HomeMy WebLinkAbout08-02-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
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Estate of ~ t.~;~~ N'~ ~-~ • ~~~t~~=j-{L (' j ~~" Deceased ESTATE NO: 21- (~ - ~`-L~J
a/k/a:
a/k/a:
Petitioner(s) who is/aze 18 yrs of age or older, apply(ies) for: COMPLETE SECTION °A' or °B' AND "C" as
a~pp~able:
~'A. Probate and Grant of Letters Testamentary or pAdministration c.t.a., or d.b.n.c.t.a. (complete Part C' also)
and aver that Petitioner(s) isfare entitled to the aforementioned Letters ~~ i f~i~~'Yu ~~.~ _ under
the last Will of the above-named Decedent, dated %li1%% I~l ~r1;~~.~- and codicil(s) dated
(State relevant circumstances, e.g. renunciation, death of executor, etc.}
Except as follows, Decedent did not many, 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 Gme of death wherein grounds for divorce bad been established as defined in
23 Pa. C.S.A. § 3323(8):
D B. Grant of Letters of Administration
(If applicable, enter d.b.n., peadent life, durante abseatia, deraate 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(8), except as follows:-
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THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County,
At 1 7, i l~ C'AA-,!'./ ,i ~"~~-` i~', ~,A~-il ~.~1-Hit ~ ~1
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with his/her last family or principal residence
(Street address with Post Office and Zip Code, Municipaliry_ Township, Borough, City)
Decedent, then ~~ ~ ~ '~'
1:~ years of age, died d~ ~L.l at __ f-(~ai/ F l S ~y" _l I ,~!-~
(Month, Day, Year of death) (City ark State where death occurred)
Estimated value of decedent's property at death:
tXl' domiciled in PA All personal property S JK i' L~ i.> v
If not domiciled in PA personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
!value of Real Estate in Pennsylvania $ ~ ~- v+ O.~ J
Total Estimated Value $ ~; ,~~
Location of Real Estate in Pennsylvania: (Provide full address if possible.) (~i ~ ~% ~~~t jam( ~~ ~ C13~t~~!- ._, ^ I I ui I
Signature(s)
Namefsl & Mailing Addrece(PCl
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RINT IN
Ev 11/2W5 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
,NEM
f'"K CERTIFICATE OF DEATH
(See instructions and examples on reverse)
1. Name of Decedem (First mitltlle, last, suffix) STATE FILE NUMBER
n / J j~ ~ ~ ' `L y~ % 2. Sex 3. Satial Sewrlly Number 4. Date of Death i Month, dayyear)
~l 'v `.l l-r cb~ 204 _ 03 ~ 1644 `~ _ 2 L _ 2 U~~
5. Age (Last elrmtley) under 1 year UrMer 1 day 8. Date of Birth (Monts, tlay, Y~z) 7. BIrM O
(~ Mature news Hove Nmvree O ~ place (Cly antl slate or foreign caanry 8a. Place of Daem (Check only one)
"l ` ~~ - ~g ~q McAdoo, PA HPapimc °the`
vrs. 77[[.,,
8h. County of Death Bc. Crty, Bom, TWP. of Death L'J Inpetiem ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other ~ Speciy:
8tl. Feaildy Name (If rot Insleution, gNe street end number( s. was Decedent of Hi
Dauphin Lower Paxton 1tap. Community General Hospital ly c~ba~n~a ongi^? "° ^vea ,o Rate: Amehaan lndien, eletk, wntte, att.
(If yes, spec oac~o
11. Decedents Usual Oct eon Klyd of work done dud rtpst of world file. Do not slate retired 12. Was Decedent ever in me 13. Decedents EtlucaBOn Mexken, Puerto Rican, etc.) I S W [11 t e
KinO of WOm Kind N Business I Industry U.S. Armed Forces? ISpetiy any highest grade mmpkled) 14. Madlal Status: Manietl, Never Mametl, 15. Surviving Spouse (II wife, give maiden name)
maintenance Elementary/Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (SpeciryJ
federal overnmen C;Crea ^No 12
18. Decedent's Mvling Address (Street city /town, stale, zip code) D i V O r C e d
DeCBdent~' PA Did Decedent
1310 Carlisle Road AmaalRealdence ,7a.Sate LNelna nt.~] Yea.DecedenrUveOio Lower Allen
fro. count' um er an Township? Twp,
I7d. ^ No, Decedent Lived wimin
18. Famer's Norma (Flst mlddk, lest, suffix) Acmel Limits of Ciry f Boro
John Joseph Dougherty f9.Mother's Neme (First middle, maiden surname)
20e. InlomrartYs Name (Type/Pnntj Anna Brennan
20b. Inlomtant's Meiling Address (Street city! town, slate, zip code)
Elaine M. Herald
2, a. Methdd of Dlaposi8on 1318 Norwa Ma le Court New Cumberland PA 17070
! f'] Cremation ^ Donation 21h. De1e of Dispositbn (Momh, tlay, year) 21 c. Place N Dia
^ Sunal ^ Removal from State Wea Cromedon or Dowtlon Authorizedr~/r pwitian (Name of cemetery, crematory or other place) 21 d. Locatlon (Ciry r town, state, zip code)---~
^ o1hef Saet+h ' byMetllnlEx.miner/cozonen I[yves^NO 7-25-2011 Evans Crematory
22e. Signs I Serv Lk;ensee (or cerson acting as such) S c has f f e r s t own , PA
22b. License Number 22c. Name end Address of Facility
~ ~~~ FD 012-848 L Parthemore FH&CS INC. PO BOX 431, New Cumberland PA 17070
Complete Items y when nrfityirg 23a. 7o the best of krow/ed deem attuned at the tlme, date end
physkian Is not avallabla at tlme of death to ~ ~' place stated. (Signature and title) 23b. License Number
cerlay cause d deeM. 23c. Dare Signed IMOnth, tlay, year)
Items 2426 mull ba completed pt' person 24. Time of Deetn 25. Date Pronounced Deed (Month, tlay, year)
who praaurces death. 26. Was Cese Refenetl to Medical Examiner I Coroner for a Reason Other ban Crernatkn or Donatbn?
