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HomeMy WebLinkAbout10-19-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVAiVIA Estate of -~ ~ ~~~ N File Number ~. ~ `0~ ~ cli ~ b also known as ~~• 111 ~ ///' Deceased Social Security Number e~ ~ ~ ~ -' _ _~ ~~ Petitioner(s), who is/are l8 years of age or older, apply(ies) for: (COtVIPLETE A' or 'B' BELOW:) ~A. Probate and Grant of r, Testamentary and aver that Petitioner(s) is / ar 3 ~ to the of st Will of the Decedent dated ° and codicil(s) dated (State relevant circwnstnnces, e.g., renunciation, death ojexecutor, 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) o ~ ~ ~ ~ ,.~ H~ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: U ~ ~ ~ w~~0°Q ^ B. Grant of Letters of Administration ~ ~ ~ (ljapplicable, enter: e.t.a.; d.b.n.c.t.a.; pendente (rte; durnnre absentia; durante tninoritate) QQQ ,~'", O ~ ~~z.1 Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and h~a' .-~ ~ ''`' Admitristration, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list ojheirs.) ~ ~ c V ~ ~ Name Relationship Res'pdence ~ ~ N O U (COMPLETE INALL CASES:) Attach additional Decedent, then _~ years of age, died on ~~ at situated as follows: 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 ersigned: i nature T ed or rioted name and residence t L ~ ~ ~~ -~r~ ~ rL 6.~ '~~~ Form RW-0? reg. (o.r3.o6 Page 1 of 2 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (If not domiciled in PA) Personal property in Pennsylvania $ ~ , ©~ D lj (If not domiciled in PA) Personal property in County $ _~ Value of real estate in Pennsylvania $ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~ ~'~,~..~Ir` ~ (^. ~~_ : The Petitioner(s) above-named swear(s) or affirn~(s) that the statements in the foregoing Petition are true and con•ect to the best of the knowledge and belief of Petitioner(s) and that, as per on 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 ov ~ or the Register ~ , Signature of Yersonat xepresenrn~rve -~ ~ u- ~ v w Signature ojPersonal Representative ~ ~ ~ '~ v Ri ~ O `" WwO~ Signature ojPersonnl Representative ~ 0 ~ x~ V Q QW~"W~~ ~f~+D~~w c Oc7c x~ File Nu ber: Z1~6 l ~~~ `~ - W ~ N O a J ~ ~~ rx U Estate of 6~ Is:~l~ ,Deceased Social Security Number:~Q """~.~ - ~ `~" ~d~ Date of Death: AND NOW, ~~ 1(' ~ ~ ,~, in consideration of the foregoing Petition, satisfactory proof having been presented b e me, IT IS DECREE that Lette s ~.P~-~r~fl "M V`C~-- are hereby granted to ~C~'~ h ~ e, ~o~_.. in the above estate and that the instrument(s) dated ~ described in the Petition be admitted to probate and filed of reco as the last Will (and Codicil(s)) of Decedent. FEES _ O V Register ojWil ~ _ Letters ............... $ Short Certificate(s) ........ $ -ate' Attorney Signature: __ - -=- Renunpiation(s) .......... $ _ ~~~ ... $ ICJ-~O Ul~a'rl ... $ ~S QO TOTAL ........ $ ... $ ... $ ... $ ... ... $ Attorney Name: Supreme Court I.D. No.: Address: Telephone: Farm RW-0? rev. 10.13.06 Page 2 of 2 105.805 REV (01/07) ~~ C~`~~-~`~ Z~'j LOCAL REGISTRAR'S CERTIFICATION OF DEATPH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 'P 14808808 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 Record s Office for permanent filing. ~~ ~ QCT 8 20 8 Local F:egistrar ' ~L`~ Date Issued w ~ O w W~'Ov OOpOc.IQ ~ ~~ Q~~~~~ ~,°"~~ ~ o O '~ N U REV 1t/l006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS HANENT CERTIFICATE OF DEATH `~ INK See InstfUCttons and exam les on reverse p ~ STATE FILE NUMSEIR 1. Name a Oxedrd (Fwl nkdde, ~, sdM1c 2. Sex 3. Sadel Secudry Nunhar 4. le ~ Deem (Month, day, year! ~~.