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HomeMy WebLinkAbout01-25-12Reset PETITInON FOR GRANT O1F LETTERS REGISTER OF WILLS OF ` ~YY~,~j Q V'`C~Y~ (13 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 Informatio Name: ~~r~ r i ~~ a/k/a: _ a/k/a: a/k/a: Date of Death: ~~n~~r~ 7 , o2G -'a Decedent was domiciled a( death in ~t?Yri~~LC`G. County, principal residence at _~Q~~ '~c~rc-,rd- 4Z~ - C~,,~, c~ 'L} ~\ ~A ~~ Decedent died at Street >rddress, Post OfSce and Zip Code Street address, Post Office and Zip File No• t;~(I ` ~ ~ ' ~~~ ~ (Assigned by Register) Social Security No: ~T (~ -- 5 g'- 7 ~ a 4 Age at death: ~'7 (State) with his/her City, Township or Boroagh Township or Borough Coaaty County "State Pn Estitnatdoax wed ut Penedent's~ operty at death: ,f sy aa ........................... All personal property $ q ~ ~ ~D • GcJ If not doneiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not dotnicilcd in Pennsylvania ........................Personal property in County $ Value ojreal estate in Pennlsylvania ......................................................... $ . fSOp • z' TOTAL ESTIMATED VALUE.... $ b0 ~ , Real estate in Pennsylvania situated at: ~(' p •"~-~~ ~~~~ (Attach additional sheers, ifnecescary.) Street address, Poat O[fice sod Zip Code City, Township or Borough Coanty A. Petition for Prob ' and Grant of Letters Testaments Petitioner(s) aver(s) helshe/ ey is/are the Executor(s) named in the last Will of the Decedent, dated ~ and Codicil(s) thereto dated State relevant circumstances (ug. rexuxciatton, 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 pendmg 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 geither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS a EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) N -r- c.t.a., d.b.n., d.b.n.c.t.a., pendente life, du sentia rant _ 'ate If Administration, ~>+~. or db.n.c.~a., enter date of Will in Section A above and com of .~. rs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divo estab°illTte~•a~ in 23 Pa. C.S. § 3323(8) and Iwas neither the victim of a killing nor ever adjudicated an incapacitated person. Q ~ `{ ©NO EXCEPTIONS ~ EXCEPTIONS VV Petitioner(s), after a proper search has/have ascertained that Decedent left no Wiil and was survived by the following spouse (if a'~- and heir. additional sheets, ijnecessar~): Name Relationshi Address ~ i~P h~~ I...t~d ~.~~~lk P I7a~ 1 L2~,, ea1- ~' w rt:r+cJZ 'Qc. 1~.4 ~ c:5 ('c-., 1~-t lr Q l 7b l l ~Q~" ~ I~.wt'¢+1.~1~ Sow Ilc'~3 Gr ~'dr,rtQ^s ~ ~~l•--~ ~ x1811 ~dwprCl ~ L.c«a~er~GC~ Soh .3laY ~.o.\~bt)'~' ~otn~' ~o~ s~~'k~k'•~ •Ci9~~ ~A. Form RW-02 rev. IU/II/lull Page 1 of 2 __ Letters .............. $ ~ ~ ` ( ~ )Short C'ertificate(s)...'. , , ~~_ ( )Renunciation(s)...... '', , . `r----- ( )Codicil{s)........ ( )Affidavit(s)....... . ~.. . ..,.. Bond....... _ . Commission...... . Other ~ ......... _ ~J ...... .... , To the Register of Wi//s: Please enter my appearance by my signature below: Attorney Signature: FEES: - - _~ ~ `~" Printed Name: Supreme Court ID Number: Firm Name: Address: r, _ ---- ~': Automation Fee......... _~ Phone: ~ ~~ ~ ,:;~;;. JCS Fee. .. ~ ~ ~" .~D Fax: ~ i TOTAL ................... Email: sa. ~ '` 'u~. 3~1 . SLR .