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HomeMy WebLinkAbout12-05-11PETIT/I~ON FOR G ,RANT OF LETTERS REGISTER OF WILLS OF (",(,LN1~~P/t `~JV~GG~, 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 Informa~on Name• ~ , m~~' rl-t~ C 5th n a/k/a: tilt ~2.- S 0 r a/k/a: a/k/a: Date of Death: ~,1'~~~ //~~ f 1 Decedent was domiciled at death in lr lA~mbi?~f L(.Imdl, ~ principal residence at ~ ~ rj ~• ~('Eti~~ YLpC ~ t Street address, Post Office and Zip Code Decedent died at 3~ ~r~k.. V1d ~' Street alddress, Post Oftice and Zip Code 1~ ~ _ ~ ~ ~j File No: ~ (Assigned by Register) Social Security No: '~`~ 2.' Z~ " "[~3 Age at death: ~' Z._ _~~ ([ware) with his/her last City, Township or Borough City, Township or Borough County State f ~ is property at death: / ~, Estr ~ td miciled n Penns lvania ............................ All personal property $ ~ ~ ~ ~ ~ "i If not domiciled in Pe#nsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pet~tnsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ "I (~ . Reat estate in Pennsylvania r;ituated at: (Attach additional sheets, if ne5essary.) Street address, Post Office and Zip Code City, Township or Borough County A. Petition for Probate and Grant of Letters Testamentary (~,~ ,- , - 1 -7 Q Petitioner(s) aver(s) heVshe/they is/are the Executor(s) named in the last Will of the Decedent, dated I f 1(~.~ L ~~ 1 and Codicil(s) thereto dated State relevant circumstances leg. 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 parry 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 EXCEPTION$ ^ 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 Administratiod, c.t.a. or db.n.c.ta., enter date of Will in Section A above and complete list of heirs. Except as follows: Ddcedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as de£med in 23 Pa. C.S. § 3323() and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^NO EXCEPTION$ ^ EXCEPTIONS Petitioner(s), after a prOpersearch has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach additional sheets, if'necessary): C7 -_- Na a Relationshi Address ~~7 ~ ~' ~ ~-~` ` rT, t ~~'>x __l C7 t n:;; ~~ ~. Form RW-02 rev. tniltnnlt Page 1 of 2 ~~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } ~ ~ } $S. COUNTY OF ~.QI,~YVt.~/`•- } f ~ ~ ' '~ ~~ r ~((- ~ Offieial Use 0}t~} J {{ rPu ~.. :.I ••11 ~ J~ ~ T Petitioner(s) Printed Name Petitioner(s) Printed ~~ ! 1 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 lmowledge and belief of Petitioner(s) and that, as Plersonal Representative(s) of the D~ce en he 1:etJiier~e ) wil well and tru y administer the estate accordin to la . Sworn to or affirmed and subscribed before ~ Date ~ the thi S da~,,~~o/f ~~~ Date BY: ~y~r-u+r-"`~~~~ Date For the Register Date BONDRequired:~YES /~'O FEES: Letters ...................... $ ~~J (~ )Short Certificate(s)...... / S- ( )Renunciation(s)'........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commiss'on ................. . Other c ........ - •~ ........ Automation Fee ............... JCS Fee . .................... ~~~ cc.~~ TOTAL ..................... $ /9~/- 5~- C.JaS H- Estate of a/k/a: r u Ir'!'f 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 File No• d) ~ - ~ ~ `" ~ ~U AND NOW, ~~~~~~~t r ~ satisfactory proof havigtg been presented before me, IT are hereby granted to the instrument(s) dated' described in the Petition be ~_, in consider tion of the foregoing Petition, that Letters ~. n`~~~ in the ;above estate and (if applicable) that to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Form RW-02 rev. 10/!1/2011 ~Vv`~ ("`x`~-" Page 2 of 2 H105.5:05 RHV f01/(1?) 