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HomeMy WebLinkAbout03-08-12Reset 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: Harold O. Jacobs File No: ~ ~ - ~ ~ - ~~Jl ~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 193-36-4883 Date of Death: November 28, 2011 Age at death: 64 Decedent was domiciled at death in Cumberland County, Pennsylvania (stare) with his/her last principal residence at 524 North 3rd Street Wormleysbure Cumberland County PA 17043 Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 524 North 3rd Street Wormlesyburs Cumberland County PA 17043 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 $ 1 ~ • ~~ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ % D'~.00 Real estate in Pennsylvania situated at: 524 Nortb 3rd Street Wormleysburg PA 17043 (Attach additional sheets, if necessary.) St[eet 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 Will of the Decedent, dated August 9, 201 1 and Codicil(s) thereto dated N/A State relevant circumstances (e.g. renunciation, death of executor, etc.) 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 lite, durante absentia, durante minoritate If Administration, c.t.a. or d.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 Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survivedby the following spouse (if any) and heirs (attach additional sheets, if necessary): ~- t'~ , Name Relationshi Address -O PJ T ~ J ~ _b ~~ /~ ,~ .-.- ` ~ ~J Q `ll ~ - . D .. ` :Y'1 ~ -fir C \~ `~ f' T'i Farm RW-OZ rev. l0i/U?011 Pa~c 1 Of 2' Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF _ } Petitioner(s) Printed Name Pe ' ' ner(s) Printed Address SNtn~~( ~. PACs, ~~, N•3~p t. h)et~~-tL~~sB~~ ~~ The Petitioner(s) above-named of Petitioner(s) and that, as Pe; Sworn to or me this By: _~ For the Register or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law. ~ and subscribed before ~C~`~ _ ,~~~,~,~ Date % - ~ t -rid ~• of Date Date Date BOND Required: Q YES ~ NO FEES: Letters ...................... $ ( )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ....,,,. Automation Fee .............. . JCS Fee ..................... TOTAL ..................... $ 0.00 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~`' Printed Name: Steven R. Snyder, Esquire Supreme Court ID Number: 90994 Firm Name: Rominger & Associates Address: 155 South Hanover S r C_'arlisle_ PA 1701 Phone: 717-240-6070 Fax: 717-240-6878 Email: ~~, Pr( rnmingerla~x~ rnm DECREE OF THE REGISTER Estate of Harold O. Jacobs File No: a/k/a: AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Shirley A. Jacobs in the above estate and (if applicable) that the instrument(s) dated August 9, 2011 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills Form RGR02 rev. lh~ll;'2011 Page 2 Of 2 Oath of Personal Representative CObi~tOVWEALTH OF PENNSYLVANIA COliNTY OF Otfcial Ore Only } } SS: } Petitioner(s) Printed Name Petitiorerls) Pru;ted .yddress d The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true a,id correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of die Decedent, the Petitioner(s) will well and truly administer the estate according to law. Sworn to r~ffirme a d subscribed before ~ ~h. r~ ~ ~a~-{~.