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Home My WebLink About12-05-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of CAROLYN J. EVENS also known as COUNTY, PENNSYLVANIA File Number~l - ~ ~ ' ~~ ~~ Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) tv A. Probate and Crant of Letters Testamentary and aver that Petitioner(s) is /are the CO-EXEC[JTORS ~ ° ~' ' -~ Q _R;~med itr~ltc _%_ last Will of the Decedent dated MAY 28, 2008 and codicil(s) dated N/A ~7 C7 t, _, "_, ~~ (~[ '--~~-''T _- .~ i'rt't 1 - -~i (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 th,~ ~ Strument(s~dffered=-';; .=~~-; for probate, was not the victim of a killing and was never adjudicated an incapacitated person: N/A ~ S i '~ ~ ' ' ` ~ _ --r .- B. Grant of Letters of Administration "~`~ (q applicable, enter.• c.t.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 spouse (if any) and heirs: (If Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at 230 N. 19TH STREET CAMP HILL BOROUGH CUMBERLAND COUNTY PA 17011 (Gist street address, town/city, township, county, state, zip code) Decedent, then 74 years of age, died on NOVEMBER 8, 2008 at 230 N. 19TH STRfiET, CAMP HILL, CUMBERLAND COUNTY PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 250,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County ~ Value of real estate in Pennsylvania e 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 panted name and eesidence CLIFFORD H. EVENS, III; 8 VICKSBURG CT., MEC:HANICSBURG, PA 17050 CHARLES D. EVENS, 64 N. 31ST STREET, CAMP H[LL, PA 17011 Form RW-01 rev. 10.13.06 Page 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed c.~ /n ,1 OCX 1~~~-~ " f"? c~a Signatur f Per ial Re rive - ~ ~ ~ before me thfe ~)~r ~ iF~ d~ay~of =r --~4 ~ ~ ~~ '_`„"+_' --' ij~ cam.'-~, r i Signature of Personal Representative ~ the ReglSter Signature q(Personal Representative ,` =;.~ -. <; ^I t' ~ _. ~::.t-~ ~+i File Number: ~ ~ ` ~~ `~~ Estate of CAROLYN J. EVENS ,Deceased Social Security Number: 176-26-5571 Date of Death:NOVEMBER 8, 2008 AND NOW, ~ ~• ~ ' ~ ~(~~ L - ~ L ` ,~~, in consideration of the foregoing Petition, satisfactory proof having been presented bef m , IT IS DECREED that Letters TESTAMENTARY are hereby granted to CLIFFORD H. EVENS, III and CHARLES D. EVENS in the above estate and that the instrument(s) dated MAY 28, 2008 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of De edent. n , FEES r ' Letters ............... $ "~ R ' rer of Wifls ~ ~~ j~ j'~ C' % CJ`af" Short Certificate(s) ........ $ Attorney Signature: 2u-c ~~^C-'~ Renunciation(s) .......... $ $ ~ ('~ Attorney Name: THOMAS E. FLOWER • $-~-- Supreme Court LD. No.: 83993 C ~.. $ L $ Address: SAIDIS, FLOWER & LINDSAY ' ' ' $ 2109 MAR]{ET STREET ... $ ... $ CAMP HIL PA 17011 • ~ ~ $ Telephone: (717) 737-3405 ... $ TOTAL .............. $ Form RW-0~ rev. 10.13.06 Page 2 of 2 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 14809390 Certification Number This is to certify th~it the information here given is cun-ectly copied from an original Ct:rtificate of Death duly -filed with rile as f_acal Registrar. The original certificate will be t<>rwarded to the State Vital Rec;urds Office for permanent filin~~. -~-~`~_- "~ ~~~-NOV 1 1 2 8 Local Registr,~r n ~ Date issued r0 ~ - ; r-r- '-t ~~ Q L. J .. -J iEV tvzoo6 RIN7 IN N T COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS K INK CERTIFICATE OF DEATH (See instructions and examples on reverse) 7. Name of Decedent (First middle, last, suKx) STATE FILE NUM BER Carolyn J. Evens 2. Sex 3. Social Secunry Number d. Date of Death (Month, day, year) 5. Age (Last Binhday) Under 1 year Under 1 day 6. Dale of Binh (Month day year) 7 Birth l C Female 176 - 26 = _55.71 November 8,2008 Mo,xhs Pan Hours kmuuls , , . p ap ( ity and stale or loregn country) 6a. Place of DeaM (Check only one) 74 Vrs February 3,1934 Philadelphia Pa Hospital: Other: Bb. County of Death Bc. Ci ty Borq Twp of Death ed F i ^In orie P nt ^ ER / Outpatient [DOA N ursing Home ~ Residence ^Other -Specify. Cumbe l d , , . . ac lely Name (If not inst2ukon, gWe street and number ~ S Was Decedent of Hispania Origin? (~yes speciryCuban No ^ Yes 10. Race: American Indian, Black, White, etc. r an Cam Hill P 230 N . 