part of the Trustee to see to the application of such
payments.When such beneficiary shall attain the age of twenty-
one (21)years or upon his or her death prior thereto,this
trust shall terminate and the Trustee shall distribute to such
beneficiary,or to the personal representative of his or her estat ,
as the case may be,any balance of principal,as well as any
accumulated or accrued income thereon.
ARTICLE FOUR
The Trustee shall have the following powers in
addition to those vested in it by law:
A.To retain as an investment for any trust hereunder,
without any duty of diversification,any assets received by the
Trustee,specifically including any stock in or obligations of
FIRST NATIONAL BANK &TRUST CO.,Washington,Pennsylvania.
B.To invest and reinvest in stocks,bonds,mort-
gages,securities or other property,real or personal,specifi-
cally including any common trust fund,without being limited
to any statute,judicial decisions or any other law relating
to investments by trustees.
C.To sell at private or public sale,to exchange or lease
for any period of time,any real or personal property,and to
give options for such sales,exchanges or leases,for such
prices and upon such terms and conditions as the Trustee deems
advisable.
D.To distribute the assets of any trust to the beneficiary
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entitled thereto in cash or in kind,or partly in each,such
allocation of assets to be in the sole discretion of the Trustee.
E.To register investments in the name of the Trustee
or in the name of a nominee,provided that the records of the
Trustee indicate clearly the trust to which such investments
belong.
F.To borrow money for any purpose either from the banking
department of the Trustee or from others or from any other separat
trust created hereunder,and to mortgage or pledge trust property
as collateral therefor.
G.To vote by person or proxy the investments of any trust,
and to exercise or sell any rights of subscription or other
rights in respect thereof;and to participate in any liquidation,
reorganization or merger of any corporation whose investments
are so held.
H.To compromise any clajm or controversy affecting any
trust hereunder.
ARTICLE FIVE
The Grantor reserves the right to revoke this Agreement
by serving written notification to that effect on the Trustee.
In addition,the Grantor reserves the right to alter or amend
this agreement by a proper instrument in writing executed by
the Grantor and accepted by the Trustee during the Grantor's
lifetime.
The Grantor shall have the right to add additional property
to this agreement during her lifetime,to designate the Trustee
as beneficiary of policies of insurance issued on her life and/or
to designate the Trustee under this agreement as recipien~of
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assets payable hereto in accordance with the provisions of the
Grantor's Will.
ARTICLE SIX
A.The Trustee shall have the right to resign at any time
during the lifetime of the Grantor by serving written notice
to the Grantor and following the death of the Grantor and the
receipt of assets for investment,by serving written notice
to the current income beneficiaries of the trust,whereupon
such beneficiary or beneficiaries by majority vote of those
who are of full age shall have the right to appoint a successor
corporate Trustee by petition to a court of competent jurisdiction
B.In the event of the merger or consolidation of FIRST
NATIONAL BANK &TRUST CO.,Washington,Pennsylvania,the successor
corporation shall become successor Trustee hereunder without
the necessity of executing any legal document or any further
action on the part of any party hereto or beneficiary hereunder.
C.This agreement shall be construed and regulated in
all respects by laws of the Commonwealth of Pennsylvania.
ARTICLE SEVEN
FIRST NATIONAL BANK &TRUST CO.,Washington,Pe~nsylvania,
shall be entitled to receive annual compensation for its
services as Trustee hereunder in accordance with its schedule
of compensation currently in effect when the services are per-
formed.
IN WITNESS WHEREOF,the Grantor has hereunto set her hand
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MLvS/fbl 5/17/72 ------------~
and seal and the Trustee has accepted this agreement by the
signature of its duly authorized officers and the affixing of
its corporate seal as of the day and year first above written.
WITNESS:
ATTEST:
GRANTOR:
TRUSTEE:
FIRST NATIONAL BANK &TRUST CO.,
Washington,Pennsylvania
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In Re:
RECEIPT
Estate of Sue Ann Britt,
a minor
,.,
KNOW ALL MEN BY THESE PRESENTS,that I,Donald M.Gavett,the
undersigned,hereby acknowledges ta have received from First National
Bank &Trust Co.,Washington,Pa.,Guradian of the Estate of Sue Ann
Britt,a minor the following:
Time Savings,First National Bank &Trust Co.,
Washington,Pa.$4,900.00
Certificate of Deposit,First National Bank &
Trust Co.,Washington,Pa.10,000.00
Savings Account,First National Bank &Trust Co.,
Washington,Pa.1,647.92
General Electric Co.6.25%Notes Due 1979.5,028.30
Principal Cash 2,389.15
Income Cash 375.20
Total $24,340.57
tf\IN WITNESS WHEREOF,I have hereunto set my hand and seal this
<2,day of fhtlP\tt51 1989.
First National Bank &Trust Co.,
Washington,Pa.,Trustee Under
Revocable Living Trust Agreement
of Sue Ann Britt dated June 9,1972.
(
BY:~mJ fh c<l1~
Donald M.Gavett,Trust Officer
Signed and Sealed in the
Presence of:
ctj.r-'\r P NOTARIAL SEAL ..''!;I;~''iJ[l.G;rYJ1J.~J MICHELLE M.SAWCHUCK.Notary PublicotarYPUbl~W2shlnglOn.Washington c~unty
Mv Commission Expires Jan.I,1991
MY COMMISSION EXPI4~7j 1't9/
REVOCATION OF TRUST
WHEREAS the undersigned SUE ANN BRITT entered into
a Revocable Life Trust Agreement,dated June 9,1972 with
FIRST NATIONAL BANK &TRUST CO.,Washington,Pa.as Trustee
and
WHEREAS in Article 5 of said Trust Agreement,said
SUE ANN BRITT,the Grantor,reserved the right to revoke
this Agreement by serving written notification to the
effect on the Trustee and
WHEREAS the said Grantor on March 13,1974 withdrew
the entire balance remaining in the Trust
NOW,therefore,the said Grantor does hereby reject
the Trust Agreement in its entirety.
IN WITNESS HEREOF Grantor has set her hand and seal
and the Trustee has accepted this revocation by the.I
signature of its duly authorized officers on the I)~
day of March,1974./.---...
Witness
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First National Bank &Trust Co.
200 WEST BEAU STREET
WASHINGTON,PENNA.15301
RECEIPT AND RELEASE
AND
WAIVER OF ACCOUNTING
I,Sue Ann Britt,hereby aCknowledge the receipt of
Forty-seven hundred ninety three and 07/100 representing a final
distribution of the,assets due me from the First National Bank &
Trust Co.,Washington,Pa.,Trustee under agreement dated
June 9,1972.
I accept the above distribution under the following conditions:
1.I specifically waive an accounting on behalf of this aG~ffi~ge
distribution and release and discharge the Trustee from any
liability in connection with the above account or its
administration.
2.Agree to indemnify and save the Trustee harmless agamnst all
liability loss or expense which may ever be incurred as a
result of the distribution herein referred to upon this
receipt and release.
In witness where of I have executed this instrument
bound.
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/
March 13,1974
the 13th day of March,1974 with the intention of being legally
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ELIZABETH LEE BRITT
appointment of guardia
IN THE COURT OF COMMON PLEAS
OF WASHINGTON COUNTY,PENNA.
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SUE ANN BRITT and
IN RE:
DECREE and PETITION
FOR THE APPOINTMENT
OF A GUARD IAN OF
THE ESTATE OF A MINOR
of estate
No.,1971,o=e.
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JOHN W.MciLVAINE
ATTORNEY AT LAW
Phone:276·2839
1008 FORSYTHE ROAD
CARNEGIE,PENNA.15106
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'S COURT DIVISION
IN RE:
SUE ANN BRITT and )
)
ELIZABETH LEE BRITT )
)No.I ,of 1971,O.C.--'----appointment of guardian )
)
of estate )
PETITION FOR THE APPOINTMENT OF A
GUARDIAN OF THE ESTATE OF A MINOR
TO THE HONORABLE,THE PRESIDENT JUDGE OF SAID COURT:
The Petition of Sue Ann Britt and Elizabeth Lee Britt
respectfully represents:
I,That Sue Ann Britt is a minor having been born on June
9,1951,and that she is the natural mother of Elizabeth Lee Britt
a minor,who was born on August 5,1969,and both are living
together in the parent-child relationship at the address of Dunlev
Washington County,Pennsylvania.
2.That your petitioners have no guardians of their respec~
t:i,ye estates.
3,That the estate of the minor,Sue Ann Britt is as
follows;
(a)The beneficiary under Metropolitan Life Insurance
Company Policy No.l5500G in the amount of $16,500.00,William
Lee Britt insured,husband of the Petitioner,now deceased as of
August 22,1971.
(b)$32,793.00 as the result of a Compromise and Settle
ment of a wrongful death claim filed in the Court of Common Pleas
of Westmoreland County,Pennsylvania,at
4.The estate of the minor,Elizabeth Lee Britt,is as follow
(a)$34,432.65,as the result of a Compromise and Settle-
ment of a wrongful death claim filed in the Court of Common Pleas
of Westmoreland County,Pennsylvania,at #146 October Term,1971.
5.It is necessary for the appointment of a guardian of the
estates of each of the above minors to protect their interests
and to prevent them from becoming the victims of designing persons
6.Your petitioner proposes that the First National Bank and
Trust Company of Washington be appointed as the guardian of the
estates of the above mentioned minors.
7.The proposed guardian has no interest adverse to the
minors,and is not a fiduciary or officer or employee of any cor-
porate fiduciary of an estate in which the minors have an interest
nor the surety nor an officer or employee of the corporate surety
of such a fiduciary.
8.That the proposed guardian has no interest in any matter
in which is adverse to or in conflict with the interests of the
petitioners.
WHEREFORE,your petitioners pray that First National Bank
and Trust Company of Washington be appointed guardian of the
estates of Sue Ann Britt and Elizabeth Lee Britt.
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Sue Ann Britt
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COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF WASHINGTON )
Before me a Notary Public,the undersigned officer,in and
for the County and Commonwealth aforesaid,personally appeared
SUE ANN BRITT,who,first having been duly sworn according to law
deposes and says that all of the facts averred in~the foregoing
PETITION FOR THE APPOINTMENT OF A GUARDIAN OF THE ESTATE OF A
MINOR are true and correct to the best of her knowledge,informa-
tion and belief.
._ .,.c4=:.·~A12~'~<~(]~<y)Q<:o~a~-{,jIa1~';=LJ0J.LL..A-U!..l..<:··~<,,,--'_(SEAL)
J Sue Ann Brltt
Sworn and subscribed to
before me this'.~0 ~L.
day of October,1971.
My Commission Expires:
6AffM~N M:Oi~/OVANNr
Notary public,Monongahela,Washington Co.
My Commission Expires July 7,197$
-3-
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
IN RE:
SUE ANN BRITT and )
)
ELIZABETH LEE BRITT )
)
appointment of guardian)No.,of 1971,O.C.
