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HomeMy WebLinkAbout06-05-12PETITI0~1 FOR GR4NT OF LETTERS REGISTER OF WILLS OF~ Cumberland COUNTY. PENNSYLVANLA 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: Pearl E. Bouder a/k/a: alk/a: a/k/a: Date of Death: May 21,~ZOL (assigned by Register) Z~ Z,- Zv Social Security No: -~9(~-?~65's age at death: 86 Decedent was domiciled at death in Cumberland County, Pennsylvania (state) with his/her last principal residence at ~ Xlorrison ~Vav Carlisle P.~ 17013 South l~iiddleton Township Street address, Post Office and Zip Code City, Township or Borough County Decedent died at ~ yiorrison Way Carlisle P~ 17013 South yliddleton Township, Cumberland County 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 $ X0,000 If not domiciled in Pennsylvania ...................... . .Personal property in Pennsylvania $_ If not domiciled in Pennsylvania .................... . ... Personal property in County $ Value of real estate is Pennsylvania .... . ................. ............................. ~ TOTAL ESTIMATED V ALUE.... $ 10,000 Real estate in Pennsylvania situated at ~ ~'lorrison ~%ay, Carlisle, PA 17013, South yliddleton Township /,tttacb additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County Q A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) helshe/they is/are the Executor(s) named in the last Will of the Decedent, dated Flay 30, 198-1 and Codicil(s) thereto dated John Bouder died 10/2~~09 (21-10-0887)• Renunciation of Jay NI. Bouder is attached; Joan ~I. Bouder armstron~ is now by m~uria4e Joan XI. Henne State relevant circumstances (e.e. renunciafion, death of executor, etc.) Except as follows: a$er the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pendin8 divorce proceeding wherein the rounds 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 killin8 nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS Q B. Petition for Grant of Letters of Administration (If applicable) - __ c. t. a., rl.b.n.. d.b.n.c.t.a., pendente lite, dza~ante absentia, durante minoritute If Administration, c. t. a. or d.b,n.c.t.a., enter date of `Vill in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pendin8 divorce proceedin8 wherein the 8rotmds for divorce had been established as defined in 23 Pa. C.S. § 3323(8) and was neither the victim o£ a kil lin8 nor aver adjudicated an incapacitated person. 0 NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), aftera propersearchhas/have ascertained that Decedent left no Will andwas stuvivedbythefollowin8spouse (ifany) and heirs (attach additional sheets, if necessary): ~ ~ ~ r3 Name Relatianshi Address ~'' ~' ~ a ~~". - ~ ~ ~ cr' . 0~~, .., ~ -.~. - ,. --+ ... to File No: 2~_ ~ ~ ~ Z`3 Fnrm RYV-tJ. rev. IQ~I L 2011 Pa~e 1 Of 7 lath of Yersonai Kepresentative COMMONWEALTH OF PENNSYLVANIA } } ss: COUNTY OF CUMBERLAND } v ui~iai ~,ac v~iiy Petitioner(s) Printed Name Petitioner(s) Printed Address Joan LI. Herne ~ 3 Morrison ~tiav, Carlisle, PA 1701 rv ~ 6._ r-r-t f' ~ ~ C i > t;~ ._ The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the the kno3~dge and~be~f of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer ~ttate acc~ing tq~~a`: Sworn to oY.affirmed an subscribed b~jfore " _ ~ i~'~_ ~ Date ~ / ~ me t ~ ~ day of ~ L c ° ~ Date •~ ~ Date By.~''F the Register Date BOND Required: ~ YES Q NO FEES: -, ~• ~t~ Letters ............. . .... .... $ ( 2) Short Certificate(s).. .... .~d Renunciations ( )Codicil(s) ........ .... . ( )Affidavit(s)....... .... . Bond ................... ..... Commission ............. .... . O .. ..... Automation Fee . .............. ` JCS Fee . .................... TOTAL ..................... $ O To t{ee Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Robert G. Frey Supreme Court ID Number: X6397 Firm Name: Frey & Tiley Address: ~ South Hanover Street Carlisle Pa 17013 Phone: Fax: Email: 7I7-2~3-838 717-2~3-6~1 rfrev@frevtilev.com DECREE OF THE REGISTER. Estate of Pearl E. Bouder a/k/a: AND NQ~V, ~~ ~ L~' ~ ~~~ ~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testament<1rv are hereby granted to Joan ~I. Herne _ j in the above estate and (if applicable) that the instrument(s) dated ~~ described in the Petition be adm •~. FormR6V-0? rev.IOill'2011 File No: ~~- / ~(~ ~r'~ ~~ to probate and file Register of Wills /~~ v Gc`~ .. oft H I: ~,. ,. ..i. ,...