HomeMy WebLinkAbout03-0513PETITION FOR PROBATE and GRANT OF LETTERS
also known as O~,',nlt_ [7 ppt. w~ en To:
Deceased.
Social Security No.
Register of Wills for the
County of ~.~/'r-¥~,.ittn~
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut /~to~n ~c. ,o- ~O,0cat e~x_. named
in the last wilt of the above decedent, dated ~ c/~.5'-o 'L. 77~ ,19__
and codicil(s) dated
Decendent was domiciled at death in ~ o/.~.eA.t.a ,~_~
h ] ~ last family or principal residence at
(list street, number and muncipality)
Decendent, then ,3 ~' years of age, died //to/cc~ ~ ,
at
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
County, Pennsylvania, with
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: /-/~ &e~rft-,
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ ~ ~O, o t9
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
request(s) the probate of the last will and codicil(s)
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -I
COUNTY OF ~.~b~r/~.r~L' ~ ss
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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed ,~d subscribed
before me~ ,;29~ __ . .
,t~Yono~, )~'],(~2~ / ~.,aT~,~ .~.&. Register'~
I 7' I q?'
No. 21-03-513
Estate Of WILLIAM H. PALMER A/K/A WINK PALMER , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JUNE 25th .~I~i 2003, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated MuniCH 5, 2002
described therein be admitted to probate and filed of record as the last will of.
WILLTAM H. PALMER A/K/A WINK PALMER ;
and Letters TESTAMENTARY
are hereby granted to THOMAS A. PAI.MER
FEES
Probate, Letters, Etc .......... $ 18.00
Short Certificates(1 ) .......... $ 3.00
~ E.>;TgA .P. AGI~..5. $ 15.00
JGP $ 10,00
TOTAL__ $ 46.00
Filed ....J.U.N.E...2.5.,..2.99.3. ................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
CALLED EXECUTOR JUNE 25,
2003
PA DEPARTMENT OF REVENUE ~unW Code Year I File Number
ESTATE INFORMATION SHEET O3 I
DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
Name (Last) (First) (Middle)
Decedent's Social Security Number Date of Death Date of Birth
TYPE FILING: Enter check (~) mark to indicate the nature of the return to be filed with the depa~ment.
[] Probate Return [~Joint Assets Only [] Estate Tax Only [] Litigation Purposes (No Other Assets)
Enter check (,,,) mark to indicate the nature of the proceedings at the Register of Wills
LETTERS GRANTED: Office. (Attach additional sheets if explanation is necessary.)
C~ Testamentary [] Administration [] No Letters [] Other (Please Explain)
ATTORNEY/CORRESPONDENT
INFORMATION:
Name (Last) (First)
Street Address
Enter all data concerning the attorney or other individual to receive all
tax information and correspondence.
(Middle) Supreme Court I.D. #
ICity State Zip Code Telephone Number
PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate
INFORMATION:
Execute r/Ad m inistrator
authorized by the Register of Wills
Name (Last)
Street Address
City
~o~--I _/g/~_-
Co-Executor/Administrator
(First) (Middle)
· Social Security Number
/75'-~a
State Zip Code Telephone Number
I Name (Last) (First) (Middle)
Social Securityl Number
Street Address
City State Zip Code
Telephone Number
Co-Executor/Administrator
Name (Last) (First) (Middle)
Social Security Number
Street Address
City State Zip Code Telephone Number
Prepared By
21-03-513
LAST WILL AND TESTAMENT
OF
WILLIAM H. PALMER
I, William H. Palmer, also known as "Wink," of 444 North West Street, Carlisle,
Cumberland County, Pennsylvania 17013, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making void any and all Wills and Codicils heretofore made.
FIRST
I direct the payment of my just debts and funeral expenses as soon after my death as may
be convenient.
I direct that all federal and Pennsylvania estate taxes, Pennsylvania inheritance taxes, and
generation-skipping transfer tax payable as a result of my death, not limited to taxes attributable to
property passing under this Will, shall be paid by my Executor from my residuary estate, including
any part of my residuary estate that otherwise qualifies for a deduction for federal estate tax
purposes.
