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Home My WebLink About04-02-12 (2)PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF LrC.C ti,,.` ~'j-c° t^~Q ~ ~J COUlVT~c', PENNSYLVANIA -~- P~titior-~r(s~ nairec beicw. ~~~7o i~ are 1"3 ;,ears of asp or older. _~pplyiiesi for L.~tt:r~ as specified bzlo~-v, and in support ther:uf aver(sj the fol,o~v:nJ and respectft:',1~, request(s) the !rant of L et:ers in the apprupriate form: Decedent's Information_ ~~I _) ~ _ ~~ 5 came: D ~ r ~l ~ L- ~ ~. ~ e r File No: _ a`k/a: (Assigned by Register) a/k/a: a/k/a: Social Securuty No: Date of Death: Cc ~ ~ 5 r ~- G t a, Age at death: ~5 ~-- Decedent was domiciled at death in C u trn b r=. r ~ li h G~ County, !~~ nta va t c (Stare) with his/her last principal residence at ~. v 13L t,i ~ Itil v u y-~cZ i of IJ; 5-f « lyle ch cc r~ ~ cz h u ~^~~ '~~ I ~ 0 50 Street address, Post Office and Zip Code City, Township or Borough County Decedent died at ;20 ~;l u c f1'l 0 4 ~ ~; ~ h U i sit: M 2 c.~'1 Ct t~ cs ~ a r~3 Cu n-~h z r la hc~ TJI~ 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 $ t- Ijnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALLJE.... $ ~ 5, e a o Real estate in Pennsylvania situated at: r._._ (Attach additional sheers, ijnecessary.) Street address, Post Office and Zip Code City, Townnship or Borough County ~] 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 ,r-@'_ 3~~ o~~~ and Codicil(s) thereto dated ___ 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 lite, durante abeentia, durante minoritate If Administration, c.t.a. or d.b.n.c.~a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a parry to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. b 3323(el and was neither the victim of a killine nor ever adiudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS r`.,~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived bythe following~t~e (if any) ~ heirs additional sheets, iJ'necessary): art Z ~ 7G r.."` Name Relationshi Address~:= ~ rrt - '~ CJ -fin ~ - - ~- - D ~ G3 `n Form R W-t72 r~~. roilliznlf Page 1 of 2 ~~ .- nr- Oath of Personal Representative COiv4~[ONWEALTH OF PENNSYLVANIA } } SS: COL'~TYOF Luvh~2.r~avto~ ~ "0 icial' e' I ~~~`~ ~.~~ -2 w~~ 11 ~ 3J ~ l'a.;.irneri;) Pr.r.t~~ Na:r.~ Pe:itionerl sl Prin ~~~ D~ -~ruw,(~cll~r- .~3`f5 S: Wh~~fo~,s; ) u-~N...~.~ ~ ~,:; ~, ~e-~ f /1i1 ~ 1-~ ~,~ ~ l-f 4= 5 3 ~ 3 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) o Decedent, the Petitiot s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before ,4-.,.~~-~~ Date L-- me tlx's .~ day of r~ ~i ~~- Date B~~'~~. ,}'^~-~~~ ,~ ~ ~ fi C, ~~~ ~' ~~c ~ Date For the Register Date BOND Required: Q YES QNO To the Register of Wills: FEES• Please enter my appearance by my signature below: Letters ...................... $~~~~ ( ~- )Short Certificate(s)...... ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. Other ~ 1 ........ /~ ^ Automation Fee ............... JCS Fee . .................... -~~ TOTAL ..................... $ i~~ ~ SZJ" Estate of a/k/a: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER File No• _~~ - ' ~ ' ~-! AND NOW, o`' D 1 ~ , in consideration of the foregoing Petition, satisfactory proof ha ng been presented before tne, IT I DE REED that Letters _ are hereby granted to in e ; bove estate and (if applicable) that the instrument(s) dated ~ /~,~~ ~ described in the Petition be admitted to probate and filed of record a~ the last gill (arid Codicil ~jof Decedent. FormR6R0? rev.lA/!1/2~!