Loading...
HomeMy WebLinkAbout09-21-10PETITION FOR PROBATE AND GRA!V'T OF LETTERS REGISTER OF WILLS OF ~l/Y-n h e ~' ~Q y~ ~ COUNTY, PENi~SYLVANIA File Number _ !~ I Estate of also known as o ~Q Y~ L° ___, Deceased Social Security Number ~ ~~ '~ ~~ ~h .~Q Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COttiIPLETE 'A' or 'B' BELOW.) 1. ~A. Probate and Grant of Lett rs estamentary and aver that Petitioner(s) is /are the ,~ Y P N L I ~' r X _ named in the last Will of the Decedent dated and codicil(s) dated (State relevant circumstances, e.g., renunciation, deaf!: of executor, etc.J 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: e.t.a.; d. b. n. c.t.a.; pendente life; durance absentia; dura~ite mi~torilnte) 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 Adntittistratiott, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationshi Residence t~ a ..:C;,; ~. ..--. ~. T7't --.: .. (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. j ~ ~'` -~ J Decedent was domiciled at death in ~; t 'w~ ,,~ tf jla~..~,r-County, Pennsylvania with his !her last prine~e`fi~e at ~(~---r-i ~ - - _ ~ N .~ (List street address, tow~~/city, township, coup ,state, zip code) ~. © ,-.,~ ~ Decedent, then ~_, years of age, died on (,fit ,l v f ~~~-~;~ ~e~ ~A Decedent at death owned property with estimated values as follows: Red ( ~ S i-Q Te ~4 S~ l (If domiciled in PA) All personal property ~e ~r ~ ~' ~ Y T t./ $ l ~.. S ' ~ ~S ~'!~4 Te (If not domiciled in PA) Personal property to Pennsylvania I $ ~ ~ h (If not domiciled in PA} Personal property in County $_v_-~~-n - Value of real estate in Pennsylvania $ °'` n vt e 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 tinted name and residence _____ _ _~ ~ ~ ~ . Form RrV-Q? rev. !0.13.06 Pate 1 of Z Oath of Personal Representative COMMONWEALTH OF PENNS~c'LVANIA SS COUNTY OF r~~ ~ C 'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true 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 subscribed before me the ~ ~ day of -- , ~~U Signature ojPersona Signature ojPersonal Representnlive :~7 ~~•-~- ~ c ~ j ~ N ~?; , e~ _-.~~~ For the Registe Signature ojPe-•so+ta! Representative ~ ~} --n ~"' ~ ~' ,;'„~-~ i~ ~ ~ _.. ` - - ~ .ri. a .... ~-'~~ • • t.. _.,... File Number: ~' -` ~ V ' `'[ 7 1 Estate of ~Qr ~ ~ lQ ,Deceased Social Security Number: ~}~ ~ ~ -~ 'rt `~ ~ ~c Date of Death: `~ `" ~ ~ - ~~~~ AND NOW, ~{ ~~ ~ ~ r ~l , ~~~, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~~~~p ~ ~~_r( ~ are hereby granted to ~1~5~C n JrVI , ~ i'1l ,~ ~ 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 ............... $ ~~ r~ - Q V Register ojWills r ~ ~ l - Short Certificate(s) ........ $ • CT~ Attorney Signature: Renunciation(s) .......... $ _. ~d1 ~.cc~~ ... $ 1 Attorney Name: ~~~ CJ • • • $ ~ ~ ~ Supreme Court LD. No.: ~lcr~-~~~n ... $ Address: ... $ ... $ ... $ ' • • $ Telephone: ... $ TOTAL .............. $~ ~ ~ ~ r-•ur» ~ Rw-U? rw. ~v.~3.vr Page 2 of 2 .';~S.R~~ R`aw' iR'h~~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 1654158.6 Certification Number ~tt05 143 REV 11.2006 TYPE !PRINT IN PERMANENT BLACK INK 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 permanent filing. Local Re car Date Issued t~v c~ a ~~ ~ r-r~ ~~ ~ -v rn ~~ ~~ -v ~~} ~ ~. x =x , ~~ c~~~~ s~ ~~~ : ~: c=~ ~ ,~ _.. p_t.,~ v ,,.~ c:'' ~s COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS : q CERTIFICATE OF DEATH Q (See instructions and examples on reverse) ~;,,< <„ ~ ,,,,,,eLO 1 Name of Decedent (First, middle, last, suffix) 2 Sex 3 Social Secunry Number 4. Date of Death (Monts, day, year) Venna Teneea Sla .fie Fema.