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HomeMy WebLinkAbout06-08-12Reset 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 support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appro Decedent's Information Name: ELLA J. HOUSEMAN a/k/a: a/k/a: a/k/a: Date of Death: June 5. 2012 File No: ~/-~ d.. ;wed belo~s+,, an~ri~ t~otm: ~- r-r~7 c'~ ~ ~~n `~~ c-,- I (Assigned by ~r) ~ - *=~' -*; Social Security No: Age at death: 79 Decedent was domiciled at death in Cumberland County, pennsvlvania (Stare) with his/her last principal residence at 1128 Fairfield Street, Mechanicsbure , PA 17050 Hampden Twp Cumberland Street address, Post Office and Zip Code City, Township or Bor ough County Decedent died at 1128 Fairfield Street, Mechanicsbure, PA 17050 Hampden Twp 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 $ 2,000.00 If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ ~_~~ If not domiciled in Pennsy!vania ........................ Personal property in County $ 0.00 Value of real estate in Pennsylvania ...................... .................................. . $ 0.00 TOTAL ESTIMATED VALUE.. .. $ 2.000.00 Real estate in Pennsylvania situated at: N/A (Attach additional 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 January 11, 2011 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 Relationship Address For,n nw-oz rev. ioiniaon Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address ("~ r'~; Jose h F. Houseman 430 Mountain Road Newville PA 17241 ~~? rv ~ ~ ~3 ~7 ~ _ ~ t r. pp ~ ~- r ~ ~ -_:~ , 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 knowge an~~ of Petitioner(s) and that, as Personal Representative(s) of the Deced Petitioner )will well and truly administer the estate acc g to law. 2 Sworn to affirmed an supse~ed before z Date ~ ' N • J Z me thi /~ day~of ~ j \ ,~,, Date By: ,C t..'° %L.,,~L~ Date 'rh~ Register BOND Required: Q YES Q NO FEES: ~ C~.~ Letters ...................... $ L~. L'-~r- ( 4) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ....... ~~ ....... • L'1S Automation Fee .............. . JCS Fee . ................... . TOTAL ..................... $ 0.00 Date To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~', ~,~ f ~/ / Printed Name: Andrew H. Shaw Supreme Court ID Number: 87371 Firm Name: Address: Phone: Fax: Email: Law Office of Andrew H. Shaw. P.C. 200 S. Sig Garden Street Suite 1 1 Carlisle, PA 17013 717-243-7135 717-243-7872 andrew a~hawlaw_ccim DECREE OF THE REGISTER Estate of ELLA J. HOUSEMAN File No: a/k/a: AND NOW, ~1 L(/~ C'_ ~ ~~ ~ in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentarv__~__~_ are hereby granted to Joseph F. Houseman in the above estate and cif applicable) that the instrument(s) dated January 11, 2011 described in the Petition be admitted to probate and filed of record Form RW-O2 rev. 10/11/2011 Register of Wills s6r+>" fir' i~w ~ y •. 1 ~t ~ftie f'e 'R PVVi~?~',,e; .- ~7~ x.~~'1~i~'W rr^({. 1 w l~ r C ~Itii+ t.;)n r,).... TYPe/Print In Permanent Black ink O z ~~12 JUN -s ~~ ~o: ay ORPW~iv`S ~in1+~C CUMBER[.~WD CO., PA _ ~ - , ~,~,~ JUN 0 7 X012 ~~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH ~ VITAL RECORDS CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, S une 5, 2012 Sa. Age-last Birthday (Yrs) 6b. Under 1 Vear Sc. Under 1 Day 6. Date of Birth (MO/D aY/YCar) (Spell Month) 7a. Birthplace (4ity d State or Foreign Country) ~ 79 Mgntns Days Hgars Minates Au 30 1932 81ac}eliclc Twp_ , PA g _ , 76. Birthplace (County) Ha. Residence (State or Fp re ign Cou ntrY) 86 ~xx (Street Sf Number -Include Apt No.) ~i ~n ' Sc- Did Decedent live in a Township? PA 1 S E airffield St . C7Lves, decedent liyea In Has[t~)den wp. 8d. Residence (county) Cumberland 8e. Residence (Zip Code) 1'705 Q No, decedent lived within limits oT city/bo 9. Ever in US Armed Forces? 