HomeMy WebLinkAbout10-19-07
~ . '--4
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF _ CUMBERLAND - coUNTY, PENNSYLVANIA
File Number fl- D l - 3j-1
Estate of
also knO~ as =
~ Deceased
Bruce A. Larson ~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
Phyllis A. LArson
N/A
-=-
.' 207-34-6609
SOClal Secunty Number -
ID A. prob." .nd G...t ofL<tt<n. T_......'" ..d "'~ \bot Pooooo<<(') ffi J ., tb<
h., Will o"bo Do""'" .....,d.l' pn 1 20, 1 9'1(\..d ood'd'~) ..... N I A
Executor
named in the
Ex,,!,' M follo~. "'"",,0' did 00< many, WM no' "'vo,wl, .... did no'bo" · ",'id - 0' "",plOd ..'" "oortiOO of tb< '0,,",0,,01(,) off"''''
fo< prob"", "" 00' tb< victi.. of. ","ing ..d "" oOV~ ""jodi""" .. io"!'"""",, p""'.l N I A
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
o B. Grant of Letters of Administration
poI(,iooo~') _ . pro"'" ","", bM J bo" ..- \bot 0-"'" loft 00 Will .... wM ,0Niv'" by "0 followin, "","'0 (if ..y) ..d hoin. (If
Admini,aa'"'' 't.a. "' ~b-"". t.a.. ,,"" dat< ofWiil i. "'"". A 0"",, and ",mpl"o Ii" af "'in.)
(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
I Name Relationshin Residence 1
c-'" ",
, .,.:'~)
,--c:C) _...J
. ~:j~- ' ,
.- -.
(COMPLETE fN ALL CASES') ...".,. _'0"", .."'" if .~",ory. ~~
0""- "" d"""dl'" .<<1"... in Cumber land Cooo", p""",iv"" wi" bffi J bo<lM' priodpol ';'1"""''' ,....
100 Mt. Allen Driv M
("''''~'' ...o~. ,~oI".' _MM. _.. ""'.. ,~ "",.J'"
c...)
Decedent, then 35.- years of age, died on Oc to b P. r '), ? nn 7 at
Cumber 1
Messiah Villalle,
~
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 PA) Personal property in County
Value ofreal estate in Pennsylvania
75,000.00
$
$
$
$
None
situated as folloWS:
Whorefore, ","im"") ~podf.i1Y ....."",) "" ,..... of'" i'" wm"'" Codioll{,) -"'" wi<h mi, 1'<titioo "'" "" "'., of L"'" in .. -pl''" fmm ,.
the undersigned:
Typed or printed name and residence
~~~~
Bruce A. Larson
4705 Rock Led e Drive
Si ature
Page 1 c
Form RW-02 rev. 10.13.06
'" ..
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF
CUMBERLAND
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 of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
19th
day of
D~ ~~~
Signature of Personal Representative Bruce A. Larson
Sworn to or affirmed and subscribed
October
2007
File Number: ;< 1- 0-, - g47
Estate of
Phyllis A. Larson
, Deceased
Social Security Number: 207-34-6609
DmeofDemh: October 5, 2007
AND NOW, October 19, , 2007 . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Bruce A. Larson
in the above estate
and that the instrument(s) dated Anril 20. 199R
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES . \1ilJX\(~~lAN"~l&:lbQUr5-ru&lW
Letters............... $ \6<5",01) R,egiJjr:!~ill/1 10 J ~ a~~
ShortCertificate(s)........ $~) .. dO Attorney Signature: /t/t/V ~ . U
Renunciation(s) .......... $ Kei th O. Brenneman
. \ I r- ..""'~ Attorney Name:
l k.) 1\ . .. $ .:::) _ L)\......J
-d0 P ... $ 10 .()o
O. ~-hx<<.chDn ... $ S. 6\)
. .. $
...$
.. . $
.. . $
.. . $
. .. $
TOTAL ............ .. $ \~ 5 . (::0 .J:t:i!f3
Supreme Court J.D. No.:
47077
44 W. Main Street
Address:
Mechanicsburg, PA
17055
Telephone:
717-697-8528
Form RW-02 rev. 10.13.06
Page 2 of2
'1'('- "
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fec for this certificate, $6.00
Certification Number
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.
awn.. .h? ~~T 0 ~2007
Local Registrar Date Issued
P 13859293
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REV 1112006
PRINT IN
4ANENT
CK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
C.0
.,..
