HomeMy WebLinkAbout02-03-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ~ l C~~~;, ( ~ t~~t~~
also known as
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(COrY1PLETE 'A' or 'B' BELOW:)
Deceased
COUNTY, PENNSYLVANLa
File Number ~ ~ rU C~ d
Social Security Number ' ~ r ~/ °'~ ~~~~
~A. Probate and Grant of Letters Testamentary and aver that Petitioner(s)`s,.2 are the
last Will of the Decedent dated ~' ~ Il ( a~~ ~- and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death ojexecutor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom 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 Administratio
((jappticable, enter.• c. t. a.; d. b. n. c. t. a.; pendente lire; durmue absentia; durance minoritnte) r.,a
n Q
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoany) and`}f2irs: (Ifr , :~ _
Adtrtiaistratian, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) t~-p rn ` '
rZ n W =_
Name Rzlationshi Reside !T1 t C'r ~`'~
~7C -.. _
"L7 r`]
D to
(COMPLETE IN ALL CASES:) Attach additiot:al sheets if necessary. ~.. .
i t,, ~
pecedent was domiciled at death in U v1/~Y_1-£ d t~A,Nc~ Cotmty, Pennsylvania with his /her last principal residence at ~__
(List sheet address, torovn/cite, torvnslrrp, county, state, zip code)
Decedent, then ~_~~ years of age, died on ND ~ ~ `~, (,'~ ~~+M~
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 foll
~ ~~, ~ ~ ,
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:
~ aignanire Typed or printed name and residence I
~ ~a of ~ r `7v~S
named in the
Form R6V-0? rev. to.~3.06 Page I of 2
Oath of Personal Representatlve
CO~I~ION'vVEALTH OF PE~NSYL~'ANIA
SS
COUNTY'OF
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are t.-ue and correct to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) ofthe Decedent, Petitioner(s) will well and truly
administer tl;e estate according to law.
Sworn to or affirmed and subscribed
before ;ne the ~ day of
1
For the Register
~~~~~~
Signature ojPersonal Representative
Signature of Personal Representative
Signature ojPersonn! Representative
File Number: c~(~ Ci "1 ~ I'
Estate of / -1~C~ ~ / `~ ~~~/ ,Deceased
Social Security Number: ~~"7~'1, r~ ~~~t~ Date ofDeath: ~ 1 ~ rl ~~~
AND NOW, ~~~"' a ~ ~ ~~ ~~~~ --~=-~--~ in consideration of tie foregoing Petition, satisfactory proof
having been presented before me, IT IS
d t ~'~
ethers I r~ ~/ tIL{~~ ~~~~~
are hereby grante o ~,
in the above estate
~~
and that the instrument(s) dated ~ L~-_~~_-- ~ Gl/ ---- -----------
described in the Petition be admitted to probate and filed of record a~~he last Will (and C~icil(s)) of IAer~edsat. ~ ~~
FEES
Letters .... ~~, ~U. • $ ~ ~
Short Certificate(s) . ~7..... $ 1~_ Attorney Signature:
Renwlciation(s) .......... $
. U + I ~ $ i ~ Attorney Name:
J , . , $ ) Q Supreme Court LD. No.
~ (J,~ ... $ ~a
Address:
.. $
... $
... $
... $
• ~ • $ Telephone:
... $
TOTAL .............. $___-__
Fenn R6V-0_' rev. 10.13.0(
~~-~
Register
Page 2 of 2
tv -~.
CJ1
It95.R0i R.F.V i0I/1171
LOCAL REGISTRAR'S CERTIFICATION OF DEATI~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14810562
Certification Number
ITEM # //
SHOLILD_READ AS FOLLOWS:
This is to certify t"at the infonYfatLO~~ here given is
c~rrectl~:~ copied truln an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will he :~frwarded to the Stet.- Vital
Records C>Ffice Iitr permanent filing.
~~ 0 3 008
Local Registrar '~` mate Issued
_ ____ _ _ _
_ _ _ __ _ c
..~
~//a ~~//
~ i
.
