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HomeMy WebLinkAbout12-22-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of LOUETTA E. BORDNER also known as Deceased Social Security Number 206-12-9757 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 bank and individual last Will of the Decedent dated March 12, 1980 - and codicil(s) dated n/a (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 Fifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritateJ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. '~--~ (~ C7 Decedent was domiciled at death in Cumberland 153 Old Ford Road. Camp Hill, PA 17011 (List street address, town/city, township, county, state, zip code) •~_ '~ County, Pennsylvania with his /her last princip~e~lence at ---t ~~~ .. .~' Decedent, then 85 years of age, died on Nov. 23, 2010 at Church of God Home, 801 North Hanover Street, Carlisle PA 17013 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 situated as follows: Land located Rt. 194 Baltimore Pike, Washington Township, York County, 1'A 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 t}-e appropriate form to the undersigned: or printed name and residence M&T Bank, Successor to Dauphin Deposit Bank and Trust Company ~, I c/o Jane F. Burke, VP, One West High Street, Carlisle, PA 17013 ~'~ ~ ~f~~onte L. Bordner, 61 Aspen Road, Dillsburg, PA 17019 'r ' _'i ~.~- _ __ COUNTY, PENNSYLVANIA r ; ,, ~~-, File Number ~~- ~ "' ~ C' - ~ ~ ~~7~- named in the $ 620,000.00 $ 20,000.00 Form RW-02 rev. 10.13.06 Page 1 of 2 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 Administration, c.t.a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS 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. Sworn to or affirmed and subscribed before me the ~ ~j day of r , For the Register Signature of Personal i. ri. .~ ~l ` Signature of Personal Representative ~`7"i ~~ ~ r 7 tV ~ ~ ~ ~~~ ~... File Number: ~ ~ ~ ~- L •-- I ;~-~~ ~ ~~ Estate of LOUETTA E. BORDNER ,Deceased Social Security Number: 206-12-9757 ~- Date of Death: November 23, 2010 C;'""3 ;~~-~ ~. ~i..~~ „wi ,~ j.._,.. f-i'1 ~.~ AND NOW ~ n ~~, ~' ~ ~ ~~'}~,r' r~ , ~~, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to M&T Bank and Monte L. Bordner in the above estate and that the instrument(s) dated March 12, 1980 described in the Petition be admitted to probate and filed of re ord as the last Will (and Codicil(s)) of Decedent. fi, A FEES (~, c- ~' " ` ~,.~(.. R. (.. $ ,~..~ ~1 ~'~ ~ `, Reg er of Wills ~-~. t ~~l ~~.'~ ~ t ~ y Letters ............... ~~ f ) l.~ ~ j Short Certificate(s) ........ $ ,~ ~ (~~ ~.' Attorney Signature: ~~~~~ ~ ~~ Renunciation(s) .......... $ i V~ ... $ y ... $ ... $ ... $ ... $ ... $ ... $ ... $_ TOTAL .............. $.~')~ 7 ~1D*Ae-r of Personal Representative Attorney Name: Edmund G. Myers, Esquire Supreme Court I.D. No.: a~oJ~' ~ 0 Address: 301 Market Street Lemoyne, PA 17043 Telephone: 717-761-4540 Form RW-02 rev. 10.13.06 Page 2 of 2 .~. R~fSTRA~R' ,ERTI~'I~:A~•IN ~' ~T~ ~^ ~s [~[[tif~ fit: s~ i[[es~~€ to ~u~a[icai:~> t~s[s ~a~~( [~~' ~ft°~o~ke~=at~t >ar p[~atac[r~t~~~a~ ,~t~ `r l~ .1 , ( " , __P ~.704530~ f I 3 REV 1112008 1 PRINT IN 1MANENT ACK INK Re; :, '~ ~h f7f p j ~u I 1~r RI i~ r iIM~!)Clilli~lUl: ~ll"I-i r~ibC17 I ~ r ~~,~ ~~,~~, ';~ ', , _ . - ~' ar~=~~j1>, , ,,,, l~~ ,)~;tri)R~fl ~ C,~)~1i4is~,f(~~ tft I)c~~lt1~ , _ `y~~ "~, ~..L' =` ~ ( ? I t iG~ ,!l:~' 4 ( ..