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HomeMy WebLinkAbout07-02-12PETITION 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 requests the grant of Letters in the appropriate form: John E. Ena Decedent's Information 1 Name: Adis A. Rasmussen File No: 21-12 ~ 1 / (,.~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 06/27/2012 Age at Death: 79 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 801 N. Hanover Street, Carlisle 17013 North Middleton Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Church of God Home, 801 N. Hanover Street Carlisle 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 $ 247,000.00 If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ 0.00 TOTAL ESTIMATED VALUE $ 247,000.00 Real estate in Pennsylvania situated at (Attach additional sheets, it 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) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated 11/22!1974 and Codicil(s) 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 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. ^X 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., pedente lite, durante absentia. durante minoritate If Administration, c.t.a ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heir . Except as follows: Decedent was not a party to 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): r-. __ Name Relationship Address ~ ~~ ~ ' ' Via.. ~ r r AJ ( f w ` ~l .. I. V ._... .~ ( _ y ~ cn p Form RW-02 reg. ~o-~ i-zoi ~ Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 oft i~`]/~/ I 11` J at o ersonal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } I-a ffic aj Use ~~ O. ~ - _~: , ; ~,,:, _ ~ F N~ t ~I ~ la i c ~ ` ~• -.~~J w Petitioner(s) Printed Name Petitioner(s) Printed Address John E. Eng Name as listed in Will: John Edward En 907 Castlerock Way Mcdonough, GA 30253 Ut''~~b"~~~'J ~% ~.•JUt~ ~ t ne reurtonertsl aoove-names swearts) or atttrm(s) the statements In the foregoing Petition are true and correct to the best of the knowledge and belief of °etitioner(s) and that, as Personal Representative(s) of the Decedent etiti er(s) .'ll well and truly administer the f~state according to law. Sworn to ~ affirmed an su scribed before '~ _ Date ~ ' me tiliS- day of, ~ ( ~ _, Date By: i`: ~ ~ ~ ~~ - f i~ ~ _ Date For the Register Date BOND Required? ~ YES ~ NO FEES: Letters . ....................................... . ( 6 )Short Certificate(s)......... ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ... ......................................... Commi ssion .................................. Other Will JCP Automation fee Automation Fee ............................ JCS Fee ....................................... TOTAL ......................................... To the Register of Wills: Please enter my appearance by my signature below: $ 310.00 24.00 15.00 23.50 5.00 $ 377.50 Attorney Signature: ~~ ~~ i~ Printed Name: George F Douglas, III Esq. Supreme Court ID Number: 61886 Firm Name: Salzmann Hughes, P.C. Address: 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Phone: 717-249-6333 Fax: E-mail: gdouglasea salzmannhughes.com DECREE OF THE REGISTER Date of Death: 06,12712012 Social Security No: Estate of Adis A. Rasmussen File No: 21-12 ) :jl ) a/k/a: AND NOW, L `- ~~ ~~ , in consideration of the foregoing Petition, satisfactory proof having been resented before me, IT IS DECREED that Letters Testamentary are hereby granted to John E. Eng in the above estate and (if applicable) that the instrument(s) dated 11/22/1974 described in the Petition be admitted to probate and filed of record as th last Will (and Codicil(s)) of Decedent. ~ ~i ( i~~'in, 1~, X11-. -~ .i , _.~ t ,~`ri ~_~ Register of Wills - , I , r .~ y ,i r .~ '~iti_ v_ ~ r ~ l~~~i ~ 't,C Copyright (c) 2011 form software only The Lackner Group Inc' ~ Page 2 of J ~~ LOGA,~ ,~~~I~j~ R'S CER~"~F~C:A7'It~V ~~ L°°~'~n i ) . i) ( WAR ~~,1~ ks-ilte,~~~{ duplicate this t*~,~~,~~ ~~(~ ~~tlo#s~~Is:~~ (>( ~:a~ ,If~),.~3 _ :.. X71;; ! L ._ I i" ~.4IJ Fee 1i)r this :.•crti~~irate. ti6 i)+) ~{'2 ~(j~ -Z Q~ ~Q; Q~ oN~'F'J'~v~.