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HomeMy WebLinkAbout07-19-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of > ~~ ` ~ ~ { ~ t' , ~ , deceased ESTATE NO: 21- - ~ ~ - aIk/a: (~ ~a c~ rr a/k/a: a/k/a: ss rro: ao ~l- zG~ ~9~1`~ Petitioner(s) who is/are 1.8 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as a plicable: A. Probate and Grant of Letters Testamentary orpAdministration c.t.a., or d.b.n.c.t.a. (complete Part Calso) and aver that Petitioners} is/are entitled to the aforementioned Letters '-~ S d' under the last Will of the above-named Decedent, dated - and co 'cil(s) date ~.-J u n~ Z~7, ~~ C (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 (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 part a pendinivorce :~~ proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g~amept as foltaws:~, .-_~ ,,_.~; Name Address R' to cedent ~-' -~~ F' . tip" ~ - } r ~ ~~ ~ ` ~ 'sue ~ '\ ~ "' / ~ .. C..,.= .. i _ .. _. '~j'_ - C=, r~ ~ :n Q ".r.,~ USE ADDITIONAL SHEETS 1F NECESSARY THIS SECTION MUST BI+; COMPLETED: Decedent was domiciled at death in Cumberlan County, Pennsylvania, with his er last family or principal residence At ~' 7 ~ (Street address with Post ice and Zip Code, Municipality: Township, Borough, City) Decedent, then ~'~ years of age, died __ ~tl- Yl ~ ~ Z.3 0~ ~ ~ fat 1 (Month, Day, Yeaz of death) (City and State here death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property $ ~~ 7SQ • C~ _If not domiciled in PA Personal property in Pennsylvania $ _If not domiciled in PA Personal property in County $ _ Value of Real Estate in Pennsylvania $ ----~ ~~~c~ Total Estimated Value $ ~~~~~ 0.6~"' Location of Real Estate in Pennsylvania: (Provide full address if possible.) f .~ ~vZ 'Y'~ ~3~7'~ ~~'t c~, , ~l f~ Signa~re(s) Name(s) & Mailing Address(es) ~ . / o? ~ ~ Q ~c/S~A/t/~ X77 ~,~i4ivl( S!~ 3p cArti 6,e-~ - Gl 2~r` G, v ~.-t C-t~/ ~ift • ~'~f •~' T C ~ rti~ .moo! Q -- lntertm norm kW-UYrevised 12.26.10 by Cumberland County_ pending action by the Court Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland :~~ ~., ; -.-, DECREE OF PROBATE AND GRANT OF LETTER ~ ~ r - ==- - = r r~~„~ ~ _ . ~f~~o ~ -~ Estate of ~~ " ~~ ~ ~ -~' ~"r,(~ ~ ,~ ,Deceased File Number: 21- ~-KJ -n --~> - ~ - AND NOW, this ~ day of ~ ~ ~ ~ ~ , in consideratio>~of the Petittfln oh'' a the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that L`~tters Testamentary of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n, d.b.nc.t.a., etc.) -mod 1~,s? ~~~~~~ , ~~ C, ~~ (d ~f ~~ (l k. '~- C~ ICS ~ /1C ~' ~YC:~i /~~1 ~ in the above estate and that instruments(s) dated ~i - ~~ ~ - ~~, l described in the petition be admitted to probate and filed of record as the last Will and Codicils} of Decedent. R ~ r ~'~ ~~~~ M a 7 ~~ ,~ enda Farner Strasbaug , rte(.. ~,~~ '~-~ ~'~ Register of Wills ~ ~ ~` ~ ~` FEES: Signature of Counsel Required to Enter Appearance Letters ....................$ _ ~ ~ . Will ....................... _ ~ ~sj (t~~ COdIC11(S) ... ............ _ (~) Short Certificates _ ~ ~ C~~ ( ) Renunciations.......- Bond ............................ _ Other ............................. ................................. _ Automation FEE......... 5.00 JCS FEE .................. _ 23.50 `~~ TOTAL .......... r-~~~8 ......$ Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Interim Form. RW-Q2 re~~iseJ 12.26. ] U by Cumberland County pending action by the Court Page 2 of 2 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. .tal~L R~CISTR~-R"S ',I~~. TN ~~~~~n,. '~~1i~~NING~ It i~ illegal to ciu~lic~°~1~~ tl°~i=~ ~. , ~~1y ;.~ ,. ~.~i~ru~t~~:~tz~t ~.-;~ ~~~)~,~~If ~~ .t 1(Y (ill', -°a_'1~:~',La(i.'. `~('~'~ - • _ __P ...._1..7..5.5.7.2.4- 5 43 REV 11/2006 E /PRINT IN :RMANENT LACK INK ., ,.;1 t'•%i {~~„e a + ~ - - it at;)I'l re ~IS I) r' ~i ;1 "`, ~'~ ~ + ~,-, ~ ~ til.Iz (- ,l."