HomeMy WebLinkAbout08-31-11PETITION FOR PROBATE AND GRANT
OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Helen F. Crouse
also known as
.loan r _~~~ ~~e o;~,.~.:_ __ ~ , - - - ,Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' OR 'B' BELOW.)
D A. Probate and Grant of Letters Testamentary and aver that Petitioners
last Will of the Decedent dated 5/6/2008 () is /are the ~Xecu OfS named in the
none and codicil(s) dated none
(State relevant circumstances, e.g., renunciation, death of executor, ~~tc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
for probate, was not the victim of a killing, was never adjudicated incapacitated, and was not a the instrume
offered _
of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3 23ry to a pending divorG_~~eeding awe ti ~'~'
="i r~
no exce tions (g)~ -n ~~ , ; , ~.~
^ t _-'.
B. Grant of Letters of Administration r ~ ~ ---
(Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; dura
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was su "~'~ ate) ^r- r
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirsa by the followin sous an ~'~
~ g p Y) aneirs:
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent, then 94 years of age, died on 8/26/2011
6 East Burd Street at Shi ensbur E isco al Home
Shi ensbur PA 17257
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal roe $ 2 000.00
(If not domiciled in PA p P rtY in Pennsylvania $
) Personal property in County $
Value of real estate in Pennsylvania
none $
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the rant of Le
the undersigned: g tters in the appropriate form to
Signature
-,
~`_ /
Jean Crouse Ritchie
James R. Crouse
931 Foxfire Trail
File Number C~-1 I ~ " ~Q a~
Social Security Number 195320870
628 Brad Street
Typed or printed name and residence
Form RW-02 rev. 10.13.06
Page 1 of 2
Decedent was domiciled at death in Cumberland
206 East Burd Street County, Pennsylvania, with his /her last principal residence at
Shi ensbur PA 17257 Shi ensbur
(List street address, town/city, township, county, state, zip code) BorOU h
Oath of Personal Representative
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
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent pe • • true and correct to the best of
administer the estate according to law. titioner(s) will well and truly
Sworn to or affirmedtan~subscribed
bef a me the ~ ° 1
day o:
,,~~~11
of Personal Representative Jean,~rouse Ritchie
Signature offers q~Representative James R. Crouse
~~''or`Che Register Signature of Personal Representative
1 ,--•
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0
File Number: ~ ~, ~ --
Estate of Helen F. Cro se ~ ~ •~'~' - ~'
Deceas~ ;~~..~ ~~~
Social Security N ber: 195320870 ~O '''~'
Date of Death: 8/26/2011 ~ ~ ~ '
AND NOW' , 2011
having been presented be re me, IT IS DECREED that Letters Testamentasideration of the foregoing Petition, satisfactory proof
are hereby granted to Jean Crouse Ritchie and J mes R. Crouse
and that the instrument(s) dated Mav 6. 2008 in the above estate
described in the Petition be admitted to probate and filed of rec s the 1st Will and Codicil
( of Dec de t.
FEES ~ n~ ~ . ~~~~ ~~ a n . ~t~ .,
Letters ............................. $ 20 00
Short Certificate(s) ••.......... ~ 80 00
Renunciation(s) ................ $
Will .... $ 15 00
JCS fee ..., $ _ 23 50
~tomation fee .... $ 5 00
.... $
.... $
.... $
.... $
.... $
.... $
TOTAL ............................. ~ 143 50
Form RW-02 rev. 10.13.06
Attorney Signature: ~~"~~ x
Attorney Name:
Supreme Court I.D. No.: 17516
Address: 14 North Main Street Suite 200
ChambersburQ
PA 17201
Telephone: L17)264-6029
Page 2 of 2
H105.805 REV (01/07)
LOCAL REGISTRAR'S CERTIFICATICIN OF
WARNING: It is illegal to duplicate this co b hot DEATH
pY Y p osi.at or photograph.
Fee for this certificate, $6.00
This is to certify that the information h
i
ere g
ve
correctly coded from an original Certificate of D
duly filed with me as Local Registrar. 'The orig
certific~ite will be forwarded to the State ~
P R~ec s O.1-ice for permanent filing.
1769501
Certification Nujmber 6 ~` Zp' Z_
Local Registrar _ Date Issued
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H105.143 REV 11/2pp6 ti~ ~ -~..~ , .•,
TYPE /PRINT IN COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORD
PERMANENT '~
BLACK INK S
'_~ ` J
CERTIFICATE OF DEATH -
~ C~ . ~~ ~~ T~
1
N
ame
of Decedent
(First, middle, less, suNix) ~
(See instructions and examples on reverse) f"`
STAT
UM
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,
p
r
n even r • Cflo(a.d e E FILE N
BER (,,,
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2. Sex 3. Social Security IVumber
5. Age (Last Birthday)
under, ear
Under 1 da
6. Dale o1 Binh Month
da
a 4. Dale of Death (Month, year)
~emaee 195 _ 32 _ 0870 Augub~ 26
2011
94
"
1rtpi1hs
Days Hours Minces ,
,
r ,
7. Binh lace Ci and state or forei n count
8a. Place of Death Check onl one
Yrs. Navembe~c. 25, 1916 hippenabung pA Hospital:
~ Other:
Bb. County of Death
CumbPJLeQ-nd
Bc. City, Boro, Twp. of Death
Sh'('ppeY1
6 bUh ^ Inpatie
8d. Facility Name (If not institution, give street and number)
h nt ^ EH /Outpatient ^ DOA
9. Was Decedent of Hispanic Origin? ®Nursin Home
9 ^ Residence ^ Other -Specify:
~]
^
.
g
S
i-ppenb bwcg ~pt,b eo p~ }lame No
Yes 10. Race: American Indian, Black, White, etc.
(n Yas, specify Cuban,
11. Decedent's Usual Occu lion Kind o1 work done
Kir~ of Work
Sehoo.e l eaehere Burin most o1 worki tile. Dona state retired
Kind of Bu mess/Industry
F
ee1'11Q
Y~~ 12. Was Decedent ever in the 13. Decedent's Education (Specity Doty highest grade cempleted~z~r! 14. MeritalcStatusc Married, Never Married, 15. Surviving Spouse (~ it maid
U.S. Armed Forces?
Elementary
ec
d
Wid
16 D
d
'
,
,
y
~
on
ary (0-12)
^Yes ®No 1
+CoIIEge (1-4 or 5+)
L/~}
owed, Divorced (Speci/y)
i
d en name)
ece
ent
s Mailing Address (Street, city /town, stale, zip code)
206 ~. $wed S~• Stu
ppe~ bung pA
Decedent's pQ
State Did Deced
Actual Residence 17a .
.
owed
ent
~
1 7 2 5 7 .
Live in a 17c. ^Yes, Decedent Lived in
17b.County ~~ eh~.Q.n Township? 17d ® Twp.
w
0
w
w
0
z
18. Father's Name (First, middle, last, suniz) No, Decedent lived within Sluppena burCg
Actual limits a City /Boro
J • pau,e l=o
19
Mother'
N
e~ an
r
.