~, v~l~J~ cuMS~~~.,~~ co , pa ..A. +...1 id d i j Certifirutir,)n N~omhL:r sb Type/Print In Permanent 81 k 1 k ~d C 3 ~,1, i'ti (, ~ z~ ~r , ~ "' . o ~I ~, ,, _, ~ ,r ~;,. ., ,,. ' .,. ..E i'ri !!i! 1i1'll 'Iltl7 1` I )~,~_I t( ,,. i 1i~.i1~~,i ~:t i ~ I ., 1, lin.° ,1.. ~ Jitt1; I 'iir~ COMMONWEALTH OF PENNSYLVANIA OE PARTMENT OF HEALTH VITAL RECORDS r`C QTICIf-'ATF AF IlF AT4~ _ __ _. n l. Decedent's Legal Name (First, Middle, Last, suffix) 2. Sex 3. Soclai Security NUmbar 4. Date of Death (MO/Day/Yr) (Spell Mo) F' 502 30 826"1 Susie 27, 20'12 Adis A_RasLnussan Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Irthp (City a d St~~tl~~ r Foreign Country) ~~~W~~~ ~ f -"- Months Days Hours Minutes -" o~~ 7cj ~ April 8, 1933 7b. Birthplace(COUnty) x'at~•or s 8a. Residence (State or Fore lgn Country) 96. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? PA St H 01 N F9 Yes, decedent Rved In North Middlemen twp. 8d- Residence (cnnn<Y) _ anover _ 8 CLIITlbE:,rlaT-1 C3 8e. Residence (Zip Code) ~ 7 ~ ~ 3 O No, decedent IWed wltFtin {)mits of __ city/born. 9. Ever In US Armed Forces? 10. Mar ital Status at Time of Death Q Married $) Widowed 11. surviving Spouse's Name (If wife, give name prior to first marriage) Q Ves [$ No ~ Vnknown Q Di vorced Q Never Married [~ Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) William P. Bates Adis E_ Trintarud 14a. informant's Name 14b. Relationship Yo Decedent 14c. Informant's Mailing Address (Street and Number, City, State, 21p Code) o Bert ~1 Dau hter 907 Cast la Rock Wa McDOnou h, GA 30253 C ... .......................................... .. 15 P ace o Deat C ec on y one ... .... ........ ........... ......... ... ....... ....... ..... ............a:....................... .............. ...... sw f+~ ' _ . ~ .. .... .............................................. . if Death Occurred In a Hospital: [_] Inpatient - : s Home If De th ~ rred Somewhere Other Than a Hospital: u Hospice Facility u Decedent ~ Q Emergency Room/OUtpaLlent Q Dead on Arrival • Nur5ing Home/Long-Term Care Facility Other (Specify) SSb. Facility Name (If not institution, give street and number; 15c. City or Town, 5 [e, and ZI de 15d. unty of Death i6a. Method of Disposition Q Burial CremaCion 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, ere tory, or other place) m ,~ Q Removal from State ~ Donation otner(specify) 6/29/2012 E<tarls Cremation Services 2 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature of F ral Service Licens rson lq-Eharge of In`erment S 17b. License Number Leo1a, PA C F'D 012633 L 0 17c. Name and Complete Address of Funeral Facility F~win Brothers Funeral Hcane, Snc_, 630 S_ Hanover St_ Carlisle, PA 17013 1B. Decedent's Education -Check the box [hat best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE ra o indicate what L F- highest degree or level of school completed at the time of death. box that best describes whether the decedent Che decedent consltlered himself or herself to be. Q 8Th grade pr less is Spanish/Hlspan5c/Latino. Check the "Nn" hire Q Korean Q No diploma, 9th - 12th grade box f decedent Is not Spanish/Hispanic/Latino. Q Black or African American [] Vietnamese ~ligh school graduate or GED completed No, not spanish/Hispanic/Latino Q American Indian or Alaska Native Q Ocher Asian Q Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano Q Asian Indian ~ Native Hawaiian Q Associate degree (e.g. AA, ASj O Yes, Puerto Rican [~ Chinese Q Gua manlan or Chamorro Q Bachelor's degree (e.g. BA, AB, Bs) Q Ves, Cuban Q Filipino ~ Samoan ~ Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Isiantler ~ Doctorate (e. g. PhD, EdD) or Professional degree (specify) Q Other (specify) __ __ . MO DOS DVM LLB, JO e en['s Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 21. Dec ~. /bite Q Japanese Q Samoan 22a- Decedent's Usual Occupation - Intlicate type of work done during most of working Ilfe. DO NOT USE RETIRED. [] Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure ~JaleS ASSOG1at:2 Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business,rlnd ustry ~ Chinese Q Native Hawaiian Q Other (Specify) Q FlRpino Q Guamanian or Chamorro BOn Ton DE~pe~rt _ Store ITEMS 23a - 23d MUST BE COMPLETED 23 a. Date Pronounced Dead (MO Day/Vr) 23 b. SI nature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH /~ - ~ _~ /// // ~ ~~ ~ S~ ~'/'I~c3 GU 23a c sl e n av/vr) 2a_ r e De~y l./ 7 ~ ~ ~ ~ (o ~ / 25. Was Metlical Examiner or Coroner Contacted? Q Ves jZTdo CAUSE OF DEATH Approximate 26. Part 1. En<er the chain of events--diseases, Injuries, or complications-that directly causetl the death. 