HomeMy WebLinkAbout08-26-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of PEGGIE K. DICK
a/k/a:
a/k/a:
a/k/a:
Deceased ESTATE NO: 21- ~ - 1`-%l~Il ~ _
SS NO: 201-18-7350
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' A.ND "C" as
applicable:
O A. Probate and Grant of Letters Testamentary or ^ Administration e.t.a., or d.b.n.c.t.a. (coniple'F Part C also)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters TESTAMENTARY __ under
the last Will of the above-named Decedent, dated 11/1/2005 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 I'or divorce had been established as defined in
23 Pa. C.S.A. § 3323(8): __
^ B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent life, durante absentia, durante minoriitate)
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 e.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 8rounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except: as follows:
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Name Address ReHPti~hi to Decedent -'~'
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THIS SECTION MUST BE COMPLETED: "' ' --r-t
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At BETHANY VILLAGE SKILLED CARE 5225 WILSON LN RM 22 MECHANICSBURG PA 17055 _
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then
years of age, died
Estimated value of decedent's property at death:
If domiciled in PA
If not domiciled in PA
_If not domiciled in PA
_Value of Real Estate in Pennsylvania
at
(Month, Day, Year of death) (City and State where death occurred)
All personal property $ 2911000.00
Persona] property in Pennsylvania $ __ 0.00
Persona] property in County $ ___ 0.00
$ _ 0.00
Total Estimated Value $ 2911000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) NONE
Signature(s)
Name(s) & Mailing Address(es)
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86 8/16/2011 MECHANICSBURG, PA
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Intcnm Furm RR'-0'_ revved I.~6.10 by Cumberland Cowtry pending action by the Court Page 1 0(2
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petition acre 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 ar affirmed and subscribed
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before me this _ -~ (,y" dax of
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For the Register ~~~, ~:~ ~ ~= ~~-'
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DECREE OF PROBATE AND GRANT OF LETTERS
Estate of PEGGIE K. DICK ,Deceased File Number: 21- ~(1 C -_(~~ ~`
AND NOW, this ~ day of ~C;~6~C:;~ ~ ` , in consideration of the Petition on
the reverse side hereon, satisfactory proof havt`i1g been presented before me, IT IS DECREEL> that Letters
x Testamentary of Administration are hereby granted to:
Q(applicable, enter c.l.a., d.b.n., d.b.n.c.t.a., ctcJ
__ PAMELA K. FRAZIER, EXECUTRIX in
the above estate and that instruments(s) dated ii/t/zoos described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
Glenda Farner Stras augh,
Register of Wills ~I'~--t~ ~ ~-~~~~-~~~ )~:i~ ~~ 1 CAL (~?
FEES:
Letters ....................$
Will ........................ 1,~ U
Codicil(s) .................
(~) Short Certificates ~ . O 1
( )Renunciations.......
Bond .............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
k ;?•838•
TOTAL ................$
Signature of Counsel Required to Enter ,Appearance
Atty's Signature
PRINTED Name: _
Supreme Court ID No.:
Address:
Phone:
Fax: __
hltcrim f=orm R~~'-UZ rceisccl I ~.~6J0 by CumbcrLind County pcnclin~ action by t(~c Court } asc ~ ~( ~
OCAL REGISTRAR'S CERTIFICATION OF DEA"I"H
WARNING: It is illegaN to duplicate this copy by photostat or phatogratah.
Fee for this rertifirlle, ~;h lN1 ,;,~~; _
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1 REV 11/2006
I PRIM IN COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
4" K",NM CERTIFICATE OF DEATH
(See Instructlona and examples on reverse) .,_.__ _.. _......___
1. Name of Decetlem (First, middle, last, sulfa) 2. Sex 3. Social Security Number 4. Data of Death (Monts, day, year)
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5. Aqe (last Birthday) Under 1 er Under 1 da 6. Date of Birth Month, de 7. Bi ace C' end state a fo ~ ceun Be. Place of Death Check on one
Mods Days Hours Mlnuhs Hospl181: Dthar:
$ 6 Yre
Feb . 21
1 9 2 5 West Fairview
PA
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^ Inpatient ^ ER / Ougretlent ^ DOA ureing Home ^ Residanra ^ Otlrer .Specify:
9b. Couny M DeaM 8c. Clly, Bao, Twp, of Death 9d. Fadltty Name (A Trot InaAMlon, glue street and nrsNrar) 9. was Oecedem of Hlspenk Ongkt7 ~ ya,a 10. Race: Amencen Itt6an, aleck, While, etc.
