HomeMy WebLinkAbout05-17-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (/ ~1~1~~c'l~.l,y~~/ COUNTY, PENNSYLVANIA
Estate of fit./, L ~rJ~~ ~ ~ J~~? ~~~~~
also known as
Deceased
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO<tiIPLETE 'A' or 'B' BELOW.)
File Number ~ ~ ~ -- ~ ~ ~- ~ +~ (~`
Social Security Number _1 ~ ~~ ',~~~' ._ ~) ~~~~1~
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the t.X~CGI 7 ~r•' named in the
last Will of the Decedent dated ~ I„z ~ ~Z ~~ c~='
1 and codicil(s) dated
(State relevant circu,nstances, 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
(Ifapplicable, enter: c. t. a.; d. b. n. c. t. a.; pendente lire; durante absentia; duran~inoritate) .,....
O ~a _ ' ~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived b the followin s y ~ ~ ~`' `
Administration, c. t. a, ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) y ~ g P4-.,,~~ may) andirs: (tj~ . +
Name :., •' €'t'i ~-- `-r :. ~._~
Relationshi Resideci~~ fir: ;.1 ~~"~
~ °_r'!
-~i r ,~. t"l'"i
.. .-.
. •-; S
(COMPLETE INALL CASES:) Attach adtlitiot:al s/reefs if necessary.
Decedent was domiciled at death in -=a ~~ ~y~~~~County,
Cc/ten( ~ ~
(Listsdeet address, tow,/c,ty, townslup, count), state, zip code)
~.'~
Ivania with his /her last principal residence at
Decedent, then -/~~~,1 years of age, died on
'7 ~ C 1 C at /r'f-~rtJ C- ,/~' ltr~'~'l: l,~?, r~ /`,'C~ ~ ( ~`~7f=?
s,,
T
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ~' ~ C ~ c ~
$-~ - ~ ' C~ ir7
(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:
Where Fore, Petitioner(s) respectfully request(s) the p,~obate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature
7 T ed or rimed name and residence
J ~`) /
Furnt R 6Y-Q ~ ,•c,,,. 10.13.06
Pale 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~' ~ Yri i3~'f' l~;t,~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 ~iffirmed and subscribed ~ ~
~• ~
t °• , ignature of Persona! Representative
before ne *,he __ ~ ;r ~t ~ day of
~I Signature of Persa:al Representative ~
~,..~ z,." ~ Y ,^ti .~ ~..~ G'~ ~1
--„"_ _ ~~ =-ra ~•
For tl,e R i ter v - ~,~
Si,,nature of Persona! Representative ;__; ~ .... '-,
_-_~~
File Number:_ ~ ~ ~ _. ~, L;~ - ~ ~ ~ ~~~ ; .. ~ ..._ - ,~ ~~-r`i
..
~ ' `~ c')
Estate of !•c% i L ~~ ~ '3' ~ /c o~~ 1 ~ c-9t~'~~~ G"*1 •~
Deceased
Social Security Number:~~ ~~~.."1 ~' -~1G~~~ Date of Death: ~ .,? ~~'~ G'
AND NOW, t~E„ y` ~
--~--~~ ~ , ~~, 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 in t,'~e above estate
described in the Petition be admitted to probate and filed of record as the last Will and Codicils 1 ofDeceden
( (),
FEES ~' ~ ~ •
Letters ............... $ Register of Wir7s ~;~w~ ~ ~ ~~-~/
Short Certificate(s) $ "'
-~~ ' ~ Attorney Signature: ~'
Renunciation(s) ..... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~U~"1-
Fa-m RbV-0? rev. /0.!3.06
Attoniey Name:
Supreme Court LD. No.:
Address:
Telephone:
Page 2 of 2
_ _ _
KEV vo , _ - - - - -
LOCAL REGISTRAR'S ~ERTIFICAI'ION O~ DE,~T~I
WARNING: It is illegal to duplicate this copy by photostat or photograhlh,
Fee for this certificate, ,`~6.OO
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Certit~icatit~n Nu)~~her
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~~(`his (s t11 1_~ertilti 'file( she int~)rniati~~n here '~~iven is
Ltjr-ectly ct~,l~icl.l 1•rt ~r)~ ,.(t) ~~~ri~~inal Ce)•tif3cG~te of• De~)th
ciul~' filed ~.'v~ith Inr 11~~ L.~~tcal Registr~(r. "Flee ttri~~i)~ai
c~ertiticate ~~ X11 t~t~ tttrv~;_u~ded t(~ the ~~tate Vital
F~~ccltrds Otf~~~c 1:1)~ itcr(na;)ent filin~T_
~~~~.:~~~ ~--__--- M 1 2 2010
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Lt~e,tl h~~~i~~O•~lr !~~ate Issued
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a3 REV 11/2008 ~ '~ 1 ^s ~~
'E /PRINT IN COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH .VITAL RECORDS ~ ~
=RMANENT
1LACK INK CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
1. Name of Decedgrtt (First, mkldle, last, suffix) STATE FILE NUMBER
/ 2. Sez 3. Soda? Secudty Number 4. Date of Death (Morrih, day, year)
5. Age (Last BlAhdeY) Under 1 • rC ~ Under 1 da 8. DateC~ MoMh~ ar 6 - ao ~ ~v'
Momhs Days Houro Minutes 7• &~ and state or cou 8e. Place of Death Check on ane
• ~ 7 ytg, Hospital:
' en. ca,nty a Deatn eo. coy, 13oro, Twp, of Death ^ lnpatlem ^ ER /Outpatient ^ Doa L7N~reing Home ^ Residence
• / 8d. Fadltty Name (tt rat inetltutbn, ^ Other
give and number) 9. Was Decedent of Hi Spedty.
