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HomeMy WebLinkAbout06-16-09 ETITION FOR PRORATE AND GRANT Off' LETT~R~ REGISTER OF ~ti'ILLS OF COUNTY, PEiv~iS~'L`"ANIA Estate of ~ ~~ L.. 1~ 1 ~L ~~~ File Number ~~ " ~ 05 IOC also known as / ~ / '~ ~ / ~3 ,Deceased Social Security Number Petitioner(s), who is/are 13 years of age or older, apply(ies) for: (CO;~IPLETE 'A' or 'B' BELOW:) IJ~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the GX L° ~~1 ~ named in the last Will of the Decedent dated t'0'S' X00$ and codicil(s) dated (State releva,it circu,nstances, e.g., renunciation, death ojexecutor, 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 Administratio (ljapplicable, enter: e.t.a.; d.b.n.c.t.a.: pendente liter durante absentia; Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following Adntittistration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ' Name Relationshi (CO~LIPLETE IN ALL CASES:) Attach additional sheets if necessary. minorilate) ~ ,_..,, t , j_. .t~(if any) arieirs: ~ ~ ' R ~'~`i[ " Decedent was domiciled at death in ~r,~, VN h er ~ ot,v~ a'( County, Pennsylvania with his /her last principal residence at 2 5 1321 A- ~t2 t ~~,~~ tiro VT p.~- I ?o z~ (List sd•eet address, tow,dcity, lownsltip, cocurty, state, zip code) n Decedent, then ~~_ years of age, died on~luhe 7.~0~ at ~ ~S $f~ (I~1~ ~ ~ ~= ~dOLi4 r,~" ~~O Z Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ , UO O (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ ~q, j>O~ situated as follows: Whe~~efore, 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 Ty ed or Tinted name and residence TEr2~5~ /~ ~~/3A~TY-I ~~ / 3 ~ ~ou.~~r S"a~ ~~ S~i~G-T ~KC ~ iTY, C~ ~~t o S~ Forn, Rr~-U? ,~e~-. 10.13.06 Page 1 of 2 105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15476009 Certification Number 3 REV 11/'1008 / PRINT IN RMANENT ACK INK ~? ~_ A+. F';C;~ ~ i`...... l~ ~ r r ~~~ ~~ C7 Q ~~ '~''''pp ;1~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) CTATF FII F NI I\ARCC N t~ °o i~ CT Z Q w -;}'; ;1 I•-~{~'~ I ~•! .r T.. '1 !` .~; ..~ ~'.~` tz .g F 1. Name d Decedent (First, midrib, last, suffix) 2. Sex 3. Social SeaMry Number 4. Date of DeaM (Monts, day, year) Mary L. Miller ~ Female 171 - 28 - 5337 Jun 7 5. Age (last Binhdey) Under 1 r Under 1 de 8. Dste of Berth Month, des a 7. BI and state a coon 8e. Pbce of DeaM Check one hbnlhs Days lioura karxnas Hospital: Other: 7 8 „~, Dec 1 1 , 19 3 0 M i nne a po 1 i s ,Minn ^ Iryratient ^ ER /Outpatient ^ DOA ^ Nursing Home ~ Residence ^ Outer • Spedty: a. County o1 Deets Bc. City, Bono, Twp. of Deets Bd. Fecitiry Neme (If rat irrtilutlon, give street and number) 9. Was Decedent nt Hispertic Origin? ®~ ^ Yes 10. Race: American Indian, Black, White, etc. Cumberland E. Pennsboro 125 Brian Dr. Enola Pa (tl Yes, epedry Cuban, Mexican,PuedoRicart,etc.) (Specify) White 11. Deoedwp's llatrl tion Kind of work d one moat of Nfe. Do rat state 12. Wes Decedent ever in the 13. Decedent's Education (Spedly ony highest grade cartp ieted) 14. Merftal Sbtus: Married, Never Marred, 15. Surviving Spo use (II wife give maiden name] Kind d W Kird of Buskras f Industry Registered Nurse U.S. Armed Forces? Elementary /Secondary (0.12) College (1.4 or 5+) Wkfowed' Divorced (SPeaN) , Hos ital ^ Yea ~] No U k D' v 1 s. Decedents Melting Address (sheet, dry /town, state, zip code) Decedent's P e n n S Y l va n l a ~ve inDecaedent East P e n n s bo r o Actual Residence 17a. State 17c ~I Yes Decedent Lived in T 1 2 5 Brian Drive . , om, Cumber 1 a n d rownsnip? 17d ^ No Decedent Lived wihin Eno 1 a P a 17 0 2 5 . , 1b' ~°""" Actual Limits of city / Boro 18. Father's Name (First, middle, lest, suffix) John H. Scholzen 19. Mother's Name (First, midnte, maiden sumeme) Gertrude Wirtz 208. InfarmanYs Name (Type I Print) 20b. Informants Mailing Address (Street, city /town, state, zip rode) Teresa Sebastian 1340 S. 500 East. Salt Lake Cit UT 84105 21 a. Method of Disposltlort r ^ Cremation ^ Donation 21 b. Date of Dieposilicn (Monts, day, year) 21 c. Place of Dislassitbn (Name of cemetery, crematory or other place) 21 d. Location (City I town, state, zip cede) I~ Burial ^ RertavelfromState