Loading...
HomeMy WebLinkAbout11-05-09. '~ PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~''l $ t-'~-~~.^~.~/~ COUNTY, PENNSYLVANIA s- ~~'2~'-/6 ~Z Estate of D ~ ~12.-~~ ~ G L- n u-- ~- File Number also known as ? ? Deceased Social Security Number ~~O ft ' c) ~, ""' ~ ~ J ». 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 Petitioners is are the lit! I'V 1 ~'~ ~ ~- named in the last Will of the Decedent dated yJ.r#/V_, / ~T_T 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 a instrumentoffered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~---- `'~ - } '~..' : B. Grant of Letters of Administration ~ ~ ~ ~ -s (If applicable, enter: c. t. a.; d. b.n.c.t.a.; pendente liter durante absentia; dur ate) ~ ;;,-1 Q !. "_'~ t~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following ~~~ny) weirs: (~~' ~~ Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ,,,,~ ~•.~~ ;;~~ j ~ ~ r,~._.. r....t..~ Name Relationshi Resi ce ~`'"~~ ~~ ~~ `~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in ~ V M ~ f K-'t--~,J ~ County, Pennsylvania wit i /her last principal residence at Z !~ d U Nt .o.~ t-~1 ~•-~. o ~ N~ J~ ~ D (List street address, town/city, township, county, state, zip code) ~ Decedent, then ~_ years of age, died on d CT . ~ ~ Z O D at ~ (~ .o y ~ 1 ~ /J ~~}. L L ~, o ,~ ~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ ~~ ~ O 0 . a ~ (If not domiciled in PA) Personal property in Pennsylvania $ -^ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $„f '3 ~ ~ ©a' O ~ ~ ~ situated as follows: 3 ~ ~ ~ L _ ~- ~ ~ ~ ~ W i2`T ~ ~¢ 2 t~l 1 ~. ~-~ /~,~. / 7 ~~ 3 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 .we ,,.,,~e.~:,,,,o.~• S_s+.--- Form RW-02 rev. 10.13.06 Page 1 of 2 • - Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~~-~ ~~ 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 befor m.e the ~,,,,~,~ day of i ` or t egister ~' r :~:a ~•~ S' ure o Personal Representative ~ ~ ° , ~ •~ ,.c ~:~~ ~;~. r-~ ignature of Personal Representative ~ `'" ~~ Q ti Signature of Personal Representative ~ ~ ~.• _ . '~~ + ~'"'~"? ,'}.z;~" 1 ~J ~ J l~ File Number: ~ 1 ~ `'"~~ l ~ l Z Estate of ~ ~ ~ • ~~~ ,Deceased Social Security Number: ~ ~Q 1 ~ 3 Z - Z ~ 3~o Date of Death: 1 ~ ~~ AND NOW, t,f~~.~ ~.~- 0'L ~ _ ~~._, in consideration of the foregoing Petition, satisfactory proof having been presented b ore me, IT I DEC EED that Letters are hereby granted to in the above estate and that the instrument(s) dated 3 ~ ~ described in the Petition be admitt d to probat and filed of record as the last Will (and Codicil(s)) of Decedent. 'T FEES ~` ,/J ~ _ ~ e ~ Register of Wills Letters ............... $ ~.(„Q ~~ Short Certificate(s) ........ $__~ • c~0 Attorney Signature: Renunciation(s) .......... $ f $ ~ ~ d b Attorney Name: ,1 c ~-,n~'~~= ~r rt-~t~r ~/z~ ,~ G- 2 f ~ ~ `7 I ... $ G U Supreme Court LD. No.: ~ 7 ~' r ~'""" ~ Address: / 3 ? f • ~^' n ~ ~ ~ ... $ ... $ 0.7-fug 1 ~ c. ~ ~'~1" /70 / ~3 ... $ ... $ • • • $ Telephone: ~ I ~ ~ 3 ~ ~''' ~ y ... $ TOTAL .............. $ ~~~~ a'4~ Form RW-02 rev. 10.13.06 Page 2 of 2 IU5.8U; RI:V ~uUn71 ~ ~ ~~ ~ ~~~~~~ ~ ~ l OCAL REGISTRAR'S CERTIFICATION OF DEATF~ ~' py y hotostat or hoto ra h. WARNING: It is illegal to duplicate this co b p P g p Fee for this certificate, $6.00 P 15931869 Certification Number This is to certify that tR~~~ information here given is correctly copied from art 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. L~x~e ~~e~.~~~~~-`~~e.~C' O C ~ 1 ?/ 2009 Local Registrar Date Issued .res _.~:.;+ , ; ~•C ~ ~:, ' 1 i ~ ,-.~..1 ~ ~*~ ~ ,`: •i ;' l~ 3~`~ r J H1oS143 REV 112008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Pte' CERTIFICATE OF DEATH ilLACK INK (See instructions and examples on reverse) STFTE FlLE NUMBER .` '~ J -~ O ~S 0 3 1. Name d Dacedad (tarts. nddde, IW. suAbr) 2 Sex 9.3odal Sewdy Number 4. Data d Dswr (Motuh, d.yy..~ Male 161 - 32- 2936 Oct 15, 2009 Robert E. Clouse lleder 1 Urtda 1 8. Dat. d 9k9t (kAcrdh, 7. ed alda a Ba. Pha d DeaOt t:hxJt ar) S. Ape (Last &Ns1sy) k ate, etorda Oryra Floua e~edr - 6~rra. May 30, 1940 Newville, PA ^i„~,ne1d ^a„ ^~ ^,,F,o,,,e pRrklenca ^txn.r-sp.dfr. M. Cwmy d DeaOr ib. Gy, Bono, Twp. d Dw1h 9d. Fadky Name (O nd hetlkrtlan, pivs WeN and camber) 9. Was Decedart d Hl.panlc thlpkt4 [~ No ^ `he 10. Rw Amedcan hdket, l1hd4 Wldta, sk: (""°~'`~"'' (White Cumberland N. Middleton Twp. 260 Union Hall Rd. wwd«n, Pwrb tOcn, tic.) ti. Decedad's lhiat d work d ate moat d Nh. Do rot eme t2 V1ae Decedem ever h dre 13. Dacsderd'e EduaOon (Spedfy ady!d9t~ ~ ) 14. HerMl Sbtux Herrkd, Never Herded, 15. SurvNkq Spaaa (If wM, ykn meldat nsme) a101°d lSP~9 W1do""d and e( "r°~ aw d 1luskrer / ha.try u.S. Amrw Parcae? , ~ Secatdery (o-1z) 9 CoMps (1• «s«) ~ never married river c Truc Steel Mfg. ®~ ^Ne • 1a Dec.d.rrt'. Hainp Addrar tom. cny t brrn, wt•, zlp eoW) D°'a PA °w hDe: ead 17a ®vae, DsoadaM Uved h Mi d d 1 esex Twp. '~'°' "" ~' 38 Mel-Ron Ct. Towmhg9 ' Cumberland ,Td.^ ~ a~rNn Carlisle, PA 17013 ~,IB„o ,7b.caa,y 18. Fetlrsre Name (FksL nlidde, W4 ardPoe) Albert A. Clouse 19. Mo9rera Noma (Fhat, nddAe, maiden sumeme) Ruth L. Keck 20a. {dormard's Name (ryp. / Pdd} lob. htarrwtf'a Hwrq Addme (Strati, a~ /town. eteta aD ~) James A. Clouse 260 Union Hall Rd., G~arlisle, PA 17013 21 L HeOIOd d DFSpasNbn ®Cranalbn ^ Dorrs8orl 21b. Dek d Dhpodlbn (Martl4 Wy, yea) 21a Place d DmpoeNM (Nsms d amaury, a Od1a place) 21d I.OGtbn (COy I VCen, slab. by cods) Home & Hoffman-Roth Funera~ . ^ t3rew ^ Renrovalteomstw waaCrm.Oon«tyonOonAutltodrd Oct. 17, 2009 Carlisle, PA 17013 Cremator n r l c ^ N d arar „ o ^ ~. by t:roa ~r 22a. sion.a,r. d F~ s.rvite Lk .. to parson scMq r era3r) 22b. i.tr~ Numbs 22a N•ms awAdd:sr d F•a"r Hoffman-Ro h Funeral Home & rematory , nc . PA 17013 l e, _ ~ _ 138425 219 N. Hanover St., Car is CornpNls Mme 29st aNy when b eltirdWanb To an(b~eef a my luowie^dOe~. a.afh ooanad at rr wr, du. and AWafne eleMd. (Spnrhn and tltls) zy3'b-. Lnle~ww Number ` ~ nDU~.,~SJf,O~ra~d~(HarOw dsy, yralrf ry ~~ ~ ~eaaedaaalh tJ~~- 11'G ~~Q,r~.. ~1V ~.'