HomeMy WebLinkAbout08-01-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of HELEN L. BRiNICERHOFF File Number ~/ ~ ~ ~~ ~ ~O~
also known as
,Deceased Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTOR named in the
last Will of the Decedent dated AUGUST 22, 2005 and codicil(s) dated N/A
(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 bom 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. Grant of Letters of Administration
(t/applicable, enter: at.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following souse (if any) aid 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.) ~ C7 ~,
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Name Relationshi ResidenceL'~ r`' j
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. , Ci -~ N
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at
770 SOUTH HANOVER STREET CARLISLE BOROUGH CUMBERLAND COUNTY PA 17013
(List street address, town/city, township, county, state, zip code)
Decedent, then 90 years of age, died on JUNE 28, 2008 at CHAPEL POINTE, 770 S. HANOVER STREET,
BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 150,000.00
(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
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
WILLIAM W. BE[BLE, JR., 805 ROSEWOOD DRIVE, CHESTER SPRINGS, PA 19425
Form RW-Ol rev. /0.13.06 PagO 1 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
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 ecedent, Petitioner(s) will well and truly
administer the estate according to law. b i ~ 3~.~
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Sworn to or affirmed and subscribed
~~~ ign lure of Persona Re resentative
ore me the ~( day of
/
``~~~~`' Signature of Personal Representative
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For the RegisteC Signature of Personal Representative :-? ~=
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File
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Estate of HELEN L. BRINKERHOFF , I~eCe~~ed lV
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Social Security umber: 207-07-6126 Date of Death: JUNE 28, 2008
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AND NOW, ~~
, in consideration of the foregoing Petition, satisfactory proof
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having been presented before me, IS DECREED that Letters TESTAMENTARY
are hereby granted to WILLIAM W. BEIBLE, JR.
in the above estate
and that the instrument(s) dated AUGUST 22, 2005
described in the Petition be admitted to probate an d filed of rec the last Will (a Codicil(s) Decede t.
FEES
Letters ............... $ '
Re 'ter of ills
/ ! ~ /
Short Certificate(s) ........ $ .~ Attorney Signature: t / ' L -'" ~-^~`'~C=
Renunciation(s) .......... $
.. $
$
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Attorney Name: THOMAS E. FLOWER
--
83943
LD
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ourt
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Supreme
-
... $ ~
Address: SAIDIS, FLOWER & LINDSAY
... $
$ 2109 MARKET STREET
... $
$ CAMP HILL, PA 1701 1
• • • $ Telephone: 717-737-3405
... $
TOTAL .............. $ ~ 0
For,n R6V-oz rev. /0.13.06 Page 2 of 2
105-805 Rf_A' ll) V071
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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 :~~54083g
Certification Nwnber
This is to certify that the information here given is
correctly copied from an original CertificaCe of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State ViCal
Recyord~s Office for permanent filing.
~~ ~ ~' l ~ K JUL 0~2 200
Local Registrar Date Issued
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Rev vvzoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ ~ iV
snnErTii" CERTIFICATE OF DEATH
,cx INx See instructions and exam les on reverse
C P STATE FILE NUMBER
1 Name of Decedent (First midtlle, last. sutllx) 2 Sex 3. Bocal SecudN Number 4 pate m Deelh iMomn, day. yearl
Helen L. Brinkerhoff female 207 - O7 '- 6126 June 28, 2008
5. Aqe (Lass Bmhdayl Under t year Under 1 day 6. Dale of Birth (Manlh, day, year) Z Bidhplace (CIN arW slate a for eign country} B a. Place o1 Death (Check only one)
Monms Days rtwrs Minutes Hoslrlal Other.
90
Yrs February 12, 1918 Harrisburg, PA
^ p ^ F.R. Outpatient DOA
In anent ^
®Nwsin Homa Residence pecity.
g ^ ^omer s
Bb. County of Death Bc City, Boro, Twp. of Death Bd. Facillly Name p1 rwY Inslilution, give streel antl number) 9. Was Decedent of Hispanic Origin? ~] No ^Yes 10. Race. American Indian, BIZCk, White, etc.
(It yes. specilY Cuban, (Specity!
