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HomeMy WebLinkAbout09-02-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS _ ~ =~, PETITION FOR PROBATE AND GRANT OF LETTERS ~ ~ ~ _- ~? ~' Estate of /YJ l'~ ~ / ! ICS ,Deceased ESTATE NO: 21- -=' ~rn „~ W - a/k/a: ~ ~ ~ __ , ~v,,,~ a/k/a: ~ ~ ~~ c:~ ~y a/k/a: SS NO: f f'7 ~P ~~ ~~ ~~ `'C -._ , . ..~, Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C~as applicable: ~A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.r~.c.t.a. (complete Part C also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters Q~ ~~~ '~~l-[~ `^ under the last Will of the above-named Decedent, dated (~;~,~/'' ,~ 1, ~ 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 for divorce h~td been established as defined in 23 Pa. C.S.A. § 3323(g): ^ B. Grant of Letters of Administration (ti 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 party to a pending divorce proceeding wherein rounds for d' orce had been established as rovided in 23 Na. C.S.A. § 3323(g), except as follows: LCtV~~ ~ ~ i i~r~ ~(~ - fie. ~'p~S~c~ _ Name Add V ~ ~ ress ~I ~Ot~SE !i Relat~onsh~ to Deced ent r ~' •= ~ la s ~ z tea.' ,~- --~.~~c ~' d~ U -I~r ~ i ~" r ~ ©~ - , ht rte, TiCR ATll1TTTl1 lor1~'I CusL'TC ic^ AtL~~Crc ~ nv ~ ~ .~, ~ a ~`. ~ - ~,•-,~....~.~.. aaii.~a~•.saaa~. a.a.a aa' I~a~l.G7JHf~i ~~,•~ ~/ _•_ _! THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumber nd Cou ty, Pennsylvania, with his/her lasct family or princi al residence At ~ - p 7 ~- ~-~ (Street address with Post Office and Zip Co e, Municipality: Township, orough, City) UI')')b2,.r/a C(~vl~'~""t-/ Decedent, then ~ / years of age, died ~/ ~- ~ ~j -• ~ C31 O at 1 >Q Jq (Month, Day, Year of death) (City and State w ere death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property $ _If not domiciled in PA Personal property in Pennsylvania $ _If not domiciled in PA Personal property in County $ j~Value of Real Estate in Pennsylvania $ jj ~~ To(ta~l Estimated Value $ ~(,~T~)D C~ 0.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) `'1~ ~a~ ~Q~(,~ ~(,~ ~ ~ ~ ~~~ ~ ~~ ~ `~~~~ Signature(s) Name(s) & Mailing Address(es) Interim Form RVV-02 revised 1?.26.10 by Cumberland County pending action by the Court v Page 1 oft ~~.;_, OATH OF PERSONAL REPRESENTATIVE ~p ~ ~.~ -'~? ~ ~; 1-'--I `` SS ~ ,., Commonwealth of Pennsylvania `~'' _p .~ , County of Cumberland ; =__ ~ ~? n~ _ ": ~ ~P ~~, _,,._ The Petitioner(s) herein named swear or affirm that the statements in the for ~' ~ ~'~ .~=~_ ;~; egging Petiti$n are true d '~~~ ~' •~•~ a 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 la~~v. ( ~ Sworn to or affirmed and subscribed ~hd be o e rpe this ~~_~ , da of ~ Q ±he Register ' DECREE OF PROBATE AND GRANT OF LETTERS ~ ~, Estate of ~'/ ~ a~ /~~- AND NOW, this day of ~ the reverse side hereon, satisfactory proo Testamentary of Administration ~~~ ,Deceased Number: 21-. 1 ~ _ ~1 - - ~~ , in con;~ideration of the Petition on a ng been presented before me, IT IS DECREED that Letters ! ~ ~ are hereby granted tn. l~ /~ ~/ /~~f applicable, en c.t.a., d.b.n., d.b.n.c.t.a., etc.) Y ~/~l ~~ t the above estate and that instruments(s) dated _~ admitted to probate and filed of record as the last Will and Glenda Farner Strasbaugh, Register of Wills FEES: Letters .................... $ 10°~ Will ....................... Co icil(s) ............... ( ~) Short Certificates ( )Renunciations....... Bond ............................ Other ............................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL........ $ ........ `~--z6-58 ' ~~ Signature of Counsel Required to Enter Appearance Atty's Signature PRINTED Name: Supreme Court ID No. Address: Phone: Fax: ire %~ escribed in the petition be:. icil( of Dec dent. ~ `1. Interim Form RW-02 revised 12.26. )0 by Cumberland County pending action by the Court Page 2 of 2 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fte for this certific~(te, $6.0O ~;, %~%~%~-%%=... Tr)is is t(~ certify that the information here given i~ ;;~j/"'" ~~H OF p ,,~,~~,P fyy ._ corre~~tly copied from an original Certificate of Deat °~`~~o~/~~~~ duly filed with me as Local Registrar. The origins ~~l ~~ certificate will b(' )~~rwarded to the State Vita. vv~ la, Re~co~~ds Office for permanent filing. _ ,, __. ~ ,, _ t,,l ----- .-_ `~-aMFNT 0~ --- ~ ~ ~'~- r~~~ A P~ 1 f/2010 Certification Numht:~r -.,,,,,,,,,,,,/"~~ _ _ I_,ocal Registrar Date [sued ~ '_~'' '~~CJ ~;' ,.~ r-- 't7 rn I i__. ~.' C!~ ~ , _7C~~~ ~.. _, -~` ,,:,. ~"'. ~ ~ •} l.~ 'fit 3 ~ --~ H105.143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RI.CORDS TYPE /PRINT IN sLA~cKNw~ CERTIFICATE OF DEATH (See Instructions and examples on reverse) grgrE FILE NUMBER 1. Name d Decedent (First, middle, lest, sulfa) 2. Sex 3. Soda) Securhy Number 4. Date d Death (Month, say, year) Miriam C. Failor F 186 - 54 - 4195 4/15/2010 ~'~, 5. Aga (Lest slrtlday) Under 1 llrtder 1 day 6. Dab d Bktlt (Month, do , ar) 7. (C and amb a ) Ba. Pmoe d Dssth (Check oro oro) txys liters sava.e _ 8 5 rrs. 2/ 14/ 1925 Mt . Holly Springs , PA ^ ~~ ^ ER / otnprtlbnt ^ DDA ®Ntrrtting Home ^ Residence ^txha - sPeary: ' 8b. Counry d Death ric. City. Born, Twp. a Death 8d. FecWly Name (0 rat IneffiWiort give sheet end numbs d 9. Vdee Decedent d Hlspsnic Onpkt? [~ No ^ Yes 10. Roca: American Indian, Bmck, White, ek. ` (n Yea. seedy Cuban, (sPed47 C~nberland Carlisle Boro. Forest Park Health Center Mexkart, Ptterdl Rkxm, sta.) White 11. Decedent's thud tion Kkd d work done mat d pb. Do not state rotlred 12. Was Decedent aver in Ste 13. DecadertYs Educalbn (Seedy only highest grade wed) 14. MenW Status: Married. Never Mertied, 15. Survlvktg Space (If w8e, Kind d Work KiM d Btairtesa / Ntduatry U.s. Anad Forcesl Elernentery / Secortdery (t}72) CaBege (1-4 a s+) Wklowed, Divorced (Sped/y) 9k'e matdert name) Hanemaker Her awn bane ^Yea I~No 11 Wir3~d - - 18.OecedertYa McWng Address (Street, ciy / rorm, stab, zip code) Deadent's ~ Decedent 460 Stone.. House. Road Adud Reakfenoe 17a smog PA Live in a 17c. ®Yes, Decederq Lived in Dickinson Twp - Carlssle, PA 17015 17b, cor,my CLIITlberland TowneltlP? 