HomeMy WebLinkAbout07-25-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Dorothy L. Carbaugh oZ ~ G~ G`-1-1°t
File Number
also known as
,Deceased Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for
(COMPI;ETE 'A' or 'B' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Co-Executor and Co-Executrix named in the
last Will of the Decedent dated September 10, 2003 and codicil(s) dated none
(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:
B, C:rant of Letters of Administration
(lfapplicabie, enter: c. t. a.; d. b. n. c. t. a.; pendente cite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) anti heirs: (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.) ~
Decedent, then 75 years of age, died on July 14, 2008 at Carlisle Regional Medical Center
Cumberland County, Pennsylvania 17013
Decedent at death owned property with estimated values as follows: ~D O6D ` G(j
(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 $
Value of real estate in Pennsylvania ~ $ ~~ ~f OQ , OC!
~f
situated as follows: ~ ~~ S ~Gf ~J(95 ~~ ` ~~L /SL L" ~ ~ /~~~
~1~ . ~ ~~ uJ ~"'" ~ ~ Marlin L. Carbaugh. 116 West Springville Road, Boiling Springs, PA 17007
Farm l;w-oz rev. !0.13.06 Page I of 2
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ' ~ p
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at ~
1895 Dou¢las Drive, Carlisle Cumberland County, Pennsylvania 17013
(List street address, town/city, township, county, state, zip code)
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:
Oath of Personal Representative
COMN[ONWEALTH OF PENNSYLVANIA
COLTN'TY OF Cumberland
SS
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 nr affrrmed and subscribed
before fne the f J day o
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or the Register Signature ojPersonal Representative '" ~° ~ `.
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File Number: p
Estate of Dorothy L. Carbaugh ,Deceased
Social Security Number: 184-26-2613 Date of Death: July 14, 2008
AND NOW, J.~a~.t a5 o bO~? , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters testamentary
are hereby granted to Marlin L. Carbaugh and Linda Kay Moore
in the above estate
and that the instrument(s) dated September 10, 2003
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters .. ~ ~.4~D. r QOQ . $ o~D,d
Short Certificate(s) ....~... $ a~
Renunci\\atio (s) .......... $
~.U 1 ~ ~ ... $ ~5~
~~ ... $ 5
... $
... $
... $
... $
... $
... $
00 .e.~_,
TOTAL .............. $~ IJ~' . .
Form F'W-02 rev. /0./3.06
Attorney Signature:
Supreme Court I.D. No.: 44853
Address: O'Brien, Baric & Scherer
19 West South Street
Carlisle, PA 17013
Telephone: (717)249-6873
Page 2 of 2
Attorney Name: David A. Baric, Esquire
105.805 REV (U]/U7)
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 1449192
Certification Number
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 he forwarded to the State Vital
Records Office for permanent filing.
pl • ~t.~,..c~.~:.+~fa~ .~. ~lUl/ 15/2008
Local Registrar ``~ Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH ~ ~
(See instructions and examples on reverse) STATE FILE NUMBER c~ ~~~q
O ll 1
N105-143 REV 11f2006
TYPE / PRINT IN
PERMANENT
BUCK INK
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1. Nacre of Decetlem (Kral, middle, 1a51, aumx) 2. Sex 3. Social Seamy Number 4. Date of Death (Mall, my, year)
Doroth I. Carbau h F 184 - 26 - 2613 July 14, 2008
5. Aye (Cyst ryrttgay) UMa 1 ear Under 1 day 6. Dale of Binh (Month, day, year) 7. BiMplaus (City and slate a foreign camry) Ba. Piece al Death (Check an ae)
Mettle pays Haiea MMUW Haspibl: Other:
75 vrs 2/1/1933 Carlisle, PA lnwaert ^ER lOUlpaliam ^DOA ^Nursing Home ^Residance ^Dther~5paciry,
fib. Canty of Deem 8c. City, Bom, Twp. of Death ed. Faagiry Name (Ii not insliWUg1, give sheet and number) 9. Was Decetlenl of Hispenk Origin? [~ No ^Yas 10. Race: American IMkn, BIaCk, While, etc.
Ctm(berland South Middleton 'Itap (It yes, spedty Cuban, (SpeciM
Carlisle Regional Medical Center MBxicen,PUenOflican,etc.) White
11. Decedent's Usual Oc tion Hind al work done dorm most of life. Oo ml state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify omy highest grade completetl) 14. Madlal 5btus: Martied, Never Married, 15. SuMVmg Spouse (II vole, give maiden name)
Orvorced (SpecifN
Wt~ed
KirM m Work Kind of Buaness /Industry ,
U.S. Am N Forces? Elemen ry /Secondary (012) College (1-0 or 5+)
Crystal Inspector P.R. Hoffman Co. pyea ®Nm 1~ Wickxaed -
16. Decedent's Mailing Address (SIreeL city / bwn, state, zip code)
• Decadence PA °i~° a~"' North Middleton
Dacedam Lived In Twp
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1 895 Dou la$ Dr .
