HomeMy WebLinkAbout03-22-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~ i,l h~.~ lC.l..1~L ~ 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:
Deceden 's Information
Name: ~-~- Q~~L~ ~ ~ - ~ ~,~ ~ -'
File No: ~---_(~ _l~
a/k/a: (Assigned by Register)
a/k/a:
~~a' Social Security No: Z~Z ° 3l0 - ~ bl~-(
Date of Death: ~ ~ ~ ~ ~ 2, Age at dneath: (off}
Decedent was domiciled at death in ~Lt~Y~-~ Count 1° fQ1 (srrtr with his/her last
principal residence at 3 Ct+ 1 ~ C~ r- . ~ ~ y~ { CS w~,htX-~ayta
Street address, Post OfTce and Zip Code City, Township or Bor gh County
Decedent died at 3~~v S ~~r,.t ~~' ~~•~,~ae~.,l.~ ~L~ Gt` ~~ ~;~~ ~~
Street address, Post Office and Zip Code City, Townshir or orough Coun y State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania .......................... All personal property $ "'1 S (~ (.j ~~
If not domiciled in Pennsy[vania ........................ Persona( property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
/~` ~n _ _ ` TO AL ESTIMATED VALUE.... $
Real estate in Pennsylvania situated at: 3C~ ~ ~ . 1 ' ~-(~.d. (~ G \ ~S f (~ '1~.--~n2
(Attach additional sheets, ijnecessary.) Street address, Post Office and Zip Cade City, Township or Borough County
(gj 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 ~ ~ 3V \q~p and Codicil(s)
thereto dated
State relevant circumstances leg. renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced, was not a patty 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
--~-~. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d. b. n., d.b.n.c.t.a., pendente life, 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.
^ NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach
additional sheets, if necessary):
Name Relationshi Address r-"
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Form RW-02 rev. !0/11/2011 Page I of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
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COUNTY OF ~L+ t' 11~-F1~~~1 F'1C~ }
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Petitioner(s) Printed Name Petitioner(s) Printed ,
1 .,1
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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 ec dent, t e Petitioner(s) ill well and truly administer the estate actor ing to law.
Sworn to or affirmed and subscribed before a Date J!I ..2.2 /Z,
met is ~~ day of fL' ~ L , ~ )/~
Il ~ ~ Date
BY•i ~ ~ ~ ~~~OC~' (,d,l'~tl~~~'7 Date
For the Register Date
BOND Required: ^ YES ~ NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters ...................... $ C) ~
( ,~ )Short Certificate(s)...... I.~ C~C1
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other_(.(~i ~~ ........ ~~•~~~
Automation Fee ............... ~~ C~~
JCS Fee . .................... -~ c~C;
TOTAL ..................... $ C y ~ ~~ • `~~~~
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of _ 1--~, (~'~ V 1 M ~(`~~ ~ File No• ~? ~ ' ~ a ~ (r' - j ~~
a/k/a:
AND NOW, ~(''t ~ C ;`~ c~G ~ L~~, in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~ `ZI3.~r~LL'{~~ /7
are hereby granted to ~ ~ ~'Ll ~~ ~~• f
c in the above esta~if applicable) that
the instrument(s) dated ~~' "' " '~' "'
described in the Petitton be
Fa~m RW-07 rev. IO/1l/2011
probate and filed of record as the last Will (and Codicil(s)) of L';,cedent.
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egister o Wills l ~-
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unx vnc rz c~..o„ ~. -_ __ -_ --- -_.
