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HomeMy WebLinkAbout07-01-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF `MILLS OF ~ ~ ~^^ ~'~~'~. L-.~ ~. eJ Estate of ~C~2~S ~ : ,~1 ND ~+f c.a.J`a also known as _ __ .Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for. (CO,YIPLETE 'A' or 'B' BELOW:) COUNTY, PENNSYLVANIA File Number ~ ~ (~;~C~ ~ w ~~ Social Security Number ~ ~ (~ - / C "" 3 e' (p L LJ A. Probate and Grant of Letters Testamentary and!aver that Petitioner(s) is 1 are the ~©h-~A C ~'~ L. ~e,l.~ ~ S ~ tia named in the last Will of the Decedent dated So N £ d. , l'~~t-j ahd codicil(s) dated (State relevant circ~rmstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorcekl, 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 ae{judicated an incapacitated person: ^ B. Grant of Letters of Administration (lfapptica~ile, enter.• c. t. a.; d.b.n.c.t.a.; pendente lire; durante absentia; duranten:iaoritate) r,~ Petitioner(s) after a proper search has /have ascertained than Decedent left no Will and was survived by the followingt~ (if any) ~$ heirs: (!f Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) i ~','~ C.._. - Name Relationshi ResideACeC~r7 r ' ~ _t~ -~ , ~ ~,- (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~" N Decedent was domiciled at death in (" V v~.~t"k~ ~ /fit-.•a(a County, Pennsylvania with his /her last principal residence at Cu ~~n.~~°;Z«y,,,r+~ _~lLvSSr.~GS !c'~artz£.~nf~•:~•; .~~iA-;i,~<<`~f I tDr~Ce~s~a.eF L+J.h--'1 ,~ ~rti2c.c5c. r°/~ /~erS (Lrst street address', town/city, totivnship, county, state, zip code) Decedent, then `T d._ years of age, died on ~'~ ~-' ~ t J ~ ~ at S: 5~ J- ~.,n 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 $ /11j~~7CC~~CC~1 $ situated as follows: s /_ 41~~' (.,(L-~ C /Y VS 'X.lJt1'~ {L~ Wherefa-e, Petitioner(s) respectfully request(s) the probate of the bast 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 ,/ ~ q G~ .~-~i,(~,iY.V C.- ~.~/ +~-G.O.~~-~ 1'C G':l::l C o~ ~.. (~ r~ TJ ~,,: ~F3 ~ ! ti-~ .~ ~.. ~~' w' ~ .2 4 V 'c J"J C 4 LA% ('~ c? t~ J li 1 J ~~ Fora, RW-0? re,~. 10.13.06 P1~e I of 2 Oath off' Personal Representative COV1~tiIONWEALTH OF PENNSYLVANIA ~ J SS COUNTY OF ~•,j ~J"~/(Cy'1~ The Petitioner(s) above-named swear(s) or affirm(fi) that the statements in the foregoing Pet ition are true and coned 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. r.~ ~-~ ~" Sworn to or affirmed and subscribed ~.~--~~~ -~ `s' S'~gnature oJPersonal Representntive ~ _ ~ ~~~ before me the day of C ~ r-" ~::, E ' ~~~ Signature ojPersonal Representative _ ~ r the Register Signature ojPersonnl Representative _.~ N s .. -r; _r` ~ N File N~um~ber: ~ ~ C C\ ~ ~9 `~ Estate of ~ ICJ !' (S ~ . ~/'~~/ ~L~.~ ~ ,Deceased Social Security Number:_ U ~ ~9 ' ~ ~ ~ 3 ~ ~~ ~ Date of Death: JC.~~'1P f ~ Z~'~ / AND NOW, ~sf~ Q ' r GL~i.,. , ~, in con ~deration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DEC ~ t~+ Letters ~ ~P~ i~ t U are hereby granted to in the above estate and that the instrument(s) dated (~ ~' c~ 7 described in the Petition be admitted to probate and idled of record as the last WilL~d Codicil(s)) ~f ~eced~nt. ,. -~ , FEES Letters ~N - ~~L~~ $ ~~ .,..... Short Certificate(s) .. ~ ... $ Renunc~at~ p(s) .......... $ fs / ~ ... $ I~ ... $ ... $ ... $ ... $ ... $ ... $ 0 TOTAL .............. $~` Attorney Signature: Supreme Court LD. No Furst R6V-0? rev. 10.13.0( Page 2 Of 2 Oi.Y~S RED !01/0?) LOCAL REGISTRAR'S CERTIFICATI~ONoOF~tDEATH WARNING: It is illegal to duplidate this copy by pho Fee for this certificate, $6.00 ~~~6~~ Certittcation Number 1'hi~ is to certi;~y tt^at the int~ormation here gig°en Is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate ~~~ill he forwarded to the State Vital r' Records Office ft>: permanent filini?. L ~Zit~e~ _ ~U 16 2009 Date hsued Local Red*istrar r~ r. -~ C ; T t ,. ; r~ I I _ .R .i ~ N : r'l ~ `i - , ~ N i COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ 1 O ~Htas-la3REVwzaofi CERTIFICATE OF DEATH TYPE I PRINT IN STATE FILE NUMBER PERMANENT (See ~TStructions and examples on reverse BLACK INK 3. Social SecualY Number 4. Date of Death (Month, day, year), z sex June 15 2009 , Name a Deaeaem (Pirsl, middle. IasL eunixl F 056 - 10 - 3160 Doris F' • AridrE:v~1S 7 Binhplece (City and slate or foreign camtry) 88. Piece of Death (Check only one) Other' Under 1 year Under 1 day fi. Date of Binh (Month, tlay, year) Hospital: ' 5. Age (lass BinhdaY) ~~ Mkvxae j NursN Home ^ Resitlence ^Other - Specfy: ^'^"n" °0ys Patterson , ~ ^ Inpatient ^ ER I Outpatient ^ DOA 9 5/ 10/ 1917 Panty qm? ~ ,D. Race: American Indian. Blank, wage, em. 92 Yrs. saeet old number) 9. Was Oecetlent of His Ori No ^Ves (SpemM Ik. City, Boro, Twp. of Deam lid. Facility Name (II not I tilution, give (If yes, speciry Cuban, White Bb. County of Death ~ Mexican, Puedo Rican, etc) South Middleton Cumberl ~ d Crossings Ret. CrnTn. gme mai Cumberland I ni n t de compiered) tn. Wdreax eaorvoMeerd~lspec Mr Manned, ts. survwing spouse Uf wife, den name) 11. Decedent's Usual Occu lion Klyd of work done du ~ most of wo ' life. Dc not slate reared 12. U.S. Aimed omeso i the tElem my t/ Sec~o^dlary (D-12ty on Y 9COllege (1> or 5+) W1~ed Kind of work Klntl of Business I Industry ^ res C~k+a 12 Exec. Secrete Un' n Pa r Co. Didoeaedem ~n„th Middleton Twp. Decedent's PA Live in a 17c3~. Yes, Decetlemt lived In ifi. Decedent's Mailing Adtlress (3treet, city I town. state, zip code) Actual Residence t7a. Slate TownshlP4 17d. ^ No, Decedent Lwad within CM I Boro 1 Longsdorf Way nn.cwnty Cumberland Acual Umga °' Carlisle, PA 17015 t9. Momer's Name (Fimt mdse, maiden wmame) ,B. Femer'a Name (Firer made, last. aanlx) Lillian Anderson Geor e Wettstein lob. Informant's Meiling Address (Street, city I town, slate, ziP ~) PA 1707 4 zoo. Iaormaas Name (Type I Pdm) 776 Middle Rid e Rd. , PO BOX 25 r Newport , Frank then I c 21d. Location (oily I I°Wn, smte, zip coda) Gail A • 21b. Dale of Disposition (Month, day, year) 21 c. Place of Disposition (Name of wmaery, crematory or o p a e) 21 a. Me1Md of Oisposilbn ®cremation ^ Donaton Leola , PA ^ Banai ^ Evans Cranation Services Removal from State 'Wes Cremation or Do gon Aulhonzetl ^ Other -Specify '~ by Medcal Examiner /Coroner? ~ Vas ^ No 6/ 1 7~ 2009 ~c Name arA Address of Facility PA 17013 ~~ 22b. L'~cense Number Inc., Carlisle, 22a. signature of Fun I ice Licensee (or Pe ' ass Brothers Funeral Hczne , FD 01 263 ~ L Ew7Y1g 23h. Uge mbar 23c. Dat Sigma (Month, day, year] a , 23a. To Ne best t mY kn"'M "~ at Ne tlmq„datq d Place rated. (Signature and title) ~ ~ ~ ~~ ~~n 1 ~1 ..,~- ~ S ,~()~) Complete Items 23ac onry whw cenitying ~J n r~ I ~•- K v ~- _ cenity cauw of tleath. 26. Was Case Rsf ~rted; to Medical Examiner / Coroner for a Reason Other than Cremation or Donation. physiaen is not available at rime of deaN Ic VNI 24. Time of Deam . Date P ncea ce (Month, daY, Year) ^Ves ~ "O I Hems 2446 must be completed by person ~. j (~ M. ~ k r 1 S d~ G ~-, t l'bN' t death, 2g. Did T°bearo Use Contribute to Death? who praxxmces death. K r Approximate internal: Pan II: Enter other ~5y_BS__t co"' "" Yas pmpeNy CAUSE OF DEATH (See Instructions and example) but not resulting in the urdedyirg cause given m Pad I. ^^ No ^ Unkrrown diseases, injuries, a compicenons -that &recty causes Ne deaN. DO NOT enter terminal events such as caNlac artest, Onset to Death Item 27, Part I: Enter the chd of eYe[~ - 29. II Ft le'. respiratory artest, ar vemrlcular libdllanon wiMoN showing the etbbgy. I.Ht only ana cause on each line. ~_ ` ~~ ! ('~ 1 ~ V ~ ~ ^ Nat pregnaa wanN past year