The URL can be used to link to this page

Home My WebLink About01-29-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of RICHARD J. JACOBY also known as Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) COUNTY, PENNSYLVANIA File Number ~~ ~~ ~~~~ Social Security Number 193-24-0138 ^/ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Executrices named in the last Will of the Decedent dated July.~0, 2004 and codicil(s) dated none. Renunciation for Beverly A. Jacoby attached hereto. (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 (lfapplicable, enter: c.t.a.; d. b.n.c.t.a.; pendente liter 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~fid heirs: (If ea..,;.,;..~r„r;n„ ~ i n nr d h n r 1 n Peter dote of Will in Section A above and complete list ofheirsJ n ~::=: Decedent, then 81 years of age, died on December 21, 2008 at Claremont Nursing & Rehab. Center, Middlesex Twp., Cumberland County PA Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property $ 190,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 0.00 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 printed name and residence Diane M. Eichhorn 408 Glenn Ave., Boiling Springs, PA 17007 Patricia K. Grove 23 N. Acorn Drive, Boiling Springs, PA 17007 Form RW-02 rev. !0.!3.06 Page 1 of 2 (COMPLETE /N ALL (,:4J'CS:) Attaen aaauiona[ sneers gnecessary. -~ ~`% N Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at "`1 423 First Street Carlisle PA 17013 (Gist street address, tawn/ciry, township, county, state, zip code) 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 tc or affirmed and subscribed Jt~~1,/} ~ pJ / {~ (J, (~~~~~~ ~ before me the ~~ da of Srgnatur Personal Representative t~ ____ y ~ ~ , ~ Signature of Personal Representative ~ ~ ~ J •~ { ~ 1 . W x ~ For the Register Signature of Personal Representative ~ _ "~ ~ (~ ~- ~~ --i File Number: ~ ` U~ L ~Gl~ Estate of RICHARD J. JACOBY ,Deceased Social S ecurity Number: 193-24-0138 Date of Death: December 21, 2008 !~ AND NOW ~~ ~ ~ i , - , n consideration of the foregoing Petition, satisfactory proof having been presented before , IT IS DECREED t ha Letters Testamentary are hereby granted to Diane M. Eichhorn and Patricia K. Grove in the above estate and that the instrument(s) dated July 30, 2004 described in the Petition be admitted to probate and filed of record as the last W'll (and Codicil(s)) of Decedent. FEES ~ ~ ~ Letters ............... $ 260.00 Register of Wills Short Certificate(s) ........ $ 12.00 `' Attorney Signature: ~-i~~y~~~-,~-•,,„-- Renunciation(s) .......... $ 5.00 Will $ 15.00 Attorney Name: Patricia R. Brown __ JCP $ 10.00 Supreme Court I.D. No.: 27474 Automation Fee $ 5.00 ... $ Address: 354 Alexander Spring Road, Suite 1 • • • $ Carlisle, PA 17015 ... $ ... $ $ Telephone: 717-249-6333 ... $ TOTAL .............. $ 307.00 Form RW-02 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 t~>r this certificate, yfi.00 P 15093240 Certification Number 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 forty°arded to the State Vital Records Office for permanent filing. <,. ~~ OE 2 2 2008 Local Registrar Date Issued ~ r-~ C O ~. ~' v.CY ,~; ~ ~ ~. ~ ,,, " -~~ ~ - t z~ ' = ~~ "--. 1.4~ ~o ~ _..... _•i_J~_..i __ -.~L_ _v ~ D ~ _ ~ ~,.! 105-143 REV 11200fi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE/PRINT IN ewcAic"~ CERTIFICATE OF DEATH (See instructions and examples on reverse) h \ J J S nt n~ ~~ra I trILt NUMtlER ~ \ \.l \ V•x~f L -, 1. Name d Decedent (Frsl. mitltlle, rest wfix) 2. Sex 3. Soda) Security Number 4. Data d Daam (Month, day, year) Richard J Jacob . M 193 - 24 - 0138 12 21 2008 6. Age (last BNhday) Under 1 year Untler 7 day 6. Date d BiM (Month, day, year) 7. Bidhplace (Gry and slate or iareign wurary) 6a. Place d Deem (Check w one) Mww IMya Hours kandes Respire): gher 81 vra. 2/28/ 192 7 NEwville, PA ^ klpatienl ^ ER / Outpatient ^ DDA ~] Nureirg Home ^ Residence ^Omar - S edt W C p y . aunry d Death Sc City. Bono. Twp. d Deem Bd. FmM' y Nama (II ref ketiw6on, give street ere n l~rl 9. Was