s
g
g a
c-
ame (FirQSt, middle~,.ma"ides surname;
20a. Informant's Name Ca~ucc.e Deut,.tt.e
(Type / PPrinQ
L
JeQ-~'l T7 • R•(,tC,II~(.e 20b. Informant's Mailing Address (Street, city /lows
state
zip coda)
,
,
- 21a. Method of Disposition r
628 Brca.d S~icee~, S6u,ppenaburcg,
^ Cr
ti
^
PA 17257
ema
on
Donaton 21 b. Date of Disposition (Month, da ,
® Burial ^ Removal Irom State i Was Cremation or Dortetion Authorized 6 Y Year) 21c. Place of Disposition (Name of cemetery, tremolo or other lace
o ~, 3 O - 2 O 11 ry P )
Other - S by Medical Examiner/Coroner? ^Yes^ No Spru.n9 ~~ Ceme
teh
'
21 d. Location (City /lawn, state, zip coda)
22a. S
to Funeral ice ' in as such)
r
22b. License Number ~
.y
Sh,%ppeil2b bwcg
pA 17 2 57
Complete items 23a-c ally when certn
in
23
~~-014351-L ,
22c. Name and Address of Facility
~oge.P~tangerc-8rci.efzeh- Fune~ca,Q Home 112 (Ue~~ King S~iC.ee~
,
S
hi.ppev~csburcg
y
g
physcian is not available al time of death to a. To the best of my knowledge, death attuned a e time, date end place led. (Signat ure and title) -
J
[
pQ 1 / 2 5 7
cenity cause a death.
It
24 ~ 23b, Lcense Number
~ r~ ` ~/
2 Date Signed (Month, day, year)
ems
.26 must be completed by person
who proraunces death. 24. Time o1 Death
/~~i~/ 25. Date Pronouns e d (Month, day, year)
~~
26. Was Case Referred t
M
~~M. o
edical Exa
~ ~(~ / ~ ^Yes `~N miner /Coroner for a Rea Other than Cremation or Donation?
o
CAUSE OF DEATH (See Instructions and amples)
Item 27. Pan I: Eller the chain of events -diseases, injuries, or complications -that direaly caused the death
r Approzimale interval: Part II: Enter other sientlicant conditi
DO NOT ente
res
i
t
i
t
l
.
r
erm
p
ra
na
o ski
events such as cardiac arrest, r
ory arrest, or ventricular fibrillation without showing the etiology. List only one cause on each line. r Onset to Death
but not resulting in the undenying cause
ding to death 28 Did Tobacco Use Contribute to Death?
given in Pan I
^
IMMEDIATE CAUSE (Final disease or /~ i
condition resulting in death) / A ~~ ~
r .
yes
^ Probably
^
^
~
-~ a. V E r No
Unknown
r
Due to (or as a consequence o1): r
Sequentiallyy list cendnions, it any, r
leadingg 1o tAe
li
b' 29. If Female:
^ Nol pregnant withi
ceuse
r
sted on line a.
Enter the UNDERLYING CAUSE Due to (or as a consequence oQ: r n past year
^ Pre
nant at li
f
r
ese or injury that inhaled the r
events resulting in death) LAST. c. g
me o
death
^ Not pregnant
but pre
nant withi
42 d
r
Due to (or as a consequence ol): r ,
g
n
ays
of death
r
d. r
r
Not pregnant, but pregnant 43 days 101 year
30a. Was an Autopsy 30b. Were Aul s Findin
Pedormed? ~ y 9s 31. Mannei o ath 32a. Dale o1 Injury (Month, da , ear
Available Prior to Completion Y Y )
~
32b. Describe How Injury Occurred before death
^ Unknown it pregnant within the past year
of Cause of Death? afural ^ Homicide
,_., ~
^ Accident ^ Pendin
mod. Time of Injury 32
^ Yes o ^Yes L`i'IG
Inve
ti
i
I 32c. Place of Injury: Home, Farm, Street, Factory,
Office Building, elo (Specify)
g
s
o
gat
on
e.
