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HomeMy WebLinkAbout09-29-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumber 1 a n d COUNTY, PENNSYLVANIA File Number ~ I v I ~/~ Estate of Evangeline T• Bowen also known as 4 9 9 3 0 4 8 9 7 ,Deceased Social Security Number Petitioner(s), ~vho is/are 18 years of age or older, apply(ies) for: (COMPLETE A' OR 'B' BELOW:) a A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the C 0 - E X e C U t 0 r S named in the last Will of the Decedent dated 1, 0 / 2 9 / 2 O 0 7 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 (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente life; durance absentia; durance 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:(/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.) (List street address, rown/city, township, county, state, sip code) C~ ~- ri Decedent, then 79 years of age, died on9/22/2009 at Harrisburg Hospital PA ],7110 2501, N 3rd Street Harrisbura Decedent at death owned property with estimated values as follows: 2 0 0 , 0 0 0 • 0 0 (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 $ 2 2 5, 0 0 0. 0 0 717 Hilltop Drive, New Cumberland, PA 17070 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the gran[ of Letters in the appropriate form to tha nnr~r•rcinn Pr•~ Si ature Typed or printed name and residence ~, •-~ '' vv~-~~ Charles A• Clement, Jr• ©• ~ New Cumberland PA 17070 David H• Stone 414 Bridge Street New Cumberland PA 17070 Form RGl'-02 rev. 10.13.06 Page 1 of 2 t _l -T7 (COMPLETE IN ALL CASES:) Attach ntiditiona! sheets if necessary. ~ - ~~ -~ Decedent was domiciled at death in Cumber 1 a n d County^ Pennsylvania, with his /her last principal re t ~e at • ~ _ . ., _ ~ , _ _ _~ __, __a Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF Cumberland 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 before me the ~----- day of i ' ~~ Fo he Register ~~` rv ~ _ -_ Sign l R res tative Cl'1 l' _~ ~ -v , w~ r-- - Sign e o Per Re resentative ` ~' -'`• ~ i - ,• 7 i;~; C -ra i -j ~.-~ ~ ~ _ .. 7 - ~ ~ tl Signature of Personal Representative --~ .~D • -- O File Number: ~ ~ ' ~~ Estate of E v a n g e l i n e T• Bowen ,Deceased Social Security Number: 4 9 9 3 0 4 8 9 7 /~~~~j Date of Death: 9/ 2 2/ 2 0 0 9 AND NOW, -~~ ~©~ o - ~ , ate" ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters T e s t a m e n t a r y are hereby granted to Charles A• Clement, Jr• and David H• Stone in the above estate and that the instrument(s) dated C~ ~~'~ ~~ ' ~~ described in the Petition be admitted to probate and filed of record as the last Will and Codicil(s~ of Decedent. ~ FEES _ ~~ L~ ~ wv w- i ~---- - R Wills Letters ............................ , . $ ~ ,_ ~ ~ Short Certificate(s) ••••••••••• • $ Attorney Signature: Renunciation(s) ••••••••••••••• ~, (~ • $ ~ S, l~J Attorney Name: D a v i d H• S t o n e $ ~~~ ~ $ ,~'~ Supreme Court LD. No.: 39785 $ Address: 414 Bridge Street •~~ • $ New Cumberland ... . $ •.• . $ PA 17070 ••• • $ Telephone: 717-774-7435 ... . TOTAL ............................ . $ ~~`' Forrn RW-02 rev. 10.13.06 Page Z Of 2 ..! \ ,i O ! ! •~ LOCAL RECaISTRAR'S CERTIFICATION OF DEATH WARNING: It is. illegal to duplicate this copy by photostat or photograph. Fee for ibis certificate, $6.(10 Ines l,s u, carols oral u1c ,nnnutauun ,ICIC :~IVCII t, correctly copied tiom an uri~,_*inal Certific~lte of Death duly filed ~~~ith me ae Local Re~,ishar. The original certificate will he for~;u-ded to the Slate Vital Records 17fficc Cor permanent filing. P 15690650 ~•.~ sEPa Zoos Certification Number ~ Local Regisn~ar Date Issued C7 ~ c- 0 ~ t; ~.T~ - -' i -i-. C7 ~ ~ ~ " ~; :' ! -r! N ~` ~ l xf '~l ~ -/ _ ~ :- 1 ,°~ _ 1 a tl ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS =,7 vRi - l N ~ --t RMANENT ~ - ~ ~-~ CERTIFICATE OF DEATH AcK INK ~ (See instructions and examples on reverse) srnTE FILE NUMBER ••~• L ~ - 1. Name of Decedent (First. mitldle, last, suffix) 2. Sax 3. Social Security Number 4. ate of Death (Month, y~Ell) Evangeline T. Bowen Female 499 -30 _ 4897 C ~ ~ 20 5. Age (Last Birthday) Untler 1 ear Untler I da 6. Date of Birth Month, da , ear 7. Birth lace C and stale pr for ei n count) Ba. Place of Death Cheri on one 79 Monma Day= Hpara Minh°~ 9/27/1929 JeffersonCity, MO "°aDila'' other. Yrs. patient ^ ER / Oulpelianl ^ DOA ^ Nursing Nome ^ Residence ^ Other ~ Specity. 