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HomeMy WebLinkAbout10-14-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of John A. Johnson File Number __~~~' V ~ ~~~ 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.) ^X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXeCUtrlX named in the last Will of the Decedent dated 12/20/2000 and codicil(s) dated 3/09/2004 +•..y >O m (State relevant circumstances, e.g., renunciation, death of executor, etc.) , -L7 ~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution oftti Te-unen~ offef~ed for probate, was not the victim of a killing and was never adjudicated an incapacitated person: NONE ' f_~.-~ -- r~~~ B. Grant of Letters of Administration ~ v ~ ~ x" (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendentelite; duranteabsentia; duran[e~oritate) --. -_ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) 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 was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 100 Mt. Allen Drive Mechanicsburg PA 17055 Uooer Allen Township (L:st street address, town/city, township, county, state, zip code) Decedent, then 91 years of age, died on 10/9/2008 at Messiah Village 100 Mt. Allen Drive Mechanicsburg PA 17055 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 75.000.00 (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 follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Wil] and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Signature Typed or printed name and residence i ~ _ __ Cathy Clough 371 Blunk Street PI mouth MI 48170 Form RW-02 rev. 10.13.06 Page 1 of 2 (COMPLETE IN ALL CASES:J Attach additional sheets if necessary. Oath of Personal Representative .~ - - COMMONWEALTH OF PENNSYLVANIA ; t .-~ 't`t ~; ~- ~~'; ~~ SS - w;~ : ~ w COUNTY OF Cumberland 2~~8 OC t 14 ~~j The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition a~~'thid ~c~correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Deced t' i er(s) will well and truly ~,~~~ ~ administer the estate according to law. ~~; ~j-~C;1,J~ ~ ` J,~~r ~ ,., ~A Sworn to or affir~m,(e~dc.a~nd subscribed before m the ~_ day of /V~ v For the Register Signature of Personal Representative Signature of Personal Representative Signature of Personal Representative File Number: 0 Ol / - ()1S Estate of John A. Johnson ,Deceased Social Security umber: 285-10-2728 ~/~4 Date of Death: 10/9/2008 AND NOW, ~ ,~, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that LettersTESTAMENTARY are hereby granted to Cathv Clough in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and FEES G~ Letters ............................. $ Short Certificate(s) ••..•..••... $ ~ Renunciation(s) .•..•••.••• ••. $ ~.. $ .... $ _ ~ ~ .... $ .... $ .... $ .... $ .... $ TOTAL ............................. $ , Attorney Signature: of Attorney Name: David H. Stone. Esquire Supreme Court I.D. No.: 39785 Address: 414 Bridoe Street New Cumberland PA 17070 Telephone: 717-774-7435 Form RW-Ol rev. 10.13.06 Page 2 of 2 lns,¢ng 2°V rn~yn~~ ~cS - ICS 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 14808077 Certification Number REV nnoo6 PRINT IN IANENT .K INN 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 pernianent filing. ~~-~' D Is tt~(Q0Q8 n - ~O t "1-[j~ ':~: I. ~~~SL~ r i(~""Tl r jC COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~~ CERTIFICATE OF DEATH ' (See instructions and examples on reverse) sT r~ m 0 C'7 --') 0 -+J _~,. _ ( *__ ~ ' _ J C. _I - ;,., } 1. Name of Decedent (First, middle, last su6W) ATE FILE NUMRER John A. Johnson 2. Sex 3. Sadel Secunry Number 4. Date of Death (Month, day, year) male 285 - 10 /- 2728 October 9, 2008 5. Age (Leal Bkthdey) Untla 1 r Untler 1 de 6. Date al BiM (Month, de , year) 7. &nhplxe (Coy and stele a laei9n rolallly) Be. Place of Dmm (ChecN Doty one) Manes onya "".