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HomeMy WebLinkAbout07-13-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of ELISABETH H.D. HICKOK '') ~ ~. C File Number a( t also known as ,Deceased Social Security Number 195-16-3877 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 December 11, 1987 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 n ~ (lfapplicable, enter.• c.t.a.; d.b.n.c.t.a.; pendentelite; duranteabsentia; dur~dnoritate) `'O -- iJ -~ ~ s , Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following stp¢ any) ~ heirs, (If , ; Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) A,, r-n :::1) "~ ~ Name Relationshi Reside ~~^ C~ t '• (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 851 Oak Oval. Mechanicsburg (iJpper Allen Twn) PA 17055 (List street address, town/city, townshtp, county, state, zip code) Decedent, then 94 years of age, died on June 29, 2009 at Messiah Village, Mechanicsburg, Upper Allen Twp. Cumberland County, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (If no[ domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $_~? Oc~~c", c,<~ TOTAL $ _5-~',<'' c~<~r_ ~,~, situated as follows: Tracts in Middle Paxton Twp., Dauphin County, PA; Borough of Lemoyne, Cumberland County, PA; and Fairview Twp., York otul y, 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: T d or rioted name and residence / ~ / 1// Charles N. Hickok Peter H. Hickok /'. `~ / ~ i .f ~ i 250 Hidden Valley Lane 5235 Terrace Road ~ I Harrisburg, PA 17112 Mechanicsburg, PA 17050 Form RW-02 rev. 10.!3.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS 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 lrnowledge and belief of Petitioner(s) and that, as persona] 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 the 1 day of f ~. I ~ ~G'U t ~~ ~, ; ~ ~ ~~ For the Register Signature of Persona( Representative ~~Q ~'3 ~ _,~~ c _i„~, Wit`^i rr1 ~~~ ..r, W t ,- --- - __ .::~ ~ File Number: oZ ~ ~ ~ V ~ ~`~ 3 ' ._ iV Estate of ELISABETH H.D. HICKOK ,Deceased ~ I .. ~:; _ ` `i Social S/ecurity Number: 195-16-3877 J Date of Death: June 29, 2009 AND NOW, / ~w~~1 d'y ~ IGti! ~ ~ , ~, in consideration of the foregoing Petition, satisfactory proof having been presented be r T IS C ~iat l are hereby granted to ~~C(/ ~ ~ I~t~Cx in the above estate 1 and that the instrument(s) dated -e/,' l ~ described in the Petition be admitted to probate and filed of record as the last Will (an~if'~'odicil(s)) o~ecedent. FEES Letters . , .5.~~., ~t:~~ $ ~~~ Short Certificate(s) .. ~~~.. $ ~ Renunci ti (n(s) .......... $ ~ ... $ ~~ L ~ ... $ J ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ `~C~ `/ `~` ~" Regis r of Wills ~`- i _ ~ _ `. ~ i ~ ,; Attorney Signature: ~ ' ~ _~~ ~-' Attorney Name: J D. Seibert, Esquire Supreme Court I.D. No.: 41713 Address: 109 Locust Street Harrisburg, PA 17101 Telephone: 717-236-9301 Form RW-O2 rev. 10.13.06 Page 2 of 2 I(15.8us RFiv ri71!U"?t LOCAL REGISTRAR'S CERTIFICATION OF HEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certifica~e. $b.00 ~, N Certification Number "Chic i; to cet~;ife that the infcn~ltuuio)) here gi~'et correetiy ca~iL'd from an ori~xinal Certificate oT D ~3uly fiL;d ~~it ; n,e as Local Re<_*i~U~ar. The ori~i certific~r.te ~~~iil he fixw:)rde<i to tt)e State V Records Offish ±~>r permanent I~ilirt~~. o`` JUL p 1 20 9 Local Re`ai~tra~ ~ [~a±e [ssu;'d C ~ w _ :~ =~ ~ t ~> rte- -- t~' < / ,ern :1~ -z7 W t 1 r -, , ~ ~: `, IV aEV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN ',ANENT CERTIFICATE OF DEATH ,K INK (See instructions and examples on reverse) ~ 1 U CS. ~`j „ ~~ STATE FILE NUMBER t V 7. Name of Decedent (FrsL m~tlle last suff) 2. Sex 3 Socral Secud Number ty 4. Date of Death (Month, tlay yea d` ~ i ~ /313c ~ i/ «r' - it J l,'x~ O r< 1" l~4'~ - ~6 7,~ 5. Age (Last Birthday) Untler 1 year Under 1 day 6. Date of Birth (Month, tlay, year) 7. Birthplace (City aM state or loreign country) 8a. Place of Deatn (Check Doty one) 7 ~ / ~ J / / r ~~ 1 J (/* -` (~ ~~r~ ~' ~~ j Months Days Hours Minuras .. C Hospital: .L.i 7 -7 rt /•) i~7~~L~ Other'. `/',/ Yrs. /7L!(.=t(~SI ,ti/; f 9/<f- _ 4'li /~-cif / is t `'r'L/ ^ Inpatient ^ ER /Outpatient ^ DOA ~~ Nursing Home ^ Residence ^Other ~ Speci Bb. County of Death 6c. City, Bore, Twp. of Death Bd. Facility Name Qf trot institution, give street antl number ty j 9. Was Decedent of Hispanic Origin? ®No ^ Yes 70. Rac Am icon I d BI k, Whrte, etc. ~Ll /YLF:.t r'/ ~ n/i.~ Lf ' ! , (u yes speclry Cuban S / ~ ' ~ ~~~ N / /f 'LCkr? ~~l ~/G~~ Mexican Puerto Rican, etc.I ~ ~ ~ / ~~ 11. Decedent's Usual Occu tlon Hind of work done d ~ most of vrorkin life. Do trot slate retired 12. Was Decedent e e in the 13. Decedent's Education (Specify onty hghest grade completed) 14 Martel Status: Married, Never Mamed, 15. Surviving Spouse (II w fe, give maiden name) Kntl of Work Kind of Business I Industry U. S. Armed Forces? Elementary /Secondary (012) College (1-0 or Si) IsP~'iM Widowed, Divorced .'~IrVCG --C'.E `7n%I'///C.' ^Ves f~No l.2 ~ti,'t~:.~~~~/~ _ 16. Decedent's Mya~1 r>g Address (Street c ty /town, state, zip code) Decedent's n Did Decedent J / _ ~ i7 ~~ C- l ; a) i_ Actual Residence 77a. State ~ ~ /V /V .~ S' 6 l_' i~ iti / /~ Live in 8 ~ ;:,y' /7/:J~= j'' ~ y v 17c Ves, Decedent Ltvetl in Townshlp7 ~ '` ~' 1. Twp /E/~: i'-if />f /c,'!_`; /~~(r K'.C.-/ t~/-1 / Je.">`j ~ 17b. county l..'GUT~;:?x~/-`'..r,/-~/y'i~ nd.^NO. DecedamLvad within Actual Umih of Ciry r goro .16. Father's Name (Fret middle last suffix) 79. MoNer's Name (First, middle, maiden surname) `-' '• G-/~RU~;iwc i~/fit ~~/~9~'1/v 1;_c ti G ;U c`c.'i<~c / 20a. Inlomrant s Name (Type / Pnnl) 20b. InformanYS Mailing Adtlress (Street, city I town state zip code) ~=/~-/~/?<ES" iV. /1 /C:/i'(7/~' ~'SG~ rd;~i~i~c/v' t-l /=~1 ccy~.',ti~~ //~~i/•;2 '~._ar-~" ~;~, 21 a. Memod of Disposition / - _ Cremation ^ Donation 21 h. Dale of Disposition (Monet, day, year) 21c Place of Disposdion (Name of cemetery, crematory or otner place) 21 d. Location (City /town, slate zip code) ^ Burial ^ Removal from Slate ~ Wea Cremation or Donehon Authorized _ % ^ Other ~ Specity: j by Medical Ezaminer /Coroner? I~ Yes ^ No ,, t" 1^~ I r ,.2 G` C! it {~ 1' {{ ~ /'. C7%l FA- f Zl I~ Y tT1 ~'i * 1 vi G' r i. %"! r - S~ a of Funeral Service Licensee (or person acti s such) ,^ 22h. License Number 22c. Name arM Address of Fadli " ~ ~/5 j/~(~~ ~r . 2. Cf • - L ~ ry :mil u ? ~ 1 r., ~ c' i_ 1 ,'Yy ~r, E 1_ F cd xv ~ f'_~} L 1'h^ 'n - L i/ i- r~ D ~ i 7 -{ .~ ®GT i ,/Y7J~ /v./~',c . S P7~E~cT i f /~-Ji.c.; `i /.) a ~ ~/>L J i ~ ~~ . Complete Items 23ac only when certitying 23a. To best of my knowledge, death occured at the time, date orb place stated. (Signature and title) Li.L `- ' 23b. ~cense Number physrdan 5 not available al arte of death to r~ ~ ` ~ > 23c. Date Signed (Month. day year) sanity cause of death. ~, ~ ., v 1 f~, ,~' d / ~ 1 1 C•, 24. Time of Death ' l• Jam- {.