9•z}' M. k~ ZZ ~.~) I ^Yes ~No
CAUSE OF DEATH (See inetruglons end examples)
Item 27. Pan I: Emer me ~hekr of events -diseases, injuries, or conpikatiorw -met tlhectry cawed the death. W NOT enter terminal events such as cardiac arrest, ~ Appr°xunete interval: Pen II: Enter other aknxinnt nMittons ~rrt rt
respiratory anesl, or ventnculer hbnllatkn wehoul showing the etbbgy Lial Dory one cause on each Me. Onset to Death M k'G 1g9e5w, 28. Did Tobacco Use ConMbure to Deam7
r but not resulting in tt1e untlenying cause given in Pan L ^Yes ^ Probaby
IMMEDIATE CAUSE IFlnal disease or ~ [] No ^ Unknmvn
condition resulting In deem) _~ a. ~ ~~ / /1 ~ / /~-. r
Due to (or ass ~ ~ ,h'- ~/` ~~C r 29. f Female.
consegwn a of) ~ ^ Not
seque~nheuy list corrdiltona, it awry, b. _ ~~~ ~ / /1 ~ ,~,v ~7 ~Y ~~C~. pragnam witmn past year
teed to the cause listed on Hna a. (// Rr' /OC ~
Emer UNDERLYING CAUSE D e to ( as a conseq ante of) ^ Pregnant at lime of deem
(disease or Iryury met initiated Me ~
events resuPong in death) LAST. a~ ^ Nol pregnant. bur pre{Inapt wdhin 42 days
Due to (or as a consepuence olj: - ~ al Beam
d' [] Not pregnem. out precnant 43 days to 1 year
r before death
30a. Was an ANOpsy 30b. Were Amapay FiMMgs 31. Manrrer of Deam r [] Unknown it pregnant within the past year
Pedomwd? Availebk Pdor la ComPletlon 32a. Date of Injury (Momh, daY. Year) 32h. Deacnhe How Injury Occurred
of Cause of Death? ®Natural ^ Homiotle 32r,. Place of Injury. Home, Fenn, Street, Factory,
D8ce Buadirg, etc. (Sped y)
^ Ves a No ^ yes ^ No ^ AcciOenf ^ pending Investigation 32tl. Tone of Injury 32e. Injury at Work? 32f. It Transportafion In u
1 ry (SP~YI 32g. Catalan of Inlury IStreet ciy /town, state)
^ Suicide ^ Could Not be Delannlned ^Yes ^ No ^ Driver r Operekr ^ Passenger ^ Petlesman
33a. Cenlfier (check any one) M. Other ~ speedy:
• Certgylrg physklan (Physician certkydrW cause of deem when Brother physiden has pronounced deem antl completed Item 23) 336. Signature and Tble of rfifi
To the best of my Imowdadge, deeM occumed dw to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,
• Pronouncing and nrNlylrp phyaklan (Physcian born pronouncing death aM centtying m cause of deeM) - _ - ~ ~ - - - - - - - ~ - - -' ^
7o tlw beat of my knowledge, deeM occurred at the tlme, date, and place, antl due to the tau a and manner ass 33c License Number 33tl. Date Signed (MOnm, day, y¢ar)
• Metlkal Ezeminer /Coroner eBl) fated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ _ \ ,.
