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Home My WebLink About03-09-07 Estate of Melva A. Derickson also known as PETITION FOR PROBATE and GRANT OF LETTERS No.21.{)I-~~ To: , Deceased 160-16-0839 Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the executor named in the last will of the above decedent, dated December 27.2001 and codicil(s) dated N/A (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania', with her last family or prinCipal residence at 713 South Market Street Mechanicsburg. Pennsylvania (list street, number and municipality) .. . Decedent, then 87 years of age, died February 11. 2007 , at Holv Spirit fWpital. Camp Hill. Cumberland County. Pennsylvania So ~ '-. j'-j - .: ::D :J'i: Except as follows, decedent did not marry, was not divorced and did not have a child bOfll ~ ~optJPafter~~'~---i execution of the will offered for probate; was not the victim of a killing and was never adjudi~~ ~c~pet~i1.t~ l_~: ~ Decedent at death owned property with estitp.ated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in-Pennsylvania (If not domiciled in P A) Personal property in County Value of real estate in Pennsylvania Situated as follows: .. 2.50o,.QO .c- $-J ,J~-" $ r $ $ .0.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY thereon. (testamentary; administration c.t.a; administration d.b.n.c.t.a.) '" 'i:I u = II> 13 II> ... ~ ~ l:B ,..., II> "'i:>. I'E ~ iZi Jean Hoffman Alice BromCr ~ %t';:7 809 East Walnut Street. Hanover. PA 17331 502 American Legion Blvd.. Pine Grove. PA 17963 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct the best of the knowledge and belief ofpetitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~~2 .~;(t~-: VJ i' i: ~ ~ )' '::-,," . No. ~-61-~22~ Estate of MELVA A. DERICKSON, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ 9 ,2007, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated \ d. . d --, -~OO l Described therein be admitted to probate and filed of record as the last will of MELVA A. DERICKSON And Letters TESTAMENTARY Are hereby granted to -JEAN HOFFMAN and ALICE BROMMER -;'~4::'_ ~~.:,..~::-- FEES: Probate, Letters, Etc. $ .Ci:J. (J::) Sort Certificates ( ) $ ~ 0 . U\J ~lltlfi"~at~on ""'; \ \ $ 10. 6D --.J<P .... ~~tr$. "S- . 60 Total $' 00 . oU MichaelCherewka No. 35073 Attorney (Sup. Ct. LD. No.) 624 North Front Street Wormleysburg. PA 17043 (717) 232 -4701 ~CIu4U~ Filed ~l 01 H105.805 REV 1/05 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. (~~alt~~ Fee for this certificate, $6.00 p 13378006 4' ~ 1'<. J-OO ') ~te () (,:;; 0 <j~g r--::l c:::: .,;;;;;;:) --J - C) (~) (~~ l~l -0 _~t.. -,:-~ ::0 t \D -:j) 7<: ::':::j ~ cumberland 11 Decedenfs u...... KII1d of WctI. Secretary 16 ~'s Maing A_so (St....., ciy 11own, _, z., code) 713 South Market Street Mechanicsburg, PA 17055 18 f_'s Heme (first. _, last .....) Ra nd Letich 201. lnIonnanl's Name (Type' P1inl) Jean c. Hoffman 21a. MeIhOd 01 DisposiIion COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) 3 Social Securily _ 160- 16 - 0839 ea. Place 01 DoalIl (Chodl only one) Hospilal: Iillnpalienl 0 ER 1 OuIpahent 0 DOA 0 Nursing Home 0 ReSIdence 9. Was Decedenl of HispanIc Origin? Xl No 0 Yes . (N yes. spec:ity Cuban, t.lellican, Pue1\o Rican, ole.) STATE FILE NUMBER ,tl/ - 0 ,.....; ~ 4. Date of Dea'" (MonI/l, day, year) FebrfU!JJL II... J 007 Hl05.143 REV 1112006 TYPE I PRINT IN PERMANENT IlLACK INK 87vrs lib County of Death DOIhar . Specify' 10. Race: AmeIlcan Indoan, llIatk, _, elt (Spoa/)1 white 17e. 0 Ves, Decedent lived in 17d.1)I ~~oIl.Ned-Mechanicsburg Twp 12. Was Decede<1l ever in the U.S. Armed fOloos? DYe. KINo =~nce 17a.Slala Pennsylvania 17b Coooty Cumberland 14. Marilal SIaIus: MaIried, _ Married, Widowed, lJr;orced (Speci/)1 Widowed ~lllCllo . to Complete hems 23a-c 0Itf 233. To the best of my 1lnowIedge, deaIh oa:UITed al1he line, dale and place sla1ed. (Signa.... ond 1iIIe) pIIysician IS nol availallle allimo 01 de 10 C6I1iIy cause of dea" _ 24-26 must be c~ by JlO'SOI1 24. TIIllO 01 Death wtlo pror.ounces dealh. 19 _'s Name (firsl. _, IIIlIidon lillf1lllIIl9) Dora Coleman 201>. Informanl's Moing _ (StreeL ciy 11own, _, '" code) 809 E. Walnut Street HanoveI:" PA 17331 21c. P1aco of Di&pooilion (Name 0I~, allf!.-y 01_ place) 21d. location (Qly ,......, _. '" code) Maple Grove cemetery Elizabethville, PA k~I~sb~~~ ~IY 17055 231>. I.icenso N_r 23<:. Dall Signed (1AonIII, day, yell) !Z ~ ~ ! lall bt II 6? 26. Was Case Re/eII"jI1O Medical e....- 1 CorOllOf for . Reason OIhar .... CfomaIioo Of Oooalion? DYes E1No Pall II: ~ _ _ _ ........... 10 dea", 28 Did T<lbacco Use ~ 10 O.alll? but nol resulling in I/le undefIying cause given in Pall I 0 Yes 0 Probilllr o No 0 UrlIulown 29 N female o Not prepnllNMwl paslltal o Pregnant allimo of _ o Not pregnant but pregnant wtlhIn 42 days ol dealh o Not pregnanl. 