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HomeMy WebLinkAbout03-02-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Janet G. Horn also known as COUNTY, PENNSYLVANIA File Number `~ `~ 2 Deceased Social Security Number 201-18-2770 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 last Will of the Decedent dated February 6, 2008 and codicil(s) dated none Executrix named in the (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 liter durante absentia; durante minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followi pouse (if ar~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.) ca `t`~ ~- f" 7~~ r-~- Name uPlar;.,.,mot,;., _ -~, _ . .._. -....... ~ ~ -r'r r~~ w.:::,,, ~. (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ © %, Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 38 Horn Road North Newton Townshi Shi ensbur Cumberland Coun Penns lvania 17257 (List street address, town/city, township, county, state, zip code) Decedent, then 83 years of age, died on January 29, 2010 at 38 Horn Road, North Newton Township, ShippensburQ, Cumberland County Pennsylvania 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 $ 6,200.00 $ 101,700.00 situated as follows: 38 Horn Road, North Newton Township, Shippensburg, Cumberland County, Pennsylvania 17257 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: Si nature T ed or rinted name and residence .~-- . ~ -, ~ ,_ ~'~ ~ . _....~ _ Patsy A. Martin 167 Overcash Road Chambersburg, PA 17202 Form RW-02 rev. 10.13.06 Page 1 of 2 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 affirn~c-d and_ subscribed before me the ~---- day of ~ ~J.-~- Signature of Persoruil Representative Signature of Personal Representative ra ~_ '`"f '""F"k } 1 N For the Register Signature of Personal Representative ~.,..+~~. T~- ' ~.,. ~' © ~; File Number:_~/ r / D~ ~ ~~ Estate of Janet G. Horn ,Deceased Social Security Number: 201-18-2770 Date of Death: January 29, 2010 20~~ , in consideration of the foregoing Petition, satisfactory proof AND NOW, having been presented before me, I S ECREED that Letters Testamentary are hereby granted to Patsv A. Martin in the above estate and that the instrument(s) dated February 6, 2008 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. /1 _ ~ s A FEES Letters ............... $ `'"'~ Short Certificate(s) ........ $ - `'O Renunciation(s) .......... $ ...$ ~.~ ...$ 3-~ ~~. - ... $ .~.a~ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $JZ7. Attorney Signature: Attorney Name: Address: 4833 Spring Road Shermans Dale, PA 17090 Telephone: (717) 582-4006 Form RW-02 rev. 10.13.06 Page 2 of 2 Supreme Court I.D. No.: 78014 _ _ HIOS.tit15 RF.V (01/(17) - - - ~ ~"~~ ~~~ ~~ LOCAL REGISTRAR'S CERTIFICATION OF DEA~'H WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 16168617 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 Records Office for permanent filing. ' ~ ~~ d Loc Reg rar Date Issued r`~ ca .... z.~ _ ~~ __.__~._.w.~. __________________...~. aD ~~'~~ ~[~.~ .._ v. _.~ - _- _ ~ ; .~ t1~ it ~ ~ ._.._______~__ ..~.____ Q ~ ~~ "i"t _ ...~. ~ ~"_ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS + ~~, H105-143 REV 11/2006 TYPE /PRINT IN CERTIFICATE OF DEATH Q --°t;~ PERMANENT BLACK INK (See instructions and examples on reverse) STATE FILE NUMBER ~I 0 w c z 1. Name d Decedent (First, middle, lest, suMiz) 2. Sex 3. Social Security Number 4. ate of Death (Month, day, year) Female 201 - 18 - 2770 1 ~' C' ~ ~ U Janet G. Horn 5. Age (Leal BMhday) Under 1 r Under 1 day 6. Dale of Birth (Month, day, year) 7. Bidhplece (C' and stale a tae count) 8a. Place d Death (Check only one) Other: kbr4ns b•YS Han karneec Hospital: 1926 NeWVille, PA ^ Inpatient ^ ER I Outpatient ^ DOA ^ Nursing Home ~ Residence ^Other • specrfy: July 4 , 83 Yrs. e dreel and rsxnber 9. Was Decedent d Hapenk Origin? No ^ Yes 10. Face: American Indian, Black, White, etc. Bb. County d Death 8c. City, Boro, Twp. 01 Death 8d. Facility Name Qf rid insMution, giv ) (It yes, speaty Cuban. ~ (~iNl Cumberland N. Newton Twp. 38 Horn Road Mexican, Puerto Rican, etc.) White Decedent's Uausl Occ Ion Kind d work done most d tile. lb rat stale retired 12. Was Decedent ever in the 13. Decedent's Education (Specify oMy highest grade completed) 14. W M~a~ Di~~ (~m Married, 15. Surviving Spouse (ll wife, give maiden name) 11 . Kind of Work Kind dBusiness / Indusby U.S. Armted Faces? Elementary / Secondary (0.12) Cdlege (1-4 or 5+) d id owe Oian FiCme ^Yes ®No 8th w 18. Decedent's Mailing Address (Street, city I Wvm, elate, zip code) Decedent's PA ~~De acedeM 170. N . Newton Twp . T ®Yes, Decedent lived k, ~ 38 Horn Road Ached Residence na. State Township? 17d. ^ No, Decedent Lived within ci lBoro mberland C • Shippensburg, PA 17257 y u ,7b.Camty Adaallm~aol 18. Fetfrar's Name (First, middle, last, sulfa) Norman A. Souders 19. Modrer's Name (Flrsl, middle, maiden surtreme) Matilda K. Atx3ersorL 20b. IMomtent's Mailing Address (Street, atY I town, slate, zip code) 20a. Informant's Name (Type /Print) PA 17202 Chambersbux'9 Roa1d Stum 1033 Pi Glen R. Horn Jr. , , p ne ^ Cremators ^ Donation 21 b. Date of DispceAbn (Month, day, year) 21c. place of Disposition (Name d cemetery, aemalory a other place) 21d. Locators (City /town, slate, zip code) 21 a. Method of DisposAion ' ~ /Dm~iort AuMarlred ^ Y • ® Burial ^ Removal Iron State wa C r~n ~or~ ^ ~ Feb~vary 3 , 2010 Ctiui~er].and Valley McDOOrial Ga~ei'>`s Car 1 i s 1 e , PA 17 013 ~ I l ^ other - Spscily: M • of Funeral (or 22b. License Number 2~. Name end Address o1 Feciity • 22a . lsan er-Bricker Funeral Home Inc. Shi ensbur PA 17257 FU014351-L Fo e • ~ title) / 23b. License Number 23c. Dale Signed (Month, day, year) , ` tiUe ~ e gams 23et only wMn 2 the bell d my ,death occurred at, date place stated. (Signature and /^v/ ~~ / ~ G ~ ~(„~! physician o not avdlebb at time nt deem to Ir~ / , certify caves of dea9,. it tors? D i C ona orat on Prorauraed (Month. day, Year) 26. Was Cese Referred b Medical Examiner I Caoner r a Reason Other than th 25 f D 4 T . . ime o ea • 2 Kems 21.26 must be cerrtpleted by person ' '1 LJ / /} ^ Yes ®No CL : ~ ~ rJ [ l/ `~ ~ ~'~ M 1 1 1 d th • . („/ . . t.. ea . who praaunces CAUSE OF DEATH ( insiructiwts and examples) r Approximate interval: Pad II: Eller other ~gm'dr M corldilions aMdbuline to death, 28. Did Tobacco Use Contratae to Death? ^ Yes ^ Probably in Part I i ven . Nem 27. Pert I: Eller the chain of everts -diseases, iryuries, a compkcatiorts -that dkecdy caused the death. DO NOT enter terminal events sudr as cardiac ercest ~ Onset to Death but not mrsulktg in the undedyirg cause g ^ No ^ UMtrawn h ti ne. r respiratory artest or ventricular f Ihoul showing the etiobgy. tat only one cause on eac r IMMEDIATE CAUSE (Final disease a I/ ~ ~ C /~ ~ ~ p r 29. if Fertrale. condition resukmg m death) _~ s. ) ~ Il r `) V r ' 1 Jc )^ i ^ Not pregnant within past year Due to (a as a rbrtsequerae of): ~ ^ Pregnant a1 time of death SequeraielN list conditions, it any, b, ~ ^ Not pregnant but pregnant within 42 days leads b the cause Nsled on kne a. Due 10 (or as a carsequerae ot): r of death Enter dte UNDERLYING CAUSE , ' (disease a ry that iMl'~tg~ dte c, r ^ Not pregnant, but pregnant 43 days to 1 year events resuMlhg n death) LAST. r ~ Due to (or as a consequence of): ^ balsa death • d. r lJnkravm ti pregnant within the past year 30a. Wes an Autopsy 30b. Were Autopsy Findirx~s 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Slreel, Factory, Office Building, etc. (Specify) Pedortned? Avaiable Prior 1o Completbn ~ Natural ^ Fbrtdcide of Cause of Death? ^ Acadent ^ Pending Investgation 32d. Tsne M Irqury 32e. ktjury at Work? 321.11 Transpalatbn Injury (Specify) 32g. Locators of Injury (Street, sty /town, slate) ^ Yes ~Wo ^ Yes ~ No ^ Yes ^ No ^ Driver /operator ^ Passenger ^Pedestdan ^ Suicide ^ Could Nol be Determined M Other ^ ~Y 777000eee 33b. Signature and Tdk d miller ~ J/ 33a. Cemirer (check only one) ronounced death and completed Item 23) sician has r h th t f d h ., 1 p p y e w an ano eat • Certifying physkfen (Physician cemifying reuse o death occurred due to the cause(s) and manner as steted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ knowledge To the best o1 m - ~ ~ ' , y • Pronouncing and certifying physician (Ptysician both proraunang death and certifying to cause of death) To the best of my knowledge, death occulted at the lime, date, and place, and due to the cause(s) and manner es stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number Sad. Date Signed (Marsh, day, year) ~ O 0 ~ ~ ~ , O ~ 7 ~ ~ ~ v L • Medical Examiner 1 Coroner On the bells of examination and I or investigat(on, in my opinion, death occurred et the time, date, end pkce, end due to the cause(s) end manner as stated_ ^ Person Who Completed Cause o1 Death (Item 27) Type /Print d Address o f n 34 Name a ! ' ~ a ` ~ ~i " I ~ ~ 35.