HomeMy WebLinkAbout01-09-12Reset
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 -. ; j
ff ~ ' , `I
Name: Terri L. Weaver File No: _I ~.•}~ - ~•:~'~,'
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 192-50-6090
Date of Death: November 27, 2011 Age at death: 54
Decedent was domiciled at death in Cumberland County, pennsylvania (State) with his/her last
principal residence at 85 Arnold Road Enola, E. Pennsboro Township, Cumberland County, PA 17025
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at M.S. Hershey Med. Ctr., Hershey, Derrv_Township, Dauphin County, Pennsylvania
Street address, Past Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsy[vania ............................ All personal property $ 1,000.00
If not domiciled in Pennsy[vania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................Personal property in County $
[value of real estate in Pennsylvania ......................................................... $ S~Tn n_nfi
TOTAL ESTIMATED VALUE.... $ 51.000.00
Real estate in Pennsylvania situated at: 85 Arnold Road Enola E. Pennsboro Township, Cumberland County, PA 17025
(Attach additional sheets, i(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 July 25, 2(~1rA -and Codicili,`s7
thereto dated n/a -' `-
_ ,.:~
State relevant circumstances (e.g. renunciation, death of executor, etc.)' ~`"`- ~ ~
:_.. ?'l
~_~ 4r•,
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorc~d;'washot 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 ,tti~l''~dt have child born-or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. _ - _
_~: - ~-,
Q NO EXCEPTIONS ~ EXCEPTIONS -' ~ ~ • ~ c ;`
f.
B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d.b.n., d.b.n.c.t.a., pendente lire, 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 o EXCEPTIONS
Petitioner(s), after a proper search 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):
Name Relationshi Address
Farm Rwoz rev. loirliznll Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
}
Official Use Only
Petitioner(sl Printed Name Petitioner(s) Printed Address
405 Mountain
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 Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to r affirmed a subscribed before ~ "r``~ ~ f~G ~ Date i ~ ~ ~! Z
me thrs ~-•~.day ~ ,c~~ ~ °3- -~ Date
Hy•Cb v L l I. c9 { i,l ~ i t y ti_. Date
For the Register '~ ate
BOND Required: o YES Q NO
FEES:
.~
~ .
~
Letters .................... .
.. $ ~ ~
( )Short Certificate(s).... .. !J'~~Gt,
( )Renunciation(s)....... . .
( )Codicil(s) ........... . .
( )Affidavit(s).......... . .
Bond ...................... ..
Commission ................ . .
Other ...... ..
~~~ ....
.. .. ~~j.i~U
L
(.> ...... .. ~1 ~i . C7~-
~~~1Ai~c~tf~,;.iti~~'~- ...... .. ~~~ ~~'
Automation Fee .............. .
JCS Fee .....................
TOTAL ..................... $ ~ ~.
`-' _~
--- ~
To the Re islet o Wills: - m
Please enter my appearance by my signature'~eaow:
Attorney Signature:
~~>,v ~ C_
~~~ -~. c_
Printed Name: Clifton R. Guise, Esquire
Supreme Court
ID Number: 93537
Firm Name
Address:
Gates, Halbruner, Hatch & Guise, P.C.
Phone: (717)731-9600
Fax: X717)731-9627
Email: ('.C'ruise ('Tatesi.awFirm.cnm
DECREE OF THE REGISTER
Estate of Terri L. Weaver File No: / I ~ . ~='"~-''
a/k/a:
AND NOW, (~~ t `" ~ ~~(~ i~" 1;~ Y'~ tri , '~C_ i : , in consideration of the foregoing Petition,
satisfactory proof having been presented fore me, IT IS DECREED that Letters Testamentary
are hereby granted to Angela Payne
in the above estate and (if applicable) that
the instrument(s) dated Julv 25, 2011
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Form RW-02 rev. 10/I!/20/1
Register of Wills ~ ~~~ i (_° l`` r is) l~'~~._ }~~~~-~'t_~'v~ .
~v
Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, X6.00
P 1803~8E5
Certifica~ion Number
s
_ _ _ _
This is to certit4 that the infornjation here r~i~:en is
correctl~° copied i~om an ori«inal Certificate of Dead
duly riled witi-I n?e as Local Rey*istrar. The ori;inal
certificate will !,~ for~~~arded to the Stale Vital
Records Office ti?r permanent tiling.
__ ll~d 8 al
Local egistrar mate Issued
c7 -z-
a 0 __
It
rn Ji~
~1 ~,
• _,~ - ,
_ -
- :a~, .
