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HomeMy WebLinkAbout01-31-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C~ ey1 ~ P~ /Q` ~ ~ 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• ~ ~- ~~~~ a/k/a: a/k/a: a/k/a: Date of Death: SQ n u a ~ /~ ° /~ Decedent was domiciled at ~de~ath in ~ rr~ ~-~ 2 ~~ fz ~-~ County principal residence at ~/Gy UI ~r s ~ !}'l a i nl S -t! ~7 ~ ~ ~ w' Street address,,~~Post Office~a/nd Zip Code Decedent died at 9~2r,d~e nb //a k/~c~' / 757 ~''' Street addres$, Post Office and Zip Code - C~ ~ e» s Township or County /at n ~> (state) with his/her last ~.,.,,-, S. nle~->'-o,J ~ m d,et-fan aC_ County State Estimate of value of decedent's property at death: $ ~` fie- ° If domiciled in Pennsylvanip ............................ All personal property If not domiciled in Pennsy[Mania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Penn~ylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ a b 0.00 Real estate in Pennsylvania situated at: (Attach additional sheets, ifnecessarN.) Street address, Post Office and Zip Code City, Township or Borough t;ounr} A. Petition for Probate and Grant of Letters Testamentary and Codicil(s) Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last Will of the Decedent, dated C1 / I$ thereto dated State relevant circumstances (eg. renunciation, death of executor, etG) 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 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 mneither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS B. Petition for Graft 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.Q.a. or db.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 ~ EXCEPTIONS fir` Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following s ~~(if any) an~heirs (~tlg~ additional sheets, if necesspry): ~ ~ t"~ ~~",,, `~~' 7 Address ~~~ ~ Name Relationshi .f.~ - _~~ ~ ~ ~ -: -...1 File No: ~ ~ ~ ~ ~ I ~ \ (Assigned by Register) Social Security No: ~?oa'~~ ~~~~ Age at death: 83 City, Township tar Boroug/h I / nta Y`ea ~. N 1:!.4~ ~N ~kYrib F r~dl.h U~ Form RW-01 rev. 10/11/20l 1 Page 1 of 2 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and con•ect to the best of the knowledge and beiiet of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will w/e~ll and truly admini ter the estate according to law. ~,.`C~ Cr~~- Date ~ ~~~' ~~ Sworn to or affirmed nd subscribed before _,~--~-~~`~ Date me th~ day of ,~Ula..~ Date By~ Date F the Register BOND Required: ®YES ®NO FEES: Letters .................... ~ .. $ ~~t/ a )Short Certificate(s).... ( .. ( )Renunciation(s)....... . . ( )Codicil(s) ........... . . ( )Affidavit(s)......... .. . Bond ..................... ... Commission ............... ~l ~ ~ .. . .... ~ Other ,1 ... .... Automation Fee . ........... .. . JCS Fee . ................. ... , TOTAL .................. ... $ ~--$6 To the Register of Wills: vrP~,~P enter my auoearance by my signature below: Attorney Signature: Printed Name: Supreme Court iD Number: Firm Name: Address: Phone: Fax: Email: ~~' DECREE OF THE REGISTER ~j Estate of File No: ~~~ ' ~~ "~ ~ J a/k/a: AND NOW, 1 °~- , in consideration of the foregoing Petition, satisfactory proof having en resented before me, IT ~S DECREED that Letters c~. - • ~ ~~ are hereby granted to 't~•,~~ i ~ ~ • ~~''`S ' in the above estate and (if applicable) that the instrument(s) dated described in the Petition be ad fitted to probate and filed o~record as tl~e last Will (an¢~ ~odici~ (s)) of D1ecedent. Form RW-02 rev. 10/1l/30l I !' ge2of2 Oath of Personal Representative - , ~ ~~~ ~-~ {'i 1 ~` _ COMMONWEALTH OF PENNSYLVANIA } ~~'~~`" '- " } SS: COUNTY OF ,,,, uinc enS oc~' ~o~+: ~ LOCA~,~ 'S CEIRTIFICATION OF DEATH WARNIN ~i~f=~lg t I plicate this copy by photostat or photograph. ~~., ,~, , 1.