HomeMy WebLinkAbout02-09-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF f .~h~-~la.he COUNTY, PENivSYLVA~;L~
Petitioner(s) named below, who is,'are 18 years of age or older, appiy(ies) for Letters as specified below, and in
support thereof a~~rer(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information _
Name: - ~r.ytt1A F LlL-r~ File No: •~ I - f - - / ~ (~
a/k,'a: (Assigned by Register)
a/Iota:
a/k/a: Social Security No: !`t~-~;-~o3C>
Date of Death: 3 ,~c~ Age at death: "~5
Decedent was do iciled at death in r I County, cti.n-lbe~'~~~--~. (srare~ with his/her last
principal residence at ~4p~ 5 ~ ,u; t t e
Street address, Post Office and Zip Code , { City, Township or Borough County
Decedent died at~~ n Utl~lk,e, I~~vtl~•e, ~.tR~tnbe.r~ct<n.~t. ~~
Street address, Post Of a and Zip Cod City, Township ar Borough County State
Estimate of value of decedent's property at death
If domiciled in Penttsylvania ............................ All personal property
If not domiciled in Petettsy!vania ........................ Personal property in Pennsylvania
Ijnot domiciled in Pennsy!vania ...................... . . Personal property in County
Value of real estate in Pet:nsylvania ........................................................ .
TOTAL ESTIIVIATED VALUE... .
l Sa ~+ad.cr G~
Real estate in Pennsylvania situated at: I ~15t{ ~~ „ =I' Pi~~DI/L IZ~I„T SOU~Yh (u~r~~t~fz-gn ~;,~r~Sh ~ 1l~ ~ 1zq~~
(A«ach additional sheets, il•necessary.) Street address, Post Office and Zip Code City, Township or Borough County
~J A.P_etition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) helshe/they is/are the Executor(s) Warned in the last Will of the Decedent, dated ~qUS~ ~~ • ~ ~~ > and Codicil(s)
thereto dated
State relevant circmnstances (e.g. renunciation, death of executor, etc.) ~~ ~3
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorc not a party t~ a pen~+Ti~
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), an i ~tave a~illd botiair_~i
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. _,_ ~ ~rrtt t ~ ~~-7
l ~.
NO EXCEPTIONS ^ EXCEPTIONS ~~ ~ ~ _'~
=~O`n ~ _r
^ B. Petition for Grant of Letters of Administration (If applicable) "~~ _- ~'
c.t.a., d.b.n., d.b.n.c.t.u., pendente life, durunt~tbsentia, durante minoFl7~te
~- ~ rJ
If Administration, c.t.a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.-t ~'
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
itt 23 Pa. C.S. § 3323(8) 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 lefr no Will and was sttrvivedby the following spouse (if any) and heirs (attach
additional sheets, iJnecessuryJ:
Name Relationshi Address
F~~-~~, aw-nz ,-w. lnirliznll Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVVANIA }
COUNTY OF }
Fa' the Register
Official Use Only
Date
Date
BOND Required:nYES L~"~
FEES:
Letters .............. ..... .
( 7> )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
........
(,~.% 1 ~ ....... .
IS.L~(~
Atttotnation Fee .............. .
JCS Fee . ................... .
TOTAL ..................... $ -- ~
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
;7 :~
Phone: ~= 0 v -r~
~
Fax: ;
-z~~'C7 t"tZ -
Email: _
T - ~ r.
- _ :~ ~
_? .-,
-_-~ ~` _
DECREE OF THE REGISTER ~~'`~~' ~ -~-'
~~ C~ T,
Estate of _ ~_%~J Y'1 Y~1 <.i 1'. ~~T-T Y Y )~(~ File No: ~ ~ -~ ~ - ~~ I ~] ~j ,~" c~
a/lv'a: -
AND NOW, ~'t ~,~"(~~'(,(_("L ~~' ( ~1 ~ j ~.L , in consideration of the foregoing Petition,
satisfactory proof having been presented before to I IS,DECREED that Letters
,..
~t' . ~ , ~, : ,~-~ ~ -L i'
are hereby granted to ~ -' -' ~; , - J _
in the above estate and if applicable) that
the instrument(s) dated _ + ~ ~, ~ r c_ ~ a ~ ,
described in the Petition be
For», ~w-nz ,-ev. roiuiznu
to probate~and filed of record as the last Will (and Codicil(s)) of Decedent.
r ~
~~ ~ ,
' -- ~_~
Register of Will
~_.~
age 2 of 2
The Petitioner(s) above-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 Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworrto r affirmed an .subscribed before ~ ~ G ~Q.~ Date r{ ~~'
met s ~ ~ -
n_..~n i t n- day 1~ ~ _ ~~~~~~ Date ~~
LOCAQ~L~REGIST~R~oA-R'S CER~"~~rCAT~Ot~ Off' t`°
w~-l/' '~i.~~~ ~~~ tJ~" duplicate ~t~i~ cr~~y try photostat ®r ~h~t±~~_ ~~:~~.