I declare that at my request my uncle Thomas A. Palmer arranged for the preparation of this
Will by my attorney, Stephen D. Tiley. My attorney reviewed the contents of this Will with my by
telephone and then, at my direction, provided the Will to my uncle, Thomas A. Palmer, to bring to
me for execution. I reviewed the Will carefully prior to signing it.
SECOND
I declare that I am unmarried. I have a child Quincy H. Palmer, whose mother is Diana
Colino. I have no deceased children nor any other children living.
THIRD
All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever
the same may be situate, I give, devise and bequeath, in equal shares, per stirpes and not per capita,
unto such of my children as shall survive me by ninety (90) days, but should any of them fail to so
survive me then the share such deceased child of mine would have received shall pass to such of his
or her issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such
issue the same shall lapse and be added to the remaining share or shares, provided, however, that
should any such beneficiary be less than twenty-one (21) years of age at the time of my death their
distribution shall be paid to the guardian provided at paragraph Fourth herein. At the present time I
have one child, a son Quincy H. Palmer, as aforementioned.
In the event that no child survives me by the aforesaid period of ninety (90) days, I give,
devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, to my uncle, Thomas A. Palmer, of 441 West Penn Street,
Carlisle, Cumberland County, Pennsylvania.
FOURTH
Should any person less than twenty-one (21) years of age be entitled to a distribution out of
the residuary of my estate pursuant to Paragraph Third herein, I direct such share shall be paid to
my uncle, Thomas A. Palmer, of 441 West Penn Street, Carlisle, Cumberland County, Pennsylvania,
as Guardian of the estate of such person. I further direct that no said Guardian shall be required to
post any bond to secure the faithful perforrnance of his or her or its duties in the Commonwealth of
Pennsylvania or in any other jurisdiction, and I authorize and direct said Guar&an of the estate of
such person to receive and to invest said distribution and to pay so much of the income arising
thereon together with so much of the principal thereof as in its opinion is necessary or desirable to
be expended for the proper maintenance, support and education of such person, and upon such
person attaining twenty-one (21) years of age, to pay the then remaining principal together with any
undistributed income to such person.
Last Will and Testament of William H. Palmer Page I of 3
I hereby nominate, constitute and appoint my uncle, Thomas A. Palmer, of 441 West Penn
Street, Carlisle, Cumberland County, Pennsylvania, as Executor of this my Last Will and Testament.
I further direct that no bond or other security shall be required of any Executor or Executrix
appointed in this Will for the performance of his, her or its duties in any jurisdiction in which he,
she or it may be called upon to act. The terms Executor or Executrix may be used interchangeably
in this Will and shall refer to any Executor or Executrix appointed in this will, or any other
Administrator appointed by a court of competent jurisdiction.
SIXTH
In addition to, and not in limitation of, the powers conferred by law or by other provisions
of this Will, my Executor shall have the following powers, each of which may be exercised from
time to time by my Executor in his sole discretion:
(a)
(b)
(c)
To retain in the form received, and to sell either at public or private sale, or to
distribute in kind, any real or personal property.
To manage both real and personal property.
To invest and reinvest in all forms of property, notwithstanding the fact that any or
all of the investments made are of a character or size which but for this expressed
authority would not be considered proper for an Executor.
(d)
(e)
To exercise any option or rights arising from the ownership of investments.
To compromise claims without court approval and without the consent of any
beneficiary.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament, written on three (3) pages (including notary page), this ~W-~-4~x, day of March,
2002.
William H. Palmer
(SEAL)
Signed, sealed, published, and declared by William H. Palmer, the Testator above named, as
and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the
presence of each other, have hereunto subscribed our names as attesting witnesses.
Nancy C. Resnick, Notary Public
Derq¢ Twp., Dauphin County
My Cornm~ss~)n ExPires Jap 29, 2006
MembeL Pennsylvania Association Of No{~des
Last Will and Testament of William H. Palmer Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF ~ )
_ We, William H. Palm.e,r, the T~stator in, and ~ o~'¥ cc [ ~-~_ ~ cc ~c,._-~ -- c<~o._ ~..~
and C~ ~ ~ ~ U~. ¢~, ~, the witnesses, to the Last Will and Testament, the
attached or foregoing instrument, who have signed the instrument, having been duly qualified
according to law do depose and say:
a. that I, the Testator, do hereby acknowledge that I signed and executed the instrument
as my Last Will and Testament, that I signed it willingly and as my free and voluntary
act for the purposes therein expressed; and
b. that we, the witnesses, were present and saw the Testator sign and execute the
instrument as his Last Will and Testament, that he signed it willingly and executed it
as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Last Will and Testament as a witness and
that to the best of our knowledge the Testator was at that time eighteen (18) or more
years of age, of sound mind and under no constraint or undue influence.
