HomeMy WebLinkAbout02-28-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Estate of Lucv L. Brink
also known as
File Number
~ / - 67008 - ()~;:)O
, Deceased
Social Security Number 195-22-9685
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE j4' OR 'B' BELOW:)
IX] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will ofthe Decedent dated 7/12/2000 and codicil(s) dated
Executor Isaac 1. Brink died 12-27-2000
Thomas Brink
named in the
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~~ co
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executioiWi#1e in~ment{s)off"red
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: none -' ' )!!.
o B. Gr:ant of Letters of Administration
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia;' durante minQf~te)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs:(.(f
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name
Relationship
Residence
1
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his / her last principal residence at
273 Newbura Road Newbura PA 17240 Hooewell Townshio Cumberland County
(List street address, town/city, township, county, state, zip code)
Decedent, then 77
Pennsvlvania
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
Value of real estate in Pennsylvania
years of age, died on 10/21/2004
at Carlisle
17013
$
$
$
$
20.000.00
none
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature
Typed or printed name and residence
89 Country View Estate
Newville
PA 17241
Form RW-02 rev. 10.13.06
Page 1 of2
()f~ iJ6l0
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF Cumberland F 28 ;,,[1 \ \: 3:)
The p,etitioner(s) above-named swear(s) or affrrm(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, PeW~&Wr<l)'w:iII'~eH and truly
. C;'.:':'::': .;e,..,
administer the estate accordmg to law.'
Sworn to or affirmed ~bscribed
before me th oJ day of
Signature oj Personal Representative
SignatfaJ Personal Representative
I
Signature oj Personal Representative
~~~
y 19--4
File Number:
02/ / ,"';OOf - cJ;9c20
Estate of Lucy L. Brink
, Deceased
AND NOW, ,2008 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, 1: IS DECREED that Letters Testamentary
are hereby granted to Thomas Brink
Date of Death: 1 0/21/2004
in the above estate
and that the instrument(s) dated Julv 12. 2000
described in the Petition be admitted to probate and filed of record as
FEES
$ &Q (1)
$ '6, 0
$ /5, (j()
$ /0 tP
$ S,oJ
$
$
$
$
$
$
~ -yr (iJ
Attorney Signature:
Letters .,..... ..... ......... ........
Short Certificate(s) ............
R .. n() N:/I
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Attorney Name:
H. Anthonv Adams
Supreme Court I.D. No.: 25502
Address:
49 West Orange Street. Suite 3
Shiooensburg
PA
17257
Telephone:
717-532-3270
TOTAL ...... .......... .............
Form RW-02 rev. 10.13.06
Page 2 of2
11tl."i;,\()." REV l)/S6
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. ()t- ;?c;:;()
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fcc for this certificate, $2.00
P 10503139
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Date
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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Hl05.143Aev 2187
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TYPE/PAINT
IN
PERMA.NENT
BLACK INK
I~AME OF DECEDENT (flrSI, Midt:lle.ldSll
SEX
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
'1. Lucy L. Brink
."GE (LaSl BwlhOavl UNDER 1 VEAR
MomM Days
UNDER 1 DAY
2.Female
3.
195 -
22
F OEATH ,MGnlh. bat. '~atJ
21,2004
5. 77
COUNTY OF Of,(J'H
v,.
Houd ! MinulM
BIRTHPLACE (C.ty.ar.c;f PlACE OF DEATH ((Neck aNy ~ we ,nS\lucloOnt 0l1'~'
StaiB 01 FcrelQn Counlrv) HOSPITAL:
Venango CO., 'n..'ie...KJ
7. Franklin , PA ...
flrlC'Uf'" NAME III no. .nsNvllon, give 51tH! ana,nlJtTlbefJ
"",,0
OTHER:
=" 0 C....>........,. 0
=,,10
MAAtl'Al... S'TAl'lJS. Uam.d
Never Married, Widow.td.
"""'-(Specdy)
14. Widowed
RACE - ArMnCan Indian. sa.ck. White. etc.
(Sl>ec'"
1.. White
SURVIVING SPOuSE
IIt~. gNemalden name)
4/
... Cumberland
DECEDENT'S USUAl OCCUP,Q'ION
(Give k,n(:l 01 work ClOne dYtlng mosr
of WOIlung Ill.; do not IJ5e lewed ~
- 1'1.. Homemaker lib.
DECEDENt'S UAIUNG AOORE$S lSlfeet. CltylTown, ~. Zip Code)
Ie. Carlisle
KIND OF BUSINESSIlNOUS'TRY
WAS CeCEDENT OF HISPANIC ORIGIN.