~ `." .,' r DECREE OF THE REGISTER r Estate of a/k/a: `n AND NOW,~~~v~?,~~ satisfactory pry g been the instrument(s) dated described in the Petition be Form R}y_p2 rev. 10/11/2().11 File No: ~ ` / a ~ ~ -~ ~ted efore me IT ' E~l-~-y"_, in co sideration of the for ~S DECREED that ~tte~ _ egoing Petition, hereby granted to _l~J . ~~ to probate and filed in the above estate and (if applicable) that ,. ~l ~ ccvra aS the ., _ (and Codici~(s)) of Decedent. ~I ' \.,, Page 2 of 2 Oath of Person9l ua.,..o..,....._.. H105.805 REV (01/07) ! ~ - - - - - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certific~ate~6.00 tee ~. ~. ~' ----______~ j V C~ 4, ~c wv 73 Ves Q Divorced This is to certify that the information here given correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origin certificate will be forwarded to the State Vit Records Office for permanent filing. • ~o _~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH . LoC~ Rl RR gistrar Date Issued CERTIFICATE OF DEATH 2. Sex 3. Soel•I SKUrky Num er5tate FII• Number: CE 4. Date of Death (MO/Day/Vr) (Spell Mo) =. Under 1 Da 6. Dite of girth (MO Days ma5pell Month), ~ OBirthPi8ace (C18 2 8 = t 8 a n 7 Hours Minut.s ~ 2 0 7 2 Elora sn counery) Ma Y 7, 7 9 3 8 7D, Birth 1 denca (Street and Number -Include Apt NoJ ie. Did Decedent LNe in a Township? unty) 405 ErPord Road .s,d.<.dentlwedln. East Pennsboro dance (Zip Cade) twp. u at Time of DNth Q Ne, decadent Ilvetl wkhln limits bf Mamled ~(WI owed il. Survl In cky/boro. Q N•vsr Married 1'"1.,_,.______ v g Spouse's Name 0f •..w. _,.._ __- - Ja. c que 1 i ne '' A 14b. RelaTlonshlD to Decedent 14c. In1 . Lau Daughter a n Death d«L~7ed In a Hospital: Eme ••.••••••YV •••••••••••••••• ~_., aCe eat vein Patient ..................... Ei'i o::iri ~ '"" " ~ ncy Room/OUtpati 356. Faellley Name (If not;instkut nt Dead on ArrNel on, gNe street d o e~:r:a $e ~ "' w me he O: Nursln Home/LOn -Ten ~ 405 Erfor an number; Road 15c.Cky°rTOwn,State,andZlp y m 16a. Methwd of Disposition Q gurlal Cam Hi 11 ] z~ Q Ramoyal from SLte other (sp•<I ) Cromatlon Q Donation 18b. Date of Disposition 16<. ~ 16d. Locatl n of Dispostion (City or T 7/ 9/ 2 0 7 2 Grantvi.lle 17c N own, Strte, and Zip) , PA 7 7028 17' S1g" ro Fun.rol 5erv'ie / ' , . ame and Complete Addros of Funeral Facility K( ~/ L ~ 18. Decedent's Eduutlon .Check the box Th ee t highest degroe or level of school at best d•serl o bas the m I t 19. Decadent of Hispanic O i .-`_ PA 77078 l d t n Ceh k ONE OR MORE ro e decadent ca sidar d hlmsaH or herself to be, to indicate whet White ~ Korean Bliek or gfrlun American ~ Vietnamese American Indian or Alaska Native 0 Other Asian Asian Indian Q Native Hawaiian Chinese Fllipinp o ~m a^ lan or Chamorro Japanese Q Other Paelfl<ISlander Other (SpecHy) 'to b•. 22a. pecedent's Usual Oecupatlon - Indicate type b} Worl done during most of working fHe. DO NOT USE RETIRED. Warehouse 22b. Kind of Business/Industry Retail ~eeas Road; --- --~"illetate'~'pCOde - Newv , PA 7247 4^° ............................. Wuer ................ . Ten • HosPILI: •y Hospice Fatality ~~~'~""""' ro Facll Other 5 ecNy) D~udent's Hom. PA 7 7 0 7 1 1sd:CountyotDeath Cumberland 0/ DISP Itl (N • 1 < i ry, romatory, or other Place) BFH Crematory (sea or Person In Charge of Interment 17b. Liuns• Number ~-- 7 38302 ~ Sth grade or less Peed at the time of death, box that best daacrlb h Q No dl~ploma, 9th - 12th grad es whet er the decadem Ia Spanish/HlspanlULatlno Ch ^ High school graduate or GE ompleted . eck the NO^ Dox N decedent IS not Spanish/Hia i Some collage crodlt, out no agree pan c/Litlno. ~ No, not Spanish/HlaPanl4Latino Q Associate degree (e.s. qq, ) Q Bachelor's degro (e,g, gq, B, BS) Yes, Mexican, Mex14n American, Chleano Q Yes, Pwrto Rlun C O Master's degree ( .g, MA, 5, MEng, MEd, MSW, MBA) O Do t 0 Yes, Cuban Q Ye h c orate (e.g, PhD, Ed D) or Professional degroe a, ot er Spanish/Nispanle/Latino . MD DDS DV LLB JD 23. Deudent's Singl• Race Sek_ i (5pecily) . s gnaTlon -Check ONLY ON[ to Indicab what