Cumberland Lower Allen (If yes, spedfy Cuban, - ISpary)
Bethany Village West Mexican,PuerroRicen,ell.) white
11. Decedem's Usual tlon ind d rood dote d rtasl of wrodd Afe. Do not slate retire 12. Was Decedent ewr M the 13. Decedents Educetlon (Spedty ony hlgMat gretle completed) 11. Merlrel SteNS: Merced, Never Married, 15. Surviving Space (N wRe, gNe meiaen name)
Kind of Work Kind of Business l Industry
homem
k U.S. Armed Fomes7 E iet~ ry ! Secorbery (D12) College (1-0 or 5+) ~' ~~ l~dM
a
er own home ^vae q wi w
16. Decedents MaNing Address (Sheet, dy I town, slate, zip code) _
Decedem's Did Decedent
Pennsylvania
4695 Sears Run Dr
Actual Reaidanca 17a. slate LNe Ina
17,c ~~„I,;~,n.~,~.fA,- n i i e„ TwP.
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Mechanicsbur PA 17050 Cum er and TownsNp?
17b. Court 1 ^ No, Decedent Lured within
ry
Actualun,RSgr cily,eom
16. FeMefs Name (Firer, mirJtlle, last, suffix)
Charles W
Wheeler 19. MotheYS Name (First rtstltlle, meMen sumeme)
• Florence M• Bretz
20a. IMormanYs Name (Type / Pnm(
Pamela K. Frazier 2~b m«~n Ys Melting Address (Street city /town, state, zip cotle) --
4Eiy5 Sears Run Dr.,Mechanicsburg,PA 17050
218. of DlsposMion r ^ Donation
Cramatlon 2tb. Date of Dlspgsttbn (Monty, day, year
I 21 c. Place of ry place)
DlsposHion (Name of cemetery, cremalo a other 21 d. Location lCiry sown, state, zq codel
Burial ^ RemovellmmState ~wucrerrretlonaDonehonAuMatred
t by Aledlcal Examiner/COrorrer? ^ Yes^ No
r Aug. 23, 2011 St.John's Cemetery echanicsburg,PA17055
22
are of Funerel Se Licensee (a person ~ng es such) 22h. Licerree Number 22c Name antl Addryss of FacNty
FD-013163-L Musselman FH&CS 324 Hummel Ave. Lemo rte PA17
Complete tterna 23ec sly when certllyhrg
physidan b npt available et fime of deem ro
h 23a. To th best d my Imov4edge, deem oaurted el the tlme, date end staled. Si eNre and AAe
Place (~ )
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23b. License Number
2 .Date Signed (Month, day, year
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Items 21-26 moat be completed by person 24. Time of DeaM 25. D Proraatced Dead (Month, tley, year) 26. Was Case Refertetl to Medical Examiner /Coroner fora anon OMer then Cremafwn or Oaatlon?
who Pronounces daeM. '70 n M- ` z O ~~ ^Ves ~No
CAUSE OF DEATIi (See Inatnzetlone a exempts) r Appreximete interval:
ttem 27. Pen I: Enter the then o1 awms -diseases, Injuries, or cortpllcetbns -Met directly ceusetl th tleaM. DO NOT enter terminal evenLS such es cardac crest t Onset to DeaM Pen II: Enter other '
but not resuttMg in the untlenying cause given In Pan I. 29. Ditl Tobacco Use CgntnbNe to Oeatho
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^ P
bl
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respiratory Brest or vemncular fibnllatbn wMOUi showing Are etiology. list onry one cause on each line. i
IMMEDIATE CAUSE (Fmel disease or
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23
If Fe
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Due to (or as a consequence og: ~ - Not pregnant wihin past year
Sequerrtlelry Am corWlAars, A any, o.
