HomeMy WebLinkAbout06-06-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~ f , m ~ ,Deceased ESTATE NO: 21- ~ ~ - (~[ (~ r~
a/k/a: .S
a/k/a:
a/k/a: SS NO: 1 ~ $ -- Z Z - ~ 1I ~
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
1~A. Probate and Grant of Letters Testamentary or ^Administration c.t.a., or d.b.n.c.t.a. (complete Part Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters under
the last Will of the above-named Decedent, dated _ (~, f~iJi< tQQ3 and codicil(s) dated K p
(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(g):
~ B. Grant of Letters of Administration
(it 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 foll~vs:
Name -...
Address R to De>'~ent ~'">
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USE ADDITIONAL SHEETS IF NECESSARY ~
THIS SECTION MUST B ~'
lvania, wit r last family or principal esidence
~-~ (~~ Ca~v~lt~. ~R r~
(Street address with Post Office and Zip Code, Mumcipal~ty: Township, Borough, City) p
Decedent, then $3 years of age, died ~ ~ ~ Z2' ~ (O at _ (i R ~Q ~ ~ _t _ i ~,
(Month, Day, Year of death) (C~ty and State where death occurred)
Estimated value of decedent's property at death:
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
Total Estimated Value
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s)
f
$ ~+~~~~
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Name(s) & Mailing Address(es)
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Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
Page 1 of 2
E COMPLETED:
Decedent was domiciled at death in Cumberland County,
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LAST WILL AND TESTAMENT
Off'
DOLORES J. BOCKELKAMP
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I, DOLORES J. BOCKELKAMP, of Camp Hill, Cumberland
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County, Pennsylvania, declare this to be my last will and
revoke any will previously made by nie.
ITEM I. I direct that all my just debts and funeral
expenses, including my gravemarker and all expenses of my last
illness, shall be paid from my residuary estate as soon as
practicable after my decease as a part of the expense of the
administration of my estate.
ITEM II. I bequeath to my grandson, Todd Edward
Baker., my Morgan Baldwin II organ.
remaining
ITEM III.~I devise and bequeath all of my~estate
of every nature and wherever situate to my daughter, Debra
J • ~~~ providin she sha
No~Mg~ g 11 survive me by thirty ( 30 ) days .
~7'EM IV . Should m dau hter ~'~~~'
Y 9 Debra J .~ , pre-
decease me or die on or before the thirtieth day following my
death, I devise and bequeath all of my estate of every nature
and wherever situate to my grandson, Todd Edward Baker.
ITEM V I~direct that all taxes that may be assessed
in consequence of my death, of whatever nature and by whatever
jurisdiction imposed, shall be paid from my residuary estate
as a part of the expense of the administration of my estate.
ITEM VI ,. I appoint my daughter, Debra J. Holman,
executrix of this my last will. If~my daughter, Debra J. Holman,
fails to qualify or ceases to act as executrix of this my last
will, I appoint John Brough executor of this my last will.
ITEM VII I direct that my executor or her successor
shall not be required to give bond for the faithful performance
of her duties in any jurisdiction.
Ir1 WITNESS WHEREOF, I have hereunto set my hand this
day o f _ _- -----
r 1993 ~ •
o~ ~Q~o
Dolores J, ockel amp
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The preceding instrument, consisting of this and
one C1) other typewritten pages, identified by the signature
of the testatrix, Dolores J. Bo~kelkamp, was on the day and
date thereof signed, published and declared by Dolores J.
Bockelkamp, the testatrix therein named, as and for her last
will, in the presence of us, who, at her request, in her
presence and in the presence of each other, Have subscribed
our names as witnesses hereto.
-2-
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 16805517
Certification Number
This is to certify that J.he information here given is
correctly copied from an original Certificate of Death
duly filed with me 4LS Local Registrar. The original
certificate will he forwarded to the State Vital
Records Office for permanent filing.
G~r~ ~ OCR 5 010
Local Registrar Date Issued
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!~ REV »~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
/PRINT IN
u~ ~ (See insEruRetlon(s and ex~ampDE onTreverae)
t. Name d Deeded (Fleet, midde, bet, euMbt)
Delores J. Bockelkamp 2. Sex
female 3. SocW SaarrRy Number n
178 - 22 -3111 4. Dab d Dulh (Month, day, year)
10-22-2010
5. Age (Leal BMhdey) Under 1 Under 1 B. Dab d Birth 7. end able a Be. Pba d Dee1h Check one
83 "'~~" °"' "°"" ''`""' 10-30-1926 Scranton, Pa. "°°PN°'~ onwr:
Yrs.