~ .~,.I Fee for this certificate, $6.00 P 18151168 ~o~~ ~aM ~ t a~ e: 3- C~.ERK pF C N()~C.CU1R pA This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for a t filing. ©~ egistrar Date Issued Certification Number TYPe/Print In Permanent COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH . ._.. _ _ S ~ - ~ D T16:lOr Ss. Age-4st glKhtlay (Yra) Sb. Under 1 YHr Sc. Under 1 Da 8 2 Months Deys Hours Mirn Se. Resideney(aftlt! or Foreign Cpuntry) eb. Residence (Serest e 1Q Sd. sldenc`e (G only) t-t ~1 ~v p's`' ~-r~~ Be. Baseline:! (Zip Codl i. Ever In US Armed Forces? 30. Marital Status at Tlme of Oe Q Yes No Q Unknown Q Diverted Q Never t y~ O e l !~ 15 b. Facll ity fdar nl (lf net' ~//t 1 ~ ~ ~l\ f 16 i. Method of Dlspositlo Q Removal from Sbte Other (SpecNy 16d. Loutlo of Dispes K l c 7 ~` I7c. Name end Com late 1 2S ia. Deed t•a Education - Q Donation Z Z~ t 1 q Z$ Tb. Birthplace (Ct 8e. Oid Decadent Llve in • Township? ~tYes, decadent Ilwd In Q No, decedent Ilved within limits of osPll ~] Nuning Home/Long-Term 4 F Ility -. City or Town, Sbta, end Zlp Code U.~ct. 1 QCi rrOat f Dlspositlon 16c. Pleu o7 Olsposltlt -O[258+l-L twP• ~ highest degree er level 01 school completed at tM time of death. Q gM grade or le box that hart tlesclrlbes lwM pier the decadent to Indicate what th d~ O O ss No diploma, 9th - 12th grade is Spanish/Hispenlc/4tlno. Check the ^NO^ e eedenS eonsideretl h m salf or hers i f to bas ~ White High school graduate or GED completed box 1/decadent is not 5 enish/His P panic/4tln°' Q Korean Q Black or African Ameri Q Soma college credit, but no degree No, not 5 Penlah/FIISPanle/Latino Q Yes Mexleen M i can Vietnamese Q Ameritan Indian or Alaska Native Q Other A i Q Associate degree (e. AA, q$ g' ) ~ ' , , ax ean Amerlun, Chlono Q Yas Puerto Rlean s an Q Asian Indian Q Native Hawaii Q B eheler s tlegrea (e.g. BA, AB, BS) M ' , Q Yes, Cuban an Q Chinese Q Guamanian or Ch Q aster s degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yas oth r S l h emorro Q Flllpino Q Sam Q DoROrete (e.g. PhD, EtlD) or Professional degree , e pan a /Hlapenic/4tlno oan Q Japanese Q . MD DDS DVM LLB JD (SPec11y) Other Peciflc Islander Q Other (SpecHy) 2 1. Decadant's Single Race Self-Designation - Ghaek ONLY ONE to i ndicate what the d d ~.Whlte Q la Penese Q Black or African Amerlu ece ent conslderetl hlmsslP or herself to be. 22a. Decedent's Usual Ocw Indicate Q Samoan Patlon - type of wort ~ n Q KorNn Q Amerlun Indian or Alaska Native Q VIltnem Q Other Pee1HC islander done during most of working Il1e. DO NOT USE RETIRED. ese Q Asian Indian -- " -- Q ether Aslen Q Oon't Knew/Not Sure >~~~~,-Q~ ~. Q Chinese ' Q Nat We Hawelian Q Flll i Q Refused Other Q (Speclly) 22b. Kind o1 Business/Industry p no Q Guamanian er Chamorro ~ ITEMS 2ga-230 MVST ECO LFTED BY PERSON WHO PRONOUNCES OR 23^. Date ProS~ud Dea (MO Day r ~ ^ 23b. 51 gnature of Person Prono ~~~`~ uncing DeKh (O l CERTIFIES DEATH 2 d. Date Sig ned (MO/D y r) ` ~_~ , Ql~ Ct ~ n y when appllu e) 29c. LI[ense Numb<r / ; ^ / a 1 Vuv 24. Time,gJ_D~eth • ~ ~ ~ ~) ~ ) 3F93 e .