the decadent considered hlmseM or Whroe p Japanese Black or Af l r ean American Q Korean Q American Indian or AIasW Njatlve Q Vl t Q Samoan Q Other Pacifle Islander a nameae Y~ O As+an Indl•n '~ Q Other Aalan Q Chine Q Don't Know/Not Suro se ', [] NatNa Hawii4n Q F llplno Q Refused Q Other (S if ' pec y) _ Q Guamanian or Chamorro _~ `v ~. ^ 2S. s Medlin ExamlMr or Coroner Contact ~~® 26. PaR 1. Enter the CAUSE OF DEATH O Yet ^'° respirato -diseases, (njurles, or complieatlons--that directly Mused tM death. DO NOT enter terminal events such as cardiac arrest f ry arrest, or ventrl Mier flbHlla[lon wkhout showing the etiology. DO NOT AggREVIATE. Enter onl one cause on a line. Add addklonal lines If necaasa ( Apprbximete IMMEDIATE Y Interval: CAUSE ----_________~~ ry Onset to Death (Final disease or Condition resulting In death) Du to (or as a eonsegwnu off; 33 Sequentially Ilst conditions, b I if any, leading to the cause Due to (or as a co sagwnee of): i listed on Ilne a. Enter the n ~ UNDERLYING GUSE (disease or Injury tnae Due eo (or as a consequ.nce ot): initiated tine events resulting d, i ~ In death)I.AST. '. Due t0 (Or is i coPSlquenc! Of): 26. Pert 11. Enter other ~ _f" =.,' ~,~ ~ ~ I `Y l but not rosulting In the underlying uuae gWen In P•r[ 1 !i Y-CiL ,/~ 1 ^ ,1 ,/y i ~ '~-~'~I 27. Was an autopsy pe rmed7 ~. G~ Y t/ l GVt•'t!1 O~• Yes No 26. Wer autopsy flrWinga avalleble 29. If Female:: to complete the cause of death? Q Not Pregnant within past year 30. Ditl ToWceo Use Conerlbute to Death? Yes No Q Pregnant at time of death Q Yes ~ Probably 31pprMr--annex o1 Oeith ~ Q Not Pregnant, but pragnantwithin 42 tla Q NO Q Unknown e~.,Natural Q Homicide Q Not Pregnant, but pregnant 43 da Vs of death Q A[cldent Q Unknown 1/ Ys to 1 ypr before tleatF Q P•nding Inwatigatlon Pregnant withir~ the past yy. 32. De[e of Injury (MO D•Y/YrJ (Spell Month) Q Sylclde Q Could not be determined 34. Plau of Injury (e.g. home; tonst ttlon site; hrm; school) 93. Time of Injury 35. Caution of Injury (Street and Number, Clty, State, Zlp Code) 36. Injury at Work 37. H ransPO{[ation Injury, SPeei Q Yes Q Driver/Operator Q pedestrian 3g. Describe How Injury p<curred; Q NO Q Passenger Q ether (SpecHy) 39a. f~ertifler (Check only one -- Certifying physician - To the be t of m knowled Q Pronouncin d { Y p, death oc<urrod due to th! cause(s) and manner stated g Certifying physician - To the best of my knowledge, tleath P O Medical Examiner/Coroneyr ~O~ry the basis of exa InaH o<currod s[ the time, date, and lace, and due to the Ouse s Signature of certMar:._l/'~~~ ~- ~ end/or Invastlgation, In mY opinion, death oc<urrotl at lM alma, date, and (la a an annex stated Title of urtlfler._ /47 /// P < d due to the ca se(e) and manner stated 39b. NaJme Address and p Cbde of rson Com letin V License Number;_ ~~ d/~~ Uc0 / ~ ~ LQ~ g e of Death (Iqm 26) - 40. Registrar s Dlstrltt Num ! `~/~ G L' 1~_ • fQ ~ ~]Q ~ ~] ~'1,c( ~~/ ~.. _ Y 39c' Dete tl Mo/Day/Yr) !7 ~t ~ ~ ~~ 41. Reg stray s Signature `u/L__ ( Cj ~G. aC ~.t ~ _ - / _ /1 _ /~ ' ' _ eglstrar a Date Mo ay 43. Amendments ~~( YC_7-g..JA..SL_ ( ~ f ~t ' Dlspasltlon Permit No. 0 6 9 7 0 8 0 1' cl- o~~ l Z H103-143 REV 07/2011 ~~ -~ Estate of )U~(,~,`(' rv«x ~_ ~ N t~ ~~! •~_.~ ~ , .... , •.- ~ ~ . t Deceased (Print Natne/s) , (each) a subscribing witness to the ^ Will ^ odici~(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he I/ they was /were present and saw the above Testator /Testatrix sign the same and that: she / he / they signed the same and that she / he /they signed as a witness at the request of the Testator / Testa~rix in her /his presence and in the presence of each other. (Signature) (Stre^et Addntss) / 1 ,. ~ (City, State, ;?ipJ Executed in Register' Office Sworn to or affirmed a~d subscribed before me this '' day of Deputy for Register of ills (Signature) (Street Address) (City, Sate, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed befo(r\~e}~me this ~ ~ r'~'day Of `N( `I~ Ml t rl t t ~ a ,..