HomeMy WebLinkAbout05-04-11PETITION FOR PROBATE AND GRANT OF LETTERS
Cumberland COUNTY, PENNSYLVANIA
REGISTER OF WILLS OF nn ~~ ff
H. Louise Clements File Number
Estate of
also known as Social Security Number 184-12-4$30
,Deceased
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 CO-Executrices named in the
last Will of the Decedent dated 9~4i'2002 and codicil(s) dated
Charles D. Clements was named as executor in the Will but he died on 3/8/2005.
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and dida acitatedaandlwas not a party to a pending di~o ce proceeding t the time d
for probate, was not the victim of a killing, was never adjudicated m p
of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g):
(If applicable, enter: c.t.a.; d. b. n. c. t. a.; pendente liter durante absentia; dura~minoritate) ~~
B. Grant of Letters of Administration `4
fan errs:.
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followin s ohs Y) ~
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) n ~~ ~-z m --[
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
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was domiciled at death in
iJLJ Vlc~~~W ...... ----.
(List street address, town/city, township, county, state, zip code)
nP.cedent. then $$___----- Years of age, died on 4/24/2011
Pennsylvania, with his /
011 Borou
at Manor C
IOf principal
_ (:amn I
at
$ 171 395.00
Decedent at death owned property with estimated values as f All personal property
(If domiciled in PA) $
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $ 150 000.00
Value of real estate in Pennsylvania
525 Grandview Avenue, Camp Hill, PA 17011 TOTAL: $321,395.00
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:
Typed or printed name and residence
Signature 1350 Sugar Mapie Vouri
Donna L. Nissel PA 1
~. New Cumberland 665 Revere Circle
- Diane Marie Way PA 1
i ~-'~ Lewisber
Page 1 of 2
Form RW-02 rev. 10.13.06
Oath of Personal Representatlve
COMMONWEALTH OF PENNSYLVANIA SS
CouNTY of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing nt Petitioner(s) w ll well and trul best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decede ,
administer the estate according to law.
-,------
Signature of Personal Representative
Signature of Personal Representative
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File Number: / ~
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Dec~sed
Estate of H• LOUISe Clements
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184-12-4830 Date of Death: 4/24/2011
Social Securi Number: /
lyi1, ,~, in consideration of the foregoing Petition, satisfactory proof
AND NOW, Testamenta
having been presented before me, 1T S DECREED that Letters
_ ~ ,..,.,.,.~ .,n~ rlianP_ Marie Wav
are hereby granted to
in the above estate
9/4/2002
and that the instrument(s) dated ~~
described in the Petition be admitted to probate and filed of recd r~l ~s the 1~ Will (a~~C~ d~ci~(s ~) of D~ ~e~ e~ ~~~ f ; 1 D ~f ,~I
FEES
Letters $ ~x 1
Short Certificate(s) •••••••••••• --.L~
Renunciation(s) •••••••~•••••~~• $ ----
.... $
.... $ ~ L
....
TOTAL ............................. $
Attorney Signature:
Supreme Court I.D. No.: 39785
Address: 414 Brid a Street
New Cumberland
PA 17070
717-774-7435
Telephone:
Page 2 of 2
Form RW-02 rev. 10.13.06
Sworn to or affirmed ai d subscribed
before me the ~ day of
Attorney Name: nayid H Stone Esquire
ssos Rr.~ ruvu,,
LOCAL REGISTRAR'S CERTIFICATIONoOF tDEATH
WARNING: It is illegal to duplicate this copy by p
This ~s to cciUt_v tl) t the uTformatlon nett riven is
gee far this certificate, X6.00 corr~,ctly copied 1-r.>I ~ an ol)r final (i.rtiticatc of Dea[h
duly filed with me la Lucas Re~~l~lta.r. "t ht original
certificate will he fon~~arded to tine State Vital
Records Office for }~'ermanent filing.
