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HomeMy WebLinkAbout08-31-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of David Noah Bair also known as Deceased COUNTY, PENNSYLVANIA File Number ~X f ~y / ~ ~~lO Social Security Number 195-07-4684 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 Executrix last Will of the Decedent dated Apri120, 2007 and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not many, 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 (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or db.rzc.t.a., enter date of Will in Section A above and complete list of heirs.) r,,,~ ~ r.~ Name Relationshi Resi ~t~j ~' C ~~n - :;, m ~ ~J'j ~ r~_7 C (COMPLETE INALL CASES:) Attach atWitlonal sheets iJnecessary. '~ ~ ~ ='_' Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at-- ' •'> _`~ 513 Eutaw Avenue, New Cumberland, PA 17070 (List street address, town/city, township, county, state, zip code) Decedent, then ~ years of age, died on August 17, 2009 at Holy Spirit Hospital Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 120,000 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: approximately $100,000 in stocks and $25,000 in checking account 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: Si a[ure T d or Tinted name and residence / Doris Mae Bair f 513 Eutaw Avenue, New Cumberland PA, 170170 named in the Form RW-02 rev. 10.13.06 Page 1 of Z _ _ _ __ _ _ H195.R05 REV (91/071 /~ ~ '/ ~~'I ~lYy LOCAL REGISTRAR'S CERTIFICATION OF DEAT'~I WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 1~~~''~ Certification Number 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. ~ AUG 0 2 9 Local Registrar Date Issued - ------- -_ _ __ _ __ _ ra -- - - - - -- CJ ° ----- ------ ---- - __._ -- -_ CQ +..co . ' G7 ~J t> ~ m c~ " + ~ I 3 c. J r-; J-~r -~ ~_ _T - ~ ; ~._1, ` ~ _.. ~ REV ttnogs COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS :Ft' _ I PRIM IN ~MANENT CERTIFICATE OF DEATH ~~ - \CK INN (See instructions and examples on reverse) STATE FILE NUMBER 1. Name of Decedent (FirM, mldtlle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Monet, tley. year) David Noah Bair male 195 - 07 - 4684 Au ust 17, 2009 5. Age (last BiMdayj Untler 1 ar Under 1 da 6. Date of BiM Manm, da , ear 7. Binh lace CI antl state or forei count Ba. Place of Death (Check onl one / Omer: Monroe Days Hours MMNas HOSpdzl' r~-v( 94 yam. September 26,1914 Harrisburg, PA ^Inpatienl LJER/Outpadent ^lbA ^NursingHOme ^Residence ^omar sootily BD. Count' of Death Bc. Ciry, Boro, Twp. of Deam Btl. Fadllry Nama (II not Insmution, give street and number) 9. Was Decedent of Hispanic Origin? ®Ne ^ yes t-. Race. American Intllan, Black, White, etc. (If yes, speciry cubes, (SpeciM Cumberland E. Pennsboro Twp. Holy Spirit Hospital Mexkan,PuedpRican,akj white f 1. DecedenYS Usual lion Kind of work tlone dun most of work file. Do not stale retired 12. Wes Decedent ever In the 13. Decedent's Education (Speciy Dory highest grede completetl) 14. MarRal Status: Married, Never Married, 15. Surviving Spouse (II wife, give maitlen name( Kintl of WoM Kind of Businessl Industry US. Arnred Farces? Elementary /Secondary (U72) Cofiege (1~4 or 5a) WidoweQ Divorced (Specify) Supervisor Computer fl Yae ^ Np 12 Married Doris Mae Simcox 16.Decedent's Mailing Address (Street, ciryltovm,state, zip code) Daeeenra Penns lvania Did Decedent y LNe ins ^ 513 Eutaw Avenue yes, Decedent Lived in Twp. t7p. AcNal Residence 17a. State Township? d PA 17070 N C b l pd.