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HomeMy WebLinkAbout02-03-12PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF _ CUMBERLAND COUNTY, PENNSYLVANIA Estate of Gail Louise Bouder File Number 2~` ~ - ~~ ` also known as ,Deceased Social Security Number 204-26-8407 Jeff Bouder Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE A' or '8' BELOW) OX A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the last Will of the Decedent, dated 02/16/2011 and codicil(s) dated State relevant circumstances, e.g, renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 (g); did not have a child born or adopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: B. Grant of Letters of Administration (Ifapplicab/e, enter: c.t.a.; d. b. n. c. t. a.; pedente liter durante absentia; durance minoritateJ Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (if Administration, c. t. a. ord. b. n. c. t. a., enter date of Will on Section A above and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided In 23 Pa. C.S.A. § 3323 (g), except as follows: n Name Residence v~ -..` `. ~'~ ~ ~ (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. a ~ ~ `-~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his !her last principal residence at 2267 Rittner Highway, Carlisle West Pennsboro Cumberland PA 17013 (Ltst street address, town/ctty, township, county, state, ztp code) Decedent, then ~_ years of age, died on 01/15/2012 at Forest Park Nursing Home, Carlisle PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 5 000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 190,000.00 situated as follows: 2267 Ritner Highway, West Pennsboro Township, Carlisle, PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: oryliaiule Typed or printed name and residence Jeff Bouder 17 S High Street Newville, PA 17241 Form RW-02 Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2006 forrn software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } The Petitioner(s) above-named swear(s) or affirm(s) that 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, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirn^ed aFd subscribed n before me this ~ ~ _ day of -~ ~~ ~~ ~ .~ ~,Le~~~. y For the Register ~ ;~~ ~~~ ~ --~, . ~ ~., ~' ~----~~ File Number: 21 ' a U ~ ~ - ~ FJ ~ ~ Estate of Gail Louise Bouder Deceased Social Security Number: 204-26-8407 Date of Death: 01/1512012 AND NOW, ~ ~~~~ ~- ~ G , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Jeff Bouder in the above estate and that the instrument(s) dated 02/16/2011 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ...................................... .... $ ~ LP n . U~ Short Certificate(s)...4.V./ .......... .... $ ~ a Renunciation(s) ........................ .... $ lA ii1~ $ i`~ ~ u~ ~ ~ $ 5. 6U $ $ $ $ $ $ TOTAL ............................... .... $ J ~ J egister of Wills ,~ ~ /~ n (~ /~/t j ,~U/1~ ~. Attorney Signature: - V`~ ` Attorney Name: Mark A. Mateya Supreme Gourt I.D. No.: 78931 Address: 55 W. Church Avenue Carlisle, PA Telephone: 717-241-6500 Form RW-O~ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 H(p~ SZivc 2FV roru~ LOC,ii~,~T~AR'S CERTIFICATION OF DEATH WAI~~~~1~ ~S'il~ to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 i~~~ ~'~~ ".~ ~~ ~~~ ~~ This is to certify that the information here given is correctly copied frc)rn an original Certificate of Death ~~ duly tiled with me as Local Registrar. The original ~„~, ~. certificate will be fortivarded to i~.he State Vital a~~ ~ ~ Records Office f~)r ilermanent filing. P I S 210 2 0 6__-- ~~.