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HomeMy WebLinkAbout11-23-09PETITION FOR PROBATE AND REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Herbert Dean Mathna also known as File Number ~ ~ ~~%~ ~~ ~ ~~ ,Deceased Social Security Number 160362822 Amanda K Zimmerman and Pamela Ann Wea~lev 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 eXeCUtOfS named in the last Will of the Decedent dated 10/12/2004 and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.J 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; durante absentia; durante minoritate) i ~ l a ~ cr N 1~ ~, W .-, ~ ::, ~ ^ ~ n ~~ H ~ ~ ~ ~~,zV~.- (COMPLETE I1V ALL CASES:) Anach additional sheets if necessary. ' " ~` x ~ r~ x o Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at _ ~ N v 163 Shippensburo Mobile Estates Shippensbura PA 17257 Shippensburg Township (List street address, town city, township, county, state, zip code) Decedent, then 65 years of age, died on 11/18/2009 at ChambersburgHospital Borough of Chambersburg, Franklin Countv PA 17201 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 (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania none situated as :follows: $ 2.000.00 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: Signature Typed or printed name and residence ~ ! ~ Amanda K. Zimmerman ,.f _ ~ " 'L~(, ' ~ 152 Kline Road Shi ensbur PA 17257 Pamela Ann Weagley C,. 2"~-e" ~? 508 Bracken Drive Chambersbur PA 17201 Page 1 of 2 >:,,.m Rw_nz rPV tot 3_nh 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.) 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 t:he estate according to law. Sworn to or affumed and subscribed before me the L3 ..., day of - 20011 ti'~~..c. For t'he Register of Amanda K. Zimmerman Signature of Personal Representative Pam Ann Signature of Personal Representative File Number: ~ ~ ~ ~ ~~ ~~- ~ t`1 ~~~ Estate of Herbert Dean Mathna ,Deceased Social Security Number:160362822 Date of Death: 11 /18/2009 AND NOW, November 23 , 2009 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary _ __ are hereby granted to Amanda K Zimmerman and Pamela Ann Weagley ir, the above estate and that the instrument(s) dated October 12 2004 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ...................... Short Certificate(s) • • • • • Renunciation(s) Will JCP fee Automation fee TOTAL Form RW-C12 rev. 10.13.06 `~ _. Register of Wills .r ~~ ~ ^ .... $ 20.00 ~ ./Y1,~0 ,pry ;, .... $ 12.00 Attorney Signature: ` a-~' .... $ i ,,,, $ 15.00 Attorney Name: Joell~ullinger i ,,,, $ 10.00 Supreme Court LD. No.: 17516 ,,,, $ 5.00 $ Address: 14 North Main Street. Suite 200 •••• $ Chambersbu~ .... $ •.•. $ PA 17201 "" $ 717 264-6029 - a Telephone: ~ ~ ~,~ ..... $ 62.00 ~ ~ ~ c; ,; ~.% W ~ ..~ "" i ~ :... r~ C. u ..i v C1 ~ ~ ~ ~ ' w .,. Palw~~z"~ .. ~! x ~ Z c " J ,.i N `; ~,..~~`,~., HFCiST~3AH'~ C~H°TIF~CATION OF DFATH ~'~'~~~ll~: ^: !t is illegal to ~up!'Itiate this copy t.y photostat or phatogra~h. ~. , _ , ~. "' Tl1"` Iti lU ~ !'I; I I IC) l 71-1 I1 L1 lt1( t1C1 !A~dll I`• rr` T "~w -,,4~ <~G ~~y ~°~ ~t)CCutil'v ._'tl)),ti -1r i 1;.:~'Ik lilli! ~,ftlll~a! t)flJCath ,-°~' G ~~y, ~.; ~ 1 Itll,lltlilllC„i~1ll 1- I rl~t1`ICILII``•;llllt`~,~ 1`I.It~)3(~,t[i!I I ,~ Z . =° s~.gl kc. iu~ I,.,1~ r ! Ian.. tiln ~y,m ai' ~~ * . .,~ ;''' -~ d ~~ ,~ f"1 f" r`' ~ ._ a r"a Oa~ r^~ 'Q _ - I „. - M ;V ~ `-. U '/ N ` ~~v ::~ :~ 'r_ ~w o`~`~ H1os~t43 REU nrzoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS "' TYPE i PRINT IN ~ L:-, t= ~ PERMANBNT CERTIFICATE OF DEATH .