HomeMy WebLinkAbout06-02-10t ~ o
Estate of
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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF _ i ~~ COUNTY, PENNSYLVANIA
J vhn `~? ~-a.-~~es J~-
File Number oC ~- 1 f~` " ~ t p O
Deceased Social Security Number Z.2~ - ~2 " C'32..1(~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO/NIPLETE 'A' or 'B' BELOW.)
L'7 A. Probate and Grant of Letters Te tamentary and aver that Petitioner(s) is /are the ~ ` ~'t'~~`'~~--~r~ named in the
last Will of the Decedent dated I t7 ~ ~2 and codicil(s) dated
(State relevant circumstances, e.g., renctnciation, 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
(Ifappticable, enter: c. t. a.; d.b.n.c.t.a.; pendente life; durance absentia; durnate n:lnoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived b the follo~vin use tf an ~,
Y g (~ y) ~ heirs: (If .r.
Admirtistratioit, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ -~- O ~
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Name Relationshi Rude - r-- ~ t"-"
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(COMPLETE INALL CASES:) Attacjh'add,,i~ti~onal sl:e-e~s ifJnecessary. '~ ~ ;-.,.~ ,r..a
Decedent was domiciled at death in ~--1^'` T ~~ ~C~- ~ t
County, Pennsylvania with his /her last rincipal residence at ~
l t t 3 t ve-1r ~ 'c PA I `"1 5Z~
(List street address, to-w~i/7ci~ty(, township, county, state, zip codet)
Decedent, then t'T" years of age, died on `~ 2c1 I ~ at CT~'~ S 1 f It l~S'71P`~CL_{
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Decedent at death owned property with estimated values as follows: _
(If domiciled in PA} All personal property $ ~~, ~ . UL7
(If not domiciled in PA) Personal property in Pennsylvania $_
(If not domiciled in PA) Personal property in County $_
Value of real estate in Pennsylvania $
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 undersigned:
Si nature T ed or rimed name and residence
nn~ ~a-m ~ tit 111 ~ I ~ ~f~~-~-c~ ~~~~d
ic~Sl(~~ p~ i ~~5~
Form R6V-0? re,-. to. r3.o6 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine and conect 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
n~
before me the day of
Ul l~
~ .c .
For the Register
C'"1 . r~
Signature of Personal Representative C7 -°•~' `
Signature of Personal Representative s.7 ~,. t:.." •- ~ '~.
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Signature of Perso,tal Representative
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File Number:~r ` ~®-` C.~1~pO
Estate of r ~ • ~~ L-- - ,Deceased
Social Security Number: ZZ~ - ~ 2 -~f Z 1~ Date of Death: ~ "~~ ' ( ~
AND NOW, v~- ~ ~ ~, in consideration of the foregoing Petition, satisfactory proof
having been present be ore me, IT IS DECREED that Letters ol,Yyi.Q,(/1~'
are hereby granted to ~ , ~h(~.,ry~ ~(] ~ !
_ in the above estate
and that the instrument(s) dated _ ~,(~ - ~"~ - ~ ~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............... $ ~0 . ~
Short Certificate(s) ........ $ ~ y
Renunciation(s) .......... $
(~ I. ~ ~ ... $ F ~ -CTU
... $
... $
... $
... $
... $
... $
TOTAL .............. $ aJ a~~
Fa•m RW-UZ rev. 1 U.13.U<
Register of Wills
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fee for this certificate, $6.00
P 16177406
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 pf~rmanent filing.
~~__%h7 ~ MA 01 010
Local Registrar Date Issued
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3 REV 1112008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
/PRINT IN '
aMANENT
Aac INK CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
1. Name of Decedent (Pint, mldde, lest, sulfa) 2. Sez 3. Sodel Nun~er 4. Date of Oalh (Month, day, yar)
John P. Haines Jr, male 224 -42.-,8210 Apr•29,2010
5. Age (Leer 131rtlrdey) under 1 under 1 s. Date a BIM Month, - ~. BI and Bare or coo ea. Place a Dean, check one
Montlb ~ tkus ABr~ Hoepitel:
74 Yre. Apr. 3,1936 olumbus,OH ,~.~ other:
~. ~+My ~ Oeanr &. City, Boro, T of Death ^ Inpetlent N_J ER I Ou~enent ^ DOA Nun,Mtg Home ^ Residence ^ ether - S
~'+P• 8d. FedNly Name (n rat bartllutlon, ~'~
• ~ etraet ~ nrar,ber) 8. Was Decedent d Hispenk; Orlpin4 No ^ Yes 10. Race: American Indlen, Breck, White, etc.
Cumberland East Pennsboro Holy Spirit Hospital ("~~~~ ~,~e
• Medcen, Puerto Rican, etc.)
• 11. Deoedem's Uwd Kind of work done du mast of N(e: Do not state ro' 12. Wee Decedent ever in the 13. Decaderrre Educetlon (Specify only hlghem Arad• oompated) 14. Mernal Status: Manled, Never Marred, 15 Surviving Spouse (n wile, give maiden name)
and or work KMd of Srufrrees r Industry us. Ambd F a ~~, / Secondary (a12) college (1-4 or 5+) ~ DNoroed fSPeaHI
tinter fed, vt. ^Ya widower
• 1 e. DAcedenrs Nag Address (street, airy /town, mare, zip code) Decedenre Did Decedent
1113 Tiverton Rd. AottblRalaerwe na.stare Pennsylvania Liveina ,7a~es,DecedentLNedin HamndPn
• Mechanicsburg, PA 17050 „b.~,,,nt,, Cumberland rawrgh'rp7 17d ^~ ~w~ln = rwp.
Acnral urM1a or city / Boro
18. Esthete Name (Pint, midrib, leaf, auflbt) 18. Monrera Name (Flrst, nYdde, maiden sumenre)
John P. Haines Louise Harrell
20a. IMonnmM's Name (Type / PrIM 20b. InMnrreM'e MeN~a Addroa cStroet, dty / stets, code)
Anne S~hambaugh 1113 Tiverton R~.,1~Iechanicsburg,PA 17050
2/a. of ~ ^ Crernanon ^ Donetbn 21b. Dare of Dbpoeitlar (Month, day, year) 21c. Place W Dlapomtlon (Name of
• cemetery, nemetory or other place) 21 d. Locatbn (City /town, state, zip code)
~" ''~'~ ' W"~'"~"010fD0""'°"A~O~d Ma 3 201 0 National Memorial Park
• ~ ~'"'~"'~nifQOeOner' ^ va^ "~ y ' Falls Church, VA22042
• of Furwral lJaroa (a person a such) 22b. License Nrxrrber 22c. Name and Address et Facitlly
- D-013163-L Musselman FH&CS,324 Hummel Ave.,Lemo ne PA 17043
lame 23ac only when asrtifyk,g 23a. ro rare beet or my knowadge, dean, oawrred m the nme, rise end place stared. (Signature and tnre)
physician b rat avelbde m tlme of death to 23b. Licerree Number
Certlly Cetree of dalh. 23c. Dare Signed (Monts, day, year)
tame 24.2s moat be oa,peted uv person 2a. Tana of Damn ~ 25. Dare Praarsaed Dead
(Morns, day, year)
who praauraes damn. `~. ~ ri ~p M. ~ i„ „ . /~ ~ ~ -
Item 27. Part I: Enter the Gtein al events CAUSE OF DEATH (Sea Inshuctbns exanplee) -
- dbeeae, arJuas. or comptlcatlorro - That drectly txtreed the death. DO NOT erMer arrrrinel everds
h
d
suc
ea cer
ac artem,
reapastory street, or ventrlaAer tibrillatlon without showing the .List oNy one on each tlne.