njury al Work? 321. II Trans nation fn u S cil
PO fry (Pe Y)
^ Suicide ^ Could Not be Delennined ^Yes ^ No ^ Driver/Operator ^ Passen
^ P
32g. Location of injury (Street, city /town, slate)
ger
edestrian
M' ^ Other
33a. Ceniher (check only one) Sped/y:
Certifyfn9 physcian (Physician cenitying cause of death when another physician has pronounced death d 33b. Signature and Title .r
T to
o e best of my knowledge, death occurred due to the cause(s) end manner as slated _ _ _ _ _ an completed Item 23)
Pronouncing and certltyfng physician (Physician both pronourx;ing death end cenitying Io cause o1 death - -
Tothe best of my knowledge, death occurred et the time, date, and ) 33c. License Number 33d. Dal
• Medical Examiner/Coroner place, end due to the cause(s) end manner as steted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ^-' ~ igned (Month,Ida ,year)
On the heals of examinetion arM / or investigation, In my oplnlon, de scarred at the time, date, end place, and due to the cause(s) end manner es slated_ ^ U , ~ ~-!
¢.~~LN.a(m~e~an(d Address of parson Who Completed Cause of D (nom 27) Type /print
35. Registrar's Signatu and x:l Number ~ ~.~^-^„ ~t~,~- `/~ t~ I'r~~,^ ~ J • l/Jl
- 12 j ~ I ^~ I ' I ~ 36. to Filed (Month, day, year) 1~' r v [ ,
Disposition Perms No. O 6 O 8 5 9 9 ~
~ ~a
//- 9~~
-~ .
JRZ - 5.1 crouse.hel April~l7; 2008
LAST WILL AND TESTAMENT
~ ~_~~o
I, Helen F. Crouse, of Shippensburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my will, hereby
revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease ~~s a part of the
expense of the administration of my estate.
II.
I give and bequeath my automobiles, household and personal
effects and other tangible personalty of like nature (not including
cash or securities) together with any existing insurance thereon to
my children, Jean Crouse Ritchie and James R. Crouse, in equal
shares, if they survive me by thirty days. ~ ,_,
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III.
I devise and bequeath the residue of my estate of every nature
and wherever situate to the Orrstown Bank, with ~-rincipal offices
in Shippensburg, Pennsylvania, to be added to and thereafter
treated as a part of that certain revocable funded trust created by
me on January 23, 1997, of which Orrstown Bank is trustee, to have
and to hold IN TRUST for the uses and purposes and subject to the
terms and provisions of my said trust agreement;, including any
alterations or amendments thereof or any other intervivos trust
which may hereafter be substituted therefor.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of m~~ estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
Page 2
principle of diversification of risk .
C. To sell at public or private sale, tc- exchange or to
lease for any period of time any real or personal
property and to give options for salE~s, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
Except as otherwise may be provided in my aforesaid revocable
trust, all Federal, estate and other death taxes payable because of
my death on the property forming my gross estate for tax purposes,
whether or not it passes under this will shall be paid out of the
principal of my probate estate so that the burden falls on my
residuary estate and none of those taxes shall be charged against
any beneficiary. This provision concerning payment of taxes shall
not apply to generation-skipping taxes and any property over which
I have a general power of appointment for Fedc=_ral estate tax
purposes.
Page 3
vi.
I appoint my children, Jean Crouse Ritchie and James R.
Crouse, as executors of this my will.
VII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
purpose of identification this ~_~ day of
21L~ -
/{~, r r
/~..a~"a...r~ JGT - {. ~ ( SEAL )
I ~ ~L-C~2~i...~'
Signed, sealed, published and declared by the above-named
testatrix as and for her last will and testament in our presence,
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses.
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d
Page 4
•
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We , ~ ~ u~ ii2_ and /r~~c~Ci L, ~~./r
the
testatrix 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 testatrix
signed and executed the instrument as her last will and testament
and that she executed it as her free and voluntary act for the
purposes therein expressed and that each of the witnesses, in the
presence and hearing of the said testatrix, signed the will as
witnesses and to the best of their knowledge, said signer was at
that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
., ~ ~-
Testatrix
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-named 'tnesses this d of
~~--- 2
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Not y Public
Notarial Seal
Carin L. Walter, Notary Public
Chambersburg Boro, Franklin County
My Commission Expires May 13, 2009
Page 5