spank Origin? klo ^ Yes 10. Race: American Indian, Black, White, etc.
~~ lG r v~~ ~~ ~ ~ /'~ ~ C~ Itt Yes, spec8y Cuban,
• i t. Decedents Usual Oce ton IGrld ~ work done du ' most world life. Do not state rail 12. Wes Decedent ever N the 13. Decedents Erltxxdbn ' " // ~xican, Puerto Rk~n, etc.) ~ /C
~ of W0~ Kind of Bua(nasc I Industry U.S. Amted Forces? ( ty higtast 9r•d• corrlpleted) 14. Marital Status: Mertied, Never Married, 15. Survivi S use tt wife, ,"
~~ .~LQ Elementary / secorWary (a12) College (1.4 a 5+ w, Divorced Isnea/y) `~ p0 ( 9h'e maiden name)
r,~Yee ^ fJo > ~ J
• 16. Decedent's Mailing Address (Street, city /town, state, zip coda ~ / do tit;,
/~ I f l Decedent's
C v CG.rr~~ f ~ ~ ~ Actual Residence t7a. State eve io~~nt t7c.
i^vYes, Decedent Lived in
fro, County Township? 17d. Q~lo, Decedent Lived within / Twp.
16. Fathers Name ( ,middle, last, suffix) Actual Limits of L ~
~,/ ,' ~ C c U~ 19. Mothers Name (Brat, middle, maiden surname) city r Boro
G ~
20a. IMonnanYs Name Pdnt)
~~~'+- ~ ~?O O /' 2-- lob/. Inromtant'a Mal Address (street, cytty /town, scale,/~ code)
zia. ~«, fo ~~ /6 c..vc°r /~a Et c~' ~rl d Chi,. ~/~ / 7 a a
• ~ ^ Cremation ^ Donation 21 b. Date of DisposBkn Month, da ,
Burial ^ Removal horn State r ( Y Year) 21 c. Place of Dlaposttlon (Name of cemetery, crematory or other gate) 21 d. Location (City /town, state, zip code)
Wu Crernetion or Donetlon Autlrorlied yy~ ~t //~~
• ^ Other - t by BMdlal F.xaminerlCarorter'1 ^ Yes^ No /''' ~' ~o`Z o~0/d d `~/ ~ Giee.~ Ce~rG~.~ l~~C y ~~
22a Signature of Fu Lkensee (or person actlng as such) 22b. Lkxxree Nurrtbar ~ ~~ /70~/
- ~ 22c. NameC..i/ of Fad?
~PI•te Items 23ec oMy when ~ ~ -p ~ ~a 7~Y~ ~ ~~ ~h'. Z~ ~, .. ~ ~ ~ ~~ ~~, ~ ~~1 ~~.
rr8ytrrg 23a. r° dre of krae4edge, death occu at to and gate stated. (signs and dtie) y ~70 a
gtysiden Is not availabb at time of deadr ro 23b. License Number , 23c. Date S'
certBy cause of death. t~ (Month, day, r)
~ kerns 24.26 must (>a completed b1' person 24. Time of Death ~~ V ~ ~ Q ~ ~ ~- ~ O 5 O '7 O
25. Date Pronounced Dead ( oMh, day, year) l
~ prorate ~~ ~ I ~ 5 ~ M. ~ I 28. Wes Case Referred ro Medic;al Examiner /Coroner for a Reason r than Cre lion or Donation?
