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PETITION 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: WILLIAM E. RIDER
File No: ;~ ~ _-. ~ '~ --- ~`; ,~ ~ J
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 206-10-9919
Date of Death: 02/18/2012 Age at death: 90
Decedent was domiciled at death in CUMBERLAND County, pFNNSYL.VANiA (ware) with his/her last
principal residence at 703 S. SPRING GARDEN ST. CARLISLE S. MIDDLETON TWP 17013 CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 770 S. HANOVER STREET CARLISLE 17013 CUMBERLAND PENNSYLVANIA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ 300,000.00
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $ 75,000 00
TOTAL ESTIMATED VALUE.... $ 375.000 00
Real estate in Pennsylvania situated at: 703 S. SPRING GARDEN ST. S. MIDDLETON TWP CARLISLE 17013 CUMBERLAND
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Wi11 of the Decedent, dated NOVEMBER 24, 2010 and Codicil(s)
thereto dated
State relevant circumstances (eg. renunciation, death ojexecutor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced,
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and d~
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~~,
rte. ~:C~ ?. ~'t
-.,.,
r-r~ ~~ -)
tai
rtyt6rapendikt~" -`t
a cI[WFId born,~or
~..t
Q NO EXCEPTIONS ~ EXCEPTIONS"'. ~ ~ "?a `~
~-- Ts _ .
^ B. Petition for Grant of Letters of Administration (If applicable) ~ . ~ N ;.~~_ f'
c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durar~2~nin- or a e
If Administration, c.t.a. or t~b.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.
Q NO EXCEPTIONS ®EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
Name Relationshi Address
Form RW-02 rev. 10/11/301 / Page 1 of 2
Official Use Only
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Petitioner(s) Printed Name Petitioner(s) Printed Address
DAVID C. BOLDOSSER 7 VALLEY STREET CARLISLE PA 17013-3174
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 Petitione/r(s) (~11y}well and truly administer the estate according to law.
Sworn to or affirmed an subscribed b fore ~ ` Cti~} ~' 1% c~-~`"'~~ Date ~ ~-7° ~ ~ ~'
me~i~ % ~c~ay of ? ~ ' ~t f~ Date
B 4 ~,1, ~~ ~~_ ~ ~ Date
~or the Register " ~' Date
C"~ ._.,
r'~x ~')
BOND Required: ®YES Q NO To the Re ister o Wills: ~ ~
g f ~ r °i ~~' ~ ^=
~
FEES'
• Please enter my appearance by my signat y ~ ~ __
'~- `
Letters ...................... $
360.00 ~
Attorney Signature: ~_~=7th
~~ ,.~ ~ ,"
--
`?
( 1) Short Certificate(s)...... 4.00 '~ ~
~
~ -
_,..
'-
( )Renunciation(s)......... ,
~~
~y F~J ~ .'
( )Codicil(s) ............. .. .. __ F
~ ~~~ ,
( }Affidavit(s)............ ~ ~-.'
Bond ........................ Printed Name: ROGER B. IRWIN, ESQUIRE
Commission ............. Supreme Court
Other ...... ID Number: 6282
WILL ........ 15.00
Firm Name: IRWIN & McICNIGHT, P.C.
.... _ , Address: (0 WEST PnMFRF.T STREET
CART.TSL.E, PA 17013
........
Phone: (717) 249-2353
Automation Fee ............... 5.00 Fax: (717) 249-6354
JCS Fee . .................... 23.50 Email:
TOTAL ..................... $ 407.50
DECREE OF THE REGISTER
.. ~.
".
Estate of WILLIAM E. RIDER File No: ~' '" ~,,~`-. ~, ~-~i
a/k/a:
t -
-'
AND NOW, ~ ~ 1 ~ ~ ~-~ , ~ ~ ~' , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, I S DECREED that Letters ~~~~t (R'. '- 1(" t " ~ ~ 1"
are hereby granted t __
in the above estate and (if applicable) that
the instrument(s) dated 1~1 ~\I-F 1'l~ ~'~-~' ~i''
described in the Petition be admitted to probate and
Form RW-01 rev. l0/ll/3011
of record as the last Will (and Codicil(s) of Decedent.
