HomeMy WebLinkAbout06-19-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ~' ~ ~ `~ ~ ~ ' ~ ~ ~ ~J
COUNTY, PENNSYLVANIA
File Number ~°~, ~ d~ ~
also known as
~~~~ %n/ f= (L .Z a ~ E' ,Deceased Social Security Number~`~ ~ ~~ '~ S rt~y
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~~,, /~/
ll~''A,. Probate and Crant of Letters Testamentary and aver that Petitioner(s) is /are the I ~= i~ /s ~T"ti/ G2..r1 named in the
last Will of the Decedent dated,~~'t-Y t * z'f"' ~~1 codicil(s) dated
(State relevm~t 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 insn'ument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ ]B. Grant of Letters of Administration
(If applicable, enter.• c.t.a.;d.b.n.c.t.a.; pendentelite; duranteabsentia; durnntemi~toritate)
_._~~~3 ~ -_ - ,
(CO.NIPLETE IN ALL CASES:) Attach additional sheets if necessary. ; - -`~ - '
Decedent was domiciled at death in ~'' %"-'- 4~ ~.2 i-/E~'1r(ls~ounty, Pennsylvania with his /her last princi al residence at
~.ss ~ N ttl~+ / r rr d-~Gt= _ ~ ~v.v ~r r 7 /y r- L~ ~• D~ i~^ r:.~ ~~ . ou ~3 ~GR~~ c.~T-y ~i~•
(List street address, town/city, torunship, coung~, state, zip code) / ~ 7.~~~
Decedent, then ~_ years of age, died on !~ ~ %~' ~ t ~~i-~~t
~f t= SS «t-11-1 t/t l~~''1-frtc ~ d ~ '!/ir rC /,1-t~t :'ir/ l '-v ~f~
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) Atl personal property
(If not domiciled in PA} Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as toll
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:
or printed name and residence
- / 7! ~ Lam' c cr's'~`.
` 17
Fcv~m RGY-0? rev. 10.13.06 Page I Of Z
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following s~o~tise (if any) at~-~lleirs: (If
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) - ~
O ~'
Oath of Personal Representative
COMivfONWEALTH OF PENNSYLVANIA
(~ SS
COUNTY OF __-q ~_~'~1~~~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine 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.
Sworn to or affirmed and subscribed
before; cne the ~__ day of
.~
Signature of Personal Representative
~~
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the Register Signature of Persam! Representative ~~ ~~
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File Number:
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P~~'1 +~ r
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Estate of
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" ,Deceased
Social Security Number: (~ ~ 38 ~S~ I Date of Death: ~~"`~- ~~-- 2~~
AND NOW, J~.an~ ~ ~ , ~, in consideration o the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Lette~r•~s tieS~C~.Y`~e.n~0_(~.,
are hereby granted to ~~~;~f`l1C~1C~ T`~E'wm
in the al•~o;~e estate
and that the instrument(s) dated Ju..\~
described in the Petition be admitted to probate and filed
FEES
Letters ... j.~.~.U.~~c . $
Short Certificate(s) ... ~... $~_
Renunciation(s) .......... $
_~ tl~ ... $ IS
~~ ... $ S
... $
... $
... $
... $
... $
... $
TOTAL .............. $ c1~
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
l `'l 20c>2
record as the last Will (and Codicil(s)) of Decedent.
.;~~ ~~1~
Register of Wills
For», RW-U? rev. 10.I3.Ul Page 2 of 2
l~~.SO~ Hii~ I>I!lIL
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
gee fol this certificate. 56.00
This is to certify that the information here given is
correct]y 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 perllianent filing.
~ 143~1~~3
Certification Number
d~-~` JllN 3 ~
Local Registrar Date Issued
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TEV luzoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~
PRINT IN
!A"E"T CERTIFICATE OF DEATH
.K INK (See instructions and examples on reverse) ~ \ ~^~ ~ ~, t r.l r. .