~ .a.~~....~ Fbn M. Vogt, NcMary Public MddNODn 7Mip., C~Mnbefbrid Count Notary Public ~ _ ~+'+~-~'sY~varxa nssc My Commission Expires: "JY) ~ f z Qt3 (Signature and Seal of Notary or other official c~iialified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer a4uhorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. OATH OF SUBSCRIBING WITNESS(ES) . REGISTER OF WILLS ~_ COUNTY, PENNSYLVANIA ~' FornrRW-03 rev. /0.!3.06 OATH OF NON-SUBSCRIBING WITNESS(ES) ', REGISTER OF WILLS 'm ` COUNTY, PENNSYLVANIA Estate of ~'~~^~ U and Deceased (each) bein du ' g y q~alified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with ~p,, ,_ Q and am/are familiar with the handwriting and signature of the decedent, and that the signature of to the i.'oregoing instrument purporting to be the Last Will and Testament/Codicil of is in his/her own proper handwriting. (Signature) (Street Address) (City, State, Zip) Executed in Register's Office m Sworn to or affirmed eland subscribed "'' befo e me this ~~~ day ~ r-'~ -s_ "-~c ~~ _ ~7~ a `' ~:, lam' ~ ,/ Deputy for Register o ills ~` FormRW-04 ,-ev.l0.13.06 a I' ~ o~ (City, State, Zip) i i Will of Maria Rose Lawrence ~ r' ^J ~= 4,y ~~ i ~. .. Part 1. Personal Information ``~' ,... I, Maria Rose Lawrence, a resident of the State of Pennsylvania, Cumberland ~ ~~' • • ~ "~ County,East Pennsborough,Camp Hill, declare that this is my will., , ~n c,~ Part 2. Rev tion of Previous Wills I revoke all 'lls and codicils that I have previously made. :Part 3. Chil ren I have the fo lowing children now living: Elizabeth Jane Lawrence, Jacqueline Ann Lau, Edward Bru o Lawrence and Robert Edward Lawrence. Part 4. Failu a to Leave Property If I do not le a property in this will to any of my children named above, my failure to do so is intentio al Part 5. Dis ition of Property A beneficiary must survive me for at least 45 days to receive property under this will. As used in this 11, the phrase "survive me" means to be alive or in existence as an organization n the 45th day after my death. If' I leave pro rty to be shared by two or more beneficiaries, and an of them doe survive me, I 1 ave his or her share to the others equally unless this will provides snot otherwise. My residuary state is all property I own at my death that is subject to this will that does not pass under a general or specific bequest, including all failed or lapsed bequests. I leave My ho se at 405 Erford Road Camp Hill Pa 17011 to Elizabeth Jane Lawrence. I leave my resi nary estate to Elizabeth Jane Lawrence and Jacqueline Ann Lau in equal shares. i All personal an real property that I leave in this will shall pass subject to any encumbrances r liens placed on the property as security for the repayment of a loan or debt. Part b. Eaecutc~r I name Jacqueline Ann Lau to serve as my executor. If Jacqueline Ann Lau is unwilling or unable to sere as executor, I name Jeffrey Davis Lau to serve as executor. age 1 of 4 Initials: s~,~. ~ ~ Date: V 9 oc~Yp Will of Maria Rose Lawrence No executor shall be required to post bond. Part 7. Eaeeutor's Powers I direct my executor to take all actions legally permissible to have the probate of my will done as sim ly and as free of court supervision as possible under the laws of the state having juri 'ction over this will, including filing a petition in the appropriate court for the independent administration of my estate. [ grant to myl executor the following powers, to be exercised as she deems to be in the best interests) of my estate: 1. To ret~I in property without liabili for loss or d ~" tY epreciation. 