:
~
REV luzao6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~ ~ ~ =.`~
'
"
,
~nNEai1" CERTIFICATE OF DEATH D
.r.K 1NK /See instructions and examples on reverse) CTaTF Fn F NI IMRFR
G•) ,,. ,~ •--
-_
1. Name of Decedent (First mitldle, lass, sulfx) 2. Sex 3. Sxlal Security Number 4. Date of Death (Month, y, eaQ
Michael J. Paul male 194- 42 ~ 9442 Nov. 29 2008
Age (Last Birthtlay) Under 1 year Urder 7 day 6. Date of Birth (Month, tlay, year) 7. Birthplace (City and slate or foreign crountry) Ba. Place of Death (Check only one)
5
.
Months Days Hours MtnNes HOSpdal: Othef.
56 Sept.9,1952 echanicsburg,PA
^ Inpatient ^ ER I Outpatient ^ DOA ^ Nursing Home Residence ^Other Bpecity
Vrs
.
Twy. of Death
City
8aro
m Bc
f D 6d. Facility Name (If not institution, give street and number) 9. Wes Decedent of Hispanic Origin? r7 No ^ Ves 10. Race. American Intlian, Black, White. etc
`~Y
,
,
.
ea
Bb. County o
E. Pennsboro
Cumber 1 and specify,
215 N. Second St. (Il yea, apepihJ Cuban,
Mexican, Puerto Rican, etc.) Whit e
11. Decedents Uwal Occ tpn KIrM of work done duri most of workin life. Do not stater ed) 12. Was Decetlent ever in the 13. Decedent's Education (Specity only highest grade completed) 14. Marital Status'. Marrietl, Never Married, 15 Surviving se (It wile, give maiden name)
paorfy) ~ em a
~
Klntl of Business / Industry0
'
`"l
G 115. Armed Forces? ElegreWary /Secondary (0-12) College (1 ~4 or Sa) ma r
I L ~el
r 1 e d
e~
~
ices Common Wealth ^Yee ®Nn
16. Decedent's Mailing Address (Street. city I town, stale, zip cotle) Decedent's - ~ Did Decedent p~
Decedem lived m F. _ P a n n c bn r n Twp.
P A Cwe in a 17c
.1Ll vas
Second .S t .
21 5 N ,
.
Adual Resitler¢e 1)a. State
Township? 17d ^ No
Decedent Lrved within
.
Enola, PA 1 7025 ,
rib cepnty Cumberland AdualLimfise, city Borb
13. Former' (F' sf middl last, s )
~'i`~~arc~ `~. Paul 19. Momer's Name (First, middle, maiden sumamel
Margaret McGahan
20b. Informant's Mailing Address (Street, city /town, stale, zip code)
20a. Informants Name (Type / Pnnl) PA 17025
Enola
Second St
215 N
Brenda K. Paul ,
.
.
osition ~Cremalan ^ Donation
f Di
h
d 21 b. Date of Cisposttion (Month, tlay, year) 21 c. Place of Disposition (Name of cemetery, crematory or other Dlace) 2ttl. Localron (City !town, state. n0 code)
o
sp
21 a. Met
o
^ Burial ^ RemovallromState sCrematlonorponalionAuthorized Dec. 2, 2008 Hollinger Crematory Mt. Holly Springs
ical Examiner I Coroner? yes ^ No
^ Other-Specity: i Y
22a. 5 lire of F eml Service Li r perso ding s such) 22b. Lcense Number
011248E 22c. Name and Address of Facillly
Musselman FH&CS Inc. 324 Hummel Ave. Lemoyne, PA
~
Complete Items 23a-c Doty when certifying
physician 5 rat available at lima of Oeam to 23a. o.t f my knowAetlge, death occunetl al the - e, date and pia stated. ( nature and Lille) „ ~ I
_ - ~
~
/C/ 23 . d~en""s Numb/er9.''[L ~ 23c. Date SI ad (Month, y, year)
~.JV .,r~ L- `7~ ~~~ /f C ~ ~~~~~
v
cenity cause of deem. ~
Time o Bath 25. Dale Pronou ed Dead (M h, day, year)
24 26. Was Case Referred to Medical Examiner I Coroner br a eason 0th than Cremation or Donation?
Items 24-26 must be completed by person
° who Pronounces deem. .
