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HomeMy WebLinkAbout06-07-12Reset 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 form: Decedent's Information Name: Beryl C. Gardner a/k/a: a/k/a: a/k/a: Date of Death: March 24, 2012 File No: (Assigned by Regis Age at death: 77 Decedent was domiciled at death in Cumberland County, e n. ylvan;a (State) with his/her last principal residence at 37 Kitszell Drive, Carlisle, 17015 South Middleton Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 361 Alexander Spring Road, Carlisle, 17015 South Middleton 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 $ 421,000.00 If not domiciled in Pennsylvania ....................... . Personal property in Pennsylvania $ 0.00 If not domiciled in Pennsylvania . ...................... . Personal property in County $ 0.00 Value of real estate in Pennsylvania ..................... ................................... . $ 0.00 TOTAL ESTIMATED VALUE... . $ 421.000.00 Real estate in Pennsylvania situated at: N/A (Attach additiaial sheets, if necessary.) 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 December 29, 1993 and Codicil(s) thereto dated N/A State relevant circumstances (e.g. renunciation, 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(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 life, 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(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 (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi f7 ca; Address f T7 ~ 'C ~-t -. `°i_ I C~~%r _._ :~ C =tea f"- s r....., r7 :~ L7 Form aw oa rev. loilliaoll Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use Only ~•,~~ ~~ ~ rn _-~~, - ~V,.. r t.r '~ Petitioner(s) Printed Name Petitioner(s) Printed Address p.,."'r Elizabeth S. Gardner 37 Kitszell Drive Carlisle PA 17015 Cam.. r_.°. C' - - - ~ ~ -0: _... ~~ s7~ ,-~ 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, the Petitioner(s) will well and truly administer the estate accordi g to law. Sworn to or ffirmed anci.- ubscribed before ~ .r - ~~ ~ -, ~t--~-{--~~-c~ Date L~ ~~~ ~- me this day of ~ ~~ '~. _.- ~.t-' '~" _ Date B ~C c_~ Register Date Date BOND Required: ~ YES ~ NO FEES: Letters ..................... . ( 'L) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ....... . ~.~hfiUh ....... Automation Fee . ............. . JCS Fee . ................... . TOTAL ..................... ~~.~~ ~~ -ar To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: r---- .~~.. Printed Name: Ely e E. Rogers, Esquire Supreme Court ID Number: 41274 Firm Name: Saidis, Sullivan & Rogers Address: f35 Nnrth 12th Street, Suite 400 T.emo~~e, PA 1704 717-612-5801 717-612-5805 PrcZg,erc(Q7scr-attnrnevc nnm ~7~s~ DECREE OF THE REGISTER ~Q ._~L) ~ $ 9-99-- Estate of Beryl C. Gardner File No: a/k/a: AND NOW, (..~ , m consideration of the foregoing Petition, satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Elizabeth S. Gardner in the above estate and (if applicable) that the instrument(s) dated December 29, 1993 described in the Petition be admitted to probate and filed of record Register of Wills Form RW-02 rev. 10/11/2011 d ,~ ~~~ ~~ t r ,.~~~ ,, ~Ql1 JUN -1 p~ 3; j ~ ,~, ORPt,~,,lfSt ~UUA r CUMBERL~Wp Op PA ; ~--, P ~~329255 ~~.~.~- MAR 26 2012 ~> Type/Print In COMMONWEALTH OF PEN N6V LVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent Blank ink CERTIFICATE OF DEATH O_ 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Ber 1 Cam bell Gardner ma.1e March 24 2012 6a. Age-Last Birthday (Vrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Vear) (Spell Month) ]a. Birthplace (City and State or Foreign Country) • 1 77 nnpntns Days Hours Minpt¢s M 28 1934 Chica o IL ay , 7b. Birthplace (County) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township? PA 37 Kitzell Drive Oyes, decedent lived in South Middleton twp Bd. Residence (County) . Cumberland Se. Residence (Zip Code) 1']15 ~ No, decedent lived within limits of city/boro. 9. Ever in US Armed Forced 10. Marital Status ai Time of Death Married ~ Widowed 11. Surviving Spouse's Name (If wife, given a prior to first marriage) Yes Q No ~ Unknown [] Divorced ~ Never Married (] Unknow Elizabeth S _ Sturtevant 12. Father's Name (First, M(d dl e, Last, Suffix) 13. Mother's Name Prior Yo First Marriage (First, Middle, Last) S_ Beryl Gardner Billie Campbell 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) s 0 Betty Gardner wife 37 Kitzell Drive, Carlisle, PA 17015 Ci .......................................................... .......................-.....-............ ......_. 