)
of estate )
ACCEPTANCE BY CORPORATE GUARDIAN
We agree to accept the appointment as Guardian of the
Estates of Sue Ann Britt and Elizabeth Lee Britt,and hereby
certify that this bank is not the fiduciary of an estate in
which she has an interest,nor the surety or an officer or
employee of any surety fiduciary,and that this bank has no inter-
est adverse to the Petitioners.
FIRST NATIONAL BANK AND TRUST
COMPANY OF WASHINGTON:
..
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
IN RE:
SUE ANN BRlTT and )
)
ELIZABETH LEE BRITT )
)No.~/~/~~O__,1971,~
appointment of guardian )
)
of estate )
DEC R E E
AND Now,iJ.?'T'...L T~71'the within Petition
(
presented in open Court and the minor,over the age of fourteen
years,Sue Ann Britt appearing in open Court,makes the choice of
the First National Bank and Trust Company of Washington as guardia~
of her estate,and as the guardian of the estate of her minor
daughter,Elizabeth Lee Britt and upon consideration thereof,the
said First National Bank and Trust Company of Washington is here-
by appointed as the guardian of the estate of Sue Ann Britt and
..
of the estate of Elizabeth Lee Britt,a minor,as prayed for herein.
BY THE COURT:
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IN THE ,COURT,DF ,COMMON ;PLEAS
.oF WASHINGTON ',COUNTY.,'.
PENNSYLVAN.IA.I'' ,
ORPHAN:lS ,GOURT:'DIVISION
No.,,Ll':Z'O~',o£_L9J..1~
IN RE:
SUE ANN BRITT and
ELIZABETH LEE BRITT
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appoiritme:ritotf,guardialf1
of 'estate
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PETITION OF FIRST NATIONAL
BANK'AND TRUST COMPANY TO.
PAY OUT OF PRINCIPAL AND 'Yo.
PAY 'MONTHLY SUPPORT AND
O'RDER AND DECREE
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JOHN W.MciLVAINE
ATTORNEY AT LAW
Phone:276-2839
1008 FORSYTHE ROAD
CARNEGIE,PENNA.151Q6 I
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHAN'S COURT DIVISION
IN RE:)
)
SUE ANN BRITT and )
)
ELIZABETH LEE BRITT )No.1120 of,1971,
)
appointment of guardian )
)
of estate.)
PETITION OF FIRST NATIONAL BANK AND TRUST COMPANY
TO PAY OUT OF PRINCIPAL and TO PAY MONTHLY SUPPORT
The Petition of First National Bank and Trust Company
respectfully represents:
1.That your petitioner was duly appointed guardian of the
Estate of Sue Ann Eritt,on November 9,1971;that said minor is
in her twentieth year;that said minor has an estate of about
FORTY-EIGHT~THOUSANDand 00/100 ($48,000.00)DOLLARS,consisting
of cash which Estate she derived as a result of a settlement of a
Wrongful Death Action and which is presently being held in trust
by the FIRST NATIONAL BANK AND TRUST COMPANY of Washington,
Washington County,Pennsylvania,for said minor,until she may
attain the age of 21 years.
2.That the minor is a widow and the mother of a two (2)year
old daughter,Elizabeth Lee Britt.
3.That the mother and daughter do not have suitable living
quarters and it is deemed by your guardian that a purchase of a
mobile home under the terms and conditions set forth in an invoic
and bill of sale hereto attached and marked EXHIBIT "A"from
Longnecker!s Enterprises,Inc.,of Belle Vernon,Pennsylvania in
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the totalamourrtw of $9,890.00 and would be beneficial to
"both the minor petitioner and her daughter.
4.That the said minor needs the sum of $100.00 per month in
cash for support of herself and that the Estate after the payment
of the aforesaid $9,890.00 will still be sufficient to produce an
annual income in that amount.
WHEREFORE,your petitioner prays your Honorable Court to grant
an order on the said FIRST NATIONAL BANK AND TRUST COMPANY,orderi g
it to pay to the minor,Sue Ann Britt,the sum of $100.00 a month
for her maintenance and support and in addition ou~of the
principal of the Estate,$9,890.00 for the purchase of a Broadmore
Mobile Home as set forth in Exhibit "A".
Said payments of $100.00 shall commence on January 1,1972,at
the payment of $9,890.00 for the purchase of said mobile home
which shall be paid forth with.
BY:
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COMMONWEALTH OF PENNSYLVANIA )
)SS:
)
COUNTY OF WASHINGTON )
Before me a Notary Public,the undersigned officer,in and for
the County and Commonweal th,personally appeared .M.L.von
Staudach
Company,who,being duly sworn according to law,deposes and says
that the facts set forth in the foregoing PETITION OF FIRST
NATIONAL BANK AND TRUST COMPANY TO PAY OUT OF PRINCIPAL AND TO PAY
MONTHLY SUPPORT,are true and correct to the best of his knowledge
information and belief.
FIRST NATIONAL BANK AND TRUST CO.
Sworn and subscribed to
before me this /3m day
Of.~1971.
'.
"My Commission Expires:
ANNA S.DZAVAN
Notary Public.California.Washington Co.
My Commission Expires June V.1£75
-3-
STATE OF PENNSYLVANIA
COUNrY OF WASHINGTON s. s.
JOINDER
'.
BEFORE ME,the undersigned authority,personally appeared Sue Ann Britt,who
being duly sworn according to law disposses~land says that the facts contained
in the foregoing petition are true and correct to the best of her knowledge,
information and belief.
SUE ANN BR T
Sworn to and subscribed
before me this /.3-r:!:!...
day of December,1971.
MARlEM M.NEil,Notary publie
CALIFORNIA.WASHINGTON CO.,PA.
My Commission expires July 14,.1973
'.".";
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".'.~,
,'..
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$
$
DATE
DELIVERED PRICE TOTAL ~$~
OFFICIAL FEES,LICENSE,TITLE"ETC,
USED TRADE-INALLOWANCE
LESS:BAL.DUEONABOVE
\.0 '(\ql\~~~~
Mobile Home Sales &Parks '
412/929-8900 R.D.#3
O~YLVANIA15012
0 FIRE AND THEFT -CAC
0 FIRE AND THEFT -COMPREHENSIVE
0 COLLISION--Amt.Deductible $
0 LIFE,HEALTH,ACCIDENT
0 CREDIT LIFE__YEARS
0 PERSONAL EFFECTS
0 VSI
BEDROOMS:
WIDTH:
ADDRESS
i\'\~,':'i.l:.hVIO':u>lVUi\..g,;
and
BILL OF SAlb ./5?
SOLD TO,~~
a;~~~~(7:;'~~--4-~4::L---I
'SALESMAN
DESCRIPTION OF TRADE·IN
seRIAL NUMBE~'2.-'3 g '7.-
MAKE
YEAR:
MAKE.
LENGTH.
MODel:
COLOR.
SERIAL #
NET ALLOWANCE
i
\1(
I
PRINTED IN U.S.A.
LESS TOTAL CREDITS
flRIH I'AYM~NT pue....__-_
_____MONTHS @ $•
INITIAL DOWNPAYMENT
CASH BEFOREDELIVERY-4vf,~~
~~.-'2-1.J £ff~---""",.J'UNPAID BALANCE $~.~,",1~-CO-S-T-O-F-IN-S~U-R-A-N-C-E-=:":::"::':':="''':::''':M=O''::N~TH:::s=-''H_':::$--------I
TO BE FINANCED
\
I H[Ar~Y ACKNOWLW05 AEt.:~t~f g~'tH5 OE9tAI9EtI M091lEHOME ANti A GO~V OFflll9If''v(II!;~,
BALANCE OWED TO:
F 250 JENKINS MOIIILEHOME PRINl'aRa ALL RIGHTS RESERVS;Dorm,MAscOUtAH,IlLli<oll.8228.
,,-,
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"
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"'
EXHIBIT "A"
I
I)
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHAN'S COURT DIVISION
IN RE:)
)
SUE ANN BRITT and 0-)ELIZABETH LEE BRITT )No.1120 of 1971
)
appointment of guardian )
)
of estate.)
AND NOW,
and DECREED
ORDER AND DECREEthiS/j~y o$L-£v
that the FIRST NATIONAL BANK
,1971,it is ORDERED,
AND TRUST COMPANY of
Washington,Washington County,Pennsylvania,sha11""pay to the
....\.
minor,Sue Ann Britt,out of the corpus of her Estate~~9,890.00
for the purchase of a mobile home under the terms and bonditions
as set forth in Exhibit "A".
It is further ordered and decreed that the guardian is empowere
and here authorized to pay to Sue Ann Britt,the minor,the sum of-$100.00 a month for her care and maintenance.Said payment shall
commence January 1,1972.
BY THE COURT:
Sworn and subscribed before me this )A .._,.day.~I...~,19.72)
~~;:Ph;~;;"c~;;;:;:"-')
'"~----------STATE OF PENNSYLVANIA,f
SS:
COUNTY OF WASHINGTON,
Personally appeared before me the undersigned authority
M.l.von Staudach,Vice President &Trust Officer of First National 'B~nk &·:(r·u·s··f···"t·o"~··~·····Wa·s··h··"'fi·g·t·o"n··~·····P·e·n·j1·s·y·,.·ij·a·fi·fa·····..······················,.
guardian of the estate of S.U.E.8.N.N B.R.1..T.I ..
..........................................................................................................................................................................................................................................................................
minor ,who being duly sworn,deposes and says that the following is a true and correct Inventory and State-
ment of the personal and real property which are of the estate of the above named minor
FIRST NA IONAl BANK &TRUST CO.
Washi on,Pennsy1~nia
. .'~~/~d~/.tJ
"V i"c e'"Pre de~..~·:·&"·..f·r ....s·t....'6'f'f..i"c·e·r..·..~·..
Dollars Cents
.
f
Insurance Co.of North America #CNR OD4 769
Group Pol.#15500G,
Metropolitan life Insurance Co ..#173-36-6366
32,793 00
16 676 22
II1---------,---I.------:--,---------llj---'-1-~
I~-+-----------:-----If---I-1---
NOTE-If real estate,give street and number,Ward of City,Borough or Township,and
County,and reference to Deed,Mortgage, Volume and Page.
If cash in !bank,give name of same.
$49,469 02
(""'...J
~t r--
:...,~'"""""';1:00
r\
I
(
/ j ~..:?~,19..7/No..................................0....."
In Re Estate
of
..........S.lJ..E A~.ri 6..B.l.I.T ..
Minors.
~.~~~
f3 p
~~.GUARDIAN'S
~J-INV_~NTOR':'n 1ND
~1<~ATE~~~~
~'1 "'---1-'_~~•<tl ".c--'-.)c',
'"!l"""~._~_..,.;:::1-'~<'<)~..,;a ..:-"I"'~.\..1.J '";
'";~J ~~~<i--....~:::c:-1 (f)::;-
('t <~I u..\:::::>.....)ifi
-(J -",-w-.u.J -<a..c:::....:
Fee $...........................