`; ~ O ;J BLACK wK (See instructions and examples on reverse) STATE FILE fdurvlHER ,:i N `i 2 1r 1, i 1. Name of Decadent (First, mitldle. last. suffix) 2 SeX 3-Social Security Number 4. Dale of Death (Month, day, year) Herbert Dean Mathna Male 160 - 36 - 2822 November 18, 2009 5. Age (Last Blnhdayl Under t year Untler 1 day 6. Dale of B'mh (MOntn, tlay, year) 7. Bmhplace (City and slate or loreign country) Ba. Place of Death (Check only one) Monlns Days Ko~ra ram,nes Hospital. Other 65 Yra, 9-3-44 Shippensburg, PA ^mpatiem [~ERrowpaaem ^DOA ^NaramgHOme ^Reaidenne ^olner-speciy. BU. County of Death Bc. City. Bono, Twp. of Death 8d. Facility Name Qf not Instuulion, give street er>d number) 9. Was Decedent of Hispanic Origin? ~ No ^Ves 10. Race. American Indian, Black, Wnite, etc. • (It yes, specify Guban, (SpecAyi Franklin Chambersburg Chambersburg Hospital Mexican,PuedoRicanetc) White Decetlenrs Usual Occu anon Kintl o! work done dorm most of workin tile. Do not state reuretl t1 12. Was Decedent ever In the 13. Decedent's Education (Specify only highest grade wmpleted) 14. Marital Status: Marrietl. Never Manned. 15. Surviving Spouse (If wile, give maiden name) . Klnc' of Work s I L tt~~ U.S. Armed Forces? Elementary t Secondary (0-12) College (1-4 or Si) Witlowed Divorced (Specify', g ~ t Mechanic ~fYea ^Nn 12 years widowed 16. Decedents Mailing Address (Street. city I town, state, zip code) Decedent's Dld Decedent Shi enSbUr TW PA Live m a 17c Decedent Lived m pp g p' Twp ®Ves 1 6?. SME . . , Actual Residence 17a. State Township? 17d. ^ No, Decedent Lived within cogmy Cumberland 17b Shippensburg, PA 17257 . ActaalDmdsof chyreom 16. Father's Name (Rrst mitldle, last, suffix) 19. Mother's Name (First, midtlle, meitlen surname) Herbert C. Mathna Lucy E. Nye 20a. Informant's Neme (Type 1 Pant) 20b. Intortnant's Mailing Atldress (Street, city I town, state, zip cotle) Amanda K. Zimmerman 152 Kline Road, Shippensburg, PA 17257 21 a. Methotl of Disposition ^ Cremation ^ Donation 27h. Date of Disposition (Month, tlay, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. location (City /town, state, zip code) ® Buria ^ RemovalromSYale ~!WasCremationorponetionAuthor¢etl 11-19-U9 b9onyul Cemetery Shippensburg, PA 17257 ^ Other ~ Specity. by Medical Examiner I Coroner? ^Ves ^ No 22a. Sgnature n a/l~~ Llcen~ (o ~person acting as such) ~ ~eflX7a.,l.^-~ 22h. License Number FD-012984-L 22c. Name and Atldress of FacilAy Fogelsanger-Bricker Funeral Home Inc., Shippensburg, PA 17257 Complete Items 23a-c only when certifying f death to il bl t O t 23a. To the best of my knowledge, death occurred at the Time, date and place slatetl. (Signature antl Title) 23b. License Numbed ~ Z 23c. DAat/e Sgned (Month/day, yeari n ' ava a e a me o physician Is no certify cause el tlealh. (] O S - (,~ l Z . ~ s t V 71 / b V ` ~ Y l ~ / ~U~ Time of D e ath 24 onth, day, year) P ro need Deed (M 26. Date 26. Was Case Ralerred to Metlical Examiner /Coroner for a Reason Other tnan Cremation or Donation? Items 24-26 muss be compkled by person . ~ l ~ / z 1 / ' /-~ ~ ~ [Yes ^ No woo pronounces death. / LJ ~ l M. / v ~) (~ y.~ j2 ~y ~ (~(./ CAUSE OF DEATH (See instructions and examples) , Approximate Interval: Pan II' Enter other jonTcanl contlitions pomnbutin9lo death, 28. Ditl Tobacco Use Contnbule to Death? Item 27. Pan t. 1 nten Ina coon of events -diseases, Injuries, or complications -that tlirectly causetl the death. DO NOT enter terminal events such as cardiac arrest, Onset to Death but not resulting in the untlenying cause given fir. Pan I. ^ Yes ^ Probably respiratory arrest, or ventricular hbnllalion without showing the elioWgy. List Doty one cause on each line. ^ No ^ Unknowi IMMEDIATE GAII$E IFinel tlisease or A contlitipn resulting m. death) e .