HomeMy WebLinkAbout12-12-08PETITION FOR PR//~~OBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (~t~m,bej'~ancz~ COUNTY, PENNSYLVANIA
Estate of /~e/°"f~~.. /`/ /f ~~ /~/'P1~~/~ File Number r~ l ~ (> ,~`-C~
also known as ~i~Y ~Q~ ~ ~~ ~? ~ /yam /?~ ~ /~ _
. Deceased Social Security Number --"~~ ~ "`~Ci ~~~~ /.~ ~~E' '~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPL,ETE 'A' or 'B' BELOW:)
~A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ,~"u,°.' C ~~d~X named in the
last Will of the Decedent dated /l - f~ ~-~ tY and codicil(s) dated
(State relevara circumstnnces, 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
(Ifapp(icable, enier.~ c.ta.; d. b. n. c. t. a.; penderue liter durante absentia; durance nurloriia~e)
n N
-- ...
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was sw~vived by the following sp~rirF~(if any) atfi~'heirs: (/f -
Adminis[ration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of {~en~s.) r~ -_
7 '~~ -
Name Relationshi Residene~ ~
r=~ _
_ ,
_ ..__
-_,
(COMPLETE LNALL CASES:) Attach additionnl sheets if necessary.
Decedent was domiciled at death in
Comity, Pennsylvania with his /her last princi
J--b.-(1 ~~ t ~~' i i i e ica , -~.ocuf~ friier: ivuin.~ ~,i
(List street address. town/city, township, county, state, zip code)
Decedent, then ~~ years of age, died on ~r~' ~~ '" /.~~ at
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 fo
X= '~ ! '
Cf7
sidence at
z , i7
GC
Whereforr., 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 printed name and residence
Form aw-nz Yet. ~o.i3.o6 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
~n~'1O ,, SS
COUNTY OF ~l..Q.~.(X'/ f Gt-I'1
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 kno~tledge 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
berore nee the /o~ day of
~= ~ r a~~
~ For the Register
Signature of Personal Representative
Signature of Personal Represeruatire "' , .~
_~,
-v
-7`T
"~ • 1
Signature of Personal Representative ~ _
-- tV
-~;
.-J -~~ ~
File Number: -~'
O
Estate of ~a°r~hc>`. 7" 1~Q,i i~ C~ ~f~ensah `~~
Deceased
Social Security Number:_ _~ a ~'S ~ ~~ 7 (G Date of Death: ~o~ ~(U ~O
AND NOW, ~o~ ~(,t.e../ U t ,~i'I~, ,~c.(/g , in consideration
having. been presented before me, IT IS/ DECRF~ED that Letters ~~kj?~~
are hereby granted to ,~~n / /'~C(., rICt1'7/1~' ~
the foregoing Petition, satisfactory proof
in the above estate
and that the instrument(s) dated ~~n~v /e~ c~l~t~
described in the Petition be admitted to probate and filed of record as the last Will,~and Codicil(s)~of Decedent.
FEES
$ ~~v(i
Letters ... ~l~t,(~~... .
Short Certificate(s) .~.... , $ !r~ ``
Renunciation(s) ......... $
C,e~~i I ... $ is`~
... $ /U°~
... $ ~ o0
... $
... $
... $
... $
... $
_ ... $
TOTAL .............. $ 87
Attorney Signature:
Attorney Name:
Supreme Court ].D. No.:
Address:
Telephone:
Register of hVills
Farm Rw-nz re,~. /n.13.n6 Page 2 of 2
10~ dl' RE:V (fll/DT
LOCAL REOISTRAR'S CERTIFIrATION OF DEATH
WAt~NING: It is illegal to duplicate this copy ny photostat or photograph.
Fee for this certiticate. ~`~6.0O
P 1 ~~1 --
Certification Number
This i, r+, ~e,t;(~ I~at thc' inl~o,)~;~,t{ivil h~rc '_'i~C'n currectl~ cop;c~i ;rrym an rn I~rinal Certit~rute of Deai}
Mule file' 1~~ith nu ,(~ Ltycat Keci~trar, ~I'!~r nli~in~)
certificate. will '~c fon~,~at~Lle~ ~:';I the State Vita
1Zccord~ Off'i~a~ 'In~ ncrn)t;n~nt filins~-
~~~m-. ~~ ~ ~ ~E~r 1 2108
Local K , i;trar I) a ~~+t~i":
__ _-
_ _ _
_ _ _
r1
~
N
c~
'-
: ~_
~
; -:~
T3 ~. , ~~ -
_ C7 =A
.: ~.~ _
~;,
:. t .~
` r ~, :3
REV ltnoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~u '~~ ~ ~ ~= _2
...;
PRINT IN ti (
i -~'
"ANENT CERTIFICATE OF DEATH ~ ® '` r~,,
CK INK
(See instructions and examples on reverse) STATE FILE NUMBER
~
~
1. Name of Decedent (First, middle, last. suXix) 2 Sex 3. Social Security Numher 4. Date of Death IMOnth, day. year)
Herter A. Henson Female 352 - 30 L 9576 December 10, 2008
5. Aqe (Last Binnday) Under 1 year Under 1 tlay 6. Date of Birth (Month, tlay, year) 7. Birthplace (City and stale or lor eign country) Ba. Place of Death (Check only one)
Monms Days Hours Minuses Hospital, Other
88 Vrs OCt
b
r 19 1920 G ^
^I
^ ^
. O
e erman npatient
ER/Outpatient
DOA NUrsing Home Residence ^Other-Speary.