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 17978678. 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 Records Office for permanent filing. L ~ixyt.~~t'~~~~mlg~' N~'V 1 $I 20.11 Local Registrar Date Issued Certification Number H10S1l9 REV 112W8 TYPE / PPoNT w PEIIAWEM fiI.ACK INK r..~ >~-+ 1;:7 rn r-~, ~:, . <.~ X3 ~ + . ~ ~ , i ~ ~ p - ~,,, _ ,~ ~ n. _ , .., >.. =' ~ ~ ca ° ~" N ~~~ .C COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS CERTIFICATE OF DEATH (Sea instructions and examples on reverse) CTATF FII F NIIMNFR 1. Name d Dedtlenl (Fist neddM, Yd, sans) 2. Sea 3. SocW Sxuny Numdn 4. Dee d Dum (Noah. daY. year) Hi Mac Nelson Male 172 -i:4 -9893 November 17, 2011 5. Aqe Red fiiOMey) IKider t Undsr 1 6. DaY d &M 7. end eroro a Be. Plsd a Deem Cheat one aaero OaYa Noun laraar HdpKal: Omer. 8 2 December Newv i 11 a PA ^ InpetlaM R / oupatleM ^ DDA ^ NueYy Name ^ Rmdarme ^ olhar ~ spaalY Yrs. m. Corey d Deem Ba CM. d Drm Fatlay N On a (K YWIMIOn, 9M Ma entl anO M . Wu Daedein d IPaPenic Onyn1 No ^ Yu MaAmn mdse. 6leaS WNb, eb. t0. Re d SolZth Mi d~leto n y Vl ~ P ~ ~ m yu, aPartlf' cu6en, P l a .py 4S f l l t e Cumberland IOt ~l W fMaidn, uarb Bdn, dc.) 11. Deddara'e llmel ~ a aaKd ae a' d ee. Do not aeee 12 was Dadtlrt ssar 13. Dedd ed's Edu osfon (SPAY onM Nghr t 9~ dn9 ~1 1!, NemY aeM: AlurYd, Never Aleriled, 15. Sueiulnp Spa r (n wYS, g'ra maden name) Ia,eawaK Kekatwsrwe/eamy u.s.AmetlFaerT Eknederyysedraay(U12) CWege(1i«s.) NAOVxstl'D11°1ed(SP°~') Married Kathleen McMillan Dair Farmer A riculture ^rr 1~1NO 12 16. Decedent's Maing AdM1re (Beset odY / tan. ahN, zipcode) DeddenYa Dk DedMd AqW Reseknce 17a. Slate PA Lheke 170.~YU,oxedanllhed in We6t PP?nn cbrTrn 7up. 35 Creek Road Aptr 1 livedwghin Cumberland T0"'"I'~7 nd.^ w PA 1724 ~d ~/~ tb'`~"r 16. famMS None (Fun, niHda, led, eaex) 19. MolMfe Name (Flru, midda, radar aurtiame) Ira 'L. Nelson Viola M. Forney 20e. InlarmeN'e Noma (Type /Prod) 20b. mlaned'e Maaep Adtler (Beset, dry l tam. amts, zip code) Kathl een Nelson 35 Creek Rd. A>t. 1 Newville, PA 17241 2/a. ANSOd d Diepolean r Ciemanon ^ ptl1ena, 210. Dale a DBPoeNm I~mm, dy, year) 21u Pmd a Dlepoellbn (Name d cnreMry. amnatay aauer pled) 210. Locewn (CNy/tan, eats, lip dde) ^ 13~d ^ Removaoomsttle ~wr «DaatlbnAWralrtl 11/18/2011 Hollinger Crematory Mt. Holly Springs PA ^ qti,. r ey EerNw/Caaerr L~ r«^ No 17U65 msigne.adwrrrs..rgt~roae(a // ~ " n cream) 2Zb.lkwmeNurrbar zzaNemeendAddreaFedNy Egger Funeral Home Inc. ~ -. L a~..~ti.~ y ' _._ FD 13895 L 15 Bi S rin Ave. N wv Conp4a ler 23at oNy whr aNyip Zia. Tc tle ~5M krioeMdge, OpdrrtW a me ark plod ehM115gneWre era tltle) 23n. llpame NlanOer 23c. Dam Sipdd (etmm, mY, Yur) phyddel w na warala d ten a seem b ' I dray drs d arm. ~ •••LG ..•. 1 L l l y 1 1 Aenr 2428 met d dnglemd W pared 2!. Tenn Dum . Deh Dasd , day, yau) 28. Wr Car Rde ~1llAeiwl Examiner I Caaier hx a Reeem Omer Mn Cmrmson a Doneson7 «he Pre r6 dNm. - ~ CJ ~• ! 