No 129 ,.. 0 .,........., """,,n.
MexiCan, Puerto Rican, .C
t.
273 Newburg Road
II,. Newbur PA 17240
FAlHER'S NAME (Firs!' Mradle. last)
DeCeDENT'S
ACTUAl
RESIDENce
{See Jnslrl.JC1lOnS
ot101t1er51del
17.. Slate Pennsylvania
l>d
-
Min'
lOWnS/1ip? 17d.O =~=Ol
UOTHER'S NAME (First. M'dale. Maiden Surname)
It. Carrie M. Beer
INFORMANT'S MAlUNG ADDRESS {Street. CityfTown. SlaW!. z~ Codel
2Db. 275 Newburg Road, Newburg, PA 17240
PLACE OF CISPOSITION. NlIlTMI of Cemetery. Cremalory LOCATION. CilylTown, Sl,t.. Zip Code
..011>0...... Franklin County,
21c. Parltlawns /IIalXlri.a1. Ga1:dens 21d. Greene Tw ., PA
HAalE AND ADDRESS OF FACILITY
~BricXer Eld, ro Box 336, ShiwensJ:m:g FA 17257
LICENSE HUMBER DATE SIGNED
0...18'""1/}()/'()L 1........O'y._,
230. f.J \J (7 7 t> U' 7 .'" / d- J d.COLf
WAS CASe REFERRED TO ::oM. EXAM1N'EAlCOAONEA? No[]/
H.
I Approximal8
~ inl8rvaJ between
I onMC and death
i Iwl(
l7C.[!g ~,~nl.li'4din
Hopewell
...".
1lb. County Cumber land
citylbofo.
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10/26/2004
PART I':
OIhet signillcant ~ conIributlng to death. bu\
noc resufling in !he I.lndefly\ng ~UH gMn in PART I.
\2f:5flf<A~ Y FA'L..v(l<[
owrL"ACONSEolfs~vc nO.N
DUE 10 lOA AS A CQNSEOUENCE Of):
Dill Eft ncuL. (77
DUE 10 100 f4S A CONSEOUENCE Of):
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WERE AUTOPSY FINDINGS MANNER OF DEATH
AVAILABLE PAM)A TO ~
COMPLETION Of CAUSE 0
Of' DEATH? Halura' HemIC.
_ode'" II P8nWI11iJ hW85ligatiot'l 0
YItS 0 No 0 &.Mcide D Could not be delerm,ned 0
DATE Of INJURY
(MOOIh.Day, Yeat)
T1UE OF rr-uUAY
INJURY AT WORK? DESCRIBE HOW" INJURY OCCUP.REO.
Yoo 0 NoD
29.
",. JOb.
PLACE OF INJURY - AI hOme. farm, slrHl. lac.t.<Ky. (l~,
building. etc. ISpecdv)
,...
...
2". 26b.
CER1IFIER Ie/leek 001'1' one\
'CERTIFYING PHYSICIAN (PhYSICJdfl C(lflllY'ng calise of death wtlel\ al\{.l\!\I* p$\YSIC,an has pronounced dedlh ana ccmplelltd tlem 23)
To the o.a' (It my know~9't. de.th occwred due to the cause(s) and mal'lner.s Itated. .
3lb.
LICENSE BER
o 31c. .Mb fUU'7 -r 31d.
NAME AND ADDRESS Of PERSON WHO COMP\..ElEO CAUSE OF
I".m fRYl'tO< P'i~O~IICC ( . ;C'l i)
D 32. 'V 8 KClOKWOPj} Avr 5'1/I"17:a
DATE FILED (MOlllh. OaY~ I
3. r.yU ;'5;' ?-O([:u/
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.PRONQUNClHG A,NOCERTlf'tlNG PHVSICIAN /phVSOCliln holh t-l'on(>uoc,n9 Ltc.Utl dlld<:ewfY'l1g locau~ 01 Oe<ltl11
TI) lhe b4-at of",y tlflCWlec:hOJf:. de41thoc.c:une4 at 'he dine, date, .md place. IInd due to theClIuse(alllnd mimnet.. sl.l~
.UEDICAl EXAMINER/CORONER
On the b..i. 0' e-xamination andJor inveslig.alion, in my opinion, death QccuneG at the time, dale, and place, and due to (he causers) and
manner as sta'ed.. .' .. .. .... ...... ............ ......,..............,.....,...... -.... -... .. -......... .....
