HomeMy WebLinkAbout09-13-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~ C"t y^ G(~ ~l ~~-, Q $' S ,Deceased ESTATE NO: 21-
a/k/a: SS NO• ~ ~ ~:' - ~ 2 - `f ~j L Z
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.n.c.t.a. (complete Part C also)
'and aver that Petitioner(s) is/are entitled to the aforementioned Letters ~ 5 ~ C'ufu r unde
r
the last Will of the above-named Decedent, dated G~-~ 2 ~__[~~_ and codicil(s) ated N ~ tip- ___ _
(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 had been established as defined in
23 Pa. C.S.A. § 3323(g):
^ B. Grant of Letters of Administration
(If 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 Sectiotd-ri, and complete list of -e-;
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a pa~to a pending divt~ree-:
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 "~e~cept a~: follows:
Name ..,.,__.._ -
°' °J ttetaIttGhshi t1l.lleced~
-: `-~
ucF annrTlnner Cucc~rc rc vc~cec.nv t
ent
_~
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_T.,
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled t death ' Cumberland County, Pennsylvania, with his/her last family or principal residence
At u ~ ~~. G~/~~v~ r~rl ye M-~c~a~lics~~,v~: PA ~'7r) s~;
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then ~-' years of age, died f~~-:3 ~ - (;~ (( at ~[~ y~r b ,~/ ~~ ,~ ~ - ~7 t~t S(j ~6 ~Cr`l t (t~
(Month, Day, Year of death) (City and State wher death occurred)
Estimated value of decedent's property at death: 1
_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 $
_Value of Real Estate in Pennsylvania $ - '1 l7 ~
Total Estimated Value $ S ~r ~v~
Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ / ,~
Sig~at~re(s)
Name(s) & Mailine Addresstesl
/ o S3Q G4~ ~ 51 MA
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O~~~zc -y3.>3
Inirrim Pnrm RW_rl~ ro..~~oa ,~ ~c ,n ti.. ~......~__,_-a n_..___ ___,,._ _ .~ .. !. _
• ~~ „y ..,,.n~~„a„~ wu~uy Nawmg acnon oy me court Page 1 oft
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named swear or affirm that the statem a d thah as pergsonalPepresentative(s) ofthe
correct to the best of the knowledge and belief of Petitioner( )
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me thi ~~ ~ day of
~~ ~ _
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.. ~ _ _~ ~
For the Register -
-EC~EE ~F PROBATE AND GRANT OF LETTERS ~ ~ '
,Deceased File Number: 21-~_-- ~ ~~
Estate of __ - ~~Y ~~
------
~ , in consideration of the Petition on
AND NOW, this ~~daY of ~,~-~-t~~~E'9' =~--C` l ~
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters
are hereby granted to:
~~ Testamentary _ of Administration
(It applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) In
,,, ~ ,
the above estate and that instruments(s) dated /r`r~ (°1)P~' ~ 1
f rd as the last Will and Codic>.1(s
described in the petition be
of Decedent.
admitted to probate and filed o reco ~.
r `
~~~ ~ " ~~Q't ~Lc ~~ ~- s I , ~ L~ '~
:~ ~`
OlendaFarner Strasbangh .~'~ ~' ~4~ti~,~74'~L( '~-
Register of Wills t
Signature of Counsel Required to Enter Appearance
FEES: ~ ~ C-,~~
Letters ....................$ ~ Atty's Signature
Will ........................ 1~~-~--
Codicil(s) ................. ~ ~ PRINTED Name:
( r}~) Short Certificates ~ ' L'~ Supreme Court ID No.:
( )Renunciations.......
Bond ...........................•• Address:
Other .............................
................... - 5.00
Automation FEE......... 23.50 Phone:
JCS FEE ................... Fax:
TOTAL ................
Page 2 of 2
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
GCAL REGISTRAR'S CERTiFi~CATIGN GI° ~; ~~ ~"
VVAI~IVINC;: It is illegal to duplicate this eopY 'hY phcstostat ter ~~`1~~,: :r
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
lSee instructions and examples on reverse) STATE FILE NUMBER
2. Sez 3. Soaal Secuhty Number 4. Dale a DeaM (MOnm,tlay, year)
,. Name a Decedent (First, middle, last suffix)
Female
480 - 22 - 4922
Au st 31 2011
Sarah G. Hass
e (Last Blnrkay)
A
5 Under 1 a Untler 1 da 6. Dale of BiM Monet, da , ear 7. BiM ate Ci aM stale «t«e Ba. Place of Deam Check
h
O
g
.
s Hours MinNes
D er:
t
HosDltal.
