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HomeMy WebLinkAbout11-14-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CumB ~~~ D COUNTY, PENNSYLVANIA Estate of ~~~~(~J ~~~~~ ~~W~ also known as Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMP'LETE' 'A' ar 'R' BEI,OW.•) File Number ~ ~ ~ ~ ~ ~ ~ ~ Social Security Number J ~~ ~ (J~" D O 1 /,~_ A. Probate and Grant of Letters 'T stamentary and aver that Petitioner(s) is ~ are the ast Wi11 of the Decedent dated ~ 3 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 oT the instrument(s) offered r,,r .,,-„t~~~rv ~,a not the victim of a killin and was never ad~udicated an Inca acitated rson: ,,..,..w..... g J P Pe ~, SGrantoflettersofAdministration .`"-i~~ ~G~~"' r) 3t`~J ~~~~~~~nb~ ~I~s/t~~ ~S CxE?Ctl""t (If applicable, enter: c. t. a.; d.b.n.at.a.r pendente Zlte,~ c~urante absentia; durante minoritate) N Petitioner(s) afrer a proper search has -have ascertained that Decedent left uo Will and was survived by the fojlo~iug~cxtse (if any j~d heirs: (If ; ~Iabrtirzistration, c.t.n ordb.rt.c.tct., ereteru(ctteofl~'illinSectianAabaveartdcomple[elistofheir.~J S~~L' ~j~G Ot,U:.'_r~ ~~ ___ C Name Relaticroshi Residenvo' !~ s:;. k_ i _.... - -- rti -- .. y. ~ .. (COMPLETE WALL C.ASES:) Attach addttiona[sheels if necessary. named in the _~ AIJ _~ -'t Pennsyh ania with his % her Iast principal residence at Decedent, then ~_ years of age. died on 3 ~ ~ at situated as follows: Fonn Rlt'-02 rer. 10.13.06 Decd e~~ s SPcuse~ Gtiarles F ,~acv~s o~+ed ch ~u 73 ?4G'I. /~ 1 {.e a (+~rn,~'~ eKecv~rX~ YaCe~+ e S~wbs /~s fined ~ env c`ra~ .n ~vGr o~l°~~~nP-l, ~~ecede~- H~ nef der riedf t-~r dog S~ie ~e s; I; for ~ I~r 1 ~ o~ -~-~----he. Pe~~i~'-u- ~ the o~c~v`~lte~ u~>~~e~e~~ fhe Qen~a~~i~a, Page 1 of 2 .~ Decedent at death owned property with estimated values as follows: ~j (If domiciled in PA) All personal property $ ~ b ~ f~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Pers<~na] property in County S Value of real estate in Pennsylvania 5 Wherefore, Petitioner(s) respectfully regaest(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 widetsianed: Oath of Personal Representative COMMON'WEAI,TH OF PENNSYhVANIA COLJN"I'Y OF CU m g~ I,~-/~J D 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 representatives} of the Decedent, Petitioner(s) will well and truly ad~::i::ister the estate according to Iaw. /~ _ ~ Sworn to ~r a:firmed and subscribed , t%'ti ~-~ ~ ~-~~~Ca---~~ % Li Signature of Personal Representative / / iv More me the day of ~ ~ ~~ry /1~~-/ O ~ _ _ ~..~~~L~~>1 tom(' r ~~~ Signature of Personal Representative ~- ~.~ f ~ '~ ~ "~„ _ ~~'-fir ~ `' 1~ or llle ReglsteT Signature of Personal Representative ' -' ` _ ,`>_-~, - Fite/~N4u'mber: /' Estate of _ 17N~/~E~~'~~] j~L,~~~~~ ,Deceased Social Security Number: ~ - I ~ ~V l ~ ~ ~ ~ / Date of Death: AND NOW, /""~ ~ JC/Y) ,~/ ~` --~-' ~ consideration of the &~regoing Petition, satisfactory proof having been presented before me, IT IS C~ED that Letters IGS Q ~ are hereby granted to _~ j /~_~ (g~ JGn d and that the instrument(s) dated 1 ~ ~ 3 ~ g~ described in the Petition be admitted to probate and tiled of FEES Letters .....J~C,(.