_~'
~_ // ,
Register of Wills ~.~~ j~' ~`i ~;~~~~ ~,~~~,: ~_ _. , (,~~ - ,_
;~
Page 2 of 2
i l i. i1 f: ',.
LOCAI~-r-~F,Cai,~T,F~AR' C"iwiCA°TIC~i~+l ~~.. ~~ s .
WARNIP~ ;~,1`~ ~"il'l~c~2~l~~~u~lir:at~ ~~i~ c,~~Y ~y ~hctast;~t 1~~ p~ lay ;
,,. ~.'~
rce ?(jt t~IS. reCTsi7c.~te. ~;I~.iiU w(?f,~ ~~~ ~]~ ~~~ ~: Illt i<) ,
C ~r{ ~ y;
~p~~~~~~~ ,~~ ~ y t'c:ih(( li(' i~
~~" ~," ""f~~~~~~~T I ~ ~ ~~ x"' ~tC ) c~. ,. t
~ 18 ~ ~ C, 9 4 0 ~._~t ~w, ; r~ Pa ~ ~,~~,, .~ k,,~ ,, -
>/ _ T""
_ _
3 Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permanent reef T~r~~w~~ .-.
e
O
_ ~ ~ ~ State Fil¢ Number:
1. Oecede nt's Legal Name (First, Mitldle, Last
Suffix)
,
2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo)
William E
Rider
_
M 206 l0 9919 Feb_ 18, 20"12
Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc. Under 1 Oa 6. Dace of Birth (MO/Day/Year) (Spell Month) 7a. BJ[th pl8F4 (CI d S or Foreign Country)
Months Days Hours Minute
-
l s C..
ar11S12 r YH
90 Juno 1 3 r 1 92'1
Jb. Birthplace (cq~nty) r an
8a. R¢sitlence (State or Foreign Country) Sb. Residence (Street and Number- Include Apt No.) 8
c
Did Decedent Live in a Township?
P
~
~
sdenc¢ Count lJ yes, decedent lived in Cup l rl Mi ddb } tw
ed. Re
( v) 703 S_ S rin Garden St_ P-
C1-u11]~erland 8e. Residence (Zip Code) QNO, decedent lived within limits of
city/born.
9. Ever in US Armed Forces? 30. Marital Status at Time of Death Q Married ~'1Nidowed Il- Surviving Spouse's Name (If
if
i
w
e, g
ven a prior to first marriage)
'Ves Q No Q Unknown Q Divorced Q Never Mauled Q Unknow - am
12. Father's Name (First, Middle, last, Suffix) 13. Mother's Nam¢ Prior to First Marriage (First
Middle
L
t
,
,
as
)
Alfred Jerome Rider Mar aret M_ Lon
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number
City
State
Zi
Cod
l
s
G ,
,
,
p
e
David C. Boldosser ,other-in-law 7 Valle St_r Carlisle, PA "170"I3
c 16a P ace o Deat C ec on y one _
If Death Occurred In a Hos Ital: --•--•----- •- ----~--------- --- .... .........
P C1 Inpai"ent
If D
th O
d
i - -
---
- -
"- ~
-
:
w .....................
ea
ccurre
Some here Other Tha
n aHospital: LJ Hos
ce Faciil
-----~~•----
P~
ty Decedent's Home
Q Emergency Room/Outpatient Q Dead on Arrival ~ursin
Ho
/L
T
g
me
ong-
erm Care Facility Q Other (Specify)
15 b. Facility Name (If not Institution, give street and umber; .lSC. City or Town, State, d Zip Code
16tl. County of Death
Cha 1 Pointe at Carlisle Carlisle, PA "170'13 C
-
m LnTil
~erland
16a. Method of Disposition J~Burial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemete
ry, c tory, or other 1
Q Removal from State Q Donation rema pace)
p om¢r(spemfv) 2/23/20"12 C>_unberland Valley M~1lorial Gardens
v 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature of Fu eral Service Licens
rge of Interment 17 b. License Number
~
'J u
,lisle PA ~ 0"13
"
0 -
D 0
12633 L
17c. Name and Complete Adtlress Of Funeral Facility
~,' Brothers Funeral Home Snc_ 630 S_ Hanover St_ Carlisl PA 'i7013
'
m 18. Decedent
s Education -Check the box that best describes the 19- Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE
t- races to indicate what
highesC degree or level of school completed at the time of death. box Shat best describes whether the decedent the decedent consider
d hi
lf
e
mse
or herself to be.