~; ~
NaIEDIATE CAUSE
disease or
oordflion roeulnrq in ~ea~m ~
N~',r
-~~'~- s ~ ~~ G
~ a
,o~ c,
re (ar ae a ~rbeq,~nae
of):
tat condnorro, N arty, b
re Calla label Orl NrM 8.
Erex UNDERLYNI6 CAUSE
Due to (or as s ooneegrrerae of):
(abase a atlrsv 8rt inltlead the
sveMe ratdta~ in death) usT.
a" __ _
Onem re Death
we ro for as a correegtrerae op: i
d. ~
30e. Was N Autopsy 30b. Wsro AuOopsy Flrxfargs 31. of Death r
P•Aomred7 AvaNeble Prior re 32a Dare of arjrrry (Monnr, day, year) 32b. Describe How Irywy Occurred
of Caua of Death Nalurel ^ Homidde
26. Was Case Re to Medical Eaurwrer /Coroner for a Reason Omer than Cremetbn or Donation?
^ Yes No
'art II: Eller other 28. Did Tobeaa Use Cordribute to DaM4
but rat resrrltlrp M tfb underlying cause given in Part I. ^ Yes ^ Probedy .
^ Na ^ unknoam
29. n Female:
^ Not pregnant winds pem year
^ Pregnant at tlme m deem
^ Not pregnant, but pregnant within 42 days
or death
^ Not pregnant, but pregnant 43 days to 1 year
before death
^ Unkrawn tl pregnant wihin rare pest year
32c. Place of Injury: Roma Fenn, Street, Factory,
~,~ Oftlce f3ulkAng, etc. (SP~+'N)
^ Yes (G No ^ Yes ^ AccJdent ^ Perdaq Irweetlpetlon 32d. Tkne of Injray 32e. Injury at Wark/ 32I. H TranaponatWn In(ury (Sped/y) 32g. Locetbn o1 I
^ Suk*le ^ Could Not be Determined M ^ Yes ^ No ^ Ddverl Operator ^ Paeeerger ^ PedeeMen M'~ (fit' ~'~ /town, state)
Omer • Spedly.~
33e. Certlllsr (check only one)
• C•~YMO Phrakan (Phyeican csrlMyirg carets of dalh when manner physidur has pronasaed death and conMrlsad Item 23) 33b. Signmure and of CertlBer
To m. bat a ray awwadga, dam oa;unsd dw re rite ear.(,) and marrrrer a slated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
• Pronorarokto end artryarg physban (Physiden bah pronoraaaq death and cannyarg to came of demh) - - - - - - - - - - - - - - - - - - 33a LKerre Number
To the bast of my knowadge, deem occurrod et the thrr, ante, and pea, and dw re tlrs auss(s) and mrurr a stared_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33d. Dare S ( nth, day, Y•ar)
• Esamknr/Catcher o aim ~~ ~ ~' y , ,, ,
on dr bas or aamNrtlon and / a imrosligstlon, m my opinbn, d..n, oaunsd n tM tun., rise, end pats, awf aw ro tM arse(s) arse mwrr a .area.. ^ era Address of Peroon Who
Cortpbted Cauee of Deetlr 2~ Ty{a / P
35. Regbtrera Slpr era District 38. FYed MoMh,da fJ~uv,er'9:.u,:~•~ ~.~.~
-.. .C' N-~ l ~"' j~
Dfsposttlon Perms No. a~ g a 7~ 1
LAST WILL AND TESTAMENT
Of ~~
t:~
JOH
N P
HAINES
JR
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I, JOHN P. HAINES, JR., of Fairfax County, Virginia, being of f~Ci~ll age, soand
r,
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mind and memory and under no restraint, do make, publish and declare this
instrument to be my Last Will and Testament and hereby revoke all Wills and Codicils
ever before made by me.