~~rnQ9 ~ . A~P~eb M a0D -,~,~ .~ ~y4.t 10' all ~,2oc d 5. Age (teat Birthday) llrkr 1 lildr 1 de 8. Deb a &M Maeh, da . I 7, C eIW Meb a teed Be. Pba a Deem (Check on one) No.glal: aher: '. New. o.ya Ileiae Mrwa. •S1A.£'rE'i ~ $<a' /~C~+ // , ,., Vrs. l7 ~ (4 I ~ .'~ ~ T}~'".4/. .3 S7s: i/ ~,y/ ^ InpaieM ^ ER / Qutpatlenl ^ ODA ^ N . ~ He pGMsitlenca ^Olher ~ SPadty: Bb. Candy d Death &. City, Barn, Twp. d Death i ! f Bd. Fadry Noma (n tat irtlrotlan, plw rtes and lanke~ 9. wee Daadant d Hlepena Ongn? No ^ Yae epecily Cuban In yae 10. Race: Ankncan mdim, Black, White, aa. lSpeaYy) C/r,//llrQ.~l/yN~ !PP ~z f/ L i.. E / M~Ch4n r LS / ~ /Y L n I ~Vxp 1. n1Qtf `) f tl 4 , , Mezicen,PUerroRaen,aa.) ~;yi T$ 11. DewMnta lbW ~ id d ash m ite mm d ~ ee. Dona deN 12. wu Deatlanr ever in 13. Decedent's Etlucetbn (Specify ady NgMel grab rorlp bled) 1/. Medal Suns: Mertbd, Never Melded, 15. Sumving Spo use (II wile, give maiden nertk) Kiel a Wad KM d Bueirlns / IndlMry 1 ~ U.S. AmIM Facae? Elemenbry I Secondary (P72) Cdlege (i-I a S~) Air .~~lo~reed (~^M ' ~^r ~j ~~T ~ ~ I /! ', ffL'p%iN C,~ •SUM/; r ~A~~ J ~ Yea ^NO ,~ Jr 1~/L,y.f=Q JCI L/.A C .~~ 'I ~(• I 18. Decedent's Mdilp Addeo (Sneer. MY /town. slab, bP code) ' DecMere'e Did Deoedxn L '~ 1'£iUN.S ~/,C rJRitll~i Uve Ina t7 Y D d t Li d i~ " ~/` T A l R ld 17 S SQ f G ~.eU~Y ~y I~Q~~ [.s C /t- t_~ ea, ece en re aua ee ence e. ate wp. Townahq? iLf.Ertiy4N tSf3U,fU . i'~/~1 /'J o:~.S 17d. No, Decoded Lived whhin 17b. ca,nty C~(//I7~ FIE' rC.lg'/tJ~ Aaaal arena a coy / eao 18. Famets Name (Fay nedde, br, gulf 1 ~.~N//~N Nr . Ar'P.~L3 19. Mothx'e Nsme (Firr, midde, rrrkrl wmemel 1JURGTNY S.~'.c::T.Z~`i~ 20e. Idarrknl'e Noma (type / Pda) AAA/•c;IJ~ M. /~E~A,~,~Y 20b. Inhxmant'e Medhlq Addeee (StreN, dly I bvm, stele, zp cotlB) sDi~ l'/~E~2y C~R2~C/_ i11.~d~AatJde,S.~iJ,~~- AA r7o,. 21a. Matted d DMpaebn don ^ Daretbn 21 b. Deb a Dispoedbn (MOdh, der, rear) z1e. P ba o f Dlepoeitlor~ (N~ m e or cenlelery. aemetay a otlrer place) '~. z1d. loce tlan (cey /town, orate, zp reds) Bunv^ Removal from Stets ^ AUtladud a ~'~~ 2~; ~~~ , Q t + ~! 7 ~ `~ L..) I^/(~ ~~C E~~~~~y ' e ly,/~LJ ~~ /~: ~j!~ f~74~,~~' ?, e ^ ~ ^Yas^No MkalEsammer A1 . . a fukral Sersire Licensee acting ) 22b. Lianas Numbr x ~ " ' 22c. Name rM Addreec a Fedmy ,,:[ C (~ j /D1.~~C ~' .~3 i i .. rrf7~'.,` r• 5,~ U+C= e /~/~ %7'~(f 3 ~ ~ -(~. , . „ ~ , c.tJ, C'JRCJ: ~.•C,~ ~~/~I/~7c`L.. ~N/L'G~.ltG /~t'i7' C' S tC.. end place elated. (Slq^arce aM tltle) 23e. 7o tla Deal d IaaMedge, deed _.. al tM tlme. d e b 23b. license Nunber n, daY. year) 23c. Dale Signed (~O~~~ physidM b not evelehb r Ores dd dasdl a n ~ ~ Ir ` - 7 r amlyaebeadeem. • I / nerra 21-26 mlml he axllpleted hY person 24. alma d~M l~ 25. Date Pronaslcad (Hoeft, , ywr) 3 28. Was Cede Referred to Medkal EaemiMr 1 Cbroner la a Reason er men remalion a Donetlon? ~ who premelae deem. ~ ' ) y M, t O ^ Yu No CAUSE OF DEATH (Sea Inatruetlone and eaemplw I Approxnkb Marvel: Pan II: Enter omr 2B. Did Tobacco Use Cantdbue to Deem? Rem 27. Pon I: Eldr dk dun d scree - dkseem, inprlW, a corrOdatiau - 61st dieetly erred aw hem. DO NDT enter lemkwl evenly such w aNlac arrest, i aba ro Deatlr hu1 not reeatlng n Ba uMerlyiq ales gNen in pen . P r ^ Yea ^ abedy IeepM101y amr, a veadlaAsr Ithr~ea011 wdhaa SMalrlg Mk Beob gJ UsI ady ale awes al Beal dM. I ' ~- ~ l ^ No 'y I ~NNOwn V ~ aaffDllttE CAUSE Fml dwece a a` .'Y17 , ,' / / ~ i / C andeal rasdlitg sl ~.am) ,~ ~ /(.