~ ~.i-I~--1~~3 ~~ ~ .~.~ ~ ¢f~ ,;, ~~ ; , . ;,~ CO., PIA 8 5~ L ~Zit~t 1~ ~~Fi~e,r,~p~x'MaY 2 2 2012 L Type/Print In COMMONWEALTH OF PEN NSV LVANIA DEPARTMENT OF HEALTH VITAL RECORDS Permane"` CERTIFICATE OF DEATH Black Ink State File Number: `^~~3 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Pearl E_ Bouder emale 202-20-1483 May 21, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/D aY/Year) (Spell Month) 7a. Birthplace ICILY antl State or Foreign Country) 84 Months Days Hours Minutes pct 30, 1( 327 Carlisle PA . 76. Birthplace (County) Cumberland Sa. Residence (State or Foreign Cpuntry) 86. Residence (Street and Number - Inclutle Apt No.) Sc. Did Decedent Live In a Township? PA 5 Morrison Way Yes, ae~edent uYed In S. Middleton twp. Sd. Residence (County) Cumberland Re. Residence (Zip Code) 1715 Q No, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status ai Time of Death 0 Married ~] Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes ~ No ~ Unknown ~ Divorced ~ Never Married 0 Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's N e Prior to First Marriage (First, Middle, Lasi) C1a on Wert S_ Catherine Lebeck 14a. Informant's Name 14 .Relationship to Decede of 14c. formant's M ~li g Address (Stre c~Nymlye City~(pte,$~~od~ ~ so far e 0 Joan Henne augYlter Morri n Way, is , F1 1 1 16 a. Place of Deat Check onl nne) 5 Y ........................................................................................................ If Death Occurred in a Hospital: Inpatient - - - ..... .............. . .............................. ss~~++rr ..................................... ..................................... 1f Death Occurred Somewhere Other Than a Hospital: I_I Hospice Facility ~} Decedent's Home ° O Emergency Room/Outpatient O Dead on Arrival . ~ Nursing Home/Long-Term Care Facility Q Other (Specify) 16b. Facility Name (If not institution, give street and number; 16c. City or To State d C 16d. County of th le f'A ~I' 8~ la 5 Morrison Way Carlis , 7 5 Cumber nd 16a. Method of Disposition ~] Burial ~ Cremation 16b. Date of Disposition 16c. Place of Dispositlon (Name of cemetery, crematory, o other place) m Q Removal from State Q Donation Cumberland Valley Memorial Gardens - Q Other (Specify) May 25 , 2012 16d. Location f Disposition (City or Town, State, antl Zip) 1Ja. Sig ature of Fu a Licensee or Person in Charge of Interment 1Jb. License Number Carlisle, PA 17013 138504 E 17c. Name and Gom ple[e Address of Funeral Facility Ho££man-Roth Funeral Home & Cremato 219 North Hanover Street, Carlisle, PA 17013 I8. Decetlent's Ed ucaiion -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE r s fo indicate what ~- highest degree or level of school completed at the time of death, box that best describes whether the decedent the decedent consideretl himself or herself to be. Q gth grade or less s Spanish/Hispanic/Latino- Check the "No" ~ White ~ Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese High school graduate or GED completed No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian ~ Some college credit, but no degree ~ Ves, Mexican, Mexican American, Chicano Q Asian Indian 0 Native Hawaiian Q Associate degree (e.g. AA, AS) ~ Ves, Puerto Rican Q Chinese Q Goa manlan or Cha motto ~ Bachelor's degree (e.g. BA, AB, BS) ~ Ves, Cuban Q Filipino 0 Samoan 0 Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander 0 Doctorate (e.g. PhD, Edo) or Professional degree (Specify) Q Other (Specify) (e. 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. Decedent's Usual Occupation -Indicate type of work White 0 Japanese ~ Samoan done during m t of working life. DO NOT USE RETIRED. ~ 0 Black or African American 0 Korean Q Other Pacific Islander Q American Indian or Alaska Native 0 Vietnamese ~ Do t Know/NOi Sqre Sales Person ~ Asian Indian ~ Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Retail Sales p Fmpino O G„amanian nr champrro ITEMS 23a - 23d MUST BE COMPLETED 23 a. Dale Pron p cetl eatl (MO/Day/Vr) 23b. Slgna ~ e of Person Pronouncing Death (Only when applica blej 23c. License Ngmber BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH /~• ~ ~ l v -J O- l '~-~ ~~ AJ ~3 g-~ ~ L~ 23 d. Date Signe (MO/D y/Yr) 24. Time of Death C , /~ - Q ~ rv` 25. Was Medical Examiner or Cprpner Co niactetl? ~ Ves ~ No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--tliseases, injuries, o mplications--that directly caused the death. DO NOT enter terminal events such a ardiac a est Interval: r respiratory arrest, or ventricular fibrillation V~Lithout shows g the t~ lology. D O> ABBREVIATE. Enter only one cause on a line. Add additional line s if necessary Onset to Death / / / ' ~ n n(/•~"~L l~ IMMEDIATE CAUSE - ----- ---- --> a. D /I l` (Final disease o ndition Due to (o as a cons q nre pf): resulting In death) b. Seq ue ntlally list conditions, Due to (or as a consequence of): if any, leading to the c e b=red on line a. enter ue UNDERLYING CAUSE Due To (o as a co nseq gents pf): (disease or injury that -_ vitiated the events resulting d. In death) LAST. Due to (or as a consequence of): s 26. Part 11. Enter other sienifica nt conditions contributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy perfp rm ed? O Ves ® No ~ 28. Were a opsy findings a aila ble [o mple<e the cause of death? o O Ve Q No 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death 0 0 Not pregnant within past year 0 Ves ~ Probably ~ Natural ~ Homicide ~ Pregnant ai Lime of death Q No Q Vnknown 0 Accident 0 Pending Investigation ~ Not pregnant, but pregnant within 42 days of tleath 0 Suicide Q Could not be determined ~ ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (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, Clty, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: ~ Yes Q Driver/Operator Q Pedestrian 0 No ~ Passenger ~ Other (Specify) 3 Certifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner statetl `~ Pronouncing 8. Certifying hysician - To the b t of my 4 wledge, death o red at the time, date, and place, and due to the cause(s) and m r stated Q Medical Examiner/GOrO - On the basis of vats and/or investiga<ionr in my opini n, death occurred at the time, date, and place, and due to the ca use(s) a nd m r stated ` ~ s Signature of certifier: Title of certifier: License Number:~~ ( 3 ~QO 39b. Name, Address and Zip Code of P rson Comple g se of Death (Item 6) P - ~ ~~q ~ 39c. Date 5' netl (M /Day/Yr) Ps i P t a i3 Z~ r-. ~ 2-z ~ -r_- 40. Registrar's District Number 41. Registra is ^ ! istrar File Date (M 42. R O/Day/Yr) Meg - , O ~ ~~ ' ' 1 S 1 1 lA OC 43. Amendments ' Dispositlon Permit No. \J I~~W `7 ~ H305-143 REV 07/20].] 04TH O~ NON-SII~SCRIBING WITNESS{ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of Pearl E. Bouder Robert G. Frey and (each) being duly qualified according to law, depose(s) and say(s) that acquainted with Pearl E. Bouder with the handwriting and signature of the decedent, and that the signature of Pearl E. Bouder to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Pearl E. Bouder is in his/her own proper handwriting. ~, (St,~nature) 5 South Hanover Street (Street.=lddress) Carlisle, PA 17013 (City, State, ZipJ Executed in Register's Office Sworn to or affirmed and subscribed before me this ``h_ day for Register of Wills Deceased she / he /they was /were Well- and am/are familiar (Signature (Street Address) ("City, State, Zip) . ~ ... r ~ ~~ :~~ i t, r--~~ ,-, ~ {-~ v? _: _ ... ~ ,~ f '~ '7l ~ , ~~ O t~ ' ~""' FornzRi{'-Od rev.l0.1i06 .~.. {.~~ O NTH +~F SUBSC~Z~BING WITNBSS(ES) ~~' ^ ~ ~ x <xi i r- r~i ~T~j -~ c17 _~ t- REGISTER OF WILLS u CUiyIBERLAND COLT~'TY, PENNSYLVANIA pc.:- ~ ='= ~~ ~-, o ~-.~ r,-, ~ ...., ~~ rn Estate of Pearl E. Bouder Deceased. Robert M. Frey , (each) a subscribing witness to (Print Name/s) the ®Will ©Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. (Signature) 5 South Hanover Street (Street Address) Carlisle, PA 17013 (City. State, Zip) Executed in Register's Of f ce Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Execr~tecl out of Register's O.f~ce Sworn to or affirmed anal subscribed U before me this ~ ~ day of ~~~ , ~~ s A. Notary Public NIy Commission Expires: Mod ao, aot-~ (SignaRra and Seal of ~otarv or other officia qualified to administer oaths. Show date of expiration of Votary's Commission.) VOTE: To be taken by Officer authorized to administer oaths. Pleasa have, present the original or copy of instruments at time of notarization. . ~.