HomeMy WebLinkAbout06-25-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ~~C~~,~~ ~t ~~ ~~~~
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number _~ ~~ ~~
Social Security Number ~ ~ ~ ~ ~ r.- .~ J U
Petit:ioner(s), who is/are l8 years of age or older, apply(ies) for:
(COt1~PLETE A' or B' BELOW:) ~ ~''~.,~ ~y j~
A. Probate and Grant of Let ers Te to entary and aver that Petitioner(s) is /are the -_~~ ~~ \~'t \ named in the
last `JJill of the Decedent dated ( ~ _ and codicil(s) dated
(State relevnnt circumstances, e.g., renunciation, depth of executor, etc.) C~
:--,
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Excerpt as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execu~r~ the insh-ament(s) Offered
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _ ~ ~ .:,a::
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^ B. Grant of Letters of Administration
(Ifapplica6le, enter: c. t. n.; d.b.n.c.t.a.; pendente life; durante absentia; dtk!'iyue~norita~t
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followirt~sp"ijuse (if an~and heirs: flf
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) u,
C Name Relationshi Residence
vania with his /her last principal residence at r
Decedent, then ~^ years of age, died on ~ ~ v ~ at
:Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ ~ ~ S ~
(If not domiciled in PA) Personal property in Pennsylvania $ --~
(If not domiciled in PA) Personal property in County $ '~
Value of real estate in Pennsylvania $ J ~ C5, a C7 D
-r-
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:
C Si nature T ed or tinted name and residence
Fo~~m R6V-02 rev. l0.13.oe Page I of 2
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Oath of Personal Representative
COMi`dONWEALTH OF PENNSYLVANIA
~t~ ~/-f~ SS
COUNTY OF lo,t,~.i } L r~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true 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
t)
b F;,re me the ;Jtir~ day of
.~~~
For the egister
Signature of Personal Representative r-~~
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Signature of Personal Representative
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Signntw•e of Personal Representative • _
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File Number:` ~ O U O ~ ~ ~
Estate of rQ ~ ~ r ,Deceased
Social Security Number: ~~ i~ ~ ~i ~~ Date of Death: ~~ V ~' (~ ~ ~~(~f'1
AND NOW, ~~~~.Q ~~ , ~~, in consi eration oft e foregoing Petition, satisfactory proof
having been presented before n}@, IT IS DECREED that Letters T ~ 'Y1E?Y1 (L~
are hereby granted to
in the above estate
and that the instrument(s) dated ~~ ~. ~~U
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described in the Petition be admitted to probate and filed of record as the ast Wi (and Codicil(s) f De edent.
FEES ~ ~ ~ ~, /'
/ Register of Wills ~
Letters ..~.~~~..... $
Short Certificates} ....~.. $ ~ Attorney Signature:
Renuncia~ion(s} .......... $
~
' ~ $ , ~
Attorney Name:
- • • • $
~ Supreme Court LD. No.:
... $
_ it
$
Address:
... $
... $
... $
- ' ' ' $ Telephone:
... $
TOTAL .............. $
1=oa m RW-0? rev. I0.13.06 Page 2 of 2
105.805 REV ((11 /07)
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 1454044
Certification Number
7EV 71/2006
PRINT IN
(ANENT
.K INK
This is to certif}~ that the information here given i correctly copied from an original Certificate of Deat;
duly filed with ire as Local Registrar. The origins
certificate will be forwarded to the State Vita
Records Office for permanent filing.
LLB O`er JU 2 b 08
Local Registrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CIf
CERTIFICATE OF DEATH c^~, c/J~
(See instructions and examples on reverse) CTATF FII R NI IxxRFG ~ ~ h`(. CV (~T ~3
1. Name of Decedent (First, middle, last, sulllx) 2. Sex 3. Sorel Secunry Number 4. Date of Death (Month, tlay, year)
Mar e -
5. Age (Last Birthday) Under 1 year Ubeer 1 day 6. Dale of Birth (Month, day, year) 7. Birthpece (CIry and slate or for ego country) 6a. Place of Deam (Check only one)
Manaa Data Hpxa Mnulea HOSpkel: Other.