Q 8th gratle or less is Spanish/Hispanic/Latino. Check the "NO" hite Q Korean
'
~
NO diploma, 9th - 12th grade box if decedent is not Spanish/His pan(c/Latino. Q Black or AF[ican American Q Vletna mese
Hi
h
h
l
Q
g
sc
oo
graduate or GED completed o, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other A
i
s
an
Q Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q N
ti
a
ve Hawaiian
Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican
Q Chinese G
'
uamanian or Cha mono
Q Bachelor
s degree (e.g. BA, AB, RS) Q Ves, Cuban Q p no Q S
'
l
l
amoan
Q Master
s tlegree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Ja
pa
nese Q
h
Ot
er Pacific Islander
Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q
Other (Specify)
. MD DDS, DVM LLB JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself TO be
22a
D
d
'
.
.
ece
ent
s Usual Occupation - Intltcate type of work
-~Jhite Q Japanese Q Samoan d
one during most of working Ilfe. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Carpet Dryer Crew Chief
Q Asian Indian Q Other Asian Q Refused 22 b. Kind of Business/Indust
ry
Q Chinese Q Native Hawaiian Q Other (Specify)
Q Filipino Q Guamanian or Chamorro C. H, Ma.Sland & 50715
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23 b. Signatu a of Person Pronouncing Death (Only when applicable) 23
BY PERSON W
Li
c.
cense Number
HO PRONOUNCES OR
CERTIFIES DEATH ~ ~ ~ , ~ -
C ~
23d. Date Signed (MO/Day/Yr) 24
- " V C~'' ~ ~ ~ R „r a) 5 q 2q ~
Time of Death (Lt C~rj L-l''
.
. ,
.
~' ~ ~ ~ ~ ~ o~ 3 1 x 25. Was Medical Examiner or Coroner Contacted? Q Yes ~~ No
CAUSE OF DEATH
Approximate
or -
26. Part I. Enter the chain of events--diseases, injuries, complications--that directly caused the death. DO NOT enter terminal events such as cardiac
t
arres
- Inie rval:
o
respiratory arre sf, or ye niricular flbrillati ithout s wing the tiolOgy- DO NOT ABBREVIATE. Enter only one cause on a Itne. Add additional Ilnes if necessary onset tq Deau,
y/r
f -
/
.
r
~
/
/
/
/
r~
< ~L
IMMEDIATE CAUSE ---------------> a. / ~"-
LI / / GL-(~~. ~//jJ ~~ S~Q ~C~G ~ ~~/S ~ /
)
(Final disease or contlition Due to (or as nseq ue nce
~~~"
of).
~
resulting in death)
-
b.
Sequentially list conditions, Due to (o as a consequence of):
If any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Due to (or as a consequence of): -
(disease or Injury that
-_ Initiated the events resulting d.
In death) LAST- Due to (o as a consequence of):
S 26. Part 11. Enter other si
¢nifi
ca
n
t cond't'o oniributi
n
a
t
d
h but not res
ping in xhe underlying cause given In Part I 27
Was
c
~ .
an autopsy perfor d?
/
'~
/
y
!