-CC L. ~ ~ , ~'~ jC... ~ ~'~~ D~t,~. ~~ ~ / ~ yv (,~~ . `1; ~ Gil :F. Cj ~! " YI " 29. a Femek: ^ ~ , Due ro la es a cakequerae dp rxatdaaa, e arty. b. i / ! ~~~"y~• CrLr.k:-Gs~/ A,..- Not pregnant wRSrl per year ^ Pregrknt at link d deem ~IINDERLYNG CAUSE a Due b la u a canseglkna aI: ~ ^ Not pregnant, dd pregnant wimn 12 days Due a (a u a consequence off: l ^ Nd pregned, ba pregnant 43 days b 1 yea I d. I before tledm Unkmwl d preprkN wdhin nb Put yer 30t Wu an Adapay 30h. Were Aulapey Findrlps 31. d Deem 32a. Date d Injury (Horeb, day, year) 32h. Dexrma How nMY Oalaed 32c. Place d n~ury: Home Farm. Strer, Fedory, Psdamed! Aveiede Pdor ro N ^ ~ Onlce Budding, ea. (Spedfy) a cr.e d Deem? ~~ Time d IryurY 32d at work? 321 II Trenpadatlm Injury (S 32e mWr kdry7 32 laeuon d In' ry (Strew dtY /tam rate) ~~ ^ Vas ~'NO ^ Yes ^ No ^ Acddenl ^ Pendrlp Irweebpaaon . . . y r , p. , ~ITT~~ ^ Sadtle ^ Could Nd ba Daemwud ^ Yes ^ No ^ ~ I DP°relor ^ Pueengr ^Padutder M Otlla - Spedy: 33e. Cersfkr (dleck oral' anal ~ ... • CertNYng phyMClen (Phyakien adtyirg awe d derh when andner pllyeiden has pralaalced dwm aM ampbted Here 23) ~/ /, G~/ /. +~ ' ft "• ~"KKK ' To dk her amy knowbdge,dMth oaurrad dwrotM ruueyel end msalr ee ebbd___________________________ _ .yr - „ • Praaaldng and aNlydlp phyeldan (Phyrdan botll praloleoq dare aM adilyng a sues d deem) _ - _ tome Der d my knowbdge, aeenl occurred r nk tlme, dste, end pba, end dos to tAs area(s) end menrur es etatM_ _ _ _ _ _ _ _ _ _ _ 33c. r '. Date~SSgglled (MOdh9deY Yeer) }~i A ~/'~ .^ r ,r v' ~ / /y r-~.'~ ~ ///I~~ • YedkY EsaMrrr l Cararler , dam( ~Cti 7 J =- V ' % U ~/ On tlk bads of arllinrbn and I a Invutlgatbn, in my opiNOn, deem occaretl Bt the tlma, Ore, end place, end dw ro the cause(e cur u eMSd_ ^ 3/ N/area era Adtlrel;letl Person W(lo ebd Deem (em 27) Typa / Pnnt ~~' ~ L•' 35. Registrar' re and a / 36. Deb IMa,m, Veer) "Y l • //J ~ ~, (/ Dispoeaan Permit No. ~^~' ~' ~ ~ ^5 ~~ --._ Last Will of THOMAS M. APPLEBY I, THOMAS M. APPLEBY, the Testator, a resident of Dauphin County, Pennsylvania, declaze that this is my Last Will. I hereby revoke all my previous wills and codicils. a w ~ <G O~c~ ~ ~ H Article One w~ W w o 0 wwalOUla 000 ~„'~ Introductory Provisions Q ~ ~ ~ z ~ ~,O~~w ~Oo O~ r T l~ N U Section 1. Marital Status '~` I am currently married to PATRICIA M. APPLEBY, and all references to my Spouse in this will aze to PATRICIA M. APPLEBY. Section 2. Children All references to "my children", subject to the exclusion of any child under subsequent provisions of this Section 2, aze to all of the children so identified in this Sectio$~ 2, but only to those children and any children born to or adopted by me subsequent to the execution of this, my Last Will. a. The names and birth dates of my children are: Name B" Date SCOTT M. APPLEBY September' 3,,1954 BRUCE M. APPLEBY July ~1,19s8 LEIGH A. BARNES October ~5, 1960 Article T~vo Appointment of My Personal Representatives Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative(s) in the order of priority in which their names appeaz: PATRICIA M. APPLEBY; THEN LEIGH A. BARNES; THEN SCOTT M. APPLEBY; THEN BRUCE M. APPLEBY If, for any reason, the Personal