HomeMy WebLinkAbout05-10-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY,PENNSYLVANlA
Estate of ::)<^.('~ IJe.S D. Co...(4<'"
also known as
File Number !JI - CJJ 4 tolo
, Deceased
Social Security Number \Cj '5 -l( ~ ~ <6S-Slr
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
-,f. A. Probate and Grant of Lette~ Tesnmentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated '} ~ ~ <jV) and codicil(s) dated
&ec. I J-f- r 11(
namedih the
(State relevant circumstances. e.g.. renunciation. death of executor. etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: JJ J Q. .~ ,
o ~~.:;
So -.J
o B. Grant of Letters of Administration . ::0
(lfapplicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante sJi~ _
--;.... n!
Petitioner(s) after a proper search has / have ascertained that Decedent left no WilI and was survived by the following spouse ($(any) liiid heirs: (If
Administration. c.t.a. or d.b.n.c.t.a.. enter date of Will in Section A above and complete list of heirs.) :.~) C: ;:J
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Name
Relationship
Resi~enGiI
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cum Pel"\a. ~
(List street address. towll/city. township, county. state. zip code)
Decedent, then 63 years ofage, died on ",Ia. J J07
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at
')I \ f ~ \ f\ I. 0..... "6 eo..eJ" '\ \{ A. .
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
trtjPlJO
$
$
$
$
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
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before me the I (.J day of
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.~or the Register
Signature of Personal Representative
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Signature of Personal Representative
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File Number: ~I- 0.- Ll(o{o
Estate of .,,2/ -0'" -:- Y lo lo
Social Security Number: \q5 - L\d - 8 ss <g
, Deceased
Date of Death: y- 2.1- 01
AND NOW, ~ \0 . . <9ro1 . in consideration of the foregoing Petition, satisfactory proof
having been presented b.e~re , IT IS DECREED that Letters \e-::'T~M~~~
are hereby granted to 0 ~~ .:s C'D...l 1: DA..
in the above estate
and that the instrument(s) dated I-~ - ~"l
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES l.. ~~~\!tI~bCUAS-~OY~
$ "(). C---- Register of Wills
Letters ............... ~__...l:::d
Short Certificate(s) . . . . . . . . $ J 0 . CD Attorney Signature:
Renunciation(s) .......... $
W"\\ ... $
~c.P .., $
('J, H ..It-~~"*"'\ ~ ... $
... $
.., $
... $
... $
... $
.., $
TOTAL.. .. . .., . .. ... $ rlD .CO
IS- ' l \\:)
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b" . (I\)
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Page 2 of2
Form R W-02 rev. 10.13.06
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FOR DIVISION OF
VITAL RECORDS
DECEDeNT
PLACE OF
DEATH
o
USUAL
RESIDENCE
OF DECEDENT
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!:! ~ i CAUSE OF DEATH
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PERSONAL
DATA OF
DECEDENT
TO
IlEDlCAL
EXAMINER:
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(Iem:!Sl- gN". ~
3 cop;.s 10 \ufMf1II is
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NOTE: W
"_119" ..... be
_.lIClIIlyrogio-
lrar ollinll cMcioion
"1OClf1"~'
FUNEIIAL
DIRECTOR
REGISTRAR
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COMMONWEALTH OF VIRGINIA
CERTIFIED COpy OF DEATH RECORD
REGISTRATION
AREA NUMBER
COMMONWEALTH OF VIRGINIA - CERTIFICATE OF DEATH
DEPARTMENT OF HEALTH - DIVISION OF VITAL RECORDS - RICHMOND
MEDICAL EXAMINER'S
CERTIFICATE
CERTIFICATE
NUMBER
STATE FILE
NUMBER
228
742
1. FULL NAME
OF DECEDENT
(first)
female
f) l{',yL
o
5. DATE OF
BIRTH
Oct 22, 1953
no
~
ON I&:-
9. CITY OR TOWN OF DEATH
VA 1?cdch.
I Out Pat.
