HomeMy WebLinkAbout06-08-12PETITION 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: Shat/ P. Farwell File No: 21 ~ / ~ - (%~" (~_~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 5/26/12 Age at death: 67
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at 1725 Walnut Bottom Road 17241 Newville Penn Township Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 1725 Walnut Bottom Rd. 17241 Newville Penn Township 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 $ 10,000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ _
!f not domiciled in Pennsylvania .............................Personal property in County $
Value of real estate in Pennsylvania .............................................................. $ 50,000.00
TOTAL ESTIMATED VALUE.... $ 60,000.00
Real estate in Pennsylvania situated at: 1725 Walnut Bottom Rd. 17241 Newville Cumberland
(Attnch ndditionat sheets, i(necessnry.) 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 12/21/11 and Codicil(s)
thereto dated NOne
State relevant circumstances (e.g. renunciation, death nfexecutor, 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 1'or 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 pf apphcabte)
c. t. a., d. b. n., d. b. n. c. t. a., pendente lite, durante absentia, durante minoritate
If Administration, c.~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 (if any) and heirs (attach
additional sheets, if necessary):
Name Relationship ~ Address
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FormRW-02 rev. 10/!l/2011
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Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
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COUNTY OF CUMBERLAND }
Official Use Only
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Petitioner(s) Printed Name
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Petitioner(s) Printed Address C! ~ , ~
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1750 Walnut Bottom Road O ~ ~ ~"
Daniel C. Farwell ~~
Newville PA '~I241 ~ -
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The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoi 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 Pet' oner(s) will 11 and truly administer the estate according to la/w.
Sworn too fi ed and subscribed befo ~ '' Date ~ ~~ ~~~~`
met is _ l ay of ~, Z- r ~` ~ Date
By: .~- ~- _ i~. ?` / Date
Register
BOND Required: ^ YES ^ NO
FEES:
Letters ....................... $
( ~j )Short Certificates(s) ...... `'`~
(-/ )Renunciation(s) ......... .
( )Codicil(s) ............. .
( )Affidavit(s) ............ .
Bond .........................
Commission ................... .
Othqr .........
=a
!~!j ......... /'~
Automation Fee ................ .
JCS Fee .......................
TOTAL ......................$
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Date
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
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Printed Name: No V. Otto III
Supreme Court
ID Number: 27763
Firm Name: Manson Law Offices
Address: 10 East High Street
Carlisle PA 17013
Phone: (717)243-3341
Fax: (717)243-1850
Email: iotto(a~martsonlaw.com
DECREE OF THE REGISTER
Estate of
a/k/a:
AND NOW, ~o --' ~~ ~,L -~-~~ ~ ~-~ ~--~.-,.in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary __
_ are hereby granted to Daniel C. Farwell
in the above estate and (if applicable) that
the instrument(s) dated December 21, 2011
described in the Petition be admitted to probate and filed of record
P. Farwell File No: / .~ ~' ~;>
Will (and Codicil(s)) of
Register of Wills
Fornt RW-02 rev. !0/11/201]
Continuation of Petition for Grant of Letters
Shay P. Farwell 165-38-2258
Decedent Name Page 1 Social Security Number
Real Estate in PA
Mountain View Road Penn Township Cumberland
Street address, Post Oftice and Zip Code City, Township or Borough County
tae 'H!r :T t ~ ~ 3 ~~ '
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~~~~ i,,. (t),~ L~t I .13c,ltc. ~'i~ ;)~i ?OI1 JUN -8 ~ _
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CUMBERLANpJC4.. t~ L~ ~ ~~~~.,~ ' nt2
~$4~7~~~ ~MA.Y 29F2
Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permanent
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tuber:
1. Decedent's Legal Name (Firs[, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
Shay P_ Farwell male 165-38-2258 May 26, 2012
6a. Age-Last Birthday (Vrs) Sb. Vnder 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Near) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
f 1 6'7 Months bays Hours Minu<es September 18 , 1944 Carlisle PA
76. BirtnPlaae (counts
Sa. Residence (State Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township?
Penns
lvani
725
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a
Walnut Bottom Rd r~l Yes, deredent li..ed in PPTI I.1 <
wp.
Hd. Re5(d ~(COU nty~
C; Um Y32 r 1. a n d
8e. Residence (Zip Code)1 7 2 4 1 ~ No, decedent lived within limits of city/born.
9. Ever (n US Armed Forces? 10. Marital Status a[ Time of Death ~ Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
Q Ves $] No Q Unknown ~ Divorced ® Never Married ~ Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First
Middle
Last)
Laroy P. Farwell ,
,
14a. Informant's Name 14b. Rel afionship to Decedent
Daniel F
l 14c. Informant's Mailing Address (Street and Number, Ci State, Zip del
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0 arwe
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1750 Walnut Bottom Rd
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Ci .......................................................... .........................................
