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HomeMy WebLinkAbout09-12-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Estate of ~~{y ~ LSO ~ . ~ t F'F 1 ~ File Number ~ ~ b O V \ Q1fT also known as ~~-- Deceased Social Security Number ~ ~~~ ( Petitioner(s), wino 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 named in the last Will of the Decedent dated /Tllelt /O Za~~ and codicil(s) dated (Stnte relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did no[ 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. Grant of Letters of Administrati Qjapplicable, enter: c. t. a.; d.b.n.c.t.a.: pendente lire; durance absentia; durnnte ntinoritate) N r_°> Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sp~e~(,(f any) anc~irs: (~ , Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) -.~ ~~ S.~ `t ? -r~ C"tl Name Relationshi Residency -':-': ~ - r ~t (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~ ~ Decedent was domiciled at death in with his LkeFlastprincipal residence at (List street address, town/city, township, county, state, zip code) Decedent, then ~ years of age, died on ~•~ ~g at 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 Value of real estate in Pennsylvania situated as Poll $ 200 Dp0 , rOn Form R6V-03 re,~. 10.13.0 Page 1 of 2 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 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect 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, ~ Sworr; to or aff rn,e~ and subscribed before me the: _~~ day of ~ ~ , i, For the Register Signature ojPersonal Representative ;_' ~ ~ _ ; _t - - t"^. --r. _ - - - - . . ~:.~ Signature ojPersatal Representative =: ;",? %'?.~~ _ r ' ~~ `J__ ~_ Personnl _.'J _~ File Number: ~~ ~~ ~l~~a' ~~ w / /`/' CT Estate of ~~ ~ ~ (~j -~{ ' '~ ,Deceased Social Security Number: ~ ~ ~ Date of Death: ~ °2O l~d i _ _~ ~~ --- r'--~ ~.~ AND NOW, inn conjsideration of he foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters /LeS7CXI'Y~l~? rZ.-i are hereby granted to %~oha. CG~ C ~e i i~ eIY in the above estate and that the instrument(s) dated _ O ~ i C ~0 a~~ described in the Petition be admitted to probate and filed of reco ~d~~ the last~Will (ar~l Codicil(s)) of eceden ~ ~ FEES Letters ...~~t.d~.~... $ c'~ Short Certificate(s) . S.... $ oZ d Renunciation(s) .......... $ J ... $ !0 ... $ .`i ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~I11 Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Form RGV-OZ rev. to.13.0~ Page 2 of 2 IOi80S REV (01/07) 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 14543iJ42 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 be forwarded to the State Vital Records Office for permanent filing. LGnrrz.o ~~ d"' " At1G Z ~ Z0O~' Local Registrar Date Issued r-.,~ « ~ ~ ~_ © co _ _: / _~ cn - ~: ._~ ~ `~ r~ ~ -~ ~ - . t !-;^( - J t...T:. ' "~ %'; N ; i -. ; ~.=7 ` ~ _ "_Y - t7 t ~ , REV 1lnlws PRINT IN MNEN7 CK INH COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH c;- (See instructions and examples on reverse) crwro F~~ ~ r.~~ ~..o~o ~ \ n X nG'l ~ 1. r'~alme of ~(l i`~( mitld rlast, suffix) 2. Sex 3. Sodel ~riry Number ~ -~'~ 4. Date of peach (MOnM, tl~aiY, year) 5. Age (last Bidhdey) UMer 1 year Under 1 d 6. Date of fBM (Month, day, year) 7. &nhplace (City aM stale or foreign country) 6a. Place of Death (Check only one) Q Monsw Ow/s Hours Minutd Hospbal: Omer rrQQ,~ PA Ll ~ (h~ ~ ~ ~ 3 Alexandria L~~ , yre. ^ Inpatient ^ ER / Oulpatienl ^ DOA ~y Nursin g Home ^ Residence ^Other - SpedN: Bb. County of Deem Bc. City, Boro, Twp. of Death Btl. Fadfity Name (H not MsliMbn, gWe street aM number) 9. Wu Decedent of Hispanic Origin? No ^ Yes t0. Race: American IndMn, Black, White, etc. Cunberland E. Pennsboro • (II yes, spedN Cuban, O~f.~ Li~- ~e~"Cx'- 'fi't ~('~ Mexicen,PuertoRkarhek.) (soea'iM White 11. Decedent's Usual Kmd al work done moss of workin tie. Do not state retired 12. Wes Decedent ever in me 13. Decedent's Eduration (Specify any highest grade completed) 14. Marital Stews: Monied, Never Married, 16. Surviving Spouse QI wile, give maitlen name) nand of Work KiM of Busateas 1 Industry A1rCraTt McCharilC U.S. GOVt. U.S. Armed Forces? Ele~~ ery /Secondary (0-12) College (1d a 5+) WiWwed, Ord ~(y~~ N1 ' Wes ^No ~V 1 U1N~GI 16. DeoedenYS MaiMng Address (Street, tity /lows, state, dP code) Decedents PA Ditl t3arsdem p~ Stale the in a AGUeI Residence 17a Lawer Allen it Boxwood Ln. . 