HomeMy WebLinkAbout06-10-10•
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Marie H. Goudv
also known as
COUNTY, PENNSYLVANIA
File Number 21-10- ~`~
,Deceased Social Security Number 204-01-2699
Richard E. Goudv
Petitioner), who is1~[[18 years of age or older, applies) for:
(COMPLETE `A' or `B' BELOW.)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner( is/~ the ~ecutor named in the
last Will of the Decedent, dated p7/14/2005 and codicil(s) dated NIL
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: N/A
^ B. Grant of Letters of Administration
app ica e, en er c..a.; .n.c..a.; en e ~ e; uran e a sen ~a; uran a ninon a e
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 iMll in Section A above and complete list of heirs.) ry
Name Relationship Residence `~ ~ c..,. ~'' ' ?~~'
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(COMPLETE /N ALL CASES:) Attach additional sheets if necessary. '`J +~~
Decedent was domiciled at death in Cumberland County, Pennsyly nia with ~ /her last principal residence t
801 N. Hanover Street Carlisle Cumberland PA 17013 -Z-
(List street address, town/city, township, county, state, zip code)
Decedent, then ~_ years of age, died on 05/23/2010 at Church of God Home, Carlisle, PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 60,000.00
(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( respectfully request(s) the probate of the last Will ~ presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name and residence
Richard E. Goudy 504 Falcon Drive
Carlisle, PA 17013-8777
717-433-5298
Form RIIV-U2 Rev. 10-13-2006 Copyright (c} 2006 form software only The Lackner Group, Inc. 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 Petitionerand that, as personal representative(s) of the Decedent, Petitioner(~q will well and truly
administer the estate according to law. ~~ n /)
Sworn to or affirmed and subscribed
before me this ~ day of
2010
or the Register
Signature of Personal Representati~T€ Richard E. GO
Signature of Personal Representative
Signature of Personal Representative
File Number: 21-10- ja5q
Estate of Marie H. Goudy ,Deceased
Social Security Number: 204-01-2699 Date of Death: 05/23/2010
AND NOW, ~~ 2 010 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS D C D that Letters Testamentary
are hereby granted to Richard E Goudy
in the above estate
and that the instrument( dated 07/19/2005
described in the Petition be admitted to probate and filed of record as the last Wll~i~i~tj of Decedent.
FEES - [~
Letters .......................................... $ 135.00
egist of lls
Short Certificates}...........~ 2 )..... $ 8.00
Renunciation(s) ............................ $ Attorney Signature: -
JPC $ 23.50 Attorney Name: Wm. D. Schrack 111
Aut mation $ 5.00
r- Supreme Court I.D. No.: 15893
$ Address:
$ Telephone:
$ E-Mail:
124 W. Harrisburg Street
P. O. Box 310
Dillsburg, PA 17019-0310
717-432-9733
Schracklaw ~a comcast.ne
TOTAL ................................... $ 171.50
1 Flo. 5~
Form RIN 02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF DEA"~I-•I
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
• P 16566265
Certification Number
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This is to certify that the information here given is
correctly copied from alp original Certificate of Death
duly filed with me as vocal legistrar. Ti~~e original
certificate will be f~~,~rwarded to the. State Vital
records Uffice for pern~)a)~ent filing.
~ MAY 2 ~5 2010
LG~~rt• ~~ ~a~sQ
Local Registrar Date Issued
REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~,
' PRINT IN (
AANENT CERTIFICATE OF DEATH
CK INK ~ .a
(See Instructions and examples on reverse) ,,,,,..,..,,
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1. Name of bece(brtt (Flrat, middle, leaf, ardflx) 2. Sex 3.3ode1 Security Number - -- - 4. Date of Deaa, (Month, day, yea!
Marie Hake Goud emote 204 -01 •'- 2699 May 23, 2010
5. Age (Last &rthdey) Under 1 Under 1 da 6. Date Of Berth Mordlt, 7. end state a 1 6a. Piece of Death Chedr ab)
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Make
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Oct . 2 5 , 1 91 5
Y o c um t o wn , P A
^,npetleM ^ ER / Outpatient ^ DOA Other.