Cumberland Carlisle Chapel Pointe Mexipan,PUenpRlpan,ate) white
11. Decedent's Usual Occu Lion Klnd of work done tlunn mast of wakin file. Do not stale retire 12. Was Decadent ever in the 13. Decedent's Education (Specify onty highest grade completed} 14. MarAal Status: Married, Never Marred, 15. Surviving Spouse III wife. give maiden name;
Klntl of WoM Kind of Business I Industry LLS. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 04) Widowed, Divorced (Specify,
Homemaker Domestic ^ves ®Nn 12 Widowed
76 Decedent's Mailing Address (Street, city 1 town, slate, rip code) Deoedent's
A
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17
St
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Pennsylvania Live ina 17a^ Ves
Decedent Lrvetl in Twp
770 S. Hanover Street ctua
esi
ence
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Township?
Carlisle, PA 17013 t7h cDbnN Cumberland 17d ®n~;°ii~s'oi"~wiln~° Carlisle ciryrB~rn
1B Father's Name (First, mslMe, lest, suffix) 19, Molhei s Neme (First, midtlle. maiden sumanie)
Andrew Beible Clementine McClarin
20a. Inlamam's Name (Type! Print) 20b. Informant's Mailing Address (Street, city 1 town, state, zip code)
William W. Beible 325 Wesley Drive, Mechanicsburg, PA 17055
21 a. Method of Dspositon ^ Cremation ^ Donation 21 b. Dale of DiSposAibn (Month, daV. Year} 21c. Place of Disposition (Name M cemetery, crematory or other place) 21d. Location (City! sown, state, zip code)
® Burial ^ RembvalfromSlate ~; Wes Cremation or DonationAutlrodzed
• July 2
2008 Holy Cross Cemetery Swatara Twp. , PA 17112
^ Other - Speciry- t by Medical Examiner I Coroner? ^Yes ^ No ,
22a. Sgnature of. T r" nsee .person acting as suCn) 22b. License Number 22c. Name end Address of FacikN
FD 012 848 L Inc., P.O. Box 431, New Cumberland, PA 17070
Parthemore FH & CS
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Complete Ile -c poly when certifying 23a. 7o the best 91pmy knowledge, death occurred at the tune, date and place staled. (Signature and title) 23d. license Number 23a Dat Signed IMenth. tlay yeap
physican i5 nCl available aI nine a death to /;' '7
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cenlry rouse m deem y ~ (,,l_(_ '.G j' ~.i LL-tt'~LC ~ :7k % l~'
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trams 2626 must be completed py person 24. Time of [Yealh
~ 25. Date Pronounced Dea (Month, day, year) 26. Was Gase Referred to Medical Examiner I Coroner fora ~ ason Omer man Creme ion or Donation
who pronounces death. ,.~
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~ ~ ~~ GI ^Yes 1\1.No
CAUSE OF DEATH (See Instructions and exam0les) I Approximate interval Pan IL Enter other ggn f~canl ondil o s c tit bN ny to tleaU, 28. Did Tohacco Use Contribute to Deam?
Item 27 Pan P Emer the chain of events -diseases. uqunes, a complications -1hal tllrectry caused the death. DO NOT enter terminal events such as cardiac arrest, Onset to Death out not resulting m the untletlying cause given in Pan I. ^Yes ^ ProhaWy
resprral0ry attest, or Venmbular hbdalibn WifheN showing 1118 BllObgy. LI81 Only brie Cause On each line.
^ ND ~Inknbwn
IMMEDIATE CAUSEIFinal disease or
condAion resulting in death) _' a r ~, I~ 9
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29. It Female.
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Du¢ to (or as a consequence ol). bl pregnant wit
in Dast year
^ Pregnant al lime of deem
SequenbalN list conditions, A any, b i
leatling Ip the rouse listed on line a.