Twp.
STATE FILE NUMBER
1. Name ol Oecedenl (FIrst, middle. last, suffix)
Phyllis A. Larson
5, Age (last Birthday)
Yrs.
4. Date of Death (Month, day, year)
October 5, 2007
6. Date 01 Birth (Month, day, ar)
95
May 2, 1912
Cumberland
10. R8C8:,American Indian, Black, While, etc.
(SpaciIYl Whi te
11. Decedent's Usual Occ tion Kind of woOl done most 01 won.;' tKs. Do nol state retired 12. Was Decedenl ever in the
Ki!]d of Wor\( Kind of Business/Industry U.S. Armed Forces?
HOmemaker Own Home Oy.. KlNo
14. Martial Status: Married, Never Married.
Widowed. Divorced (Spoc;/yj
Widowed
. 16. Decedent's Mailing Address (Street, c~y flown, stale, zip codel
100 Mt. Allen Dr.
Mechanicsburg, PA 17055
Oececlenrs
Actual Residence 17a. State
17b. County
PA
Cumberland
He. I[] Yes, Decedent Lived in
17d. 0 No, Decedent Uved within
ACluallimilsof
Upper Allen Twp.
Twp.
City/Bora
18, Falher's Name (First, middle, last, suffill.)
Arthur Adelman
19. Mother's Name (Arst, middle, maiden surname)
Nora Christian
2Ob. InlorrTl8f'lt's Mailing Address (Street, city' town, state, zip code)
4705 Rockledge Dr., Harrisburg, PA 17110
21e. Place of Disposinon (Name ol cemetery, crematOl'y or olhef place)
21d. location (City I town. slate, zip code)
Mechanicsburg, PA
23b. License Number
23<. Da" Signed (Month. day, yaa~
24. lime 01 Death 25. Data Pronounced o..d (Month, day, yaar)
/1 I 0 - 0 S;.
CAUSE OF DEATH (See Insbuctlons and examples)
Item 27, Part I: Enter the ~ - diS8aS86, injuries, or complications -thai directly caused !he death. 00 NOT enter terminal events such as cardiac arrest,
resplraloty arrest, or ventricular flbrilation without showlng lile etiology. Us! only t?"' cause on each line.
26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
DYes ONo
~3~~~~se=;
Approximate interval: Part II: Enter other sianific8nt condlllon!l; oontrihutina to dHlh, 28. Did Tob8cco Use Contnbute 10 Death?
OnaotlO Daalh but not raatItiIg in the underlying causa gIvan In Part i. 0 Yes 0 Prollahly
o No [}1n\known
C,t/ J4
~
Co"':J
29.~~
!2fNol pregnanlwithin past year
o Pregnant at lime 01 death
o Not Jl<81IIlant, but p<&gnant with. 42 days
ol<leath
o No! pregnant, but plllg1ant 43 days to 1 year
befcnd8alh
o Unlo1ownHpragnantwllh.lhepe~yaar
32c. PI80e ollnjury: Home, Farm, Street, Fectory,
DIlicaBul~k1g,elc. (SpecIfy)
a~~/)Ct
Doe 10 (or as a consequeoce of):
O~4l5 ~~
~1~lislcondiBons, if any,
=1: UHOE~:rtr.:r a.
=~~~L1M.'e
b.
Due to (or as a consequence 00:
c.
Due 10 (or as a consequence of):
308. Wa8 an Autopsy
PartO<med'?
d.
3Ob. Wore Aulq>sy FWldngs
Avai8bIe Prior to Completion
ol Cause of Death?
35, Registrar's Signat
~
1~1/1?i (I (I
32d. Ttme 01 Injury
OY.. ~
DYes ONo
3Uta_ 01 o..th
0'-1O~ D-
O Accident 0 Pending l"'eelIgalion
o Suicide 0 Could N.. be Determined
M.