10. Marital Status at Time of DeatM1 ~ Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) ~ Ves ~J No ~ Unknown Q Divorced ~ Never Married ~ Unknow 12. Father's Name (F- Middle, Last, Suffix) f ~t 13. Mother's Name Prior to First Marriage (First, Mitldle, Last) Frank Pi l loclc Stella Santisian 14a. In(orman s Name 146. Relationship to Decedent t 14c_ Infprman C's Mailing Address (Street and Number, City, State, Zip Codel Viclc i M_ Koh1s Dau hter 1128 Fairfield Street, Mechanicsbur PA 17 ' 15a. Place of Death (Check only one) _ rn Hos tai: 0 In bent ~ If Death Occurred ' a pi pa _ _ _ If Death Occurred Somewhere Other Than"a Hos tai. ~ Has pi pice Facility ~ Decedent's Home ~ Emergency Roam/Outpatient Q Dead on Arrival _ 0 N rig Ho a/Long-Term Care Facility Q Other (Specify) 15 b. Facility Name (If not i ,gives t and number; 16c. City or Town, 5 ate, and Zip Code i5d. Co my of Death 1128 Fairfield Street Mecl-ianicsbur PA 17050 Cumberland 16a. Method of Disposition ~ Rarial Cremation 166_ Date of Disposition 16c- Place of Disposition (Name of ce meiery, crematory, or other place) p RemoYal from state p Dnnavqn June 6, 2012 Hoffman-Roth Funeral Home & Crematory -_ ~ Other (Specify) 16d. Location of Disposition (City or Town, State, and Zipj 1?a ign of Funeral S e L r Person in Charge of Interment 1Z6. License Number Carlisle, PA 17013 _ 013144E E lac. Name and Complete Address of Funeral f-a cility 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 ZO. Decedent's Race -Check ONE OR MORE r o indicate what t ~ highe t degre r le el of school completed at the time of death. bo that be t de ribs whethe the de edent the decedent considered himself or herself to be. ~ 8th grade or Icss is Spanish/Hispanic/Latino. Check the "NO" White 0 Korean Q No diplorna, 9th - 12th grade box if decedent Is not Spanish/Hispanic/Latino. ~ Black or African American 0 Vietnamese $] High school graduate or GED completed ENO, not Spanish/Hispanic/Latino Q American Indian or Alaska Native ~ Other Asian ~ So ollege relit, but no degree Q Ves, M Me icon American, Chicano x ~ Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Gaa manlan or Chamorro ~ Bachclo is degree (e. g. BA, AB, BS) Q Ves, Cuban ~ Filipino 0 Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino Q Japanese ~ Other Pacific Islantler Q Doctorate (e.g.' PhD, EdD) or Professional degree (Specify) Q 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- Oecede nt's Usual Occupation -Indicate type of work White Q Japanese ~ Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American 0 Korean ~ Other Pacific Islands Homemaker ~ American Indian or Alaska Native ~ Vietnamese ~ Don'[ Know/Not Sure ~ Asian Indian ~ Other Asian ~ Refused 22b. Kind of Business/Industry Q Chinese ~ Native Hawaiian Q Other (Specify) p Fuipinq p Guamanian qr chamgrrq Own Home ITEMS 23a - 23d MUST 6E COMPLETED 23 to Pro nounced_Dead (MO/DaY/Yr) 236_ Signature of Person Pronouncing Death (Only when appli<ablel 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ''ll ~ / ~ GI cr- j, - '/ ~ ~ }L/ ~ ~ ~S~ 23d. Date Signed (M~Day/Yr) - of D th ~ ~` (J(/ fCV//III LLL - S ~ ~~. ~] ~ So p-w~ 26. Was Medical Examiner Cora r Co acted? ~ Ve Q No CAUSE OF DEATH Approximate 26. Part 1, Enter the chain of a en[s--diseases, injuries, o mplications--[hai directly caused Lhe death. DO NOT enter terminal events such a ardiac arrest Interval: respiratory airs- r ventricular tibrillatron without show rig the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary On et to Death st o i ' IMMEDIATE CAUSE - ------ ----- > a. ~ V (~~ 1 v `~rJ ~ 1 L~CC F^ `F al d s use or condition ~ /~ ue to ( as a qql` rice of): 1 1 q.~I~ ` D esalting in deatn) e ~- b_ \~ \C~ ~ \ U J~ nU CCU !Z. 1 ~c~121~J ~s ( "~e~l ~1/\~ ~~ iV'V Sequentially list conditions, Due to (or as a consequence of): t e e if l di a y, ea ng listed on line a oEnter the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury Cha[ ted the a nts re salting d. -_ i e Due to (o as a consequ rice of): in d eaTh) LAST. 26. Part Il. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed? o ayes o N ~ 28. Were a opsy findings available m to mplete the c of death? a q O Ves D No 29. If Female: 30. Ditl Tobacco Use Contribute to Death? 