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HomeMy WebLinkAbout03-22-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTS', 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 I I Name: Helen R. Bock File No: ~'! ~ l ~ ' ~~~~ ~~a' (Assigned by Register) a/k/a: a/k/a. Social Security No: Date of Death: March 13 2012 Age at death: 87 Decedent was domiciled at death in Cumberland County, pe_ „~,lvania (scare) with his/her last principal residence at Golden Living Center 46 Erford Road Camn Hill PA 17011 Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 46 Erford Road Camo Hill 17011 Camn Hill Boroueh Cumberland PA Street address, Post Office and Zip Code City, Township or Borou h g County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 4,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ................................................... . ..... $ TOTAL ESTIMATED VALUE.... $ 4.000 00 Real estate in Pennsylvania situated at: (Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough Coun ty ® A. Petition for Probate and Grant of Letters Testamentar Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated Jttne 22, 2006 and Codic s thereto dated none - ( ) 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. § :f323(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. O NO EXCEPTIONS o 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.za., 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. © NO EXCEPTIONS o EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following additional sheets, ifnecessary): ame Form RW-02 rev. 10/11/2011 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Address \~~ ~e (if any) and~rs (att ~ ~~ _.~ A r` r"; ~tnX 1'V -- ."_~ ~ _ _.; 7~~ ~ -'~ ~ ~ ~ j Page 1 of 2 ]j~ L~, ~.i fW . i-1L1 ~~ _ ",ft ryi~i2 ~~~ 22 ~~~ 9~ 56 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the fore oing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec ent, th itioner will well and t y administer the estate accordin to law. Sworn to or affirmed d subscribed before ~~~~-~ Date 0 2 2 me thi day of ~A rt,~~ r'~ ~~, Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'c 12 ~~R 2~ Gig 9~ 5Ei The Petitioner(s) above-named swear(s) or affirm(s) the statements in the fore oing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec ent, th itioner~well and t 1 administer the estate accordin to law. - T Date 0 Z 2 / Sworn to or affirmed d subscribed before me thi day of ,~1~~ Date Date By: Date For the Register BOND Required: Q YES NO To the Register of Wills: FEES• Please enter my appearance by my signature below: Lettesrs .................... .. $ ( ~ )Short Certificate(s).... . . ( )Renunciation(s)....... . . ( )Codicil(s) ........... . . ( )Affidavit(s).......... . . Bond ..................... ... Commissioq ............... 1 .. . Other ~~ ••••• ••• ..... Automation Fee ............ ... ... 'r ~~ JCS Fee .................. ... TOTAL .................. ... $ Sl S . (~~~ Attorney S' ture: /~ ~~ Printed Name: Richard L. Pla<:ey, Esquire Supreme Court ID Number: 7232 Firm Name: Placey & Wright Address: '~^' wr^~''' ~~"^' street - Harrishurg. PA ~ ~> > n_i az2 Phone: (717)236-9577 Fax: (7171236-0843 Email: =~la = end nPt DECREE OF THE REGISTER Estate of Helen R. Bock a/k/a: AND NOW, _ satisfactory proof ~~ p~~" , ~~_, in consideration of the foregoing Petition, been presented before me, IT IS DECREED that Letters Testamemarv are hereby granted to Philip L Bock III in the above estate and (if applicable) that the instrument(s) dated June 22 2006 described in the Petition be admitted to probate and filed of } } SS: } File No: ~ - I ~ "~ ~~ the last)JJill (and Codicil~s~) of `/ (' ~' ~V~~ " - Image 2 of 2 Form RW-02 rev. 10/11/2011 H105.805 REV (9/111 _ _ - - __ - - - - _ _._ LO BAR'S CERTIFICATION OF DEATH W ~L ~w ~r t ,F$ IJ~~~ to duplicate this copy by photostat car photograph. Fee for this certificate, $6.00 ~~~~ ~~~ 22 ~ 9; J~ This is to certify that the information here given is correctly copied from an original Certificate of Death C~~~K Q~ duly Filed with me as Local Registrar. The original certifiicate will be forwarded to the State Vital Q~P~Is C~U~T Records Office for permanent filing. P 181612 6 Oc~ ~~~~~. a~° c~ . P~ - - ~`'y~Z~~ M 1 8 Certification Number Type/Print in Permanent T, C _~ 'J yam' g scan R. 8 7 month Days 3a. Residence (State or Foreign Country) 8b. Re Penna_ 4E 3d. Residence (County) 8 Cumberland ae. Re 1. Ever In U~S aAr~m~ed Forces? 30. Marital Sta Q Yea ~PIO QUnknown Q Divorced L2. Father's Name (First, Middle, Last, Suffix) William Sperow ~ 2~. Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS CERTIFICATE OF DEATH 2. Sex 3. Social Security Number5tate Flle Nu4: D c of Death (MO/Day/Yr) (Spell Mo) fem '196-14-2063 March '13,20'12 t. V nder 1 Da 6. Date pf Birth (MO Day/Vear) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Hpurs Mlnutea Nov . 4 , 1 9 2 4 Leml~ ne PA idence (Street and Number -Include Apt No.) 8c. Did Decedent LWe i~ng~ Townahlp7 untyl Cum er an alEpr~~i~,R$A ~vea,detedentgyealn_East Pennsboro twp. :deneT (Zip Code) L '1 '] O 1 1 Q No, decedent Ilved within Iimlta Df _. _ Never Married Q Unkno ~ -" -'- s a""'se s name (Ir wffe, gh,e name prior to first marr w 13. Mother'a Name Prior to First Marcia (First, Middle, Last) Daisy Mae Arnt~1~ 14b. Relatlonshlp to Dettdent 14c. Informant's Malling Address (Street and Number, C son Ry, state, z+ code) a .~~.. _, O Dannah Dr. ,<:arlisle,PA 1 e/Ol 5 iSb. Faclll Name (If not ins[Itutlon, give street and numberhral l ..._.. _ ...,~„~..~: u Hoah'e Fatmty _--_Ll ~oe«a~.;r:'i+o:::e... Nurzing Home/Lang_Term Care Facility Other 5 CI ( Peci rlSC T Go den Living - Camp ~ PE~iSYtl;nd~~°dj -7p~ ~ lsa.cq~t t ypf rn a 16a. Method of Dlsposltion 0 Burial Q Cremati f - ~ Cumser~_ and on Q Removal from State onatlon t~ ~ 16b. Date of Dlspositlpn 16c. Place of Ols position (Name of cemetery, crematory, or other place) L :omer(spetlry) en ment 16d Lo ti f Mar. 21 , 20'1 Rolling Grefan Cemetery . ca on o Disposition (City or Town, State, and Zip) 1 gnatyre of F Camp Hill , PA 1 7 O l l n rvlce Licensee or P ~ ° on In charge of Interment vb. uanae Number 17t. Name and MusserigmanAFH&CS,r2ncry D- 0 1 3 1 6 3 -L 324 iB Dec d ' Hummel AvE . ,Lemoyne PA 1 7 O 4 3 . e ent s Education -Check the box that bas[ describes the hl hest de g gree or level of school com l t d h , 19. Decedent o panic Origin _ Check the 20 O d ' e e at t p e time of death. Q Bth grade or less box that best describea whether the decedent . ero ent s Race -Check ONE OR MORE races to Indigie what the dec d t Q No diploma, 9th - 12th grade Is Spanish/His panic/Latino. Check the "hl0" e en ; considered himself or herself to be. White ~ y~ High school graduate or GED co m leted box if decedent Is not Spanish/Hispanic/Latino. Q Korean Q Black or African Ameri e Q Some collage crodlt, but no degre Q No, not Spanish/Hispanic/Latino can Q Viet namese Q gmerican Indian or Al k Q Associate degree (e.g. .z,q, q5) Q Yes, Mexican, Mexican American, Chicano e as a Native Q Asian Indian Q N f r Naaw Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Puerto Rlesn a Q Chinese 0 a iVQ Ilan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW MBA) Q Yes, Cuban Q Y h Q Flltplno Guamanian or Chamorro , Q Doctorate (e.g. PhD, EdO) or Professional degree es, ot er Spanish/Hispanic/Latino Q lapaneze Q Samoan ~ Q Oth P if . MD DOS DVM LLB JD (SPecify) er ac ic Islander Q Other (Specify) 21. Ogcedent's