HomeMy WebLinkAbout08-02-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of Barbara S. Bourdette
also known as Barbara Bourdette
Deceased
Social Security Number 192-30-0903
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 Executrix
last Will of the Decedent dated 10/14/2009 and codicil(s) dated
(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 life; durante absentia; du~nte minoritateh.,~
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followin~e (if any~nd heir: (If 1
Administration, c. t. a. or d. h. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) : -~ ~ c.._ r , -~
Name Relationshi Res,~d -"Eel ~
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~ .
Decedent vas domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
15 Cedarhurst Lane Camp Hill PA 17011
(List street address. town/city, township, county, state, _ip code)
Decedent, then 70 years of age, died on July 25, 2010 at Holy Spirit Hospital, Camp Hill, Pennsylvania.
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $_q.~, J~.~- ~~
0
(If not domiciled in PA) Personal property in Pennsylvania $_
(If not domiciled in PA) Personal property in County $_
Value of real estate in Pennsylvania $_~ S ~ ~-~~
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 rinted name and residence ~? """
....._. 'fi ..-~r
, Lisa B. Bock, 15 Cedarhurst Lane, Camp Hill, PA 17011 ~~ C
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Form RW-02 rev. 10.13.06 - ~1ge I O~'i~
CUMBERLAND COUNTY, PENNSYLVANIA
File Number ~," ~~ "
named in the
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. ~~
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Sworn to or affirmed and subscribed ~~ ..-~'
Signature of Personal Representative ~) `~-•. t-' ;
before me the ~.>C day of ° ~, ~~
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For the R gister Signature of Personal Representative ~ ~ =~,
File Number: ~ ~ _ ~ y L ~'l ~
Estate of Barbara S. Bourdette ,Deceased
Social Security Number: 192-30-0903 Date of Death: 07/25/2010
AND NOW, ~7 `~-' ` ~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters T--~'~~i- (1~t,fi ~T~~ (? E
are hereby granted to L 1 ~ r~ ~ ~` '~ ~ ~
in the above estate
and that the instrument(s) dated 1 I ~ ZL~-~~-f _
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES ~ j 1C.(L~~ ~~~_7.~~~`7 ~J fi ilLt..~,~~ ~ ~ _-
Letters ............... $ ~"~ ~ ~) • Q ~> Register o Wills ~,~ ~ , ~ ~~~ ~C, ~ .~
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Short Certificate(s) ........ $ ~ U • G ~(,i Attorney Signature: ~~~~~'~~
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Renunciation(s) .......... $ ,.~
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Attorney Name: James W. Kollas
~) ~ J ... $ ~c3 `J C~ Supreme Court I.D. No.: 81959
Address: 1104 Fernwood Avenue
... $
$ Camp Hill, PA 17011
... $
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• • • $ Telephone: 717-731-1600 ~--~
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TOTAL .............. $c~~j~~, ~~
Form RW-02 rev. 10.13.06
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) CTATF FII F NItMRFR
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1. Name of Decedent (Flrel, middle, last, suffix) 2. Sex 3. Social Securtiy Number 4. Date of DE~ath (Month, day, year)
Barbara S. Bourdette female 192 - 30,-0903 July 25,2010
5. Aga (Last Birtfzky) Under 1 ar Under 1 da 6. Date of Birth Month r 7. BI and slate or fo rei cou 6a. Place of Death Check onl one
70 ""°""" °ari "°"'~ M"""°' Aug.?, 1939 Harrisburg, PA Hospital: Other:
Yrs. Inpatient ^ ER /Outpatient ^ DOA ^ Nuremg Home ^ Residence ^ Other • Specify:
8b. County of Death 8c. City, Boro, Twp. of Death 6d. Facility Name (If not institution, give street and number) 9. Wes Decedent of Hispanic Origin? ~ No ^ Ye:; 10. Race: American Indian, Black, White, etc.
Cumberland
E. Pennsboro
Holy Spirit Hosp. (If yes, apecdy Cuban,
Mexican, PuertoRicen,etc.) (Speal»
White
11. DecedeM's lJsuel tbn Kind of work d one d urkr most of wo Ida. Do not state retire 12. Wes Decedent ever in the 13. Decedent's Eduratbn (Spedly onry highest grede compl eted) 14. Marital Status: Married, Never Marred, 15. Surviving Spo use (It wife, give maiden name)
Kind,eld Work Kind of Buslnessl Industry U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5+) Widowed, DNorced (Specify)
eX2CUL Ve ^ Yea No
18. Decedents Mailing Address (Street, city I town, state, zip code) Decedents Did Decedent
"~~ Residence 17a. stela P A Live Ina 17c, ~ Yea, Decedent Lived irLow e r A 11 e n Twp.