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Ndual Residence 176.
late
T0N°'ah'~? rid
Decedent urea whMn
^ No
Carlisle, PA 17013 .
,
1fi.Canry 1 amaelLknibm Day/Bore
18. Fam4r's Name (First, mklde, asl, aunty 19. Mother's Noma (First, midhe, maitlen surname)
Daniel - Bauder Floza - Shultz
20a. Infomant's Name (Type! Print) 20b. IniomanYS Mailing Address (Street, city /lawn, sbb, zip cotla)
Boiling Springs, PA 17007
ville Rd
S
rin
6 W
Marlin L. Carbaugh .r
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.
11
21 a. Memod of Disposition ^ Crematon ^ Doration 21 b. Date of Dapositian (MOnm, my, year) 21c. Place of Oisposilkn (Name of cenieterY, cremetary a Omer place) 21 d. Localbn (Gilt' /town, slate, rip cadet
Buda) ^ Rertroval from State WaA
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w 7 18 2008 Westminster Manorial Gardens Carlisle, PA
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r/Corone
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^ Other ~ Speary: i M'
22a. sigataa d Lkerisee (a pa rig suca 22b. license Number 22c. Name and Address M Fadlity
. - FD 012633 L Fkvin Brothers Funeral Home, Inc., Carlisle, PA 17013
Cagkk hems Sec aAy when cergtyirg 23e. To the hest of my knw'kd9a, am aaured at me gme, date all Plea stated. (Signature and title) 23b. license Number 23c. Data Sg~red (Mont", day yeaq
plrysican'a cwt avahade at dma of deem to
tMNy cause of deem.
~ Time of Daam
24 25. Data Prorounced Dead ( ,day, ye r) 28. Was Gaw Refertatl m Metlkal ExarMrer I Coroner br a Ream Omer then Cremation « Donation?
Items 2426 rtMSI a canWetea by pawn
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CAUSE OF DEATH (Sea tnatrucUona ell a:emplea) ~ Approximab Interval: Pad II: Eller aka yjhgdkant mndhkns contributing to tleem, 28. Ditl Tpbeccp Use Catn'bute to Deam7
Emer me Cain m evens -diseases. kryAee, a camplkztiora -mat drechy caused me deem. W N0T enter temdnel evens such as camkc crest, Orval ro Deam
Pert I
hem 27 bN riot resuheg in the undaAyirp cause given in Pan I. ^ Yee ^ Prebady
.
.
reNArarorl' arrest, a vantriailar gbrilletion wdtaut showing me etrology. List gnN one cause an each Gne. ^ No ^ Unknown
NAMEDIA7E CAUSE Fetal dkeasa a / 1 r7 // _
WMilron resWAng in ~eaml
~n~St"~!G ~.DG-a.Yev AdM.L e't' T~ ealOln /raw r^•-r^b 29. If Female:
^Na
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Due to (or a conaequerpe of/:
a
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^ Pregnant al lime of deem
Arre a.
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eO' W Ne i,ause NaUed al
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rig Due W (or as a consequence oq:
UNDEifIIYING CAUSE
E ^ Not pregnarA, but pregnant wimin 42 days
f d
nkr me
(tlaease ar mjtxy mat Irakled me r eem
o
events resultrig7 in death) LAST. ~
Not m, al em a3 da s ro t ear
^ Dre9na Pre9n Y Y
Due to (« as a ansequarice op:
d balae seem
^ Unknown II pregnant wimin the past year
,
30a. Was an Autopsy 3W. Wore Aulopay Fmdngs 31. Manner d Deem 32a. Date n Injury IMgnm, day, year) 32b. Describe Haw Inury Occurred 32c. PWce al Inju7: Hans, Farm, Street, FB<bry,
OFice fluikirq, etc. (Seamy)
Penamed? Avaibble Prior ro CanplMim
f Deam7
f Ca
e ~ 1d1y1°I ^ Hy'"iede
us
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o ^ accident ^ Pelldirg mvestigalbn 32d. Tme C Injury 32e. Irdury al Work? 32f. If Trenspanatbn Injury (~N) 329. Laration al Injury (Street. chY / rown, stele)
^ Yes [ ^ Yes ^~17
^ Suictitle ^ Could Na be Determined ^ ~
^ Yes ^ Odver /Operates ^ Passenger ^Pedesbian
M ^~ Specih
33a. Certifier K~ any abl
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kted Item 23)
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d 33b. Signs and TAta C Certifier
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• Certllymg phyeklan IP"Yskiyn candying reuse n deem when anoltl0r physkAan has Ixapunced
deem occurred due to lha causga)entl m•mermsbbd_________________________________ ^
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• Pronoralchg end cen6Yln9 phyelden (Physk'an born Praroundny deem antl cenirying b cause C deem) .License Number 33tl. Dat
Sg (Monet, day. Year)
e
To the best of my knowbdge,dwlh acurree at the time,data, and place, all due to me ceuse(s)aM manner as stetM__________________ 6
~A _OY3of~I 'L
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• MetlinalEwminer/COrorar
On tae basis of examinaaon arM / a Investlgelkm, in my opinion, death ocarrad at me lime, dab, antl pbca, and tlue to tae causefa) and manner u stated_ ^ 3a. Name all1\'Addr~ss of P~j~^ Who~1C~/!^/~~ad Cause of Deam glem 27) Type! Prim
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nature and Dist' bar
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OF
Dorothy 1. Carbaugh
I, Dorothy I. Carbaugh, of 1895 Douglas Drive, Carlisle, Cumberland County,
Pennsylvania, do hereby declare this to be my Last Will and Testament and hereby revoke
all Wills and Codicils previously made by me.