Filed................................~.
/
',,):1-_)..,..:..;:;:.;,,19~~..
Attorney.
~2
STATE OF PENNSYLVANIA,}"
S8:
COUNTY OF WASHINGTON,
Personally appeared before me the undersigned authority
M.L.von Staudach Vice President &Trust Officer of First National Bank &..................................................................,.Trust Co.,Washington,Pennsylvania
guardian of the estate of E.L.l.Z.8.6..E.IH l.~..~~.RJ..T.I ..
CO.
Sworn and subscribed before me this )
.............day Of...h ...._..19.1tl.d
~\
mmor
AAnUV .-............".:........................................................
Cler of Orphans'Court.
I
i
I Dollars Cents
Insurance Co.of North America #CNR 004 769 I 34,432 65
I
I
,
I
I
I
II
I
I
"'I
II
..
I
I
II
.I
I
I
I
II
I
NOTE-If real estate,give street and number,Ward,of City,Borough or Township,and $34,43';:65County,and reference to Deed,Mortgage·,Volume and Page.
If cash in Ibank,give name of same.
-.-r-
Nb :.!..!?:!::.~,19 7./
;\InRe Estate
of
....J.h.L?t\.§.sI.!:!J.sI !?..fU..II ..
.............................................................................................................
J1.>&'
~.
Minors.
CJ::::l
J LW..._-...LL.
"-l!l r---"I..",......,P,a.
~:GU,ARDIAN:S .<;:::)c>()J <:
~-INVE~.TORY~~~D
~._....STtATEME.~T.;,-1 --0
.:--=..~~.'j ;:::~:-
,;,, , -~j -.,J :.~lo........t.-__
co r..f):::~0 <I)c::I.J-l <!C":::;t.....-
rJ
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"-.~~~.
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~-~
)
Fee $.
Filed........................................................................,19_/".r-/,I:f-Y ..
..................................~;,~·····..A·tt~~~·~·~:····
~2
..,\"
'375 20,
$2,4;34.0 57
":-~
&TRUST CO,',>"
1",0 17 5,,0";'.
642 30
$
,$5J ',)90 :22
:27 ,8~24 '85
"
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to"
.~,~
,'.~.,.'.';'-:~:'',f..~
"....,.,..:.Balance
I _ , .Utt~X<Xl>axtXeX!.X''.,
';:'.",',~.:-.,.'I'
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N6.,,'"
".'~"
'.",.,.,>._-,,,;U .'Inheritan~e·'Tax'FullyPa.id:
;,\
,-~/...
r'O ~~,';.."~
....."-•"._~.•,I •,Account,of F,I RfST NA T I0 NAt'BAN K
OF-SUE ANN BRITT a Mino'r ',.'.-"':",,',.'&~OjX',
,1
SUMMARY
,;...
','
,TOJAl
'BaJal1ce',
'~.',~~.-.":''.-
B "Disbursements.
'f .;\~,/~".,
A Receipts,'
B -Disbursements'
Net Ba1ance.
,',
>,:~,..'..it.~,'""Re~~~pts
~~".,J~S:..
II Income-
,"","'":'\~A;,?~lNGT6N::';,<,"<<.~;"""""
THE"ORPHANS'COURT'OF "~:«l'S~N(F)<,COU~T,Y>P~NNSYI:;V:ANIA
'..;":;,..~,;~:'•'-.'f'>~,'-,_.'::,:"..:':."::,~.;~>'-.,...~,:';_'t/..,...,,:.......~.r .._...
i-;,'};",
IN
:This netb.alanceconsi~ts'of the following:
Tfme.Say/r,igs,,Fjrs;t,Na'tio'~:h\>'~ar1..~.'.&,;tru:s,,~·,.,,'~h,'.
,.'">"Wash'in gton "Pa":.,\i:;..•..,.
Cer t.,of De p'os;i;t /'Ffr:st.,Na t{o'n a:1B'ank &fru s·t
:.,.:,'.Wa.shington,Pa.·'"
Sa'v ih'gs<:Ac C0 unt;,·,F,i,rst:,Nation a1 Ban k:&'TX"lJ st:
.;..,:;'':,"·Wa sh ing ton,P(1'.".
'Ge'nera 1;;;'tJectri'c6'.1 ,/4,%'Note S,,;du e
P,r i nci pal,Cas h,.,'"
"';cI:,n'c Oil)e";,t ash....'0
'.
~.'O~pha"ns'~ourt'Accoutit ~.Fir8t Sheet-;).',..'-...'--'
",'," ,,,'.The.FLR'SL&FI NA{
Wa's"h i n'g to n "Pa .:';,"G,UARDl'AN..'.-.,"-'.;
In-v:,entory fil~d :
"
I
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,.,'.
...:...'
~Q~phans',Court Account-Second Sheet",••J,-":'
..,
,.
Estate of SUE ANN BRI TT,a Min0 r
',',,'
I"PRINCIPAL
A.RECEIPTS
.'.',
,..:-\,"
Longnecke~Mobile Home '"
FiTst,National Bank,accounta,ntls'comp,en's:ation
Att I y.John McIlva in'e,fi na 1 account lega':l fee
Clerk of COu'~ts"fiHng final account "
1 ,01 7 -50 .,.
27,824
51 ,790 ;,2 2
300 00
717 50
9,89'0
300
,6
1,4'18
4,043
2,'500
2,300
6,900
250
.200,
17
16,676,
<35 , 114
'.
,;"
II.INCOME
A.'RECEl PTS
Metropolitan Life"Insurance settlement
Insurance Co.of North Americ'a 'settlement,
Transfer Princ:ipal to Income
Interest savings account &ce,r}iJicate of
•deposit,First National'Ban,k.&Tru~t Co.
Wash in 9 to n,Pa .
Funeral ,Expenses
Hagan 01 dsmob,i.le'
Robert &E,l i za'beth Cordes (Pers,onaf~qan)
B.DISBURSEMENTS
Legal Fe,es-Clerk of Courts
S~:e'Ann Britt,dfstribution of Principal'
Longneck'er Mobile'Home.Transf~r·to Income
2/7/72.
4/12!72
,'.to " '
;,6/20/72"
"
12/l~/7·'
,2f7';,72 "
~:.t/2S/12 ':,,";'tq,;"
',.313/72I:tj};9;,~.2""
i<q /717 2'C"
3/+/1,;2
i,'fo,",
:6)i /72"~7113)}2
J/21}72
"
"l.2L31Ii2
)/:14/72
,:/
';1/10/7.2
to
,5}:J0/72,
J'/lO'/72
t :to
6/5/72
~~:
"
B.DISBURSEMENTS
,M on t h1y allowan ce"Sue Ann Br itt
Firs t Nati 0 nal 'B ank &Tr us teo.,acG0 U nt a nt I s
compensatjon
.,.;,...~
600 0'0
42 30 642 30
"
",
.,
The Court is respectfully requested to determine
proper distribution in this estate.
i
\1
iI
III
."
'"'-;"..
STATE OF PENNSYLVANIA,
WASHINGTON COUNTY,}55:
The within named Accountant being duly sworn according to law,depose and say that the above account
as stated is true and correct as _.__..~__.__verily believe.
,fIRST NAnONAL BANK &TRUST COMPA~Y
A INGTON,PfNNSYLVANIA
Washington County,ss:I do certify that I have given legal notice to all persons
concerned of the filing of 'the within account in the manner
prescribed by Statute and Rule of Court,as evidence by proofs
thereof filed to No._.&~._~__7_7-:::::_.7~_A-
I
Witness my hand and official seal this-----a4---7.-.--.------.
day of --../V..(!....J:(_???1i?..~.._...._..19.~.1-
...._...~__..~.F~
.R.egister of Wills l ~
<D~J
s:::co_0 ....-+-':........,c5 '...,-.9:0 Ill:-ci ....,>::
::l :co":-i ...,~:s.i 0 0 ....,
~I l=l ~!tti 0 ,:::
:::::l ...'001-:~Q)0~<)~.l:1 :c;
<)FI l E D,'...,~:c;""'-.9-q <11 ~!~L 0 ....1<11...,Q)(-...l:i $0 \1J:.....,..;-~!'C :0
'-..J Q),....~s:::!'1 ...,0 "(!»'72 AUG PH 2 49 ::::§N ..m:Q),:Q)
rx.~co;in rn ...~::::tQ)...D---.l 0 ci:....0 ~j '"~r-:ell p.~.;,~~I-i co!...,~~i<11 I~Eo<-H :::~ft~<11 H s:::,-0)RUSSELL \'Haw :::'C 1!l-/-oi ~"IM r\0 :::Eo<<)corn~-roo:-,.-:.REGISTER OF WILLS <)~~co ....'4 -+-,;..s::!:2 t.ttl!~:::~WASHINGTON CO.,PA.:a d .~~I0:zi 2:i cd ...;....,0 M 5i;;:::::~'~'-.~:;:l Q)~P::.,:4 -+-'i co .(;0 SIll;;....,Q)t-;:-..1.w!.l:1 ..........:~f ~;i ~~;;::
:::::>!-......~d 0 :::';)!:::01u-l 1 <)I..,!'C0:::.,.;..../)<11 0Zr-i ....
I'
..
\..
IN THE COURI'OF COMMON PLEAS OF
WASHINGroN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABETH LEE BRIT!',
A Minor.
No.1120 of 1971,O.C.
1
co ~
~.~
PErITICN .FOR··ALI.CMANCE
~
:E,.
IIIJ:"....L\~~"s,.70-f :to IT1 4::l.co~~,~\~~§"".~.r ~~•"'~,.~Q.C'\Z:::~'i3 Q ~~~ma~:=r
-<Zc;W.D~C'.PII !:>~..GO
,.III t1'>;:"Z -f-~C>~~~~~~Ct:t~8_C':)S'
2"CI:>
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Jy'.
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t"T"lco
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4'>-en
--im::0mo
t~\.
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,
t
goollge CRetoo.JIl.g u4:soocfates
cA CJ\~ssIOlla~ColpoitatlOll
cAttolneys at :;£ow
RETOS..LAW BUILDING
'/70 EAST WHEELING STREETtoWASHINGTON,PENNSYLVANIA 15301
\
~
IN THE COURI'OF CQ.MM)N PLEAS OF WASHINGroN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABErH LEE BRITI',
A Minor.
)
)
)
)
)
No.1120 of 1971,O.C.
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON.PA.15301
PETITION FOR ALIa'JANCE
'ID THE HONORABLE,THOMAS J.TERPUTAC,PRESIDENr JUDGE OF SAID COURI':
The Petition of the First National Bank &Trust Co.of
Washington,Pennsylvania,respectfully stated:
1.Your Petitioner was appointed guardian of the Estate
of Elizabeth Lee Britt,a minor,by decree of your Honorable Court at
the above number and tenn.