• ~ !V 25. Was Metlicai Examiner or Coroner Contactetl7 Q Yis 26. Pere L Ertter :he pnam et ~~-diseases, Injuries, or eempl resplntory arrest, or ventrlcubr flbr111aHon with t h Nq GAl15E OF DEATH lcatlons--Shat directly caused the death. DO NOT enter terminal events s s'pproximete h ou s owing the etiology. DO NOT ABBREVIATE. Enter one Y one uc as cardiac arrest - Interval: cause on a Iln Add - ,^ ^- ~ ~ IMMEDIATE CAVSE ----- > ~ r /'• a%I s ~ ~ e. additional Ilnes if necessary Onset to Death r , i (Final disease or condition f~ O O ~ / ' resulting In death) O t ( q ce of). , 1 ~ ~' (~~ b. i Sequentislly Ilse conditions, ~ If any, leading So the cause as ¢ eon Oue to (or sequence of): ) ' listed on Ilne a. Enter tM f VNDERLYING CAVSE i (diseise or Injury that Due to (Or as a Consequence of): F~ ~ initiated the events resulting d, ~ ~, i In death) LAST. Due to o as a con ( r sequence ef): i 26. peR 11. Enter other I¢nifl dl i t Ib tl t d b t u not resulting in the undlrl In V g cause given In P art I ~ 27. Was en atKOps y performetl Yes 28. Werc autopsy findings wadable 29. If Fem ~ to complete the u of desthT use of pregnant wlthln pas[ year 30. Dld Tobacco Contribute to Death? 31 M Q Yes No Q Pregnant ime of de H h Q Y! Q Probably . a De¢th ~ a Not pre ,but nant Q i Preg nt wlthln 42 days of death o Q Unknown Homicide atu en Q Q Attld f I- Q Not pregnant, but pregnant 43 days to 1 year before death Q U k 32. Date of In u /D (M ) Q Pending Investigation Q Suicide Could not be d tl Q n nown If pregnant wlthln the past ye.r o ry ay/Yr) (Spell Month e nnined ) 34. Place °f Injury (e.g. home; eonstruetl°n site; farm; school ~~ , ___.. -. 33. Time of lnJury Ves robe Hbw lnJury Occurred: Operator Q Pedestrian O r 0 P•sse n NO Q gar Q Other (SpecMy)~- - j ~_ 39a. C er (Check only one): eKifying physician - To the best of my knowled dee[h occurred due t° the cause(s) end mann Q Pronoun e B :T c er stated . Certifying ph (clan - To he b f my knowledge, death occurretl at the time, date, and plea Q Mldleel Ex finer/COrone n t b I ehd due t th , o e cause(s) and manner stated s Ination, and/or Investigation, In my opinion, death red [ the tim d ~ pi e, Signature oT certifier: ' ate, and place, and due to th l~A ~) d manner sLted ,t ,. fi / -- Title of certifi '~ p ' y/ 3 er: / / /~ /~ 9b. Name, Atldress and 21p C P n Completing Cause oT D ((ff License Number:_ ~"6 p f th I e e ea ( tem 26) "3 4 n- , S; 39c. pat Signed Mo/Day/Yr) 0 Registrar's Dl l f N ~~~ ~ . r s ct umber ~ ~ ( ~ 41. Registr gnature 4 _ / ~ 4 egistrar Flle Date (MO Day/Vr) v _ 3 Amendme t g . n s - Dlspositlon permit Np._ ~ ~ l91 ~ ~ ~ H105-143 REV O~/20]1 LAST WILL AND TESTAMENT I, BETTY J. DONOVAN, of R. D. 4~ 1, Box 329, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved husband, MERLE W. DONOVAN, absolutely. THIRD. In the event my said husband predeceases me or is not living on the 60th day following my death, I then give, devise and bequeath my said estate to my daughter, DIXIE L. COONS, on a per stirpes distribution basis. FOURTH. In the event that any beneficiary of this my Last Will and Testament is under the age of eighteen (18) years, I then give and bequeath said beneficiary's share to and appoint as Guardian of any property which passes under this TrTill or otherwise, IRVIN W. BOWERS, JR., of R. D. ~~ 2, Shippensburg, Pennsylvania, AS GUARDIAN, NEVER- THELESS, to invest and re-invest the same until the said beneficiary reaches the age of eighteen (18) years, with the following powers in addition to those presently gives by law: 1 ~) ~ m Li~ _~ ~ 4-- L1= r.._ `.