®NO, Decedent Lived within Cumberland New Cumberland t7b.cou"try um er an , ew ciryrBprp AdualUmihof 1 e. Famer's Name (First midtlle, last, suaix) 19. Mothers Neme (First, middle, maiden sumamel George Washington Bair Ellen Mildred Benner 20a. tnlortnant's Name (Type! Print) 20b. Infomuml's Meiling Adtlress (Street, dry! town, sate, zip cotle) Doris Mae Bair 513 Eutaw Avenue New Cumberland PA 17070 21 a. Method of Disposition r ^ Cremation ^ Donation 21 b. Dare of Dispos0on (Month, day, year) 21c. Place of Disposkion (Name of cemetery, crematory or other place( ltd. Location (City l town, slate, zip code) ® Brtnal ^ RemovalfromSWte i WasCrematbnwDOnatlonAMhorhetl Au ust 20 2009 Rollin Green Cemeter Lower Allen Tw PA 17011 ^ parer. g r by Medkal Exammerl CoroneR ^ Yes^ No g f g y p • a 22a. SgnaNre unerel rvice L' (or ailing as such) 22b, License Number 22c. Name and AOMess of Facility - FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete items 23ec Doty when certdying 23a. To me hest of my knowledge, tleaM occurred at the time, tlate end place stated. (Signature and IPoe) 23b. License Number 23c. Dale Slgnetl (Month, tley. year) physidan'rs not avagabk at time of deem tc cerory cause of deem. Rams 24-26 must a completed Dry person 24. Tlme of Death p 25. Date Prgwurxed Dead (Monet, day, year) d to Medkal Examiner /Coroner Ier a Reason Other man Cremation or Donation? 26. Was Case Refe rre who pronounces death. / v~ / M ~ °1 ~ v~ x ~ ^ Yes 181 Na r Approzirtate interveP. CAUSE OF DEATH (See Inatructlons end ex les) Pan IP Enter Deter sianifnnt condillons contrihulinq to death. 2B. Did Tobacco Use Contribute to Death? Item 27. Part I: Enter me chain of events - tliseases, Injuries, or complications ~ that dlrectty ceased the death. DO NOT enter Terminal events such as cardiac arrest, Onset to Death but WI resulting in the urMadyirg cause given In Pad I. ^ ryas ~ Probaby respiratory artesl, or ventricular IDnllation without showing are etiology. List only one cause on each lure. ^ No ^ Unknown IMMEDIATE CAUSE (IFinal tlisease or - .A ~ r condition resulting in death) ~ a_ (~. ~~%J ~ft~r ~ 1' V ~ ~Y' (C LG`L'-( ~. r~ r `'D'' j' J ~ r ~ 29. II Female. n nt withi t ^ N l Due to (or as a consequence of). ~ preg n pas year o a ^ Pregnant at time cl tleath SequentiallyY list arrdians, it arty, h ^ kadinq to th reuse listed on line a. I Enter dra UNDERLYING CAUSE Due to (or as a consequence oq. Not pregnant, but pregnant within 42 days of death (tlisease or Injury met initlated me c ST ^ N t t b t t 43 d t events resWlirg in death) LA . Due to (or es a consequence oQ. o pregnan , pregnan year u ays to before death d. ^ Unknown it pregnant within Iha Dast ear y 30e. Was an Arrtopsy 30b. Were Autopsy F'ardirgs 31. Manner of Death 32a. Dale of Injury (Month, day, year) 32b. Desedhe How Injury Occurred 32c. Place of Injury: Home, Ferro, Street, Fadory, Pedomretll AvailaD4 Prior to Completion of Cause of Death? ^ NaNral ^ Homidda OXlce Building, etc. (Spedyl AA~yy ^ Y N ^ V ^ N ^ Accident ^ Pending Imesagefion 320. Time of Injury 32e. Injury et Warty? 32f. N Transportation Injury (Specify) 32g. Location of injury (Street, city I town, slate] o es Id es o i ia ^ C M N t h D t i d ^ S ^ Yes ^ No ^ Driven Operator ^ Passenger ^ Pedestrian erm u c ou a e e ne M. gher ~ Sped()- 33a. Certifier (check ony one) cause d tleath when enomer h skian has ronarrcetl death and com leted Item 23) • Cerdl in h sichn (Ph sican cenil in 33b. Signature antl Title of Certifier r, / / ~ C ~---" /~ l -~ i - p y p y g p y y y g p Tothe beet M my knowedge, dseM atoned due to the ausge) end manner ee MMed _ _ _ _ _ _ _ _ _ _' _ _ _ """" _ """-"- ^ , , ' • Pronancing and eMNying phyMelen (Physician bosh pronouncing tleem and cert4ytllg to reuse of oath) d d d ^ 33c. License Number ` ~ 1 ( j L ~ ~ ~ _L 33d. Date Signed (Month, tley, year) ~ ,. ~ % ' ' r To the heat M my knowledge, death Doused et the tfine, date, end Plea, antl ue to the uuee(a) an manner as Mate _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Aladksl Exeminm/Coroner I . - : ak ;~ ~: fi On the bale of examinatbn and I or Invaetlgstlon, in my opinion, deals acurted M the time, date, and place, end da to the cause(s) and manner tie ateted_ ^ 3q. Nama antl Atldress of Person Who Completatl Cause of Death (Item 27) Type / Print ~ ~ (7 r 4; L j ~,~ Y"1 , i 3s. Regiatrer 9rewre and ~ 3s. Data rla ( ohm, tley, rear) ~f~~J , / J k ~~ sT~ c e 1 ~~ ~ #~ ~'~ v rl P ~ l~ ~j ' / U y-~ Disposition Permit NO. IJ~~Q~ `/~ LAST WILL AND TESTAMENT OF DAVID NOAH BAIR I, DAVID NOAH BAIR, of New Cumberland, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and revoke an~.nd ~a all previous