le~drg b the rave Acted an Are a ^ Pregnant et tlme of death
Eller Me UNDERLYING CAUSE Due to (or as a consequence of): ~ ^ Not
pregnant, but pregnant wdhin 42 tlays
(disease a InjurX Met Atltletetl the r of tleaM
ewes resuMng in death) LAST. c' ^
Due to (or as a consequence oQ:
- Nol pre
grant, but pregnant 43 days to 1 year
d before daeM
^ Unknown it pregnant within Me past year
30a. Wes an Auropsy
Padomred? 30b. Were Auropry FiMkgs
AvaAeble Prior to Compleaa 31. Manner of Deets
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^ 32a. Date of Injury (Monts, day, year) 32b. Dasalbe How IMury Occurted 32c. Place of In u Home, Fann, Street, Facto
Olfica Bu1Wlry~ etc ry~
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of Cause of DeaM? ~Neturel
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Homkitle P
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^ Ves L`_f No ^ Vas ^ No ^ 0.ccitlent ^ Pending Inwatigetion mod. lime of Injury 32e. IMury at Work? 321. If Trerrepatetbn Injury (S/.wcifyJ 32g. Locatlon of injury (Shea', r-iry; town, state)
^ Suicitle ^ Coultl Not be Detenninetl ^Ves ^ No ^ DrNer/Operator ^ Passenger ^ PedesMan
M ^ Other - speciy
33a. CerMar (check any one) 33b. SgnaNre arts Title of Canifrer
• GrtHying phyaldan (Physician cerdty'mg cause a de9M when anoMer physicun has pronourroed tleaM and Completetl Item 23) /ti-q~~~ . //y I-Y7 ~
To the best of my lorowledga, deem oeeumed due to the ause(e) end manner es etHed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -
Pronaundng end aNlylstg phyelden (Physician bdh prorrourxdng daeM end cerilying to rouse of daeM) 33c. license Nurrbar 330. Date Signed (Month, day, yeerl
To 1h• best of my kmwkdga, death occurred et the time, date, end place, end due to the uuee(s) antl manner a rdeletl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ rn p [
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• MadlalEwnhrr/Coroner , 4~ l7 2011
On the testa of sumMetlon sM I or Inwe6geUon, In my opinion, death occurred N the thee, dale, antl place, and due to the a
ace(s) end menrrx as staled- ^
34. Name and Atltlresa a Person Who Completed Cause of DeaM (Item 27) Type r Print
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Dlsposieon Permtt No. U ~ ~ ~ ` ~ t
'~a~t ~iIC attb ~e~tatttent
OF
PEGGIE K. DICK
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I, PEGGIE K. DICK, of Bethany Village, Mechanicsburg (Lower Allen Township),
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declar? this as and for my List'.^!ifl and Testa~~~ant,
hereby revoking all other Wills heretofore made by me.
ARTICLE I
I direct the payment of my legal debts, the expenses of my last illness and disposition of
my remains and any inheritance, estate or other taxes that may be assessed in consequence of
my death from my estate as soon after my death as conveniently may be done. All of the
foregoing shall be considered expenses of the administration of my estate.
ARTICLE II
I direct that my Executrix distribute my tangible personal property as follows:
A. My ring comprised of a one carat diamond in the middle with a half carrat diamond
or, each side surrounded by diamond chips and worn on my right hand to my
husband's niece, KAREN LESARGE. ~....K ; s J ,,
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B
C
My two carat solitaire ring with diamond chips in the band surrounding the diamond
worn on my left hand to my friend, PAMELA K. FRAZIER.
The ring consisting of two diamonds of one carat each to my niece s'T~n'~'
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D. The remainder of my personal property to my friend PAMELA K. FRAZIIER.
ARTICLE III
I devise and bequeath all of the rest, residue and remainder of my estate as follows:
A. 75% thereof to my friend PAMELA K. FRAZIER.
B. 25% thereof to my godson BRIAN J. SMITH.
ARTICLE IV
I appoint my friend, PAMELA K. FRAZIER, Executrix of this my last Will.
ARTICLE V
I direct that my Executrix, or her successors, shall not be required to give k~ond for the
faithful performance of her duties in any jurisdiction in which she may be called upon to act,
insofar as I am able by law to do so.
IN WITNESS WHEREOF, I hereunto set my hand and seal this ~ day of November,
2005.
;~~, (SEA! 1
-~f Peggie K. Dicc
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence of us, who at her request, in her presence and in the
presence of each other have hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
I, PEGGIE K. DICK, Testatrix, whose name is signed to the 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 p!~rposes therein expressed.
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fir, ~.,~ .,
-~~ f~eggie K ~Dic~k
Sworn or affirmed to and acknowledged before me, by ,the Testatrix, this ~ ~'t day of
November, 2005. /1
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Notary Public -~ ~ r
:~..~~~,~rvwFalrH of ~NrvsnvavtA
Elizabeth OLT~l~ N ~~
emoyne Bo% ~ Public
"~ C.orn~mtssi0p Expires ~y o
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
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We, ~`~ , k.r,~. ~a~ e:[~ : ~i ~" , .~ ; and ~~r`s-~~~1 ~' . \~\`~e~~~y~C~~ the
witnesses whose names are signed to the foregoing instrument, being duly qualified ;according to
law, do depose and say that we were present and saw the Testatrix sign and execute the
foregoing instrument as .Last .U`~ill and Testament; that she signed wiiiinyly and that she executed
it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing
and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the
Testatrix was at least 18 years of age, of sound mind and under no constraint or unduE~ influence.
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nnSworn to or affirmed to and subscribed to before me by ',~ . ~~~~,~_, i„),`;;>;~~, ~t~~;r j ~~
and l~_r~~~~ti t, ~' . ~ti1 ~~~MG~ ,witnesses, this 1 ~'-~ day ofYVovember, 2'005.
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connr~w~na ~ PENrvsnvoN~A
NOTARIAL g~EA~
Elizabeth L Ziept~~ Notary Public
MY ~miseion E~ir~N~ joy
o OIir1ES