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Home My WebLink About01-23-12PETITION 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 Name: Emest H. Blake File No• 21- a/k/a: (Assi ned by Register) a/k/a: a/k/a: Social Security No: 247-20-2920 Date of Death: 1/112 (11A5 Age at death: 89 Decedent was domiciled at death in Cumberland County, PA (State) withhis/her last principal residence at 314 Manchester Road Came Hill Cumberland Street address, Poet OlBce aed Zip Code City, Township or Borough County Decedent died at 314 Manchester Road Camp Hill Cumberland PA Street address, Post Office sad Zip Code City, Towmhip or Borough Couety State Estimate of value of decedent's property at death: /f domiciled in Pennsylvania ................................All personal Property $ 20,000.00 /f not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ If not domiciled in Pennsylvania .............................Personal property in County $ Value of real estate in Pennsylvania .............................................................. $ 100,000.00 TOTAL ESTIMATED VALUE.... $ 120,000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, ijnecessary.) SReet sddrae, Poet Otflce sad Zip Code City, Towmhip or Horoagh h. C_r Couety ® A. Petition for Probate and Grant of Letters Testamentary Petitioners) aver(s) helshelthey is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated LYoIle ev State relevant dreumataaea (eg. renuneiatian, death ojexecutory eta) Except as follows: after the execution of the instnunent(s) offered for probate Decedent did not marry, was not divorced, ~''~-i'~ party to a'yi divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not 1"iaVe a child born~l' adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Cd! ® 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.ta or db.n.c.t:a, enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was no[ a party to a pending divorce proceeding wherein [he grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS Petitioners), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additionalsheeu, if necessary): Name Relationship Address Form RW-01 rev. !0/!1/10!! Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } ~ Official Use Only ' -- Petitioner(s) Printed Name ~-- --- - - '' P~a B. Vazquez _ ~~_. ._ - _ 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 Petnigner(s~ w~ 1 well and truly administer the estate according to law. Sworn to or affirmed and subscribed before F;~r1rV'~ti ~-' ~~•.. ~ ' _ Date -r "- ~ ~% ~ ~~ -~ ;. 't s '-~.._~- ~ Date me tht .-~=' - day of• - i i ~ ~C't' , -- By. t_ ' . ~ I .! l i(_3_ _- 3 t '^- _ _ Date For the Re,~ister Date ~== To the Re ister o Wills: ~ ``' yT: `~ BOND Required: ^ YES ® NO g f ~ ~_ .--; ~ ~. FEES: Please enter my appearance by my signatur~ ~ _ , : C.` Letters ....................... $ ( )Short Certificates(s) ..... . ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other ..•~~•••~ !V t ..., Attorney Signature: ,`c.` ~ ~ `. ,: ; {'_= C ~~~ ~ ,-; ~ ~ __~ ~ _~ G ~ ~..~ ~ .r1 t L? Printed Name: Seth T. Mosebe "Fl -- -ti`+_ _ _ __ Supreme Court '~ ~ ID Number: 203046 ___ Firm Name: Martson Law Offices Address: 10 East High Street Carlisle PA 17013 Petitioner(s) Printed Address Automation Fee ................ . JCS }~ee ...................... . TOTAL ......................$ Phone: 717 243-3341 __ Fax: (717) 243-1850 __ EmaiL• smosebey(a,martsonlaw,com DECREE OF THE REGISTER Estate of Ernest H. Blake a/k/a: - ~, File No: 21- j~ ,. } . AND NOW, ~ _ ~~~ ' + ' ,` E "~ 2012 , in consideration of the foregoing Petition, satisfactory proof having been p~ese ed before me, T IS DECREED that Letters Testamenta_r~_ __ __ are hereby granted to Pamela B. Vazquez _ __ _ in the above estate and cif applicable) that the instrument(s) dated September 2, 2011 _ -- described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ~'_~ , ~ :. r . , ,_ F ~ A For„~ Rw-oz reg. roit~iznu ~ Page 2 of 2 522 Westover Road i ),, , 1 ~) ~ >r~ ~~ t ' , TYPe/Print in Permanent ;~7,yL y~~ SAN 2 ~ t0i2 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS f"FQTI FIf"'ATF iflF I7F~TH _. _.. .. lack In k f~-»-i"`t 1. Decedent's legal Name (First, Middle, Last, Suffix) _. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) ~ Ernest Ha and Blalce Ma1e 247 - 20 - 2920 Januar 17, 2012 Sa. Age-Last Birthday (Vrs) 56. Under 1 Vear sc. Under i Da 6. Date of BIrtM1 (MO/Day/Near) (Spell Month) 7a. Birthplace (City and State or Foreign Country) $~ ' Ch l Months Days Hours Minutes eston, . ar 89 Se tember 13 1922 Zb_eirtnplace (copnty) Charleston 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Decedent live in a Township? Penns lvania 314 Manchester Road ®ves, decedent raved in Lower Allen -twp. ad. Residence (cp~nty) Cumber land Se. Residence (Zip Code) 1 7 Q 11 ~ No, decedent lived within limits of __ city/boro_ 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marr age) ~f Yes ~ No Q Unknown ~ Divorced Q Never Mauled ~ Unknow ! 12. Father's Namo (First, Midtlle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Elcie Curtis Blake Ma me Lee S orts 14a. Informant's Name 14b. Relationship io De cetlent 14c. 1 f Maili g A r ;s (Street a d N rn ber, City, State. Zip d 9 ~ an~ortq-L since ~t Ue A t s3g1 ~7 Patricia A. Bowser Dau titer - p . G .,. --...-.., ,_---,- _._ 15a. P ace o Deatt~ c ec onN one .. ' " If Death Occu rrecl in a Hospital: Q Inpatient = - cility Decedent s Home a 1f Death Occurred Somewhere Other Than a Hospital: Q Hospice _ o Q Emergency Room/OUTpatie nS ~ Dead on Arrival _ Q Nursing Home/Long-Term Care Facility Q Other (Specify) 156. Fac-•lity Name (If not institution, give street and number; 15c. City or Town, State, and Zip Code SSd. County of Death 314 Manchester Road Cam Hi11, PA 17011 Cumberland 16a. Method of Disposition ~ Burial ~ Crem arson 166. Date of Disposition 16c. Place of Disposition (Name of cemetery.:.rematory, ar other place) m 0 Removal from State Q Donation 1y 20, JanZa EV ans Crematory „°-' Other (Specify) O ZZ Location of Disposition (City or Town, State, and Zip) 16d u re of Fu I Servic nsee or Person in Charge of Interment iZa. Si na t 176. License Number . Schaefferstown, PA 17058 ~ / ~J'~, FD 013 340 L 1?c- Name and Complete Address of Funeral Facility 0 Parthemore FH & CS Inc. P_O. Box 431 New Cumberland PA 17070 18. Decedenx's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE race o indicate what t .- nignesT degree or level of school completed at the time of death. box that best describes whetM1er the decedent the decedent considered himself or herself to be. ~ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" ti i h Hi i /L White ~ Korean Black or African Amer~ran 0 Vietnamese ~ No diploma, 9th - 12th grade no. / span c a b x if decedent is not Span s [~ 0 High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino American Chicano i M i M Q American Indian or Alaska Native Q Other Asian ~ Asian Indian Q Native Hawaiian ~f Some college credit, but no degree , ex can ex can, Yes, i h 0 Associate degree (e.g. AA, AS) ~ Yes, Puerto Rican an or C a mono ~ Chinese Q Guaman ~ Bachelor's degree (e. g. 6A, AB, BS) Q Yes, Cuban ~ Filipino ~ Samoan ~ Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific Islander ~ Doctorate (e. g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify) MD, DDS, DVM, LLB, JD) 21. Decade rat's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work .~yy+I White ~ Japanese Q Samoan ifi I l d done during most of working life. DO NOT USE RETIRED. Ma iTlt e allCe & g 6eratiOn s an er c O Black or African American Q Korean ~ OtM1er Pac dian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure I i A f. p n S ^^ mer can n Q ~ A:;ian Indian ~ Other Asian ~ Refused Chinese Q Native Hawaiian [] Other (Specify) 22b- Kind of ss/Industry .