LOCAEE~;lRt7~R'S CERTIFICATION OF DEATH
WARN{`lik is ((leg' ~,~ duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00 ~~~~ ~i~R ZZ ~~' ~' 2J This is to rertifti th~;t the intbrmation here l= •~~
l~tt1 !ti
rorrectly~ copied Preen an oriz;inal Certificate of Death
C( ~R~ (~F dal}' tiled with nr~ L~s 1 t~~~ai Registrar I'he ~~rigittai
D~Pf-(~'s COURj' certificate will he f(irv~arded tf~ the States ~/ital
k ~ Records Office i+3r permal~ent filing,
CU~If~E~; fiN~ . C(? Pp,
P 1619 5 016 1~~ ~ ~ ~1 ~ _ 31_-~ ~1_s:~--
--- ---
ertification Number Li~cal Registrar Date Issued
/Pant In [OMMONWEAITH Of PENNSYLVANIA • DEPMTMENT Of HEALTH • VITAL RECORDS
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a^~orteu-wre i.
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1. Decedent's fetal Name tFlnl, MItldN, Last, SuHIKI ], Se. 3. SocNl Sxudh Number .. Date of Death IMO/Day/rrl npell Mol
ALAN HAKE M 202-36-7067 March 16, 2012
Sa. 4ltlast BlrtMay (Yn) $b. Under 1 Yesr X. Untkr 1 pa 6. Date of llrth (Mp/DKY/YNr) (Spell MDMh) )a. /lrthpuce ([ley antl Suu ar Fonyn Country)
MDmnP o.ya Hwn MInPn: June 24, 1947 Mechanics Penns lvania
64
Jb. Nrthpuu IcDwhl Qmlberlard
Ba. ROkexe(SUU Or foniln Country) /b. ReiMence (Street and Number-Include Apt NO.l Bc. Dk DecedMt UVe ens TpwnsNp]
1 is 301 E
ye.
aetetlenthyee,n r)~r Allen
Meadow Driv
,
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e
two.
°d. Keskence ICOSMyI
tZmberli3nd e<.Reauencetzlptodel 17055 ^NO.axeaentlNeOwiWnnmluof city/Mro.
9. Ever in US Armed Forces] 30. Markel Sutw at Time of Oexh Marrkd Wkbwetl 11. SurMVlnj Spouse's Name (Il wile, /lee name prior ro Ilrtt marrla(el
^Yes ®NO ^Unkrown ^Dlrorced ^NMrMarrietl ^UNsnovm hfarlp-rte h], 1+(+ri
17. FatherY Name (First, Middle, fast SuNla) 13. Mpther's Name Prbr ro First NNrM[e (First, MIsNk
LasU
,
Robert E. Hake Helen A. Stambaugh
14. InformanCS Name lab. RebtbniMp [o Decadent lAf. informant's MaIRry Address (Street aM Number, Cip/, State, ZID Codel
Marlene M
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a
e 301 E. Meadow Drive, Mechanilsb PA 1705
a .......................... ...........................:.. ceo at e- on one -...-......... . .
If DeaM IXCUrtatl lnaHppkal: to lnpatknt Ilf Deatn OCCUned SOmawnere Other ThanaHUaul: 17HaSDke FaGNry ~L]-
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lSb. fatRNy Name (Ir rbt iulkutkaL lNe rtrNt and number) '15c
Cky or Tevm
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Hos ital of the Universi
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a PA Philat9el is
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m Srw. MethoO of Dhpmitbn Burial ^ Uematbn )fib. Dale of DhposlMn i&. Plsn of DNpositlon (Name or [emetery, crematory
or other axes
^RemwnrromsMte ^DOw[bn h 20
201 ,
Mechanicsbur
Cem
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ery
c S6tl. location of Dhposkbn lClry or TOVm,SUte,sM Zip) IJa. Silnatur~ (Service ll or Person lnCMrle of Interment 3]b. lkenu Number
Mechanicsburg
PA 17055 ~ ~
~ , FD-13R630
F llc. Name sM Complete Address of Funxal Facillh
~ 18. DxedM['s Etluutbn - CMCk tM bov that best tlesMbes tM 19. Dxedent of NNpank Oryln - EMCk tM 10. OxMent's Rau -Check ONE OR MORE rxes n Intlkate what
h
r knest tlelree or level of uhod tomaetee at tM Nme of dnth. k.K W t best deurlMS wMIMr tM dxedent IM dxetlent consMxetl himul/ pr Mrxlf to D<.