2.The said minor is ten (10)years of age and resides with
her mother,Sue Ann Britt,at P.O.Box 41,Perryopolis,Pennsylvania,
15473.The minor's father is deceased and her estate is a result of a
ccmpranised settlement of a wrongful death claim from the minor's deceased
father's estate.
3.The principal of the minor's estate consists of $53,305.68,
comprised of $26,102.00 invested in First National Bank &Trust CO.
Collective Trust Fund "A";$24,729.55 invested in First National Bank
&Trust Co.Collective Trust Fund "B";$265.18 invested in a savings
account at the First National Bank &Trust Co.;$1,500.00 invested in
a certificate of deposit;and $698.15 of uninvested incane cash.The
initial value of the estate was $32,793.00 and has increased to its
present value since the settlement of the original claim.
4.The minor has accumulated various medical bills totaling
$2031.52 dating back to August of 1977.Copies of most of these bills are
attached hereto and collectively marked as Exhibit "A".The mother,Sue
Ann Britt,had previously been employed and was able to provide medical
insurance for the minor which paid for a portion of the outstanding
medical charges;however,the medical insurance no longer provides adequate
coverage for the child.In addition,the mother,Sue Ann Britt,has
attempted to pay these bills out of her awn resources but is no longer
financially able to do so.
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON.PA.1530t
5.No other previous allowances have been applied for or
granted.
6.The anount of the allowance required is $2,500 for the
purposes of paying the still outstanding medical bills,and the
attorney's fees and Court costs appurtenant tothe filing of these
proceedings.
7.Your Petitioner has been notified of the alxJve facts by
Sue Ann Britt,has investigated the same and believes than to be
true.
8.There is no provision for the payment of the outstanding
medical bills under the present guardianship,which requires that a
Petition for Allowance be made for that purpose.
WHEREFORE,your Petitioner prays for leave to pay the sun of
$2,500.00 to the respective creditors of Elizabeth I.ee Britt or
to reimburse Sue Ann Britt out of the incane of the guardianship and
then whatever principal is needed,to discharge the outstanding
medical bills and any attorney's fees and Court costs related to the
filing of this Petition,all under the provisions of Section 5164 of
the Probate,Estates and Fiduciaries Code.
Respectfully sul:mi.tted,
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
IN RE:ESTATE OF
ELIZABETH LEE BRITT,
A Minor.
)
)
)No.1120 of 1971,O.C.
)
)
JOINDER
I,SUE ANN BRITT,mother of Elizabeth Lee Britt,hereby acknowledge
that I have received notice of the intended presentation of the foregoing
Petition and join in the prayer thereof.
~~£&uti/SUE ANN BRITT
1--
",
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF WASHINGTON
)
)
)
SS:
Before me,the undersigned authority in and for said County
and State,personally appeared G.David Underwood,Trust Administration Offi r
who,first having been duly sworn according to law,depose (s)and say (s)that
the allegations of fact set forth in the foregoing,-AP~e~tl~·t~l~·a~n~.are
true and correct to the best of (his)~knowledge,information and belief.
G.DAVID UNDERVroD,Trust Adrnininstra ion
Officer
Sworn to and subscribed
before me this /1 day
of ~~,1911.
My Commission Expires://-/-?0
.'
(((
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EXHIBIT "A"
'".;
..<:::.•.....<~~~:~~{.~::;:
..-~...-~~.-;-..::....-.:.._.....
15666
_.--~------....~::.~?._...
999
.lEPHONE O'i?Rrn 077fS'fii'\547-3502 ULSLW Lf.Mtj
rn~[l~PAGE NO.
OJ1
...'".,.._.c.•.,.•~.,.(
H.C.FRI·CK CCr-'1'IUNITY HOSP
50a S.CrURCH ST.
MT.PLEASANT ,PA.
RESP.BIRTH DATE
03 08-05-69
FEO.I0.25-0·965375
C:...T1ENT N........e JACCOUNT Nu.~ai:."",,-,-.lo'-,'"IT..n:-...;'A~y
BRITT,ELIZABETH 190707-0 roo 110 I 7S
AC.'.\Ic;,'j )N I HARL.!H.I.NUMaa....'0.~AY ,,:C.TIJ.tiE ''-0.0.\1 .;~.,....
~8'O&791 I C8~61791 I
PERSON INSURED IINSURED'S EMi'lOYER
UNEMPLOYED
GUARANTOR
BRITT,SUE A
PO BOX 41
PERRYGPCLIS,PA 15473
COVERAGE
CONTRACT NO.
GROUP NO.
COVERAGE
CONTRACT NO.
,GROUP NO.
·BIRTH DATE
:0&-05-69
I
f
t·
DAY STAV /ADMISSION .
.0 08-06-79 IDISCHARGE
08-06-79
TCTAL-Ob
·08-08 060019
·08-08 060019
.:08-01 081026 .
,08-08 093161 I
i'I~!
;20
Z:50I2:70
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15:00
lZOO
27:00
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/25:70;,'
J
PATIENT
RE<EIVlNG .CHARGE
SEiMCE
PHAR~ACY
PHARIiACY
DESCRIPTION
TCTAl CHARGES **.............
DATE
.',00.,DAY
~OO PRESC~IPTION
bOOi PRESCRIPTIONI:TCTAL
I
I:TCTAL-02 DRUGS
I,
08:0(;EMERGENCY ROOM VIS IT
Oa:Oi ER DOCTeR FEES
TCTAl
Bee sti."1g left ha-"ld
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H.C.FRICK CO~~U~ITY Hasp
50a S.C-lU~C~ST.
MT.PLEASA~T,PA.15666
PATlEN;NAME
GUARANTOR
BRITr,SUE A
PO 30X.41
PER~YapaLIS,PA
TELEPHON,01Y~r~oa:f>®·~-.:-
547-3502 u rn
PAGE NO.rno nJL001999
COVERACE
CONTRACT NO.
GROUP NO.
RES?BIRTH DATE
03 08_05-69
FED.ID.25.0965375
15473
COVERAGE
CONTRACT NO.
I
.GROUP NO.
'BIRTH DATE
:08~05':'69-
i
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DAY ST~Y IADMISSION _.".1DISCHA~GE ....
.'_n n.,_.1 Ci.70·n.,_1l:i.7Q
DATE I PATIENTDESCRIPTION.REGIVING CHARGE.VtO.,DAY .SERVICE
oZ:l E P~ESCRIPTION PHARMACY I :45I
02;lt:PRESCRIPTIQN PHARMACY ,1:80I.0Z:1E:PRESCRIPTIQN PHARMACY I :20I
I TOT~L I Z45II
I I IIII
I TOTl\L-OZ DRUGS J III2i45III
I I I
02:16 I ICHEST.__...-2500I. I TOTAL 25:00I-..._-
I I
I -IITOTAL-OS X-RAY 25:00I
I I
I I02:15IE~1E~GENCY ROOM VISIT 1500
02:16 ER DOCTOR FEES.lZ:OO
:TOTl\L I.27;00I
1 I
ITqTl\L-06 21,00
I
I
I
I
I
I
**·TOTAL CHARGES **.5445I,
I
IJIIJIJIIIIIIIII
I
Possible bro~chitis I
I
I
I
I
I
I
I I
I I
I .I
I I
I I
:02...16·
:02-16
:02...16
'02-16
60079
60079
60079
71183
..
81026
93161
,
i
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r
,
j
!..,
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i'!.
!
-.;"--'
•.
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.'.-.~~'~·~::;;:':~~~~}Y-:_#':'~~
EXHIBIT nAn
/.
)'.
-'.-:-'
.'~....
-'.
(
t-I
(
!
/
I
-----~._--_._.._-_._----.--_._--.\.
Elizabeth Lee Britt -094760-6 •
'..
Adm.11-13-73 to 11-26-78
Diagnosis:Bi.lateral Bronchopneumonia
Total Bill $1,987.25
Nutual Of Qnahapaid 1,540.00
447.25
Sue Britt Pd.---a3.00
•
$424.25
,"
Balance Due
.,,'
".
\
/'-,
,.'
..
.-:-
-...--..'','--.,:.~..
'I.••'
.....-
. f
/
:":::.~~.'."EXII:IBIT'-"A".\..?'''''-,-r,-:,....:..
....i:'..•..
..
i
'.I
:GROUP NO.
I
I
I
I
I BIRTH DATE
:08...05...69
I
i
I
I
I,.
I
I
,
I COVERAGE
I
:CONTRAa NO.
COVERAGE
GROUP NO.
CONTRAa NO.
RES?BIRTH DATE _
03 08';'05':'69
_.FED.ID~25~0965315
15473'.
GUARANTOR
BRITT.sUE
PO BOX 41
PERRYOPOLIS,PA
DAY :r~Y _IADMISS~O_N._'...IDISCHARGE
,~..n "-1~_7a ;'~~~_7A
H.c.FRICK COMMUNIT'I(JSP TElE;~;:35020'IT'~~Oll~.~.1"
5{)8 S.CHURCH ST.'PAGE NO....rnO[L[L":
MT.PLE SANT.PA.15666 001 999 I
_.L~,..:..,.
I
DATE I I PATIENT·DESCRIPTION RECEIVING...CHARGE.vo.,OAvl .SERVICE'.
'.
".
~-..-.'
'..
...-"':-.;
\.Ii'.
1
\'
..',.,
:-";~i.
':''..~.~",:-'..;-...
'~.L,.~~1.:..~':;~~)..
'......;.~.:».".
i '";11~14 -30049
;11~14'30049 \
I 11",14 30(}49I .'.-
'1 11~14 30049IIll~14·30049 .
I ";11"",11 30049ill!"!·17 30049!
I 11..17 ·30049
I 11.;';"17 30Q~9 t·,
I 11~18 30049I ,
~1~18 30049 ,.,
I 11-.;,19 30049:
.../
.'I :~';~J
i •~I:(.:..
iii;.i4.60079
:ll"'1,4·60079
:~1~'~560079
;11~'11 60079
'11~-17 60019
;11~·17 60079;11~18 ·60079
,11,;,,18 60 019;11~la 60019
:11",,18 60079
:11","21·60079
:lt~22 60019'
:lle22 600'19
:11,.;24 60079
,
'"I,.'·:
:3:00
.1:3-?
:2:00
I':54·
154·I:20
:20
:20
2:64·
1:32
:96, I
::96
I ..I
I I
I I
I II ,
I I
I I"
I I',I ,.....'
:855:00
:380:00
I I
I I
1:23500I I
I I
I '1'
:.1:80
:4:50
:8:00
5:00
4:50
5:00
8:00..