• ~ ~ [ D ^ Yes ^ No
kern 27. Part I: Eller the s~aia of events _ diseases, injuries, ar aomgk;atlonEsA- that ~~ In~~rons and e~ramples) ,
r Approximate intenrel: Part II: Enter other 26. Did Tobacco Usa Contribute to Death?
reagretory arrest, or ventricular tbd8atbn without showi the a ~Y ~~ ~ death. DO NOT enter terminal evems such as cardiac arrest, r Onset to Death
ng trology. ust Dory one cause on each line. r but not resulting in the urMedying cause in Part I. ^ Yes ^ pre
IMMEDIATE CAUSE (Fne1 disease or r t~bh'
condkion resulting in death) _~ a. 1 A 1 ~ A I ~ T I ~ y~ 1 r ^ No ^ Unknown
~ ~ v , V { I `J r 29. If Female:
Seoua~ ry D/ue~ro (or efs a/c~orrseq-~u1e y r
Ieedi to Ihelist condtlone, If any, b. ll 1 L L f't S I ~~ ~ ~ ~ ~} ~ ^S'p C ~ /•G / r ^ Not pregnant within past year
aeuse Bated on fine a •+,.. r
Enter UNDERLriNC CAUSE " " " 'or as a ' ^ Pregnant at time of death
(disease or In~try that kdtiated the t wnsequence o1): r
• events esultlng in death) LAST, c r ^ Not pregnant, but pregnant within 42 days
r of death
Due to (or as a consequerx~ of): r
• d. ~ ^ Not pregnant, but pregnant 43 days to 1 year
r before death
30a. Was an A r
utapsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of In y Y ) M ry ^ Unknown if pregnant within the past year
Perforated? Available Prbr to Comgefion n~~ ~~ jury (Month, da , ear 32b. Describe How I u Occurred
of Cause of Death? L~1.ssel0ral ^ Homidde 32c. Place of Injury: Home, Fann, Street, Factory,
Olfice Building, etc. (Specly)
^ Yes I~ye. ^ Yes ^ No ^ Accident ^ Pending Investlgation 32d. Time of Injury 32e. Injury at Work? 32f. tt T
rensportatron Injury (SpecllyJ 32g. Location of injury (Street, city /town, state)
^ Suidde ^ Could Not be Determined ^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestden
M. ^ Otlar - Spedly:
33a. Certifier (check only one)
' ~~~ PhY•~n (PhYsiaen certitying cause of death when another ~ S and Title of iffier
To the beat of my , death occurred due to the physidan has pronounced death and completed ftem 23) ~ v V ~
. cawe(s) and manner w stated _ _ _ _ _ _ _ _ _ _ _ - ~
roma be ~m~ ~Mng PMelaan (phYsiaan tx>B, Pmno~nck,g death and cartirying so cause m ~atn) - - - - - - - - - - - - - - - - - - - - -
mY 9•, death occurred st the time, date, and gate, and due to the ca 33c. liven Number 33d. Date S d (Month, day, year)
• Medrosl FssminerlCoroner ttss(s) and manner u ataled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ ~~
On the buts of e><amhbtiort and / or Investlgetlon, in my ognron, death occurred tl the time, dale, and ~ ~ I
gate, end due to the cause(s) and manner u stated_ ^ 34, me and Address of Person Who
Registrars Sigrta and District N r ~./ (~ -^ !~ ~ Nlf ~ ~ ~ of ~~ (kern 27) Type / Prtnt
~/ ~~ I ~ Iv? I / I ~ I ~ t/ (Moron, day, year) u K ' L t~ ~ ~'1'V~?YJ
C~ Q ~ / 3 ~~ Tivv~d I c 2 ~ccl CG- J ~
Disposition Permit No. - ~ T / ~ ~ ! ~~ 1 ~~ I
LAST WILL AND TESTAMENT
I, Wilmer L. Romberger, II of the Township of Locaer Allen,
_~
Cumberla.r~d County, Pennsylvania, declare this to be my will, ~ eb ~
Y ,,.