William H. Palmer
Subscribed, sworn to and acknowledged before me by the Testator and the witnesses above-
named, this .c., ~---¢--t-x day of March, 2002.
Notary Public
~otana~
Maiar~c¥ C. Resnick, Notary Public
Oerry Twp., Dauphin County
My Commission Expires Jan. 29, 2006
Last Will and Testament of William H. Palmer Page 3 of 3
POWER OF ATTORNEY
NOTICE
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY,
WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL
OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY
YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO
EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT
MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH
THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR
LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A
COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S
FUNDS.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR
AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY
ARE EXPLAINED MORE FULLY IN 20 PA. C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND,
YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND
ITS CONTENTS.
WILLIAM H. PALMER (Date) _
Notarial ~eal
Nancy C I .... oick, Notary PubliC
Derry 'T'¢,o. ;' ,~r,~hir~ Oounty
My Commission Lxp~. :: !an. 29, 2006
I, WILLIAM H. PALMER, of 444 North West Street, Carlisle, Om~el~L~yh~~°n of Notaries
Pennsylvania, do hereby nominate, constitute, and appoint my uncle, THOMAS A. PALMER,
residing at 441 West Penn Street, Carlisle, Cumberland County, Pennsylvania, as and for my tree
and lawful attorney-in-fact, and as my agent (referred to herein as either my "attorney-in-fact" or
my "agent"), for me and in my name, place and stead, and for my use and benefit to transact all my
business and to manage all my property and medical and health affairs as I might do if personally
present, and competent, as hereinafter set forth:
immediately.
incapacity.
Effective Immediately, Durable. This power of attorney shall be effective
This power of attorney shall not be affected by my subsequent disability or
General powers. My attomey-in-fact shall have the following powers:
a. To ask, demand, sue for, recover, collect, and receive all sums of money, debts,
dues, accounts, legacies, bequests, interest, dividends, annuities, and demands whatsoever as are now
or shall hereafter become due, owing, payable, or belonging to me, and to use all lawful ways and
means in my name or otherwise for the recovery thereof, and to compromise and agree to the same
and give acquittances or other sufficient discharges for the same;
b. For me and in my name, to make, seal, and deliver, bargain, contract, agree for,
purchase, receive, and take any interest in real property; to accept the possession of, and all deeds
and other assurances for any interest in real property; and to lease, let, demise bargain, sell, remise,
Page 1 of 5
release, convey, mortgage, and hypothecate any interest in real property upon such terms and
conditions and under such covenants as my attorney-in-fact shall think fit;
c. Also to bargain and agree to, buy, sell mortgage, hypothecate, and in any and
every way and manner deal in and with goods, wares, and merchandise, chooses in action, and other
property in possession or in action, and to make, do, and transact all and every kind of business of
any nature and kind;
d. And also for me and in my name, and as my act and deed, to sign, seal,
execute, deliver, and acknowledge such deeds, leases, mortgages, hypothecations, bills of lading,
bills, bonds, notes, receipts, evidence of debt, releases and satisfaction of mortgage, judgments and
other debts, and other instruments in writing of any kind as may be necessary or desirable;
e. Giving and granting unto my attorney-in-fact full power and authority to do
and perform every act necessary, requisite, or proper to be done in exercising this power of attorney
as fully as I might or could do if personally present, with full power of substitution and revocation,
hereby ratifying and confirming all that my attorney shall lawfully do or cause to be done by virtue
hereof.
f. To take possession, have access to and order the removal and shipment, of
any of my property from any post, warehouse, depot, safe deposit box, dock, or other place of
storage or safe keeping, governmental or private; and to execute and deliver any release, voucher,
receipt, shipping ticket, certificate, or other instrument necessary or convenient for such purpose.
