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HomeMy WebLinkAbout04-01-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~,~utl~ COUNTY, PENNSYLVANIA Estate of ~_(~ (Z ~ /,~• ~ ~ r ~ JU /y (s (D QL~ also known as j ~ ,Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'E' BELOW:) File Number ~~ "~~QQ ~~ ~~~ Social Security Number ~ ~<~ " ~~ tBf A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the last Will of the Decedent dated L( ~"' ~ I J /1~and codicil(s) dated~~~ rv Q c~ i ca r _~ R~tmed ~fihe_ aD ~ ~ 7 (State relevant circwnstances, e.g., renunciation, death of executor, etc.) ;~ n Q C_` t C'? d "z'7 ~ '~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ~-~t t~isU-umen (~ offered. ~:_} r:; for probate, was not the victim of a killing and was never adjudicated an incapacitated person: `L7~ - C!'1 ^ B. Grant of Letters of Administration (Ifapplicable, eizter.• c.t.a.; d. b.n.c.t.a.; pendente lire; durante absentia; durnnte miiza~imte) 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: (If Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) L Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additiata! sheets if necessary. t was domiciled at de~th it~--~~ ~RL /'}~ IQ,fxounty, Pennsylvania with his /her last (List street address, tower/city,~townshrp, county, state, zip code) dence at 1"'/ 2 Decedent, then ~~ years of age, died on ~J - /7 -~_ at ~.~ ['~ / L/ S P / R / -Z- ~`~ S /~ 1 7` !~ C Y4~ ~-~ ~ ~ r L ~~ P /~ V ~ ~ 1 ~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ ~ ~/ ~ ~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Valut: of real estate in Pennsylvania $ ~ - ~ D © ~ situated as t'o L/ ~ i? I i'7 G C ~A '~ ~ y ©~ r/V`~ ~ ~ X/f L' ~ 1 ~ ~ G ~ (~ ~ ~ 7 ~ S ~ 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: V A~ Form RW-U? rev. 10.!3.06 P1bB I Of 2 ~ f ~~ ~~~.. 1, l Oath of Personal Representative ~'' '''` - - COMMONWEALTH OF PENNSYLVANIA ~~~$ ~~~ - ~ AM S% 4Jr SS COUNTY OF~~ (_,t~~~S r~~~_ OD~~~ ~ 01= The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition a ~ ~~1c~~~ r~~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. Sworn to or affirmed and subscribed /`~'~ before me the day of ~' ` /~ F~-o-~rftl-~e Register Signature ojPersonal Representative Signature ojPersonal Repr-eserrtative Signature ojPersonal Representative File Number: i~C~-' o1~t-(J,~ ~ ~/~"5 ~p~ Estate of ~ ~ ~ ~ (Z z -~- (~-yU 1\J ~ ~ (~ Z E ,Deceased Social Security Number: ,~ ~ ~ 3 Z ~- ~] ((~~ Date of Death: (7 ~ v4" AND NOW, E~ ~ ~/ ~'P ~ ,~~` , in consideration of the foregoing Petition, satisfactory proof having been presented beforehhme, IT IS DECREED that Letters ~"' L ,S 7_ " ff~ y~ ~''~ l T{ ~Q1~ __ are hereby granted to . 1 ~ ~ ~ '`--~ ~~ L t4.~ L ~q. [j (7 L G ~l, and that the instrument(s) dated Z ~ ~'~L - L'~/ Q described in the Petition be admitted to probate and filed of record as the last Will hand Codicil(s))~of Decedent. FEES Letters _~~ ~~ Short Certificate(s) ........ $ ~ ov Renunciation(s) .......... $ ,.1~'~' . $ lG' ~ ... $ ... $ ... $ ... $ TOTAL .............. Attorney Signature: in ttte abovestate Attot7~ey Name: ~ ~' (V (~ ~ (+~ ~/ `~~ Supreme Court LD. No.: ~ ~ ~~ ~j~~ Address: ~ ~ ~j ~ ~ lf}-~ ( ~-'~ s~ ~ ^]a ~l -~1 Z2~ $ Telephone: $_~~~ ~~ ~7-X37-d~'~~` Form RW-l1Z rev. 10.13.Oti Page 2 of 2 f,•,a v. ~crr-..,, ,,, LOCAL REGISTRAR'S CERTIFICATION OF DEATH (~ VVARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14~.2~93~8 Certification Number This is to certify that the information here given is con-ectly copied from an original Certificate of Death duly tiled with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. y`' MAR ~' 2 108 Local Registrar Date Issued ...... _....... _... _ __ tV C no m -= ,s ue!^^a • I ~ f" 1 Z 4~,/ ~ . <_ °~ ~ - ~ `-~: D ~ - REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRIMI IN ~ ~ CH INKT CERTIFICATE OF DEATH (See instructions and examples on reverse) $TATF FII F NI Iah RFR ~. ~. ~ nm yrlrsr, imwre, lass, sumx) 2. Sex 3. Serial Security Number 4. Dale of Death (Monm, day, year) Mar aret Ann Goble Female 380 - 32 - 7108 March 17 2008 A 5 L s Bi h ge ( . as rt day) tinder t year Untler 1 day 6. Dale of Binh (Monm, day, ear) 7. &miplace (City antl state or foreign Gantry) Ba. Place of Death (Check Dory one) Morwu Days Hwrs MlnNea Hospital: Othen 75 Yre. January 26 ,1933 Burr Oak Mi ~ , Inpalienl ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other ~ Specify: 66. County of Death 6c. City, Boro, 7wp, of Death 6d. Facility Name QI not instdulion, glue street and number) 9 W . as Decedent of Hispanic Origin? No ^ Yes 10. Race: American Indian, Bieck, White, etc. Cumber land (" yam' ry Dpben (M East Pennsboro Holy Spirit Hospital Mexkan PuertoRi t , can,e c.J ite 11. Decedent's Usual Occu tbn Kintl of work done tlu' moll of xo ' Ilia. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Spedty Dory hghesl grade completed) 14. Marital Slatus~ Marded, Never Married, 15. Surviving Spouse (II wife, give maiden name) Hind of Work Nintl of Business / Intluslry 115. Armed Forces? W d i owed, DNOrcetl (Specify) Elementary /Secondary (612J College (1-4 or 5+) Teacher Stur is School Di t ^vea ~Nn 4 Married Nicholas Goble 16. Decedents Meiling Atldress (Street city !town, stale, zip code) Decedent's na Dki Decedent $~ "dual Residea:e 17a. Stale C T ~'~ ' nc. ['] Yes, Decetlenl lived in Silver Spring T R ~ ~p ~ a~ ~~ ~~i' V e c i i s irgr)>l~' a 17050 17b. ceanry Cl Imherl anti ro. 17d. ^ Np, Denedem LNetl w;min Actual Limits of Ciry I Born 16. Famei s Name (First, middle, last, suRix) 1 B. Momefs Name (FrsL middle, maitlen surname) Victor Boyer Mary Hansen ' ZOa. Informant s Name (Type / PdnU 2W. Interments Meting Adtlress (SUeel oily! tovm, state, zip mda) Nicholas Goble 42 Rid ewe Drive Mechanicsbur Pa 17050 21 M th d f D a. e o o isposdan j ^ Cematbn ^ Donakon 21 b. Dale of Oisposhi0n (Monm, day, year) 21c. Place of Dispoeltlon (Name of camel fy ery, crematory or other place) 21 d. Locadon (City /Town, state, zIp code) Lp Burial ^ Removal from Slate j Was Cremation a Donatlon Authanzetl ^ timer-spa"": I ByMadlcalExamhier7caonerr ^Yea^NO March 21 2008 Indiantown Ga National C t eme er Annvil e a nature o aleral Service Liven ea a rson actlltg as slklll 22b. License Number 22c. Name antl Address d Fadq'ry - 011654-L M ers-Hamer Funeral Home Inc1903 Market Street Ca Hill m Pa 17011 pie ems 23a-c Ony when rlllying 23a. To Ibe best of my know4etlge, tlealh occurtetl at me tlme, date antl place staled. (Signature antl title) 23b Li h i i N . p ys cense c an ie not available al lime of death l0 umber 23c. Dale Signetl (Month, day, year) _ Gamy wusa of deem. Items 2428 must be aalgletetl by person wbe prawunces death. 24. Time of Death 26. Date Prorwuncetl Dead (Monm, tlay, year) 26. Was Case Referred to Metlical Examiner! Coroner for a Reason Other Than Cremation or Donation? • M' ^Ves ~No CAUSE OF DEATH (See Inatructlons and examples) r Approximate interval: Pan II: Enter Aber sicnihcanl COntlilions conMb tin to Item 27. Pan I: Enter Ibe chain of events -diseases, injuries, scan{4icatbns -met directly caused me tlealh. W NOT enter terminal events such as caNiac arrest -fig-~~ 2B. DIU Tobacco Use Contribute to Death? , 1 respiratory arrest, w uemrkuler tmrtllsaon whh0ul shots me el' Onset to Deam but na esuldng in the untledying cause given In Pan L ^ Yes ^ Probedy ng lolOgy List oMy are cause on aadi line. IMMEDIATE CAUSE IFlnal tlisease w ~x i ^ No ~.ynknown cmAllon resulting in death) C ~r, z~` ~, ^' 1 ~ / ~7„ ` ~ n i -1• a. sR I Imo' ( L'~ ~ _ I/ ; 29. II Female: Due to (or as a consequence op. ; [~•NOCpregnant witMn past year SequenllaAy lial COMitprls, it any, b l di h ea ngp to t e cause listed on Ilne a. i ^ Pregnant at Ilme of tlealh Due to (or as a consequence oQ. i Eller the UNDERLYING CAUSE (disease a injury that initialed the r ^ NO~ragnanl, but pregnant within 42 days c events resulting In Beam) LAST o . d Due 10 (a as a Cerle~,aquenpe Of). ^ Nol pregnant, bN pregnan163 days to I year ' belOre deem 30e. Was an Autopsy 30b. Were Autopsy Findings 31 Manner a Death i ^ Unknown it pregnant within the past year Padormed7 32a. Dale of Injury (Month, day, yearl 326. Describe How Injury Occurred Availade Prior la Caripletion 32c. Place of Injury' Home Farm Street Facto . , , , ry, of Cause of Deam? Natural ^ Homicitle Oliice Building, etc (SpecityJ ^ Yas Q.fQ/! ^ Yes [~'~ ^ Accident ^ Pentling Investigation 32d. Tme of Inryry 32e. Injury a1 Work? 321. II Tramporlaaon Injury (SpeGtyl 32g. Location of Inryry (Street city /town, slalel ~~` ^ Suicitle ^ Could Not be Determined ^ Yes ^ No ^ Driver / Oparata ^ Passenger ^POOestdan M ~___~_, _ . Olher~ 33a. Ceniher (check only one) - 3pecr"' _Y,._ _ 33b. Signature all TNe of ~--- "'---~ • Certifying physician (Physician ceniryirg cause of death when anomer physician has pronouxetl death and completetl hem 23) w...' TO the best of my knowledge, Aeath occurred due to the cause(s) and manner as claled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronouncing antl cenlfying physician (Physkian born pronouncilg death and cedilying l0 cause of deem) J 33c. License Number To the best of my knowledge, death acurred at the time, date, and place, and tlue to the cause(s) all manner as slated_ 33d. Date Signed (Month, day, year) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner/Coroner ./1 jr) _ ?, ~ ~ ~ ~ /2 ' On the basis nl examination and 7 or in / tl li I V V lY "10 Q 1I t ves ga on, n my opinion, tlealh occurred at the time, date, and place, and due to the cause(s) and manner as stated- ^ 3a N . -.,__ ame^ddress d Person Who Completed C~aus/eof Death (item 27) Type I Print 35. Registrar s $ elute and Distri Ny trB~/ 36. Dale FAed (M~yIIh, day, year) t t YA'Ad~ ~ ~ VryR z ~ • /~, - / I r~l /I ~I /I ~ ~ ,~, / LZIp J-ntL(tKk,:u..,. Witu ~,)~ Da I~•ri7r x'~ Disposition Pertnil NO. D/ ~ 5 ~ ~~ ~ -------~'-~~~~~~- ~j V V / 5 ~ ,~ ~l ~lV JL V V ~~~ l ~l1 i ~ ~~~~L ~1~~1 V JL ' ' ` ~ ~, --~ c= Q= v ~ ~~ -~' ,a- cqql~~. ~-~ - ~o U c~a I, MARGARET ANN GOBLE, of the Township of Silver Spring, County of Cumberland, wealth of Pennsylvania, declare this to be my Last Will and revoke any Will or Codicil made by me. ITEM 1: Upon my demise, I direct that my body be buried at Fort Indiantown Gap Cemetery, Annville, Lebanon County, Pennsylvania. ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical my death. ITEM 3: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of W O the expense of the administration of my Estate. z~z ITEM 4: I give, devise and bequeath all the rest, remainder and residue of my estate of Z ~ every nature and wherever situate, together with all insurance thereon, to my beloved husband, NICHOLAS L. GOBLE, provided she survives my death by thirty (30) days. ~ ~ ~~~~ ITEM 5: Should my beloved husband, NICHOLAS L. GOBLE, predecease me or fail to survive my death by thirty (30) days, then I give, devise and bequeath all the rest, remainder and residue of my estate of every nature and wherever situate, together with all insurance thereon, in equal shares, to Page 1 of 6 children, MICHAELLA A. PLACIDO of 1001 Oak Street, Hood River, OR 97031, MARK K. IGOBLE of 3413 East Pratt Street, Baltimore, MD 21224 and NICHOLAS TOBIAS GOBLE of 36 South I39`h Street, Camp Hill, PA 17011, per capita. ITEM 6: My Executor or his successors shall have the following powers in addition to (those given by law to be exercised by his in his absolute discretion, which powers shall be applicable to fall property held by him, effective without the order of any court and until the actual distribution of all such property: a. To retain any investments at discretion including stock of any corporate fiduciary (hereunder or of a holding company controlling it; b. To invest and reinvest in the executor's discretion as permitted under Act 28 of 1999, as lamended, the "Prudent Investor Act," with the specific right to invest in stocks, bonds and real estate, including non-income producing residential real estate for the occupancy of any present income iary or beneficiaries, and in such diversified, proprietary money market and mutual funds, r~ W Q~ ~ `.~~ ~ Q~ C7 ~rs `~ ~~ including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executor deems appropriate; c. To sell, to grant options for the sale of, or otherwise convert any real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; e. To compromise claims by or against my estate or any trust created hereunder; Page 2 of 6 f. To allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such that they will pass by delivery; h. To join in any recapitalization, merger, reorganization or voting trust plan affecting investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and ly to exercise all rights of security holders; To manage, operate, repair, alter or improve real estate or other property, and to lease real estate and other property upon such terms and for such period as my executrix