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HomeMy WebLinkAbout10-01-09Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of FayA. Peiffer No. ~ I -0~1 - 0`~Z(~ also known as Deceased Social Security No. 172-01-2433 Petitioner(s), who islare 18 years of age or oltler, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is the executrix_ named in the Last Will of the Decedent, dated February 15, 1995 and codicil(s) dated Slate relevant cimumstances, 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 documents offered for probate; was not the victim of a killing and was never adjudicateld incompetent: B. Grant of Letters of Administration (d.h.n.c.t.a.: pentlente liter tlurante absentia; durance minoritale) 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: c Name Relationshi Residence _t ~~ O t. - - :_ _ t ~. -:. - , :.J~`a C_.. ~ .. ..1 •• - (COMPLETE IN ALL CASES:) Attach additional sheen if necessary. ~.J Decedent was domiciled at death in Cumberl~lnd County, Pennsylvania, with his/her last family or principal residence at 558 Walnut (list street, number and Decedent, then 91 years of age, died Septerr~ber 25, 2009, at Golden Care, 770 Popular Church Road, East Pennsboro Townshi Cumberland County. Pennsylvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ............................................... $ 80,000.00 (If not domiciled in PA) Personal propeerty in Pennsylvania ..................................... $ (If not domiciled in PA) Personal property in County .......................................... $ Value of real estate in Pennsylvania ....................................................... $ 150,000.00 Total ........................................................................... $ 230,000.00 Real Estate situated as follows: 558 Walnut Street, L~monye, PA 17043-1546 Wherefore, Petitioner(s) respectfully request(s) the probate ofthe 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 Karen M. Gillardy ~_%~/ _ ~^^ / f ,, ~ / 445 Shelleys Lane ,C~.P~ !%~ / ~~ ~,r// F~i9 Etters, PA 17319 Form RW-1 Page 1 of 2 (Cumhedand County) -Rev. 9192 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) thatthe 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 accotding to law. Sworn to and affirmed and subscribed i before me this ~ day of October 2009 Karen M. Gillardy n ~ c~ o ~ ,~ ??_~ ~::' :: ~ t , T ~ r- ll~i ~ ~ ~~ _ -l ._ ~..., _ _:. DECREE OF REGISTER ~-_~~~ ~ ~ _ _ .- -t~ _. ~ tCi _. , - Estate of Fay A. Peiffer ~, Deceased No.,,`~/-h`i ~09ZL~ ca w also known as Social Security No: 172-01-2433 Date of Death: September 25, 2009 AND NOW, October I , 2009, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ^ Testalmentary ^ of Administration d.b. n.c.L; pendente tile; durance absentia; durance minoritate are hereby granted to Karen M. Gillardy in the above estate and that the instrument(s) dated February 15, 1995 described in the Petition be admittedto probate and filed of record as the last Will of Decedent. FEES Letters ........................... Short Certificate(s)...5..... Renunciation .................. Affidavit ( ) ................. ~~ ( )..~.~.1.l.,.. Codicil .......................... JCP Fee ........................ Inventory ....................... $ c0 : ~~0 $ 2(~ . c~ $ 5 . cJU $ $ ~ . CO Other.. !'`~4?h!~s~~. i. ~ $ ~ .Old TOTAL ................ $ ~,O - Attorney: Stephanie Kleinfelter I.D. No: 80089 Keefer Wood Allen & Rahal, LLP Address: 635 N. 12th Street, Suite 400 Lemoyne, PA 17043 Telephone: 717- 901-7786 DATE FILED: Fonn RW-1 Page 2 of 2 (Cumberland County) -Rev. 9/92 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ;~cc hyr [hi,, certificate. S6.OU ,~ ;~ This i~, to ccrtifv that the information here ~~riven is ,1`'r~~pljH Of pEy~ _ anrcrll~~ co~ied~ti-um an original Certificate of Death ~~~`~o~/~ `~l~_ dui}~ filed e~~ith me as Loc~il RegiStr-~u-. The original g' ~ z ccltihaue Uill he Cun~ardal to the State Vital ~?°' ;; a Rccord~ Ol~iic~~ for hcrmanent Filing. * /C * cr P 15690692 ~-oF,o~ ~~~'°~ ~ s~P !~ - \~9~rMfNT 9F~~P'', Certification Number „~„i%r~~ ~'"="= ~ c~ I e~~strar Date ]s,tiued IV ~~ c:~'7 © ,- { ~,~j ~ Q f i 1_ C7 7 C"7 ,` ;~ ~ ~ l.1 f - - - <:?.a ., r ' ~ ~ '~ ~ - _ _..~ ~ - ~ GJ a REV 11no06 COMMONWEALTH OIL PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS /PRINT IN Ac~INI"cT CERTIFICATE OF DEATH (See Instructlons and examples on reverse) „_.__ _.. _ ......___ 1. Name of Decadent (First, mitltlle, last, suffix) 2. Sex 3. Social Security Numoer V 4. Date of Death (MOnlh, day, year) Fay A Peiffer . Female 172 - O1 - 2433 Se tember 25 2009 5. Age (Last Binhtlay) Under 1 ear Under 1 de 6. Date of Birth Monm, da , 7. Bidh lace Ci and state or fwei count Ba. Place d Death Check onl one Mmm$ Days Hours MiMaBS Hospital: Omer'. 91 Yr9. September 26,''...191 Lemoyne, Pa ^ Inpatient ^ ER / oulpaaent ^ DDA L~ Nursing Hnme ^ Residence ^ other speciry eo. County of Death &. City, Bwo, Twp. of DeaM Btl. Fadlby Nameljlf not institution, give street aM number) 9. Was Decedent of Hispanic Origin? ~ Ne ^ Yes 10. Race: Amedcan Intlian, Black, While, etc. Cumberland East Pennsboro pl yes, speedy Cuban, ISp•GM d Mexican, Puerto Rican, etc.) White t t. Decetlenrs Usual Occ lion Kind of work done Burin most of world Poe. Do wt state retired 12. Was Decetleht ever in me 13. Decedent's Educelion (Spedfy only hghasl grede completed) 14. Marital Status: Marled, Never Monied, 15. Surviving Spouse (lf wile, give maiden name) Clerk Kind of Work Kintl of si ss ntlust U i ~u'~ '~ ~ U.S. Armed Awces? Widowed, Divorced (SpeayJ Elementary 1 Secondary (D-12) College (1-4 or 5+) n te e ep one 8 ^ Yes ~p Widowed 16. Decedent's Mailing Address (Street, coy I town, state, zip cotle) Decedent's Did Decedent A Pa 558 Walnut Street ctual Resitlencd 17a. State Live in a 17c.I ~I Yes. Decedent Lived in Twp T 7 ownship? 17d r~1 NO, Decedent Livetl within Cumberland 17b. County YJ ~oYne Actual Limits of Ciryl Boro 78. Falhels Name (First, mitlrne, last, suffix) 19. Mothels Name (First, mitltlk, maiden surname) C1 de Coulson Ethel r ld 20a. Infonnam's Name (Type /Print) 20b. Inlonnant's Mailing AdMess (Street city /town, state, zip code) Karen Gillard 445 Shell s Lane Etters Pa 17319 21a. Method of Dispositon remotion ^ Donation 21h. date of Disposition (Hoorn, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21tl. Location ICiry/town, state zip code) ^ Bunel ^ Rertaval from State i Was Crematlon or Donaton Authorlud ^ Omar. S ' : ~ by Yedtcal Examiner/Coroner? ®..vas^ No ~ -p?8 Q Hollin er Cremator , Mt Holl Sri s Pa 22a. Si of Ful Service a ' az such) 22b. License Number 22c. Na a and Address of Facility 17011 - 011654-L ers-Hamer Funeral Home Inc 1903 Market Street Cam Hill Pa Complete kern 23a-c only when certifying physician is not avaiWble at time of tleath to 23a. To the best of my knowledge, death occurred a1 the time, dale and place slated. (Signelure antl title) ~ 23b. License Number 23c. Dale Signed (Month, day, year) certify cause of death. ` ~~ , / /~ ~ Gli ~ /V r~ ~~ /~{Al ~ ~ - l:~L L 1 .