Single Race Sel/-Designation -Check ONLY ONE to Indicate whet the decedent considered himself or herself to be. 2?a. WhRe 0 Japanese Decedent's Vsual O Black or African American Q Korean Q Samoan ccupation -Indicate type of wort done during most of ki Q American lndlan or Alaska Native QVletnsmeae wor Q Other Psclflc Islander ng life. DO NOT VSE RETRED. ' Q Asian Indian Q Other Asian QDOn t Know/NOL SUre homemaker Q Chinese Q Native Mawailan Q Flgpin° Q Refused Q Other (Specify) 22 b Kind of Business/Industry Q GusmanisnorChamorro OWn home - ITEMS - 2 MU BE COMPLETED 23a. Date Pro o nc d Dead Mo Day r 23b. Signature o P BV PERSON WHO pRONOVNCES OR CERTIFIES DEATtf -%Q / / 3 erson Pronouncing Oeat (Only when applicable) 23c. License Number 23d. D to Sign (MO/Oay/Yr) 24. Time of Death ~ ~'~s ~ /'Z~ Y ~1.~ + ~~ ~// / ( 26 Was M dl - 3 <)r ~S 7, . e e miner or Coroner Conb< ted7 xa O Yes p Nq 26. Pa 1. Enter the chain of ev t• di CAUSE OF DEATH s - seases, Injuries, or complications--that directly caused the death. DO NOT enter terminal eve Approximate rc piratory arrest, or ventricular flbrillatlon with t t h ou s owin n s such as cardiac arrest g the etiology. DO NOT ABBREVIATE. Enter onl Interval: y one cause on a Iln Add IMMEDIATE GUSE ------_-___> a e. additional lines if necessary 1 Onset to Death ~ , . (Final disease or condition ~) ~ ~ Q resulting in death) Due to (o as a consequence of): Sequentially gat condl[lons, If any, leading to The cause Due to for az a consequence of): listed on Ilse a. Enter the UNOERLYINO GUSE f (disease or Injury that Due to (or as a consequence of): initiated the evenb resulting d, In death) LAST. Due to (or as a con sequence ot): 26. Part 11. Enter other alanificanr rr.ndl L Ib ti t d h but not resulting in the underi In y g cause given in Part I 1 ' to complete the ca~ death ' Femao e: 3D. Dld Tobacco Use Contribute to Deaths Q Y N Q"FI t pregnant within pest year Q Yes Q ProbaobW^ 31. M of Death Q Pregnant at time of death Q No [Mural Q Homicide Q Not Pregnant, but Pregnant within 42 daYS of death ~Onkn [] Accident Q Pending Investlgatlon Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In u [] Suicide Q Could not be determined Q Unknown H pregnant within the past year 1 ry (MO/Day/Yr) (Spell Month) Q Ves - - ~ an. Describe How Injury Occurred: ~ Driver/Operator Q Pedestrian -~ Q No Q Passenger Q Other (Specify) \~ 39a. Certifier (Chock only one): -V'i Q Certifying physician _ To the boat of my knowledq, death occurretl due to the uuse(t) and m 0 Pronouncing ga Certifying physician - To the bas[ of my knowledge, death occurred at the qme, dale land place, and due to the cause(s) and manner stated Medical Examiner/Coroner - On the basis of examinstlon, and/or investlgatlon, in my opinion, death occurred et the time, date, and place, and due to the cause Signature of certifier: _ ~ ZZ /-t. (s) and m nner stated ~ Title of certifier. ~e~ License Number:__ ~S 6t~~j (y' ~ L 39b. Name, gddrle`s and ZI CLotde of Person Completing Cause of De th (Item 26) t tiCt~ R. ~r IGARTNER, p.Q• ~jo ~n~ ~ e~~ / ~(J t c./ 39c Data Signed (Mp/Day/yr) 40. Registmr's District Number 41. Registrar's 51 ~- I~ '- /.5~~- 2- ~Z / _ ~ ~ ~ 42. Registrar Plle Dale (MO ay r) 43. Amendments ~7 / 7 J~~' _- - J / Dlsposltion Perm It No. O>•" ~ ~ • / ~ H105-143 _. _. _ _. _ - _. _ _. _ - _ __. REV 07/2011 y tom„ i~ ~ ~ N ..~i '~ ~ i'i"'1 ~ ~~ n ~ ~ rs ~ _.