~I~
I (` '`ii
VI., ~ ¢..,,.I~
F~c~ tier (i3i~ (, ~ ti: is etc. 5t.t7(i ~ i~hts i•.. ~
~G~2~"tQ-9 Pty 3=~7 ,.~~ ~~~'_- ;O,(t )~.,(.
'~ z.~ t. ttI_a) ,.
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CLERK CAF
---- ,
-- _ --- __---- ~ ~ , i JA{J 2 4,`
212
o (`ert)i,~.riOn ~_)ta,ber - ~ 1~ ), ai k~._
Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ pEPARTM ENT OF HEALTH ~ VITAL RECORDS
Permanent
d
_r.(
a
v
0
~i
~" ~ ~ State File Number:
1. Decedent's Legal Name (First, Middle, Lasi, Suffix)
2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo)
Donna F
Hoffman
_
Femal 195-28-0030 January23
2012
Sa
A
L
,
.
ge-
ast Birthday (Yrs) Sb. V nder 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Yea r) (Spell Month) ]a.~irt hpp~~ (~~tv ign Country)
Months Days Hours Minutes 2iaV ell ll-a ~ Stat,Ay1ple
~~ V [1 CJ
7 5 Oe t_ 1, 1 9 3 6
]b. Birthplace (county)
8a. Residence (SS to or Foreign Country) Bb. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Llve in a Townshi
?
P 2nnS
~V
p
y
anla Yes, decedenT Uyea In R _ Mi dAl et-r-,
r
Sd. Residence (cppnty) 1 404 walnut Bottom Rd iw
p.
Cumber 1 and
Be. Residence (Zip Code) 0 ~ No, decedent lived within limits of
city/boro.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married Widowed 11. Surviving S
ouse's N
f
p
ame (I
wife, glue n e prior to first marriage)
Yes ~ ryo ~ Unknown Q Divorced Q Never Married ~ Unknow am
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, last)
John Floyd
Elona Erhardt
'
14a. Informant
s Name 14b. Relationship To Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) '~ 7 (J '( 5
Cathy S_ Greeley D
h
o
G aug
ter 402 Crossroad School Rd_Carlisla PA
..................................
lsa
P awe o eat c
s .
........................ww...................................
e
If Death Occurred to a Hos Pital: LI In '-"----'~'---'-"--""------""--------•••--- ~ -~-c on Y one .--- ..• --- - ---_•.-• µy - --••
...
patient ; If Death Occurr
d S
h
e
omew
ere Other Than a Hospital: LJ Hospi a Facility
Emer Decedent's Home
Q gency Room/Outpatient 0 Dead
A
i
l
¢c on
rr
va
Nursing Home/Long-Term Care Facility Other (Specify)
lSb
Facili
Nam
(if
t I
i
•
.
ty
e
no
nsi
tutlon, give street and number;
iSC. City or Town, State, and 2Ip Code iSd
. County of Death
ewvill 1 1
m m I n
16a. Method of Disposition ~ Burial j~~CremaUOn 16b. Date of Disposition 16c
Place of Dis
ositio
(N
f
.
p
n
ame o
cemetery, c ory, or other place)
p Removal from State p Donatign 1/ 2 5/ 2
a
!~ Q Other (Specify)
0 1 2 Ho 11 i nger Crematory
~ 16d. Location of Disposition (CITY or Town, State, and Zip) 1]a. Signature of Funeral Service Licensee or Person in Char
f I
v ge o
nterment 1]b. License Number
Mt_ Ho11y Springs, PA17065 ~,.,: ~_ ~
E 011589E
1]c. Name and Complete Address of Funeral Facility
8 Ho11in erFH&Cremator 01 B ltim
~ v 1
1B. Decedent's Education -Check the box that best describes the 19. Decedent of Hlspa nic Origin -Check th
'
e 20. Decedent
s Race -Check ONE OR MORE races to indicate what
highest degree or level of school completed at the time of death. box that best describes whether the dec
d
t
h
e
en
t
e decedent considered himself or herself So be.
