HomeMy WebLinkAbout09-21-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSY
REGISTER OF WILLS LVANIA
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of'y~ ° I'`.t1r. ~ ,~ ~'/~ /f/.e
a/Wa: ,Deceased ESTATE NO: 21- ~ ~ " 4~~~
a/k/a:
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C+~
applicable:
~A. Probate and Grant of Letters Testamentary or OAdministration c.t.a., or d.b.n.c.t.a. (complete Part as
and aver that Petitioner(s) is/are entitled to the aforementioned Letters --~ Calso)
the last Will of the above-named Decedent, dated 9. may,. ~~~
~_ under
2 and codicil(s) dated
.---•
(State relevant circumstances, e.g, renunciation, death ofexecutor, etc.)
Except as follows, Decedent did not many, 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 no
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): t a
D B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent life, dunnte absentia, dunnte 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 o
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pendin div
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(01_ ~Y~P.,, e- o_„___ f
g orce
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last famil or ``.J G
At .~:=~
"' ~,c y principal residence
(Street ad ss with Post Office and Zip ode, Munici li Townsh - ~~ ' ~ ~ "~"~~~ 'i" "'t ~+
Pa h'~ p, Borough, City)
Decedent, then ~Q years of age, died _°J- ~'4~+ h~„/~., lC_ ~~ti ~
~S! - ri P !f f ~ ~ / ~G!
~._at _Biti'_Us .r' -~L~cs~ 2
Estimated value of decedent's ro (Month, pay, Year ofdeath) (Crty and State wherr, death occurred)
If domiciled in PA p ~~' at death:
_If not domiciled in PA All personal property
If not domiciled in PA Personal Property in Pennsylvania S --s`-°-°
_Value of Real Estate in Pennsylvania Personal property in County S
a
Total Estimated Value S ~e-- =s'-
Location ofReal Estate in Pennsylvania: (Provide full address if ssible. S ~ ~ ~ ~yj.- CC>
Signature(s) T
C7
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Oath of Personal Representative .J
COMMONWEALTH OF PENNSYLVANIA ~' r,~~ __ ,
COUNTY OF- ~~~~=MSG ~ .` -
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The Petitioner(s) above-named swear(s) (s) that the statements in the fo L~ ~ '• + ` ,~'
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent't~on are tttie and correct to the best of
administer the estate according to ]aw.
Petitioner(s) will well and truly
Sworn to or affirmed and subscribed ~
bef me the 'S ~ Signature ojPersonal Representative
- day of
Signature ojPersonal Representative
~~
For the register
Signature ojPersona! Representative
File Number: ~ ~ - l~"
Estate of~~a,~y~V
/~ .l7~~i .....
Social S ~ ~~ ____, Deceased
ec~,i city Number: _ G~
~~ f1 Date of Death:_~~ , / y
AND NOW, ~~ ""'°~f-
having been presented before me, IT IS DECREED that Letters ' to consideration of the fore oin Petition, satisfacto
are hereby granted to g g rY proof
L:7 nu..
and that the instrument(s) dated
described in the Petition be admitte~o~ and ftsled f
FEES
Letters .......... , . $ ~ ~. OZ
Short Certificate(s)
Renunciation(s) , .. , .. $
._ ... $
... $
-------_
... $
------_
.. $
~~
... $_
... $
'-~-~~_
... $_
TOTAL ...... ..... $ ~,5
C
Funn R1KU: rev. lU.lj.U6
Attorney Signature:
in the above estate
Supreme Court LD. No.: _ ,2~ '~, ~'r- --_
Address: `~
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Telephone:
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Page 2 of 2
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OATH OF SUBSCR~.gING WITNE'SS(ES) : l~ '
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REGISTER OF WILLS
~-~/~ ~/ COUNTY, PENN
SYI~VAIVIA
Estate of
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Deceased
the,~yVill O Codicil(s) presented herewith, (each) being duly ualifie ' (each) a subscribing witness to
. say~`(s\~) that sh he q d according to law, depose(s) and
~eY as /were present and saw the above Testator
and that she / e /they signed the same.~and that. she estatrix sign the same
the Testato Testatr ~ they signed as a witness a.t the request of
in her his presence and in the presence of each other.
