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Home My WebLink About05-16-12Reset PETITION 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 request(s) the grant of Letters in the appropriate i-olm: Decedent's Information Name: John J. Seibold, Jr. a/k/a: a/k/a: a/k/a: Date of Death: 05/12/2012 File No: ~.~ ~ ~ ~ ~ )~i-~~!) (Assigned by Regiister) Social Security No: Age at death: 57 Decedent was domiciled at death in Cumberland County, Pennsylvania (ware) with his/her last principal residence at 52 Ouarry Hill Road, Newville. 17241 Penn _ Cumberland Street address, Post Office and Zip Code Cih~, Township or Borough County Decedent died at 500 University Drive, Hershey, 17033 Hershev 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 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania If not domiciled in Pennsylvania ........................ Personal property in County Va[tte of real estate in Pennsylvania ........................................................ . TOTAL ESTIMATED VALUE... . $ 1,000.00 S -- $ -- $ _ 150,000-00 8 151.000.00 Real estate in Pennsylvania situated at: 52 Quarry Hill Road, Newville, 17241 Penn ___ Cumberland (.9ttach additional sheets, ifnecessan.) 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) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated n/a 04/ 18/ 1990 and Codicil(s) State relevant circumstances (e.g. remmciation, death of executor, etc.) Except as follows: after the execution ofthe 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 bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS 0 B. Petition for Grant of Letters of Administration (Ifappticable) _ c. t. a., cl.b.n., d. b.n.c.t.a., pendente lice, 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 a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. O NO EXCEPTIONS Q 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 Relationshi Address-z= ~ a7 `~ ,_~ . .~ ~C ;~ C= --. t ~_ ~: -'c_, %~ _= ~ ~ C,..3 `-,~ C~ Cx Fonn RW-02 rev. !0,?!/2011 page 1 Of 2 v Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use O-ttLy , ,- ~ C, ~i~~. ~ , . .., 'J ~: Petitioner(s) Printed Name Petitioner(s) Printed Address, . _ Gre o O. Seibold ,. 104 Derb Court Kin NC 27021-7978 -;,+; ! ,~ ~.~'•~-~-~'~' Cl1MBE~~ ~~~ ~ ~ ~~ , 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 ' e Petitio r(s). ill ell nd tnily administer the estate accor ing law. Sworn to or affirmed and subscribed before ~ Date me thi j day of ~ ~ ~ Date BY~ ~~!\l~ ~~~ ~ ~`L_~~~ Date For the Register Da'Ce BOND Required: ®YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ (~ .~.,) Short Certificate(s)...... r-j ~( , (~(' ( )Renunciation(s)...... .. . ( )Codicil(s) .......... .. . ( )Affidavit(s)......... .. . Bond ..................... ... Commission ............... .. . Other ~.~, ~, ~ ~ .... ... 1 `-) ~%~ Automation Fee ............ ... ~ ~' JCS Fee . ................. ... ,~. -~ ~ ~( TOTAL ..................... $. "~ I .^. x'0.00 Attorney Signahire: Printed Name: Adam R. Deluca Supreme Court ID Number: 311738 Firm Name: Address: Allied Attorneys of Central Pennsylvania 61 West T.ou her tr Carlisle, PA 17013 __ Phone: Fax: Email: 717-249-1177 717-249-4514 ardehicaRSna~l cam __ DECREE OF THE REGISTER Estate of John J. Se_i_bold, Jr. File No: ~ 1 - 4 e~ ~i.`~. ('` a/k/a: AND NOW, 1` ~~ ~~ ~. C ' ~) ', ' ', ~-- , in consideration of the foregoing Petition, satisfactory proof having b presented before me, IT IS DECREED that Letters Testamentary _ are hereby granted to Gregory O. Seibold in the above estate and (if applicable) that the instrument(s) dated 04/18/1990 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent • Register of Wills ~,; Fo~~n RYi~-02 rev. l~%IU3011 ,_ 1 y:,~ t. (.i` ~~~~'~agt~- 2 Q1~2 ,.Y .~ WAR t _ I# is illeg~~}tp duplicate th~~ ~ s~t~l t~~,, ~rl ,^tt~~i~ ~ ~, . E~L~~, r,); ~t,;, ~z~~~f;cah. ~sf, llr, ;,~+ r ~~Y ! 