HomeMy WebLinkAbout05-21-07
REGISTER OF WILLS OF
PETITION FOR PROBATE AND GRANT OF LETTERS
r!OWt ~/'-^J
(f;v;,~
COUNTY, PENNSYLVANIA
Estate of
also known as
t5~A. Jy.e2 ~-
v.
File Number
.;) \ - 0 '1 - OS D \
, Deceased
Social Security Number
Itt-/z- 6/'11
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
'\2 A. Probate and Grant of Letters Tejmentary and aver that Petitioner(s) is / are the E~tv .Jy.-X
tGst Will of the Decedent dated 3 /'~ If 8y and codicil(s) dated all,./ UtJ5'"
named in 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:
o B. Grant of Letters of Administration
C) ~".',~
(Ifapplicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; d~r7in'ii!ninOritate)~
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Petitioner( s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following s~~{if any);hd heirs:
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) . N
(If
" : ':;<
r Relationship c-:-: " , \I
Name Resjd~e. ) ~,,'l
j
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Decedent, then
90
years of age, died on
S-flr./U'7 at
, ,
~, s tvr-r
. ../
Irft yeU
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
'2 "- ,,,#. -
.
situated as follows:
1/3
~
3~ ~ sf. .
,
~d,... ~ ~.
V I
/"", , /) d. -
~~U C. ~,I-
~
$
$
$
$
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:
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2SU
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Page 1 of2
Form RW-02 rev /0./3.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
The Petitioner(s) above-named swear(s) or affinn(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.
.~~~~
SS
COUNTY OF
before me the
~\
day of
Sworn to or affirmed and subscribed
Signature of Personal Representative
.-<,~
%~~
~e~st&
. ~ "' ~
f'-.)
Signature of Personal Representative
.) - , ;
J.:-:->;
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Social Security Number:
\ l() La
- \:)'$ - o,s-o 1
\[ ~v-" C2ff"
l.D \'-\~ Date of Death:
, Deceased
Estate of
SI\I.o\\J1
AND NOW, ~rl.\ , ~
having been presented before me, IS DECREED that Letters
are hereby granted to
, in consideration of the foregoing Petition, satisfactory proof
\~~~~~
in the above estate
~~::~e~i~~~~e~~; : : L~. . :
Renunciation(s) ... U~), . . $
(-"-::)1 \ \ .. . $
Co at,0. \ .. . $
~U? ...$
~\U ... $
.. . $
.. . $
.. . $
... $
.., $
TOTAL.. .. .. . .. .. . .. $ <-.J, 1\ oD
60
:::JlnD
\\.000
500
Do
\~
\S OU
1 DOO
soD
<8
and that the instrument(s) dated '('(\0.-' '- ~ cia
described in the Petition be admitted to probate and filed of recor
FEES
Attorney Signature:
Attomey Name: L l'iA
Supreme Court LD. No.: 537 ~r
Address: ~ a I tl~ rf.
~ '),/J.{ 1)- /7'1I-I(J.2. 7
Telephone: 117 - 7 ~ 7 ....() Y 6 c.r
Page 2 of2
Form RW-02 rev. 10./3.06
<1105.805 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 duplicat~ this copy by photostat or photograph.
Fee for this certificate, $6.00
p
13524323
No.
(~~ ~.J,./~
Local Registrar
1!(~
.
II. d ttl11
I
Date
C)
c;O
; --:0
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25
oJ:""-
H105.143 REV 1112006
'TYPE { PRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverul
STATE filE NUMBER
0"1 o~1
19. Mochet's Name (Fdt, mOle, maiden surname)
Bertha Li
2<lb._slAaiIngAddtessi_,ctly/_,_,lipoodlll
250 Green Lane Drive C
2Ic.l'Iaceol_iNameol_,_or_placel
6. Dale 01 Birth (Month, day, year)
7._1
F
20 1917
York PA
Bd. FacMity Natrie (n not i1stilu1ion, give 51reet and oomber)
12. Was Decedent ever in the
U.S. Armed FOICes?