^ 8th lnde or less Is SwnlsiLMkwnk/latiro. Check tM'NO' White
^ Korean
^ No tliaoma, 9th - IlM trade beK if decedent b not SpaNSh/Hiswnk/latlrb.
^ wetne"kse
Ig Hyh Knool
nduat
GED
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rr
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comaele
No, not S agrR(/latino
^ A
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rkan Indian o
unHh/MI ^ Other ASNn
A
ka Na[IVe
^ some cdk/e creak, but rb scene ^Yes. Meakan, Meabn Amerlun, CMCano ^ Asian Indian ^ Native Hawaiian
^Asfoclal
tl
A
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elue(e.I~
A, AS) ^Yes. Puerto Rkan ^CNirwse ^Gwmanianpr Chamorrp
^
'
Bxhebr
s tlelru lea. BA, AB, BS) ^Yes. Cuban ^ Flliano ^ Sanloen
^Maslers deluete.l. MA, MS, MEry, MEd, MSW,MBA) ^YU.oMerSwnish/Hispnk/latlnp ^lawnese ^Other Pecllic Islander
^ Doctorate le./. PhO, EdD) or Profesabnal eeprx ISpeclhl ^ OeMr ISpecilyl
M VM IIB D
l l Decedent's Sinlle Race Self.Desk^atbn ~ CMCY ONIY ONE to iMkate what the dxetl<nt consbereo himul/ or hersell to be. lea. DxedentY Uswl Ottuptbn -Indicate type of worts
ID Whit
e ^ IaPanes! ^ Samoan
do^<duHnl most of warkiry life. DO NOi USE RETIRED.
^BNCko/Alrkan Amerkan ^KprHn ^Oth
P
h
er
aci
c Islander
^ Amerlun IMlan or Akska Natve ^ Vktnamex ^ Don't Nrgw/Ngt Sure Egllit~rtLerlt Technician
^ Awn IMlan ^ OtMr Afhn ^ RlIuSM lib. Kind o/BUaiMSa/Intlufiry
m
^ u
,
ex ^ Natlw H.wahen ^ omer Ispetlhl
^FRlaro ^Gw ,m.nprcnamgrro Communications
REMS tea • I3d MUST B[ COMPLETED 13a. Date Pronounced Dead tMO/Day/Vr) 23b. Sllwture of Person Pronouncing OnM lOnk wMn appikabkl I3c
Lkense Number
.
°EnnF"i ° ouTM P°ONOUN~ O° 0 3/1 612 01 2
lad. wee synea IMOroar/Yrl le. nme or Deatn
()9:12 ZS. Was MedkalEnminer or Coroner COntattetlT ®Yes ^ Np
PAUSE OF DEATH
Appro.imate
16. PeN 1. Entertne thaln pl events-tliseases, Inlurks,or comDlkatbns--tMt dlrxtly cawetl tM death. DO NOT entertnminal events such as cardlx arrest
Interval:
,
resarabry arrest,avenbkuhr(IbNllatbn wltnout ihowinl lM etlpbly. DO NOT ABBREMATF. Enter onk on • nallne. Aod atltlitbnal llwslf necesxry. ~ Onsetn Death
u
IMMEDIATE UUSE ----._._._> Hemorrhage following procedure for: atrial rupture
s/p ablation < 24 hr(s)
IfIMI eixase Dr condkbn Due to for as a consegwrKe oq:
reapltirylndut") ° atrial fibrillation 23 day(s)
SequenMMy Kst contlkbns, Oue [o (or as a cpnsegwrce oil:
it am, katling ro M<~~use
Iistetl on Nr,e a. Enter tM
UNOERlY1NG UUSE Oue to for as s consequence oft,
Idlsesx a Injury tM[
F bhlatetl tM events rcsulknl d.