` Nxxxa 91 vre. June 16, 1917 Hpapnal: Omer: Port Clinton, OH ^Inpalienl ^ER/Oulpatbnl ^DDA Nureirp Home ^Residenp ^Olher-Specity~. ' Bb. County d Deem ek. City, Born, rwp, d Deem &. FedNty Name (N nd inatnutlon, give sheet ant mrmbal ' Cumberland Upper Allen Twp. 8. Wes pepdenl of H Ispenic Origin? ®No ^ Yes 10. Race: Amedcen Indan, Black, While, eW. ~ \ (nym,apedlycuben, (sPe~~ 11. DecetlenYa lheW kn KNd d work doro du mpt of Me. Do nd ereb re 12. Wee Decedent ever kt IM d WaN Nand d Businasa / Indmhy U.S. Amred Faces? ( t Mexican, Puerto Rican, eta) whit e 13. Decedent's Edueel Doty Ngtxsal grade rompretral) 11. Marital Satre: Married, Never Married, 15. Surviving Spouse Ilf wile, give maiden remel Aximini at-ra for/Teacher Education ®Vea ^Na Erementa12 ondary (0-12) Cortege (1-e or &) WNlowed, DNOrpd (SpeaYy) • 16. DepdeM'e McNYq Address (Street city /torn. stele, zip rode) DBpedeM'a 6 widowed 863 Oak Oval AdmlReddence na.Sae DM Decedent Pennsylvania ~ ro „p:~yq,DecedanlLivetlm ttAper Allan Mechanicsburg, PA 17055 tm c«•m' n ? Twp. _ Cumberland nd.^NO, Deprrent LNed wimp 16. Fame's Name (Feat rtiitlde, lest, auXW) Actual Limes d CNy / Boro Gust Johnson 19. Mdher's Name IRmt nlitltlle, maiden surname) ' Mary Tiari ZOa. Inkrmanl a Name (Type / Pnnl) 20b. InrertnenYa McN'mg Address ISreet city I lawn, stile, zip coda) Cath Clou h ' 219. Metlwd of Diappnion ~ ^ CremaWn ^ Donation 21b D f Di re 371 Blunk Street, P1 outh, MI 48170 . a o sposition (Month, day, year) 21c. Place d Di ® Buda) ^ Rartavel Iran Stale i Wm Crenlslbn a Danetlon AlzltarWed app6ion (Name d prnetery, crematory a other pace) 21tl. Lroatbn (City f town, stele, zip coda) October 13 ^dh s 2008 R ll er• pedly: byNel&elExaminerfComwT ^ym^Np ~ ~ , o ing Green Cemetery Lower Allen Twp., PA 17011 22a. Sipneaa¢21 Ftrgrsl __ ... ac9rq ec such) 22b. Ucenae Nlmber - - {~ "~'v"L' ~~ -'---•~-' 22c. Name and Addreea d fadly - FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland PA 17070 , Donplae Hare 23ec oMY when ceMyxp 23e. 7o me Wa d my knpaledge, dmtll occurred 91 me Woe, dare and pep creretl. (SpnaNre and title) phyeiden re ret avaee6re a dme d deem ro 23b. Llceree Number z3c. Dale sigred (MOnm, day, year) _ aemfr eve d deem. Ileme 2426 rtxrH be roniplered q' pang who DraldaNm deah. 21. Time d Deem 25. Dole P (Month, day, Yeerl 26. Was Cem Rderred to Medcsl Examiner / Cororer for a Raman Omer men CrameNOn a Donaton? M, ` ^Vea ^ No CAUSE OF DEATH (3~e Inetnretlxwle and sxampNs) r Apprpxmale mrervel: PaA II: Flea dher ' ' Item 27. Pan I: Ezner the ~jpgey6tl6 - deeeees, vyunea, a pmpNpllpa - mat dreay caeed me deem. DO NOT enter tenterel evade such m prdec anent 26. Dd Tobeceo Use Canamule re Dmm? ' raepA elory areal, a vaddcder Ndipetbn witlnul ahowmg the etlolagy. Lret only one puee p eeCll Ina. r r Oneel re Dmm bd nd reedung NI me urdenying muse pron m Pen L ^ Yes Probably W pTEC m FhmW rfaeam a (~~~ oon~tlonreWhlp~~e) -s e CiY( ' l S/ZF~ C ia C'( ~ , r ^ UNeawn . __ x . . - zr . rytyod Du ro ~'~`(~, ~ j~ ~(w~v~tc ~onnL~Iicvn~o 2s.uramare: r ~ e (a m a pnmquence oq. SePrergaNY Ibt caNtlar. M ary. b. ^ Nd wghin i .... ` pr•9r~1 P~ Ymr kedrq re tlr eelr Noted m wle e. EMa Br yNDERLYEq CAySE Due to (a m a wnaequence oQ: ~[lY{7y~C~{ rf ~lf.