00 NOT enter terminal a ents such a ardiac arrest Interval: ~~£. Enter o line. Add additional lines if necessary Onset to Death one ca usp o he a logy. DO NOT AB R EV ow ing t respiratory arrest, or ventricular fibrllfation w IyA l!yyx x~~ ~~~~~~~ / ~ ~ ~ ~~ ,,(( , , / J / / IMMEpIATE CAUSE ------------ -- f~.~~~~~ZG ~fl ~CX~-~ __-- _.-_ ~\~ // {Final disease or condition D v~co quence of): resulting in tleafh) b. _ -__- - Sequentlally Ilst conditions, Due to (or as a consequence of): if any, leading to the cause listed on Ilne a. Enter the c --~ UNDERLYING CAUSE Due to (or as a consequence of): (disease or Injury that -_ initiated the ¢venis resultln8 d. in death) LAST. Due to (or as a consequence o/): 26. Part 11. Enter other si¢n'fica nt conditions ontributin¢ to death but not resulting In the underlying cause given in Part I 27'. Was an autopsy p rf metl? ~ Q Yes No ~ 2P:. Were autopsy flntlings available '- tv .. plete the c of death? a p [] No C] Yes 29. If Fe ale: i i t ' N 30. Did Tobacco Vse Contribute Co Death? Q Yes Q Probabl 31. Manner of Death ~ Natural ~[] Homicide € ~ n pas year ~ ot pregnant w th t ti of d ath P t y ~NO [] Unknown Q Accident ~~ Pending Investigation t e~ me regnan a e Q Q Not pregnant, bu< pregnant within 42 days of death Q Suicide ~~ ~_ould not be determined f- Q Not pregnant, bu< pregnant 43 days To 1 year befor¢ 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; constru Rion site; farm; school) 35. Location of Injury (Street and Number, Gity, State, Zip Cotle) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injpry Occurred: [] Yes Q Driver/Operator Q Pedestrian Q No Q Passenger Q OYher (Specify) 39a, ertifler^Check only one): ~Ce Ifyi g physician - To the best of my knowledge, death o ed due to the c e(s) and m tared Q Pronouncing f;< Certifying ph i Ian - To the best of my knowledge, death occurred a[ the time, datef antl place, and due to the cause(s) and manner stated I~ red at the time, date, and place, and due to the cause(s) and Mann rated O is of examination nd/or investigation, in my opt nlon, death O n h Q Metlical Examiner/COr e r on J/ /h {'~ aA ~ ~ ~ O~S~7 ZE - ` ~ , Ucense Number: l j ~%~_L _ Title of certifier: / Signature of certifier: 396. Name, Address and Zip Code of Person C mpi flog C of Death (Item 26) 39c. OatF Signe (MO/Day/Yr) I v- I~.a.n ~( MD .3G.3 //-BitDaE~fnrcf-G- r4VY- /iZ'-l~' f~/~ S .rte J t~`~ /7D/a~ Olv .a2.7 a0/1- m be 40. Registrar's O^^ls tric[ Nccu-- 'r 41. Registrar's 5 ~ 42. Regi .t rar ile Date (MO Oay r) ~~ ` \ / ., o~ \ c~+. C. V ~ l O 43. Amendments ''\\ \ H105-143 Ofsposltion Permit No. of 1 ~~ ~O ~~ REV 07/ZO11 .~ LAST WILL AND TESTAMENT OF ADIS ANN RASMUSSEN I, ADIS ANN RASMUSSEN a legal resident of the City of CARLISLE, County of CUMBERLAND, State of PENNSYLVANIA, being of sound and disposing mind and memory, and not acting under duress, coercion or undue influence of any person whomsoever, do hereby make, publish and declare this ~_nstrument as my Last Will and Testament, hereby revoking all wills and codicils to wills previously made by me. ARTICLE I I direct that all estate, inheritance and other death taxes payable by reason of my death on any property included in my estate for tax purposes shall be paid out of my residuary estate as an expense of administration, without contribution from any person, and without apportionment. ARTICLE II My children now living are BETTY JO RASMUSSEN ENG, born February 18, 'Y 1953, BARBARA ANN RASMUSSEN, born June 19, 1954, RONALD RICHARD RASMUSSEN, JR. fi born April 26, 1958 and MARY ELLEN RASMUSSEN, born October 17, 1961. I intend the provisions of my will to apply to such children as well as any c:h-ildren ~, subsequently born to or legally adopted by me. My personal representatives and trustees (subsequently called my executor or executrix, or trustee) may rely on such dates of birth for any purpose. ;- ~, ARTICLE III i I give all my tangible personal property together with any insu.