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HomeMy WebLinkAbout03-26-12PETITION 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: Glenn R. Adams File No: 21•• j~ `~• ~~~ a/k/a: Ravmond Glenn Adams (Assigned by Register) a/k/a: Date of Death: 2/13/12 Age at death: 84 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 343 D. Street, Carlisle 17013 Carlisle Borou hgh Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 361 Alexander Spring Rd. 17013 Carlisle Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: Ijdomiciled in Pennsylvania ................................All personal property Ijnot domiciled in Pennsylvania .............................Personal property in Pennsylvania Ijnot domiciled in Pennsylvania .............................Personal property in County value ojreal estate in Pennsylvania ............................................................. . Real estate in Pennsylvania situated at: (Attach additions! sheets, ifnecessary.J g 50,000.00 TOTAL ESTIMATED VALUE.... $ 50,000.00 Street address, Post Office and Zip Code City, Township or Borough County ® A. Petition for Probate and Grant of Letters Testamentarv Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 4/23/86 and Codicil(s) thereto dated None State relevant circumstances (e.g. -enunciatwn, death ojexeeutor, erc.) 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 bom 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 life, durante absentia, durante minorttate If Administration, c.t.a. or d.b.n.c.t.a., Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS _ ..,, as defiriod~ :~t:r~r-t 7 3a~ ry'_' _ ~ c=. Petitioner(s), after a proper seazch has/have ascertained that Decedent left no Will and was survived by the fallowing spous~6ddy~ additional sheets, if necessary): CJ ~ ©"T1 Name Relationship G~ Address .~ D (7"s _ . ~ v 1~ 7 he~(attach' ,'-=' ~._, ~ _ T; lt' _ ~ c~ Form RW-02 rev. 10/l //2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Petitioner(s) Printed Name Petitioner(s) Printed Address Margie M. Adams CLERK GF 343 D Street Carlisle PA 17013 Cl1MRE~l ~~~ C~ PA I, 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 Petitioner(s) will well and truly administer the estate according to law. t_.; . Sworn to o~affirmed and ubscrtbe~'efRr~J ~ "i~~Jct~a~ ~Yl -- Date ~' ~ g - ~ a me `} day of ~~ a'' Date By. ~!r~~~l Date For the Register Date BOND Required: ^ YES ®NO FEES: Letters ....................... $ ~V ( /)Short Certificates(s) ...... ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commissi ~ , . ................. . Other ~ "- Automation Fee ................ . JCS Fee ....................... TOTAL ......................$ f To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Christopher F's. Rice Supreme Court ID Number: 90916 Firm Name: Martson Law Offices Address: 10 East HieJt Street 'I Official Use Only r ~"r [[ Carlisle PA 17013 Phone: (717, 243-3341 Fes; (717) 243-18.50 Email: crice(c~martsctnlaw.com DECREE OF THE REGISTER Estate of Glenn R. Adams File No: 21-_ 1~ "' ~ ~~ a/k/a: Raymond Glenn Adams AND NOW, ~ o~ (~ ~~ ~ , in consi ration o~f~the foregoing Petition, satisfactory proof hav~ g been presented before me, IT IS DECREED that Letters s~~ ~1~~ ~~ are hereby granted to Mar~,ie M. Adams in the above estate and (if applicable) that the instrument(s) dated 4/23/1986 described in the Petition be admitted to probate and filed of recay;d as the last `]dill (and Codicil~~s~ ofof Register of ~Vill~`" '~J- Form RW-02 rev. l0/ll/2011 ~ Page 2 of 2 n p;.crs RF': i9;',.: ,~y ~ GISTRAR'S CERTIFICATION OF DEATH ~Fi ) I~/ t is illegal to duplicate this copy by photostat or photograph. ~~~i'ty~ ~- , I...,., Fee for this certifica~~~~4.Qp~, 26 P ~~~ C~; ~ {~ This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The o iginal ~~~~( (}F certificate will be forwarded to the State Vital QRPH~1~ S ~~URr Records Office for permanent filing. [` C;~ . PA ~. 