R1a5-tea REy ttnaos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
1VPE I PRIM IN
PEfiMANEM CERTIFICATE OF DEATH
&.ACN INK (See instructions and examples on reverse) STATE FILE NUMBER
~...
~e
1. Name d Decedent (Fxd, midde, Wet suffix) 2. Sex 3. Social Security Numbw - 4. Date d Death (Month, MY. Yew)
Terri L. Weaver Female 192 - 50- 6090 November 27, 2011
Aga (Law ttidhdaYl Undw 1 llridar 1 M 6. Date d Bklh 7. ~ ant state «lo too ea. Plaza d Death Check one
5
.
54
YB ~""' ~ Naxa M.~u October 3,1957 Harrisburg, Pa Hospital: Other:
~ Inpahem ^ ER / OulpaEenl ^ DOA ^ Nursing liatw ^ Residence ^ ONw - Spedly:
.
• gp. County op DeaM &. City. Boo, Twp. d Dwlh 8d. Fecily Nerre (If not instrWion, gwe street end number) 9. Was Decedent d HispwEc Odgin? ~ No ^ Vas 10. Race: American Inden, Black, While. etc.
p
d
C
O
IAN
en,
(
yes, spe
ty
u
Mexipn PueM Rican. eb.) Wh)te
11. Depdanl's Usual Eon Kad d wok Bone du moat d be. Do M stab 72. Was Decedent ever b dx 13. DepMnl's Edxatun (Spealy spy highest gratla oonpMedl 14. Madbl SbAa: Marred. Never Marred, 15. Survivkg Spouse In woe. 9^• maiden name)
WMOwed, Divorced I~b1
K' d /I
K~ atw
Customer°r~ervice ~ons>~ruc n U.S. Armed Forces? Ekwredary I S~ndary (o-12) Cdbge (14 w Sr)
' L Divorced
^Yes L~9 ,~
- 76. DepMnys Mding Address (Street, MY /town, stab, nD ~) Decadwd•a East Pennsboro
PA live nt 17c
Decedent LNed in Twp.
®Yes
405 Mountain $t. .
,
Adore'Residence t7a state Tawmhip
Cumberland ~ ,7d. ^ ~
OeVo~~~"^
Summerdale, PA 17093 cdy/Boro
,7b. Counry
O,d
18. Fadtefs None (First, midde, last, sdfix)
David Gingrich 19. Motley's Name (First rnttltlle, maiden surname)
Patricia Gardner
20e. Inkxmanl's Name (Type / Prim)
Angie Payne ZDb. Infomiwx's Mep'vg Adtlress (Street. cAy' I brm, slate. zp codel
85 Arnold Rd. Enola, PA 17025
21a. Method of Disposition Cremalini ^ Oonetien 27b. Dde d Dispositon (Month, day, year) 21c. Pbp d Dspositon (Name d cemetery, wernataY or dter plxe) 21d. L«stbn (City/tam, state, zq code)
^ Bedal ^ Remaalk«nstab ~ ~ cr.ma
m ~
^ N November 28, 2011 Hoffman Crematory Carlisle, PA 17013
E
a
Yaa
^ Otller -
3yi$iwreuHe d Funeral -Service Liinrwes (w Dew wbn9 az w~)
Y)/J
_ _ < 22D. Lk:erae NwMer
FD-13845-L 22c. Name antl Address d Facity
Sullivan Funeral Home 51 N. Enola Dr. Enola, PA 17025
~/
~,
Conglate gems 23at nity when cerElying 23e. ro tle best d my tnowledge, death occurred d tle time, date end P~ shied. (Sigrrdure ant Elie) 23h. License Number 23c. Deb Silted (Modh, My, rear)
physiden'a rot available al time d death m
prdY cause d death.
Tme d Deam 25. Dale Pnxewxed Dead (Mnitlt, day. Yrer) 26. Was Case Relerred b Meical Exwntrer /Cornier for a Beeson Omer than Cremafion or Donation?
21
-
.
Ibrre 24-26 mud De cprgbbd M persni
~Q I ^Yes ^ No
rwanicee Mwh
-
ta
I I ~M M
I
~'
v
.