~ LAST WILL AND TESTAMENT =~ z ~' N ~~~ ~'" ZG~~ _,,> ~- ~o -" ~ ~.:: r~-r HELEN R. BOCK ~ `'`' - , I, HELEN R. BOCK, now of Camp Hill, Cumberland County, Pennsylvania, do hereby declare this to be my Last Will and Testament and hereby revoke all prior Wills and Codicils made by me. ITEM I. I direct that all of my just debts and funeral expenses, including the cost of my gravemarker, if any, shall be paid from my residuary estate as soc-n as practical after my decease as a part of the administrative expenses of my estate. ITEM II. I give and devise all of my estate of every nature and wherever situate in equal shares to my children, CYNTHIA NAGY, PHILIP L. BOCK, Il[I and EARL D. BOCK, or their respective issue, per stirpes. Should any of them predecease me and die without issue, such beneficiary's share shall be paid to the surviving beneficiaries, or their issue, per stirpes, as the case may be. ITEM III. If any income or principal shall be payable to any person who shall be under the age of twenty-five (25) or who shall be incapacitated for ;any reason, my personal representative, as trustee, shall such income and principal for such beneficiary until the age of twenty-five (25) or during incapacity (whichever event occurs first) and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person after considering other resources available to such person for 1:hose needs without the appointment of any guardian or committee or any authority of court, and shall be entitled to make direct application hereunder or to make application by payment thereof to the parent or other person in charge of such person, or to his or her guardian or tc- a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be paid and distributed to such person upon attaining the age of twenty-five (25) or upon the termination of incapacity. ~. ' ~ `~ - Helen R. Bock ITEM IV. I appoint my son, PHILIP L. BOCK, III., Executor of this my Last Will and Testament. No bond shall be required by my personal representative in any jurisdiction. ITEM V. In addition to the powers given by law to my personal representative(s) and trustee(s) [hereinafter fiduciaries) in the administration of my estate and of any trust(s) created herein, they shall have the following discretionary powers applicable to all real and personal property held by them, including property held for minors, effective without court order until actual distribution. A. To retain any property owned by me at my death anti to invest any funds held by them in any stocks, bonds, notes or other securities or property, real or personal, including common trust funds, mutual funds and money market deposit accounts operated or offered by my corporate trustee, if any, or any affiliate of it. B. To sell or otherwise dispose of any property, real or personal, at any time forming a part of my estate or the trust estate, for cash or upon credit, iri such manner and on such terms as they see fit, and no one dealing with the fiduciaries shall lie bound to see to the application of any monies paid. C. To manage, operate, repair, improve, mortgage or lease for any term [even if beyond the duration of the trust(s)] any real estate at any time held or ovvned by them as fiduciaries D. To hold investments in the name of a nominee and exercise and dispose of warrants. E. To engage in litigation and compromise, arbitrate or abandon claims and property. F. To conduct any business in which I am engaged or in which I have an interest at the time of my death for such period as the fiduciaries deem advisable, with the power to ~I He en R. Bock 2 ~ ~ borrow money and to pledge the assets of the business and to do all other acts which I, in my lifetime, could have done, or to delegate such powers to a partner, manager or employee without liability for any loss occurring therein. G. To allocate items of receipt or disbursement between principal and income as the fiduciaries deem equitable regardless of the character given such items by law; to distribute in cash or kind or partly in each at valuations fixed by the