D ~ Q Q ~• M. /~ ~U ^Yes No
CAUSE OF DEATH (See Instructions ezamp ) ~ Approximate interval:
t
i Pan II: Emer other sionifieanl conditions conlributne to tlealh,
iven ut Pan I
cause
ltin
in the underl
in
t
t
b 28. Did Tobacco Use ConMbule to Death?
^Yes ^ Probabl
ac arres
, r Onset to Deeth
Item 27. Pan I: Enter the cha n of events - tliseases, injuries, or complications -that diredty caused the dea . DO NOT enter terminal events such as card .
g
y
g
g
no
resu
u
respiratory artesl, a ventnwlar fibrillation without showing the etiology. List Doty one cause on each line. ^ No nknown
IMMEDIATE CAUSE Final disease or
to ~alh)
\V:.C ~ St + l'e
condition resultin
E ~
D S ~T A ( 29. If Female.
nant within
ast
ear
^ N
1
re
_,~ y
g
.
. p
g
p
y
0
Due to (or as a consequence ofj:
^ Pregnam at time et death
di
i
if
ons.
any. h. ~
SequemiaHy list con
t
leadir~ to the cause listetl on Tine a. Due to (or as a consequence ol):
Enter the UNDERLYING CAUSE r
that initialed the
e or inry
di ^ Not pregnant, but pregnant wilhm 42 tlays
of death
c
ry
(
seas
events resulting to death) LAST.
r
^ Nor pregnant. but pregnant 43 days to 1 year
Due to (or as a consequence of).
r before death
^ Unknown tl pregnant withn the past year
d
30a. Was an Autopsy 306. Were Autopsy Findings 31. Manner m 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurted 32c. Place of Inryry. Home. Farm, Street. Factory,
Office Building. etc. ISpecily,t
Performed? ailaGe Prior to Completion Natural ^ Homicide
of Cause of Death? ^ Accident ^ Pending Investigation 32tl. Time of Injury 32e. Injury a1 Work? 32f. It Transportation Injury (Specity) .Location of Injury (Street, city! town. state)
^Yes No ^Yes o
^Yes ^ No ^Oriver/Operator ^Passenger ^Pedesln
_ ^ Suicioe ^ CauM Not be Determinetl M ^Other ~ Spenfy:
33b. Signature antl The of Ceniller
33a. Cedifier (check only one)
• Certifying physician (Physician certitying cause of tleam when anomer physician has pronounced death and completed Item 23)
^
t
t
d -
---~----
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
a
e
To the best of my knowledge, death occurred tlue to the cause(s) and manner as s
• Pronouncing antl certitying physician (Physician both pronouncing death and certifying to cause of death)
To the best of my knowledge, tleath occurred at the time, date, and place, and due to the cauaefs) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number i 33d. Date Signed (Month, tlay. yeas!
~ S e (~ ' j ~ ` (~ I ~ I (l ~•
• Medical Examiner) Coroner
On tl~a 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 inanner as stated_ ------ - --- -----~--°---~-----"-"---"-
d. Na nn Adores of Peso Who C feted Caug ~f D ath Ihem 21~ Tyoe: Print
-
35. Regislr ur rid DI / d ~ /
a ~t ~nlh tla~, YYaazp1
~r~t ~ ~ S Y ~. ,. L Ati C \l ~ [ 1( Q •' lrj
~ (? c ((
I I I i I
- i G~ ('~W\9 t~4. Il
~ ._.~-.._
n~rsnrsirnn Permit Nc. v~ V N ~ ~ U
~ ~ c~ ~~~ ~~ -ly
ILA~~' ~~]L~L A1~T~ ~']E~~'AI~[~I~T~'
~~
~ `~'
~~' ~~ -.,
~~r-
~~
I, MICHAEL J. PAUL, of the Village of West Fairv' ~ ca
iew, Township of East Pennsboro,
Cumberland County, Pennsylvania, declare this to be my Last Will and revo
previously made by me. ke any will or codicil
ITS Upon my demise, I direct my body be released to Muss
Home, Lemoyne, Pennsylvania where I have pre-arran ed c elman Funeral
g remahon and funeral services. I
further direct my ashes be disposed of in accordance with directions I hav
e given my personal
representative.
