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HomeMy WebLinkAbout08-02-10REGISTEP~ OF `;'vILLS OF C~L~iT~", PEA ~S~:~i~,~":'~-~til~~ r ~n ~_ °_ Estat° of` uL~c~~ t ~ `~ File Number ~ ~` ~ ` ~ ~ -. r also known as ~tt l G ~ \ 1 ~ \(a r 1` 1 ,~ Dece~ sod Social Securit}~ `~umher ~~ ,~~~_.-- Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (CO;ti(PLE7'E 'A' or 'I3' B.ELOyY:) t ~~m ~A. Probate and Grant of Letter Te tamentary and aver that Petitior.er(s} is /are the '~C%` ~! ' Ynamed in the last 1%Viil of tl~e Decedent dated ~ ~ and codicil(s) dated _- --- (Strte reievnrrt circwnstances, e.o , renLrnciatiaz, death o~e.recutor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born of adopted after execution of the insttvment(s) offered for probate, was not the victim of a kiling and •was never adjudicated an incapacitated person: - ^ B. Grant of Letters of Administration (Ij opplicable, enter: c.t,a : d.b.n.c.t.r.; pendente life; durnnte nbser~ti~.; du,-nnee nrinoritnte) r- ~~ Petitioner(s) after a proper search has !have ascertained that Decedent left no Will and was survi~fed by the followir m:s~a~tse (if anytd heirs: (1j+.` AdrnLnLStratron, c. t, a. ord.b.n-c.t.a., enter date of Wi!! in Section A above and complete lat of heirs.) -:r:3 ~~ - f -,'. - -- , - '.~-~------r-~- , .i . _-. ..~ S._lM -..- 1. :. .. j .i.-.. {CO;Y(PL ETE LV fILL CASES.) Atlaclc addltioLtn! sheets if itecessnry. ~~ ~_.. Decedent was dor;~iciled at death ii ~ ~_~ Coo ply, Pennsylvani• with 1 ~ i er la 't prince ~~l.i;iaidence at ~-~~ `__ (Lis4 street ,address, lo~wr/city, lownsfLlp, count}+, state, ?ip code/ Decedent, then ~_ years of age, died on Z ' © at ~' ~~~ Decedent at death owned property with estimated values as follows: 4 ~ r,.~p-~ (If domiciled in PA) All personal property $_~e:~ ~ LJV (If not domiciled in PA) Personal pioperty in Per7nsylvania ~_ .-- (Ifnot domiciled in PA) Personal property in County $_ Value of real estate in Pennsyl•~ania $_ situated as follows: ~ - - Wherefore, Petitioner(s) respectfully request(s) the probate of the !ast 4Vil! and Codicils} presented with this Petition and the grant of Letters in the appropriate form to the undersisned: Si~,nanire ed or urinted name and residence t FoL,n RbV-D' rev. lD.13.06 Page 1 of 2 Oath of Personal P~cpresentatl~~e CO~~I~ION`~ti">r_-~LT~-iGr PFN~S~-LVa~iI_-~ COL'NT`c' OF SS The Petitioner(s) above-named s«•ear(s) or afnrnl(s) that t11~ statement; in tale for~~oing Petition are t1~ue and con~ect to the best of the kno~.vied° a:1d belief of P~titiener(s) al:d that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly adminlster the estate 3000rdlll~ to la~.v. Sti~orn to or affirmed and subscribed b:'foCe lTie the ~ day of ~~' ' ~~ e igr.ntur2 ojPerson~f Rzprzsentnr:ve ~~ l..}~ ~fr ~ ~ Sigr.~z:ur•z ojPerso~,al Reprzsenrn;ivz ~~ -~~~ x~ FOC thz Reo:SteC Sigr~tur2 ojPzrso~,nl Rzpresent~tlve C _l~ ~ ~ ~ •- File Number: _..-~ .. • Estate of ~ `~'~;t ~ . ~ ~~~.'t ~ Y ~ , Decked N -; -~! Social Security Number: ~-~ ~ ~ -~ ~ Date of Death: ~1 ~ ~ ~ ZL~ ~~,V AND No`vV, ~ j~:~ L ?U ((~ ,inconsideration of the foregoing Petition, satisfactory proof having been presented before'~11e, IT IS DECREED that Letters /F-`~ ~ `~~ f-~~S.r U~-_---- ---- are hereby granted to - r i r ~^ in the above estate and that the instrument(s) dated _ L~~. _ ~. ~ _ ~ ~~? ~ -- described in the Petition be admitted to probate and filed of record as the last Fill (and Codicils}} of Decedent. r / '~.~- ~ ~Lt ~~-.~1~~-r ,~ :~-=~, Regcster ojYYitts ~~ ~~ r r r~t'<..t,~ Ck.e~ Letters ............... $ ~CU~ t` Short Cerlificate(s} ........ ~ L ~ Attonney Signature: Renunciation(s) .......... ~ ~,~ ~~ ~ ... $ 1 ~ ~ ~ Attorney Name: C ~C ~ ... g~~~ `~-' Supreme Court I.D. No.: ... ~ Address: ... ~ ... S ... $ ... ~ Telepll~ee: ... ~ TOTAL .............. S ~~ , ~ ~~ r~~;,,, .Rlt'~(1 ~ ,~~~. iLtl_ Un J.~3~e 2 of 2 OCAL REGISTRAR'S CERTIFICATION OF DEA-'TH 4l'~"~,RNING: [t is illegal to duplicate this copy by photostat or photograph,. ~'-E't ttl!' t}ll~ ~`C:tCi11~:~1~C. ~~il-f; P 16~a61 (~.