HomeMy WebLinkAbout06-23-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ ~ ,.,,,rj~~ COUNTY, PENNSYLVANIA
Estate of fi L L f~~, /~ ~: ~~ ~- S File Number ~ / - { ~-% r v~~t„~
also known as
Deceased Social Security Number 1~ ~. ~. ~, Z L ~'
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO~YIPLETE 'A' or 'B' BELOW.•)
® A. Probate and Grant of L~e!tte~rs ~stamentary and aver that Petitioner(s) is /are the ._JtJiO'h! ~' /,/ A~7"Z!1' ,~/~- named in the
last Will of the Decedent dated-~1~--`3- 00"°~ and codicil(s) dated _
_ a
(State refevmit circumstances, e.g., renunciation, dead= of executor, etc.) ., -~ C_
-U C ~'
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofttl~ ~tumet~s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: y ; y. ~ fr3 t r`
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^ B. Grant of Letters of Administration ~ _ -
(IJapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durante absentia; dura~~ii+noritate) ' ' ' ~
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) £~3 heirs: (If
Adncinistratiort, c. t. a. ord.b.rt.c.t.a., enter date of Will in Section A above and complete list of heirs.)
(COMPLETE IN ALL CASES:) Attach additional s/:eels if reecessary.
Decedent was domiciled at death in ~ 1b ~,~ +~ County,
f J 1 G r~ ~ L >~ N (~~ G"~
(List street address, tow~dcity, township, county, state, zip code)
Decedent, then _ years of age, died on ~"C3 ° ~t7 at
lvania withers /her last principal residence at
_~~f3'ZS
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
sihiated as follows:
g ~5 0'0 0
Fam RW-0? re~a 10.13.06 P3~8 I Of 2
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 fm'm to
the undersigned:
Oath of Personal Representative
COMMONViEALTFI OF PENNSYLVANIA
~ ~ y~ ~r~p p~ SS
COUNTY OF ~x.(,~ y~.'iZ'~~Q :
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are five and con•ect 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 su4scribed
before me the r~'_ day of
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S nature of Persona! Representative
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Signature ajPersonal Representative
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Signature ojPersaial Representative J ~~ N = r-.
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File Number: (~ ~ ` ~ V ~ ~~( ~.~ /
Estate of (~L.L ~`.'~~ ~~ .~ ~ Lf~-~ ,Deceased
Social Security Number: ~ ."i~' ~f.~ Z~ ~ 3 Date of Death: ~~ "' ~ 3 ~ 1 i~
l~T•_
AND NOW, ,~~ ~~' ~ .~.n , ~~l I ~ , inLconsideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters (e J1 ~~~-rn~~-~/~~
are hereby granted to
in the above estate
and that the instrument(s) dated G~~,9 ~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES ~ ~ ~~
(~i Register of Wills ~ ~'
Letters ............... $ ~ /~
Short Certificate(s) ........ $--~~ Attoi~ey Signature:
Rei unciation(s) .......... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $~ .
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
r-a,„~ Rw-oa rep 10.13.0 Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF C~EATI~
WARNING: it is illegal to duplicate this copy by photostat or phatoyrt~ph.
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PRINT IN
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) ~r,_~ ~„
1. Name a Decedent (Fkst, nYdtlle, soil, sumxl 2. Sex 3. Sodel Security Number - 4. Date of DeaBi (Noah, tlay, year)
Ellen M. Myers Female 166 - 20 ''-2283 June 13, 2010
5. Age (last BiMday) under 1 year Under 1 da 6. Date a Birth (MmM, de , 7. Biluplece arts slate «ro '
Ba. Place a Dath Check ana)
Noner Oava Nara Mkaxaa
Pa I. omen
84 Y
Oct 3, 1925 Berwick
,
rs
^ Inpatient ~R / Oulpetlea ^ DOA ^ Nursag Horne ^ Residence ^Ollar ~ Spedty:
8b. County a Death &. City, Born, Twp. a Death !b. F
etlity Name (II not betllutlon, give etr961 and number) 9. Was Deoedea of Hispenb Origin? ~ No ^ Yes 10. Raw: American Irx~, Breck, While, ac.