(Signature) C / A ~ _~ ~~ ! ~
(S~gnarure) ~ ~
(S[ree[ Address) _-+~ ~~ ~ ~- '" /` J
(Ci[y, S[a[e, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before.. e this '~
day
of • ~/
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e uty for Register of Wills
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NOTE:
(Sheer Address)
c.-v` Gam, ~,~);~ y; ¢ 2E3~
~iLtGC S~ ~ /~~ ~ ~iG'/ ~ ,
(C[ty, Stare, Zip) .~
Executed out of Reg,t`ster's Office
Sworn to or affirmed and subscribed
before me this
- --~_ day
of
Notary Publi
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
To be taken b Off
Y tcer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
Form RW-03 rev. !0. /3,OC~
- Register of Wills of Cumberland County
OATH OF NON-SUBSCRIB.IlVG WITNESS
Estate of ~Q„~~~Y
I~}w ~/C~
No.
Also known as ~'-'
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,Deceased
(each) a subscriber hereto, (each) being duly qualified according to law, deposes and s
familiar with the si ,. () ay~s) that
gnature of / __ ~~ r ~~
subscribing witnesses to) the codici]/will presented herewith and that S.(e b/-~le ~e e~'~of (one of the
on the codicil/will is in the handwriting of - s the signature
-~_ knowledge and belief. ~ ~ `~~~N~~' to the best of
Sworn to or a;~ ate( subscribed
B ore me is ,>' d of
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LOCAL REGISTRAR'S CERTIFtCATtOP~ OF DEATAx~.H
WARNING: It is illegal to duplicate this copy by photostat or phot~ngraph.
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TYPpE / PRINT IN COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH .VITAL RECORDS r
SLACK INK
1. Name of Decedent (Firs( mitlMe, last, su16x)
(See i atru~ctlonls a^d ex~amplDes on averse)
Dorothy Pauline 2. Sex STATE FILE NUMBER
5. Age (Last Birmtla DanneC 3. Social Secunry Number
Y) Under 1 ear Untler t h 6. Date of Binh Month, h , ar Female 1'71 4. Dale of Deam (M«m, day year)
80 Momms Dare Hrors Mnulea 7. Binh lace c arMataleorlomi nroant - 30 _ 6707 September 14, 2011
DE?C. 5, 1930 ea. Plaea m Beam cnepk onl nna
Yr6. Perry County PA Hospual:
6b. County of Death ~ Other;
6c. Chy, Bore, Twp, of Death B4. FacilNy Neme (11 rot instiNli ^ Inpalienl ^ ER / ONpalienl ^ DOA
C ' Cumberland S. Middleton cn, give street and number) 9. Was Decedent of Nh ^ Nursing Home ®Residence ^ Other ~ Sperily:
~P• 50 BonnybrOOk Rd Carlisle, PA Pardcorigirn No ^Yas iD.Rape:Amerkanmdian.Blaok
11.0«edenl's Usual Occu fion Kintl al wale tlorre tlud ' ~ III yes, soeciry Cutan,
White, etc.
most of workin life. Do nd stale reli2tl' 12. Was D«edant ever in me 73, p Mexican, Puedo Ri:an, etc.) (SP«'i>l1
Kintl of WoM Kind of Business/Intluslry U. S. Armed Forces? ecetlenc's Educalim S
Cleanin 1 pecily Dory highest grade completed) 14, Marital Status: Marred, Never Marrieq 75 Burvrvin B Wh1te
COIL a f7, Elementary / Seconds 042 Witlpwh, Divorcetl (Speciry) 9 pouse (II wile, give maiden name)
16. Decetlenc's Mating Address (Street, Ltity /town, state, zip code) ^Yas ysNo 8 ry ( ) College (1 d or 5+)
50 Bonnybrook Road, Lot 22 °«edent's Widowed
Carlisle, P AamalReaidence na slate- pp, DieDecedent
A 17013 rywsa ,7c iX~Yea,DecedentUyedm S. Middleton
1B. FameYS Name (First, middle, last, sl>Kx) 17b. County Cumberland To n hip?
17tl. ^ No, D«edent Lived within Twp.
