HomeMy WebLinkAbout06-05-12PETITION FOR GRwT OF LETTERS
REGISTER OF ~~'ILLS OF ~y-'~+ r3 FZ ~~•,.. r) COUNTY, PEV~;S~"L~-_~tiI.~
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Decedent's Information
dame: ~l/'~~in~F ~• S'P>`C~-/L C.~
File Rio: .~ ~,;~ ~~~;, ~,~
ai'k;'a:
a/kta: (assigned by Register)
a/kt'a: Social Security No: !?S - I y-- l0 3 Y 3
Date of Death: ,$~- R7 -~ v / ~, Age at death: °f
Decedent was domiciled at death in Ctiwt r3 Ert ea.~- n County, ~$ (stare) with his/her last
principal residence at -~~-5' ~-vE'seEY X12 rH~'erf~?s~+iCl?~21,. ~ih e_ e~•~t.t E1~ye ~,.,..0
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at f~a S~- ~F ~ ~ Sr pE•~GF rf-rtrC~t.tSB..R G- p/}. / 7~r a
street address, Post Oftce and Zip Code City, Township or Borough County
Estimate of value of decedent's property at death:
If donriciled in Pennsylvania ............................ All personal property $ ZZ y^~a V b
If trot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ T-
If trot domiciled in Pennsylvania ............. . .......... Personal property in County $ --
Valtee of real estate in Pennsylvania ......................................................... $ --
TOTAL ESTIMATED VALUE.... $ 2 2 ~, t~ 0 0
Real estate in Pennsylvania situated at: /`JdN f'
(Attach crdditionat sheets, i~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 ~ - /i " ~ o ~ J and Codicil(s)
thereto dated
State relevant circumstances (e.g, renuncintion, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, ways 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 o` Administration (If applicable) _ ~<~ N _~
c.t.a., d. b. n., d.b.n.c•.t.u., pendente life, chrrunte ~e~~a,_du ra tr t~tinori~
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete t f p~feirs. ~ ; ~ ~-"
r f r~~~
[i~ ;:. ui _i~ t_.~
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had3b~rt;established as defirte2l ` ~.
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. C~ ~ -"' `i-~
~ .. 'vi
®NO EXCEPTIONS ^ EXCEPTIONS _ ~p W i~ t"ri
Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following sp~ se (ifany) and4tolrs (attac•h ~j
udclitionul sheets, r/'necessary): ~
Name Relationshi Address
Dr4v~ Q A , OPOo-Gi~fL cS v ~ (a°.Z ~ /~'l/Mt$c t nt2 I/F~~'nj2f~ C/f
/I'1~~~.4 L . Sl~E~'r~rL %~'f~4NrEr>~ 31 ~ w . g 1 s1' Sr ~!Y -v Y o0 2
State
F»,~,» nw-nz r~~. lniuizn~i Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} ss:
CO[,'NTY' OF
~~. ~'LI Ik._r-. y~I
?OfY JUN -5 PM 3~ 38
Peti*.ioner(sl Printed Name Petitioner(s) Print ~ ,_,~ „':,fir
Q-4v ~ O R ~ SP~c f ESL /$ a ~ r~ ~9Glr-so c 02 . U r~'V' M~IiRj ~ ,?oo
/~1f>f-/?crA~ t_... ~t=c.~--i/'2 3 t s' w. q I t'` S7- ~t Y N Y / a o ~.
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 Chat, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed a str~scr~ before ~ • Date (P S ZO / Z
met '" ~~a of ~~~~~-- ~
Date .. G
~~
BY• ~ _ ',~ . s°L `, Date
~F~Of C e Register Date
BOND Required: AYES ~NO
FEES:
Letters .............. ...... $ ~~ I l~l_i
( ~ ) Sltort Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) . ........... .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
1 _ ~ ~
(,~' i 1 ....... ~,
Automation Fee ............... ``-~-
JCS Fee ..................... -
TOTAL ..................... $ .~ <~~~ ~:~ ~
To the Register of Wills:
Please enter my appearance by my signature t~elow:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email
DECREE OF THE REGISTER
Estate of ~~~,~.?C I ~ ~ `~~~'C~~E~ ( File No• ~~_ (;.~ ~(_,` (~~ _~
a/k/a:
AND NOW, ~ (;~'~ (~~ ~ i ~ ~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters j.-~;~~-~~ ~~~,(~ ~,i~
are hereby granted to ~("~ ~; ~ (_ '~ ~ ;, : _~ r i ~ Yl~ l ,, ,
I~AC~,~ t ~~ I ~' ~ E ~~_(-~~ ~ m the above estate and (if applicable) tl'iat
the tnstnunent(s) dated _ ~ ~ l d ~ - Jl )~ I
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of L)ecedent
F~,~„~nw-nz ,~w. tniniznri
Register of Wills -T'-
`~~B~~ 2 Of ~
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Certificatic)n `d>.j;1il,t,;. -,- i ~ ~ ),,.~, ~,i)~:i'
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
Permanent /"GQT~CEP'ATC AC gIC ATV
~_
1. Decedent's Legsl Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Num ber> rv4. Dace of Death (MO/Day/Yr) (Spell Mo)
Maxine Ellen Specter Female 175-14-6343 Ma' 27 2012
6a. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Vntler 1 Da 6. Date of Birth (MO/Day/Yes r) (Spell Month) 7a. Birthplace (City antl State or Foreign Country)
Months Days Hovro Minutes F8119 Cr ale PA
91 Februar 20 1921 Jb. airthplace (County) Cl~earf fie ld
Ba. Residence (6fa[e or Foreign Country) Bb. Residence (Street and Number - Inclutle Apt No.) 8c. Ditl Decedent Live in a Townships
Penns 1Vani8 Yes, decedent Ilved in
tyyp
__
.
gd.Resmence(county) 325 Wes le Drive A t. 3216
Cumberland Se. Residence (Zip Code) 17055 ®NO, decedent Ilved wKhln limits of Me Chan is 9burg city/boro.
9. Ever In US Armed Forces 10. Marital Status at Tima of Death ~ Married O Widowed 31. Surviving Spouse's Name (If wife, give Warne prior to first marriage)
0 Ves ~ No ~ Unknown ® Divorcetl ~ Never Married ~ Unknown
12. Father s Name (First, Middle, Last, Suffix) 13. Mother's Name Prior [o First Marriage (Firs[, Middle, Last)
Otto Coleman Margueraite'?Rithkley
14a. Informant's Name 14b. RelaCionship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code?
g Ms. Marcia L n S serer Dau hter 315 West 91st Street New York ]VY 10024
G
ac .......................................................... ..................................................?..~..p a=.e.~....e95... e~ on y one _
...................................
If Death Occurred In a Hospital: Inpatient :If Death Occurretl Somewh¢
re Other Than a Hospital: Hospice Facility ~~~Decedent's Nome
Q Emer ency Room/Outpatient ~ Dead on Arrival Nursing Home/Long-Term Care Facility Other (Sp¢clfy)
.
S6b. Facility Name (If not insiituTion, give street and number; SSC. City or Town, State, and 21D Code 15d
Count
of Death
Carolyn Croxton Slane Residence .
y
Harrisburg? PA 17110 Dauphin
16a. Method of Disposition ~ Burial ® Cremation 16b. Dste of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
0 Removal from State ~ Donation
other (specify) May 30, 2012 Cremation oc fie ty o£ PA
16d. location of DisposfTion (City or Town, State, and Zip) 17a. Slgna of Funeral Ser
~I LI rson In Charge of Interment 1Jb. License Nurnber
~` Harrisbur PA 17109 /
(/~~ FD~-138753
E 17c. Name antl Complete Address of Funeral Facility
3 Auer Cremation Services Of Penns lvania Inc.
m 16. 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 ra o Indicate what
t
highest degre r level of school completed at the time of death. box that best describes whether The decedent the decedent considered himself or herself to be.
~ eth gratle or less Is Spanish/Hispanic/Latino. Check the "N O" ® WhlTe 0 Korean
No diploma, 9th - 12Th grade box if decedent Is not Spanish/Hispanic/Latino. 0 Black or African American ~ Vietnamese
Q Hlgh school graduate or GED completed ® No, not Spanish/Hlspa nic/Latino Q American Intlian or Alaska Native ~ Other Asian
~ Some college credit, but no tlegree 0 Yes, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawaiian
Q Associate tlegree (e. g. AA, AS) 0 Yes, Puerto Rican ~ Chinese ~ Guamanian or Chamorro
~( Bachelor's tlegree (e.g. BA, AB, BS) 0 Yes, Cuban ~ Filipino ~ Samoan
Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander
~ Doctorate (e.g. Ph O, Ed D) or Professional tlegree (Specify) ~ Other (Specify)
. MD DDS DVM LLB 1D
21. Decedent's Single Race Self-Designatign -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
® White Q Japanese ~ Samoan done during most of working life. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
~ American Indian or Alaska Native Q Vietnamese O Don't Know/Not Sure RC gis tared N11r3a
~ Asian Indian ~ Other Asian ~ Refused 226. Kind of Business/Industry
Q Chinese Q Native Hawaiian ~ Other (Specify)
Q FIIlpino O Guamanian or Chamorro Medical
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronouncetl Dead (MO Day r) 236. Signature o Person Pronouncing Death (Only when app hca ble; 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTFIES DEATN M8 27 2012
23d. Date Signed (MO/Day/Vr) 24. Time of Death
9:50 .m. 25. Was Medical Examiner or Coroner Contacted? ~ Ves ® No
CAUSE OF DEATH
Approximate
26. Part I. Enter the chain of a ants--d iseazes, Inju rtes, or compllcatlons--that directly caused the death. DO NOT enter Terminal events such as cardiac a Interval:
r
respiratory arrest, or ventr cular fibrillatio
n
without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add adtlitional lines
ii necessary Onsei to Death
~
A
IMMEDIATE CAUSE - > r 1 ~ -T ~ ~ A T~ L C L y N C:~t ~. d~ (~ C / h.'C CT's f~
~ J3'J UY) WJ S
___
(Final disease or condition Due to (or as a consequence of):
resulting in tleath)
b.
Sequa Wise lly list conditions, Due to (or as a consequence of):
If any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or injury that
F initiated the events resulting d. -_
In death) LAST. Due TO (or as a consequence of):
3 26. Part il. Enter other sl nifi i h but not resulting in the underlying cause given in Part I 27. Was an autopsy performed?
~ ~ Yes
28. Wer utopsy 1lndings available
.o plate the c u of death?
cq
a
O No
O Yes
4
E 29. If Fe yle:
®~fl t pregnant within past year 30. Did Tobacco Usew-C O~ntribute <o Deaths
Y
b
bl 31~. Man~nlr of Death
ag
Q Pregnant ai time of death ~
es gQ rra
a
y
~ No ~ Unknown ~ Loral [] Homicide
~ Attident [] Pentl{ng InvesiigaTlon
o Q Not pregnant, but pregnant within 42 days of death Q 6u1<ide [~ Could not be tlefermined
Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mp/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 of Injury (Sireei and Number, City. State, Zip Code)
36. InJury at Work 3J. If Transporta[lon Injury, Specify: 3B. Describe How InJury O<cu rred:
0 Ves ~ Driver/Operator 0 Pedestrian
p No ~ Passenger 0 Other (Specify)
39a. C~~~~iffier (Check only one):
ETCertNying physician - To the bas of my knowledge, death occurred tlue to the cause(s) and m rated
O Pronouncing S Certifying physician - To the beat of my knowledge, death occurred at the time, date fantl place, and due fo the cause(s) antl manner stated
~ Medical Examiner/Coroner - On [he basis of examination, d/or investYgatlon, in my opinion, death occurred at the time, tla<e, and place, and due to the cause(s) and manner stated
61gna of c rtifie ~~1~ Title of c rtlf're r: fVt ~ ~( 2 j g gV a Number: M ~ 4 z / 9 Try
n
39b. Name, Adtlress and Zip Code of Person Completing Gause of Death (Ire 2
I'
~
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-
-
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-
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~~ 39c. Date: Signed (MO/Day/Yr)
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40. Registr 's istrict mbar- ~~~ 41. Registrar's Signature 42. Registrar Flle D
a
t
e (MO Day r)
43. Amentl ments ~ 7
~~
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H105-143
Disposition Permit No. 07621$0 REV OJ/2011
wills-spectermaxine_ Februan,~,6,2001
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I, MAXINE E. SPECTER, of 5002 McDonald Drive, Mechanicsburg, Cumberland
County, Pennsylvania, declare ±his instrument to be my Last Will and Testament, in
manner and form following:
FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by
me.
SECOND: I hereby direct my Executors to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicable after my death.
THIRD: I direct that all taxes which may be assessed in consequence of my
death of whatever nature and by whatever jurisdiction imposed shall be paid out of my
estate as a part of the administration of my estate.
FOURTH: I give, devise and bequeath all the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatsoever kind and wheresoever situate to my
children or to the survivor of them, in equal shares, share and share alike, namely: my
son, DAVID A. SPECTER, of Seattle, Washington; and my daughter, MARCIA L.
SPECTER, of New York City, New York.
FIFTH: I nominate, constitute and appoint my son, DAVID A. ;SPECTER,
and my daughter, MARCIA L. SPECTER, to be the Executors of this my Last Will and
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wills -specter maxine _ Februar--~ 6, 2001
Testament. No personal representative shall be required to file bond in this ~or any other
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal this ~~
day of ~ , 2001,
:~
,~ ,
Maxlne E. Specter
SIGNED, y4LED, PUBLISHED and
DECLAR in the pr sec o
/.
,~
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wills -specter maxine February 6, 2001
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, MARINE E. SPECTER, 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 MARINE E. SPECTER,
Testatrix, this f~
day o~li~.c.c~z.-~ , 2001.
Maxine E. Specter,, Tes
/,'
C~~~/~
C~
Notary P lip
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wills -specter maxine _ Febnaan 6, 2001
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
We, ~-~c;~ ~~ . ~ ~.~.~s,~ ~% and i~z'c~ :.~ . ~c,~c 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
Testatrix, MAXINE E. SPECTER, sign and execute the instrument as her Last Will; that
she siarred willir?gly and that she executed it aS her free. and vol! ~ntar,~ ?ct #nr t!,e
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 of our knowledge the Testatrix was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me by C>>9~'c~c_ ~ ~ r~~~,~R~
and ~~~ ~_ ~~,~Kf/o~~~~-,~_ witnesses this C~'~` _ day of
^~~+~ct~i , 2001.
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