1$ C e d a r h u I' S t L n. Township?
Cumber 1 a nd 17d. ^ No, Decedent Lived within
m 111 PA 1 7 01 1 17b. County
Actual Limits of Ci / Boro
ty
16. Father's Name (Flret, middle, last, suffix) 19. Mother's Name (First, mkkde, melden surname)
John W. Shaeffer Mary E. Eichelberger
20a. InfomteM's Neme (Type f Print) 20b. InfomranYs Melling Address (Street, rtlly /town, state, zip code)
Lisa B. Bock 15 Cedarhurst Ln. Cam Hill PA 17011
21 a. Method of Disposition r ~] Cremation ^ Donetbn 21 b. Date of Dspositlon (Madh, may, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City I town, state, zip code)
^ Buda! ^ Removal from state i Was CremNbn a Donstlon Authorized u 1 2 7 2 010
Y H o 11 fi n e r Cremator
g Y t. H o 11 y
^ offbr- krel Exrrllnar/Coronerr ~Yea^ No ~
22e. S of F rat Sarvke pe s such) 22b. License Number 22c. Name end Address of FedNly
- ~ 011248E Musselman /FH&CS Inc. 324 Hummel Ave.Lemoyne,PA
Complete kerns 23ec only wlbn cartllying y knovdedge th at the and place gtat re and fide)
23a. o 23b. Lkrense Number 23c. Date Signed (Month, day, year)
physiden Is rat e,reNable at time of death to i
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ceAHy cause of death. 4
dams 24-26 must be cortgleted by person 24. Time of Death 25. Date Month, day, r 26. Wes Case Refe to Medical Examiner /Cosier for a Reason r than Cremation or Donation?
who prarlouraes death. ' M. ~ ^ Yes No
CAUSE OF DEATH (Sss Instructions and sza pks) I Approximate interval: Part II: Enter other 28. Did Tobecca Use ConMbute to Death? -
Item 27. Pert I: Enter the chehl of everts -diseases, injuries, or ranlpticatlons • that directly caused tics death. DO enter knninal events each as cardec arrest, i Onset to Death but not resulting in the wdedying cause given in Part I ^ Yes ^ Probably
respiratory arrest, or ventrkxrdar fibdlktbn without showing the etiology. List only one cause on each R r ^ No ^ Unknown
IMMEDIATE CAUSE ((Final disease or i r
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29. If Female:
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Due to (or es a consequence of): ~+ 1
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^ Pregnant at time of death
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Gal fist ranrRtlone, ti any,
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Eller the UNDERLYING CAUSE Due to (or as a consequence of~
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of death
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(disease or irqurY drat initiated the c. L.-1~T
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Due to (or as a consequence af): . - ot pregnant, but pregnant 43 days to 1 year
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30a. Wes en Autopsy 30b. Were Autopsy Endings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe Fbw Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory,
Perfomxd? Available Prior to Completion
of Cause of Death? ~ stare! ^ Homidde Oldce Building, etc. (Specify)
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^ Y ^ Acddent ^ Pending Investigatlon 32d. Time of Injury 32e. Injury et Work? 321. If Trensportatbn Injury (SpealyJ 32g. Locator of Injury (Street, city /town, state)
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^ Suicide ^ Couk Not be Detemaned
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^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
Other - Spedly:
33e. CerUller (check ony one) 33b. signature and THIe of Certifier
• Csrtlfying physkdsrr (Physiden certllykg cause of death when another ptrysicien hoe pronounced death and completed Item 23)
To the best of my Imowkdge, dsalh occurred due to tM cause(s) and manner a stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , =~ ^,
Pronouncing std certlfylny ptryakkn (Physidan boll proraundng death end certilying to cause of death)
To the best of my laawlsdgs, death aeeurred et the time, date, end plea, and due to the ease(s) end manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
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On tlta bask of szrttlnatlon end / or Invsstigatbn, in my opinion, death occurred at the time, date, and plea, and due to tM ease(s) end manner as stated_ ^ Cause of Death (Item 2
7)
T
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34. Name and Address of Pecan Nita Completed
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LAST WILL AND 'TES'TAMENT ~ ~'~~~-~ '~' ~ `,`
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Barbara S. 13ourdette ~ ~ ~ ~> ~:-:
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I, Barbara S. Bourdette, of 15 C'edarhurst Lane, Camp Hill, Cumberland County,
Pennsylvania, do make and declare this to be my last V~'ill and Testament, hereby revoking all
prior Wills and Codicils.
