HomeMy WebLinkAbout03-03-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PnE~NNS~Y)LVANIA ~j
Estate of DAVID H. CLOUSER `~`"/ ` ~ ~y
File Number
also known as
,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 CO-EXECUTORS named in the
last Will of the Decedent dated 211 712 0 09 and codicil(s) dated NONE
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(State relevant circumstances, e.g., renunciation, death ojexecutoq etc.) ;A n .ZY L; _
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execu~ inst~tent(s~,?offet~d
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
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B. Grant of Letters of Administration -~ r-~
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(/japplicable, enter: c. t.a.; d. b.n.c. t.a.; pendentelite; durance absentia, durance min~te) j,-
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Petitioner(s) after a proper search has /have ascertained [ha[ Decedent left no Will and was survived by the following spouse (if any) and heirs: (Lf
Administration, c. t. a. or d. b. n. c. t.a., enter date of Will in Section A above and complete list of heirs.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 1204
Mitchell Drive Mechanicsburg PA 17050 Mechanicsburg Boro rah
(List street address, town/ciry, township, county, state, zip code)
Decedent, then ~ ~ years of age, died on 2/20/2009 at Holy Soirit Hosoital
Como Hill PA 17011
Decedent at death owned property with estimated values as follows
(If domiciled in PA) All personal property $ 10.000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 151.000.00
1204 Mitchell Drive, Mechanicsburg, PA
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) [he probate of [he last Will and Codicil(s) presented with [his Petition and the gran[ of Letters in the appropriate forth to
the undersigned:
(COMPLETE WALL CASES:J Anach addiliona! sheets ijnecessary.
Page 1 of 2
Farm RW-02 rev. 10.13.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
The Petitioner(s) above-named swear(s) or affum(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.
icy- ~~ ~ Sad x
Social Sec !y'//Numb/et: ~7 Date of Death: 2/20/2009
AND NOWT ~( (~'~~~L- ~_"S , 2009 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Douglas G. Clouser and Debra A Horseman
in the above estate
and that the instrument(s) dated II
described in the Petition be admitted to probate and filed of recor{J as the last Will (a/td Codicil(s))~f,Decedera.
FEES ~Lt~(d .- ~~
~~ ~. ~ ister Will ~ ~ ~~%-O
Letters ............................. $ ~ rr .
Short Certificate(s) ............ $ ~ ~ '' ~ j':
Attomey Signature:
Renunciation(s)~`~I~ ~~~~~~~~~ $ ~ 6. (
$ Attorney Name: Murrel R. W~Iters. 111
_ "" $ I~~µ~ ~~/~Af1 Supreme Court LD. No.: 24849
. $
.... $ Address: 54 East Main Street
. $
$ Mechanicsburg. PA 17055
. $
Telephone: 717-697-4650
... $
TOTAL ............................. $
Form RW-01 rev./0./3.06
Page 2 of 2
Sworn to or affirmed and subscribed ~ ~
Q Signature aJPersono[ Represeniarive ~Dpu ~S G. CI~IS~~
before me the ~ day of / 1 / ~ t
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ fee for this certificate. 56.00
P 15_?~ 6462
Certification Number
This is ro certify that the infiirnuftiun he•c ^icen is
correctly aYpied liom an original Certi fica'r I If Death
duly file) with me as Loeul Regisnnr. 'I-he original
certificate will be forwarded to the Sime Vital
Records Office tix permanent filing.
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Local Registrar •
Dale Issuer
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LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT ~ ~~
I, DAVID H. CLOUSER, a resident of Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make, publish and
declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and
all Wills and Codicils previously made by me.
I
I declare that I am not married, my beloved wife having pr~decease~ me,
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and that I have two children, DOUGLAS G. CLOUSER ai~~Bl A.,
~ ~ ~ 'i
HOUSEMAN. u5 ~'' `-
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I direct that all my just debts and funeral expenses shall be paid frolf3 my
residuary estate as soon as practicable after my decease.
III
I direct that all taxes that may be assessed in consequence of my death, of
wha±ever nature and by wha.*_ever jurisdiction imposed, shall be paid from my
residuary estate as a part of the expense of the administration of my estate.
IV
I give, devise and bequeath all my property, whether real or personal,
wherever situate, including any property over which I may have a power of
appointment, to my children, DOUGLAS G. CLOUSER and DEBRA A.
HOUSEMAN, in equal shares, per capita.
V
My daughter, DEBRA A. HOUSEMAN, currently resides with me at my
residence. If Debra should continue to reside there at my death, then I give her
the opportunity to continue to reside there with the condition that she
immediately after my death start paying all utilities. After the passage of three (3)
months after my death, she may continue to reside there if she pays not only the
utilities but also taxes and insurance, as well as making a monthly payment of
THREE HUNDRED DOLLARS ($300.00) to my son, DOUGLAS G. CLOUSER.
VI
I nominate, constitute and appoint my son, DOUGLAS G. CLOUSER, and
my daughter, DEBRA A. HOUSEMAN, as Co-Executors of this LAST WILL, to
serve without bond.
IN WITNESS WHEREOF, I, DAVID H. CLOUSER, have set my hand to this
LAST WILL this /~7 day of ~--~~i- , 2009.
~ ~
DAVID H. CLOUSER
Signed, sealed, published and declared by the above-named DAVID H.
CLOUSER, as and for his Last Will and Testament, in the presence of us, who, at
his request and in his presence, and in the presence of each other, have hereunto
subscribed our names as witnesses.
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
I, DAVID H. CLOUSER, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my LAST WILL; that I
signed it as my free and voluntary act for the purposes therein expressed.
~: 1 / (~f'
DAVID H. CLOUSER
Sworn or affirmed to and acknowledged before me by DAVID H. CLOUSER,
Testator, this / ~`~` day of ~ Q ~>,~u«~ , 2009.
Notary Public
NOTARAI SEAL
DIANE M SMITH
Notary Public
MECHANICSBURG SORO, CUMSERIAND ~,
My Commission Explrsa Jun 22, 2012
Sworn or affirmed to and acknowledged before me
this ) ~`~~-day of ~=~_k~~a.C~-~~~: , 2009.
,~
/.
Notary Public
NOTARIAL SEAL
DIANE M SMITH
Notary PubIIC
MECHANICSSURG BORO, CUCrS1ERlANDCNIY
My Commission Expires Jun 22. 2012
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
We, l"~L~r~r~ti. ,2. c;.lK t ~-"F:/('/ ((~~~~` ands ,~/Jt'f~~ l~ .'~'fy'~%~>>
the witnesses whose names are signed'~o the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present
and saw Testator sign and execute the instrument as his LAST WILL, that DAVID
H. CLOUSER signed willingly and that he executed it as his free and voluntary
act for the purposes therein expressed; 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 the time 18 years of age or more, of sound mind and'under
no constraint or undue influence. / /~ ~
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