deems advisable even for than five (5) years and beyond the duration of any trust; j. To deduct administration expenses upon either the federal estate tax return or fiduciary income tax return with or without adjustment as between principal and income, as my corporate or isinterested executor shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian W O '~ -~, C7 ~J ~~ ~ ~~ and investment advisor, and other agents and to compensate them from principal or income or both, as my shall determine, such compensation to be a reduction of the compensation of my executor; To associate with her at any time, in his absolute discretion and of his choice, a corporate fiduciary which shall have the same powers as my executor, such designation by my executor and acceptance by a corporate fiduciary to be in writing; m. To combine, without prior court approval, any trust herein with any other trust with substantially similar provisions, although such other trust may have been created by separate instruments by different persons, and, if necessary to protect different future interests, to value the assets at the time of such combination and to record the proportionate interest of each separate trust in the combined Page 3 of 6 fund; provided however, that no such combination shall be permitted if the effect of such combination would be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or (3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the tax; n. To exercise any stock options which they may receive; to borrow such funds from any source as my executor may deem necessary for the exercise of such options; and to pledge assets as my deems appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court (and failure to account alone shall not be considered such a breach); shall trustee be required to obtain the order or approval of any court in the exercise of any power or decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- skipping transfer tax to any property to which I am deemed the transferor under the provisions of Section 2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred under my will and any properly not in my probate estate and any property transferred by me during life as to ~, ~, which no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios ~~ applicable to such transfers to be zero; ~q. To disclaim any interest in property without court approval; and ~~; r. To do all other acts and things necessary or appropriate in the management, _,~ administration and distribution of my estate or trust. STEM 7: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. Page 4 of 6 ITEM 8: I appoint my husband, NICHOLAS L. GOBLE, Executor, of this my Last Will. IIn the event my husband, NICHOLAS L. GOBLE, predeceases me, fails to qualify or ceases to act as Executor, I appoint my daughter, MICHAELLE A. PALCIDO, first alternate Executrix of this my Last In the event my daughter, MICHAELLE A. PALCIDO, predeceases me, fails to qualify or ceases Ito act as Executrix, I appoint my son, NICHOLAS TOBIAS GOBLE, second alternate Executor of this ~my Last Will. ITEM 9: I direct that my personal representative or successors, shall not be required to (give bond for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and this ~~ day of , 2007. 5 i / ~, ABET ANN GOBLE Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have subscribed our names as attesting witnesses. 't residing at p ' ~, ,~,~ f ~~~~ residing at n,4 , ~ o s s -~~ Page 5 of 6 TH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: We, MARGARET ANN GOBLE, /~ /1.~e l~ ~ ~t~L-- and 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 that she had signed willingly, and that she executed it as her free and voluntary act for the purpose 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 the time eighteen (18) years of older, of sound mind and under no constraint or undue influence. G T ANN GOBLE Witness ~ ~ . ?mac-c..~.~~.~.~.~ ~a .-~. _ Witness Subscribed, sworn and acknowledged before me ZGARET ANN GOBLE, the ~~ day of ~~ ~ ~ , 2007. Public ~ 1~~..n .< </ ( mac' ~~~ ~' by Testatrix, and subscribed and sworn to before me by and _ d..1~ l~`~ .a ~~ 4.~// S (-~ ~~ ,the witnesses, this NoraRiAL sEAL HENRY F. COYNE, NOTARY PUBLIC NAMPDEN TWP., CUMBERLAND COUNTY Page 6 of 6 MY COMMISSION D(PIRES JUNE 17, 200: