HomeMy WebLinkAbout09-07-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of David Victor Fisher
also known as David V. Fisher
COUNTY, PENNSYLVAN_ IA
File Number 21-11 - ~~ `--{
Deceased Social Security Number 167-40-2098
Donna Rae Fisher
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' or `8' BELOW:)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the EX@CUtrIX named in the
last Will of the Decedent, dated 07/18/2007 and codicil(s) dated
State relevant circumstances, 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 23 Pa. C.S.A. § 3323 (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:
B. Grant of Letters of Administration
(If applicable, enter: c.t.a., d.6.n.c.t.a.; pedente life; duranfe absentia; durance minoritate)
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 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 23 Pa. C.S.A. § 3323 (g), except as follows:
313 Keith Road, Mechanicsburg, Hampden Twp. Cumberland PA 17050
(List street address, town/aty, township, county, state, zip code)
Decedent, then ~_ years of age, died on 08/24/2011 at 313 Keith Road, Mechanicsburg, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
All personal property
Personal property in Pennsylvania
Personal property in County
25 000.00
150.000.00
situated as follows: Home and property situate at 313 Keith Road, Mechanicsburg, PA 17050
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:
I signature Typed or printed name and residence I
-. \ ~~~t ~ ~~ ,.~ ~ I Donna Rae Fisher 535 Shed Road
1,-\-~ ~ ,_T/~-,`C-~/J^ Newville, PA 17241
Form KW-UL Rev. 12-26-2010 (interim lorm, pending action 6y the Courf) Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
} SS
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The Petitioner(s) above-named swear(s) or affirm(s) 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 affirmed and subscribed ~
before me this _~_ day of
~~ ~~ ! ~~
of Personal Representative Donna Rae Fisher
Signature of Personal Representative ~..~
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For the Register Signature of Personal Representative - '-_
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File Number: 21-11 ~ G 1.,~ 1 :}' • • ~ - - ~'
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Estate of David Victor Fisher
Social Security Number: 167-40-2098
AND NOW, - 1N Y~~ f~~ ~Q.r
having been presented before me, IT IS DECREED that Letters
,Deceased
iDate of Death: 08/24/2011
~~ ~ l , in consideration of the foregoing Petition, satisfactory proof
Testamentary
are hereby granted to Donna Rae Fisher
in the above estate
and that the instrument(s) dated 07/18/2007
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ...................................... .... $ a l ~ Li ~ ~
) ~' ~ ~ !~ ~. 1j ~ ) ~
Short Certificate(s) ................... .
i
.... $ ~ (./~!
E
\
Registero/Wills
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._~1.~ ~ ` ~.(..~w Ugh
G~k.{? .
Renunciation(s)......_ ............... ..... $ Attorney Signature: '~- -. _, __ ~ ~ ~ , ~~~ i^-'-
~ i ~ ~ $ ~ ~'~) LV Attorney Name: Jan M Wiley
$ ~~, Jl:
$ ~. C~ y Supreme Co LD. No:: _06298
The Wiley Group, PC
$ Address: 3 N. Baltimore St.
$
$ Dillsburg, PA 17019
$ Telephone: 717-432-9666
$
$
TOTAL ............................... ..- $ ~ I I , ~1~~
Form RW-O2 Rev. 10-13-2006 Copyright (c) 2006 form software only T he Lackner Group, Inc. Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
f. Name of Decedent (Frsl, midde, las( suflixf 2. Sex 3. Social Security Number 4. Date of Deem lMOnih, tley, year)
David V Fisher Male 167 - 40-2098 Au ust 24 2011
S. Age (Last Birthday) Untler 1 year Urker 1 da fi. Date of &nh (Month, tley, ear) 7. annpace lCM and state a forei country) Ba. Place of Deam (Check any one)
Mmahs Days Noun Mirxaea Haspilal: Other:
6 2 Yre. December 4 1948 Carlisle P A ^ lnpaeenl ^ ER f Outpatient ^ DOA ^ Nurehg Hortre Residence ^Other - Spedly:
8b. Counry of Deam 8c. Ciry, Bar Twp. of Death 6d. FacilDy Name (If ml InstllNron, give sheet aM arrt6er) 9. Was Decetlent al Hispenit Origin? Flo ^ Yes 10. Race: American Intlian, Black, Wnlte, arc.