16 a. Place of Death C ec on y one) ~ _ ~Mer If Death Occurred in a Hospital: 46 Inpatient _ ____ _ _ _ ____ _ _ _ ___ _____ ................................... If Death Occurred Somewhe ~~ ~~~~ ~ ~~~ ~ ~ ~~ ~~ ~~~~ ~~~~~~~~~~~~ e Other Than a Hospital: Hospice Facility [~ Decedent's Home ° Q Emergency Room/Outpatient Q Dead on Arrival . ~ Nursing Home/long-Term Care Facility Other (Specify) 156. Facility Name (If not institution, give reet a d n ber; 16c. City or.TOwn, State, d Zip Code 16d. County of Death arlisle Regional Medical Center Carlisle, PA 17015 Cumberland 16a. Method of Disposition ~ Burial Cremation 16 b. Date of Disposition 16c. Place of Disposition (Name of cemetery, ory, o other place) r m p R¢mo..al from state p Dnnaunn Mar 27 , 2012 Hof £man-Roth Funeral Home & Crematory - Other (Specify) 16d. Location of Disposition (City or Town, State, and Zip) 1> S' atu re of Funeral Se e s r Person in Charge of Interment 1]b. License Number Carlisle, PA 17013 013144E E 1]c. Name and Complete Address of Funeral Facility Hoffman-Roth Funeral Home & Cremato 219 North Hanover Street, Carlisle, 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 r s to Indicate what r- 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. ~ 8th grade or less Is Spanish/Hispanic/Latino. Check the "NO" White ~ Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese Q High school graduate or GED completed g] No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native 0 Other Asian Q Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano 0 Asian Indian ~ Native Hawaiian Associate degree (e.g. AA, AS) ~ Ves, Puerto Rican Q Chinese Q Guamanian or Chamorro Igj Bachelor's degree (e.g. BA, AB, BS) ~ Ves, Cuban 0 Filipino 0 Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) O Yes, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander 0 Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specs fY) . MD, DDS, DVM, LLB, JD 21. Decedent's Single Race Self-Design atlon -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work $] White ~ Japanese Q Samoan done during most of working life. 00 NOT USE RETIRED. ~ Black or African American ~ Korean ~ Other Pacific Islander 2ndustrial Engineer Q American Indian or Alaska Native Q Vietnamese Q pon't Know/Not Sure ~ Asian Indian ~ Other Asian ~ Refused 226. Kind of Business/Industry Q Chinese [] Native Hawaiian Q Other (Specify) Carpet M£g _ a Fii pino a Guamanian qr Ghamorrp ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day/Vr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR GERTIFIES DEATH 3 2~-t C':- / G l..t-` M~04 KC vsL 23d. Dace Signed (MO/Day/Yr) 24. Time of Death 3 2.{ 1`J~ (~ ~ 25. Was Medical Examiner or Coroner Contacted> Q Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, o mplications--that directly caused the death. DO NOT enter terminal a ents such a ardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add addi[lonal lines if necessary Onset to Death MEDIATE CAUSE -> a. ~F• ~TA+ CJ .4ai F•A(Z•Ll.k'~ 0..~ (Final disease o nditipn Due to (o as a co nsequ nce of): resulting in death) - b. Seq uen[lally list conditions, pue to (o as a consequence of): _ if any, leading to the cause listed on lin Enter the UNDERLYING CAUSE Due to (o as a consequence of): (disease or Injury that _ Initiated the events resulting d. in death) LAST. Due to (or as a consequence of): ,aJ 26. Part 11. Enter other si¢nificant conditions c tribut'ne to death but not resulting in the underlying cause given in Part I 2>. Was an a topsy pertormed? Ves ~ No 28. Were autopsy findings available m to complete the c of death? a ~ N O Ves - 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death 0 0 Not pregnant within past Year Q Ves 0 Probably ~( Natural ~ Homicide [] Pregnant at time of death ~ No ~ Unknown 0 Accident ~ Pending Investigation ~ Not pregnant, but pregnant within 42 days of death 0 Suicide ~ Could not be determined ~ 0 Not pregnant, but pregnant 43 days to 1 year before death 3Z. Date of Injury (MO/Day/Yr) (Spell Month) ~ Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location pf Injury (Street and Number, City, State, Zip Cotle) 36. Injury at Work 3>. If Transportation Injury, Specify: 38. Describe How Injury Occurred: 0 Yes ~ Ori er/Operator 0 Pedestrian ~ No p Passenger 0 Other (Specify) 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due to the cause(s) antl m ted Pro pouncing 8< Certifying physician - To the best of my knowledge, death o red at the time, date land place, and due to the c se(s) and m r stated Q Medical Examiner/GOroner - On tFS~a~is of examination, and/or investigatlonr in my opinion, death occurred at the time, date, and place, and due to the cause(s) antl manner stated Signature of certifier: ~ ~ Title of certifier: ND License Number: Kn OCi L[C V •yL 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Vr) rt..,,,4 eo...._:., S t ~n ~- two-~-•'s~~ c om e t •s s zee 1 z 40. ftegistra r'S District Number 41. Registrar's $bg[t3iure ^ 42. Re gistrar ile Date (MO/Day r) - \~ ~ `/ r~~1~~1 C 43. Amendments {-~ H105-143 Disposition Permit No. Cl ~ ~ ~~ 1. `7 REV 0]/2011 J. ,u.ear~..