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Home My WebLink About02-23-12IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of ~bn tzI d ~, ~ors~trq ,Deceased ESTATE NO: 21- C a -- al-( a/k/a: J~nald >~l- ~ ~ fir e~-~t a/k/a: a/k/a: SS NO: J 9 ~ - ! z -787'1 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ~A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters TZ S fg m p,~i'~trN under the last Will of the above-named Decedent, dated m ~, !~~ 2405 -artd~rtodiz,Z}(~}-data{ lv,;~ prea/e c ra sccl o ~ . ~f, Zmvb - (State relevant circumstances, e.g. renunctation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(g): NO ltXC~1S0/75. - ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent life, durante absentia, durance minoritate) C. 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. or d.b.n.c.t.a., enter date of Will in Section A 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:- Name Address R 1 t' h' B e a ions t to occ C7 C :~~ _ -v _~ r- `zm `~~: iiCC • TTiT.Aai • . ..nn . ~.. UJG f1.1v111V1~HL Jl7GG1J 1C 1VC THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland At~~oo - ~srQ/JCr'on GUa.y . A?ec~a.,:cs (Street address with post Office and Zip Code, Borough, ~~ i ter-; ~~ t r; > ~J - _r~ `~.~ ;_ may-, .:... ~ ,= J `-- ~' `t ~ ""s. t: j principal reence`~ ~-, Decedent, then $~ years of age, died ,~ ~ Z o/Z at -~CC~i~ihits~ur~~/~ff (Month, Day, Yeaz of death) (City and State where death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property $ ~ DDD• d'~ _If not domiciled in PA Personal property in Pennsylvania $ _If not domiciled in PA Personal property in County $ -Value of Real Estate in Pennsylvania $ Total Estimated Value $ 5~ ODD. sy Location of Real Estate in Pennsylvania: (Provide full address if possible.) N//~' Signature(s) Name(s) & Mailing Address(es) x J ooh ~~.,. ~ ~~ J,in~ve /1?ech ni~sb r~o Pennsylvania, with hisA~ last family or 10~/7D 50 . ~i1~/~c>'ciI ow~s.S .,,..,.,,,, , ~,,,~ ,...-„~ ,.,.,~~~ ,~.co.,v oy ~.umocnanu ~uunry penamg acnon oy the court Page 1 oft OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland 4~i2 ~Et~ 23 P~ 2~ 3~ The Petitioner(s) herein named swear or affirm that the statements in the foregoing Peti~~~~ue Tared correct to the best of the knowledge and belief of Petitioner(s) and that, as person ~ the Decedent, Petitioner(s) will well and truly administer the estate according to law. ~ ~~~~~ ~ _, ,1. Sworn to or affirmed and subscribed before me this r day of -~ h r~~~r~' , ao I ~ ~p F t S x ~. ~ ~o~tnQ 1, . Clap per For the Register DECREE OF PROBATE AND GRANT OF LETTERS Estate of'Dbnalc~ Cc. ~ors~rg ,Deceased FileNumber: 21- 1 2 - ,~y3 AND NOW, this ~~ day of ~Ph ~ ~ J ~~1=76a~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary _ of Administration are hereby granted to: (If applicable, eater c.t.a., d.b.a., d.h.a.ut.a., etc.) '9oh*~ct 1... C~ ~1GdJei" in the above estate and that instruments(s) dated l'?'1 19 ZoDS described in the petition be admitted to probate and filed of record as the last 11 and Codicil(s) of Decedent. Glenda Farner Strasbaugh,-~~ Register of Wills-~ i ~~°~~~,~~; ~~G'~ \ ~~~ FEES: Letters ....................$ Will ........................ Codicil(s) ................. (~) Short Certificates _ ( )Renunciations....... Bond ............................ Other ............................. . .......................... Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................ $ 9 .~~~a~naul C w I.VUIIJCI 1(C(;UIreQ LO JC'rilLer Atty's Signature ~~j~,~ ~l~fL,C,e~~ij~Q~ PRINTED Name: ~~~-/~S ~, s`i~~lc~s~- Supreme Court ID No.: 38S'/3 Address: ~ ~/puSCr ~g~ me chart r e s 6N r,~, P/~ ~7c. Phone: 7/7- 7l0 ~ - OZD 9 Fax: 7/ 7 - ~4S - >~7~3 Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 oft HIOS.ROS REV rnl/0~1 Lq~~~t~RAR'S CERTIFICATION OF DEATH ~':'It-""i~:~~if~ai to duplicate this copy by photostat or photograph. Fee far this certificate, $6Ai~~~2 ~' ~~ ~.3 P~ ~~ 3~ This is to certify that the information here given is correctly copied from an original Certificate of Death ,~ERf{ 0~ duly filed with me as Local Registrar. The original ~~,~ CC?