(-tif-tL;(iitTr~ '~~t.(Ia~l~t..r ~r~ , ,~jr~a~TH/Of P . ,1 yztrtt~~i ~!~~',,t. ~ r0 q' `~,K' ,~. % ~ ~- . is ~ ~ ~? ;;~ -9 'Ivl y ~.~ ~~ ~'~ ~ ;1 ~~9~r __, ~~,~~,,,,%/ It ~~~ `~'~ENT Q~ , t ., 1~'hi~ a ti? certif-~ ,h,~t tl~e"irlt~~rl~~atiorl Here liven is ~.`~~rrertl~ ~(,piec3 frnnl an (~ri~~inal Certificate ~>f Death (lulu r~ilet~ v~ith (nc ~(~, l_~>ca( Re*istrar. The ~~riginal ~~/~(-tiii~~al~ ~~ill he t-;lrw~ircleil t~ the State Vital l~t~~l~~lld~. Office jtfr hlerm~tne'nt filing. ~ ~ ~ r ._tfc ai R ~i~;tr~l(~ Date [sued r..a C ;1 .. ,. ;~ ;~• _,_- _ )-7_j ~ _ . ._ ,~ ..-~ J -f ~;~;% s T`1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS '~ r CORONER'S CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER H105.144 REV 11Y2006 TYPE /PRINT IN PERMANENT BLACK INK ~k,i2-•311 z w w U w O w a z 1. Name of Decedent (First, middle, last, sulfixl 2. Sex 3. Social Security Number 4 Date of Death (Month, day, year) Sheri C Warner Female 211 - 46 - 2179 July 22, 2010 5 Age (Lass Birthday( Under 1 yeas Under 1 day 6 Date of Binh (Month, day, year) 7. Birthplace (City and stale or for eign country) B a. Place of Death (Check only one) Munn~s nays Nuw, Minutes Hospital: Other. 5 4 Yes May 7 , 19 5 6 Phi 1 ad e lp h i a , PA ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home esiderlce ^Olfier ~ specify: 8b. County of Daeth Bc. City, Bor Twp. o Death Bd. Faakty Name (II not institution, give street and number) 9. Was Decedent of Hispanic Origin? ^ No ^Yes 10. Race: American Indian, Black, Whil Cumberland Lower Allen (h yes, specity Cuban, (SpeciM 910 Rupp Avenue Mezican,PueroRican,etc.) 11. Decedent s Usual Occ aeon Kind of work d one dunn most of workin life Uo not state reuredl 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Married, Never Marred, 15. Surviving Spouse (If wife, give maiden name) >eCil ) Divorced (S W d d Kind of Work Kind of Business; Industry U. S. Armed Forces? Elementary! Secondary (0-12) College (1-4 or 5+) y ) i owe , Data entry computer ^Yes X]No 12 widow 16. Decedents Mailing Address IStreel, city : wwn, stale, np code) Decedent's PA Did Decedent }}~~-,, Lower Allen 910 Rupp Ave . Actual Hesidence I7a. State Live in a 17c. Lj Yes, Decedent Lived in Township? DecedrmtUvedwithin 17d ^ No Mechanicsburg, PA 17055 . , nb counry Cumberland Actual Limits of Cily / 18 Father's Name jFust middle, last, sufl~xl Paul Border 19. Mother's Name (First, rmddle, maiden surname) Caro 1 J . Har er P 20a. Informant's Name (Type ! Prinll Jenna M. Hemminger 20b. Informant's Mailing Address (Street, city /town, slate, zip code) 7 William Penn Dr., Camp Hill, PA 17011 21a. Metfwd of Disposition ~] Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (City! town, stale, zip code) ^ Burial ^ Removal from State :, WasCremalionorDOnationAuthorized July 27, 2010 Hoover Funeral Homes Crematory Harrisburg, PA 17112 I~ ^ Other - Specity: by Medical Examiner / Coronerl ~.pYes ^ No ~ 22a, Signature of S Licen~ee for on acting as such) 22b. Ln;ense Number 22c. Name and Address of Facility Hoover Fu n e r a 1 Homes & Crematory I rte . ~ .,L ~,s,,.~1,t~ FD 011921 L 6011 Linglestown Rd. , Harrisburg, PA 17112 Complete It rs 23a~c my w en cenrfymy 23a. To the best of my knowledge. tleath occurred at the lime, dale and place staled. (Signature and Inle) 23b. License Number 23c. Date Signed (Month, day, year) physician i5 not available at time o1 death 1~ certify cause of deals erson st be com leted b 24-26 m Il la. Time of Uealh Aprx . 25. Dale Pronounced Dead (Month, day, year) 26. Wa Case Referred to Medical Examiner /Coroner for a Reason Other than Cremalron or OonatWn p y p cros u who pronounces death. 