3b. Countx °I Death ac. Ciy, Boro. Trop. of Death '3d. Facility Name Ilf not institution, give street antl number) 9. Was Decedent of Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black, White, etc. Dauphin Harrisburg Harrisburg Hospital-PinnacleHealth mye:'apeciyaban. M lspatiM exican, Puerto Rican, etc.) white t 1. Decedent's Usual Occu anon Kind of work done O urin most of workln life. Do oat state retired 12. Was Decedent ever 'm the 13. Decedent's EduceAon (Specity only highest grade comp leted) 14. Marital Status: Married, Never Married. 15. Surviving Spo use (If wife, give maiden name) Klntl of Work Kind of Businessllndustry U.S. Armetl Forces'+ Elementary !Secondary (R12) College (1-4 or Si) Widowed, Divorced ISpocily) Re istered Nurse Healthcare ^Yea ®Np 12 +4 widowed t6 Decedent's Mailing Address (Street, ciN r town, state, zio code) Jecedenl's pA Did Decedent Live Ina A t l R id 17 S ^ 717 H111 t O p DY . ua ence c es a late t7c Yes. Decedent Livetl m Twp T hi ? New Cumberland, PA 17070 owns p 17bcounty (:nmharlanrl 17tl.C~"°.DagetlemLivedw"hmNew Cumberland Actual Limits of ~1'I~f I Boro 16 Father's Name (First, middle, last, suffix) 19. Mother's Name (First, mitldle, maiden surname) Arnold Traubitz C nthia Bu 20a. Informant's Name (Type I Print) 20b. Informant's Mailing Address (Street city I town, state, zi code) F Stephanie Flierjans 4680 Quentin St. SW Ca lgary, Alberta T2T6E1 Canada 21 a. Methotl of Dispositon ~ ~] Cremation ^ Donation 21 b. Date of Dispositon (Month, tlay, year) 21c. Place of Disposition (Name of cemetery, crematory or Omer place) 21 d. Location (City/town, stale, zip code) ^ Burial r ^ 9emovalfromStale WasCramationorponaHOnAUthorized ^ C ~ r g/26/2009 Con 0 Lite Crematory Schaefferstown PA 17088 by Medical Examiner) oroner? Yes No ^ Other- S a 22a. Signature al Funeral Se Licensee r person acting as such) 22b. License Number 22c. Name and Address of Facility - FD 013340 - L Parthemore FH&CS Inc. 1303 Bride St. New Cumberland, PA 17070 Conplele items 23a-c Doty when certitying 23a. a the best of my knowledge, deem occuned at the lime. date antl place slated (Signature and title) 23b. License Number 23c. Dale Signed (Month, tlay, year) physipan is not available at time of death to cenity cause of deem. teems 2426 must be cmmpleted by cerson 24. Time of Deam 25. Date Pronounced Deatl (Mo~h , d ay, year) 26. Was Case Relerred Ie Medical Examiner r Cprpner for a Reasqn Other man Cremation or Donationp who pronounces death I I ; Q ~ P~ M ^ n l ~~ 1 Yv7'C~r ~2 ~1Q1 /~ ~fJ ~J ^ Yes No r ApDroximata Interval: CAUSE OF DEATH (See Instructlans and ex mples) Pan II: Erder other sipnilicant conditions contribulinp to death 26 Ditl Tobacco Use Contribute Io Death? Item 27. Pan I: Enter me chain of events - tliseases, injuries, or complications -that directly caused me death. DO NOT enter terminal events such as cardiac arrest, Onset to Death irato or venlritular librillation without showin the etiolo List onl one Wuae on each Ilse es artesl but not resulting in the underlying rouse given In Pan I. ^ Yes Probaaly g gy. y ' r p ry , ^ No Unknown IMMEDIATE CAUSE (Final tlisease or ~t ` ~ 1 condition resulting m death) _~ a V '-~ F~ ! - /~ 1 / n (' ~r\1 V C~ K.JL ~l \it 29. II Female-. ^ N t t ilni t Oue Ie for es a consequence o~ S ~l S-e ' ~ ~ pregnan w n pas year o ^ Pregnant al time of death C ~ SequentiallyY 141 conditions, If any, b 1 ^ katli to the cause lisletl on Ilne a. Enter the UNDERLYING CAUSE Due to for as a consequence op. Nat pregnant, but pregnant within 42 days of death (disease or injury that Initiatetl the t ~e lti in tlealh) LAST c' ^ N t t 4 1 even su nq . s Due to mr as a consequence olj. pregnan , but Dregnanl year o 3 days to belore death d~ ^ Unknown If pre nant within the ast ear g p y 30a. Was an Autopsy 30b. Were Autopsy Flntlings 3 Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factpry, Pertpm,ed? Available Prgr to Compleoon ~ ^ OHICe Building, etc. (Speciy) of Cause of Dealh~ atural homicide ^ Y ^ Y ^ N ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury al Work? 32f II Trensponafion Injury (Spenty/ 32g. Location pf Injury (Street, city /town, slate) es es o ^ S i itl ^ C ltl N h D t i d ^ Vas ^ No ^ Driverl0 for ^ Passen pare gar ^ Pedestrian u c e ou at e e erm ne M. ^ Other-Specity 33a. Certiller (check Doty one) 336. Signal re itle of C rti ier • Cenltylrg phyalclen (Pnys~cian ceniyrtg cause of tlealh when another physician has pronouncetl deem and complefetl (lam 23) To the beat of my knowbtlge, deem occured due to the ceusga) and manner es stated.- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ I - 1 i Y f • Pronoundnq and cedHyinq physldan (Physician bath pronouncing tlealh and certitying to cause of deem) 33c. License Number 33d. Dale gyred (Mom day, yeap To the beat of my knowledge, death occurred al the time, date, and place, and due to the cause(s) end manner es eteted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ l.( ~ 2 ~ / ~C • Madinat Exeminerl Coroner l lJ On the heals of examination and / or inveatlgation In my opinion death occured at the time date and place end due to the cause(s) end manner es stated ^ 34 dress of Person Who Com leted Cause of Deam gram 27) T e; Print erne a nd , , , , , - yp .. ~ p '' 11 / 7 ~ ~ V ~ 35. Registrafs 'gnature and / - ° a~ ~ ~ ~ ~ `~~ ' ~ ~ 36. Date Filed (Mont day, year) g c .~~~~ ~ I C ,az~ ~ 2-ifl2t~ N~. 3y~ S~e~ ,1-C~.wts P~-l- I~--(12 Disposition Permit No. ` ~ ~~ ~ 1 ~ ^~~ ~~~'~~ _c \o-;i-1s ~~,BCWE6,EVANGELIVS r ~ ~~ - 9i~ i LAST WILL AND TESTAMENT OF ~' c~ -, EVANGELINE T. BOWEN r-;.n i ~ ;, rTl ; ~- ~ ~ -~ , ~ r.~ iv . ;T' ~ ;_ I, EVANGELINE T. BOWEN, of the Borough of New Cumbe~~~-nd,~ Cumberland County, Pennsylvania, declare this to be my =fast wiT3 acid '`' ~ .. ~-~ ,. revoke any will previously made by me. ~. ITE~•i I: I bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities) together with any existing insurance thereon to my daughters, MALANIE GENBAUFFE, LAURIE DAMS, STEPHANIE FLIERJANS, and KIMBERLY MASSAL, as are then living, too be divided among them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. ITEM II: I bequeath the sum of $20,000.00 to my daughter, MALANIE GENBAUFFE. ITEM III: I direct that my house located at 717 Hilltop Drive, New Cumberland, Pennsylvania be sold and the proceeds therefrom be distributed as part of the residue of my estate. ITEM IV: I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, in equal shares to my children, MALANIE GENBAUFFE, LAURIE DAMS, STEPHANIE FLIERJANS, and KIMBERLY MASSAL, as survive me. Should any of my Page 1 of 4 children predecease me, I devise and bequeath the share of such child to her issue, per stirpes; and should any such child of mine leave no such issue living following my death, I devise and bequeath the share of such child to my issue, per stirpes. ITEM V: I appoint my CHARLES A. CLEMENT, JR. and DAVID H. STONE, Co-Executors of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, EVANGELINE T. BOWEN, have hereunto set my hand and seal this .Zc1 day of ~c~~.r.~. 2007. .. t'` ~ EVANGEL E T. BOWEN J, Page 2 of 4 SIGNED, SEALED, PUBLISHED and DECLARED by EVANGELINE T. BOWEN, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the abscribed our names as witnesses. 414 Bridge St New Cumberland, PA Address 4i4 Bridge St New Cumberland, PA Address COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND . I, EVANGELINE T. BOWEN, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last wall; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~`, , EVANGELINE BOWEN << Sworn to or affirmed to and acknowledged before me by EVANGELINE E- t~~ T . BOWEN, the Testatrix, this ~ day of ~,~?~-~ 2007 . ~.\a 1 NIA Notary Public COMMONWEAili-1 OF PEN(.1SYLVA NOTARIAL SEAL Public CAROL I_. TROXELL, Notary New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, ~ e 3 o f 4 .. COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND we ~ ,\... ~ ~ ~~~~-~.-. and 11Ct~,~~~~' U1 ~$ t ~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as r_er last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. W Witness Sworn to or affirmed to and acknowledged before me by ~~~ ~ ~ `- '~ -ti... and ~ ~ ~..~ witnesses, this w>1 day of ~~ ~. / 2007 . .,.. , ~. COMMONWEALTH OF PENNSYLVANIA Notary P ub t i c NOTARIAL SEAL ~ CAROL L. TROXELL, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, 2009 Page 4 of 4