Due to for as a consequence ol). ^ Nol pregnant, nut pregnant within 42 days
Enter the UNDERLYING CAUSE of deem
(disease or ilryury Ihal Initiated me c
LAST
events resulting in death)
Due to Ibr as a consequence of): ^ Not pregnant but pregnant 63 days to 1 year
d oelpre deem
^ Unknown If pregnant within the past year
30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Deam 32a. Dale of Injury (Month, day, year) 32b. Describe How Inlury Occuned 32c. Place bl Injury'. Home, Farm, SIreeL Factory,
Pedormed+ Available Prior to Completion
of Cause of Dealh7
~xglaWral ^ Homicide
V Omce Building, etc. (SpeatyJ
^ Accident ^ Pending Investigation 32d. Tune M Injury 32e. Injury at Work? 321. If Transpodalion Inlury (SpeclN) 32g. Location of Injury (streel, city 1 town, state)
Yes Na
^ ~ Yes No
^
^ Suickfe ^ Gould Not De Determined
^Yes ^ No
^ Driver I Operator ^ Passenger ^Pedestrian
M ^ Other ~ Specrly
33a Certifier (check only one)
cause of death when another physician has pronounced death and completed Item 23)
sician (Ph
sician cenAyin
• Cedif
in
h 33b. Signature TUIe of GertiKer
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To the best of my Nrwwledge, death occurred due to the cause(s) and manner as staled. _ _ _ _ .. _ _ _ _ . _ _ _ _ _ _ .. _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , V
~~ ~~
• Pronouncing and certifying physician (Physician both pronouncing death and cenAymg to cause of death)
^ 33c. License Number 3d Date Signed !Month, day year)
To the heal of my knowledge. death occurred at the time, dale, and place, and due to the cause(s) end manner ae stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~~ a.~ ~` ~ ~' ~ ~ v ~ ~,0' ~d ~~
V
• Medical ExeminerlGorwler
On the basis of examination and / or investigation, in mq opinion, death occurred at the time, dale, and place, and due to the cause(s) and manner as elated. ^ 3a Name antl Address el Person Who Completed Cause 1 Detralh Item 27~Typ¢ t Prim' a
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LAST WILL AND TESTAMENT
-~ _
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HELEN L. BRINKERHOFF
I, HELEN L. BRINKERHOFF, of Carlisle, Cumberland County, 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 Wills and Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and the expenses of my last illness and
SAIDIS
SHUFF, FLOWER
& LINDSAY
2109 Market Stree[
Camp Hill, P,A
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
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, in
equal shares, unto my nephews, WILLIAM W. BEIBLE, JR. and RONALD B.
BEIBLE, per stirpes.
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
I hereby nominate, constitute and appoint my nephew, WILLIAM N!' BEIBLE,
JR., to act as Executor of this my Last Will and Testament. Provided that, if
WILLIAM ~!! BEIBLE, JR. is unwilling or unable to act as Executor, I direct that the
duties of Executor be performed by my nephew, RONALD B. BEIBLE.
FIFTH
I direct that no personal representative appointed under this instrument shall
be required to give bond for the faithful performance of his duties in any jurisdiction.
SAIDIS
SHUFF, FLOWER
& LINDSAY
2109 11arket Slreet
Camp Ilill, PA
2
IN WITNESS WHEREOF, I, HELEN L. BRINKERHOFF, have hereunto set
my hand and--s~-eal to this my Last Will and Testament, this ~ day of
ic.A--t` , 2005.
"1
HELEN L. BRINKERHOFF
Signed, sealed, published and declared by the above-named HELEN L.
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORVEI'S•AT•LA14'
2109 Market Street
c~~„~ ri~n, ~~n
BRINKERHOFF, 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.
?~,~ r ADDRESS „~ lC! ~' l'~C~1 K~
Witness '' ~y ~ ~~ r ..~~~~
~u .~ ~ = ~-~--" ADDRESS '~ ~C/- ~~~ . ~t ~'1 '
Witne~ '
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3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SAIDIS
SHUFF, FLOWER
& LINDSAY
TTTOR IVF.I'S• AT• LA VV
2109 Market Street
Camp Hill, PA
We, HELEN L. BRINKERHOFF,
ss.
Tt~~s E • ~ louver- and
~e--+~.~i Z L- . L~ ~• r~ ,the Testatrix and witnesses, respectively 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
she executed the instrument 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.
~/Q~ ,~
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HELEN L. BRINKERHOFF
4
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fitness , ~'
~t~__._------
Subscribed, sworn to and acknowledged before me by HELEN L.
BRIN ERHOFF the Testatrix, and subscribe to ands orn or affirmed to before me
bye. ,~ ~ _ an ~... ,
witnesses, this~day of , 2005. ,
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Notary,~`yblic
NOTARIFtI SEAL
MERLENE J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 20i~
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATI'ORNEI'S•AT•Ir1IV
2109 ~1arkel Street
Camp Hill. PA
5