+~ Date i -// /~_ me this d y o , ~ v' Date Date By: Date r e Re~tste~ ,.,, ~ BOND Required:QYES O FEES: Letters . $ ,,ii`~ ................. ( j{; )Short Certificate(s). .... ..... l.{Ci,(i't/ ( )Renunciation(s).... .... . ( )Codicil(s) ........ .... . ( )Affidavit(s)....... .... . Bo,td ................... ..... Commission ............. .... . OthelIr • ••••• Automation Fee ............... (./~-! Fax: 1CS Fee . .................... 0 ~ " L' Email: TOTAL ..................... $ I ~- -. L ~4~ ' {J? ~\ JC~ ? ~ -rt ?j YV ~,. -~ coo ~~ fl~ C" C JC! -.,r.., ~.t'~ ~. _ . T.: ~~ c'_7 -T1 DECREE OF THE REGISTER Estate of y~ ~ '~ ~ ~ 1'~ ` ~ ~~I~l a"~ t) a/k/a: AND NOW ~')~~ ~~) ~ ~~~ ~~.~ ~~f}- , in c satisfactory proof having been presented before me, IT IS~ECREED th t Letters are hereby granted to r_~;~'111~~~.t_-~ ~~~ i~~ ~ the instrument(s) dated ~ ~ described in the Petition be admttted Form R6V-OZ rev. l0/IIi20/I File No• ~~~~1 ~ •`'~~-~., of the foregoing Petition, ~L~r,~~t:~rt ~ in the above estate and (if applicable) that probate and filed of record as the last Will (and Codici',O) of Deced?,it. 1-- ~ n ~ .~ ~} e t ~~~ Register of Wills ~ ~ ~'; ~'~ ,~ 1 ~~ ,,~ Page 2 of 2 To the Register of Wills: Please enter my appearance by my sign Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phoue H105.>S(15 kiLA rQf~U'I LOC F.~L$ RAR'S CERTIFICATION OF DEATH WA ~ `:''~t_i~~ Il~~g~l~ duplicate this copy by photostat or photograph. r ~ ; a„'li j (? Iii ,J' (;~ .~ .-,'J ~~~~ ~ t. pyarYY'""'~~-~ T(lIS IS CO l,Elll(1' Ifl ll Tfit. ll1fOTlla ILIU11 h~'CS' r~lbl,ll I: pr Fee for this certificate. X6.00 ~ r~ I R -$ ~~ L~~ ~~} ,,t''`t~P~~~--~~Eij%~ e,olrectl} ~<~pled t'um an on ~il~ 11 t~lt~l~ic~te of I>+r Ith `~t~~to~~ ~`~~_ duly fiileLi ~~Ith IIC as Local Re~ri~tlai. I'he oll~~lna ~~' ~' `,y, c,u~tlficate u~~ill 'ac frnwarded to laic Srtte Vit CLERK 4r o f , ~~~~~ Ca~.iRr ~~ ~ ~ !a~ Records Office' ir1 >ermanent filin~y_ ~_ , P 17 9 6119 ~~~-~~_,~v~ ;;,~ pa =~~;, P~~,,, ~ ~ `-9rMfN104'~~' - Certification Number jjjjO'yydrfPdtt Local Registrar Datr issued _ _ __ _ __ ___ "' rEV ,t,2o3g COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PE PRINT IN ~~LAUM CERTIFICATE OF DEATH (See instructions and examples on reverse) „_,_, ~„ ~,,,,,____ I. nLne p U°CadL4 bust Itwlde. ws, wltu) 2. Sex 3. Sadal Sacwry NunlMr a. Date d Dean IMUn, My. yaL) Harold 0 Jacobs . Male 193 - 36 - 4883 Novem er 28 2 s. Ags (Last &rlnyY) under 1 ar Urber 1 y 6. Dab a &M Monty, y . arl 7. C' and wb «tae coon ga. Plaz• d Dean Caeca aw N..,ms Days