HomeMy WebLinkAbout04-20-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENN YLUANIA
Estate of Verna Mae Dagen File Number ~~ f ~ ~ (,.! °' ~,)
also known as erna a en --r
ecease Social Security 211-18-7693
Petitioner(s) who is/are 18 years of age or older, apply(ies) for:
[X~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor(s) J. Edward Dagen
named in the Last Will and Testament of Verna Mae Dagen
state re evenat circumstances, e.g. renunctatton, eat o 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.; .n.c.t.a.; en ente tte; urante a sentta; urante in~norrtate
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.)
COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent tvas domiciled at death in Cumberland County, Pennsylvania with his/her last principal residence at
770 South Hanover Street Carlisle Borou h of Carlisle
ast street a ress, town city, towns tp, county, state, ztp co e
Decedent then ~'' ~7
years of age died on 23-Mar-10
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.)
(If not domiciled in Pa.)
(If not domiciled in Pa.)
Value of real estate in Pennsylvania ~1.-~~ ~u<•~r.~ t.y „z~~ ~+«
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 a ro riate form to the undersi ned:
i nature a or printe name an ress ence
~~ ~ ~~ / / ~~ J. l~award llagen
_~ 'V ~ 1205 Fleetwood Drive, Carlisle, PA 17013
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEATLH OF PENNSYLVANIA
couNTY of CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition 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 this _ '~-~~-'~ day of April, 2010.
For the Register ~ _,
File Number:
Estate Of VERNA MAE DAGEN
Social Security Number:
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211-18-7693 Date of Death
3-Mar-10
AND NOW
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to J. Edward Dagen
in the above estate
and that the instrument(s) dated July 20, 2007
described in the Petition to be admitted to probate and filed of record as the last Will and Codicil of Decdedent.
Register of Wills
FEES
Signature
p'~I Attorney Name
Letters ~ ~ ~~
Short Certificates
Sup. Ct. LD. No
Renunciation
~.~-~ _ I c~. Address:
~~-~~ ~ ~
Telephone:
TOTAL... %-]T~-,, t=.~
_____ --
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s
Stephen D. Tiley
32318
5 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-5838
Page 2 of 2
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS '`+J ~ - Cpl
CERTIFICATE OF DEATH ~ ~ ,
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(See Instructions and examples on reverse) ~
STATE FILE NUMBER
a nm.,,r a~an ee,.,,......._.., _ .,... . ._.. 2. Sex
F 3. Social Sewrly Number
211 - 18 7693 4. Date of Deelh (Month, tlay, year)
March 23, 2010
Ht O6~tC3 REV 112006
TYPE I PgINT IN
PERMANENT
BLACK INN
1. Name 01 Decadent IFirsl, middle, last, suffix)
Verna M. Dagen
T`
0
87 vrs XXXX XXXX XXXX XXXX August 22, 1922 West Wll low, PA Hospital. Other:
• Bb. County d Death Bc. City, Bom, Twp. of Death ^ Inpatient ^ ER I Outpelienl ^ DOA ®(Nursing Home ^ Residence ^pmer . Specity:
Bd. Facility Name (H riot inslilNk)n. give 5meel aM number) 9. Was Decedent of Hlspanc Origin? ~ No ^ yes 10. Race: American Indian, Black, While, etc.
Cumberland Carlisle Chapel Pointe Health Center (Ilyaa,apetiycobe"' (spepryi
Mexican, Puerto Rican, etc.) Wh I to
tt. Decedent's Usual Ora uon KiM d worN done dlli moss of waki Nle. Do not state retired 12. Wee Decedent aver ut me 13. Dceedem's Etlucation (specify arty highest grade completed) 14. Marital Sutus: Marred, Never Married, 16. Surviving Spouse (If wife. give maiden name)
Kind of Wwk grid of Business I Industry U.S. Amred Forces?
Homemaker Elementary I secoMary (0-12) College (t 4 or 5+) Widowed, Divomed (Specil~
Domestic ^vea ®NO 8 XXXXXXXXXXXXXXXX Wldowad
• t6. Decedent's Mailing Address (Steel, city I town, stale, zp code) Decedents XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Actual Residenre I7a. Sale Pennsvlvanla uve~ a~n1
770 South Hanover St. Car I 1 s I e, PA 17013 nt. ^ va:, Decedent Lwed i" Twp
7ownsnip7
rib. county Lancaster nd.I,y~NO,DecedemLivedwnnin Carlisle
t8. Father's Name (First. middle, last, sumx) Adual Limits of Cary I Dorn
Harry S. Bechtold 1s. Mmber's Name (Brit mitldle, maiden wmame)
Viola Henry
20a. Imormanrs Name (type / Prml
J. Edward Dagen 20h. Inlormenl's Mailing Address (Srcet cityllawn, slate, zip mde)
1205 Fleetwood Dr. Carlisle, PA 17013
21 a. Method of Dispostion ^ Crematron ^ Donation 21b. Dale of Disposdion (MOnm, tlay, year) 21 c. Place of Disposugn (Name d romafe , creme!