fiduciaries. H. To borrow money, including the right to borrow from any corporate trustee, if any, and to mortgage or pledge as security or to hold its own stock if a corporate trustee. I. To join in any merger, reorganization, voting trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto. J. Should the principal of any trust herein provided for be or become too small in trustee's opinion so as to make establishment or continuance of the trust: inadvisable, my trustee(s) may make immediate distribution of the then remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportion they are then entitled to income. Upon such termination, the rights of all beneficiary(es) who might otherwise have an interest as succeeding income beneficiary(ies) or in remainder shall cease. K. In general, to exercise all powers in the management of the assets of my estate or the trust estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as the fiduciaries may deem best, and to execute and deliver all instruments and to do all acts which the fiduciaries may deem necessary or proper to carry out the purposes of this will or any trust(s) created herein. L. To apply income or principal to which any beneficiary is entitled, directly for his or her comfort, maintenance and support, should the fiduciaries deem such beneficiary incapable of receiving the same by reason of age, illness, infirmity or incapacity, or to pay the same to such person or persons as the fiduciaries select to disburse it, whose receipt shall be a complete acquittance therefore without the intervention of any guardian. i r- Helen R. Bock 3 M. To assume continuance of the status of any beneficiary with reference to death, marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable without liability for disbursements made on such assumptions. N. All principal and income shall, until actual distribution to any beneficiary, be free of the debts, contracts, alienations and anticipations of any beneficiary, and the same may not be liable for any levy, attachment, execution or sequestration while in the hands of any bene- ficiary, and the same may not be liable for any levy, attachment, execution or sequestration while in the hands of any fiduciaries. IN WITNESS WHEREOF, I have hereunto set my hand and seal thi~~dfay of ~(,~ l~ -~ , 2006. ,,.~~ . Helen R. Bock The preceding instrument, consisting of this and three other pages, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by Helen R. Bock, the testatrix therein named, as and for her last Will, in the presence of us, who, at her request, in her presence, aid in the presence of each other, subscribed our names a;; witnesses hereto. ~. .... /. G .,~ ~ r-r ~ _. ~~ ~~ ~ / ~~~ i 7/lU 4 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN . SS. I, HELEN R. BOCK, testatrix 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. Helen R. Bock Sworn or affirmed to and acknowledged before me, by Helen R. Bock, testatrix, this ~~'''~ day of `~`~ , 2006. EALTH OF PENNSYLVANIA Nofari2l Seal Mt'Iisa M. Ltx~s, Nary Public ~ ~•, county My CAmrttissiat Expires Oct.13, 2007 Memt~er, Pennsylvania Association Of Notaries _ %~"ti h-, Notary Public My Commission Expires: AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS. We, /~'ti..ll~~a( C, f lip.. ~ the witnesses whose names are signed to the ttached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowle t:; the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or iue ' uence. ~i";::; -~~ ~ ~~~ "~'r o~~~,Q~o Sworn to and subscribed before me this ~"`~ day of u , , 2006. COMMONWEALTH OF PENNSYLVANIA `"~!j Susqueh M-aL wp , De~ph~ ~ ~ ~ ~ l~lota~~ • rY Public My ~ Expires Oct.13, 2007 Member, Pennsylvania Association Of Notaries My Commission Expires: