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HomeMy WebLinkAbout05-04-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Dorothy I. Leach File Number 21-09-~_4?..1 also known as ,Deceased Social Security Number 174-20-3561 Mark A. Leach Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE `A' or B' BELOW.) ~X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the last Will of the Decedent, dated 05/08/2007 and codicil(s) dated 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 apprca e, enter.- c..a.; .n. c. t. a.; pe ente de; urante a senGa; urante mmontate f'^,3 Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp@v,Se (if any) an~'ieirs: (If Administration, c. t. a. ord. b. n. c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ~~ ~ s~ -t7 ?~, Name Relationship Residence - _,~ ~ C (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 2 Sussex Road, Camp Hill, Lower Allen, Cumberland, PA 17011 (List street address, town/city, township, county, state, zip code) Decedent, then $2 years of age, died on 04/14/2009 at Decedent at death owned property with estimated values as follows: (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: All personal property Personal property in Pennsylvania Personal property in County 32,165.00 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: ~ Signature Typed or printed name and residence ~ Mark A. Leach 2 Sussex Road Camp Hill, PA 17011 Form Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 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 to or affirmed and subscribed before me this ~_ day of r ,, ~ ~ ~ l t, ~ ;~ or the Register f of Mark A. Leach r~~ t"7 ~- ~~ O ~-. .~ Signature of Personal Representative ~ ~~~ _.~ --< `-j j ~ ..` Signature of Personal Representative -- ,. -; `~ Jt ~ r.~ .. File Number: 21-09- O'-~"1~\ Estate of Dorothy I. Leach ,Deceased Social Security Number: 174-20-3561 Date of Death: 04/14/2009 AND NOW, ~ G ~ Lrr ~(~~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED at Letters Testamentary are hereby granted to Mark A. Leach in the above estate and that the instrument(s) dated 05/08/2007 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Letters . ............J~.I~~........... $ ~G Short Certificate(s).......... °~........ $ a'J Renunciation(s) ............................. $ ~l~l $ >'~ TOTAL ................................... $ fo?~ Supreme Court I.D. No.: 41263 Address: 429 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 n Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attorney Signature: ~ ~~.- Attorney Name: Michael L. Bangs OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photoc~r~.ph. }"Ee tUi' i~~lti lf'1'lltiCll(C_ ~f`-.O(' ru,. :~ Thlti l5 CU Lltl!'\ hdi ChL, lll~)flll litlldl jillL ~'I~eil ! ~,t' ~~H OFr ' ' c(>ucctly cfyp(ec' ,t ~sa~ ~)(~ ,.) ,jt3a~ l Itl~(~ Ire <it t~eatj) r,t°~ ~ ~ sj ~~~~ ~ ~~ Lhtl~ filed lvith (T1 a~ i u~.l: Kr_ I~tra1. I (~i' f>u~rinal ~~ ~ y~ c~ll)t)cate w~!I ~ iifn~ (rlic~l i1• the `Mate `.%itul ~,~ ., ~A,~ Ree~irc~, (~Itirr Ir : ~ent;.uicnl tl'1.~`_~. ,~_ ~ ~ ~ i ~ ~ 71 ~ \~ ~~9~1M~N1©~~``~~~~f -_ AP~ 1 6 009 -----_ __ ---- D`` enit(r.a!~1m `albrfiher ~~-"~ L±>cal Rer_i~trar Ihllr I,;ueL~ r'~J f~ `_~ ~:~ r-a O '4, 1 .s ? ~ ~~ ~. 1 _ -. -z ,~- - _ -`l ^ ~~ c.~ ;) =-~ .. , :_~ .~_ REV 11/2oos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRIM IN AANENT CERTIFICATE OF DEATH cK INK (See instructions and examples on reverse) '~ \ ~ ~"` (; t.