taws Sanwa Rosprtar. pgw,, 64 Yn April 5, 1947 Mechanicsburg PA , ^Inpawnt ^ERioam.wa ^ppA ^NUrsirg tbnr QReaOerca ^Oner-Spepay w C p ony a een ec cry, e«p. rwp a Dean ee. Faca,y rams ul rw nsulugm, q~~e alral Lb nurtlderl q. was Dauym a on ? ~nK 91n ®No ^ Yes 10. Rau: Amenwn Man Bradt WMe. Mc (tt yes. sP•cel' Chen, ISDedYN Cumberland W 1 "~"""'•'"°"°"'~" °ri ' ite t t Decedent's Usud Ott don Kind d wort, darw Our most d wo Ne Do nol wb reared) t2. Was Oeceynl ever .n IM 13. DauynYS Earvlbn ISpeclh ditty ngnest gray c«nplateel ta. Medal $bWS' Marrwd, Never MLr~eO, ts. Savwng Spouse (tt wee, Y•w ntai0an nanWl w w rba «s KabofBusresslalaiMq U.S. Arnwd Faces? Elemenbry! Secondary IPt21 College (t> or 5.1 Wed' DM1°rcB°'sa«'N/ Meehan. Contracto O.L. Jacobs sons ^ 10 ® vas Np Married Shirley A. Spidle t6. Deceynts MLlirg Ayres (SUeal.ory;town,wa. zp pope) oapeaanYa Penns lvania Did °BCe08N b y ~~ R es enca 17a. Salta L rv~n 17c. ^ Yes. Decedent lived n T . 5 2 4 N . 3rd S t . T ,p , Wormy bur PA 17043 ,7o cdunry C amh rand w nd. ® a~reOxiN'" Wormelysburg D" Luats Mtud crylBom t8. FaCwfs Name IFirst mdde. last suns( t5. tbttwls Name trrs, nMdla, mLyn Sonoma) Martha A. Berkheimer 20a. InlamwlYS Name (Type ; : anti 2gb. InbmanYS Maing AdMesa ISUaet dry / bwn, sbb, 7p cab) h'rle A Jacobs 524 N. 3rd St.Worrrleysburg PA 17043 2ta. Meead a Dapovtbn ®Cremalron ^ Dnalion 21 D. Dale of Dlspulam (Manor. day. veal 21c. Ponca of Oupowuon wane a camera ry. crematory«unr pace) 210. Laraoon ICIy I!own, wb, zp copal ^ Burw ^ RemovL nom Sl t a e I Was Csertuliort a OortaGOn ArAlbAaed ^°e>« 'prwaulEaalniwlcoratwT ©Yaa^Np 2 1/2011 Bitner Crematory, LLC arrisburg, PA 22a. Sgnarura d Funeral $anKe ~c a I« person acOrg as aucnt 2za Lnens° Nurtgar zzc. Narre aM AOaess pl Faonry e r l c rams 1 /~ ~ FD-014404-L 3125 Walnut St. Harrisburg, PA 17109 Compaw Mors 23ac any wram umyug WIYaKUn a raj ava,laob al rvne a xan b .sorry calve a seam 23a. to ne lws d ~ n r eland pace s bd. ISgruwra are rnal 23D. 4ca~se NuM«s ~ ~ 1 ) s y ~t Q ~ 2y Sgned 1 ~ . M', gar) . 1 1 1 ` a ~ ~ ~ O ~ ~ ~ ~ ~ " nW11t 2a~2g mat u canpbleo M pa s,n vela pronaxes dean 2a. Tore a Dean C ~ J ~ ~ 25. Dab Prawlalae0 DaaO I n, tla~Y° 7 P I~ a~ N J I I ^ 26 Was Case Rafe to Mea~cal E.wm°r ; Coraw to a Rs•am pnpr pan Gamaem a pu~ypt? M. U eL~ C A ^ Yea No CAUSE OF DEATH (Bee fnearuetbne artd exampMS) r Approxlmale ~nbrval: Item 27. Pan r. e the sAan W nears - asaases, ryuries. « Wmpacalsnns - net ycoY' ~uvp gp yen. W NOT enbr termlW erenls suds as cardiac arre t Part II: Enbr sitar - 28. Ob TaMxo Use Cowaub to Dun? s . Onset to Dean spy gory ones . « ventnaWr Iexalaaon wenow srewng the stbbgy. lial aey pne Hasa on exit lire. Out rwt rewlarg n ne unyrryvg cause Part 1. ~ n ° ° ~ 1W1E01ATE CAUSE 1FnL Oiaease « 'A ,sQ [ I Q No o l Mwlowt ' ~ ~ ~ condition raaaung In Dean) _~ a. ~'( O S v ~-^\ 29. a FLMb. Due