1?d. ^ No, Deadant I.hred wt8dn Adwl Umlb d Ciry /Bore 18. FaBar's Name (FYst nddde, met su8bt) 19. kbtlter'a Nerve (Flrst nddde, maiden sumertte) Harold - Vanasdalan Eliza - Osborne 20a. IrVormenre Name (Type /Print) 20b. Intonrtrd'a AAeNYtg Adtlreea (street, Gty / roan, am1e, bP code) David A. Failor Jr. 464 Stone House Rd., Carlisle, PA 17015 21 a pdetltod a DiepaeKion ^ c ^ D 21b. Dab a • °n (, daY. Y~ 21a Pma d DiyoeNlon (Name d amMery, aemetory a otlter pba) 21d. L ocalbn (Cqy /town. state, Zip code) w° Q Burial ^ Removal ban 9bte tNp l~matlon a Doratlon Autltahed ^ 01~- by r*aaltenmkar/ca«err OY.aC]Na 4/20/2010 Ctmnberland Valley Mgnc~rial Gar s Carlisle, PA `~ 22a F kxrtsee (a paaon 22b. lJcerae Ntartber Th. Noma end Address d Fedlky ~ FD 012633 L Ewing Brothers Funeral Hane, :Cnc., Carlisle, PA 17013 carobm Mrra 23ae ony when ansYb9 23a. To sa best a my krtowkdgs, death u tla fire, dam and pba ammo. (SlgnaWre and tlde) 23b. Llarae Number phyaiden k at avellehle at time d death ro t 23c. D~b Sigrad ( th, day, yesr) ardyauseddeetn. (~c N ~~),.)...S~Q~:S L r ~~~o<B /~ _- Kerrq 24.26 rtaat be carpbled M person 24. Thne a Death 25. Deb (Month, day, year) Z8. Wes Case Referred ro Medical Examiner / Coraar to a eeaon Otlar then Cremation a Dorretion? who prartotetces death. Q ~] M. ~,~ Q/U ^ Yes CAUSE OF DEATH (See lnstructlorw examples) r Apprtxdrttete Inbrvel: Pad II: Enter other 26. Did Tattaoco Use ConMbule ro Deatlt? Kam 27. Parr I: Erder the ~„Q(~g - diseases, . a oomppatlone - flat dNectly caused Ste death. DO NoT sorer temdnsl events such u ardmc arrest r Orreet ro Deelh but nnt reap m tla reepkatory arrest, a veMrialar Abrpmtlon wKlatd attowing tla elblogy. Uet ady ors ease on each Ike. r ro9 r+n~MMq given in Pan I. ^r ~Yes~ ^ Probaby ~~EEq (~F~,,~a~ ,,,A ~i / A ` r l1J-~ ^ tkdatown `aMlUort"~'es'tlAi'°ndeeM') ~ a. //i/ /7 ~ /1 ~0//~ L /N1~'Alz-C~ 1 bN ~ ~'2r~~5~ aN 2g.,M--F,am/~a Duero (a as a consequerae of). i L1d' Nd Pre9neM MOwt Pact year ~ txxtatlaa, w am, b, G ~t.rx,n n.. r (E(nm~~r bwwE~rNik~G CAA dUSE a Duero (a as a conaequerae oQ -T~o~ ~` '~ ~~"e'~``~ ~ 1I' , ,'~ b f l ~ 5 ~/ r ~ ~l 1~(~ ~ ^ Pregrtent at tkne d dam • bvanle r~n ~M) LAST a ~ ^ ~ PAM. ~ P witldn 42 days ~ r ~~-( j% a aeath Q Due to (a as a ooraequence oQ: ^ ~ Pre9~t. ~ Y~ • d. , pregnant 43 days to 1 Autopsy 30b. Wero r ^ llnWtovm N pregnant wBMrt tla pest year v 30a Perbnrad7 p Au~ toffs 31. klytner d DseM 32a Dale d Injwy (Month, day, yeeQ 32D. Descrbe How Ir~ury Oavned d Cause of Death , i~-JNatural ^ Hartdcide ~• ~ d ~u7 Home. Farm, Bred, Facmry, Buildsg, etc. (SA•dA'1 ^ Yes Qdfb ^ Yes ^ No ^ Acciderd ^ Pertdrp Irtveetlgstla 32d. Time d hgury 32e. In)tay et Work? 32f. K Trertepabdon m,ury (Seedy) 32 . Laatbn d I g rthxy (Street w' /town sate) ~ ^ Suicide ^ Could Nd be Detemtkted M ^ Yes ^ No ^ Dover / ~~ ^ Paseertger ^Peaeshmn . ~( 33a Cardfar (dtedr ony one) meter - SPeaA'•' 33b. ,~/) \ ~hkq PM~~ ( ease d death when eratlar ~ praaunced deadt and corrtpebd Item 23) Sgretae end Title d Certifkr To the beat a my knorrbdge, asatlt acetxred dw ro the cwws) end merarr a s~ - _ _ _ _ _ - _ ~ ~ ~ / [St/~(Y` / ' ~on~a~g twtd ~y1n0 Phy~n ( batlt praratatdrtg dae8t and angyirtg rocaw~ ddeath) - - - - - - - - - - - - To the feet a my knowkWpe. deatlt omrned at tla tlme, dam. arM piste, end dw rothe - - - - - - _ _ ^ 33a lJarae N Q f/-• 33d Dab Slgrad (Month, deY. Yom) «awe)rMmartnerasebted________________ f) D/!~ ~ 5 `' PR l t~ o reaar ExantYbr /coroner j~ r' 1 0 On tla ttaeb a examkatbn arx! / a MvaetlgHbn, m my opinion, death occurred at the tkrte, dtm, end errs, arM due ro the saws) and merxar ae stared., ^ 34. Name and Address d Perron Wlp iorCaa! pf Death (Item 27) Type / PMt 0 3s. Reglslrer•s and Dbtrict N~tbarl J. ~};"J~U'vV 1'v 5 1.. ~l'1 l~ 38. Dam FBed (Manor, day, rear) a S , 1^I r C1 4, J ~ .t- iairiait iii '° ~„ ,t-~~ P ~~2~ Dispaitbn Permit No. ~ `t1010 ~ ~ 1P ~~ 'WILL O F _ ~~. ,;: ;~., ': t. MIRIAM C. FAILOR r~}~~ ~~°m ' ~'1 ~,..~.. ... ,. .. _~._.. 1, Miriam C. Failor, of Carlisle, Cumberland County, ~^t~. ~ `~_ ~,:,r' ~', Pennsylvania, declare this to be my last Will and hereby revoke all } ~= prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I leave everything to David A. Failor, Sr. Should he predecease me, I leave my estate to be distributed in equal shares to my children David A. Failor, Jr., Audrey F. Failor, Vickie F. Frye, Rodney L. Failor, Michael L. Failor and Wesley E. Failor. Should any of my children predecease me, I direct that their share shall lapse and go to the surviving children. 4. I appoint David A. Failor, Jr. as Executor of this my last Will. If he should predecease me or cease to act in such capacity, I appoint Audrey F. Failor as alternate. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WITNE R F, I have hereunto set my hand this ~ day of , 2002. LAW OFFICES OF ~ ~ ~ _ +„ ~~C~y~ , /~° 7 STEPHEN J. NOGG Miriam C. Fa ilor ~ {,~1~,~s}- 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 i ~ LAW OFFICES OF s~P~av J. Hoc, 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Miriam C. Failor, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. 1 -~ ~ ~~ .~£, ~ ~~ WITNESS ~ WITNESS LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania County of Cumberland ss I, Miriam C. Failor, the testatrix, 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; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. _, MIRIAM C. FAILOR Sworn to or affirmed and acknowledged befo a by M I RIAM C. FAILOR, the testatrix, this° day of 2002. ,~~ -~ NOTAR4IL sEAL ,,~-'~ ,r 8TEPHEN J. HOGCi, NOTARY PUBLIC CARLISLE BORO, CUMBERLAND CO., bsA MY COMMIS810N ExPIREB sEPTEMBER s, Zoos Notary Public/Attorn AFFIDAVIT State of Pennsylvania SS County of Cumberland We, ~L~1 ~ ~~ and ,l~r~ f~e~1e C a,~~ ~La,~ ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. S orn to or aff~ed nd ubscribed to efore me by witnesses, this ~ day of , 20 , tea= T• ~'*~~ Notary Publi 8TEPHEN J. HOGO, NOTARY PUBLIC c~RUeLE BoRO, cvMBERU~rID ca., PA MY C'OMYIg11DN iiXPIREB 8EPTEM88R 8, ~