1 1 1 1 ^ Yu lf7'f No RUSE OF DEATrI lase Inatructbm end seam ) r AppmzYrem mmnal: Part h: Emar dear ~. Dk Taeaao U Comraum b Orm4 IWn Ty. PM I: Fidr me fTdiDW.e'alE- deree4 i m ve bkd r Ibidkn a , «argrdrone ~ and dedy durdme dam. DO NOT eder mrmirl everde duce r drdec enrt Ored m Dorm av etld U ol n e h Iq d r l ed rot aeatn9 in the uMedy'ag dies given in Pod I. ^ Yu Probedy reap r ri ay ar a e p ogy. e y o g. a e p e twe m eac , ^ Unknwn ppa~~PATE CAME FYeI derr a drsrtlon resa6M h ~m) _~ g r 29. II Female: ^ Nd unt wlmM re ut nr Due m (a r ~ i p p p Y ^ Prepient at tlrna d seem M dii«irarae, r ~. o' ^ b dies imd an Yee. od b (a Er•ar UNDERLYKxi CAU6E ~, i Nd pe~len4 na pageant wlWn 42 tleys of aura (dare a MaY tlW iileamd tle ~ b aY a m LAST i ^ err rse rg n r ) . Due m (« a drae9verid aQ. Nd pregnant, hul pegnarn 03 days b t yur I»Iae arm a r ^ lheean r rs ned wiYYn me peel ear p g y 3d. wr en Auaney 30a. wan Aubpny 1'FwtYge ~. 31. Nemer Deem 32a. Dam d eiurY (Monm, dy, Y•arl 32b. Daeuba Ha e{ay Oocunad 32c. Pmdd mjuy: Hone. Farm, Srd, Pacbry, PsdmnM Avelaem Prbr bCmpktlonl a Ceuee a DMIh7 ^ ~~ L Wise~uel Olfld fiaidrq, eb. (SpecYlyl ^ Y L f I~ ^ V ^ Aaitlent ^ Pa~drg hrortlpea°n ~. Time d Irgny 32e. Inlay n WarKf 321. M Trerrporletlon Ndury (Speay) 32p. Lodtlon a iryury (Steal, dP/ / ben, elele) r U . ea ^ Backe ^ CaiM Na ee DemrmYied N ^ Vu ^ No ^ Orlaar/Openly ^ Peeeenga ^ Peddden Omar- Spedy: SY. Caehr (drek ody eel (Ph drie d ji d m M tl h H h e a m tl t tl IM z3 • D««M• i ~ i 39b. 5igre Tab dCedlkr ~ ~ a ` ` y r iu c ee a am er p ya en en u iya,and r compa a n ) r I r n9 Toth brlamy loaeYdye, deem aeern•d to tle •area(•)and mYlMrr aramd________________ _ ~~,~ JL/ (l t ~~ t~ t ______ __________ PIa110Y11CYlg an0 carlKyaa PeY•Y:Yn (~Yaaa4 Odh perwaMq demand cxetyip m dw d arm) ^ 33c. Ucwu ! ^ ~ C 33tl. Dam Siprtl ( nm, tlay, y ar) To tle lerd.ry eneerdoe, s.m aedrnddm. tlrne,dam, eetl place, and d»mm.ewr(p ark mamarrdN•d__________________ seder Eardnr/C«aer i 1 1 ~ ' ~ „~ ~~.V// ~ g - 1 On tlr eaW daaarartlm andl«InwtlgrYr,In my aplnlon,arm owaratl at ms tlme, tlalN Urtl pmd,arM duantM dur(e)antl ma«err ammd_ ^ 3<. Name and dPareo+Who 6grlh (Ram ;'wee" - .~°I~ ~ ~ l ~ o ~ ~ ~ I ~ 3e D.NR~d, .~y.Yrr) L u ~~~C. ~ r ~ 1 ~ ~ OJ.t . ~ ~ e . i Dieportlan Permit No: -~~~ I ~..~ ^-v ~` LAST WILL AND TESTAMENT © `~ -~ ~ r~. , H. MAC NELSON ~• ~ ~ cap - . v. ;~ _ `~~~~ I, H. Mac Nelson, of Newville, Cumberland County, Pennsylvania, being ~~~ound a~'Cl .1 3~~ ~.r> c"'~ disposing mind, memory and understanding, do hereby make, publish ,and declarethis as ancar~pr ~`t my ]Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct tl~e payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct that my remains be cremated and spread in the woods at 191 LeFever Road, Newville, Cumberland County, Pennsylvania. r SECOND r~ I give and bequeath certain articles of my tangible and personal property in accordance with a hand written list made by me during my lifetime and attached hereto. In the absence of such a list or designation on said list, said articles of my tangible personal property shall be added to the residue of my estate. THIRD I hereby make the following additional specific bequests: (~4) All of my investments in American Securities Fund and my Sovereign Bank certificates of deposit to my children, Kristin Nelson, Aaron Nelson, Blake Nelson aid Kelly Perkins in equal shares. Should any of my children predecease me, I direct that the deceased child's share be distributed in equal sh~~res to my remaining then- living children. (B) To each foster child who I am sponsoring at the time of my death through Latin Child Care of Assemblies of God Church and/or through World Vision - an amount equal to the monthly sponsorship rate for that respective child multiplied by the number of months remaining from the date