HomeMy WebLinkAbout12-05-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of DONALD E. MARTIN
also known as DONALD E. MARTIN
COUNTY., PENNSYLVANIA
File Number, ~) ~J ~, ~1 ~i
Deceased Social Security Number
Petitioner(s), who 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
last Will of the Decedent dated ~ ^ ~5 '~ ~ and codicil(s) dated
m -~ _
f~"1 ,_, ~~ ; _ ,
~ - .:
~~ a
CIl 1 ' _~
~ .~~
'sue c~ ~ -. .
(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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(If applicable, enter.• c.t.a.; db.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. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Name
LINDA M. HARTLEY DAUGHTER 101 WILSON LANE, NEW BLOOMFIELD, PA 17066
ELAINE M. PHILLIPS DAUGHTER 68 PHILLIPS LANE, FORKSVILLE, PA 18616
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at
128 WEST WILLOW ST. CARLISLE PA 17013
(List street address, town/ciry, township, county, state, zip code)
Decedent, then 95 years of age, died on 11/26/2008 at CARLISLE REGIONAL MEDICAL CENTER
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 follows:
$ ~51v151~p ,
Wherefore, Petitioner(s) respectfully request(s) the probate of the last WiII and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Tn SignatuYe Typed or printed name and residence
~'`~~~~ `~ ~/ ~ ~ I LINDA M. HARTLEY 101 WILSON LANE, NEW BLOOMFIELD PA 17066
_ ~ °t7
__!~n
'•`~
~.~ ~~
Form RW-02 rev. /0.13.06 Page I of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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 representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirym..~~ed and subscribed
before me the •J~ t, day of
~~~~~ l ~~~' ~,-~
~i~'' ~ , r lf''
Fcr th Reggister
~,
eft ~~ "
ire of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
File Number: ~ ~ ~%~ ' (~ ~ ~(i
Estate of DONALD E. MARTIN
n N
n
c~
~r, -ti'.
~
_L
-p '
r ,~-_, ~ _
!J ~
'.., r"".
_-='
-.~ ~
Q ..~ f -'l
~ .
W
Deceased
Social Security Number: 174-20-5682 Date of Death: 11/26/2(108
AND NOW, ~ l~h N1i,,` C>~ ~P(~ ~.i'j'1 ~)~~ ~~~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented befog , IT IS DECREE that Letters 1 C'~t(pI'y"]C'Vl ~ rll~( ~
are hereby granted to Ll O ~ " ~ . {-}(~ ~ -~- r i ~ -
in the above estate
and that the instrument(s) dated _ ~ ~ I '^j
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) gf Decedent.
t~ t
FEES
Letters ............. .. $ ~ ~ d 0
Short Certificate(s) .... .... $ ~;l u ~ (s
R
e
nunciation(s) ....... ... $
'
`
W1~~ ... $ 1.~~~i'~
`1LI~ ... $ r ~ .
... $
... $
... $
... $
... $
... $
TOTAL ........... ... $ ~~8-
Registe of Wills ~, `':: (,x ~;~
/ ~ ~ ~ U
Attorney Signature:
,r'
Attorney Name: STEPHAN:[E E. CHERTOK
Supreme Court I.D. No.: 52651
Address: 61 WEST L,OUTHER ST.
CARLISLE, PA 17013
Telephone: 717-249-11'77
Form RW-02 rev. 10.13.06 Page 2 of 2
~'j-~'~l ~~4,
LCJCAL REGISTRAR'S CERTIFICATI®N ®F DEATFI
WARNING: It is illegal to duplicate this copy by photostat elr photograph.