~~1RT certificate will be forwarded to the State Vital Records Office for permanent filing. Cl1MF~Rl. ANA C°;~ . PA P 18 0 4 9 310 _ ~~~.~y~i~~:~ ~; ~. ~:~_~~ Certification Number Local Registrar Date Ys~ued Type/Print In COMMONWEALTH OF PENNSV LVANIA DEPARTMENT OF HEALTH VITAL RECORDS Permane^` CERT{F{CATE OF DEATH Black Ink State Flle Number: ._.J v tX 1. Decedent's Legal Name (First, Mitltlle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO(Day(Yrl (Spell Mo) DONALD E. FORSBERG MALE 192-12-7877 FEB. 7, 2012 .Under 1 Oa 6. Dale of Birth (Mo/D ay/Year) (Spell Month) 7a. Birthplace (City and Scare or Foreign Country) MonChs Davs Hours Minutes MONESSEN PA 88 ___ FEH . 19 , 1923 7b. Birthplace (cot,nty) WESTMORELAND 8a. Residence (State or Foreign Country) Sb. Resltlen a (Street and Number -Include Apt No.) 8c. Did Decedent Live In a Township? V 2A __ GRANDON WAY - -~ puss, decedent uYad In twp. 8d. Residence (County) 1 y ~v CUMBERLAND ere. Residence (zip code) 1 7050 P, datedant Jjyetl within limits of MR CHAN7C'.48 R , trey/borq. 9. Ever in US Armed Portia? 10. Marital Status at Time of Death Married Wldowetl 11. Sv rviYing Spouse's Name (If wife, glue name prior Co first marriage} [~Ves Q No (~ Unknown p Divorced Q Never Married p Unknow NONE 12. Father's Name (First, Middle, Last, Suffix) 13- Mother's Name Prior <o First Marriage (First, Middle, Laat) ERZC FORSBERG ELSIE SADLER 14a. Infgrmant's Name 14b. Rela tionshlp [o Decedent 14 c. Informant's Mailing Address (Street and Number, CI[y, State, Zip Cotle) o DONNA L. CLAPPER DAUGHTER 1032 HIGHLAND DR. MECHANICSBURG PA 17055 t ... ..... ..... . a. P ace o eath C e _ ........................ c qn y ens . ........., . ........ ........ ... ... ......... .... ....... ....... ..... ... ... .......... ... .. ... .. ... ... .... ...3 ...... _ ...._.,-,. ._-,,.... ....... .............. ........... ...._...... .... ....... .... .. ... w. If Death Occurred In a Hospital: [_I Inpatient .. .. . )If Death Occurred Somewhere Other Than a Hospital: ~] Hospice Fa cil'ty (~ De<eden['s Home Emergency Room/Outpatient Q Dead on Arrival _ Nursing HOma/Long-Term Care Facility 0 Other (Specify) SSb. Facility Name (If not ins[itutiq n, give street and number; 15c. CI[y or Town, State, and Zip Code 15d. County of Death a EMERITUS AT CREEKVIEW MECHANICSBURG PA f'705'O CUMBERLAND 16a. Method of DisposiTion d Burial p Cremation 16b. Dale of Dlsp OSitlon 16c. Place of Disposition (Name of cemetery, crematory, or other place) .~ p Removal from state p Dona[Ign Other (Specify) FEB . 11 , 2012 MON . VALLEY MEMORIAL PARK 16tl. Location of Disposition (clYy or Town, State, and Zip) 17a. Signs Funeral $ervic! n Or Person in Charge of Interment 17b. License Number E PA 15033 DONORA ~~ - - FD011915L , ~ 12c. Nam< and Complete Address pf Funeral Facility DALFONSO-BILLICK FUNERAL HM. INC. & CREMA ON SERVICES 441 REED AVE. MONESSEN PA 15062 .~ 16. Dlcetl<nf's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE r s [o indicate what r- highest degree or level of school completed at the time of death- box that best describes whether the decadent the dated ent considered himself or herself to be. ~~Bih grade or leas la Spanish/Hispanic/Latino. Check the "NO" ~ White Q Korean ~ No tliploma, 9Ch - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American Q Vietnamese Q Hlgh school gr>duate or GEO completed No, noT Spanish/Hlspa nit/Latino p American Indian or Alaska Native Q Other Asian ~ Some college <rediC, but no degree ~ Yes, Mexican, Mexican American, Chlca no ~ Asian Indian p Native Hawaiian p Associate degree (e.g. AA, AS) ~ Yes, Puerto Rican Q Chinese ~ Gu Wien or Cha mgrro p Bachelor's degree (e.g. BA, AB, BS) p Yes, Cuban Q Filipino p Samoan 0 Master's