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HomeMy WebLinkAbout11-15-11Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information I Name: Samuel H. Black File No: ~o~` '- ~ ~ ~ ~ ~ ~ a'~ a~C/a: (Assigned by Register) a/k/a: a~C/a: Social Security No: 168-26-4147 Date of Death: November 11 2011 Age at death: 80 Decedent was domiciled at death in Cumberland County, pPnnSVly n;a _ (State) with his/her last principal residence at 12 East Portland Street Boroue,Yt of Mechanicsburg Cumberland t C Street address, Post Office and Zip Code City, Township or Borough y oun Decedent died at 12 East Portland Street Borou h of Mechanicsbur Cumberland PA State Street address, Post Office and Zip Code City, Township or Borough County Estimate of value of decedent's property at death: $ ~/ r7 a0 0.00 If domiciled in Pennsylvania ........................... . Al] personal property $ i , If not domiciled in Pennsylvania . ...................... a . Personal property in Pennsylvan If not domiciled in Pennsylvania ...................... .. Personal property in County $ $ Value of real estate in Pennsylvania ..................... .................................... TOTAL ESTIMATED VALUE.... $ 7 ~ ~GV 0.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough l:ounty A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last Will of the Decedent, dated May 31, 2007 and Codicil(s) thereto dated None State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d. b. n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS 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 (attach additional sheets, if necessary): ~ Name Relationshi - Address r -~- - _, r- ~ °;~ m -•. ~? C.' ~ ~~~.:~ ` -~<J-n C:. ~~ -~ _ry: i +~. ~i C _~ r'7"t "'rl FormRW-O2 rev. 10/11/2011 Page 1 of 2 - - ':-. , ,-~ ___. -r-F = -sa - Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Oberland T, Official tJs~ c_~ _- ~_n ~.. ~,- x~ u; h i `-, -~ ,a ~~ .. ~ ~.' .~ ~; I~T~ ~~ °n 'rhe Petitioner(s) above-named swear(s) or affirm(s) 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 Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law. Date 11 / 15 / 2011 Sworn to or affirmed and subscribed before ~ mgt' 15.da of November 2011 onstance E. Roland Date B ~ ~ ~ ~~ (~ Date y' `'- ~ Date For the Register BOND Required: Q YES ~ NO FEES: Letters ................... ... $ ( ~ )Short Certificate(s)... .. . ( )Renunciation(s)...... .. . ( )Codicil(s) . ......... .. . ( )Affidavit(s)......... .. . Bond ..................... ... Commission ............... .. . Other t,u~1L .... ... IS•U Automation Fee ............ ... JCS Fee .................. ... U TOTAL .................. ... $ To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature Richard C. Snelbaker Printed Name: Supreme Court ID Number: 06355 Firm Name: Snelbaker & Brenneman P.C. Address: 44 West Main Street - Mechanicsburg„ ~'A ~ 7055 Phone: 717-697-8528 Fax: 717-697-7681 Email: DECREE OF THE REGISTER Estate of Samuel H. Black a/k/a: AND NOW, November 15 ~ 2011 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Constance E. Roland in the above estate and (if applicable) that the instrument(s) dated Ma 31 2007 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. YlC;~ Register of Wills Farm RW-02 rev. 10/11/2011 Page 2 Of 2 File No: ~~ ~ t ~ - ~ a-a } } SS: 1O5.8U5 REV (U V077 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 17978548 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital 5~ Records Office for permanent filing. L~.~~t~~~~+1Dtlr~~C,. NOhI 1 4/ 2011 Local Registrar ~ Date Issued n ___ ~-~ `~ ___ _x~ -,~ -, ll _T.. C7 ~ r j r- _ - _. : ~ ~.~ _ f ,- ~: ~_ . ~_:_s ~7 , -, -~ _~ ~~ _ ?y-r y ~~ O -n c- • H105~1A3 REV 11![908 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS rrPE y PRIM IN CERTIFICATE OF DEATH PERMANENT BLACK INN (See Inehuctions and exempts on roveroe) STATE FILE NUMBER N d 0 U n `~ !. ~ d ( deY~ YeeA / Name d Deeded ( , IuL aulPoq y 2. 3. Number 1 / - . a N o 5. Age (La& BMMey) Under 1 Wldu 1 9. Dtle d Bids 7. and tmle a man 89. PIeG d D•ath Chxk one Hospital: Dden Manvw DsYe Houe ~~ NUAln9 Fmme ReaWer'ce ^ UMr ~'.geoFf' Mi 11 er s t own P A ^ hpetiud ^ ER I adpedw,l ^ OOA ^ p- 8 0 vre 9. Wee Decetled d HePe^k Drigln? g] No ^ Vas to. Race: Arredcen Indlen, aled~, Whee, ek. Twp. d Deem Btl. Faddy Noma pl not kemutlon, 9h'• street aM nimMr) Bom 9c CaY D (s~i , . . uran, BE. Canty d DMm QI yes, epec8y Cumberland Mechanicsburg 12 E. Portland Me~n.PaaneR~t.ek.l White 0•cedMYS UeuY Kind d wok done a' moo d W. Do not elMe 12. Wee Demdmt ever n 9e 13. petaOenYa EAkatlon (Spectly anry hipheet Pede conpl•sedl 14. MedM $IeM: AIadM, Never Married, 15. SurvNkg Spouse (p rde, 9M rteiden name) Widowed, Diverted (SyeWry) 11 . U.S. Amed Forces? d BuemeeelkvmeNy Elerentery l SecondaRl1~21 Cotlege l1-b w 5rl W 1dOWed Superintendent Buiplding &Gro d~7 yBe ~ ~, • 18. Dxedenra Mulkg Address (street ctly l lovm, state. xiP code) PO .Box 5 9 12 Fast Portland St. De'eded'' ~ Decedent Acne Residence na. stem P enI1+S i 1 van ~ a T~hip? 17c. ^ res, Deceeent LNed in T"'D Cumberland t7d.C]d a d~iwn Mechanicsbur g l~ Mechanicsburg,PA17055 re Ddr 17bceany 19. Momer'c Name (Flrel, nsdde, meMut wmwnal 18. Fatlefs Name IFlreI, mitldla, teal, wlfal Dorothy Harlan Andrew S. Black 29a. IMamaMe Name (Type I Prmtl 29b. mbmmnrs MYlkq Atldeee (Stree4 dY I m•vt, also. NP codel 12 R• Portland St.Mechanicsburg,PA 17055 Margaret Moll etlan 21 b. Dae d DePOaitlon lManm, dry.Yer) Bb i ^ D i 21c. Place d Dlepoeidon (Name d cenelery, cremamry a other place) z1a. lacetkn Iclrynawn, male, nv mdeM 7 0 6 5 ,I epm at 27a. Muhod d D n Cremetlan ^ Buda ^ RemovdlranSlse i WrCmnetlaraDartlonAugprl~d~, 11 /1 A/2010 ^ • n s PA Hollinger Crematory Mt.Holl S ri No _ .: M kMdkM emm~«ICaarer7 rJ ra ^ ore r ~ 22e. mre d Funeral Licensee Iw Parana ~ ea such) 72b. Lkwroe Nunmer 22c. Name and Atldress of Facory 011 9L Hollin erFH&Cremator MteHoll S rin s PA17065 ( ~ ,;;~ • CanpMe items 23ac aeY wlerl adMn9 23e. To ne beet d my ocartedat me m .ISigeun 2T. Lkerw Nwimer 23c. Dare ( , deY~ Yes N S ~6 3 ~~ L i t // ~Q / phyeidan a nd .vetleble m time a dmm m cu MY ease d deatltli. day Yaer) 28. Wet case RN m ktedkM Evaminer ~ Cormar for a Beeson Otler than CaemaBon a Danaeon? Dale (MOdh 25 , . 2d. rime d Deem IWro 24-28 mat be mnabed by person {~ n, ~ ^ vas No I 16 ~M. ~ I 'I I pal/ who Dionorekee deem . 1 • Approdmae nduval: Pad II: ErIM otMr 29. Did Tabeao Uee CormWb m Dwm? • CAUSE OF DEATH (Se• kusrunbro end a ) I Ibm 27. Put I: Emer the fdBD.- dMeesea, kl~lnm, a wrykaeem -ihM dhedy ceased ma deem. W NOT order Mmhei evema such as terries arteaL Oren m Deem but nd resdtlrq n 9e urMenyin9 setae 9~ in Pmt L ^Q No^ P Udliman reeptratay cared, a ventrkular Ibrlle8on wmud Mewing 9e eaeiegl. Lk1 a9y ae rme on eadl are. 29. II Female: r ~~etlEEDNITE Fnal 6eease a l .t9 fUK4Y4 A~'1 O I ~C~+~A~ i ^ Nd Pngant wiWn Pau Yeer aentlNOn rewmng n deem) _~ a . as a oQ: ~ I ^ Pregient u drn• d deem Due m~pl ,~ rlWly hl cadlian. tl aM, b, - 7 • ..:ten ~ 1 c~ Y E: 1]T ^ Nd pmgnant. bd 0~^ent MNin 02 days S e p u e d deatll 1 e e d n o Eder Mm drLypq CI1U5E a Due m (a ea a can•arenm dl. ^ Nd pregenl, bet Dreyem 43 days m 1 year (dYeMe a y~rv tltm Ytltlamd tle GNaa tlssm awrne reedYnf" M deem) LAST. n' Due to for ae a cuweawke dl~ ^ Udarown B preglwd within tle pall year a. • 30e. Wee an Autopsy 30b. Were Adapey Fm6tge 31. Mover d Deem 32a. Data d Iryury (Monet. daY, Yaerl 32h. Descrbe How Irpey Oaurred 32c Pkka d Irpwy Roma, Fum, SlreeL Factory, Ollke Bdkk9, ek. (SpxYg•) Pedomedt AvaYebM Prior m Complefon IL}llaural ^ FlorrscklB d Cause d Deem? ^ p Nutt ^ Pal6q mvMigadon 32tl. Tme d Iryury 32e. Iryuy u Work? 321. M 7renepanetlon Ir~uy /Spedfy) er ^ Pademden 1O ^ Paeeu t ^ 32g. LocaBan d Iryury (Street, dy / mwn, atom) ^ roe ~Na ^ Vea ~NO ^ Vas ^ No g Drivr er Pere ^ Suutla ^ Caad Nd M Dalelrninetl M, Ogef. .. Sea. CereMr (dieck ony one) 33b. SipeWre d CwN9sr ~].,_~ ~ Q ! V ~ • CaRtlymg M7•I•e^ (PhYSidan cadiYk4 Hues d dwm vsen eralh•r phyeidm hoe pvewkad deem aM aomgaed Item 23) , - ? TatM MUd my knowNdg•, 6Mh oowmddwmtM UU•N•1eM muvwraeteeW________________________________ License NunCU 33c 33d. Dam Siped lMonm, deri I • Prwlarrdrg uM udrying phyNOMa (Phyeitlen bdh p~orianu+g deem aM cadllykq b muse d rwm) Toth Metd ny tmowledpe.drm oaurrednm.Nm•,daM.rwt pea,erd euemttw wu.elsl one mannuuueNd__________________^ . ~ ~ 'a I.. pp 1 ( .~Ca ~( • Yedlul EvrnlrwlCOrona OntM iwlsdexamin•Ban ul0l or invaaliqulon, In my opinion,dwm ax arMLLSw dme,dsh, end Dbke••nd duemtM Cwaelal end venrvnr aWad. ^ 31. Nmre end Addressd Perem Who ComWatatl Caused Deem lltem 271 Typo/Print -~~/ Vewr Ll~a~~`cnEt~ 4~ I i Irk I I 10 I '~ 0 Fredl~m, 6 rl ~eLll t,.r u 7s 1 rM/~'Q/-'r~ 7 ~' Disposklon Permit No. v ~ ~ SO5 O 0 LAST WILL AND TESTAMENT I, SAMUEL H. BLACK, of the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my wife, namely, JOANNE M. BLACK, absolutely and in fee simple, if she survives me by as many as sixty (60) days. THIRD. In the event that my wife, JOANNE M. BLACK, does not survive me by as many as sixty (60) days, then and in that event, I order and direct that my Estate be distributed and disposed of as follows: A. I order and direct that all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, shall be divided into ten (10) equal parts, which parts I give, devise and bequeath in the amounts and to the persons as follows: ~~ C7 c~ .~ ~; _.. _~ ~: LAW OFFICES SNELBAKER & BRENNEMAN, P.C. (1) Two (2) parts unto my daughter, namely, SUSAN C. F+ ci EAGEN, absolutely and in fee simple. f7= ~; (2) Two (2) parts unto my daughter, namely, MARGARET A. __ - ..~ ~= `= ~ ~ WOLL, absolutely and in fee simple. `_. ` - ~~ _ - =~=~~= (3) Two (2) parts unto my daughter, namely, CONSTANCE E. v =-_ U ROLAND, absolutely and in fee simple. (4) Two (2) parts unto m}~ daughter, namely, JESSICA A. BLACK, absolutely and in fee simple. (5) One (1) part unto my grandson, namely, AARON J. BLACK, absolutely and in fee simple, subject, however, to the protective trust provisions contained in Paragraph C of this Item Third. (6) One (1) part unto my grandson, namely, JORDAN D. BLACK, absolutely and in fee simple, subject, however, to the protective trust provisions contained in Paragraph C of this Item Third. If any of my said daughters should predecease me, I order and direct that the foregoing share of my residuary Estate attributable to such deceased daughter shall be distributed unto her issue per stirpes by representation and not per capita. B. In the event that either of my grandsons, namely AARON J. BLACK or JORDAN D. BLACK, have not attained the age of twenty-five (25) years at the time of my death, I order and direct that the subject matter of the foregoing diapositive provisions shall be paid over and distributed unto CONSTANCE E. ROLAND (my daughter) and KIERNA S. BLACK (mother of my grandsons, Aaron and Jordan Black), or either of them in the event that one so nominated shall fail to qualify or cease so to serve, as my testamentary Trustees, IN SEPARATE TRUSTS, NEVERTHELESS, to hold, manage, retain, sell, lease, mortgage, invest, and reinvest, for the respective benefits of said AARON J. BLACK and JORDAN D. BLACK, until the respective beneficiary has attained the age of twenty-five (25) years, at which latter time the trust for such beneficiary shall be terminated and the then remaining assets in such trust shall be distributed unto the said beneficiary, absolutely and in fee simple. During the existence of the foregoing Trusts, I authorize and direct as follows: (1) I authorize and empower my said Trustees to invest any cash type assets added to or generated by said Trust in any reasonable manner and not be limited or restricted to so-called "legal" or statutory investments for fiduciaries. LAW OFFICES SNELBAKER Ec BRENNEMAN, P.C. (2) I designate said Trust to be a spend-thrift trust. The beneficiaries of said Trust shall have no right to invade, pledge, assign, hypothecate or otherwise dispose of the assets of said Trust (including -2- future income) nor shall any creditor of a beneficiary have any right to seize, levy or execute upon, or attach said assets by reason of any judgment, pledge, assignment or other transfer, whether voluntarily or involuntarily made by said beneficiary. I order and direct the Trustees to reject and refuse to recognize any transfer made by said beneficiaries or any of them. LASTLY. I nominate, constitute and appoint my wife, namely, JOANNE M. BLACK, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my daughter, namely, CONSTANCE E. ROLAND, to be the Executrix hereof. If both of the foregoing persons should fail to qualify as my personal representative hereunder or cease so to serve, then and in that ultimate event, I nominate, constitute and appoint my daughter, namely, MARGARET A. WOLL, to be the Executrix of this my last Will and Testament. I order and direct that none of the above named persons shall be required to post bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, SAMUEL H. BLACK, have hereunto set my hand and seal to this my Last Will and Testament, which consists of three (3) typewritten pages to each of which I have affixed my signature this 3lstday of May , A.D., Two Thousand Seven (2007). (SEAL} SAMUEL H. BLACK LAW OFFICES SNELBAKER & BRENNEMAN, P.C. The preceding instrument, consisting of this and two (2) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by SAMUEL H. BLACK, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. -3- COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND Testator and the witnesses, respectively, whose names are signed to the attached or foregoing We, SAMUEL H. BLACK, RICHARD C. SNELBAKER and JANE J. GOONEY, the instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testator ess tness COMMONWFALTti OF PENNSYLVANIA LAW OFFICES SNELBAKER & BRENNEMAN, P.C. Subscribed, sworn to and acknowledged before me by SAMUEL H. BLACK, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. GOONEY, the witnesses, this ~ ~ ~ day of ~i ~ , 2007. SS. ~~1~.~- Notary Public Ndarial Seal Sandra K. ShcrMers, Notary PubYc Medlar-icsburg Boro, Cumberland County lyy Cart~isalon Expires Nov. 22, 2007 Member, Pennsylvania Assodation Of Notaries