to la as a oa sequenu al: r ^ Nd pregueN wdwt peat YaL Sagan sat 'arb~ti«Ia ;1 any. p ~ ^ PregrWN L ertw d yen aOng td cause salad m line a. Enlr the UNOERLYWO CAUSE Due b la as a cans°gwrce dl. ~ 1 ^ Na pegrunl RO pregwe won A2 yYa Itisease a nN°Y tlut ~nwatM na c evaW rudbg n yen( LAST. . d yen Due b (« as a cons•guLtce o7: ^ Nd pra4~anL IM prs¢we U yYa b t yaL I d. ~ ' Debra yen ^ UrlandYm d prsgbnt wEn aM peal year 30a Was an Aulcpsy 70D 'Nara Awopsy Fin&Igs ]I L of Dann 32a. Dale a11nNry IMonn, yY, year) 720. DascrlDe Hove Injury Occurred PMOrmed7 Ava~u«e Pnor ;o Campaaan 32c. Plan d Inyxy tome, Farm, SbeL. FL]ay a Cause W Dean? tua1 ^ 'y , Dace ~~. ~. !~/ ^ Yea Yo ~~ ~ ^ Ye5 ^ ACridaa ^ Pa(xtirlq Inveallgall«I 72d. Tune el Injury ]2a ayury L W«r? 321 It iranspNtatwn Injury (Speceyl 32q. Laauon o1 ,Mary ISeeL. v ry r town, sale) ^ $uuiy ^ Cab Nd y Oalelmalep ^ Yes ^ Mo ^ Dnver, ^ Paeae OPa dl« nger ^ Peysaan M t Over ~ SPauh' 73a. CemliL Idack city anal y • Caawying pnyaicun IPnysw.an cerurymg cause d yen wren anopwr pnysiuan nu proraunced yen and competed ~~tem 231 Td Ur M t d L ]3D $ dture and Tale d 4eNlier " ,I // / - / /1ir~ !vi /~ ' ~ ! ~~. a my awkdga, yen occumd rMw to Ur o+ue•lal +utd ntwwr u abtM _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • P l """"' ppp~.V/vv('///"`~~~ .., 1, ~~ ~s (((! l ` ranwrtcing orb uniryug pnyucbn IPhysx'iLl ono«icm9 Oeatll are uralyug to cause d dean) To t11f Mae 01 my aMwboga, ynh Occurred .dale. Ltd Dbu, and dal 10 tM CiWelal and 1lbnrer a atatM_ _ _ _ _ _ _ _ _ _ _ _ _ _ aa.diw ExamireryCaona _ _ _ _ • ]3c. Lcensu N«Mer I / / ~ ~ ~ a '_ ! L J 1]0. Date Sigwd IMonn ywl ~ / /~ O ~O~/ ` ` On tM Mab of ea IMlan aM / «i in my opinion, yatD Opplxted al IM InM, data, enp ghee, aM dtre to tM cauagf) arM menrer as shred- ^ yes Name rW Ayte ~ s d Parses Wre Caroal Cavse Oean Ilbm 27) type! Pnnl 75. P L s ~gnawr , rer / _ Sd /Q [~7 ~~iYJ(~~L ~ys~ ' ~ - IMOnn. der sear l ~~ s o ,~~L r~~i, ~ o~ ,r~~%~ , P~ ~~o~ / Oispostan Permit No. D ~~__.~~~~..~ 1 n -a _~ r ~~ te, ~ -TJ --,~ r"t"1 r THE LAST WILL AND TESTAMENT ~~~ ~ x' ~ i-. -?' V: _ T mac ~' ;: OF : ~- , ~ ..; ~, ~ ~` ~ - T1 r D ~-.. ~: ~ HAROLD OTTO JACOBS `~ I, HAROLD OTTO JACOBS, a resident of 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, hereby revoking any and all other Wills and Codicils previously made by me. I direct that all my just debts and funeral. expenses shall be paid from my residuary estate as soon as practicable after my decease. I further 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. I give, devise and bequeath all of my property, whether real or personal, including the marital residence located at 524 North Third Street, Wormleysburg, Cumberland County, Pennsylvania, 17043, and all of my financial assets, wherever situate, including any property over which I may have a power of appointment to my dear