Nursing Hans ^ Raaerae ^Other - Specify:
6b. County of Death Bc. Cly, Born, Twp. of Death 6d. FedSy Name (N not gtstllullon, gHe street and number) 9. Was Decedent of H
Iapen~Orlgin7 ~JNo ^Yea
10.Race:.4mericanlrxl'ian,t3leck,VYhite,etc.
Cumberland Carlisle Church of God Home Cr
~ (sPe~lb'1
Mexksn, Puerto
R
aan, etc.) White
11. Dscederd'e Uwel Kind of work d one d moat d INe. Do not state reared 12. Was Decedent ewer In the 13. DecedenYe Educatlon (Spedly any hlgtbst grade comp leted) 14
Madlal Stable: Married
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Krnd at Wok oLAtrktea InduMry
Bookkeeper he~ys S~portin
U.S. Armed Forcee4
E~ment~, / Serandary (0-12)
(1-4 a 5+)
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Wiowed .
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pouse (If wNe, give maiden name)
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18. DeoedatYe Meting Addrea (Street, coy / bwn, DecederrYe
Da Decedent
P A
5 0 4 Falcon Drive Aduel Reskkrae , 7e. stagy
use ~ e 17c. ^ Yee, Decedent lJved In
Twp.
.
Carlisle, PA 17013 17b.Camty Cumberland T°~"r'I'~' 17d•C~ No,DecedenlLlvedwltNn Carlisle
AGual umne of city !Boa
16. Fatlbr'e Name (FkaL midrke, last, sulfa)
Harry Hake ~ l e r
1Ethe (KltZml °'41"CSR)
20a. InrormeM'e Name (type / Pdnq 20b. InronnanYe McNtrp Addrea (Street, rhty /town, state, zip cads)
Ri h rd E Goud 504 Falcon Drive, Carlisle, PA 17013-
21 a. Meatod of Dleposltbn
RemovalrramState
^ ~ Cremetbn ^ Donetbn 21 b. Date of Dbpoelaon (Month, day, year) 21 c. Place of DkipoelNon (Name of rsmetsry, crematory a other place) 21 d. Lacatron (CNy I town, state, zip code)
• ^ o
mer sea ~~Do;edonAutnormee yes^,~ May 25, 201 0 BFH Crematory Grarltville, PA 1 7028
• 22e, of F licensee (a acting a such) 22b. Lk;ena Nwrtber 22c. Noma end Address of FacNNy
- FO 012342-L Stone & MurrayF.H., 408 3rd.St.,New Cumberland, PA 17070
karts 23et only when oertNykq
phyMCIM is not aveNable et time at death 10 23a. To of ,death occurred et the thne, date and place stated. (Signahrre and tl6e)
f- ~ 23b. Lkense Number ;?3c. Date Signed (Mcnth, day, Year)
cerlNy taus d Oast. ~ ~ Q,`, ~ IV a y 7 6 $ 81r o.Sr - ~- 3 ~- ~ o
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_ Name 2426 must be completed by person
who proraunca death 24. Time of Death
~ ~ ~ 26. Date Prarauraed Dad Month, de
^~( Y. Y••r)
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26. ~ Ceae Referred to Medkal Examiner / Corarer for a Reason Other than Cremation or DonetlonY
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CAUSE OF DEATH (See Instnrcaons artd sxumrp4a) r Approxknate Interval:
ttem 27. Part I: Eller the rltain of events - dfseasa, ktjudes, a campBcetlone -that dhectly eased the death. DO NOT enter tenNrtel events such tie cartfec anent, t Orreet ro Death
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but rat rauNfn M the
9 urtderying came plven in Pert I. 26. Da Tobaaw Use ContribNe to Death?
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etbn wNlaut showing the eNdogy. list ony one cause an each Noe. i Q No
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MIMEDIA~ ~ Fkbl disease a r
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) ~ a. (, ~ v.~ p.~ ~+ u _ ~; iQ.~r,/`~r •~wt~,~A,/te ~ 2 u-.o • 29. II Female:
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Due to (a as a ace of): ~ L,r Not pregnant within past year
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Nst oortdlaorrs N arty, b
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^ Pregnant at rhos of death
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ro rxua Neted
on Nrte a. r
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Due to (a es a consequence of): ~
Enter UNDER
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' ^ Not Pregnant, but pregnant within 42 days
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) LAST. a' ~ of death
Due to (a as a axtsegtxertce o
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^ Not pregnem, but pregnant 43 days to 1 year
• d. i before death
^ Unknovm N pregnam wttftin the past year
~ 30a. Was en Autopsy
Perrortrted9 30b. Were Autopsy Ffndkgs
AvaNebb Prig to Contpbtlon 31. Manner of Death 32a. Dale of I
MurN (, daX Y~ 32b. Dacrlbe How In Ocarred
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32c.