I OOA Emer Rm Inpattenl
: 0 0 0
inside ctty or town limits?
yes no
IKI 0
11. STATE (OR FOREI.GN COUNTRY) DF DECEDENT'S RESIDENCE
Pennsylvania
Cumberland
13. CITY OR TOWN OF RESIDENCE
Carlisle
inside city or lown limits? 14. STREET ADDRESS OR AT. NO. OF RESIDENCE
yes no
~
ZIP CODE
o
1878 Douglas Drive
17015
15. NAME OF DECEDENT'S FATHER
16. MAIDEN NAME OF DECEDENT'S MOTHER
18. OF HISPANIC ORIGIN? If yes. specify Cuban, Me.icen,
p~ Rican, etc. KJ no 0 yes
4
ElementerylSecondory (0-12) College (1'" or 5 + )
DIVORCED 0 23. ~ ::;=?~ :~ED, NAME OF SPOUSE
WIDOWED 0
26. KIND OF BUSINESS OR INDUSTRY
21. BIRTHPLACE (_ or country)
22. NEVER MARRIED 0
MARRIED IXJ
2~. SOCIAL SECURITY NUMBER
25. USUAL OR LAST OCCUPATION
27. INFORMANT. OR SOURCE OF INFORMATION - RELATIONSHIP
Kimberly S. Carter- Wife
INTERVAL BETWEEN
ONSET AND DEATH
; ~.-~l
,
~~~~='~~~
CAUSE (IliIMM or Injury IheIlnillBled
_ _ng In _) LAST
(B)
DUE TO (OR AS A CONSEQUENCE OF):
~
~c""o
(C)
PART ". ~ ~ ~ contributing to death but not resulting in the undeitying cause given in Part I.
yes
o
28c. IF EXTERNAL CAUSE, IT WAS
PRIMARY 0 or CONTRIBUTING 0
unknown 0 TO CAUSE OF DEATH
(day) (yeer) 281. INJURY OCCURRED
. 28d. DESCRIBE HOW INJURY RELATING TO
281>. IF FEMALE, WAS THERE A PREGNANCY
IN PAST 3 MONTHS?
3 yes 0 noD
is 288. TIME OF INJURY (mo.)
I A.M.
P.M.
ch
o
I 28h. (city Of town
I
I
(county)
(state)
28g. PLACE OF INJURY (home, fa.m,
factory. street, office bldg.. 81e.)
:th:rk D :~w~~le 0
g8 of the remains described above, viewed the body, made inquiry and in my opinion death resulted at or about
ACCIDENT 0 SUICfDE 0 HOMICIDE 0 UNDETERMINED 0 PENDING 0 -
----- --------------------------------------IDA~S1~~--------------------
pnn}N t:.tL'_ - - - - - - - - - - - - -I ADDRESS OF-MEDiCAL-rXAMIN~R - _-11 k 1101._ - - - - - - - - - - --
u~ : ~It UfnA-e..vt- A ~
(AM) (PM) from:
30. PlACE (name of cemetery or crematory)
OF BURIAL,
o 0 OJ: REMOVAL, ETc'Hoffman-Roth Crematory,
31. (Signature of funere! diractoror person legelly filing this certificete) . NAME OF FUNERAIHO omon rown unera ome
u~~€:Kt-~ ~9CGiCP...? ~g~M~~8464 Tidewater Dr.Norfolk,Va
32. (e!gn.. of regiBl.er) DATE RECORD
~ / . ~~
THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT REPRODUCTION OF THE ORIGINAL RECORD FILED WITH THE VIRGINIA BEACH
DEPARTMENT OF PUBLIC HEALTH, VIRGINIA BEACH, VIRGINIA
DATE ISSUED: t/1i\ Y - 1 Zaal
\jCl~~~l
DEP RE RAR
SEAL:
ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY STATUTE.
DO NOT ACCEPT UNLESS IT BEARS THE IMPRESSED SEAL OF THE VIRGINIA BEACH HEALTH DISTRICT CLEARLY AFFIXED.
Section 32.1-272, Code of Virginia, as Amended
..- .
1 ~ ~.
LASTWILLANDTESTAMENTOFJ<J\CQUES .'D.' GARTER
I, JACQUES D. CARTER, of the Township of West
Pennsboro, County of Cumberland and State of Pennsylvania,
being of sound and disposing mind, memory and understanding,
do make, publish and declare thi.s my Last Will and Testament,
hereby revoking and making void all former Wills by me at
any time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently
be done.
2.
All therest,resLdue and remat.nder of my estate,
real, pers.onal and mixed, of whatsoever natU!ie and wheresoever
, -.)
situate, I give, devi.s'e and bequeath to my wife,
CARTER, absolutely and in fee simple.
c,
KINBERLY
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In the. event my wife should predecease meo? die~
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within thirty (30) days of my death, then I give, devise and
bequeath my entire estate to my daughters, KELLI SUE CARTER
and JAMIE LEE CARTER, share and share alLke.
