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HomeMy WebLinkAbout06-25-12Reset 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: KATHLEEN A. MOCK a/k/a: a/k/a: a/k/a: Date of Death: 06/16/2012 File No: ~ ! ~ ~ ~ ~ ~. (Assigned by Register) Social Security No: Age at death: 78 Decedent was domiciled at death in CUMBERLAND County, pENNSYI.VANiA (Stare,) with his/'~er last principal residence at 232 AVON DRIVE. CARLISLE 17013 CARLISLE BOROUGH <'UMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 232 AVON DRIVE. CARLISLE 17013 CARLISLE BOROUGH 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 S 188,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $~~ppp 00 TOTAL ESTIMATED VALUE.... $ 388.000.00 Real estate in Pennsylvania situated at: 232 AVON DRIVE, CARLISLE 17013 CARLISLE BOROUGH CUMBERLAND (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 FEBRUARY 29, 2000 and Codicil(s) thereto dated State relevant circumstances (eg. 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 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. Q NO EXCEPTIONS ®EXCEPTIONS ^ 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 t~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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ®EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (il~any) and heirs (attach additional sheets, if necessary): r,,,,, t" 7 Name Relationshi Address ~ ~.., m ~.- ~ ~.._ 3J~:!_' . tU - Cs , C7~ C_. ~r; w - D t:.J i./~ t~'+ Form RW-02 rev. i 0/IIi2011 Page 1 of 2 v ~~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use Only , C{f ,,,, , yC v ~. ~ ~ G{ 2 Petitioner(s) Printed Name Petitioner(s) Printed Address FREDERICK C. MOCK ~._ 103 CANNA AVENUE STARKVILLE MS 39759 ~Kh` '' e ' ' 'r '` ^ i ANDREW J. MOCK 140 BAY ST, A2, JERSEY CITY, NJ 07302 ~~ ~" pA The Petitioner(s) above-named swear(s) or affirm(s) the statemen in the ore in etition a true d correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the cedent, e P o r(s) w 1 a d fly administer the estate according to law. Sworn ±o or affirmed and subscribed before) ~ ~ ' ~~% ~~~ ~ G~- ~/ Date ) ~• I c ~~ ~ % C' 1. ~ me this ~..~-y- day, Of~~f ~ „ ~.,1 ~ 1~ ' f'~ ' i%~ DHt~ vG~ ~ ' By: ~ ( i _ i l U ~ (~. e ' Date ~; 1~~ ~ For the Register Date BOND Required: Q YES Q NO FEES: Letters ...................... $ 360.00 ( 4) Short Certificate(s)...... 16.00 ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ WILL ........ 15.00 Automation Fee ............... 5.00 JCS Fee ..................... 23.50 TOTAL ..................... $ 419.50 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~~' ~ L r// . L Printed Name: ROG R B. IRWIN, ESQUIRE Supreme Court ID Number: 6282 Firm Name: IRWIN & McKNIGHT, P.C. Address: 60 WEST POMFRET STRF,ET CART.IST.F. ~A 17013 , Phone: (717)249-2353 Fax: (717) 249-6354 Email: DECREE OF THE REGISTER Estate of KATHLEEN A. MOCK a/k/a: File No: ~ L-~ ~~ (_~ AND NOW, . ~~ ~ ~~_( ,~ ` ~ , ->'C lr~- , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters TESTAMENTARY - t r e~ u t ~. ~ P~t r" , ~~ k r, __l ~r j are hereby granted to R,,^"^T" ° ''° °n'~'- --~ ~ j r '- ~ ~ ~~1 '1 4~ L' 1,,~;_) IV ~ C _ in the above estate and (if applicable) that the instrument(s) dated ~~3~E~-289-- (~ ~L'_ ~ LL~~ _~ _ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of i~ecedent. ~~ ~ 1 C ~C'~~ ~ ~~C Y ~; ~ ~~ (" - 1 -~~ ~ ~ ~ ~ l~~ l Ste, ~ ~`f ~-~~ Register of Wills .) 1 ~ ,ti Form RW-02 rev. /0/!l/20/! pc~~e 2 ~`Y~2 HIUS. Rth Rli~' fi'l'l!: sac t~~~~~~R'~ ~~~ai~~~~~~~~~~~ ~ .~~ ~.w WARN ;r#t~i5 ~i~g~ll~t8 dupiica4e t~sf (;vi~y ta~~ ~ahf3~4?~(~s} r.~ ~,~~ H« r<)1' this «I'~;i~~;~t(~. ~;r. u~~' ~~412 JUi~ 25 F'h4 3~ 32 ,:~,~ , ~ ~, . l ~ ~.i L ,~ 1 ~ , ; It ll~. ~`'~ ,l ~, t ;, itii~7i '&11 d CO.. PA ~ * ~-~ CUMBERi.AN ; t~ - --, ~' ' ~=_ , j ., ``1 '1' ~ ~ ~ ; ~1 ~ (` ( 4'?~ ~r ~ti f c~ ~ ~ ^ _ `~t-e-~.c~,tiSD.e~rz~' - _ ~w ~~ 2 012 _ - _.. _. Ct'.I'UtlClill(II] ~lllll'~('?~ __ .- i )..,t „!.