Representative(s) named above aze unable or unwilling to serve, the next successor Personal Representative(s) shall serve in the order of priority listed until the list has been exhausted. Unless otherwise specified, if Co-Personal Representatives are serving, the next named successor Personal Representative shall serve only after all of 1th~ Co-Personal Representatives cease to act as Personal Representatives. Section 2. Waiver of Bond No bond or undertaking shall be required of any Personal Representative nominiit~d in this Last Will. Section 3. General Powers My Personal Representative shall have full authority to administer my estate under tl~e laws of the Commonwealth of Pennsylvania relating to the powers of fiduciaries. My Personal Representative shall have the power to administer my estate under the Pennsylvania Prob~.te, Estates and Fiduciaries Code. Article Three Disposition of My Property Section 1. Estate Planning Letter or Memorandum To the extent permitted by state law and not necessary to fully utilize my Unjused Applicable Credit Equivalent, my Personal Representative shall distribute such of my perso~hal! or household items to such persons as I may direct by a written instrument signed by me and I delivered to my Personal Representative. Section 2. Distribution to My Revocable Living Trust I give all the rest, residue and remainder of my property of whatever nature and kind and wherever located to the then acting Trustee(s) of my revocable living trust of which I am a Trustor known as the: THOMAS M. APPLEBY LNING TRUST, dated February 23, 1996 and any amendments thereto. I executed said revocable living trust prior to the execution of this Last Will. Section 3. Alternate Disposition If my revocable living trust is not in effect for any reason, I give all of my property to my Personal Representative under this will as Trustee who shall hold, administer aid distribute my property as a testamentary trust the provisions of which are identical to those df my revocable living trust on the date of execution of this Last Will, or as thereafter amended. Article Four Death Tazes Section 1. Definition of Death Tazes The term "death taxes," as used in this will, shall mean all inheritance, estate, 'succession, and other similar taxes that are payable by any person on account of that person's inte,~est in the estate of the decedent or by reason of the decedent's death, including penalties alnd'' interest, but excluding the following: a. Any additional to the federal estate tax for any "excess retirement accumulation" under Internal Revenue Code Section 4980A. b. Any additional tax that may be assessed under Internal Reven~le Code Section 2032A or 2057; and c. Any federal or state tax imposed on a Generation Skipping Transfer, as that term is defined in the federal tax laws, unless the applicable tax stat~te~ provide that the Generation Skipping Transfer Tax is payable directly out of the assets of my gross estate. Section 2. Payment of Death Tazes Pursuant to the terms of my revocable living trust, all death taxes whether or nit attributable to property inventoried in my probate estate shall be paid by the Trustee from my 'rust. However, if my Trust does not exist at the time of my death or if the assets of my Trust ale insufficient to pay the death taxes in full, I direct my Personal Representative to pay any death taxies that cannot be paid by my Trustee from the assets