Decedam d Hhpenk Origin? ®No ^ Vas 10. Roca: Amerimn Indian, Black, While ak. , Iu yes. spedty Cuban. (snadM Cumberland Middlesex rT~.,., Claranont Nursin & White +^y• g R2hab. Cntr. Mexican. PUedo Rkan, ek.) ' 17. Decedent s Uwel Ocx eon Kxvi d work done most d wo ' ere. Do rat slate 12 Wes Decedent ever in me 13. DecedenYS Education (Seedy Dory highed grade competed) 74. Madre) SreNS: Married, Never Monied, 15. SurvNing Spouse pl wife, Siva maiden name) KiM d Work I6nd d Bwiless / Ireu U.S. Amato Fomes? dr w Y Elementary /Secondary (U12) Cdkge (td or 5+) d• ~o~ IspedM Letter Carrier .S. Postal Servi ]Yes ^ra 12 11TidC7Wed _ 16. Decedents Milling Address (sred, dry /tam, state, zip code) DecedenYS Did Decetlent PA 423 First Street Adud Resitlerice 17a sofa LNe in a 17c. ^ vas, Decedent Livetl in Twp Township? Carlisle PA 17013 t>b.ca,^ry Cumberland '7d.~No•De~awnLnretlwknin Carlisle Adual Lknks ai C' /Boo 16. Famer's Name (First, midge, red, sulfw) 19. Mother's Name (Fhsl, mitlde, maiden wmeme) dY John - Jacob y Lulu M. Hoch 26a. InlormanYS Name (Type / Pdnt) 26b. mlormenYS Mdgng Addess (Strad. dry / term, slate, zip catle) Patricia K. Grove 23 N. Acorn Drive, Boilin S rin s, PA 17007 2ta. Meaed d O al hom Slate i ^ Crwldion ^ Donation 21 b. Dale d Dispositlon (MOMh, day, year) 21c Plea d D~Siaw (Name d cemetery. aernat«y a ottxu place) 21 d, l.ocetion (City /town, dale, zip cede) Budd ' Was Crematon a Donetloa Audwrtred _ ^ Olhar-seedy: ; hyMStlkdlcxaminer/CaaieR ^Yea^rm 12/26/2008 C~unberland Valley Memorial Garcle s Carlisle, PA 72a. SigreNre d F IJCensee la ~ 220. liceme Number 22c. Name and Atldress d Faaldy - - FD 01 6 3 L >~aing Brothers Funeral Herne, Inc., Carlisle, PA 17013 Compete Items 23ec aey when cer0ying 23a. me )tail d m rted al de time, der a p stated. ISgneNre aM tAle) 23 . Nu physiien h rat aveeade d time of tleath to , ^~~' / ~ ~ 23c. re Signed (Mwm, day, year c«my ceaaa a deem. d ~py) ~ ~a J _ j~ Xenw 242fi mud be canpde0 0y person 2d. Tjm peatll 26. Dat Prmavlcsd peed ( Y, yaarf 26. Was Case Referred Metlical Examiner /Coroner for a Reesm 010er than Cremation or DonatAn7 • woo pronwaes deem. T M f , _ r ^Yes No v CAUSE OF DEATH (See InstrucNOrts arM aaemples) r Approximate imerval: Pad II: Enter amar ' 26. Dre Tobacco Use CwMdae to Death? Item 27. Pad I: Enter the gem d evens -diseases, injuries. a compkcations -did tlinsdy caused the death. W NOT enter temliral ev«ds suds as wrdac artesl , r Onsd re Death hd nil reveltlrlg ki the undedyiig cause given in Pad I. Yes P resprelay arted, a vwukurer fibriretlan witleul shawmg the etiobgy. Ud alty are cause w eadi line. ^ ^ robably ' ^ No ^ Unknown BAME(xr1TE CAUSE IFinal disease a ( 11 `` t jj-- cantlihon r lli in m ~ ( } ~ //~~ eve ng n ) _~ a. ~ I ' ~~~~'~\ `~ ~ 441 ~~ IY(.If y (i ~ \ 29. If Female: f Due Io (a as a wrvsequanca d): ~ ^ Nd pregnant vdmin past year id carMlbns, tt arty, b. I ~ U t.P /-~ l,l S! ^ Pregnant ar lime d deem a die cause gyred w kre a ~ ~ . NDERLYdlG CAUSE Due b (« as a cansegdehca oq. En ( a iryay and irlitiatetl the l ^ Nd peg^ara, hd pregnant wBMn dz days c t evwre N l d m reve rlg n ee ) LASy. al death Due to (or as a consequence df. ~ r ^ Not pregnant but pregnant 43 Sys to 1 year d. r before deem ^ Unkrewrl X pregnant wimin me pad year 36e. Was an Autopsy 366. Were Autopsy FMdags 37 al Deem 32a Dere d Irgury IMmm, day, ymr) 32b. Describe How mjury Ouuned Parlaned7 AvaRede Prior b Camplatiw 32c Plaza d Inury: Ibme, Farm, sreaL Factory, d Cause of beam? Natural ^ Homicide ~. Omce Beading, etc. (Specify) ^ Vas ~ ^ Yes ^ No ^ Auden) ^ Pen&Ig Invesegatan 32tl. 7me d Injury 32e. Injury at Wak7 321. tt Trsmpodatlw Injury /SPea'y/ 32g. Location d Inury (Sired, dry /torn, state) ^ Suidtle ^ Cadd Nd be Delemlined ^ Vas ^ No ^ Drtv« l ~~ ^ Passenger ^Petledden M~ ^Omer~~h^ ~~ ~~ (~~ o^ry ~) 33h. SigmNre and TNe of Certltiar • cadnywy phy,ld.n (PFryew7ari ~Mn9 comae a deem wow a~lnar phyaidw naa prax,a,~ad deem am aanpatad Item z3) 7o tle baH Ol l kM ~. ~ mY mow 3a, dead) aeeumddue to the uuea(a)wd mmmrbdered_________________ ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Pronouncl^g antl cediyln9 OhYSidarr (Physidw bdh pvlwrcel death aM ce 0l l t d d • - Jt.