$ I~l.~ `?I~+L(c(f i [)~! t~)3~~f))i(~ 1 ~~© ~~ , ,. , 'l ( ~..'_ i~ ;I ~ _!?t-~~"cj , 1(r l~?u' '"tt~lCl' ~. !(c!.f ~a ~, ~ ,. ~~ . ~ . ~ v ~~p ,~~~~~~''~ ~) T t k __ _ __ , ~~. ~~. r , ~~.i(~~ ~~.tiL1Cl~ ¢°.. y ~~7 L «/ . ~~? rn N ~ ~~ ~ , ~ ~~ +~-y rr , _ ~~ t,~ ~1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) srarF Flt F ntuMat=_R 1. Name of Decedent (First, middle, lest, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) Louetta E. Bordner Female 206 - 12 ,- 9757 November 23, 2010 5. Age (Lest &rthday) Urrdar 1 r Under t 8. Date of Bhth Month, d 7. BI C and state a M rei coon Be. Place of Death Check on one ~• Days Hours Minutes Hospital: Other: 85 y~ Apr i 1 8 , 19 2 5 Wi 11 isms t own , PA ^ inpatient ^ ER 1 OutpaBent ^ DOA ®Nursing Home ^ Residence ^ Other -specify: BD. County of Death 8c. City, Boro, Twp, of Death 8d, FaciNty Nerve (If not institution, ghre street and number) 9. Was Decedent of Hispanic Odgin? ®~ ^Yes 10. Race: Amertcan Indian, Black, White, etc. . Cumberland Carlisle Church of God Home (If yea, speciy Cuban, Mexican, Puerto Rkan, etc.) (SP~iM white 11. DecedenPs Uawl tlon Kind of work done dud moat of Nfe. Do rat state retl 12. Wes Decedent ever In the 13. Der~denPs Edtxxtbn (Spedly only higf>est grede completed) 14. Madtal Status: Mflrtied, Never Married, I5. Surviving Spouse (If w1fe, give maiden name) IGnd of Wok Klnd d Business! Industry U.S. Amred Forces? Elementary 1 Secondary (a12) College (1.4 or 5+) Widowed, Divorced (Sperryy) Homemaker Domestic ^ Yae ®h1o 12 Widowed • 18. DecedenYa MaNing Address (Street, clry /town, stars, rip coda) Decedents Penns lv an i a D1d °~~"t C a r r o 11 y Live in a 17 t Li d i T ®Y D d R 153 Logan Road en ve c. es, ece n wp. Aduel esidence 17a. State TawnsM°' Dillsburg, PA 17019 17d.^No,DecedentLivedwithin York 'm~~°°nty ActualUmitsof City/Boro 18. Fathers Name (Flrst midge, lest, suffix) 19. Mothels Nerve (Flrst middle, maiden surname) Earl R. Beard Mary Ellen Zimmerman 20e. Informants Name (Type I Print) 20b. Intortnants MaRing Address (Street, cflY /town, state, zip code) Monte L. Bordner 61 Aspen Road, Dillsburg, PA 17019 21 a. Method of Dispositlon r ®Cematon ^ Donaton 21 b. Date of Dieposllion (Month, day, Year) 21 c. Place M Dispoekbn (Name of cemetery, crematory or other place) 21 d. Location (City /town, state, zip code) • ^ Burial ^ Rertavel from State i Wae Crematlon or Dortetlon Authorlud ^ Otlter - r by Medial ExamIMrlCoroneR ~ Yes^ No , November 2 4 , 2 010 Evans Cremator y S c ha e f f e r s t o wn , PA 17 0 8 8 Servloe or rson actlng as such) ~ 22a Signs Fu 22b. License Number 22c. Name and Address of FaCiGtij . - FD 013 340 L Parthemore FH & CS, Inc. P.O. Box 431, New Cumberland, PA 17070 Cwnptete flame 2 only when artltying 23a. To the best of my krtowled e, death occurred at Bte tlme, date and place stated. (SlgneNre and tithe) 23b. License Number 23c. Date Signed (Month, day, year) phyeks;ien M not available at time of death to - " /1 t ~ ~ .~,R..f7 N J ( /` ~~1 tom- 4 v ~ ~ ~ ~ ~ ~ ~ ~ I 4 ~ I / ~ 3 / r~ O 1 O / artlty cause of death. . . y • Hems 24.28 moat be compbted by person 24. Time of Death 25. Date Praauraed Dead (Month, day, year) 28. Wes Case Refereed to Medal Examiner I Coroner for a Reason Other than Cremation or Donation? who pronounces death. V 7 S ~ P M. ~ 1 ~. 