~e 213- 09 - 7839 Sep~emben 14, 2010 5 Age (Lass Birthday) Under 1 ear Under 1 da 6. Dale of Berth (Hoorn, da , ear{ 7 B. ace 1C. and stale or tones count 1 8a. Place of Death Check on one) ' n L Manms Days Hours A4nutes • Hospital: Other: Yrs. Ju.C 20 1914 8nue Mown pA ^ Inpatient ^ ER !Outpatient ^ DOA ®Nursing Home ^ Residence ^ Other .Specify: Bb County of Death &. City, Bao, Twp. of Death 8d. Faceiry Name tll not ursatuuon • , g,ve sneer and number) 9. Was Decedem of Hispanic Origin? ~ No ^Yes 10. Race: American Indian, Black, While, etc. pt yes, spenty Cuban, Mexaan Puerto Rican, etc.) um en~.a d Can.•P.i.e~e C.2ane~non-t Nu~cs~.n R Rehab.ie.i.ta.t.ion G1h.ite f i Decedent's Usual Occ tan Kind d work done d uns rtasl of kle. Do not state reared 12. Was Decedent ever m the t 3 Decedents Educatan tSpenty Dory hrynest grads completed) t 4 IAaraal Stat M i d N M Kind of Wak KindolBusiness/Industry US. Armetl Forces? Elements Seconds t0-121 ry ! ry Colle ge (1.4 or D.) us: arr e , erer arried, Widowed. Divorced (Specify) 15 Surviving Spouse (II wife, give maiden name) Labonen Manu aetun.tin Co . ^Yes ~r+~ 8 Glcdowed • t6 Decedent's Marling Address (Street, city /town. state, npcode) Decedent's Did Decedent 2253 Doves C.t Actual Residence t7a State ,p~ PA Lwe in a 17c. ~] Yes. Decedent Lived in u -2t?Jr A.e.Q tZYI ~ - Twp • Mechan i c~sbun PA 17055 t 7b County . Cumben..2and Township? 17d ^ No, Decedent Lived within , . . Actual Limitsol Ciry/Born 18 Father's Name (First middle, last, suffix) 19 Molner's Name IFust middle, maiden surname) m Man an och.en~sm.(,th 20a. Informant's Name (Type / Print) 20D Informants Ma~6ng Adtlress (Street, city !town, state, lip code) Su~San M. Sn den 2253 Dove~c C.t Mechan-i..c~sbun PA 17055 21 a Method of Disposition r ^ Crematan ^ Donatan 21b Oate of Drspos~uon Ibta,m, day. year) 21c. Place of Dr • r spos~tan tName of cemetery, crematory or other place) 21d Location (Ciry /town, slate, zip code) l ^ R 8 l I S una emova rom tale r Was Cremation a Donation AtdhorWd n OHter ~ cr ' W 1Mdal ExtaninerlCorater'f ^ Yas J No S em6en 17 2010 Annune.i,a~t~.o C emeten. Mesh 22a. Sgnature of Funer Service Licensee persona as such) 220. License NwrtWr 22c Name and Address of FaciGry ~ 3. 013564-L Fe.i~en Funena.~ Home Inc- 302 L.I.W. New Ux and PA~50 Complete items 23ao Doty when certifying 23a. To the best d , deaM occurred at the time, da ace slated. (S~gnatwe and arts) 23b License Number 23c. Date S' Month, da physician ~s not avarlaWe al Urtre of death to rgned ( y, year) certiry cause of death. ~I ~/ 5/ 3 ~ (,~(„~ L ~ y, Items 2446 must be corttpleted q' person ,• who pronounces death. 24. Time of Death ~a : 5a ~ 25. Date P ed Dead N, day, year) ~" ~( ~ ' O lO 26. Was Case Referred to Medical Examiner /Coroner fa a Reason Other Htan Cremation or Donation? . M. ~ . I ~ ©Yes ^ No CAUSE OF DEATH (Sea Instructions and xampks) r Approxxnate interval Item 27. Part I: Enter IM chain of events - dseases, injuries, a complicatant ~ that Mretdy caused the death. 00 NOT enter terminal events such as wrcyac arrest r Onset to Death Pan IP Enter oMer •igrtificaM conditiME oat ter' to dean Dal not resutung n the undedying cause given in PaA I 2B. Did Tobacco Use Contribute to Death? ^Y ^ respiratory arrest, a ventricular hbnllation without showing Hre etiobgy. Lrst Dory one cause on each kne r r . es Frdbabfy ~ ^ IMAAEDIATE CAUSE Final disease or ~ r No Unknown condnion resuaag in ~ath) C ~ r 29 H Female: _~ a r . ® Due to (or as a consequence ol): Sequentwuy list conditions, A any, b kadinyy to the rouse Nsted on line a. ~ i r Not pregnant wilnin past year ^ Pregnant at lime d leapt Eruer Yra UNDERLYING CAUSE Due to for as a consequence op ~ ^ Not ant, but re pregn p grant within 42 days (disease a injury that iruGated the c of Beam events resudrng in death) LAST. r ^ Due to jot as a consequence oll r Not pregnant, but pregnant 43 days b t year • d. ~ r ^ be~orrawn H pregnant within the past year 30a. Was an Autopsy Pedormed? 30b Were Autopsy Findings Available Prior to Completion 31 Manner of beam 32a Date of Intury {Hoorn, day, year) 32b Describe Mow Iryury Occurred 32c. Plans of Irqury: Home, Farm, Slree4 Factory, of Cause of Death? ^ Natural ^ Homicide Office Buildin e 9• tc. /SP~N1 ^ Yes ~ No ~t ^Yes C~'NO ^ Accident ^ Pendr Invesh Lion ~ ~ 32d. Time of injury 32e Iryury at SYOrkv 32t H Transportation InWry /Speciy) 32 Location of in u Street, ci !town, state 9~ 1 ry ( N 1 ^ Basile ^ Could Not De Determuxd ^Yes ^ No ^ Dover; Operator ^ Passenger ^ Pedestrian M ^ Other Spatrly 33a CeNfier (check only oriel 33D Signature and Title of • CeAityiny physician (Physician certitymg cause W dealt when anotMr physician has pronounced death and completed Hem 23f ~~ To the Wp of my knowNdya, deaM occurred dw to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ C.~ , PronouncHq aM r;ertllybtp physkian tPtrysician troth prortourtcing death and cerutyvtg to cause of death) 33c Lw:ense Number 33d. Date Signed (Month, day, year) To tM best of my knowkdpe, death oeeumd at tM lime, dale, and place, and due to tM ease(s) and manner as sated _ • Medical ExamMerl Coroner _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - - - - (U (~ // ~ ~ ~ f- t~tl ~ /~ J ~ On the Weis of examination and / or investigation, fn my opinion, death occurred at the time, date, and place, and due to lM cause(s) and manner as stated_ ^ 34 Name and Address of Person Woo Completed Cause of Death (Item 27) Type /Print ~ 35. Ruyistrar's Signature an Oxstrict Nu r ^ . ~ ~ a Fd~d IA'ktnth years y y i l~ ~ ut pr's J ~1 ~~/ ~ -- / ~ L' / ~L -t!iQ~'C.' ~ - ~ ~ ~ . . ~f)C ~OL1V ~, ~) C. ~f)(,Y/~~ d/)~~1 Z (J Drsposdion Permit No. ~• ~' 3 ~ ~,~ f , ~, • LAST WILL AND TESTAMENT ,\, OF VERNA T. BEAGLE I, VERNA T. SLAGLE, now domiciled in Adams County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. 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 Executor 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. :z:;.t :~ cn ~~, ~ ~ °. ~.~ _ ~~ ~,1 .! ~i.. ~ ~ iii ~ ;-- c 1 tV p p~~ ~.~ i ,y^,..I -~J C1a ~ =x. ~ ~"? -~, ~o ~ n ~ r,: i ~~ © ~~ Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my daughter, SUSAN M. SNYDER, of Cumberland County, Pennsylvania. If SUSAN M. SNYDER predeceases me or fails to survive me by thirty (30) days, I give, devise and bequeath her share to her issue who survive me, per stirpes. Article V I nominate, constitute, and appoint SUSAN M. SNYDER as Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my son-in-law, TERENCE L. SNYDER, of Cumberland County, Pennsylvania as successor Executor of my Last Will and Testament. I direct that my Executrix or successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executor shall receive reasonable compensation for services rendered to my estate. -2- Article VI In addition to the powers conferred by law, I authorize my Executrix and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. -3- IN WITNESS WHEREOF, I, VERNA T. BEAGLE, hereby set my hand to this my Last Will and Testament, on ~--,c~ - 2005. ~~.~, 7A~SLA L In our presence, the above-named VERNA T. BEAGLE signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name ,~ " v C~ ~ - C... ~ SG~ Address 845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109 845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109 -4- I, VERNA T. BEAGLE, 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 expressed. Sworn to or affirmed and acknowledged before me by VERNA T. BEAGLE, the Testatrix on ~' 2005. Not Public ~;'-`J ' F ;; VERNA T. BEAGLE unxpu~~~ w gee. u as 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, that she 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 J va ~~t I~- Cbe 1~2 and 'Pau~a~ , witnesses, on ~' , 2005 v G~ ~'`-r~~ - itness of Public TH of ~~ TARIAL SEAL. - 5 1ACOUEUIN: A. IfEILX NOTAUY PUBLIC IAMIER PAiITON TwP., DAtIP111N COUNTY Mr COMMISSION ESPIRES DEC.17 2007 Witness