~'`.c>_ ~ ~~`l~ Short Certificate(s) .. ~... . $ ~ ~ Kemuaciation(s) .... ~ .... . $ Jr' ~`~A~3Z.' .. . $ J ... $ .$ ~roTAL .............. ~ `kala' -e-ee-' as the last Wiil (hand Codicil(s)) Attorney Signature: in the above estate Attorney Name: rl-~~j/l/IL~/~ J ~ r~~~j Supreme Court I.D. No.: ~ / ~ ~~ ' Address: l /Q ~ IV, t~G4? ~~.J~ Sr ~"~ ,~i~i,`~~/~y ~ f~ /~/DZ Telephone: G71 ~~nz3 ~ 313 F'orrn RGi'-02 rev. 10.13.06 p~g0 2 of 7 LOCAL REGISTRi4R'S CERTI~IC~4TION 01= DE~,T>°I WARNING: it is illegal to duplicate this copy by photostat or ptlotographa. Fee Yor thi, c~.lti~ll~ate, `~i~,fl(i _ P_ 14±~09~~7----- Grtificata~n '`~I_unh~r Ih(t lc (;~ l~ft!ly. if (~-t rttCtTl tUirl' Ii ic' 7\C11 :~ ~~^ LSH OF p ~ ~ -~ - i+~~,A,_- f~%~ ~<Itr~'c~tlr ~("I?{ec] i f ~~)~ " ,ft):i1 ~ utu;~ t,cs tti f~Lath ,;l - ©~% ~ ~'J'~' ` tjLlc t1lc(1 y.~1th ? u (. ;_t t~ ~~~ 7 ,-'. lI7C <yCl tl:~li ~ fGi\` ~. ~yt °.'PI Ill~tiif J~III i~ iiffV4 I_''.I if I'iC ~t.ll.' tilLal ~ °; ~~ai Rc, )•.is (}If~c~ ' ,i )? Ll t fit{{~ ~` f„~:- , 1.(7~1i I2.c~i~ilal {?tat 1,~.!,~~d C7 ° r.~ -, ~ c'a° -- ~7 ~ - _t7 -I_.7 (R"~ _ ~ - '-- {.__ ._-- _ •~" -. ~~ _ ~ T -, _~ :i --i ' ~ . . -;;7. C.J -- , G7? lEV ttrzoos 'RINT IN ANENT K INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~ , ~~ i `~ (See instructions and examples on reverse) STATE FILE NUMBER r 1. Name of Decedent (First. mitlclle, last, sudix) 2. sex 3. Social Secwtry Number 4. Date °f Death (Month, tlay, year) An e:1a Hull Jacobs female 199-07 •6097 ov.3,2008 5. Age (Last Birthtlay) Under 1 year UrMer t day 6. Dale of Birth (Month, day, year) 7. Blnhplace (City antl state or loreign country) ea. Place of Death (Check only one) gg """'"' °'"' "~"' MI""~ July 31,1919 Long Island, N. Y. "OSpilal otn°" yrs g] Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Residence ^Omer - Speciy. Bb. County of Death Ik. City, Boro, Twp. of Death Bd. Facility Name (If not institution, give street antl number) 9. Was Decedent of Hispanic Origin? ~] No ^Ves 10. Race. American Indian, Black, White, etc. Cumberland E. Pennsboro Hol S irit Hos Y P P - muse, specify Cuban, Mexiqan, Ppenp Riwn etc.) (sperlly~ 11. Decedent's Usual Ikcu tbn Kintl of work d one d uri nrosl of worki life, Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade compl eted) 14. Marital SIaWS: Married, Never Married, 15. Surviving Spo use (If wife, give maiden name] Kind of Work Kind of Business I Industry U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Specil)9 home maker ^Yea ~,° 16 idowed 16. Decedent's Mailing Address (Street, city /town, state, zip code) Decedent's Did Decedent P A use in a , 7p Decedent Lived in Lower A 11 e n Tw (~ vea St A t l R id f 7 t 2 0 S O u t h 3 9th .S t. , . p. c es ence a. a e ua low"ship? t 7d. ^ N°. Decedem Lived within „bcpdnryCumberland Cam Hill PA 17011 Adaalum@spf city/B°m 18. Father's Name (First, middle, last, suffix) 19. Mother's Name (Rrs6 middle, maiden sumeme) Horace Hull Ruby Spaulding ZOa. Informant's Name (Type I Pnnq 20b. Informant's Mailing Address (Street dry /town, state, zip code) Ms. Alice J. Catalano 20 South 39th St. Cam Hill PA 17011 , 21a. Method of Dispositron ^ Cremation ^ Donation 21b. Date of Dlsposdwn (Montq