~~__-- _ ~'~ rs Zc{2 ~ Certification Number Local Registrar Date Issued 1 (/ Type/Print In COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH . VITAL RECORDS Permanent dEa R_n no Il^FRT~CIf"ATF AC P1FdTu 1. Decetlent'S Legal Name (First, Middle, Last, Suffix) 2. Sax 3. Social Security Number" ,Y4r Date of Death (MO/Day/Vr) (Spell Mo) ail L Bouder Female 2 - 8 Januar 15 2012 6a. Age-Las[ Birthday (Vrs) Sb. Untler 1 Year Sc. Under 1 Oa 6. Dat! of Birth (MO/pay/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) I Months Days Hours Minutes P 79 October 15, 1932 7b. Birthplace (county) ail 8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8<. Did Oecetlent Live in a Township? PA yes, decedent lived In West P T O twp. ad. ae,mente (county) 2267 Ritner Hi hwa CLm)berlanel 8e. Residence (Zip Cod!} 1 7 1 5 {]NO, decedent Ilved within limits of city/born. 9. Ever In US jj~yf ed Force57 30. Marital Status at Time of Death Q Married ~ Widowed 11. Surviving Spouse s Name (If wife, give name prior to first marriage) Q Ves ['J'NO Q Unknown ~ Divorced [~ Never Married 0 Unknow 12. Father's Name (First, Mldtlf e, Last, SufFlx) 13. Mother's Name Prior to First Marriage (Firs[, Middle, Last) Frank Culbertson Martha Wri ht 14a. Informant's Name ]4b. Relationship to Decadent 14c. informant's Mailing Address (Street and Number, City, State, Zip Code) g .Tef£rey Bouder Son 17 S. Hi h St_ NeWVi11e, PA 17241 G .......-- •---•• ............... --•--.....~.._.P.................................... 1f Death Occurred In a Ho ital I tl t ,._....._...a:..•a~s.°..,_sr.S.•, qn y one .............----.......---•° ' ~ ~ _ sp : n e en :If Death O<cu red Som where Other Than a Hospital: ~ HOSpice Facility ~ Decedent's Home Q Emer envy Room/OUtpatlent Dead un Arrival _ Nursing Home/Long-Term Care Facility Other (Specify) 15 b. Facility Name (If not insfltufion, glue street and n tuber; lSc. City or Town, State, and 21p Code 16d. County of Death Forest Park Carlisle, PA 17013 Cumberland 16a. Method of Disposition ® Burial p Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from Efate p Donation omer (specif ) 1 23 201 2 Z y 16tl. Location of Disposition (CITY or Town, State, and Zip) Westminster Cater=te 17a. Slgns[u r! of F n 1 Service Licensee o in C of Interment 17b. License Number S T Carlisle, PA 17013 _ ~ FD 012633 L 555~ 17c. Name antl Complete Address of Funeral Facility E.bain Brothers Ftarleral Hcctte, Snc. , 630 S_ Hanover St. , Carlisle, PA 17013 ~ 18. DlCeden['s Education -Check The box Thar best describes [he 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races Yo indicate wh t ~- a highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be . p 8th grade or less is Spanish/Nispanic/Latino. Check the "NO' (~hite [] Korean Q No diploma, 9th - 12Th grade box if decedent Is not.Spanish/Hispanlt/Latino. ~ Black or African American Q Vietnamese p High school graduate or GED completed ~qVo, not Spanish/Hispanic/LaYlnq Q American Indian or Alaska Native [] Other Asian [~SOme collage crotllt, but no degree [] Yes, Mexican, Mexican American, Chicano Q Asian Indian ~ Native Hawaiian p Associate degree (e~g. AA, AS) p Ves, Puerto Rican Chines! p Guamanian or Chamorro ' p p Bachelor s tlegree ( .g. BA, AB, BS) Q Ves, Cuban Fili Ino O p p sampan ' Master s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino ~ lapa Hasa p Other Paclfle Islander p Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other 5 ( pacify) . MD DDS DVM LLB JD 21..,.~D.e~cw~ar~~dlnt's Single Race Self-oesignatlon -Check ONLY ONE to indicate what the tllcetlent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate typ! of Work lt ly>rvvn e p Japanese p Samoan done during most of working Ilfe. DO NOT VSE RETIRED. p Black or African American ~ Kor n ea p Other PaclFlC Islander p American Indian or Alaska Native p Vietnamese p Don't Know/Not Sure Praetieai Nurse Azlan Indian Q Other Asian p Refused 226. Kind of Business/Industry Q Chines! ~ Native Hawaiian ~ Other (Specify) p Filipino 0 Guamanian or Chamorro Nursing ITEMS 23a - 2 MUST 8E COMPLETED 23a. Date Pronounced Dead Mo Day r) 23b. Signature of Person Pronouncing Deafh Only w en applica le) 23c Cleanse Num ! r . cERTIF ES DEATH PRONOUNCES OR Januar 15 , 2012 23tl. Date Signed (Mo/OaV/Yr) 24. Time of OeaTh 7:35 A. M. 25. Was Medical Examiner or Coroner Contacted? Ves p No CAUSE OF DEATH Appreximate 26. Part 1. Enter the chain of events--diseases, Inju rtes, or complications--that tlirectly caused the tleath. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing The etloiogy. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add additional lines If necessary Onset to Death IMMEDIATE CAUSE ---------------> a. Se11 ESi3 (Final disease o condition Due [o (or as a consequence of): resulting in death) b._ Urinarv Tract =n£ection Sequentially Ilst conditions, Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the Multiple Traumatic Ind ur ies UNDERLYING CAVSE Du! to (or as a can f sequence o ) (disease or Injury that Initiated the events resulting d. Motor Vehicle Crash In death) LAST. Due to (or as a cgnsequence of): 26, Part 1/. Enter other significant conditions c trib tl d Hth but not resulting in the untlerlying cause given in Part 1 y ~ 27. Was a autops n p rformed7 ~ Yes No R l I ffi i ~• ena nsu c ency 28. Wereautopzyflndingsavailable to complete the cause of death? p Yes No 29. If Female: 30 Dld T b o . o acco Us! Contribute to Death? 31. Manner of Death p Not pregnant within past year p Ves ~ probabl y ~ Natural Q Homicide ~' ~ Pregnant at time of death p Not pregnant, buT pregnant wlTh{n 42 days of death p No Q Unknown ~ACCldent p Pentling Investlgatlon Suicide C ld b d `- 0 ou not e etermined Q Not pregnant, but pregnant 43 days tq 1 year before death 32. Date of Injury (MO/Oa y/yr) (Spell Month) Q Vnknown if pregnant within the past year 33 Ti f I . m! o njury December 8 , 2 ~ 11 A 1 rox. :25 P.M. 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, CITY, State, Zip Code) Rural Roadwa Williams Grove Road, Mechanicsburg, PA 36~ Injury a[ Work 37. If Tra nsportatlon Injury, Specify: 36. Describe How Injury Occurretl: p vas orlyer/operacor p Pedestrian Operator Failed to stop at Red Light - No p Passenger pother (specify) Struck other Vehicle. 39a. Certifier (Check only one): Certifying physician - To the beSG my letlge, de occurred due To the cause(s) and manner stated ,[] Pronouncing ffi eertl In - y knowledge. death occurretl at the time, date, and place, and due to the cause(s) and manner stated 7R ( Medi l E n ~ / ca xam n r pro r - O t b i f lxamin I and/or i stigation, In my opinign, death occurred at the time, date, and place, and due to She cause(s) and manner stated Signature of certifier: certifier ~'Or OnE!Y Ucense Number: 39b. Name, Atldress and Zip Code of Pe on Com ring Cause of Death (Item 26i 63 75 Bas ehor a RO ad Stlita ~~ 1 39c. Date Signal (Mo/Day/Yr) , Todd C. Eckenrode, Coroner 40. Registrar s District Number 41. Registrar s 51~1~yra 18 2012 42. Registrar File pate Mo DaY ~ 43. Amendments Disposition Permit No. (l try ~ ` o ~ ` H106-143 REV 07/2011 ~4 ~ ~~~ r.,, -~ LAST WILL AND TESTAMENT ~ c- ~W c-a cxi ~., .~_, r;, OF ~~~ ~ .~ , --- -- ~ ~ ~~ ~ ~ :: , ~;,, GAIL LOUISE BOUDER , r`v -'~ :T ~ `j .. I, Gail Louise Bouder, of 2267 Ritner Highway, Carlisle, Cumberland Catty, Pennsylvania, make this my will. I revoke any other wills or codicils to wills made by me . ARTICLE I. DISTRIBUTION OF MY ESTATE A. I give my household goods and tangible personal property to be divided evenly between my children, Paul M. Bouder, presently residing in Cazlisle, Pennsylvania„ Jeff Bouder, presently residing in Newville, Pennsylvania, Ronald L. Bouder, presently residing in Boiling Springs, Pennsylvania, and Jack S. Bouder, presently residing in Carlisle, Pennsylvania, provided they survive me by sixty (60) days, as my Executor determines. Tangible personal property includes stamp and coin collections but does not include other money or stock certificates or other evidences of intangible rights or interest. Tangible personal property does not include any property that is held primarily for investment purposes or used in connection with any business in which I may be engaged or in which I may