CTATF FII F An IxxGCo
1. Name M Decedent jFlrsl, mddle, last, wXix)
2. Sex
3. Serial Security Nurtlber - v/ - ~Y ~.
4. Date o(Deam St+~nt
, da
yea~
Clara Belle Ream Female 164 _ 38 _ 5584 '
~
June 11 LL z OjS
5. Age (Lass Bidhday) Under t year Under 1 day 6. Date of Bing (Hoorn, day, year) 7. &nhplace (City and state or for eign aunlry) 8a. Place of Death (Check only one)
84 y Manors Oeys Hares .Ninulas
November 11,1923
Harrisburg,Pa
"O5P"ah
Diner
re ^ Inpatrenl ^ ER I Wlpatient ^ DOA Nursing Home ^ Residence ^Other - Specity:
8b. County of Death Bc. City, Boro, Twp. of Death 6tl. Facility Name (N not msmuaon. give street and number) 9. Was Decedent of Hispanic Orgin7 No ^Ves 10. Race: American Indian, &ack, While. etc.
Cumberland U r Al ten Trap (It yes, speciy Cuban, jgy~y)~
~`-'~C5S iCLY1 ~ l l i ~ Mexican, Puerto Rican, etc j White
11. pecadenYS Usual Occ don KirM of work dote dune moss of wo ~ Ida. Do not stale retired 12. Was Decedent aver in the 13. Dac@tlenYS Educatbn (Specity oMy Rightist grade completed) 14, Madtal Status: Mimed, Never Merced. 15, Surviving Spouse (If wde, give maiden namel
Kind of Wak Kirb of Business I IMustry U.S. Armed Farces? Elements /Secondary (0-12) College (1-4 or 5+) Wldowetl, Divorced (Specl/yf
~
N A ^Ytie ®Na
1 Single
• 16. Decedent's Mailing Address (Street, city I town, state, tip code) Decetlent's a Did DeCedBn! Up
p Li
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id
17
er Allen
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100 M t Allen Drive v
ua
es
ence
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a.
late
n a 17c. [
vas, Decedent Lived in
Twp,
T
Pa 17055
Mechanicsbur mansnip?
Lun er an
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'ro D°°r'N 17tl ~ "
B;
~no;"~'~"""
, Ac,a
a,
;
City / Baro
16. Falner'S Name (FlBL middle, last, Su%ixl 19. Momafs Name (First, midde, maiden surname)
Geor e Ream Bessie 5hatto
20a. Inbxmanys Name (type / Pnnt) 20b. IntomlenYS Maaing Adtlress (Street, city /town, slate, zip code}
1716 Locust Street New Cumberland Pa 17070
21 a. Memod of Disposkbn ^ Crematlon ^ Donatian
• 216. Date of Disposaion (Month, day, year 2tc. PWce of DI'
sposllion (Name of cemetery, crematory or other piece)
21 d. Locatbn (City I sown, stale, ziD code)
Burial ^ Rermrval from Slate j Was Cremat(on or Donation ArAhpdzed
^ -Speciy: ; byMedkalExaminerlCoronerl ^Yas^No
June 17 2008
Rollin Green Cemetery
camp Hill, Pa
2 re of rai Servce licensee rson "ng as such) 22b. License Number 22c. Name and Address of Facility
' - 011654-L M ers-Harner Funeral Home Inc 1903 Market Street camp Hill, Pa17011
Complete Items 23a-c Doty when ceNtying 23a. To me best al rtry knowledge, death occurred al me Ilnle, date aM place stated. (Sk3nature and alley 23b License Number 23c. Date Signed (MOnIh, day, year]
physican is rat available at time d deem to
cedNy caus@ of death.
~~t@j by ~~ 2d. Tune of DeaN
@an P2~ ~ 25. Date P ~ ~ i)Q (Month, der , year)
Q
2
+ 26. Wes tease Referr Nt
o Medial Examiner I Coroner for a Reason Other than Crematlon or Donation?
a
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CAUSE OF DEATH (See instrVCtions arrd examples) 1 Approamete imerval: Pad II: Enter other Sjgpifkxnl mrldi0ons mntributira to death, 28. Did Tobacco Use ContnbNe to Death?