~91"J, ~~~ ) 1i~'<lL~i ~ ~ w ',~ ~ ~~ : 1 ~ r ~ ~ _° ; , ,t t c (~~tE :. ~ ~~ ; ~ ~ ~ , n ~ ,~ , w . '"'", :i ~~ * , ~ I 1 • JUN ~~ 0 2011 , .~ ~~;; . ~y ~ ~~ , LGwn ~~ - .~~t ~ ~. ,..., . ~ ~.. ~ ~ a,pi~ ~;~~tls _. '~ :-. L:.9 ~ ~ ~ -- .. r ., -v ---~ _. ~ __ r--n z- ~- .;~ Q ~; ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) .._.__ _.. _ ......___ 1. Name of Decedent (First, midde, last, suffix) 2. Sex 3. Sodal Security Number 4 Date of Death (Month, day, year) Grace M. Frank _ female 204- 26~-7945 June 28 2011 5. Age (Last BiMday) Under 1 r Under 1 de 6. Date of Birth Month, da , er 7. Birth lace C and state a fo ' n count 8a. Place of Death Check on one 7 7 Myrtha Days Hours Minutes Jan . 5, 1 9 3 4 S umme r d a l e, P A Hospital: Other Yrs. ^ Inpehenl ^ ER /Outpatient ^ DOA ^ Nursing Home Residence ^ Other -Specify: 8b. County of Death 8c. City, Bao, Twp. of DeaRr Bd. Foci' Name If not InstRutlon, HY ( give street and number) 9. Was Decedent of Hispanic Origin? ~ No ^Ves 10. Race: American Indian, Bladc, White etc. Cumberland E . Pennsboro 1 21 2 Fourth St , of yea, specify Cuban, , (Sa~iM Mexican, Puerto Rican, etc.) hit e 11. Decedents Usual Bon Kind of work done d u ' most of world fife. Do not state retired 12. Was Decedent ever in the 13. OecedertYs Edtrcetbn (Specify only highest grade completed) 14 Marital Status: Married N v M r d 15 S i Kind of N(a house wi~e Kind of Business /Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1.4 or 5+) . , er e ar e , Widowed, DNorced (SpecJyy) . urv ving Spouse (I1 wife, give maiden name) ^ Yes No 16. Decedents Mailing Address (Street, city /town, state, zip tale) Decedents Did Decedent 1 2 1 2 Fourth S t. vy--~~t Actual Residence 17a. State _ _ P A Live in a 17c.4r~1 Yes, Decedent Lived in 1? _ P e n n S 1JC~ r ~ Township? Twp' 17b. county S'llmbe r 1 a n I'~ 17d. ^ No, Decedent Lived within Actual Limits of City! Boro 18. Fathers Name ( trst, middle, last, suffix) George W Heck 19. Mothels Name (Firet, middle, maiden surname) . Grace Bumbarger 20a. Informants Name (type /Print) 20b. Informants Mailin Address Street, g ( dtY /town, state, zip code) Elaine M. Grove 210 Fourth St. Enola PA 17025 21 a. Method of Dispositon ~ ^ Crematon ^ Donetlon 21 b. Date of Dispositon (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory a other place) 21 d. Location (City /town, state, zip code) ® Burial ^ Removal from State r W or Dortetlon Authorized ^ other- r by ExeminerlCaorteR ^ Yea^ No Jul 2 2 01 1 Y - R o 11 i n g Green Mem . Park Camp Hi 11, PA . $fgnatWre ref Servicerson rig such) 22b. License Number 22c. Name and Address of Facility W ~ 011248E Musselman FH&CS Inc. 324 Hummel Ave.Lemoyne,PA Complete Rams 23et Doty when certifying physblan is not available et time of death to 23a. To the beat y knowledge, death occurred t the time date and place stated. (Signature end title) 23b. License Number 23c. Date Signed (Month, day, year) tartly cause of death. ~ nn ~~ ~ ~~~lJ Items 24-28 must be completed by person who pronounces death 24 Time of Death 25. Date Pronou Dead (Month, day, year) ~ 26. Was Case Refereed to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? . 