HomeMy WebLinkAbout03-06-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of
'Vo( o(J\e) A J~ev"
File Number
, Deceased
~ \ G 't; (J~ 'S ~
Social Security Number / ()
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
W A. Probate and Grant of Lf},ttep TesJamenJ.\1ry and aver that Petitioner(~ is / are the t? ye.c~-l1ov\;{
last Will of the Decedent dated k L f' L q ~ and codicil(s) dated
.
named in the
(State relevant circuli/stances, 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 instll.lment(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
(If applicable, ellter: c.t.a; d.b.lI.c.t.a.; pelldente lite; durallte absentia; durallte /1~b19r~ate)
..J,)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if\tny) aclL,heirs: (If
Administratioll, c.t.a. or d.b.ll.c.t.a., enter date of Will ill Section A above alld complete list of heirs.)
~~ -:
Name
Relationship
Residence
l
:~;~
.' ,
~.
to~-
Decedent, then "1;;- years of age, died on (f\.
I q"2-0 LJ.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
V"" of ",' ~"" 10 P""'y'"o', ~
situated as follows: ~L ~ \"~'v e~Cl/1tC--l../~ "
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:
?> 606 00
$
$
$
$
rinted name and residence
o
FO,.,,1 RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMINIONWEALTH OF PENNSYLVANIA
SS
COUNTY OF 6�1'hel-L"?
The Petitioner(s)above-named swear(s)or affirm(s)that the statements in the foregoing Petition are true and con"ect 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,
Swon,to or affirmed and subscribed
hc day of (Signature of Personal Representative
h
e for,, i ne t
rVI
� c'h Signature of Personal Representative
Al ( I
ci filao
For the Register Signature of Personal Representative
File Number: 0—i�s(-1(7
Estate of L 14/ore's 66 e K Deceased
Social Security Number: to of Death: A '3'
AND Now, j2 in consideration of the foregoing Petition,satisfactory proof
having beet)presented before me,ITIS DECREED that itetters-._
are hereby granted to J LV l/C
in the above estate
and that the instrument(s)dated 'Jutqe' W 6
described in the Petition be admitted to probate and filed of record jasthe last Will(an
, Yodicil(s))of Occedent I
FEES
Letters . . . . ....(0 P(-U
Rer of wills J,
Short Certificate(s) $ Attorney Signature:
Renunciations) . . . . . .. . .. Attorney Name:
jp Supreme Court I.D.No.:
Address:
A,,A 7l D
Telephone: �(7—
TOTAL . $ 167.
1--onn R JV-0? rev. 10.13.00" Page 2 of 2
HI05.805 REV (Ol/071
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
P 14123051
Certification Number
This is to celtify 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.
/? !? vr: MAR 0 6 2008
~ ~//
Local Registrar Date Issued
t"'...)
_1'''
.::;
en
['..:
Ci;
c'
3 REV 1112006
1M/NT IN
IMANENT
ACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
6. Date of Birth (Month, da , year)
75 Yrs.
8b. County of Death
11.DecedenrsUsual0lX: lion Kind of wOO dooedurin mostol U'e.Donolslalere
Kind of Work Kind 01 Business Ilndustly
secretar Defe e D
.. 16. 06ced6nfs MaiMng Address fSlreel, city I town, stale, zip COde)
105 E. Allen St.
Mechanicsburg, PA 17055
18. Falher's Name (FItSI, mjd(#e, last, suffix)
17a. State
Pennsylvania
Cumberland
17b.Counly
19. Mother's Name (First, micldle, maiden surname)
Beatrice Machamer
Clair Baer
2Oa. Inlormanl's Name (Type I Print)
oOther . Specily'
10. Race: American In(fian, Black. WMe, etc.
:h'fte
14. Marital Status: Married, Never Married,
Widowed. Oivo<<;ed ISpecifyj
never married
Did Decedent
Uveina
Township?
17(:. 0 Yes, Decedenl wed in
17d. hiI..'o. O"edenl Uved with. Me c h ani c s bur g
~1.ctual Umils 01
Twp.
City/Boro
Joan Conrad
2Ob. Informant's Maiting Address (street, city I town, stale, zip code)
60 Drexel Place, New
21c. Place of Disposition (Name of cemetery. crematory or other placel
Hollinger Crematory
Cumberland,PA 17070
2M loc.9tioflICliy/loWn, stale, 1'11:1 17065
Mt.Holly Springs
Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA17043
=~A=S:=)dise~
S"~YJ5 j~c::..
Duenor as , oonsequence"o('
b. rne ul'M.on,'11..
Due 10 (or as a consequence of):
I Approximate interval:
I Onset to Death
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
=tUs(cau~'~~a.
Enter fhe UNDE~LY1NG CAUSE
(dsease or injury that initiated the
events resuhing In death) LAST.
Doe to (or as a consequence of):
d.
3Oa. Was an AvIopsy
Pertomled?
JOb. Were Autopsy Findings
Available Prior to Completion
of Cause of Death?
31. Manner of Death
~ Neiural 0 Homicide
0- oPendlngl_1ioo
o Sulcide 0 Could Not be Determined
M.
