HomeMy WebLinkAbout07-05-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CU/h8ElZLA-N,D COUNTY, PENNSY"LVANIA
Petitioner{sj mined belosc, who isare 18 ,v ears of ale or older, anpi~~(iesj for Letters as speciiled before, and in
support thereof aver(s) the :oliorr in and respectfitiiy request(s) the Brant of Letters in tha appropriate form:
Decedent's Information
Name: r ie DO i d QpGk File No• ~/ -/2 ^ ~ • ,~ ~
a/kta: C. Dhtic~ pG/< (Assigned by Register
a/k/a: Carrie D • k
a/k/a: Social Security No: /(~$-a(o-SS-20
Date of Death: ~ a f ap / 2 Age at death: ~/
Decedent was domiciled at death in C ~rrn ber I ~d County, V (Srcrre) with his/her last
principal residence at Iq FiP~~ ~ r^n ct• "71,.:.i. M., t1~M ._ . 1_ __ ___ a.,, e„ 1 • _ T . _ n t
Street address, Post Office and Zip Code ~ City, ownshi or Borough r Count
Y
Decedent died at Ca~l~ she ~t.~i.-ona.~ ~'l~c~, Ctr Gtl'~is~[. Cfi,ry,~-jP,YfQ,y~~ ~~
Street address, Post Oftic~and Zip Code City, Township or Borough County ~ State
Estimate of value of decedent's property at death:
!f domiciled in Pennsylvania ............................ All personal property $ 1, D4Q bo
If not domiciled in Pennsylvania ........................ Personal ro er -' '
p p tyro Pennsylvania $
!f not domiciled in Pennsyh~ania ........................ Personal property in County $
Value of real estate in Pertnsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $~ppp, ob
Real estate in Pennsylvania situated at: /-~ON~
(Attnch additionnl sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough Count
Y
^ A. Petition for Probate and Grant of Letters Testamentary ~•
Petitioner(s) avert here/theys~are the Executor(s) named in the last Will of the Decedent, dated IL~1• ~$~ an) ~
E~eFete-efate~
State relevant circwnstances (e.g. renunciation, death of executor, etc.)
Except as follows: after the execution ofthe instntment(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(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.
NU EXCEPTIONS ^ EXCEPTIONS
B. Petition for Grant of Letters of Administration (Ifappticable)
c. t. a., d. b. n., d. b. n. c. t. a., pendente lice, durmue absentia, durunte minoritute
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 divorcc 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 lefr no Will and was survived by the following spouse (if any) and heirs (attach
udditiatal sheets, iJnecessury):
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Oath of Personal Representative
COti1140NWEALTH OF PENNSYLVANIA
C O [; ~i T Y O F r u M~ EiZ.LA-/1~
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?'~u:ionerlsi Printed Name ~ Petitioner(sj Printed Address - ~ :i~~i Iy "--
~ G. ~r,~~ 76 Grp. ~ fir. /Y) 'e 6 ~ ~ l7 0 ~.~
Sur+on ~. ~Io~P,~' 76 Greg r;n r s ~ 1705`a
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the I~ecedet ,the Petitioner(s) will well and tnily administer the estate according to law.
Sworn to or affirmed and subscribed before ~' ~ -i* -k~` t_ Date ~ -l ,~
the t ~~~~day of ; ~ '' ~ x - Date - ~ -- )~
By: (, ~~~ %7 (' Date
i^ the Register Date
BOND Required: ~ YES ~ NO To tl:e Register of Wills:
FEES: Please enter my appearance by my signature below:
Letter ......................
( _~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ......
i
`LEI. ........
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Attorney Signature:
C~s~~~/-~ ~ ~ ~!
Printed Name: (~i/ar/es E; ~Sh~e/mss
Supreme Court
ID Number: 38Sf'3
Firm Name: ___
Address: _ ~2 _~~OLfSG/' , D
~C'Cl~2r-iC's ur~-. /7oSS'
Automation Fee ...............
