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HomeMy WebLinkAbout01-23-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF L U (!~,(~ ~(~ LA N ~ 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• (1'1~}~~ {~~ C~(Z a/k/a: IMAR;' ~. C~2~ a/k/a: tnA(t~' f~-t.a..~/~i c4-l-2R a/k/a: ~1 -1~ - ~c'~~ File No: _ (Assigned by Register) Social Security No: Date of Death: , i - a~ - la. Age at death: Decedent was domiciled at death in C J MBA t4+~.1~ County, ~P~N~SYr`v ~ +`~' R (Scare) with his/her last principal residence at Q`~~. ~ix,~, SNtP ~NsB~2G Cy~$~~~N~ Street address, Post Office and Zip Code .3 ~ t A~XI~ Ci ,Towns ip oar Bl~orCorug~~7013 County Decedent died aK~K~ 1 Se.i= R~ MAD tClt~ ~-~~-~ C¢1-R~is~Y Cu rn BE2uR~/9 P Street address, Post Offce 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 $ ~~ , ~ a ~J If not domiciled in Pennsylvania ........................ Personal property in Pem~sylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsyfvania ......................................................... $ Q TOTAL ESTIMATED VALUE.... $ Real estate in Pennsylvania situated at: l~o~ R1Q~~ R~ SFE~PP>~sSy~G Qfl Cti)•~'t'~~~ (Attnch additional sheets, if necessary.) Street address, Post Office and Zip Cade City, Township or Borough County ~A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver{s) helshelthey islare the Executor(s) named in the last Will of the Decedent, dated ~ ~ ~~ and Codicil(s) thereto dated Np Cb Q t Ct ~. State relevant circumstances (e.g. renunciation, death of exectuor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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(8), 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.tu., pendente life, durante absentia, durance minoritate If Administration, c.t.a. or d.b.n.c.ta., 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS [] EXCEPTIONS r.,~ Petitioner(s), after a proper search has!}tave ascertained that Decedent left no Will and was survived by the following spoufany} and hei~tttach e~.~ aclditionul sheets, ifnecessaryJ: ~ t.~ ~ ~7 Name Relationshi Address ~ W 8 ~" ~~ -' ~=, ~>;~ .-~ F~~n, ntv nz rev. l O/11/2111 f Page I of 2 Oath of Personal Representative CO~(~tONW'EALTH OF PENNSYLVANIA } } SS: COCNTY OFD-~m'g`t(Z~~ } _;y-f'i't ' -; ~ law `~~R r 'i'~1 (Yse'O`>yly ' ~~~ Petitioner(s) Printed Name Petitioner(s) Printed .~d ~~ ~ ~ ~ c ~~ 9 ~a ~~ 0 ~•~_ QD sr~ I P P~sg~~- ~ 1`ta z The Petitio?er(g) aUove-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 P~titicner(s) and that, as rr^ersonal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law. Sworn to or a€firmed and subscribed before Date me ~ day of ~ r~t7 i`~, ~ 1 M Date j ~ ~3 ~~o~.--- By'~~ 1~.~ ~ 1.1 l_ r~t ~~ l,l ~i 1 Sit 1 Date For rk~~ Re; aster Date BOND Required: Q YES ~NO FEES: Letters ..................... . $ ~' d ( ;j )Short Certificate(s)..... . r`~ -UT~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ....................... . Commission ................. . Other (Ali ll ..••. • t~- Automation Fee ............... "-~ ~ ~ JCS Fee . .................... ~ ~ (; TOTAL ..................... $ F'~?~73 JC 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 I y~ ;t `(~ ~ n tl ~ ~.r ~ File No: ~ ~ - ~ ~ ~ ~-'` O b a/k/a: AND NOW, '' ~ ,-~6 ~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presen ed before me, IT IS DECREED that Letters ~S~i~Q V\ ~~-!` fLI are hereby granted to ~~~,~j-~('p (Y ~ ~ ui the above estate and (if applicabie? that the instniment(s) dated ~~; ~ - ~) `1 ~ __ described in the Petition be admitted to probate and filed of record as the last Will (and Codicils}} of Decedent. ,~ r~ r;~Cx c~~~ b t~~,r~~~:t.