.
w
p
1
lr
)
CAUSE OF DEATH (See instnzcUOns and examples) r Approxirteb Marvel: PeA IL Eder oEer arv,,w.-a,e rondiEOre cnitrEulke to deem 2B. Oitl Tobaco Use Caxrbute to Deem?
n w P
n I
n
^
n t
d
d
p
^
.
he un
g cause ge
e
rg
e
y
P
Yes
Item 27. Pan I: Entw the drab d evenb - diaeesaz, kyuries, «arigwaEore - tlbl dredM pueed tle deem. W NOT eder brmnd events such az prdac arrest' r Onset b DeaN dd rot resrp
^ N
i
~n
o
re. r
respkabry arrest. a vedreubr fibdletlan vdtled shanig tlx etblogy. Lill Ml one pose ni earn
r
WMEDIATE CAUSE Fmel dseaze or t ~ 29. II Fem
cadiEni resWErg n ~aN) _~ a ^' ~ JA/~, m~ !e)1 (4lLlV IGWIC~ [j'T '~-~ t/1 Ll~f'~ r pregum within Dast Year
Due b (« az a oQ: ~ ^ Pregnwu d wne d deem
Est cordfiorw, 9 wt'. p, i ^ Nd pregnant bd aegnant w9hin 42 Mys
to pose Nded ni ire a. pre b (« as a cwweQuenp d):
EUNDERLYING CAUSE ~ of deaM
nant Dd pregrem 03 Mys to 7 yew
^ Not
re
d Fifiated tle
tl
'
k
c
p
g
i
eeaze w
(d
RUY
evenb resdtin9 n sewn) LAST. ~
Due b (w as a coreegrence d): i helae death
tl. ^ Unlmown it pregnant wxtm the past year
-
30e. Waz an Autopsy 3gb. Were Autopsy Fndigs 31. Manner d Dpth 32a. aab of Inpay (Month, day, year) 32b. Desaba Flow Injury Owured 32c. Play d Injury: Fbma, Farm, Shed, Faday,
Olfxe BrNdng. etc. (SyedyJ
Pedamed? AvaiMde Pror to Conplefini ®Netural ^ Honpcida y
d Cause d Deets?
^
^ Aorident ^ PeMkg IrnestlgaEan 32d. 7me of Irpiry 32e. Iryury at WadC! 321. tl Trensp«atlon Injury (Speayyf
r ^ P«bstnan
^
^ P
O 32g. Lopdni d injury (Street, dty /tam, stele)
^ Yes ^ No No
^Yes ^Yes ^ No essnige
Ddver/
perabr
^ Suidda ^ Caatl Nd re Detertnked M. Otler ~`PwyY~
33a. Cedaer (deck oriy one) ~
33b. Sgnelue ant Tips d Certifier ~~
~
• CwalYfn9 MY~len (PM'sMen ceruFNg pose d dedh whni Brower physidan has proriarrad deem and conpbbd Ilwn 23)
--"'-' ^
slebd
d ~ "V "'
_ .
.
-
__________________"------
mm~nwab
io the hestd my krgwbdga, Math omumd Mato dye eawa(a)an 33c. Liense Nuribw 33d. Dab Signed (Mnia, daY• Ypr)
• PronouMing and anKykrp phyakbn (Physinen bent Drorounckg deaM end prlMin9 b pose d daeb)
® T //
iotM haMdnry knowbdge, deetlraceurrM dthe tbe,Mb, atW phce,and duo to the cause(s)and manner as sbtatl__________________ ~ i /I
• Medical ExemberlC«oner
and due to tM puae(a) wM manner as sbtad..
an
d
place
ad d the time
d
a4°
h
Ad«ess d Person Who Carrybled Cause d Dea« (Item 27) Type / Prkn
31. N~
an
tl
ne
,
,
,
rr
o
au
Mo
n, Md
op
« irveedgdlni, I
n
m
y
On Me hssla d examlrWbn arts I
~
l
~
y
r
/
~
~
~
~
~
~
~
~
Reg~,rera sigreture aitl ltf.~. {-vl ill.l.C1(.11+2LV~ I ~ " ~` dta'-F ~ I ~~~b 02~ plO (~l Q
_
~
~
IY~'o~ ~ M.S. Hershey Medical Ctr-
l7 l7(0 °-f 0440
DispodEon Pemdt No.
- --
~ ;.:
LAST WILL AND TESTAMENT
._. ,-,
OF t ~ `
~., , .-,
TERRI ll'EA ['ER -'
~.,
1 l c ti ~~%c<~~ er. c~j' F~:nola, 1'enns~ l~ ania. rep cake mti fortl~er ~~ ill> rind Co~~icils <~n{1 decl~zr~ t -his t~}' `'-
;~~ t7~~ Last Wii) and ~t~estanlent.