This Will is not the result of any contract between myself and any beneficiary,
fiduciary or third party; this Will or any Will made by me may be amended or revoked
by me at any time at my sole discretion. I declare that I am not party to any
antenuptial contract limiting my discretion in making this Will.
ITEM I
I direct my Executor to pay all of my just debts (including the expenses of my
last illness), and the expenses of my funeral and burial or cremation (without regard
to any limitation in the applicable local law as to the amount of such expenses) and
of the administration of my estate.
ITEM II
I direct my Executor to pay all inheritance, transfer, estate and similar taxes
(including interest and penalties) assessed or payable by reason of my death on any
property or interest in property which is included in my estate for the purpose of
computing taxes. My Executor shall not require any beneficiary under this Will to
reimburse my estate for taxes paid on property passing under the terms of this Will.
INITIALS: Testator Witness #1 ~; Witness #2 L~~,%`-~ Page 1
ITEM III
I hereby authorize my Executor to utilize the services of an attorney,
accountant and any other professional as may be necessary or desirable in the
administration of this, my Last Will and Testament. The expenses incurred by the
Executor using such professional services shall be an expense to my estate and shall be
paid by my estate.
ITEM IV
My Executor named herein shall be entitled to reasonable compensation
commensurate with the services actually performed and to reimbursement for expenses
properly incurred.
ITEM V
I hereby give, devise and bequeath to my grand-daughter, AMANDA R.
O'DONNELL, the sum of Ten Thousand Dollars ($10,000.00), if such beneficiary shall
survive me. In the event such beneficiary shall fail to survive me, this specific bequest
shall fail and be of no effect.
ITEM VI
I hereby give, devise and bequeath to my grandson, MATTHEW ROY
O'DONNELL, the sum of Ten Thousand Dollars ($10,000.00), if such beneficiary shall
survive me. In the event such beneficiary shall fail to survive me, this specific bequest
sh~l1_ fail and be of no effect.
ITEM VII
I hereby give, devise and bequeath to my grandson, ROBERT RYAN
O'DONNELL, the sum of Ten Thousand Dollars ($10,000.00), if such beneficiary shall
INITIALS: Testator Witness #1 D~~~~ W' ~~~'/~
fitness #2 ~ Page 2
survive me. In the event such beneficiary shall fail to survive me, this specific bequest
shall fail and be of no effect.
ITEM VIII
I give, devise and bequeath the entire residue of my estate, whether real,
personal or mixed, of every kind, nature and description whatsoever, and wherever
situated, which I may now own or hereafter acquire, or have the right to dispose of at
the time of my death, by the power of appointment or other:wise, to my daughter,
ANNE LESLEY BLOCHER.
ITEM IX
Should, however, the residuary beneficiary named above fail to survive me,
then the gifts, devises and bequests to such residuary beneficiary named above shall
fail and be of no effect, and in that event, I give, devise and bequeath the entire
residue of my estate, whether real, personal or mixed, of every kind, nature and
description whatsoever, and wherever situated, which I may now own or hereafter
acquire, or have the right to dispose of at the time of my death, by the power of
appointment or otherwise, to LOUISE V. HEDRICK.
ITEM X
I nominate and appoint ANNE LESLEY BLOCHER and LOUISE V. HEDRICK as
Co-Executors of this, my Last Will and Testament, and require that said Co-Executors
serve without bond or surety.
ITEM XI
If any gift, bequest, devise or legacy made by this, my Last Wi11 and Testament,
would, but for this Item, be made to any person who, at that time, is less than
twenty-one (21) years old, then in that event the gift, bequest, devise or legacy shall
INITIALS: Testator Witness #1 ~• Witness #2 % ' L~~ Page 3
~~
be made to ANNE LESLEY BLOCHER, as Trustee in trust, for the benefit of said
person.