••~ rsw~~.no ~+~.. i~~ -_.t ,~-~~ ct. ~ r~j ~~ ~ €~.~.~ .: twig ti. ` :'i ? ~ WILL r-r= ~ ~- m ~ p~ I, BERYL C. GARDNER, revoke all my prior wills and -: U codicils and declare this to be my will. FIRST: Last Expenses. I direct the payment from my estate of the expenses of my last illness and funeral. SECOND: Tanctible Articles. A. I bequeath all my articles of personal and household use and ornament, including jewelry, clothing, furniture and furnishings, automobiles and similar tangible property, together with all insurance thereon, to my wife, Elizabeth S. Gardner, if she survives me. If she does not survive me, I bequeath all such property and insurance to my children who survive me, to be divided as they may agree or, in the absence of agreement, as the executor may think fair. THIRD: Residue. I devise and bequeath all the rest of my estate, real and personal, including any property over which I may have power of appointment, to the trustee of the Revocable Insurance Trust Agreement signed by me earlier today, wherein my wife, Elizabeth S. Gardner, is named the trustee, to be added to and become a part of the principal of the trusts created thereby. FOURTH: Taxes. The executor shall pay, from the principal of my residuary estate, all estate, inheritance and other death taxes, including interest and penalties thereon, imposed upon all property passing under my will. FIFTH: Powers. In addition to all other powers granted to her by law, the executor shall have the following powers to exercise without court approval: A. To retain and invest in all forms of property without being confined to legal investments and without regard for the principle of diversification; B. To borrow money, mortgaging real property and pledging personal property as security; C. To lease real property without restriction as to time and to repair, alter, improve, exchange or give options with respect to real property; D. To sell real and personal property at public or private sale for cash and/or credit; E. To carry investments in bearer form or in the name of a nominee; F. To distribute hereunder in cash or in kind, or partly in each; G. To compromise claims; H. To exercise any election or privilege given by the federal or other tax laws, including, without limiting the foregoing, joinder with my surviving wife in filing income tax returns, consent on gift tax returns to have any gift made by her considered as made in part by me for gift tax purposes, payment of any portion of income or gift tax due under such returns, 2 rv rm ~~+ Y^TaP*~P'~.'°^?»"'°`"^Pmr+"N.Y"«r w~.pw.5^^' ^~m~s .+rv~nsnR~1:..A,+~`[~-~^~za..~..~v......-.~'e[.rn.+n!1*r,+T.r,~"'r .gx^'~S~R,w~.~+ww. _ election of the alternate valuation for federal estate tax purposes, allocation of generation skipping transfer tax exemptions, and election to claim deductions for death tax or for income tax purposes; and to make or not make equitable adjustment for the exercise or non-exercise of any such election or privilege; I. To compromise and pay death taxes on all interests, present and future; J. To buy investments at a premium or discount; K. To determine whether any receipt or disbursement shall be allocated to principal or income, or partly to each; L. To join in any corporate action, reorganization or voting trust plan, to deposit securities under agreements and pay assessments, to subscribe for stock and bond privileges, to give proxies, to grant, obtair. or exercise options, and generally to exercise all rights of security holders; M. To borrow from and to sell real and personal property to the trustee of my trust mentioned earlier herein; N. To disclaim all or any part of any interest in any property which I may have or to which I or my estate may be or become entitled; 3 O. To distribute directly to the individual beneficiary any part of my estate otherwise distributable to a trustee for that beneficiary if the beneficiary would be entitled to immediate distribution from the trustee. SIXTH: Election of