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HomeMy WebLinkAbout06-01-12Reset 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: Edna M. Holland a/k/a: a/k/a: a/k/a: Date of Death: Mav 8. 2012 ~) ~ ~ ~~ File No: ~"~ .)y ~. ~ .'~ ~ ~~' (Assigned by Regis er) Social Security No: Age at death: 92 Decedent was domiciled at death in Cumberland County, pA (Stare) with his/her last principal residence at 3E Round Ridee Road, Mechanicsbure, PA 17055 Unner Allen Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Harrisburg Hospital, 111 S. Front Street, Harrisbure, PA 17101 Harrisburg City Dauphin PA Street address, Past 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 $ 1,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 1.000.00 Real estate in Pennsylvania situated at: (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 July 18, 2001 and Codicil(s) thereto dated State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds far divorce had been established as defined in 23 Pa. C.S. § 3323(g), 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 ~ EXCEPTIONS Q 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. Q NO EXCEPTIONS ~ EXCEPTIONS ~ t _~ (,.~ ~ ~_ , L.~7 1 ~.) E., 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): C7 - .-- _ ~ _~~, Name Relationshi Address t~ ~ c-- '~'_+ ~ , _ «~ _ ~, Farm RW-02 rev. 10/1 //2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } .~ .~ } t~icial Use Onlyc__ ~~ `; ~~;~ ~- _ ~ ~. ~-~ ."Z7 ~ :.~ ~~'. ~~r t !_. r--,~-. T-„ - Petitioner(s) Printed Name Petitioner(s) Printed Address. -'- Ma L. O'Donnell 3E Round Rid e Road, Mechanicsbur , PA 17055 ~ €~~, ~'' 7 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 knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the~etitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed an subscribed before ~ ~ ; ~,., ¢.;i it-,1 ~ /~ v-~-r~t ~~ Date G~ ~ ~ ~i=-~ me this ~~`da~ of ~ ~;" -- , ~ `~>.~ ~ ~. " Date By: , t ~ ~ ~ ~ , Date ,,Fart Register Date BOND Required: Q YES Q NO FEES: Lett s ...................... $ ~~ ' ~ ~' ~ ( .~) Short Certificate(s)...... e'' ~~` ( )Renunciation(s)......... ' ( )Codicil(s) ............ . ( )Affidavit(s)........... . Band ........................ Commission ................. . O r~. ........ -, ........ r_: Automation Fee ............... ~ ~" JCS Fee ..................... , TOTAL ..................... $ --8.P0-- To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~ 1 r PrintPd~lame: Lisa Marie Coyne, Esq. Supreme Court ID Number: 53788 Firm Name: Coyne & Coyne, P.C. Address: 3901 Market Street ('amn Hill, PA 1701 1 Phone: 717-737-0464 Fax: 717-737-5161 Email: lisaC~rnynPandrnyne.rnm !`~~ ~~ ~ 1 ( DECREE OF THE REGISTER `~ P ~ Estate of Edna M. Holland File No: '°-' ~ _ ~ ~~ ~~~~ a/k/a: g S ~~~~ AND NOW, `l. (,(. ~;r ~? ,~ _~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary _ are hereby granted to Mary L. O'Donnell in the above estate and (if applicable) that the instrument(s) dated July 18, 2001 described in the Petition be admitted to probate and filed of record as the last Will (and Ccdicil~s)) of Decedent. ~~ G Register of Wills ~ ~~ ri C ~ ~ ,~~ ~~'~ Form RW-02 rev. 10/11/2011 ~ affe ~"Of 2, ~. 1-l: C.. III ifll,l L )rl ~(...IiL .. .!I '..~~f. a1V~~ _ ~ rA' SS'i '~ - .. , -. URI-hJ411 ,L11:}: ~*) cu~~~~R~ ~<~ cry , ~>4 ~~~ ~~- ~~ ~~ May o ~ Z~t2 _p 1852674 ,1~ Type,t,V W~T]A (i)](',jij()j] ~ )]])~i ?.", COMMONWEALTH OF PEN NSV LYANIA ~ OEPARTM ENT OF HEALTH ~ VITAL RECORDS Pe~a~k ~~kt CERTIFICATE OF DEATH state File Ngn,b¢r. d~ `~ ~, T T /~^ `~ ~~ 1. Decedent's Legal Name (First, Middle, Last, Suffix) Z. Sex 3. Social Security Number (Sp~l Mo) 4. ~a<e of Death (MO/pay n J Y Edna Mae Holland emale u ~ (~ ~I V a. Age-Last Birthday (Yes) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/D ay/Year) (Spell Month) 7a. Birthplace City apd S ~ tate or Fo gn Country) Months Days Hours Minutes NeW aris~ PA 92 January 15, 1920 Jb. Birthplace (cggn<y) Bedford 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Hc. Did Decedent Live in a Township? Penns lvania 3 Round Ridge Road Unit E Yes, decedent eyed in _--Upper_ A11en _ ____ twp- Hd. Residence (County) Cumberland COUnty 8e Residence (Zip Code) Q No, decedent lived within limits of ity/boro. 9- Ever in US Armed Forces? 