7299432 ~~~°~ -~
P ~ Local Registrar mate l~sued
Certification Number
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~
3 REV 112005 CERTIFICATE OF DEATH
- I PRIM IN
RMANENi (See Instructions and examples on reverse STATE FILE NUMBER
ACK Ita( d. Date a Deem (MOnm, tley,~e•r
2. Sex 3. Sodas Saa,~Y N~12 _4830 April 24, L it
,. Name a Dacedard (Brat middle, last, aul0x) Fgnale 184
H• Louise C,],emeLltS 7 Bi and sbb or cou ee. Plea d 10sedl Ctack one
lhldar i r Urzbr 1 d 6. Dab d &dh Momh da er Hospital: Other.
5. Ape Itaal Birmdey) ^ Other Specity:
^ Inpabem ^ ER I Oulpetlem ^ DOA LpNaeing Fbme Residence
_ '"~'"° °e~ "°"' M~ December 23,1922 FYanklintown, PA rr77
a8 10. Race: American Inden, Black. Whse, ero.
Yrs. Bd. FedAly Name (11 nd klsdhNon, gNe street and number) 9, Wee Decedam of lilapnnlc Orbm7 ^ Yes (3pe4Yh1
&. CAy, Born, Twp. d Death lK Y•8, apedly Cuban, to
~. Coin a Deem Hill Mexican, Puerro Rkan, ac.l
~~ Hill $Or0 • N1ffi10r Care b 14. Medial Sbd>s: Herded. Never Manled, 15. SurvMng Spouse Is was, gN• meMen name)
12 Wes Decedent ewr M tla 13. pecedenYe Edxatlon (Speedy ~Y hl 9rad• ce'^P tad) Widm~ed, Diuerced ISP•dNl
it. pecederMa shod Kinddwak done du moltd Iae. DO rot eteb U.S. Amad F«cea7 ErylSecoMery 1612) College ll-4 «St) *,~
.W~ KM of &uinasallMuelry Wl
ratr J~a~,,.~.~iYK`M•dmd`- Hpme ^ Vea No
pecedenYS Live in~a ant 17c. t^q Yes, Decedent Lived In L ~,. T~~
- 18. B~N^9~Street c~dy1 rows, state, zip code) Actual Residence t7a. State l~ yY~~ TwmshN? 17d. 11x N~ ~ wiMin ~~e'~7SUltl g CuY I Bono
eW Ave. 1t7Leli
Camp Hill, PA 17011 17h °ainN
19. krotlaYS Name (Flrst R , meiden~sus~Qc
• 18. Fadar's Name (Post. rrddde, lest sulfizl l(a ilnwuo.~
Paul Y. Stetler za,. Inrormenfa Malang Adar.m Istr«t I tom. ~•~ ~ ~e ].gam PA 17070
1350 Sugar l'~~l.e Ct., Cumber ,
20e. InfamanY6 Name (Type I Pdm)
Nissel 21d. Location (Caylrown, sbte, tb code)
Dotma 21b. Date d pisponition (Monet, day, Year) 21c. Place d DlePOaitim (Nana d cemetery, aemarory a atlar place) ~~,,1,,,,` L ~..
21a. Method d ' ^ Cremea« ^ oonatron L-lwaxaallCSuuL g, PA
^ Buda ^ Removal ban state ~ yu a ~ AI'm0'M•d ^ Ves^ No it 30 zx.2ta01a.a Addreee of FF • JOSS C~me~ .
ee 2ffi. lJcenee "lamer 1
~,. d Feral 014819
23b. Lkenee Number 23c. Date Sigced lHmm, day, year)
deem ocamed et me lisle, dab and place atebd. (Signerore and 1Poe) ~ 6 (6 5 5 I ~} ~ a ~ ~ a o I I
• Oanplere itxm 23et aaN when aerlHying 23e To the beet of my leawledge, ~(
physiden c not eveReble at tine d deem tc .~(''ar+,~^`a'-' 'L-~-----J"~
cerah ceuee d deem. l 28. wee Casa RefelIrlvveld1 ro Medicel Examksr I Coroner I« a Beeson Omer man Cremeaon or Donation?
