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HomeMy WebLinkAbout09-01-11 PETITION FOR P'FtOBATE AN® GRANT OF SETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLV Estate of Gerald R. Zimmerman File Number r also known as ,Deceased Social Security Number Jere D. Zimmerman Petitioner(s), who is/are 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 EX@CUtOr named in the last Will of the Decedent, dated 061~1I2009 and codicil(s) dated .Ipffr~ M_ immermanr,pamari Cn_FYpcutnr~ rpnnunr_pd his right fin art as a Cn-FYpr_utor of this Eatatei~favnr nf.lerp D_ ZimmPrman_ State re/evantcircumstances, e.g., renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in Pa. C.S.A. § (g); did not have a child born or adopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: No Exceptions ? B. Grant of Letters of Administration (Ifapplicab/e, enter.' c.t.a.; d.b.n.c.t.a.; pedente liter durance absentia; durante minorifate) Petitioner(s), after a proper search, has/have ascertained that Decedent left no WiA 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 on Section A above 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 Pa. C.S.A. § (g), except as follows: Name Relationship Residence ~ ° .`C'1 fed . 7 F.~ . ::.,.j ~ :::r~.'~ r , r (COMPLETE IN ALL CASES:) Atfach additional sheets if necessary. . ~ L~ ~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at ' ~ Bethany Village, Wilson Lane, Mechanicsburg, Lower Allen Township, Cumberland County, Pennsylvania (List street address, town/city, township, county, state, zip code) Bethany Village, Wilson Lane, Mechanicsburg, Lower Allen Decedent, then years of age, died on at Township, Cumberland County, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Persona! property in County $ Value of real estate in Pennsylvania $ situated as follows: None 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: Signature Typed or printed name and residence Jere D. Zimmerman Shannon Road ~ Boiling Springs, PA Form RW-02 Rev. 12-26-20os (interim form, pending action by the Courf) Copyright (c) form software only The Lackner Group, Inc. Page 1 c Oath of Personal Re resentative {~,~y COMMONWEALTH OF PENNSYLVANIA } SS ~ ~ ~ ~ ~ - CouNTY of Cumberland } ~ , The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and corref~best~fr - the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will we ~tru~- ~ - administer the estate according to law. ~ ~r~ -r~ Sworn to of affirmed and subscribed Signatu e f Personal R prese ative Jere D. Zimmerman befo me this day of Signature of Personal Representative For the Register Signature of Personal Representative File Number: 'r Estate of Gerald R. Zimmerman ,Deceased Social S urity Number: y` JDate of Death: AND NOW, ~ r ( , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Jere D Zimmerman in the above estat= and that the instrument{s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES ~ • Q ~ Letters $ - Register of Wills r}~; Short Certificate(s)........~t~....... $ ~ Q e unciation(s) $ - ~ Attorney Signature: r ~ ~ $ Aftorney Name: Je nifer B. Hi ~U ~ ~ ~ Supreme Court LD. No.: x§556 Bogar and Hipp Law Offices ~ Address: 1 West Main Street $ ~ .Shiremanstown, PA ~ Telephone: TOTAL $ J l.fr~ V Form RW-OZ Rev. Copyright (c) form software only The Lackner Group, Inc. Page HIOi.S(lj ftF.A' lilt/n'i i ~ LOCAL REGISTRAR'S CERTIFICATION OF DE,A,T'H WARNING: It is illegal to duplicate this copy by photosl:at or photograph. Fee for this certificate, ,,,u~~~~"""----., Phis is to certify that the i~iformati~~)~ hire gi1 ' ~jH OF P , ,1i ~t~,P Fy~"- _ correctly copied from is n original t: erti ~icate of . lam`, duly tiled with me as Loral Regi~~t~-ai . 