~~<~~\ Register of Wills _~, ~ ~.~~ ~~~Jr~~ r Form R N-~2 rev. IOJI 112011 Page 2 of 2 H 105.805 REV f 9/ i 1 ~ LOCAL ~,~~ CE'RTIFICATION OF DEA-TW WARNING: ~~c~~Ic~~,F~~~ plicate this copy by photostat or photograph. Fee for this certificate, $6.00 P ~.8~.~~.~28 Certification Number Type/Prln[In Permanent Black ink x/33-186 ~Dl1,~~N 23 PM 2' "' ors °F , Phis is to certify that she information l~)ere given i5 correctly copied from an original Certificate of Dc~at~l duly filed wit}z me as Local Registrar. Tt~e original certificate wi11 b(~ li~rwarded to the. State ~/ital Atecords Otfice to( i;errnanent filing, egisu'ar Late Issued COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS CERTIFICATE OF DEATH _____ ~.._ _.___.___ 1. Decedent's legal Nsme (First, Mitldle, Last, SufRz) 2. Sex 3. Social Security Number 4. Date Of Death (MO/Day/Yr) (Spell Mo) Mar A Carr Femal 230-50-2576 Januar 20, 2012 sa. Age-Last 8lrthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign COUniry) Months Data Hours Minutes Harrisonbur vA 71 A ri1 4 1940 76. Birthplace (County) Rock' n h m 8a. Resident! (SSate or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Bc. Ditl Decedent Live In a Township? P nn v n 482 Ridge Road ®rYes, decedent IlVed In Southampton twp. ad. Residence (counts Shippensbur PA Cumberland Be. Residence (Zip Coda) ~ 7257 O No, decedent lived within limits of city/boro. 9. Ever to US Armed Forces? 10. Marital Status et Time of Death ~ Married 0 Widowed 11. Surviving Spouse's Name (If wife, glue name prior to first marriage) ~Yas ® No ~ Vnknown ~ Dhrbreed ~ Never Married ~Unknow Carter H. Carr Sr. 12. Father's Name (First, Middle, Last, SufRx) 13. Mother's Name Prior fo First Marriage (First, Mlddia, Last) Jay A11en M rna Dorman 14a. Informant's Name 14b. Relaflenshlp to Decedent 14e. Informant's Melling Atldrsss (Street and Number, Gity, State, Zip Code) Carter H. Carr, Sr_ Spouse 982 Rid a Rd. Shi ensbur PA 17257 ..................... ......... ......................................... ~- ~ ............~:...ae~..°.. ..eat... .._ec en_y one .............................. ` ~ ~~~ ~~ ~{ .................... Inps[ISnt ; IT Death Occurretl In • Hospltal~ L~( 1 .w If Death Occurred Somewhere Other Than a Hospital: ~ HOSpice Facility LIDecedent's Heme ~S Eme enty Room/Outpatient ~ Dead on Arrival Nuryln Nome/Long-Term Car! Facility Other (S aclfy) a2 1 b. Facility Nam! (If not MatiSUtion, glue street and number; 35c. City or Town, SUte, d Zip Code SSd. County Of Death Carlisle R¢ loose M¢dical C¢nt¢r Carlislef PA 17015 Cumberland 16 .Method of Dis DOStCIOn Burial Q Cremation X$ Removal from Stafe 0 Donation 16b. Date of Disposition 36c. Place of Dis POaltiOn (Name Of cemetery, crematory, Or other place) Other (specify) 'I-25-202 os e1 Hi11 Mennonite Church Cemeter 16tl- Loudon of DlsposlSlon (City Or Town, State, and 21p) 17a. 31 naryl Service Licensee or Person In Charge of Interment 176. License Numbly Harrisonbur VA 22802 01483-L 17 c. Name and Complete Adtlrass of Funeral Facility Fo elsan er-Bricker F_H. Inc- l'12 West Kin t_ h en A 17 ~( 18. Decedent's EtlVUtlon -Cheek the box that best dlfcribaa She 19. Decedent of Hiapanlc Origin -Check the 2D. Dlcstlent's Rice -Check ONE OR MORE races to Indicate what i- highest degree or level of school completed at the time of death. box that best dNCribas whether the decedent the decedent considered himself or herself Lo ba. Q 8Sh gradr or