pf yea, spadly caban, Ispaaryq
Cumberland Ham den 313 Keith Road Maxicen,PuenoRican,ek.) white
11. Decedents Usual Oav tie Kintl of woM tl one du' most d wodMt Ma. lb not slate refired 12. Was Dewtlenl ever In iM 13. DecetlenYS Edxatbn (Seedy Doty highest Breda comp leted) 14. MarDal BlatUa: MarrieQ Never Married. 15. Surviving Spo use (II wile, give makfen name)
Kintl of Work Kind of Business / IMusiry U.S. Amtad Forces? Elementary /Secondary (0~12j College (1-4 or 6+) Widgrea' ~o~ (~M
Divorced
Supply Specialist Government ~fres ^Na 12
18. Decatlent's Meiling Atltlress (Street City I town, SFele, zip code)
3 16 K e 1 t h Road Decedent's Drd Decedent Ham d e n
Aclael Residence na. solo P A Live Ina 17c. ~] res. oecedem wed in P Twp.
Mechanicsburg PA 17055 ,m copnrv Cumberland r ship? ,,d.^No, l3ecadenl LNee wDNn
Adual umds or Clry / Boro
16. Fatner's Name (Flnst miaue, cal, sanix) Is Homer:Name (Fell, midge, maiden wmamef
Victor M. Fisher Helen J. Heller
20a. Inlomranfs Name (Type /Print) 20h. Infamanfs Mailin Adtlress Slreel, city /town, slate, zip Wtle)
Donna R. Fisher •
535 Shea Road Newville PA 17241
21 a. Method of Disposition ~' ®Cremator ^ Oonalion 210, Dale of Dispositbn (MOmh, day, year) 21c Place d Disposition (Name d cemetery, aemetory a other place) 2 Iron ( t 1 J
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^ Batlel ^ Removal ham stela , was crem.eon ar Danatwn Aatnortrrtl 8 2 9 2 011
/ / H o 11 fi n g e r Cremator
y ~
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P A 17 0 6
^ Olher~ 5pecryy
by Medical Examiner l CoronerT Ves ^ No
22a. sgre~ ~a•Fel~rys Lrcaaz lot parson tdng as aatn)
' 22D. Ixanaa NamMr na. Noma aria address or Fa~iy Egger F u n e r a 1 Home Inc
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( , ~~ FD 13895 L
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Compete Dams 23ac Dory when canifyktg 23a best tl my knowledge, tlaam occuned at IM ems, date and place slalad. (Signature aM tills) 23b. License Number 23c. Date Sgnetl (Month, tley, year) '
pnyskdan a not available at ems or seam m ,
canny Cause of death.
Dams 24-26 must M carpeted by person 2<. Time of Death 26. Dale Prorrouncetl Deed lMOmh, day, year) 26. Wes Case Referred to Medical Examiner! Coroner fa a Reason Other than Cremation or Donation?
wM lxona,nces deem. A rx. 8:00 A. M. Au ust 24, 2011 vas ^"°
CAUSE OF DEATH (See InetruoliOne antl examples) r Aplarozimete interval: Part II: Enter other siortieraM mMkpre mnlrihNinm In death, 28. Did Tobactu Use CmtdDlrte to Dealh7
horn 2T. Pan I: Enter me chain "f events -diseases, Injuries, a tomplir lions - Inel tlireclly caused me deem. DO NOT enter terminal evem9 such as caNiac anesl, On%1 t" Death but rM result gin the undenying Cause given in Part l ^ Yes ^ PmDaIMy
razprelory arrest, or venintular fibdllaea wilhoul showing the enology. List onty one cause on Bach Gne.
IMMEDIATE CAU
E Frc
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' ^ No ^ Unknown
S
al
sease or
to tltm"re~alengm~eamf ~ Atherosclerotic Cardiovascular Disease
a HTN, Remote CABG zs uFemale:
Due to (or as a consequence off: ^ Not pregnenl wdhin peal year
SepmrttlalN 4e wntlitians, II ant, b.
leatliry b tthh cause listed on 6ne a ^ Pregnant et ems of deem
. Due to (or az a con
Emer the UNDERLYING CAUSE sepuence off: r
^ Nol pregnan6 but pregnant wimin 42 ieys
(6eeese a Injury that idlutetl the ~
events resuDing in deamf LAST. c
r of deem
Due to for as a c
onsaquenca op: ^ Na pregnant but pregnard 43 days to t year
d. balsa deem
^ Unknoast it preglenl wilMn me pest year
30e. Wes en Autopsy 30b. Were Autopsy Fintlings 3f. A/annez of Deam 32a. Dale of Injury (Mmm, tley, year) 32b. DescriM Haw Injury Occuned 32c. Place d Inlury: Home, Farm, Street, Factory,
Parlarmed7 AveaeDle Prior to Campeton
Natural ^ Hamidtle Office Building, arc. (Seedy)
of Cause d Deam?