Fee for this certificate, $6.00
" P 148105:-~
Certification Number
How Injury Occunetl
~,,._ DEC A 2 20(18
N
c Date l~sued
m _Y_ _F j.:.l
p ~nr-`S
I ~~_., -~
r~-~ ~vt
F_. ~_,
i~
.-_ "j
.C- % rz
C r ,>
W
aEV tf2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
RIM IN
K"NM CERTIFICATE OF DEATH
(See instructions and examples on reverse)
S747E FILE NUMBER
1. Name d Decedent (Fast, midde, last, sumx) 2. Sex 3. Social Secun Number
Donald E. Martin ry a. Dale nr Deem (Ma,m, day. Yeart
Male 174 -20-.5682 November 26, 2008
5. Age (Lass Birthday) Under 1 year Under 1 day 6. Date of Binh (MOmh, day, year) 7. Birthplace (City and state or forei n camtry) 0a. Place of Death (Check Dory one)
M«ahs OeYS flam Mkxaee Other:
P :
5 Yrs. 4/7/1913 Enola, PA [~ma dam ^DOA
BU. Coon of Deam Pa ^ ER /Outpatient ^ Nursi Home ^Other - Speciy:
ry 8c. City, f3om, 7wp. of Deem 8d. Facility Name (If not inslitulbn, gA'e street aiW number n9 ^ Residence
j 9. Was Decedent M Hispar k: Origin? ®No ^Ves 10. Race: American Intlian, Black, White, etc.
Cumberland South Middleton 'Itup. Carlisle Re Tonal Medical Center (I+Ya,epedrycuban, (saen;M
g Mexican, Puerto Rican, Elc.) Wn1te
11. Decedent's Usual lion Kux1 of work dale d most of wo ' INe. Do rid state refired 12. Was Decedent ever in ttre 13. Decedent's Education (Specify aJy highest grade completed) 14. Mandl Smlus: Marnetl, Never Marred, 15. Surviving Spouse (II wife, give maiden name)
KxM M N'~ Kind of Business / IMUStry U.S. Armed Forces? Elementary /Secondary (0"12) College (id or 6.) Widowed. gvorcetl (Spedryq
Superintendent A.R.M. Olmsted A.F. Base ®Yee ^rm 12 Widowed
16. Decedents Maileg Address (Steal, city I sown, state, zip code( Decedent's PA Did Decedent
128 West Wlllaa Street Aduel Resklence 17a. slate live in a 170. ^ •,aa, Decetlenl LNetl in _-
Carlilse, PA 17013 rowrenip?
17D. County (j ~ nyj 17d. ®fb, Decedent Uvetl wthin
Adel Limits of
18. FaMier's Nacre (Rrsl, nliNle, last suffix)
tail l Taco F. Martin 19. MolheYS Name (Rrsl, miade, maiden surname)
Bertha E. Wagner
20a. InlormanTS Name (Type / Pnnp
Linda M. Hart 1 ey 20b. Informant's Meiling Adtlras (Street, city /town, state, z'ry code)
101 Wilson Lane, New Bloomfield, PA 17066
21a. McMartl d Disposibon ®Cemation ^ ponatbn 21 b. Date of q iMOn Manor, de , ear 21c. Place of
spa ( Y Y 1 Dispositon (Name of cemetery, cremaro or other ace
^ Burial ^ Removal from Slate :Was Cremetbn err Daatlon Audgrhedryl ry IN ) 21tl Location (City /town, stale, zip code)
^ oMar"spe«y: ' ~'"~~~yco~n #~vea^NO ~ p,;:, ,>?~'~ ~ Hollinger Crematory Mt. Holly Springs PA 17065
22a. Sganae d Fureral Service Licensee (a person acting as such) 7tb. License Number 22c. Name and Atltlress of FadlMy
- ~ - FD 0]2774-L Richardson Funeral Home 29 S. Enola Dr. Iinola, PA 17025
Camplela hems 23at only when cerMykg 23a. best of my krpwiedga, deem occurted et Iha lime, dale and place shared. (Skylmure and Lille) 236. license NaMler
physician a rot avaMade at 6me of death to 23c. Date Signed (Hoorn, daY, year)
OerMy name of deem.
h 24 T d Dee
ems 24-26 must be cangleled oy parson aria
m 25.
D
a
~a Pr
omunc
ed Dead (Month. tlay, Year)
who prmaxkes aaM. ,J
2-1 ) O ~M. {
y
I
•
l
,(i!(br2•k'a"sl2v,~-~ 2 ~$ "~C: ¢
U
Item 27. Pan I: Enter tlse pain d evens - dise CAUSE OF DEATH (See Inatru
ases, i^NrMS, a canplicafiora - Mat tiredy cause etlona and esramplea)
r Approxrtnale iMenal:
d the dam. W NOT enter tennnal evems such as
di
car
ac emest
respimrory arrest, a ventricular iDRMedon witlpN s the e ~ Omer Ie Deem
howing Iwbgy Lisl only one cause on each Gne. r
MIS TEra~IA
uSn (Fi mj disease a
de
++
~
er
-~ n ?
a. Sri 1 IrZ~.'Tl Ur'y ~ YLL,wYVU9yx^+-~ C .yX ~ N~~l
{ r
Seguentialry Ist mndAions. it any,
ha
to cause (sled on Ins a .