of my death until the date o:f that child's 18~' birthday. FOURTH I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved wife, Kathleen A. Nelson, absolutely and in fee simple if she survives me by thirty (30) days and she is not institutionalized in a health care facility or nursing home;, or receiving benefits through the PDA Waiver Program or any other public benefits program. FIFTH In the event that my wife, Kathleen A. Nelson, fails to survive me by thirty (30) days or in the event she shall be institutionalized in a health care facility or nursing home, or receiving benefits through Ithe PDA Waiver Program or any other public benefits program, I hereby give, ,J'`~ devise and bequeath my estate to my children, Kristin Nelson, Aaron Nelson, Blake Nelson and Kelly Perkiihs, equally, share and share alike, per capita. SIXTH I direct tl~uat any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. SEVENTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrurizent, in his or her absolute discretion: (Ai) To retain in the form received, or to sell either at public or private sale any real or personal property; (1~) To exercise any options to subscribe for stocks, bonds, or other investments; (C) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bands or other securities; 2 (D) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his or her sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (E) To make settlements and compromises on such 1;erms as my personal representative in his or her sole discretion may deem wise without the necessity of obtaining any court approval thereof; (F) To make distribution hereunder either in cash or kind, as my personal representative in his or her discretion may deem wise. EIGHTH ~~ I do hereby nominate, constitute and appoint my daughter, Kelly Perkins, to act as f ~ Executrix of this Imy Last Will and Testament. Provided, however, that if she is unwilling or unable to act as executrix, I direct the duties of Executor to be performed by my son, Aaron Nelson. NINTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrurl1ent shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, H. Mac Nelson, have hereunto set my hand and seal to this my Last Will and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my signature in the margin for identification, this 2"d day of March, 2009. / ~~~\ H. Mac Nelson, Testator Signed, sealed, published and declared by the above-named H.. Mac Nelson, Testator, as and i:or his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of said Testator and of each other. ~~' ~~~~ ADDRESS ~~~ ADDRESS ~fU ~~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~um ~er/a~ We, H. Mac Nelson, ,/~or~i ~/. /~//sh~~s~ and m~l7~f O;,~q~rf ,the Testator and witnesses, respectively whose names are signed o the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authjority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed 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 witnesses and that to the best of their knowledge the Testator was at the time eighteerx (18) or more years of age, of sound mind and under no constraint or undue influence. H. Mac Nelson, Testator ~~~~a~- ~~( Cc.~., ~~~C. ,Witness Subscribed, sworn to and acknowledged before me by H. Mac Nelson, the Testator, and subscribed to and sworn or affirmed to before me by /~Q~^,l~ ~ ~Q/~~JV~~~S'~ and T,~~~,/ ,;,~~~ ,witnesses, this 2°a day of Mari, 2009. 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