0 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" White 0 Korean
~ No diploma
9th - 12th grade
,
box If decedent Is not Spanish/Hispanic/Latino. ~ Hla<k or African American ~ Vietnamese
~ High school graduate or GED completed
No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian
Some college credit, but no degree ~ Ves
M
i
M
,
ex
can,
exican American, Chicano ~ Asian Indian ~ Native Hawaiian
~ Associate degree (e.g. AA, AS) ~ Yes
Puerto Ri
,
can 0 Chinese 0 Guamanian or Chamorro
~ Bachelor's degre
(e.g. BA, AB, BS) ~ Ves
uban
e
, o
Q P no
Q Master's degree ( .g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, ther Spanish/Hispanic/Latino Fili i ~ Samoan
Doctorate (e.g. PhD, Ed D) or Professional tlegree ~ Japanese Q Other Pacific Islander
. MD DDS, DVM LLB JD (SpeCity) ~ Other (Specify)
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself [
b
'
o
e. 22a. Decedent
s Usual Occupation -Indicate type of work
® White - )~ Japanese ~ Samoan
done during most of working life. DO NOT USE RETIRED.
Q Black or African American ~ Korean ~ Other Pacificlslander
~ American Indian or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure
Cleric
~ Asian Indian ~ Other ASIan ~ Refused
226. Kind of Business/Industry
Chinese ~ Native Hawaiian ~ Other (Specify)
~ Filipino ~ Guamanian or Chamorro Blue Shield
ITEMS 23a - 23d MVST BE COMPLETED 23a. Dare Pronou Head Deatl (MO/Day r) 23 b. Signature of Person Pronouncing Death (Only when a
BY PERSON WHO PRONOUNCES OR
lic
bl
pp
a
e 23c. License Number
nn~~ `
CERTIFIES DEATH \.! ~ ~ . ~ 3 - ~ ~ -~
23d
Date Si
ned (MO/D
/Y
~
2
.
g
ay
r) 24. Time of Da iLLh,,
~/
/~ r Q N ~ 13 7 ~~
_
~~
~'~ ~% "l
~ A'\ 26. W edical Examiner r Coroner Contacted? Q Ves No
CAUSE OF ATH
26. Part 1. Enter the chain of events--diseases, injuries, or com plicat(ons--That direct) Approximate
y caused the death
DO NOT ent
t
.
er
erminal events such as cardiac arrest Interval:
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a li
Add
ne.
additional lines if necessary Onset to Death
IMMEDIATE CAUSE ---------------> a. CfMi.c7 ~' \ Q-- ~(/
~~
Q
i
~ ` G
.
.~-
(
(Final disease or condition Due to (or as a consequence of):
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of): -
if any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Due [o (or as a consequence of):
(disease or in)ury that
F Initiated the events resulting d.
In death) LAST. Due to (or as a consequence of):
S 26. Part Il. Enter other siRniflca nt cond"t'o ontrib ti t d th but not resulting in the underlying cause given in Part I
2]. Was an autopsy performed?
O Ves )~ No
m 28. Were autopsy findings available
to complete the cause of death]
4 29. If Female: 30
~ Yes Q No
Did Tobacc
U
o .
o
se Contribute to Death?
33. Manner of Death
~NOt pregnant within past year Q
Ves
Probably
~
O
~
Natural Homicide
)~ Pregnant at time of death
~ Not pregnant, but pregnant within 42 days of death ~ Unknown (] gccident ~ Pending InvesUga[ion
F-- ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO Da /Vr 5 ~ Sui<Ide ~ Could not be determined
elt M
1 / Y ) (
th
p
on
)
~ Unknown if pregnant within the past year
33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 3]. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
~ Yes ~ privet/Operator 0 Pedestrian
~ No ~ Passenger 0 Other (Specify)
39a. Ce Check only one):
Certifying physician - To the best of my knowledge, death occurred due to the c se(s) and m r staled
~ Pronouncing ffi Certifying physician - To the best of my knowledge, death occurred at the time, date, and place
and due to the c
d
,
se(s) an
manner stated
Q Medical Examiner/Coroner ih sof examination, and/or Investigation, in my opinion, death occurred at the time
d
t
d
l
,
a
e, an
p
ace, and due to the cause(s) and Mann r stated
Signature of certifier: Title of certifier:_ ~ - U License Number: ~l~(~ ~~ t~ e ~_
39b. Name, Address and Zip Co f Person Com plefing Cause of Death (Item 26)
39c. Date Signed (MO/Day/Yr)
40. Registrar's District Number 41. Registrar:~+1t{tnature
42. Re istrar File Date (MO Day
n
j~
~ - ~o
}
E
43. Amendments
a~ o ~a
t H106-143
Disposition Permit No. REV 0]/2011
LAST WILL AND TESTAMENT
OF
DONNA F. HOFFMAN
....,
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I, DONNA F. HOFFMAN, of 285 South Side Drive, Newville, Penn
Township, Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding do make, publish and declare this to be
my Last Will and Testament. I hereby revoke all previous Wily and
Codicils at any time heretofore made by me.