Du/~'to (or ~ a m 1n-equence oQ~.+ ~ f~/
b. `fJ Cvl~Pi1'i l +Ln 'f ~.L4~" Mt ~t EKE '
1
.
Enter UNDERLYING CAUSE ;
to (or a consequen0e of).
(dace or ryury that inidetetl me
events resul6g n daml LAST. // -- r
c. ~ l~~.li~ J/xbw1.-- `..
L ~yVwy r
)
Due to (o as a consequence oQ. ~
d.
30a. Wes an Autopsy 300. Were Autopsy Findngs 31. Manner of Death 32a. Date of Injury (Mmm, tlay, year)
PeRomied7 Available Pita ro Canplelion
u d Cause of Deem? ~Nahwal ^ Homidtla
^ Yes D(I Na ^ Yes ^ No ^ ~~t ^ Pending Investigation 32d. Tore of Injury 32
This i~ to certiiw that the infrn~mation here given i,
correctly copied from an original Certificate of Death
duly f"filed with me as Lo: al Registrar. The original
certiticate u ill he forwarded to the State Vital
Records Office for permanent tiling.
~~
~G i4 ~~;~>ra,
CQ
T7 ~U
_r~C71
_ n_1 ~/~ Y
s ~"~ y J J~-\l
.7 ~ r^)
",} ~ -T"1
t~ ~
-LJ -~
D
26. Was Case Referretl to Medical Examnar /Coroner for a Reason Other Than Cremation a Donation?
^Y
Twp.
Bao
es No
Pan II: Emer other MjgmBgppLjbndfims_0ontrihyn~pa to death 28. DM obacco Use Contribute m Deam?
hN rim resuMing in the undenyirg cause given in Part I. Yes ^ Probabry
(~
~ ~ ~ ,~ ~y~
L ^ No ^ Unknown
29. If Female.
1
."
//11 ~~ .L. f
l.V.t w.~ w lJ hl ~ yx-1,~....- ~ti l ^ Nol pregnant within past year
^ Pregnant al time of deem
L,y~" ^ Not pregnant out pregnant within 42 nays
of lath
f_- ^ Nol pregnant hM pregnant d3 days to 1 year
belare tleam
^ Unkrgwn it pregnant within the past year
32c. Place of Injury: Herne, Farm, Slreel, Factory,
Office BuiHing, etc. (Specy/
32f. If Trensponalpn Injury (Spea7yl
^ Saatle ^ DaAd Nd he Deremnnetl ^Ves ^ No ^ Driver! Operera ^ Passenger ^ Pedadnen
33a. CaMfier (deck Doty one) H Omer " Speedy:
33b. Signature antl TiMe of CerlMier
Comlying physkien (Physican cerlirying cause of dam when another physican has pronounced Beam and completed Mem 23) Q
To the best of my knowledge, lath oaumed due to the reuags) and manner ere slated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ -
• Prorqunri and cent _ _ _ _ _
rig hying phyeielan (Physician born pronouncing dam antl cemlying to cave of dam) 33c. License NurMer
To the bat of my krpwkdge, earn occurretl at the lime, date, and place, end due to the cause(s) and mmner as stated_ _ _ _ _ _ _ _ ^
• Medkal Examiner/ Commer _ _ _ _ _ _ _ _ _ _ A^ ~ C{ S I 3 S
On the Dacia d examinatkm and 1 a invesMgalbn, in my opinion, dam occurretl at the time, state, and place, end der to the cause(s) aM manner a sgted_ ^ f_ 1
34. Name and Address of Person Wlw Completed Cau
35. Registrar' nature aM Di m~ ~ I C l ~ / l / l 36. Dale Effect (MO ,day, year) ~.~~`~ t `hi't' y~'~ ^'6'A' .Mrrc
-
/" ~ !~'~ c!.'M~t.! ~s~~w~.~~~~
Disposition Permit No. ~ `g ~j G ~~ / /
Injury (S1raL city /town, satel
I33d, Date Sgnetl (Hoorn. tlay, year)
~:ia.'ew~lh~ 2'j iwc~,
Deem (kern 27J Type / Ptinl
Carlisle
LAW OFFICES OF
STEPHEN J. HOGG
401 E. LOUTHER STREET
CARLISLE, PA 17013
WILL OF
DONALD E. MARTIN
I, DONALD E. MARTIN, of Carlisle, Cumberland County, Penn-
sylvania, declare this to be my last Will and hereby revoke all
prior wills and codicils.