( tl Irv v "' Page2of2 N 10.805 RBV i)lll~~ LOC ,.~r,~,_. ,~ R'S CERTIFICATION CAF DEATH WA !~'`1$is;.tle~duplicate this copy by photostat or photograph. ~~r,l.l,... ,..J_V Fee for this certificate, $6.00 2fl~~2 ~P~ -2 ~~ ~T: j~ This is ro certify that the information here given is correctl}~ copiedfrom an original Certificate of death duly filed with me as -Local Registrar. The original CL~RK (;F certificate ~ will be forwarded to the State Vital o~~llnf'S v~~i~? Records Office for nnanent filinb. P 18 3 014 3 4 ~.~~R,F~i_~.-~;~ C~ aA c.~ .3 ~ ~ Certification Number type/Print In Perm.nent ~ 6 i Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS ~u lack In k 33-21 - - ""' " '-' Sex 3. Soelal SecurRy Number 4. Date oT D••th (MO/Day/Yr) (Spell Mo) 2 . 1. Decatl•nt's L•pl N•me (Flrrt, Middle, Lest, SuMx) ZO:- aZ ~ ~ ~SL~ Dar 1 ~ E Ma: a • Sa. A{e-fart Birthday (Yrs) 3b. Vnd•r 1 ••r Sc. Under 1 D• 6. Date of Birth (MO D•y ) (Spell Month) 7•. Bir~hsl•e• (City end State or For•1{n Country) /~~y1/ Menthe Days Hours Minutes Se temb@r 1 7b. BirthPla<e (COYnty) /I/8 s2 8a Ruid•nca (State or Forpl{n Country) Bb. Residence (Street end Number-. Include Ap[ No.) M. Dld D•eed•nt Uve In a Tow ~hipi S/s VLI! SIPIItjNf~ twp . iawfYaV N ~ ~ML /Y~NtgITA/A {/Ji ~ve:, deud.nc Iwea in ads R•ald•ne• (eounq.) Be. Residence (Zip Code) ONO, decedent Ilytl within limits of city/born. '~ L Ever In US Armed Fprees7 10. Maribl Status at Tim• of Death Married Wltlow• 11. Survlvln{ Spouse's Nama (It wife, {IVe nam4 PrlOr to first marrlap) 9 . ~YU Q No Q Unknown Q Divorced Q Never Mewled Q Unknown Middle, Last, Su x) Father's Nam• (Firrt 12 13. M •r's Nam• Prior to First Mxrrlaie (Flrrt, Middle, Laat) , . :~ ~ ~tr 14b. RNatbnship to Decadent ' d Number, City, stab, Zip Code) e 14C. InfOrm•nt's Mallin{ Address (( s Nam• 14a. InformarH ~ I T~Sa 1.. ~I VE t it rse ................................................... .... ......................................... If Death Occurred In . Hospital: ~ Inpatient on y on. .............................. ................................... .................................... ........... ~:...~u........ ~.......!~.............. If Outh Occurred Somewhere Other Then • Hospital: ~ Nosple• Fac11iN ec•d•nt's Home Em• en Roem/Outpatient Oeatl on ArrlvN NuHin Nome/bnpTerm Care Facility Other (Space' ) County o Duth lSd SSb. Facility Name (If net Inrtitutlon, five street end number; . lSe. City er Town, Sbb, and Zip CAde 20 Blue Mountain Vista Cttmberlan 16a. Method o} Dlspealtion Burial Cremadon 18b. Dab of Disposition 18c. Piaee of Disposition (N•me ~of cemetery, crematory, or otMr plats) ~, Q Removal from Stab Q Donation ~~~ ~/~ _~t /~-plA.~.~~ ~~~/~~` er~ ~/Y~V ~I~ Other (Sped ) 16d. Location of Dispealtlon (City or Town, 5bb, end 21p) f 17e. 51{na Funeral Servlee Lleenf•e of P•rso In Ghary i Inbrmen< 17b. Llcanse Number J Pea /7o~a' I d/2/sa` ' 17e. Ne d Come Addreu of FuM I Fae11i ~~ may/ ~ ~ T' n R~~, ~~' ~A. ~ 7 ~ ~~ + • ' 7 ~= ec•dent of Hispanic Or181n - heck the 20. Decedent's Race -Check ONE OR MORE races to Indicab what 19 . D cedes ` Education -Check the box that best d•scHb•a tM • 1B ~- . hl{hut de{ree or level of school compNted at the time of duth. box that best dueribes whether the decedent the decadent considered himself or herself to be. Q 6th {r•d• or less la Spenlah/Hlspanie/Latino. Check the "NO" White Q Kor1•n box M decadent b not Spanish/Hisp•nlc/LaNno. Q Bieck er African American ~ Vietnamese ~ No diploma, 9th - 12th {rode Jg HI{h acheol {raduab or GED completed No, not Spanish/Hisp•nlc/latlno Q American Intllan or Alaska Native Q Other Asian n H Il N i aw• a at ve Q Some collep credit, but no de{ree Q Yes, Mulon, Mexican Amerlun, Chicano Q Asian Inellen Q fan or Chamorro Q Chinese Q Rl ean Q Aasochb d•{ree (e.{. AA, AS) Q Yes, Pu•KO 5 moan Q Filipino Q y C b an ef, u Q Bachelor's de{re• (e.{- BA, AB, BS) Q MS, MEn{, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Jspan•s• Q Other Peclflc Islander Q Master's de{ru (e.{. MA , Q Doctonb (e.{. PhD, Etl D) or Probssbn•1 detru (Specify) Q Other (Specify) . MD DDS DVM LLB 1D D•cadent's Sin{le Raee self-Deal{nation -Check ONLY ONC to Intlicab what tM decedent considered himself or herself to be. 1.2a. Decad•nt's Usual Occupation - Indleab type of work 21 . Semean clone tlurln{ most of workin{ Ilia. DO NOT USE RETIRED. fe Q Other Peclflc islander 0 ~ ~ _ ! E~ Q B s k or African American Q Kor•an s'e~ ' t Know/Not Sure Q Amerlun Indian or Alaska Native Q VI•Cnam•se Q Don Q Retused :!2b. Kind o} Business/Industry i h A an er s Q Allan Indl•n Q Ot Q Chinue Q Netlve Haw•Iian Q Other (SPecHy) G ssr ~Th~Q Chamorro s(f' O~~ i r an or Q FIIIPino Q Guaman EMS MU BE MP O e. Dab un<e Mo Day 2 . SI{nature o Parson ronounc n{ DeKh n y w an app Ica 23c. Ucenae Num er e BY PERSON WHO PRONOUNCES OR 2$ 2012 Mar Ch CERTIFIES DEATH 23tl. Date SI{nad (MO/Day/Yr) 24. Time 01 Death A rox. 1 : OO A. M. 2s. w.a M.dlol Examin.r or coroner cont.ctedz Yu Q No CAUSE OF OEATN l Approximate 26. Mrt I. Enbr tM chain of events--diqu•s, InJurlea, or compllut/one--that direetty caused the dgth. DO NOT enbr Hrminel events such as cardiac arrest, ) Inbryal: set co Death O n respiratory arrest, or wntrlcular flbrllla[lon without showin{ the etlolory. DO NOT ABBREVIATE. Enter only one cause on • Ilne. Add addrcional Ilnu iT necasaary 3 IMMEDIATE GVSE - -> OCC1u8 ive Coronarv Arterv Disease (Final disuse or condRion Due to (or as a cons•gwnca of): ~ reaultln{ In death) b. 1 Sequentially Ilst Condltlons, Due to (or as a eonsequenee off: ' H any, leaden{ to tM cause i Ilrted en Ilne a. Enbr the VNDERLYING GVSE Due to (or •s a eonsequen<e of): (disease or Injury that f Inltlabd the events resultin5 d. c In death) LAST. Dw W (or as a onsegwnee of): 26. Pert 11. Enter other ~I M ~ dRions cantributine to death but not resultln{ In the undarlyln{ cause {Ivan In Pert 1 27. Ws an autopsy pe ormed7 es No 28. Were a toPaY fin In available u ~ deamz M•uLra. f Hyperlipidemia - to<omp N o v.y 29. If Female: nant within past Year re N t 30. Dld Tobacco Us• Contribub to Duth7 Q ria Q Probably 31. Manner o1 D•Kh $ Natural Q Homicide { Q o P f d h Q No ~ Unknown Accident Q Pendln{ Inwstlptlon ~' ut 0 Pre{nant at time o but pre{nant within 42 days of d••th pant N t r Q Sulclde Q Could not be dK•rmined , o p e{ Q Q Not pre{nant, but pre{nant 43 days to 1 year before d•Kh 32. DN• 0/InJury (MO Day/Yr) (SDall Month) Q Unknown If pre{nani within the past ye•r 33. Time of Injury 34. Place of InJury (e.{. home; conrtruetlon site; farm; schoel) 35. Location of InJury (street and Number, City, Sbte, 21p Coda) 36. InJury at Work 37. HTransporbtlon Injury, Sp•c11y: 38. Describe Now Injury Occurred: Q Yes Q DrWer/OP•rator ~ Pedestrian Q No O Passen{er Q Other (SpeeMy) 39a. Certifier (Check only one): ~ CartHyln{ physician - To the best of my knowledp, death occurred due to the cause(s) and manner stabd Pronouncln{ ~ CertNyln{ physician - To tM be t o1 my kn duth occumd at the tlme, dab, and place, and dw to the cause(s) and manner stated ~Medlcal Examiner/COro On tM bas(s f ,antl/or InwaNptlon, In my opinion, tleath occurred et the time, dada, and place, and due to the cause(s) end manner sbted ~ ~ ` ntle of c.relfler: Chie £ Deputy CoroneAc•nae N~mwr: `nature of aeKlfler: ~ ~l ~ sl{ 39b. Name, Address antl Zip Code of Person Completln{ Gauw of Death (Ibm 28) 637 BehOre ROad s Suite# 1 39e. Date SI{n•d (MO/Day/Yr) Matthew S. Stoner Chief De cat Coroner Ma icsbur PA 17050 March 26 2012 40. Re{IStrar s strict Number 41. { str r n t 42, e{ atr•r b O Day r 43. Amendments ! r L~ U B DlfPOSltlon Permit No.~ / ,~ y ~ REV 07/2011 . ~sE~C~~' ~ ;~~~~~E 0~ LAST WILL AND TESTAMENT ~IE(2 APR -2 ~~41i: 30 OF G'I_ERK 0~ a~f-~v~s cou~~ DARYL E. BAKER ~~»~"~~I_r~~~~JC± (~~ , ~A I, DARYL E. BAKER, of the County of Broward and State of Florida, being of legal age, sound mind and memory, and under no restraint, do publish this, my bast Will and Testament, revoking all others heretofore made by me. ITEM ONE I may leave a written statement or list disposing of certain items, of my tangible personal property. Any such statement or list in existence at the time of my death shall be determinative with respect to all items devised therein. If no written statement or list is found and properly identified by my Personal Representative within thirty (30) days after his qualification, it shall be presumed that there is no such statement or list, and any subsequently discovered statement or list shall be ignored. ITEM TWO I give, devise and bequeath my entire estate, whether real, personal or mixed of every kind, nature and description whatsoever, and wheresoever situated, which I may now own or hereafter acquire, or have the right to dispose of at the time of my decease, by power of appointment or otherwise, to the Successor Trustee of the REVOCABLE LIVING TRUST OF DARYL E. BAKER executed simultaneous with this Will. Page 1 of 4 ITEM THREE I direct that for purposes of this will a beneficiary shall be deemed to predecease me (or any other person upon whose death the interest of such beneficiary depends) unless such beneficiary survives me (or such other person) by more than thirty (30) days. ITEM FOUR I hereby nominate and appoint DONALD DRUMHELLER, as my Personal Representative, to serve without bond. In the event DONALD DRUMHELLER is unable; to serve in said capacity for any reason whatsoever, I then nominate and appoint JULIA DRUMHELLER to act as alternate Personal Representative, to serve without bond. I direct that no appraisement of my household goods and furniture be made. ITEM FIVE I grant to my Personal Representative, or any successors thereto, all powers conferred on Personal Representatives under Florida Law. I also grant to my Personal Representative the power to retain, sell at public or private sale, exchange, grant options ori, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to hold property in bearer form or in the name of a nominee; to divide and distribute property in cash or in kind; to render liquid my estate or any trust in whole or in part, at any time and from time to time, and to hold cash or readily marketable securities of little or no yield for such periods as my Personal Representative shall deem advisable to exercise all powers of an absolute owner of property; to incorporate any business and hold any interests in corporations; to vote stock or securities, in person or by proxy; to exercise subscription and conversion rights, and to participate or re:fuse to participate in any reorganization, re-capitalization, merger, consolidation, liquidation, dissolution or other action Page 2 of 4 with respect to any corporation; to transfer any business or property to a. partnership and to be a general or limited partner; to compromise and release claims with or v~~ithout consideration; to execute and deliver instruments, including releases; and to employ attorneys, accountants and other persons for services or advice. IN WITNESS WHEREOF, I have hereunto signed my name and acknowledged this instrument as my Last Will and Testament, in the presence of the undersigned witnesses, on this day of December, 2008. D L E. BAKER WE HEREBY CERTIFY that DARYL E. BAKER, the maker of the foregoing Last Will and Testament, subscribed his name thereto on this day, in our presence, and to us declared the same to be the maker's Last Will and Testament; that we subscribed our names hereto as witnesses, in the presence and at the request of said maker, and in the presence of each other, and that at the time of the execution of said instrument as aforesaid and of our subscribing the same as witnesses, the said maker was of sound mind, to the best of our knowledge, information and belief. WITNESS our hands, at the County of Broward and State of Florida, on this 3O day of December, 2008. _ ~~'~--d~-xr Witness •~ C Witness Page 3 of 4 • ~ , STATE OF FLORIDA COUNTY OF BROWARD W DARYL E. BAKER, ~~ a ~,.. ~ • ~ ~d d Q and ,the maker and the witnesses respectively, whose names are signed to the foregoin instrument, being first duly sworn, cio hereby declare to the undersigned officer that the maker signed the instrument as the maker's Last Will and Testament, and that the maker signed voluntarily, and that each of the witnesses; in the presence of the maker, and at the maker's request, and in the presence of each other, signed the Will as a witness and that to the best of the knowledge of each witness, the maker was at that time over 18 years of age, of sound mind and under no constraint or undue influence. /!/ ~. DARY .BAKER Witness c Witness SUBSCRIBED AND ACKNOWLEDGED before `mJe by DA /R~YL E. BAKER, the maker, an~ s scribed and sw rn to before me by ~ ~~ I l ~ 0.M r • ~ ~- `~ °'~ and ,the witnesses, on this =3~ day of December, 2008. ~,L ~ ~- NOTARY PUBLIC My Commission expires: =~~1" " : PAUL E. BLADE .. :.; :~ carxnission DD nasa~ Expires May 23, 2012 Page 4 of4 '~~. BmdedThiuTmyFeMMrurwB00~3657019