day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 tl. Location (City I lawn. state, zip code) g] Burial ^ Removal from State Was CremationarponationAuthorized ' ov. 7, 2008 Indiantown Gap National Cem Annville, PA ^ Other ~ Speciy: Medical Examiner! Coroner? ^ Yes ^ N° 22a. Sign re of u rat Service Lic or pe ling as such) 22b. License Number 22c. Name aM Address of Facility 324 Hummel Ave. Lemoyne PA Musselman FH&CS Inc ~`~,;~,~,,,` ,,• 011248 L , . + Complete Hems 23ac onty when certifying 23a. To the W my knowledge, death occuned et the lime, date end place staled. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year) physician is not available at lime of death to cemry cause of deem. Items 24-26 must be compleab by parson 24. Time of Death v ~ 25. Date Pronounced Dead (Month, day, year) ~ ~ ~ ~ 26. Was Case Referred fo Medical Examiner /Coroner for a Reason Other than Cremation or Donation? who Prorrounces Oeeth. ~ ~ ~ '~ t ~ v M. ~ ~ ~~ ~ C~y ~ ~ ~ r~ ^Ves ~No CAUSE OF DEATH (See Instructions end examples) r Approximate interval, Pad II: Enter Omer 5jgll'ficant contlNOns cpnldbutinq to death, 28. Did Tobacco Use Conlnbute to Death? Item 27. Pan P. Enter Me q~jn of events -diseases, Injuries, or complications -that directly caused the death. DO NOT solar terminal events such as cardiac arrest, r Onset to Death but not resultng In tie underlying cause given in Pan L ^ Yes ^ Prohabty respiratory arrest or ventricular hhdlla6on without showing Me tblog/y//fist o49,+ry one cause on each line. i ^ No ^ Unknown IMMEDIATE CAUSE (Foal disease or t ~ // 11 ^ i wrd'NOn resulting in death) a (~ (,) (~ ~ ~ s 1 ~ -•G ~ 29. If Female: ^ r Due tp (or as a copse rice of): r ` O ~ x~ r SequeMialry list coMitions, ti any, n, (~ Not pregnant within pest year ^ Pregnant of time of death leatl~rg to the cause listed ar line a. Due to (or~ a consequence ot1: ' UNDERLYING CAUSE ~ E U ^ Nat pregnant, but pregnant within 42 days e mer (disease or 1Mury that loNiatsd the ~ c of death events resuaing In deem) L4,ST. Due to (or as a consequence ot): r Not aril, but ant 43 tla s to t ear ^ pregn pregn y y d haters death ^ Unknown if pregnant within the past year . 30a. Wes an ANOpsy 3(W. Were Autopsy Findings 31. Manner of Death 32e. Date of Injury (Month, tlay, year) 32b. Describe How Injury Occurtad 32c. Place of Injury: Home, Fartn, Street Factory. Performed? Available Prior to Completion of Cause of Death? ~ Natural ^ Hom'icide Office Building, etc. (Specify) ^ Accident ^ Pendirg Investigation 32d. Time of Injury 32e. Injury at Wotk? 321.11 Transportatbn Injury (Speciy) 32g. Locaton of Injury (Street, city I town, state) ^ Yes ~ No ^ Yes ^ No - ^ SuiclUe ^ Could Not be Determined ^ Yes ^ No ^ Driver /Operator ^ Passenger ^P M ^Other- Speciy: 33a. Cenifier (check only oi>e) 33b. Signature and Title of Cenifler • Cenltying physh:ian (Physician cenirying cause of death when another physician has pronpunced death and completed Item 23) death xcurred due to Me cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ To the best o1 my knowledge ' , • Pranoundng and certltying physldan (Physician both pronouncing death and cenitying to reuse of death) To the best