ITEM ONE: I direct the payment of my debts and the expenses of my last illness
and funeral from my estate as soon after my death 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 far
perpetual care, using, therefore, funds from my estate, 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, in this connection, 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
I direct the payment of my debts and the expenses of my last illness and funeral from my
estate as soon after my death as conveniently may be done.
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ITEM TWO: I give, devise and bequeath my entire estate of whatever nature and
wherever situate to my children, Linda Kay Moore and Marlin L. Carbaugh, in equal
shares, per capita if they shall survive me by thirty (30) days.
ITEM THREE: My Executors shall have the following powers in addition to those
vested in them by law and by other provisions of this Will, applicable to all property, real,
personal or mixed and wheresoever situate, including property held for minors, whether
principal or income, exercisable without court approval, and effective, with respect to each
item of said property until actual distribution thereof.
A) To retain, as investments of my estate or trust, any or all assets of my
estate, real, personal, or mixed, without regard to any principal of diversification, and to
purchase and acquire real or personal property and to hold any or all of such real and
personal property retained or acquired without making the same productive of income.
B) To pay all taxes, charges and expenses of maintenance, upkeep,
improvements, development, protection, preservation and investment of any retained or
acquired real or personal properly, such payments to be made from either principal or
income as my Executors or Trustee shall determine.
C) To retain or invest any and all funds, whether principal or income, in any
real or personal property without restriction to legal investments; to purchase investments
at premiums; to exercise all rights of a security holder or share holder in any corporation;
and to lease, mortgage, pledge, give options upon or sell at public or private sale and
without approval of any court, any real or personal property, or portion or portions thereof,
irrespective of the manner or the means by which the same was acquired by my said
Executors.
D} To make payment or distribution herein provided for in cash, kind or partly
in cash and partly in kind, at valuations fixed by my Executors at the time of distribution.
ITEM FOUR: Any and all payment or payments of any sum or sums, whether in
cash or in kind and whether for principal or income, payable to an heir, or any of them,
shall be made upon the sole receipt of the respective individual to whom the payment is
made, and free from anticipation, alienation, assignment, attachment, and pledge, and free
from control by the creditors of any such beneficiary.
ITEM EIGHT: !appoint my children, Linda Kay Moore and Marlir3 L. Carbaugh,
Executrix and Executors of this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear
my signature in the margin for the purpose of identification, this the 10th day of September,
2003.
aQ' (SEAL)
orothy I. Carbau
Signed, sealed, published and declared by the above named testatrix, Dorothy I.
Carbaugh, as and for her Last Wi!! and Testament, in the presence of us, who, at her
request, in her sight presence, and in the sight and presence of each other, hav
hereunto s s d ur names as witnesses.
ADDRESS
ADDRESS~~~ ~~~, ~~ ~ I7I~f~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
. SS.
We, Dorothy I. Carbaugh, ~'Ui ~ ~ . ~~~C and~.~~c.°~i~~:tcY `~. L_r r1+c-~~c~ ~,l
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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 of her Last Will and Testament, and
that she signed willingly and that she 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) years of age or older, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed before me this the 10th day of September, 2003.
~~/ti~.a.~.t~r~.. ~-r:~SG~.~~-~
Notarial seal
Arr~nda L. Fisher, Notary Public
Carksle i3oro, Ctxnbedand Courriy
My Commission Expires Apr. 17, 2006
Member. Pennsylvania Association Of Notaries