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HomeMy WebLinkAbout09-08-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Mary Jane Lance, a/k/a Virginia Mary Jane Lance also known as Virginia Mary Jane Lance Deceased File Number ~~ - ~ I - ~ C~ y ~ Social Security Number 201-16-6552 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 Executor last Will of the Decedent dated November 21, 2003 and codicil(s) dated N/A (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 bom 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: N/A ^ B. Grant of Letters of Administration (lfapplicable, enter: c. t. a.; d. b. n. c.t.a.; pendente life; 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 d. b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name ~{'~~ A C~' c,T (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. ~~-si ~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last princi~re`~s deuce ate ~~ ' T= Church of God Home 801 N. Hanover Street, Carlisle, PA 17013 G? :x`. (List street address, town/ciry, township, county, state, =ip code) Decedent, then 86 years of age, died on August 22, 2009 at Carlisle, Pennsylvania Decedent at death owned property with estimated values as follows: ([f 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 situated as fol g l 5,000.00 0.00 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: or printed name and residence Dale R. Lance, 1 10 Eagle Lane, Etters, PA 17319 named in the Form awoz rev. l0.13.06 Page 1 of 2 f ~ 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 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 t.~-- before me the ~ day of For the Register n D ~j~ Signature of Personal Repres/en/ tative Signature of Personal Representative Signature of Persona! Representative v7 i"ti m ~ c.3 ~1-(~9 - 084c~ -~ File Number: Estate of Mary Jane Lance, a/k/a Virginia Mary Jane Lance ,Deceased _ r:'. -^~ u. -- (.' ,.1 ~.q:}.p:,.f ~~f r~_ i -.--~ : i - ~: •~,:=, E^ .._a <-, Social Security Number: 201-16-6552 Date of Death: August 22, 2009 AND NOW, _ ~ 1a~~,~n ~ UCH , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Dale R. Lance in the above estate and that the instrument(s) dated November 21, 2003 described in the Petition be admitted to probate and fi led of record as the last ill (and Codicil(s)) of Decedent. FEES ~y~, " ~ 10114 60.00 Letters $ Register of Wills p ~, ~.Y ". ,^^."w ............... Short Certificate(s) ........ $ 40.00 ~ ~~ Attorney Signature: Renunciation(s) .......... $ 7CP $ 10.00 WILLIAIV[ R. KAU AN, ES Attorney Name: Q• AUTOMATION FEE $ 5.00 Supreme Court LD. No.: 78627 Will $ 15.00 Address: 940 CEN`T'URY DRIVE, SUITE B ... $ ... $ MECHANICSBURG, PA 17055 ... $ ... $ " ' $ Telephone: 717-766-7702 ... $ TOTAL .............. $ 130.00 Form RW-02 rev. 10.13.06 Page 2 Of 2 OCAL REGISTRAR'S CERTIFICATION OIF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Certification Number This is to certify that the information here given is correctly copied frol7i an original Certificate of Death duly filed ~~~ith me as Local Registrar. The original certificate will he forwarded to die State Vital Records Office 1~3r permanent filing. ~L~• ~ ~ A 2 5 2009 Local F.e«istrar Date Issued REV n2oo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN '.A"E"T CERTIFICATE OF DEATH .K INK (See instructions and examples on reverse) STA7E FILE NUMBER t~.s ~ 4 ~ . C ~ ? ; ...~ - Sr.~ (~ r ( r*~ t.r_i i..._., ~~ ~' ~ ` `y' 1 GG ' l ,/ ~ ~ ~~ '-~ 's ~~ ,~ S V Q -~ "~ ~ -y ~ ~ i . ` i i ~ ` `3 ~~ 7. Name of Decedent (FlrsL middle, last suNlxl 2. Sex 3. Social Security Number 4. Data of Death i:MOnth, day, yearl female 201 - 16=6552 Au .22 2009 5. Age (Last Birthday) tinder 1 year Under 1 day 6. Date of Bidn (Month, day, year) 7. Birthplace (City and state or foreign country) Ra. Place of Deam (Check only one) 86 Morons Days Han Minutes Dec. 4, 1922 Marysville, PA Hospital: Other Yra ^ Inpalienl ^ ER! Outpanenl []DOA Nursing Home ^ Rastlence ^Other ~ Speary: 6b. County of Death 6c. City, Boro, Twp. of Death gtl, Facrllty Name (If not inslilutipn, give street and number) 9. Was Decedent of Hispanic Ongin? Ne ^ Yes 10. Race. American Indian. Black. White. etc. Cumberland Carlisle (II yes. specify Cuban, (Speciryq Church of God Home Mexigan,PoertpRman,lnp) white 1 t. Decedent's Usual Occu lion Kind of woM done tlurin most of workin Ilfe. Do not slate refired 12. Was Decetlenl ever in the 13. Decedent's Education (Specify only highest grade completed) 74. Marital Status: Macied. Ne r Married, t6. Surviving