2. Ta dis~ose of property by public or private sale, or exchange, or otherwise, and receiv~ and administer the proceeds as a part of my estate. 3. To vote stock; to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities; and to exercise all other rights and privileges of a ;person owning similar Inronertv 4. To leas any real property in my estate. 5. To ab don, adjust, arbitrate, compromise, sue on or defend and otherwise deal with an settle claims in favor of or against my estate. 6. To cont~nue or participate in any business which is a part of my estate, and to incarpo~f ate, dissolve or otherwise change the form of organization of the business. These powers, 'authority and discretion are intended to be in addition. to the powers, authority and discretion vested in her by operation of law by virtue of her office, and may be exercised asl, often as is deemed necessary or advisable, without application to or approval by an}~ court. Part 8. Payment of Debts Except for liens! and encumbrances placed on property as security for the repayment of a loan or debt, I direct that all debts and expenses owed by my estate be paid in the manner provided for by Ithe laws of Pennsylvania. ///1 /I// //// age 2 of 4 Initials: , ~ ~ Date: q /~3/'O Will of Maria Rose Lawrence Part 9. Payment of Taxes I direct that'lall estate taxes assessed against property in my estate or against my beneficiaries be paid using the following asset: with my money market at PSECU. Part lo. N Contest Provision If any bene ciary under this will contests this will or any of its provisions, any share or interest in m estate given to the contesting beneficiary under this will is revoked and shall be dis sed of as if that contesting beneficiary had not survived me. Part 11. Sev rability :[f a court inv lidates any provision of this will, that shall not affect other provisions that can be given ffect without the invalid provision. Signature ~ I; Maria Ros Lawrence, the testator, sign m name to this document this day of ~i~ , at (city or coon ,and state). I declare that sign and execute this document as my last will, that a sign it willingly and that I execute 't as my free and voluntary act. I declare that I am of the age of majority or otherwise leg lly empowered to make a will, and under no constraint or undue influence. m Signature: Witnesses W e, the witne ses, sign our names to this document, and declare that the testator willingly signe and executed this document as the testator's last will. In the presenc of the testator, and in the presence of each other, we sign this will as witnesses to th testator's signing. U// //// I 1//~' //// ~ //// ~' //U //1/ //// ///~ //U //// age 3 of 4 Initials: G ~ ~ Date: ~ 9 ?o/o Wil! of Maria Rose Lawrence To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is of sound mind and is under no constraint or undue influence. We declare ~nder penalty of perjury that the foregoing is true and correct, this day °f . at (city or county, and state). First WtTtne ~/~ l~ Sign your e: Print your name: ~ ~a l ~ s ` C'~ ~ , Address: ~ ~ ~ _ City, State: ~ ~ (~ S ~ ~ Second Wu ~ c Sign your e: 1 print your I e: ~ ~5~.\ address: ~, ~``\ G} , ~' v (~ity, Stater C `~~,~ ~__`~ ,~~C 2 r Iii ~~ Pale 4 of 4 Initials: ~ ` ~~ Date• ~ ~~ ~9_ % ~0 ~3 Cf~ ~S T ~'/rC~'~ ~f;R/ ~ ~ ~~~c~