wife SHIRLEYANN JACOBS. Should my wife not survive me, then her shares to be divide equally to: CHRISTOPHER ALAN JACOBS MELISSA ANN SPIDEL ROBERT WILLIAM SPIDLE Page l or 4 I nominate, constitute and appoint my wife SHIRLEYANN JACOBS, as Executrix of this LAST WILL and TESTAMENT, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint, my son CHRISTOPHER ALAN JACOBS as Executor of this LAST WILL and TESTAMENT, to serve without bond. If both my wife and my son are unable or unwilling to act in that capacity, then I nominate, constitute and appoint MELISSA ANN SPIDEL as Executrix to serve without bond. IN WITNESS WHEREOF, I, HAROLD OTTO JACOBS, have set my hand. to this LAST WILL and TESTAMENT, this __~__ day of 2011. O?'To AROLD OTTO JACO Signed, sealed, published and declared by the above-named HAROLD OTTO JACOBS, 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 N D ~ ~ 4"- /~Y~o aY~ t/ Name Address ~iZ 7 <71~ ~awa~r ~ '(~oo~ ~- ~'l Name Address X27 JV z-'1~ 5t~eert Page 2 or 4 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA . COUNTY OF CUMBERLAND SS I, HAROLD OTTO JACOBS, 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 this instrument as my LAST WILL and TESTAMENT; that I signed it as my free and voluntary act for the purposes therein expressed. ROLD OTTO JACOBS Page 3 of 4 ACKNOWLEDGEMENT . COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND _ and We ~d,,,~~ ~ [D~-t.4.--- ~I,UGc -~~ ~~ ~ OD,r~ ~/~-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 the Testator sign and execute the instrument as his LAST WILL and TESTAMENT; that HAROLD OTTO ,JACOBS 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; aid that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. -s"~4AJ ~j~ ~ ~ ~a~ YL Name Address To~, a r yh. A- l a Name Address ~ ~ ~ ~ ~ kc~ ~~'~ e~ ®v-rK~ bt~r ~ I ~Z~~3 Page 4 of 4 ~ OATH OF SUBSCRIBING WITNESS(ES) ~ °~ ~'~ ~ ~' `~' ~ ~ =~ ~~~ a, . - REGISTER OF WILLS ~~'~~~ =' CUMBERLAND COUNTY, PENNSYLVANIA ~' ~ ra ~-_~= ?-r=, a ~ ~~~ cx Estate of Harold O. Jacobs Deceased (each) a subscribing witness to ~ (Print Name/s) the ®Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. -r'~~ ~~~ (Signature) ~ Z~~ ~ ~~ ~~~~~ (Street Address) (Gifu. State. Zip/ Executed in Register's Office Sworn to or affirmed and subscribed before me this of Deputy for Register of Wills ,~ ~ ~. ~ Notary Public N ~ My Commission Expires:5~~~{'oZ01~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary~s Commission.) NOTE: To he taken by Officer authorized to administer oaths. Pleasc have present the original or copy of instrument(s) at time of notarization. (Signature) (Street Address) (City. State, Zip) ~. V Executed out of Register's Office Sworn to or affirmed and subscribed day before me this ? day of ~~ewe-~- Da ~~ 3z < y A~ O 3 m ~z `^ ~ZyZ ~~oy0 X G Q^ Z ~ ~ W~~f m m C H «~Q~m _ r 0 Z A v Form R1V'-03 rer. 10.13.06