~ a_ ~ CV~` Z ~ __ ~C UJ ~. ~ ~~ Cy'J W G , :-i ~ ",~" ' Ls, ~ C..' ~ ~ ..t._' ~.>r . _ ~ ~: ~ tt~~ Cz. .' _ ,. - w ~. ~ MARK & WEIGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG, PENNA. 17257 A. The power to expend the income towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power to expend the principal, within the discretion of the said Guardian, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; C. The power to sell any and all real estate, within the discretion of the said Guardian; D. The power to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of eighteen (18) years, without the necessity of a formal adjudication of the Guardian's account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; E. The principal of the Guardianship and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, nor to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individ- ually or collectively; F. In the event the above mentioned Guardian is unable to accept the Guardianship, I then name, constitute and appoint MARY R. BOWERS, of R. D. ~~ 2, Shippensburg, Pennsylvania, as Guardian, with the same powers hereinbefore stated, FIFTH. I nominate, constitute and appoint my husband, MERLE W. DONOVAN, to be the Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint my daughter, DIXIE L. COONS, to be the Executor of this my Last Will and Testament SIXTH. I direct that neither my personal representatives nor Guardians shall be required to give bond for the faithful performance of their duties in any jurisdiction. -~`~~/~ -2- MARK & WEIGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG, PENNA. 17257 IN WITNESS WHEREOF, I, BETTY J. DONOVAN, have hereunto set my hand and seal to this my Last Tnlill and Testament, written on three pages, the first two pages signed for identification purposes only, this S~ day of ~ 1983. (SEAL) L This instrument was by the Testatrix, BETTY .J. DONOVAN, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our .presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, BETTY J. DONOVAN, the Testatrix whose name is signed to the foregoing :nstrument, having been duly qualified according to law, do hereby acknowledge that -3- MARK & WEIGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG, PENNA. 17257 I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and subscribed before me by Betty J. Donovan, the Testatrix, this / J ~~ day of ~C~ %~ .~r7/~i.~~~ ~ 19 83 . Mary, E: Beavers, Ns'tary Puafic Shippensburg, PA Cumberland County My Commission Expires July 27, 1886 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF_ We, the witnesses whose and = .t71.~~ e / ~f ~i1Z~,c.(~.. ~.p, , the foregoing instrument, being duly qualified according to law, do depose and say that eve were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affi ed to a b crtib d bef re me b a.nd 3_tnesses, t~isy~/$,~(day of ~, 1983. /~0/ Mary .Beavers, Notary Pubiic Shippensburg,. PA Cumberland County My Commission Expires July 27, 1986 -4- MARK & WEIGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG, PENNA. 17257