^ Yes ~ No ^ Yes ^ No ~'dem ^ Pending Invesllgeeon 32d. Time d Inryry 32e. Injury al Work? 32f. If Trenspanetion Injury (Speciry) 32g. Laceaa of Injury (Street, city / rown, state)
^ Surcide ^ CouM Nd be Determined ^ Yes ^ No ^ Driver / Opaelor ^ Passerger ^Pededrian
M ^Omer - Seedy:
33a. CeNfbr lthrxk onty one)
• Dertltying phyeoNn (Physician cennyeg cause of deem when another phys~an nos pmnancad deem antl competed Item 23)
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To Dm beat of my knowledge, death occurred due totM UUSgs)entl manner es stelse_________________________________ ^ oroner
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• Pronouncing arM certlrying pDyNClan (Ptryskian both prawuncing seam aM cen4ying to cause of deem)
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63 7 5 Bas eho re Rd . , Suite 111
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Disposition Pertnil Nn ~) ~~ ~~ ;~~
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~~~t rll ~xrtd tZest~tment
OF
DAVID VICTOR FISHER
BE IT REMEMBERED, that I, DAVID VICTOR FISHER, of 313 Keith Road,
Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and
-~,
understanding, do make, publish and declare this as and for my Last Will and Testament,
~_ ~ -~
hereby revoking and making null and void any and all Wills and Testaments and ~~3~ ~.,~
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in the nature thereof by me at any time heretofore made. ~ > > ~~'' ~--
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ITEM 1: I direct that all my just debts and funeral expenses be paid as soo~'after ~k
my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, whether it be real, personal or mixed, including property over which
I have a power of appointment, I give, devise and bequeath unto my three sisters, DONNA
RAE FISHER, KATHY JO WEBER, and KIMBERLY LEE FISHER, in equal shares,
per capita.
ITEM 3: I direct my hereinafter named Executrix to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise passing by reason of my demise,
may be subject and to charge such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal law now in force
or hereafter enacted, shall be prorated among the persons interested in my estate to whom
such property is or may be transferred or to whom any benefit accrues.
WITNESS:
~ ,:' /)
~z~~~ (SEAL)
DAVID VICTO FISHER
-1-
ITEM 4: I appoint my sister, DONNA RAE FISHER, as Executrix of this my
Last Will and Testament. Should DONNA RAE FISHER, predecease me, fail to qualify,
cease to act or renounce probate, I then appoint my sister, KATHY JO WEBER, as
alternate Executrix of this my Last Will and Testament.
ITEM 5: I direct that my Executrix, cr her successor shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
[N WITNESS WHEREOF, I have hereunto set my hand and seal this 18`" day of
July, 2007.
WITNESS:
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~~(SEAL)
DAVID VICT FISHER
-2-
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
SS
We, DAVID VICTOR FISHER, JAN M. VVILEY, ESQUIRE and MARCY K.
RENSHAW, the Testator and the witnesses respectively, whose names are signed to the
attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as his Last Will
and Testament and that he had signed willingly (or willingly directed another to sign for
him), and that he executed it as his free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testator,
signed this Last Will and Testament as witness and that to the best of their knowledge the
Testator was at the time eighteen (18) years of age or older, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed
before me this 18`'' day of
July, 2007.
NOTARY PUBLIC
MY COMMISSION EXPIRES:
_ = r ~„tJ~'!~VI~~ISE~
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=fCt~il4y I
,vy "~, r-,„ . u,: Lx~.ira,~ 149ay 17, 2009
Member, PQnnsyivsnia !association of Notaries
+~otarial &eal ~
S. Dawn Claafadter, Notary Public
Dilisburg Boro, York County
My Commissio7 Expires May 17, 2009
Mombor, Ponnsy;vaoia Association of Notaries
;\ r J 7 ~
I~VID VICT R FISHER
-3-