~RTICLI= I
PAYME\iT OF DFI3TS :YND EXP1'VSES
1 :lir<~~ t that m~ irrst do°bts. funeral expenses and expenses of last. illness be fiat t~t.id from tn~
st<t'~_
ARTI('LE II
llISPOSITlO'~ OF PROPERTti'
~`_l_~t~ltl_ii"ti lsta~~_ I direct that tnv residuary estate. be distributed to the fotlcr~;in<~ l~eneiici~tries ial
111e ~~c't°c:erltages as shoLGrl:
;t~,Ilt)"~~ to %~n~~ela Pa~~ne. Enola. penns~~l~~ania. If this person does not sur~ir ~ me° this sl~a~°e
,l.all be distributed proportionately to the other dish•ibutee(s) listed under tl~i~ taro~~isi~~~n.
^,41,t)O~ o to :-~mc E3uckwalter, Enola. pennsti~l~~ania. if this person does not staeai~e tne. thi~>
~:rre shall be distributed propi~rtionatelti to the other distributee(s) listed t_t~ui.,° t-~i>
G~s~o~.ision.
ARTICLE III
N01'iI~ATInti OF EYECL~TOR
nd~n9inate .ingela Pane. of Enola. penns~l~ania. as tl~e E~lecutor. «ithout honLf ~~r sl~r~rit~ .
AR"TICLE IV
EXE('LT()R I'Oti'VERS
~I~ Executor. in addition to other powers and authoritti~ ~~ranted by 1a~~ or n~ces~,tr~ ~~~~
appropriate Ior proper administration, shall ha~~e the right and power to icsase.:>~ li. 3~IOrt~~a~~e° <~~a°
~th~rti~ise cncim~k~er ane real or personal property that ma~~ he included in m~ r:~>l re. ~~ithout ~~
~~rde~• ~)#~court and ~,~~ithout notice to anyone.
'~I~ l~ecutor shall 11a~e the right to administer nl~~ estate using "informal" "un~.,u~.)erviscd". o,~
' in~ie~~endent" probate; or equivalent legislation desi~~ned to operate ti~~ithout ur1;~le .cssal'~
interlcntion b~~ thy: probate court.
.ARTICLE ~'
VIISCF,LLANF.O('S PR()tiISIONS
~,. I'sir~l~~r~t~(~_I Itl~s and Gender. ~I•he titlos ~,~i~~n to the para~~raphs of'tl)is `i'ii! ; re instrt~cl f~~;-
~~c!•crz~nce ptllpose~ only and are not to be considered as Forming a part of this ~~ i ~~ i in internretin
is })riwisions. .^~ll u-ords used in this ~~%ill in an~~ gender shall extend to and in~li~ae all ~.~e.nde;•~.
<~nd am-~ singular ~~-ords shall include the plural expression. and vice ~-ersa. whe11 ;hc context or
rtct, c) require, and any pronotuTS shall be taken. to refer to the person or pcrso;l, intended
~•c13~i1-chess ol`<~ender or number.
~. 1 .abilitl-_of'llLluciarv. No tiducialh ~~ho is a natural person s11a11. in the ai~~er~c;. of•i~r~tuc~t;i~nt
-- -- - .
•otltlnct or bad laith. be liable individuallti to any beneficiary of~my estate. and ;~ ~ estate sha',I
nclchlnity such n<aturai person from any and all claims or expenses in comlecti~~n ~~ith or ttrisin~~
~i.dt t7' that t1C1tICla1`\`'s <~OOd lalth aCtlOns or nOnaCt](?Ils as the 11dUClar~. except T~.~i st1C'~1 aitl0l?~; i?`'
lonitc~tions tivilicll constitute liaudtllent conduct or bad faith.
:~. ~~o_S~?ouse. 1 am 11ot currently married to anyone.
). 13cl1eticiart Dj~utes. If any bequest requires that the bequest be distributed ~etti~een or
- --- -
tn1~~l~t,! t~°o or more beneficiaries. the specific itellls of property comprising the I"~spccti~e sh~tre~
>hall be determined }~~ such beneficiaries if they can agree, and if not. by rn~ 11.ctltol-.
('~ ,1~{I I \'IS~ ~'~ 1 }I=.fZL01. I have subscrihcd mti name holo~~, this _ ~,'~ da; :,~
l estator Si~7nanu•e' ~-
I errs W eager
~~`,, ~i1e undcrsi~,~ned. hereb~~~ eel•tify that the above instrument. which consists {~~~ ~ pages.
`;lTtitl',:1i11g Iht pa`~e(s} ~~'hlch C011ta1n the ~1'tint55 SlgnattlreS. ~'laS signed n1 C?ui" ~~i`'11t and presel)t:c
~~» l~~xrri ~~caver lthe "Testator"). ~Tho declared this instrument to be hisiher 1_~l,t 4t~i11 anal
i~c~l~ nlent anti ~~ e. at the I estator's request anc} in the I estator's si`aht and presc~lT~c. <lnd in ti-~,
.,i~s?t and nrLellcti clt each other. do hereby subscribe our names as ~~`itnesses r+l~ the. date ~h~~tY,1
l~''itnc~~ Si~Tnat~n~e: ~~
__ _
---- -- -
'~ ame:
- -_
Cite:
State: _~'
l~'itness Si~Tnature: ~~~
--- - ----
- ---- -
--- -
Sr~te:
~~ Uv
AFFIDAVIT
C'() 1110'~WI~:;~L"fl I OF PF'~I?~'SYLVANIA
('Ot"~"i Y ()E' C't~1BERLAND
. ,.
~ ~, e /n .S
and l/rltX/~s _
_ -~-1~--- - - ---- - -
t!1~. ,~ ;messes ti~~ilo_ names are signed to the attached or foregoing rostrum t. ',?~ ~ni? d~ii~
c~laiified according to law. do depose and sad that tine ~.~-ere present and sa« the 1 stator si~~n ail~i
c ~ecute the instrument as the "Cestator's Last 'Will: that the "testator si~~ned ~~illin~ l~: and L~ecutec.i
ii <:~~ tilt:Testator's free and ~.oluntar~ act for the purposes expressed in it: that c,c+1 of t.is i,l til;,
i,~:~~~rir,~T and siil~t +_}f the Testator si<gned the Will. as a ~~itness: and that to the Eyes? ~?i'our•
~~.,~~,;~ ~edt~e the "i stator was at that time 18 or more years of agc. of sotuid rain<i z~~td uncicr 11~'
co~l~traint oi• undue influence.
>~~ori1 to or' affirmed and subscribed to before me by ~p~ -~E~~ie~~
--_ _
~,nd ~i2~d~ ~'~ _ _. ~~itnt.sses, this~,~'~c~la~ of
..1 v .~~ --__ ___ _- -- ~~
'.~ itnt°s Sii?natru•e:
~i ame . 1!_!H .1,
-- - - -- _
C' i t ~ : ~/1 n ~ ---- ----- -- ---- --
~t~ite°
ti~~iln~~ss Sl~anature: ~.° , _._~ •.°-
\at11t: ~ ~ ~I~~_ _
(~lL.ti . - 7/~ ~ --
state: t~ ~t..- ~~~"~ -
Signature
COMMONWEALTH OF PENNSYLVANIA
()~q ~~ Np}ailat Sepal ry,~u
~ ~ a i ~ast isenn~s5orov~, ~tn'b~1'an~~•.
My Commission Expirea May 30, 2013
Member, Pennsylvania Association of Notaries /~
>?rti;~sv>!.v.~~>i;~
4elf-Prop in;~ (.'cause
~.. l_3 ~~.rll~~~"`... 1.~ ~ll i L \.J 1' ~1._iV :V.7 1 l_ VT.'~~Li
. 1 wrri ~~eai~er. tl~te Iestator ~~~hose name is si~~tl~d to the attached. car #oi°e~7ain<< i~,strt_Im~,~~~.
~a~ in,:~~ been c~ril~ cl~_talitied according to la~~. dc, herebti ackno~~ led4~e that I si`~t~,:t{ ~it~cl it ~e:utci;l
?Ic irl~trw~~ent CIS i1~~ bast Witl: that 1 5i`dned it ~tiillin<~l~ and as t»~ free and ~~~iti ,tIt'~l act for tltc
tit ~~~ ~cti c~pre ~~ed in the instrument.
,p~6jr:. tc> c~i':~ililt~~eci and acjkno~~ie itved before Ine h~ Terri ~~ea~er. t11e le,t<t~.:.~~t. zlis _~~~t~i~
~~~~ J~
~, .~
i'~t~ii~r ~1~~'natttr~~
- - ~~-- -
7erl'3 ~'ea\,et'
-- - -- _ _
~;I~~I:~ture of Ices _
---_- --/ v~:. ~ air C- _ _ _ - _
()t"tidal capa ~' ~ of officer
COMMONWEALTH OF PCNNSYLVAyIA
Notarial Seal
iCristy L. Magaro, Notary Public
---___.--_.._.-- Earl nns~oroTwp..,~utri~rtandCcardY
~ ~ ~ ~~ 1 ~ _ My _Co_mmission Expires May 30, 2013
~. {~-s ' -~-~~ Asseciation of Notaries
y~ ~V
1