~ I l 'E.- ~ J (t, Items 24-26 must he completed by person 26. Date P nouncetl Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other Than Creme on or Donaton? wiro Pronounces death. /. C) ~ M. / \ ~ C Ox (~ ~ (,~ C 1 wr r 4~ ^ Yes ©tJtl' CAUSE OF DEATH (See Instruction and a mples) ~ Approximate interval: Pad II: Enter other siPnd¢anl condlions mntnoutinp to ath, 26. Utl Tobacco Use Contribute m Death? Item 27. Pan I: Enter the clwin d events -diseases, injuries, or compications -that directly caused the death. GO NOT enter lerninal events such as cardiac arrest, Onset to Death but not resNa to the unded in cause respiratory arrest, or ventricular fibdllatbn withou! showing the etiology. List only one rouse on each line. n9 ~ Y 9 given in Part L ^ Yes ^ Probabty IMMEDIATE CAUSE (Foal disease or r ^ No Unknown contlttbn resulting in death) ~ `-,/,~p(,•~,(~~/ ~ C,(J ~^ ,J ~i p ,: i q C'n /~ ~ // ~ . /~~ n~~ti ;~ ~ &J~ ale: a. / C/L(.,CL.-~-bC~t-C~.S^ L L G~ G ~ (/Li l '!; • ', , Due to (or as a consequence of): i r / ~ / ~~/,~, ~ot pregnant within past year Seq entHlty list conddans, if any, b r /_NXCi' 6z-~ ~~ /^ pregnant at time of death leadir~ to the cause lisletl online a. r L Enter the UNDERLYING CAUSE u t ( u ry. (disease or injury Thal initialed the r ^ Not pregnant, but pregnant within 42 days events resuldrg to death) LAST o' t ~,~J of death Due to (or as a consequence on. d ^ Nol pregnant, but pregnant 43 days to t year ~ befor ln d 30a. Was an Autopsy 30b. Were Autopsy Findings Performed? available Prior to Completion e ea ^ Unknown it pregnant within the past year 31 Manner of Death 32a. Date of Injury (Month, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Injury Home Farm Sh F of Cause of Death? , eet. actory, rural ^ Homicide Office Building, otc. (SDecilyJ ^ Yes ~No ^ Yes ^ No ^ Accident ^ Penthng Investigation 32d. Tme of Injury 32e. Injury at Work? 32f. If Transportation Injury (SpecityJ 32g. Location of Injury (Street. city! town. slate) r ^ Suicitle ^ Coultl Nol be Detertninetl ^ Yes ^ No ^ Dnverl Operator ^ passenger ^Ped¢strian M Other ~ Specity' 33a. Certilier (check onty one) • Cenltylnq physician (Physican cenilying cause of death when anWher physkian has prorauncetl death and Completed Item 23) 33b. Sig dTtleof Cedifier ^' ~ ' ' ~/ / '" ~ To the best of my knowledge, death occurred du e to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,.O /~~%, ~- • Pronouns rg antl certifying physrcian (Physician _ _ _ _ _ _ _ _ _ _ _ _ both pronouncing tleath antl certifying to cause of death) ~ GGG J To the best of my knowledge, death occurred al the time, dale, and place, and due tp the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ ^ • Medical Examrner /Coroner ~ i On the basis of examination and / or mveshgatron to m o rmon d th ct 33c. License Number ~ -~{~p~n l~ (~S~ 33d. Date Signed (Month, tlay, yearf /_ ~ I ! ~ ~~~ , y p , ea ocn tra at the time, date, and place, and due to the cause(s) and manner as stated_ ^ 34. Name and Address of Person o Com~etetl Cause o earn (Item __ s /Print 36 Raa~tr is Signature ~ rirjlftlrtl~er ' f - / ~ E 36. Date Find (M h, day, year)- ~.~~~~ y~ L~~ ~~ ~~' / ~ I I L I ~ I/ I '~ L //~G% /G'~'~ /.'.