Marital Deduction. The executor may, in her sole discretion, elect to have a specific portion or all of the Marital Trust under the Insurance Trust Agreement signed by me earlier today qualify for the federal estate tax marital deduction in my estate if such property could qualify by making the election. The executor's decision concerning the election of all, part, or none of the federal estate tax marital deduction potentially available to my estate shall be conclusive upon all parties affected by such decision, and she shall not be liable to anyone for the effects of her decision. In exercising this discretion, I suggest, but do not direct, that the executor consider the benefits and eventual costs of deferring taxation until my wife's death, possible increase or decrease in values during my wife's lifetime, the foreseeable and relative needs of the beneficiaries, and any other factors that the executor may deem relevant. It is my purpose in so providing that the executor shall have the option of having deducted from my gross estate subject to federal estate tax so much or so little of the marital deduction allowed by the Internal Revenue Code as she may, in her sole discretion, deem best. I direct that my will be 4 so interpreted and that the powers herein conferred on her shall be exercised in conformity with my said purpose and intention. SEVENTH: Administration and Interpretation. A. The interests of the beneficiaries in income and principal shall not be subject to anticipation or to voluntary or involuntary alienation as long as they are in the hands of the executor. B. All executors and all beneficiaries not referred to by name are for convenience referred to in this will in the feminine singular. C. I am married to Elizabeth S. Gardner. All references in this will to my wife are intended to mean her. I have three children, Beth G. Aucoin, Sharon L. Gardner and Laura G. Leistra. All references in this will to my child or children are intended to mean one or more of them. References to my issue are intended to mean my children and their descendants. D. Any employee benefits payable to the executor shall not be liable for or used for the payment of or lent for the purpose of paying any taxes, liabilities, debts or any other claims or charges against my estate. E. If my wife and I die simultaneously or under such circumstances that the order of our deaths cannot be proven, it shall be presumed that my wife survived me. 5 F. No executor shall be required to enter bond in any jurisdiction. G. If a beneficiary or the Trustee of a trust under my Revocable Insurance Trust Agreement mentioned earlier exercises any election or power to withdraw or distribute the whole amount of any trust before that trust has been completely funded, the executor may, if the Trustee approves, make distribution directly to the beneficiary. EIGHTH: Appointment of Executors. I name my wife, Elizabeth S. Gardner, as executor of my will. If she shall fail to qualify or cease to act, I name my daughter Beth G. Aucoin as executor. If she shall fail to qualify or cease to act as 6 executor, I name my daughter Sharon L. Gardner as executor, or, if she shall fail to qualify or cease to act, I name my daughter Laura G. Leistra as executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~„~"~~~ day of ~.Q,LmyY~I1~ , 1993. C ~ (SEAL) r~~ c. C . ~a ~ ~o,ti ~6L Signed, sealed, published and declared by Beryl C. Gardner, the testator above named, as and for his will, in the presence of us who, at his request, in his presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses. ~~ ~'~ 11FiG/ ~Ci U~ 1-~ 1CCX'~~'l ~Oc ~ ~i{ 1 ~ Address /'N ~il~~n~ A~~~ ~~ ~ P11 ~~. Address ' 7 STATE OF ~~~`-~~ ~ ~ 0.~)C~ SS. COUNTY OF ~ ~- (l We, Beryl C. Gardner, ~;~ ~-- ~~v~~~~'-~ , and I'~ the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator, in the presence and hearing of both witnesses, signed and executed the instrument as his last will, that he signed willingly, that he executed it as his free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the testator and the other witness, signed the will as witness and that to the best of our knowledge the testator was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ C. ,~~~ Bery C. Gardner ~~ fitness `~ Witn ss ~"~ above named testator and subscribed and sworn to before me by the above named witnesses this v~,~~ day of ~C-2t~'~ ~f'--I'' , 1993 . ~~~ Notary Public .I~en i s e ~ . Then ~suh (~~ y c.~~nu,~s~-~., ~~-i re~; Q~.c~sf 7 , ~9 ~ Subscribed, sworn to and acknowledged before me by the