Monts
ay
August
0 1921 Rural Lorimor IA ~Inpaaent ^ ER / Ouryatient ^ DOA ^ Nursing Home ^ Residence ^ Other SpecAy
14
9
Yrs.
• 6C. Counry of Deem Bc. Clry. B«o, Twp. a Dpm ,
Btl. Fadl'ny Name (h riot iptiWkon, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^Ves t0. Race: American Indian, Black Whae, etc.
(u yes. apetiry Cuban. (spaciy,
Clm(berland East Pennsboro
• Hol S irit Hos ital Mexican, PueM Ripn, ea;) White
Dt not state retired
a lif Was Decedent ever in me 13. Decedents Education (Bpedry only ngnest grade pmpletetl) ta. Marital Status: Marred Never Married, 15. Surviving Spouse (If wde, give maden name)
t2
;
e.
11. Decedents Uwal Occu non Klnda w«k doned~n moll
l I
d .
Hl
U.B. Armed Forces? wlaawed. Drvorpe /svat
Elementary /Secondary (0-12) Cdlege (1'4 or 5.)
n
ustry
Klnd of Work Kind of Business
Homemaker Own HoEne ^ vea ~ Na 4 Widowed
Decedents Mailing Address (street. cny / mwn, state. zip rode)
16 DecetlenYS ~ Decedent iTr,
Pennsylvania LNe in a t7c. ~ Yes, Depdent lived in ~P r Allen Tyro,
.
100 Mt. Allen Drive Attu91 Residenp 17a. state
Cumberland Township? l7tl ^ Na, Dec%lenf Lived within
Mechanicsburg, PA 17055 16Go""N Actaalumiua cm/B«o
16. Famels Name (First, mitldle, last suffix) tg. Molhefs Name (First mkNe, maiden surname)
ther Schneider
E
Herman Groesbeck s
20b. Informant's Mail'ug Address (Street, cdy I mwn, sate. zip code)
20a. InfonnanYS Name (Type /Print(
Miller
H
Kara J 121 B R
i
d
.
.
^ Donation 27b. Date a Disposition (Monet, day, year)
osinon ^ C
f Dl
ti
n
d p co
e)
21 c. Place d D'sposkiar (Name of cenrerery, vemakxy «omer place) 2t d. Location (Gry/ tarn, stare, z
sp
on
o
o
rema
2, a. Met
[~ Burial ~~'y~r9 State .Was cremation « D«,asan AuNwnxed ^
r 7 2011
t
b
S
~
• Oakland Cemet ~t ~-~, ~
21[t
No
e
e
~7/ LV I I r M Madkal Examiner/Coronen ^ vas
S i
^ Otl
ter ~
rv~e person acting as a~tro zx. uprise Number 2x Noma and Adtlress a FaaGry 8 Market Plaza Way
~ re o
F'D - 014889 Mal zzi Funeral Home 'c b P 1
_ ~
to - s i mry when t ~ ~ 23a. To the best a my knowYetlgl+, deem occurred at the rime, data and pUp slated. (Sgpture and line) 23b. lQic~nse1 Number Q 23c. Dale Signed (Monet, tlay. year)
le (1 S•~' 31 t 2 a ~ /
'\,V Ate" `f 4 O `7 7 A (
KK available at time I deem It
i
h
ki
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,
an
s r
p
ys
e S L C'L ~t MCin
f d
m
.e
~
ee
.
prtiry pose o
y
re
'rat Examinr / Comrrer I« a Rpsm Omer Nan Crematim or Donation?
Date Pr«wunced Deatl (Mmm, day, year) 26. Was Case Referred lo
26
o
.
24 Tune of Deem
harts 2426 must be completed by parson l r] ~ ZQ ~ / ^ Yes
m M. HC 4 $"7 J
ronounces dpin
8 ~ ~ t`J
1
.
.
w
a p
Approximate interval: Pan II: Enter Deter ~ o 'f t cantlil ~ cant b ~Cm to tleam 26. Dld Tobacm Use Contribute to Death
CAUSE OE ATH (See Instruettona and examples) r
Item 27. Pan I: Enter the than of events - 0.seases, inryries, «complications ~ mat 6rectry pusetl me dean. DO NOT emer rermirW events such as card'lac arrest Onset to Deem da not resuttkg in me urkerying pose given In Pan I. ^Ves ^ Probady
^ No ^ unknown
respiratory arrest, or ventr~lar fSnllation wMOUt showing the atblogy. List any one pose on earn line.
29. if Female:
IMMEDIATE CAUSE IFinal tlisease or n -
S (s ^ Not pregnant whin past year
m
~~
l
d
.
ting In
ee
) _~_ a
condition resu
^ Pregnant at time of death
Due to (« as a conseq rx:e oft:
C ~ ~ ^ Not Dregnant but pre9naa wimin 42 tlays
5ern~entially Nsl prxgaons, k anY. b.
leading W the pose listed on line a. Due to (or as a c«rsequerrce of): a tleam
Enter the UNDERLYING CAUSE
(disease a injury mat Initiated me ^ Not pregnant ba pregnant 43 tlaya to 1 year
c
events resulting In deem) LAST.
Due to (« as a consequerra a)' bef«e deem
^ Unknown if pregnant wMk the past year
a
30a. Was an AutoDSy 30b. Were Autopsy Findings 3t Man a Deem 32a. Date of Injury (M«M, daY, Ypr) 32b. Desuibe Mow Injury Occurred 32c. Place a Injury: Home, Farm, Sheet Factory,
OlYre Buld'vg, etc. (SpeciFy)
Pedortned? Available Prior to Completkn NaWrel ^H«n'latle
/ of cause a Deem?
Investi
anan
t ^ Pendk
^ A
dd
~~ Time a Injury
32e. Injury at Work?
32F. If Trensportatian bury (Speo'y1 3z . Loption a m so-em, tm /town, atare(
9 Wry
r-~
s Ir/J No
^ V ^Ves ^ No g
g
en
c ^Ves ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
e ^ Suiade ^ Coultl Not ba Delertnmed M. Oytpr - ~~y.
3 3b. Sgrature and Title d Certifier
/ r1
33a. Certifier (dreck only one(
h rtrqunptl deem and wmpleletl hem 23)
sician (Physician prtitying cause of deem when another physician asp
tftyin
h
C i
~
g p
y
er
To tfre beat of my knowbtlge, deem ooeurtetl due to the pose(s) entl manner as emted _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 3c. Licenee Number 33d. Date S' tied tn, day, Year(
• Pronouncing aM caddying phyekian (Pnysician ban pronourxing deem ark pritlyirg b cause d deem)
To the best of my knowledge dmm aaurred at the dme.date and PVp• and due to the pose(s) and manner ae statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
r~l . -1 ~ I I ~~
~ I
I ~
• Medipl Examiner I Cor«w rid eta, ark tlue to the tau a ark manner as ataled_ ^
On the basis of examinalbn entl I «Invesbgation, in my opinion, death occurred at the time, date, a pl ae() 34. Name and Address of Person WM Completed Cause d Deam (hem 27) Type /Print
__ I
~L 1 "+ ~-~'-M•, ~ S j~ ~ ~ ~ {~ (~~ ( I G) t
~ N
~~
35 eg r' cure DI Dat Filetl (Monet. daY. Yjer) .
^
0599605
Disposition Permit No.
TO: Lee County District Court
i....._ L.._. k..,.. ~
From: Napier, Wolf, Popejoy &Auge, LLP ~ ~ ~'~~ + 7 ~~~~' ~' r t
U!S i iIGT CC;IJ:; ~
APPLICATION TO SEND ORIGINAL WILL TO ANOTHER ST~I~O~NTY, ~~W,^;
~~~~ ,n
Application is hereby made to have the Lee County District Clerk's Office in Fort
Madison, forward the original Last Will and Testament of SARAH AMELIA GROESBECK
HASS to The Clerk of Court of Cumberland County, Pennsylvania.
The undersigned has been contacted and informed that Ms. Hass died on August 31,
2011, a resident of Cumberland County.
I CERTIFY UNDER PENALTY OF PERJURY AND PURSUANT TO THE LAWS OF
THE STATE OF IOWA, THAT THE PROCEEDIN IS TRUE D CORRECT.
i
Lloyd H. olf, Attorney
Napier, olf, Popejoy &Auge, L
607 8`~ Street, Suite 1
Fort Madison, IA 52627
PH#319-372-2934
ORDER
Upon the application hereinabove, the Court FINDS: That the Lee County District Court
Clerk should transfer the original will of Sarah Amelia Groesbeck Hass to the Cumberland
County Clerk of Court, located at #1 Courthouse Square, Room 102, Carlisle, PA 17013.
Dated this day of , 2011.
Judge of the 8`'' Judicial District
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SAR AH AMELIA GROESBECK HASS --+ ~ ` ;~
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I, Sarah Amelia Groesbeck Hass, of Fort Madison, Lee County, Iowa, declare this to be my
Last Will and Testament and revoke all former Wills or Codicils thereto heretofore by me made.
