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HomeMy WebLinkAbout02-28-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Doris J. Eppley a/k/a: a/k/a: a/k/a: Deceased ESTATE NO: 21- ~~ C ~ ~ ~ C~ 13 SS NO: 209-12-9670 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ~ A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamentary under the last Will of the above-named Decedent, dated 3/18/2004 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 instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(8): ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent lite, durante absentia, durante minoritate) C. 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 and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending.divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g),~cept as folla~vs:_ w~~. c7 - , Name Address Re ~4`~hip to => rn -~ t~., _.'~ "i ° _t "".."f •'ti •-- ~..-_ LiSE ADDITIONAL SHEETS IF NECESSARY ~, ? :7C~ ~. ~.r. ~ ~---~ -; ~_> . 7 ::~ .. - ~ i `~ _ ~,. ~.~~ ~j _,~.,~ THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At Forest Park Health Center, 700 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then years of age, died Estimated value of decedent's property at death: If domiciled in PA If not domiciled in PA _If not domiciled in PA _Value of Real Estate in Pennsylvania at (Month, Day, Year of death) (City and State where death occurred) All personal property $ 4 7 0, ~ ~ 0. ~ 0 Personal property in Pennsylvania $ Personal property in County $ ~ $ _ Total Estimated Value $ ~~ . ~~ Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s) Name(s) & 1Vlailing Address(es) . John A. Eppley, 1509 York Road, Carlisle, PA 17015 Interim Form RW-02 revised 1226.10 by Cumberland County pendine action by the Court Pane 1 of ~ 84 2/9/2011 Carlisle, Pennsylvania OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioner(s) herein named swear or affirm 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 aff rmed a:'id subscribed before one this ~ r~ ~ day of 1 ~~~a ~. C7 Fn ~~`f . -rJ 1....: ~~.~. __T., ;. ~, r~^-y, . J r ~ 1 I _"~i ~ i pp !! T' lam! 1 ! T ~~ .. 1_ r ",f _ :~ y p.Wr _ _ ...+4_) .l . .. ._ .~ ~ ,.~ 7-i ___ For the Register -_~ DECREE OF PROBATE AND GRANT OF LETTERS Estate of Doris J. Eppley ,Deceased File Number: 21--~~~ L ~ ,__rti- .. P' ....... 4~.._:~.~ L.~ ~~t. ~~ - c~ ~~~,3 AND NOW, this ~ day of ~~b ~ Q r~ ~~J , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented` bTefor-e me, IT IS DECREED that Letters X Testamentary of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) John A. Eppley in the above estate and that instruments(s) dated 3/18/2004 described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.. ~-~~ ~1 ~ c~s~-~S~-~f- ~. ~cc.,-U~ h Glenda Farner Strasba~i h,i c'X- .~:, ~;~~ r- Register of Wills FEES: Letters ....................$ ~~~ ~~ Will ....................... 1'~ ~ CTC) Codicil(s) ............... (~° )Short Certificates a~ C3C~ ( )Renunciations....... Bond ............................ Other ............................. Signature of Counsefi~quired to Ep~r Ap Atty's Signature PRINTED Name: David A. Baric, Esquire Supreme Court ID No.: 44853 Address: 19 West South Street ................................. Automation FEE......... 5.00 JCS FEE .................. 23.50 Phone: ~ ~ ~' ~v Fax: TOTAL ................ $ --z-e :~A interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2 Carlisle, Pennsylvania 17013 (717) 249-6873 (717) 249-5755 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by phottostat or photograph. Fee fC~r this ~ertii•icate~. `~(~.Otl P 17047509 Certif~ic~rtion '`~Iumhel This is to certify that the information here given is correctly copied frol» ;_>n original Certificate of Death duly filed with )ne ~-~ L~(~cal Registrar. The original Certificate ~~'ill he 1~t>r~~~arded to the State Vital F!ec rds Office for per~n,.inent filing. ~~~ / ) 02011 Local Rer~istrar ~-ate Issued ~ r~.._. t ~ r ~ ~ f ~ - ~ _ ~C7 ~;~ -7 ;~s ~'~: _::; ,.. _ ~~ t.~ _... t.w) ~_., ,. 