6 ~~ ~~~~ i0~ ..j ~; o . ~~~ ~ , ~ ([,111„ , ,1..~(: ~~ _ - ~ , , ~ , Y;A. ~~ {, ..y y, - ~ r rc s 1.1 ~, E 11:?:. 1 'C )c 11. ~'1 , ~ . Y V~f ~iHIV LJ ~~~ ;r`. ') r I ~` c~.m ~~ .. ' I 1~ 'h X4876 2 _p ~ ti , ~' " ~ ~y r R.t~~.~~~. MAIf` 1 42012 ~ --------- ------ - --_ - _. r _ ~l ~ ~~~ - -- - ---- Certification Numb~~ _ Type/Print In Permanent COMMONWEALTH OF If" PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CQTI CIf"ATC AC r1C ATu G O ~~ ( .,/~-~I V , - - - - Flle Number: 1. Decedent's Legal Name (Firs[, Middle, Las[, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/V r) (Spell Mo) John Joseph Seibold Jr_ ale 152-46-1162 M..-ay 12, 2012 6a. Age-Last Birthday (Yrs) 6b. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace City and State or Foreign Country) 57 Mpntns Days Hogs Mingces June 15, 1954 New ~ortc Cit NY ]b. Bircnplace (county) w V o r]t Ba. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Llye in a Township? ~'"L~ -i3' 1 ?i n s~ )crYan a 52 Quarry Hi 11 Road es decedentlwedin Pl?rln , <„yp Ba. Reslden~e (cggnty) ----- C umbe r 1 a n d Se. Residence (Zip Code) ] '7 2 4 ] 0 No, decedent IlVed within limits of - - city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Mauled 0 Widowed il. Su rviying Spouse's Name (If wife ive name ri t fi , g . p or o rst marrlageJ Q Ves ® No Q Unknown Q plyorcetl X.i~EJeyer Married ~ Unknown 12. Father's Name (First, Middle, last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle Last) , Sohn Jose h Seibold Sr. A nus Livingston 14a. Informant's Name Rel ti hi t D d ' " p o ece ent ro~Y-ier d ~ Gr S ib 14 c. Informant s Mailing Address (Street and Number, City. State, Zip Code) g eg e ol ~i lso. P ace o Deat C ec on y one ...........................................................(, ..........................-..........--..t....... ...... . c - ° a .. ......................................... ................. ......... ..... If Death Occurred In a Hos Ital: CJ In p patient :If De Sh Occurred Somewhere Other Than a Hospital: [~ Hos i ~~~~ ~~..ww ~~~ ~~ """"""""""""'""""' p ce Facility ~~ I I Oecetlent's Home _ ~ Emergency Room/OUtpafient Q Dead on Arrival 0 Nursing Home/Long-Term Care Facility Other (Specify) ~ SSb. Facility Name (If not Instifutlon, give street and number; 15c. City or Town, State, and Zip Code 15d Co t f h - un y Deat M_5. Hershey Medical Center Hershey, Pa. 17033 D hi m aup n 16a. Method of Disposition 0 Burial ~ CremaTlon 16b. Date f Disposition 16c. Place of Disposition (Name of cemetery, ere mar_ory or other place) , ~Rempyalfrnmstate ~Dpnaclon 5/15/2012 Hollinger Cremator o[ner (specify) Y 2 Locati f pi Itlo (Ci Town, Stat d Z 1]a. Signature of Funeral Service Licensee or Person in Charge of Interment 1]b. Ucense Number ~~. ~o ~y ~pt~-ings ~~ x}7065 - ~ r FD 13895 L c 1]c. Name and Complete Address of Funeral Facility --- E er Funeral Home Snc 15 Bi S rin e Newville, PA 17241 m 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 r 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 . ~ Hth grade or less is Spanish/Hispa nlc/Latino. Check the "NO" ~ White ~ Korean Q No diploma, 9th - 12th grade box If decedent is not Spanish/Hispanic/Latino. 0 Black or African American Q Vietnamese ~ High school graduate or GED completed o, not Spanish/Hispanic/Latino ~ American Indian or Alaska Natiyf• 0 Other Asian ~ Some college credit, but no degree 0 Ves, Mexican, Mexican American, Chicano ~ Asian Indian 0 NatlVe Hawaiian A ssociate degree (e.g. AA, AS) Q Yes, Puerto Rican 0 Chinese 0 Gua ma l Ch ' n an or amorro Bachelor s degree (e.g. BA, AB, BS) Q Yes, Cuban ~ Filipino ~ Sam ' oan ~ Master s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino ~ Japanese Q Oth P ifi I l er ac c s ander ~ Doctorate (e.g. PhD, EdD) or Professional