g. I direct that my attorney shall not sell any of my household goods or
furnishings unless it shall be necessary in order to provide adequate funds to pay for my reasonable
living and medical expenses. I direct that my attorney shall retain all such household goods and
furnishings as my attorney believes I may currently need or need in the future. In the event my
attorney deems it necessary to dispose of any household goods or furnishings not needed to be
sold to raise money for my care and not deemed to be needed by me currently or in the future, then
I direct that all such household goods and furnishings be given to the person or persons to whom I
have provided that they pass either specifically or as part of the residue of my estate in my most
recently executed Last Will and Testament and that none be sold.
h. If my mental condition shall have deteriorated so that I am no longer able to
give gifts to persons to whom I have customarily given gifts, then to the extent that my attorney
deems the assets of my estate, both principal and income, are in excess of the amounts reasonably
anticipated to be required for my proper support and maintenance, then I direct my attorney to make
gifts up to $100.00 each to my children and to their descendants, on the following occasions:
Christmas, birthday, marriage, and baptism.
3. Additional statutory powers. To make limited gifts. To create a trust for my
benefit. To make additions to an existing trust for my benefit. To claim an elective share of the
estate of my deceased spouse. To disclaim an interest in property. To renounce fiduciary
positions. To withdraw and receive the income or corpus of a trust. To authorize my admission to
a medical, nursing, residential or similar facility and to enter into agreements for my care. To
authorize medical and surgical procedures. The powers contained in this paragraph shall be
construed and implemented in accordance with the provisions of Chapter 56 of Title 20,
Pennsylvania Consolidated statutes, in effect on the date of execution of this power of attorney.
4. Access to my medical and other personal information. To request, review, and
receive any information, verbal or written, regarding my personal affairs or my physical or mental
health, including medical and hospital records, and to execute any releases or other documents that
may be required in order to obtain this information.
5. Employ and discharge others. To employ and discharge physicians,
psychiatrists, dentists, nurses, therapists and other professionals as my agent deems necessary for
my physical, mental, and emotional well-being; and to pay them, or any of them, reasonable
compensation.
6. Consent, or refuse consent, to my medical care. To give or withhold consent to
my medical care surgery or any other medical procedures or tests; to arrange for my hospitalization,
convalescent care or home care; and to revoke, withdraw, modify or change consent to my medical
care, surgery, or any other medical procedures or tests, hospitalization, convalescent care, or home
care which I or my agent, may have previously allowed or consent implied due to emergency
conditions. I ask my agent to be guided in making such decisions by the personal preferences I
have expressed regarding such. Based on those same preferences, my agent may alsO summon
paramedics or other emergency medical personnel and seek emergency treatment for me, or choose
not to do so, as my agent deems appropriate given my wishes and my medical status at the time of
the decision. My agent is authorized, when dealing with hospitals and physicians, to sign
documents titled or purporting to be a "Refusal to Permit Treatment" and "Leaving Hospital
Page ~2 of 5
Against Medical Advise" as well as any necessary waivers of or releases from liability required by
the hospitals or physicians to implement my wishes regarding medical treatment or nontreatment.
7. Consent, or refuse consent, to my psychiatric care. Upon the execution of a
certificate by two (2) independent psychiatrists who have examined me, and-in whose opinion I am
in immediate need of hospitalization because of mental disorders, alcoholism or drug abuse, to
arrange for my voluntary admission to an appropriate hospital or institution for treatment of the
diagnosed problem or disorder; to arrange for private psychiatric and psychological treatment for
me; to refuse consent for any such hospitalization, institutionalization, and private psychiatric and
psychological care; and to revoke, modify, withdraw or change consent to such hospitalization,
institutionalization and private treatment which I or my agent may have given at an earlier time.
8. Refuse life-prolonging procedures. To request that aggressive medical therapy
not be instituted or be discontinued, including, but not limited to, cardiopulmonary resuscitation, the
implantation of a cardiac pacemaker, renal dialysis, parenteral feeding, the use of respirators or
ventilators, blood transfusions, nasogastric tube use, antibiotics, and organ transplants. My agent
should try to discuss the specifics of any such decision with me if I am able to communicate in any
manner, even by blinking my eyes. If I am unconscious, comatose, senile, or otherwise unreachable
by such communications, my agent should make the decision guided primarily by any preferences
which I may have previously expressed and secondarily by the information given by the physicians
treating me regarding my medical diagnosis and prognosis. My agent may specifically request and
concur with the writing of a "no-code" (DO NOT RESUSCITATE) order by the attending or
treating physician.
I CERTIFY THAT I HAVE READ THE PROVISIONS OF THIS ARTICLE
AUTHORIZING MY AGENT TO REFUSE MEDICAL TREATMENT FOR ME UNDER THE
CIRCUMSTANCES SPECIFIED IN THIS ARTICLE, THAT SUCH PROVISIONS HAVE
BEEN EXPLAINED TO ME TO MY SATISFACTION, THAT I UNDERSTAND SUCH
PROVISIONS AND THAT THEY STATE MY WISHES AND DESIRES UNDER THE
CIRCUMSTANCES DESCRIBED.
WILLIAM H. PALMER ! ...... ... -.. -.,~.,ion ~zo,res ~r:,:':'...
9. Provide relief from pain. To consent to and arrange for the adm~mstrauon ot
pain-relieving drugs of any type, or other surgical or medical procedures calculated to relieve 'my
pain even though their use may lead to permanent physical damage, addiction or even hasten the
moment of, but not intentionally cause, my death.
10. Protect rights of privacy. To exercise my right of privacy to make decisions
regarding my medical treatment and my right to be left alone even though the exercise of my right
might hasten death or be against conventional medical advice. My agent may take appropriate legal
action, if necessary to enforce my right in this regard.
11. Anatomical Gifts. To make anatomical gifts of body parts or organs for use by
other living persons, but not to make a general gift of my body for scientific research or other
similar general gift.
12. Third party reliance. For the purposes of inducing any physician, hospital, or
other party to act in accordance with the powers granted in this document, I hereby represent,
warrant and agree that:
a. If this document is revoked or amended for any reason, I. my estate, my heirs,
successors, and assigns will hold such party or parties harmless from any loss suffered, or liability
incurred, by such party or parties in acting in accordance with this document prior to that
party's receipt of written notice of any such termination or amendment or that party's actual notice
of my death.
b. The powers conferred on my agent by this document may be exercised by my
agent alone and my agent's signature or act under the authority granted in this document may be
accepted by third parties as fully authorized by me and with the same force and effect as if I were
personally present, competent, and acting on my own behalf.
c. No person who acts in reliance upon any representations my agent may make
regarding the scope of authority granted under this document shall incur any liability to me, my
estate, my heirs, successors or assigns for permitting my agent to exercise any such power.
d. All third parties from whom my agent may request information regarding my
health or personal affairs are hereby authorized and directed to provide such information without
limitation and are released from any legal liability whatsoever to me, my estate, my heirs, successors
Page 3 of 5
or assigns for complying with my agent's requests. With specific reference to medical information,
including information about my mental condition, I am hereby authorizing in advance all physicians
and psychiatrists who have treated me, and all other providers of health care, including hospitals, to
release to my agent all information and photocopies of any records which may be requested. All
physicians, hospitals, and other health care providers are hereby authorized to treat my agent's
request as that of a legal representative of an incompetent patient and to honor such request on that
basis. I hereby waive all privileges which may be applicable to such information and records or,
applicable to any communication pertaining to me and made in the course of a lawyer-client,
physician-patient, psychiatrist-patient, clergyman-patient, or sexual assault victim-counselor
relationship.
e. My agent shall have the right to seek court orders mandating appropriate acts
if a third party refuses to comply with actions taken by my agent which are authorized by this
document, or enjoining acts by third parties which my agent has not authorized.
13. Nomination of Guardian. I hereby nominate my uncle, THOMAS A. PALMER,
as guardian of my estate or person in accordance with 20 Pa. Con. Stat. §5604(c)(2) and any
successor section which authorizes me to nominate a guardian of my estate or person if
incompetency proceedings for my estate or person are hereafter commenced.