79yre Dec. 25, 1928 Millmont,PA
npetient ^ ER / Outpatient ^ DOA
^ Nursing Hame ^ Residence ^Other ~ SPedly.
6D. County of Deam &. City, Bom, Twp. of Death Btl. FacilM1y Name (II not institution, give street and number) 9. Was Decadent of Hispanic Origin? No ^Yes 10. Race: American IMian, Black, While, etc.
Dau bin DettV T•xm
'
p • ~
" .S. Hershe Medical Center Pl yes, specify Cohan, (gpepiy)
y M
i
P
Ri
Y
! ex
can,
ueno
can, etc.) whit e
11. Decedent's Usual Occu tan Kpxl of work sate du' most of wxxki fife. Do not stale retired 12. Was Decedent ever in the 13. Decedent's Educetian (Speciry only highest grade completed) 14. Mantel Status: Married, Never Marred, 15. Surviving Spouse (It wife, gNe maiden name)
Klntl of Wcrk Kind of Business / IrMustry U.S. Armetl Farces? Elementary / Sewndary (012) College (1-4 or 5t) Widowed, Divorced (Specify)
ersonal care a d nursin home ^Yea~ND 12 widowed
16. Decetlent's Mailing Adtlmas (Street city /town, sate, zip code) Decedent's Ditl Decedem
2139 Chestnut St . Actual Residence 17a. State P P h h C 1 V A n i a Liva in a 17c. ^ yes, Decadent Llvetl In
rwp.
y
PA 17011
Hill
C Township?
17b.Counry Cumberland na.l$INO~Decebeno'wedwitlknCamp Hill
,
am City / Kara
16. Father's Name (First, mkl0le, lest sullix) 19. Mother's Name (First, mkkae, maiden aumame)
Harr Lau Margaret Emsweller
20a. InlomrenYS Name (Type / Pnnq 20b. InformanYS Maning Address (Basel dry /town, state, zip code)
Deborah Bittner 3937 N. Sixth St.,Harrisburg,PA 17110
21a. Methotl of Disposkion ^ Cema6on ^ Donator 21 b. Dale of Deposition (Norm, day, year) 21c. Place of Disposnkxi (Name of cemetery, crematory or other pace) 21d. Locetan (City /town, state, zry code)
Yrt(1~Burial ^ Removal from State ;Was Cremation or Donation Aldhortzed June 2 7, 2 0 0 8 R o 11 i n g Green Cemetery Camp H i 11 , P A 17 O 1 1
^ Other - Spedty: i by Medkal Examiner I Coroner? ^Yes ^ No
tore of Funeral tie Licensee (a person acting as such) 22b. license Number 22c. Name aM Address of Fadliry
FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043
Co a Items 23a< only when certgying 23a. To ttre best of my knowledge, death ed at the time, date and place sated. (Signature and title) 23b. License Number 23c. Date Signed (Norm, tlay, year)
physician a rot available al time of deem to
certiry reuse of death.
Items 2426 must be completed by person 24. Time of Death 25. Dal^mrwuncetl Deatl (Mo7nm, day, year)'] <,
y 26. Was Case Referred to Metlical Examiner /Coroner for a Reason Other Iran Cremation or Donation?
wM pronounces death. ., ~ J M. s /r ~'f? F
l',,t7 (~ i" ^Yes ~fJo
CAUSE OF DEATH (See Instructions and ezamplea) r approximate interval: Pan II: Enlar other.sk±nifir=nt condaions canmbcaina to death, 26. Ditl Tobacco Use ConlnWte to Death?