~r<znce> policies and claims under such policies on such property, except such property K used in any business in which I may have an interest, to my children who survive me in shares of substantially equal value, to be divided among ~~ them as they, and such other person as my personal representative ma.y select to represent any child of mine believed by my personal representative to be incapable of acting in his own best interest, shall agree. In ca.sf~ my children and such other person do not agree within six months after ~ my death as to the division among them, my personal representative shall make the division. Notwithstanding the foregoing, should my personal representative, ~' in his sole judgment, determine that it would not be in the best interest: of my children to receive possession of any item of such property, such as an automobile, my personal representative may sell such item and add the proceeds to my residuary estate. ARTICLE IV I give, devise and bequeath all of the rest, residue and remaincic~r of my estate and property of which I may be seized or possessed or to which I may be entitled at the time of my death, of whatsoever nature and wheresoever situated, be it real, personal or mixed, including lapsed legacies and. any property over which I may have power of appointment, forever and in fee simple, in equal shares to my children but if any of my children shall not survive me then to the issue of such child or children who shall survive me such issue to take per stirpes. PAGE ONE OF FOllR PAGES ,-..:. f ~ ~=_ r- c ~ ~ ~ t'' ~ ~ r G C.., ~ `~ D ~~ `-'~ O . .~" ~ ~ • ARTICLE V In the event my children nor the issue of my children do not survive me, then I give, devise, and bequeath all my property be it real, ~?ersonal or mixed, of whatsoever nature and wh eresoever situated, forever and in fee simple, to my son-in-law, JOHN EDWARD ENG, provided he shall survive me. ARTICLE VI I hereby appoint my son-in-law, JOHN EDWARD ENG, as Executor of this my Last Will and Testament. In the event that he shall predecease me or shall for any reason refuse or be unable to serve or continue serving as Executor hereof, then I hereby appoint my daughter, BETTY JO RA~SMUSSEN, as Alternate Executrix. ARTICLE VII 1 1 .\ ti! ti. ~, v.-- I direct that no executor, executrix, guardian or conservator, or any successor, shall be required to give any bond in any jurisdicti.an and that if, notwithstanding this direction, any bond is required by any law, statute or rule or court, no sureties be required. I desire ghat bond be waived to the full extent permitted by law. ARTICLE VIII In administering my estate, my executor or executrix (as the case may be) may exercise the following powers: hold, retain, invest, reinvest and manage without diversification as to kind, amount or risk of nonproductivity in realty or personalty and without limitation by statute or rule or• law; partition, sell, exchange, grant, convey, deliver, assign, transfer,„ lease, option, mortgage, pledge, abandon, borrow, loan, contract, distribute in cash or kind or partly in each at fair market value on the date of distribution and without requiring pro rata distribution of specific assets, hold in nominee form, continue businesses, carry out agreements, deal with itself, other fiduciaries and business organizations in which fiduciaries may have an interest, establish reserves, release power_=;, and abandon, settle or contest claims. of administration of my will is outside Colorado my fiduciaries ma.,y also exercise all the powers in the