HomeMy WebLinkAbout12-03-10PETITION FOR PR/O~BATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (~ h+bc~~~
// ~ COUNTY, PENNSYLVANIA
Estate of _ ~ n h tel.-fz~~ ~ I
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
File Number ~' ~ ILJ ...+ ~ 1 ~~
Social Security Number I l 3 ~ ~~-Qq(p a
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the J G~ rt Vv1 '~,c,.t~~ '~
last Will of the Decedent dated __S_~~ - 0 l~ and codicil(s) dated named in the
(State relevant circumstances, e.g., rertunctation, 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
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
ea ~..
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rn , _:..
offeted-r
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(/J applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente life; durance absentia; dzrrcmte p~oritate) f V -'-= _s ~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) a~heirs! (!f
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ `~ ~
(COMPLETE IN ALL CASES.) Attach a~d^ditional sheeets if necessary.
Decedent was ¢ostti iced at death i ` ~ ~ ~tJ /~•- ~ County, Pennsylvania with his /her la rincipal re idence at ~6 D
(List street address tow~ctty to nshrp county state ztp code) L~ ~t o ~~ ~ ~~ q ~ ~
Decedent, then CPU years of age, died on ~~ - 2 / D ( ,'r, ^~ ~ lam, t /~it,J
Decedent at death owned property with estimated values as follows: /
(If domiciled in PA) All personal property
(If not domiciled in PA) $ ~~~t OG O
Personal property in Pennsylvania $
(If not domiciled in PA) Personal ro e
Value of real estate in Pennsylvania p p rtY in County $
situated as follows:
~'`7
Form RW-Ol rev. 10.13.06
Page 1 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 .n rhP ~.,,..,...,..._ ~___
the undersigned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
/~ / SS
COUNTY OF ~•- (i/rl by/~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct t
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and trulyest of
administer the estate according to law.
Sworn to or affirmed and,subscribed
before me the r day of
For a Register
SiSncrtt •e ofPe~al R~ sent
~ v-= .~.
Signature of Personal Representative
Signature of Personal Representative
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File Number:
~ ~ - 10 -- i I q ~{ --~
,t a~
Estate of V ~ , A ~r
n 11i l• ~(~ Y1~' 1 S ~ D
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D
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C7 -p
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--,
> eceased
Social Security Number:~,3 ' ~j~~ ~
t d ~ Date of Death:
AND NOW, l C
~, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters
are hereby granted to
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters ............... $ v
Short Certificate(s) ........ $
Renunciation(s) .......... $
lei(( ...$ -
... $ ~j
.$
... $
... $
... $
... $
... $
... $
TOTAL .............. $_~~~'$'~'
Form RW-02 rev. 10.13.06
as the last Will (and Codicil(s)) of Decedent.
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
in the above estate
Page 2 of 2
Attorney Signature:
105.112 REV. 1/05
(FEE FOR THIS
CER7lFICATE $6.00)
CERT' NO.'
WARMNG; IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
T6334352
November 11, 2010;
Date of Issue of This Cerlitieation
Name of Decedent' Johrr M.
First Middle
M 1 193 - 38 - 0962
Francis-
Last
Sex a e Social Security No. Date of Death
Date of Birth March 1,1 , "19 5 0 Birthplace Fa 11 s Church , VA
Place of Death Holy Spirit I~ospital Cumberland E.Pennsboro Twp. Pennsylvania
Facility Name County City. enrough or Township
Race `White Occupation Sales Armed ,Forces? (Yes or No) No
Decedent's
Marital Status Widowed
Mailing Address 5 6 0 Valley St . Summerda le °PA 17 0 9 3
Nixhbyr Street Cky ~• Prnah State
Informant Jake Francis Funeral<Director Sally A. Myers
d Add f
Name an ress o
Funeral Establishment David Myers Funeral Home, Newport, PA 17074
Part L Immediate Cause
(a) Cardio Respiratory failure
(b) -Cirrhosis of liver
(c) Acute Renal failure
~d)
Part II: Other, Significant Conditions
Manner of Death
Natural " ~< Homicide
Accident ^ ` Pending Investigation
Suicide ^ Could <not be Determined
Name and Title of Certifier
Nov. ,2, 2010
t
l
Interval Between
Onset and Death
fv
b
Describe how injury occurred ~ `'~
N.
Viswanathan S. Iyev M.D.