~' T~vl9 ne r ~ _9~ ~u6 Items 24-26 must be completed by person 24. Time of Death 25. Date Pronounced beatl (Month, Bey, year) 26. Was Case Refe rre d to Metlicel Examiner I Coroner fw a Reason Other than Cremation or Donation? wta pronounces death. ~j ~ . ~ ~' f~' M. S `(~'.NY1 ~ (' 1~ : ~ 7~ ~„ CJ L ~ rr -- !! ^ Yes ty`No / ` CAUSE OF DEATH (See Instructlons antl exam les) r Approximate inmrvak Item 27. Pan L Enter me chain of events -diseases, injuries, w complicetiens -That directly causetl the Beam, DO NOT Inter terminal events such as cartliac anesl On t t D th Pad IP Enter omer s gnTran t ondiao ~ contrih n rp to alh 28. Did Tobacco Use Contlbute to Death? , se o ea respiratory arrest, or venmcular fiblllalon without showing the etblogy. List Doty one cause on each line. but not resulting in the untlenying cause given In Pan I. ^ Vas ^ Probably r IYYEDIATE CAUSE (Final disease or r ^ No ~nNnown condition resultkg in Beam) C ~ ~. r 29 If Female _~ a . Due to (or as a consequence of)~ ~NOt pregnant wdhm past year SaGGuentially list mntlitlona, if arty, b, leadingg to the cause ksled on tine a. ^ Pregnant al time 01 death ^ Enter the UNDERLYING CAUSE Due to (or as a consequence ot): Nol pregnant, out Dregnant within 42 days (dsease w injury mat inilHtetl me of death events resulting in tleath) LAST. ^ Due to (or as a consequence off. Not pregnant, but pregnant 43 days to !year d. i before death ^ I Unknown if pregnant wehn the past year 30a. Waz an Autopsy Pen d? 300. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Injury'. Home, farm Street. Factory omre Available Prior to Completion Natural ^ Homicide , , Office Buildin etc g• (SPec'Nl of Cause of Deam1 ^ Ves ~ No ^ V ^ N ^ Accident ^ Pentling Investigation 32d. Yime of Injury 32e. Injury at Work? 32f. If Transportation Injury (SpeciyJ 32g. Location of injury (Street, city I town, state) es o ^ Suicide ^ Could Not be Determinetl ^Ves ^ No ^ Driver/Operator ^ Passenger ^ PetlesMan M ^ Other Speciy- 33a. Certifier (tlreck Doty one) 33b. Signature a rtle of Certifier • Certifying physician (Physkian cenityinq cause of death when anomer physician has pronounced death and completed (tam 23) ~... To the best of my knowledge, death occurred due to me cause(s) end manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ,i ,.i • Prorwuncing and artltying physician (Physkun both pronouncing deem and cenifyiry to cause pl death) 33c. License Number - 33tl. Date Signed (Hoorn, day, year) Ta Ise best of my knowledge, death occurred et the time, dale, and place, aM due to the peuae(s) end mafrner as atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Examiner/Coroner ~ y~0 Z ~[^ ~ `{ A 3 ~' C .. ~ -~ C ~ I z j 2 (7 % [ On the basLs of examinatlon and / or Investlgatlon, In my opinion, death occurred at the time, date, and plhce, antl due to the cause(s) and manner as stated ^ 34. Name and Adtlrgeed~/P/arson Who Comdetetl Cause of De h (Item 27) T pe / Plnl 4Jw~ •7D 7 ~ ~/ / ~ ~ C ~ , 35 R strays ature and Disl - e9' 36 ~ate~ lad (Montq day Year) , ~ L 7 ' ~ j ~A -' - 3 / ~ ~ . , , . ~ ~ Y~ , Dispositon Permit No. ~iC.