ARTICLE I
I state that I am single, being the widow of Kenneth Octave Hass, and that [have four living
children who are: Ken Marik Hass presently residing at 590 Sinai, Summit Hills, Rio Piedras, Puerto
Rico 00920-4333, Neth M. Hass presently residing at 3215 Nash Road, Anna, IL 62906-381.0, Tave
Erin Hass presently residing at 4208 East Oak Knoll, Springfield, MO, Kara Jenann Hass Miller
presently residing at 410 Fairway Drive, Mechanicsburg, PA 17055-5713. Wherever the word
``child" or ``children" are used herein it shall be deemed to mean the children herein named.
ARTICLE II
In the event I have made a separate written statement, letter or list to dispose of items of
tangible personal property not otherwise specifically disposed of by this Will, I direct my executor
to distribute such items in accordance with such writing. Such writing need not be in existence at
the time of the execution of this Will, but it shall be dated, and either be in my handwriting or
signed by me, or both, and may be altered, added to or changed in any respect by me after its
preparation, and it may be a writing which has no significance apart from its effect upon the
dispositions made by this Will. This provision is intended to comply with Section 633.276 of the
1999 Code of Iowa.
ARTICLE III
I direct that my estate shall be divided in equal shares with one share for each living child
of mine and one share for each deceased child of mine who is survived by lineal legitimate
descendants. I give one share to each child of mine and one share to the lineal descendants, per
stirpes, for each deceased child of mine.
ARTICLE IV
I nominate and appoint my oldest child who is qualified and willing to so serve as Executor
of this my Last Will and Testament. The children in such order therefore would be Ken Hass, Neth
Hass, Tave Hass and Kara Miller. I direct that my Executor shall be authorized and empowered to
sell, mortgage, lease or convey real or personal property without the necessity of obtaining order of
the Court and in all events I exonerate my Executor from giving bond. I further state that unless
there is agreement among all of my beneficiaries that any land that I might own in Union County,
Iowa, shall be disposed of or sold by my Executor in the administration of my estate, rather than
have fractional interest in said real estate distributed. I authorize and empower my Executor to do
all things that are necessary to sell or otherwise dispose of such real estate as my Executor in his or
her sole discretion sees fit. No bond shall be required for such sale.
IN WITNESS WHEREOF, I have subscribed this my Last Will and Testament on this _
_2-.~hday of G ~'~~p~ ~( , 1999.
,' ,
~. ~ ,, ,
-'
SARAH AMELIA GROESBECK HASS
On this Zt\~~' day of ~c_~r,~ ~( , 1999, the foregoing instrument was in our
presence signed and executed by Sarah Amelia Groesbeck Hass, and by her declared to us to be her
Last Will and Testament, and at her request, and in her presence, and in the presence of each other,
we have subscribed our names as witnesses thereof.
Witnes ~~~ Address
'~. ~~_:
Wi' ess ~ Address ~ V,
STATE OF IOWA
COUNTY OF LEE
ss:
Before me, the undersigned, on this day personally appeared, Sarah Amelia Groesbeck Hass, _
~~ ~.~dv~ b 1 I~$\ . ~. ~ and .~ ~ i 1 ° ~ ... eT~ r i r ~ ~~ ;~ ; t ~ ,known to me to be the Testator and the
witnesses, respectively,wJhose names are signed to the attached instrument, and all of these persons
being by me first duly sworn, Sarah Amelia Groesbeck Hass, the Testator, declared to me and to the
witnesses, in my presence, that said instrument is the Testator's Last Will and 'Testament and that
the Testator willingly signed and executed such instrument, or expressly directed another to sign the
same for the Testator, in the presence of said witnesses, as the Testator's free and voluntary act for
the purposes therein expressed; that said witnesses and each of them declared that such Last Will
and Testament was executed and acknowledged by the Testator as the Testator's Last Will and
Testament in their presence and that they, in the Testator's presence, at the Testator's request, and
in the presence of each other, did subscribe their names thereto as attesting witnesses on the day of
the date of such Last Will and Testament; and that the Testator, at the time of the execution of such
instrument, was of full age and of sound mind, and that the witnesses were sixteen years of age or
older and otherwise competent to be witnesses.
/ / / ~- ` ~. .xef l
SARAH AMELIA GROESBECK I-LASS, TESTATOR
S
Witness '~'~
Witness ~'
Subscribed, sworn and acknowledged before me by Sarah'A~me~lia Groesbeck Hass, the Testator;
and subscribed and sworn before me by Syza,~t~o ; t~,~ J and , i ,~ i _: ~_~ ~ i'~~ ~~3%r;
witnesses, this 2~~ day of ~L ~~~ , 1999.
Ck~' ~~ ~ Notary Public iyt4 ~rfd fj~lr the State of Iowa
~ / / ~