Address' 690 Poplar Church Rd. ,
M.D. D.O., Coroner, M.E,)
Suite 204B, Camp ilk, PA 1T011
This is to certify that the information here given is correctly copied from an original certificate
of death duly filled with me as t_ocal Registrar_ The original. certificate will be forwarded to the
State Vital Records Office for permanent. film
~~ Q. 50-455
_ Local Registrar of Ural Records Disti~ci No
Ncwember 9, 2010 101 Barnett St., New Bloomfield, PA 170:b8
Date Receivetl by Local Registrar Street Address Gry, Borough, TownSliip
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LAST WILL & TESTAMENT ~ can ~ w :.
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joxN M. FRANCIS
III a--a ~- ` '' ~;
, .
IN THE NAME OF GOD, AMEN N
I, john M. Francis, III, of 560 Valley Street, Summerdale, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament, hereby revoking and making void
all previous Wills and Codicils heretofore made by me.
1
The expenses of my last illness and funeral shall be paid from the property of my estate.
I direct my Executor to provide for a funeral service in conformity with my station of life.
2
I give, devise and bequeath the rest, residue and remainder of my estate, real or
personal, and my property of every kind and description (including lapsed legacies and
devises), wherever situate and whether acquired before or after the execution of this Will, to my
son john ( fake ) M. Francis, lV.
3
I giant my personal representative the following powers in addition to and not in
limitation of such powers as my personal representative shall hold by law:
(a) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(b) To operate any business that I may own at my death.
(c) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
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LAST WILL AND TESTAMENT OF JOHN M. FRANCIS, III
terms and conditions as my personal representative shall see fit in his, her, or its
absolute discretion.
(d) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
(e) To compromise claims without court approval including, but not limited to, any
controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(~ To distribute in cash or in kind upon any division or distribution of my estate.
(g) To undertake any and all acts deemed necessary and proper by my personal
representative for the proper, advantageous and prompt management of the
settlement of my estate.
(h) In general, to exercise all powers in the management of my estate, which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
4
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in income
or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in
the possession of my personal representative for the liability of such beneficiary.
2
LAST WILL AND TESTAMENT OF JOHN M. FRANCIS, III
5
I nominate, constitute and appoint my son, John ("fake") M. Francis, IV, as Executor of
this my Last Will and Testament. In the event my son is deceased, unable or unwilling to serve
or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my
brother, Scott Francis, as personal representative of this my Last Will and Testament. I direct
that my personal representative shall not be required to give or post bond for the faithful
performance of his, her or its duties in this or any other jurisdiction.
6
I hereby declare it to be my express desire that my personal representative employ the
Karl E. Rominger, Esquire, of Cumberland County, Pennsylvania, for legal advice and
assistance regarding this my Last Will and Testament, he having considerable knowledge of my
affairs, views and wishes respecting any matters that may arise at the probate of this
instrument, the administration of my estate, and the execution of the powers herein mentioned.
Any mention of Karl E. Rominger, Esquire in this, my Last Will and Testament, is my free and
voluntary act and through no influence by any person.
IN U~ WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this --~-- day of ~p
~~~•
WITNESS:
-- G~ ~---...-.
o M. Francis, I
3
LAST WILL AND TESTAMENT OF JOHN M. FRANCIS, III
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA .
COUNTY OF CUMBERLAND ~'
I, John M. Francis, III, the testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I
signed it as my free and voluntary act for the purposes therein expressed.
Jo M. Franc}s, I
Sworn or affirmed and acknowledged before me by John M. Francis, III, the testator, this
_ ~ day of ~~
otary Pu lic
COMMONI/VE~H OF PENNSYLVANIq
T~rnie Ll Seal
~rY Pudfc
e ~~ Cumberland
~ ~~ E~Ires Sept ~
Membar, PQnnaylyan+a Association of Notaries
4
LAST WILL AND TESTAMENT OF JOHN M. FRANCIS, III
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ~'
WE, Jennifer K. Jones and Linda J. juniper, the witnesses whose names are attached to
the foregoing document, being duly qualified according to law, do depose and say that we were
present and saw John M. Francis, III sign and execute the instrument as his Last Will and
Testament; that he signed willingly and that he executed it as his free and voluntary act for the
purposes therein expressed; that each subscribing witness in the hearing and sight of the
testator signed the Last Will and Testament as witnesses and that to the best of our knowledge
he was at the time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed and subscribed before me by Jennifer K. Jones and Linda J. jumper
~~ day of ~_
rrOAAMONWEAi.7'H 4F PENNSYLVgNIq
Notarial Seal
'TBmmle L Peters, Notary
t~xiberfarxJ Courny
~!' Cotrtsr~-:^ moires Sept 9, 20f 1
lA®rnt~r, i~~~ „ta y ^i:~ J; saciatbn of Notaries
L
Notary Public v
5