+.,.;° 5~ Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS Para k;~k` CERTIFICATE OF DEATH a O Z 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security NumberY a 4• Date of peath (MO/Day/Yr) (Spell Mo) 138-26-3824 J 6a. Age-last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Dace of Birth (Mo/Day/Near) (Spell Month) Ja. Birthplace (City and State or For Igo Country) ii Months Days Hours Minutes Staten =eland NY 1 78 Nov 24 f 1933 Jb. Birthplace (county) Ric Sa. Residence (state or Foreign Country) Sb. ftesldence (Street and Number- Include Apt No.) 8c. Did Decetlent Live In a Township) 232 Avon Dr1V2? QYes, decedent Ilved in t„y Bd. Residence (County) __ p. _ - Cumberland Se. Residence (Zip Code) ~ No, decedent Iiyed within limits of ~+~~~ ~8~@ city/bor 9, Ever In Us Armed Forces? 1D. Marital Status at Time of Death Q Married ~] Widowed li. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Ves ~ No Q Unknown Q Divorced ~ Never Married Q Unknown 12. F ther's Name (Fl rst, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Raymond Wolf Catherine Rafferty 14a. Informant's Name 14b. Relationship to pecedent fiat. Informant's Mailing Adtlress (Street and Number, City, State, Zip Codel 0 Frederick Mock son 103 Canna Avenue, Starkville, MS 39759 G ................ ................_ __ .... _..... .........................,.,_,.~,_,... ~~~ ~ ,,._..... 1sa. P ace. _,...eac._. c ec on y o.,e ~ If Death O ccur red in a Hospital: In patient - __ _ Ilf Death Occurred Somewhere Other Than a Hospital: Hospice Faciii ~ ~~ ~ ~~~ ~ ~ ~ ~~~~ `~ ty ~ Decedent's Home ~ Emergency Room/Outpatient Q Dead on Arrival ~ Nursing Home/Long-Term Care Facility Q Other (Specify) , i5b. Facility Name (if not institution, give street and number; _ 15c. City or Town, State, and Zip Code i5d. county of Death LL 232 Avon Drive Carlisle, PA 17013 Cumb rland S6a. Method of Disposition W Burial Q Cremation 16b, Dace of Disposition e 16c. Place of pisposition (Name of cemetery, c e story, r ther place) .~ Q Removal From State ~] Donation TO $e _ ocner(speciry> Determined Arlington National Cemetery i6d. Location of Disposition (City or Town, State, and Zip) 1Ja. Sig of Funeral $ervi n Charge of Interment iJb- License Number Arlington, VA 22211 -- 1 38504 1JC. Name and Complete Address of Funeral Facility ~ 18. Decedent's Education -Check the box that best describes the 19. Dece ent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR ORE races to indicate what I- highest degree or level of school completed aC the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. Q 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" White ~ Korean Q No diploma, 9<h - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American 0 Vietnamese Q High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Otfier Asian Q Same college cretlix, but no degree Q Yes, Mexican, Mexican American, Chicano 0 Asian Indian [~ Native Hawaiian Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Chinese Q Guamanian or Cham orro Q Bachelor's degree (e.g. BA, AB, Bs_:) Q Yes, Cuban Fiii Ino ' a Q Master s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese ~ OYhe r Paciflc Isla prier Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) . MD DDS DVM LLB, JD - 21. Decedent's Single Race Self-Designation - Gheck ONLY ONF to indicate what xhe decedent considered himself nr herself I:p be. 22a. Decedent's Usual Occu patlon -Indicate t f k ype o wor While Q Japanese Q Samoan done durin most of rki lif D g wo ng e. O NOT USE RETIRED. Q Black or African American Q Korean ~ Other Pacific Islander American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure Teacher Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q Flliptno p Guamanian qr champrrp Public School ITEMS 23a - 23d MUST BE COMPLETED 23a. D to Pro n ced Dead (Mo Day Yr) 23b. Si nature o Person Pronouncing Death (Only when applicable) 23c License Num e . BY PERSON WHO PRONOUNCES OR ~ ~ CERTIPIES DEATH ~~ 23 to 51 nediMg/DaY/Yr) 24- Time of D a ~ / rd l ~V~ Z5. Was Medlcai Exa finer or Coroner Contactetl? Q Ves No CAUSE OF DEATH Approwrr~ate 26. Part 1. Enter the chain of events--diseases, InJurles, or tom plica[lons-that directly caused the death. DO NOT enxer terminal events such as cardiac arrest Interva~: respiratory arrest, or ventricular fibrillation w it h out showing the e[f ol orgy. DO NOT ABBREVIATE. Enter only one cause on a line, Add additional lines iF necessary Onset to Death y ~ 1 IMMEDIATE CAUSE --- ------------- a. i/r~~ `-~ y~ f ~Q~j"~(-~ ~ L <LA,^Fa c _ (Final disease or condition Due [o (o a consequence of): resulting in death) 1 ~ b. Ll 1 Y7'10 1'l r / ~ !