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Home My WebLink About03-16-12PETITION 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: LEWIS E. BELCHER FileNo• .t~-I.:~_(-~U aik/a: - _ (Assigned by Register) a/k/a: _ a/lc/a: Social Security No: 185-12-9413 Date of Death: 3/8/2012 Age at death: 88 YEARS Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA (State) with his/her last principal residence at 26 RIDDLE ROAD 17011 CAMP HILL CUMBERLAND _ Street address, Post Office and Zip Code City, Township or Borough Countv Decedent died at 26 RIDDLE ROAD 17011 CAMP HILL CUMBERLAND PA• 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 If not domiciled in Pennsylvania .............................Personal property in Pennsylvania If not domiciled in Pennsylvania .............................Personal property in County $ 380,000.00 Value of real estate to Pennsylvanta .............................................................. $ 12 0 , 0 0 0 • D 0 TOTAL ESTIMATED VALUE.... $ 5 0 0, 0 0 0. 0 0 Rea]estateinPennsylvaniasituatedat: 26 RIDDLE ROAD 17011 Camp Hill Borough Cumberland (Attach additions! sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough Countv ® 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 $ / 2 ^ / ~ ^ ^ 9 and Codicil(s) thereto dated Slate relevant circumstances (e.g. renunciafion, death ojexecutor, etc.) ~-- "- ~-I ~~ ~ ~rj Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, wj warty te~pendif3g~ C.% divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not~it~i gild born or ~ ~J t= adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~ ;`% ,. ~ - ° ® NO EXCEPTIONS ^ EXCEPTIONS '~7 7 ,~ ~ ~. ~~ ^ B. Petition for Grant of Letters of Administration (lf applicable) _ a == i--r c. t. a., d. b. n., d. b.n.c.t.a., pendente life, durante_ sentiq duran e~rtinortYil2 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. ^ 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, ifnecessary): Name Relationship Address Form RW 02 rev. !0/!1/20!! Page I of 2 Oath of Personal Representative ottuai usee u~~y COMMONWEALTH OF PENNSYLVANIA } } SS: COiJIv'TY OF CUMBERLAND } Petitioner(s) Printed Name Petitioner(s) Printed Address SUSAN L• HIRSHMAN 151 YELLOW CAMP HILL BREECHES DRIVE PA I 17011 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 Decede the Petiti~r(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before ~ ~~ ~ ®.3 ~ me tl~'s~~~~~~~ day off, ~-- tlp~ ~`1 cam' /~- Date $ ~i,r,tii'{` ~ ~ ~_ _-,GL~"l2 ~G ~ Date y~ ~" Date For the Register Date BOND Required: ^ YES ^ NO FEES: Letters ....................... $ 410.0 0 (8 )Short Certificates(s) ...... 32.00 ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other Will .,...,.., 15.00 Automation Fee ................. 5.00 JCS Fee ....................... 23 • 50 TOTAL ......................$ 485.50 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ~ _ ID Number: ~ - _ ~ ~ ~,, - ~ , ~ ~~ Firm Name: ~ ~ C7 ~ " ~ -~ ~ --> Address: ~ ~ }' rr- - -~_r «=' fJ~ x ~ %.1 i ..~`~~ ~~ a.._.~ _ .. -~-: Phone: si --r ` ~ n`r=t ~ Fax: G} ~'~ O Email: DECREE OF THE REGISTER %1 Estate of LEWIS E • BELCHER File No• .~ ~ - ~ ~ ~ ~' a/k/a: • AND NOW, ~ CP ~' ~ ~~~~C ~'} ~ C ~ ~-' , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~' ~~Ci r'Yl >vY~ ~C~ r~ C - are hereby granted to ~ LtS c'; r'1 L . E}l f S~ ~ ~-~ ~z +,, in the above estate and (i.f applicable) that the instrument(s) dated _ b` ' ^' ' ~' ~ n n n f~~ La described in the Petition be Form RW-02 rev. 10/U/?01 / to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ~,~~~ ~t~ ~~ ~~~ ~, ~ .~ ~• ~ Page 2 of 2 LOCAL REGf57RAR'~ R`~fIFfCA~ftJfV Gf~ ~ ~~~:,~, ~_~L~1,,~N~;~I~al to cluptic~t~ tt~~~ cc~~a}~ ~y phcstostai ,ar ~hcs;, , ~,.' CLERK nr ~ ~~ ~)i (,~~~ ._ v V ~ hr;~ ~ .. ~' 1$ ~ ~ ~ ~ ~~~~~~ "~'~, ~~ PA ~ -~~: ``' ~~ a~-'' R 2 2012 .. --- ---- -- - --- - ~ ~ MA ~~, . _ _ Cert,f, aei. „ Ltu»~~>e~ II _ -_ .,,, - , Type/Print In COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH ~ VITAL RECORDS 1 Permanent ~~ j 1. Decedent's Legal Name (First, Middle, Last, Suffix) ...., v ~ s ^ State File Number: 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo) Lewis E. Belcher Male 185 - 12 9413 March 8, 2012 6a. Age-Last Birthday (Vrs) 56. Under 1 Year Sc Under 1 D . a 6. Date of Birth (MO/Day/Vear) (Spell Month) 7a. Birth lace Cit Months Days Hours