24. rime d Deam 2.5. Date Pralourlced peed (Halm. day, Y•atl ^ves w No
~ Kern 2a-28 must DB cemPbbd by Pam ~ ~ 28. Did Tobacco Use ConmLute to Deem? .
- ,el,apronaaK„deem. I.0 ~08. QM M. April 24, 201 , ~,~,,;~aro,aarval: PanicEmerdnar
CAUSE OF DEATH (See IneWellone end exernP~) i Onset m poem ba not reeultin9 in tla undedyhlg cause ghen ro Pan I. ^ Yes ^ Pr
mat dredN caused da deem. W NOT enter brmmd events such ae carder artest ^ No Unknown
Item z). Pen I: Enix as M•i^ d evema -diseases, ~heS, a cornplketrona -
da 9tldogy. list ody era ~°B ~ °~' ~. r 29. If Femek. + /1st
reapkNaY mast «vamrkuler flbralaaon wwwlt~~Qaas ahowirq ` ~ - l~a'7.
~~~, , ^ Not pregnant wehin past year ~„/
~~ ~ Fmd daeeae « '
m 1 ) _~ a I ^ Pregnenl at Hme of deem
Nd pregnant, bN pregn
deem Wa ro (a ae a carwaqu•rke og: I ant wimin 42 tlays
I
I of death
ast cnrldaana, a any, h. I
r~~ a puee Cbad on ana a. pus ro (a ae a wnseGuence og: I ^ Nd Pregnant buf Pregnant 13 days to t year
Emer tMDEI1LYM6 CAUSE ; berore deem
(dMeese a rohaY met eatleted da p.
evens reeaang m deem) LAST. pus ro la u e ooraequenae oil' r ^ Unkrawn II pregnant wahin Me Pest Year
. I
• d 32c. Place of Injury'. home. Farm, Street Faday.
32e. Dale d Injury (Month, mY~ Year) ~~ Describe Noe Injury Oaumed l)Ifice Building, etc. (Speciryl
Spa. Wee an Autopsy 30b. Were Autopsy Fmdmgs 31. d Deem
Pedormed7 Avalleae Poor ro C«Igletlan Nalurel ^ kbrrlidde yce In 32g. Locehon of injury (SUeaL sty I rows, state)
a cause a Deem? Sze. 7kne a Irpury Sze. Injury et work? 321. N Trensporb' P'Y (spealY) ^ Pedeatrlen
^ Accidem ^ Perldug ImeMlgmron ^ Yes ^ No ^ Merl Operet« ^ Passenger
^ Yas p ~ ^ vas f~Ne ^ sti~aa ^ caaM r~l be pelam,hed M. omar - swdy
/ / 33b. Slgnelwe ~--+
33y Certlfar 1~ onN ar) deem end completed derv 23)
• CerUhlia9 PNY•kl•a (phyeden anMM9 sues d deem vRan ergear phyeicbn her P _ _ _ _ . 33c. Lkense Nlmber 33d. Dale Sigad (Honor, day, Year)
To the beetd my larowbdga deedr oeaamddarothepwe(B)and plylneaeMed____-_---- ----------------- A (~/~~ r
• Prawandrw and aruMng phyerolrl IPhY•k•'a" ban praaunctrq m.m em cedaYhg ro ramie d seam) ^ MO U ~(L / Q 7 LT 7
Toms. woof mrta,owbdge,e.nr«amedem.time,dW,end ptece~end duerod»aaeel•1 •nd mennerr Hebd--------------- Ceuaea peem lltem 27)Typel Pdnt
• Yedkal Examhrrl Carver end 1 a Ipvestlgdon, In my ophdan, deeM ooeurrsd et the tmr, deb, end PMb4 sad due ro tM awN•) •ed al•^"K a etatad_ ^ 34. Namef' «Id Address a perecn Who CanMetad
onm.Melemex.deedon E Brn1Cr A'k0•
~ ~ ~I~1o~0// X90 Pe lA~ C~ur~l. M~• Camp N,ll ,l~ 17r711
3s. Aagetrar: spld~a .napro~.+ I .2 I / I ~ I / I I
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Dieposaion PemNl No.
ep\wills\CLEMENTSlouise
LAST WILL AND TESTAMENT
OF
H. LOUISE CLEMENTS
I, H. LOUISE CLEMENTS, of the Borough of Wormleysburg, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I: I direct that my Executor hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be it
done after my decease from the residue of my estate.