~I~~ I 1V L- oc.(!(, 'UUIIU tlsna 24-26 mat w coniplMw bry porn 24. The d Osah , 25. DNe Dew )1AOrdA, dry ~ 28. Was Car Retuned b Hsdioei Ewnk~r / Cororrr br s Reseon Otrrer than Cranetlon a Donalbn9 who prarourcr deaO~ l ~ ~ M. 1 J Vii ^ Wr No CAUSE OF OEATH (Sea IMtructbas and asamplaa) r Appradmab krbnal: h r aN e emA r t l d DO NOT d d ts d O D b • Pad 0: Enter orMt iven h Pct L h bn undsrykr core adMt hd d 28. Tabamo lha CoMrbuk b Drth9 ~ YYa ^ Preb•aY e , rr eva e arc or er enr ea r. Oraet b ea r Item Zl. Pert l: F=rla tM t~hd>6~6-~•. lr+h~. a -~ a•~Y errsw i reepkMay amt, a verdrfpYr Abriebarr without ehowkrp the etldopy. Llet only oro auee m each tie. , r p g n n p , ^ No ^ lAdatown WH TE CAUSE dbsra a //~,; ~~ ~, ~ (~ y~,~ rendlkg h ~br) _~,. rL `-Vw C- 1 11~~(1"1'~°~. ~T 'mil P \Q L, i,(, /~Q ' ~r e 29.9 FaN aa l . 8t h W ^ d Due b (a r a rbraequarce oQ: r r b a w r o r P Y D~• ^ Pragnard al the d drtlt i a. ' e eauq MYd m M Due b (a as a d): ^ ~ Pr•7~L brd pegrwd wadrh 42 days r Eller UNDERlY1110 CAUSE ((Msere a , tlrt hibtlw M r c a d death ' ~ p n deatlr)) LAST. ivanh re Due b (or es a oorraequence d): r ^ Nd prepnaM, but prepnerd 43 Wye b 1 yea baton dasbs d. r ^ lAdatovm 9 praprrad wiWn the P••I year 30a. Wr en Auropry 30k. Wan Aubpay Firdrrpa 31. Hearer d Daa9r 32e. Date d trrNY pdarA4 Wy, year) 32b. Deedba Flow hireY tkparad 32a. O b Merry (') Sbee4 FadaY, Butdnp, Pedonned7 Avahhle Prbr b CargMlbn d Carer d Deelh7 ^ ~~ ^ Yea ~ ^ y°° ^ M ^ Aodderd ^ P•^dq invrdpebon 32d Time d ill 32s. h)ry at Work? 321.9 TrenepoNtlon hJuY (~Y) ~G l.oCdlon d ~Y (Sr••L dy / born, eraM) ^ Suidda ^ Could Nd he Detemdrred ~ ~ ^ Ddva / Opsnla ^ ^ ^ Yes ~ ~. Sf>~Y' 33a. Cerdtia (dracrc oNy ar) 33b. and Tltla d Ca1NM CerO+ykw physldan tPhysf Wn ar~n9 puea a Wath when n,09ra pirysldan Me pronourre.a aealn a,d mnrplat.d k«n 2~ ,1e~ arthoearreddwbthaaua(.tandmwwesbea~-------------------..------------ 4ou TotMtMetdmytonwMd/e - . • a9 ~ ~9 PM~~ lphy~ ~ D~~q deabt std ceriByYg b raw d deah) To IM bat d my IarowMdpe, Math oearrrod at tlr ene, Wh, and pha, and due m Or eauee(a) and maeter as dated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ sx. tloenr Number 33a Deb say, y~ t(n~ O 1~ ,~~ ~j l ~ r ~ ~)~ l V -- ' ( C , C Y. ~ • Hedleal P nr / Corarrr On tM beeN d asankrtlon end / a tmedlyetion, h my oWdon, death oecurrod at tlr lkrr, deb, amt place, all due to Ors cane(s) and mrarr r afatsd_ ^ ~ Canpyi~ M d \ ad Qeuss yl Dselh (Hem 27) 'ry'Pe / PdN Penon Who Addnes d 34. Neme and~ rotor Honm W .ar) 38 a ~~ ~~ ~ I / . r Repktnr lus ~~ X' I I ~ I O I ~' f i I a ~ ~` . y, y t . o e ~~ (''~ ~ ~ 3 ~~ '~i l l ~" S'+~ C.Gv~I is IC c ~ . e~ ~ ~ , Dbpaeltlar Pwrm" No. ~ ~ 'TW O~Z~ ~~ ~. ~~~z ~ :. ~, OF ~~ .,Q = w ROBERT E. CLOUSE '~ ~ ~ ~=~ ,,,~:~ ..V BE IT REMEMBERED, that I, ROBERT E. CLOUSE, of 38 Mel-Ron Court, Carlisle, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof made by me at any time heretofore. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my brother, JAMES A. CLOUSE, absolutely, providing he survives me for a period of thirty (30) days. ITEM 3: Should my brother, JAMES A. CLOUSE, predecease me, fail to survive me for a period of thirty (30) days, or should we die simultaneously, Ithen give, devise and bequeath my entire residuary estate unto my two nieces, WENDY L. DEIBLER and MICHELE M. MORROW, in equal shares. ITEM 4: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, maybe subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my brother, JAMES A. CLOUSE, as Executor of this my Last Will and Testament. Should my brother predecease me, fail to qualify, cease to act, or 1 renounce probate, I then appoint my niece, WENDY L. DEIBLER, as Executrix of this my Last Will and Testament. ITEM 6: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 7: My Personal Representatives shall have the following powers in addition to those vested in them by Law and by other provisions of this, my Last Will and Testament, exercisable without court approval, and effective until distribution of all property: 1. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 2. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 3. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. 4. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. 5. To borrow money from persons or institutions, themselves included, and to mortgage or pledge any or all real or personal property as they in their sole discretion shall choose, without regard to the dispositive provisions of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7. To make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 13`h day of January 2009. ~-~.J~ ~". ~ D_,_ ~,~~ (SEAL) ROBERT E. CLOUSE 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS We, ROBERT E. CLOUSE, DAVID J. LENOX, ESQUIRE and MARCY K. RENSHAW, 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 had signed willingly (or willingly directed another to sign for him), and that he executed it as his .free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ~ ~o -~,~,~i`- Imo' RO T E. CLOUSE WITNES r `~ WI ESS Sworn to and subscribed before me this 13`h day of January, 2009. NOTARY PUBLIC MY COMMISSION EXPIRES: CpN!~~IO,yVtiEAI.~H_O~F_F _~NNSYLV NIA Na'•artial Seal S. Davw'r Gladfelter, Notary Public DNlsburp t3oro, York Canty My Cornrnl~On Expires ~y ~~~ 2006 Member, Pennsylvania gesoclaifon of Notarlee 3