The purpose of said Trust is to ensure an adequate level of income, support,
maintenance and education for said beneficiary. It is my express intention and
direction that the income or principal of said Trust shall not supplant or replace the
legal obligation for support, maintenance or education which any other person might
have with respect to said beneficiary, but rather shall only supplement other, existing
sources of income. To meet this purpose, I empower the Trustee to distribute, or not
to distribute, all or part of the income and to invade all or part of the principal as the
Trustee in its sole discretion decides.
The Trustee shall have the power to manage, invest and reinvest the assets of
the Trust estate, to collect the income therefrom and to apply so much or all of the
net income and principal thereof as set forth above. Any net income not so applied
shall be added to the corpus of the Trust and held, administered and. disposed of as a
part thereof.
The corpus of the Trust shall be paid over to such beneficiary when he or she
reaches the age first referred to in this Item, or, if such beneficiary shall die before
reaching that age, upon his or her death the corpus of the Trust shall be paid over to
the residuary beneficiary of this, my Last Will and Testament, or, if none are then
surviving, to my then living heirs at law, by right of representation.
ITEM XII
Regardless of anything in this instrument to the contrary, no Trust shall
continue more than twenty-one (21) years after the death of the survivor of myself
and each lineal descendant of mine living at the time of my death. Immediately prior
to the expiration of such period, each Trust then in existence shall terminate, and the
INITIALS: Testator Witness #1 ~ ~'1~Witness #2 ~ ~'~
4~ Page 4
then existing principal of each such Trust, including any undistributed or accrued
income thereof, shall vest in and be distributed to its then current income beneficiary.
To the extent permitted by law, the principal and income of any trust shall not
be liable for the debts of any beneficiary or subject to alienation or anticipation by a
beneficiary, except as may be otherwise provided herein.
If, at any time, the size of any Trust under my Will is so small that, in the
opinion of the Trustee, the Trust is uneconomical to a 'ster, my Trustee may
terminate the Trust and distribute the assets to the person then authorized to receive
trust income, or if more than one person is authorized to receive trust income, to the
ona~ or ones of them my Trustee may deem appropriate and in such shares as such
Trustee may deem appropriate.
ITEM XIII
In addition to the powers conferred upon executors and trustees by the Code of
Virginia, Section 64.1-57 (1950), as amended, which is incorporated herein by this
reference, my Executor and Trustee, if any, or any duly appointed successor shall have
authority without adjudication, order or direction of the court:
(a) To sell, pursuant to option or otherwise, at public or private sale and
upon such terms as the Executor shall deem best, any real or :personal property
belonging to my estate, without regard to the necessity of such sale for the
purpose of paying debts, taxes or legacies;
(b) To retain any or all of such property not so required without liability for
any depreciation thereof;
(c) To assign or transfer certificates of stock, bonds or other securities;
(d) To adjust, compromise and settle any and all claims in favor of or
against my estate;
INITIALS: Testator Witness #1 • Witness #2 ~ ' ~--~ Page 5
(e) To conduct and carry on all business now conducted by me and to do all
things necessary or proper in the usual course of business until such time as the
business can be sold or distributed as a going concern or otherwise, and the
Executor shall be exonerated from any loss which may result thereby; and
(f) To do any and all things necessary or proper to complete the
administration of my estate, all as fully as I could do if living.
ITEM x:IV
Where appropriate to the context, pronouns or other terms expressed in one
number or gender shall be deemed to include the other number or gender, as the case
may be.
ITEM XV
Any person named or referred to herein shall be deemed to have survived me
only if such person shall in fact survive me for a period of at least 30 days. Any
person named or referred to herein who shall not survive me for a period of at least
30 days shall be deemed to have predeceased me.
IN TESTIMONY WHEREOF, I have hereunto set my hand, this ~''7 day of
_ ~',~ , 1992, to this my Last Will and Testament, typewritten on eight
(8) pages, and, for the purposes of identifying the same, I have initialled each page
hereof.
i ..
HN P. HAINES, JR.