'he or ~ z~ certificate will br~~ forwarded to the State ~ y ~a~ Frecords Office for permanent fit jng. Certification Number ''''91--f N~~~""jq~~~ Local Re~gstrar Datf~ Issue ~ t , ~ ~ ~ - _rm Z3 1 . ) - - . ...+1J r--'.. ~ - _.7.i i REV COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS r PRlrrt IN ' CERTIFICATE OF DEATH ACK INK (See instructions and examples on reverse) STATE FILE NUMBER Plerrre d Detailed (Flrot, midrb, leaf, suHdt) Sex Soda) Security Ntmba Date d Death (Month, day, year) Gerald R. Zimmerman male Aug.24,2011 Age (Lest Bktlrday) Under 1 r Under 1 de Date d Birth Month BI C end state a I Be. Place o1 Deem Ctreck ml are - ~(he Days ~e Ae~ Hospital: Other: - - 9 3 y,~• Dec . 4 , 7 New Cumber 1 and , Inpatient ? ER /outpatient ? DOA Nursing Hans ? Residence ? other - spedly: i1b. County d Deatlt CNy, Boro, Twp. d Death 8d. FadNy Name (M not krotltrfion, give street and number) Wee [kcedent d Hiepank Origin? No ? Ytrs Race: American Indian, Bledc, Whit, c Cumberland Lower Allen Bethany Village i~~n'°R~,aro.) wshte DacederM's lleud d work done moat d fife. Do ref stab Wee Decedent aver m the Decedenye C-dreatbn (Seedy ony highest grade completed) MerBal Status: Mertied, Never Maned, Surviving spouse wife, give maklen name) i(ind d Work IOnd d Busiraas I Industry U.S. Armed Forces? Ebmerdary / Setxxtdary College a Wkfowed, ~o~ (~byl minister church Y„ 4 widowed i8. DeaeaeM's Mailing Address (street, dty /town, state, zip coda) DecedenPs P e n n S y 1 V a n 1 a Did Decedent Tx Actual Residence 17a. state live Ina 1?c. ~M'ea, Decedent Lived In L a w e r A e n Wilson Lane, room um er an TownstriP? fro iTd. ? No, Decedent Lived within M ChaniCabur PA A~IL~+nso+ _cny/eo, Father's Name (First, middle, feat, suffix) Mothers Name (Fleet, middle, maiden stmnarne) John Milton Zimmerman Maria Jennie :Hoffman 20a. Inlonnerrt's Name (Type I Print) 20b. Inlomanra MaNkg Addreee (Street, d y I town, elate, zip code) Jere D. Zimmerman Shannon Rd.,Boiling Springs, PA a. Aletlpd d Dfspoeition r ? C~~ ? D~t~ 21b. Date d Ofepoe8bn (Month, day, year) 21c. Pkos d Ditpai8on (Nanw d cemsbry, cremeMry a other place) d. Location (City! town, state, nP code) - ~ 1J4olT Burial ? Remaaliromstate ~ ~ee~~( AutlroHzed? Y~? ~ Aug. 1 Rolling Green Cemetery amp Hill, PA 1 1 - - _ F (a person ailing ere such) 22b. Llcenee Number 22c. Nerve and Address d Fsc9fiy D-013163-L MusselmanFH&CS,324 Hummel Ave.,Lemoyne,PA IMms 23e•c Drily when eertlhAng 23a. To the best d my krrowledge, death occurted at ale rMte, date and place stated. (SigrratUre and 1MIe) 2:ib. License Number 23c. Date Signed (Month, day, year) phyeidar b eat eveilebb et rise d death ro r aertfiy serve d deaam. ~ 5 ~ SDc~4 t1 L ~ ~ Zp c { ~ Torre d Death Date Praaunced Deed Monm, der Ilertls must be co~e1•d by parson ,q ( y, year) Were Casa Refer~rejd to Medfeal Examiner / Gasser for a Rea Other than Cremation or Donatbn? ~ who prorrorrrnoec death. D 7 t J p-M• ~ ~ ~ aO 1 r ? Yes till NO CAUSE OF DEATH {Sea instructions an examples) ,Approximate haerval: Pori II: Enter other Dkt Tobacco Use ConMbute to Death? Item Part I: Enter the drain devents - dfseeses, Injuries, a cortpNceBons • that directly caused dre death. DO NOT order terminal events such as cardiac errost, r Onset to Death but not resutdng M the underlying cause given fn Part ? Yes~ reepiretory ertea, or venMcula flbriNatlon without the etiology. List a,y are muse an each Bne. r ~y Probably r r_I No ? Unknown ~dea~ a. ~ N ~ /v ~ n f~ / " ; 'Y ~C.