Ov.. mNo
Decedent's
ActuaIResidenCe 17a.Stati
. 16. DecedeRt's Mailing Adltess (Street. city I town, stale, 4l code)
113 North 36th street
Camp Hill, PA 17011
\8. Father's Nane (First, mirkIe, last. suIIix)
CIa ton McCubbin
'7b. County
14. MariIaI Status: Married, Nevel Married,
Widowed,llMlrcod(Spoci/)l
Widowed
0;0_
liveina
Township?
H>I~n
He. ~ Yes, Decedent liYed in
'7d.ONo,_Uved_
ActulIIliniIsof
Top
CoIyIBo<o
Q
~
':fJ. ~
:ii ~
Hoffman-Roth Cremato
22cNameandAddtessolFaOIIy 8 Market Plaza
PA 17013
tIems 24-26 muil btCQfTlf)leted by person
. who pronounces dealh.
~tJ1
CAUSE OF DEATH (See inatructions and examples) I ApprOJtimale interval:
Rem 27. Part I: EnteJ....~_dis&ases.~,.orcomplications_lhaldirectlycausedlhedealtt.OONOTenlerlern I eveoes sudI as caraac arrest, : OoseItoDealh
re5pralOJyarresl OfVenllictAarlibrilationwilhoutshowingtheetiology listonlyanec:auseoneachine 'I
~~==dise~ a 0Cft'"4 ~ ~.- ~ ~~.
~C'-,'any, briUt;n:;:"'JJ~~~.,.., J:.o__: ~Uc-
=UIIIlE~==a Duel. IOf as 0_01) ~ -cr :r
=~u:~mre :,
Due to (or as a ooosequeoce of): I
d. '
31.Manne~aVl
E)"...... D-
0-' 0 P_"w,sligotion
o """cia 0 Coold Nor "" De","""""
3Qa. WasaflAutOpsy
p""""",,
301>. ....A~ f"onoings
Avdable Prioflo~
of Cal.lli8 01 Deai'l/-
o Vas 0'""No
32d. Time oIlnju1y
OVes
M.
"'~I"-onIyona)
Cdtying phylidln tPhysician cerIiIyWlg cause of death when another physician haS pronounced dealh and completed hem 23)
t... buttl my kMwtIdge,dNlhoccuncl due Iothl ClUM(s) and manner aslli&ed..... _......... ---- ---... - -- - -........ - -...... - - - -......-
. ~":,a::=~:~:::.:..~;::""':'':~..lo==_..___________________ 0
. =-~.=:: ancI' Of invntlplion, In my opWon, dNttl occurred at the time, datil, and pIKe, and due 10 the cau&e(sl and manner as llaled.. D
)
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o
l!l
l5
I
I.J.I/IJ...II 1.;1. I
2:1>. Ucanso_
230. Date 8;gnad (......, day, _I
26. Was Case Referred 10 Medical Examiner I Coroner for II Reason 0Itler Ihan CIemabon or Oonalion?
o V.. 1KI No
Pan It: Enter other similic:anl coodiIions cand1t.4ino lD dedi, 28. ~ T~ ConIIWe to Oealb?
bulnolresulingin1heooded'p'lgCilU$egMlninPal'tI ~ DPtobabty
ONo 0"""""'"
A9nc";/~ it-C/.-r-=-. 29"---~
.., ~pregnanlWIItlinpastyear
o P'ognar<.1imIoI_
o Hal pr8!J'ill1. bYt pregNnl wJthin 42 days
ol-
D Norpr_,,,",prognar<"''''yslo I ye.v
..... -
0""""""""-""''''''''''''
32c;. PI8lce of: Irpy: Home, Farm, Skeel, Factofy,
OlIicoIlUldio>g,olcl_1
32g.Locationol"*,,,ISl<aoI,ctlyl_,_1
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CODICIL TO LAST WILL
OF
BEATRICE V. BURGER
I, BEATRICE V. BURGER, of the Township of Hampden, Cumberland County, Pennsylvania,
declare this to be the sole Codicil to my Last Will, dated March 20, 1984.