Item 27. Pan I: Enter me cNrin el evems - tliseases, injures, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest, r Onset to Death but not resulting in the underrying rouse given in Part I. ^Yes ^ Probably
respiratory arrest, or ventnculer 5bnllenon wkhout shoving the elrobgy. list only one cause on each line. ~
{ r
IMMEDIATE CAUSE Fi
di ^ No ^ Unknown
sease or
nal
1 ` r
condition resulting in ~eath) _~ a. ~ 5 Z7 /~ fl G. L.I a i.t GxL~'~'J1 (, ~C~-•r C. r «~ !: ! +'y L'.t r 29. If Famale~
Due to (or a5 a wnsequence o ^ Not pregnant within past year
Sequentially list condkbre, d any, b ~
l
di
t
th
li
t
tl
li ^ Pregnant al lime of death
ng
e cause
s
e
or
ea
o
ne a. Due to (or as a consequence of): ~
Enter t7te UNDERLYING CAUSE ^ Not pregnant but pregnarn within 42 days
(disease or injury That initiates the o t
events resulting m tleath) LAST. t of death
Due to (or as a consequence op: t ^ Nol pregnant but pregnam 43 days to 1 year
d ~ before deem
^ Unknown if pregnarn wnMn Ibe past year
30a. Was an Autopsy 306. Were Autopsy Fintlings 31. Manner of Deem 32a. Date of Injury (Norm, tlay, year) 32b. Describe How Injury Ocartetl 32c. Place of Injury: Home, Farm, Sreet. Factory,
Penortned? Available Prior to Completion
~Naturel ^ Homicide Ofice Building, etc. (SpearyJ
of Cause of Deam?
^ Yes No ^Yes ^ No ^ Acgdent ^ Pending Imesligatian 32d. 7ma of Injury 32e. Injury at WoM? 321. It Trenslxxlatbn Injury (Specify)
/O
^ P
^ Do
^ P 32g. Laa6on of Injury (Street city /town, state)
^ Suicide ^ CoNd Not be Determined ^ Ves ^ No ver
perator
assenger
etlesliian
M ^Other ~ SpeaTy~
33a. Cannier (cnedc ony one,)
• Cenitying physicksn (Physician certifying reuse of deem when another physican has prorwunced death and completed kem 23) 33b. Sgnature arM Tdk of CerMrer
~
To the bast of my krwwkdge, death occurred due to the cause(s) end manner es sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - // / (.
'"
• Pronouncing and eerlBying physician (Physician both prorroundng tleem and certifyng to cause of death)
^ 33c. License Number 33tl. Date Signed (Month, tlay, yea0
_ _ _ _ _ -
To tae beat of my knowledge, death acumed el tM time, dek, and plate, end due to the ceuse(a) end manner es ateted_ _ _ _ _ _ _ _ _ _ _ _
• Metlical Examiner/Coroner y / ~)
~~ / / 2 ~C~ ~ ! C, ~' ~ ~
j /~• }t~ '~
On the bests of examination end I or invealigation, in my opinion, death occurred et me time, date, end place, and due to the eeuae(s) and manner as saated_ ^ _
34 Name and Address of Person Who Compleletl Cause of Deam gtem 27) Type I P i '
1~
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h
M
di
l Ctr
5
35. Regist 's Signature and Distort N mbe
~ Io?I~IdI~I~ I
3fi. Date Filetl (Month, day, year) .
.
.
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~h, ~, ~, ~~ ,~.(,(1 ,/ •- f~ij ~. • -! Hershe PA 1703 3
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LAST WILL AND TESTAMENT r`'
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OF _ ~`~ <_. ~-
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MARGARET E . MO S ER ~; = 7 c,.~ i _ _
- - -;
I, MARGARET E. MOSER, now residing in Dauphin~.Cainty:
:~ -
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Pennsylvania, declare this to be my Last Will and Testament anc~`
revoke all prior 6Vills and Codicils made by me.
ITEM I. I direct that all of my just and currently
due debts, funeral expenses and the cost of my gravemarker, if
any, shall be paid from my estate as soon as practical after
my decease as a part of the administrative expenses of my estate.
ITEM II. I give and devise all of my estate, of every
nature and wherever situate, in four separate and equal shares
to the following named individuals in the following manner:
A. One separate and equal share shall be given unto
my son, RICHARD. C. MOSER, JR., now of Carlisle, Pennsylvania.
Ii. then deceased, unto his then living children in equal shares.
B. One separate and equal share shall be given unto
my daughter, ROBIN D. GATES, now of Hummelstown, Pennsylvania.
Ii= then deceased, unto her then living children in equal shares.
C. One separate and equal share shall be given unto
my son, JEFFREY A. MOSER, now of the territory of Guam. If then
dE~ceased, unto his then living children in equal shares.