4:50. I1~10
8:00\
·5;00
'2:50
i4:10
,5:00
1
•75;20
I
I
75:20·"
'1'rOOM.ANO::~UR5ING'SERVI.CE'
ll:l3iSEr.U 0242 9.0DAY~95.00
ll:22iSEML 0241,:'·4..0DAY@;:95.00
.1.ITOTAL~Ol''
iJiJ PRE~~Rip~ION PHARMACY.'1~1~PRESCRIPTION PHARMACY
1~1~PRESCRIPTION PHARMACY'1~1~PR~~tRIPTION PHARMACY
ltl~PRESCRIPTION PHARMACYl~l~PRESCRIPTION PHARMACY-"I il~l~PRESCRIPTION PHARMACY
ll'l81 PRESCRIPTION PHARMACY1~1~PRESCRIPTION PHARMACY
11:181 PRESCRIPTION PHARMACY
112~'pRESCRIpTION pHARMACY
1121 PRESCRIPTION PHARMACY'
1~2 PRESCRIPTION PHARMACY
1~23 PRESCRIPTION PHARMACY
I I .:'TOTAL~:;,....',
I
I •:.TOTAL~02 DRUGS,
I
l~l~MISC~SUPPLIES CENT~SERV.
1i:l3J.\ISC'.SUPPLI ES CENT.SERV.l~:l~MISC~SUPPLIES CENT.SERV.
11:13MISC.SUPPLIES CENT .SERV.
11:1 31M ISC'.SUPPL IES CENT .5ERV.
11:17;MISe-.SUPPLIESCENT .SERV.
11:17;M ISC.SUPPLI ES'CENT.SERV.
11:17,M I SC'.SUPPL 1ES CENT'.SERV.l~liMISC~SUPPLIES CENT,SERV.l~l~MISC~SUPPLIES CENT.SERV.11;1~ISC·,SUPPL'IES CENT,SERV.
11:19M ISC.SUPPL I ES CENT.SERV.
I
I,
I
I
I
EXHIBIT "A"
','
,~.,...\
~----------------------------------,
.,
f
I
GROUP NO.
,BIRTH DATEOa...05~69
;COVERAGE
,CONTRACT NO,
COVERAGE
GROUP NO.
CONTRACT NO.
RESP.BIRTH DATE
03 08...05~69
FED.ID.25~0965375·
547 ...3502U u,L::l u.vUUL::l '-'1+~"L..J))I
PAGE NO,,.00 0OJL 6':
002 999 1--]:
•.~~~" .. I
I
15473
':OMMUNITY H05P
.CH ST.("'.
:NT ,PA.156"
GUAiV\NTOR
BRITT,sUE
PO BOX 41
PERRYOPOLIS,PA
J.
'.r=-;:-:-:-::=-:-:-:~l""":"'::_:_:==.,--~----r==~=_---_____
DAY SfAY IADMISSION IDISCHARGE.',~_n 11_1':l_7~l'_7~_7R
DATE I PATIENT ~I'DESCRIPTION >RKEIVING.CHARGE
'''\O.,OAY SEilVtCE
:,{
.11'!'i21 40592 1-
1'.:,
i
:11~14·81026,
.~.
..:........~.
"..~.
~.~
",".··....1·-;.p .•.•..'.
~'\.J ......'•
71183.
'71183
71183
'11183
04382
0401Q
69930
06445
'97121
0211~
01594
01586
01578
00133
00133
00133
01594
01594
:11~1.S
:11...17',.
:11,:,22
:11~25I
I
;ll~i~,
:tl.;,14·
11~14
:11~),4·
:11';'14·
i 11';;'.15
;.11";'15
"11,,:,,1~
lle·lS.
l1e;.17
ill!!'017
:11~l7'11~1,8
'lb..2S·
1~2~MISC~SUPPLIES.CENT~SERV..~32
I :..TOTAL:~.-,:',.'~:~','15:20
•~:..."....II,'.,~~/
:TOTAL~03:DRESS/SUPPLIES 1$20
J I
./.I
11:13CHEMISTRY .~.4~0
11:i~HEMATOLGY"~~-&00Ili:1~CHEMISTRY.:~':"-,-12:80
11:13,SURVEyS'.....'.19,20
1~13BACTERIOLOGY'40.00l~l~URINALYSIS--~OO
.It1~aACTERIOLOGY '2a.OO
:11:14:8ACTER l-Qt:OGY 28:00
j 11:14BACTERIOLOGY I 2a:OO
,1111:1 ~BACTER I OlOGY 2~00
1
1Ill:l7;BACTER I,OL.,OGY .28;00
1111;1 7iBACTER I OlOGY 28;00
111;1B,BACTERIOLOGYZB;OO
1 11:24BACTER I OlOGY 2a:OO
1 :TOTAL 35~O1:': :
I I I:TOTAL~04·LAB . .:354;40
I / I
I "I ~I11:14iCHEST -.-,<:'25;00
1
1I.;l7:CHEST :25:00·
1:11:2~CHEST :25;00.1'11;'ll:2~CHEST ..~.~:2~00
11 :TOTAL 110000
ill :: :
1
111 1 :TOTAL..05X..RAY :10000
11 ::
il1I1-l;l3iEMERGENCY ROOM VISIT 15;00
.fll :TOTAL 15:00
ill ::
ill :TOTAL ...Ob 1500Iii!1112dM I5C I NflALA nON THERAPY ]50
:I ::Ll L..:.......:.-L..-=--__---l'-J.--\-.---':---I
.,~--,
:~-~.:.....-;:.--
.-
EXHIBIT "A"
/
Elizabeth Britt 0821Sy.:5
Adm.0$-08-77 to oo::.i0-77
Diagnosis:Hypertrophy of tonsils and adenoids.
-'....._.._.•.._._--_.._-_...._._-_._..-----..._---
Sue Britt Pd.
"-~'_J-*><.
iii
.BalaIlce Due
..
llO.OO
7.00
$103.00
5553.35
443.35
(
"
(
Total Bill
Mutual of Qnaha Pd.
-"
-
/
'EXHIBIT "A"..\
H.C.FRI C,<CJ'~'~~::~('~::'Sp'~"~Z~N~3502ill![E ~O~~1i
5U8 S..C~HJ~Oi ST.PAGE NO.I rnOUJL
MT.PLEASANf,PA..15666 001 999
~....."..
...~._.~.~:~~~~~~~~~_..:~.~_~"_~&i~.~.:~_iR~
~.,~1::1 .';7.\~~[}:~~?,;~;~?-.~!~
......'.0....f'
.;.."-::..
".:;.;..
I•_......:.,0.~.:.:~.
R:SP.BIRTH DATE
03 08..05!'"69
FED.ID.25-0965375
i
I
I·
I
/
I./
;,
:08--11 60079
'08..09 30049
.08-08 ·30049
'08-09 30049
.08",,09 ,30049
;'08-08 04010
:08-08 02113
.;08-10 02154,
I,,.
'08..09 10181,\
10207,08...09,
09818,08...09
I,
I
I
:08~09 40592
I
I
I
I
I
I
I
!
,
I
I
I BIRTH DATE,
'08~05-69r • . .
I
I
I.I .
I
,CONTRACT NO.
I
i GROUP NO.
:COVERAGECOVERAGE
INS
CONTRACT NO.
GROUP NO.
I I
I I
I I
I ,
J,7000
I ,
I II ,~70PO
I I
I I:1apo
:lapo
I I
I I
I 200
300
795
315I16~0
I
I
800
400
1600
2800I
I
I36~5
130PO
13000
29625IIII
:25bo ~~9I I
:25pO
I IIIIj
I IIIII553~5
I IIIIIIIIIIIIIIIIII.
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I I
15473
GUARANTOR
SRITT,SuE ANN
P J BOX 41
PERi~YOPOLIS,PA
PATieNT NAME
1t*TaTAL CHARGES **.
DAY STAY IADMISSION)IDISCHA~GE
., .'.'I-_-t./~'"'IW:"...L-L.-._..l..Ltn,>:l~-L\'n.L<'Q:1-7.L.'-'-'7--r..L-~:-::lni"l:1~~,£.~n_4'7r~'7_-1
.',._,.,DATE!l'PATIENT·'.'
...~DESCRIPTION RECEIVIN<r.,:CHARGEMO.,OAY .SERVICE ',:-:~'i j.....:...;-.f-'----------.L--=-=.:;..;.:;~r-+-_r-_r___;1 ~CJM,AND NURSING SERVICE I
PaPasEMI 02432.0DAY@ 85.00: I:""OT.AL-Ol'ta~lPRE5CRl?TION PHARMACY
·".:"'OTAL-02.DRUGS .
•a68 lIS:~SUPPLIES CENT.SERV.
'paba'll 5C·.SUP-PL.;!ES CENT .SERY.
bsb9~ISC~SUPPLIES CENT.SERV..08~9~ISC~SUPPLrES CENT.SERY.
:OT~L-03 DRESS/SVPP~IES
·II ..
Japa E,"lA.rOL:lY
08pac RI"iALYSIS
J8:LOII ISsuEs
:torALo.04.LAB
PS69RECJVERY R~'JM,~a~9bTriER ANESTHESIA'P8P9bpERATIN~ROOM
:r~Hl\L-06
pab9~HS:::(INHALATION THERAPY
:rOT~L-08 OTHER SERVICESI
I
I
I
'.;.~~
.EXHIBIT "A"
.\
,....\,......,
-.'',I'~.~./.:.-.,.
,,.:.r':'~~.;
((
II
Elizabeth lee B"'~~..Q986S7-<J
Adm.0l,.-10-79 to 6i-17-79 .
Total Bi..U $2,072/12
J.!utUal of OnahaPd.1,067.00
$1,005.12 Bal.Due
lliagnOsis:Acute g""l:renous "PPendicitis.
..
..-
•
\
•••••.".."0"
",.."
I
.IBI~"A"EXH\
:j':'
H.C.FRICK:CQMMUNI1!HOSP
508 S.CHURCHl 51.
MT.PLEASANT.PA.
...':':'.:",:...,."
.PATIE~.~CCOUNT NUMBEoI<;;:~-:\I;.;IA/r
fSR I TT.ELII ZABETH LEE 098657-01 04·21'1 c
i ADMI';'I N '1<;(~A~r.i H.I••NUMBER:;~('l 0.),"0:.TIMe M.DAY y~.rIME
r041079115ft51041717911146-1
COVERAGE'
.CONTRACT ~O.
COVERAGE
CONTRACT NO.
[PeRSON INSURED IINSURED'S EMPLOYER
·l HOU5EW I FE
GROUP NO.GROUP NO.
{
GUARANTOR
BRITT.SUE
PO BOX.41
PER.RiYO~OLIS.~A..15473
RESP.BIRTH DATE
03 08-05-69
~ED.ID.25-0965375
BIRTH DATE
08-05-69
04-10--19'04-17-79
ADMISSION DI~CHARGE
!DATE .PATIENT"..
DESCRIPTION .RECEIVING .'CHARGE
;,'A()"OAY ,SERVICE -,
,I
..
I
11
'I','.,
i-t,..
s~
"r~1
h1,\
"".-:-
60019
60019
60079
60019
60079
60079
60019
60012
60079
60079
60079
60019
60079
60079
60019
60079
60079
60019
60019
60019
60019
60019
60079
60079
60079
60019
,.-.