8 21~ t.~.~yh,~Cl ~~~~~ FEB /13 Z01a ~~ ` Certification Number Type/Print in Permanent Black Ink G rl \\ V ~. ~ G5 ~_ Local Registrar ~ {~ Date Issued COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CERTIFICATE CIF DEATH 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Raymond Glenn Adams Male Februa 13, 2012 Sa. Age-Las[ BlKhtlay (Yrs) 6b. Under 1 Year Sc. Under 1 Da 6. Date of BIKh (MO/Day/Year) (Spell Month) 7a. Bin:hplace (City and State or Forelgn Country) 84 Months Days Hours Minutes Nov 29 1927 P _ f ]b. Bin[hplace (County) ppt.. 8a. Resld e n ce (State or Forelgn Country) Hb. Resldence (Street and Number -Include Apt No.) 8c. Ditl Decedent Live In a'rownshlpT E 2 A _ 343 D _ Street Oyes, Decedent Ilved In _ twp. 9d. Rezitlence (County) Cumberland Be. Resldence (2Ip Gode) o, decedent Ilved wlthin limits of C`a 7 i al p city/boro. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death a7ried Q Widowed 11. Iving Spou e's Name (If wife, give name prior to first marriage) ~ argle ~'1. Jumper Q Yes (~NO QVnknown QDivorced QNever Marrle QUnknown 12. Father's Name (First, Middle, Last, Suffix) 33. Mother's Name Prior to First Marriage (First, Middle, Last) E. Howard Adams Elizabeth Messimer 14a. informant's Name 146. Relationship to Decedent 14c. Informant's Malting Addres!: (Street and Number, City, State, Zip Code) g Margie M_ Adams wife 343 D_ Street, Carlisle, PA 17013 G awe p .,.«..o,,,y pne _ If Death Occurred in a Hospital: Inpatient ; If Death Occurred Som where Other Than a Hospital: ~ Hospice Facility ~• Decedent's Home Q Emergency Room/Outpatient Dead on Arrival - Nursing Home/LOn -Term Cara Faculty Cliher (Specify) i5b. Facilit?, Name (If not institution, glue street and number; 15 c. City or Town, State, d Zip Code 15d. County of Death Carlisle Regional Medical Center Carlisle, PA 17013 16a. Method of Disposition Burial Q Cremation 16b. Date of Dlspositlon 16c. Place of Disposition (Name of cemetery, crematory, or other place) p Rem yal frpm scats p opna[ipn oOther (Specify) Feb 17 , 2012 Westminster Memorial Gardens i 16d. Location of Disposition (City or Town, State, and Zip) 17a. 5 ajolt tyl'e of Fu a al 5 ensee or Person in Charge of Interment ~~ ~ ~y 1]b. License Number Carlisle, PA 17013 ~ ~ _~ T- 138504 17c. Name and Complete Address of Funeral Faculty 3 Hoffman-Ro h Fun al H & Cremato 219 Hanover Stree Carlisl PA 17013 °e3 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race - Gheck ONE OR MORE races to indicate what I- highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to ba. $] 8th grade or less Is Spanish/Hispanic/Latino. Check the "NO" Q, White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed ['~NO, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other ASlan Q Some college redit, but no degree Q Ves, Mexican, Mexican American, Chicano ~ Asian indlan Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chine::e Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q FIIlpino Q Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, ocher Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Ocher (Specify) . MD DOS DVM LLB lD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself (o be 22a. Decedent's Usual Occupation -Indicate type of work