Bb. County of Death 6c. City, Bono, Twp. of Death Bd. Facility Name (If not institution, give street and number) 9. Was Decedem of Hispanic Origin? ~ No ^Ves t0. Race. American Indian. Black, White, etc.
(If yes, speciry Cuban, (SceclM
Cumberland Lower Allen Twp. 1200 Carlisle Road Mexican, Puerto Rican, etc.) ite
11. Decedent's Usual Occu tkm (KIrM of work done Burin most of workin life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: MarrieQ Never Married, 15 Surviving SDOUSe (If wile, give maiden name)
Kind of Work. Kind of Business / Industry U. S. Armed Forces Elementary I Secondary (0-12) College (1~4 or 5+( Witlowetl, Divorced (Scecity)
Teacher Child Care ^vea ®No 12 Divorced
16. Decedent's Mailing Address (SlreeL city /town, state, zip code) Decedent's Did Decedent
1200 Carlisle Road Actual Raaidanna 17a. Slate Pennsvl van; a rive m a nc ®Yes, Decedent Lied id.ower Al 1 en rw
p
Hill
PA 17011
Cam Township?
nb cepnrv Cumberland 77d' ^ n~i
°eiemasof"edwithi°
p
, u
ci, en,e
Y'
16. Father's Name (Flrsl, middle, last, suNix) 19. Motnei s Name (First, middle, maiden surname)
IInimown Anna Seifert
20a. Informant's Name (Type' Print) 20b. Informant's Mailing Address (SVeet city /sown, state, zip code)
Moniker M. ]?ost 4430 Packard Lane C Hill PA 17011
27a. MethoO of Oispostion ®Cremation ^ Donation 21 h. Date of Disposition (Month, day, year) 27o Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (City I town
stale
zip codef
/
^ Burial ^ Removal Nom State i Was Cremation or Donation Authorized
.j ,
,
,
^ Other~Specilyr i byMedicelEzaminer/Coroner? Ves^No December 11 2008 Cremation Societ of PA Harrisbur , PA 17109
22a. g t re ~`F,uner Service Licensee (or person aainq as such)
~ 226. License Number 22c. Name and Address of Facility Allen Cremation Services of Pennsylvania, InC .
~ ~ C'
'~-' FD 013376 - L 4100 Jonestown Road Harrisbur PA 17109
Comps Items 23a<onl hen cenitying 23a. To the best of my knowledge, dean occurred at the lime, date and place staled. (Signature and Ihle) 23b. License Number 23c. Date Signed (Month, day, year)
physician is not available at time of Oeath to
cerdty cause of tleath.
Items 2426 must he completed by person 24. Time of Death 25. Date Pronounced Deatl (Month, tlay, year) 26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
whn pmnouncea Beam. 8:56 AD"~ December 10, 2008 ^Ves ®No
CAUSE OF DEATH (See ins6uctlons and examples) , Approximate interval: Pan IC Enter other 5ionificanl conditions contribuunq to death, 28. Did Tobacco Use Contribute Io Death?
Item 27. Pan C Enter the yhyiilyt Ev_y~ -diseases, Injuries, or complications -That tliredty caused the death. DO NOT enter terminal events such as cardiac arrest, Onset to DeaM but not resulting In the undedying rouse given In Pan I. ^Yes ^ Provably
respiratory amest, or ventricular fibrillation without showing the etiology. List only one cause on each line. N
IMMEDIATE C
USE IPin
l di
r ~ o ^ Unknown
A
a
sease o
WndRion resulhn In death
9 ) .~ a, Co~ru~~ul UJI~ ~u~, t -~
~ ~~h9~ti~ 29 If F ale'.
Due to (or as a cons ue ca ~
'
~
~
~
4 S
r ~„I Not pregnant within past year
/^1
Sequentially list cond
nions, if aiy, b.
Q
SSi
(y i
~,
leadingg to the cause listed online a II I I '11 Pregnanl at time of tleath
. Due to or as a copse uence o r I
Enter fhe UNDERLYING CAUSE ( q ~- t
^ Not pregnant, but pregnant wihin 42 days
(disease or injury that initiatetl':he r
events resulting in tleath) LAS'~f. t ISO, , ~gv~ ~
~' of death
Due to (or as a wnsequence op: I t
-
J ^ Not pregnant, eut pregnam 43 days to t year
d before death
^ Unknown II preonanl within the past year
30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 326. Describe How Injury Occurred 32c Place of Injury Hame. Farm, Street, Factory,
Penormetl? Available Pnor to Completion
Natural ^ Homicide ONlce euilmng, etc /S-ecity/
of Cause of Death?