~.C' J ^ Pregnad et Woe a deem ~ I r.l UI YG~ . ~ntlW~Mtlsled IM c, ~ LAST. ' ^ Nd Prepnent bn pregnant wghin 42 days Due ro la m a pnaequence op: d. I d dmm i ^ Not progrialt bd pregrum N3 days to 1 year r haiore deah w 30e. Wef an Aurepey 36b. Ware Aurepry FNI&gs 31. d Daetli 32a. Dated 1 ^ Unknown n pregnerN wMn ~ ~ ref Pedarrwd? Aveirehb Prior re ConipleNOri nh"1' IMaKh, deY, Ymd 32b. DeecrWS FWw cowry Occurratl of Coup d Dmm? Nelural ^ Morrecide ~,[/ 32c. Plop d Injwy: Houle, Fenn. Sraa, faddy, OMp Bui IdMlg, etc. (Sperry) ~ ^ Yea I~ ~ ^ Vas ~o ^ Aaddent ^ PeMmg Irrvegtigalion 32d. Tirre d Injury 32e. Injury a Work1 321. II Trenepaladon Injury (SVedhl 32g. Localbn of Injury (Brea. coy' / Mm, steel - ^ Suicide ^ Codtl Nd be Delennined ^Vea ^ No ^ DrNer / Opereta ^ Pmaengar ^Petleemen 33a. CatWer (umetlc only ore) M Oma ' ' GrehNq phytkren (Phyaiden prolYnO ppe d tleem when anrNher pnyeicren hea pronounced tleath and To the best d ~ aarpreletl Hem 23) my Nnowreege, dean orxxend dp to the oeu a) ant manner n arered_ _ _ _ _ - . Sigiade True of Certllrer - ~~ G ' ' _ _ ' Pzaletlndrq ~ uRNyIM Dhyektarl (Phywan born prorqundng deem and certllyYlg re pose d deem) - - - - - - /(~i~~ (..~ - - - - - - - - - - - - - - - - % !w'~~~ / Te tlN beat of my hnowredgs, dMlh oecunW a the tlrre, deb, end pop, eM dp to me puae(s) and manner es etared_ 33c. Licenp Number 33tl, Date Signetl (MOnm, day. ymr) _ _ -- _ _ _ _ - - ^ -, M.dkalEx.mh»r/Dererer ------ ~ ~ a sµ~ ~ ro _ 9 _a ~~~ On the heB o/ a:amhutlon eM / a InveaOgetbn, in my apinlon, dmth occurrW st tlM thee, dare, sod plop, and are ro IM prue(a) end mamla m sle0ed_ ^ R re ~ ° ~ 31. NemepM Addreaa o~ reon Wtyo fcomple,9zdad ~p~ m (Item 27) Type /Pant 3s. Dare (Madh, , rmo - ' , I / I / I ~ I I / V MT ~G // y t/ E i- /O / ~ Y , Cr0 / J~CH'~YNlCSBuA~G ~ "~vSj / Dieprxsllion Permit Na. \ OZ~i oC) ~~ II. ep\wills\johnson.ja\12-00 _ _ i ©$ • (c~~ C~ ~ _ ; _`= LAST WILL AND TESTAMENT _ OF `' ~'~' ~„ _ _ .a JOHN A . JOHNSON ' . '~ `~ ~ ±~_~ -t Y.__ __ ~~ ~ ", ~~ I, JOHN A. JOHNSON, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all other wills previously made by me. ITEM I: I direct that my Executrix, hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I hereby give and bequeath the sum of One Thousand Five Hundred Dollars ($1,500.00) unto the MESSIAH VILLAGE ENDOWMENT FUND at Messiah Village in Cumberland County, Pennsylvania. ITEM III: All the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give and bequeath as f.o7_lcaws: A. Twenty-five per cent (25%) unto my late wife's niece, PHYLLIS STIERSTORFER, if she survives me. B. Thirty per cent (30%) unto ST. PAUL'S LUTHERAN CHURCH in New Cumberland, Pennsylvania. Page 1 of 5 II r C. Five per cent (5%) unto my nephew, BRAD BEHRMAN, or if he does not survive me, then unto his issues in equal shares, per stirpes. D. Twenty-five per cent (25%) unto my niece, CATHY CLOUGH, or if she does unto survive me, then unto her issue in equal shares, per stirpes. E. Five per cent (5%) unto my sister, EDNA BEHRMAN, or if she does not survive me, then unto her issue in equal shares, per stirpes. F. Five per cent (5%) unto my nephew, MARK JOHNSON, or if he does not survive me, then unto his issue in equal shares, per stirpes. G. Five per cent (5%) unto my nephew, JAMES JOHNSON, or if he does not survive me, then unto his issue in equal shares, per stirpes. ITEM IV: All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, together with any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid from my residuary estate without apportionment or right of reimbursement. Page 2 of 5 ITEM V: I hereby nominate, constitute and appoint PHYLLIS STIERSTORFER Executrix of this my last will. Should PHYLLIS STIERSTORFER fail to qualify or cease to act as Executrix, I appoint my niece, CATHY CLOUGH, Executrix of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I, JOHN A. JOHNSON, have hereunto set my hand and seal this ZC~ day of ~Cnn.