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HomeMy WebLinkAbout02-08-12PETITION 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: BETTY C. BEAMER File No: ~ I ~- ~ ~ - C 17(~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 204-26-9692 Date of Death: 1/23/2012 Age at death: 86 Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA (State) with his/her last principal residence at 1524 W. TRINDLE RD., CARLISLE 17015 MIDDLESEX TOWNSHIP CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent dled at HARRISBURG HOSPITAL 111 S. FRONT ST 17101 HARRISBURG DAUPHIN PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: lfdoneiciled in Pereresylvar:ia ................................All personal property $ 90.000 00 If not domiciled ir: Per:resylvareia .............................Personal property in Pennsylvania $ If not domiciled in Penrrsylvarria .............................Personal property in County $ Valeee of real estate ire Pereresylvania .............................................................. $ 148.000.00 TOTAL ESTIMATED VALUE.... $ 238.000.00 Real estate in Pennsylvania situated at: t524 W, TRINDLE RD, CARLISLE 17015 MIDDLESEX TOWNSHIP CUMBERLAND (Attach ndditiaml sheets, if»ecessary.) Street address, Past Office and Zip Code City, Township or Borough County ® A. Petition for Probate and Grant of Letters Testamentary Petitioner{s) aver(s) he/she/[hey is/are the Executor(s) named in the last Will of the Decedent, dated 7/1 912 01 0 and Codicil(s) thereto dated EXECUTOR ROY MINNI H R NO N FD IN FAVOR OF h"AR AR T h" POTT If~FR State relevant circumstances (e.g. renunciation, death oferecator, etcf 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 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.t.a., pendente life, dnrante absentia, dnrante minoritate If Administration, c.t.a. ord.b.n.c.~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 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 (attach additional sheets, if necessary): Name Relationship Address ,-,,, Q ,~:, -a-' -` r°, ~J r-rt ~n ~.. ~ar~ 0 ©-r-t ~ -a ~ d -- For»r R6f! 01 rev. 10/1!/1011 ~ ~ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Official Use Only ~'' ,~, F~~:.. -. ~. c _.ti.U ~ f ,. K-. 1.~ I 4- Petitioner{s) Printed Name Petitioner{s) Printed Address MARGARET M. POTTEIGER 67 FAIRFIELD STREET ~~Q~'~ ~• (J~F CARLISLE ;r~lF 17 13 ~~ The Petitioner(s) above-named sweat{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 Petitioners) will well and truly administer the estate according to law. S:~.vorn to .affirmed and subscribed before r1 ~ .~ n' Date ~ ~~ met s day of ~ ~~ Date By: _ Date For the Register Date BOND Required: ^ YES ®NO FEES: Letters ....................... $ . (3 )Short Certificates(s) ...... ~,~ - CEO ( ~ )Renunciation(s) .......... • ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other ~/y ~ ~, Automation Fee ................ . JCS Fee ....................... TOTAL ......................$ To the Register of Wills: Please enter my appearance by my signature Attorney Signature: Printed Name: MURREL R. WALTERS. III Supreme Court ID Number: 24849 Firm Natne: MURREL R. WALTERS. III Address: ATTORNEY AT LAW 54 E. MAIN STREET MECHANICSBURG PA 17055 Phone: Fax: ~~ Email ~~~0 ~Q 717-697-4650 717-697-9395 DECREE OF THE REGISTER Estate of BETTY C. REAMER File No: r~ ~ " ~ <~ -C `1L a/k/a: AND NOW, ~~ f~ZJ Q r ,~ (~ ~ > in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ ~ ~(YYL~k~ a ~.