ITEM II: I devise and bequeath all the rest, residue and remain-
der of my estate, of every nature and wherever situate to my husband,
CHARLES D. CLEMENTS, if he survives me.
fail to
ITEM ; Should my husband, CHARLES D. CLEMENTS,
survive me, I devise and bequeath all the rest, residue and remainder
of my estate, of every nature and wherever situate, in equal shares to II
i
my children, JAMES D. CLEMENTS, DONNA LOUISE NISSEL, and DIANE MARIE
WAY, as survive me. Should any of my children predecease me, I devise
and bequeath the share of such child to his or her issue, per stirpes;
and should any such child of mine leave no such issue living following
my death, I devise and bequeath the share of such child to ~ issue,,^
.: ;_~
per stirpes . ~_~~ ,~ ~,
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F'..._ '' . i 1'1 1r
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Page 1 of 5 ~-='c->~,
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ITE_ M IV: I appoint my Executor and his successors guardian of
any property which passes, either under this will or otherwise, to a
minor and with respect to which I am authorized to appoint a guardian
and have not otherwise specifically done so, provided that this ap-
pointment of a guardian shall not supersede the right of any fiduciary
in its discretion to distribute a share where possible to the minor or
to another for the minor's benefit. Such guardian shall have the
power to use principal as well as income from time to time for the
minor's support and education (including college education, both
graduate and undergraduate) without regard to his or her parent's
ability to provide for such support and education, or to make payment
for these purposes, without further responsibility, to the minor or to
the minor's parent or to any person taking care of the minor.
ITEM IV: I appoint my husband, CHARLES D. CLEMENTS, Executor of
this my last will. Should my husband, CHARLES D. CLEMENTS, fail to
qualify or cease to act as Executor, I appoint my daughters, DONNA
LOUISE NISSEL and DIANE MARIE WAY, Co-Executrices of this my last
will.
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties
in any jurisdiction.
Page 2 of 5
LOUISE CLEMENTS, have hereunto set my
IN WITNESS WHEREOF, I, H.
2002.
hand and seal this ~ day of -~`~
H. LOUISE CLEMENTS
SIGNED, SEALED, PUBLISHED and DECLARED by H. LOUISE CLEMENTS, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of ea~-h nt-l,Pr, have subscribed our names as witnesses.
Witne '~ ~. ,
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Witness !~~'
COMMONWEALTH OF PENNSYLVANIA: SS:
COUNTY OF CUMBERLAND
1,
Address
,,,, L ~
Address
I, H. LOUISE CLEMENTS, the Testatrix 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 this instru-
Page 3 of 5
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
~ J ~~ ~
H. LOUISE CLEMENTS
Sworn to or affirmed to and acknowledged before me by H. LOUISE
_~ da of 2002.
CLEMENTS, the Testatrix, this L y
~.
Notary Public
NOTARIAL ~~ PubUC
CAROL L. TROXELL,
New Cumberland Boro. Cumberland Co.
My Commission Expires Dec. 27, 2005
COMMONWEALTH OF PENNSYLVANIA SS:
COUNTY OF CUMBERLAND ,~
~, ..
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~ and 'o , Gy~~"~ t .`"~ ~~-~_.~~
We, ~"` ~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
Page 4 of 5
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
Wi s
fitness
Sworn to or affirmed to and acknowledq d bef~re me b~ ,,
(~ -~ ~ ~ and t `'~ ~' ~„~
~~~~ o _ 2002.
witnesses, this ~_ daY of -'-~
~~~-.
Notary Public
_ NOTARIAL ~ Public
CAROL L. TROXELI..,
New Cumberland Boro. Ctanberland Co.
My Commission Expires Dec. 27, 2005
Page 5 of 5