, .",:"~'"-j
.•.•!-_.
-.'~~.'..~~...'t.
....::"'(~;.~-
04':'11
04-11
04-11
04-11
04-12
04-12
04-12
04-12
04-12
04-12
'04-12
04-12
04-12
·04-12
04-12
04-12
·04-12
04-12
04-12
04-12
04-13
04-13
04-1tf.
04-17
04-18
04-18
:":-,.;
I I_l.,.I
:9~00
:99.00
:475,00,,...
I ,
:66500, II.,C
, I.',,930•4:00
~50
12;60
6'20
3540
Z50I'50I1~20
~40
2;50
~OO
8'40
3Z60
300I~20
39.40 ,
1~20
~30
1260
1;360
1920I20011;20
lt~20
,2;00
:24520
,I
I I
:24520I I, ,
I ,
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I I, I
.~;.';
TOTI\L-02,DRUGS
I
":'EXHIBIT \"A"
/"
..
l·'!ACCOUNT NUMBEoiSl A -.'.I:"j .•),>.T;o'
six ZA3ETH
MO ...~f.:f,
LEE 098651-oI04'21'1c
""j 01·HA~H.I.NUMilE~~TIM::~.~O 0..\"H.IME .
#1545104-17119111461
q'.J~ED IINSURED'S EMPLOYER
.HOUSEWIFE
COVERAGE
CONTRACT NO.
GROUP NO.
COVERAGE
CONTRACT NO.
GROUP NO.
.'
.GUARANTOR
SRI TT.SLJE
Po.BOX 4·1
~ER"RiYOPOLI5,PA .15473
RESP.BIRTH DATE
03 08-05-69
fED.10.25-0965315
BIRTH DATE
'08-05-69
.'
.":-
89748
891'48
30049
897'48
89748.
30049
30049
30049
89748
89148
30049
89148
897'48
30049
89748
30049
89748
300it9
30049
30049
89148
30049
89748
89748
30049
30049 .1.·.·..30049
30049
89748
30049 I
89748 }
~~~::F
30049 tt ..
30049 '1\.•
30049 ~
.89748'·ii .
[
I;.;
Fq
IIIt
'04;.11
.04-11'
..04;.11
:04-11
.04-11
04-11
'04-11
04-11
04-11
04-11
04-11
·04-11
04-11
04-12
·04...12
04-12
04-12
04-12
04-12
04-12
.04-12
·04-12
04-12
04-12
04-12
04-12
04...12
04.12
04-12
04-12
04-12
04-12
04-12
04-12
04-1.2
04.12
04-13
,.
Z30
516•'54I
1;86
7.50
:96
1:30
300
530
372I:54
~50
1;36
3.30
412•'96,
1'361qoo
1;00
~15
·t10
:98
·276I164.,
:92
~30
1;06
1:50
t64
570
408I~Oo
:20
3.80
:94
:62
115I
I,
I
I
I
DAY Si.o.V IADMISSION IDlS:HARGE
.'7.0''..,0~lO-79-04-17-79
i,)~lqI;V:PROCEDURES :;..:';;•'::;:~...~.,:i';
~'lalV PROCEDURES)410Ml 50.5UPPl.'i E5~CENT.5ERV.I I'-..-P~lOI V PROCEDURES1 ,.
)4,101 V PROCEDURES
)~lqMI SCr•SUPPL;I E5 CENT.SERy.
J~10MI5~5UPP~crESCENT.SERV.:)~10Mr 5 0.SUPPLlI E5 .CEN T•SERV •b~ldI V PROCEDURES ~
)4101 V PROCEDURE5I •.
J4110MI 5CI~SUPPUI ES._CENT .SERV.J~ldI V PROCEDURES .-
b~ldI V PROCEDURES
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')411';MI5C'.SUPPL'IES·CENT .SERV.)41~I V PROCEDURES'•)41~MI5C'.SUPPL:IE5 CENT.SERV.I .__
)'-;.1,iMI5C'.SUPPt.:IE5 CENT~SERY.b~1~MI50~SUPPL:IES:CENT .SERy.
b4l1 ~L V".PROCEDURES
Jtt:1 ~Mr5C'.sUPPL:I E5 CENT.SERy.
)41!lL V':PROCEDUR~S::','._;:',.
J~l~I ~PROCED0RES .
)41~MIS~.SUPPL'IES CENT.SERV.
:)lh 1Mlscr.SUPPL]E5 CENT.SERV.Jih IiMIScr.SUPPL:I E5 CENT.SERV.bt.il~MI5C'.5UPPL;IES CENT .SERV.
b~liI:V'PROCEDURE5 -
J~lliMIscr.SUPPLiE5 CENT.SERV.
J~l~1 V-PROCEDURES-
b~liMI5C'.SUPPLIE5 CENT.SERV.)~1l;MI50.SUPPL;IE5 CENT.SERV.
J411jM I so.SUPPL:I ES CENT.SERV.J~ll:MisO'.sUPPL:IES CENT .SERV.
)411 tM ISO.SUPPL1!E5 CENT.SERV.
)4121 V PROCEDURES .-
: iI: I, I
D~TE I I"";'PATIENT "•......DESCRIPTION '.-:RECEIVING·;·CHARGEj·-\O.,OA'"..'SERVICE .
EXHIBIT "A"'.
I
";.\-'..··:..:A,
...,,'".
.,~..'.'.:.-..~~....~.
.-."._....
:1;;:)I •PAGE NO.
l,PA.15666 003 999
(/...,(C~::~~:NUMaE'-"'~;:~'~~jl'"'TF
,l ZABETH LEE ~98657-01 04:21''1~
I,"i;("'A~G'-rl.l.NUMaEilA'.r ri.'-"E 10'').c"'....·.~.!ii¥,:
/154510t,..1179111461
COVERAGE
CONTRAa NO.
GROUP NO.
COVERAGE
CONTRAa NO.
GROUP NO.
RES!>.BIRTH DATE
03 08-05~&9
~ED.ID.25-0965375
15473
IDAY STAY 1ADMISSION \DISCHARGE
7.0-'04-10-79 04-17-79
BIRTH DATE
08-05-69
DATE I 1"~.PAnEHT.'.:~,...-..l .DESCRIPTION 'UCElVING .
MO,/CAYI .SEiNICE':
'O~1~Ji'H50;'SUPPLIE5 CENT.5ERy.'
O~1~I:V:PROCEDURE5dO~12lI"V PROCEDURES '
I O~l~L r PROCEDURES
O~l~I:V PROCEDYRES
O~lZMISC~SUPPLIES CENT~SERY~
104:1~I ":V .PR'OCEDURESO~l I V PROCEDURES10~1 I~V PROCEDURES
I O~liI V PROCEDURES
1 041.:1 1',V .PROCE·DURESIO~1 I.V PROCEDURES.10~1~1.V PROC.E.DURES
I O~l~I V PROCEDURES
•O~13MISC'.5tippi.'IE5 CENT~SERV.I:O~l~I y PROCEDURES '
I O~l~1 ,y PROCEDURES(O~l~I V PROCEDURESO~l~lV PROCEDURES:o~ldI V~ROCEDURE5
:TOTAL'II ::'l TOTAL-03 DRE55/5~~~L~ES," '
:'IO~lQHEM:ATOLOGY',04!lC~CHE)lH STR;YI~IO~1q8AcrERI OLOG!
Ie104:1qUR I NAL.Y5I 5
t ,04:10HEMA.TDLGY!l04u:,cHEM:I 5 T~.Yl~10~1 q6ACTER I OLOG!"
(j0410HEMATOLOGY ,(IO~lq8AcrERI OLOG'(
:04i 1QCHE~jI 5TRYIO~l1;CHEMII 5TRY
04:1~8ACTEitI:)LOGYIO~l t'PATHOLOGY
II 1
CHARGE
·96 .04;"'12,30049IIlb4-.04~IZ 89748•~30 04..13 89748
~30 04-.13 89748
1;00 04...13 89746
:90 04..12,30049
I'1:70 04-1Z 89748,
Z30 04~14,89748,
1:00I 04-14 89748,"II~70 04-13 89748II10,00 04-13 89748I
I ~30 04-14 89748,,1:75 04-14 89748I,1:64 04-.13 89748,
I :96 04-13'30049,
1;00 04-15 89748/5,30 04-15 '89748
1:75 04-15 89748
~30 04-15 89148,04-17 89748I
,14392 ""LI ,
I II /:14~92
';-,I ~~.~1~~t ~~.;_:~:.:.I
~20 04-11 04150
~40 04-11 .03046
2£(00 04-11 01578It:oo 04-11 02113
800 #~9 04~11 04010
4640 04~11 04382
2800 04-11 01586I~40 04-11 00786
40.00 04~11 97121
E(40 04";'11 03012
~40 04-12 03046
2S00 04-12 07542 ''
I
3200 04-12 06791':"
j'I
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EXHIBIT "An
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COVERAGE
CONTRACT NO.
GROUP NO.
CONTRACT NO.
GROUP NO.
'i,PA.15666 "'004~'999 ~ULSLS-,,,.--u-I -...~..~'-~'.,.~_:;"-'-•.,,::-::..:,-'::':--''1-,-'"-'--'--'------''''--'"'---'------''---.-.---,
l ~JNT NUM3E ")A --- .'''(-
"""',DAV,"_COVERAGE-
""tZABETH LEE 098657-0104.21'7(',
;!,DI~HAR H."~llJM3ERj;T.·~:,·.\0.DA'(y~.T1M~
/1545104-17179111461
.......
I'.~UARANTORI6RITT,SUE
1 PO BOX.4-1
PERRiYOPOLIS,~A 15473
RESP.BIRTH DATE
03 08-05;"69
FED.ID~25;"0965315
BIRTH DATE
08;"05-69
04-12 04382 I04-12 04010
04-12-OZ113
04~12 03046 ---
04-12 03046
04,..;12 03053
•!DAY STAY IADMISSION IDISCHARGE--l:1.0"---04-10-'19--l------.04~17-19 --..
:Y}DATE 'I'.PATIENT "',.
---.'C.j MO.,OAY ---;:'--','-'DESCRIPTI~.~;-:_.~_:I-~:'~~~~~~~,_..~HARGE ,
-::c-O'illlCHE~!I STRif ..~..':4640
.';Ie Q~11 HEMA.rOL-G)'·~·l·~·:jO;;\T:J ':~OO,-i v O~ll ~R H'-A LYS-I S:~'":;D).,'L~'.--'::~OOc04\11 CHEM:!S.TR~,-c.;,,,,;.___..',--<-'.:__~40
C 04!l1 CH EMiISTR;Y -......•~r ~40e,
-•.C 04111 CHE.'>H S.TR;Y -:l:\40
C .':-TOTAL -,-:30800'
- I I I
-"-Cc r~:.~~iO:TAL'_04.i~AB..~:.:F~:"':'-:.,:3.0~0·0
.~I ..-,}:..""1 ........;!'..::,1 .;.~I I .