+~ ~-r' is ~~~ ~l ~ l~C2s t S Sequentially list conditions, Due to (or as a consequence of): - if any, leading to the c e listed on line a. Enter the V NOERLYING CAUSE pue [o (or as a consequence of): (disease or in)ury that initiated the a nts resulting d. e in death) LAST. Due to (or as a consequence of): 26. Part 11. Enter other sienificant_ dihons contributing io death bu< not resulting in the unde rlying cause given in Part 1 27 W . as an autopsy p rformedJ Q Yes No ' 28. Were autopsy Fl dings aVailahle to co ~~ r • t~-"_ plete the ca of death) o Yes ~ No 29. If Female: 30 Oid T b o - o acco Vse Contribute to Death? 31. Manner of Death a o[ pregnant within past year Q Yes Q probably Natural Q Homicide Pregnant at time of death ~NO Q Vnknown Q Accident Q Pending investigation N [ Q o pregnant, but pregnant within 42 daYS of dea<F Q Suicide Q Could not be determined N t- ot pregnanT, but pregnant 43 clays to 1 year before deatF 32. Date of In Q jury (Mo/pay/Yr) (Spell Month) Q Unknown if pregnant within the past yeas 33. Time of Injury 34. Place of InJgry (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City. State, Zip Code) 36. Injury at Work 3J. If Transportation Injury, Specify: 38. Describe HoW Injury Occurred: Ves Q Driver/Operator ~ Pedestrian ~ No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): Cerrt ifying Physician - To the best of my knowledge, death occurred due to the causr_(s) and manner sta[etl i !k C f l nc ng e rtl ying physician - To the best of my knowledge, dea<h occurred at the time, dace, and place, and due to <he cause(s) and manner stated ~ Medal Examiner/Coroner- Op the basis of examination, and/or Investigation, in my opinion, death ccur d t the time, date, and place, and due to the cause(s) and m a n ner stated ' o Stgnatu re of certifier ~ p y .~ Itle of certiFler: [' C~ License Number: pS©P fv2-~~_ 39b. Name, Add and Z" Co rson Cam leting f Death (Item 26) 39c. Da 51 gn d (MO/Day/Vr) 40. Registrar's Distnc[ Number 41. Registrar's ~~ 42. istrar File Date (MO/Day Vr 43. Amendments Disposition Perm i[ No._ \J(4~ ~~ lP~ V REV D'l/2011 LAST WILL AND TESTAMENT I, KATHLEEN A. MOCK, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executors to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of the my estate of every nature and wherever situate to my two sons, Frederick C. Mock and Andrew J. Mock, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint Frederick C. Mock and Andrew J. Mock to be the executors of this my Last Will and Testament, they are to serve as such without bond. ,p_., ~, o ~ , -,- ~ ~ m-° ~- ~ ~= C, t~ ~ ~c ~~~.~ F ~ N ~~ .~_ ~`; t_ ~. -f , =.' cs"' ~ w ~n rv 5. I hereby suggest that my personal representatives retain the services of Irwin, McKnight & Hughes as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and sf;al this 29~" day of February, 2000. ~~ ~.~~ (SEAL) KATHLEEN A. MOCK Signed, sealed, published and declared by KATHLEEN A. MOCK, the testatrix above named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~~~ 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, KATHLEEN A. MOCK, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will, and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~~ (_~ ~~ ~~ ~ ~ KATHLEEN A. MOCK ~ CHERY L. CLELAND l~ MA THA L. NOEL COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND . Subscribed, sworn to and acknowledged before me by, KATHLEEN A. MOCK, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this 29T" day of February, 2000. ?ice ~3. ~_ N tary Public r~~otarva! sea; ~.._._ Roger ~? ~rw;o. (Votary Pubic Carlisle Bono ~;urr~beriand County i My Commission. !=x~3ires Oct 3 2000 Men7be! Pcnll<;: _ sac~ztion o+Notaries