001 pregnanl43 days 10 1 year before dealh o Unknown N pre!1l"f1l wiIIlIn tho pasl je.. 32<. Place of 1niurY. _. farm. ~..t. fac1Oty. 0IIIce llutIdrlg. ole. (Speci/y) ("* ...... o \. ) CAUSE OF DeATH (5etllnlltructlllllS end .lUImp..) Appro_ inIortal: Item 27. Part I EnIe< 1he ~ ~ diseases, injunes., 01 compIicaIions -1IIat direc1Iy.'. caused IIlo deall. 00 NOT enter Ierminal evenlS SUCh as ca<<Iac ar. resl, 00581 to Def' resplralOly anest, 01 vem:uIar liIdabon without showing Itle e~. USl 0Itf one cause on "'line. / J t Jj J; Jt( IMIIEDlATE CAUl!E Ifll1ill dIse... 01 ""'( eJ-cJ. J).. (. ~ 0f(; 0 tv. I~ -J:. fJ ~ '-' r W . ~ condiIIon resulJrog .. deaIh) -.. a. ,. Due 10 (01 as a consequence 01): ' SequenIiaIy Iisl condolions, d any, ~~~=crus-:a (dI..... 01 II1juty 1hat oniliaIed Ihe ovenls resulbtlg Il dealh) LAST. Due 10 (01 as a conseqoence 01): Due 10 (01 as a oonsequence 01): JOe Was an AuIopSy pe.lormeep d. n. Were Autopsy FondIngs Av_ Poor \0 CompIeIIon 01 Cause of Dealh? o Ves 0 No 31. MannerolDealh li Nalural 0 HomlQde o AcGIdent 0 Pending InvesligabOll 320. T.... of Injury o Suoode 0 Could Not be OeIermll1ed 32g.locabon ollf1ury (Streel, cily I......, Slate) o Ves Oi No M 33a Certifier (check only one) . Cel1ilying p/lysldan (PhySICian oel1Jtymg l;dUse 01 dealh when anolher phySICian h.. prOllOUllCed death and COf11IlIeled Ilam 23) To'" best of my~, dtolll occuRed due 10 the causo(s) and mannet' aallltocL. _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - -- ~=~:,:,-: :::=:'J::' .:::.:a; :lhll:'":'"":~::'~~::io~::'~~~: manner al ~io;L _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 :':...~=~ and I or investigation, in my opinion, death occurred al.no time, de", and place, and due 10 lhe COUie(I) ""mo.- II 11010<1_ 0 )' Disposilion Pennil No 21, o(-~~S- Last Will of MELVAA. DERICKSON I, MELVA A. DERICKSON, of Mechanicsburg, Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am not now married. C'"J ;] I have no children, living or deceased. Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: MELVA A. DERICKSON, sole Trustee, or her successors in trust, under the MELVA A. DERICKSON LIVING TRUST, dated December 26, 2001, and any amendments thereto. )1). g /1. s&cJ{\ ~ Page 1 V- .., '-, I ~-~, 25 --.J :.':;'-'-. :;0 I \.D -0 -,. '.~ .r.- Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date of my death. Article Three Powers of My Personal Representative My personal representative shall have the power to perform all acts reasonably necessary to administer my estate, as well as any powers set forth in the statutes in the Commonwealth of Pennsylvania relating to the powers of fiduciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. 1r!. a'/J. S/2/ J q~ Page 2 Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Article Five Appointment of My Personal Representative I appoint the following to be my personal representatives: JEAN HOFFMAN and ALICE BROMMER, or the survivor of them. I direct that my personal representatives not be required to furnish bond, surety, or other security. 7nf'~,~ srei fI'r / Page 3 I have initialed all of the pages of this Will, and have signed it on December 27, 2001. ~ ct.~ M LVAA. DERICKSON SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, MELVA A. DERICKSON, as and for her Last Will and Testament in the presence of us who, at her request, in her presence and in the presence of each other, all being present at the same time, have hereunto set our hands as witnesses. ~rc~" . WITNESS . 0 ~~G~~ WITNESS' COMMONWEALTH OF PENNSYLVANIA) ) ss. COUNTY OF CUMBERLAND ) I, MELVA A. DERICKSON, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ?l!:fPt&. ~ ME ~ A A. DERICKSON Sworn to and subscribed before me by MELVA A. DERICKSON, Testatrix, the 1.1 fl4. day of ~RllM4'4/V ,200l. ~/ ~te-- Notary Public ?Jcli .sJ ~ Notarial Seal Michael Cherewka, Notary Public Page 4 Wormleysburg Boro, Cumberland County My Commission Expires Feb. 5, 2005 ~tlrr1her, PepnsvllranlCl J\ssociation of Notaries COMMONWEALTH OF PENNSYLVANIA) ) ss. COUNTY OF CUMBERLAND ) W e, ~ I and ~. 0:;' ",-.,\ ~ -L Cj Le. {.I~el... the witnesses whose names are si d to the attached or foregoing Instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~~-~~JT //'\ (;d~ C q~ . , ~ Sworn and subscribed before me by Sax 0.... CB.. l\J ~~~d Le <:-. \ \ ~ G. L..e..c-_<L h , witnesses, this 2..?fA day of , 2001. ~Md~ Notary Public Notarial Seal Michael Cherewka, Notary Public Wormleysburg Bora, Cumberland County My Commission Expires Feb. 5, 2005 lIAamber. Penn'3'II"..''''''8 :\ssociation Of Notaries ~ SICr! Page 5