(":-'-,"...,:_,r ~-~.'.-?:~!t,.~~~,~--,."::
(O'f,lC,CHEST.:..',:29,00cO~105URIJEY'EXAMINA~)ON __"39,00
.-C..__:TOT.AL~._6QOO.-',~.
--{:".I
(,:.TOTAL-O'5X-~AY 6doo..•"I ,(,.,
(I,O~l~OPERATING ROOM 4~OO
(,O~l~OPER'ATING ROOM'" ..i,'_.325,00
(;:,:-,'TOTAL -'..."F...'36~00.,-,I
..I;."':.'I .
,_04111 RECOVERY ROOM '_i"4500
:',TOTAL 4500I-.,:.-I '
- I '-..'._I
-(:Ott:llANESTHESIA lqoo
,(:O~l'ANES.THE5I A,_,~,:':.-_"...,23qoo
..(I"'::':~::TOTAL;,c:·."_~;'''·'.,:Z4QOO
--.I I.I r ",:,,:.:----'::'.."'--.:5"--:X.:~,_,- -- •I
. i I~,":;~TOTAL-06.·,'-"i ,,-:.'".,':65~00
I I.-'---,.,".--'r;.•_-,'~,'._ ",-.",,--...~'..
I I ..1:--:;:'.,'.::
......:I I
".•.J •.-.:'.1 I
:1:,,'1-**·TCHAL CHAR~=~..**~Ol~IZ,
','
04~11
,04-11
,:.:-'''"''*
~'.,.",.
.'"::.~'.;.
04-12
'04~12
'04-12
04-12
:04~lZ
--" I
.71183
15895
....-
,.~.
10212
102rZ
,I
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I
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IN THE COURI'OF COMMON PLEAS OF WASHINGIDN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABETH LEE BRITT,
A Minor.
No.1120 of 1971,O.C.
ORDER
AND NOW,this 7 day of February,1980,ufX)n M::>tion of
George Retos,Jr.,Esquire,it is
ORDERED AND DOCREED
that a hearing on the within Petition be held on the "day of
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
I 70 EAST WHEELING STREET
WASHINGTON.PA.15301
_--,~~......:tfJ:..........::J(-=.=..~·h~__,1980,at /.'31)o'clock t .M.,Court Room No.-.!i:-,
Washington County Courthouse,Washington,Pennsylvania.
A copy of this Order shall be mailed to Sue Ann Britt and
the First National Bank &Trust Co.of Washington,Pennsylvania.
BY THE COURI':
IN THE COURI'OF CG1MON PLEAS OF WASIITNGroN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABErH LEE BRI'IT,
A Minor.
AND NOW,this
No.1120 of 1971,O.C.
ORDER AND DECREE
9 day of __--1)9..................Y'--'-~_'_·_L ,1980,
uI=On consideration of the within Petition,it is
ORDERED AND DECREED
GEORGE RETOS.JR.
&ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON.PA.15301
that the First National Bank &Trust Co.of Washington,Pennsylvania,
guardian of the estate of Elizabeth L.Britt,a minor,Guardianship
Accomt No.300030,pay to the respective creditors of said Elizabeth L.
Britt or to reimburse Sue Ann Britt,the sum of $2,500 for medical bills
of the minor,and any Court costs and attorney's fees related to the filing
of this Petition.
BY THE COURI':
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.
IN THE COURI'OF CQMM)N PLEAS OF
WASHINGroN COUNTYI PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABErH ,LEE BRIT!',
A Minor.
No.1120 of 1971,O.C.
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RETOS..LAW BUILDING ~1/70 EAST WHEELING STREET ~___6 WASHINGTON.PENNSYLVANIA 15301 ~
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PEI'ITION FOR ALIDWANCE
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IN THE COURI'OF COMIDN PLEAS OF WASlITNGIDN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABEI'H LEE BRITI',
A Minor.
)
)
)No.1120 of 1971,O.C.
)
)
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON,PA,1530t
PEI'ITION FOR AI...la'JANCE
'ill THE HONORABLE,THOMAS J.TERPUI'AC,PRESIDENT JUDGE OF SAID COURI':
The Petition of the First National Bank &Trust Co.of Washington,
Permsylvania,respectfully stated:
1.Your Petitioner was apfX)inted guardian of the Estate of
Elizabeth lee Britt,a minor,by decree of your Honorable Court at the
above number and tenn.
2.The said minor is ten (10)years of age and resides with her
mother,Sue Ann Britt,at P.O.Box 41,PerryofX)lis,Pennsylvania,
15473.The minor's father is deceased and her estate is a result of a
compranised settlement of a wrongful death claim from the minor's deceased
father's estate.
3.The principal of the minor's estate consists of $52,804.63
comprised of $26,112 .80 invested in First National Bank &Trust CO.
Collective Trust Fund "A";,$24,729.55 invested in First National Bank
&Trust Co.Collective Trust Fund "B";$1,547.5ginvested in a savings
account at the First National Bank &Trust CO.;$0.00 invested in
..
a certificate of deposit;and ~14.69 of uninvested-income cash.The
initial value of the estate was $32,793.00 and has increased to its
present value since the settlement of the original claim.
4.The minor is in need of bedroom fumiture.The mother,Sue Ann
Britt,has obtained a reasonable estimate on appropriate furniture and a
copy of said estimate is attached hereto and marked as Exhibit "A".
5.The guardian,The First National Bank &Trust Co.,has authorized
this purchase provided any transaction would be handled directly by the
guardian and also subject to Court approval.
6.The rrother,Sue Ann Britt,does not have the financial capability
at this time to purchase said furniture out of her own resources.The
amount of the allowance requested is approximately $1,000 for the purposes
of purchasing the furniture,Court costs and attorney's fees appurtenant
to the filing of these proceedings.
7.Your Petitioner has investigated the al:xJve facts and believes them
to be true.
WHEREFORE,your Petitioner prays your Ibnorable Court for leave to
spend a sum not to exceed $1,000 fran the accumulated income of the minor
for the purchase of bedroan furniture,reimbursement of Court costs and
payment of attorney's fees related to the filing of this Petition,all under
the provisions of Section 5164 of the Probate,Estates and Fiduciaries Code.
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON,PA.15301
Respectfully subnitted,
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SALES ORDER NUMBER
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TAX
SUB TOTAL
SUB TOTAL
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IJr,lPAID BALANC_P,l;IRCHAS~,PRICE't'I·~.'!F~tl\:'~.,:i';.11~.'I'l'.""'!~lI"t,.J,.!,."','....,If>'i '
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BUYER'S SIGNATURE ,,';,:1.;'".,
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TRANS.TYPECS.'''CD FI ,..~•.....,n./'0 "r~)ON ORDER , " .,',',CA~C.O.D Yd'FINANCE ,..•.,/"..,.>I'J .,~'"Ct.•E.D.A.,'j'l.;~I
SALESPERSON NO.1 ..C'.'~SALESPERSON NO.2,,.'..r.'":',','.':".'.~'.!".
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TRANSACTION
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8
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BUSINESS PHONE
FINANCE CO.
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" i H.EREBY ACKNOWLEDGE THE RECEIPT
'I'€iF THE ABOVE ARTICI.ES IN GOOD
OR-QER.
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116
~~------------------------,---,
IN THE COURI'OF COMM)N PLEAS OF WASHINGroN COUNTY,PENNSYLVANIA
ORPHANS'COURI'DIVISION
IN RE:ESTATE OF
ELIZABEI'H LEE BRITT,
A Minor.
JOINDER
No.1120 of 1971,O.C.
I,SUE ANN BRITT,mother of Elizabeth Lee Britt,hereby acknowledge
that I have received notice of the intended presentation of the foregoing
Petition and join in the prayer thereof.
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETQS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON,PA.15301
ROBERT A.ZUNDEl,NOTARY PUBLIC
PERRYOI'OLIS BORO,FAYETTE COUNTY
MY COMMISSION EXPIRES JUNE 11,1983
Member,Pennsylvania Association of Nolarillf
,. I
COMMONWEALTH OF PENNSYLVANIA
COUNTY·OF WASHINGTON
)
)
)
SS:
Before me,the undersigned authority in and for said County
and State,personally appeared.G__o_D_a_v_i_d__Un_d_erwood,__Tr__us__t_Admi'_nl_'_S_tr__a_t_io_n__o_ffi er
who,first having been duly sworn according to law,depose (s)and say (s)that
Petitiontheallegationsoffactsetforthintheforegoing.~are
true and correct to the best of (his)Xkax)knowledge,information and belief.
G.David Underwood
Trust Administration Officer
Sworn to and subscribed
.-/-t!cJ
My Commission Expires://
.'
•
\. .,'
IN THE COURI'OF COMMON PLEAS OF WASHINGION COUNTY,PENNSYLVANIA
ORPHANS I COURI'DIVISION
IN RE:ESTA'IE OF
ELIZABETH LEE BRITT,
A Minor.
AND NOW,this
No.1120 of 1971,O.C.
ORDER
oc.-r"6 ~,
day of 7 2 ![,1980,upon consideration
of the within Petition,it is
ORDERED AND DECREED
that the First National Bank &Trust Company of Washington,Pennsylvania,
guardian of the Estate of Elizabeth L.Britt,a minor,guardianship
account no.300030,be authorized to expend a sum not to exceed $1000.00
from the accumulated incarre of the minor for the purchase of bedroom
furniture,reimbursement of Court costs and payment of attorneyI s fees
related to the filing of this Petition.
BY THE COURT:
GEORGE RETOS.JR.
Be ASSOCIATES
ATTORNEYS AT LAW
RETOS LAW BUILDING
70 EAST WHEELING STREET
WASHINGTON,PA.15301
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
u
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N
U1en
NO.63-71-1120
)
)
)
)
)
o R D E R
ESTATE OF
a minor.
SUE ANN BRITT,
IN RE:
AND NOW,this /tJ a day of July 1989,the Guardian,
First National Bank and Trust Company,in care of Donald M.Gavett,
Trust Officer,and the Attorney for the Estate,John W.McIlvaine,
are hereby ORDERED TO SHOW CAUSE why they have not completed admin-
istration of the above-captioned estate.
The Register of Wills is directed to issue a citation to
First National Bank and Trust Company,in care of Donald M.Gavett,
Trust Officer,and John W.McIlvaine,Esquire,returnable before
the undersigned in Courtroom Number 3,Washington County,Courthouse,
Washington,Pennsylvania at /t7 o'clock;4 M.on ~.:JI
1989.
The Audit Clerk is directed to serve the citation and a copy
of this ORDER on the Guardian and their Attorney by first-class mail,
postage prepaid.