Spouse (It wife, give maiden name) Kind of Work Klnd of Business I Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (7-4 or 5+) Widowed, Drvorcetl (Specih/t e ^yea ~0 8 widowed Ifi Decedent's Mailing Address (Street city /town, stale, zip code) Decedent's Did Decedent 1 10 Eagle Lane P,ctual Residence t7a. Stale _ P 2 n n R ~ 1 va n i a Live in a t7c ^ Yes, Decedem Lived m Twp To nahi ? w ° nd Np, Decedent Liyed within 17b. Court ro Cumberland ~ E e r s P A 17 3 19 Apwal umha m ~' a r t i .a l a city r earn 16. Famer's Name (First middle, last suffix) 19. Mother's Name (First, middle, maiden surname) Philip F. Weaver Sarah Mae Rider 20a. Informant's Name (Type /Print) Dale Lance 20b. Inlormenl's Mailing Address (Slreel. ciy /town, slate, zip code) 110 Eagle Lane, Etters, PA 1731.9 21a elhotl of Disposition '~ ^ Crematon ^ Donation 21 b. Dale of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 27d. location ;City (sown. state, zip coder Burial ^ Removal hpm sale 'i waa cremangn er oanatian AMthodzed er ~ Specify: by Medical ExamineN Coroner? ^ Yea ^ No Au 2 6, 2 0 0 9 g R o 11 i n Green C e m e t e r g Y a m H i 11 p , P A 17 O 1 1 re of F Service Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Facility FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043 mplete Items 23a<only when cenitying 23a. To the best o! my knowledge, death occurred al Ihe'ime, date and place staled. (Signature and title) 23b License Number 23c Data Signed (Month Uay year) physican u not availaok al time of death to certify cause of deem. /' Ll L./'7 LG~ /~//l Ei ?~C/ /2 C /U~ ~~1.~'" Ste, ~' L( `'~ y , / L, ~~ LC'~~ r~~ l ~CY Hems 2d~26 must be wmpleretl by person h tl m 2d. Time of Death ^ f ~L 7 26. ale Pronounced Dead (MO th, day, ye ) ) r / l 26. Was Case Refenad to Medical Examiner /Coroner for a Reese Other than Cremation or Donations w o pronances ea . C (, M - (, L l7 ) ~ ('~, CAUSE OF DEATH (See instructions an xamples) t r Approximate interval. hem 27. Pan t. Emer the chain of events-diseases. iniunes. or complications - that dlreclly caused the beech DO NO7 enter larminal events such as cardiac arrest Pan It Enter other i i ni sontlitions contributing to death, 26. Did Tobacco Ilse Contribute to Deaths . , Onset to Death respealDry aneal, a venlncplar fibrillabpn without Snowing the etiology IJSI only one Cause On each line. Uut not resulting in the underlying cause given in Pan i. ^ Ves ^ Probably '^ No L^'(Inknown IMMEDIATE CAUSE `Final disease or r~ condition resulting in death) -~ ;~ („u -~ ~ 5.~. i Z •.:; ~ 1 a '~ Wz Y !i i C ~G( .zt l z.~ ~ C~ 3 u '~ 29. lr Female. ! ~~ ii Due to (pr as a consequence ol)' ~ Ly~iJol pregnant wahin past year $equenaaly list condnicns,heny. b. ~ leadingg to the `epee listed on line a ^ Pregnant al lime of death pue to or as a copse hence of '. Emer the UNDERLYING CAUSE ( p 1 i Not ^ pregnant. but pregnant whhm 42 days (disease or injury Ihat initiated the c events resulting in death) LAST. of deals pue to (or as a consequence of I - ^ o preg pregnan ys year N t pant, buI I a3 da to t o, before death ^ Unknown it pregnanl wnnin the past year 30a. Was an Autopsy P ^ 30b. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury IMOnth, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury. Home Farm. 3heel Factory edortned Available Pnor to Completion m,! L7 r'lawral ^ Homicide , , Office Building, etc_ (Speclry) of Gause of Deaths ^ yes [~NO ^ yes ^ No ^ Accidem ^ Pestling Investigation 32d. Time of Injury 32e. Injury al Work? 32f. II Transponalion In'ryry (Specity) 32g. Lxallon of Injury (Sheer, city / own, stale) ^ Suicide ^ Could Nol be Delerminetl ^ Yes ^ No ^ Driverl0perator ^ Passenger ^Petlestnan M ^ Other ~ Specify 33a. Cannier (check only one) • Certifying physician (Physician cedilying cause of tleam when another physician has pronounced death and completed hem 23) 33b. 3ignah Band Ale of Ce{lifier / ~ y ~~ ~ ~ To the best of my knowledge, Aeath oeeurced due to the teasels) and manner as slat , i _. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ' - `~ ~, (/ f ® / ~ , ~ • Pronouncing and certltying phys c an (Physc a ~ both pronouns ng deem and cent ly ng to cause of death) Tc the best of my knowleAge death occurreA at the time date and place and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ „ _ _ _ _ ^ • Medreal Exa Her I Corona 33c. License Number ~ 33d. Date Signed ( o .h, Jay ye I ~~~ ~~~ ~ (\ ~.