14. General reliance on Power. This power may be accepted and relied upon by
anyone to whom it is presented until such person either receives written notice of revocation by me
or a guardian or similar fiduciary of my estate or has actual knowledge of my death.
15. 'Coordination With Living Will. I direct my attorney-in-fact to follow the
provisions of my Living Will, using the version which is most recent to the time when my attorney-
in-fact may be making any such decision, and to defer to the wishes of the surrogate named in said
Living Will, if that individual is different from my attorney-in-fact, when making healthcare
decisions.
IN WITNESS WHEREOF, I have hereunto signed my name and seal this
5+*''- day of CV'-o-,'-°---t/N. , 2002.
Witness:
WILLIAM H. PALMER
Social Security No.: 182-54-1182
(Seal)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
On this the 5++`` day of ~ ,2002, before me, the undersigned officer,
personally appeared WILLIAM H. PALMER, known to me to be the person whose name is
subscribed to the within instrument, and acknowledged that he executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
(SEAL)
Page 4 of 5
ACKNOWLEDGMENT EXECUTED BY AGENT
AN AGENT SHALL HAVE NO AUTHORITY TO ACT AS AGENT UNDER THE
POWER OF ATTORNEY UNLESS THE AGENT HAS FIRST EXECUTED AND AFFIXED
TO THE POWER OF ATTORNEY AN ACKNOWLEDGMENT IN SUBSTANTIALLY THE
FOLLOWING FORM:
I, THOMAS A. PALMER, HAVE READ THE ATTACHED POWER OF ATTORNEY
AND AM THE PERSON IDENTIFIED AS THE AGENT FOR THE PRINCIPAL. I HEREBY
ACKNOWLEDGE THAT IN THE ABSENCE OF A SPECIFIC PROVISION TO THE
CONTRARY IN THE POWER OF ATTORNEY OR IN 20 PA.C.S. WHEN I ACT AS AGENT:
I SHALL EXERCISE THE POWERS FOR THE BENEFIT OF THE PRINCIPAL.
I SHALL KEEP THE ASSETS OF THE PRINCIPAL SEPARATE FROM MY ASSETS.
I SHALL EXERCISE REASONABLE CAUTION AND PRUDENCE.
I SHALL KEEP A FULL AND ACCURATE RECORD OF ALL ACTIONS, RECEIPTS
AND DISBURSEMENTS ON BEHALF OF THE PRINCIPAL.
THOMAS A. PALMER
(Date)
COMMONWEALTH OF PENNSYLV,A~A
COUNTY OF_~~ rO~/f~ } ss
On thisthe l? day of f~L~t:-~,2002, beforeme, the undersigned officer, personally
appeared THOMAS A. PALMER, known to me to be the person whose name is subscribed to the
within instrument, arid acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~G. (SEAL)
Susan W. Deaven, Notary Pul3#c
Demi Twp., Dauphin County
My Commlaaion Expires Oct 22, 2005
Page 5 of 5
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
i~!~il~r~ H- /°/~Lt~n~
Date of Death:
Will No. ~,~ OO ~ ' ~1 ~ Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ia. 2_3-o
Capacity: __
Signature
Address
Telephone ~/'7) ')...c<9.' ~{~
V~Personal Representative
Counsel for personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2005
PALMER THOMAS A
441 WEST PENN STREET
CARLISLE, PA 17013
RE: Estate of PALMER WILLIAM H
File Number: 2003-00513
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 3/08/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
cl
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
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Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: i)' J i If , 11 "'"' /-i PAL"" -<-IL
Date of Death: :3 - It-- 2. 002.
Estate No.: 1-(0) -005/ \
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
I. State ~h>Jher administration of the estate is complete:
. Yes ET No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No ~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: (')
c. Did the personal representative state an account informally to the parties in
interest? Yes E::t No 0
c. Copies of receipts, releases, joinders and approval offormal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: 2... ~()-p S
l}d.J."'_~ a.. .../.L~(I.
Signature
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7hoYllJ9.J. ,4., /'/J.L"",",,_"-
Name
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Address
C~'
70 - 'L/.-tfi- N; 4 '1
Telephone No.
Capacity: ~ersonal Representative
o Counsel for personal representative
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