Item 1: I hereby revoke Item 3 of my Last Will and replace it with the following: Should any
beneficiary entitled to a share of my estate not have attained the age of twenty-five (25) years at the time
of distribution to him or her, I devise and bequeath the share of such beneficiary to the SURVIVING
SPOUSE of my deceased daughter, as Trustee, to be held in separate trusts, to hold, manage, invest and
reinvest the share so received, in accumulation of income thereon, and to use and apply the income and
principal, or so much thereof as, in Trustee's discretion, may be necessary or appropriate for such
beneficiary's maintenance, support, and education (including college education, both graduate and
undergraduate) without regard to his or her parents' ability to provide for such maintenance, support or
education, or to make payment for these purposes, without further responsibility, to such beneficiary's
parents or to any person taking care of such beneficiary. Any principal or income not so applied shall be
distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years. If he
or she dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be
distributed to his or her personal representative.
I .(~ }.
I .
Item 2: In all other respects, I hereby ratify, confirm and republish my Last Will, dated March
20, 1984, together with this sole Codicil, as and for my Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this I c,. day of
~ A1/)/IA.-*-.
,2005.
~~ v:~~
BEATRICE V. BURGER
Signed, published and declared on the date thereof by the above named BEATRICE V.
BURGER as and for the sole Codicil to her Last Will, dated March 20, 1984, in the presence of us, who,
at her request, in her presence, in the presence of each other, have subscribed our names as witnesses
hereto.
residing at
~50 6rfi tN lIW6 "lJR. 61I1!P I:b tL Rl//lJ1
SrS(, U~(~U-ee~~, M~lQ~~A.
2.., ( CZ-
residing at
COMMONWEALTH OF PENNSYLVANIA )
) ss:
COUNTY OF CUMBERLAND )
We,
BEATRICE
V.
BURGER,
Ste.lle/) L,
S Iw'l^ b4V1 A.
II
and
J-toWAtJ f~;1L
, the Testatrix and the witnesses respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the instrument as the sole Codicil to her
Last Will, dated March 20, 1984, and that she had signed willingly, and that she executed it as her free
and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix, signed the Codicil as witness and that to the best of his or her knowledge, the
Testatrix was at the time eighteen (18) years of older, of sound mind and under no constraint or undue
influence.
----
L
Subscribed, sworn and acknowledged before me J-/e.....Lj t~ &1/1-L
BURGER, the Testatrix, and subscribed and sworn to
SttvuJ L. Sh~~b,,"v jf.- and f-I"w.lAd p" h-
J ~ 'tJ... day of 1'\4A.l..l , 2005.
by BEATRICE V.
before me by
, the witnesses, this
P:::
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~~
~~
LAST WILL AND TESTAMENT
OF
BEATRICE V. BURGER
I , BEATRICE V. BURGER, of the Township of Hampden,
Cumberland County, Pennsylvania, declare this to be my last
Will and revoke any Will previously made by me.
ITEM I. I devise and bequeath all of my estate of
every nature and wheresoever situate together with insurance
thereon, to my husband, CLAIR Y. BURGER, providing he shall
surVlve me by thirty (30) days.
ITEM 2. Should my husband, Clair Y. Burger, predecease
me or die on or before the thirtieth day following my death, I
devise and bequeath all of my estate of every nature wheresoever
situate, together with insurance thereon, to my issue, per
stirpes, living on the thirty first day following my death.
ITEM 3. Should any of my issue entitled to a share
of my estate not have attained twenty five years at the time of
distribution to him or her, I devise and bequeath the share of
each such issue, to the Commonwealth National Bank, Harrisburg,
Pennsylvania, in separate trusts to hold, manage, invest and
reinvest the share to be received and the accumulation of income
thereon, and to use and apply the income and principal, or so
much thereof, as, in Trustee's discretion, may be necessary for
such issue's medical care, support and education (including
or education, or to make payment for these purposes, without
further responsibility, to such issue or to such issue's parents
or to any person taking care of such issue. Any principal and
income not so applied shall be distributed to my issue in the
following manner:
1'. ,
.1.>.