~~GI rC7~-A'~~~'~ ~ /QC~I /t2M /a If Female: Due to (a ae a corxtequerroe d}: r ? Not pregnant within pest year yy cp,~,ry Harry ; C~2C/Nf~m A PROS"Ti4Tf ? Pregnant at time d death b. Elder ~IMDERLYtl GdCAUS~E a Due to (or es a cansequerxx of): ; ? Not pregnan4 but pre~aM wf8rm days - (dleeaee a injaY that irraisted ~ c ; Q ys GN /~G~.I Q d death ~ evenb rn deem) r ? Not pregrrent, (xd pregnant days to 1 ye Due to (a ere a of): r before death ~ d• i - ? Unknown H pregnant within me past year 30e. Was an Autopsy 30b. Were Autopsy Findktgs Man d Deem 32a. Date d Injury (Month, day, year) 32b. Describe How Injury Ocarted 32c. Place d Injury: Hortre, Farts, Street, Factory, Performed? AvaHebb Prbr ro Compledon Natural ? Fbrnirtide Office Building, etc. (SpecHy) d Cause d Deem? ? Yes {Q No ? Yes ? No ? Accident ? Pendrq Investlpetion 32d. Tkne of Inury 32e. Injury at Work? 3N. H TrarutwrfaHon h~ury (SpecMy) 32g. Locaton d ir>Jury (Street, city /town, state) ? S~be ? Could ~ be D~~~ M ? Yes ? No ? Driver I Operator ? Paeeerger ? Petlestrian Other - Spedly: 33a. Certlfler (dreck any one) 33b. Signaturo and Title d CerCfier 1 ' • certUyfng phyekNn (Phyaiden ceNlyrrg cause d death when erro8ter phyekdar tree prorrorerced deem end completed Item ~,t_~,~,,.y~,,/~ati /~Y m Totir(tsetafmylaawbdpe,desthoacu?ndduetothaaues(s)andmnneraeteud~-------------------------------- Pralolxrehlg affil oeRHyMq physieieti (Physician both praroteroirtg deem and oertMykq ro reuse d deem) 33c. License Number 33d. Date Signed (Month, day, year) To ttta beat al my knoMdsdge, death aaurted at the dms, dots, end pboe, end due b tfw ofiWe(e) and rnenner se ebbd_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ? 1M ~ Z(9 S~ ~ Zca ~ / / • Msdkd IexaminerlCaoror On the beak d sxemtratlon ant / or Imreetlgefloty m my opinion, dsNh oecumd H the time, deb, end plax, end due b fM cwee(e) and manner a sbbt~ ? Name aril Address d Person Who Canpleted Cause of Deem (Item Type I Print Registrars signawre and t]Iatrki Number ~ I / I 1 I ~ 3s FAed ( day,year) 3l^ St. v7-Yr.erLC..c 2 C~~ ~ Dlspositlon PemnH No. D ~ ~ v ~ v ~ ~ J::) --fit ~r ~ r , ~ 4 OATH OF SUBSCRIBING WITNESS(ES) ; ~ t REGISTER OF WILLS ~ =~i CUMBERLAND COUNTY, PENNSYLVANIA `~l-(~'~~~f Estate of GERALD R. ZIMMERMAN ,Deceased Jennifer B. Hipp and Beth B. Lengel (each) a subscribing witness to (Print Name/s) the ~ Will Q Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he 1 they was 1 were present and saw the above 7['estator /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. (Srgnat fifer Hipp (Signature) Beth B. Irengel One West Main Street One West Maui Street (Street Address) (Street Address) Shiremanstown, PA Shiremanstown, PA (City, State, Zip) (City, State, Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed before me this day before me this _ ~of~ day of of oho ~ ~ C~t~ Deputy for Register of Wills Notary Public My Commission Expires: ap~3 (Signature and Seal of Notary or other ofi~cial 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. $I~MAN$TOwN MY COMMISSION EMPIRES A11611SZ RENUNCIATION ~ ~ j ~ REGISTER OF WILLS ~ Wit.., CUMBERLAND COUNTY, PENNSYLVANIA =m Estate of Gerald R. Zimmerman ,Deceased I, Jeffrey M. Zimmerman , in my capacity/relationship as (Print Name) named Co-Executor of the above De;cedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letter ? be issued to Jere D. Zimmerman r August (Date) (Signatur Marie Avenue (Street Address) Severna Park:, MD (City, State, Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciation for the purposes statE;d within on this c>7[~ fh day of ! 1 Deputy for Register of Wills Notary Public: My Commission Expires: /c~ f ~ ~ / (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH DI: PENNSYLVANIA NOTARIAL SEAL Form RW-06 rev. BETH B. LENGEL, NOTARY PUBLIC SNIREMANSTOWN BORO., CUMBERLAND COUNI~ IVIY COMMISSION EXPIRES DEC.