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' ......... 15 a. P ace o Death C ec_ only one
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If Death Occurred In a Hospital:
~
Inpatient _ __ __ _ __ _ _ _ _
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:If Death Occurred 6omewhe a ~ ~ ~~~ ~ ~~ ~~ ~ ~~ ~ ~ ~~~~~~~~ ""' """' ""'
e Other Than Hos ital: Hos Ice Facilit
P P Y .p
y~l~ecede ht's Home
Q Emergency Room/Outpatient 0 Dead on Arrival ,
_ ~ Nursing Home/LOngr Term Care Facility Q Other (Specify)
156. Facility Name (If not institution, give street and n tuber;
n 16c. City or Town, State, and Zip Code 16d. County of Death
.. 1725 Walnut Bottom Rd ewville PA 17241 Cumberland
. 16a. Method of Disposition $]KBurial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, o <her place)
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O RemPyalfrnmstate p Dpna<lon 5/30/2012 DicKinson Presbyterian
Church
:` p omer (specity) Cemeter
16d. Location of Disposition (City or Town, State, and Zip)
C
i 17a. Signature of I Servlc License r Person in Charge of Interment 176. License Number
Une
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d arl
sle PA 17015 ~
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FD 13895 L
E 17c. Name and Complete Address of Funeral Facility
E er Fu e
m 18. Decedent's Education -Check the box chat best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what
ti highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be
.
~ 8ih grade or less is Spa nls h/Hispanic/Latino. Check the "N O" hire 0 Korean
~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese
High school grad ua<e or GED completed g] No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native 0 Other Asian
~ Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano Q Asian Indian 0 Native Hawaiian
0 Associate degree (e.g. AA, AS) ~ Yes, Puerto Rican Chinese
~ Q Guamanian or Chamorro
~ Bachelor's degree (e.g. BA, AB, BS) » Ves, Cuban ~ Fill Pino 0 Samoan
'
Q Master
s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific Islander
~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify)
. Mb, DOS, 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 Occupatio -Indicate t
e of work
yp
white ~ Japanese ~ Samoan done during most of working RfenDO NOT USE RETIRED
.
0 Black or African American ~ Korean ~ Other Pacific Islander
F a rml=_ r
~ American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure
0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry
0 Chinese 0 Native Hawaiian ~ Other (Specify) Ag r i c u 1 t u r e
Filipino Q Guamanian or Chamorro
ITEMS 23a - 23d MUST BE COMPLETED 23 a. Date Pronounced Dead (MO/Day/Vr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c
License Number
BV PERSON WHO PRONOUNCES OR
CERTIFIES DEATH ~~ a 6 aQia .
23d. Date Signed (MO/Day/Yr) 24. Ti a of Dea<h
7- ~ 25. Was Medical Examiner or Coroner Contacted? Q Ves No
CAUSE OF DEATH
Approximate
26. PaK 1. Enter the chain of events--diseases, injuries, or complications- that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval:
res
irato
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l
f
p
ry
res
, or ventr
cu
ar
ibrillation without
s h
o
wing
the etiology- DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death
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A
IMMEDIATE CAUSE - > a. ~~s2 ) y ~'{ ~s~6~ f (~y /A1/~
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(Final disease or condition T
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esulting in death) /
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Sequentially Iis< conditions,
o
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f
):
if any, leading to the cause
listed on line a. Enter the -
UNDERLVING CAUSE Dtre to (or as a con
sequence of):
(dis r InJury that
Initiated the a nts resulting d.
e
In death) LAST.
Due to (or as a consequence of):
S 26. Part 11. Enter other sienificant c nditlons contr'but'ne to d th but not resulting in the underlying cause given in Part I
0 27. Was autopsy perform ed7
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~ 28. Were
a topsy findings available
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KI r to complete the cause of death?
~ Ves ~ No
- 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
0 0 No[ pregnant within past year
~ Pregnant at time of death ~ Ves 0 Probably
~ N
U
k Natural 0 Homicide
~
m
~ Noe pregnant, but pregnant within 42 days of death o ~
n
nown Accident ~ Pending Investigation
~ Suicide ~ Could not be determined
ti 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Mo/Da /Yr 5
JI'ry ( Y ) ( pelt 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 (Street and Number, City, State, Zip Gode)
36. Injury at Work 37. If Transportation InJury, Specify: 38. Describe How InJury Occurred:
0 Yes ~ Driver/Operator ~ Pedestrian
~ No 0 Passenger ~ Other (Specify)
39a. Certifier (Check only one):
~ Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
ncing 8< Ce rtlfying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the c se(s) and manner stated
Medical Examiner/COrone - Ination, and/or investigation, in my opinion, dea h o curved at the time, date, and place, and due to the cause(s) and m
er stated
. •
Signature of certifier: TI[le of certifier: ~ ~ Hcense Number: DS arm)? ~I J
39b. Name Address and Zi Cod of P r on Completing Cause o Dea h (Ire 26) 39c. D to Signed (MO/Day/Vr)
J.S ~ - o~ ao~-Z
40. Registrar's istrict Number 41. Registrar's Signature 42
.
R
egis ar File D
a (MO/Day/V r)
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43. Amentlments
(~ /' ~1 H105-143
Disposition Permi< No. ~ ' L~ ~ t0 O0. REV 07/2011
F~FILESVClientsV14596 Shay FaiwellU 4596. Lwill 2011
LAST WILL AND TESTAMENT
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I, SHAY P. FARWELL, of Penn Township, Cumberland County, Pennsylvania, being of
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sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will
and Testament, hereby revoking any and all former Wills or Codicils made by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes (whether such taxes may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or other property not passing under
this Will.
