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HomeMy WebLinkAbout04-13-12PETITION 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: Caroline J. Jardine Decedent's Information Name: J. Dale Jardine File No: 21-12 •- [~~ y a/k/a: James Dale Jardine (Assigned by Register) a!kla: a/k/a: Social Security No: Date of Death: 02/21/2012 Age at Death: 79 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 685 Barnstable Rd., Carlisle 17013 West Pennsboro Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 685 Barnstable Rd., Carlisle 17013 West Pennsboro 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 $ 0.00 If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ 84,500.00 TOTAL ESTIMATED VALUE $ 84,500.00 Real estate in Pennsylvania situated at Barnstable Rd., Lot 3, 17015 West Pennsboro Township Cumberland (Attach additional sheets, if necessary.) Barnstable Rd., Lot 4, 17015 West Pennsboro Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County ® 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 01/10l20¢~ al~Codicil(s)~~ thereto dated ''- tv ~? ' -r~ -- _..~ -r, -z_ State relevant arcumstances (e. g., renunciation, death of executor, etc.) Y ~ W ° ~_-~,~ ~,- Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not marry, was not divorced, ~'~io~t a party to a pendfig~ divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did n~~a~child t7ETn or - T adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. _ ~ -- ^:7 -- ' ~ ®NO EXCEPTIONS ^ EXCEPTIONS -- - `~' O ^ B. Petition for Grant of Letters of Administration (If applicable) .~ c. t. a., d. b. n., d.b.n.c.t.a., pedente lite, 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 h -trc. 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 Form RW-02 rev. fo-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } ss: ~i COUNTY OF Cumberland } Official Use Only ~ { ('i- V~ i,r I lit c Petitioner(s) Printed Name Petitioner(s) Printed Address(: ~ f ~ a Caroline J. Jardine 685 Barnstable Rd. Carlisle, PA 17013 CLERK roc CUMR~P~;?~y! ~ ~;i1~ PA 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 a Decedent, etittoner(s) will w truly administer the estate accordin to la . `_ - X02/ Sworn to or affihrmed a subscri ed before --y~ Date me this day,of J'~.J~~ Date By: Date For R Date L BOND Required? ~ YES ~ NO FEES: Letters . ......................................... $ ( 1 )Short Certificate(s)......... ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ... .......................................... Commi ssion .................................. Other JCP Automation Fee Will Automation Fee ............................ JCS Fee ....................................... TOTAL ......................................... 210.00 To the Register of Wills: Please enter my appearance by my signature below: 4.00 23.50 5.00 15.00 $ 257.50 Attorney Signature: C ~ ~~ Printed Name: George F Douglas, III Esq. Supreme Court ID Number: 61886 Firm Name: Salzmann Hughes, P.C. Address: 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Phone: 717-249-6333 Fax: E-mail: gdouglas@salzmannhughes.com DECREE OF THE REGISTER Date of Death: 02/21/2012 Social Security No: Estate of J. Dale Jardine File No: 21-12 a/k/a: James Dale Jardine -y~ ~ ~~~ AND NOW, , `~rJ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Caroline J. Jardine in the above estate and (if applicable) that the instrument(s) dated 01/10/2002 described in the Petition be admitted to probate and filed of record as~~eApst V1/ill (an Cc ~. 2>sgister of Wills' "' , ./}(p,~ ;; j~r ~, ,( r7",~ (c) 2011 form software only The Lack~ier Group, Inc. "~.-Y ~ ,~,J~ ~ ~ Page 2 of 2 ~ ~ LOCAL REGISTRAR S CERTIFICATION OF DEATH W RI~I~C~ _ It„fig i~~ g,~f~ to duplicate this copy by photostat or photograph.. ( 1 ,~ n J; ~. F I `,rat, ,_. .~~L'.C Fee Ibr this certificate, $6.00 ~~"lIS l:i IO CeftlI~ ~~1.li l!le 91j.fOr1718Cjo[i l1c~j"C ;tlV'('I"j j>~ correctly co0ied 9 r(~l ~ an uj jrinal C`ertifi( ate ut~ 1)ut~h ~'~~ ~ ~ ~~ duly filed with rrlc ); 1.u al Rey*istrar the Origin~~l certificate ~~ill r)e t~~)s~~,.jrded to l:he State 'Vital C~~~K ~' Records Oftice 1;)r c,~rrllanejlt filing. I ~~~r5 vV~ ~1r ~" _ P 18 2110 3~ ~ nr ~, r; ~ PA ~~ )T?.c~ L~'-]/~:/-9{,~-{ ~ ~ ? -~12 - Certification Number ~ t_ocal Registrar t~ate~ lssur.:d ;` Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS P<rman<nc CERTIFICOTE CIF t~EOTH ~'---t ~I 0 1. Decedent's Legal Name (First, Mitltlle, Last, Suffix) 2. Sex 3. Social Security Number 4. Oate of Death (MO/Day/V r) (Spell Mo) M 204 30 6735 Feb. 21 2012 sa. Age-Last Birthday (Yrs) Sb. Under 1 Year sc. Under 1 Da 6. Dare Of BiKh (MO/D ay/Year) (Spell Month) ]a. Birthplace (CI and State or Foreign Country) 1 Months Days Hours Minutes Carlisle PA 1 79 OCtObE'r 27 , 1 932 ]b. Birthplace (County) Ba. Residence (STafe or foreign Country) 86. Residence (Sf ree[ and Number -Include Ap[ No.) 8<. Did Decedent Liy< In a Township? PA Ves, decedent lived in West PennSbOr'O t'"'p' 8d. Residence (County) 685 Barnstable Road Cumberland 8<. Residence (Zip Code) 1 7 1 ONO, decedent lived within limits of city/boro. 9. Ever In US Armed Forces? SO. Marital Status at Time of Death ~ Married Q Widowed 11. Surviving Spouse's Name (if wife, give name prior to Flrsf marriage) dyes Q NO Q Unknown Q Diyorcetl Q Never Married Q Unknow Caroline J _ Fisher 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) James Clark Jardine Miriam G_ Trago 14a. Informant's Name 14b. Relationship to D<c<dent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) 0 Caroline J_ Jardine Wife 685 Barnstable Rd_ Carlisle, PA 17015 G .......................................................... ... .................................. Jsa. P ace o eat c pn y o.,e ......................................... eC....... .. .............. Pa ~ If Death Occurred in a Hospital: In tlent : _ ................ If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~};pecedent's Home ~ ° Q Emergency Room/Outpatient Q Dead on Arrival _ Q Nursing Home/Long-Term Care Faclllty Other (Specify) d 156. Facility Name (if not institution, glue street and number; 16c. City or Town, State, d Zip Code 16d. County of D th l ~ 685 Barnstable Rd_ Carlisle, PA 17015 Cumber and ~. 16a. Method of Disposition $] Burial Q Cremation Q R¢moyal from State Q Donation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, cremaTOry, or other place) ,~ ocn<r (sp<cify> 2/25/201 2 Westminster Memorial Gardens Z 16d. Location of Disposition (City or Town, State, and Zip) 1]a. Signatur oral Service Uc r Pe Charge of Interment 1]b. License Number ~ Carlisle, PA 17013 ~ FD 012633 L 1]c. Name and Com pieta Atldress of Funeral Faclllty Elwin Brothers Funeral Hclrne, Snc. 630 S_ Hanover St_, Car1i 1e, PA 17013 ~ 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 races to IndlcatEwlta[ 1- highest degree or level of school completed ai the time of death. box that best describes whether The decedent t he d ¢cedent considered himself or herself to be. ~ ~ " Q 8th grade Or less is Spanish/Hispanic/Latino. Check [he "N O" ~ white 0 Korean Ja"}JO diploma, 9th - 12th grade box If decedent Is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q Hlgh school graduate or GED com pleYed not Spanish/Hispanic/Latino Q American Indian or Alaska Native ~ Other Asian Q Some college credit, but no degree Q Ves, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Assoclat! degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, A6, BS) Q Yes, Cuban Q Filipino ~ Samoan ~ Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) O Ves, ocher Spanish/Hispanic/Latino Q Japanese Q Other Pacific Isla ntler Doctorate (e.g. PhD, EdD) or Professional degree (Specify) O Other (Specify) . MD DOS DVM LLB lD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent consideretl himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work _,B'Q/hite Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q D'on't Know/NO<SUre Owriar/Operator Q Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry Q Chinese Q Native Hawaiian Q OTher (Specify) Q FIIIpinO Q Guamanian or Chamorro Dairy Farm ITEMS 23! - 23d MUST BE COMPLETED 23a. Dale Pronou nc<d Dead (MO/Oay r) 23b. Signature of Person Pronouncing Death (Only whe applica bleJ 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH lk 0.r 0 ~ a /~Y 23d . D ate Signed (MO/Day/Yr) 24, Time of Death (,~ ~ /e~~~~ ~~ ~L_ ~ ^ ~ T->~'RRI o /~ 2-~ / ~Z ~~I~S -/J-f 25. Was Medical miner or Coroner Contacted? Q Ves No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--tliseases, injuries, o mplications--that directly caused the death. p0 NOT enter terming( events such a ardlac arrest Interval: respiratory arrest, or ventricular fibrillatio n w i t hout sho ng h e l o ~I t ti gy . DO NOT A BR E AT E . Enter my one taus T t/ line. Atld additional Tines if necessary Onset to Death O/ ~ y ~ / ~ ._ { - j~ r ~f ~) / ~ O / . - l / IMMEDIATE CAUSE ---------------> a. {e]// 1~~~~ t////// (~ j~ / V/ ~ ~ ~C ~~[ ~O_Sf ~ ~ . (Final tllsease o ndition Due to (or as a consequence of): resulting in death) b. Sequentially list conditions, Due to (or as a consequence of): If any, leading to the cause listed on line a. Enf¢r the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury thaC F Ini<latetl the <V<nts resulting tl. ~ In death) LAST. Due to (or as a consequence of): S 26. PaR 11. Enter other siantfican[ conditions contributing to death buT not resulting in the underlying cause given In Part I 27. Was an autopsy rfo ed? ~ ~/\ D Ves No ~ ~ f "~ ~,~y ~ 1: ~/~V-~~~w~ . 28. Were autopsy findings available ~ to complete [he q death? O Yes .J:< o 29. If Female: 30. Oid Tobacco Use Contribute to DeathT 333~33{~~~{~(.. M}}}}}}pppppp ner of Death E Q Not pregnant within past year Q Yes Q Probably Natural Q Homicide as Q Pregnant at time of death ~ Q Unknown ! ~ Accident Q Pending Investigation °vi' Q Not pregnant, but pregnant within 42 days of death Q Sulcitle Q Could not be determinetl ~ ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date Of Injury (MO/Day/Yr) (Spell Month) Q Vnknown If pregnant within the pas[ year 33. Time of Injury 34. Plac! of Injury (e.g. home; construction site; farm; school) 5. Location of Injury (Street and Number, City, Slate, Zip Code) 36. Injury at Work 37. If Transportation Injury, 6peciTy: 38. Describe How Injury Occurred: 0 Yes Q Driver/Operator Q Petlestrlan Q No Q Passenger ~ Other (Specify) C Iffier (Check only one): rt ~Ce rtlfying physician - To the best of my knowledge, death o red due to the cause(s) and m r stated Q Pronouncing R Certifying physician - To the best of my knowledge, death occurred at the time, date, antl place, and due to the cause(s) antl m r stated Q Medical Examiner/COro On a basis a Ion, and/or Inyesttgatlon, In my opinion, deatM1 occurred at the time, date, and place, and tlue to theme .ctau~se(s) d m'a7nner stated // j/ '] Signature of certifier: Title of certifer: ' ' / ~ License Number:,,lVO/~ / ~~~ 39b. Name, Add Zip Gotle f Comple th (Item 26 ~~~ ~C ~ ~f 39c. Dale Signed Mo/ y/Vr) / / rCt J i % / - /Z 40. Registrar's District Number 41_Re is SI ature _ gQ a 42. Registr File Date (MO Day "' - te- -~~ ~ ~ i~ a3. Am¢ndmincs i Disposition Permit No. C.J /~ D T tip / H305-143 REV O]/2011 LAST WILL AND TESTAMENT I, J. DALE JARDINE, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, declare the following to be my last will and testament, hereby revoking any and all wills heretofore made by me. Item I. I direct my executrix hereinafter named to pay all my debts and funeral expenses. Item II. I give my two building lots 3 and 4 on Barnstable Road in West Pennsboro Township to my two sons, Dennis J. Jardine and Derek D. Jardine, in equal shares per stirpes. Item III. I give, devise and bequeath all the rest of my property, both real and personal, to my wife, CAROLINE J. JARDINE, providing she survives me by 30 days. Item IV. In the event that my wife does not so survive me, or dies in a common disaster with me, I devise and bequeath all the rest, residue and remainder of my property, both real and personal, 50% to my children and 50% to my wife, Caroline J. Jardine's, children, as follows: Caroline's children: Jennifer A. Bowman, Jimmy H. King, Jr., Jan S. Messina, and Jason D. King, the 50% share to be divided equally per stirpes. My children: Dennis J. Jardine and Derek D. Jardine, the 50% share to be divided equally per stirpes. Dale's children: Dennis J. Jardine and Derek D. Jardine, the 50% share to be divided equally per stirpes. /~ - ~,-~ y Item V. I nominate, constitute and appoint my wife, Caroline J. Jardine, as my executrix. If she should be unable to serve, I appoint Dennis J. a Jardine as substitute executor, and I direct that they should serve othout ~ _,~ bond. _~, ; .r, .,, ~~ -r x_ .Y U, _; _ : _ ,, j~_.:f.7 ~..~,,. .,._~ ~7 ...gyn. _ -~ _.~~ r c,_rj G IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of 2002. ~~ ~ i ~ ~-' SEAL J. Dale ardine Signed, sealed, published and declared by the above named testator, as and for his last will and testament, who at his request, in his presence, in our presence, and in the presence of each other have ereunto s scrib d our names as attesting witnesses: ~~ - ~, COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, ~' and ~ ` whose names are signed to the attached or oregoing instrument, being d ly qualified according to law, do depose and say that we were present and saw estator sign and execute the instrument as his last will, and that he signed willingly and that he executed it as his free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. G: l~ Sworn to and subscribed before me this I ~ day of 2002 ~~~ Notarial Seal Anne M. Cox, Notary Public Carlisle Borough, Cumberland County My cnmmission expires )ufy l4 'lU0 ~ __J e ~ i COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, J. Dale Jardine, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Lam- ce -z ,~~. ~. J. D e Jardine Sworn to and subscribed befor me this the / D day of ~ 2002. Notary Notarial $eal Anne M. Cox, Notary Public Carlisle Borough, Cumberland County My commission exprces July 14, 2003'