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HomeMy WebLinkAbout04-18-12PETITION 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) tl following and respectfully requests the grant of Letters in the appropriate form: Dianna L. Bentz Decedent's Information Name: Eva K. Cooper a/k/a: a/k/a: a/k/a: File No: 21 -12 ,_ `-T LL's (Assigned by Register) Social Security No: 168-24-4071 Age at Death: 80 Date of Death: 04101/2012 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 520 Orrs Bridge Road, Camp Hill 17011 Hampden Township Cumberland Street address, Poat Office and Zip Code City, Township or Borough County Decedent died at 520 Orrs Bridge Road, Camp Hill, PA 17011 Hampden Township Cumberland PA 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 !f not domiciled in Pennsylvania ................ Personal property in Pennsylvania If not domiciled in Pennsylvania ................ Personal property in County Value of real estate in Pennsylvania.......... Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) 190,000.00 150,000.00 TOTAL ESTIMATED VALU63 340,000.00 Street address, Post Office and Zip Code City, Township or Borough Q A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated County 12/08/2005 and Codicil(s) (State relevant circumstances, e.g., renunciation, death o/executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not ma ,was not divorced, was not a pa~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 chi om or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 rv ^X NO EXCEPTIONS ^ EXCEPTIONS ,~ ~ zk• ^ B. Petition for Grant of Letters of Administration (If applicable)-`"?''"'- "'~ ~ ~' rTl ~,_ ~--1 c..a.; ..n.; ..n.c..a.; pe en a e; tag en ra; ^ n e ncyl If Administration, ai a or d.b.n.c.t.a., enter date of Will in Section A above and comolete list of heirs. "-~ ~'~ ~ ~ , -, -n ~ - Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been established as~~ed • =- in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ _y ~ ;'-~ ~~ ^X NO EXCEPTIONS ^ EXCEPTIONS _ ]> ~ ~~ Petitioner(s), after a proper search has/have ascertained that Deoedert left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationship Address Bruce W. Bentz Son 529 Lamp Post Lane Camp Hill, PA 17011 Debra L. Buttorff Daughter 630 Allen Street New Cumberland, PA 17070 Dianna L. Bentz Daughter 824 Indiana Avenue Lemoyne, PA 17043 Form RW-02 rev. f0-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS: rni WTV C)F Cumberland } The Petitioner(s) above-named swear(s) or affirm(s) the,statements in the foregoin Petition are true and correct to the best of the knowledge and Personal Representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. belief of Petitioner(s) and that, a ~ ~ M ,.n ~ ~ o ~..~, Date ,,J Date Swom to or affirmed an subscribed before ~/~ Date me this ` y of B~ . _ o~. v ~ ~/ _©~ BOND Required? ~ Yes ~° FEES /~ Letter ........................................... $ ( ~) Short Certificate(s)......... ~ V ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other IA) ~~ t Automation Fee ............................ l' JCS Fee ........................................ TOTAL .......................................... $ L{ To the Register of please enter my Attorney Printed Name: ~ Robert G Radebach Supreme Court 19255 ID Number: Firm Name: Law Office of Robert G. Radebach Address: 912 North River Road Halifax, PA 17032 Phone: 7171896-2666 Fax: 7171 E-mail: missyswartz5l~aol.com DECREE OF THE REGISTER Date of Death: Social Security No: File No: Estate of Eva K. Cooper a/k1a: ~j.~ 1•~ _ , in consideranon or mC ~~~~y.,~"y • ~••••- • AND NO •t satisfactory pr f haul been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Dianna L. Bentz in the above estate and (if applicable) that the instrument(s) dated 1210812005 '~/1 described in the Petition be admitted to probate and filed of record,a~e la^~Will (~a[~~o i ~^ n~°~,D I n~ ~/a~tA ~ 1 0410112012 168-24-4071 21 -12 Register orvvma~~ ~ ~~~LiI \I,...W~~l~~2or2 Copyright (c) 2011 form so ar o ly The Lackner roup. I Qffc)~I~us i EYOF ~f_;~U~~;~ ~. ~: Fi , f-~` ... ~ ,. 6..~ H 105.805 REV 19/ I i ) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARN~eQ~i~~1~~{~uplicate this copy by photostat ar photograph. JJ '111 !C Fee for this certificate, $6.00 This is to certify that the information here given is ~`~{ i b?R 18 Pty 12= 55 correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital C~E~~ ~~ Records Office for permanent filing. ORPHAf~`S "GI~FsT ~~'~,~„~ APR 0 3 101 P 1 Q~ Q R '~ R~ cu~naF~i a~~~ c;~ . Pa ~/~,p.,~- Certification Number ,0 TYPe/Print In Permanent ~/ Y C __ Local Registrar ~G Date Issued COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH .VITAL RECORDS t`COT~cs/`ATC AC f1FAT4.1 lack In k Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo) Sex 3 2 . . 1. Decedeni's Legal Name (Firs[, Middle, Last, Suffix) Etna Coo er F. 168-24-4071 Sa. Aga-Last Birthday (Yrs) 9b. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Dsys Hours Minutes 80 November 13 1931 7b. Birthplace (cqunty) ' hi 7 8a. Residence ( fate or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) owns p Bc. Did Decedent Live In a T n Pennsy~vanla dge Rid. 520 Orrs Br] ~en t""P es, decedent lived In _ ~+ F 8d. Residence (County) (]~mberland . Be. Residence (Zip Code) QNO, decedent Ilved wlthln Ilmhs of city/boro. 9. Ever In VS Armed ForcesT 10. Mar ital Status at Time of Death Q Marrlad Q WI owed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) ~ Ves No ~ Unknown Di vorced O Never Marrletl Q Unknown 12. Father's Nsme (First, Middle, Last, Suffix) • 13. Mo[he~ s Name Prior to First Marriage (First, Middle. Last) 14b. Relationship to Decedent 14c. Inf rmant's Mailing Address (Street and Number, Clty, State. Zip Cotle] ' s Name 14a. Informant Dianna Bentz Daughter 824 Indiana Avenue Lemoyne,Pa 17043 o ~ . ec on ono _ ..... ....... ....... ..... _ ace o eae ..............Y. ...... ... ..- . ........ .. ... ... .-....... ......................................................... ......................... ... .......................... a :....................... .... atient Flf Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~Deceden['s Home ~ I l np : If Death Occurred in s Hospita n Arrival Q Nuraln Hame/LOn -Term Care Facility Other (Specify) Q Emargen Room/Outpatient Q Dead ~ 16c. City or Town, State, and 21p Code lSd. County of Death u 35b. Facility Name (M not Institution, gWe street and n mberj • Burial Q Cremation 16b. Date of Dlsposltion 16c. Piece of DlsposiTlon (Name of cemetery, crematory, or other place) 16a. Method of DlsposlTlon Q Removal from State Q Donation Other (Specify) nse Number Lic t 17b f Intermen . e o erso 16d. Location of Disposition (City or Town, State, and Zip) 17 ral_Se n in Charge o 011654-L 17c. Name and= omplete Address of Funeral Facility ~' Decedents Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races To indicate what 18 . hest degree or level of school completed at the time of death. box that best describes whether She decedent the decedent considered himself or herself [o be. hi g Q Bth grade or less Is Spanish/Hlspanlc/Latlno. Check the "NO" White Q Korean ~ No diploma, 9th - 12th grade box if decedent Is not Spanish/Hispanic/Latino. Q Black or African American 0 Vietnamese ~~Hlgh school graduate or GED completed Q No, not Spanish/Hispanic/Latino Q American Intlian or Alaska Native Q Other Asian O Asian Indian ~ Native Hawaiian Chi i can, cano Q Some college credit, but no degree O Yes, Mexican, Mexican Amer n Q Chlnee:e Q Guamanian or Chamorro rt Ri Y P o ca es, ue Q Associate degree (e.g. AA, AS) O Q Samoan Fili i p no Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Q Other Pacific Islander 0 Master's degree (e. g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) . MD DDS DVM LLB JD le Race Self-Designation -Check ONLY ONE [o Indicate what the decedent considered himself ar herself to be. 22a. Decedent's Usual Occupation -Indicate type of work Sin d t' D g ece en s 21. White Q Ja Panese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or Alrlcan American Q Kgrean Q Other Pacific 151a nder AmeHCan Indian or Alaska Native Q Vletnamase Q Don't Know/Not Sure t I n us ry Q Asian Indian Q Other Asian O Refused 226. Kind o slness/ Q Chinese Q Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Chamorro tVeW Cumber land Arm De t ITEMS 23a - 23d M CO PLETED 3a. Date Pronounce Dea Mo Day Yr 23b. Signature o Person Pronouncing De!at On y when appllca lej 23c. Ucense Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d. Date Signed (MO/Day/Yr) 24. Time of Death Q " ~/-/lY)f 25. Was Medical Examiner or Coroner Contactetl7 Q Ves Q No CAUSE OF DEATH Approximate Enter the h 1 f t -diseases, Injuries, or compllcatlons--that directly caused the death. DO NOT enter Terminal events such as cardiac arrest. Interval: 26 Part 1 . . VIATE. Enter only one cay,se on a Ilne. Add addltlonal lines If necessary OnseC to Death NOT ABB R E lo D O t h e e tio gy or ventricular flbrlllatlon w thqut showing arrest irato res , ry p / ~ ~ ~~ ~~ s~ ~~ ~~ ~~ ~~ --s~ ~~tt , y IMMEDIATE CAUSE -------------> s'r~~VVCT/'!/ -~'" ' (Final disease o onditlon Oue to (o as a consequ ace of) resulting In death) b. Sequentially Ilst conditions, Due to (or as a consequence of): if any, leading to the cause listed on Ilne a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): ,r~ (disease ar Injury that F ~ initiated the events resulting d. as a con in death) LAST. Due to (or sequence of): 26. PaK 11. Enter other i IFl t di[I t ib it t d th but not resulting In the underlying cause given in Part 1 27. Was autopsy perto edT Q u es Q F`Fo il bl fi d ~ e n ing a a 28. Were a topsy to co plate the cause of death? O vea O No 29. If Female: 30. Did Tobacco Usa Contribute to DeathT 31. Manner of Death Q Not pregnant wlthln past year Q Yes Q Probably known U N Q Natural Q Homicide O Accident O Pending Investigation °~ Q Pregnant at time of death but pregnant within 42 days of death Not pregnant n o Q Q Q Suicide Q Could not be determined , Q s to 1 year before death nant 43 da t b t 32. Date of Injury (MO/Day/Yr) (Spell Month) ~ y , u preg Q Not pregnan Q Unknown If pregnant wlthln the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street antl Number, Cify, State, Zlp Code) 36. Injury at Work 37. If Transportation Injury, Specify: 3H. Describe How Injury Occurred: Q Ves ~ Driver/Operator ~ Pedestrian Q No Q Passenger Q Other (Specify) 39a. C ar (Check only ono): Certifying physician - To the best of my knowledge, death o curved due to the cause(s) and manner stated s ledge, death occurred at the time, date, and place and due to the se(s) and manner stated ~ Pronouncing 8< Certifying physi 1 - To the bet f y k ` d manner sla/tad and place, and due to [h e e( ) 1p9, and/or investlgatlon, In my opinion, death occurretl a[ the time, date ~.s of e> Q Medical Examiner/COrq(Ier - On sire b ~ ~ ~ y ~ ~/ /-F D (/V ~ 1 ~ ~ F~• r Li N b ~X ] ^' / ~ : cense um e / ~Y ~~ Title of cer[Ifler: \F G=s,4,t/ ~ Slgnaf ure of rortifler_ 39b. N e Address and 21p Code of Person Completing Cause of Death (Item 6) ~~ r ~ ~ f / v~e~ h , z~is Nt-D - Zoe /~e d~~ 39c. Date igned (MO/Day/Vr) ~/Gc 3 40. Registrar's District Number ~ 41. Registrar s Slg Jf __ ~ J 42. Registrar le Date Mo Day r) a1 / .. ~/ / < 3 ~o/-L B 43. Amendments Dlsposltion Permit No~ ~ /A ~~~J REV 07/2011 LAST WILL AND TESTAMENT n f._, .~ OF ~ ~ ~ ~~ v '~Zn --~ ~~~ ' '~' ~ ` ' T~ ~ EVA K. COOPER `_'~ Cn ~ "' ~ ` T r 4 ~j :~ ' _:i -D R) i ~._ ~~ 4~7 la."' I, EVA K. COOPER, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will. I revoke all other Wills and Codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. ~' ~~'., Article III I give, devise and bequeath my tangible personal property in accordance with any memorandum I have either handwritten or signed, located with my Will or with my valuable papers and found within 30 days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Article IV hereof. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath in equal shares, to my daughter, DIANNA BENTZ, of Cumberland County, Pennsylvania; my daughter, DEBRA BUTTORFF, of Cumberland County, Pennsylvania; and, my son, BRUCE W. BENTZ, of Cumberland County Pennsylvania. However, if a beneficiary does not survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, Per Stirpes, the share the beneficiary would have received had he or she survived me by thirty (30) days. The share of any deceased child who does not have living issue shall be divided and distributed to my surviving children. _2_ ~ ~C Article V I nominate, constitute, and appoint my daughter, DIANNA BENTZ, Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my son, BRUCE W. BENTZ, successor Executor of my Last Will and Testament. I direct that my Executrix or successor Executor be permitted to serve without bond. In addition to those powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executor shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executrix or successor Executor in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, 3 ~~ (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which :[ am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, EVA K. COOPER, hereby set my hand to this my Last Will and Testament, on lJ ~~ ~ ~ , 2005, at Harrisburg, Pennsylvania. ~~ I~. C EVA K. COOPER In our presence, the above-named EVA K. COOPER signed this and declared this to be her Last Will and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address (~51,~l~Uil~Q.~~~1 ~ C~.1.Q1(Vl ~l 2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110 2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110 4 I, EVA K. COOPER, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by EVA I .COOPER the Testatrix, on , 2005. otary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Public Marielle F. Hazen. Notary Susquehanna Twp.. Dauphin County My Commission Expires Sept. 23, 2006 ~ k ~ ~/ ~~ EVA K. COOPER We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subs~ri-b-ed to before me by ~,~ }--~ . Sr~or~ and < <(Y,1__ ~. ~(~, witnesses, on ~~1.~~iE'~- ~ , 2005. Not ry Pu i ~~ 1`~ Witness Wim s COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Hazen, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Sept. 23, 2006 _5_