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Home My WebLink About07-10-07 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA File Number 21-07- tlol-.\S" Estate of Grace B. Hazen also known as , Deceased Social Security Number 199-32-2620 James B. Hazen Petitioner( who is/*18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) 00 A. Probate and Grant of Letters Testamentaryand aver that Petitioner(H last Will of the Decedent, dated OS/28/2003 and codicil(s) dated is/Xl( the NIL Executor 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 bom 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: Nt A o B. Grant of Letters of Administration Name Relationship Residence SEE ATIACHED -u ;CO .J:>- r- (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ..; 0:5 :::0 Decedent was domiciled at death in Cumberland County, Pennsylvania with _I her last principal r~~~!f~t 0 2828 Rosegarden Boulevard West, Mechanicsburg, Upper Allen Township, Cumberlancf~' 017055Je (Ust street address, town/city, township, county, state, zip code) ;;;! --; 0; 0 '0; C) ... , r1, r\J l....-...J (---. Decedent, then 101 years of age, died on 06/16/2007 at Colonial Park Care Center, Lower Paxton Twp., Dauph~ounty, PA'~ Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property $ 71,960.00 (If not domiciled in PAl Personal property in Pennsylvania $ (If not domiciled in PAl Personal property in County $ Value of real estate in Pennsylvania $ 154,000.00 situated as follows: single-family residence at 2828 Rosegarden Boulevard West, Mechanlcsburg, Upper Allen Township, Cumberland County, Pennsylvania (Tax Parcel 42-31-2153-008) Wherefore, Petitioner(M respectfully request(s) the probate of the last WiI~ presented with this Petition and the grant of Letters in the appropriate form to the undersigned: James B. Hazen Typed or printed name and residence 7706 Farmdale Avenue Harrisburg, PA 17112 Signature ~ 717-236-7336 Form Rev. 10-13.2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 PETITION FOR PROBATE AND GRANT OF LETTERS (Continued) REGISTER OF WILLS OF a.M3ERLAND COUNTY, PENNSYLVANIA Estate of Grace B. Hazen also known as File Number 21-07- Social Security Number 199-32-2620 . Deceased Name Relationship Residence Bordlemay, Terry Friend 188 Crooked Gulley Circle Sunset Beach, NC 28468-4438 Curry, Karin Beth Grandchild 8 Roxiticus Road Mendham, NJ 07945 Hazen, James B. Son 7706 Farmdale Avenue Harrisburg, PA 17112 Lowdermilk, David Hazen Grandchild 23821 Pepperleaf Street Murrieta, CA 92562-3295 (") ~S~ '!'IO "~S;: Fn --:: ::IJ en:;;>:: (yo 9" .:0 ::u-i ..> r-..> = = --' '- c:: .- o :0' :~~ . .~~ :. ) (:J ..:-:) c) 'TI -"-j __ -11 :-. c,"5 n-' C) -71 :00- :x <2 N .. COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Oath of Personal Representative } SS } The Petitioner(Mabove-named swear(s) or affirrn(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(ij and that, as personal representativeOO of the Decedent, PetitionerOO will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 10th day of File Number: I Representative Ja azen Signature of Personal Representative Signature of Personal Representative rl So t?5;g f1-rO .;~~ _l(JQ C)-n ::.D , Deceasew. -l r--3 0:= '= --' C- c:: r- ~T:J , . I (-J C""") ~T" 1~.=1 n~ o .~:: "'~ -rJ .'.' .~~~ c:> 21-07 - 6l&l\S > ::E C5 N .s;:- I ~ -,"'J Social Security Number: Estate of Grace B. Hazen Date of Death: 199-32-2620 06/16/2007 AND NOW, are hereby granted to James B. Hazen 2007 , in consideration of the foregoing Petition, satisfactory proof Testamentary in the above estate and that the instrumenQi) dated OS/28/2003 described in the Petition be admitted to probate and filled of record as the last Will ~ of Decedent. FEES Letters...................... .................... $ Short Certificate(S)......L5J,....... $ Renunciation(s)............................. $ l~, \\ $ ..iC~ $ Au~ $ $ $ $ $ $ $ TOTAL.................................. $ Form RW-02 Rev. 10-13-2006 ~,~.\)() d.