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HomeMy WebLinkAbout05-30-12PETITIOV FOR GR~rT OF LETTERS REGISTER OF "'ILLS OF CUMBERLAND CO[,~tiT~°. PE~~ISYL~":~NI~ 1 .i0 '~. ~ ":O ~ i~S 5 F 1' ~ i~ :c5' vi I.~tt ;i .1~ C~"? ~ I a bll~'~ 01 _~I ,3 `.~; s ~ .. :el;owln~ ,i:,~' ;~5~ ~„~Ct .:. .,, c,t~ J~i,s ~ ih~ ~~, In. ui LZ, e _ 'n Chc ap~r~ pl.at~ ior:n: [)ecedent's Information dame: Clara K:. Hertzler a/kta: File Rio: ~.,~'~~ ~ ~ "+' i ~}, (Assigned by Register) ai k,~a: a/lc,'a: Social Security No: Date of Death: May 1 8 , 2 01 2 Age at death: 9 3 Decedent was domiciled at death in Cumberland County, Pennsylvania (5rctre) with ]irl~her last principal residence at ~ Valley St ~`arlisle, Pennsylvania 1 701 3 Street address, Post Office and Ztp Code City, Township or Borough Count Y Decedent died at Church Of God Home Carlisle, Pennsylvania 17013 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 $ /! Si ~^©~ ............ I~'not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ . If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ / ,.1 j =~ ~~ TOTAL ESTIMATED VALUE.... $~.~i~ ..>> > r Real estate in Pennsylvania situated at: 24 Valley Street, Carlisle, PA 1 7013 ~„mhorl ~,,,a (Attnch crdditionnl sheets, i/ necessary.) street address, Post Office and Zip Code City, Township or Borough Count Y ® A. Petition for Probate and Grant of Letters Testamentar pp Petitioner(s) aver(sS'lshe/tKe~is/#rxthe Executor(! named in the last Will of the Decedent, dated September 1 8, an~~Co~~il thereto dated - ~s) State relevant circumstances (e.g. remrnciatiorr, death ojexecumr, 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 born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. tGl""O EXCEPTIONS EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c. t. u., d. b. n., d. b. n. c. t. a., pendentelite, ctzrranteabsentiu, durmrteminoritate 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 detned in 23 Pa. C.S. § 3323(8) 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 W ill and was survived by the following spouse (if any) and heirs (attach aclditlonal sheets, if necessary): Name Relationshi Address Geraldine I. Shughart Daughter 22 Valley Street, C Fnrm RGR01 rev. l0/!l/1011 r-~ r..r - ~~-. Isle,. A r- -~- -~ ," :.: - _: c. ~ - `:.. ' i '~ .Y? .. ` ` J T, ~. Page 1 oft ~~~ ~~ The Petitioner(s) above-r;~tmed swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of [he w~owledge and belief of Petitioner(s) and th.ar, as Persona] Representative(s) ofthe Decedent, the Petitioner(s) will well and truly administer the estate according to law. Sworn ±o or affirmed and subscribed before ~ ~' _ rr:e tha._s-'" "~ `~ Date 3~ / Z da f i' .~ , ,~'.ra, z ~ ny~ , ~ Date _ Date For the l2e~st¢r n Date - 3? ~~~~ -7= ~ 1 BOND Required: ~IyES ~NO FEES: Letters ...................... $ ~ ~ ; ( ~ )Short Certificate(s)...... L ~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Boiid ................ ........ Conunission ................. . Other ~~ ~, l 1 _ ....... I; ~ ~ ~ =r-- `.~' ri- -«: - To the Register of Wills: ~' W r~ease enter my appearance by my signr~i~re below: ~-' Attorney Signature: ~ ;: t.~.~- _. ~y~ ., ~.: f-- Printed Name: <--~~f~/l'/ai' _ - /",,`/'~~. Supreme Court ~~ '' ID Number: ._.3~~.. ~3'//~ Firm Name: ~a ~~ Address: _S' ~,.%, f. 'i`~Dv iy~ Automation Fee.. .. JCS Fee. ...... TOTAL ..................... $ L i~- Phone: _ .// y - r'S !' S ~ ~ ~' Fax: `_... _ ~,. >_ . ~ Email: J~.. f'S,.