In tleaM) LAST. Oue tp (or as a consequence oil:
,~ 36. Pan 16 Enter other shnifkant raxstlklons conMbuHa d hbut rwt resulting In the untlerlylndtause [hnnin Pan 1. 2l. Was anauropry peMormetli
~ ® ^N
ll. wxe eNmpar nnanga annaae
E to comaete the capes or deaMv
^
~c' 39. If Female:
^ N
t
l
M 30. DM Tobxco U Contdbuu to DeaM7 31. Manner of DeaM
d o
prelwM w
t
n wsl yur
^ Pregnant at tkrw of death ^Yes ^ Probably ~ Natural ^ Homkitle
^ Not pre{Mnt, bsn pr<lnant wlMin al days of tleaM ^ No ®Unknown ^ Acckknt ^ PentllnllmestlyMn
^ Suicide ^ Could not be tletermined
^ Not Dul^aM, but pregnant /3 tlaYS to 3 year bNOre tleaM
^ U
k
k 32. Dxe of Injury (MO/Ory/Yr) )Spell MomM
n
rbwn
pegnant wkMn tM past year 33. Time of Injury
3e. Place al lnlury le.E. Mme: constnMbn We; hrm, uhool) 35. Lputbn of Injury 16veet antl Number, Clty, Stale, lip Code)
3 6. Injury at WoR 3J. If TranslsMatlon Injury, Spxih: 3l. DescNM How Injury Occurred:
^ Yes ^ OrNer/Operator ^ PetlesWan
^ No ^ Passenger ^ Other lSpecily)
3 9a. Certkkr ([neck only oMl:
^ CMl/ylnl aMkkn - To tM Mst of my krowkMle, tleaM occurred due to [M tausNU and manner stated
.
® Pronountlrg & Cenllybk physician. To tlse best of my knowled/e, death otturretl at tM Ume, date, antl dace antl due to the twat:) and manner nested.
^M
dk
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e
a
Um
Mr/C .On crush of eKaminatbn,antl/orlmesllytbn, In my oanbn, death ocumed attM time,dale, and ghee,aM dw to tM <ause(sl ark manner stated.
sM^atwe or cemMr: nne mcenkkr: A.ep ucenx Nnmbeo MT196580
3 9b Name, AtltlrefsaM Code of Person COmDlatlry Cause of DeaM lltem l6l 39c. Dau lwdlMO/Day/Yr)
MARTINEZ-WI SON, HECTOR F 3400 SPRUCE ST. PHIIA., PA 19104 3 / / L
a 0. Re/NtraM1 Dlankt Numher 11. R rs ipnturc /'r
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oNpo:inpn Permit Np. 0729376 HlosaA3
----- -~-- REV OJ/2011
OATH OF NOS;-SLrBSCRIBI~TG `~TTNESS(ES)
IA ,,n/ REGISTER OF WILLS
U ~ `~' ~a ~ ~ COUNTY, PENNSYLVANIA
Estate of ~C( V{ }-~ ,
Deceased
l , ~ .S ~ J' - Gt ~ ~' and
,.
(each) being duly qualified according to law, depose(s) and say(s) that he,/ he /they was1 were ' well-
acquainted with V1 a and ani/are familiar
with the handwriting and signature of the decedent, and that the signature of ' ~ l'1 J~Ot ~--
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~'I G ~~ ~ ~ ~_
~ __.--
is i hisJher own proper handwriting.
i;aa ,-e)
~10I ask Meado,~, r, v~e
(~treet Address)
~e~~antcs ~~~~, Pfd, mass
(City, State, Zip)-~~
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~~_ day
Deputy for Register of Wills
(Signature)
(Street Address)
(Cuy, Stnte, Zip)
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Form RW-04 rev. !0.13.0(
O NTH OF NON-SLTBSCRIBItiTG `ti"ITNESS(ES)
C REGISTER OF WILLS
~,r~cL COUNTY, PENNSYLVANIA
Estate of ~ l C~1
l<lL__
Deceased
GLC ~~ v~,~e.~5
and
(each) being duly qualified accor~di1ng to law, d1epose(s) and say(s) that she / he /they ~as l were well-
acquainted with ~1(~ 1,n t-i Gt.t(SL and an~/are familiar
with the handwriting and signature of the decedent, and that the signature of t-! }-~0~,~(~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~ y~ ~ ~a,}~
is i his/her own proper handwriting.