___ are hereby granted to ~Q 11/1 _ in the above estate d (if applicable) that the instrument(s) dated ~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent Form R6V 0? rev. 10/ll/2011 n ~. Register of Wills age 2 of 2 LOf~~~;~t~~~RAR'S CERTIFICATION OF DEATH WTI' ~tisl=~l~L~al to duplicate this copy by photostat or photograph. ~. Fee for this certificate, $6.00'1 32 ~~$ _a ~~ 8' ~~ ~f'Ihis is to certify that the information here given is con~ectly copied from an original Certificate of Death ~~~ ~~ duly filled with me as Local Regist~:-ar. The original ~~~~,~ ~~~~T certificate wilt he ii~rwarded to the State Vitaf Records Office for ~~errnunent filing. CtJM~ER!_A~~S~ ~;(~ , PA P 18 210 4 6 2___ ~.5~.~~ _ - ~2o~z_ Certification Number Local Registrar Date Issued _,-- In Type/Print In COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS P°r"'a"e"t CERTIFICATE OF DEATH Black Ink State File Number' 1. Decedent's Legal Name (Firs[, Middle, Last, Suffix) 2. Sex 3. Spcial Security Number 4. ate of Death (MO/Day/Yr) (S all M ) Bert C_ Beamer F 204 - 26 - 9692 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Oa 6. Dale of Birth (MO/D ay/Vear) (Spell Mpnth) 7a. Birthplac e ( City antl-St Foreign C ntry) Months Days Hours Mlnufes '} ~ ~ (NO't K71G7VJI1) PA 86 Jan _ 3 , 1 926 7b. Birthplace (county) CLmlberland Sa. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Llve In a TownshipT PA yes, decetleni lived In Middlesex [M,p, Bd. Raaidentt (cpunty) 1 524 W _ Trindle Rd. CLUnberland Be. Residence (tip Code) ~ 7 0 No, decedent lived within limits of city/born. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death Q Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to Rrst marriage) [] Yes $) No Q Unknown Q Divorced Q Never Married ~ Unknow - 12. Father's Name (First, Middle, last, Suffix) 13. Mother's Names Prior to First Marriage (First, Middle, Las[) M e =rene (Not Knowr>_ ) 14a. Informants Name Sob. Relationship to Decedent 14c. Informant's Malling Address (Street and Number, City, State, Zlp Code) o Mar aret Potteiger Daughter 67 Fairfield St_ Carlisle, PA '17013 ... .. .... ........ ........ ......................... ..--°-•-- •--------------°-- °--•°---. ..-.. sa. P ace p __ _ _ .......-..eat...... ®~-_on,y one . ............... ...... .... ..--- ..--- If Death Occurred in a Hospital: In tbnt pa _ __ ___ _ _ __ _ __ ___ __ _ ____ 5 . .. .. .. .. If Death Occurred Some h re O[he Than Hospital- Wµy! ~~- ~-~- ~~~- ~~- ~~~~- ~~ ~ ww ~~~~- ~-~-- ~~~ ~~~~- -~~~ w e r a l,J -Hospice Facility L4 Decedent's Hame Q Emergency Room/Outpatient Dead on Arrival Nur ing HOma/Long-Term Care Facility Other (Specify) 15b. Facijlty Name (If not institution, give street end number, 15c. City r Town, Stale, and ZIp Code 15d. County f Deafh- Harrisbur Hos ital Harrisbur PA Dauphin : 16a. Method of Dlsposltion Q BuFlal ~ Crematlpn 16b. Date of pisposition 16c. Place of Dlsposltion (Name of cemetery, crematory, or other place) Q Removal from State [] Donation Other (Specify) 1 25 201 2 E~7an5 Cranation Se1V1CE-'S 16d. Location of Dlsposltion (City or Town, State, and 21p) r 17a. Signature of al Service Licensee a son arge of Interment 17b. License Number Leo1a, PA FD 012633 L 17c. Name and Complete Address of Funeral Facility Davin Brothers Funeral HcxTte, =nc_, 630 S_ Hanover St_,Carlisl , PA '17013 1H. Decedent's Education -Check the box that best describes the 19. Decadent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what i- highest degree or level of school completed aY the time of death, box [hat best describes whether the decedent the decedent considered himself or herself to be. Ja'Hth grade or less Is Spanish/Hlspa nic/Latinp. Check the "NO" ~'OVhite Q Korean Q No diploma, 9th - 12th grade