DYes ~No
DYes oNo
320. Tlffleallnjuly
33a Certifier (check only one)
Certifying physician (Physician certifying caU$8 01 dealh when another physician has pronounced death and l:OITlPIelad Item 23)
To the best of myknowtedge, death occurred duelothecause(sllnd manner as stated- _ _ _ _.. _.. _ _ __ _ _.... _.. _ _ _.. _.. _ _ _ _ _.... _ _ 0
Pronouncing and certifying physician (physician boIh proI1OU1Cing dealh and C8f1J1ying 10 cause of dealhl
To the bett of my knowledge, death occurred 81 the time, dale, and place, and due to the cause(s) and manner as staled.- _ _ _ _ _ _ .. _ .. _ _ _ _ _ _ _ _
~~I~:sm~":,x~= and I or Investigation, in my opinion, death occurred at the time, date, and place, and due to the C8Use(S) and manner as stated.. 0
~.Registrar'SSignatur~ber
I ~I ( I "-I / I I I
ru""",,;lVtn PoIlrmuNo
23b. License Number
23c. Date Signed (Month, day, year)
26. Was Csse Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
Dyes ~
Part II: Enter other sionl1icanl com:ilions conlributina to death, 28. Did Tobacco Use Contribute to Death?
but not resuttlng in the underlying cause given in Part I. 0 Yes 0 PrOOabIy
o No 0 Unknown
29. If Female:
o Not pregnanl within past year
o Pregnant at time of death
o Not pregnanl, but pregnant wID'Im 42 clays
ofc\eath
o Not pregnanl. btJt pregnanl 43 days 10 1 year
before death
o Unknown ri pregnant within the past year
32c. Place of Injury: Home, Farm, Street. Factory,
Office BuUdlng, etc. (Specify)
329. location of Injury (Street. city flown, stale)
jlJ /701/
~
OF
DOLORES A. BAER
I, DOLORES A. BAER, of the Borough ofWormleysburg, County of Cumberland and State of
Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be
my Last Will and Testament, hereby revoking and making void all previous wills or testamentary
dispositions heretofore made.
ITEM I.
I direct that my hereinafter named Executor pay my just debts and funeral expenses
as soon after my death as is practicable.
ITEM II. I give, devise and bequeath all of my estate, real and personal of whatsoever kind
and wherever situate, to my lifelong friend, JOAN CONRAD, currently of 6 Drexel Place, New
Cumberland.
ITEM III. If JOAN CONRAD does not survive me, then I devise and bequeath all the rest,
residue and remainder of my estate to the children of JOAN CONRAD in equal shares. If any of Joan
Conrad's children do not survive me then that child or children's share shall be given in equal shares to
her surviving children.
ITEM IV. I direct that my Executrix, shall not be required to post any bond or give any security
of any type for any purpose whatsoever, any law or rule of court of the Commonwealth of Pennsylvania
or any other jurisdiction to the contrary notwithstanding. My Executrix shall have the following powers,
in addition to those given by law:
To invest in, accept and retain any real or personal property, including stock of~ corporate
fiduciary or its holding company, without restriction to legal investments;
; I
c\
Page I of 4
To sell, exchange, partition or lease for any period of time any real or personal property al1d to
give options therefor for cash or credit, with or without security;
To borrow money from any person including any fiduciary acting hereunder, and to mortgage or
pledge any real or personal property;
To hold shares of stock or other securities in nominee registration form, including that of a
clearing corporation or depository, or in book entry form or unregistered or in such other form as will
pass by delivery;
To engage in litigation and compromise, arbitrate or abandon claims;
To make distributions in cash, or in kind at current values, or partly in each, allocating specific
assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable
determinations of current values;
To make elections, decisions, concessions and settlements in connection with all income, estate,
inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the
distributive share of income or principal of any person affected thereby; and
To payoff any loans I may have taken against any life insurance policies owned by me that
remain unpaid at the time of my death.
ITEM V. I appoint JOAN CONRAD, Executrix of this will.
IN WITNESS WHEREOF, I, DOLORES A. BAER, have hereunto set my hand and seal this
otic
0- day of
~
U'
,19~.
/(
r;~ab~Seal)
Dolores A. Baer
Page 2 of 4
The preceding instrument, consisting of this and two other pages, was on the date thereofs'igned,
published and declared by DOLORES A. BAER, the Testatrix therein named as and for her Last Will
and Testament and 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.
'__O<-L' 'i QM (li ki" t- '-\..'
~.~ 9. )1~
Residing Ilil!/1.,J.,e fI)'1,~HI( JOo1/
Residing 2m -z,.~(~ ~')' (b~Yl1. I f~ Ilo 70
Page 3 of 4
COMMONWEALTH OF PENN8YL VANIA:
88.:
COUNTY OF b AlJ.+lc."'\,
')" We,DOL?RESA.BAER,and {O~ /LM.L ,and
fJI1A)\L~:{L Cf. ~ , the Testatrix and the witnesses, respectively, whose names are
signed to the attached or foregoing instruments, 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
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
witnesses and that to the best of their knowledge the Testatrix was at that time eighteen (18) years of age
or older, of sound mind and under no constraint or undue influence.
~. 06cJL-
~~~LOREj;R
~ Witness
~~?~
Witness
SUbscrib. ed, sworn to and acknowledged :~e me by D~S A. BAER, the Testatrix, and
subscribed and sworn to before me by witnesse~~ and
n~Ut.Q.0(;k ,0nthisLdayof uuu_ ,191i.J
WW& J/ / )f/d)i/
J NOTARVIUBLlC
My Commission Expires:
" Notarial Seal
" Patricia A. M101la, Notary PublIc
East P~Q fwp., CUmberland County
My CommISSion Expires Nov. 15. 1999
Membel; Pennsylvania AssOdltlQn of NotarieS
Page 4 of 4