(Signature)
(S[reet Address)
Execcrted i~: Register's Offtce
Sworn to or affirmed and subscribed
before me this ~_ ~ day
~ ~ ~ i~
Deputy for Register of Wills
Fa-m RW-04 rev. l0.I3.0(
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(City, State, Zip)
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LAST WILL AND TESTAMENT OF ALAN H. HAKE
I, ALAN H. HAKE, of the'Township of Upper Allen, County of
Cumberland and State of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this
my Last Will and Testament, hereby revoking and making void any and
all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same can be conveniently done.
2.
In the event my wife, MARLENE M. HARE, survives me, I give,
devise and bequeath my entire estate, real, personal and mixed, as
fol]_ows:
(a) I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to my step-daughter, STAGY L. POWERS.
(b) I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to my step-daughter, STEPHANIE L. POWERS.
(c) I give and bequeath forty (40~) percent of the residue
of my estate to my wife, MARLENE M. HARE.
(d) I give and bequeath thirty (30~) percent of the residue
of my estate to my daughter, LISA M. HAKE.
(e) I give and bequeath thirty (30~) percent of thr~sidue-~=
of my estate to my son, STEVEN HARE. ~ ZC7
~~
3 . .7 c`~ ~, °° p
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In the event of my simultaneous death with my wife, MARLENE C.''~
M. HAKE, I give, devise and bequeath my entire estate, real, personal
and mixed, as follows:
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(a) I give and bequeath forty (407) percent of my estate
to my daughter, LISA M. HARE,
(b) I give and bequeath twenty (207) percent of my estate
to my son, STEVEN HARE.
(c) I give and bequeath twenty (207) percent of my estate
to my step-daughter, STACY L. POWERS.
(d) I give and bequeath twenty (207) percent of my estate
to my step-daughter, STEPHANIE L. POWERS,
4.
In the event my wife, MARLENE M. HARE, predeceases me, I give,
devise and bequeath my entire estate, real, personal and mixed, as fol-
lows:
(a) I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to my step-daughter, STACY L. POWERS.
(b) I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to my step-daughter, STEPHANIE L. POWERS.
(c) I give and bequeath forty-five (457) percent of the
residue of my estate to my daughter, LISA M. HARE.
(d) I give and bequeath fifty-five (557) percent of the
residue of my estate to my son, STEVEN HARE.
5.
I nominate, constitute and appoint THE FIRST BANK AND TRIIST
COMPANY OF MECHANICSBURG, PENNSYLVANIA, to be the Guardian of the es-
tate of any legatee who is not of age of the date of my death, and
direct that said Guardian, in its sole discretion, shall apply prin-
cipal, as well as interest, for the maintenance, education and sup-
port of such child or children when the same is in their best in-
terest, without the necessity of petitioning the Orphans' Court for
permission to make such expenditures. I direct that said Guardian
shall. take possession of all insurance or annuity contracts on my life
-2-
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to which said minor or minors are entitled, and any and all pensions
or death benefits from my employer or from any society or organiza-
tion of which I am a member, said proceeds to be added to the share
of each child under this Will.
6.
LASTLY, I nominate, constitute and appoint my wife, MARLENE
M. HAKE, Executrix of this, my Last Will and Testament, and in the
event she should predecease me, or should she be unable or unwilling
to serve in such capacity for any reason, I nominate, constitute and
appoint my brother, GALEN E. HAKE, Executor of this, my Last Will and
Testament, in his place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
3 ~ ~ day of March, A. D. 1990.
(SEAL)
Alan H. Hake
Signed, sealed, published and declared by the above-named
ALAN H. HAKE, 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.
s s- .
-3-