-
•r
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
CITATION
IN RE:
SUE ANN BRITT,
A MINOR
COMMONWEALTH OF PENNSYLVANIA (
)SS:
COUNTY OF WASHINGTON (
TO:First National Bank and Trust Company
SUR PETITION OF:Court Order
GREETING
NO 63-71-1120
WE COMMAND YOU,First National Bank and Trust Company
THAT,LAYING ASIDE ALL BUSINESS AND EXCUSES WHATSOEVER,YOU DO FILE IN
THE OFFICE OF THE CLERK OF OUR ORPHANS'COURT OF WASHINGTON COUNTY,A
FULL AND COMPLETE ANSWER,UNDER OATH,TO EACH AND EVERY OF THE AVERMENTS
OF THE SAID PETITION,ON OR BEFORE Thursday,THE 31st.DAY OF
August,1989,AT 10 O'CLOCK~.M.,AND SHOW CAUSE
WHY you have not completed the administration of the above-captioned
estate.
AND FURTHER ABIDE THE ORDER OF OUR SAID COURT IN THE PREMISES,
IF YOU FAIL HEREOF,THE PETITION MAY BE TAKEN PRO CONFESSO AND
A DECREE MADE AGAINST YOU.
WITNESS THE HONORABLE Samuel L.Rodgers,JUDGE OF OUR
SAID COURT,AT WASHINGTON,PENNA.,THE-7~~_
_ESQ.
ATTORNEY FOR PETITIONER
(SEAL)
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
CITATION
IN RE:
SUE ANN BRITT,
A MINOR
COMMONWEALTH OF PENNSYLVANIA (
)SS:
COUNTY OF WASHINGTON (
NO 63-71-1120
TO:John W.McIlvaine,Esquire
SUR PETITION OF:Court Order
GREETING
WE COMMAND YOU,John W.McIlvaine,Esquire
THAT,LAYING ASIDE ALL BUSINESS AND EXCUSES WHATSOEVER,YOU DO FILE IN
THE OFFICE OF THE CLERK OF OUR ORPHANS'COURT OF WASHINGTON COUNTY,A
FULL AND COMPLETE ANSWER,UNDER OATH,TO EACH AND EVERY OF THE AVERMENTS
OF THE SAID PETITION,ON OR BEFORE ThursdaY,THE 31st.DAY OF
August,1989,AT 10 O'CLOCK~.M.,AND SHOW CAUSE
WHY you have not completed the administration of the above-captioned
estate.
AND FURTHER ABIDE THE ORDER OF OUR SAID COURT IN THE PREMISES,
IF YOU FAIL HEREOF,THE PETITION MAY BE TAKEN PRO CONFESSO AND
A DECREE MADE AGAINST YOU.
ORPHANS'COURTCLERKOF
WITNESS THE HONORABLE Samuel L.Rodgers,JUDGE OF OUR
SAID COURT,AT WASHINGTON,PENNA.,THE 1 tho DAY OF July 1989.
_ESQ.
ATTORNEY FOR PETITIONER
(SEAL)
,
.-..
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
IN RE:ESTATE OF
SUE ANN BRITT,
a minor.
)
)
)
)
)
NO.63-71-1120
o R D E R
AND NOW,this /iJtf-.day of July 1989,the Guardian,
First National Bank and Trust Company,in care of Donald M.Gavett,
Trust Officer,and the Attorney for the Estate,John W.McIlvaine,
are hereby ORDERED TO SHOW CAUSE why they have not completed admin-
istration of the above-captioned estate.
The Register of Wills is directed to issue a citation to
First National Bank and Trust Company,in care of Donald M.Gavett,
Trust Officer,and John W.McIlvaine,Esquire,returnable before
the undersigned in Courtroom Number 3,Washington County,Courthouse,
Washington,Pennsylvania at
1989.
_/_u o 'clock;4 M.on {:--"--yv~~.:JI
The Audit Clerk is directed to serve the citation and a copy
of this ORDER on the Guardian and their Attorney by first-class mail,
postage prepaid.
Samuel L.
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
CITATION
IN RE:
SUE ANN BRITT,
A MINOR
COMMONWEALTH OF PENNSYLVANIA (
)SS:
COUNTY OF WASHINGTON (
TO:John W.McIlvaine,Esquire
SUR PETITION OF:Court Order
GREETING
NO 63-71-1120
WE COMMAND YOU,John W.McIlvaine,Esquire
THAT,LAYING ASIDE ALL BUSINESS AND EXCUSES WHATSOEVER,YOU DO FILE IN
THE OFFICE OF THE CLERK OF OUR ORPHANS'COURT OF WASHINGTON COUNTY,A
FULL AND COMPLETE ANSWER,UNDER OATH,TO EACH AND EVERY OF THE AVERMENTS
OF THE SAID PETITION,ON OR BEFORE ThursdaY,THE 31st.DAY OF
August,1989,AT 10 O'CLOCK~.M.,AND SHOW CAUSE
WHY you have not completed the administration of the above-captioned
estate.
AND FURTHER ABIDE THE ORDER OF OUR SAID COURT IN THE PREMISES,
IF YOU FAIL HEREOF,THE PETITION MAY BE TAKEN PRO CONFESSO AND
A DECREE MADE AGAINST YOU.
WITNESS THE HONORABLE Samuel L.Rodgers,JUDGE OF OUR
SAID COURT,AT WASHINGTON,PENNA.,THE 1 tho DAY OF~~L-
_ESQ.
ATTORNEY FOR PETITIONER
(SEAL)
~-------------------------------------------
IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENNSYLVANIA
ORPHANS'COURT DIVISION
IN RE:ESTATE OF
SUE ANN BRITT,
a minor.
)
)
)
)
)
NO.63-71-1120
AFFIDAVIT OF MAILING
I ,_N=o=-r~m~a.-::::.J...:..----=-=W~ic.::e:..:;n:..::c:...::e:..:.k=--__,on _---=:..J~u.=.l.Ly_,,J.{..!.~Q2.L--.!...,-=..1.:::.9::::.8.:::.9 ,did c ause
to be plac~d in the United States Mail,First-Class Postage Prepaid,
a copy of the ORDER dated
Citation,addressed to:
John W.McIlvaine,Esq.
33 West Beau Street
Washington,PA 15301
July in,1989 and the issued
First National Bank &Trust Co.
c/o Donald M.Gavett
Trust Officer
200.West Beau Street
Washington,PA 15301
.(/
I verify that the statements made in this Affidavit of Mailing are
.true and cotrect.I understand that false statements herein are
made subject to the penalties of 18 Pa.C.S.§4904 relating to
un~worn falsification to authQrities.
.
/i~k 9rJiLe;n~~.f
NY7 J
lu t1r~aruurt uf arummnu 'lrttli uf lIan4iugtnu <!tuuuty,
Jruunyluauia ®rpqaun'aruurt mittiniuu
ESTATE OF \No.63-1120 0 f ..--:::...19~7~1=-_
SUE ANN BRITT,
A HINOR
In the matter of the FIRST AND FINAL
Accountof FIRST NATIONAL BANK &TRUST CO.,
WASHINGTON,PA.,GUARDIAN
ADJUDICATION AND DECREE
And now i"Ugust /0 ,19.8..2-,this matter having came on for
hea,ring,audit and distribution and testimony taken;upon due consideration thereof,the bal-
ance for distribution in the hands of the Accountant is determined to be $24,340.57
and the account is accordingly confirmed;and it is ordered,adjudged and decreed that the said bal-
ance be paid out by the Accountant in accordance with the schedule of distribution hereto attached
and mode a port hereof,unless exceptions hereto,be filed sec.reg.or on appeal taken herefrom sec.
leg.
SCHEDULE OF DISTRIBUTION
Balance per account 1
,-.
Balance'1
$24,340.57
$24,340.57
Attorney John W.,McIlvaine,Esg •.I.
TO:FIRST NATIONAL BANK &TRUST CO.,WASHINGTON,PA.,
TRUSTEE UNDER AGREErlENT OF SUE ANN BRITT DA~ED
JUNE 9,1972.
Time Savings,First National Bank &Trust Co.,
Washington,Pa.$4,900.00
Certificate of Deposit,First National Bank &Trust
Co.,washington,Pa.10,000.00
Savings Account,First National Bank 0 Trust Co.,
Washington,Pa.1,647.92
General Electric Co.6.~5%Notes Due 1979.
Principal Cash
Income Cash "l""00 N01~NIHSYM
SlllM ;JO H3.LSI~3t1
OS 01 WtJ 11 8ntJ 68
5,028.30
/'..\2,·389.15
375.20
24,340.57
No.63-1120 of 1971
In the matter of the
FIRST AND FINAL ACCOUNT
Account of
FIRST NATIONAL BANK &TRUST CO.,
WASHINGTON,PA.,GUARDIAN
of Estate af
SUE ANN BRITT,A MINOR
Abjubttntinu nub ittttt
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.-.....•"IESTATEOFPAGE2127PROC.INDEX VOL 6 BLOCKBRITTSUEANN
FILE NO.
RESIO.ENCE
DATE OF DEATH Dunlevy,Wash.Co.Pa.
EXR.OR ADMR__&ADDRESS
ATTY.DKT VOL.PAGE NO.YI!AR MORo.c.
DATE OF LETTERS
INH.TAX I,
INV.-
OC
~CCT.First &Final Augu.~t 11 1q72 AA 1~q 76 1120 )f 1971
AUD.
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IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY,PENN.
ORPHANS'COURT DIVISION
IN RE:
ESTATE OF
SUE ANN BRITT,
a minor.
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"No.1120 of 1971
HEARING ON AUDIT
BEFORE:THE HONORABLE ALEXANDER R.CURRAN,J.,
Spec ially Presiding.
APPEARANCES:JOHN W.McILVAINE,ESQ.,of Monongahela,Pa.,
representing the Accountant.
TIME:Thursday,December 21,1972,at 10:00 o'clock A.M.,
EST.
THE COURT:The first estate is the estate of Sue Ann Britt.Mr.
first and final ace ount in the estate of Sue Ann Britt,who has
now reached her majority as of June 9,1972.The First Nation
This is the time and day for the presentation of the
Bank &Trust Company is appointed as the guardian of her·estat
McIlvaine?
MR.McILVAINE:
which she received as a result of an auto collision in which her
husbq;nd was ikilled.And this is what the accounting shows,that
..
there~is a net bala'nce presen.tly due'of $24,340 ..57.And we wou
2
need for the guardianship to be im posed on her.
Ann Britt,as she has now reached her majority and there is no m
Is there anybody else in Court interested in the estat ofTHECOURT:
suggest to the Court a distribution of that money be made now to ue
of
Sue Ann Britt?
~~~I hereby eertUy that the proeeedtnqs and evidence are
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~oontained tUlly and accurately tn the notes taken by me on the hearlnq 01u
o~the above cause,and that this copy is a.correct transcript of the same.
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(NO RESPONSE)
The Court will consider the audit closed.
. ( AUDIT CLOSED)
-S.y tbe.Court...
J,,,'Tbeforeqotng-record of the pr6eeedlngs upon·the hearing'of
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uii:lI.o the above cause ls hereby approved ~nd ~lrected to be ~Ued.