Cumberland East Pennsboro Holy Spirit Hospital (tlra,~yowan, ('
Mexican, Puerto Riven, eM.) Whit e
11. DewdenYa t)sud Kind a work dove moat d worN Me. Do not stater 12. Wes Dxrodent ever in the 13. OecedsnYa Educelbn (Spedly oay highest grade wrtpbad) 14. Merkel SaNS: Manled, Nev« Married, 15. SuMNng Spoiue (If wile. give meWen name)
KeN a Work KMM a Bueklas / IMmtry
Practical Nurse Hos
ital U.S. Armed Forws? Elemeaery / Sec«Mery (012) College (1> or 5+) W+ vrdidu , Daorwd (SPecily)
^
7
p Ya {~
Na 12 Widow
16. Decedents Matlkig Address (StraL city I teen, elate, zip code)
1 01 C
rol L
e DewdenYa Did Decedent
Ac1uel Reeklenw ,7a. stare Pennsvlvania Uve a,a ,7c,®Y~,, ,,, I;,,ed ~, East Pennsboro Twp
1 ~
a Cumberland T°""°"p? ,7d.^ De
mwedwm,in
fro. c«xny
02 b
Cat l Bea
18. FsMefs Nana (Fast, middle, rest sufizl 19. Motley's Name (Flrsl, nudge, maitlan surname)
John W. K the Nancy A. Price
20e. Inrortrerx6 Name (TYpe / Print) 20b. IntomenYe MelSng Adtkbe (Street, Gly / bwn, state, zq wde)
Susan Myers 101 Carol Lane, Enola, Pa 17025
219. Nkthod a OlepwPo«r I ^ Crerretim ^ Danetlon 21b. Date d Diapwitlon (Mash, day, year) 21c. Plow a
DiapwPoOrl (Name a wrrletery, crematory «olhx plow)
21d, location (Ciy /town, state, zip ooee)
~Q Bunel ^ Removal from Sete I""e ctenutbrt «IroMbn AldhorMd
^ tDtler - speoYy: by Fsember I C««tar4 ^ Ya ^ No June 16 2010
~ Stone Church Cemetery Silver Spring Twp, Pa
22a ~ F servke LiwneeB person ~ a euch) 22b. liwnse Number 22c. Name aM Address a FacNly S u 11 i va n F one r 1 Home
FD011897-L 51 N. Enola Dr. Eno~a Pa 17025
Complete 23e<oNy when 23e. To the beet d my kpwleUge, deefh accred al the tlma, date end place stated. (Sigreture eM title) 23b. License Number 23c. Date Signed (MOnm
daY
tar)
phyelden fe na evYebb at tYne a death W ,
,
ted9y reuse d deaM.
Ileme 21.28 mqt be dompreted by person 24. Time a Daed1 25. DaM Prorrounced Deed (Noah, tley, year) 28. Was Case Rere Medkel Examiner I Conner for a Reason Omer then Cnxnatlon or Donation?
xlioea°"` 1:06 A M' June 1 3 201 0 ^Ya ~
CAUSE OF DFATH (See Inatruatlone end exemplar) r Apprwdmere kMrvd:
Item 27. Part I: EnM tl1e dell a ewnre -dosses, mNrres, «wmpkwtbns -dW dhxMy caused the dalh. W NOT ender termirel evens such as cerdec areal r
Oreet ro Deets
i Pad II: Eaer oth« '
hN not rasultinp n the uafenykp woes given ro Pen I. 2B. Did ToDeao Use Conhihma ro Death?