~. --,- fir:=v ~,/ -'~i ~~'ir'7 DECREE OF THE REGISTER Estate of ~ ~ ~~~. ~ ~1 ~ ~- ~~ ~ ~ ,/~ ~~~ File No: ~ ~ - ~ ~ _ ! ` ~ t' (-~ a/k/a: AND NOW, ~~, ~ ~ (<:>Z , in consideration of the foregoing Petition, satisfactory proof having bee resented before me, IT IS DECREED that Letters `-~ ~ - are hereby granted to ~~~' ~~~~ i ~ ~ . ~ j in the abo estate and (if applicable) that the instrument(s) dated ~~' / ~X ~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedeni. I egtster of WiC s FnrmRW-0? rev. l0/(1/201/ ~'" Page ' ~f 2 Oath of Personal Representative Official Csc Only C0~t1fO~LL`E:YLTH. OF PE~i~SY"LVAVIA } / 'r SS: I LOG~-L REGISTRAR'S ~vERTII`I+~~-`I~I~~Id~ Off. ~~~~' 'UV~,~RNING: It is illegal to duplic.a~ie this ~.r~q~~ ~-;,~) ~~c>i~~.~~t~~ ~~)~~ tro~r7~;~~~~ai'~. m~~ Fec f•or this certit)cate. ~fl (Ii; ~ -~ „). -.,[ ~~`l~ ~ i31< i1, +..'(I7l )t),il~s~~,t ,~(~ 1a ,^ ,I ~' li .~ i ^7cal~'sirl __f~(.~lhTl~.~'cOY) L';)Ih a~ ~~~~ ~f ;~~ ~ , ~ i!(~. , ~ ~I f" IS( ~!~ (l<~ t~ i sal ~~~ rt.~ ., f ~ ;,, ~ I it ~"Ti, `yt~re `t ,<,I -I '~ - ~LJi sue" ,~1 ,(ii ~'x~i i r~ 1(1O> - .~ ~ ` rri d~ ~ sue. --1 _ . ... _- ~ ~.848774~ ~: ' - ti1E 7 ~ ~ .. ~~ , ... _. Certiticari(m ~uj771rer ~ ~~, ~ i ); 'r + lO TYPe/Print In .. ii `~l (I/~:, Permanent COMMONWEALTH OF PENNSV LVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECD ROS Black ink CERTIFICATE OF DEATH 1_ Decedent's Legal Name (First, Middle, Last, Suffix) State File Number: C.' 1. A R A It H E R T Z L);• R 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) F emal 183-09-6865 M/~ti7 ~a Sa. Age-Last Birth tlay (Vrs) sb. Under 1 Vear Sc. Under 1 Da 6, pate of Birth (MO/Day/Near) (Sp. ~ ^ • ^~ 1 9 3 Months Days Hours Minuses August 21 1978 8a. Residence (State or Foreign Country) gb. Residence (Street and Number -Include Ap[ No.) 8c. Did Pennsylvania ad. Resiaence (copnty) 24 Valley Street Ayes, Cumberland ae. Re 9. Ever in US Armed Forces? 1.0. Marital Sta ~ Ye ® No [] Unkn ~ piv ed 12. Father's Name (First, Middle, Las[, Suffix) o Charles A. xlihll 14a. Informant's Na G I~ {Y v~ -i ~J <7 .~ at Time of Death ~ Married _~ Never Married Q U eraldl_ne Shughart i 0 s If Deatn ocenmed ~i~ a'iios tai: -......-." "' .............................. Emer pl ~ Inpatient ~ ~ gency Room/O Utpatien 0 Dead on Arrival lSb. Facility Name (if not institution, give street and number; L~ ~ H UI~.C>G 16a. Method of Disposition ~3C Burial Q Cremation m ~ Removal from State ~ Donation !€ Other (Specify) ~ 16d. Location of Disposition (City or Town, State, and Zip) - Mt. Holly Springs, Pa 17065 E 1]c. Name and Complete Address of Funeral Facility ~ 18. pecedeni's Education -Check the box that best describes the ti highest degree or level of school com p~leted at the time of death. p su erode or less ~ No diploma, 9th - 12th grade ~ High school graduate or GEO completed Q Some college credit, but no degree Q Associate degree (e.g. AA, q5) Q Bachelor's degree (e.g. BA, Ag, Bpi) Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) ~ Doctorate (e.g. PhD, EdD) or Professional degree e or Forela -_~-_.._~~~ cave m n hip? decedent lived in pw South Middleton twp. decedent lived within limits of city/boro 1. Surviving Spouse's Name (If wife, glue name orlor to flrct m~.~~~.,et - ~ •-• ~•_• ~ ..a ne r or t rst Marriage (Fir Nettie Glessner Relationship To Decedent 14c. Inform s Mafiing Address (Street and t Daughter 22 Vahie St Carlisl is P D t c y ne_ _____ Slf D -......... .... e........ eath Occurred Somewher Oth ••~~~~~~~~~~""""""' "•~~~~ __. er Than a Hospital: (-`Y'u...._.. arlisle, ~PA-17013 ----- -~ --~~~~-_• r, ~•e.