2 r M ~ Q u ^ Yes No CAUSE OF DEATtt ( Instructions sod x mples) r Approxknate interval: Item 27. Part I: Enter the chain of events -diseases, injuries, or complications -that directty caused the deaM. Tenter terminal events such es cardiac arcest, ~ Onset to Death Part II: Enter other but not resuMng in the undertying cause given In Part I 26. Did Tobacco Use ConMbute to Death? ^ Y ^ P b b respiratory arcesL or ventricular fibrtllation without showing the etiology. List Doty one cause one line. r r IMMEDIATE CAUSE (Final disease or es ro a ly ^ No ^ Unknown candRbn reauRing in death) ~ ' ,~' ~ G~ ~ C ~ 2 ~, C • y r 29. If Female: s _~ a. r ~~ ~ 1 ` ^ Oue to (or as a con sequence ofJ: , Secuen0ally list condRiorrs, R any, b i leafing to fire cause Rffied on line a. Not pregnant within past year ^ Pregnant at time of death Enter the UNDERLYING CAUSE Due to (or as a consequence of): i ^ Not pregnant, but pregnant within 42 days (disease or Injury that initiated the r c of death events resultlng In death) UST. ' r ^ Due to (or as a consequence of): r r Not pregnant, but pregnant 43 days to 1 year d r before death ^ Unknown if pregnant within the past year 30a. Was an Atrtopsy Pertomred? 30b. Were Autopsy Flndings Available Prior to Completion 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, of Cause of Death? ~ Natural ^ Homicide Office Buildin etc. S 9~ (P~dy) ^ Yes 1~,No ^Ves ^ No ^ Accident ^ Pending Investigation 32d. Tme of Injury 32e. Injury at Work? 321. If Transportation Injury (SpecNyJ 32g. Location of injury (Street, city I town, state) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ DrNer/Operator ^ Passenger ^ Pedestrian M ^ Other -Specify: 33e. Certdier (check only one) 33b. Signature and TIBe rtifier • Csrtfly{ng physician (Physician certHying cause of death when another physician has pronounced death and completed Item 23) To tM beat of my knowledge, death occurced due to the cauee(q and manner ae stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - - l • Pronouncing end certHying phyelNen (Phys~ien both pronoundng ~ieeth and certifying to cause of death) 33c. License Number 33d. Date Signed (Month, day, year) To tM best of my knowledge, death oceurred at the time, date, and place, end due to the cause(s) and manner as atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Exsmlrxr/Cororxr / M (~ of Z Z ~ ~ 'V I O a On the basis of examinaNon and I or InveatigMlon, In my opinion, death otx:urred at the time, date, and place, and dire to the cause(s) and manner as atated_ ^ 34. Name and Address of Person Wfa eted"Cause Death (Item 27) Type !Print 35. Registrars Signatur District Num 36. Date FlI Mo y, year) ~4 ~yYZS H- Z/~-.~t--~~~r~...-v~_ Disposition Permit No. - ~ ~ l 0~ / © ~ ~ i C7 _ ~. -x~ ..~.=' 'Q 4r.., 1_i_ i <_ .'r"... ~ r ~ T' C7 OATH OF SUBSCRIBING WITNESS(ES~' ~ ~ r°_ ~ _, ~~~ , .. -; ;,,, ~ ~ _ . -- REGISTER OF WILLS ` ; -~ ,, ~ ~ ~ :~ __ ~ .~ ~ COUNTY PENNSYLVANIA •~' , ^- `;~ a , ~ --~ ~. Estate of _~~ ~"(,~_,(~ ~ f ~'' l !"J ~ ~ ~ /~ ~.~ i'~.../y~;r-r;~% ,Deceased 1-~ ~ ~~-~ ~ S ~''~ ~~ erv ~ ~ ~ ~ ~' !?- ~'" SS~it~ f C, (each) a subscribing witness to (Print Name/s) the;l~ 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. a~~~~~ (Signature) ignature) (Street Address) ~ ~,1 ~~ ~-~ ~ ~ ~-- (City, State, Zip) Execaated in Register's Office Sworn to or affirmed and subscribed before m_e this day of Deputy for Register of Wills (Street Address) U~-~'Yl r Pct. t~(~--~ (City, State, Zip) Execaated oast of Register's Office Sworn to or affirmed and subscribed before me this ~ _ day of ,~~~ Not y Public My Commission Expires: (Signature and Sea] of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Offilcer authorized to administer oaths. Please have present the original or co Q' i ~~I~A Notarial Seal Kimberly K. Gibney, Notary public Fornz RW-03 rev. 10.13.06 New Cumberland Boro, Cumberland County My Commission Expires May z8, 2014 Member. p'ennsvivania Assvclatfon of Notaries • 1 ~.: s-~. r,.. "", :v ` ~ ~-rte C .D . ... ~..f, t"~ II~ I, GRACE MARIE FRANK, of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all prior Wills and Codicils. T-PTT Jr T T d LL. ~ .L ~ ~n ~-.rt=~ 11 L1V1 1. 