~ NOTARIAL SEAL ieiouSn~CuntbeA~ind~ M FnrtnR[G=O. rev. 10.1.06 1b E~p6~~90,II014 (Signature) (Street Address) (City, State, Zip) RENUNCIATION In Re Estate of PEARL W. BOUDER. deceased No: To the Register of Wills of Cumberland County, Pennsylvania. The undersigned JAY M. BOUDER, son of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to JOAN M. BOUDER ARMSTRONG, now by marriage JOAN M. HENNE. WITNESS my hand this 23rd day of May, 2012. JA . BOUDER Affirmed and subscibed before me this 23~d day of May, 2012. h/ ~t./1.a Notary Public Mar~.t-+aF NosFx ~raew- w. uc-ss, e~agww ~Ga ~o~nFtiw ~- ._., N ~ ~ ~• r'+ .~-~, ~r? ~ ,:i3 C !3 O'+ ,... , *~a ~:a ~ ~ ~~::; LAST WILL AND TESTAMENT ~:~'~ ~ r ~- PEARL W. BOUDER ~~ ~ ~-- ~, ~ ° ~ r~i I, PEARL W. BOUDER, of Middlesex Township (mailing address: 112 North ~iddlese~ Road, Carlisle, Pennsylvania 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 anytime heretofore made. 1. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. 2. 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 husband, John M. Bonder, his heirs and assigns, to the exclusion of my children, born and unborn, provided my said husband, John M. Bouder, shall survive me by a period of ninety (90) days. 3. Should my said husband, John M. Bouder, pre-decease me or fail to survive me by the aforesaid period of ninety (90) days, then in such event 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 as follows: (a) Any interest which I may have in the house and lot of ground situate in South Middleton Township, Cumberland County, Pennsylvania, known as and numbered 113 Petersburg Road, I give, devise and bequeath to my daughter, Joan M. Bouder Armstrong, her heirs and assigns, provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me then to such of her issue as shall survive me by a period of ninety (90) days and should there be no such issue then the same shall lapse and be included in the residue of my Estate. This devise and bequest to my daughter shall be under and subject to any liens and encumbrances which may pertain to said house and lot of ground. (b) Any interest which I may have in the house and lot ground known as 1058 Victoria Avenue, San Leandro, California 94577, presently occupied by my son, Jay M. Bouder and his wife Patti S. Bouder, I give, devise and bequeath to my son, Jay M. Bouder and his wife Patti S. Bouder, or to the survivor of them, provided at least one of them shall survive me by a period of ninety (90) days, but should neither of them survive me by a period of ninety (90) days, then to such of their issue as may survive me by a period of ninety (90) days, per stirpes, and if there be no such issue then the same shall lapse and be included in the balance of my Estate. This devise and bequest to my son and his wife shall be under and subject to any liens and encumbrances which may pertain to said house and lot of ground. (c) The balance thereof I give, devise and bequeath in equal shares to my two (2) children, Joan M. Bonder Armstrong, and my son, Jay M. Bonder, their heirs and assigns, provided they shall survive me by a period of ninety (90) days, but should either of them fail to so survive me then the share such deceased child would have recieved shall pass to such of his or her issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such issue the same shall lapse and be added to the other share. 4. I hereby nominate, constitute and appoint my said husband, John M. Bonder, as v Executor of this my Last Will and Testament, but should he pre-decease me or fail to qualify, then in such event I nominate, constitute and appoint my son and daughter, Jay M. Bonder and Joan M. Bonder Armstrong, or either of them, as co-Executors, and I further direct that ' none of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. Page 1 of 2 Pages IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on two (2) pages, this 30th day of May , 1984. ---f!/ --~~c~ ~ ~~ SEAL) Pearl W. Bouder Signed, sealed, published and declared by PEARL W. BOUDER, 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. {~~~ ~_ ~ ~~ Page 2 of 2 Pages