17c.4*•1 Yea, Decedent LNed in ? T la Twp Hill PA 17011 owns D 17tl. ^ No, Decedent Lrved wiNNn 17b. County land Actual Limda a city / Bwo 18. FaMefs Name (Brat, rmtltlle, IuL suffix) 19, Mother's Name (Fksl, middle, maiden sumeme) Chester Giffin Mar'orie Iti er 20a. IMonnenYs Name (type I Prim) 20b. IntomrenYs Meiling Address (SreeL city I town, slate, ap cede) Donald Giffin Jr. 1934 Kent Dr. hill PA 21a. Metlrod of Disposition '' remotion Donafan 21b. Dste W Dlspoadxtn (MOnm, day. year) ~}~ plsposigon (N of tamale , mat or other ) ~ al °~ P~ 21 d. Location ICI I town, stale, d code) " ^ Burial ^ Removal Iron Slate ~ Wes Cremation a Dan.NOn Authod7ad ^ Other-Specify: by kh+dkw Exarrrkler ? [Yea^NO August 25, 2008 [lOinger imer ; iome Cremato Mt. Holly Springs, PA 22e. S Funeral Service ' (or son as such) 12h. License NumAer 22c. Name end Atldress of FaciNry rrAr •~s~~rner Funeral Home ~ 014819 L 1903 Market St. hit Campfete Items 23ac only when cerNN>„g 23e. To the best of my krxxwledge, death omaned at the ' , tlete antl place statetl. (Signawre aM fifie) 23b. Licenu Number 23c. Date Signed ( onth, day, year) physician a rot avaieble at tlme of death to ceraAr reuse of death. o ql ~ - p ~-~1 w~ 0 ~ O`er Horns 24-26 moat ce cornpletad by person 24. Time of DeaM 25. Date P need Dead (Month, day, year) 26. Wu Case Referred to Medical Examiner / Coroner fora eason Olhar Than Cremation or Oonatlon? x4ro pronounces death. ~ M. y ^Ves [gNo CAUSE OF DEATH (See Inatruetlona and exa ea) ~ Approximate inldrwal'. Item 27. Pad I: Faster Nte chain d evenLS -diseases, injuries, a canpkcatans - that dredN caused,lhe deafA. W N0T enter temanal events such es cardiac arrest, r Onset ro Death Pad II: Enter other donNra 1 !+~+tlitlons can dh sine to death, bW na sesWdng in the underlying cause given re Pan I. 26. Did Tobaca Use Cmmbute to Death? ^Ves ^ Prodably respiratory amesl a venlnculer Itbrilletlon without showing the etlobgy. LJSI Doty one cause on each fine. r t pIMEDIATE CAUSE IFin l dsease a ~ ^ No •~lfiknown ~ ca~Gan resuNkg in dee 1 ~{~T /'~ - ~ x 29 ff Female: ~ . f y~y~ -~ C f~_L _~ a_ r . Due to (or as a wnsequence op: ^ Nol pregnant within past year SequentlallIyy fist candkons, N any, b. Iea~rp to the cause hated an ease a ^ Pregnant at time el deem . Due to (or as a con ante o Enter Bye UNDERLYING CAUSE ~ ~~ ^ Nol pregnant, but pregnant wilMn 42 days (disease a nryry that irtifieted me c ~ events resuMng m deem) LAST. r of tleam Due to (or as a consequence of): ^ Not Pregnant. but Dregnant 43 days Io 1 year d. i before death ^ Unknown if Pregnant wkhin me pest year 30a. Was an Autopsy 30b. Were Autopsy Rndrgs 31. Manner d Deem 32a. Date of Injury (MOnm, day, year) 32b. Describe How Injtmy Oxurred 32c. Place of Injury: Fbme, Farm, Street. Factory, Performed? Available Prbr to CamPlekon ,--,/ Nawral ^ liomkiae Lam ~ .-. -. Offaxs Buikin ,etc g ~'Nl d cause of Deem? . ~~~, tex!,\ ~~``` ^ Yu ~., ^ Accident ^ Pending ImesGgetbn 32d. Time d Inju ry 32a. Injury at Wpk? 32f. It Transpormeon Irry'ury (Speclly) 32g. laraGon of InNry (SlreeL dry I tovm, slate) ^ Suidde ^ CouM Not oe Determined - ^ Yas ^ No ^ Odver I Operator ^ Pasungar ^Petlasman M. ^Other- SpedN: 33a. Comfier ldreCk onN one) 33b. Signature and Tdle d Cenifrer • CerlNying phyeldan (Physidan ceNNying rouse of death when anomer physidan has pronounced tleam aM completed ttern 23) .. ". ~ r~3 7o tlw beat o1 my knowedge, deeNt oewrred due to Nxe cause(s) and manner as stated_ _ _ _ _ . _ _ _ _ ., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ • PronounUng and eertilyirrg physkkn (Phyaldan boN pranountlrg tleam and cenNykg to cause of death) To tlx bat o1 my knowledge, death occurred M the Nme, date. eM place, and due to the cause(s) eM manner u atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number _ ~ *^ [ 33d. Dale Signed (MOntn, day, year) • MedkU Exmrrlrw / Caroror ~~ ~ ~ ~ ~ - !-'-! l-. ~' - ~ ,. ~ r CA z I U~ On tM beau of ezamination and / or InvuNgMlon, In my oplnlon, death occunetl at the Nme, date, and pkee, aM due to the cause(s) and manner u smMd_ ^ tt~y 34 Name antl Address of Pe~baGynpygd CgyAe r(Bay{hr(Il 1"I - t sa,rt7ltiyyaJ PrjlNs " 35. Registrar's S re and District ~ r ' 36 Date ~ .7 Cl] r7 CI IL7HtS ? z I I V CI f LJ . .~~ I ~ I ~I ~ I i ~ - l~ - Cs~ . } ~~~~OO rt r.rs ~~o Po, Cum ' ~P+.n / ~F- d C./ Dlaanaitbn Pannit No. 0228638 O ~,~ ~~r'c7 ?~ __ :. r - '~ '' r'\ V ~ I, DONALD C. GIFFIN of the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by me. ITEM 1: Upon my demise, I direct my body be cremated and my ashes be interred in a lot which I own in Mooresville Cemetery, Mooresville, Huntingdon County, Pennsylvania. I further direct that there be no viewing or funeral services conducted. ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in ,~~ z w C7 ~ U Q O C~ Q consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my Estate. ITEM 4: I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon, to my son, DONALD C. GIFFIN, JR. of 1934 Kent Drive, Camp Hill, Cumberland County, Pennsylvania ITEM 5: Should my son, DONALD C. GIFFIN, JR., predecease me or fail to survive my death by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate, wherever situate, together with insurance thereon, to my nephew, RICHARD P. SNYDER, JR. of 103 Quail Lane, Summerville, South Carolina. Page 1 of 6 ITEM 6: My Executor or his successor shall have the following powers in addition to those given by law to be exercised by him in his absolute discretion, which powers shall be applicable to all 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 _~ z w w . ~ U Q ~z ~ O Q amended, 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 beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, 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 terms 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 property, 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; 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; Page 2 of 6 g. To register investments in the name of a nominee or to hold the same unregistered in such form 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 generally 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 executor deems advisable even for more 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 disinterested executor shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian ~1 z w ~/~ C7 ~ U Q ~, z ~Q and investment advisor, and other agents and to compensate them from principal or income or both, as my executor shall determine, such compensation to be a reduction of the compensation of my executor; To associate with her at any time, in her absolute discretion and of her 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 and 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 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 Page 3 of 6 more 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 generation-skipping 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 executor 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); nor 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- ~. l ~, ~~ z w w L7 U Q z Q 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 property 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. ITEM 7: In the event any legatee or devisee named in this will dies under such circumstances that there is not sufficient evidence to determine absolutely whether such legatee or devisee survived me, I direct such legatee or devisee shall be presumed to have predeceased me and devise and Page 4 of 6 bequeath the gift in favor of that legatee or devisee to such persons and in such manner and in such proportions as set forth in this will for distribution if the legatee or devisee predeceased me. ITEM 8: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 9: I appoint my son, DONALD C. GIFFIN~~xecutor of this my Last Will. In the event my son; Donald C. Giffin, predeceases me, fails to qualify or ceases to act as Executor, I appoint my nephew, RICHARD P. SNYDER, JR. of 103 Quail Lane, Summerville, South Carolina, alternate Executor of this my Last Will. ITEM 10: I direct that my personal representative, or his successor, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Testament, this day of , 2008. ~ ~~ DONALD C. GIFFIN IN WITNESS WHEREOF, I~h;~e hereunto set my hand and seal to this, my Last Will and ~~~'~'' w Signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ' residing at /~>°.c~c~--i° CS ~ ~-,., ~l 7~ ~5` ~~s,.c._. residing at /u ~ ~~d~~~~- c~•C,1.~'--...~ ;~,~ ~ ~a/~ Page 5 of 6 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, DONALD C. GIFFIN, ~ l ~ ~ ~'~'~ ~ `fin -z- and I-~ ,yi ~ ~, ~. (~ a ~ r'-~.,- ,the Testator 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 Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the will as witness and that to the best of his or her knowledge, the Testator was at the time eighteen (18) years or older, of sound mind and under no constraint or undue influence. ~ ~~~ Witness Subscribed, sworn and acknowledged before me rc, /- ~-ti 1~-- by DONALD C. GIFFIN, the Testator, and subscribed and sworn to before me by ~~ ~~ ,~ ~~ ~ ~ ~ /v`E' and ,'~,~1 n c ~~• -~. o ~- I'~~`" the witnesses, this ~~~ day of ~T2,,~ , 2008. I Notary Public (SEAL (~fAw OF PE~INS~YAMIA NOtQRIAI SERI MEN#Y ~ C0K1lE, NOUtRr rU1tl6 NAYPDEN iMtP., (21YBERLAIiD 12)UN11 MY CDIAMISSiON EXPIRES JUNE 17.2001 Page 6 of 6