IMMEDIATE CAUSE (Final disease or ~" c'~ ^ pregnant at 6me of tlealn conditbn resulting H death) _~ a. C Due to tar as a c sequen oq. ^ Not pregnant, but pregnant within 42 days of deaN _ Sequentiegy Nst conddons, if an% b. leapingg to IM cause Gsletl on line a. pus to (or as a consequence of): t ^ Not pregnant, but pregnaa 43 days to 1 year ~1 Enter the UNDERLYING CAUSE bolero death (disease a injury that initialed Ne c, eu rs rewlbng in death) LAST. Due to (or as a consequence ol): ^ Unknown'rt pregnant within the past year d r 32c. Place oI Injury: Home, Farm, Street. Faaory, 32a Dd~e of Injury (Month, day, Y~0 32b. Describe How Injury Occuned Office Guiding, etc. f5pec,Nl w 30a. Was an Autopsy 30b. Ware Autopsy Findngs 31. Manner of DeeN '1' Pedormed? Avegaae Prior to Compb6on atural ^ Homicide '. 329. t.acation of Injury (Street, city I town, state) of Cause of Death? 32d. nine of Injury 32e. Inury e[ Work? 321. II Tmnsponallon Injury (Speciy) ^ Aaident ^ PemFng Investigation ^ Driver I Operator ^ r Pedestrian ^ Yes ~la ^ Yes ^ Nc '. ^ Yes ^ No . ^ Suicide ^ Could Not be Determined M. ^Olhar ~ Speo'N: 33b. Squat e o ~ - yl '" 33a. Ceniger (check only one) cyn has reed death and corppleled Item 23) v Cerlltying physician (Physician ceNfying cause of death when enaher DhYS~ M~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 33d. Data Signed jMonm, ea ,year) } To the Dest of mY klrowbdge, death occurted sue to the cause(s) arM manrwr as staled_ _ - _ _ - - - ~.- - - - - - 33c. Lice s r ! ~ (/~ ~l Prorrouncinq entl cenHYing PNYalcian IPMsiaan bah Proneuncing death and renltylrg to cause a death) ( ~~ ~ S - ~, 6 l ! lJ _ To the beat of my klwwledge, death occurred at the time.date, and place, end due to me cause(s)and miner es stated------------------ ^ f ) Ype • Medical Examiner I Coroner 3d. Name and Address of Person Whn Compleletl Cause of Deam (item 27 7 I Print On the basis of examination and 1 or investigation, in my oplnbn, death occurred at the time, date, antl pace, and due to the cause(s) and manner as statetl_ ^ PA .Date Fried lMomh. adv. rear) Darryl Guistwite D0, Carlisle, 35. Registrar's aa~e ani Disu[~1~Nf~r1 1 vY I f I 1 ' Disposition Permit No. `- `-l ~I LAST WILL AND TESTAMENT I, DORIS E. ANDREWS, residing at #265 Robinson Way, in the Borough of Lincoln Park, in the County of Morris and State of New Jersey, being of sound and disposing mind, memory and ^. : __~ understanding, do hereby revoke all Wills and Codicils b~=~e at ~~y time heretofore made and make, publish and declare thi~~.m~ Last , ., _~_ Will and Testament, in the following provisions: '~ ,- FIRST: I direct that all my just debts which are~na-~ barred -, -. .. by the Laws of Limitations and funeral expenses be paid. ~`:; SECOND: I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS to my late husband's daughter, SANDRA LYNN COKER, residing at #8006 Cool Forest, San Antonio, Texas 78329, if she survives me. THIRD: I give and bequeath the sum of FIVE HUNDRED ($499.00) DOLLARS to my step-granddaughter, AMBER COKER, if she vurvi gyres me . FOURTH: I give and bequeath the sum of FIVE HUNDRED ($499.00) DOLLARS to my step-grandson, CRISTOPHER COKER, if he survives me. FIFTH: I give and bequeath the sum of ONE THOUSAND ($1000.00) DOLLARS to any grandchild of mine, living at the time of my death. SIXTH: All the rest, residue and remainder of my estate, both real, personal and mixed, including any interest owned by me in cemetery plots, and all property over which I shall then have any power of appointment, I give, devise, bequeath and appoint in three (3) equal shares to be distributed in the manner following: A. I give, devise and bequeath one (1) equal share unto my daughter, GAIL ANN FRANK, residing at #109 North 24th Street, Camp Hill, Pennsylvania 17011; Page One of My Will ~" ,' --.