2.
I give such items of personalty as are itemized in a certain list, if any, to the persons named
thereon, which list is signed and dated by me at the end thereof.
3.
I give, devise and bequeath any and all interests that I have in my home and farm at 1725
Walnut Bottom Road, Newville, Pennsylvania and in a certain mountain tract owned with my
brother, DANIEL C. FARWELL, unto my brother, DANIEL C. FARWELL. In the event DANIEL
C. FARWELL, should predecease me, or if I am the survivor and have inherited those parcels of real
estate, I direct that they be sold and the proceeds therefrom be distributed as aprt of the residue of
my estate.
4
I give the sum of Three Hundred Thousand Dollars ($300,000.00) unto my Trustee, intrust,
for the benefit of my nephew, MATTHEW T. FARWELL, for the following purposes:
a. The Trust shall be held for the benefit of MATTHEW T. FARWELL, during his
lifetime. The net income derived from the Trust shall be paid to or applied for the benefit of
MATTHEW T. FARWELL, during his lifetime. Payment shall be made in such intervals and in
~a
[Initials]
Page I of 4 Pages
such amounts as the Trustee deems appropriate, but at least quarterly. The Trustee shall apply any
amount of the principal in such intervals and in such amounts as the Trustee, in its uncontrolled
discretion, shall deem needful or desirable for the support, welfare, maintenance, and for medical,
surgical, hospital or other institutional care for the benefit of MATTHEW T. FARWELL.
b. At the time of the death of MATTHEW T. FARWELL, any share remaining intrust
shall be distributed outright unto my brother, DANIEL C. FARWELL, if living. Should DANIEL
C. FARWELL, be deceased, such share shall be distributed unto my niece, NICOLE FARWELL.
c. If the principal of the Trust should at any time have a principal balance of less than
Twenty Thousand Dollars ($20,000.00), the Trustee is authorized to distribute said amount unto
MATTHEW T. FARWELL, or to apply it for his benefit.
5.
I give, devise and bequeath all the rest, residue and remainder of my estate, both real and
personal property, unto my brother, DANIEL C. FARWELL, my sister-in-law, PATRICIA
FARWELL and niece, NICHOLE FARWELL, in equal shares, absolutely.
6.
I nominate, constitute and appoint brother, DANIEL C. FARWELL, as Executor of my
estate, I the event he is unable or unwilling to act in such capacity, then I appoint ADAMS
COUNTY NATIONAL BANK, to act in such capacity.
7.
I nominate, constitute and appoint ADAMS COUNTY NATIONAL BANK, as Trustee of
any Trust created under this my Last Will and Testament.
7.
I direct that all fiduciaries acting under this Will, whether or not named herein, shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
8.
I authorize and empower my Executor and Trustee, or their successors, in their sole and
absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized
or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange,
dispose of or grant options in regard to any or all property of any kind forming a part of my estate
S~
[Initials]
Page 2 of 4 Pages
for such terms and such prices as they may deem advisable; to borrow money for any purposes
connected with the protection and preservation of my estate; to mortgage or pledge any real or
personal property forming a part of my estate or to join in or secure the partition of same; to
compromise any claims or demands of my estate against others or of others against my estate; to
make distribution in kind and to cause any share to be composed of cash, property or undivided
fractional shares in property different in kind from any other share; to employ agents, attorneys and
proxies and to delegate to them such power as my Executor and Trustee, or their successors
considers desirable and to pay reasonable compensation for such services as may be rendered by such
agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to
carry out any of these powers. In addition, I direct that my Executor, or his successor, shall have the
power to conduct an inventory of any safe deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this 21st day of December,
2011.
-!~~'.~~ ~ 4~~ (SEAL)
Shay P. Farwell
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed
our names as `itnesses thereto, in the presence of the said Testator and of each other.
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Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND
We, Shay P. Farwell, No V. Otto III and ~~~ ~ y ~r p,,t.;~c.~ ,the Testator and
the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testator signed and executed the
instrument as his last Will and that the Testator has signed willingly, and that the Testator executed
it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testator, signed the Will as a witness and that to the best of his/her
knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
~~h aT~~
Shay P. Farwell, Testator
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'°~~i'_j~ ~~,
Witness
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Subscribed, sworn to and acknowledged before me by Shay P. Farwell, the Testator, and
subscribed and sworn to before me by No V. Otto III and ' ~/ (C~.t y `rn • 1 .~-l.~ 2 ,the
witnesses, this 21St day of December, 2011.
~~~ c~
Notary Public
~:U_ivLV[UNWF'~3,"~H OF PENIVSYLVANYA
~.~I'~C)'3'ARIAL SEAL
"~ `r+-;., ~-ia L. Otto, Notary Public
C'arlisie Baru, Cumberland County
My cun:~is_i~n 4 =pins December 20, 2014
Page 4 of 4 Pages