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, J
4.
Notwithstanding the above, should my daughters. be
less than the age of twenty-five (25) years at the time of
distribution he.reunder, I di.rect that their shares' be paid in
trust to my Trustee, my sister-in-.law' and her husband, STACY
and BRAD STRINE, to be dealt with according to the following;
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..
...
.. '
(A) My Trustees. shall invest the principal and pay
the income thereof to my daughters, or to their Guardian
should they be less than twenty-five (25) years of age.
(B) My Trus.tees may pay such amounts of principal
as in their sole dtscreti.on is advis.'aole for the educa.....
tion, maintenance, and support of said children.
(C) Upon my daughters reaching the age of twenty...
five (25) years, then all principal and accumulated in-
terest shall be distributed to them;. at whi.ch time this
trust shall end.
(D) In the event ei.ther daughter should predecease
me or dies prior to reaching the age of twenty-five (25)
years, then the share of said deceased child shall pas.s
to the surviving daughter.
(E) I authorize my Trustees to 1I1ake paYll'l.ents ac....
cordi.ng to the terms hereof without petitioning the
Court for permissi.on to do so, and I further direct my
Trustees shall serve without bond.
5,
I nominate, cons.titute and a,ppo:i:.nt my sistel:'....i.n....law
and her husband, STACY and BRAD STRINE, to be the guardians of
the persons and estates of my daughters i:.f they have not reached
the age of majority at the t~e of my death.
6,
LASTLY, I nominate, constitute and appoint my wife,
KIMBERLY S. CARTER, to he the Execut:t."Pt of tbi:s, my Las't Will
and Tes:tament, and in the event she should be unwilling or
unahlefor a.nyreaaon to act a.ssuch,l nOIllinate, cons:t1:.tute
-2-
.
'- '
and appoint my mother1 JEAN .~~ CARTER 1 to be the Executrtx
of this, my Last Will and Testament1 in her place and stead.
seal this 2, L c:L day of
se t my' hand and
} A, D. 1987.
(SEAL}
. Carter
Signed, sealed, published and declared by the aboye-
named JACQUES D. CARTER 1 as and for his Last Will and Testament,
in the preS.ence of us, 'Who, at his. request and in his presence,
and in the presence of each other, hayehereunto subscribed our
names as witnesses.
..~J:~/~
-3-
OATH OF NON-SUBSCRIBING WITNESS(ES)
C REGISTER OF WILLS
l.J .nJ:whla-vvJ... COUNTY, PENNSYLVANIA
Estate o~~
b.~JL
, Deceased
C~~tU1t'~
!L'll
and
(each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were well-
acquainted with ~~ D. (!ak:;t,q iL. and am/are familiar
with the handwriting and signature of the deceden~ and that the signatore ot<ff~ r: (!ClJd:tL
to the foregoing instrument purporting to be the Last Will and Testament/CodIcil of '" ~ 'b~
OJ) J-dJA....-- is in his/her own proper handwriting.
c::)ttl-~~.ILtL
/lpIPtj QurU) Drive,.
(Street Address)
7C~5k) P A 17013
(Signature)
(Street Address)
(City, State, Zip)
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pu for R gister of Wills
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Form RW-04 rev. /0./3.06
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
Cumberland COUNTY, PENNSYLVANIA
Estate of
Jacques D. Carter
, Deceased
J. Michael Eakin , (each) a subscribing witness to
/ (Print Name/s)
the la Will 0 Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that ~/ he / ~ was / ~ present and saw the above Testator / ~ sign the same
and that .F1 he /!Per signed the same and that ~ / he / ~ signed as a witness at the request of
the Testator / ~ in .J;1,.ef?/ his presence and in the presence of each other.
(Signature)
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4720 Old Gettysburg Road. Suite 405
(Street Address)
(Street Address)
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Mechanicsburg, PA 17055
(City. State. Zip)
(City. State. Zip)
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Executed in Register's Office
Sworn to or affirmed and subscribed
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this
day
before me this
of May
9th
day
2007
of
d(MLo~ ~,1' ~
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Deputy for Register of Wills
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or c
at time of notarization.
..........
..........
If NDIaIy PWlIo
1ll8rClF~/U"'C1I1~-I~
_CGmr... ......,., 7. 2IDD7
Form RW-03 rev. 10.13.06