ITEM 2: I direct that all my funeral expenses be paid as soon as racti
~ ~ death. p cal after my
c,, Q
w
` ti ITEM 3: I direct that all taxes and interest and penalties there
a on that may be
assessed in consequence of my death, of whatever nat
U ure and by whatever jurisdiction imposed,
~ shall be paid from my residuary estate as a
part of the expense of the administration of my Estate.
IT- M 4~ I give, devise and bequeath all the rest, residue and remainder
of eve of my estate
ry nature and wheresoever situate, together with insurance thereon, to my wife, BRE
K. PAUL, provided that she survive my death by thirty (30) days. NDA
~°
ITEM 5: Should my wife, BRENDA K. PAUL, predecease me, or fail to
death by thi 3~ y ~ g ~ q survive my
m' (0 da s then I ive devise and be ueath all the rest, residue and remainde
my estate of eve r of
ry nature and wheresoever situate, together with insurance thereon, as follows:
A. Fifty percent (50%) to the BONE MARROW UNIT of JOHN
HOPKINS
UNIVERSITY, c/o Associate Director of Development Fund for John Ho
pkms
Medicine, One Charles Center, 100 N. Charles Street, Suite 422, Baltim
ore,
Maryland; and
B• Fifty percent (50%) to the LIVER TRANSPLANT UNIT, JOHN
HOPKINS
UNIVERSITY, c/o Associate Director of Development Fund for John Ho
pkms
Medicine, One Charles Center, 100 N. Charles Street, Suite 422, Baltim
ore,
Maryland.
ITS My Executrix or her successors shall have the followin
addition to those given by law to be exercised by her in her absolute g powers in
discretion, which powers
shall be applicable to all property held by her, effective without the order of an
the actual distribution of all such property: Y court and until
a• To retain any investments at discretion including stock of any corporate fiduci
hereunder or of a holding company controlling it; ary
b• To invest and reinvest in the executrix's discretion as permitted under
1999, as amended, the "Prudent Investor Act," with the specific ri Act 28 of
ght to invest in stocks, bonds
and real estate, including non-income producing residential real estate for the oc
cupancy of any
t
~~
t
present income beneficiary or beneficiaries, and in such diversified, proprieta mo
and mutual funds, including such mutual funds of any corporate fid ~ ney market
uciary hereunder or those of
any successor or affiliated corporation or a holding company controlling it, as m
deems appropriate; Y executrix
c• To sell, to grant options for the sale of, or otherwise convert any real or ers
property or interest therein, at public or private sale, for such prices, at such p onal
and upon such terms as they may think proper, and to exe time, m such manner
cute and deliver good and sufficient
conveyances, assignments and transfers thereof without liability of any purchaser to se
e to the
application of the purchase money;
d• To borrow money and to secure the repayment thereof by mort a e
g g of real or
personal property, pledge of investments or otherwise, without liability on the art of
to see to the application thereof; p the lenders
e• To compromise claims by or against my estate or any trust created hereunder
f.
To allocate and distribute different kinds or disproportionate shares of ro ert
undivided interests in property among beneficiaries or trusts, in cash or in p p y or
kind, or partly in each;
g• To register investments in the name of a nominee or to hold the same unre iste
in such form that they will pass by delivery; g red
h• To join in any recapitalization, merger, reorganization or votin
affecting investments; to deposit securities under agreement; to sub g trust plan
scribe for stock and bond
privileges; and generally to exercise all rights of security holders;
ax
y
1• To manage, operate, repair, alter or improve real estate or other property, and to
lease real estate and other property upon such terms and for such period as m ex
advisable even for more than five 5 Y ecutrix deems
( )years and beyond the duration of any trust;
j• To deduct administration expenses upon either the federal estate tax re
fiduciary income tax return with or without adjustment as between ri turn or
p ncipal and income, as my
corporate or disinterested executrix shall determine;
k• To associate with them in the absence of a corporate fiduciary, an accounta
nt,
custodian and investment advisor, and other agents and to compensate them from rind
income or both, as my executrix shall determine, such coin ensation p pal or
p to be a reduction of the
compensation of my executrix;
1• To associate with her at any time, in her absolute discretion and of her cho'
corporate fiduciary which shall have the same powers as my executrix, such ice, a
designation by my
executrix and acceptance by a corporate fiduciary to be in writing;
m• To combine, without prior court approval, any trust herein with any other trust
with substantially similar provisions, although such other trust may have been created b
y separate
instruments and by different persons, and, if necessary to protect different future
interests, to
value the assets at the time of such combination and to record the proportionate intere
st of each
separate trust in the combined fund; provided however, that no such combination shall b
permitted if the effect of such combination would be (1) to violate the a licabl e
pP e rule against
perpetuities; (2) to disqualify any interest in one or more of such trusts for a deduction for f
ederal
~~
a.