JCS Fee.
TOTAL ..................... $~~ L-_
Estate of
a/k/a: Ci
Phone: •]/ 7- 7610 - oao 9
Fax: 7- 79.5--
Email: CLShiB/[/S.3® h.,l~~s . n~
DECREE OF THE REGISTER
C. Ohria~a U~~~ File No: a~- /cZ -'
AND NO«', L// " ~ ~~ ~ ~- , in consideration of the foregoing Petition,
satisfactor~~ proor l.avin~ eer, presentee before'r.e. IT IS DI<CRI:ED ;hat Letpters T St[tM Pa1!'ei~e _
are hcreb_v granted to ~~~ ~ G-• ~ vtur' Q.n J •~ u rfar'' ~ ~.o ~"
in the above esiate ate: (if applicable) that
the instruments s ~ dated ~.b _ 1 S. ~ o i 2
described in the Petition be admittec to probate and hied of record ~s t!ze last ~~~il Viand Codiciii ~~; v. Decedent
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Register of Wills
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Form R4G"-0? rev. i0/1l/20l! age 2 0
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( crtif~ic ~tiun ~'u~nhri~r
ape/Print In COMMONWfgLTH Of PENNSYLVANIA • DEPARTMEN3 Of HEALTH • VI1gL RECOfl DS
er CERTIFICATE OF DEATH stat¢Fhe Npmber
Int. Decedent's Legal Name (First, Middle, Last, 6uHix) 2. Sex 3. Social Security Number 0. Dale of Deatn IMO/vay/.rl I~pen mvl
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Cor+~~ Orle:id~ rck - _~~
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Sa. Age~last Birthday IYrsl 9b. Under S Vear Sc. Under 1 Da 6. Date of 8ir[h IMp/Day/Year) )Spell Month) 1a. Birthplace (City and State or Foreign Coun
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Months Days Npurs Minutes R u5~'~ 3 i / 19 3 b 1b. Birthplace ICOUntyl
Residence (State or Foreign Country) 8b. Residence (Street and Number ~ Include Apt NP.I e,.~d Decedent Live in a Township r
Ha
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t~ two.
F12-~ dCYLb'fi '(~Y, U1* 5. decedent lived In S 1 Ir ~Y
Sd. Residence )County) <Ity/barn.
Residence IZip Code) 11 (~ ~ ^NO, decetlent lived witM1in limits of
' 8e
.
Marital Status at lime pf Death ^ Marrs d [~'VJidowed 11. Surviving Spouse's Name Ilf wife, give name prior to first marriage)
rces) 30
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^Yes [E]'lro ^Unknown ^Divo ced ^Never Married ^Unknp n
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her's Name Prior to First Marriage IFirst, Middle, last)
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Middle, last, SuHlxl
Father's Name (First
32
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14b. Perlatlonshlp [o Oecetlent 14c nlorman['s Malling Address )Street and NUm ,City, Slate. Zlp Cptle
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ame
14a.lnformant
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C ...... ........ .H........i..............O.H..........`...III.................d..0ecedents Hpme ..
.............. .. ... ... ..... oz is ac [Y
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osplta: P ¢
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D If Death Occurred Spmew`herec0[her Than a ~~~~~~~~~~~~~
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_ If Death Occurred in a Hospital'. lJ Inpatient
t ^ Dead on Arrival ^ Nursing Home/Lang-Term Care facility ^ Other Ispeciryl
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^ EmerB
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it ^ Burial remotion 16b. Date of Disposltip 16c. Place o(Dispozition Name
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2 16e. Location pf Disvositlpn Icity or Town, state, and zip) na. signatp.e or Funeral servme ncenseelpr Person in char a of mtermem vb. uanse Npmber
~ ~ C ~ ~i 4
v Shy ~sbuv PA x.57
11c. Name and Complete Atl ress of Funeral Facility ~ s P I ~ CJ
cedent'S Educa -Check the box [hat best describes the 19. Recede of Hispanic Origin ~ Check the 2D. Decedent's Race ~ Chec E OR MORE races to indicate what
18
idered himsel(Dr herselF
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.