tlegree (e.g. MA, MS, MEng, MEd, MSW, MBA) p Yes, other Spanish/Hispanic/La Yine Q Japanese p Other Pacific Islander Q Doctoral! (e.g. PhD, Edo) or Professional tlagree (Specify) ~ Other (Specify) . MD DOS OVM LLB JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate tYPe of work [[~j~ White ~ Japanese ~] 5amean done during most of working life. DO NOT USE RETIRED. [J Black or African American [] Korean Q Other Paci/ic Islander Q American Indian or Alaska Native p vletnameaa O Don't Know/Not Sur! LAB TECHNICIAN Asian Indian Q Other Asian Q Refused 22 b. kind of Business/Industry Chinese Q Native Hawaiian p Ocher (Specify) STEEL MILL p Fmplno p G.,amamm~ qr chamerrq ITEMS 23a - 23d MUST BE COMPLETED a Pro o ced Dead (Mo Day Vr) 236. Signature of Person Pronouncing Death (Only when cep pitta bee) 23c. Ucense Number BY PERSON WNO PRONOUNCES OR CERTIFIES OE TH ~~ ay/Yr) 23 d. O t g B ( 24. T t ~ (~ 25. Was Medical Examiner or Coroner Contacted? p Yes CAU5E OF DEATH gpproximate 26. Part I. Enter the cha"n of a ents--tlizeases, injures, or complications--[hat directly cavsetl the death. DO NOT center terminal eve r,ts such a ardiac err st Interval: res plra[ory arrest, err ventricular f(brillatign w thou showing the etiolo 00 NOT ABHREVI TE. Ent my to USe on a line. Odd dit(Onal line f essary - Onset tq Death r o e ec ' IMMEDIATE CAUSE ------- ---- --> a_ _ (Final disease or condition Due to (or as a consequence of): res ultinH (n death) b. Sequentially Ilst conditions, Due to (or as a cpnseq ue n<e of): if any, leading To the cause Ilsietl on iln! a. Enter the UNDERLYING CAU5E Due to (or as a consequence Of): . u (disease or Injury the[ - initiated the ev nts resulting d. e ~ Due to (or as a consequence of): In death) LAST. s 26. Pert II. Enter other I n'fi nd"[i n de H but not resulting in the underlying cause given in Part I 27. Was an autopsy perfo d7 _ Q Ves No ~ 28. Were autopsy f dings available To completes the cause of death? ~ Q Yes O No 9I 29. if Female: 30. Dld T co Usa Cgntribut< <o Death? 31. fvla of Death Q Not pregnant within past year Vea ~] Probably aural ~ Homicide Q Pregna t Time of death Q No p Unknown Accident p Pending InvestigaClon Q Not pregnant, but pregnant within 42 of ~ Suicide 0 Could not be determined 1-- ~ Not pregnant, but pregnant 43 days to 1 r efore death s 32. Date of Injury (MO/Day/Yr) (Spell Month) Unknown if pregnant within the pas[ year 33. T~me 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 37. It Tra nsportghon injury, SpacifY: 38. Describe How inju y Occt.rretl: )~ Yes [] Driver/Operator Q Pedestrian Q No p Passenger ~ Other (Specify) 39a. Cer eck only one): rtifying Physician - To the best of my knowled ath o red due to the cause(s) and m stated u Occurred aT the time, date, and place an d tO the c se(s) and Tan tl ne st ~ onouncing g. Cert4fying physician - Tp wl gpd~gp[•ar slated Q Medical Examiner/Coroner - On t ,and/or investigation, in my opinion, death occurred i ate, and place, and d ~ y ~ / ~ / ~ ! /l L '-C Signature Of certifier: Title of certifier: ~ License N G 39b. Na Address nd f erso Completing Cau f Oe th Item 26) ^,~~ h~~~ 39c, to Signed (MO/Day/Yr) a ~v erg Ch rcLi iPa o 6~•g ~ o2o~Z ~i. , er ~I~al~e'- 89o 40. Regisxra is District Number 41- errs $Igna[ur 42. R IsTrar FII ate ( o Oay/Vr) ~ cb.4~~~~ ~S-s 9~ I 4~sni)iE C' ,{ SS ~ I ~ ~hc~c4 ec~T yes 3h,pd~n' J-I-cgHScl',o,+i `vi~clurG X17 - ~~ . d ~ Disposition Permit No. L/ /~.lU / `r`T- REV 07/2 11 LAST WILL AND TESTAMENT OF DONALD E. FORSBERG Date ~ ~-1 ~ 9 , a DOS (,v~ I1~arr- L• 5~~d~ Witness ~l3Lc-~o h Ci... Witness ~.