have any interest at the time of my death. B. I give the sum often thousand dollazs ($10,000.00) to Brenda Anderson, presently residing in Carlisle, PA. C. I give the reside of my estate to Paul M. Bouder, presently residing in Carlisle, Pennsylvania, Jeff Bouder, presently residing in Newville, Pennsylvania, Ronald L. Bouder, presently residing in Boiling Springs, Pennsylvania, and Jack S. Bouder, presently residing in Carlisle, Pennsylvania, in shares as neazly equal as possible, in the absolute discretion of my executor, per stirpes. D. Whenever property is to be distributed to the descendants of a person (the "ancestor"), such property shall be divided into equal shazes, one share for each then living descendant in the first generation below the ancestor in which at least one descendant is living, and one share for each deceased descendant in such generation who has a descendant then living. Each share created for a living descendant shall be distributed to such descendant. Each shaze created for a deceased descendant shall be divided and distributed according to the directions in Page 1 of 5 ~ ~ ~ G.L.B. the two preceding sentences until no property remains undistributed. E. A person who has a relationship by or through legal adoption shall take under this will as if the person had the relationship by or through birth, except that a person adopted after reaching age twenty-one and descendants of such a person shall not so take. F. Any beneficiary or the legal representative of any deceased beneficiary shall have the right, within the time prescribed by law, to disclaim any benefit or power under my will and the interest so disclaimed shall be distributed as if such beneficiary had predeceased me. ARTICLE II. PAYMENT OF EXPENSES AND OTHER CHARGES I desire a modest Christian funeral, to be provided by Ewing Brothers Funeral Home. I do not want a wake or other traditional meal in observance of my passing. I have purchased burial plots at Westminster Cemetery, Newville Road, Carlisle, Pennsylvania. I direct my Executor to pay for my burial expenses (including the cost of a monument or marker over my grave and the entire cost of my burial). The estate, inheritance and similar taxes assessable on my death (including taxes on assets not passing under this will) shall also be paid as a cost of administering my estate and my Executor shall not request any beneficiary to pay any part of such tax. ARTICLE III. MISCELLANEOUS PROVISIONS Matters of Interpretation. For simplicity, I have expressed pronouns and other terms in one number and gender, but where appropriate to the context these terms shall be deemed to include the other number and genders. The bold headings are for convenience and shall not affect interpretation. ARTICLE IV. APPOINTMENT OF FIDUCIARIES AND POWERS A. I name Jeff Bouder, presently residing in Newville, Pennsylvania to be my Executor. If administration of my estate or trust should be necessary in any jurisdiction where my Executor is unable to qualify, or if my Executor deems it necessary for any other reason, I give to my Executor the power to designate any individual or corporation with trust powers to serve with my Executor or in my Executor's stead. If the said Jeff Bouder is unable or unwilling to serve as my Executor, I name Paul M. Bouder, presently residing in Carlisle, Pennsylvania, to Page 2 of 5 ~~~ G.L.B. be my Executor in his stead. I request that no security be required of any Executor, including an Executor named pursuant to the preceding sentence. References in my will to my "Executor" are to the one or ones acting at the time, except where otherwise specifically provided. B. Any corporate Executor or Trustee shall receive for its services the compensation for which it is willing to undertake similar services for others at the time such services are rendered, as evidenced by its published fee schedule in effect from time to time, unless it is willing