-'~~1G~~2 ,.. ' ~ . ~ ~i~C,j ~. G (~ Disposition Permit No. V --3) <? i~-7 .1 ~~ ~i11 ~n~ C~~. ~~k~.m~~.x ~~~k OF ELISABETH H. D. HICKOK I, ELISABETH H. D. HICKOK, of Wynnewood, Montgomery County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare the following to be my Last Will and Testament, hereby revoking and making void, any and all wills, codicils and testamentary dispositions by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses be paid and satisfied by my Executor hereinafter named as soon as conveniently may be after my decease. ITEM II. I give, devise and bequeath all the rest, residue and remainder of my estate, whether real or personal, and wherever the same may be situate or located, to the Trustee under my Trust Agreement executed on December 9, 1987, under which I am named as the Trustee, IN TRUST, to treat it as an addition to the principal subject to that Agreement as it exists at my death. ITEM III. I direct that any and all inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. ITEM IV. In addition to the powers conferred by law, I authorize my personal representatives in their absolute discretion: A. To retain in the form received and to sell at either public or private sale, any real o_r personal property. B. To manage real estate. C. To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, c-~ ^' ~. , ~ c_~ ,.:~ r~ -ta `-- E qty C7 z..x ~: v`' ~~ ~_ ~~? ~ -~ ~~~ _ ~_:+ -i N .rte ~.. 3` r-i N _.. , D, To exercise any option or rights arising from ownership investments. E, To compromise claims without court approval, and without the consent of any beneficiary. ITEM V. I nominate, constitute and appoint my sons, CHARLES N, HICKOK and PETER H. HICKOK, or the survivor of them, as Executors of this, my Last Will and Testament. I hereby relieve my personal representatives from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act insofar as I am able to do so by law. IN WITNESS WHEREOF, I, Elisabeth H. D. Hickok, have hereunto set my hand and seal this ~1 day of December, 1987.E ~, ~ _n ~ Elisabeth H. D. H' ok Signed, sealed, published and declared as and for the Last Will and Testament of Elisabeth H. D. Hickok, the Testatrix, in our presence, who, in her presence, and in the presence of each other, and at her request, have hereunto set our hands as subscribing witnesses hereto. ~, , __ ' - '/.... Name Address {/,~ f 7 Name Address 2. C C n OMMONWEALTH OF PENNSYLVANIA SS: OUNTY OF DAUPHIN ' 1 and Elisabeth H. D. Hickok ~~~~ ~'~~/ ~s ''~ ' We , ~`' .,~'~ ' ~, ~~)~, ~ ~ ~ the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing Lnstrument, being first duly sworn, do hereby declare to the Indersigned officer that the Testatrix signed the instrument as r~er Last Will and that she signed voluntarily and that each of the witnesses in the presence of the Testatrix at her request, and in the presence of each other, signed the Will as a witness and that to the best of the knowledge of each witness, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. r--- -~ ~a-~ ~~ ~. ~~~~"~ Testatrix - Elisa eth H. D. Hickok ~ _. ; ~! 1 ~ Witness Witness worn to and subscribed before e by Elisabeth H. D. Hickok, the estatrix,an~ bscribed and sworn to of ore m/ by and ,~ the itnesses, L ~n this ~/ ~h--daY of ~"~~ ~ 1987 . r Notary Public { K;a1' t, d'vUUIET, Notary Public N,:,-r=!~urg, i?~unnin Lo., Pa. rJ,~ Com~„i~;cn expires March 19, 19A0