11 • 00 P M. J u 1 y 2 4 , 2 010 ~' Yes ^ No CAUSE OF DEATH (See instructions and examples) r Approximate interval. Pad It. Enter other ~iticant condnion:~pntrbuti to dp,;tlti, 28. Did Tobacco Use Conlrbute to Death? Item 27. Pan I'. Enter the ~h~in of eygnl~ -diseases, inlunes, or complications -mat duectly caused the death. DO NOT enter terminal events such as cardiac arrest, i Onset to Death but not resulting in me underlying cause given in Part I. ^Yes ^ Probably r respuatory anesL or venlncular tibrllation without showing Ire etiology. List only one cause on each line. r ^ No ^ UrVcnown IMMEDIATE CAUSE Final disease or r conditionresuningin~eanrr -~ ;, Multiple Complications of Alcohol Abuse Alcoholic Hepatitis 29. If Female: ithi l ^ N t Gue to (or as a consequence oil r Sequentially list conditions, d any. b ~ w n I>as year ol pregnan ^ Pregnant at time of death leading to the cause listed on line a Due to (ur as n cunsequence of 1 ~ ^ Not pregnant but pregnant within 42 da . Elver the UNDERLYING CAUSE r (disease or injury that uiihaled the c of death events resulting in dealhl LAST ~ Due to jur as a consequence tilt. ^ Not pregnaN, but pregnant 43 days to 1 before death • d. ~ r ^ Unknown if pregnant within the past yea 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Descnbe How Injury Occurred 32c. Place of Injury: Home, Farm, Street Factory, Pedormed'? Available Prior to Completion ~.,/ Office Building, etc. (SpecilyJ of Cause of Death? D~LNatural ^ Homicide /~'~ ^ Accdent ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (Specify) 32g. Location of Injury (Street - ate) Yes No ^ Yes No ^ ^ ^ Suicide ^ Could Not be Determined ^Yes ^ No ^ Driver /Operator ^ Passenger ^Pedestrian M ^Other - Specity.~ 33a. Cenilier (check only oral • CeAirying physician (Physician ceNfymg cause of death when another physician has pronounced death and completed Item 23) To the best of my knowledge, death occurred due to the cause(s) and manner as sfated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33b. Signature and Title of Ceniher - r on e r CCCJJ-~~~~~''''~~~____ • Pronouncing and cenitying physician (Physician both pronounnng death and ceNtying to cause of death) ^ 33c. License Number 33d. Date Sgned (Month, day, year) To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner I Coroner July 2 6 , 2 ~ 1 0 On the pasts of examination and / or Investigation, in my opinion, death occurred at the time, dale, and place, and due to the cause(s) and manner as st~led_ 34. Name a Address of Person fw Canpleled Cause of Death Qlem 27) Type /Print Coroner Ec~Cenrode Tod C 35.Regislrar'sSign r ndDistrictNu bee - / ~ Z ~~ a ~ ~ ~~teFil~7h, ~aa~ , . 6375 Basehore Rd., >uite l~l • ~„ ~ ,/ -1 I -I -I (~ 1, U J Disposition Permit No. 0476343 LAST WILL AND TESTAMENT OF SHERI C. WARNER c~ c- ~ ~:7 -~-~~ :~ -- -n /;' ~7 '-~,`__ _; _-;.~ ,:__. _~~ - ---1 S~ ri _~ -.~ ~ ~-, ._ .3 ~ ..~~ ; Tr ~ )`~~ I, Sheri C. Warner, now domiciled in Dauphin County, Pennsylvania, declare this to be my Last Will and Testament. I hereby revoke all other wills and codicils that I may ha~Te previously made. Article I I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment or cremation of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, a gravesite or other memorial site. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executrix has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III 1. I give, devise and bequeath all of my tangible personal property of every kind and description, including but not limited to, books, pictures, clothing, articles of household or personal use or adornment, and household furnishings and effects, to my children, Steven Machemer, Jenna Warner Hemminger, and Justin Warner, in equal shares, or as they see fit. 2. I give, devise, and bequeath the remainder of my estate as follows: A. One-third (113) to my son, Steven Machemer, or his issue, per stirpes; B. One-third (1/3) to my daughter, Jenna Warner Hemminger, or her issue, per stirpes; and C. One-third (1/3) to my son, Justin Warner, or his issue, per stirpes. If at the time of my death any of my beneficiaries are under the age of twenty-one (21) years, his or her property shall be held in trust under the terms and conditions established in this Will. Child Beneficiaries At my death, if any of my beneficiaries have not attained the age