ent cons
Highest degree or level of school completed a[ [he time of death. box that best describes whether the deceden [he dece
KOrean
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^ 8th grade or les i Spanish/Hispanic/Latino. C
l is not Spanlzh/Hispanic/latino ^ Black or African American ^ vle[nameze
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^ No diploma, 9th - 12th grade bo+ j
@'~j not Spanisn/Hispanic/lannp ^ Amercan Indian or Alaska Native ^ O[M1er Asian
~Igh school graduate or GED completed
Mexican, Mexican American, Chicano ^ Asian Indian ^ NaUVe Ha ^aiian
^Yes
,
orro
^ Same college cretli[, but np degre
Puerto Rican ^ Chinese ^ Guamania or Cham
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^ Associate de AA, AS)
Cuban ^Filiplnp ^ Samoan
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^ Bacnelor's degree le.g. BA, AR, BSI ^
ino Japanese ^ OtM1er Pacl(ic Islander
other Spanisn/Hispanic/Lal ^
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^ Maslei s degree le.g. MA, MS, MEng, MEd,
^ Other (6pecity)
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^ Doctorate leg. PhD. EdDI or Professional tlegree ISpecifvl _ _ _
MO. DDS, DVM, LLB, ID
enentsusfaW
n~Check ONLY ONE IO indicate wnat the decedem <onsitlered hlmsell or hersel(tD be
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21.Decedent
tlpne du
'White ^ Napanese ^ Samoan g m sto
^Black or African American ^ ^Other Pacific Islander
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tnamese ^ Don'[ Know/Not Sure
American Indian or Alaska Native ^ V'ie
^ Relused 22b Kind of Business/Industry
^ Asian Indian ^ Other Asian
^ omer Ispemw
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^ cninese ^ Natme
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^Fllipinp ^GUamanlan or Champrro
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23d MUST BE COMPLETED 23a. Date Pronounced Dead IMO/Day/Yrl 23E. Signature pf Person Pronouncing Death Innly when applicable 23c. License Num
ITEMS Zia -
BV PERSON WHO PRONOUNCES OR % J'~/~~/ 1 ~~J~ ~Y~ ~yQ(~7(I ~ 11 L
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CERTIFIES DEATH
23d. Date Signed (Mo/Day/Yr) 24. Time f Death J
Medical Examiner or Coroner Contacted? ^ Ves No
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Approximate
CAUSE OF DEATH
I Y cause IntervaP.
Enter the chain pf events- diseases, In uries, or complications--that
cddaitipnatlia^esrilenecessary Onset to Death
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DO NOT ABBREVIATE
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IMMf DIATE CAUSE --._....--.x a.
Due to for as a conse9uence of).
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UNDERLYING CAUSE Due to (or as a consequence oft.
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Zfi. Part II. Enter other ' f' tl~ t IbU[ine m death but not rezultin he underlyin ^ YP5 ^ Np
28. Were autppsY findings available
E [o omplete the cause of tleathl
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v 3o Did Tobacco USe Contribute tp Death? 31. Maanur of Death
29. If Female: rat ^ Homicide
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o ^ Not pregna within past r
yea
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No ^ Unknow
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ume of death
^ Pregnant at
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^ Suicide ^ Could not be
^ Not pre8nant, but pregnant within 42 daVS of deat ury (MD/Day/Yrl )Spell MDnlhl
Date o! In
31
^ Not pregnant, but pregnant 43 days to 1 year before death .
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33. Time pt Inlury
^ Unknown it Pregnant within the past Year
34. Place of Injury le.g. home; construction site; farm; school) 35. location of Inlury (Street antl Number, Clty, State, Zip Code)
Specify
I
i 38. Describe How Inlury Occurred:
36. Injury at Work on
nlury.