~. 1'^r) ~r ) 0 ~ Filipino Q Guamanian or Chamorro Fade OV ernment~ ~,...~ ITEMS 23a - 23d MUST BE COMPLETED 23 a. Date Pronounced Dead (MO/DaY/Yr) 236. Signature of Person Pronouncing Death (Only whe ble) 23e.l.icense tfJVmbE'f'1 J i~~ ` BY PERSON WHO PRO NOU NGES OR CERTIFIES DEATH Januar 1 $ , 201 2 _r _ yY' ~~ ~ f`,~ ;:',S•: 23d. Date Signed (MO/DaY/Vr) 24. Time of Death A rOX. B ~O A.M. 25. Was Medical Examiner or Coroner Contacted? No 11 -} CAUSE OF DEATH ~ ~Adp~oahn are v o ar c r 26. Part I. Enter the chain of a ents--diseases, injuries, rcomplications--that directly caused the death. DO NOT enter terminal events suacM1 di rest .-~'-Into al: .;p~Death Add d o~i a~VRdt if necp~.?ry Jp ttSe%. Enter only one cause on a line DO NOT ABBREVIATE l i th ti . - . ng e e o ogy respiratory arrest, or ve ntncular fibrillation without show 7 f"'1 ^ -i~- - ~ "71 ~ IMMEDIATe cnusE ----------> a. Pulmonary Embolism ~ ~ (Fina; disease r condition Due to (or as a consequence of): 4.~ ~ ~ resulting in death) ~ ~~ ~~ ~7 b_ _ !~ Sequentially I~st conditions, Due to (or as a consequence of): V~+ if any, leading To the cause h e c listed on line a. Enter t UNDERLYING CAUSE Due to (or as a consequence of): Vr (dis ury That n - e rats resulting d. - -------- nit ated the e _ Due to (or as a consequence of): in death) LAST. S Enter other significa of coedit" ontr"b urine to death but not resulting in the underlying cause given in Part I Part II 26 n autopsy performed? 27. Was a - . . ~ ~/ ~p Yes ~ No 26. w r opsV findings a ailable t - p [he c use of death? a to n~ Yes O No ~ If Fe-male: 29 30. Ditl Tobacco Use Contribute to Death? 31. Manner of Death o . Q Not pregnant within past year ~ Yes O Probably ~ Natural ~ Homicide Preg na nT at time of dea[M1 ~ No ~ Unknown ~ Accident ~ Pending Investigation bui pregnant within 42 days of death Nof pregnant ~ Suicide Q Could not he cteterrnined m , 0 nant 43 days to 1 year before death t but re 32. Date of Injury (MO/DaY/Yr) (Spell Month) ~ , p g 0 Not pregnan 0 Unknown if pregn rat within the past year 33. Time of 1 fury 34. Plar a of Injury (e. g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Ves ~ Driver/Operator Q Pedestrian Q No Q Passenger ~ Other (Specify) 39a. Ce stifles (Check only one): ~ Certifying physician - To the best of my knowledge, death occurred due to the c use(s) and m nn r s Led t t ath occurs nd at the f:;o e, date, acd place, C nd due to the cause(s) and manners ed d e ~ Pronouncing 8. Ce rtlfying physician -TO he be of my kn wledge ^ o aus anner b i of i Lion and/or stigatio n, r mY oPin death o r ed a tM1e time, date. and place, and due to tha c e(s) and m stated Medical Examiner/COro , °~'( eU LL I f Deptlty COrORe rcic eNUmber: ~hj-ef f ifl ~ ~ s __ c rt er Title o Sign ofc tifier: ./ 39b. Na me~Address antl Zip Code of Person Completing Cause of Death (Item 26) 6375 BasahOra Road , Suite 1 39c. Date Signed (MO/Day/Y r) Matthew S. Stoner, Chief Deputy Coroner Mechanicsbur PA 17050 Januar 19, 2012 40. Registrar's Dis[rici Number 41. Registrar nature 42. Registrar File Date (MO/Day/V r) ~ / ~ ~ ~ ~ O ~ Z' ~ /n; /rr~/fffyt //~ /A/n#/~~I V G,~./. ~,1 / ~ /!~) 43. Amendm~ t%Y/'/ / //,f+n~ ~JJ ~'/ ~~V -~/ ///f.i/ /I \ J' ~ / J ~j i~.%~Z `~l~J ~CJ~ .~. /// v ~/ /^/ / OULD READ "'~ ? /~ - C'/~i L~~ ~c~T D f' / I SH 6 ~~ Disposition Permit NO.~7 ~~1~~ H105-143 REV 07/2011 F'~FILES ClientsU 4474 Blake 14474.1 will LAST WILL AND TESTAMENT I, ERNEST H. BLAKE, of LowerAllen Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all death taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property ~t assing~-t~nder,~7 ~. this Will. ~" ` ~ 2. ~ c~a~ ca ' _ .'. I give such items of personalty as are itemized in a certain list, if any, to tl~~~ns n~ned ~~~, J.. thereon, which list is signed and dated by me at the end thereof. -~ ~ ~ ~~ ` T' > ~- ~. 4. 3. I have intentionally failed to provide for my daughter, PATRICIA BOWSER. Insofar as I have failed to provide in this Will for my said daughter, such failure is intentional and not occasioned by accident or mistake. 4 I give, devise and bequeath all the rest, residue and remainder of imy estate, of whatever nature and wherever situate, in equal shares, unto my grandchildren and great-grandchildren who are living at the time of my death. 5. In the event any of my said great-grandchildren have not attained the age of eighteen (18) years at the time for distribution, his or her share shall beheld by his or her parents, in trust, for the following purposes: a. I direct that such trustee(s) shall hold, invest and reinvest the same, collect the income arising therefrom, and after paying all expenses incident to the management of the trust, to use and [Initials] Page 1 of 4 Pages apply as much of the income and principal as may be necessary in the sole discretion of such trustee(s) for the support, well-being and education of the beneficiary of such trust. b. I direct that the beneficiary of such trust shall have the right of withdrawal of the principal and any accumulated income of such trust as he or she attains the age of eighteen (18) years. c. Prior to the distribution of the principal, the said trustee(s) shall have the sole discretion to invade the principal of such trust for the support, maintenance and education of the beneficiary thereof, regardless of age. d. To the extent that the same is permitted by law, none of the beneficiaries hereunder shall have any power to dispose of or to charge by way of anticipation any interest given to such beneficiary; and all sums payable to such beneficiaries hereunder shall be free and clear of the debts, contracts, alienations and anticipations of the beneficiaries, and all liabilities for levies and attachments and proceedings of whatsoever kind, at law or in equity. 6. I nominate, constitute and appoint my granddaughter, PAMELA B. VAZQUEZ, as Executrix of my estate. 7. I direct that all fiduciaries acting under this Will, whether or not named herein, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 8. I authorize and empower my Executrix and trustee(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and ~~ [Initials] Page 2 of 4 Pages to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my Executrix and trustee(s) consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my Executrix shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this 2nd day of September, 2011. Ernest H. Blake ~~'~-~ (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testator and of each other. c ,~ J. Page 3 of 4 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Ernest H. Blake, Seth T. Mosebey, and _ ~Q ~ ~~ ~r~ 2 ~- /~~ ~e~ S ,the Testator and the witnesses, respectively, whose names are signed to the foregoing 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 that the Testator has signed willingly, and that the Testator 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/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Ernest H. Blake, Testator '~-"" ~~ Witness ~i~~~ Witness ~ Subscribed, sworn to and acknowledged before me by Ernest H. Blake, the Testator, and subscribed and sworn to before me by Seth T. Mosebey and ~Qr~' rr~ e ~ . I' ~~ e the witnesses, this 2nd day of September, 2011. y COMMONWEALTH OF PENNSYLVANIA Not ry blic Notarial Seal Mary M. Price, Notary Public Carlkle Boro, Cumberland County My Commission Expires Aug. 18, 2015 MEMg~R, ptNN5Yl4ANJA A5,5(X:(ATION OF NOTARIES Page 4 of 4 Pages