~ S ~ 4, `I I .J ~(_ S~ r Z `( ~ On the basis of examination and / or mvestrgat on in my opinion, death occurred at the t me date, and place, and due to the cause(s) and man ter as stated ^ ~ - ~ ~T ~~ _ ~ Name and Address o Persu, Who Complee~ Cause of Death Ise 7) ype ~ ' r " 35. Regstrars5~nature and Ds L,/~C&-~H-~ 14~~s ' } 36 {Dale Fl)edC(MO ,d//ay/year ~,~~''~~~~j'p~'' ' ice, y~: t 1' ~ ~~ ~ ~ "I I O/fa/~L~'C%/ gip. _ ~~ ~~- ~ ~i ~__ ~,~M>~-. ~rf~ ,~ ___ __. l r ~ S ~~ ~ Gi v 'i j I<' d~j • ~G v'~~+n.lY y' (j~ I ~3 .~ "~ ~~: Disposition Psrmn No ~ ~~~ ~__,-_-- r f LAST WILL AND TESTAMENT :. --, :-' ~ ~. ,: ' ~cnX °° ~ ~ MARY JANE LANCE ~ ~" t_~ ~ ~~~~ ',,,, d' _ - YT ~ ~ _ ' I, MARY JANE LANCE, of Lower Allen Township, Cumberlan`c'~ County, Pennsylvania, being of sound mind and body declare this to be my Last Will and Testament and revoke any and all Wills and Codicils previously made by me. ITEM I: I hereby direct that all ,just debts, funeral expenses, all administration expenses, including inheritance tax shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I hereby give, devise and bequeath all of the assets of my estate, real and personal, wheresoever situate and in whatsoever name, to my Husband, HOWARD C. LANCE, if he survives me by thirty (30) days. ITEM III: In the event that my Husband fails to survive me by thirty (30) days, I hereby give, ~~evise, and bequeath all of the assets of my estate, real a:~d personal, wheresoever situate and in whatsoever name as follows: (a) Ten percent (l00) to the EBERLY'S MILL CHURCH OF GOD, 115 Creek Road, Camp Hill, Cumberland County, Pennsylvania. (b) Ninety percent (900) to my children, BETTY LOU HECKERT, and DALE R. LANCE, per stirpes. Page 1 of 4 f- ITEM IV: If my Husband and I die in a common disaster or from illness or disease under circumstances where it is not possible to determine with certainty which of us survived the ,other, it shall be conclusively presumed my Husband predeceased me. No person, to whom any gift or interest shall have been given by the terms of this will shall be deemed to have survived me who !shall have died at the same time as I, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine which of us survived the other. ITEM V. I confer on my executor to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and. to execute and deliver good and sufficient conveyances, assignments, and transfers of the property, without liability of any purchaser for the application of any 'consideration; to borrow money and to secure its payment 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; to remain any investments at discretion; to invest and reinvest at discretion, without restriction to so- called ~~legal investments"; to make distribution in cash or in kind; to allocate and distribute kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and to do T Page 2 of 4 all other acts and things necessary or appropriate in the management, administration and distribution of my estate. ITEM VI: I hereby appoint My Husband, HOWARD C. LANCE, ~as Executor of my estate. If for any reason he should fail or cease to act, I appoint my son, DALE R. LANCE, as Executor. ITEM VII: The Executor shall qualify and serve without the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding two (2) pages, this ~ day of 1~)~/~YLI$~2_ , 12003. <y. aA ) MA J E LANCE ,~ '~'7,, C._ /U- (SEAL) Residing at: /~fd~ ~fgi„pT AVt. We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named 'Testatrix as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. (SEAL) Residing at: 34,j ~,, 8~17~-'7t.P~ Page 3 of 4 rr COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, Mary Jane Lance, William R. Kaufman, and ~~nc~ ~,.,, /~;~ ,J7z 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, that she signed it willingly, and ,,that she executed it as her free and voluntary act for the ';purposes therein expressed, and that each of the Witnesses in the (,;presence and hearing of the Testatrix signed the Will as a Witness n and that to the best of their knowledge, the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under '~ no constraint or undue influence. T e a t i x ~~~ ~~'~ Witness Witness Sworn to, acknowledge and subscribed before me by Mary Jane ,Lance, the Testatrix, and sworn to and subscribed before me by William R. Kaufman and ~h~ ~. ~os5,~, the Wit:~esses, this ~ ~ 5? day of '~1Q~f(~g~'L A. D. , 2003 . !~ , J (~~ .L~,t,w-- /~ ~( ~ Notary Pub is COMMONWEALTH OF PENNSYLVANIA Notarial Seal Patricia A. Bender Notary Public East Pennsboro Twp. Cumberland County My Commission Expires Sept. 19, 2007 Page 4 of 4