3 ~. Cf/ a ^ Yea ~No CAUSE OF DEATH (See instructbne and examples) r Approximate interval: Item 27. Part I: Enter the drain of events - dseases, injuries, or complications - that drectly caused the death. DO NOT enter terminal events such as cardac arrest i Onset to Death Part II: Enter other;tianifiant conditions cattdbutingJo death. but not resultlng in the undedyirg cause given in Pen I. 28. Did Tobacco Use Corddbute to Death? - ^Yes ^ Pro bly respiratory artest or ventricular fibdRation without showing the etidogy. List only one cause on each Nne. r t No mknown gIMEDIATE CAUSE ~Flfgnal gasses or ~ ~(`'' r conditlon resuPorg in death) _~ a '~~ (Ju' GQ l% G4,d.C~~ CA LCD f r~'~. ` i '~~G"~.N ~d~~W^{~~ 29. h F flmale: ( Q ' Not re nant within ast ear Due to (or as a consequence of): r r ,~ ~ r[ ~J a p g p y Pregnant at time of death list corrditlone, fl anY, b, r SaQYy n ts' `GI'1 i i ~ ^ Irq W atue Rated on One a. r ba0 the Eller Bra UNDERLYING CAUSE Due a (or es a corrsegrrance oft: r ~ r ~ Not pregnant but pregnant within 42 days et death (gasses Or NtJury tlrat inltlated the r c' lr ~ ~ ~ ^ 1 ~ • events resrdtlng in death) LAST, Due to (or as a consequence oQ: /" ( 1 Not pregnant, but pregnant 43 days to year before death i • d ) ~ (~ ,j,J ^ lnknown if pregnant within the past year . r 30a. Wes an Autopsy 30b. Were Autopsy Flndings 31. Manr~t 61 Death 32a. Date of injury (Month, day, year) 32b. Describe Flow Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, Perfomtedl AveNeWe Prior to Campletfon al Cause of Death? NaNrel ^ Homicide Office Building, etc- (Specify) N ^ Y No ^ Y ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Injury (Specify) 32g. Location of injury (Street, city I town, state) es o es ^ Suicide ^ Couk1 Not be Determined ^ Yes ^ No ^ Driver/Operate ^ Passenger ^ PedesMan M. Other - Speclly: 33e. Certifier (check ony one) 33b. Signature end Tflle o1 Certifier • C•rtlMng phyetdan (Physkktiaart certltying cause of death when another physiden has prorauraed death and completed Item 23) death occurred due to tM awe(s) and mmrbr ae stMed To tlts beat of m ~b e ~~ f'~~,~ f ~,~ie., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,. _ _ _ _ - _ _ _ _ _ _ _ - _ _ - y g , 33c. Lkx•nse Ntxnber 33d. Date Signed (Month, day, year) • Praauneing and ceRllYing phyalchn (Phyeidan both pronouraing death and Cartflyklg to cause of death) t t d ^ h d l d d t h d -- - / ; _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ msnrrer ae s e e time, gets, an p ace, en ue o t e awe(s) an a To the beet of rrry IawwAedge, death occurred m t l Exemlrtsr/Cororrx ~ • M di - { t% [ e a On the Deets of sxamlrutbn and I or InvasBgatbn, fn my opinion, death occurred at the Bme, gets, end place, and dw to the awe(s) and manner as stated. ^ of Death (Item 27) Type /Print Cause re~s of Per on Who Completed 34. Name and A d d p L s / ` ~ '1'L t ~ ~r ~~ t!3-~i t,-~ L/~ V ~ 35. Registrels re and a "~ ~1 f ~ d i l 1 ~ 1 38. Date Flied (Month, y, year) ~ ~ d / ~~eC) C~ l~~[ r I~ ~ AL ~~ ~ 7 ~ ~ io d 7 ~ rs C - Disposflbn Partnfl No. nC ~T 2 2 1 OATH OF NON-SUBSCRIBING REGISTER OF WILLS CUMBERLAND ~~ WITNESS( r +~- _~ ~~ ~o c, ~--- COUNTY, PENNSYLVANIA b ~"` F.`, } G~.,1 t~ ..... ~~ .r--- ~~: ~_ `:: -~_~. -~ .. ~.. .-~ ""f ~..'