Minutes P ( Y and State or Foreign Country) gg Barnesboro PA D ecember 25 , 1923 7b. Birthplac¢ (cpr,nty) Cambria Sa. Residence (State or Foreign Country) 8b. R¢sidence (Street d N b an um er -Include Apt No.) 8c. Did Decedent Live in a Township? Penns lvania 26 Riddle Road ISIVes,tlecedentlivedin Lower Allen 8tl. R¢sitlence (County) twp Cumberland 8e. Residence (Zip Code) 1 7 O 1 1 ~ No decedent lived withi li , n mits of 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married ® Widowed 11. Su rvivin 5 city/boro. Ves Q No Q Unknown Q Di g Pouse's Name (If wife iv , g e name prior to first marriage) vorced Q Never Married Q Unknow 12. Father's Name (First, Mitldl¢, Last, Suffix) 13. Mother's Name Prior To First Marriage (First, Middle, Last) Lewis E. Belcher Sr , _ Willfelmina Sheetz 14a. Informant's Name 14b g . Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Ci Susan L_ Hirshman Dau hter 151 2 g Yellow Breeches Drive, Camp Hi11 PA 1701 s , If Death o«r,rr¢d in a Hospital: ~~ In dent ...-.ace_p D¢a[ cn¢c on y one _ _ ......................... Pa :if Death O ccurred Somewhere Other Than a Hospital: Hospice Facili ~~ Emergency Room/Outpatient Q Dead on Arrival ty u~ Decedent's Ho ~~ W me Q Nursing Home/Long-Term Care Facility Other 5 15 b. Facility Name (If not institution, give street and number; ( Pecify) .15 Ci c. ty or Town, State, and Zip Code 15tl. County of Death 26 Riddle Road a Cam Hi11, PA 17011 16a. Method of Disposition ® Burial Q Cremation 16b Cumberland Date of Dis ositi . p on 16c. Place of Dis Q Removal from State ~ Donation position (Name of ce mete ry, crematory, or other place) Ma 14 ocn¢r(sPeplfy) 2O12 , Rolling Green Cemetery 16d. Location of Disposition (City or Town, State, and Zip) 17a. signet- F Service Licensee P or erson in Charge of Interment 17b. License Number Camp Hill, PA 17011 0 17c. Name and Complete Address of Funeral Facility O ` m Parthemore FH & CS T.nc_ P.O. Box 4 1 ew Cumberland P 18 D ' I- . ecedent 1 O s Educat(on -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20 hi h ' g . Decedent s Race -Check ONE OR MORE races to indirate what est degree or level of school completed at the time of death. box that b¢st describes whether the decedent h t ~ 8th grade or less e decedent considered himself or herself to be. No dl I is Spanish/Hispanic/Latino. Check the "NO" ~ White ~ oma 9th 12 h p , - t 0 Korean grade box if decedent Is not Spanish/Hispanic/Latino. Q Black or African American Q Vietn High school graduate or GED completed amese ® No, not Spanish/Hlspa nic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Ves M i , ex can, Mexican American, Chicano Q Asian Indian Q Q Associate degree (e.g. AA, A6) ~ Native Hawa(lan Yes Puerto Rican , Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Chinese Guamanian or Chamorro ~ Fili Ino Q Master's degree (e.g. MA, Ms, MEng, MEd, MS W, MBA) Q Yes, other Spanish/Hispanic/Latinp Q p Q Samoan Q Doctorate (e.g. PhD, EdD Q Japanese Q Other Pacific Islander or Professional degree (s if p¢c y) Q Other (Sped . MD, DDS DVM, LLB JD fy) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be 22a Q White D d ' . . ece ent s Usual Occupation -Indicate ~ Japanese ~ Samoan type of work Q Black or African American ~ Korean done during most of working lif¢ DO NOT VSE RET Q Oth . IRED. er Pacific Islander Q American Indian or Alaska Native Vietnamese Q Q Oon't Know/NOL 6ure Clai M Q ASIan Indian ms anager Q Ocher Asian ~ Refused Q Chinese Q Native Hawaiian Q Other (specify) 226. Kind of Business/Industry Q Filipino Q Guamanian or Cha mono 51 1n S1S ranC r? ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r) 23b natu r f . e o BY PERSON WHO PRONOUNCES OR g Person Pronouncing Death (Only when applica blej 23c. License Number CERTIFIES DEATH g LO Z 23tl. Dat¢ 61gne (MO/Day/Yr) 24. Time of Death ~ ' ~ ~Q ( ~ (OJ 0' 1 25 . Was Medical Examiner or Coroner Contacted? Q Yes No r CAUSE OF DEATH 26. Part 1. Enter the chain of events--diseases, injuries, or mplicatlons--that directly caused the death co '4pprOJr'mate DO NOT . enter terminal events such as cardiac arrest _ respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE Interval: Enter onl . y one cause on a line. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE ---------------> a. O-Y\YJ y~~ a ~ ~ ~3 ~ ar (Final disease or condition ~' ~ t ~ //x~-a ~~ D f as a consequ ence of), l resu ting in death) ~~ ,// / se ~ w ti ll l quen a y ist conditions, Due to (or sequence of): as a con , if any, leading to the cause ~ -4 '~ Sri ~ listed on I(ne a. Enter She ~/ t t/ y ~~ /JC J ~ ~ e A ~~ UNDERL _ YING CAUSE , t ( s a conseq uen< Z (disease or Injury that ¢ ~ F Initiated the events resulting d. In death) LAST_ Due to (or as a consequence of): S 26. Part 11. Enter other signi£canT/cond't/' t ib ti t d th but not resulting in the underlYing cause given In Part I 27. Was an autops ¢rfo ~~/r h d ~ Nmoe ? ( -T 1 ~s i'-1 ~~ A ~Q'~ Q Yes V P m -r-~ v (•~L /~[ 'A~ 1'-t V a,.1 ~-~~~1-~// J 28. Were utopsy findings available ~ to complete the cause of death? 29. If Female: 0 Y c es Q No 30. Did Tobacco Use Contribute to Death? 0 Not pregnant within past y¢ar 31. Manner of Death Q Q Pregnant aL time of death Nos Q Probably ~ Natural Q Homicide Q m Q Nof pregnant, but pregnant within 42 days of dean Unknown Q gccident Q pending Investigation ~ Q Not pregnant, but pregnant 43 days to 1 year before death 32 ~ suicide ~ Could not be determined Date of Inju M . ry ( O/Day/Yr) (Spell Month Q Unknown If pregna nT within the past y¢ar ) 33. Time of Injury 34. Place of Injury (e.g, home; construction site; farm; school) 35. Location of Injury (Street and Numbe CI r, ty, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: O Yes Q Driver/Operator ~ Pedestrian Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): ~~Certifying physician - To the best of my knowledge, death occurred due to t he cause(s) and manner t t d _ s a e Q Pronouncing Jf Certifying physician - To the best of my knowledge ~ ccurred at the Lime dat d , e, an place, and due to the cause(s) and manner stated Q Medical Examiner/Coroner - On the basis of exams Ion or Investigation in m o ini d , y p on, eath occu r retl at the tim¢, date, and place, and due to the cause(s) and manner stated Si f gnature o f ~ certifier: Title of certifier: ~1.-b License Number: /`7 /~ ~ YJ~'o 33_ ~ 6 39 . Name, Address antl Zip Code of Person C ng Cause of Death Item 26) ._ 39c ~ 4 D t A . . -' J a e Signed (M Day/Yr) r , ~~ ,. ,.>,~. ~ 1v .0 1.:i C.~v>t,~ rc.~ Caw /II /!- 0 3 ~ ~ ' 40. Registrar s District Number za i L_ 41. Registrar's ature ~ (1 j 42. Re st a File D (MO/Day r) ~ i -ez ~ ~ ~ ' ~ : ~ ice. 9~ 43. Amendments Disposition Permit No. O~ ! Ol ~ ~ H106-143 REV 07/?Ott LAST WILL _~ OF ~~ 7 ~ {'~-- '~L- t'T't ~~ :J _.__ ~ l _ , _ C: ~ - ~ . t ~ ~> , ~ LEWIS E. BELCHER ~ , : ,~~'~~ y ; c~ -, _. .. .~ pa~ - ~~ r ` ~. I, LEWIS E. BELCHER of 26 Riddle Road, Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. 1. I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executrix out of the property passing underthis Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executrix even though on proceeds of insurance or other property not passing under this Will. 2. I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executrix, and all property subject to all such powers shall be included in my Estate. _ ~-~ ~~ ~' f' ~.:'' Initial 1 3. My wife, Marian L. Belcher, having passed away on March 16, 2009, I hereby give and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, together with all policies of insurance hereon, to my children Susan L. Hirshman, Jeanne M. Davis, Linda R. Benson, and Amy K. Belcher, in equal shares, per stirpes. Should my said surviving children be unable to agree between or among themselves upon such a division of said property, alternate choice of individual items thereof shall be made by them as follows: the first choice of individual items thereof shall be made by my oldest surviving child, the second choice shall be made by my next oldest surviving child, and so on according to age until an equal or nearly equal division and distribution of said property items is completed. 4. Should any of my children predecease me, then such predeceased child's share shall be divided and distributed equally among or between those of her children who may survive me at my death; should such predeceased child of mine leave no children of her own surviving me, such predeceased child's share of my said estate shall pass to my other surviving children, or their children, as hereinbefore provided. 5. In the settlement of my Estate, my Executrix shall possess, among others, the following powers to be executed for the best interest of the beneficiaries and in my Executrix's sole discretion: -~~ ~~.'