box If decedent is not Spanish/Hlspani4Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed Q'NO, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Som college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q ASlan Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican 0 Chinese [] Guamanian or Chamorro Q Bachelor's degrees (e. g. BA, AB, BS) Q Yes, Cuban Q FIIlpino Q Samoan Q Master`s degree (e.g. MA, MS, MEng, MEd, MS W, MBA) Q Yes, other Spanish/Hispanic/Latinp Q Japanese Q Other Paclflc Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) . MO DDS DVM LLB JD G 21. Dace ent's Single Race Self-Designation -Check ONLY ONE to Indicate what The decedent considered himself or herself to be. 22a. Decedent's Usual Occupatipn -Indicate type of work ~ ite Q Japanese Q Sam done during most of working Ilfe. DO NOT USE RETIRED. Q Bieck or African American Q Korean Q Othe aPaclflc Islander COOk Q American Indian or Alaska Native Q Vietnamese Q Oon'i Know/Not Sure Q Asian Indian Q Ocher Asian Q Refused 226. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q FIIlpino Q Guamanian or Chamorro Restaurants ITEMS 23e - 23d MVST BE COMPLETED 23 .Dace Pronounced-Dga MoDDay r) 23b. Signature o Person Pronouncing Deat On y w ¢n applica e) 23e. License Num er BV PERSON WHO PRONOUNCES OR IJ3 / O ! CERTIFIES DEATH 23d. Date Signed (Mp/Day/Yr) ,Time of D th / („(/ 25. Was Medical Examiner or Coroner ContactedT Q Yes No CAUSE OF DEATH Approximate 26. Part I. Enter She chain of events-diseases, Injuries, or complications-thaT directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: _ aspiratory arrest, or v¢ntricular fibrillation thout howing the etiology. D NOT ABB VIATE. E ter o ly one c a line. Ad{ additional lines if nettssary Onset to Death A° r us J ~. t ~{I1 IMMEDIATE CAUSE ---------------> a. G ~l~- Y~ e L>t ~ {~ e (Fins{ disease or condition Due to (or as a co equence of): resulting in death) ~ b. ~ K ~ Gc A(" S 6~l> Seq uantially Ilst conditions, pue or as a con q ce of) s if any, leading to the cause ~~ ~ ~ ~ ~ listed on Ilne a. Enter the J ' V S 61'S. c UNpERLY1NG CAUSE Due to (or a consequence of): a ~ (disease or Injury that ~_ ^ ~~ ~~ A, t ~S i i d th l 0/( p ~ c - tiate n e events resu ting d. , dJ a i L d h T n eat ) AS . Due to (o{js a consequence of): 26. Part 11. Enter other significant conditions contributin¢ to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy partormedT Q Yes No ~ 28. Were autopsy findings available to <om plate the cause pf death? v Yes No 29. If Female: 30. Did Tobacco Use Contribute to DeathT 31. Manner of Death Not pregnant within past year Pre nant at time f d th 0 Yas Q Probably ® Natural Q Homicide °m' g o ea ~ Not pregnant, but pregnant within 42 days of death ~ No Q Vnknown Q Accident Q Pending Investigatipn 0 Suicide ~ Coultl not be determined r Q Not pregnant, but pregnant 43 days to 1 year before death 32. pate of injury (MO/Day/Yr) (Spell Month) Q Unknown If pregnant within the pas[ year ~ 33. Tima of Injury 34. Plata of Injury (e.g. home; construc[ipn site; farm; school) 35. Location of Injury (Street and Number, Clty, State, 21p Code) 3B. Injury at Work 37. If Transportation Injury, Specify: 36. Describe How Injury Occurred: Ci Yes Q Driver/Operator Q Pedestrian ~ No ~ Passenger ~ Other (Speclty) 39a. Certifier (Check only one): Certifying physician - To the best of m mowledge, death occurred due to the cause(s) and manner stated Pronouncing 6 Certifying ph YSlcian - T the best of my knowledge, death occurred at the Time, date, and place and due to the cause(s) and manner staled Q Medical Examiner/Coroner - O ba mina[ion, and/or inves[igatlon, In my opinion, dea th ed at [he time, date, and place, and due to the cause(s) a d ta ~ed r / y) / Signa[u re of certifier: Tltie of certifier: ~/L~ License Number: {t'1 ~ ~ ~'~ L 39b. Na~e, Address and 21p Code of Person orrpletlgg Cause of Death (It 26) 9c. Date Signed M /Day Yr) ~ / ' ~ ~ / ~ s 4e a /v ~ eel .i 1 40. Registrar's District Number ~'~~~~aayy~~ 41. Registrar's S 2. Reglstr Ile Dale Mo Day r ~O ~F~ ~ ~ ~a~ 43. Amendments Dlsposltion Permit No. V ~D ~ \ ~ l O H105-143 REV 07/2011 ~.,, ~© :.~ " ~ ~; RENUNCIATION -~ ~7 _~ ' r'~ m ~7 . ~ vz~ ~ : ~__; :;,,~-: - ~„ ~ coo _~ ~~ REGISTER OF WILLS ~ co `-~ ~'' _ ~~ CUMBERLAND COUNTY, PENNSYLVANIA -~' m r~ ~t A N ~~ ..t Estate of BETTY BEAMER ,Deceased h RnRY MINNICH_ ALSn KNOWN AEA, _ ROY MINNICH , in my capacity/relationship as (Print Name) FXFCI~TOR of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to 2/7/2012 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (S n re) 1274 MINNICH ROAD (Street Address) MFCHANIGSBLIRG PA 17055 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renun~cka~on for the pu ose stated within on this~_ day of ~- a ° I.Z Notary Public My Commission Expires: ~ /Z Z ~~ c; ~ 2 (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTARIAL SEAL_ DIANE M SMITH Notary Public MECHANICSBURG BORO, CUMBERLAND CNTY My Commisslon Expires Jun 22, 2012 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, BETTY C. BEAMER, a resident of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I have two daughters, LORRAINE C. SHELLER and MARGARET M. POTTEIGER. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give and bequeath my Troy Built lawn mower to my grandson, LARRY SHELLER, JR. V All the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my daughters, LORRAINE C. SHELLER and MARGARET M. POTTEIGER, in equal shares, per stirpes. ~ -~~; o ~.~ -'~ e~ (' 1 ~ ~dJ -~ ~~! ~ r-- -~' ~1~; ~ c: ~ Ti tai _ F'*~ '~~ ~ VI I nominate, constitute and appoint ROY MINNICH, as Executor of this LAST WILL, to serve without bond. If he is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, MARGARET M. POTTEIGER, as Executrix of this LAST WILL, to serve without bond. If she is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, LORRAINE C. SHELLER, as Executrix of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, BETTY C. BEAMER, have set my hand to this LAST WILL this / ~ day of -~~ , 2010. t V~ BETTY .BEAMER Signed, sealed, published and declared by the above-named BETTY C. BEAMER, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each otfher, have hereunto subscribed our names as witnesses. ~~ ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, BETTY C. BEAMER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. ~ ~ ~- BETTY C BEAMER Sworn or affirmed to Testatrix, this (9~ and acknowledged before me by BETTY C. BEAMER, day of ~G, ,/~ , 2010. "~~' Notary Public N07ARIAL SEAL DIANE M SA4lTH Notory Public MECHANlCSBURG BORO, CUMBERLAND CN1Y My Commission Expires Jun 22, 2012 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND : _,, We, ~,1~,~F'L f~ (~/~ !~~ and OSe~n~~l~,~ ~iL~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL, that BETTY C. BEAMER 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 o. ` knowledge, the Testatrix was at the time 18 years of age or more, of _ sound r~ `nd and under no constraint or undue influence Sworn or affirmed to and acknowledged before me this ~ q~ day of ~~ , 2010. Notary Public NOTARIAL SEAL DIANE M SMITH Notary Public MECHANICSBURG BORO, CUMBERLAND CNTY My Commission Expires Jun 22, 2012