D. One separate and equal share shall be given unto
COMMONWEALTH NATIOPdAL BANK of Harrisburg, Pennsylvania (herein-
after called "TRUSTEE") who shall hold such property, together
with any other property that may be added to this Trust (all
of: such property being hereinafter called the "Principal"), IN
TRUST, for the benefit of the children of my daughter, DEBORAH
K„ BITTNER, namely, JESSICA J. BEAVER, BRANDY K. BEAVER, AURI B.
BEAVER, AARON BEAVER and ZACHARY K. BITTNER, pursuant to the
following Articles of Trust.
1. TRUSTEE shall collect all property or sums of money
given to it by virtue of this provision of my Last Will and
~,,~ ~ , ~C~ ~~Z .:1' ~~~ Il ~nf-y: 1~
Margret E. Moser
Testament, compute the total value of such property and divide
the same into five (5) separate and equal shares, one (1)
for each of my above-named grandchildren who are the children
of my daughter, DEBORAH K. BITTNER. Thereafter, TRUSTEE
shall maintain and administer each such share as a separate
Trust for the benefit of each such beneficiary in accordance
with the following provisions.
2. TRUSTEE shall invest and reinvest the principal
or corpus of each such Trust and shall pay or apply so much
of the income and so much of the principal of such Trust as
it, in its sole discretion, deems necessary to support the
beneficiary thereof in his or her accustomed manner of living,
to meet the medical, dental, hospital and nursing expenses
or any expenses of invalidism of such beneficiary and to
meet the expenses of such beneficiary's education including,
but not limited to, preparatory, collegiate, graduate and
professional education provided such beneficiary maintains
the required scholastic standards of the institution or in-
stitutions attended.
3. When each such beneficiary shall have attained
the age of twenty-one (21) years, TRUSTEE shall compute the
then remaining principal and any undistributed income of
the separate Trust held for such beneficiary and shall dis-
tribute the same absolutely to him or her at that time.
4. Should any of the above-named beneficiaries pre-
decease me or die during the term of the separate Trust
established for his or her benefit and prior to distribution
of the balance of the principal of the same, TRUSTEE shall
distribute the share that would have been allocated to such
beneficiary or the then remaining principal and any undis-
tributed income of the separate Trust established for such
beneficiary, as the case may be, in equal shares to the surviving
members of the above-named beneficiaries, such shares to
be added to the Trusts established for those under the age
Marga et E. Moser
_ 2 _
of twenty-one (21) years or distributed outright to those
over the age of twenty-one (21) years.
ITEM III. I direct that all estate, transfer, inheri-
tance and succession taxes upon or in respect to the estate of
which I shall die seized and possessed, and upon all other property
upon which or in respect to which any such taxes shall be due
and owing shall be paid out of my estate as if they were my debts,
without any apportionment or right of reimbursement, and all
legacies, devises and other gifts of principal and income made
by this Will or by any Codicil thereto shall be free and clear
thereof. In the discretion of my Personal Representative, taxes
on future or limited interests may be prepaid.
ITEM IV. I appoint my brother-in-law, RUSSELL E. MOSER,
:now of Camp Hill, Pennsylvania, as Executor of this my Last Will and
Testament. No bond shall be required by my Personal Representative
in any jurisdiction.
ITEM V. In addition to the powers given by law to
my Personal Representative(s) and Trustee(s) hereinafter fiduciaries]
in the administration of my estate and of the trust(s) created
herein, they shall have the following discretionary powers applicable
t:o all real and personal property held by them, including property held
for minors, effective without court order until actual distribution.
(The words "he" and "him" as used herein shall be deemed to include
the words "she", "it", "they", "them", "his", and "her" as appropriate.)
A. To retain any property owned by me at my death
and to invest any funds held by them in any stocks, bonds, nctes
or other securities or property, real or personal, it being my
intention to give them the broadest investment powers possible
within the limitations of the law.
B. To sell or otherwise dispose of any property, real
or personal, at any time forming a part of my estate or the Trust
estate, for cash or upon credit, in such manner and on such terms
as they see fit, and no one dealing with the fiduciaries shall
be bound to see to the application of any monies paid.
`_
~~~Ct,'. 'r ~; ~ ~l ~1 3--s.e_ ,
Marga~et E. Moser
C. To manage, operate, repair, improve, mortgage or
lease for any term any real estate at any time held or owned
by them as fiduciaries.
