HomeMy WebLinkAbout06-24-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
...
Estate of ~. ,.; ~,` ~ ~ ~ Ug t''1n 1'Y1 ~~ -~ ~ ' ,Deceased ESTATE NO: 21- ~ ~-
a/k/a:
a/k/a:
a/k/a: SS NO: d2-i< ~ ~' ~ r w ~`'/
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. (complette Part Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters _ under
the last Will of the above-named Decedent, dated , ~? r, ; ~~ ~ 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(g):
^ B. Grant of Letters of Administration
(lf applicable, enter d.b.n., pendent life, 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~xce~pt as fol~~vs:
Name Addre ~ 1~ - '~
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THIS SECTION MUST BE COMPLETED: ~~u `' 7
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or prilicipal residence
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(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
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Decedent, then `~ ~~ years of age, died ~ > /` ~i i i at ~~. r:~ -~ ~_~ ~ ~~, . i`/ , ,~`'
(Month, Day, ear of death) (City and State where d~
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) 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 ~l~ ~~`
OATH OF PERSONAL REPRESENTATIVE
before me t}-i~s ~ ~ day of
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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 and subscribed ~'~
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For the Register
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DECREE OF PROBATE AND GRANT OF LETTERS ~~-~ ~' ~~
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Estate of _ .~_,.~~~~ E ~`~'~ ~ ~- ~~ ~'I(tl~-~~.k. ~ ~ ~ ,Deceased File Number: 21- ~~ ~ ~ ~ ~ ~' ~ '~'~
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AND NOW, this ~ `~ day of ~ i , in consideration of the Petition on
the verse side hereon, satisfactory proo aving een presented before me, IT IS DECREED that Letters
_~,~estamentary of Administration
are hereby granted to:
(I applicable, en er c.t.a., d.b.n., d.b.n.c.t.a., etc.
the above estate and that instruments(s) dated
admitted to probate and filed of record as the last
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'ill and Codicil(s) of Decedent.
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enda arner Strasbaugh, ~ ~ ~r ,~:.~~~ ~,~~~'~._ ~~ , ~,
Reglster of Wllls
FEES:
Letters ....................$ ~ 1~~ ° (.1~~
Will ........................_~!'~=fir`
Codici 1(s) .............. .
.~
(j) Short Certificates ~~,~
( )Renunciations.......
Bond ............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE .................. 23.50
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TOTAL ................ $ --~,.~0
Signature of Counsel Required to Enter Appearance
Atty's Signature
PRINTED Name: _
Supreme Court ID No.:
Address:
Phone:
Fax:
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
c ~ .r : ~ t in
Page 2 of 2
GCAL REGISTRAR'S CERTIN«ICAT'~;`~I~ _ = ~4 "
~~'~~RNING: It is illegal to duplicate this. r.c:~l.~y h,~ I~hcrte,~:~*ai ~.~r.° ~-a~~lr~a~.~~~ ~ ,~,,
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•143 REV 1112006
'PE I PRINT IN
'ERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (First, mkldle, last, suffix) 2. Sex 3. Sadei Security Number
John P. Hummel
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l 4. Date of Death Month, da , ear)
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,
. ma
e 204 _ 03 _ 1 21 1 Jurte12, 2
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5. Age (Last Birtltdey) Under 1 ar Under 1 da 6. Date of Birth Month, da , ar 7. Birth ace C and state or fore) count Ba. Place of Death Check on one
$ 8 ~onths Days Hours Minutes Hospital: Other
Y~. March 13,1923 Harrisburg
PA
,
^ER/
Inpatlent Outpatient ^ DOA ^ Nu
eb
Coun
of o
atn
rsing Home ^ Residence ^ Other -Specify
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ry
e
8c. Ciry, Boro, Twp. of Death Bd. Facilty Name (If nd Insfttutlon, give street and number) 9. Wes Decedent of Hispanic Orgin?
Cumbe
l
d No ^Yes t0. Race: Amerksn Indian, Bladc, White, etc.
r
an
East Pennsboro Holy Spirit Hos ital (lryea,epecirycuban,
p (SPedM
Mexican, Puerto Rkan, etc.) h
11. Decedents Usual lion Kind of work done
du ' most of worki Me. Do nd state reti
12
Wes Deced
nt
i
h
1
' _ W
1 t e
Kind of Work .
e
ever
n t
e
U
S
A 3. Decedent
s Education (Spedfy only highest grade completed) 14. Marllal Status: Married, Never Marred, 15 Surviving Spo use Qf wrfe
give maiden name)
time management Kind of Business/Industry
Nav
De
t .
.
rmed Forces? Ele tary /Secondary (a12)
~~ college (1.4 or 5~) ~~'~~ Divorced (SpedlyJ ,
y
po Yes ^ No 4 widowed
16. Decedents Meiling Address (Street, city I town, state, zip code) Decedents Pennsylvania Did Decedent V
8 2 4 L i s b u r g R d. ,Apt . 2 3 3 Actual Residence 17a. State Live in a 17c. Yes, Decedent Liv ed in
.L1 W P
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1
_
_
,
.
Tw
Cumber 1 a nd Township? P
Cam H i 11 PA 1 7 01 1 17b. County 77d. No, Decedent Uved within
Adual Umlts of
18. FatfleYS Name (Frst, middle, last, suffix) 19. Mother's Name (Frst, middle, maiden surname)
John P
Hu
l City / Boro
.
mme
, Sr. Bertha Wise
20a. Informant's Name (Type /Print) 20b. Informants Mailing Address (Street, city /town, state, tip code)
Cynthia A
Coover
.
2331 Meadow Oak Circle,Kissimme:e,FL 34746
21 a. Method of Disposiion r ^ Crematon ^ Donation 21b. Date of Disposiion (Month, day, year) 21c. Place of Disposiion (Name of cemetery, crematory or other place)
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B
d
l ^ 21 d. Location (CIry /town, state, zip code)
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a
Removal from State r Was Crometlon or Donedon Auttwrited June 2 5 , 2 01 1 R o 11 i n g Green Cemetery
^ r- r by Medaal Exsminer/Coroner? ^Yes^ No Camp H i 11, P A 1 7 01 1
of Funerel (or person ectlng such) 22b. License Number 22c. Name and Address of Faciltty
!~? D-013163-L Musselman FH&CS,Inc.,324 Hummel Ave.,Lemoyne,PA17043
mplete Rams 23a-c Doty when certHying 23a. To the t of m owledge, death rted at the ,date and place stated. (Signature and Nile) 23b. tkense Numlxar
physician is not available at Nme of death to
certify cause of death. ?3 . Date Signed (Month, day, year)
~
2 u n ~ a a ao ~ ~
ttems 24.26 must be completed by person
4. Tme of Death 25. Date Pronounced Dead~^(Mo/nt~h, day, year) 26. Was Case Refe~r~re,~/'to Medial Examiner /Coroner br a Reason Other than Cremation or [bnetion?
who pronounces death. i ~ ~, 2 A ~„J1 M. J ~ ~ OGerC a o \\ ^Yes ILL No
CAUSE OF DEATH (See Instructions and examples) i Approximate interval: Pan II: Enter other siorificant rx>nd~Nons contrib
Item 27. Pen I Enter the chain of events -diseases, injudes, or complications -that direcHy caused the death. DO NOT enter terminal events such as cardiac artest
r O urx+o to uth 28. Did Tobacco Use ntrlbute to Death?
,
nset to Death but not resulting in the underlying cause
respiratory artest, or ventricular fibdllation without showing the etiology. List only one cause on ea line. r given in Part I
^Yes Probably
IMMEDIATE CAUSE (Final disease or r^ ' ~ ~
N r
condPoOn resulting in death) ~ (f~ r-p~ f ~.( ~ /~ C ~ O ~
^ No ^ Unknown
-~ a. I r 29 If Female:
Due to or as a copse uence o
q ~ ~ i
Seauentlally list corMitions, R any, rI - //fJ~ ~ r
b. _ _ C fn.1)'c•- /~1 ~ r ~ c.-~ ~~
f
di
t
th ^ Not pregnant within past year
^ Pre
nant at time of d
th
r
ee
ng
o
e cause listed on fine a.
Enter the UNDERLYING CAUSE Due to (or as a consequence ot): i
(disease a injury that Inltleted the g
ea
^ Not pregnant, but pregnant within 42 days
c. r
events resulting m death) LAST. r of death
Due to (or as a consequence of): i
r ^ Not pregnant, but pregnant 43 days to 1 year
d. r
r
30
W before death
- ^ Unknown if pregnant within the pest year
a.
as an Autopsy 30b. Were Autopsy Flndings 31. Manner Death 32a. Data of Injury (Month, day, year) 32b. Descr~e How Injury Occurted
Performed? Available Prior to Completion
32c. Place of Injury: Home
Farm
Street
Fadory
of Cause of Death? Natural ^ Homicide ,
,
,
,
Office Building, etc. /Specify)
^ Yes No ^Yes ^ Accident ^ Pendi Inver' trop 32d. Time of Injury 32e. Injury at Work? 32f. If Tran nation In u S g, j ry ( )
^ No mg ~ ~ j ry l PecdY) 32 Locaton of In u Street, city /town, state
^ Suidde ^ Could Not be Detertnirred M ^Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
^ Other - Spedly:
33a. Certlfler (check Dory one) 33b. Signature and Trite of CerNf
• Certlfying physiden (Physician certifying cause of death when another physician has pronounced death and cxxnpleted Item 23)
To the beat of my Imowbdge, death oceurrsd due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ /1~1 - (~
• Pronouncing and certHying physician (Physician both prorwundng death and certHying to cause of death) 33c. Ucense Number 33d. Date Signed (Month, day, year)
To tfrs beat of my knowledge, death oceurted at the time, data, and place, and due to tlb cause(s) and manner u ststed _ _ _ _ _ _ _ _ _ _ _ _ _ ^ M s'J n ,
• Medical Examiner/Coroner -' -' - L.b 0 6 ~ 2 . 11
On the basis of exeminadon and / or inveatigetlon, in my opinion, death occurred at the time, date, end place, and due to the cause(s) end manner as statecL ^ 34. Name and Address of Parson Who tad Cause of Death (Item 27) "yoe /Print
35. Registrars $19tfature and Dist' G p 1(„~p,~ CU f'//lH S
// I-~~ ~ ~ ~I / I ~ I 38. Date ( Y, Year) /
~ s//~~Lo J So 3 ~ 211 ~ ~ s T C4.-,~~~ (-h~~ PA l ~ o cl
Disposition Permlt No. O ~ ~+
LAST WILL .AND TESTAMENT
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JOHN P. HUMME:L, JR. '--~~' ~; ~ {: ~` ~- ~~
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I, JOHN P. HUMMEL, JR, now domiciled in Cumberland County , Pennsylvania, declare
this to be my Last Will and Testament. I revoke all other wills and codicils that I may have
previously made..