Wills and Codicils I have made. ~ '~ ~-, ~=,, r- :.:_ ~ rl"1 W ~~Ti c,~ ~. _ _. - .. ~a ITEM I: I direct that all of my just debts and funeral expenses,=~;ric~luding;.all ~ = ~~=~ expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death, as a part of the expense of the administration of my estate. ITEM II: All federal, state, and other death taxes payable because of my death with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid out of the residue of my estate, without apportionment or right of reimbursement. ITEM III: I give, devise, and bequeath seventy-percent (70%) of the rest, residue, and remainder of my estate, wheresoever situate, to my wife, DORIS MAE BAIR, on the condition that she survives me by a period of thirty (30) days. 1 If my wife, DORIS MAE BAIR, does not survive me by a period of thirty (30) days, I then give, devise, and bequeath thirty-five percent (35%) of the rest, residue, and remainder of my estate to my daughter-in-law, ELOISE LYNN KEMMERLING, or her children, der stirpes, and thirty-five percent (35%) of the rest, residue, and remainder of my estate to my son-in-law, JOHN KENNETH SMITH, or his children, der stirpes. ITEM IV: I give, devise, and bequeath thirty-percent (30%) of the rest, residue, and remainder of my estate, wheresoever situate, to my son, PHILLIP DENNIS BAIR, on the condition that he survives me by a period of thirty (30) days. If my son, PHILLIP DENNIS BAIR, does not survive me by a period of thirty (30) days, I then give, devise, and bequeath fifteen percent (15%) of the rest, residue, and remainder of my estate to my daughter-in-law, ELOISE LYNN KEMMERLING, or her children, der stirpes, and fifteen percent (15%) of the rest, residue, and remainder of my estate to my son-in-law, JOHN KENNETH SMITH, or his children, der stirpes. ITEM V: If any person entitled to share in the distribution of my estate under the terms of this Will becomes an adverse party in any proceeding to contest the probate of this Will, that person shall forfeit his or her entire interest hereunder, 2 and all provisions in favor of that person shall be void and of no effect. The share of the person so forfeited shall be distributed as part of the residue, except that if that person is entitled to share in the residue, that interest shall be distributed proportionately to the other residuary distributees. ITEM VI: I hereby appoint my wife, DORIS MAE BAIR, as Executrix of this my Last Will and Testament. If my wife, DORIS MAE BAIR should predecease me or otherwise fail to qualify as Executrix, I then appoint my daughter-in-law ELOISE LYNN KEMMERLING as Executrix of this my Last Will and Testament. ITEM VII: I direct that no Executrix serving hereunder be required to post bond or enter security in any jurisdiction. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of z ~ ~ , 2007. DAVID NOAH BAIR The preceding instrument, consisting of this and three other typewritten pages, was, on the date thereof signed, published, and declared by, the named Testator, DAVID NOAH BAIR, as his Last Will, in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. _ ~ residing at ~~~ ~- ~S~ ~~~ ~~ ~~ (~ c~o~ ~ /~>Z S ~ AAtivS .A G!/LC~ ~ovc// '~''~- residing at n'Yl~~ ~b ~ ~~ hu.cg ~•4 r 7cS'S 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss WE, DAVID NOAH BAIR, ~ ~ ~ riz~ J~ h -~ ' d ~ ,and r ,~ i 1 ~ ~l ~ R r2 0~ the Testator 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 Testator signed and executed the instrument as his Last Will and Testament, and that he signed it willingly and that he executed it as his free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. %2.D~ DAVID NOAH BAIR Wi s ~ (~ U YL- Witness Subscribed, sworn to, and acknowledged before me by DAVID NOAH BAIR, the Testator, and subscribed and sworn to before me by L h~~>{ ,5~~~~~~ and ~r L f ~0~2~~ ~, , witnesses, this a ~ day of ~ ~ ~ ; , 2007. _~ ~ /_ ~~ ~( /v Pub 'c My Commission Expires: ~u~vii~~,yy~p~rH (1F i'tNNSYLVANIA NOTARIAL SEAL CARMELO J. CLAUDIO, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Feb. 27, 2010 5 -- .,.~ ,......