? ~'; Initial 2 (a) To sell either at public or private sale and upon such terms and conditions as my Executrix may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons or acquired after my death by my Executrix, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executrix in this paragraph 4(a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executrix shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. (d) To retain any investments I may have at my death so long as my Executrix may deem it advisable to my Estate. -~~J ~ Initial 3 (e) To vary investments, when deemed desirable by my Executrix and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as she or he shall deem wise, without being restricted to so-called "legal investments". (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other. (h) To vote any shares of stock which form a part of the Estate and to otherwise execute all the powers incident to the ownership of such stock. (i) In the discretion of my Executrix, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (j) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by my Executrix with respect to any person, profit sharing or other retirement plan in which I am a participant. ~ ~ C ~r Initial 4 (I) To do all other acts in judgment of my Executor necessary or desirable for the proper and advantageous management, investment and distribution of my Estate. 6. Any person who shall have died at the same time as Testator or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased him. 7. I nominate, constitute and appoint my daughter, Susan L. Hirshman, to be my Executrix. In the event of the death, resignation, refusal or inability of Susan L. Hirshman to serve as my Executrix, I nominate, constitute and appoint Jeanne M. Davis to serve as Executrix. My Executrix is specifically relieved from her duty or obligation of filing any bond or bonds. IN WITNESS WHEREOF, I, the said Lewis E. Belcher, hereby set my hand to this my Last Will, typewritten on and consisting of these five (5) sheets of paper, at the bottom of each of the preceding pages of which I also have placed my initials, on this%;z6 day of August, 2009. ~ ~ Z Lewis E. Belcher ~~ ~'~ o~- Initial 5 On this ,;'~ ~ day of August, 2009, Lewis E. Belcher declared to us, the undersigned, that the foregoing instrument was his Last Will, and he requested us to act as witnes the same and to his signature thereon. He thereupon signed said Will in our presence, we being present at the same time. We now, at his request, in his presence, and in the presence of each of us, hereby subscribe our names as witnesses thereto and have placed our initials at the bottom of each of the precedin t at he believes this testator to be of sound mindpa gd m emorydoing, each of us declares ~~~-. residing at 3S'I ~ 3ee~~ ~, ~.r~ ~ P ' residing at %~~'fo~' n~~ ~~~ } ~.~./~~~~w U^ residing at ~~`~ l~~ryu ~~E la/~i;~~-, ~~ '~' COMMONWEALTH OF PENNSYLVANIA ~ SS. COUNTY OF ~'~; „~ 1a~',~,~;., C~ I, Lewis E. Belcher, Testator, whose name is subscribed to the attached foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed such instrument as my Last Will, and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by Lewis E. Belcher the Testator, this ;;Zb (~, day of August, 2009. ~' Lewis E. etcher ~~~ ,~~ .~ ary Public My Commission Expires: ~-'/'~~' :223868 trow~ ~ ~ ~o CNty ~Ar E~ wy ~t, tots COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~'~~~'~~~'~ ~~~ ~~ ~ SS. We, l~ c,~,,,cs\I~eesv,e. ~ _~~~...~~/ ~ ; ~.3-r;/' F~~:F~ the witnesses whose names are signed to the attached foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Lewis E. Belcher, the testator, sign and execute such instrument as his Last Will; that such testator signed such instrument willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of such testator signed such Last Will as witnesses thereto; and that to the best of our knowledge, such testator was at that time 18 or more years of age, of sound mind and under no constraints or undue influence. worn gL affirm d to and subscribed before me b ~ .fey G~'-''`~`' ~'~~~ witnesses, this ~o ~ day of ugust 2009. W NESSES: ~~~ ~ , :; ~ ~ /' '~~ ~~ ~% -~~ ~~- ~a Notary Public My Commission Expires: ~~0 ~- ~ 1NI1- AAb ~ ~"" ~ ~x. 2'o~s