HomeMy WebLinkAbout11-18-11PETITION FOR GRA~)NT OF LETTERS
REGISTER OF WILLS OF w,~J•t r ~~ o 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
Name: ~.ry_ ~.. ~vrir'G~
a/k/a:
a/k/a:
a/k/a:
Date of Death: ~f~O~faO~{/
Decedent was domiciled at death in
principal residence at /3a It~~}+
County,
(ware) with his/her last
Street address, Post Office and Zip Code 'r City, Township or Borough County
Decedent died at ~'" ~{ Chan 6GrS6~~l /fl~sa~To. / G~~~br .~ uss f'-Q ~%r1n~/I, a /~/~
Street address, Post Office and Zip Code ' City, Township or Borough ~ County State
Estimate of value of decedent's property at death:
~~
If domiciled in Pennsylvania ............................ All personal property $
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................Personal property in County $
Value of real estate in Pennsylvania ................................................ . . .... . . . . $
p /TOTAL ESTIMATED VALUE.... $ / C- ~ ~ p
Real estate in Pennsylvania situated at: /30~ /l~= ! P ~ n S ~ v~h l,L~ .i~ ,~ /gyp y'2,Q e K ~ S(~~6g ~ . o ~ysya~ r•/A o c~
(Attac additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated -~~N ~ / 99 ~ and Codicil(s)
thereto dated
State relevant circumstances (eg. 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
ado d; 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 life, 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 W ill and was survived by the following spot~.sg (if any) and heirs (attach
additional sheets, if'necessary):
Name Relationshi Address .' ~ <7
-.-fn
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n _. , .: _
File No• 02 ~ - r~ ~} ~I i - ~ p~ y 3
(Assigned by Register)
Social Security No: /' $'O ~ S'$- 78 ~,a
Age at death: (a ~'
:x~
' -Yj
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Forn: RW-01 rev. 10/1l/1011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF ~~ } Vti1,~--Q ~ 1C~ I~~Ca }
~ rv- rr , ~- _ •,- ~,~
I. ,r
Offici~l,Use Only
.~
i ~ F 11
I :rl! i ~~
Petitioner(s) Printed Name Petitioner d ~; ~T
~
CAr41 1~..-,
Q
~~~ri~`,~ ` .,`yy r-.~,
```--r~ ~ ~
The 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 D edent, the Petitione will well and truly administer the estate according to law.
Swor~-a to or affirmed and subscribe before ~ ~ Date -~ ''
met ~^ ~~ day of ~ ~ Date
gy; .^ Date
For the Register Date
BOND Required: YES ~NO
FEES:
Letters ...................... $
( ~) Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........
~) i ( ........ '.
Automation Fee ...............
JCS Fee .....................
TOTAL ..................... $ J
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~~~.j ~ ~(~ ~ ICE T) File No: r„2 ~ - l ~ - j n `~ 3
a/k/a:
AND NOW, ~) ('~ ~,Q ~ ~ ~ ~ X ~ U ~~ , in consideration of the fore oing Petition,
satisfactory proof having been presented before tne, IT IS DECREED that Letters T~~-fC( f'Y(~Q-{~1~-
are hereby granted to CCZ, r~ P ~ U`( k,Q. (~-
in the above estate and (if applicable) that
the instruments} dated _
described in the Petition be
Form RW-OZ r•ev. !0/11/2011
3 to ptobate and tiled oT record as the last W tll (and Codicil(s)) of iJecedent.
r.
_ ~ - ~ ~'~
R gtster of Wills ~
~~ ~ ~~~'C(Lr..~'1~Sc t'~ Cam. ~' ,_
Fage 2 of 2
V!n5 On5 ACS, - ~ __. ~ _. _-.
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 ~ 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 orig-final
certificate will be forwarded to the State Vital
Records Office for f~ermanent tiling.
P 18008109 ____ y~
Certification Number /~
.oc• egistrar ~..~ ~. ' Date Issued
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H105.113 REV 1112005 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS _.i1 L- - - r'('1
TYPE / PRMT N
~"r CERTIFICATE OF DEATH zt -~ • • ' ,
(See Instructions end eactrreoles en rxveea., T" ~ ~ ~ 0
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,. Nww a Decedea)Fep mddk lap. auRW 2 sex 9. Sodp Saaari Number J 1^, ~ r,• c • V T 1. Date a Dwh t~,e^n. day, rs9 • .
GARY L. BURKETT M
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flpnr.r'a rdgnrla ~ ,s. P~.sar.mo Iwona J Janicka, M.D.
d!/r O 20 501 East Main Street, Waynesboro, PA 17268
'_ ~ DbDSluon PmnX No. 0713404
001
C'> ~_._: :ate
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LAST WILL AND TESTAMENT ~ ~- ~ "`'
_;
~~> , . .
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C~
-
GARY L. BURKETT ~~;
-
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..
I, GARY L.. BURKETT, of Shippensburg, Cumberland County, Pennsylvania, being of sound fnind, _.,_y
memory, and understanding, make, publish, and declare this to be my Last Will, and hereby revoke all wills
and codicils previously made by me.
ITEM I. 1 direct my Executor hereinafter named to pay all of my legal debts and funeral
expenses, including the cost of my gravemarker, and administration expenses of my estate, as soon as
practicable after my death.
ITEM II. I give and bequeath all my automobiles, jewelry, wearing apparel, books, pictures,
household furniture and furnishings, and all other articles of household and personal use, together with any
insurance existing at all, to my wife, CAROL E. BURKETT, if she survives me; but if she predeceases me,
then to my children, SHAWN BURKETT and KATHY SIDERS, to be divided among them as they shall see
fit, but if said children fail to agree upon such division within a period of two (2) months after my death, then
the items to which there has been no agreement shall be sold and the proceeds therefrom shall be added
to, become a part of, and administered with my residuary estate as hereinafter set forth.
ITEM III. The rest, residue and remainder of my property and estate of every kind and
nature, and wheresoever situate, including all lapsed legacies and bequests, and including any property
over which I may have a power of appointment at the time of my death, I give, devise, bequeath as follows:
A. If my wife, CAROL E. BURKETT, survives me, to her absolutely and forever.
B. If my wife, CAROL E. BURKETT, predeceases me, one-half (1/2) thereof to
my son, SHAWN BURKETT, or if he is not then living, to his issue per stirpes and the
remaining one-half (1/2) thereof to my daughter, KATHY SIDERS, or if she is not then living
Document #: 152155./
to her issues, per stirpes.. In the event that a child of mine shall predecease me without
issue him or her surviving, his or her share shall be distributed to my other surviving
children, or if one of them is not then living, to his or her issue per stirpes.
ITEM IV. All estate, inheritance, legacy, succession, or transfer taxes, including any interest
and penalties thereon, imposed by any domestic or foreign law with respect to all property taxable under
such laws by reason of my death, whether or not such property passes under this Will, by operation of law,
by contract, or otherwise, shall be paid without any right of reimbursement from any recipient of any such
property, without any right of apportionment, and without postponement.
ITEM V. Should any person entitled to a share of my estate be a minor at the time of
distribution to him or her, and should the value of such property be more than the amount which may be
paid or delivered to him or her or in his or her behalf without the appointment of a guardian or other fiduciary
or the delivery of security, such share shall be paid and distributed to my Trustee hereinafter named to be
held IN TRUST and managed, invested, and reinvested, together with the accumulation of income thereon,
if any, and the Trustee shall use and apply from time to time such portion of the income and principal thereof
as it deems necessary or desirable for the minor's reasonable maintenance, support, and complete
education, including preparatory, college, post-graduate, or professional training, or to make such payment
for such purposes to the guardian or person with whom such minor resides or directly to or for the benefit of
the minor without further responsibility to such minor or any person taking care of such minor, and when
such minor attains the age of eighteen (18) years, any principal or income not so paid or applied shall be
distributed to such minor, or if he or she dies prior thereto, to his or her personal representative.
ITEM VI. In addition to the powers granted by law, my personal representative shall have the
following powers:
A. To sell at public or private sale, to exchange, to lease, to pledge, to
mortgage, to transfer, or convert or otherwise dispose of, or grant options with respect to
2
Document #: 152155.1
any and all property, real or personal, at the time forming a part of my probate or trust
estate, in such manner, at such time or times, for such purposes, for such price or prices,
and upon such terms, credits, and conditions as shall be deemed advisable or necessary
under the circumstances.
B. To compromise any claim or controversy.
C. To invest in all forms of property without being limited to legal investment.
ITEM VII. t nominate and appoint my wife, CAROL E. BURKETT, or if she predeceases me,
fails to qualify, or ceases to act, I nominate and appoint my daughter, KATHY SIDERS, as the sole Executrix
of this my Last Will, to serve without bond for the faithful performance of duties in any jurisdiction, and I
nominate and appoint my wife, CAROL E. BURKETT, or if she predeceases me, fails to qualify, or ceases to
act, I nominate and appoint my daughter, KATHY SIDERS, as the sole Trustee of any trusts created by this
my Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this _1T day of May, 1999.
~~
Ga L. Burk
The preceding instrument, consisting of this and two (2) other typewritten pages, was on the date
thereof signed, published, and declared by GARY E. BURKETT, the Testator named therein, as and for his
Last Will, 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.
Witnesses:
Name
Name
Document #: 152155.1
l-,~f~-~Z~1~ ~ t.~ vi(,>~
Address
ddress
3
Commonwealth of Pennsylvania
County of Dauphin
ss
I, the Testator, whose name is signed to the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledgethat Isigned and executed the instrument as my free and
voluntary act for the purposes therein expressed.
~r
`Ga L. Burk
SWORN to or affirmed to and acknowledged before me by the above named Testator this y ~~
day of May, 1999.
+~ ~ LYTER~ ~ PUBLIC
My ~ ~'pec. lay 2ooa , ,
Commonwealth of Pennsylvania
County of Dauphin
L ' ~ GL
~ ~~~-~
Notary Public
My Commission Expires:
(SEAL)
ss
We, the undersigned witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present and saw Testator sign and
execute the instrument as his Last Will; that he signed willingly and that he 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 Will as witnesses and that to the best of our knowledge the Testatorwas at the time eighteen (18)
or more years of age, of sound mind and under no constraint orrTrr~iue influence.
SWORN or affirmed to and acknowledged before me by the above named witnesses this y of day
of May, 1999.
~~~~ ~
Notary Public
~~~~ ~~ My Co} mission Expires:
SEAL
Mq Commission Expires Dec. 2a 2000
Document #: 151770.1