-'-'~ 1 STATE FILE NUMBER 1. Name of Decedent (Frsi middle, lash suffix) 2. Sex 3. Social Secunry Number v 4. Date of Death (Month, day, year) Dorothy I. Leach female 174 -20 -3561 ~ -- I ~-- ;ZC~C-~' 5. Age (last Birthday) Untler 7 year Under 1 day 6. Data of Binh (Month, tlay, year) 7. Sinhplace (Ciry antl state a for eign country) 8a. PWce of Death (Check only one) Manors Days Hours Minutes Hospital: ether: 82 June 21, 1926 Harrisburg, PA Yra In bent ^ pa ^ ER /Outpatient ^ DOA ^ Nursing Home ®Residence ^Other -Specify: Bb. Counry of Oeam &. City, 0oro, Twp. of Death ed. Facility Name (h not ksdhdian, gWe street atnf number) 9. Was Decedent of Hispanic Origin? ®No ^ Ves 10. Race. American Indian, Black, While, etc. Cumberland Lower Allen ~f4,.~ ^!' • 2 Sussex Road (If yes, specity Cuban. (Specity) Mexican, Puerto Rican, etc.) whit e 11. DecedenYS Usual Oct Ibn Kind of woM done dun most of workin life. W trot slate refired 12. Was Decedent aver in the 13. Decedent's Education (Specify onty highest grade completed) 14. Marital Status: Marred, Never Married 15. Surviving Spouse (If wife, give maiden name) KiM of Work KiM of Business / Intlustry U.S. Armed Farces? Elemenu /Secondary (0.12) College (1-d or 5+) Wxbwed, Divorced (Specify, Homemaker Domestic ^ves ®No ~ Widowed 16. Decedents Meiling Address (Street, city I town, state, zip code) 2 Sussex Road DecedenYS Did Decedent AmualReaideme ne.Slate Pennsylvania Liveina nc.®Yea,Decedemuveain Lower Allen Tw PA 17011 Camp Hill p. Township? fived within 176. cppnry Cumberland 17d.^p~Decedest , o Ciry / Bora ' 16. Famer's Name (First, mitlde, last, suffix) 19. Homer's Name (First, middle, maiden surname) Harry Chubb Clara Hosan 20a. Informant's Neme (Type / Prnt) 20b. Informants Mailing Address (Street, city /town, state, zip code) Mark A. Leach 2 Sussex Road, Camp Hill, PA 17011 21 a. Method of DisposPoOn ^ Cremation ^ Donation 216. Date of Disposition (MOmh, tlay, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Locatan (Ciry I lows, state, zip cotle) Bartel ^ Removal Irom State ;Was Crematbn or Donation AtMarized ^ Omer-Specify: j byMedicalFaeminer/Coronet? ^Yes^rtp April 17, 2009 Woodlawn Memorial Gardens Lower Paxton 'ltap. ,PA 17109 22a. Signature ey F Lken (or person acting as such) 22b. License Ntxnber 22c. Name and Address of Fadiiry - `~ ti~~"`'` FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete hems 23a~ only when certitying 23a. To the best of my knowledge, deem occured at ttte Ome, dale and place stated. (SignaMe antl title) 236. License Number 23c. Date Signed (MOmh, tlay, year) physician is rwt avaiWMe at time of deem to ceNry cause of Beam. Items 24-26 must be completed by person 24. Lore of Deam 25. Dale Pmnounced Dead ( M onet, tlay, year) 26. Wes Case Refered to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? wfp pronounces deem. / Z , [ ~ 7 ~ M. ^ / ' A I^I ~ ~ 4 Z,~C•~ ^ Yes ~ No CAUSE OF DEATH (See Inatructions and examples) t Approximate interval: Pan II: Emer other stgniflcent cond~l ors contributing to tleam, 28. Did Tobacco Use Contn6ule to Death? Item 27. Part I: Enter the them of events -diseases, injures, or complications -that directly caused me deem. W NOT enter tertninai evenu such as cardiac arest, poser to beam but not resulting in the untletlying cause given in Pan L ^ Yes ^ Probably respiratory arrest, or ventricular fibrillation withoN showing me etiobgy. list only one cease on each line. t t ^ No ^ Unknown IMMEDIATE CAUSE Final disease or r^ oxMebn resulting in ~th) _~ a. .~~/~~ ~%!