~((Buriel ^ Removal ban Stale :Wes Cnmetlon or Donation Authorlied ry ary or olber plero) 21 d. Lorolion Icily /town. stale, lip rode)
^omar-speary: ;byMedlrolExamlror/coroners ^vBe^~ March 31, 2010 f3oehm's United Methodist Cemetery Willow Street, PA 17584
22a. - Funeral race (or person actin s such) 22b. License Number 22c. Name and Atldress of FeciNry
~ + %~^ mro t ~ Z ~ FD138424 Gundel Funeral Home 415 N. Duke St. Lancaster, PA 17602
complete IlemsJl3e only when cerliryiig 23a. To dta best of my Mrpwiadge, deem tuurted al me dme, dale end place staled. (Signature aM b11e)
physician is bk al lime d death l0 23b. Llcense Number 23c. Dale Sgned (MU,m, tla
ronity cause of deem. ~ /l Y. Year)
Items 24-26 muss be completetl by person 24. Time of Deem 25. Dale Pmrxluncad Dead (Norm, day, year) ~ ~ ~ / ~
wlw prorrounces death. U ~ i' ~ M ~ 1 ~ 26. Was Case Relerred la Medical Examiner I Coroner for a Reason mar man Cremation or Donation?
-I cri i J ^Yes ~No
CAUSE OF DEATH (See Inetruellone and eza plea) ~ Approximate Interval: Pan II: Emer other sion MaN cortl In rib r t d Ih,
Ilam 27. Pan I: Enter the main of Is - aseases, injurres. Dr cortplketbns -mat Olreclty ceased me deem. DO NOT enter Mmmal events such as camiac amesl, ~v Z? 26. Dw Tobacco Use CanlriMae to Death?
respiratory artcel, or venbiculer fArillalion without showing the eliobgy. List only one cause on each lire. Dnset to Deem but not revelling in ttte undertying reuse given in P n I. ^Yes ^ ProbeMy
INMEDIATE CAUSE (Fxel disease or ~~ ~ ~ No ^ Unkrgwn
aa~bon naWUrg m am) _~ a. i v ,
h ~A~r 29.11 Female:
Due to (or as a consequence op:
SBquenlialty list callditione, it any, o ^ Not pregnant within past year
leetlirg to the Uuse lisletl m line a. ^ Pregnant al lime of death
Enter Dre UNDERLYING CAUSE Due to (or as a consequence of)~ ^ Nat
(disease or injury mat Inileled me pregnant. but pregnant within a2 tlays
Is resutling In deem! LAST. of death
t Due la (or a5 a consequence olj'.
d. ^ Nol pregnant. bN pregnant 43 tlays to 1 year
30a. Waz an Autopsy 30b, Wen AN ' belore death
apsy FMegs 3t. Manner d Deem ' ^ Unknown it pregnant wihin me
32a. Date of In Month, da a 32b. Describe Now Injury Occurred past year
' Perwmed? Avauable Prior to Complelbn Nry ( Y. Y arj 32c. Place of Iryury: Home, Farm. Sreel. Fact
of Cause WDealn7 ~Nalurel
^ Homicide OK Duildng, em_ lspeciNl ~
^ Yes ~JO ^Yes ^ No ^ Accident ^ ParxBrg Invesligaaon 32d. Time of Inlury 32e. Injury al WorN? 321. II Transportation Injury ($paglyJ 32g. Location of Injury (Street, city I town, stale!