~. cP ~~~rOU ~l~~ C~ Attorney Signature: \ 6. bt \o.ch 6.cj) Attorney Name: Wm. D. Schrack 11\ Supreme Court 1.0. No.: 15893 Schrack & Linsenbach PC Address: 124 West Harrisburg Street P.O. Box 310 Dillsburg, PA 17019-0310 Telephone: 717 -432-9733 \1 1&.>0 .rP Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 H105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. 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. Fee for this certificate, $6.00 P 13698174 Certification Number I'.) l:::;) = ~ c.... c:: r- o ~o ~o~ "IO ',!'l>I- 7rn cI5:O CO]' ^ '. 00 ,;)O-n '....ole " :;:J ::-o--i :t> o > :rc 9 N .s::- a\ D\ COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) Hl05-143 REV 11/2006 TYPE I PAINT IN PERMANENT BlACK INK b\o'i'S STATE FILE NUMBER 4. Dale of Death {Month, day. year) June 16, 2007 3. Social Security Number 199 - 32 ,. Name 01 Decedent (First, middle, last, suffix) 2620 Hazen 6. Dale 01 Birth (Month. day, yeaf) 5. Age (laSl Birthday) Fayette County, July 14, 1905 101 Yffi. 10. Race: American Indian. Black, While. elc. (Specify', whi t e ad. Fac~i1y Name (U no! institution, gf/e slrael and number) Sb. County of Dealh Colonial Park Care Center Dauphin Twp. 11. Decedent's Usual Occu lion Kmd 01 war!<; done durin most 01 'NO life. Do not state retired Kind of WOl'k Kind of Business I Industry teacher ublic education . 16. Oecedenrs Mailing Address (Street, city flown, slate, zip code) 7706 Farmdale Avenue Harrisburg, PA 17112 18. Father's Name (First, middle, last, sutfix) 14. Marital Status: Married, Never Married, Widowed, Divorced (Specify) widowed 13. Decedent's Educalion (Specify only highest grade completed) Elemenlafy / Secondary (0-12) CoUege (1-4 or 5+) 12 2 12. Was Decedent ever in ltIe U.S. Armed Forces? Dyes ilJNo Decedent's AclualResidence 17a.State Did Decedent livti ina Township? 17c,IZ!"Yes,Oe<edontLNed_ Lower Paxton 17d, 0 No, Oecedentlived within AclIJ&l limits of PA Dauphin Top. 17b. County City/Bom 19. Molher's Name (First. middle, maiden surname) Chints Craft Isaac 1. B ers 2Ob. Infomlanrs Mailing Address (Street. city 11oWn, stale. zip code) 7706 Farmdale Ave. Harrisburg PA 17112 20a. Informant's Name (Type / Print) James B. Hazen 21d. Location (City .floWn, state, zip code) Vanderbilt, PA 21c. Place 01 Disposi!lOfl (Name 01 cemetery, crematory or other place) Bowman-Flatwoods Cemetery o w "' ::> "' .. ::; .. 22c. N::I.me and Address 01 Facility oover F.H. & Crematory Inc. P.O. Box 475 Hershey PA 17033 . ~ 23c. Date Signed (~~th, day, year) K YJ.9 L ~~.'-> o (,,- I ~ - c9- C'O '( 26. Was Case Referred 10 Medical Examiner I Coroner for a Reason Other Ulan Cremalion or Donalion? DYes ~o 25. Date Prol1QlJflCed Dead (Month. Q.1Y, year) llems 24.26 must be completed by person - who prooounces death. /t... - ;J..oo7 .I I '.5'S-- CAUSE OF DEATH ( instructions and examples) Item 27. Part l: Enter the ~ - diseases, injuries, or compliCatioos -thaI directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest, or ventrictJlar librillalioo without showing the elioklgy. lisl ontv ooe cause on each line. O(P-- M. Part II: Enter other ~igflg contribulioo In death, 26. Did Tobacco Use Contribute 10 Death? but oct resulting in the undertying cause given in Part L 0 Yes 0 Probably o No B'u"",own L'/t!vet;-./ L,/lW ",IfFemale: , - ,-- @-NoIpregnarllwilhinpastyear o Pregnanlallimeofdeattl o Not pregnant. but pregnant within 42 days 01 death o Not pregnant. but pregnant 43 days 10 1 year before death o Unknown if pregnanl within the past year 32c. Place of Injury. Home, fllffll, Street, Factory, Officelluilding,elc.(SpeciIy) Approximate inlerval: Onset to Death ~ r e" ~e /I ~ Y'()Jc tR VI -1-1 'c Due to (or as a consequence 01): /fl'J '- IA('~ If TN , f.opi) =~;e~~~~~1)dise::. yectlS Sequentially list conditions, if any, ~~:a: ~JD~R~I~~~~~E a. (disease or ir)fUry!hat initiated the events resulting Ir'I death) LAST, b. Due to (or as a consequeoce 01): Due to (or as a consequence of): d, 31, Manner 01 Death ~IUlal 0 Homicide o Accident 0 Pending Invesligation o Suicide 0 Could Not be Dt'temUncd 3Ob. Were Autopsy Findings Available Prior to Completion 01 Cause 01 Death? 