^ InpetlOnt ^ ER I OufpNNM ^ DOA
Nunirg Home ^ Residence ^ Omer • SpOCtly:
Bb. County d Death 8c. Ciry, Boro, Twp. d Deem ~.
Faddy Name (n not krelMuUon, 9h'• street •~ ~•d 9. Wee Decedent d WepeMc Origin?
No ^ Yes 10. Race: Artredcar Inden, 81edc, White, etc.
Cumberland
Cam Hill
Golden Livin Center (N yes, •P•dIY Cuban,
M.>d»an.Pu.raRltan..ro.)
( white
11. Daadarye l1auN d wale d one moat d M0. Do not stab 12. Wu Deaderd ever h nre 13. DOOederrya Educetlon (Seedy ady highest grade oomp ieted) 14
MerNel 3htue: Marrbd
N
M
bd 15
S
IOrrd d Wale lard d Btrkresal Indtretry
clerk lueCross
U.S. Armed Forces?
C
~ / Seery (0.12)
College (1-4 a 5+) .
,
ever
an
,
WbOMNd' ~ (SP•p'Nl .
urvivkrg Spouse (N wife, give maiden name)
^ y„ ~
] Nt widowed
18. Deadad'a McNing Addrus (Street, oily /town, ebb, zip code)
770 Poplar Church Road Deadad'e pid peaderd ,
~~+ 1?•.sbte Pa' Lweln• nt
[~Yea
hredin~ast Pennsborc
Deoedadi
Camp Hill, Pa. 17011 ,
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.
Cumberland T0N'"°h~? „d. ^ ~,,,~;,,
1n.ctumy
~/gym
18. Famafa Name (First, tNddle, Iset, auftlx)
George Albri
ht 1 g. Molfrer0 Name (Fxal, middle, maiden 0umeme)
g Evelyn Audre
20e. trdornwd'a Name (Type / Prtrtt)
20b. InfamarPa Meipng Addneea (Street; dy /town, state, zip code)
.John E. Brou h Jr. 1401 Market St. a
21e. Method d Diepoewon r ^ crenwnon ^ Donation
•
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^ 21D. Dose d Dbpo•ilbn (Monnr, day, year) 210. Pleoe d Dbpoenion (Name d
arrrabry, esrtrasory a omer place)
21 d
. Loatlon
(atr/town, state, zro code)
B'""
`°"'a"~e ' "'"~"anorponitlonAi°'°''~''
^ ~ by Madlal EaarrtlrwlCaawR ^ Yee^ No 10-27-2010 Rolling Green Cemetery 1
81 1
Camp Hi~}isle Ro~S~011
, Pa .
22a. d Funeral savBa Lioerreee (a u each 22b. Lkaru Number 2zc. trams and Addreu d Faritly N . ri S t .
~ FD 014151 Neumyer Funeral Home Inc. Harrisburg, Pa. 17102
only wtwn arttytrrg
phye not aveNbb at mire d dean, b 23a. To me lxset d my krawledge, de.tlr ocaxred at Cw time, dab end plea ebbd. (Sipnahae and tltl•)
/_ J 23b. Llarree Number
`- 23a Dace
Signed (Madh, day, year)
ar1Ny auu d wean. .
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~~i~CA~~. U C: ~ ~
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Ibrrrs 24.28 moat be complesed by person
who prorrourraa duth 24. Timed
~ 25 (Mmm, day, year)
~
~~ 28. Wee Case Rebrrrr~~eld1 ro Medial Examiner I Canner fe a Beeson Other nun Cremation a Da>etbn?
. ~
M. ~
L
't ^ Yu liJ No
CAUSE OF DEATH (9•• hytructlona aW •xampbs) ~ Approodmel0 interval:
Nam 27. PaR I: Enla the - ~eeea, Nyrrlu, a carrpNeaUorr • prat directly arced the daa8r. DO NOT emx bmdnel everts ouch u carder arrest, r Oroet ro Duch
tr
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i
b
ftb
N
' Pert 11: Enbr onbr
but not restdlirg h the urxbrlytrrg auu gNen M Pert I. 28. Did Tdxoco Use Caddbub ro Dee1h?
^ Yes ^ -
~ob°~'
rup
a
ory artuL a venb
txr
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r
elbn wtllwut ywwing lire enobgy, l.bl ony ate auu on rich Ilne.
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M
DIATE CAUSE (Final dleeaee a r
A Unlmowm
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ruWtlrrg a ) -~ e. ~e/ ~ ' ~1 '~ f ~ !~`r ~ ~/~ r / /~l ~ t.C ~ _'~ ' f - ~_ / r
[ ~1 h G ~ Q1.7(K ~!