estate tax purposes which would otherwise be allowable; or (3) to cause the loss of th
status of one or more of such trusts from the imposition of the generation-ski e exempt
ppmg tax;
n• To exercise any stock options which they may receive; to borrow such funds fro
any source as my executrix may deem necessary for the exercise of such o tions• m
assets as my executrix deems appropriate for this purpose• p ~ and to pledge
o• No trustee shall be required to qualify before, be appointed by, or, in the absenc
of a breach of trust, account to any court (and failure to account alone shall not e
be considered
such a breach); nor shall trustee be required to obtain the order or approval of an
exercise of an y court m the
y power or decision granted hereunder;
p• To allocate any generation-skipping transfer tax exemption from the federal
generation-skipping transfer tax to any property to which I am deemed the transferor u
provisions of Section 2652(a) of the Internal Revenue Code of 1986 nder the
and its successors, including
any property transferred under my will and any property not in my probate estate and
property transferred by me during life as to which no allocation was made rior any
p to my death, to
the extent necessary to cause the inclusion ratios applicable to such transfers to be
zero;
q• To disclaim any interest in property without court approval; and
r• To do all other acts and thin s necess
g ary or appropriate in the management,
administration and distribution of my estate or trust.
ITEM 7: Until distributed, no gift or beneficial interest shall be sub•e
anticipation or voluntary or involuntary alienation. J ct to
ITEM 8: I appoint my wife, BRENDA K. PAUL, Executrix of this m Las
the event m Y t Will. In
y wife, Brenda K. Paul, predeceases me, fails to qualify or ceases to act as Executrix I
appomt my brother, JAMES pAUL of 5005 Constitution Avenue, Harrisburg, Penns lvan~
alternate Executor. Y is as
~ ITEM 9~ I direct that m
y personal representative or her successor shall not be
required to give bond for the faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, m L
and Testament, this (~ Y ast Will
day of_ ~,~ ~ ~
2008.
MICHAEL J. PAUL
Signed, sealed, published and declared by the above-named Testator as and for h~
dill and Testament in our presence, who, at his request, in his resenc is Last
p e and m the presence of
Bch other, have hereunto subscribed our names as attesting witnesses.
residing at ~~.~~,-C,S`~t/r ~ ~.`f
.~s~,~.
._ 1'i'1 ~~~ `"'~'"~` residin at ~ '
s J~-•/~
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND ) ss:
We, MICHAEL J. PAUL,
~ ~ ~~ ..
j~ _ ~' f (~_ ~ = and
-~Z ~l " .~ ,~~~..~,.. _ , the
Testator and the witnesses respectively, whose
names are signed to the attached or foregoing instrument, being first duly sworn do
declare to the undersigned authority that the Testator si ~ hereby
fined and executed the instrument as his
Last Will and that he had signed willingly, and that he executed it as his free and
voluntary act
for the purpose therein expressed, and that each of the witnesses, in the presence
and hearing of
the Testator, signed the will as witness and that to the best of his or her knowled
was at the time eighteen 18 fie, the Testator
( ,) years or older, of sound mind and under no constraint or undue
influence.
Subscribed, sworn and acknowledged before me
MICHAEL J. PAUL, the Testator, and subscribed r ~ C ti - by
~ ~ and sworn to before me by
;and _ ~~-v1, trt ~=-- ~~,
this ~ ~ " ~' `^ ,the witnesses,
~_ day of ~ 2 8
Notary Public
( EAL)
COMrpMyEEAt1N OF -ENN=rtYANrA
NOTARIAL SEA'
Henry F• Coyne. Notary Public
Hampden Township, Cumberland County
MY Commission Expires Juna ~ ~ ~~,
MICHAEi, ~ P A r rT