Article I
M_y just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executrix or Executor from the principal of my residuary estate as soon. as practicable
after my death.
Article II
All inheritance, estate, and succession. taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid. out of and
be charged generally against the principal of my residuary estate without reimbursement .From any
person. This provision is not a waiver of any right which my Executor or Executrix has to claim
reimbursement for any such taxes which become payable as the result of any property over which
1 have the power of appointment.
Article III.
I give, devise and bequeath in accordance with any memorandum which l; have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days
of the probate of my will. Gifts may only be to persons who survive me or to organizations which
exist at my death., and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my stepson, JOHN D. TIMKO of
Waldorf, Maryland, and to my daughter, CYNTHIA A. COOVER of Syracuse, New York.
However, if a beneficiary does not survive me by thirty (30) days, but leaves descendants
who survive me by thirty (30} days, those descendants shall receive, per stirpes, tlhe share the
beneficiary would have received had he or she survived me by thirty (30) days.
Article V
I nominate, constitute, and appoint my daughter, CYNTHIA A. COOVER, as Executrix
of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any
reason whatsoever of my Executrix, I nominate, constitute and appoint JOHN D. T7[MKO as
Successor hxecutor of my Last Will and Testament. I direct that my Executrix or Successor
Executor be permitted to serve without bond and in addition to those powers granted. by law, I grant
them power to distribute in cash or in kind in like or in unlike shares and to file any qualified
2
disclaimer I could have filed if living. My Executrix or Executor shall receive reasonable
compensation for services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my .Executrix or Executor, in her or
his absolute discretion:
(a} to retain in the form received and to sell either at public or private sale, arty real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
to invest and reinvest in all forms of property without being confined to legal. investments,
and without regard to the principal of diversification,
{d) to exercise any option or right arising from the ownership of investments,
(e} to compromise claims without court approval and without consent of any bf;neficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such. property..
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services, and
(I} to conduct alone or with others, any business in which I am engaged in,. or have an
interest in at time of my death, and
3
(j) to receive reasonable compensation in accordance with their standard schE;dule of fees
in effect while their services are performed.
Article VII
I direct that my Executrix or Executor employ the services of Jan L. Brown & associates to
assist in the administration of my Estate, since this office has provided me with legal adwic;e and has
knowledge of the Estate.
IN WITNESS WHEREOF, I, JOHN P. HUMMEL, JR, hereby set my hand to this my Last
/,~,
Will and Testament, on this ~ day of ~ , l 999 at ~ Penns lv ni
bl~- y a a.
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HN P. HUMMEL, JR. (~
In our presence, the above-named JOHN P. HUMMEL, JR. signed this and declared this
to be his Last Will and Testament and now at his request, in his presence, and in the ;presence of
each. other, we sign as witnesses.
Name Address
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I; JOHN P. HUMMEL, JR., Testator, who signed the foregoing instrument, ;having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my Will,
and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn. to or affirmed and
acknowledged. before me by
JO ~N P. HUMMED , JR., the Testator,
this day of _ ~ ~u. , 1999.
~ ~ ~ ~~
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~It7otary Public
Notarial Seal
Jan L. Brown, Notary Public
Lowet Paxton Twp., Daupphin County
My Commission Expires IfAar. 20, 2000
We, the undersigned witnesses who signed the foregoing instrument, being du(y qualified
according to law, depose and say that we were present and saw the Testator sign and E;xf;cute this
instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the
purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn. to or affirmed and
subs ribed to before me
by ,~ ' z - k_'~ '_ Ga
and ~~.~~~... ~= __ ~ 4..~-7-~, Witness
witnesses, this ~ I
day of~t~~_-__, 1999. ~ ~' ~~~
Witness
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N~6tary Public
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Notarial Seal
Jan L. Brown, Notary Public 5
Lower Paxton Twp., Dauphin County
My Commission Expires Mar. 20, 2000