1~ ~ ~ .i ~_- J <~ ._ -- --1 ~ .. r... REV 11/2006 'PRINT IN AANENT CK INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) CTATF FII F NI IaARFR 1. Name d DeoQ_dertt (Rrst, middle, I ~ x) 2. Sez 3. Social Securlly Number ' 4. Date of Death (Month, day, year) ~ ~~ DarZS female 209 -12 -9670 eb.9 2011 5. Ape (Last Birthday) lJrtder 1 1 6. Date o1 Birth Mtxtth, ar) 7. Bi and state a fo Ba. Place d Death Cttedt one) 8 4 Maras Days Han MIaM Hoepttal: th r : O e - Yra. Ju 1 y 2 9 ,1 9 2 6 Lemoyne , PA ^ Inpatbnt ^ ER I Ouatetlent ^ DOA ~ y ' ' [pNursing Home ^ Residence ^Other -Specify: 8b. County of Death 8c. City, Boro, Twp. d Death 6d. Fatttllly Name (tl rat nslRutlon, gNe street and number) 9. Was Decedent d Hlapeltic Origin? ~ No ^ Yes 10. Race: American'Indlan, Black, Whtte, etc. - Cumberland Carlisle Forest Park Health Center MexlcartPoertoR srl,dc.) ( White 11. Decedent's Usual tbn Klnd of work d ata moat d Nb. Do rat sbb rea 12. Was Decedent ever In the 13. Decedents Edttcatbn (Spectly only highest grade comp leted) 14. Marital Statue: Mertied, Never Married, 15. Surviving Spo use (If wife give maiden name) Ktnd d Wa1c Kind d Buslrlesa /Industry U.S. Amled Forces? Elementary / Secaldary (o-12) College (1.4 or 5+) ~ ~'~ (~~ , I• ^Yes ~JNo 12 W1dOWed - 16. DecedenPS Mallkq Address (Street, dry /town, elate, zip code) Decedent's Did Decedent 61 0 Somerset D r ~ Reeiderzxi , 7a. stab _ P A ova `" a „~. ^ ya, ,,, ~,~, ;n Twp. . - PA 17055 h i b M Township? 17d No Decedent Lived wRhin M c C h a n 1 C S b u r 17b.camty Cumberland ~ 4 an cs ur ec A~um~d ctty/lam 18. Father's Name (Ebel, middle, lest, slAfixl Willis Bentz 19. a Name (R sumeme) Eser ra~ea`s 20a. Inlortrrera's Name (Type I Print) 20b, nbrtrtenYs MeilMg Address (Street, I.•Ily /town, slate, zip code) John A. E le 509 York Rd.Carlisle,PA 17015 21a. Medad d Dlsposltlon ®Cremation ^ Dortetlort 21b. Dale d Dlepoeitlort (Mash, day, year) 21c. Pbce d DiaposlAat (Name d certletery, aemalory a dher place) 21d. LocaAon (City I town, state, zip code) ^ Burial ^ Removal from State liya Crartatlorl a Domtlon Audtorized Feb .1 1 , 2 01 1 Hollinger Crematory t . H o l l y ^ outer • speay: try Examinx / cororter4 8 Yea ^ No S Z' ]. n S P A ~ 22a. F Service (a u such) 22b. License Ntrrtber 22c. Noma end Addraea d FecNty - - 011248E Musselman FH&CS inc. 324 Hummel Ave.Lemoyne,PA Complete Rama 23ec only when cenRyfng - 23a. To the d my krawledpa, death occurred at the time, date a nd pl~ce stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, d~y year) , physiden Is not a,taAable at tlrne d death to ~ j ~ ~-y/J , 0 [ c~ ~ ' ` ~ R nl s~ ~a L C y ~~ ~ - cer6ry terse d ash. . ~-~- / l~ / (i(/1 CQJ QJ ~ I ~ ~ - / o / . - - Remy 2428 rattl be oonpbted by person 24. Time of Death 25. Deb Prmatraed Deed Month, de a ( Y, Y d 26. Wes Ceae Referred to Medical F~taminer /Coroner for a Reason Other than Crematbn a Donation? - who pralatrtoes death' r7 O L O U ~J M' l ~ Q~/ ^ Yes ~k CAUSE OF DEATH (t3ee InstrueNona and axampka) r Approximate Interval: Pert II: Eller oMer 28. Did Tobacco Use ContribAe to Death? Item 27. Part I: Enter the then devents - deeases, kMuries, a compRCatIons - Rtet directly au>sed the death. DO NOT enter terminal eveMS such ea cardiac artest, r Orreet to Death , respkatay anesL a ventdwbr AbrlAetlort withatt showing the etiology Lint a,y eta cause on each Ana but nd resuRln m the 9 underytrtg cause given M Pan I ^ Yes ^ P . r IRnel dbease a AAED1ATE CAU ^ No Unknown ~ ) ~nd Ilion death ~ ~v P ' J ~ ~ ~ ~ 29. R Fame a _ /hQ~JLM l1AR 1L .l ~ ( Due to (a a e consequence of): ~{ . r Pregnant wdhin past year tl~y Art carwitbrre, tl any, b. ~~,~ ~~ ~ 1 ~'~ ~An~ i I~ r a to dte reuse Rated on Ana a ~ ^ Pregnant at time of death Due to a as a uence o Enbr UNDERLYING CAUSE 1 cones ~~ ~ ^ Not pregnant, but pregnant within 42 days ' (dlseae a inµrry that milletedthe c I - events reattlktp n date) usT. , of death Due to (or as a consequerxxi d): . [] Not pregnant but pregnant 43 days to 1 year r ~ d. r before death ^ Unknovm A pregnant wxhin the past year - 30a. Was an Aulapsy 30b. Were Autopsy Fztrxngs 31. of Death 32a. Date d Injury (Month, day, year) 32D. Describe Now I ' t)cCltrred ~ry 32c. Plant of Injury: Home, Farm, Street, Factory, Performed? AvaAettle Prbr b Campleaon Natural ^ Hanlcide Office Building, etc. (Spect'y) d Cause d Death? . ^ Yea No ^ Yes ^ No ^ Atxaderx ^ Pendrg Investlgatlon 32d. Ttrne d Injury 32e. Injury