~.--tir ~ . ~--ti..., Gs DORIS E. ANDREWS B. I give, devise and bequeath one (1) equal share unto my son, BRUCE ALAN WATSON, residing at #3916 James Avenue, Huron, Ohio 44839; C. I give, devise and bequeath one (1) equal share unto my son, RONALD CLIFFORD WATSON, residing at 7 Nalron Drive, Ledgewood, New Jersey; In the further event that any one of my beneficiaries shall die survived by issue living at my death, such issue shall take his or her share per stirpes, absolutely and in fee, but if any one of my deceased beneficiaries shall not be survived by issue living at my death, then the whole thereof shall be divided equally among my surviving beneficiaries. SEVENTH: In the event that any grandchild has not attained the age of eighteen (18) years, I give, devise and bequeath said grandchild's share unto my child who is said grandchild's natural parent, to be held in a Custodial Account until the time he or she attains the age of eighteen (18) years of age. EIGHTH: I nominate, constitute and appoint my son, RONALD CLIFFORD WATSON, to be Executor of this, my Last Will and Testament. Should my son, RONALD CLIFFORD WATSON, fail to survive me, or should he fail to qualify, then I nominate, constitute and appoint my daughter, GAIL ANN FRANK, to be Substitute Executrix of this, my Last Will and Testament. NINTH: I direct that na bond, surety or undertaking shall be required of my Executors in any Court or place of jurisdiction. TENTH: I hereby give unto my Executor and Substitute Executrix, full power and authority to grant, bargain, sell, convey, lease, mortgage, partition, invest or otherwise dispose of any and all of my lands and property whether real, personal or mixed, of whatsoever kind and nature and wheresoever situate, whereof I may die seized at the time of my deatri or of which they may be seized or possessed. Upon the sale thereof to execute, ~``~ ~ ,.- P a g e Two o f My W i 11 , ~,`~---u.-~...~,~.~ C, ~.~=mot.. < u_..,, ~ .~ ~..~...,~ DORIS E. ANDREWS acknowledge and deliver any and all necessary and proper Deeds and documents required therefor. IN WITNESS WHEREOF, I, DORIS E. ANDREWS, herewith set my hand to this, my Last Will and Testament, typewritten double spaced on three sheets of paper, including the attestation clause and signature of witnesses, upon the lower margin of each one of which I have also written my name this 2nd day of June, One Thousand, Nine Hundred and Ninety-Seven. DORIS E. ANDREWS SIGNED, SEALED, PUBLISHED and DECLARED by the said DORIS E. ANDREWS, to be her Last Will and Testament, in our presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. Page Three o f My W i 11 '~'.~„---~-~--~ ~ ~a-R-c~? ---,~--e...~.c,e ~...- DORIS E. ANDREWS STATE OF NEW JERSEY: . ss COUNTY OF MORRIS I, DORIS E. ANDREWS, the Testatrix, sign my name to this instrument this 2nd day of June, 1997, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and Testament and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. ~ ~ _. DORIS E. ANDREWS ~ f~U /-'-, FEENG`/ and L/ ~ ___-- Z-i'}~~Th~ YJ, ~I ENK ~ ~U S the witnesses, being first duly sworn do each hereby declare to the undersigned authority that the Testatrix signs and executes this instrument as her Last Will and Testament and that she signs it willingly and that each of state that, in the presence and hearing of the Testatrix, we hereby sian that Will as witnesses to the Testatrix's signing and that to the best of our knowledge the Testatrix is eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. P ~. 9 _ / e ~ .,-~ ~ ,~ ~ ;~ ~ i .---~ Subscribed, sworn to and acknowledged before me by DORIS E. ANDREWS, the Testatrix, and subscribed and swo(r~n t-o~-before me by ~J U!-fN F ~r EN Ey and _~L~Zg/3 E Tip 'J- `/F"NKIA1 S witnesses this 2nd day of June, 1997.