3Oa. Was an Autopsy Per100ned? 32g. location 01 Injury (Street, city Ilown, state) DYes~ 32d. TlITle 01 Injury Dyes DNo M. 333. Certflier (check only one) Certifying physician (Physician certifying cause of death when aoothef physician has pronounced death and completed Item 23) To the best of my knowledge, deathoeeurred due to the cause(s) and manner IS statecL...... _...... -.. - --.. -.. - --................ -.......... ;=:~I:~ =~J::~=: :~i~~in:;:C:~~~:10t~~:~~(~~~~~ manner as stated_ _ _ _ _.... _ _.... _ _.. _ _.. _ 0 ~:~;::"~;':~~;:=~ and I or Investigation, in my opinion, death occurred atlhe time, date, and place, an<! due 10 the cause(s) and manner as stated_ 0 ~ ffi 5l ~ o w ~ I at aJ d..J. ;). N I ~ O"po,,"oo P"mll No () l t ~ It t q c:\myfiles\wills\GraceHazen(jsg) llast ~ill aw ijt.estam.en~g '-=i-oo o;C.- .'"-~~;m ~::o C/).^ 00 ,~;; >-2 .1 ---' "'J ~~ ~~ OF GRACE B. HAZEN f"-.,) = c:.:) ...... <- c= .-- o :;po. ::.r: C5 N .- BE IT REMEl\IBERED, that I, GRACE B. HAZEN, presently of 2828 Rosegarden Boulevard, Mechanicsburg, Upper Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory, and understanding, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. I direct that my hereinafter named Executor pay all my just debts, my funeral ITEM 1: expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executor to expend for my funeral expenses and interment such amounts as may be considered necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Executor to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. I give to my former neighbor, TERRY BORDLEMAY, the sum of FIVE ITEM 3: HUNDRED DOLLARS ($500.00) as a token of my appreciation for all that he has done for me in making it possible for me to continue to live independently at my home. ITEM 4: All the rest, residue, and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I direct my Executor divide into two (2) shares that are as nearly equal as is practical, which shares shall be distributed as follows: A. One (1) share to my son, JAMES B. HAZEN. Ifmy son should predecease me, I direct that this share be divided between his children in as nearly equal shares as is practical. B. One (1) share to be divided between the children of my daughter, Margery, KAREN BETH CURRY and DA VID HAZEN LOWDERMILK, is as nearly equal shares as is practical. If either Karen or David should predecease me, I direct that the share of such deceased grandchild pass to his or her issue, in equal shares. ITEM 5: I nominate, constitute, and appoint my son, JAMES B. HAZEN, to serve as Executor of this my Last Will and Testament, directing that he not be required to post bond to assure the faithful performance of his duties in this, or any other jurisdiction. 1f1l WHEREOF, I have hereunto set my hand and seal this A.. l..- day of ,2003. !J/ULD-<-i '& ~MJ GRACE B. HAZEN The preceding instrument, consisting of this and one (1) other typewritten page, was on the day and date thereof signed, sealed, published, and declared by the Testatrix herein named, 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, have subscribed our names as witnesses hereto. C:~C2R OF f2f?'W~1 f4 ~ C.- -R~ OF \.>.JeI.\S",\\OL \),; Page 2 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF YORK ...,1 / :./ ~ ,p r;e, GRACE B. HAZEN, <=-.)hn A /J {hiLZ -- l// /l. r I n ' _ LWjJUJ ( - ..J ~ ' the Testatrix and the witnesses, respectively, whose names are signed to t e attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument and as her Last Will and Testament, and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. ~/ 'fl- ~~/ G~PQ C)~~~ SWORN TO AND SUBSCRIBED BEFORE ME THIS ~nAY j .-/ Notarial Seal Janet s. Gore, NoIary PttiIlJ DiIIsburg Boro, York Comly My Corm1issIon Expires Oct. 25, 2006 Member. AilnnsyIIIanIe AeeocIstion or ~