~ ~CiCI C/ ~MSf ij~ ~11~ (~EB1MMtriPIYt O F ~~ cy7 `'' F A Y A. P E I F F E R ' -`_ ~? . ,--- rr7 ~7 '~ - '~ ~_' t _ J. `` I, FAY A. PEIFFER, being of sound and disptssing mind, declare this to be my Last Will and Testament and hereby revoke all prior wills and codicils made by me. -1- My Executrix shall pay from the residue of my estate all debts, administrative expenses and all estate, inheritance, succession and transfer taxes imposed by the United States or any state, territory or possession which shall become payable by reason of my death. It shall not be necessary to file any claims therefor, nor to have them allowed by any court. -2- 1 giti'e, uevis~ and bequeath the rest ~ residue and remainder of my estate, real, personal and mixed, of whatever kind and nature, and wherever situated at the time of my death, including any property over which I now have or hereafter acquire a power of appointment to my daughter, KAREN M. t~ILLARDY, provided she survives me by sixty (60) days. -3- In the event my daughter, KAREN M. GILLARDY, predeceases me or does not survive me by sixty (60) days, the rest residue or remainder of my estate to my granddaughter, LiBA R. MC BRTDI~, AT s is~9s' "~- c.~ c..; -4- Should my granddaughter, LISA R. MC BRIDE, predecease me or fail to survive me by sixty days, I direct that the rest, residue or remainder of my estate be divided between my great grandchildren living at the time of my death.' At the time I write this My Last Will and Testament, my great grandchildren are ANDREW MICHAEL MC BRIDE, RYAN CODY MC BRIDE AND ALEBANDRA NICOLE MCBRIDE. -5- I appoint ',my daughter, KAREN M. GILLARDY, as Executrix of this, My Last Will and Testament. In the event that my da~ighter, KAREN M. GILLARDY, fails to survive me, fails ~o qualify, refuses or ceases to act as Executrix, I appoint my granddaughter, LISA R. MC BRIDE, as Executrix of this, My Last Will and Testament. In the event that my granda~aghter LISA R. MC BRIDE, fails to survive me, fails to qualify, refuses or ceases to act as Executrix, I appoi~ht my nephew, JAM88 L. COIILBON, JR. , as Executor and as T$~ustee for that portion of my estate designated for arty great grandchild who is a minor at the time of my death to serve in that capacity until said great grandchild alttain their majority. Either LIBA R. MCBRIDE or JAMES ~h. COIILBON JR. are to serve without bond or without being required to account to any Court. IN WITNEBS WH~REOF, I, FAY A. PEIFFER, have set my hand and seal this ',~~'day of ~.~. ~, 199+ ~~ . SEAL 2 ~., Signed sealed, published and declared by the above named Testatrix, FAY AI. PEIFFBR, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our nafies at his request as witnesses hereto, in the presence of the said FAY A. PEIFFBR, and of each other. The preceding document consists of this and 2 other consecutively numbered typewritten pages. ~~~=., { Q --~' residing at~.r.s ~ ,r,.Y~ _,,,~ ~,ev. r ~"'0 ~ ~1s~.~~L~-•e~.~--~ residing at ~•.cu~- Cc~~P~r.~ _-~.~ (/'~~-- ~T COMMONWEALTH OF PENNSYLVANIA . SS COUNTY OF CUMBERLAND We, FAy J3 /°,E"i ffE/'~ ~~,,t~(ef f~. ~~ and ~-M ~ ~ r ~~~~ ~~ si e4 the Testatrix and the witnesses respectively, whose names are signed to the foregoing instrument, having been duly qua~ified according tc law, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; 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 resence and hearing of the Testatrix, signed ~he will as witness and to the best of their knowledge thie Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or und~,ie influence; and that I, the said Testatrix do herby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and that I signed it as my free and voluntary act for•the purposes herein expressed. ~ ~~ Sworn and subscribed to before me 19 ~ S ~ s~~ day o f ~~-ti,r,~,~,-~ t~~.,) t~ . ~,~~,rl /~ Notary ~blic ~!ctariai :;aril Da~,M1 ~e Nws•~ ~ •iki^ !rotary Public Pl ~`4F ~ y~ 'tom ~;~u~iy 3