i WaCrenrtionaDorrtlatAuthorized ^ June 1 1 2009 Tri-Count Memorial Gardens y Lewisberr P ^ Oyer . r by tlMdkal ExanYner/Coroner? Ya^ No ~ y, a 22a. ' txterel Service Licensee (or pe ng as such) 22b. License Number 22c. Name and Address a Factliry S u 11 i va n F u ne r a 1 Home - G FD 011897-L 23a•c only when rziddyirtg 23a. To the best d my aM occurred at the time, date and stated. (Signature ~ title) 23b. License Number 23c. Date Signed (Month, day, year) pitysktien is rat avatiebb at tlme of deaM to ~ ~ ' ceraly cause a chat. ~ iL Items 24.28 moat be compbted by persart i 24. Time d DeaM 25. Date Prcoounced Deed (Month, day, year) ~ / ~ ~ ~ 28. Was Case R erred to Medical Examiner I Coroner for a Reason Other than Cremation or Danatfon9 w a prorauncea desM. y , /~ ~ M. ~ / / V V ^ Yes No t Approximate interval: CAUSE OF DEATH (See Instructions and exampMs) Pad il: Enter other 28. Did Tobacco Use Contribute to Death? yam 27. PeA I: Enter the dakt of events -diseases, injuries, or corrtplicalbns -art directly caused ar daM. DO NOT enter terminal events such as cardiac arrest, ~ Onset ro DaM but rat resulting in the underlying cause given in Pad I. ^ Yes ^ Probabty reaptratory arrest, a ventrictdar flbMbtion wtllaut showing the etiology. List only one cause on each line. r ^ No ^ Unkrawn ~~ c>v~R~~-I.1 c~~c~2~ a ~~s a. 29. II Female: ^ N Due to (or as a consequence oQ: r r ot pregnant within past year ^ Pregnant at time d deaM ~ conditions a Ile b M t d e b' ^ on n tetra e e a. Erder UNDERLYING CAUSE Due to (or as a consegtrence of): r Not pregnant, but pregnant within 42 days of deaM (dress or iryurX Met inttiebd the c r events to death LAST rostrlNrtg ) . Due to (or u a consequence nt): r r Not pregnant but pregnant 43 days to 1 year t>erore deaM d' r r ^ Unknown tl pregnant within Me past year 30a. Wee an Autopsy 30b. Wero Autopsy Findings ~1. Me r of DaM 32a. Dale d Injury (Monts, day, year) 32b. Describe How Injury Orxuned 32c. Place of Injury: Home, farm, Street, Factory. Perfomrd? Avatlabb Prior ro Campbtion Naturel ^ Homidde Offk:e Building, etc. (Specity) of Cause 01 DeaM7 ^ Y a No ^ Y ^ N ^ Acradent ^ Pending Irtvesdgatlon ~• ~^e of Injury 32e. Injury al Work? 321. It Trensportation Injury (SpacNy) 32g. Location of Injury (Street city /town, stale) e ea o ^ Sulfide ^ Could Not be Determined ^ Yes ^ No ^ DrNer / Operetor ^ Passenger M. Otlar•~ti. 33e. Certifier (dtecir ony one) 33b. signature end Tale of Ce ~- • CaRNying phyacwt (Physician ardrying cause d deaM when another phyeiciert has pronanoed daM and completed Iqm 23) To the bat of my knowbdge, daM oawred dw to the caus(e) end manner u etNad _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,,vim - ),.7 '~'~ / • Praauneing arts cenNykp phyakian (Phyalrrart both praaunang daM and cedilyxrg to cause of deaM) ^ 33c. License Nwnber -f ` ' 33d. Date fy ( th, y, year) To the beat of my knowbdge, daeth oaurred at the time, dNs, and pba, and dos to lM cawe(q end manner a stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • MedlalExamNar/Coroner M ~ Z. 3 Z I S (C /_ 1~ p ~O On an bob of examination and / or ImeeagaNon, in my oplnbn, death occurred d tM time, date, and pbu, ant due to tM caws(e) and manor a etaee~ ^ 34. Name and Address of Per son Who Completed Cause of Da (Item 27) Typo / Pri t M _ l Q 35 Registrars and Obtrkkt r ~ De M nts d ~ l { ~r ~ `©` 1 V0 ~~ ` ` ~ ~~ Al ~ S 1 •~~C"C:. . ~ a ~ / 1 I I I I - / L ( , ay, year) o j ~-p - ' - _ ~ t~ ~ 111 L 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 forwarded to the State Vital Records Office for permanent filing. JUN 9 2 9 o a egis ar Date Issued v Disposdion Pemvt No. ~ S~ s7ti ~n l_/ S `"'~ V~ ~A~T 'I V ~~ Al V ~ T~~T~1 ~ T ®~ ~1' MARY ~v M~~~R `~l ~ ~ ~ `~?, ~, r' ~~` /~~ f.~ ~--- "'~ w _. 3 ~ t -..._ :..