29. N Female:
~
Dus~ppo ~(,a~u a oneaquerx~ d): / 4 ~ r~
owalsead~ar Nr~ie a b' _ /" l~ ~ ~Q ~ ~~~` ~A a / " C ~~'~ l !i ~Cis~iMr/~ifi+~~ lG~/„
~-
'-
~,~ ~/ ~'j:~ ~ Pam Put Yaer
O Pregrrant at time d duth
r ~
Erda II IND~EyRLYNIQ CAUSE Duero (a/9~a corarequena oQ: ~j ~
' (iverds nmdWq~ In dedh) LAST c. `" ' ~'C+~ ~ /~ ~ / "~7 i %~~' i ~ - pregnen4 but pregnant within 42 days
d death
^
Duero (a a a
on~ Nd pregnant, but pregnam 43 days ro 1 year
'
d. r
r berore deem
^ Unproven tl pregnant witltin me pest year
30a. Wu an Autopsy
Pedombd? 30b. Wen Autrfpey Fkrdrrgs
Avetlebls Prior ro Carpbnon 31. Manner d Death
r--~~ 32a. Dace d
~Y ~~~ d•Y. Yur)
32b. Deeaibe Fbw Ir~ray Occurred
32c. Plea d Injury: Flortre, Farm, Street, Pettey,
d terse a Deem? L~SN Wrel ^ Hankerle Only UuikAng, etc. (SpearlyJ
^ Yu ~ ^ Yu ^ No ^ Aoddent ^ Perrdng Irnestlgenon 32d. Thrb d Injury 320. Injury et Wodff 32f. n TrarrapoAetlon Injury (SpareYyl 32g. Laatbn d M1eY (Street, city I town, state)
^ Suidde ^ Could Ndbe Dsbmdrred ^ Yea ^ No ^ DMa/Operator ^ Peeeager ^ Pedestrian
M Other - Spedfy:
33a. Canlbr (drank ardy one)
33b. Sfprstas d Cartltlsr
• CaANying Phy~•n ( ~yhg sues d dutlr when arrotlrer phyeicbn has prorrourrced Guth end
Nem23)
----------------- ^
TotMbMdmyknotsbdpa,daMhoccunddwmtlrauae(a)andmwnruataled------- ~~,
tY ~ Y PM•~ ( txtlh Preu+r~n0 death end oertlryinp ro cause d loth)
To do eat os my wrowNtlga
deem oaurnd at dw tlar
deb
ab pica
and dw ro the aue0
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and
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bd 33c, uarw Number
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manner a e
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Mewl t.xarntrw/Corona ~
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2
(~J /~.1 n.~ ~ /O
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On flra bob of axamtrratlon and / a InwatlgNlon, M my aplnlon, loam oceunsd M 1M tMrO, dab, ant plea, and due to tlr
arr0(a) and mama a staled.
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Cauea d Dam (Item 2~ ype /Print
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Regbtrara endDlatrktl,s~~ ~ I ~ , ( ~I ! I ~ I
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Dlepoailbn PermN No.
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CIJR~BERLAND COUNTY, PENNSYL~TANIA
Estate of Dl/LORE3 J. BOCKELKAMP
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Deceased
RAYMOND H. BOWERS (each) a subscribing witness to
(Print Name/s)
the ~ Will L 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.
afore) (Signature)
20 N. 12th Street
(Street Address)
Lemoyne, PA 17043
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
(City, State, Zip)
.F,arecuted_out of Register's Office
Sworn to or affirmed and subscribed
before me this d-3 day
of _ ~Cu,e 2~ ~/
COMMONWEALTH OF PENNSYLVANIA
Notahal Seal
' Cathy L. Youngblood, Notary Public
Notary Pu l1c Lemoyne ro, Cumberland County
My Commission Expires June 22, 2014
My Commission Expires: ~ F~hnsrlvenle Asseeiai:ion of NotaHes
(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
(Street Address)
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of DECOKES J. BOCKELK;AMP
Deceased
JOHN E. BROUGH, JR and N/A
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with DECOKES J. BOCKELKAMP and am/are familiar
with the handwriting and signature of the decedent, and that the signature of DECOKES J. BOCKELKAMP
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
DECOKES J. BOCKELKAMP is in his/her own proper handwriting.
e)
1401 Market Street
(Street Address)
Camp Hill, PA 17011
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
sj~ ~ ~~ ~ ~a ~~
Deputy for Register of Wills
(Signature)
(Street Address)
(Gty, Slate, Zrp)
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Form RW-04 rev. 10.13.06