^ Ves ~ Ne ^Ves ~No ^ Accident ^ Pending Investigation 32tl, Tme of Injury 32e. Injury at Work? 32f. If Transponetion Injury (Speaty)
i
/O
^ P
t
^P
^ D g. Location of Injury (Street, city s town, states
^ Suicide ^ Could Nat be Determined ^Ves ^ No r
ver
pera
or
assenger
etle t n
M ^ Other ~ Specity:
33a. Cenilier (check only one) 33h. Signature and The of Cenilier r
• Cenltying physician (Physimian certiying cause of tleath when another Dhysician has pronounced tleath and completed Item 23)
, I~
'
To the best of my knowledge, death occurted due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ I` W ~
• Pronouncing and cedltying physician (Physician both pronouncing tleath and cenitying to cause of death)
T
the be
t of m
kr
owletl
e
de
th occ
ed at the tim
d
l
l
d d
d
t
th
d
t
t
d
^ 33c. License Number 33tl. Date Signed (Month, day, year)
o
s
y
i
g
.
a
urr
e,
a
e, an
ace, an
p
ue
o
e cause(s) an
manner as s
a
e
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical Examinant Coroner 54 ~~~I ~ ~ I ~ I ~ I r'
r~ V
On the bests of examination and / or investigation, in my opinion, tleath occurred ai the time, date, and place, and due to the cause(s) and manner as stated_ ^ 34. Name and Address of Person Who Completed Cause of Death Iltem 27; Type' Print
35. Registr s gnature and °'
,_ l L `~~~ ~ ~ °~~ ' ~ ~~ Date .iletl (Mepth, day, year)
~-1 ~' dC~"~'
I, hid j~Dn' Iv~p I~~U ~~J~ ~ ~aa~ ~-halq, ~tlA I'I~ ~5
" 0309147
Dlsoosiban Permit No.
N
C~? `~ -
-i:,~
-,_~ e--~
`-
~ f.,~ _ + }
~.A~t ~irr ~ ~ -
. -~,,, -
®f ~ - ~~
~ert~ja ~[ine ~ett~art =~ ~ -
I, Hertha Aline Henson, of 1200 Carlisle Road, Camp Hill, Pennsylvania,
being of lawful age, sound mind and memory, and under no restraint, do publish
this as my Last Will, revoking all other Wills or'Codicils previously made by me.
FIRST: All expenses, fees, costs, and taxes related to this estate shall be
paid from the probate assets, including but not limited to funeral expenses,
and the cost of my final illness. There shall be no grave marker, there is no
inheritance and there are no gifts to be given since I do not own a car, real
estate, financial investments and no savings.
SECOND: I make the following specific bequests: to my daughter,
Monika Marianne Post, who has taken lovingly care of me for the past ten years
and until my death, my only possessions, my appliances in the home which was
provided for me to live in for the remainder of my life at no expenses to me.
THIRD: In the event my daughter Monika Marianne Post, does not
so survive me, I direct as follows that as mentioned in "Second" will be given to
my grandson Kristian Brian Post.
FOURTH; In the event that any devices herein challenges the probate
of my will or any provision thereof and is not successful in a court of competent
jurisdiction, then in such event, 1 direct and require that they forfeit their share as
set forth herein to the fullest extent that the law of the jurisdiction in which I die
domiciled permits a testator to provide for such a forfeiture, including, but not
limited to, a deduction from such share of the total additional costs and fees
incurred by my executor in resisting such challenges.
FIFTH: I nominate and appoint my daughter, Monika Marianne Post,
to be the Executrix of my Last Will, granting to her authority to sell and convey
any or all of my estate which is only personal, without obtaining any prior order of
the court therefore. I also grant her full power and authority in the settlement of
my estate, to compromise, adjust, and settle any and all debts and liabilities due
to or from my estate, for such sums, and upon such terms and conditions as she
shall deem best. In the event that she shall for any reason decline to serve, or
fail to qualify for any reason, or having qualified and been appointed, fait to
Page 1
complete the administration of my estate, the I nominate Kristian Brain Post to be
the Alternate or Successor Executor. I direst that no bond or surety shall be
required of any administrator or fiduciary named herein.
I, Hertha Aline Henson, hereby sign this Will at AAA, Camp Hill,
Pennsylvania, 17011, this day of November p~T, 2008.
v ' ~ ~ l~
HERTHA ALINE HENSON
IN WITNESS WHEREOF, I have hereunto subscribed my name, and
acknowledge and publish this instrument as my Last Will in the presence of the
un rsigned witnesses, on November 13, 2008.
~' Y
i ss
Print Name
Witness
Print name
;OMtdlO'N~VLHt~ H lit r'ENNSYLVANIP
PIOTARIAL SEAL
CHERYL R. CARMAN, Notary Public
Camp Bill Bono, Cumberland Cou~-ty
~y Conxn~ssion Exams May 20, 2012
Page 2