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Street, Factory,
of Cause of Dath7 ~ ^ Homirdde
Natural ~~ ~
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^ Yes [yNo ^ Yee ^ No ^ Acddent ^ Pendrtg Irtvestlgetlon 32d. Time of Injury 32e. Injury at Work'1 32f. N Trenepatatbn Injury (Speclly) 32g. Location of Injury (Sheet, rdly I town, state)
^ Suicae ^ Cotdd Not be Determined ^ Yes ^ No ^ Driver /Operator ^ Pasenger ^ Pedestrten
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33a. CatlNa (r9teck oMy one) 33b. Signature and /-
• CerNytrrg WryaN:Ian (PAyeiden ceRNyirg cause of death when anoabr physk~an has pronauaed deettr end axnpleted Item 23) ( VJ
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To tM trot of rgy larogrMrlge, death occurred dw to aw pose(s) erW manner .. ehled- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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, aeeM occurrod et are tlnN, d.a, end plea., .rte sue ro are ague.(.) ab mmna a et+ad
^ 33c. l.kerroe Number 33d. Date Signed (Month, day, year)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _•
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On the bale of suanlnstlon end I a invatlpetron, In my oplnron, death occurred M the ems, data, end plea, end due to lfte ra
ace(s) and msnrrar a ahled_ ^
34. Name end Address I Person Who
9 Completed Cause of Deadt (Na
m 27) Type /Print
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MARIE H. GOUDY ~ ~ c~ ~,
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BE IT REMEMBERED, that I, MARIE H. GOUDY, presently of 824 Lisburn Ro ad
Apartment 610, Camp Hill, Cumberland County, 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 by me at any time heretofore made.
ITEM 1: I direct that my hereinafter named Executor pay all my just debts, my
funeral expenses, and the expenses of the administration of my estate. With this
direction, I authorize and empower my Executor to expend for my funeral expenses and
interment such amounts as he may consider necessary and proper, without regard to any
limit that maybe prescribed by a court of law.
ITEM 2: I direct my 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, may be subject,
and to charge such taxes against my residuary estate. It is 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 3: I give and bequeath the contents of my apartment unto my son,
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RICHARD E. GOUDY, absolutely.
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ITEM 4: 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 the heirs
hereinafter named, in the amounts designated:
A. Fifty Per Cent (50%) thereof to my son, RICHARD E. GOUDY;
B. Thirty-Five Per Cent (35%) thereof to my son, DONALD R. GOUDY;
C. Seven and One-Half Per Cent (71/2%) thereof to my granddaughter,
PAMELA GOUDY ROMAN; and
D. Seven and One-Half Per Cent (71/2%) thereof to my granddaughter, LISA
GOUDY PEIRANO.
ITEM 5: I nominate, constitute and appoint my son, RICHARD E. GOUDY,
to serve as Executor of this my Last Will and Testament, directing that he not be required
to give bond for the faithful performance of her duties in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~day
of , 2005.
IE H. GOUDY
The preceding instrument, consisting of this and one (1) other typewritten page,
was on the day and date thereof signed, sealed, published, and declared by the Testatrix
herein named, as and for her Last Will and Testament, in the presence of us, who, at her
request, in her presence and in the presence of each other, have subscribed. our names
as witnesses h ret
OF
~~
COMMONWEALTH OF PENNSYLVANIA
SS /~
COUNTY OF YORK
i/
We MARIE H UDY ~ r and
',
,the Testatrix and the witnesses,
respectively, w ose names e signed to the attached or foregoing 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 it 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) years of age or older, of sound mind, and under no constraint or undue
influence.
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E G
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SWORN TO AND SUBSCRIBED
BEFOKF..~E THIS Iy'K DAY
2005.
'ARY PUBLIC
,lttt~t 3~. c~o~e(No1M-
OMebuep Soto, Yak
Carrtroie~lon Expitos Oct. a5, 2006
~r_ pia Aaoodtslbr+ Ot Nolat'