HomeMy WebLinkAbout03-19-08
PETITION FOR PROBATE AND GRANT OF LETTERS
Register of Wills of Cumberland County, Pennsylvania
Deceased
File No. ~ \
Social Security No.
o ~ ()~6tp
187-16-5914
Estate of
EDITH I. MOHN
ROBERT T. MOHN, JR.
Petitioner, who is 18 years of age or older, applies for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner is the
named in the Last Will of the Decedent, dated March 29, 20000
o
Co-Executor
The Decedent also named her son, Jeffrey T. Mohn to serve as Co-Executor of her Last Will and Testament. Mr. Jeffrey
T. Mohn has renounced his right to administer the estate and as nominated Robert T. Mohn, Jr., to serve as sole Executor
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:
D
B.
Grant of Letters of Administration
(if applicable, enter: c.I.a.; d.b.n.c.l.a.; pendent elite; durante ~entia; dura7~cminoritate
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Name
Relationshi
Residence
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(COMPLETE IN ALL CASES): Attach additional sheets if necessary.
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at
635 "0" Street. Enola. Cumberland County, Pennsylvania 17025
(List street, address, town/city, county, state, zip code)
Decedent, then 85
years of age, died on
February 16, 2008
at
Holy Spirit Hospital. Camp Hill. PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property.....................................................................$ 21 ,000.00
(If not domiciled in PAl Personal property in Pennsylvania.....................................$
(If not domiciled in PAl Personal property in County....................................................$
Value of real estate in Pennsylvania ......................................................................................................................$
T otal......................................................................................................... $ 21.000.00
Real Estate situated as follows:
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:
Sionature TVDed or Drinted name and residence
~'fJ1{~~ ROBERT 1. MOHN, JR.
6112 Charing Cross
Mechanicsburg, PA 17050
Oath of Personal Representative
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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The Petitioner above-named swears or affirms that the statements in the foregoing Petition.pre true and
correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the
Decedent, Petitioner will well and truly administer the estate according to law.
/9
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Sworn to and affirmed and subscribed
Before me this
day of
,2008.
File No.
~ \ 0 15 6~(:)\P
Estate of
EDITH I. MOHN
, Deceased.
Social Security No: 187-16-5914
Date of Death:
February 16. 2008
AND NOW, \%,( c \-\ \ ~ I 2008, in consideration of the foregoing Petition, satisfactory
proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to
ROBERT T. MOHN, JR. in the above estate and that the instrument dated
March 29, 2000 described in the Petition be admitted to probate and filed of record as the
Last Will of the Decedent.
FEES
Letters......~/...9..Qg. $
Short Certificate(s)d.. $
Renunciation......./...... $
- Affigavit ()02J..O'..... $
Extra Pages ()....... $
COdiCil.......................h $
JCP Fee...L..~..... $
Inventory...................... $
Other.............................. $
CoO
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Register of Wills
IS
Attorney Signature: ~&:i /Jr'A')-
Attorney: RICHARD W. STEWART
1.0. No: 18039
Address: Johnson. Duffie. Stewart & Weidner.
301 Market Street. P.O. Box 109. Lemoyne. PA 17043-
Telephone: 717-761-4540
TOTAL......... $
103
H105.905MS REV. 6/06
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
Hl05-143AEV 11/2006
TYPE I PRINT IN
PERMANENT
BLACK INK
WARNING: It Is Illegal to duplicate this copy by photostat or photograph.
/!.JI. ~ ~d
V'(5 ~ ~~ tfwyoL
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
Frank Yeropoli
State Registrar
1334616
MAR 0 3 2008
No.
Date
STATE FILE NUMBER ~ \ 0 01)3b LP
--5914
DOthet - Specify:
10. Race: American Indian, Black, While, eIc
(Specity) White
/}../
11. Decedent's Usual Octu tion Kind of work clone dun roosl of world ~te. Do 001 state retire
Kind of Work Kind 01 Business I Industry
Homemaker Own Hoae
8a. Place 01 Death (Check Ollly one)
Hospital:
IIIlnpalient 0 ER I Outpatient 0 DQA 0 Nursing Home 0 Residence
9. Was Decedent 01 Hispanfc Orign? XJ No 0 Yes
(II yes, specify Cuban,
Mexican, Puerto Rican,etc.)
14. Marital Sialus: Married, Never Married,
WiOOwed, Divorced (Specil)1
idowed
. 16. Decedent's Mailing Address (Street, city I town, state, zip code)
635 "D" Street
Enola, Pennsylvania 17025
Decedent's
AcluatResidence 17a.Stale
17b. County
Pennsylvania
Did Decedent
Liveina
Township?
17C.~ Yes, Decedenllivedln East Pennsboro
17d.D No, Decedent Lived within
Actual Umits 01
Top
Ral h Gates
r.'11'111hPTl Sln.t
19. Mother's Name (First, middle, maiden SlJmame)
Edna Lickel
City/Bore
18.Falher'sName(First,middle,last,suffix)
- ~
200. Informant's Mailing Address (Street, city I town, state, z~ code)
635"D"Street, Enola, PA 17025
21c_ Place 01 Disposition {Name of cemetery, crematory or other place} 21d.localion (City Ilown, slate, zip code)
co
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~
~
~
~
Cremation Society of PA
Auer Memorial Home and
ne Road Harri bur
230. Ucense Number
Harrisburg, PA 17109
Crema~ion Services, Inc.