32f.IIT_tionlniJ~(SpecIfy)
o Drive< I Operal.. 0 Paasange< OPedestrlan
Other . SpecIfy
33b. Signature a
32g. Location ollnjtJry (Street, cIly llown, stale)
338. Certifier (check only one)
CtrtItying phYllcian (Phyliaan certifying cause of death when anolher physician has pronounced death and completed lIem 23)
To the best ot my know..... dNth ocoumd due to theClUse(I) and I\"IIIfIlW" stIted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Pronouncing and certifying physician (Physiclan both pronouncing death and certifying to cause 01 death)
To the beat of my knowtedge, deIth occurred at the time, ell", and place, and due to the CluM(lllnd manner II stated.. _ _ _ _ _ _ _ _ _ _ _ _ __
MHleal Euminell Coroner
On the be.11 of e:umlnstlon and' or Invaal69atlon, In my opinion, death occurred et the time, date, end place, and due to the ClUae(I) end menneI' I' atatecL 0
u
Disposition Permit No
34. Name and Address r Who~leled Cause otpeath (Item 27) Type I Prinl
..j.t~r1--r -rWe ~pJ~-o
/VD rY7~A-t1...6? / IZ.. <C'/<..u,.;.cs6..:.' I.A
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LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
LAST WILL AND TESTAMENT
OF
(")
,~._.-
PHYLLIS A. LARSON
C:-:'-l
. . - \.s)
I, PHYLLIS A. LARSON, of Hampden Township, Cum~erland
- - I( __) _..,
--
County, Pennsylvania, being of sound and disposing mind, ~mory
- i ..
.;->0 c.,)
and understanding, do hereby make, publish and declare th!s as
and for my Last Will and Testament, hereby revoking and making
void any and all wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses be paid
as soon as practical after my death by my Executor or Executrix,
whichever the case may be, hereinafter named.
I direct that all taxes that may be assessed as a
consequence of my death shall be paid from my residuary estate
as part of the expenses of the administration of my estate.
2. I bequeath the sum of Thirty Thousand Dollars
($30,000,00) to my granddaughter, JANET MOHLER.
3. All the rest, residue and remainder of my estate, real,
personal and mixed, and wheresoever the same may be situate, I
give, devise and bequeath in equal shares to my son, BRUCE A.
LARSON and my daughter, KAREN L. MOHLER, absolutely.
In the event my son, BRUCE A. LARSON, should
predecease me, I give the share my said son would have received
hereunder to my daughter, KAREN L. MOHLER. In the event my
daughter, KAREN L. MOHLER, should predecease me, I give the
share my said daughter would have received hereunder to my
granddaughter, JANET MOHLER.
4. I hereby nominate, constitute and appoint my son, BRUCE
A. LARSON, as Executor of this my Last will and Testament, but
...
"
should he predecease me or fail to qualify, I nominate,
constitute and appoint my daughter, KAREN L. MOHLER, as
Executrix of this my Last Will and Testament.
I further direct that no person serving as Executor or
Executrix hereunder shall be required to post any bond to secure
the faithful performance of his or her duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament written on Two (2) pages this
20th day of April, 1998.
f ~ (fI, i~SEAL)
yllis A. Larson
Signed, sealed, published and declared by PHYLLIS A.
LARSON, the Testatrix above named, as and for her Last Will and
Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto
subscribed our names as attesting witnesses.
~~
( SEAL)
_4~ tL ?P{;~(SEAL)
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
-2-
COMMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY
OF
CUMBERLAND)
We, PHYLLIS A. LARSON, KEITH o. BRENNEMAN, ESQUIRE and SUSAN
L. ZYCH, 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 Testament and that she had 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 witness
and that to the best of his or her knowledge the Testatrix was at
that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
Y~-~J; d ;! Jvt~
Jkh=
witness
~~~ ;<. ?jr),
~ Witne
Subscribed, sworn to and acknowledged before me by PHYLLIS A.
SON, Testatrix, and subscribed and sworn to before me by KEITH
. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 20th
ay of April, 1998.
~I~
No ar Public -
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
Notarial seal
Christine M. White. Notary PublIc
MechanicsbUrg Bore. CumberI8nO CountY
My ComlTllSSlon Expires Sept 17 2001
r. Pennsylvania Association of NotafieS