revcki n ail r ' ''~ ~'
g prior wills and codicils. ~=~ ~ -~
~~ ~
r" '' .:~ `~.1
FIRST: Regardless of any other bequest made her~~~~-r~~ I-~
specifically bequeath, to my step-son, Ronald Moore of.~' nola,==
Pennsylvania, my diamond rin °"''
g, all steins of his choice, my
picadillos from Germany, all collectible coins (includ.ing gold and
silver), all model cars and vehicles including display table and
case, my oval dining room mirror with shelf and cuckoo clock; to
Virginia Moore, wife of Ronald Moore, all Waterford crystal exre t
p
the 2~J00 Christmas present for Beverly Edwards, my mother-of-pearl
lamp, my tulip lamp, my small cherry desk, all Bradford E~>chan e
g
plate collections, my jade marble top tables, my Penr~syl ~Tania House
oak bedroom set (back bedroom) , my Chinese gold medallion ar.d neck
chains; to my step-granddaughter, Robin Zydallas of Jersey Shore,
Pennsylvania, my ceramic Christmas tree, my living room sofas, end
tables, chairs and lamps of her choice; to my step-grar~d,:;on,
Kenneth Moore of Enola, Pennsylvania, my oak d_Lninq room
furniture, including breakfront table, chairs and Sidebar, m
Y
cerarni_c bulldog; to my Step-daughter, Beverly Edwards of Hegiris,
Pennsylvania, my atmos clock and her 2000 Waterford crystal
Christmas present; to my niece, Ellen Palmer of
Chambers~urg,
_.., f
._ _..
-,._~ f. _-~,
t , ~j
~ -' , ":
r h1
,`' _ T
-_ __
~ ~~-.,
-~•~
Pennsylvania, my Swiss music box and my red and yellow cxlass
pitcher.
SECOI~ID: I give the rest and residue of my estate in equal
shames to my step-son, Ronald Moore of Enola, Pennsylvania, acid m r
step-daughter Beverly Edwards of Hegins, Pennsylvania, per <~ati,i to .
THIRD: All income which is undistributed and accrued at a
beneficiary's death shall be treated as if accrued thereafter.
FOURTH: My executor and his successors shall have the
fol7_owing powers in addition to those given by law to be exe-rcised
by them in their absolute discretion, which powers shat?
be
applicable to all property held by them, effective without the
order of any court and until the actual distribution of all. such
property.
A. To retain any investments at discretion including
stock of. a.ny corporate fiduciary hereunder or of a holdir. com~ari
g r Y
controilir~g it;
B. To invest and reinvest at discretion wl.thout
restriction to so-called "legal investments" with the sY.,ecific
i
right to invest in common and preferred stocks and in such c~
mammon
trust, diversified, money market and mutual funds as the~~ c~ee
m
appropriate;
~• To sell, to grant options for the sale of, or
otherwise convert any real or personal property or interest a'
t
public or_ private sale, for such prices, at such time, in sac
h
manner and upon such terms as they may think proper, and tc execute
and deliver good and sufficient conveyances, assignments and
tran~;fers without liability of any purchaser to see t;~ the
application of the purchase money;
D. To borrow money and to secure its repayment by
mortgage of real or personal property, pledge of investments or
otherj~,~ise, without liability on the part of the lenders tc see to
the application thereof;
E. To compromise claims by or against my estate or any
trust created irl my Will;
F. To make distributions in cash or kind, or partll in
each;
G. To register investments in the name of a nominee or to
hold the same unregistered in such form that th
ey will pass by
delivery;
H• To
reorganization or
deposit securities
privileges, and c
holders;
join in any recapitalization, merger,
voting trust plan affecting investments, to
under agreement, to subscribe for stoc:K and bcr~d
generally to exercise all rights of security
1
1. To manage, operate, repair, alter or improve real
estat'~ or other property, and to lease real estate and other
property upon such terms and for such period as my executor and
trustee deem advisable even for more than five years and beyond the
duraL i orl of any trust;
J. To deduct administration expenses upon either the
estate tax_ return or fiduciary income tax retu
rn, with cr GY'lthout
adj ustmerl~- as between principal and income, as m exec ~~-
Y u ~.or shall
determine;
K• To join with my spouse and file any income tax or ift
g
tax returns that may be due on my behalf and to pa so mu •,
Y ch of Bach
taxes as my executor may deem appropriate and to conse
nt to any
gifts made by my spouse being treated as Navin been ma
g de cane-calf
by me;
L. To associate with them in the absence of a con orate
p
fiduciary, an investment advisor, accountant, custodi -r ~ „~-
an d_ia ., Sher
agents and to compensate them out of principal or income orb -}-
o~h as
nay executor or trustee shall determine, such comper~sat i en tc~
~e a
reduction of the compensation of my executor or truste -
e,
M. To associate with them at any time, in their absolu
to
discretion. and of their choice, a corporate fiduciar T ,
y Which shall
have the same powers as my executor or trustee, such
deslgnafi1on by
my executor or trustee and acceptance by a con
porate fiduciary to
be ire writing;
N. To delegate to a corporate fiduciary the exercise
of
any powers, with the same effect as if the executor or tY--~~,~
tee
delegating such power had joined in the exercise of suc
~h power, ar~d
to revoke any such power, provided, however, that the rev - ~ .-,r
ocat~~~, of
any such delegation shall be in writing delivered to and accer~
~.ted
by the corporate fiduciary;
0. To exercise any stock options which they may receive
ir~cludi rlg my stock from any source as my executor or t
trustee may
deem necessary for the exercise of such options; and ~-
~o pledge
assets as my executor or trustee deems appropriate for_
this
purpose;
F• 'I'o do all other acts and things necessar_ or
Y
appropriate in the management, administration and distribution
of
my estate cr trust, including incorporation of my estate.