~
e
J
/
/
O Yes O
~J ~~( 2`~
~S /
T
Z1
/
/
-
°
~E'
m /7/
Gr/~
~ TG
L
7 ~ i
S
G~I w
l
~ 28. Were autopsy findings a aila ble
to c mplete the c of death?
a
q
~=
u
o O ve:
O No
29. If Female: 30. Did Tobacco Use Contribute to Death? 31. ~ er of Death
Q Not pregnant within pas[ year
es
P
b
bl
~
Q
ro
a
y ,],7~ Natural Q Homicide
Q Pregnant at time of death
No Q Unknown Q Accid
t
en
Q Pentling Investigation
Q Noi pregnant, but pregnant within 42 days of death
Q Suicide Q Could not b
d
t
~ e
e
ermined
Q No[ pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr) (Spell Month)
Q 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 a[ Work 37. if Tra nsporca[lon Injury, Specify: 38. Describe How Injury Occu rretl:
Q Ves Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (Specify)
39a
-
Certifier (Check only one):
~
(
pl Gertifying physician - TO [he best of my knowled ,death occurred due to the cause(s) antl m gated
Q Pronouncing 8. Certifying ph an - To the bes y knowledge, death occurred at the time, tlate sand place, antl due to the cause(s) antl manner stated
,
I
Q Medical Examiner/Coroner -
n
s~
the Is/of ex ~ /t/JJJppp n`~
mod//~ investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) antl manner stated
~
Signature of certifier:
Wt- f/ f' / ~ Title of certifier: M 17 License Number: M a 03'-f-$ SH E
396- Name, Address and 21p Code of Person Com pl¢fing Cause of Death (Item 26) 39c
D
t
Si
~i~.z a.~e~t X03 ,~, c3.~t~y,-.ol-~ F1„e_ '~~-~Du S ,r, ( s-
' .
a
e
gned (MO/Day/Vr)
~b ao ova
40. Registra r
S District Number 43. Regis ar's Signature ~ 42. Registrar File Date (MO/Day r)
43. Amendments
Disposition Perm tt No. `, ~ [ / ~ % ~ o H105 ,143
WILL OF
WILLIAM E. RIDER
I, William E. Rider of Cumberland County, Carlisle,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
I direct that all my jus; debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason cn my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I direct that my entire estate go to David C.
Boldosser, Charles Rider, Patti Boson, Kay
Russell and Joseph Rider Sr., in equal shares.
B. Should David C. Boldosser, Charles Rider, Patti
Boson, Kay Russeli or Joseph Rider Sr.
predecease me, their share shall lapse and be
divided into equal shares between the survivors.
4• I appoint David C. Boldosser, Executor of this my last
V4'ill. If David C. Boldosser should predecease me or
cease to act in such capacity, I appoint Ad;~ L. Boldosser
as alternate.
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
5. The Executor of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
IN WIT ESS WHER F I have he unto set my hand this
day of ,
2010.
~-.,
_~:,
William E. Rider :~~ _- ~ ' `~ :-
c7 . ,~ -~
`T' ~ - .
G~1 ~ +.~
:-~o c~ ,_
y~,:~/];1i~ ~.J ~._ -mos. ~'T
2>.
G.5 ~-~
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
William E. Rider as and for his last Will in the presence of us, who at
his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
~~~~ ~,.
WITNESS
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
County of Cumberland
ss
I, William E. Rider, the Testator, whose name is signed to the
attached or foregoing instrument, having been dul
to law, do hereby acknowledge that I signed and exec ted heccording
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
_1
L
William E. Rider
Sworn to or affirm ~d acknowle be ore me William E.
Rider the Testator, this ~~--~ uaY of _~!~~
2(11 n _,~?,
~ARWL SEAS
n J. Hogg Pub ~
Car~Fs~ ®, C
-~ ~,,~3~ ~~°^~ C0. PA Notary Public%
-__._ _ ...~ ~r .,~.. ~~ s, 2o1s
State of Pennsylvania AFFIDAVIT
County of Cumberland ss
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
We,~D~ `env !~1 s~e~'~~rand _ ~T- r•\c~~
witnesses whose names are signed to the attached or foregointhe
instrument, being duly qualified according to law, do depose and say-
that we were present and saw the Testator sign and execute the
instrument as his last Will; that the Testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the Testator signed the Will as a witness; 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,
rn to or a e and
this day of
NOTARIAL. gEq~
~ePhsn J. Hogg, perry public
C°rlis~lc ~orae CumbeNand C0. PA
~' ~rar?~e~z~ ~"~E~
..~.~..~._._._.~...___ 3.2013
~bsc ' d to befo me by witnesses,
~o~ .%~. _
ry Pl~lic/Attorney