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Home My WebLink About03-28-12PETITION FOR GRANT OF LETTERS ~~ ~. REGISTER OF WILLS OF ~ ...aL~'^~``, ~'~ `"' ~~i~1 Gl 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 In-f~mat-i.o~n Name: "~ ~ 11~ .`~C~.Z \ ~'Y..~' ~ ,~ ~C ~,~~`~ \a , a/k/a: a/k/a: a/k/a: Date of Death: "~ Q(~ ~ ~, ;~~) '~ Decedent was domiciled at principal residence at 1 ~ Decedent died at Street address, File No• ~1 - l ~ - (~! ~'> (Assigned by Register) Social Security No: ~ ~ ~ (,~ ~~~ Age at death: _~„p Estimate of value of decedent's property at death: omtil in Pennsylvania ......................... .. All personal property I/'not Bled in Pennsylvania ........................ Personal property in Pennsylvania If not domiciled in Pennsylvania ........................ Personal property in County Value of real estate in Pennsylvania ........................................................ . Tt1TAi. FCTiMATFT VAi iiC Real estate in Pennsylvania situated at: (Attach additional sheets, il'necessary.) ~vau.c~ •r a• 11 Ja '. ~'~iT~p uml~t,l~l~~d ' county County State ~ '~~ v~J ~.uy, a ownsmp or norougn County ~~ I ~ rn [~ A. Petition for Probate and Grant of Letters Testamentary r ' 7T Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ v~ ( t ~ and Codicil(s) thereto dated 'c ,~;Y~e52__. State relevant circumstances (eg. 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 life, durante absentia, durante minoritute If Administration, c.t.a. or d.b.n.c.ta., 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 iit 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 spoll&e (if any) andrs (attach additional sheets, if necessary): t ) ~-„ n rv Name Relationshi Address ~ ?~t7 -~'" ra% 'r- ~- ~ ~ . -:- `7 c:r~ - cz~ _ ` ~- n, _- a -~ ~- ~.d"e :'~~i c'S ~? ~_~ ~. ,. ~ C:? ~:, Form RW-n2 ,-~~. roit~nn~! Page 1 of 2 _ ~ _ _ _ _ LOCAL T 'S CERTIFICATION OF DEATH WARNIN is~'tFegal ~~dgplicate this copy by photostat or photograph,. Fee for this certificate, $6.00 ~'iJi~ ~~R ~$ F~ ~~; ' T'hi~ is t> ~~~ t~f f ~~ t ~ f - P 1g~.6~233 Certification Number Type/Print In Permanent Gam" ~_ M~R_1 512012 Loco egi~,t r Date Issued COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS 1. Decedent's Legal Nama (First, Mlddie, Last, Suffix) v r ~ ^ State File Number: 2. Sex 3. Social Se<urky Number 4. Date of Death (MO/Oay/Yr) (Spell Mo) Michael F_ Dau Male 483 - 60 - 0045 March 12, 2012 Sa. Aga-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Data of Birth (MO/Day/Vea r) (Spell Mpnth) 7a Birth l . p ace (Clay and State or Foreign Country) Momtns Days Hours Minutes Fremont NE 64 June 23 , 1 947 7b. Birthplace (councy) Dod e 8a. Residence (State or Foreign Country) 8b Residence (Stre t d . e an Number -Include Apt No.) 8c. pitl Decedent Live in a Township? Penns lvania 1 O Plainview Road Yes, decedent Ilved In Lower A11en t 8d. Residence (County) wp Cumberland ge. Residence (Zip Code) QNO, decedent lived wkhin limits of city/boro. 9. Ever In US Armed Forces? 30. Marital Status at Time of Death ~ Married 0 Widowed 11. Surviving Spouse's Nama (If wke, give name prior to firs[ marriage) B Yes ~ No QUnknown Q Divorced Q N ever Married i~Unknown C nthia Ga le Clark 12. Father's Name (First, Middle, Last, Suffix) ' 13. Mother s Nama Prior to First Marriage (First, Middle, Last) Kermit Dau Be1va Pawlin 14a. Informant's Name 14b. Raladonship t° Decedent 14c. Informant's Mellin Address (St ~y~+ g reet and Number, City, State, Zip ('.ode) Cynthia G_ Dau Wife 10 Pl i L.+ a nview Road, Camp Hi11, PA 17011 ........ 'a ................................................. .........................................~........ 15a. P De C If Desch occurred In a Hos ital: wPye ,_,,,,ace.o......at..... ec..on Y one ..._ . ...... P U Inpatient lf D h ~~~~~~~~~~~ .................. i eat Occurred Somewhere Other Than a Hos Ital~ P Hos Pice Facili """" LY ~ Decedent's Home ® Emergenty Room/Outpatient 0 Dead on Arrival Q Nursing Home/LOn -Term Cara Facility Other (Specify) lSb. Facilty Nama (If not Institution, give street and number) •1S Gi ~ C. ty or Town, State, and Zlp Code intl. County of Death Harrisburg Hospital H i arr sburg, PA 17101 Dauphin I6a. Method of Dispositon Q B i l ur a Gemation 166. Date of Disposition 36c. Place of pisposition (Name of cemet¢ry 0 Removal from State Q p crematory or other l , , p ace) onatlon Other (Specify) MaJF ~~'1214, Evans Cremator Z y 16d. Location of Disposition (City or Town, States, and Zlp) 17a. SI G 1 f ral Service Lic ~ ¢nsee or Person in Charge of Interment 17b. Ucensa Number Schae££erstown, PA 17088 FD 012 848 L 17 C. Nama and Com pieta Address of Funeral Facility P h ~ a.rt emore FH 6 CS, inc., P.O. Box 431, New Cumberland PA 17070 ' ~ , 16. Decedent s Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races tq indicate wh highest degree or level of school completed at the tim¢ of d t h b a eat , ox that best describes whether the decedent the decedent co nsld¢red himseH or herself to be ~ 8th grade or lass . Is Spanish/Hispanic/Latino. Check the "N°" Whke Q Q No dl ploma, 9th - 12th grade b 0 Korean ox if decedent iz not Spa nlsh/Hispanic/Latino. Q High school graduate or GEO completed ~ Black or African American Q Vietnamese ~ NO not S i h/Hi . , pan s spanic/Latinq Q American Indian or Alaska Native Q ether Asian i~ Some collage credit, but no degree Q Ves Mexican Mexi an A i , , c mer can, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) i7 Vas Pue K° Rican , Chinese ® Bachelor's dagrae (e-g. BA, AB, BS) Q Yas Cuban Q ~ Guamanian or Cho mgrro , Q Master's tle Q FIIlpino Q Samoan gree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Vas, other Spanish/Hispanic/Lati no i7 Ja panase Q Other Paciffc Islander ~ Doctorate (e.g. PhD, Ed D) or Professional dagrae (Specify) Q Other . MD pD5 DVM LLB JD (Specky) 21. Decedent's Single Racer Se H-Designation -Check ONLY ONE to indicate what the decedent considered himself or hersek to be 22a Deced White t' l . . en s Usua Occupatbn -Ind kate type of work 0 Japanese Q Samoan done Burin Q Black or African American Q Korean ~ Other Paclflc Islander B most of working Itfe. DO NOT USE RETIRED. Q American lndlan orAlaska Native QVlatnamase QDO n't Know/Not Sure Cryp~tologi Technician. Q Asian Indian r t a 0 Other ASlan Q Refused Q Chinese Q Native Hawaiian Q Other (Specify) 226. Kind of Business/Industry ~ Filipino Q Guamanian or Chamorro US Navy fTEMS 2 3e - 23d MUST BE COMPLETED 23a. Data Pronounced Desd (MO/Day/Vr) 236. Signature of Person Pronouncing Death (Onl BY PERSON WHO PRONOUNCES OR wh li b y en app ca le) 23c. License Number March 12, 2012 CERTIE IES DEATH 23d. Date Signed (MO/Day/Vr) 24. Tlma of Death 07:31 AM 2S. Was Medical Examiner or Coroner Contacted? ® yes Q No CAUSE OF DEATH 26. Par[ 1. Enter the rhoin Approximate ~n.•~., -diseases, Injuries, r complications-that directly caused the death DO NOT t s i¢ . en er terminal events such as cardiac arrant, re plratory err t, r ricular flbrlllatlon without showin the etlolo 1 terval: B gy. DO NOT ABBREVIATE Enter onl . y one cause on a Iin¢. Add ad dklonal Ilnes if n¢cessary ~ Onset to Death IMMEDIATE CAUSE -------------_> e. Multiple Traumatic Injuries (Final disease or condition Due to (or as a consequence of): resulting in death) b. Pedestrian Struck sequennany nse ~pndltipnn• Dua to (pr as a cgnsequence pt): If any, leading to the cause listed on line a. Enter the UNDERLYING CAUSE Dua to (or as a consequence of): (disease or Injury that -- Initiated the events resu king d. ~ In death) LAST. Dua to o as a con ( r se ue nc -- f ~ yy a7. g a o ): - 26. Part 11. Enter other Ignifl t ditl [ Ib ti . S h but not resulting in the underlying cause given in Part 1 27 ' Was an aut f ~_ . o pry per ormed? ® ven D No $ 28. Were autopsy findings available ~' to complete the cause of death t 29 If Female E . : 30. Did Tobacco Use Contribut¢ to Death? ® yBZ NO Q Not pregnant with In past year 31. Manner of Death S Q Pregnant at time of death 17 Ves Q Probably ~ Natural Q Homicide ~ N ~ Q Not pregnant, but pr¢gnani within 42 days of death O Q Unknown ® Ac<Id eni 0 Pending Investigation t- Q Not pregnant, but pregnant 43 days to 1 Q Suicide Q Could not be determ load year before deatF 32. Date of Injury (MO/Day/Yr) (Spell Month) Q unknown If re na t l h i p g n w e n the past year March 1 2, 201 2 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Nu mbar City State Zi C d , , , p o a) Roadway 1061 S. Cameron St. Harrisburg, PA 17104 36 Inju t W . ry a ork 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: p ves O prover/operemr ®Pedertrlan Pedestrain Struck ® No ~ Passenger Q Other (Specify) 3 9a. Certifier (Check only ono): Q 4rtifying physician - Ta the bast of m kn ~ eaih occurred duo to the cause(s) and m er stated Q Pr i onou nc e ng S Certifying physi<la my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manne ® Medical Examin er/Coroner - On s d r ate Inatlon, and/or Investigation, In my gplnlon, death occurred of the time, date, antl plat. e, antl due to the cause(s) and manne d r rtate Slgnatu re of certifier: Title of certifier: Coroner 3 License Number: 9 b. Name, Address and Zip Code of Person Com plating Cause of Death (Item 26) 39c. Date 51 Graham S. Hetrick, 1271 South 28th Street, Harrisburg, PA 171 ~ 1 goad (Mo/Day/Yr) 4 March 13, 2012 0. Registry is Dhtrlct Number 41. Registrar's 51 r 42. Registrar Flle pate (MO Da / Y/Yr) o~ / _ ~ ~~ 4 3. Amendments ~/~-S/°~~~ ~~ ,, c ~crl ti rj~Lt tje i^ oitnahon here given Js correctly copied fr(~,m un original Certificate of Death ~~E~K ~~. duly filed with me a, Local Registrar. "I Ile origins( ~~~~,~ ~~~~~~, certificate will hr fsn~warded to r_tle State ~'iial Records Office for permanent filling. CU~~REf~I ,~N^I ~;~ . PA Disposition Permit No. OL ~ (~ 9 ~ ~ H105-143 REV 07/2011 WILL OF MICHAEL FREDERICK DAU PERSONAL INFOR1~iATION I, Michael Frederick Dau, a resident of Pennsylvania, County of Cumberland, declare that this is my will. My Social Security Number is . REVOCATION OF PREVIOUS i~tILLB FIRST: I revoke all wills and codicils that I have previously made. ~,~ MARITAL STATUS SECOND: I am married to Cynthia Gayle (Clark) Dau. CHILDREN ~ ....~ `- O _~ ''"' -T. ~ ~? ~ ~. C7 - 1 =T ran ra ~._~ ca cIJ ~, --~ rJ -r-, .., .. THIRD: I have the following child(ren) now living: Louisa Ann Dau, Keri[t~t James Edward Dau, Meghan Cathleen Dau, Elizabeth Nicole Dau. T' `'' ~:: FAILURB TO LEAVE PROPERTY FOURTH: If I do not leave property in this will to one or more of the children or grandchildren whom I have identified above, my failure to do so is intentional. DEFINITIONS FIFTH: As used in this will, the term "specific bequest" refers to a gift of specifically identified property that I leave in this will. The term "residuary estate" refers to all property subject to this will that is not passed by specific bequest or that is specifically left to or becomes a part of my residuary estate when a beneficiary of specific bequest fails to survive me. The term "residuary bequest" refers to a gift of all or a portion of my residuary estate. _,~ l ~ ~ ~_--~ '~-'~ ~-- ,~ -, ...~'~ t SPECIFIC BEQUEST OF PROPERTY SIXTH: If my wife, Cynthia, does not survive me, I give equal shares of my house, contents not specifically bequeathed, bank accounts and automobiles to each of my youngest two daughters, Meghan C. Dau and Elizabeth N. Dau, to hold and use as their own. My intention is that Meghan and Elizabeth have a home and comforts until they are of such age that they should have their college degrees and are able to fend for themselves. At such time beforehand as Meghan and Elizabeth decide, or June 30, 2006, the house shall be put up for sale and each of my four children shall have equal share in the proceeds. If any child desires to buy the house, he or she shall have six to twelve months to arrange financing at fair market value. However, if one of these beneficiaries does not survive me, that beneficiary's living children shall take his or her share equally. If there are no living children, the surviving beneficiaries shall take the share equally. If there are no surviving beneficiaries, the property shall go to-my r/~siduary estate. Page 1 : INITIALS` ~-C~ / ~ l~~ !/"~ Date: ~ ~ ~ ~ ~ ~CC~ HILL OF MICHASL FREDBRICR DAU To my daughter, Louisa Dau, I bequeath the following: the chrome Pavoni expresso coffee maker, her Grandmother Dau's cedar chest (not contents), my Spanish bedroom set, all my gardening books, the Anniversary Waltz Lladro bought for her grandparents 50th wedding anniversary, the little girl Hummel, the Talavara cruet set, and my Spanish wine barrels. To my son, Kermit Dau, I bequeath the following: my father's diamond ring, my red Pavoni expresso coffee maker, my red Pavoni coffee bean grinder, my BMW 750 motorcycle, my mechanical {not woodworking) tools, the Abraham Lladro and the Fishing Boy Lladro, the antique chocolate set brought from Germany by his great- great-grandparents. To my grandaughter, Shalah Hallford, I bequeath the the following: her great- grandmother's collection of Spanish Mud Dolls with display case, and the green and white, dresden plate pattern quilt made by my Grandmother Pawling. ///// /// /// /// /// /// I!/ /// J// /// !// /// /// //1 /// /// /// /// /// /// /I/ /// /// I// /// Page 2 Initials: ~~'C-- ~. l~f~ ~l~J Date: ~ ~ ~ ~ ` / `-' T~till of Michael Frederick Dau RESIDUARY ESTATE SEVENTH: I give my residuary estate to Cynthia Gayle Dau. However, if Cynthia Gayle Dau does not survive me, my residuary estate shall go to Louisa Ann Dau, Kermit James Edward Dau, Meghan Cathleen Dau, Elizabeth Nicole Dau in equal shares; and their individual share to their children if they do not survive me. ENCUMBRANCES AND LIENS EIGHTH: All personal and real property I give in a specific or residuary bequest shall pass subject to any encumbrances or liens on the property. SURVIVORSHIP PERIOD NINTH: When this will states that a beneficiary must survive me for the purgose of receiving a specific bequest or residuary bequest, he or she must survive me by 45 days. DIVISION OF BEQUESTS TENTH: Any specific bequest or residuary bequest made in this will to two or more beneficiaries shall be shared equally among them, unless unequal shares are specifically indicated. PERSONAL GUARDIAN ELEVENTH: If at my death a guardian is needed to care for my minor child or children, I name Meghan Cathleen Dau as guardian. If this person shall for any reason fail to qualify or cease to act as guardian, I name Ruth Akiens to serve as guardian. No bond shall be required of any personal guardian appointed under this will. PROPERTY GUARDIAN TWELFTH: If at my death, a guardian is needed to care for any property belonging to my minor child or children, I name Cynthia G. Dau as property guardian. If this person for any reason does not qualify or ceases to act as property guardian, I name Harlan and Rhonda Price to serve as property guardian. No bond shall be required of any property guardian appointed under this will. PROPERTY MANAGEMENT THIRTEENTH: All specific bequests and residuary bequests made in this will to Elizabeth Nicole Dau shall be held in a separate trust for Elizabeth Nicole Dau until he or she reaches age 21. This trust shall be managed under the trust administration provisions set forth in this will. The trustee for the Elizabeth Nicole Dau trust shall be Cynthia Gayle Dau. If Cynthia Gayle Dau cannot serve, the trustee shall be Harlan Price. No bond shall be required of any trustee. Page I~ /~~~` , Initials : t/ ~ ~~ ~ Date ¢ ~ ~ ~ ~ ~ ~ t~ Will of I~iichael Frederick Dau (e) In addition to other powers granted a trustee in this will, a trustee shall have: (1) all the powers generally conferred on trustees by the laws of the state having jurisdiction over the trust (2) the powers conferred by this will on the personal representative as to accumulated property and income in each trust, and (3) the authority to hire and pay from trust assets the reasonable fees of investment advisors, accountants, tax advisors, agents, attorneys and other assistants to administer the trust, manage any trust asset and handle any litigation affecting the trust. (f) It is my intent that any trust established in this will be administered independently of court supervision to the maximum extent possible under the laws of the state having jurisdiction over the trust. (g) The interests of any beneficiary of a trust established in this will shall not be transferable by voluntary or involuntary assignment or by operation of law and shall be free from the claims of creditors and from attachment, execution, bankruptcy, or other legal process to the fullest extent permitted by law. {h) Any trustee serving under the terms set forth in these provisions shall be entitled to reasonable compensation out of trust assets .for ordinary and extraordinary services, and for all services in connection with the complete or partial termination of any trust created by this will. (i) The invalidity of any trust provision of this will shall not affect the validity of the remaining provisions. PERSONAL REPRESENTATIVE SIXTEENTH: I name Cynthia Gayle Dau as my personal representative. If Cynthia Gayle Dau for any reason does not qualify or ceases to act as personal representative, I name Meghan Cathleen Dau as my personal representative. No personal representative shall be required to post bond. PERSONAL REPRESENTATIVE'$ POi~IERS SEVENTEENTH: I direct my personal representative to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petiti n the appropriate court for the Page ~ Initials : G' ~` / ~ ~~~_ ~^ "c/ Date: ~ ~ ~ ' ~V I~-c t~ O NTH OF ~10N-SLTBSCRIBItiTG `~'IT~ ESS(ES) REGISTER OF WILLS COUNTY, PENNSYLVANIA Estate of }~1 ~ C` ~1(',. P , ~r (~ .r ~ r k ~ Q lJl_ ,Deceased and each bei dul ualified accordin to law de ose s and sa s that she / he the was were ' well- ~ ) g Yq g P ~) Y~) acquainted with m i ~hC v ( ~~~ Dx ~ ~ ~~(k a~ and am/ re amiliar {~ with the handwriting and signature of the decedent, and that the signature of ~ ~ f .4'~ ,1 Frei' .til C~ Z.(X-l~l to the foregoing ins-tr~um~ent purporting to be the Last Will and Testament/Codicil of ~ ~ C `1(AQ,' ~~' ~ ~~! _~ ~; a,l is i hi her own proper handwriting. ~~ (Si~nctlecre) 4 C~G P L_C3.1~ ~ (Street Address) l (Ctty, Stnre, Ztp) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ ~ day of I~~_~C ~~~ ~l ep~ Register of ~~'iils ~= o ~' _~-. c~ ,7 .x;, r - _ ~~ m _a --~ ~. , ~a ~_ ~~ W r`~ c~ c~ ~~ -x, :-~-, c',.,~ ~,, _1 L _l t ~, • ~~~ i~ c.~ ~ -,-~ Forst RW-04 rev. 10.13.Oti -~~/, ~ ~-~ s6u~~, ~ ~ 17~~`z-f ( Uy, Stnte, ZipJ