1 t~ll C%l. l,llc~l, 1,110 E~NenJ~GJ Vf ITly 1Q.:J ~ 1111iLJJ Ci11U lurll~..rai r.. c: ~.,a.tu from my estate as soon as practicable after my death. ITEM II. I direct that my real estate be held for the use of my children during their lifetimes. My children residing in my residence shall pay the real estate taxes, :insurance, utilities and the cost of repairs. My son, LEE ALEXANDER FRANK, shall have a lifetime lease in the real estate for him to use as his residence. At tl~e time of the death of my son, LEE ALEXANDER FRANK, if none of my other children choose to live in the property, the property may then be sold with the proceeds distributed pursuant to the residuary paragraph (Item IV below). If th.e property has not been sold when only one of my children is still living, the property shall become the sole and separate property of that child. PAGE I OF IV ~ r ITEM II:I. I hereby reserve unto myself the right to make a list disposing of items of personal property. If I make such a list, from time to time, it will be signed and dated, will describe the items to be devised and the individual devisees thereof. If no such written statement or list is found and properly identified by my Executor within thirty (30) days after the issuance of Letters Testamentary or Letters of Administration, it shall be presumed that there is no such statement or list and any subsequently discovered statement or list shall be ignored. Any reasonable distribution expenses incurred with respect to tangible personal property, including but not limited to packing, shipping, storage and insurance expenses, shall be paid by my Executor as an administrative expense of my estate. These items are being distributed as a remembrance of my life. iTEivl iV. i give, devise and bequeath ail of the rest, residue and remainder of my estate of whatsoever kind and wheresoever situate, in equal shares to my son, CLARENCE MICHAEL FRANK, per stirpes; my son, JEFFREY EUGENE FRANK, per stirpes; my daughter, ELAINE MARIE GROVE, per stirpes; my son, RICHARD MARK FRANK, per stirpes; and my son, LEE ALEXANDER FRANK, per stirpes. ITEM V. I direct that the bequest to my son, LEE ALEXANDER FRANK, shall be held in trust for him. ITEM VI. In the event that a Trust is created by or as a result of any part of this Will for my son, LEE ALEXANDER FRANK, the duties of the Trustee shall be to administer the terms and conditions of the Trust as follows: PAGE II OF IV r_ r a. To pay the net income together with so much of the principal thereof as Trustee shall consider advisable for the beneficiary's support and care after taking into consideration all other readily available assets, sources of income and other resources. b. If the beneficiary shall die before receiving final distribution of his entire share, the undistributed balance shall be distributed outright to my residuary beneficiaries, per stirpes. ITEM VIII. I nominate and appoint my daughter, ELAINE MARIE GROVE, my son, RICHARD MARK FRANK, and my son, CLARENCE MICHAEL FRANK to serve as Co-Trustees for any Trust established in or created by this Will. If any of one of them is unable or unwilling to serve the others may serve together or serve alone. ITEM VIII. I nominate and appoint my daughter, ELAINE MARIE GROVE, my son, RICHARD MARK FRANK, and my son, CLARENCE MICHAEL FRANK, Co-Executors of this my Last Will. If any of one of them is unable or unwilling to serve the others may serve together or serve alone. ITEM IX. I direct that my Co-Executors and Co-Trustees or their successors shall not be required to give bond for the faithful performance of the appointed duties in any jurisdiction. ITEM X. I direct that all taxes due at my death or as a consequence of my death shall be paid from my residuary estate. PAGE III OF IV • IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of ~~.~~~ ,2011. GRACE MARIE FRANK „~~ ~ ,~ Signature Print or Type Name Signature Print or Type Name