less is Spanish/Hiapanl4Utino. Cheek the "NO' White 0 Korean ~ NO diploma, 9th - 12th grade Q Hlgh school graduate or GED completed bo H decedent Is not Spanish/Hiapanlc/I.atlno. ~NO, not Spa nlsh/Hbpanlc/T.atino ~ Black er African Ameritsn 0 Vietnamese D.Amerlean Indian pr Alaska Native ~ Other Asian Q Some college cretlit, but no degree [] Yes, Maxlcsn, Mexican American, Chicano ~] Aalan Indian , 0 Native Hawaiian ~'( Associate degree (a.g. AA, AS) Q Yes, Puerto Rican [] Chlneae ~ Guamanian or Chemorro [] Bachelor's degree (e.g. BA, AB, BS) Q Yef, Cuban [] Filipino ~ Samoan Q Master'f degree (l.g. MA, MS, MEng, MEd, MSW. MBA) Q Yef, other Spenlsh/Hhpanlc/Latino [] Japanese ~ Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Prolesslonal degree (Specify) ~ Other (Specify) a. MD DDS.DVM LLB 1D 21. OKedent's Stngle Aace Salf-DSSignation -Check ONLY ONE to Intllwte what She decedent comidered hlmsaM or herseN to b<. 22a. Decedent's Usual Occupation - Indiote type of work hlte Q Js PSnese ~ Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American 0 Koresn Q Other Pacific Islander [] American Intlian or Alaska Native ~ Vietnames< ~ Don't Knew/Np[ Sure Administrative Assistant Asian Indian -- -' Q Other ASlan ~ Refused 22b. Kind of Business/Industry Q Chines! Q Native Hawaiian ~ Other (Specify) ~ Filipino [~ Guamanian or Chemorro city Of Harr is OnbUr VA ITFMS 2Jta - 23d MVST 8E COMPLETED 23e. Date Pronounced Dead (MO/Day 23b. signature of Person Pronouncing Dea<h (Only when applicable) 23c. License Number 8Y PERSON WNO PRONOVNGES OR CERTIFIES DEATH Janllar 20 2012 23d. Date Signed (Mp/Day/Yr) 24. Time of Death 4 A _ 25. Was Metlieal Examiner or Coroner Coniacted'T Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter The chain of eyenis-diseases, Injuries, o mpllcations--Shat directly caused Sh! death. DO NOT enter term lose a cots such a ardlac arrest i Intervml: respiratory arrest, or ventritutar fibrillailon wlihout showing the etiology. DO NOT ABBREVIATE. Enter Only one cause on a Ilne. Add adtli[IOnal Ilnes If necessary Onset to Death IMMEDIATE CA VSE --____> Atfi¢roscl¢rotic CO rOnarY Artery Disease (Final disease o ondi[lon pue to (or as a consequence of): resulting In death) b. Sequentially Ilat conditions, Due to (or as a consequence of): li any, leading t0 the cause _ listed on line e. Enter the UNDERLYING CAVSE Due t0 (or as a cons<quence of): ~, (disease or Injury that G In lTiated the events resulting d. ~ In death) LAST, DUe t0 (or as a consequence of): ( t 26. Part 11. Enter other i ni c n iii n In h but not resulting In the underlying cause given In Part i 27. Wss an autopsy p rtormetlT S D Y<a No ~ Remote M=, N D M 28 l l ~' t0 complete the cause of des h 7 ~ O Yes No 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death e Not pregnant within pas[ year Q Pr ant t time f death ~ Yes ~ Probably N V k ~yqy~ Natural ~ Homlcltle ' ~' a egn o 0 Not Pregnant, but pregnant within 42 tlaYS of death ~ o ~ n nown Q Accident ~ Pending Investlgatlon Q Sulclde ~ Could not be determined ~ ~ Not pregnant, bui pregne ni 43 days to 1 year before death 32. Date of Injury (MO/pay/Yr) (Spelt Month) ~ Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home, construction site; farm; school) 35- Loceilon of Injury (Street and Number, Clty, State, 21p Code) 36. Injury et Work 37. If Transportation injury, specify: 38. Describe How Injury Occurred: Yes 0 Driver/Operator Q Pedes[rlan ~ No [~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): Certifying physician -TO th sl of m led e, de