at Work? 321. R Transporbtbrt Irt)Itry (SpectYy) 32g. loceticn of Injury (Brest city f town, state) ^ Sttickb ^ Could Nd be Debmlined ^ Yes ^ No ^ Driver! IOpereta ^ Passenger ^Pedestrlan M Otl>ar • Specfy: 33a. CertlAer (dlsck rxay ane) ~~ Tttb d ' CaAMYDq physleWt (Physician certllyktg cause d rfaM when another physician hen pratourtced death and canpbted Item 23) `' / 9 To Uta Dal of mY keawMdge, daaM oceumd due to ttra caus(e) and manner a abta~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ' Prorrolaalrg and cartlfyhtp phyalcMrt (PhyekBen boll pronottraktg loth end osrtHyktg to cease d deetlt) To the bat of trry Ilnowladga, deefh oxurted at tM tNne, risk, and plea, and due to dra ewaa(e) end manner u abted_ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - - - r 33C. N ~ 33d. Date ' Stgrted Month, day, year) ' ~ ,/},/ / a~ l ~ ~ ~ ~ a ~ t r D~W a tl d, U ti I i b l th h ^ I /V r(y/ ex ro an an a ~mra ga on, n my op n n, a occurred a1 t e Ume, dab. end plrx, and due to the aua(p and manner a atetad_ 34. Name and/Addroes d Person Who Cortgbbd Cause ( TTy d p~ /Print 1 Re istrar's S Dktrbt N , ~ / f ~ !Y Y rI ~U V~ N~ CJ I`v I ' ' J g / L ~ I / I v `I I I ~ I 36. Da O ( , daY, Yasr) 1 ~~/ Disposiaort PerrnH No. O Jr'I ~ ~ / ~/ ' r r `-~' c'~ '~` LAST WILL AND TESTAMENT ~; ~--~ -, :,~~ __~ ~, DORIS J. EPPLEY ~ ~ r,l~'"~'' t 'j l.~ (.,~ 4~ I, DORIS J. EPPLEY, of Mechanicsburg, Cumberland- ~_~~ _~ County, Pennsylvania, make, publish and declare this as anc~for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, unto my husband, CLARENCE G. EPPLEY, provided he survives me by sixty (60) days. SECOND: Should my husband, CLARENCE G. EPPLEY, prede- cease me or die on or before the sixty-first (61st) day following my death, I devise and bequeath all the rest, residue and remain- der of my estate of whatever nature and wherever situate, includ- ing any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, DONNA K. BARNEYCASTLE and JOHN A. EPPLEY, provided that should any of my children predecease me, I give and bequeath such child's share unto his or her issue per stirpes by representation, and if there be a failure of same, then I give and bequeath such deceased child's share to my surviving child as provided herein. THIRD: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon .:~` ~. . ~~~ ~._ ~ i~,",.~ _,.,~_ ,~,~ :. -, -_!~_~ _. -~--1 ~.._.. ~..~ ~~ _.~_~ 1 ~,) such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax C laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise 2 any other rights which they may have under the plan, in whatever manner they consider advisable. FOURTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. FIFTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. SIXTH: I nominate and appoint my husband, CLARENCE G. EPPLEY, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said CLARENCE G. EPPLEY, I nominate and appoint JOHN A. EPPLEY, Executor of this, my Last Will and Testament. In the further event of the death, resignation or inability to serve for any reason whatsoever of the said CLARENCE G. EPPLEY and JOHN A. EPPLEY, I nominate and appoint DONNA K. BARNEYCASTLE, Executrix of this, my Last Will ar_d Testament. I direct that my Executor or Executrix, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ ~'~day of ~ ~,~..,~J, 2 0 0 4 . a.. -'~ ( SEAL ) D RIS J. EP EY 3 Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address '/3. '~~~ 4 OATH OF SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA a r-- _ .. `-; `--_ ; ~r ~'''. Estate of DORIS J. EPPLEY ,Deceased James D. Boar and Beth B. Lengel , (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. ~~ (Signatur) Jc3ileS D dr One West Main Street (Street Address) Shiremanstown, PA 17011 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Executed out of Register's Office Sworn to or affirmed and subscribed before me this ~~ K d-- day i of OTARIAL SEAL CAROL A. BOGAR, NOTARY PUBLIC SHiREMANSTOWN BORO, CUMBERLAND COUNTY /s MY COMMISSION EXPIRES NOVEMBER 13, 2011 Notary Puby lic 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. t (Signature) Beth B. nge. One West Main Street (Street Address) Shiremanstown, PA 17011 (City, State, Zip) Form RW-03 rev. 10.13.06