~~a •ory, or otner place May 22, 2072 Mt. Holly Springs Cemetery >a. Signature o era) Service ee n to Charge of Interment 1]b. License Number ~ ~~~~'~~ F D 0 1 2 9 n 9 Carlisle, Pa 17013 19. Decedent of Hispanic Origin -Check the box that best describes whether the decedent is Spanish/Hispanic/Latino. Check the "NO" ~x If de edent Is not Spanish/Hispanic/Latino. No, not Spanish/Hispanic/Latinc Q Yes, Mexican, Mexican American, Chicano Q Ves, Puerto Rican Q Ves, Cuban Q Yes, other Spanish/Hispa nlc/La[Ino (Specify) . Decedent's Single Race Self-Designati White on -Check ONLY ONE to indicate what the der_cdent co ns~ Q Black or African American 0 Japanese ~ Korean ~ Samoan Q American Indian or Alaska Native ~ Vietnamese Q other Pacific Islander Q Asian Indian ~ Other Asian 0 pon't Know/Not Sure Q Chinese ~ Filipino ~ Native Hawaiian ~ Refused 0 Other (Specify) ~ Guamanian or Cham __ orro .MS 23a - 23d MUST BE COMPLETED PERSON WNO PRONOUNCES OR 23a. Dat Pronounced Dead (MO Day r) 23 b. Signal RTIFIES DEATH _ , , ^ ,v~~ y i ~-~ 2f7 1 -~ _ Homemaking .. ~... „me pr tJea LO • /~ 25 Rtv~~9-78L . Was Medical Examiner or Coroner Contacted? O Yes p No 26. Part 1. Enter the chain of events--diseases, injuries, or compl CAUSE OF DEATH ications--that dire tl res pi rafory arrest, or ve ntncular Flbrlllat w ut ss g c y caused the death. DO NOT enter ter the etloio gy DO NOT A gB minal events such a Approximate s cardiac arrest ~ ~ IMMEDIATE CAUSE ~ ! / . REVIATE~^ter only one cause / ~ / ~ ~ ~ ~` _ t j on a Ilne- Add addi . Interval: tional lines if necessary Onset to Death (Final disease or condition - C ~ //vY~ / iT'7 result ng in death) I Due to (or onsequence oF): ` -- b. Sequentially hst con diti°ns, if any, leading to the cause Due to (or as a consequence of): -- listed on line a Enter the UNDERLYING CAUSE (disease or Injury that Due to (or as a consequence of): -- in itlated the events resulting d. W In death)tAST. ' - ' Due to (or as a consequence of): S 26. Part II. Enter other signi£ca nt_tditions contrib tl d th but not resultin In th d ' g e un er) i y ng cause given In Part I - 2]. Was an autopsy pert rmed? Ves No 28. Were autopsy Flndings available 29. If Female: co to plete the cause of death? E ~ Not pregnant within past year 30. Dld Tobacco Use Contribute to Death? 31 M anner of O Yes 0 Nq D h S ~ Pregnant at time of death ~Q Ye.s ~ Probably y. y ~ CL Natural eat m ~ Not pregnant, but pregnant within 42 days of death P~ NO ~ Unknown 0 Accident ~ Homicide ~- Q Not pregnant, but pregnant 43 days to 1 year before death 32 D t Suicide ~ ~ Pending lnvestigatlon C ld Q Unknown if pregnant within the year past . a e of Injury (MO/Day/V r) (Spell Month) o ou ~ t be determined 34. Place of Injury (e.g. home, construction site: farm: crhr...n _ _ 33. Time of Injury ~. ~mury at Work 37. If Transportation Injury, Spec(fy: 36. Describe How Q Yes 0 Driver/O Injury Occurred: ~ N° Q Passengererator 0 Pedestrian Other (Specify) ,~ rtifier (Check onin one): 1Q Certifying physicia - To the best of my knowledge, death o red due to the c se(s) and m Q onouncing 8< Certifying phYSi is T the best of my knowledge, death occurred at the time, date Sa nd place, and due to the cause(s) and manner stated ~ Medical Examiner b s f exa in~io ,and/or .nvestigation, in my opinion, death //~je ~/5~ 7~ ~/~ n red at the time, date, and place, and due to the cause(s) and manner sta [ed Signature of certifler:/ / // n Title of certifier: M pcur Lice seNpmber:_ / 035R'7~6 'b. Na Add d Zip C de of Person Completing Cause of Death (Item 26) _ ~~ ~ss anQ~ ~s ~ ~ ~O~ ~ ~.tDYZ ~ ~ ~! I ~^ 1 ~ w~ n 39c. Date Sig ed (MO/Day/Yr) R gi O i tN b 41 R g t SI u ~'DI ft •,u~s Qrj' ~p ~~nr.:._ .