D. To hold investments in the name of a nominee and
exercise and dispose of warrants.
E. To engage in litigation and compromise, arbitrate
or abandon claims and property.
F. To conduct any business in which I am engaged or
in which I have an interest at the time of my death, for such
period as the fiduciaries deem advisable, with the power to borrow
.money and to pledge the assets of the business and do all other
,acts, which I, in my lifetime, could have done, or to delegate
such powers to a partner, manager or employee, without liability
:Eor any loss occurring therein.
G. To allocate items of receipt or disbursement between
principal and income as the fiduciaries deem equitable regardless
of the character given such items by law; to distribute in cash
or kind or partly in each at valuations fixed by the fiduciaries.
H. In general, to exercise all powers in the management
of the assets of my estate or the Trust estate which any individual
could exercise in the management of similar property owned in his
own right, upon such terms and conditions as the fiduciaries may
deem best, and to execute and deliver all instruments and to do
all acts which the fiduciaries may deem necessary or proper to
carry out the purposes of this Will or the Trust(s) created herein.
I. To apply income or principal to which any beneficiary
is entitled, directly
support, should the f
of receiving the same
incapacity, or to pay
fiduciaries select to
acquittance therefore
for his or her comfort, maintenance and
iduciaries deem such beneficiary incapable
by reason of age, illness, infirmity or
the same to such person or persons as the
disburse it, whose receipt shall be a complete
without the intervention of any guardian.
J. To assume continuance of the status of any beneficiary
with reference to death, marriage, divorce, illness, incapacity
Marga et E. Moser
- 4 -
or other change in the absence of information deemed reliable
without liability for disbursements made on such assumptions.
K. No interest of any beneficiary of my estate or
any trust created herein, either in the assets of my estate or
the principal or income of any trust created herein, shall be
subject to anticipation or to pledge, assignment, sale or transfer
by such beneficiary, nor shall any beneficiary have the power
in any manner to charge or encumber his or her interest, nor
shall the interest of any beneficiary be liable or subject in
any manner while in the possession of my Personal Representative(s)
or Trustee(s), as the case may be, for the liability of such
beneficiary, whether such liability arises from his or her debts,
contracts, torts or other agreements of any type and the same may
not be liable for any levy, attachment, execution or sequestration
while .in the hands of any fiduciary.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this / ~.ic, day of _ .~~~_j, ~~_,;,,,_,, 1990.
,~
h1.V .~
Mar ret E. Moser
The preceding instrument, consisting of this and four (4) other
i:ypewritten pages, identified by the signature of the Testatrix,
was on the day and date thereof signed, published and declared
by MARGARET E. MOSER, the Testatrix therein named, as and for
Yier last Will, in the presence of us, who, at her request, in
her presence and in the presence of each other, subscribed our
names as witnesses hereto.
_-,
- 5 -
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
I, MARGARET E. MOSER , testatrix whose
name is signed to the attached or foregoing instrument, having
been duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my last Will, that I
signed it willingly, and that I signed it as my free and voluntary
act for the purposes therein expressed.
Margaret E. Moser
Sworn or affirmed to and acknowledged before me, by
-MARGARET E. MOSER , testatrix, this /~ 7~ day of
rt-c G 19 9 0 .
-mil - L~-I1
Not ry Public
My Commissipaa_...F~xpir,.es
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AFFIDAVIT
(:OMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN / ),~ J ~.
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G/? d K ~ e~1 G~~ a~
C2C.t-c~ , the witnesses whose names are signed
t:o the at ached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and
saw testatrix sign and execute the instrument as her last Will;
ghat she signed willingly and that she executed it as her free
and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the testatrix signed the Will
as witnesses; and that to the best of our knowledge the testatrix
was at that time 18 or more years of age, of sound mind and under
r~o constraint or undue influence.
~; /~--
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worn to and subscribed before me this ~ ~ ~ day
o f ~i'L( ~ 19 9 0 .
~,
No ary Pu lic
My Commis on xg~~L.~,,;_~ ---
~t ~ , whY t c sy ' u~iic
N; ~ t~ ~ r .
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