~ =~ N - ~ ~ ,~ -,o ~ rY, ~ ~; ,, i~ w ~ --- ' , ~ ~ ~ 4 `i , ~+} l- -J ~ ~ N `~ t" ~"1 ~ r + L • M1 h LAST WILL AND TESTAMENT of DONALD E. FORSBERG I, DONALD E. FORSBERG, of Camp Hill, 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 and making void all former wills, codicils and other testamentary dispositions by me at any time heretofore made. 1. I direct my Executor, hereinafter named, to pay as soon as practicable after my decease all my legally enforceable debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all of my estate, whatsoever and wheresoever situate, unto my wife, Clara E. Forsberg, providing she survives me by sixty (60) days. 3. Should my wife predecease me, or die on or before the sixtieth (60th) day following my death then and in that event, I give, devise and bequeath all of my estate to my children, Donna L. Clapper and Donald E. Forsberg, Jr., equally, share and share alike. 4. Should either of my children predecease me or die on or before the sixtieth (60th) day following my death, then and in that event, I give, devise and bequeath the share of my estate, to which my deceased child would have been entitled had she or he survived me by more than sixty (60) days, to my surviving child. 2 •, ~ ~ `• 5 I appoint my daughter, Donna L. Clapper, Executrix of this my Last Will and Testament. If Donna L. Clapper fails to qualify or ceases to act as Executrix, then and in her stead I appoint my son, Donald E. Forsberg, Jr., as Executor. 6. My personal representatives shall have the following powers in addition to those invested in them by law and by other provisions of my Will, applicable to all property, including property held for minors, whether principal or income, exercisable without court approval and effective until actual disbursement of all property: A. To retain any or all of the assets of my estate, real or personal without regard to any principle of diversification, risk, or productivity. B. To invest and reinvest in all forms of property, including stocks, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania Fiduciaries, as they deem proper, without regard to any principle of diversification, risk, or productivity. C. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as my personal representative from time to time thinks proper in its sole discretion. E. To make distribution in cash or in kind or partly in cash and partly in kind. I direct that my Executrix, and her successor, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Donald E. Forsberg, the Testator, have hereunto set my hand and seal to this my Last Will and Testament on this / 9~~ day of ~~ , 2005. (SEAL) Donald E. Forsberg 3 . ~ ...' ~ , Signed, sealed, published and declared by the above named, Donald E. Forsberg as and for his Last Will and Testament in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ,~ ~ .~ A E(, Witness Witness COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, Donald E. Forsberg, Testator, 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 willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn to and acknowledged before me by Donald E. Forsberg, the Testator, this /9 ~` day of f'-'t~ ~ , 2005. (/~~,~,l~at ~-`~~ (SEAL) Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Dawn S. Sunday, Notary Public Mechanicsburg eoro, Cumberland County My Commission Expires Oct. 1, 2008 Member, Pennsylvania Association Of Notaries 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, ~~, Z c~,1~e.~ r'~~,tvha and wr i)rarn L . SS~natG-~ ,the witnesses whose names are signed to the attached or foregoing inst~eing duly qualified according to law, do depose and say that we were present and saw the Testator, Donald E. Forsberg, sign and execute the instrument as his Last Will, that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, that each of us in the hearing and sight of the Testator, signed the Will as witnesses, and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by ~ / r z a.~Q.~.. ~ fd/~~ and ~~, ~ ~ , ~.,.~ L S u rt ,witnesses, this ~ 9 ~---day of , 2005. Witness Witness Notary Public COMMONWEALTH OF PENNSYLVANIA Ndtarial Seal Dawn S. Sunday, Notary Public Mechanicsburg Boro, Cumberland County My Commission Expires Oct. 1, 2008 Member, Pennsylvania Association Of Notaries 5