~9.. 2000. JOH JOHNSON SIGNED, SEALED, PUBLISHED and DECLARED by JOHN A. JOHNSON, the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request, in his presence and in the pres ce of eac o her, have subscribed our names as witnesses. 'tnes v Address ` /~~~e~''Iyiyt.G(.IiJ')- /`f~~~G~rL~3 ~ii ~~!-g'7 .4 //~ Witness Address Page 3 of 5 COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) I, JOHN A. JOHNSON, the Testator 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 this instru- ment as my Last Will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. JOHN A. J NSON Sworn to or affirmed to and acknowledged before me by JOHN A. JOHNSON, the Testator, this o~Q~'~ day of /_~~~ifr~T~=,~ 2000. ~-~~ otary Public NOTARiAt. B~A~. GERALD J.6H~Iq.~T'BK{ Nit Public ~~~ COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We , t l ~ .~ and ~~~et. ~ • /~ ~ ~c-Qt~r~r ~, the witnesses, whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say Page 4 of 5 that we were present and saw Testator sign and execute the instrument as his Last Will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at the time eighteen years of age or more, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by __ (i ~P ~ •, -..~~~_ and ~Dh ri~ ~7~D~7~-l_~iu~- witnesses, this __`~ day of 2000. Notary Public ~~~ OTARIAL SEAL J ConMt~~ ~' ~~Pt~bilC ab- ts~lon 6cpkes Nov a2002~ Page 5 of 5 ep\wills\JOHNSONjohnCODICIL ~~- cc~~ CODICIL TO THE LAST WILL AND TESTAMENT OF JOHN A. JOHNSON 4 I, JOHN A. JOHNSON, of Upper Allen Township, Cumberland County, and Commonwealth of Pennsylvania, declare this to be the Sole Codicil to my Last Will and Testament dated December 20, 2000. ITEM I: I hereby revoke Item V of my Last Will and Testament and in its place there shall be a new Item V which shall provide as follows: "Item V. I hereby nominate, constitute and appoint my niece, CATHY CLOUGH, Executrix of this my last will." ITEM II: In all other respects I hereby ratify, confirm and republish my Last Will and Testament dated December 20, 2000, together with this my sole codicil. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of ~~~~ 2004. ~.o 0 _ ~-- `` :,~ ~:'- l •¢ ~ - CO ~ ' JOHN A . J NSON ~' i..LJ - ~., _7 -~. U ~~~: ~J ~ 4:' ~ ~ 1 ~ ~7 C'y Page 1 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by JOHN A. JOHNSON, the Testator above named, as and for a Sole Codicil to his Last Will and Testament, and in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses. Wit ~ Address Witne Q . A dress COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) I, JOHN A. JOHNSON, the Testator 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 this instru- ment as a Codicil to my Last Will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. i JOHN A . JO ~ S ON Sworn to or affirmed to and acknowledged before me by JOHN A. JOHNSON, the Testator, this ~~ day of~~\~~\`QS~ 2004. -.:~.. CARQI NOTAR-q~ gE,q~ Notary Public ~ TR4XEtl, Nola New Cum6eriand Boro. Ctxr-berland Co. Page 2 o f 3 MY Commission Expires Dec. 27', 2005 COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, ,,. ~. _~,~ and /~1 c~ ~-r ~2 ~ 6.-u c j°C e v the witnesses, whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as a Sole Codicil to his Last Will and Testament; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at the time eighteen years of age or more, of sound mind and under no cons t or undue influence. ~~ Sworn or affirmed to and subscribed to before me by ~,1.rxri i n ~ --rTt~..r~ and ~ ~ . ~ t-e C ~, witnesses, this ~_ day of~^\~~\~p~(C~ 2004. NOTARIAL SEAL CAROL 1. TROXELL, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, 2005 ,.ti Notary Public Page 3 of 3