19th Street , , M Po P IScecM 11. Decedent's Usual lion KiM of work do ne du' most of world tile. Do not stale retired 12. Was Decedent ever in the 13. OacedenYs Education (Spec ty only hghest grade compl ez a eted ) n, uerto Rican, etc.) 14 M nl l S White Kind of WorN 0 Kind of Business I Industry U.S. Armed Forces? Elementary 1 Secondary (042) CWlege (1-4 or S•) . a a lalus: Marred, Neve Widowed, Divorced ISoeciM r Mametl, 15. Surviving Spouse (If wife, give maiden name) r amst Church ^yea ~4q 12 76. Decedent's Mailkg Address (Street, city I Town, state, zip Adel Deredent's Pa ~ ~~ 230 N .19th Street Aqual Raaidanca 17a. Slate Live in a Camp Hi 11, Pa 17011 ,7b cganN Cumberland rwnahip? 76. Father s Nana (FrsL mxldle, lest, suffix) Wallace Jones 20a Inlomtant's Name [type /Print) Clifford Evens Jr 21a. Menwd of Disposition ^ Burial ^ Removal Irom State ] Omer - ScenN~ Conglete Hems 23ac Dory when certirying ~ physidan rs rwt available at time of death to certKy cause d dey(i. ` items 24.26 mull be completed by person 24. who pronourrxs death. Cremeaon U Donalbn 21b. Date of Disposition (Month, day, yea cremation or Donation authorized NOVP_Il']be r 11 , 20 edkal Examiner /Coroner? g] yes ^ No ~ as such( 22b. license Number 22c. Name and 011654-L Myers IDe}I of my~nowledge, deem occured at he lime, date aM~lace state (Sgnature ann~ title) 25. Date Pl~ncetl Dea0 th, day, 17c. Vns. Decedent Lived in Twp 17d. ~, Decadent Lived within amp Hl A:tual Limits of City I Boro r) 21 c. Place of Disposition (Name of cemetery, crematory or other plats) 27d. Location (City /Town, slate, zip code) Address of Facility 79. Mother's Name (First, middle, maiden surname) Helen Stobbe 20b. InhxmanYS Mtiling Address (Street, city /town, stale, zip code) 230 N.19th Street Camp Hill, Pa 17011 0 Hollinger Crematory Mt Holly Springs, Pa -Horner Funeral Home Inc 1903 Market St Cam Hill Pa 17011 23b. License Number 23c. Date Si red (Month, day, year) 26. Was Case Relenec,to Medical Examiner r Coroner fora earson Other men Cremation or Donation? ^Ves IJo l:AVSE OF DEATH (See inetructlons alSd examples) t Approximate Interval: Item 27. Pan I: Enter the their of e~=ors _ diseases, injures, or complkations - that drectly caused lbe deem. DO NOT enter terminal events such as prdiac arrest Pan II: Enter other ' S~OLftnditions pnlr dnq t deg h, 26. Did Tobago Use Conlnbute to Death? , respiratory arest, or ventricular fibrillation wimoul showing the etiology. Ust Doty one pose on each line. Onset to Deam but not resulting in the r ndenying cause given Pan I. ^Ves ^ Probably IMMEDUITE CAUSE (Final disease or ~ coneitbn resunirg in death) _-' a i .~ ~/ I /~D ' r ^ No ^ Unknown 1 ~ Ai ~ r Due to (or as a consequence of). J r 29. If Female: Sequeraa let condrans d any b ^ Not pregnant within pall year leading to the puce listed m line a. t Enter the UNDERLYING CAUSE Due to (or as a consequence oQ: t ^ Pregnant al time of death ~~~ ewlt rig mtd~etaM reIAST s o~ 9nam, bu! pregnant within 42 days ^ Due to (or as a consequence oU'. of tleal d ^ Not pregnant, but pregnant 43 days l0 1 year ~ b lore death 30a. Was an Autopsy P d '+ 30b. Ware Autopsy Findngs 31. Manner of Death 32a. Dale of Injury (Monm day ear) 32h D rib H e ^ U known II pregnant wimin the past year e ormed Availade Prior to Completion of Cause of Deam? ^ NaNral ^ Homicide , , y . esc e ow Injury Occuned 32c. Place of Injury: Home, Farm, Street, Factory, Onlce Building, etc (SpeciyJ ^ Ves ~ No ^Ves ^ No ^ Accident ^ Pending Investigatbn 32d. Time o/ Injury 32e. Inryry at Work? 32f. If Transportation Inryry (aryl 3:! Location f I S ^ Suicide ^ Could Nol be Determined ^ yes ^ ~ ^ Driver I Operator ^ Passenger ^ pedeslnan g. o njury ( treet, dry (town, state) 33a. Certifier (check only one) Uvv,m - oPaary 33b. Signature and T r • Certlrying phyaician (Physzian cenrying pose of tleatn when another phystaan has pronanced Death and completed Item 23) To the best of my knowledge, death occurred due to the cause(s) aM manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Pronouncing and certltying physician (Physkian born prorwuncing death aM certifying to pose of deem) To the best 01 my knowledge, deem occurced at me tame, date, and place, and due to the pose(s) arM manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Nu • Nedkal Examiner/Coroner On tbe basis of examination and I or investigation, in my opinion, death occurred at the time, dale, and place, and due to the cause(s) and manner as staled_ ^ 34. N@/~nd Aytlcasa 36. Regislr s gnature and L[9' ~ /~j 36. Dale Fiyl d(Mon day, year) % ~ / / Disposition Permit No. ~ ~~ ~~~~ &3d. Date Signet onth, ay, year) ~_/J' ~~ ,~ f ho 1 I'^~ISe 01 Death (Item 27) type /Print ~~~1 /~ LAST WILL AND TESTAMENT OF CAROLYN J. EVENS I, CAROLYN J. EVENS, of the Borough of Camp Hill, Cumberland, County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct that all my just debts, including expen~;es of my funeral and last illness, be paid from my general estate as a part of the cost of administration as soon after my death as practical. II - I make the following specific bequests: 1. The sum of $5,000 to the Harrisburg Chapter, American Guild of Organists. 