[~ep~ `st`ar's SignLLature arrcl/[~~trict Number r _ St~LJI_~li ! iu~_iJ ___ 36. Dale Filed (Month, day, year) ~" 0~~~ ~ ~ f~ 7 1~ ~/ V '~ 'y, ~ ~~ 9 -~ ~7I/ f >~V1~ ~ I'/~~ Disposition Permit No. +•r ;1-; LAST WILL AND TESTAMENT ~ ~ ' -', ~~> :~ r ~, "7 JANET G. HORN ~ tv ~_ ~~ :~=Y. c-.. I Janet G. Horn, of Shippensburg, Cumberland County, Pennsylvania, be' ouY$ ~ ~:~'~ and disposing mind, memory and understanding, do hereby make, publish and decl~e~his as ~}d ~, t~ for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FI_ I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct my remains be buried in my prepaid cemetery lot in Memorial Gardens, Carlisle, Cumberland County, Pennsylvania. If none exits, I authorize my personal representative to purchase a contract for perpetual care of my cemetery lot, using therefore funds from my estate in such amount as she shall consider necessary and desirable. Further, if none exits, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give and bequeath certain articles of my tangible and personal property in accordance with a hand written list made by me during my lifetime and attached hereto. In the absence of such a list or designation on said list, said articles of my tangible personal property shall be added to the residue of my estate. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved spouse, Glen R. Horn, absolutely and ire fee simple if he survives me by thirty (30) days and he . is not institutionalized in a health care facility or nursing home, or receiving benefits through the PDA Waiver Program or any other public benefits program. FOURTH In the event that my spouse, Glen R. Horn, fails to survive me by thirty (30) days or in the event he shall be institutionalized in a health care facility or nursing home, or receiving benefits through the PDA Waiver Program or any other public benefits program, I hereby give, devise and bequeath my estate to my children, Glenda J. Branthafer, now of Orrstown, Pennsylvania, Janette L. Horn Washington, now of Carlisle, Pennsylvania, Patsy A. Martin, now of Chambersburg, Pennsylvania and Glen R. Horn, Jr., now of Chambersburg, Pennsylvania, equally, share and share alike, pro rata. Should any child predecease me, their share shall pass to my surviving issue, pro rata. These provisions also appear on my spouse's Will and are intended by both to be reciprocal, each providing the consideration for the other. FIFTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. SIXTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his or her absolute discretion: (A) To retain in the form received, or to sell either at public or private sale any real or personal property; (B) To exercise any options to subscribe for stocks, bonds, or other investments; 2 (C) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; (D) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his or her sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (E) To make settlements and compromises on such terms as my personal representative in his or her sole discretion may deem wise without the necessity of obtaining any court approval thereof; (F) To make distribution hereunder either in cash or kind, as my personal representative in his or her discretion may deem wise. SEVENTH I do hereby nominate, constitute and appoint my daughter, Patsy A. Martin to act as Executrix of this my Last Will and Testament. Provided, however, that if she is unwilling or unable to act as Executrix, I direct the duties of Executrix to be performed by my daughter, Janette L. Horn Washington. EIGHTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. 3 IN WITNESS WHEREOF, I, Janet G. Horn, have hereunto set my hand and seal to this my Last Will and Testament, consisting of five (5) typewritten pages, the first three (3) of which bear my signature in the margin for identification, this ~ day of , 2008. ~1- `~' ~- Janet G. Horn, Testatrix Signed, sealed, published and declared by the above-named Janet G. Horn, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. ~` ~ ADDRESS ' T ~ r' ~~~ ADD~SS X 11 ~U, ~ , S~~L2 1-~r~~ bv~, , ~fl- 1'7I0~. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~j~C/}~U~'r'/~~ We Janet G. Horn, ~ and ~~~ ~ /~ - /~Or° ~~~ the Testatrix and witnesses, respectivel h se names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. C Janet .Horn, Testatrix r ~ 4 Witness r ~~ ~ ~ ~l I 1 sha~,,~~, pDU U ~ ~~~ ,Witness 4 Subscribed, sworn to and acknowledged before me by Janet G. Horn, the Testatrix, and subscribed to and sworn or affirmed to before me by IVIQ,r~i t~ ~\~S (~~ and witnesses, this ~ day of ~~D~o/lX5' /~• ~Io~c°r Zoos. o y Public cornvioriwE~,TH of P~snv iHotar~"~ Seal Sa~ilis ~,Ish~~.e, ~lotary Public Carron Tw,., arty Coun My Commission Expires Mar. 2 , 2008 5