^ Yes ^ Probahhy
rap
relory arrest. a venmalar Abaretion wMxxit elpwing the etldogy. Lbl oNy one cause m each fre. i
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l _~ a. Lam(/ „l~`~'/ ~ /1 L/Y VC/ / Cti ~ /~ ~/ ~ r / l~/~ r j ~• ~~ 29. H Panels:
Due to (« oq: j ^ Not pregnaa wkhin peel year
Sep~lf~ Wsl wMaons. B erry, b. ~ ~
lea6e b the rope iekd m Ere a. ~~tl ~ ,~ , ~.
i CLLu~ ^ Pregnant at tlme a death
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Emer 8le UNDERLYMG CAUSE ~ a °~~
6aee a tlel' ' tle
~vaareaaalaatn""j°~B~r
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LBILI~I/t' ^ ~ pint, WI pregienl wXNn 42 days
adwm
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Due o e wnseq on: ~ ^ Na prsgnenl bin pregnant 43 days to ,year
~
d. berore death
^ Unknown 9 pregnant wgMn the peat Year
30a. Wes en Autopsy
Pedormed? 30b. Wero Auopsy Fndrga
Ave9ehle Pn« to Conpletbn 31. a DeeN 32e. Date a ~Y (Noah, deY, YeaA 32b. Describe How I u Ocwnad
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32c. Plow a Inj«V Home, Famn, aree4 Factory,
a Cane a Dam? ~~ ^ Hornckb OlAce Buildng. eR. ISpecih,)
^ Vas No ^ Va ^ No ^ Acdtlenl ^ Pendsq Irnestlgetlon 32d. Tate a Injury 32e. Inhmy at WorK! 321. 8 Trsnapamtlon Injury (Spetllyl 32g. Lacallon a injury (Sheet, dry /town, stale)
^ Sudde ^ Cook Na be DeternYned ^ Yes ^ No ^ Dnverl Opersror ^ Peaergar ^Pedatrlen
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33e. Certltler laledr ony one) 33b. Slgnelure and Tiue a
Certllying phyekYn (Phyeicen CWtdying wuee a dead, wMn amtlrer physidan has pmnaxced death and mrQkled Item 23) ~~//~ ~~
To Ste beet of my ImowNdge, deNh occuned due to de eaua(s) BIM mrxter a ehted_ _ _ _ _ _ _ _ _ (/ i
• Pr«lorardng end wrtllyNrg phyek4n (Phyaaen bah prenounchlg death and carltlYnA to wow a eeeM)
To die bat a m
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^ 33c tlwnas Neroer 33d. Dare Signed (Norm, tlay, Year)
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manner a stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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On the beets a axrrlNelhn end I «Invatlpetlon, M my opiaon, deaM oaumd N the time, dale, eM prew, end due to Bte a1xM(e) end many," a ereted_ ^ /
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3/. Name and AddreY,r{aeeaJYb~ep4Dypm ~Itam 27) Type / Pna
P.epatrer's N ~ I ~I ~ ( ~) I 1 I I 3e. Date I_ , day, rear) 1yLSl' SHURE PAMILY PRA 1Cf lC~ P.Gi.
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_. ... _ .... n t[_Q ~ -/ ~X !IB(:WUVIGSBURG. PA t7050~
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LAST WILL AND TESTAMENT - '
OF '' ~' _
ELLEN M. MYERS =~ -~ ~~ ~' `~ '
~~~
I, ELLEN M. MYERS, of the Township of East Pennsboro, Cumberland County,
Pennsylvania, declare this to be my Last Will and revoke any Will previously made by me.
ITEM 1: Upon my demise, I direct that my body shall be laid to rest next to my
husband, LLOYD S. MYERS, at the family burial plot at the Stone Church Cemetery,
Wertzville Road, Mechanicsburg, Pennsylvania.
ITEM 2: 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
apart of the expense of the administration of my Estate.
ITEM 3: I give, devise and bequeath my quarter (1/4) carat diamond ring to my
granddaughter, STEPHANIE A. HARTMAN, of 50 Windsor Way, Camp Hill, Pennsylvania.