Item 27, Pan I: Enter Ilre tpJyIl of events -diseases, Injudas, or camplicaaans - that direcMy caused 1Re death. DO NOT enter terminal even@ such as cardix anesl, r Onset to DeaN but rrol resuting in the unrlerlyirg cause given in Pan I. ^ Yes ^ Probabty
rBSpirtitery err e51. Or venlrkUlar flbnHatlen NitRWf 4hOWHlg thB BtidOgy. Let Only enB CBU9@ en Bach InO. r
r
tMNED1ATE CAUSE IFlnal disease or r
-
[a'NS' Q Unknown
mrldition resuamg m deem) ~ t
--~ a _~ L16'71~10N.. ~ G'V10~riF~LS 9
-T(.tC'~t,~ - ~ ~3;~ ~~Jy2G7'fo~ 29. I( Female.
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Due (or as a consepuence off: r '~ I~ 'vol pregnant wifnin pest year
SequenfiaNV Nst wndaans, it arty, b. _~-~,Y~~~~ ~ [~ ~ ~ ~~ l /lyL~/--j-.~ 1~ ~ ~ (JP~
leadulo to the cause listed on Gne a ^ Pregnant at time of deem
. Due to (or as a conser•uence of•:
Enter the UNDERLYING CAUSE ~
^ Nol pregnant bm pre~lant within 42 days
(disease or injury mat initial@d the r
events resulting in deamj LAST r
c of death
Due to (or as a cronsequerae op: Not
^ pregnant, but pregnant 43 days to 1 year
d before death
^ Unknown if pregnant within me past year
30a. Was an Autopsy 30b. Were Autopsy Fimkngs 31. Manner of Daeth 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury Home, Farm, Street Fatlory,
Pedormed? Arailable Prior to Completion
etural ^ Homicide Omce Bulking, etc. (Specify/
of Cause of Deem?
^ Yas [~ ^Ves ~o ^ A.Cndtint ^ Pending Imesagatkn 32d. Tlma of Injury 32e. kjury at Work? 32f. h Transponatlon Inlury (5pecr~y/ 32g. Locatbn o/Injury (Slretit city I town, statef
^ Suicide ^ Couk Nat be Dalennkled ^ Yes ^ No ^ Ddver! Operates ^ Passenger ^Petleslran
M. ether - SpBCihr
33a. Cenaiar (check any orre) 33b. Sgwnxe and Title d Cer1drer
/
• CenNying physician (Physcian cenlying cause of death when another physician has praauraetl death and caspleled Item 23) !~%~/
/~/ /~~ p
-
~
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To lh@ 68ai Of mN knoWledg@~ d@8m OCCUrced mle fO the CeU80(e) end manner 85 ateted_ _ _ _ _ _ _ ... .
~
.
-fix'"
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• Pronouncing amt cetiilying physician (Physician both pronoundng death and ceditying to cause of deem)
knowl
To the be
t of m
d
em oc
urred
t th
ti
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dat
d
d
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th
d
d
^ 33c. Licen Number 33tl. Date Signed (Honor, tlay, year)
y
,
a
e
ge,
e
c
a
e
m
e, an
p
ace, an
ue
o
e cause(s) an
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
manner as state
• Medh:el Examinw! Coroner / ~7
/7~~ L(~ ~~ ~ T S C~ ~ - ~ ~ " U `~~)~
On Xre basis o1 ~axaminatlon and / Or investigation, in my opinion, deem occurced at the Nm¢, date, and place, and due to the teasers) and manner as stated.. ^
34 Name and Atldress of Person WM Completed Cause of Death (Item 27) TyYpPe~ ! Pnnt
35. Regislrer's Signet and District Nu bar
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~ 36. Dale F led (Mon ,tlay, year)
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U n,~nnslrnn P@rmit No. ~ ~_y/ ~ // / ~_
LAST WILL AND TESTAMENT
OF
CLARA BELLE REAM
I, Clara Belle Ream, of Camp Hill, Cumberland County,
=~
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORN EYS•AT• 1.A W
2109 Market Slreet
Catnp Hill, PA
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and
for my Last Will and Testament, hereby revoking all other
;~
C.j `=.~
Wills and Codicils heretofore made by me. ~_-~ 4~-.a -.i
-,=~
FIRST - `-~ ". -
C-, ' _ ~(,
I direct the payment of my j ust debts and expc~~s¢~ of~-my =
---~t 4~
last illness and funeral from my estate as soon after my d~th ,-:
~~
as conveniently may be done. If there be no cemetery lot
available for my interment owned by me at the time of my
death, I authorize my personal representative to purchase such
cemetery lot with a contract for perpetual care, using
therefor funds from my estate in such amount as he shall
consider necessary and desirable, and I authorize my personal
representative to cause title to or ownership of such lot so
purchased to be vested in such person as my personal
representative shall designate.