PA 17109
23c. Date Signed (Month, day, year)
hems 24-26 must be completed by person
who pronounces death
25. Dale Pronounced Dead (Month, day, year)
Feb rUQr (("
CAUSE OF DEATH (See instructions and ex.m~.8)
Item 27. Part I: Enter the ~ diseases, injuries, or complicatioos -that dreclly caused the death. 00 NOT enter terminal events such as cardiac arrest,
respiratory arrest, orvenlr~uIarfiOrillationwithoutshowingth&etiology, Lisl only one cause on each line.
24. TlmeolDeath
;2:Of d.
.p. M.
Z0c>8
26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
Dy" DNo
#
=ntiany list concjtlons, if any,
~~~~oJHeDW~=~~ a.
=~re~~urynt~~~~~r~~
Due to (or as a consequence of):
b. mf)/"-TfofUdtN
Due to (or as a consequence of):
gtP1'1 C ShoC/?:"
Due Ie (or as a consequence 01)
d. 6!2.-"tf() t:U.!.:: rrrvG"
s,ry rr C6m/19
I Approximaleintel'llal:
: Or1sel to Death
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
CftIZON/C. '/<fDNA r1,1f;Ef}~
I~t;t,
(Of3N I N [, r TTS
Part II: Enlerothersianificanl cond"lIior1s contrioolina 10 c18ath,
bulnot resullingin the under1ying cause given in Parl I.
28, Did Tobacco Use ConlrilJute to Dealh?
D Yo, DProb"'~
vEJ No 0 Unknown
29.lfFemaJe
It.of::r Not pregnant within past year
o Pregnant allime 01 dealh
o Notpregnanl,Out pregnant within 42 days
01 death
D Not pregnant, but pregnant 43 daysio 1 year
lJeforedeath
o Unknown il pregnant within \he past year
32c, Place of Injury: Home, Farm, Street. Factory,
OIfice Building, etc, (Specify)
=~~~:~~~~~)dise~
CA;K ~ I OpU L-rr>CJ "'A~'1' i/T(:Zaf?S T
FAr r...UR.e
3Oa. Was an Autopsy
Perlormed?
300. Were Autopsy Findings
Avalable Prior to Completion
of Cause 01 Death?
31. Manner 01 Death
Dv" ~No
Dv" DNo
o Nalural 0 Homicide
o Accident DPendinglnvesligation
o Suicide o Could Not be Determined
32<1. Time of Injury
32g. Localiooof Infllry(Streei, city I town, stale)
<..
~
~
32f,IITransportalionlnjury(Specjfy)
o Drivel' / Operator 0 Passenger DPedestrian
M. Other - Specify:
33a. Certifier (check only one) 33b. Signature and M\~' ~~tL' ~
~:~'Z:sf::=:n:':f)i:C~= :::~~:nu:~~n~t:~:rh:= ~:~~_ ~~ _~ _co_m~~~ :e~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ... ~ /
Pronouncing and certifying physician (Physician IJoth pronouncing death and certifying to calISe of death) 330. License Number
To the best of my knowledge, death occurred ill the time, clale, IlI'Id place, and dye to the cause(s) and manner as stated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
~:.~~~m~:,:~~;:~~:~ and I or investigation, In my etplnion, death occurred at the li~, date, and place, and due 10 the cause(s) and manner as siate<L 0
\fit) L1211 ':3 "l?:>
35. Registrar's n
~
1.",21 II .;?I / I / I
34. NameandAddtesSA1ru~{omPIe()~uset-fe~!h ~ Type I Prinl
tp3 l\l.2i~j..- 5~T) CftI-nD(1((lL P,4 /701/
Disposition Permit No
019'i6l'i
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LAST WILL AND TESTAMENT OF
'a \ D'6 D3t:> l.Q
~1 ~ a resident of the STATE OF ~r , COUNTY OF
being of sound mind and memory, do hereby declare that this is my will. My Social Security
FIRST: I revoke all former wills and codicils that I have previously made.
SECOND: I give, devise, and bequeath the following money or personal property:
o
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,<OJ
2~ Si~
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_-L.l
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':.) (-)
)":"...4
:.XJ
I
\C}
~
~ ~JUl~
'5 c.,.-v\-
to:
~-;fr~ ~ F'oZ~ ~=k- ~~ ~
!~116 7~ j..do ~ ~n . .
'?::fl~ 1~Md~ ~k~ ~
HOWEVER, in the event that the above person or persons predeceases me, I give that same money or personal
property to his or her surviving beneficiaries.
If there are no surviving beneficiaries, this money or personal property shall go to:
c1, 'v/SI (j Yl
FOURTH: I name
(executor) of this will without bond. I
as personal representative, I name
without bond, instead.
~!-R&< 12~ ~ 'J,~J"~~:~'J;e-"~~d:iJ I'?r;.
THIRD: I direct all my just debts and funer expenses be paid as soon as possible after my ~ath. ~
~f ~_.L '-"f../lllt1- P. .1 ,_-' l' J Dc::; C
D1.XJ Ul ...d I Yl(j1lVY\.., as personal representative
this person or institut' on s al reason fail to qualify or cease to act
~/ as personal representative, again
FIFTH: I hereby empower my Executor to sell property, real or personal, for cash or on time, without an
order of Court, at such time and upon such terms and conditions as shall seem best.
I, g ~ J · ~ , the testator, sign my name to this will, consisting of L pages,
this :J-.CJ dayof~,a ~O~
Being duly sworn, I declare to the undersigned authority that I sign this document as my Jast wiH, that I sign it
wiJlingly, and that I execute it as my free and voluntary act for the purposes therein expressed.
I declare that I am of the age and majority or otherwise legaHy empowered to make a will, and under no
constraint or undue influence.
t J;ft ;,~
(Signed)
We, the witnesses, sign our name to this document, and we eclare under penalty of perjury, that the forego-
ing is true and correct, this i1 ~y of ' , l~-o--~
~ '77; ai:t;,v residing at: !fJ 7 77J(l~;/;t. - ~~) ~, 1703 1-
/ I2tj,Af~~/.L reSidingat:N71l.s)~/D De. ["!!Pin J~. /7~ol5-.
~ a . Aj ~j residing at 731 (),....//-t'f Sf }::~.) 4 J fa. I 7 (j ::{ :,-
* FOR NOTARY PUBLIC *
THE STATE OF
, COUNTY OF
Subscribed, sworn to and acknowledged before me by
and,
, and
, witnesses, personaHy known to me (or proved to me on the basis of
satisfactory evidence to be the persons), this day of , 19
SIGNED:
Official Capacity of Officer
<0 S.J.T. Enterprises, Inc.
iA \ 0'6 b)bLP
OATH OF SUBSCRIBING WITNESS
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of
EDITH I. MORN
, Deceased
I, PATRICIA A. GINGRICH
a subscribing witness to the
Will presented herewith, being duly qualified according to law, deposes and says that she was
present and saw the above Testatrix sign the same and that she signed the same and that she
signed as a witness at the request of the Testatrix in her presence and in the presence of the other
subscribing witness(es).
Isl f~ C{ 4'4~
Patricia A. Gingrich (7
731 Valley Street .~.~ 0
Enola, P A 17025 . -,--.
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;>....
before me this
day of
Executed out of Re~is'ier's Office
Sworn to or affirmed and subscritYed
before me this /g~ay of
'tJ1~ ,2008.
1iL~?J~;fruM
Executed in Register's Office
Sworn to or affirmed and subscribed
,20_.
Deputy for Register of Wills
NOTE: To be taken by officer authorized to administer oaths. Please have presentthe original or copy ofInstrument(s) at time of notarization.
~\ bY>()3D~
OA TH OF SUBSCRIBING WITNESS
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of
EDITH 1. MORN
, Deceased
I, S. ARLENE BECK
a subscribing witness to the
Will presented herewith, being duly qualified according to law, deposes and says that she was
present and saw the above Testatrix sign the same and that she signed the same and that she
signed as a witness at the request of the Testatrix in her presence and in the presence of the other
subscribing witness( es).
/s!.d a~/hL
S. Arlene Beck
197 Ashford Drive
Enola, P A 17025
\.,Cl
2'"~."
Executed in Register's Office
=-5
Executed out of Reg1sttr's o.l/fce
Sworn to or affirmed and subscribed
before me this
day of
Sworn to or affirmed and subscribed
+h
before me this I g day of
~ ,200g.
~~fJ7?cuM
,20_
Deputy for Register of Wills
NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy ofInstrument(s) at time of notarization.
;t \ (/6 D3.b le
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYL VANIA
Estate of
EDITH I. MOHN
, Deceased
I, JEFFREY T. MOHN. in my relationship as Son of the above Decedent and named Co-Executor of
the Will dated March 29, 2000, hereby renounce the right to administer the Estate of the Decedent and
respectfully requests that Letters Testamentary be issued to Robert T. Mohn, Jr, Son of the Decedent and
named Co-Executor under the Will.
oJ./,
WITNESS my hand this / ft; day of ~
,2008.
r74Y
(Date)
~ crfl1L~
Jef~. . Mohn .~.:.2
2270 Old Trail Road .~= ~:2
Etters, PAl 7319 c;
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Executed in Register's Office
Executed out of Register's Of/JdJ
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF
SWORN to and subscribed before me
this _ day of , 2008.
Deputy for Register of Wills
Before the undersigned personally appeared the
party executing this Renunciation and certified
that #he executed the Renunciation f9I the
.purposes stated within on this ~ WiJay of
-r~ . tf~
/Notmy Publk f
My Commission ExpIres:
COrlMOa~Al:YH OF PENNSYlVNM
rmri.RIAl SEAL
S),\UNDRA RADLE, Notary Public
Fairvlew Township, York County
My Co.'l'ifIMstoo ~es Jan. 17, 2009