Colorado Fiduciaries Powers Act which I incorporate in my will as the Act exists on the date of my will. In addition, if I die domiciled in Colorado, or if the situs of administration is in Colorado, my fiduciaries may also exercise all the powers in i~he Colorado Fiduciaries Powers Act, as amended after the date of my will and after my death. If I do not die domiciled in Colorado or if the si.tus ARTICLE IX L tom., ~ ~~~J~x ~~~ c5 5~ In the event that I shall die leaving a minor child or children surviving me, I hereby appoint my daughter, BETTY JO RASMiJSSEN ENG as Guardi<~n of the person and property of each minor child of mine who shall survive me, during his or her minority. In the event that she shall predecease me or shall for any reason refuse or be unable to serve or to continue serving as Guardian, then I appoint my son-in-law, JOHN EDWARD ENG as Alternate Guardian, with the same powers and authority. PAGE TWO OF FOUR PAGES ARTICLE X Adopted Children: A child adopted by any person and the descendants by blood or adoption of such child shall be considered descendants of such person and of such person's ancestors if the adoption is by legal proceeding while the child is under twenty-one years. ARTICLE XI Unless the context requires otherwise, words denoting the singular may be construed as denoting the plural, and words of the plural may be construed as denoting the singular, and words of one gender may be construed as denoting such other gender as is appropriate. ARTICLE XII Wherever in this my Last Will and Testament it is provided that any person shall benefit hereunder if such person shall survive me, such person shall be deemed not to have survived me if he or she shall die either within sixty (60) days after my death, or at the same time as I, a:r in a common disaster with me, or under such circumstances that it is difficult or impossible to determine which of us died first. IN WITNESS WHEREOF, I sign, seal, publish and declare this as 'my Last Will and Testament in the presence of the persons witnessing it at: my_request this . ~ -.day of ,.. ~ Y. 19' ,~, at .~~ . -- ~...,,. _.. Signature of Testatrix The foregoing instrument, consisting of four typewritten pages, was this Ein,~ day of Na~.~.-~,~,.~,- 19')~, signed, sealed, published, and declared by the said Testatrix as and for her Last Will and Testament, in t:he presence of us who, at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses thereto. WITNESSES: ~~~~,~T ~~~' ~-~'"~ ;~ ~ - r~ ,~ - 7 ~-~ c ~ S1 J~ X .t~ _ ~~~; _v~C l ADDRESSES: ~r ~~ , ,v 1 PAGE THREE OF FOUR PAGES ~., rWe, ~° ; ~ 1 ~ 1' ~; (, `: ~ i ?.`,C i'+} ~~, f"~[`~i-1 , ~ [J ~t'~~~L. ~ G'GI~C4~_~ and ._ ~j:~, ~ ' i~ .~ ~~ the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do declare that the foregoing instrument was signed, published and declared by the testatrix, as and for her Last Will and Testament, in the presence of the witnesses, who at her request and in her presence, and in the presence of each other, have subscribed their names to this instrument as attesting witnesses on the day and year last above written; and that: th.e testatrix executed the foregoing instrument as her free and voluntaz•y a.ct for the purposes therein expressed; and that to the best of our knowledge, opinion and belief the testatrix was at the time eighteen years of age or older, of sound and disposing mind and memory and under no constraint or undue influence. ~ _..~ _t~C.~'L1,~ ~t-ti-~ ~-~s~.~:::~k's~'gnature of Testatrix ~:; ~~r//-~--'~-~,~~~~'. Signature of Witness a-(;~:'.- n f -~~-~-~c-c. ~ S ignature o f' W i t n es s - ~ ~i1ff', ~`"".- ~~-~~.~%; L~ Signature of Witness State of Colorado ) ss County of E1 Paso ) ~--, Subscribed, sworn to and acknowledged before me by,,~b~',,~_ ~',~~, ri~_r-~.~ _,=~:_i~_. the testatrix, and subscribed and sworn to before me by J /--, ~(~ {~ ~'rt.'~'"E ~~ y to L~ , and,~~>~a~ ~~ /C~~^~t'.f,fT , W1tneSS@S, th1S ~ ,~-nc may 19,74 ~ -~ <~ o f -~ , ~,..ki-~ -t ~~CT ~, NOTARY PUBLIC My Commission Expires: `~~~(~ PAGE FOUR OF FOUR PAGES