of my knowledge, death occurred at the time, date, end place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c, License Number 33d. Date Signed 1 onth, day, ea0 ('t )~ , 1;~ / 4'.,~ 1 1 ~ `,+ S U ~ 1 -1 4i J' I • Medical Examin+yCdroner On the basis of examination and I or investigation, in my opinion, death occurred at the time, date, antl place, end due to the causes{and manner as srakd_ ^ / yb Nam and Atltlress of Person Who Completed Cause or Death (Item 27) Type r Pi,m , ~ ~ ~ ~ 35. e t rs Slgnatu~ Nu / ~ / / ^ ~~ ~I I~ I I I 36. Dare He0 (Month, daY. Y~r) r ~<,e)! ~ i)7 y 7 '~ ~ ~ ~'-~''- ) ~ 4- v _ it ~ ~ M, .~-, I ,/ 06 OOH' ~~' r,G ~ Y~, _~l Cc:r-r ~-ll( ~ 17~ ( Diseosition Permit No. ~~ V ~ •., U N re.a _ _ r~ : i 7 ~ 7 _ _ t ~ 1~, LAST WILL AND TESTAMENT OF `~ ~ ~' :':~ .. ANGELA HULL JACOBS :~--' ~~ -- - ix? I, ANGELA HULL JACOBS, of the Borough of Camp Hill, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind and of full age, do make, publish and declare this as and for my Last Will and Testament, hereby ~' revoking any and all Wills or Codicils thereto by me at any time ~ heretofore made. ~~Jyy .J ITEM _I I direct that all my just debts and funeral expenses be ~° ~ paid by my Executor as soon after my decease as may be V conveniently done. \''` ,~ ;V ;~~ ITEM II I direct that I be interred at Indiantown Gap National Cemetery in Annville, Lebanon County, Pennsylvania. ITEM III All the rest, residue and remainder of my estate, of -1- whatever kind and nature, I give, devise and bequeath unto my beloved husband, CHARLES E. JACOBS. In the event that my said husband shall predecease me or shall not have survived me by at least thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate to my daughters, ALICE J. CATALANO and VALERIE JACOBS RYAN, in equal shares, per stirpes. ITEM IV In the event that my husband, CHARLES E. JACOBS, and I ;shall die simultaneously or under circumstances which make it difficult to determine which of us died first, I direct that I shall be deemed to have survived my husband and I direct further that the provisions of my said Will shall be construed upon that assumption, irrespective of any provision of law establishing a contrary presumption or requiring survivorship for a fixed period as a condition of taking property by inheritance. ITEM V I expressly direct that all principal and income of any estate or trust created hereunder shall be free and clear of_ the debts, contracts and engagements of those beneficially interested therein, and from anticipation, assignment, alienation, attachments, executions or sequestrations, by any process, legal -2- or equitable, and shall be paid over directly to the persons ntitled thereto hereunder upon their own proper receipt in writing only. ITEM VI My Executor shall have the following powers in addition t:o those vested in him by law: (a) To retain any or all of the assets of my estate; (b) To sell real and personal property for the purpose of paying my debts or making distribution or for any other purpose, at public or private sale, for cash and/or credit, without Order of Court or consent of any beneficiary; (c) To compromise claims by or against my estate