~ -~ ra ~__ ~v.A ~ ~~~ I, MARY L. MII.LER of the Township of East Pennsboro, County of Cum~rland, '~~~~' Commonwealth of Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by me. ITEM l: Upon my demise, I direct a funeral Mass of the Christian Burial be celebrated and my body be laid to rest in the Mausoleum in Tri-County Memorial Gardens, Lewisberry, Pennsylvania. ITEM 2: I direct that all my funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in a consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from a H my residuary estate as a part of the expense of the administration of my Estate. ~- a ITEM 4: I give, devise and bequeath all of my jewelry to my daughter, TERESA A. ~ SEBASTIAN. ti -~ ITEM 5: I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon, in equal shares, to my children, as follows: A One third (1/3) to my daughter, TERESA A. SEBASTIAN of 1340 S. 500 E, Salt Lake City, Utah 84105, per stirpes; Page 1 of 6 B. One third (1/3) to my son, STEVEN J. SEBASTIAN of 755 Panza Drive, Mechanicsburg, Pennsylvania 17050. Should my son, Steven J. Sebastian predecease me, I direct his share be distributed in equal shares to my then remaining living children, per stirpes; and C. One third (1/3) to my son, PAUL M. SEBASTIAN of 22 Hellam Drive, Mechanicsburg, Pennsylvania 17055, per stirpes. ITEM 6: Should any beneficiary entitled to a share of my estate not have attained the age a w a a H a a of twenty-five (25) years at the time of distribution to him or her, I devise and bequeath the share of such beneficiary to my daughter, TERESA A. SEBASTIAN, as Trustee (I appoint son, STEVEN J. SEBASTIAN, as alternate Trustee), to be held in separate trusts, to hold, manage, invest and reinvest the share so received, in accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee discretion, may be necessary or appropriate for such beneficiary's maintenance, support, and education (including college education, both graduate and undergraduate) without regard to his or her parents' ability to provide for such maintenance, support or education, or to make payment for these purposes, without further responsibility, to such beneficiary's parents or to any person taking care of such beneficiary. Any principal or income not so applied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be distributed to his or her personal representative. Should the principal of any trust herein provided for be or become too small in the trustee's discretion so as to make establishment or continuance of the trust inadvisable, the trustee or my personal representative may, without court approval, make immediate distribution of the then-remaining principal and any accumulated or undistributed income outright to the person or persons in the proportions they are then entitled to income. Upon such termination, the rights of all persons might otherwise have an interest as succeeding income beneficiary or in remainder shall cease. Page 2 of 7 T i ITEM 7: My Executrix, trustee or their successors shall have the following powers in addition to those given by law to be exercised by them in their absolute discretion, which powers shall be applicable to all property held by them, effective without the order of any court and until the actual distribution of all such property: a. To retain any investments at discretion including stock of any corporate fiduciary hereunder or of a holding company controlling it; b. To invest and reinvest in the executrix's or trustee's discretion as permitted under Act 28 of 1999, as amended, the "Prudent Investor Act," with the specific right to invest in stocks, bonds and real estate, including non-income producing residential real estate for the occupancy of any present income beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executrix and trustee deem appropriate; c. To sell, to grant options for the sale of, or otherwise convert any real or personal property a w • a a H a a or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; 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 property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such form that they will pass by delivery; Page 3 of 7 7 ~ t h. To join in any recapitalization, merger, reorganization or voting trust plan affecting investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and generally to exercise all rights of security holders; i. 