~IF'TH: My personal representative is further authorized ii '
1 zts
disc~~etion to rriake such loans, advances or expenditures
out off- the
principal of the trust as trustee may consider desirabl -
e ir. order
to facilitate the settlement of my estate. In exercis'r
i-lg s uch
authority, trustee may pay in whole or in part the ex en
last illness and burial p Ses o~ my
debts, income taxes, estate or inheritance
taxes, legacies, commissions, counsel fees and other admi '
n1stration
expenses, owing by me or by reason of my death, which pa~~ments
y may
be made directly by trustee or to my executor a1
Zd neither mY
executor rlor any beneficiary shall be required to reimbur_ s L
e she
trustee for any funds so loaned, advanced or ex ended
p
SIXTH: No interest in income or principal shall be assi
gr~able
by a beneficiary or available to anyone havin a cl '
g aim against a
beneficiary before actual payment to the beneficiar
y.
SEVENTH: X11 estate, inheritance and other death taxes
together with interest and penalties thereon, payable with res ect
p
to prope~~ty or interests passing under my Will or ar~y codicil
thereto shall be paid out of the principal of my residuary estat
~ e
without apportionment.
EIGHTH: I appoint, Ronald K. Moore as executor of rly estate.
If Ronald K. Moore is unable or unwilling to qualify as executor
or hav-i n
g qualified is unable or unwilling to continue to act, I
appoint as executor, the following person: Virginia Moore. If
Virginia Moore is unable or unwilling to qualify as executor
or
having qualified is unable or unwilling to continue to ac~-
~- , I
appoint as executor, the following person: Kenneth Moore. I Furth
er
direct that my executor shall not be required to furnish secu '
rity
ir. any jurisdiction.
NINTH: Words used in the singular may be read to include the
plural or the plural may be read as the singular. Similar_l~
y, the
masculine form may be read to include the feminine and neuter; th
e
feminine may be read to include the masculine and neuter a
nd
the neuter rrtay be read to include the masculine and feminin
e.
I ha~,re signed this Will this ~ ~da of
~_ Y
2009. -~
WILMER L. ROMBERGER, II, TE ATOR
Signed by, Wilmer L. Bomberger, II, The testator, as his ~f~Till
in the presence of us, who, at his request, in his presence and i
n
the presence of each other, have signed our names as witnesses.
~~ A
Witness
• ~ ~
CC'~ONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
. SS.
We, TATilmer L. Romberger, II, the testator and undersi
wit_n_esses to the Will, the attached or foregoin instr~ r,L fined
have signed the instrument, having been qualified accor ~~me11~,' who
do depose and say: ding to law
d.•) that I, the testator, do hereby acknowledge that I
signed the instrument as my Will, that I signed it Willi ~ ~- -~
my free anal voluntary act for the purposes therein ex re l~ ~_rsd as
p sz~.., and
b•) that we, the witnesses, were present and saw
testator sign the instrument as his Last Will, that he the
willingly and executed it as his free and voluntar- - -.~ ~gn~d it
purposes therein expressed; that each of us in the hearin1 the
sight of the testator signed the Will as a witness and - g and
best of our knowledge the testator was at that tim ~ ra ~ '"~' the
more years of age, of sound mind and under no constraintgore~~,or
influence. U~_c~ue
,-
WIL~$R L. ROMBERGER, T, TESTATOR
~~
WITNESS
Sworn and subscribed before me this )1 ~ ,~.,
2009. ~--
(SEAL) ~ P LIC
My commission expires:
COAl1M01VV1/EALTFi OF PENNSYlVA7VlA
Notarial Seal
Melissa S. Myers, Notary Public
Qty of Hartisbur~, Dauphin ~,
My ~rusiora E~ires,une 11, 2011
°-t~t~on ~f N~tari~s