Frank Zeigler 19 Mother's Name (First, middle, maiden surname) Actual Limirs of
20a. Imormant's Name (Type I print) City/Borc
Wanda L. Lynch Dorothy Miller
20b. Intormenl's Melling gdtlress (Scree,, city /town, stele, zlp cntle)
2,a. Me1hM of Dlapoa4ion 50
^ Borial ~cremalion ^D«aa« 2,bDeteolDi Gilbert Road, Shippt=~nsburg, PA 17257
^ Rempyal (rpm State i Was Crematbn sposilion (Month, day, year) 21c. %ace of Dis
^ Omen -: ' b mpne°or /nCororler;+~n~8a posilion(Name of cemetery, crematory or omer place)
_ ~" raaFal,eral son xa Yea^NO Sept. 16, 2011 Hoffman-Roth Funeral e & 2,dL«apon(arv/town,atate,z;peode)
zza s ~ rcan e, HeNrl
< ~ --~ appngaaa«ro zzb uP na N mbe Carlisle, PA 17013
138504 zzc. Name and Adtlreaa of Fapiliy
complete aems ~ Hoffman-Roth Funeral Home &
PhraKianianotavailableanim~o~~ ~;9° z3a TO mabaa,olmyknowle,iga.aeam«etlnadatmatima,dataanepladeatatad.(signawraandrde) 219 North Hanover S Cremato
"amncausaatdaam. treat, Carlisle, PA 17013
23h. License Number
llama 2a-26 must be 23c. Date Signed (Month, day, year)
completed by person 24. ilme of Death 25. Date Prone«e0 Dead (M«m, day, year)
wfw pronounces deem.
1:35 P M. September 14, 2011 zs. was caaa Rarelmtl to Medcal Examiner /coroner ror a Reaann omer man cmmali« or Donau«?
Item 27. Part I: Enter the Man L av h _ diseases, injures, oUcmm OjcationsA7H (See Inetructlane antl exampleR) ^ Ve5 i~ No
reapiralory arrest, or vent«uWr fibrillation with«i 5~ing me a Mal dlractly eased me deem' W NOT omer terminal events SuM es cardiac arrest, ' APDroJUmate interval: Pan II: Enlerother
IMMEDIATE CAUSE (Final disease or ' Ust °nN one cause on eaM Me. Onset to Death SIgN(I~nt mrvf I t LN l n' th 28. Did Tobacco Use Comribule to Death?
condition resulting in e m ~-y but nal resultng In me underlying cause g' an i pan I
a) '-~ a ~d(`"~ ~L/Y L/ !7./ ^Yas ^Probabty
Du t `-'ls~ ^ No ^ Unknown
SsW Bally Ilsl wlyitions, if any, I s Q R
leadsng b Ih listed on Ilne a. b _~~ 29. II Female:
Enter the UNDERLYING CAUSE Due to (or a -'- ^ Not pregnant within
fdiaeaaa a unary that impaled me a a oonaepnan~ op: Peat year
vents resultng m «alh) LAST, c _ ~_- ^ Pregnant al time of deem
Duo to (or as a ~----
consequence off: ^ "Nr ~egnanl, but pregnant wdhin 42 days
tl_ i ~_
30a. Was an qulc s ~ -~- ^ Nol pregnant, but
P Y 30b Were Autopsy Finds pregnant 43 days l0 1 year
Pedormed? n9s 3t Mannar of Oeam 32a. Dale of Injury (Harm, tla , r -----~- befo a tleath
Available Prpr to Completion ~,/ Y year) 32b. Describe How In u --
ol Cause of Death? L") NaNral ^ rypmMiM I rY Occuned ^ Unknown it pregnant within me pall year
^ vas 32c. Plece of Injury: Home, Farm, Slrael, Factory,
No ^ yes ^ No ^ Accident ^ Pentlmg Invests pen 32tl. Tlme pl Inju Odlce Building, etc (SptCbyJ
~ ~ ry 32e. Injury at WoM1? 321 II Tren
^ Suicide ^ Caultl Nol ba Determinetl sPortatwn Inury (terry) 32g. L«alian of in u
33a. Comfier (check Doty oral M. ^ Vas ^ No ^ Dliver/OPemtor ^ Passenger ^ Pedesinan I ry fSCreal, City /lows, stale)
^ Omer ~ SP«ily
(:enHying phyaicun (Physician cenityirg cause or death when aMIMr pdyaiGan has pronounced tleath and rompletetl Item 23)
• 7o the heal o/ my knowledge, death occurretl due to the ceua 33b. Bgnature TiNe of Cenmer
' Pronouncing and xtlllying physiclen (Ph sitter e(s) and manner as stated _ _ _ _ _ _ _ _ _
To the best of my knowledge, hash occu red at the tl rnnoancxy deem antl certifying m cause of death) - -' - -' - - - -
° Medipl Examiner/Coroner me, dale, end place, antl due to me cauae(a) and manner as staletl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c License r v
o On the basis of examinetbn and / or investlgalion, i u _ 33d. Dale Sgrre (Month d ,year)