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 my executrix and trustee deem advisable even for more than five (5) years and beyond the duration of any trust; j. To deduct administration expenses upon either the federal estate tax return or fiduciary income tax return with or without adjustment as between principal and income, as my corporate or disinterested executrix shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian and investment advisor, and other agents and to compensate them from principal or income or both, as my executrix or trustee shall determine, such compensation to be a reduction of the compensation of my executrix or trustee; 1. To associate with them at any time, in their absolute discretion and of their choice, a w . a a H ~'C • a corporate fiduciary which shall have the same powers as my executrix or trustee, such designation by my executrix or trustee 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 by 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 interest of each separate trust in the combined fund; provided however, that no such combination shall be permitted if the effect of such combination would be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or more of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or Page 4 of 7 (3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the generation-skipping tax; n. To exercise any stock options which they may receive; to borrow such funds from any source as my executrix or trustee may deem necessary for the exercise of such options; and to pledge assets as my executrix or trustee deems appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court (and failure to account alone shall not be considered such a breach); nor shall trustee be required to obtain the order or approval of any court in the exercise of any power or decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- a w a a H ~' a x skipping transfer tax to any property to which I am deemed the transferor under the provisions of Section 2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred under my will and any property not in my probate estate and any property transferred by me during life as to which no allocation was made prior 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 things necessary or appropriate in the management, administration and distribution of my estate or trust. ITEM 8: In the event any legatee or devisee named in this will dies under such circumstances that there is not sufficient evidence to determine absolutely whether such legatee or devisee survived me, I direct such legatee or devisee shall be presumed to have predeceased me and devise and bequeath the gift in favor of that legatee or devisee to such persons and in such manner and in such proportions as set forth in this will for distribution if the legatee or devisee predeceased me. Page 5 of 7 ITEM 9: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 10: I appoint my daughter, TERESA A. SEBASTIAN, as Executrix of this my Last Will. In the event my daughter, TERESA A. SEBASTIAN predeceases me, fails to qualify or ceases to act as Executor, I appoint my son, STEVEN J. SEBASTIAN, my alternate Executrix of this my Last Will. ITEM 11: I direct that my personal representatives, trustee or their successors, 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 and seal to this, my Last Will and Testament, this ~~ day of ~~- ~~~~ , 2008. MARY .MILLER Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. r residing at ~~ 9 ~ o ~- ~.. L. `~ residing at ~ ~%(~ ~ / Page 6 of 7 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We MARY L. MILLER, t1' n n~2. ~• ~ ~~-~~- and ~~ ~,,~ w . ~~L,~i~t ~ ,the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the will as witness and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years or older, of sound mind and under no constraint or undue influence. M L. MILLER ,; Witness ~,., Witness worn and acknowled ed before me ~ i S fl- /l/~ ~ E t/ by MARY L. Subscribed, s g _ ',~~~ MILLER, the Tcstatrix, and subscribcd and sworn to bcforc me by /~I and G1. ,the witnesses, this ~_ day of Q c~ , 2008. Notary ublic (SEAL b COMMONWEALTH OF I~ENN3VtV N-A N,OfiAR~AL SEAL Liss Merie Coyne, Notary Pubt,iC Hampden Township. Cumberland County My Contn-issioa Expaos Jw+e i 0. ~01~3 Page 7 of 7