without Order of Court or consent of any beneficiary; (d) To make distribution either in cash or in kind at valuations to be determined by my Executor or his successors. ITEM VI I nominate, constitute and appoint my husband, CHARLES E. JACOBS, to be the Executor of this, my Last Will and Testament. In the event of the death, resignation or inability of my said husband CHARLES E. JACBOS to serve in such capacity, I nominate, constitute and appoint my daughter, VALERIE JACOBS -3- F:YAN, to be Executrix of this, my Last Will and Testament in his ~~tead . Any successor fiduciary shall have the same powers, rights and duties which I have conferred upon the original fiduciary. •~ No fiduciary hereunder shall be required to enter :security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and ~.~,a seal this ~~ u''day of November, 1989. ;~~ ANGELA HULL JACOBS ' v :d SIGNED, SEALED, PUBLISHED and DECLARED by the ti ~*` above-named Testatrix, ANGELA HULL JACOBS, as and for her Last ~', `j Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~ ~ ,, r .~ J ~...` Address ! rI~' ~~; r"' Sri"% ~ ~> ,t^i)L;~~ 0 ~ ~ ~ .%i. ~_: -~--• f !' -G 7` r ~ 1, ~, ' d ~'.~` . ;%._ -4- ACKNOWLEDGEMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . ss COUNTY OF DAUPHIN WE, ANGELA HULL JACOBS, the Testatrix and witnesses, respectively ,; whose names are signed to the attached instrument, dated the. "~- day of November, 1989, being 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 it 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 witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ANGELA~HULL JACOBS v~ Witness `'~' % ~ Witness Subscribed, sworn to and acknowledged before me by ANGELA FIULL JACOBS, the Testatrix, and subscribed and sworn to before me by the above, her witnesses, this _`t'_ day of November, 1989. Notary Public NOTARIAL SEAL RITAW. RHOADES, NOTARYPUBLIC HARRISBURG, DAUPHIN COUNTY MY COMMISSION EXPIRES SEPT. 7,1992 Member, PennsyMania Assoaation of Notuies Register of Wills of bauphin Couhty, Pennsylvania RENUNCIATION Estate of A-~~E~~- t1 ~~ T~CO~S No. ~ ~ ®~ ~ ~ ~~ also known as ,Deceased The undersigned, ~q~efr) Q. ~~ DtCD~S ~y~Ct/1) ~~~~~~ V '1w,1~/~e~~~//l~ of (Bela Clty) the above Decedent, hereby renouncels) the right to administer t^he~est/a~te and respectfully requestls) that Leiters J Ps llil~'1 ~_. be issued to !"'f ~(~ LJ+ C~t~ f anb __ Witness ~y hand this ~~~ day of Qfr~~em ~~ ,~>~~ t ~ ,...- liti" (Sign re) /3~3=i T~`,~ ~~ti ~~~;.a,~ S:~i,% ar~ht~ c:~ ~~a~3v IAddressl _f___.-__-.___-__. fSignature- (Address) Sworn to or affirmed and subscribed befpre me thi `~~_ day of lnlotary Public _ nny Commission Expires: ~~ ~ ~ ~ ~' I:ny~rm rrrn wnd ,r ra nl Nnt wry ni nrl~«r ..11iriM y„Mai«n .,. wen.,,i,lw. nwrn. srnw nwr«.,r r. prmnw. nl Narmy'• r,.w. r,ifiunn --- (Signature) ~---------- --- _----------~-- ~'; ,_- ~:~ _ , ~_-, -_, (Address) -' --~ ~ ~` __ -.r :~ .~' - ~, NOTI1RIAl fifiRllL ~. ~„ AMAEE fl iRAt1Np ' ~~ ~Mwary flubNc = ~ ~ -i C11Y, OiAfJflf-Nfir COlifirry ~ -~' c.J MY ~.anpNMfkm NN 17, ~Ol 1 Qp NOTE: Renunciations executed outside the Olfice of Register of Wills are required in some counties to h© notarized. RW-t3 (Rvsd 9/92)