degree (S ecif ) p y ~ Other (Specify) . MD DOS OVM 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 U l O . . sua r_cu potion -Indicate type of work ($j White Q Japanese 0 Samoan do tl i ne ur g most of working life. DO NOT US)= RETIRED. ~ Black or African American 0 Korean ~ Other Pacific Islander m e r g e n e y Order s h i pp e r A i ~ mer can Indian or Alaska Native ~ Vietnamese Q Don't Know/Not Sure ~ Asian Indian 0 Other Asian ~ Refused 22b. Kind of Business/industry Q Chinese Q Native Hawaiian Q Other (Specify) $M T e eh n o t er gY ~ FIIl pino ~ Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable 23c. License Number 0Y PERSON WHO PRONOUNCES OR M 2 CERTIFIES DEATH i ~/!~ 23d. Date Signed (MO/Day/V r) 24. Tim of Death O 25. Was Medical Examiner or Coroner Contacted? Q Yes ~ No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, Injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest I t l n erva : respiratory arrest, or ventricular fibrillation without showing the e[IOIOgV. DO NOT ABBREVIATE. Enter only one cause on a line Add dditi l I' . a ona ~nes if necessary Onset to Death ~ IMMEDIATE CAUSE ------ -----~~--> a. Ji,L wf1~)1i ti (Final disease or condition Due to (or as a con __- - - sequence of): rasulting In death) ~ b. S 4---A_JV b7'y~ 5 Sequentially list 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): - (disease or Injury that initiated the events resulting d. m death) LAST. Due to (or as a consequence of): - S 26. Part 11. Enter other significant conditions contr'b tl t d th but not resulting in the underl in i y g cause g ven in Part I 2J. Was an autopsy performed? ~ D Yes ~ No 28. Were autopsy findings available ~ co - to mplete Ghe eau of deathT V O Yes ~ No 29. If Female: o 30. Ditl Tobacco Use Contribute to Death? 31. Manner of Death ~ Not pregnant within pas[ year ~ Yes ~ Probably Yy.., Natural Q Pregnant at time of death aJ [~ Homicide ~ No ~`] Unknown 0 Accid t ti en [~ Pending Investigation ~ Not pregnant, but pregnant within 42 days of death ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In"u Q Suicide [7 Could not be determinetl 1 ry (Mo/Day/Yr) (Spell Month) __ 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 Cgtle) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Ves Q priver/Operator ~ Pedestrian ~ No Q Passenger ~ Other (Specify) 39a. Certifier (Check only one): - Certifying physician - To the best of my knowled eath occurred due to the cause(s) and manner stated P o i ffi r nounc ng Certifying physician - To the bes y knowledge, death occurred at the time, date, and place, and due to the cause(s) and manne tatetl Q Medical Examiner/C O h r oroner - n G basis atian, an~or inye ~t"g^/tion, in my opinion, dew/<h occurred at the time, date, and place, and due stated to th/~{~~ Signature of certlfiect~ ~ ~ ) ,~~ / Title of certifier: f L~ 2 ~~ r"L !G) ea.` License Number: V / Q 396. Name, Address and Zip Code of /Q on Com leting Caa~[otgle~[Ipg~~ Medical Center, Hershey, Pa.17033 39 c D ate Sign d (MO/Day / Yr) ~ y t / ~ ,~ 40. Registrar's District Number 41 Registrar' a . ~~ 42. Regi trar Flle Date (Mp/Day/Yr) 43. Amendments ~~ ~ ~ acs L~ Disposition Permfi No. o ! l~~r-}-~ _ H105-143 REV 0]/2011 ~ ~ I, JOHN J. SEIBOLD, JR., of the Borough of Spotswood, County of Middlesex, State of New Jersey, do make, publish and declare this to be my last Will and Testament, hereby revoking all prior wills and codicils made by me. FIRST: I direct that all my lawful debts, funer~~ ,-i, ~3~~and -z:~ ~.- -r ~ ~ r-; , testamentary expenses be paid as soon as practicable aft~~~- "'~ e='=" __, ,._. c. ;.. death. ~._,. .. -. ,. _:,. SECOND: All the rest, residue and remainder of in ~ :estate, ~~-~ -ri ~ 'y c,.a `.