_'' ~ "~"~1 ~.n Estate of LOUETTA E. BORDNER ,Deceased Karen L. Tomassone and , (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with Louetta E. Bordner and am/are familiar with the handwriting and signature of the decedent, and that the signature of Louetta E. Bordner to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Louetta E. Bordner is in his/her own proper handwriting. (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ (~w day of ' C ~~ I'Y'~-~ ~~ ~ ~C~ ls! ti Deputy for Register of Wills ignature) M&T Bank, One West High Street (Street Address) Carlisle, PA 17013 (City, State, Zip) Form RW-04 rev. 10.13.06 r... ~.+r- te / ,r -^ ~ E ~ ~D `" Ty t"' ~~ ' ~? BING WITNESS ES OATH OF 5UBS~RI ( ) -.- ~ ~ ~ ~ ~ _f ~ ~ REGISTER OF WILLS ~ --~+ • • ~n CUMBERLAND COUNTY, PENNSYLVANIA ~' r~ Estate of LOUETTA E. BORDNER ,Deceased Edmund G. Myers , (each) a subscribing witness to (Print Name/s) the ~ Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. (Signature) /~ (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ ~ , day r`~ / ~ ,A It - r/~~ ~ 1`~~i ~' / 1r I ~ t ~ ~:~%" fit// ~eputy for Reg><ster of Wills 301 Market Street (Street Address) Lemoyne, PA 17043 (City, State, 7,ip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this day of , Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 c "~ 9 ~ ~ ' ~~ ~ .~~ ~ X11 ~ ~xt~ ~e~~~.m~ert.~ ~~ r..~ ~ ~ ~r ' A... ~ ~ ' V S'~1 j ~ +"~ i~ 1 ~.,,, r ~~ LOUETTA E . BORDNER ~~' ' ~- `° 4 ~ Cj ~ ~~ t'~ I ~ w -. k ~~ I, LOUETTA E. BORDNER, of the Township of Fairview, York Coun`try ,' Pennsylvania, make, publish and declare this to be my Last Will f and (Testament, hereby revoking and making void any and all former Wills ` 6 by me at any time heretofore made. ARTICLE I I direct my Executor to pay all my just debts and funeral ex- penses as soon after my decease as conveniently may be. ARTICLE II I give and bequeath unto my husband, JOHN J. BORDNER, if he survives me, my household goods, jewelry and items of tangible per- G E 6 sonal property. If my husband shall fail to survive me, I give and bequeath the same unto my children in equal shares, to be divided among them as they shall agree. If they are unable to agree as to ` any item, the same shall become a part of my residuary estate. ARTICLE III All the rest, residue and remainder of my estate, of whatso- ever nature and wheresoever situate, I give, devise and bequeath unto MONTE L. BORDNER and DAUPHIN DEPOSIT BANK AND TRUST COMPANY, Trustees under Agreement with John J. Bordner made contemporaneously ,~ with this Will and as the same may hereafter be amended, to be held k F and administered in accordance therewith. ARTICLE IV I name, constitute and appoint JOHN J. BORDNER to be the Exec- utor of this my Will. Should John J. Bordner fail to survive me "or fail for any reason to complete the administration hereof, I ',appoint MONTE L. BORDNER and DAUPHIN DEPOSIT BANK AND TRUST COMPANY to be the Executors in his stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of 1,a0. Y' ( SEAL ) Louetta E. Bordner Signed, sealed, published and declared by the above-named RTestatrix, as and for her Last Will and Testament, in the presence '~of us, who at her request, in her presence and in the presence of >each other, have hereunto subscribed our names as witnesses. ~....~ ~,,~-~ r i i -2-