red due <o the cause(s) and manner stated Pronouncing 6 Cert1 In h site - es my knowled ,death Occurred at the flme, dace, and Piece, and due Co fh< cause(s) and manner stated Medical am er/Coy n asl of ex I ion, end/o Investigation, in my opinion, death occurred at The time, date, and place, and du! to the cause(s) end m r stated anne Signature OT Certifier: oT Certifier: C+OrOner License Number: < 39b. Name, Address and Zip Cade of Per on Co IeTing Cause of Death (item 26) 6375 Basefiore Road, Suite ~~1 a 39c. Date Signed (MO/Day/Yr) Coron¢r Todd C_ Eclcenrode, 170 O Januar 20 2012 40. Registrar's District Number 41. Regi 's Signatur 42 egls[rar Flle Date (MO ay Yr) ~ ~ ~: ~.r a ~ „~ 03. Amendm ¢nts PisPOSitlpn Permit NO-J /__~~~;~ _-____._ ___ RfV D7/70]] LAST WILL AND TESTAMENT OF MARY ANN CARR I, MARY ANN CARR, of 982 Ridge Road, Shippensburg, Cumberland County, Pennsylvania, being of sound mind and disposing memory do hereby make, publish and declare this my Last Will and Testament, hereby revoking all former Wills Codicil to Wills made by me. ~ its ~- c,- ~ ~ z G~ r ARTICLE ONE ~ ~`' '~ direct that all my legal debts, my funeral expenses, and the costs o~.~ rv =~ ~; administration of my estate be paid as soon as practicable after my death. ~ ~} ARTICLE TWO I give the entirety of my estate to my husband, CARTER H. CARR, SR., if he survives me by thirty days. ARTICLE THREE If my husband, CARTER H. CARR, SR., is not living on the thirty-first day after my death, I give, devise and bequeath the entirety of my estate, whether the same be real, personal or mixed, to my children, MYRNA GAYLE JOHNSON, BRENDA JOYCE FARROW, CARTER H. CARR, JR., AND LENWOOD CLINTON CARR, then living in equal shares and deceased children of mine leaving issue then surviving in equal shares, per stirpes. ARTICLE FOUR I appoint my husband, CARTER H. CARR, SR., to be the Executor of this my Last Will and Testament and if he shall fail to qualify, or having qualified shall die, resign, or cease to act as Executor, then I appoint my daughter, MYRNA GAYLE JOHNSON, Executrix. If MYRNA GAYLE JOHNSON is unable or unwilling to serve as THIS IS THE FIRST OF FOUR PAGES OF THIS MY LAST WILL AND TESTAMENT MARY ANN RR DATE OF EXECUTION my Executrix, then I appoint my daughter, BRENDA JOYCE FARROW, Executrix. No Executor/Executrix named herein shall be required to furnish bond or other security in any jurisdiction for the faithful performance of his/her duty, but if bond is nevertheless required, it shall be without surety. ARTICLE FIVE In addition to the powers conferred by the common law, statute, or any other provisions hereby, my Executor/Executrix is hereby empowered as follows: A. To sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, to convert, or otherwise dispose of, or grant options with respect to, any and all property, real, personal or mixed, at any time forming a part of my probate or trust estates, 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 make distribution in division of the probate estate in cash, in kind, or partly in both; C. To distribute items of tangible personal property to a minor or to his or her guardian or to any person taking caring of the minor to hold for the minor within the limits authorized by statute or rule of law; D. To compromise any claim or controversy; E. To apportion between principle and income any receipts and disbursements and to ascertain income and principal in accordance with the statutes and rules of law of the Commonwealth of Pennsylvania; F. To make, execute, acknowledge, and