~i(.l.t(X r W g r y rg o ease eem) To tle heal d my Mowladga, deaM o«.wred d the tlme, dale, aM pace, arM due a tle ease(s) and maraer u stered_ _ _ _ _ _ _ _ _ _ _ _ • Medipl Examiner/Comer ------ 33c. license Narlber b ~ 3,M. Date Sigetl (Modh, daY. Year) On the heeq d axardnaeon and / or InvesdgaBOn,'n my opmbn, deem accuwed d tie rYlle, dab, end place and due to He cauae(a) amt maml« ere areted ^ s~ ~J -1~ '- ~~- ~-,~(YJj , _ 34. Name veil Adtlress W Person Who Cwpreted Cause d D e ath (Ite m 27i Type / Pdnl 35. Registrar's ~ - ~.t~,~~c- la I I l a I - I O I Dare Fled (Momh, day, Y~r) I ® , ~ q/Q.f~') Dom. ~ h ~ 'C~"IIdQ / ~ U ~ rr cap , } ~ ~,d . Disposition Penntt No. ~~ ~ ~~ ~ yi ~ a~,~ LAST WILL AND TESTAMENT I, Richard Jacoby, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, declare the following to be my last will and testament, hereby revoking any and all wills heretofore made by me. Item I. I direct my executrix hereinafter named to pay all my debts and funeral expenses. Item II. I give, devise and bequeath all my property, both real and personal to my children, Beverly A. Jacoby, Diane M. Echhorn, and Patricia K. Grove, in equal shares per stirpes. In the event any of my children should die without issue, their share will go to my remaining living children. Item III. I nominate, constitute and appoint my daughters, Beverly A. Jacoby, Diane M. Eichhorn, and Patricia K. Grove, as my executrices, and I direct that they should all serve without bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this l7 day of ~'tr , 2004. ~~ SEAL Richard acoby Signed, sealed, published and declared by the above named testator, as and for his last will and testament, who at his request, in his resence, in our presence, and in the presence of each other have ereunto subscribed our names as attesting witnesses: r_ ~~~- .~ n n3 cra: `--~' Q ~° =' ~ ~.. ~ ~ - _ ~~; _ ~ = ~ , _=~ ~ , ~ _ _. ~ l_ -.. J ~ - i ~J ~~ :; , ~ -~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ G~~,~~~2-~ and ~ _ hose names are We, signed to e attached or oregoing instrument, being dul qualified according to law, do depose and say that we were present and saw testator sign and execute the instrument as his last will, and that he signed willingly and that he executed it as his free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind and under no constraint or due in pence `~ scl.s~t F- Sworn to and subscribed before ~ 2004. me this ~ o day of otary Notarial Seal Anne M. Cox, Notary Public Carlisle Borough, Cumberland County My Commission Expires July 14, 2005 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Richard Jacoby, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I a d that I siened it ashmy free and voluntary act fork the signed it willingly, g purposes therein expressed. %, _ ~ Richard Jacoby Sworn to and subscribed ,~v ~ , 2004. before me this the day of ~- E~ ~ ~~ Notary _ __~_ _._ Notarial Seal Anne M. Cox, Notary Public Carlisle Borough, Cumberland County My Commission Expires July 14, 2005 .~. ~ ~~ ,- ~ .~ -~__} ~ ~, RENUNCIATION ~ -~- r> ~= - - ~-; ~ ii J ~-~ c. Estate of Richard J. Jacoby ,deceased. ~ }~~`~ ~ _~ .. To the Register of Wills of Cumberland County, Pennsylvania. y ~ The undersigned Beverly A. Jacoby, daughter of the above decedent hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Diane M. Eichhorn and Patricia K. Grove WITNESS hand(s) this 17th day of January , 200'9. ~~~~ ~~. SIGN~'~URE Affirmed and subscribed before me this r I'N~+ day of ~i~fW~ar , 2009. :~_ `~ Il (.~i,~~•~rn ~ k~l. /c~~?~, /~i`~ ~'0 ~C7 ADI~ESS ' ~~~ s4.4~ Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Or Tamara S. Sregrist, Notary Public Waynesboro Bono, Franklin Courriy My Commission Expires Dec.1,2010 Affirmed and ,~~t 9 Notaries day of , 200 . SIGNATURE ADDRESS SIGNATURE Register of Wills ADDRESS Deputy