On dre basis m exsmire8on end / or Inveatlgetlon, I^ my opinion, deeM oeeumed at the time, date, end place, eM due to Me nose(s) and manner ss statM_ ^ ~ ~ ~ ~ ~ O ~ ` ~ Z /zl~`
34. N e and Address of Person Who Com I tad Cau of Daem (Item 27 7 e ~ Pont
35. Registrar's Signet ntl Dist~NugMyr,a ~..~ I ) I [ / / ~ ,r ~ ~ / y p~ _ ,v cep ~ _ .,~ yp
~j ~ ~ / ~ 1 1 36. Del¢ F d (Month day,_Ve^r) !_' ~G,~~J:~( ~~(,t',(~
7~~ //s ~/ 4:300 ( rrsb~ ~ ~i A 7
Disposition Permd No. _~10 `'Y,
LAST WILL AND TESTAMENT ~
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JOHN J. DOUGHERTY ~~~-'`~ -T:
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I, JOHN J. DOUGHERTY, of Camp Hill, Cumberland County, Pennsylvania, do
make, publish and declare this to be my Last Will and Testament, hereby revoking all
Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executor out of the property passing under ITEM IV of this
Will, as an expense and cost of administration of my estate. The Executor shall have no
duty or obligation to obtain reimbursement for any such tax so paid, even though on
proceeds of insurance or other property not passing under this Will.
ITElVI II; I direct the Executor to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an expense
and cost of administration of my estate. I also direct that my body be cremated and my
ashes be disposed of at the discretion of the Executor.
ITEM III: I specifically give, devise and bequeath the following:
a) Fifty Thousand Dollars and 00/100 ($50,000.00) to my brother,
AUSTIN DOUGHERTY; and
b) Fifty Thousand Dollars and 00/100 ($50,000.00) to my niece, ELAII~IE
HERALD.
ITEM IV:
I devise and bequeath the rest, residue and remainder of my estate as follows:
1) Twenty-Five (25%) to be paid to my sister, MARY DONAGHY. In
the event my sister predeceases me, I direct her share shall be
divided equally between the remaining beneficiaries named in
subsections 2), 3) and 4) of this Item;
2) Twenty-Five (25%) to be paid to my brother, AUSTIN
DOUGHERTY. In the event my brother predeceases me, I direct
2 ~
his shaze shall be divided equally between his spouse, if she survives
me, and his surviving issue;
3) Twenty-Five (25%) to be equally divided between the surviving
issue of my deceased brother, CHARLES DOUGHERTY; and
4) Twenty-Five (25%} to be paid to my brother, LAWRENCE
DOUGHERTY. In the event my brother predeceases me, I direct
his shaze shall be divided equally between his spouse, if she survives
me, and his surviving issue.
ITEM V: In the settlement of my estate, my Executor shall possess, among
others, the following powers:
(a) To retain any investments I may have at my death, as long as the Executor
may deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and conditions
as the Executor may deem advantageous to the estate, any or all real or personal. property
or interest therein owned by the estate;
3
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the Executor's judgment deemed necessary or
desirable for the proper and advantageous management, investment and distribution of the
estate.
ITEM VI: Any person who shall have died at the same time as I shall have, or
m a common disaster with me, or under circumstance that the order of deaths cannot be
established by proof, or within thirty (30) days of my death, shall be deemed to have
predeceased me.
ITEM VII: I appoint my brother, AUSTIN DOUGHERTY, to be Executor of
my Estate. In the event my brother, AUSTIN DOUGHERTY, cannot act or refuses to
act as Executor for any reason, I nominate, constitute and appoint my niece, ELAINE
HERALD, as alternate Executrix. The Executor(trix) is specifically relieved from the
duty or obligation of filing any bond or other security.
~~
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding four (4) pages, at the end of each
page of which I have also set my initials for greater security and better identification this
day of June, 2005.
(SEAL)
HN J. UGHERT
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testator as and for his Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the day
and year first above written, and we certify that at the time of the execution thereof, the
said Testator was of sound mind and memory.
Laura J. ghes
Amanda L. Baker
Residing at: 123 Seventh Street
New Cumberland, PA 17070
Residing at: 20 Stiles Drive
Marysville, PA 17053
S
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA ,
COUNTY OF CUMBERLAND ~ SS.
I, JOHN J. DOUGHERTY, Testator 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 the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
Sworn to and subscribed
before me thi /~ day
of June, 2~ ~-----~
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~____~~
~'`~NOTARY PUBLIC
My Commission Expires:
(SEAL)
NownK six
e~eNr~ -suwv~w
NEW'CIMMERL1IND BOROUGH
CUMBERUV~D COUNiY
Commlalon Nov 15, 2007
(SEAL)
HN J. D GHERT
6
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA ,
COUNTY OF CUMBERLAND : SS.
We, Laura J. Hughes and Amanda L. Baker, the witnesses whose names are
signed to the attached or foregoing instrument, being dul}~ qualified according to law, do
depose and say that we were present and saw Testator, JOHN J. DOUGHERTY, sign.
and execute the instrument as his Last Will and Testament; that Testator signed willingly
and he executed said Will as his free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testator signed the Will as
Witnesses; and that to the best of our knowledge the Testator was at that time eighteen
(18) or more years of age, of sound mind and under no constraint or undue influence.
~GV / L
WITN ~ S
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WITNESS
Sworn to and subscribed
before me phis 7 /S~ day
of June, X00
,~~-J';~
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~` NOTARY PUBLIC
My Commission Expires:
(SEAL)
Novu~uu sou.
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cuare~awau courm
commkrion Nov i s. zo0~
7