to agree upon a fee that is less than its customary fee. Any individual who serves as Executor or Trustee shall be entitled to receive reasonable compensation for his or her services and, whether or not such individual receives compensation, shall be entitled to be reimbursed for expenses incurred for such services. C. I grant my Executor the powers set forth in 20 Pa.C.S. §§ 3311-3332 and 20 Pa.C.S. §§ 7771-7780 respectively. In addition, my Trustee may merge any trust under this will with any trust having the same trustee and substantially the same diapositive provisions. If at any time after my death the size of any trust under this will is so small that, in the opinion of my Trustee, the trust is uneconomical to administer, my Trustee may terminate the trust and distribute the assets to the person or persons authorized to receive the trust income in such shares as my Trustee may deem appropriate. No Trustee who is also an income beneficiary of the trust at issue shall exercise any discretion granted in the preceding sentence. My Executor and my Trustee may distribute tangible personal property passing to a minor to any adult person with whom the minor resides, and that person's receipt shall be a sufficient voucher in the accounts of my Executor and my Trustee. D. I request that my Executor confer with Mark A. Mateya, Esquire, in the handling of my estate, he being familiar with my affairs. ARTICLE VI. DEFINITIONS The following definitions shall be applicable to all of the provisions of my Will except where otherwise specifically stated: 1. The use of the masculine shall include the feminine or neuter and the use of the singular shall include the plural, and vice versa. Page 3 of 5 ~ ~ ~ G.L.B. 2. The term "estate," where appropriate, shall include. any trust hereunder. 3. The term "minor" shall mean an individual who has not attained the age of twenty-one years. Executed this ~~0-'~~day of ~~'?.t.~.a 2011. Gail Louise Bouder Signed, sealed, published, and declared for and as her last will and testament by the testatrix in our presence, we all being present at the same time; and we, in her presence and at her request and in the presence of each other, have subscribed our names as witnesses whereof, all on the date last above written. n I l~ ,_ ~~-- ~~1~ Page 4 of 5 ~ ~~ G.L.B. COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY : to wit: Before me, the undersigned authority, on this date personally appeared GAIL LOUISE BOUDER and~'Y)A~~C ,~1. ~ AT,E'y/p , and~Nnl l~ T• ~EI ~-I•l'(y~C; known to me to be the testatrix and witnesses, respectively, whose names are signed to the foregoing instrument and, all of these persons being by me first duly sworn, GAIL LOUISE BOUDER, the testatrix, declared to me and to the witnesses in my presence that said instrument is her last will and testament and that she had willingly signed and executed it in the presence of said witnesses as her free and voluntary act for the purposes therein expressed, that said witnesses stated before me that the foregoing will was executed and acknowledged by the testatrix as her last will and testament in the presence of said witnesses who in her presence and at her request and in the presence of each other did subscribe their names thereto as attesting witnesses on the day of the date of said will and that the testatrix, at the time of the execution of said will, was over the age of eighteen years and of sound and disposing mind and memory. Sworn and acknowledged before me by GAIL LOUISE BOUDER, the testatrix, l~A,e~ ,~ - ~"1~T,EVt1 ,witness, and ~~J,V 1~ f• ~Fl~l7'0~. ,witness, this day of F=e ~~ • , 2011. ~ ~:~. ~ ~ M~ l~ ~~~ Gail Louise Bouder P Witness ~ s ' ,' Witness Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Frances A. Aumiller, Notary Publk South Mlddieton TWp., Cumberland County Commission Ekplres March 16, 2014 MNmt>rr, pennsylvenia Assodatlon of Notaries Page 5 of 5 ~ t~ _°~5 G.L.B.