White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIREp. Q Black or African American Q Korean Q Other Pacific Islander Laborer Q American Indian or Alaska Native Q Vletna mesa Q Don't Know/Not Sure Q Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Tire Mf g _ Q FIIlpino Q Guamanian or Chamorro ITEMS 23a - 23d MVST BE COMPLETE 23a. Date r cad Dead (MO Day Yr) 23 . Signature of Person Pronouncing Death ( my when applicable 23c. License Number BY PERSON WHO PRONOUNCES OR T I Z O I z CERTIFIES DEATH Z 13 23d. Dot Slgn9d (MO/Day/Yr) 24. Time of Death z /3 / a v / Z~ ~ ~ ZS. Was Medical Examiner or Coroner CantaRed7 Q Vez ~ No CAUSE OF DEATH Approximate 26. PaK 1. Enter the chain of a ants--diseases, Injuries, o mplicatlons--chat directly c sad the death. DO NOT enter terminal events such a ardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a I(ne. Add additional lines If necessary Onset to Death IMMEDIATE CAUSE > Cif /2 Q//S-G X22 E'S' T (Final disease or condition ~ Due to (or as a consequence of): resulting in death) b. ~,yo X/ c 3 /L ,6-/,t/ 1 NJ u 2 Y Sequentially list conditions, Due to (or as a consequence of): If any, leading to the cause Iistetl on line a. Enter the f ~~Q ~ ~- ~~~ / 0 ~~ UNDERLVIN6 CAUSE Due to (o as a consequence of): (disease or inlury that F Initlatetl the a_vents resulting d. ~ in death) LAST. Due to (or as a consequence of): a 26. PaK 11. Enter other I n fl ItI rib tin i h but not resulting In the underlying cause given In Part 1 27. Was autopsy performed? D Yes Q No ~ 28. Were autopsy findln gs available m to complete the cause of deathT Yes Q No 3~ 29. If Female: 30. Dld Tobacco Use Contribute to DeathT 31. Manner of Death Q No[ pregnant within past year Q Ves Q Probably ~ Natural Q Homicide s Q Pregna a[ time of death Q No Q Vnknown ~ Accident Q Pending Investigation °.~ Q Not pregnant, but pregnant wlthin 42 days of death Q Suicide Q Could not be determined ~ Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr) (Spell Month) Q Vnknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; conStruRlon site; farm; school) 35. Location of Injury (Street and Number, City, State, Zlp Cotle) 36. Injury at Work 37. If Tra nspo Kation Injury, Specify: \ 38. Describe How Injury Occurred: Q Ves ~ Driver/Operator Q Pedestrian , Q No ~ Passenger Q Other (Specity) 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death o cu rred tlue to the c use(s) and manner statetl ~rVronouncing 8 Ce Kifying physician -TO the best of my knowledge, death o red at the time, date, and place, and due to [he c se(s) and m stated r Q Medical Examiner/Coroner - On the basis of examinations and/or Investigatlonr In my opinion, death o ccur r ed at the time, elate, and place, and tlue to the ca se(s) an d manner stated w J ~ a-~ / Signature of ce Kifler: Title of certifier: /'!/~ License Number: / • D O ~ y 3 Z Z ~- 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Sign d (MO/Day/Yr) ~v~-f~32 N/ iEf K/ r /'TO ,3~/ ~LEX,A,VpER SCR /N6 RD- c~~oRL/SLi= /°~/7~/ Z ~/3 ~ZO/Z 40. Registrar's District Number 41. R istrar s Signatur 4 Registrar Fi a Date Mo Dsy r ~~ -a-iv ~~ 72. F~b_ i3 ~oi~- 43. Amendments - Dlspositlon Permit No. D ~ ~ I ~ O ~ H305-143 REV 07/2011 OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS cuMSERLAND _ COUNTY, PENNSYLVANIA Deceased Estate of GLENN R. ADAMS MARGIE M. ADAMS and ' (each) being duly qualified according to law, depose(s) and says(s) that she / he /they was /were Well- and am/are familiar acquainted with GLENN R. DAM with the handwriting and signature of the decedent, and that the signature of GLENN R. ADAMS to the foregoing instrument purporting to be the Last Will and Testament/Codicil of GLENN R. ADAMS is in his/her own proper handwriting. (Signature) (Street Address) (City, State, Zrp) Executed in Register's Office Sworn to or affirmed and subscribed before me this%1~ day of ~ ~~~-~ ~~~/ V eputy for egi e of Wills .,.