deliver any and all instruments which may be deemed advisable or necessary to carry out any of the powers herein granted or provided by law; THIS IS THE SECOND OF FOUR PAGES OF THIS MY LAST WILL AND TESTAMENT ~-~ ~ 7 MARY ANN ARR DATE OF EXECUTION __ G. To invest and reinvest the principal of the estate together with any accumulated income thereon in all forms of property without being limited by any statute or rule of law concerning investments by fiduciaries; H. To disclaim inheritances and interests in property. ARTICLE SIX Notwithstanding any other provision of this will, I direct that if any beneficiary of mine is under eighteen years of age, my Trustee shall retain whatever share such beneficiary otherwise would have received hereunder and apply so much of such share or the income thereof as my Trustee considers advisab{e for the beneficiary's support, education, and welfare, accumulating any income not needed for these purposes. When a beneficiary attains the age of eighteen years, the Trustee shall distribute to such beneficiary the then remaining principal and income of his or her share, discharged of the trust. My Executor/Executrix shall have the authority to appoint a trustee for any trust created under this will. IN TESTIMONY WHEREOF, I have hereunto subscribed my name to this, my Last Will and Testament, consisting of this and two preceding typewritten pages, and for the purpose of identification I have signed and dated each page, all in the presence of the persons witnessing it at my request on this the _~ day of September, 2007, at Shippensburg, Pennsylvania. MAR ANN RR THIS IS THE THIRD OF FOUR PAGES OF THIS MY LAST WILL AND TESTAMENT ~=- s - ~ ~ MAR ANN RR DATE OF EXECUTION The foregoing instrument, consisting of this and three preceding typewritten pages, was signed, published and declared by MARY ANN CARR to be her Last Will and Testament, in our presence, and we, at her request and in her presence and in the presence of each other, have hereto subscribed our names as witnesses on this the ~ day of September, 2007, at Shippensburg, Pennsylvania. ~, ITNESS I RESIDING AT ,~~ ~ ~U ~~ ! /~/ RESIDING AT < /'-~///// l~~ THIS IS THE FOURTH OF FOUR PAGES OF THIS MY LAST WILL AND TESTAMENT RS-07 MARY ANN ARR DATE OF EXECUTION COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND RE: WILL OF MARY ANN CARR SS The undersigned, who are witnesses to the Will of the above named Testatrix to which this Affidavit is attached, being duly sworn, according to law, may hold as follows: 1. That each of us is an adult resident of the Commonwealth of Pennsylvania and that we are witnesses to a Will executed by MARY ANN CARR on this the 5 day of September, 2007. 2. That the Testatrix declared the above-dated instrument to be her Last Will and Testament and requested that each of us be witnesses thereto. That the Testatrix signed the said Will in the presence of each of us and that we, in her presence and the presence of each other, signed the said Will as witnesses on the date and at the place indicated above. 3. That at the time of the execution of said Will, each of us is of the opinion that the Testatrix was of sound mind and over eighteen years of age. 4. That this Affidavit is executed on this the S~ day of September, 2007. WITNESS L/~ ~1 WITNES Sworn to and ubscribed before me on this the ~ day of September, 2007. g NOTA UBLI ~Otttrtia~ Seal ~,eny Hottmsn, ~t~t Pubpc My commission expires: ?3zwtttt°~t~n terr;~ah1~1, Ftanklia County '11Fy~. __',;,3i_~et C~pitls March 2, 2009