~~ G ~", > - 29. II Female: ^ N i l i -, . Due to (or es a c ~~ \ equence el)~. ol pregnant w l t n past yeas ^ Pregnam at Ime of due.Rr Sequentially list rondllions, it any, b leading to the cause listed on line a 1 ^ Not plegnam. but pregnant within 42 days ): Due to (or as a consequence o Enter the UNDERLYING CAUSE o: death (tliee9se or njunr Thal initialed the ~ events resulling'~n death) LAST. ^ Nol pregnant but pregnant 4? days to 1 year Due to (or as a consequence oq: belore death I d ^ Unknown i1 pregnant willtin the pest year . 30a Was an Autopsy 30b Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (MOnlh, day, year) 32b. DasenUe How Injury Occuuetl 32c. Place of Injury-Nome, Farm Street Factory, l Padonned? Available Prar la Completion of Cause cl Dealhv ©'~ tonal ^ Homicide Olllce Bu ltling, atc. (Specy) [~ Accitlenl ^ Pestling Investigetlon 32tl. Time of Injury 32e- Injury at Work? 321. II Transponatron Injury (Spectily) 32g. Loceeon of Injury (Street mty /town, stale) ^ Ves [~o ^ Yes ^ No ^ Yes ^ No ^ Dover /Operator ^ Passenger ^Pedestrian ^ Bu¢itle ^ Could Npl be Delerminetl M ^Olher ~ Specity 33a. Cenlher (checx only one, 33b. Signaturo and T41e of Cerlilier ei ifyinq physician (Physician caddying cause of death when another physician nos pronounred death and crompletetl Item 23) • T death occurred due to the cause(s) end manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L knowled t o1 m e rt h ~, /~~ ' e'-~ -' ~ ( o y g , e es ng physioian (Physican both pronouncing death antl cendpng to cause of death) Y ^ a d U3c. License Numher 33tl. Dale Signed (Month, day, yoa~) u y wletlge, death occurretl a1 the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ To the best of m kno ~~ ~ ~ ~ ~ ~ l _ ~ I I ~`~ T~ ~ r • Metlical Examiner I Co n On IM basis of exammal on and I or nvestgalion, in my oplni .death occurred at the time, date, antl place, antl due to the cause(s) antl manner as stated_ ^ 34- Name ar tl Atltl ass of Person Who Completed Carr ~ Deatl It ~~n ; 7) type r Pnnr 35. He9slrar s S~gnelurc antl uln Num el /1//'~~ - //~ z ~ C ~ /~ l ~ ~~ / I I V ~ ~ ~ ~ 3G a/Je ti(.d~ed (Month. day, year) /YUO• ~D D ~ ~ ~ ~~ } J /n~ ~I-U~f'>, I,~'~.r Y~ ... 1~. ~~CC~ lf_`~1' •V-."~-i ~.l.,-(. ` ~-~ v ' Disposition Permit No. ~"1~ 1 ~Y 2 `I ~ ~ 4-~.i-'-~~ I / ~P ~) I l J ~s - ~ Lr ,.r„ r r~ ~ ~~ LAST WILL AND TESTAMENT I, HERBERT DEAN MATHNA, of Shippensburg Mobile Estates 163, Shippensburg, Shippensburg Township, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debt and funeral expenses as soon as my be convenient after my decease. SECO~lD. I give, devise and bequeath all of my estate, real, personal and mixed, whatsoever and wheresoever situate as follows. A. One share of my estate to my daughter Amanda K. Zimmerman. B. One chare of my estate to my daughter Pamela Ann Weagley. THIRD. In the event either of the beneficiaries named in the paragraph SECOND should predecease me or is not living on the thirtieth (30th) day following my death, leaving issue who survive me, I then give, devise and bequeath said deceased beneficiary's share to her issue who survive, on a per stirpes distribution basis. FOURTH. In the event my daughter Amanda K. Zimmerman should predecease me or is not living on the thirtieth (30th) day following my death, and dies without leaving issue who survive me, I then give, devise and bequeath my daughter Amanda K. Zimmerman's share of my estate to her husband, Douglas L. Zimmerman, provided that he survives me and that he was legally married to my daughter Amanda K. Zimmerman at the time of her death. In the event my son-in-law Douglas L. Zimmerman should predecease me, or in the event he was divorced from my daughter Amanda K. Zimmerman at the time of her death, I then give, devise and bequeath my daughter Amanda K. Zimmerman's share of €ny estate to my daughter Pamela Ann ~Neagley. ,~ ~~,- ~ s. ,~ :; r ~~ ~ ,: ~, ;r (~ ~~~~., ~~W~~ w ~ v; _ xfzx~N ^ .^ M Q /'~ /. ,v w ~ ~ J N FIFTH. In the event any beneficiary of this my Last Will and Testament is under the age of twenty-one (21) years, I then give and bequeath said beneficiary's share to and appoint as Trustee of any property which passes under this Will or otherwise, by daughters, Amanda K. Zimmerman and Pamela Ann Weagley, or the survivor thereof, AS TRUSTEES, nevertheless to invest and reinvest the same until the said beneficiary reaches the age of twenty-one (21) years, with the following powers in addition to those presently given by law: A. The power to sell any and all real estate, within the discretion of the said Trustee; B. The poser and obligation to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of twenty-one (21) years, without the necessity of a formal adjudication of the Trustee's Account in the Court cf Commcr: Please cf Cumberla~~d County, Pennsylvania or other Court of proper jurisdiction, upon the receipt of a good and valid release; C. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, not to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively. D. In the event both Amanda K. Zimmerman and Pamela Ann Weagley are unable or unwilling to serve as my Trustee, I then Nominate, constitute and appoint my son-in-law Michael L. Weagley to serve as my Trustee. SIXTH. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SEVENTH. I nominate, constitute and appoint my daughters, Amanda K. Zimmerman and Pamela Ann Weagley, or the survivor thereof, to be the Executrices of this my Last Will and Testament. EIGHTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, HERBERT DEAN MATHNA, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for indentification only, this ~ y ~ flay of October, 2004. -mot ~~ -, I~ °`~_ ` ~ 7'! ~ ,^, r.~. -" r:1 ~ -r"% „~ri:~ (,Seal) This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, presence of each other, we believing him of sound and have hereunto subscribe our names as witnesses. r .,,, ~_ ,, . ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND who at his request and in the disposing mind and memory, I, HERBERT DEAN MATHNA, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby 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 therein expressed. ~- f f ,~ Sworn or affirrl7ed to and acknowledged before me by HERBERT DEAN MATHNA, the Testator; this 1" day of October, 2804. L r~ ~ r Notarial Seal Vict~ia N. Perkins, Notary Public Shippeasburg Boro, Cumberland Coanty My Commission Expires Oct. 15, 2006 M@mb@r, Pennsylvania Ass~ciatinnof NMariHs COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We v_: ~~~ ~ ~ ~°', (' ~.~v< < ~~ and .~tF~~°F~>~,, ,;~ ~''~ ~k~~,~ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw HERBERT DEAN MATHNA, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and the he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (i 8) or more years of age and of sound mind and under no constraint or undue influence. . ~~h . Sworn or affirmed to and subscribed before me and .} y' -~ witnesses, this 1~th day of October, 2004. _vr~