~ whether real, personal or mixed, of whatsoever it may consist acrd wheresoever it may be located, including any property ovE~r which I may have the power of appointment or other disposition, I give, devise and bequeath to my brother, Gregory O. Seibold. _. . ..,_ THIRD: My Executor is hereby granted all powers conferred upon executors and trustees under the laws of the State of New Jersey. In addition, my Executor and Trustee are empowered to mak;e dis- tributions in cash or in kind, or partly in cash and partly in kind. FOURTH: The decision of my Executor with respect. to the exercise and nonexercise by them of any discretionary power under this my Last Will and Testament, or the time or manner of the exercise thereof, made in good faith, shall fully protect, them and shall be conclusive and binding upon all persons interested in my • estate. All of the rights, privileges and powers granted to my Executor shall apply to all property at any time held by them under this my Last Will and Testament, and until the actual dis- tribution thereof. FIFTH: Any beneficiary under this my Last Will and Testament shall be conclusively presumed to have predeceased me if he or she shall die within (30) days after my death. SIXTH: I order and direct my Executor to pay from my residuary estate any and all inheritance, succession, transfer and estate taxes, including any interest or penalties assessE~d in connection therewith, imposed against my estate or the lE~gacies, bequests and devises given, devised and bequeathed or trusts created in and by this my Last Will and Testament and any codicils thereto, or imposed by reason of the inclusion in my estate for tax purposes of any life insurance proceeds, gifts, inter vivos or other property. SEVENTH: I nominate, constitute and appoint my bz•other, Gregory O. Seibold to be the Executor of this my Last Will and Testaments to serve without bond. to be the Executor of this my Last Will and Testament to serve without bond. -2- a LASTLY: Wherever used herein, the words "Executor", "Trustee" and "Guardian" shall be deemed to include the feminine wherever the context so requires. IN WITNESS WHEREOF, I have hereunto set my hand a.nd seal this ' $ day of ~ p T i" ~ , 1990 . ~~c-~Ol . (L . S . ) JOHN J. SEIBOLD, R. The foregoing will consisting of three (3) typewritten pages, including this page was signed, sealed published a.nd declared by the said JOHN J. SEIBOLD, JR. as and for his Last Will and Testament, in the presence of us, all being present a.t the same time, and who, at the Testator request, in his presence, and in the prese each 'her, have hereunto subscribed our names a d addr sses as attesti g witness ~ ~~), t --C_ _~- ~ --~-.._ `r-.`~ . ___ ~ - ~-_-~ '~ ~``~.. ~... e~ -3- In the Matter of the Will -of- JOHN J. SEIBOLD, JR. I, JOHN J. SEIBOLD, JR., the Testator, sign my n2ime to this instrument this / $ day of (~' ~ ~% 1 ~ , 195-0, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eighteen years of age or older, sound mind, and under no con- straint or undue influence. a JOHN J. SEIBOLD, JR., Testator ~`t ~ ~ ~ We,.~1! .1,~-~-~Pf ~~~ ~~, and ~ S l~ ~ ~(/'j~'7. witnesses, being first duly sworn, do each hereby declare: to the undersigned authority that the Testator signs and executes this instrument as his Last Will and that he signs it willingly and that each of us, in the presence and hearing of the Testator, hereby signs this Will as witness to the Testator's signing, and that to the best of our knowledge the Testator is eighteen years of age or older, of sound mind, and influence. State of New Jersey: County of ~ ~~~~~.~ Subscribed, sworn to and acknowledged before me k>y JOHN J. SEIBOLD, JR. , the Testatoor and subscribed"and ~slwo~irn/~'to k>efore me by ~~~~(~~~ ( ~• (,~~~.C~ and ~~r~ ~ f~l"~k~ ~ l~.(.IJZ(/1G wit- nesses, this I~ day of ~~~r'" -- ~ .1990. ARLENE T. i+nAAUNCHAK Notary Public o! New Jersey My Commission Expires April 28,199;'s