~ (_ J (h ~ ~„ h ~ ~ 42. Registrar Flle Datr• rM.,ir,~....... to indicate what the decedent co nsideredehimseif or he sOelf to be White , ~ Korean Q Black or African American ~ Vletna mese ~ American Indian or Alaska Native ~ Other Asian ~ Asian Indian ~ Native Hawaiian ~ Chinese ~ Filipino ~ Gua mantan or Cha morro ~ Japanese 0 Samoan ~ Other (Specify) ~ Other Pa clFlC Islander 22 Oecede n< s Usual Occupation -Indicate type of wort done during most of working Ilfe_ DO NOT USE RETIRED. Homemaker Disposition PermlL No._ ~~ f~ ~ ~_~•~ ( H1O5-143 _ _ REV 07/2011 n~ . ~~ T-j ;T7 _~ '_i 74;.. ~. _ • ~ ~ ~ , _.lJ =.,, -. _~__ ,D' ~~ C_J OATH OF SUBSCRIBING ~~'ITNESS(ES) ~;~ ~ -~, ,~, , - . REGISTER OF WILLS ~ `~ ~ ~ ~~ cv CUMBERLAND COUNTY, PENNSYLVANIA ~ x~ Estate of CLARA. K. HERTZLER Robert M. Frey and Trisha A. Liess Deceased (each) a subscribing witness to (Print Name/s) the~l Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that ~~~1~eY/ they X~~~were present and saw the above ~~ Testatrix sign the same and that 84~4~~they signed the same and that ~1~§~they signed as a witness at th f the ~fc~-~ Testatrix in her~~1's ~-~;~ ~ _ ~f ~ ~~.~~ `C' (S~!'~`~~rt M. Frey 5 South Hanover Street (Street Address) Carlisle, PA 17013 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Carlisle, PA 18013 (City, State, Zip) Executed out of Register's Office Sworn to or affirmed and spbscribed before me this ~~ ~-, day of /~ o~ Z c, ( Z ~~ --/J- Notary Public My Commission Expires: ~ (Signature and Seal of Notary or other official yualt to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. 1!t Form RW-03 rev. 10.13.06 ,~ ~T Q PREY, NoYeyfid~ ~IMlal d QrNN, CurtbAr~d Cowt~M My Csavt4eion Eapftat.Mne 1 2D71 b e request o presence and in the presence of each other. ~. - _ ._-~ ~~ ~~ -.~ J~~ (Signgtur~l ' L-- ~ / Trisha A. Liess 5 South Hanover Street (Street Address) LAST WILL AND TESTAMENT OF CLARA K. HERTZLER I, CLARA K. HERTZLER, widow, of South Middleton Township (mailing address: 24 Valley Street, Carlisle, PA 17013), Cumberland County, 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 and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executrix to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. 2. I give and bequeath the sum of $1,000.00 to each grandchild of mine who shall survive me by a period of ninety (90) days, but should any grandchild fail to so survive me then the same shall lapse and be added to the residue of my estate. At the present time I have four grandchildren. 3 . I give and bequeath the sum of $1,000.00 to each great grandchild of mine who shall survive me by a period of ninety (90) days, but should any great grandchild fail to so survive me then the same shall lapse and be added to the residue of my estate. At the present time I have five great grandchildren. 4. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my daughter, GERALDINE L. SHUGHART, her heirs and assigns, of 22 Valley Street in South Middleton Township, Cumberland County, Pennsylvania. 5. I hereby nominate, constitute and appoint my daughter GERALDINE L. SHUGHART as Executrix of this my Last Will and Testament, and direct that she shall not be required to post any bond to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (1) page, this l $,Qod ay of September, 2002. (SEAL) CLARA K. HERTZLER Signed, sealed, published, and declared by CLARA K. HERTZLER, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~ ~~-~' ~' ' `~ ~ ! 'e~C/~J ~_ ~~ c~ - .- o A ~~ ~ z~ ~ ? ~ -~ ~.~ ~~ ~_ c> .?c~~ C% ~-• --, ~~;.> ~.T --. D µ i ,c-