of my probate estate by equitably prorating and apportioning those taxes among the beneficiaries of this will. Unless specifically provided otherwise in my Trust, all death taxes incurred by reason of assets being transferred outside of my Trust or probate estate shall be assessed against those persons receiving such property. Section 3. Waiver of Right of Reimbursement Under Code Section 2207A I hereby waive my estate's right of reimbursement under Code Section 2207A. Article Five General Provisions Section 1. No Contest Clause If any person or entity singulazly or in conjunction with any other person or entity, directly or indirectly, contests in any court the validity of this Last Will including any codi~il~ thereto, then the right of that person or entity to take any interest in my estate shall cease ar~d the demise of that person (and his or her descendants) or entity shall be deemed to have occurreld prior to mine. Section 2. Captions The captions of Articles, Sections and Pazagraphs used in this Last Will are for convenience of reference only and shall have no significance in the construction or interpretathor~ of this Last Will. Section 3. Severability Should any of the provisions of this Last Will be for any reason declazed invalid; such invalidity shall not affect any of the other provisions of this will and all invalid provisions'shall bewholly disregazded in interpreting this Last Will. Section 4. Governing Law This Last Will shall be construed, regulated and governed by and in accordance with the laws of the Commonwealth of Pennsylvania. I signed this, my Last Will, on f EB 2 4 2000 THOMAS M. APPLEBY ATTESTATION CLAUSE On this ~~~ ~ 4 200 THOMAS M. APPLEBY, Testator, personally Published and Declazed the foregoing instrument, as and for his Last Will and Testament, in the presence of each of us and all of us together, who, at his request, in his presence, and in the ~re~sence of each other, also signed the said instrument as witnesses. We further state that each of! us believes that at the time he executed the foregoing instrument he was of sound mind and me~iory, of lawful age, and did so execute it as his own free act and deed and not under the constraint or undue influence of any person. Witness Street Ad ess (qty, State, Zip JU~ ~~MU.lI ~~.~P,t/.L S et Address ~ ~ ~~-1 ~7~33 City, State, Zi COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN and the Testator and the witnesses, respectively, whose names are signed to the attached lg instrument, being duly first sworn, 'do hereby declare to the undersigned authority that the we were present and saw the Testatot~ sign and execute the foregoing instrument as his Last Will; that the Testator signed it willingly, or directed another to sign it for the Testator, that it was executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the presence and'hearing of the Testator signed the Last Will as a witness; and that to the best of our knowledge the Testator was at the time of sound mind and memory, of lawful age, and under no constraint or undue influence. NA~t THOMAS M. APPLEBY SUBSCRIBED, SWORN TO and ACKNOWLEDGED before me, a nota#y public, by, THOMAS M. APPLEBY, the Testator, and ~~~_ ~, L . L~ s and~~t- ~ ~ FED 2 4 2p~fl the vv~tnesses, on this v No Public (SEAL) Notarial Seal Linda L. Fetterhnft, Notary Public Derry Twp.. r~-=,,,. ;..,, ;'.^unty My ~Q'r1t'.,5.`.;::;.; i::,~_srs..~, t'~ta~+~. t7, 2003