Signed, published and declared by the above-named Testator, ,TOHN P. HAINES,
JR., as and for his Last Will and Testament in the presence of us, who, at his request,
INITIALS: Testator Witness #1 , „v't~ ,~ Witness #2~'- Gr'~ Page 6
in his presence and in the presence of each other, have hereunto subscribed our names
as attesting Witnesses thereto.
" ~ !_. ~
Resides at ~ ~ ~ C
ess # 1 Signature Street Address
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Witness #2 Signature
Resides at ~ J ~' - ..
Street Address
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City, State, Zip
COMMONWEALTH OF VIRGINIA
COUNTY OF FAIRFAX
SS.
Before me, the undersigned authority, on this day personally appeared John P.
Haines, Jr., ~ ~ ~!ti - G -~ and
-.
-~~r % ~- ~ ~ ~" ~ ~: ~ ~ r ~~~ ,known to me to be the Testator and the
Witnesses respectively, whose names are signed to the attached or foregoing
instrument. John P. Haines, Jr., the Testator, being by me first duly sworn, declared
to me and to the Witnesses in my presence that said instrument is his Last Will and
Testament and that he had willingly signed or directed another to sign the same for
him and executed it in the presence of said Witnesses as his free and voluntary act for
INITIALS: Testator Witness #1~~~,~~; Witness #2 •~~(-`, Page 7
the purposes therein expressed. Said Witnesses, being by me first duly sworn, stated
before me that the foregoing Will was executed and acknowledged by the Testator as
his Last Will and Testament in the presence of said Witnesses, who, in his presence, at
his request and in the presence of each other, did subscribe their names thereto as
attesting Witnesses on the date of said Will and that the Testator, at the time of
execution of said Will, was over the age of eighteen (18) years and of sound and
disposing mind and memory.
Jcs P. Haines, Jr.
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Witness
Subscribed, sworn and acknowledged before me by John P. Haines, Jr.,
Testator, and subscribed d sworn before me by
~~` ~~
~r 'and .~-!,~';~ ~ a ; _~
~~
Witnesses, this 2 ? day of ~' ~"~ ~~
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This instrument was prepared y Gary
Suite 200, Springfield, Virginia 22150,
~9 ~ ~, j,..,--,
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No P lic !
~y Co 'ssion Expires 31 ~''~"~
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lal, Myatt Legal Services, 6417 Loisdale Road,
70~') 922-1700.
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INITIALS: Testator Witness #1 ~~Nitness #2 t` r~''r' Pa e 8
g
HYATT LEGAL SIItVICES
641 T Loisdale Road, Suite 200
Springfield, Vuginia 221 SO
JOHN P. HAINES, JR.
ABOUT YOUR WILL
Attached is the original of your Last Will and Testament. We want to commend you
for having the foresight and care to prepare a Will.
Here are a few ideas to keep in mind regarding your Will.
1. If you should move to a different state or country, check to make sure that
your Will is valid under the laws of that state or country.
2. You should review your Will whenever there is any change in your personal
circumstances, such as birth, death, divorce or remarriage.
3. If your assets grow substantially, you should have estate planning done to
legally avoid the very high estate and inheritance taxes.
4. You should keep your Will in a safe place; make sure that you tell someone
that you have a Will and where to find it.
5. You should keep this information sheet with the Will. Attach a list of your
main assets and indicate where your other important papers are kept. The
asset list should also include information about your life insurance policies, any
jointly owned property and any personal retirement plans you have set up, such
as IRA or Keogh Plans.
6. Do not write on your Will or attempt to change your Will yourself; consult
your attorney.
Your Executor should contact us before proceeding with the administration of your
estate.
As you know, we have taken steps in the preparation of this Will to simplify the
administration of your estate. Of course, we would welcome the opportunity to
discuss your Will or your estate with you or the person you have named as Executor.
We are pleased to have been able to serve you in this matter. If you have any other
legal questions or needs, please feel free to contact this office at any time.