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REGrSTAAR'S SrGNATUf!E AND NUMBER
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LUCY L. BRINK
I, Lucy L. Brink, of Newburg, Cumberland County, Pennsylvania, being of sound
and disposing 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 and
Codicils heretofore made by me.
FIRST
I order and direct my personal representative hereinafter named to pay all of my
just debts, funeral expenses and expenses involved or connected with the
administration of my estate as soon after my death as is reasonably possible. However,
my personal representative need not accelerate and pay those unmatured obligations
which, in his, her or its opinion, it might be proper and more advantageous to retain or
renew and pay as they become due and payable. If I do not own a burial plot or a grave
marker at the time of my death, I authorize my personal representative, in his, her or its
sole discietion, to purchasa a burial plot and to erect a suitable marker at my grave. and
to expend sums from my estate for this purpose.
SECOND
I give, devise and bequeath my entire estate together with all insurance proceeds
thereon of whatever nature and wheresoever situate to my beloved spouse, Isaac T.
Brink, providing that he survives m~ by sixty (60) days.
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THIRD
Should my spouse, Isaac T. Brink, predecease me or die on or before the
sixtieth (60th) day following my death, then I make the following specific devises:
c. I give, devise and bequeath all rights in 273 and 275 Newburg Road,
Newburg, Cumberland County, Pennsylvania to my son, Thomas Brink and
his wife, Lisa Brink; and
d. I give, devise and bequeath all rights in and to a mortgage and note dated
,j./!/ /J .)c()(; between myself and my beloved husband, Isaac T. Brink (as
mortgagees and note holder) from my beloved son, Thomas Brink and his
wife, Lisa Brink (as mortgagors), to my beloved daughter, Linda Brink
Shubbert.
FOURTH
I give, devise and bequeath the rest, residue and remainder of my Estate in
equal shares, share and share alike, to my son, Thomas Brink, and my daughter,
Linda Brink Shubbert, per stirpes. If either of my children predeceases me, then I
direct that their share shall go to their issue. If either of my children fails to leave issue,
then their share shall go to the other child.
FIFTH
My executor and trustee are authorized and empowered to exercise from time to
tljme in his, her or its sole discretion and without prior authority from any Court, in
respect of any property forming part of any trust hereby created or otherwise in its
possession hereunder all powers conferred by law upon trustees or executors and the
testator intends that such powers be construed in the broadest possible manner.
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SIXTH
I nominate, constitute and appoint my spouse, Isaac T. Brink, of Newburg,
Cumberland County, Pennsylvania, Executrix of this my Last Will and Testament. In the
event Isaac T. Brink is deceased, unable or unwilling to seNe or shall cease to seNe
for any reason whatsoever, then I nominate, constitute and appoint my son, Thomas
Brink, to seNe instead.
SEVENTH
I hereby declare it to be my expressed desire that my personal representative
employ Lisa M. Greason, Esquire of Cumberland County, Pennsylvania, for legal advise
and assistance regarding this my Last Will and Testament, she having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
I') j'^, Jt I
T estamentthis I .~ day of" 'f' iF ~ , 2000.
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'/Witness/ l/
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=ZJ:.LA2'V ;: ..
Lucy L. Brink /
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Vllitness
ACKNOWLEDGMENT
. COMMONWEALTH OF PENNSYLVANIA
:SS
COUNTY OF CUMBERLAND
I, Lucy L. Brink, the Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to the law, do hereby acknowledge
that I signed and executed the instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
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LUCY'L~~~~7
0.7:'
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15./'-<. '. v1
Sworn or affirmed and acknqwledged before me by Lucy L. Brink, the Testator,
d'
this /~ day of ....~ hI' ,2000.
/
Notary Publi"
- ..," NOTARIAL SEAL. - "---'
AOEERT J. 1IUlDERIO, t6lWy p..tnro j
CIttbIo Boro, ~ CQtc.my, PJ~. ~
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:SS
COUNTY OF CUMBERLAND
We, L ')1"1 l~\ 6 I {iA Sin and t< en 11 yl/1" ,S VVLI t-h, the witnesses
whose names are attached to the foregoing document, being duly qualified according to
the law, do depose and say that we were present and saw Testator sign and execute
the instrument as her Last Will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testator signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testator was at the
time 18 or more years of age, of sound mind and under no constraint or undue
influence.
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Sworn or affirmed and subscribed before me by
t<{Ylf( iV. \YlliHl this/;Z/lr'dayof .,']dl)'"
.
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and
,2000.
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