--' ,,,~ ~C/;/a ('„~-{[ ~^,: f1,/h /+/1 ~ 1 29. N Female. ^ Due to (or as a consequence pf): t Not pregnant mtnin past year Sequentialy list Cor1d111011a. N any, b t li l d m ti tl ^ Pregnant al lime of death on ea rg to a cause ste ne a. Due to or as a con uence o t Enter the UNDERLYNIG CAUSE ( ~ ~~ t Nol Dre ant, but ^ 9n pregnant within 42 days (dsease or injury mat iniAated me c r events resutling m death) LAST. t of death Due to (or as a consequence off: t ^ Not pregnant, but pregnan143 days to 7 year ~ before tlealh d ^ Unknown it pregnant within the past year 30a. Was an Amopsy 30b. Were AutoPSy Findngs 31. Manner of Deam 32a. Dale of Injury (Honor, day, year) 326. Describe How Injury Occuretl 32c. fslace of Injury Home, Farm. Street Factory, Performed? Available Prbr to Complefbn ^ Natural ^ Homicide Otlice Building, etc. (Specity) of Cause of Death? ^ Yes ~] No ^ Yes ^ No ^ A¢Wenl ^ Pendng Investigation 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (Specr'tyJ 32g. Localien of injury !Street, city /town, stale) ^ Suicide ^ Coultl Nol be Determined ^ Yes ^ No ^ Dover /Operator ^ Passenger ^ Petlesaian M ^Other~ Specity: 33a. Cenifrer (check only one) 33b nature atM T ~' ~ ~. ~ > i • Certifying physician (Physician certifying cause of dean when another physician has pronounced death antl cornpleled Item 23) l ~ - 1 -,, / t !~^'~ ' - '" -~ To the best of my knowledge, death occuned due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~~ • Pronouncing and cenltying physician (Physician bath pronoulH•ing death and cemryinq to cause of deem) n, death occurred at me time, date, and place and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ly; To the best of my knowledge 33c. License Num~fer» h ~ ' 3a Date Signed (MrMlh, day2ye rl y) A r ~ (~ , ~ ~ •) ~ , , . , ~ f y ~ F = ~ r ~ J I 1, , ' / '? J \\\ • Medical Exam her (Coroner On ma bads of examination and / or investigation, In my opinion, death occurred al the time, date, and place, and due to the cause(s) and manner as sfeted_ ^ : 39 Nartre antl Address of Peron Who Completed C ~th (Ire 27) type / P t Reg stray' Signature antl D tract Nugj~,(/ ~ .-s ~ l 36. Dal Fi (Mon tlay, year) -. ,n.,~ ~ ~ T~+ , 7, /Y:, ,'i ~` rte` r l . . . I ~ I I I I I (/ p( ~ ~,,vw. a ` P , - _ _ ... ,,z-~ ~ ., .~ f~ r.~ J ~j -, .:°-~ -_ _ ~- = < < ~ _ ~~ ' I, DOROTHY I. LEACH, of Lower Allen Township, Cumberland County, '~~ `~ `+ Pennsylvania, declare this to be my last will and revoke any will previously made by~}e. cx~ ITEM I. I direct that all my just debts and funeral expenses, including my gravemark~r and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or - otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ~~ ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all ,~ other articles of household and personal use, equipment and ornament, together with all Cam, -- _ insurance thereon and relating thereto, to my son MARK A. LEACH provided he survives my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate to my son MARK A. LEACH provided he survives my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my son MARK A. LEACH executor of this my last will. 1 ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this ~~ day of ~~~~ C~~'~~ , 2007. ~; } r C~ X /, -,-~~ ~~~ c., ~~--~"'-~C-Y~L-_ DOROTHY I. LEACH 2 The preceding instrument, consisting of this and TWO other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by DOROTHY I. LEACH, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~'~; ) ~1 DOROTHY I. LEAC Sworn or affirmed to and acknowledged hef~re me by the tot r' named above th`s ~,~~d ofe ~., , 2007. G~ ~~ ~ , No*.ary Publi ~~y~/~ 4~~$~'SE.'~L a Jl~'w:IFi./~~ ~. S+i-c'ti+3'.~'0~'a~y I~i 4 1~1:6:Ei~r FJi~ v+ ,-~rr4~~~;~ :~~,;3y`6,16;13;9 -Oy 2~ ,~_ COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) WE, ~`'~~ 1~~.r~ ~ L._~~r~~F~ and ~~`jGl~S ~t~c~"+ ,the witnesses whose names are signed to the attached or foregoing instrumen ,being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Y ~ ~ ~ Sworn or affirmed tg a d~acknowledged otfore rn t s{' '~.-day of ~~: ~ 1 , 2007. ~~ BENDY S. C~59~0, Pic I.omn~ ~~ Tv~., My Co~'c~ ~~ May 1Q, 2I107 4