oftwenty-one (21) years, his 2 or her share of the proceeds from my estate shall be retained in a separate trust for his or her benefit. I direct that the trust shall be administered under the following terms: 1. As much of the net income and principal as my trustee from tune to time might think desirable, taking into account funds from all other sources, shall be expended for the health or education of said beneficiary; 2. As much of the net income and principal as my trustee from tune to time might think desirable, taking into account funds from all other sources, shell be expended to provide a college or vocational education for said beneficiary; 3 . When said beneficiary attains the age of twenty-one (21 }years, the remaining principal and any accumulated income in the trust is to be distributc;d to said beneficiary. Article V No interest in income or principal shall be assignable by, or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. ArtirlP VT I hereby appoint my son, Steven Machemer, as trustee of any trust created in this Will for his child/children. I hereby appoint my daughter, Jenna Warner Hemminger, as trustee of any trust created in this Will for her child/children. I hereby appoint my son, Justin Warner, as trustee of any trust created in this Will for his child/children. No bond or other security shall be required in any 3 jurisdiction for the performance of any of my trustees' duties. Article VII I nominate, constitute and appoint my daughter, Jenna Warner Hemminger, Executrix of my Last Will and Testament. In the event of my daughter's, Jenna Warner Hemminger, death, resignation, or inability to act for any reason whatsoever as my Executrix, I appoint my son, Steven Machemer, as Executor of my Last Will and Testament. I hereby relieve my Executrix, whether original, substitute, or successor, from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act so far as I am able by law to do so. My Executrix shall receive reasonable compensation for services rendered to my estate. ~ rtirlP VTTT I hereby authorize my Trustee and my Executrix: A. To retain and to invest in all forms of real and personal property, regardless of any limitations imposed by law on investments by executors or trustees; B. To compromise claims and to abandon my property which in my ExE;cutrix's or Trustee's opinion is of little or no value; C. To sell at public auction or private sale, or to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; D. To join in any merger, reorganization, voting trust plan, or other concerted action of 4 security holders, and to delegate discretionary duties with respect thereto; E. To borrow, and to pledge property for repayment of funds borrowed; and F. To distribute in cash or in kind. These authorities shall extend to all property at any time held by my Executrix or my Trustee and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this Will shall be in addition to those granted bylaw and shall be exercisable without leave of court. TN WITNESS WHEREOF, I, Sandra J. Sandy, hereby set my hand to this my Last Will, on this ~ ~ ~ day of ID-~U~I , 2008, at Harrisburg, Pennsylvania. _ ._ .~ c ,~ . erl .Warner, Testatrix In our presence, the above-named Testatrix signed this and declared this to be her Last Will and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address ~~ - I, Sheri C. Warner, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressced. Sworn to or affirmed and acknowledged before me by Sheri C. Warner, the Testatrix, this ~~lay of ~,~.~,~,~~ , 2008. NOIA~2IAL ~>EAL Notary t`utJiic SUSQUEHANNA TW~'U~,UPHIN COUNTY My Commission Expnes May 7 2008 c ~y' / - ~` w._ ~'~ Sheri C. Wa er, Testatrix We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, the Testatrix was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by and witnesses, this " (~ day of 2006. NOTARIAL SEAL DEBRA A EVANGELISTI Notary Public SUSQUEHANNA TWP7gUp~iN COUNTY ~ '~ ;~r, ~ ~...,.....,.w. ...,,,.»,... ., . _ " (~~lQ~. ~ Witness r ~ ~~ ~~ ~~ Witness ~-- 6