10- Marital Status ai Time of Death Q Married ~] Widowed 11. Surviving Spouse's Name (If wife, give name prior to first mare age) Q Ves )g] No Q Unknown Q Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suff z) 13. Mother's Name Prior to First Marriage (First, Middle, Las<) Ra1pt1 Jacob Hengst Esther Mar aret Kau m 14a- Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, Sta ¢, Zip codePA 170rj5 Mary O•DOnne11 da hter 3 Round Ridge Road, Unit E, Mechanicsburg, ° Oeath (check only one) _ lsa. Place ot ....... ..._- _ ... .... ............ ..n ___._... If Death Occurred in a Hospital ~ patle nt _ _ ._... a Hos pipe Fa[iu ..... _ ~ oecedenrs Home If Death Occurred Somewhere Other Than Vital Q Hos ty _ 0 Q Emergency Ro m/Outpatient Q Dead on Arrival ~ Q N ng H ¢/Long-Term Care Facility Q Other (Specify) 15 b- Facility Name (If n institu[ on, Rives reet and number; pt t 15c- City or Town, State, and Zip Code 15tl. County of Death '7 ~ - Harrisbur Hos hal Harrisbur PA 17101 Dau in Co. `x g ~ 16a. Method of Disposition [~ Burial Q Cremation 16b. Dale of Disposition 16c- Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from State Q Donation - pother <specify> 5-11-12 Bedford Count Memorial Par}c 16d- Location of Disposition (City or Town, State, and Zip) I7a- Signatu ral Service a Per n Charge of Interment ~ 1]b. License Number Bedford, PA 15522 010930-L E 1ZC. N d Complete Address of Fun¢rai Facilrcy Timoth A_ Berkebile Etiineral Hone Inc. 214 S_ m 18. Decedent's Education -Check the box that best describes the 19. Decedent of His panic Origin -Check Che 20. Decedent's Race -Check ONE OR MORE r s to indicate what highest degree or level of school co pleted at the time of death. box Shat best describes whether the decedent he decedent considered himself or herself tq be- 8th grade or less s Spanish/Hispanic/Latino. Check the "NO" ~ White Q Korean No diploma, 9th - 12th grade f decedent snot Spa ish/Hispanic/Lab no. b o - Q Black or African Amencan Q Vietnamese Q High school graduate or GED c mpleted ~ a~' ' LJ'.+zo not Spanish/Hispa is/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Y ,Mexican, Mexican American, Chicano Q Asian Indian Q Native H aI Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Gu manl nor Chamorro a Q Bachelor's degree (e.g. BA, AB, BS) Q Y¢s, Cuban Q Filipino Q Samoan Q Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other $panlsh/Hispanic/Latino Q Japanese [] Other Pacific Islander ~ Doctorate (e-g. PhD, Ed D) or Professional degree (specify) _ _, Q Other (Specify) (¢- MD, DDS, DVM, LLB, JD) 21. Decedent's single Race Self-DesiR^ation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a- Decedent's Vsual Occupa< -Indicate type' of work n l~ White Q Japanese Q Samnan DO NOT USE RETIRED. done during most of working life Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q Do < Kn w/Not Sure o Homemaker Q As n Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Cl.inese Q Native Hawaiian Q Other (specify) O[JI1 home Q Filipino Q Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Da Y/V r) 23b- Signature of Person Pronou nc ng Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH S-$-12 23d. Date Signed (MO/Day/V r) 24. Time of D ath- y7 `// 25. W edical Examiner o r Conta ct¢d? Q _ No CAUSE OF DEATH - Approximate 26. Part L Enter the chain of ¢ -diseases, injuries, o mplications--that directly c sed the death. DO NOT en er erml al ¢ uch a ardiac a Inge rval: r Death t o if necessary Ojls¢t BBREVIATE. Enter only one cause on a line Add additional lines respiratory arrest, or ventr~a~rlar fibrillation w- hout s ho wing th e etiology. DO N O T A 1 IL 1 / ~ ~ ~ ~< /l / ~ / , ^ ` 1f _J~ v~1~ •~iI ~ _ VV ~ __ =_-1 a IMMEDIATE CAUSE --- ~-----~ ______ ! - rv Due to (or as a consequence of): (Final disea s¢ o ndition h d cai ) r¢~u1u e. ~ b. u ~ ~ y lis ndin s, Due to (o as a cons q ncc of): r if any, leading [o the c ¢ h ~ ed on line a Enter t e .. - UNDERLYING CAVSE Due So (or as a consequence o(): _ cc w mJ (disease or ury chat LL initiated She events resulting d. _ _ __ ___ _ = In death) LAST. Dual to (or as a consequence of): ~ 26. Part er other significant c__nditions c ribu g o death but not resulting in the underlying cause given in Part I n Ent ` 27- Was n autopsy performed? s No O v ~ ~ r~ -7 ~ t 28. Were au opsy findings available to mplete the c use of death? a o Q No Q Yes v 29. If ale: 30. Did loba cco Use Contribute to Death? 31 nee of Death o hin past year [~NOt pre gna nt Q Yes Q Probably ~ Na[u ral Q Homicide t 1Te ' Q egn t [ of death t Q No Unknown J~ Accident Q Pending Inv¢silgation eL n(, but pregn within 42 days of death Q Not pregn Q 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, constru ctlon site, farm; school) 35. Location of Injury (Street and Number, City, Sta<e, Zip Code) 36. ury at Work I 37. If Transportation Injury, Specify: 38. Describe How Injury Occurretl: 0 Yes Q Driver/Operas or Q Pedes<rian Q No 0 Passenge Q Other (SPecify) 39a- Certifier (Check only one): a Certifying physician - To the best of my wledge, death occurred due to [he c use(s) and m nn r s ed e nd place, and duet the ca e(s) and m ed Q Pronouncing 6 Ce tifying physician T e best of my knowledKe, death n u ed a the t da o r d a n d m nn¢r ca use( s ) date, and place, and due <o th e u reed at the time cc Q Medical Examiner/Coroner - b Is of ati nd/or rove tiga ion, n my opinlo ~ death o ~( ~t ~ / ~ ~ / ! ~ ~ ~L Z ~ ~ r' m I l License Number: )Y1 (,( 30 Signature of certifier.- Title of certifie 39 Na dress d Zip Hof Comp ng C f Death (Item 26) /7 - 0 S ~~ ti ~ 7y,A) 1 f 39c. Date 5- ed ( o/Day/Vr) n ~r 20 ~ 40. Registrar's District Number 41. Re - <ra 's Si a[ur 42. Regis(r File D to ( /Day/V r) C> , '7 ~ Io 43. Amendments H106-143 Disposition Permit No. 0752632 __ ___ REV OJ/2011 n _1-l --~ ~~-' -r? ~ ,-~ ~ ,_ 7l 1~ ~ _ i. ~ .... -~, ~~-7- r .. ."' r, ._" _.. LAST WILL AND TESTAMENT OF EDNA M. HOLLAND ~~ __ ~_'_ c- _ :Tr r, . I, EDNA M. HOLLAND of 1010 12th Street, Apt. 618, Altoona, Pennsylvania 16601, being of sound and disposing mind, memory and under- standing, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills, Testaments and Codicils by me at any time heretofore made and as to such estate as shall have at the time of my death, whether it be real, personal and/or mixed, of whatsoever nature and character and wheresoever situate including that over which may have the power of disposition, I direct that the same shall be disposed of as follows: FIRST. I declare that I am the widow of EDWARD H. HOLLAND and that I have two children, to wit: MARY L. O'DONNELL and RONALD M. HOLLAND. I have one child who predeceased me, to wit: NANCY DOUGLAS. SECOND. All federal, state and other death taxes (including any interest and penalties thereon) payable on the property forming my gross estate for those purposes which may be payable by reason of my death with respect to property passing under this will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which have a general power of appointment for federal estate tax purposes nor shall it apply to any generation skipping taxes. 1 ~'"' 1 ". ' ~. ~~ ~~ ~ THIRD. I direct that all my just debts, funeral expenses and expenses in connection with the administration of my estate be paid as soon as practicable after my death. FOURTH. All the rest, residue and remainder of my estate aforesaid, I do hereby give, devise and bequeath unto MARY L. O'DONNELL, RONALD M. HOLLAND, DAMIAN ALBANO, CHRISTOPHER ALBANO, RHONDA HOLLAND, SHEILA FINK, MICHAEL DOUGLAS and DIANE PERSON, in equal shares, share and share alike. FIFTH. In the event that any of the aforesaid MARY L. O'DONNELL, RONALD M. HOLLAND, DAMIAN ALBANO, CHRISTOPHER ALBANO, RHONDA HOLLAND, SHEILA FINK, MICHAEL DOUGLAS and/or DIANE PERSON should predecease me, then and in such event, the share which he or she would have taken here- under shall pass unto his or her issue per stirpes. SIXTH. In the event that RHONDA HOLLAND should predecease me without issue, then and in such event, the share which she would have taken here- under shall pass unto SHEILA FINK. SEVENTH. In the event that SHEILA FINK should predecease me without issue, then and in such event, the share which she would have taken here- unde shall pass unto RHONDA HOLLAND. EIGHTH. In the event that DAMIAN ALBANO should predecease me without issue, then and in such event, the share which he would have taken here- under shall pass unto CHRISTOPHER ALBANO. NINTH. In the event that CHRISTOPHER ALBANO should predecease me without issue, then and in such event, the share which he would have taken hereunder shall pass unto DAMIAN ALBANO. TENTH. In the event that MICHAEL DOUGLAS should predecease me without issue, then and in such event, the share which he would have taken here- under shall pass unto DIANE PERSON. ELEVENTH. In the event that DIANE PERSON should predecease me without issue, then and in such event, the share which she would have taken here- under shall pass unto MICHAEL DOUGLAS. TWELFTH. I do hereby name, constitute and appoint MARY L. O'DONNELL as Executrix of this my Last Will and Testament. In the event that MARY L. O'DONNELL should fail to qualify, cease to act or predecease me, then and in such event, I do hereby name, constitute and appoint GERALDINE MOCK as Executrix of this my Last Will and Testament. I direct that no fiduciary acting hereunder be required to enter bond or any other security in any jurisdiction. IN WITNESS WHEREO, I, EDNA M. HOLLAND, Testatrix, have hereunto initialed the first two pages of this Will and to the last page I have ~ ,~~ f'~ hereunto set my hand and seal this ~ .~ day of -.~ ~ ~ ~ ~~ 20 O1. ~~~C--Y~~r_..9 ''.?-y-? ~ '~.~--~°~,-Y-r_.~~!_ ~ SEAL ) Testatrix Signed, sealed, published and declared as and for the Last Will and Testament of EDNA H. HOLLAND, Testatrix herein named, who signed the same in our presence and we, at her request and in her presence and in the presence of each other, have signed the same as subscribing and attesting witnesses. ~-- ~ ~ 701 No. Second St., Juniata, Altoona, PA 16601 I ~ _ ~ ~~ 1 r~ ~ 701 No. Second St., Juniata, Alt ona, A 16601 STATE OF PENNSYLVANIA COUNTY OF BLAIR I, EDNA H. HOLLAND, 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 EDNA H. t!, 2001 . HOLLAND, Testatrix, this 'r~ day of ~ ~' ~ ~f , . / `~ // Testat~Z'ix ~~ t '~~. NOTARW.3EAL MEt.Orl N.IACCAlK3fiAN. NoAM~!{Ip~C My Cbn~Expi~es~J~~7.1'00~ STATE OF PENNSYLVANIA COUNTY OF BLAIR SS We, ALLEN E. GIBBONEY and DONALD T. GIBBONEY, 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 the testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it 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 of our knowledge, the testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn and affirmed to and subscribed to before me by h ALLEN E. GIBBONEY and DONALD T. GIBBONEY, witnesses, this ~~r day of `, j,,, 2001. "~~~ ~: i G;~ ~~li ~ ~ ., mil,,' ~-"J~'l'(.t,{, t~ ,;:~, Witness ~,. ~-_~-- ~_ .~`.~ c. Witness ( ~ i' ~__ ) ~ ,~ ,, ~(~ ' ' C ~ ' ~` r,i ,~ __ i ..~~., NOTAR{AL 3EAt, MELdA N. McCAUGHAN, Notary Pubic AMoona Blair County, PA "~,~ f;nmmis;it?n ^YDi~aS ,13n. 7, 2003