ITEM 4: I give, devise and bequeath my one-half (1/2) carat diamond ring to my
daughter-in-law, JUDY M. HARTMAN, of 50 Windsor Way, Camp Hill, Pennsylvania.
a
~ ITEM 5: I give, devise and bequeath my one-half (1/2) carat diamond and ruby ring to
~ my daughter, SUSAN MYERS, of 101 Carol Lane, Enola, Pennsylvania.
a ITEM 6: I give, devise and bequeath my two burial lots located at the Stone Church
~a
Q W Cemetery, Wertzville Road, Mechanicsburg, Pennsylvania, one each to my son, JOHN W.
1
HARTMAN, of 101 Carol Lane, Enola, Pennsylvania, and one to my daughter, SUSAN
MYERS.
ITEM 7: I give and devise Five Hundred Dollars ($500.00) each to my grandchildren,
STEPHANIE A. HARTMAN, ERNEST J. HARTMAN, and WILLIAM L. HARTMAN.
ITEM 8: I give, devise and bequeath all my furniture in my residence, located at 101
Carol Lane, Enola, Pennsylvania, to my children, JOHN W. HARTMAN and SUSAN MYERS,
to share and share alike.
ITEM 9: I give, devise and bequeath all the rest, residue and remainder of my estate, of
every nature and wheresoever situate, together with insurance thereon, to my son, EUGENE A.
HARTMAN, of 50 Windsor Way, Camp Hill, Pennsylvania, provided that he shall survive my
death by thirty (30) days. In the event my son, EUGENE A. HARTMAN, shall predecease me
or not be living on the thirtieth (30th) day following my death, I give, devise and bequeath fifty
percent (50%) of the residue to my daughter-in-law, JUDY M. HARTMAN, and fifty percent
(50%) to my grandchildren, STEPHANIE HARTMAN of 50 Windsor Way, Camp Hill,
Pennsylvania, WILLIAM L. HARTMAN, of Lemoyne, Pennsylvania, and ERNEST J.
HARTMAN, of Mechanicsburg, Pennsylvania, to share and share alike.
ITEM 10: I appoint my son, JOHN W. HARTMAN, Executor of this my Last Will.
a Should my son, JOHN W. HARTMAN, fail to qualify or cease to act as my Executor, I appoint
~ my daughter, SUSAN MYERS, Executrix of this my Last Will.
ITEM 11: I direct that my personal representatives or their successors shall not be
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,~~, ,'~a required to give bond for the faithful performance of their duties in any jurisdiction.
~W
2
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, this ~ day of YC~ _ , 2000.
~7
EL EN M. M
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in our presence, who, at her request, in her presence and in the presence of
each other, have hereunto subscribed our names as attesting witnesses.
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residing at (, ~(.~'~`b~~ ~jy /7 d /j
~G/8" Gv. Lis~6~.-..
residing at ^/21,~ ~ ,c.r ~~ ~/~ ~ ~o s-,r''
COMMONWEALTH OF PENNSYLVANIA )
ss:
COUNTY OF CUMBERLAND )
We, ELLEN M. MYERS, ~~ L /C-, ~ erg and
(~ g ~ ~~~,y P~ ('D ~/c/L°__ ,the Testatrix and the witnesses respectively, whose
names are 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 that she had signed willingly, and that she executed it as her free and voluntary act
for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of
the Testatrix, signed the will as witness and that to the best of his or her knowledge, the Testatrix
was at the time eighteen (18) years of older, of sound mind and under no constraint or undue
influence.
0
ELLEN M. ~ RS
~ ~~C--
Witness
~ ..
~-----
Wi ess
Subscribed, sworn and acknowledged before me r ~ L~/ N'~- by ELLEN
~ MYERS, the Testatrix, and subscribed and sworn to before me by
Cs1 u w and ~ ~ a. ~l~s-i L ~•M~v~-- , the witnesses,
this __~y /_ day of ~~. r~,w~ , 2000.
Notary Public
Nt'iTAi~Ai. S!E49.
HENRY F. CJYY;~'° , ~doiary Public
Hampden Twp., Cumbadond County, PA
My Comnnissien Ezpir~s June 17, 2C~Q0
4