~~ V ~ - (Signature) 343 D Street (Street Address) Carlisl - PA 17013 (City, State, Zip) n rU ~ O ~ `~ rF7 ~ - r~r 1 C"~ C3 ~~~ ~ ~ v ~ _ _ ~~ ~_ ~- cn ~ ~`~~ -; ..~_~ J~ ~~~ rn ~, --, ?,. ~ cn p ~ Form RW-04 rev. 10.13.06 r ~'_ s_ ~ ~. _.,. ~~ OATH OF SUBSCRIBING WITNESS(ES) ;'~li? BAR 2b Ai°! 9~ 16 REGISTER OF WILLS CLEPI~ C~- ~ r ORPHRN'S COI,R CUMBERLAND COUNTY, PENNSYLVANIA CllMRE~"_~~ C;0 . PA. Estate of GLENN R. ADAMS ,Deceased SHIRLEY W. AHLERS , (each a subscribing witness to (Print Name/sJ they Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she /.lie./ >r~ay was / present and saw the above Te:>tator / T~~ sign the same and that -~ / dial tklEe3c signed the same and that she /~e--they- signed as a witness at the request of the Testator / xir~t~t.:~~ - in ~ his presence and in the presence of each other. (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills GPI/ ~ ~ ;, (Signature) 20 Strawberry Drive (Street Address) Carlisle PA 17015 (City, State, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this ~~~ ~~ day l NOTARIAL SRAi • otary Public victoria L. Otto, Notary Public y Commission Expires: Carlisle Boro, Cumberland County M~ commission ex ices December 20, 2014 ignature and Seal of Notary or other official qualified to minister oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 Y r F ~ ~ ~ a ti a ~^ I, GLENN R. ADAMS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and testament, and revoke all wills and codicils which I have previously made. I - I give, devise and bequeath my entire estate, real and personal, unto my wife, Margie M. Adams, absolutely and in fee simple if she shall survive me. II - If my wife, Margie M. Adams, fails to survive me, I give, devise and bequeath my entire estate, real and personal, as follows: A. One-half to my son, Glenn R. Adams, Jr., if living, otherwise to his surviving issue, per stirpes. B. One-half to my son, Donald E. Adams, if living, otherwise to his surviving issue, and if no issue survives, then one•-fourth to my daughter- in-law, Cathy Adams, and one-fourth to the issue then living of my son, Glenn R. Adams, Jr. III - Any share of my estate which shall become distributable to a minor may be held in a savings account, certificate of deposit or similar security, in a federally insured banking or savings institution in the name of the minor and marked not to be withdrawn until the minor attains the age of 18 years. IV - I appoint my wife, Margie M. Adams, as Executrix of this will. If for any reason she shall fail to qualify or cease to act as ;such during the administration of my estate, I appoint my sons, Glenn R. Adams, Jr. and Donald E. Adams, as substituted executor. I direct that no bond shall be required of any fiduciary named in this will. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~3 day of f 9 8'6 April, ~-9$5z ~i ~ ''~'"ct'-%d"~'"° ( SEAL ) Signed, sealed, published and declared by Glenn R. Adams, testator above named, as anr3 fnr h;_~ )?~t ?ai.ll snd tPstam~nt., written on one sheet of paper, in our presence, who in his presence, at his request, and in the presence of each .~? other have hereunto subscribed our ~ ~ names as attesting witnesses: _~ ~ n r ~ ~ . ~ .'~ O Q r.._~ -v r 01 ~' S_'a, ~`. -~ -... ~~ O; r ~~ r j ^rl: 7 f` -j