31. Manner of Death o ~NOt pregnant within pas[ year ~ Ves 0 Probably Natural ~ Homicide ~ Pregnant at time of death Q No ~ Unknown 0 Accident Q Pending Inve s[Igation m ~ Not pregnant, but pregnant within 42 days of death 0 Suicide Q Could not be determined Q Not pregnant, but pregnant 43 days to 1 Year before death 32. Date of Injury (MO/Day/V r) (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 Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Ve O Driver/Operator O Pedestrian Q No Q Passenger ~ Other (Specify) rt iffier (Chock only one): 39a _C e s P a ~C tifying physi - To [he best of mY knowledge, death o ed duet the c e(s) and m ed t d pia rid due to the c e(s) and m stated date, an ~ Pronouncing 8. Ce tifying physician - To the best of my knowledge, death o ed a the t r u r r t the time, date, and place, and due to th asis of examination, and/or investigationr in mY opinionP death r d e c a u se(s) d toted Q Medical Examiner - h n b n a ` I~ ^ ~ - t/ ~ ( ~ n n . ~ ' ` ~ T~ ' ' f v ~ ~~ license Number: t / Title of certifier: \ \ Signature of ce rtifie ~ l T ' J 39 b. e, Address and Zip Code of Person Completing Cause F Death (It 6) (1 (ur 1 J m 2 ~ c_ ed ( o/Da / ) ~ ~Y1n~ t 1 7~ t ~ ~ a~ ~ ~i~ L- ~1 1 Z ~ ~_ 4D. Regist r' Dist i ber t 41. Regis ~S-gn ature 42. Registrar File Date (MO/Day/Yr) lU ~l-~ .~~ Y7Z-~1~ ~c~n~ ~ -z-o/~- 43. Amendments )50 Disposition Permit Nq. ~ ~~ Q ~ ~ ~ REV 07/2011 ~f~~~ LAST WILL ~ ~ r r ' ~ ' t'j~7 ~ r c.:? ~' ©' ~~, ~ .~ _ ~ and ~ C:: - ~. . ;.~~ TESTAMENT ~ ~ ~' I, ELLA J. HOUSEMAN, of 1128 Fairfield Street, Mechanicsburg, Hampden Township, Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be cremated in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. In the event my son, ALBERT W. HOUSEMAN, JR., has not repaid the Twenty Thousand Dollars ($20,000.00) previously loaned to him and evidence of payment must be in written form signed by me, I give, devise and bequeath the sum of Twenty Thousand Dollars ($20,000.00) each to my children, KAREN L. NAILOR, VICKI M. CROMER, DEBRA J. COLLINGS and JOSEPH F. HOUSEMAN. If my son ALBERT W. HOUSEMAN JR., has repaid said loan, then he shall receive the same sum of Twenty Thousand Dollars ($20,000.00) as KAREN, VICKI, DEBRA and JOSEPH. FIFTH. I give, devise and bequeath all of my estate of whatever nature, be it real, personal or mixed, and wherever situate unto my children, KAREN L. NAILOR, VICKI M. CROMER, DEBRA J. COLLINGS, JOSEPH F. HOUSEMAN and ALBERT W. HOUSEMAN, JR., in equal shares, per capita. SIXTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SEVENTH. I hereby nominate, constitute and appoint my son, JOSEPH F. HOUSEMAN, as executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received and to sell either at public or private sale any real or personal property owned by me at the time of my death. EIGHTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executor and Beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this % f ~ day of ~, ~,u, ,2011. v ;_~-, ,, ELLA J. HOUSEMAN Signed, sealed, published and declared by the above named Testatrix ELLA J. HOUSEMAN as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, ELLA J. HOUSEMAN, Testatrix 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. Sworn or affirmed to and Acknowledged before me, by ELLA J. HOUSEMAN this // day ~ 1~ ) 1 y ~ ___/ ary ublic NOTARIAL SEAL LIMA J PIPP Notary Pubtic CARLISLE BOROUGH, CUMBERLAND CNN My Commission Ea,M: Jun 18, 2013 ,. ,~ ELLA J. I~OUSEMAN Q,~-Z~~~,,,~ of, 2011. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, A ~ ~-~ vn ~ S ~- ~ fry= ~ r-- and ~~ f!~ ~ r-~!~ {=,' ld~~.r ~ ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw ELLA J. HOUSEMAN sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and Subscribed before me by ~~ ~ Q s~yt C- S ~ Q- ~~ ~ r; r And ~~ ~ ~ r t ~, ~ ,` ~ ~ k. ~ bl ~- ,witnesses, This I I ~ day of ~~. Ca..~,.~.~.~~-'j_ , 201 l Not'~ry Public NorARiu sEAt LINDA J PIPP Noblry Public CARLISLE BORDilQN, CUMBERU1NOrCNTY My Conania~ion Eft Jun 18, 2013