I ~i EM I
I order and direct my Executor, hereinafter named, to pay my debts,
funeral expenses and expenses involved or connected with the
administration of my estate as soon after my death as is reasonably
possible.
ITEM II
I direct that my body shall be cremated according to my plan with
the Cremation Society of Pennsylvania and the ashes scattered on my
property in Newville. I also direct that there be no viewing or public
memorial services.
ITEM III
I give, devise and bequeath all of the remainder of my property, of
every kind and description (including lapsed legacies and devises)
wherever situate and whether acquired before or after the execution of
this Will, to my husband, EARL E. HOFFMAN, if he survives me, or if he
predeceases me, to my children, CYNTHIA MANGUM, SHARON ANN EAKIN and
CATHERINE GREELEY, per stirpes.
Page 1 of 4
„ f %~t' ` ~" a 1, ';`' `~-
ITEM IV
In the event that EARL E. HOFFMAN and I should die simultaneously
or under circumstances as to render it impossible to determine who
predeceased the other, or within thirty (30) days of each other as the
result of a common accident, I shall be deemed to have survived him.
ITEM V
I hereby nominate, constitute and appoint my husband, EARL E.
HOFFMAN, as Executor of this my last Will and Testament. In the event
Of 11i5 renilnCiatiGL'i, death, reSig.latiGii Gr iildbllity ±:O dCt for any
reason whatsoever, I nominate, constitute and appoint my daughter,
CATHERINE GREELEY, of Highspire, Pennsylvania, as Alternate Executrix,
of this, my last Will and Testament.
ITEM VI
I hereby direct that no Executor or other Fiduciary named or
appointed by this Will shall be required to post any band or give any
security of any type for any purpose whatsoever, nor be liable for
failure to file any report, accounting or inventory, in any jurisdiction
in which he or she may be called upon to act, insofar as I am able by
law to do.
ITEM VII
I authorize my Executor in his discretion, to sell, with or without
notice, at either public or private sale, and to lease any property
belonging to my estate, subject only to such confirmation of Court as
may be required by law, for such prices and on such terms and conditions
as he deems best, and to make distribution hereunder either in cash or
kind, as he may deem wise.
Page 2 of 4
~,~~~,i,v~y~~
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal
~ r~
this / ~ day of August, 1998.
DONNA F. HOFFMAN
~~
;' l ~' / ~~f residing at L-r<< ~ ti~Y~G I' / 1 ~-/
Witn~~ "s , /%~
~~ ~~~ ~~ ~, ~, ~~ ~,c residing at ~ ~j~
witness
J
a ~< ~; , .._<,~. ~, ~'~ ~~-,._ residing at C~_:_.,_ ~< . ~ ~ ~.
Witness
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, DONNA F. HOFFMAN, JAMES J. KAYER, DEBRA D. NELSON and PATRICIA
R. BROWN, Testatrix and the witnesses, respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn,
do hereby declare to the undersigned authority that the Testatrix signed
and executed the instrument as her Last Will and Testament, and she had
signed willingly and that she executed it as her free and voluntary act
for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as witness
and that to the best of his/her knowledge, the Testatrix was at that
time eighteen years of age or older, of sound mind, and under no
constraint or undue influence.
~,'~.
~~ ~ `~- ~'l- 1 J
DONNA F . HOFF - TEST~~C E~IX
Page 3 of 4
°~
~, l~ ,
v s~ .'." ~~~~~ residing at L.~- ~ -~ = ~ .~-.
W' nes~'~
p1 ~~ 1 i ~~
~i~~ ~t ~, ~~iv ®~, _ residing at y~-
Witness
~-t- ~_ c ~ ;~.:-~:..,..~ residing at ~ `~ ..
Witness
Subscribed, sworn to and acknowledged before me by DONNA F.
HOFFMAN, the Testatrix, and subscribed and sworn to before me by JAMES
J. KAYER, DEBRA D. NELSON and P.ATRICIA R.
~ ~ ~
~' day of August, 1998. ~ ,
-Nata
NOTARIAL SEAL
DENISE PINAMONTI, Notary Public
Carlisle Borough, Cumberland County
M Commission Expires Nov. 20, 2000
BROW1~,~ witnesses , this
i
~.
lic
Page 4 of 4