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal
representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my
grave.
SECOND
I give, devise and bequeath all the rest, residue and
remainder of my estate as follows:
A. One-third to my brother, Raymond C. Ream, if he
survives me by thirty ( 3 0 ) days .
B. One-third to the Bethesda Mission of 611 Reily
Street, Harrisburg, Pennsylvania.
C. One-third to Calvary United Methodist Church of 700
Market Street, Lemoyne, Pennsylvania.
THIRD
I direct that any and all inheritance, estate, and
transfer taxes imposed upon my estate passing under this Will
or otherwise shall be paid out of the principal of my
residuary estate.
FOURTH
In addition to the powers conferred by law, I authorize
any personal representative acting under this instrument, in
his absolute discretion:
A. To retain in the form received, or to sell either
at public or private sale any real or personal property;
B. To exercise any options to subscribe for stocks,
bonds, or other investments;
2
C. To join in any plan of lease, mortgage,
consolidation, exchange, reorganization or foreclosure of
any corporation in which my estate or any trust may hold
stocks, bonds or other securities;
D. To sell, transfer, convey, mortgage, pledge, lease
or exchange any property, real or personal, which at any
time may form part of my estate, for the payment of debts
or taxes, or for any purpose of administration or
distribution, for such prices and upon such terms as my
personal representative, in his sole discretion, may deem
wise, and to execute and deliver deeds of conveyance or
~ transfer thereof;
~ E. To make settlements and compromises on such terms
~j~ as my personal representative in his sole discretion may
deem wise without the necessity of obtaining any court
approval thereof;
F. To make distribution hereunder either in cash or
kind, as my personal representative in his discretion may
deem wise.
FIFTH
I do hereby nominate, constitute and appoint my brother,
Raymond C. Ream to act as Executor of this my Last Will and
Testament. Provided, however, that if he is unwilling or
unable to act as Executor, I direct the duties of Executor to
be performed by Thomas E. Flower.
3
SIXTH
I direct that no personal representative, guardian,
trustee or other fiduciary appointed under this instrument
shall be required to give bond for the faithful performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I, Clara Belle Ream, have hereunto
set my hand and seal to this my Last Will and Testament,
consisting of fQ1it~ ('~) typewritten pages, the first three (3)
of which bear my signature in the margin for identification,
this ~/day of ~u~ 2002.
~- ~~~ vim=
Clara Belle Ream
Signed, sealed, published and declared by the above-named
Clara Belle Ream, Testatrix, as and for her Last Will and
Testament in the presence of us, who have hereunto subscribed
our names at her request as witnesses thereto, in the presence
of said Testatrix and of each other.
`~~ ~ 'dr1'I ' /~~' ADDRESS
;'
~ ~ ADDRESS
fir , /~~-
4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, lar Belle Ream, /LZf' ~ > and
~ ~ the Testatrix and witnes es, ectively
whose names are signed to the foregoing or attached
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
signed willingly and that executed 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 the time eighteen (18) or more years of
age, of sound mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged before me by Clara
Belle Ream, the Testatrix, and subscribed to and sworn or
affirmed to before me by the witnesses, this ;~I day of July,
2002.
~.
ary Public
Notarial Seal
Sallie Allst-arse, Notary Public
Carlisle Boro, Cumberland Coupty
My Commission Expires Mar. 29,2604
5
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