Fiftx.:i/.sO%) percent when he or she attains
-.__._v
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; ',.1 ,.. c,.,,;-,
twenty-five (25) years of age and the balance when he or she
attains thirty (30) years of age. If he or she dies before
attaining age thirty (30) , the trust shall terminate and such
share shall be distributed to his or her personal representative.
ITEM 4. I direct that all my just debts and funeral
expenses shall be paid from the assets of my estate as soon as
practicable after my decease.
ITEM 5. I direct that all taxes that may be assessed
in consequence of my death, whatever nature and by whatever
jurisdiction imposed, shall be paid from my residuary estate as
a part of the expense of the administration of my estate.
ITEM 6. I appoint my husband, CLAIR Y. BURGER, of
this my last Will. Should my husband, Clair Y. Burger, fail
to qualify or cease to act as Executor, I appoint my two
daughters, JOAN M. DUNKLE and JANE N. SCHAFFNER, Co-Executors
of this my last Will.
ITEM 7. I direct that my personal representatives
and trustee or their successors shall not be required to gIve
bond for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
~
/2 tJ --
day of
//~
,19 t5f
.1 _;I- . /'.~
~^a~ jI_,/rJ '
BEATRICE . Bl GE
The preceding instrument, consisting of this and
two (2) other typewritten pages, each identified by the signature
of the Testatrix, BEATRICE V. BURGER, was on the day and date
thereof signed, published and declared by BEATRICE V. BURGER, the
Testatrix therein named, as and for her last Will, in the presence
of each other have subscribed our names as witnesses hereto.
g<>.~ ~. ~~ residing at
. U-- Yn. G~ residing at
')ob M~~~\N 'D~.
CAMp 1-\; 1\ I~ \lO\ l
'-t\\ f~ ~
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COMMONWEALTH OF PENNSYLVANIA )
) ss:
COUNTY OF CUMBERLAND )
WE, BEATRICE V. BURGER, D~"iD E. S~~'K~~tA~~ , and
--BCLEtJ H. G~W~\~ , the Testatrix and the
witnesses respectively, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testatrix signed and
executed the instrument as her last Will and that she signed
willingly, and that she executed it as her free and voluntary
act for the purpose therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed
the Will as witness and that to the best of his or her knowledge,
the Testatrix was at the time eighteen (18) years of age or older,
of sound mind and under no constraint or undue influence.
./a~~fW6~E!i~~
<8~~. ~
JL)n. G~.
I'J~
Testatrix, and
Subscribed, sworn to and acknowledged before me,
2o~
~ft'L ' by BEATRI CE V. BURGER, the
subscribed and sworn to before me by ,f)~ E
and. 1:1~ )}n - ~:14, , witnesses, this
day of ~~'- ' 191!j.
~
rAM'
- - - 0 u lc t
(SEAL)
My Commission Expires:
~'~q:.~.t. : ;:""". 1 c, ~ I 'f .k.J
fC" Cc..'t::mi."::::lOn '<OJ',., ,:. ro,""'"' :\} "1
~. _ '~""J t'1m, Pa. ,",,'..:tn00:';. ia110 W'...~.h
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of BEATRICE V. BURGER , Deceased
I, JANE M. PRITZ, formerly Jane N. Schaffner , in my capacity/relationship as
(Print Name)
co-Executrix of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
JOAN M. SHAMBAUGH, formerly Joan N. Dunkle
("",,) "i'f7f7
74
1/ .dI ...
~,
f/..J(, ,//kd~J: )~//c~
(Street Address)
/JtLJk77f~;;;. $.3/~
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciatio~or the
purposes stated within on this I ? day
f /It , Un7
N ary Public
y Commission Expir
Deputy for Register of Wills
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
h h '(111.1\./ 1
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COMMONWEALTH OF PEffNSYLYAIIA
NOTARIAL SEAL
USA MARIE COYNE, NOTARY PUBUC
HAMPDEN TWP., CUMBERLAND COUNTY
MY COMMISSION EXPIRES JUNE 10 2008
Form RW-06 rev. 10.13.06