^ Surcae ^ could Not be Delerminetl ^ vas ^ No ^ Drnef I Operator ^ Passenger ^Pabestran
M. ^omar-seamy
33a. canawr (cheek only oroj
33b. signalrtl~ and rue a canirer
• Canltying physican (Physcian renityirg cause of beam when alwmer physkian has pronourrad beam aM completed Item 23) 1,i/
Tome best of my knowbdge, death attuned due to Ibe caucele) and manner as 318ted_ _ _ _ _ _ _ _ ' 4.,
Prorquntlrp and cxfilymg physician (Physician both prorqundng deem and CMitying to reuse of deem! _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ ~ - - ~ - - ~ - - 'i ~ ~'
To me best of my knowNdge, dwth occurred at tM time, date, and place, and dw to the coo _ ^ 33c. Llcense Number 33tl. Dale Signed (Mon day, yearj
• Metlkal Examiner /Coroner sets) end manner as sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
On me basis of examinetlon and / or Investigation, In my opinbn, deem oecunetl et Me time, pets, and place, and due to IM teasels) and manrtar as stated_ ^ ~\~ ~ ~ ~~ ~ ~r r~2 r (.5~. ~3' ~'~ ~9
35. Registrar's SignaWr and Disbicl Number 3d. Name entl Address of Person Whp ComplHed Cayyol Death (Item 27) Type /Print
F Ce2 ~~t-- 13 I G 13 I S I y I 36. Data Rletl tMonm, day, rear) ~ G d ~~ ~ - ~ (`2nS V v M e) ~ ~O
3 - a ~~--/a,n ~o (mac v~ ~ «x, C't r (,lJ h ~ I ~o I ~
Disposition Permit No.O (~ /. ~ ~~ /
LAST WILL AND TESTAMENT
I, VERNA MAE DAGEN, of the County of Cumberland and Commonwealth of
Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare
this to be my Last Wiil and Testament, revoking any and all Wills and Codicils by me at any
time heretofore made.
FIRST: I order and direct my Executor hereinafter named to pay all of my just
debts and funeral expenses as soon as can conveniently be done after my decease.
SECOND: I direct that all inheritance, estate, transfer, succession and death taxes,
of any kind whatsoever (including any interest and penalties thereon), which may be payable
by reason of my death, whether or not with respect to property passing under this Will, shall
be paid out of the principal of my residuary estate. Taxes on future interests may be prepaid.
THIRD: All the rest, residue and remainder of my estate, both real and personal,
I give, devise and bequeath unto my son, J. EDWARD DAGEN, his heirs, personal
representatives and assigns, in fee simple, absolutely.
FOURTH: All legacies, shares or interests in my estate, whether principal or income,
payable to any beneficiary under my Will shall to the fullest extent permitted by law be paid
free and clear of, and the interest of such beneficiary shall not in any manner be subject or
liable to, his or her debts, liabilities, contracts, engagements, anticipations and alienations or
those of any other person, or subject to attachment, execution, or sequestration, for the debts
or liabilities of any person whatsoever; and the personal receipt by such beneficiary shall be
the sufficient and only discharge of my Executor.
FIFTH: I nominate, constitute and appoint my son, J. EDWARD DAGEN, to
be the Executor of this my Last Will and Testament. I order and direct that my Executor shall
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serve without bond and that no indemnification, bonding or certification of any kind shall be
required in the administration of this estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this , .-'.~~ ~`~ _ day of
__ t > ~ ' , 2007.
VERNA MAE DAGEN '
Signed, sealed, published and declared by the above named Testatrix, VERNA MAE
DAGEN, as and for her Last Will and Testament, in the presence of us, who at her request
and in her presence and in the presence of each other have subscribed our names as witnesses
hereto.
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COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF LANCASTER } SS:
}
I, VERNA MAE DAGEN, Testatrix, whose name is signed to the attached
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.
Affirmed to and acknowledged before me, by VERNA MAE DAGEN, the Testatrix
_, ~.~ ~l
this ~iay of ~ :'_._ ~' , 2007.
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VERNA MAE DAGEN
No ary Public
COMMONWEALTH ~r~ z'ENNSYLVANi:~.
Notar.?i ~ _"
Karen M, Tumer, Ndary public
Carlisle Sam. Cumberland County
My Commission E ,~,-y 21, 24t wC,
Member, Pennsylvania Associa?p, ~ -~ ""
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COMMONWEALTH OF PENNSYLVANIA }
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COUNTY OF LANCASTER }
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WE " `~ -~-~tt,. 4 ti, ~ and ~ d. 6 %-, r : ,
' ~ ~ ` ,the witnesses
whose names are signed to the attached instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testatrix sign and execute the instrument as
her Last Will; that VERNA MAE DAGEN 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; and that to the best of our knowledge the
Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no
constraint or undue influence.
Affirmed and subscribed to before me by /(~Y~,y f~ ~~-~'~ and
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~~~ "~F :' ,witnesses, this t `' ~ day of ~'„ ~` 2007.
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Notary Public
1tv9C;NWEALTii OF ~~hERlSYLVI>NfA
-_ Notarial Seas _ -
Karen M. Tamer. rsc ;'-.Sbiic
' Carlisle Boro, ~;+s~ .;j~. •. r. ' :"c~ ~nty a
MY Commission ` ,, : __ '..~ 20' Q8
1Aember, ?ennsyi, ~~ ~ - "~?~ notaries
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