FIRST: I direct that all my debts and funeral expenses be paid as soon after my
death as may be practicable. I further direct that all estate, inheritance, transfer, legacy or
succession taxes which may be assessed to my estate or any part of my estate as an e~~pense of
administration and without appointment.
SECOND: I give all the rest and residue of- my estate to my daughters, LESLIE J.
SAlr'SOIV'E and LISA B. BOCK in equal shares. In the event any ol~my children shall not be
living at the time of my death, I give, devise and hcqucath the share of my estate which she
would have received, to her child or children, in equal shares. In the event any of my children
predecease me and leave no child or children surviving, I give, devise and bequeath the share
which he would have received, to my surviving children, in equal shares.
THIRD: Without limiting the powers conf-erred by statute by general rules of law,
my Executrix is specifically authorized and emhowcred:
(a) To invest any funds ol~ my estate in any corporate shares, bonds, notes, or
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other securities or property, real or personal, including any common or commingled funds,;
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maintained by my Executrix. This is to reflect my intention to give the broadest powers and
discretion to my Executrix;
(b} To sell or otherwise dispose ul~ any property, real or personal, at any time
forming a part of my estate, for cash or upon credit, in such a way and on such terms as my
Executrix may deem best;
(c) To manage, operate, repair, improve, mortgage, and lease for any term any
real estate at any time held;
(d) To make distribution in cash or in kind upon any division of my estate;
and
(e) In general, to exercise all powers in the management of my estate which
any individual could exercise in the management of-similar property in her own right, and to do
all acts which my Executor or Executrix may decor necessary or proper to carry out the purposes
of this Will.
FOURTH: I appoint my daughter, I.1SA R. BOCK of 38 Essex Road, Camp Hill,
Pennsylvania, as Executrix of this Will. In the event Illy daughter, Lisa B. Bock, will not or
cannot serve as my Executrix, then I appOlnt 111y dall~llter, Lh:SLIE J. SANSONE of 3310 W.
Bright Terrace, Tucson, Arizona 85741, as 1:xecutrlY OI t111S W111, No Executrix acting
hereunder shall be required to post bond or enter surety in any jurisdiction.
IN WITNESS WHEREOI', I hereunto set my hand this ~!-~~_ day of October, 2009
13 Y : G- ~u~~ ~---w" -- / - ~ ~-~ cam"
BARBARA S. I3OURDETTE
SIGNED, PUBLISHED, and DECLARh:D by the above, BARBARA S.
BOURDETTE, as and for her Last Will and 'hcstamcnt. in the presence of us, who, at her
request, in her presence, and in the presence of each other, have hereunto subscribed your names
as witnesses:
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COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
I, BARBARA S. BOURDE'I"1'E, `l~estatrix, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that: I have
signed and executed the instrument of my I .ast W i 11 and `hcstament; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes therein expressed.
Sworn to and acknowledged before me by BARBARA S. BOURDETTE, the Testatrix,
this b day of October, 2009.
f
Notary Public
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BARBARA S. BOURDETTE
NOTARIAL SEAL
CAROIE A ROaE
Notary Public
LOWER ALLEN TWP, CUMBERLAND COUNTY
My Commission Expires Dec 6, 2011
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COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
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We, ~P, ILS:SGt. I ~ -~~I~Z77~~ ------ and , f ~~~'-~-~ ~'li_, the witnesses
whose names are signed to the atta~hed instrument, being duly qualified "according to law, do
depose and say that we were present and saw the 'l'estatri~, BARBARA S. BOURDETTE, sign
and execute the instrument of her Last Will and 'l~estaillent; that she signed it 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 Testator signed the Will as witnesses; and that to the best of our
knowledge the Testator was at that tune 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed to before me by 11~e.~~ s~ ~ and
,* '~~'_ ~-~- ,witnesses, this ~~'~ day of Octo er, 2009.
Witness
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W itncss ~`"
Notary Public
NOTARIAL SEAL
CAROLE A R05E
Notary Public
LOWER ALLEN TWP, CUMBERLAND COUNTY
My Commission Expires Dec 6, 201 1