2. The sum of $5,000 to St. Stephen's Episcopal Cathedral, Harrisburg, Pennsylvania for use in its music program. ~___I '-' 3. The sum of $2,000 to the Salvation Army, Harrisburg Chapter. 4. The sum of $2,000 to the Volunteers of America, Harrisburg Chapter. 5. The sum of $1,000 to the Bethesda Mission, Harrisburg, Pennsylvania. III - If my husband, Clifford. H. Evens, Jr. survives me b~, sixty (Fn) d~y~, I SAIDIS, FIAWER Sz LINDSAY ,~~.~.~W 2109 Market Street Camp Hill, PA devise and bequeath the residue of my estate of whatever nature and wherever situate unto the trustee of the Clifford H. Evens, Jr. Revocable Living Trust. IV - Should my said husband fail to survive me by sixty (60) ~ys, then~ive, ~~ devise and bequeath all the rest, residue and remainder of m f~state unto ~ Y ~ r~~~s,'ford ~ i-r ~ - H. Evens, III and Charles D. Evens, in equal shares, the share of a decea~~ to l~ paid_ ~- . to his issue, per stirpes. ~~~~_ -~ ~ -; c- ; A~ _~ ~r:,r,: -~ 1 V - All principal and income shall, until actual distribution to the beneficiary, be free of debts, contracts, alienations and anticipations of any beneficiary, and the same shall not be liable to any levy, attachments, execution or sequestration while in the possession of my executor. VI - I hereby direct that all estate, inheritance, succession and other death taxes imposed or payable by reason of my death, with interest and penalties thereon, if any, with respect to all property comprising my gross estate for death tax purposes, shall be paid out of my estate and can be considered a cost of the administration of my estate. VII - My executor may join with my husband or his personal representative or trustee in a joint income tax return covering any period of time for which an income tax return has not been filed up to the time of my death, or in a gii:t tax return on gifts made by my husband prior to my death, for which a gift tax return has riot been filed, and in connection therewith to determine what taxes, interest and penalties are proper and to pay the same even though such payment may result in additional liability to my estate. VIII - I appoint my sons, Clifford H. Evens, III and Charles D. Evens, as Co- Executors of this, my Last Will and Testament. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. 1N WITNESS WHEREOF, I have hereunto set my hand and seal on this, the SAIDIS, FLOWER ~ LINDSAY ATTORNEYS•AT•IAW 2109 Market Street Camp Hill, PA /~ o~ ~ ' day of ~"'~ 2008. ,~ a '' ~ t ~' -P~-t. (SEAL) CAR LYN .EVENS Signed, sealed, published and declared by Carolyn J. Evens, 'Testatrix therein named, as and for her Last Will and Testament in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. . ~ r ,~ Name: t~tCMfils ~. t--c.cvulE2 Name: /~ Address !y 4 _ JY~a r l~Cvf ~~ . C Address COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND SS. WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do :hereby declare to the undersigned authority that the testatrix signed and executed th~~ instrument as her Last Will and that she signed willingly (or willingly directed another to ;sign for her) and that she executed it as her free will 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 that time eighteen years of age or older, of sound mind, and under no constraint o~r undue influence. -, ~~ ~ CA OLY . EV S, Testatrix ~~/L(,1ti1 Witness Witness SAIDIS, FL:oWER ~ LINDSAY nr~owvets.nT•uw 2109 Market Street Camp Hill, PA Subscribed, sworn to and acknowledged before me by the testatrix, and subscribed and sworn to before me by both witnesses, this '^ day of 2008. Notary Public COMMC~NWEALTH OF PENNSYLVANIA Notarial Seal Yvonne Sersch, Notary Public Camp Hill Boro, Cumberland County My Commission Expires Feb. 1, 2012 Member, Pennsylvania Association of Notaries