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Home My WebLink About04-26-12PETITION 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 requests the grant of Letters in the appropriate form: Kendra K. Heinbaugh Decedent's Information Name: Joanne Y. Kotzmoyer File No: 21-12 - ~f1 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 210-28-9207 Date of Death: 04/11/2012 Age at Death: 74 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 348 McAllister Church Road, Carlisle 17015 West Pennsboro Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at M.S. Hershey Medical Center Hershey Dauphin 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 $ 100,000.00 Ifnot domiciled in Pennsylvania ................ Personal property in Pennsylvania $ Ifnot domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ TOTAL ESTIMATED VALUE $ Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough ^X 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 10!09/2003 State relevant circumstances (e. g., 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(8), 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., pedente /ite, 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,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 (if any) and heirs (attach additional sheets, if necessary): Name Relationship Address ;_°~ -~ ~, ~; ~ L _, . ~ _"' r, -,= r- CJ+ __ :l` , t~ z ., : -n _:, :_ - _ _-,_, 4 --; , 0.00 100,000.00 County and Codicil(s) Form R W-O2 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative fficla~useonlyfi.~; _,_, =,-, ^ ~ - COMMONWEALTH OF PENNSYLVANIA } T' ' COUNTY OF Cumberland } ~. ~- - ~7 U` Petitioner(s) Printed Name Petitioner(s) Printed Address ;~,--, _, - ~. ' c_ ; :t-= _:; '. Kendra K. Heinbaugh 493 Crossroad School Road >c__ ~ . - Carlisle, PA 17015 ~i ~ ',,~ ~- U ~. ,._ 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, PetitioneJr~(_s) will well and truly administer the estate according to law. Sworn to raffirmed and subscribed before ~~-~~~~'~~~~ r~~ T~~i ~~"'~~- Date Y-~~L l ~~~ me t i f~iay of , ~Z ; : Date By: Date ~F th~`Register Date BOND Required? ^ YES ~ NO FEES: Letters .......................................... $ 210.00 ( 1 )Short Certificate(s)......... 4.00 ( 1 )Renunciation(s) .............. 5.00 ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other Will 15.00 JCP 23.50 Automation fee 5.00 Automation Fee ............................ JCS Fee ....................................... TOTAL ......................................... $ 262.50 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: \\ /f/fJ'1 ) /~ Printed Name: Patricia R. Brown Esq. Supreme Court ID Number: 27474 Firm Name: Salzmann Hughes, P.C. Address: 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Phone: 717-249-6333 Fax: 717-249-7334 E-mail: pbrown@salzmannhughes.com DECREE OF THE REGISTER Date of Death: 04/11/2012 Social Security No: 210-28-9207 Estate of Joanne Y. Kotzmoyer File No: 21-12 -~~_ a/k/a: /"~ - AND NOW, ~ -~~ _ ~~% ~ , in consideration of the foregoing Petition, satisfactory proof avi g been presented before me, IT IS DECREED that Letters Testamentary ~_ are hereby granted to Kendra K. Heinbaugh in the above estate and (if applicable) that the instrument(s) dated 10/09/2003 described in the Petition be admitted to probate and filed of record as th t WiII (and Co ctl(s)) of Decedent ~~~~~~~1 Register of Wills Copyright (c) 2011 form software only The Lackner Group, Inc. %/ age 2 of 2 ~~~ REGISTER OF WILLS OF RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Estate of Joanne Y. Kotzmoyer ,Deceased I' Roy F. Kotzmoyer in my capacity/relationship as n a e Spouse of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kendra K. Heinbaugh (Date) (Signature) Roy F. Kotzmoyer ~~- ~~ .~- ~ ~__ ~` 348 McAllister Church Rd. ~_~ -_ _ , c~ L-- .-~ `^~ (Street Address) a ~_; ~_.~: -. ~=~: c,~`- Carlisle, PA 17015 ~ ~ ~' -~ ~~ '.. _.._7 -l i~l: (City, State, Zip) -- . f ..._ L~ Q- lL. . - .a" . ~ c.. ~~ -_ CJ Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on thi~'~day of t ~.) a"' ~ ~ '~ . ~; t Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths' r~i~r ~f~~5~r~.) ~~...~__...~ Notarial Seal +"~?rY zra 5. Siegri5t, Notary Public =r. ~nicdfs~ton Twp., Cumberland County - ,mrnission Explres_dec._3 X014 ~u~:vl.NAN tom` _' ~ N Aptl~S Form RW-OB Rev. f0-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. j~ ~Z ~!/~ +..~ _ . ~J CLER{ ~.,Y P ~.. g~ 2~~ 4 7 L' QE~~e~.c`~x,~~rr~x' APR 1 3 2 012 ~- , ~_, TYPe/Print In COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent CERTIFICATE OF DEATH Black Ink State File Number: O 2 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spelt Mo) Joanne Y_ Kotzmoyer Female 210-28-9207 April 11, 2012 6a. Age-Last Birthday (Yrs) 6b. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/D ay/Vear) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Sl .74 Months Days Hours Minutes Se t 30 1937 ~ p , 7b. Birthplace (cPl,nty) Cumberland Sa. Residence (State or Foreign Country) 86. Residence (Street and Number- Include Apt N t Sc. Did Decedent Live in a Township? PA 348 McA11 inter Church Rd _ ®Yes, decedent lived in West Pennsbo>rp ty„P 8d. Residence (County) Cumberland Se. Residence (Zip Codej 17015 ONO, decedent lived within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married 0 Widowed 11. Surviving Spouse's Name (if wife, give name prior to Frst marriage) ~ Yes ~ No ~ Vnknown Q Divorced ~ Never Married ~ Unknow RO KOt:Zm0 ar 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Lee B_ Bretin Geraldine E_ Gleim 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) 0 Ro Kotzmo er husband 34S McAllister cnurcn Rd_ Carlisle PA 170 C _ ........................................................... . ................... 15a. P ace o Deat C ec onl one ............................................-........Y.....-................................... ...................... . I^ a If Death Occurred in a Hospital: p tlen - : . ...................................................... If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~ Decedent's Home ° ~ Emergency Room/Outpatient Q Dead on Arrival . ~ Nursing Home/Long-Term Care Facility Q Other (Specify) ~ 1Sb. Facility Name 11f not Institution, give street and n tuber; u 1SC. City or Town, State, and Zip Code 15tl. County of Death M.S_ HersY)ey Medical Center Hershey, Pa. 17033 Dauphin 16a. Method of Disposition ~ Burial Q Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) p RemgYal frgm state p DPnatipn Apr 13 , 2012 Westminster Memorial Gardens - Q Other (Specify) 16d. Location of Disposition (City or Town, State, and Zip) 17a. Si tore of Funeral Service Licensee or Person in Charge of Interment 126. License Number Carlisle, PA 17013 013144E E 1?c. Name and Complete Address of Funeral Facility s 18. 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 ra o indicate what t ~ 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 be. Q 8th grade or less s Spanish/Hispanic/Latino. Check the "NO" ~ White 0 Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American 0 Vietnamese High school graduate or GED completed ]~] No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano Q Asian Indian ~ Native Hawallan Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Guamanian or Cha motto ~ Bachelor's degree (e.g. BA, AB, BS) ~ Ves, Cuban 0 Filipino ~ Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/His ante/Latino p ~ Japanese ~ Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) . MD, DDS, DVM, LLB JD) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work While Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Black or African American ~ Korean ~ Other Pacific Islander ~ American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure Accountant ~ Asian Indian Q Other Asian ~ Refused 22b. Kind of Business/Industry 0 Chinese Q Native Hawallan Q Other (Specify) Banking ~ Filipino Q Guamanian or Cha mono ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mq/Day/Vr) 23 b. Signature of Person Pronouncing Death (Only when applica ble7 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH CL 20 L D`~ l( L 23d. Da a Signed (MO/Day/Yr) 24. Time of Death ~' l L ~ Q 26. Was Medical Examiner or Coroner Contacted? ~ Yes Q No - CAUSE OF DEATH Approximate 26. Part I. Enter the chain of events--diseases, injuries, or complications--Shat directly caused the death. DO NOT enter terminal a ents such a ardiac arrest Inte rvai: respiratory arrest, or ventricular fibrill a [ l on without showing the etiology. DON OT ABBREVIATE. Enter only on e ca u se on a line. Add additional lines if necessary Onset to Death 1 r ~ - t' ' - _ IMMEDIATE CAUSE > 1-K~~CY~ `~l/Vb-t~tNA+~_ }-~p - --t~Q,~S `_ ( final disease o onditlon pue o (or as a c quente f): resulting in death) b. Sequentially list contlitions, Due to (or as a consequence of): _ {f any, leading to the cause listed on line a. Enter the NG CAUSE Due to (o as a co nseq pence of): D (dis injury that 'n itiated the events resulting d. in death) LAST. Due to (or as a consequence of): S 26. Part II. Enter other significant c nditions c ntributing fP death but not resulting in the underlying cause given in Part I 27. Wa u<opsy perto ed? S _ ° O Ves O No ~ 28. Were autopsy findings available m to mplete the c of death? co a a o Ve O No s 29. If 30. Did Tobacco Use Contribute to Death? 31. Manner of Death o t pregnant within past year ~ Yes 0 Probably Q~N atu ral ~ Homicide regnant at time of death 0 No Unknown ~ Accident ~ Pentling Investigation ~ Not pregnant, but pregnant within 42 days of death 0 Suicide ~ Could not be determined ~ ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr) (Spell Monthj Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: ~ Yes ~ Driver/Operator ~ Pedestrian ~ No ~ Passenger 0 Other (Specify) ifier (Check only one): 39a. Ce rt ~~ / Q (.erc1fying physician - To the best of my knowledge, death occurred due to Lhe cause(s) and manner stated ~/Pronou ncing ffi Certifying phyyy 'clan - the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/COroner~0 th is of examination, and/or investigation, in my opinion, de a t h o urred at the time, date, and place, and due to the cause(s) and manner stated [ ff ~. ~ t Signature of certifier: Title of certifier: ~`f V ` ~ License Number: 39b. Name, Address antl Zip de son Completing Cay6q ~De¢1Filli~ip~ Medical Center ~ V ~ fl e'f 1 1 Hershey Pa 17033 c~. to Igned (MO/Day/Vr) 39L , , . , C ~ ~ ~.LV'1..-- 40. Registrar's District Number 41. Registrar' 42. Regist r File Date (MO Day Yr) 43. Amendments ' .5 H 1O5-143 Disposition Permit No. REV 07/2011 l_L. k..7 ! - ~ .~; _ Cri ~_ ,._ __ ~ ~_;, ~o =- s :~- LAST WILL AND TESTAMENT ~: ~~ ~;~ C:, . {- --~ `r r U Z t.~ ~~ OF ~ '~-~ v JOANNE Y. KOTZMOYER I, JOANNE Y. KOTZMOYER, of 348 McAllister Church Road, West Pennsboro, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do make, publish and declare this to be my Last Will and Testament. I hereby revoke all previous Wills and Codicils at any time heretofore made by me. ITEM I I order and direct my Executor, hereinafter named, to pay my debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. ITEM II I direct my Executor to arrange for a funeral in conformity with my station in life to be followed by the interment of my remains in my burial plot in Westminster Gardens at "Garden of Christis", Lot 68-A (space 3 or 4). I also own Lot 69-B to be given to my daughter, KENDRA K. HF,iNBAITGH. My Executor is further directed to purchase, erect and inscribe a suitable :rarker for my grave. ITEM III I hereby give and bequeath to my daughter, KENDRA K. HEINBAUGH, per stirpes, the following items: yf~ A) All of my jewelry, including my diamond ring, wedding band and jewelry boxes owned by me or in my possession at the time of my death. B) All of my oil paintings. C) My antique oak curved-glass china cabinet. D) All of my antique dishes, vases and pitchers. E) All of my shares of common stock of Wachovia Corporation, its successors and/or assigns. F) All of my shares of common stocks of Allied Irish Bank, PLC, its successors and/or assigns. G) All of my US EE Savings Bonds. ITEM IV I hereby give and bequeath the following items to my grandson, DEREK N. HEINBAUGH: A) The sum of Five Thousand ($5,000.00) Dollars from my IRA account. B) All the coins and money in my safety deposit box. ITEM V I give, devise and bequeath all of the remainder of my property, of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will to my husband, ROY F. KOTZMOYER, if he survives me, or if he predeceases me, then to my daughter, KENDRA K. HEINBAUGH, and to her issue, then living, per stirpes. 2 . ~ f~ ll ITEM VI If my grandson, DEREK N. HEINBAUGH, is less than twenty-one (21) years of age at the time of my death, I hereby direct that portion of my property in which he will share, wherever situate and whether acquired before or after the execution of this Will, be placed in trust to his mother, KENDRA K. HEINBAUGH, of Carlisle, Pennsylvania, with the following conditions and provisions: A. Trustee shall hold the principal of this trust for the benefit of my grandchild (beneficiary) and shall distribute the principal and income in such proportions as Trustee shall determine, for his health, maintenance, support, business endeavors and education, including college, graduate level or professional education after considering the beneficiary's age, aptitudes, interests, abilities anc: needs. Education shall be defined broadly to include trade school and other similar training. In the event the income of this Trust shall be insufficient to provide the beneficiary with adequate maintenance, support, welfare or education, the Trustee may invade the principal of the Trust for this purpose. The Trustee, in exercising her discretionary authority with respect to the payment of income or principal of the Trust estate to my beneficiary, shall take into consideration any income or other resources available from sources outside of this Trust that may be known to the Trustee. The determination of the Trustee with respect to the necessity of making 3 payment out of income or principal to my beneficiary shall be conclusive on all persons however interested in the Trust. B. If the beneficiary should die, without issue, before attaining the age of distribution, all unapplied principal and income shall become part of my residuary estate. C. The beneficiary of this Trust shall not have any right to alienate, encumber or hypothecate his interest in the principal or income of the Trust in any manner, nor shall his interest be subject to claims of his creditors or liable to attachment, execution or other process of law. D. In order to carry out the purposes of this Trust established by this Will, the Trustee, in addition to all other powers granted by this Will, or by law, shall have the following powers over the Trust estate, subject to any limitation specified elsewhere in this Will: 1. To retain any property, real or personal, received by the Trust estate for as long as the Trustee considers it advisable. 2. To spend funds for the maintenance and repair of real property. 3. To sell at public or private sale, exchange or lease for a period of time, any real or personal property and give options for sale of the lease. 4 ~/ ~' ,1 4. To execute and deliver any deeds, assignments or other instruments as may be necessary to carry out the provisions of this Trust. 5. To borrow money and to mortgage or pledge any real or personal property. 6. The Trustee shall maintain accurate records and accounts showing receipts and disbursements of principal and income no less frequently than annually. The Trustee shall receive fair and reasonable compensation for administration of this Trust, not to exceed five (5%) percent of annual income. 7. To distribute property in kind. 8. To do all other acts that are in her judgment necessary or desirable for the proper management, investment and distribution of the Trust estate. E. The Trust estate for the beneficiary shall be administered until said beneficiary is twenty-one (21) years of age, at which time the Trust will terminate and Trustee shall distribute the remaining principal and accumulated interest to the beneficiary. ITEM VII I direct that the personal property listed in the Memorandum (Directive) attached to my Will be distributed by my Executor as indicated therein. 5 ~, ,~ ~~ ~.1 ITEM VIII In the event that ROY F. KOTZMOYER and I should die simultaneously or under circumstances as to render it impossible to determine who predeceased the other, or within thirty (30) days of each other as the result of a common accident, I shall be deemed to have survived him, and all the provisions of this Will shall take effect as though I had survived my husband. ITEM IX I hereby nominate, constitute and appoint my husband, ROY F. KOTZMOYER, as Executor of this my Last Will and Testament. In the event of his renunciation, death, resignation or inability to act for any reason whatsoever, I nominate, constitute and appoint my daughter, KENDRA K. HEINBAUGH, as Alternate Executrix of this my Last Will and Testament. ITEM X I hereby direct that no Executor or other Fiduciary named or appointed by this Will shall be required to post any bond or give any security of any type for any purpose whatsoever, nor be liable for failure to file any report, accounting or inventory, in any jurisdiction in which he or she may be called upon to act, insofar as I am able by law to do. ITEM XI I authorize my Executor in his discretion to sell, with or without notice, at either public or private sale, and to lease any property belonging to my estate, subject only to such confirmation of Court as may be required by law, for such prices and on such terms and conditions as he deems best, and to make distribution hereunder either in case or kind, as he may deem wise. 6 ,~ °C~L IN WITNESS WHEREOF, I hereunto set my hand and seal to this, this ~ day of ~~~~,[s~t~--~~L , 2003. ,1 ~ (SEAL) J ANNE Y. KOT OYE Signed, sealed, published and declared by the above-named Testatrix, JOANNE Y. KOTZMOYER, as and for her Last Will and Testament, in the presence of us, who thereupon at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~~~ 7 COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND We, JOANNE Y. KOTZMOYER, PATRICIA R. BROWN, and VALERIE F. GSELL, the testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being duly sworn do hereby declare to the undersigned authority that the testatrix signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ,~ ~,,~~ i ° ~ SEAL) J ANNE Y. KO Z OY i `-1-~..~=~2..~ t,~ ~ y~-~~,~-~--- (SEAL) n ,Witness ~_ _ ~~'~~-~-~' (SEAL) Witness SUBSCRIBED, sworn to, and acknowledged before me by JOANNE Y. KOTZMOYER, the testatrix and subscribed and sworn to before me by PATRICIA R. BROWN and '~ the witnesses, on the~~V day of ~%~.~~-~ ? % , 2003. ~~ 1 ~,y _ r ~ ~ C ~ r" ~ i" Notary Public ANN L A ~TIIRr 1~tN; CARL131,E ~BERIANd COUNTY