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HomeMy WebLinkAbout10-10-08Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of GLADYS M. COX No. ~- I ! ©0 ~ I(~~ ! ~---~r, o Deceased Social Security No. =-'~-, c'=' --~ 0 Petitioner, who is 18 years of age or older, applies for: ~_' =_ (COMPLETE "A" OR 'B" BELOW:) _l ,_ L~ ~., •• A. Probate and Grant of Letters and aver that Petitioner is the Executrix named in the Last Will of~'-, ® the Decedent, dated March 9, 1999 and codicil(s) dated 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 documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (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 spouse (if any) and heirs: . Name Relationshi Residence COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at ManorCare Health Services -1700 Market Street Borough of Camp Hill. PA (List street, number and municipality) Decedent, then 89 years of age, died September 19 2008 at _ ManorCare. 1700 Market St Camp Hill. PA 17011 (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .....................................................................$__ 190,000.00 (If not domiciled in PA) Personal property in Pennsylvania .....................................$_ (If not domiciled in PA) Personal property in County ....................................................$_ Value of real estate in Pennsylvania ......................................................................................................................$ NONE Total ......................................................................................................... $- 190.000.00 Real Estate situated as Wherefore, Petitioner respectfully requests the probate of the last Will and codicil presented herewith and the grant of letters Testamentary thereon. Si nature T ed or rinted name and residence - Dorothy A. Bell ~? ~ 2151 Meadowsweet Lane, Streetsboro, OH 44241 i Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. ~- ~ Sworn to and affirrm\ed and subscribed v Before me this ~D~~ day of ~~ ~ , 2008. ~ _~ --.-7 ^ - CJ `?M 1!` ~ 11 y 1 , ~ i No. -="- Estate of GLADYS M. COX y , Dased. Social Security No: 204-03-5148 Date of Death: SEPTEMBER 19.2008 AND NOW, 1~~1 k.~t~-~' ~, ~~_, 2008, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated MARCH 9. 1999 described therein be admitted to probate and filed of record as the last Will of GLADYS M. COX and Letters Testamentary are hereby granted to DOROTHY A. BELL in the above estate. FEES Letters ........................... $ ,~i~P~. r~~ Short Certificate(s) n ..~;.l.l.. Affidavit ( ) .................. Extra Pages ( )....... Codicil ............................ JCP Fee ..................... Igyp~,~.~n~ Other .............................. $ ~.~: oc~ $ l ~, f~ a TOTAL......... $ egister of Wills ~4~ n , Attorne ~ `~'" iG~~~~~~~r~ /~o~+~~ ~C• y Jerry R. Duffle ~/ I.D. No: 09601 Address: 301 Market St. P. O. Box 109 Lemo ne PA 17043-0109 Telephone: (717) 761-4540 1 `~ (~ ~ I (~'' LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this cony by photostat or photograph. Fee for this certificate, $6.0~ I P ~.4~2z~53.3 Certification Number ~~I H705~143 REV 11!2006 TYPE /PRINT IN PERMANENT BLACK INK O z This i.; to ccrtifa that the tinlonnation here given is correctly copied from an original Certificate of Death duly filed with rr~)e as Loca] Registrar. The original certificate ~~~ill be forwarded to the State Vital Records Office i'en- permanent filing. Local Re's=i~ttar Date Issued ,w.~ - - ~ ~, ~:-~ .:_) _, __ -- _ __ -- - c~~ ~' c-; __ __ _-- _ __ _. - t~:1 - ,"~ - --:-I ~:.. _.. --1 C (V G;1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) „_.__ _.. _ ......___ 1. Name <I Decedem (First, mddle, last, sullix) 2. Sex 3. Social Security Number 4. Dale of Death (Monty, day, year) Gladys M. Cox female 204 - 03 - 5148 Se tember 19, 2008 i Age (Lass BiMtlayt Untler I year Under 1 day 6. Date el Binh (Month, day, year) 7. Birthplace (C)ry entl slate or foreign country) 8a. Place of Deam (Check only one! 89 xlonrns Days Hours Min~ilea HOSpilal: Dlhel: vra. June 15, 1919 Harrisburg, PA ^Inpalient ^ER; Outpatient ^DOA Nursing Home ^Residence ^Other-Speciy: Bu. County of Dealn dc. Gry, Boro, Twp. of Death fid. Facility Name (II not Inshtuhon, give street entl number) 9. Was Decedent of Hispanic Origin? ~ No ^ Ves 10. Race: American Intlian, Black, White, etc. Cumberland Cam Hill ManorCare Ill yes, specify Cl.ban. (Spe<iry) Mexman,Pee"°Ri<an,el<.) ' white I7. Decedent s Usual Occu Don IKinO of work done Bunn most of workin tile. Do not slate reared 12. Was Decedent ever In the 13. Decedent's Etluwlion (Specity only highest grade completed) 14. Marital Slalus: Marrietl. Never Married, I5. Survrving Spouse (11 wile, give maiden name) Kmd of Worx Nand of Business! Industry U.S. Armed Fo r ce s? Elementary 1 Secondary (0-72) College (1-4 or 5+) WidO~wed, Divorced (Specilyp homemaker N/A r y I ^vea ICJNn widowed 16. Decedent's Marling Atldress (SVeel, city r town, stale, rip code) Decetlenl's DiA Decedent PA 1700 Market S t . Actual Residence 17a. Stale Live in a 1R. ^ vas. Decedent Lived in Twp, Camp Hill, PA 17011 y 17b. Count Cumberland T°"'oship? n<~ Nn,DecedentL"edwdhm Cam Hill p Actual Limits of City I Boro 18. Father's Name (Fuel middle, last, sutlix) 19. MolOeis Name (Frei mitltlle, maitlen surname) Samuel H. Zeiders Glad s M. Barton 20a. Inlormanl's Name (Type / Print) ZOb. Inlormanl's Mailing Address (Shea!, city I lawn, state, zip code) Dorothy Bell 2151 Meadowsweet Lane Streetsboro OH 44241 21 a. Method of Disposition ~ Cremation ^ Donation 21 b. Dale of Dlsposiuon (Month, day, year) 21c Place of Dlsposifion (Name of cemetery, crematory or alter place) 210. Location (City I town state zip code) , , ^ Burial ^ Removal from State ~ Was Crematicn or Donation Authorized ^ aher-specry~ ! by MicalE:aminer/Coroner? p'Yaa^r,o Se tember 22, 200 Hoover F.H. & Cremator Inc H i b P 22a. Sgnature of neral Service Licensee (or acting as such) 22b. License Number . . arr s ur A 17112 22c. Name entl Address of Facility " ~ FD 013902-L Hoover Funeral Home Complete Items 23ac on n cenipkrg physician is rid available al Ume of death to 23a. To the f my knowledge, tlealn occurretl al the hme, dale aM place slated. (Signa ~"-' ture entl title) 23b. License Number 23c. Date Signed (Month, day, year) ceNhy cause d death _ ~ / ~ ~ ~ s Q hems 24.26 must be completed by person 'L4. Time of Death 25. Dale Pronourlcetl Dead (Month, tlay, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donaton? wM prmounces death. ~ f, M ~ C Q ^ Yes Q No CAUSE OF DEATH (See instructions an exam es) r Approximate Interval. Item 27. Pan I: Enter the chain of events - tliseases, inryries, ar canpicalions -that direNy caused Ilre death. DO NOT a ter ermine! even such as cardiac anesl, t Onset to Death n 1 Pan II: Enter other Sjrylf I c°ndt ~ I b t'no 1 de M, b t not Wd i th 26. Dk Tobaan Use Contribute ro Death? - respiratory arrest, or venfri<ular tibnltation 'trout show the fi .List onl ig4 oN ]y y one ca eon each lire. t u res ng n e untlerlying Cause given le Pan I. ^ Yes ^ Probably IMMEDIATE CAUSE IFlnal tlisease or t //~` • r ^ No ^ Unknown caMiliat resulting rn death) _' a ~~ • r'~ , 29. II Female: Due l0 (or as a consequence ol). ^ Not pregnant wthin past year Sequenlialhy hsl arditians, if any, 0 ^ Pre nant at lime of de M lea0uq to dre cause hste0 on line a. g a Due to Enter the UNDERLYING CAUSE for as a consequence oN: ^ Not pregnant, hul pregnant within 42 days (disease or injury That iniliatetl me events resuking in tlealh) LAST. °' D ' d tlealn ue to (o as a consequence ol): ^ Not pre~lam, bM pregnant 43 days to 1 year d. ^ bUenfk mown pregnant wilhln the past year 30a. Was an Autopsy Pedormed? 3UD. Were Autopsy Findings Available Prior le Completion 31. Manner of Death 32a. Date of Injury (Mon th, tlay, year) 320. Describe How Injury Occurretl 32c. Place of Injury: Home, Farm, Street, Factory, of Cause of Deatn? Natural ^ Homkide Ogice BuilOirg, etc. (SpeciryJ ^ Yes ^ N ^ Yes n Nv ^ AcciOem ^ Pending Invesligalion 32tl. Time of Injury 32e. Injury at Work? 321. II Transporlalion Injury (Spectty) 32g. Location of hjury (Street, my I town, stile) ^ Suinde ^ Could Not be Determine0 ^ Yes ^ No ^ Dmer I Operalw ^ Passenger ^Pede:anan M ^Dmer- Speaty~ 33a. Cenrtier (check only one) 330. Signature and Title of C • Cenirying ptryalclan IPhyvcan certifying cause al tlealh when another physician nas pronounced death and completed hem 23) Te the best of my knowledge, tlealh oc<urred due to the <9usels) and manner as slatad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronouncing and reniryin h sician (Ph sicizn b rn i d h d i _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ g p y y o pronounc ng eat an cert fying to cause o1 tlealh) To the best of my knowledge, tlealh o<curred at the time, date, and place, and tlue to the causeta) and manner a staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c Lie N ber• ~ ~ 3 ale 5 tl Ih, tla ary, ~ r • Medical Examiner/Coroner ~ ~ On the basis o1 examinalionand / or investigation, in my opinion, death occurred al the lime, date, and place, and due fs th e cause(s) end manner as s1alM_ ^ 7 ~ N ame and A ass I Pers Who Cnmpleled Cause of Deatry (Item 27) Type Print 35. Registrar's Sgn rid District 'pe m ~ ~/L~"`^~ ~^.T / ~esC~ ~ ~I ~ ~ 1 ~ 36-Dale Filed (Month, tlay, ye~pJr) - ~~~1 ~ l ~ - ~ , ~ f /~ ~" "~'- / • ,v A(l , p 0 ~v~IC/V l 1 Uisposhion Permit No. ~~~ 1 X y,o _J J ~ \' 008826-00001 /1.29.99/) RD/MAM/118939.1 +rtts# mill ttn~ ~p~#ttmEnt of (Rlttd~~ Ali. C~ln~ I, GLADYS M. COX, of East Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I direct that all my legal debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expenses of the administration of my estate. II. I bequeath my household goods and personal effects and other tangible personalty of a like nature (not including cash or securities), together with any existing insurance thereof, to my son, WARREN LEROY COX, and my grandchildren, DOROTHY A. BELL, DAVID L. COMFORT, CHERYL L. GODSEY, KENNETH E. COMFORT, VIRGIL L. BEASTON, VICKY L. WOOD, LAURA K. McMILLAN and TARA J. TAYLOR, to be divided among them by my Executrix with due regard for their personal preferences, in as nearly equal shares as practical. III. I devise and bequeath the residue of my estate of every nature and wherever situate as follows: A. One-third (1/3) thereof to my son, WARREN LEROY COX. 008826-00001 / 1.29.99/J R D/MAM/ 118939.1 B. One-third (1/3) thereof, in equal shares, to my grandchildren, VIRGIL L. BEASTON, VICKY L. WOOD, LAURA K. McMILLAN and TARA J. TAYLOR. In the event that any of my grandchildren, VIRGIL L. BEASTON, VICKY L. WOOD, LAURA K. McMILLAN or TARA J. TAYLOR, shall predecease me, I devise and bequeath his or her share to his or her then living issue, per stirpes, and in default of any such issue, his or her share shall be added to the share or shares of the surviving grandchildren or the then living issue, per stirpes. of a deceased grandchild or grandchildren, as applicable. C. One-third (1/3) thereof, in equal s~~ares, to my grandchildren, DOROTHY A. BELL, DAVID L. COMFORT, CHERYL L. GODSEY and KENNETH E. COMFORT. In the event that any of my grandchildren, DOROTHY A. BELL, DAVID L. COMFORT, CHERYL L. GODSEY or KENNETH E. COMFORT, shall predecease me, I devise and bequeath his or her share to his or her then living issue, per stirpes, and in default of any such issue, his or her share shall be added to the share or shares of the surviving grandchildren or the then living issue, per stirpes. of a deceased grandchild or grandchildren, as applicable. IV. Should any of my issue entitled to a share of my estate not have attained the age of twenty-three (23) years at the time of distribution to him or her, I devise and bequeath the share of each such issue to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of Harrisburg, Pennsylvania, IN SEPARATE TRUST, to hold, manage, invest and reinvest the share so received, and any accumulation of income thereon, and to use and apply the income and principal or so much thereof as, in Trustee's sole and absolute discretion, may be necessary or appropriate for such issue's support or education (including trade schoal and college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support or education, or to make payments for these purposes, without further responsibility, to such issue or to such issue's parent or to any person taking care of such issue. Any principal or income not so applied shall be distributed to such issue absolutely when he or she attains the age of twenty-three (23) years. If he or she dies before attaining the age of twenty-three (23) years, the Trust shall terminate and such share shall be distributed to his or her personal representative. 2 008826-00001 /1.29.99/) RD/MAM/118939.1 V. I direct that the interest of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. VI. I direct that all taxes that may be assessed in consequence of my death, of whatever nature or by whatever jurisdiction imposed, shall be paid out of my residuary estate as a part of the expense of the administration of my estate. VII. I appoint my granddaughter, DOROTHY A. BELL, Executrix of this, my last Will. Should my granddaughter, DOROTHY A BELL, fail to qualify or cease to act as Executrix, I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of Harrisburg, Pennsylvania, Executor of this, my last Will. VIII. I direct that my Executrix and Trustee, and their successors, shall not be required to post bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of M .~,~R. , 1999. J.~ . c;.- G L~-LYS M. OX Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto sul ' 3 008826-00001 /1.29.99/JRD/MAM/118939.1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: I, GLADYS M. COX, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. GLADYS M. COX ~- S orn or of o and acknowledged before me, by GLADYS M. COX, the Testatrix, this ~ day of , ~ ggg. \ ` ' ~\ Notary Public -- GiR.~P•~E~ I_E~;i~, ~~~o1~`y P~~lic L~~t7c~,ry~ i~~arourh C~z~i~iarland Co. P~I~ C~ rr~r~~issian Exlir~:s f~ec. 21, 2001 4 008826-00001 /3.9.99/JRD/MAM/118939.1 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, ~ ~~~~_ and~t~c~•~.~.~. ~~ .-v~~c-._ ~, the witnesses whose names are signed to the foregoing instrument, being duly qualified acc ding to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that 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 that time at least 18 years of age, of sound mind and under no constraint or undue influence. ' Sworn affirmed to n subscribed to before me by t ~if; l ~ and LE ~ ,witnesses this ay of , 1999. ~v~~ Notary Public NOTi^~d~lr^,L SEAL 5 QIANI'JE LI=hlIG, No!,~r~r Public Lemavne Oor~ugh C~an~i~nrland Co. t~iy Commissi~ ,r; Evpires ~Jcc. ~'1, 2001