1. I direct that all my just debts, funs=ral expenses, grave-
marker and administrative expenses shall be paid from my residuary
estate as soon as practicable after my death.
2. I direct that all inheritance, estatE~, transfer, success-
ion and death taxes of any kind whatsoever which may be payable by
reason of my death shall be paid out of my residuary estate.
3. I direct that my entire estate be di~/ided as follows:
A. I leave my entire estate of whatever nature and wherever
situate to my two daughters, LINDA H{aRTLEY and ELAINE
PHILLIPS.
B. Should either of my daughters predecE~ase me, then that
daughter's share shall pass to her children equally.
4. I appoint my daughter, LINDA HARTLEY„ as Executrix of
this my last Will. If she should predecease me or cease to act in
such capacity, I name my other daughter, ELAINE PHILLIPS to so
serve.
5. The Executrix of this Will shall havE~ the power to distri-
bute my estate in kind or in cash, or partly in either.
6. I direct that no Executrix acting under this Will shall
be required to enter bond in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this /5 'day
of , 1991.
4
~~
DONALD E. MARTIN ~_
d
`}
~_ C7 rT1
C7
=~ '~ F~
~~ ~-,-p
~J ~
~
0
W
rx, S~ C.
,'
_I
.... {..7..z
' `' "-~
The preceding instrument consisting of this and one other
page was on the day and date hereof signed, published and de-
clared by DONALD E. MARTIN, as and for his last Will in the
presence of us, who at his request, in his presence and in the
presence of each other have subscribed our Haines as witnesses
hereto.
LAW OFFICES OF
STEPHEN J. HOGG
401 E. LOUTHER STREET
CARLISLE, PA 17013
ACKNOWLEDGEMENT
LAW OFFICES OF
STEPHEN J. HOGG
401 E. LOUTHER STREET
CARLISLE, PA 17013
Commonwealth of Pennsylvania
County of Cumberland
ss
I, DONALD E. MARTIN, the testator whose name is signed to the
attached or foregoing instrument, having been duly qualified accord-
ing to law, do hereby acknowledge that I signed and executed the in-
strument as my last Will; that I signed it willingly and as my free
and volutary act for the purposes therein expressed.
~,{ ~ ` ~ ~
DONALD E. MARTIN
Sworn to or affirmed and acknowledged before me by DONALD E.
MARTIN, the testator, this ~S'-~. day of 1 , 1991.
~~ I
-,;; SL-z,, ~ i
4 ;fin ~,t-- ~a ~ ~ ~ ~ ~ Notary blic/Atto ne~~
r .. _. ..
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
ss
We, ~c ,x ;~„a-. 6='1-~,iz~.,~ _ ~., , ~ and o,~'cr.cq, r /~1. ~a,~`ut/' ,
the witnesses whose names are signed to the attached or foregoing in-
strument, being duly qualified according to l;~w, do depose and say
that we were present and saw the testator sign and execute the instru-
ment as his last Will; that the testator signc~d willingly and execu-
ted it as his free and voluntary act for the {purposes therein ex-
pressed; that each subscribing witness in the hearing and sight of
the testator signed the Will as a witness; anc~ that to the best of
knowledge the testator was at that time 18 or more years of age,
of sound mind and under no constraint or undue' influence.
s~-
Sworn to or affirme and s bscribed to bE~fore me by witnesses,
this / 5 -~ day of 6c , 1991. /
/ ~/
,__.W__ _ ~ ~~~
Notary,, u l.ic/Attor ey ~~