n my opinlpn, bath occurtetl el the time, date, and place, and tlue to the ca ~ ~ (~ /
a 35. Regislral a and Distrel yymtRT use(s) and manner as sraled_ ^ 34. Name antl Address of Person Who Compleletl Cause of Deam jllem 2I) Typa / y t v 6
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. l~.L~~~~ I~ I I I ~ I f I f-` I 36 Date Filetl (Month, day, year) Bryan Reid, M. D,, v-
V I S _ 1921 Spring Rd. ,. Carlisle, PA~ 7013
Dispositlon Perms, No. ~ ('1051 ~ (D 4-
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I, DOROTHY P. DANNER, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this to be my Last Will and revoke any will previously made by
me.
I
II
III
I give and bequeath to my daughter, DEBORAH F. HERSHEY, my 1977 Astro
mobile home, VIN PAAMSVC4063531Aiocated at 50 Bonnybrook Road, Lot
22, Carlisle, Cumberland County, Pennsylvania 17013, together with all the
furnishings and household effects therein, lot rent, and insurance thereon,
provided she shall survive me by thirty days. Should my said daughter, Deborah
F. Hershey, predecease me or die on or before the thirtieth d.ay following my
death, this gift shall lapse and become a part of my residuary estate.
I give and bequeath all of the rest, residue and remainder of my estate of every
nature and wherever situate in equal shares to such of my following adult
children, my daughter, WANDA L. LYNCH and my son, HERBERT M.
DANNER, JR., as survive me by thirty days.
Should my daughter, WANDA L. LYNCH, or my son, HERBERT M.
DANNER, JR., predecease me or die on or before the thirtieth day following my
death, I give and bequeath the share of such child to his or her issue per stirpes
]'.wing on the thirty-first day following my death; and should either my said
daughter, Wanda L. Lynch, or son, Herbert M. Danner, Jr., leave no such issue
living on the thirty-first day following my death, I give acid bequeath the share of
such child to my other child or to his or her issue per stirpes living on the thirty-
first day following my death.
IV. I make no further provisions in this my Last Will for my daughter, DEBORAH F.
HERSHEY, or any provisions herein for my son, KEVIN M. DANNER, not for
lack of love or affection but because they have otherwise been provided for.
V. All federal, state and other death taxes payable because of~my death, with respect
to the property forming my gross estate for tax purposes, whether or not passing
under this will, including any interest or penalty imposed in connection with such
tax, shall be considered a part of the expense of the adminiistration of my estate
and shall be paid out of the residue of my estate without apportionment or right of
reimbursement.
VI. I appoint my daughter, DEBORAH F. HERSHEY, executrix of this my Last
Will. Should my daughter, Deborah F. Hershey, fail to qualify or cease to act as
executrix, I appoint my grandson, STEPHEN WILES, executor of this my Last
Will.
VII. I direct that my executrix or her successor executor shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
~/~
IN WITNESS WHEREOF, I have hereunto set my hand z~nd seal th~ ~ day
of September, 2010.
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DOROTHY P. A ER
The preceding instrument, consisting of this and two other typewritten pages
identified by the signature of the testatrix, DOROTHY P. DANKER, was on the day and
date thereof signed, published and declared by DOROToHu ~D~ Tit heRr quest, inrher
therein named, as and for her last will, in the p
presence, and in the presence of each other have subscribed our names as witnesses
hereto.
G~ o y
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