31. If iranzportat
^ Yes ^ Driver/Operator ^ Pedestrian
^ No ^ Passenger ^ Other lSpecl(yl __ - .---_
39a Certifier )Check Only one)
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40. Registrar's Dlshi<t Number 41. Re~B[r 's SignaturJ gs[rar
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43. Amentlments
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ONEIDA ROCK
LAST WILL AND TESTAMENT OF C ..
" `~'
. ~~,
a.k.a. CABBIE ONEIDA ROCK
I, C. ONEIDA ROCK a.k.a. CABBIE ONEIDA ROCK, unremarried widow, currently
of 19 Fieldcrest Drive, Mechanicsburg, Silver Spring Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and making void any and all prior
Wills and Codicils by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situate, I give, devise, and bequeath to my sister, PEGGY G. HOFER, and
my niece, CABBIE SUE EAMES, in equal shares.
~.
In the event that my said sister, PEGGY G. HOFER, should predecease me, then her
share is to go to her husband, BURTON E. HOFER. In the event he has also predeceased
me, then to my niece, CABBIE SUE EAMES.
In the event my said niece, CABBIE SUE EAMES, has predeceased me, then her
share herein, however derived, shall go to my brothers, who survive me, they currently being:
ALBERT D. GILL, GEORGE FRED GILL, and JOHN H. GILL.
4.
It is my intention that beneficiaries named before or after the date of this Will on my
life insurance, annuities, individual retirement accounts (IRAs), in Trust for or joint bank
accounts and any other assets for which I may designate beneficiaries will receive such
investments and that my Will provisions shall not control such investments.
5.
I nominate, constitute and appoint my sister, PEGGY G. HOFER and her husband
BURTON E. HOFER, to be the Co-Executors of this my Last Will and Testament. In the
event that both one of them are unable or unwilling to act as Executors, I appoint my niece,
CABBIE SUE EAMES, to be Executrix in their place and stead. I further direct that they
Page 1
shall not be required to file bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
of February, A.D. 2012.
r j~1~-
,, ~~,~7,v~Y++
C. ONEIDAJC~
~J day
(SEAL)
(SEAL)
a.k.a. CABBIE ONEIDA ROCK
Signed, sealed, published and declared by the above-named C. ONEIDA ROCK
a.k.a. CABBIE ONEIDA ROCK, as and for her Last Will and Testament, in the 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.
,GC-~~-tnl~ ca .~r.~-o
t~ C`~ ~--
Page 2
C. ONEIDA ROCK a.k.a. CABBIE ONEIDA ROCK, the 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; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before` me by C. ONEIDA ROCK a.k.a.
CABBIE ONEIDA ROCK, the testatrix, this ~`~~ day of February, A.D. 2012.
l v'
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C. ONEIDA RO(~/CK ~; ~a~e
A~ V~~~
I~
a.k.a. CABBIE ONEIDA ROCK
(SEAL)
~~~ ~L1 ~~~-~-~
Notary Public
We, ~c~~ ~~~ ~ ~ ~ ~-~ c S and .~~~.~ f r~iv ~-~ ~ ~~, c~ , tY~.e
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 the testatrix signed willingly and executed it as her free and
voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and
sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the
testatrix was at that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn to or affirmed and subscribed to before me by
~'cs~.t%~ ~ ~_ ~=;~~ ~ J and
~~c~ ;I4~n. (~ ~?~ 6Ci C(~'.
NotdrlB~ S~ael
Paul N. [)etrkk, Notary PuF~lfc
North Mlddletc3r^ ~Wp., CumbQrland County
My CAmnUsslon E~NBS APrN 29.2015
dated this /J~~ day of February, A.D. 2012.
MEMtlGK~ Yt11115RY~~~+~
n ~L~~Y
~ . ;~
x. ~W> ~: nr- :~ ~ ~wlc f
S ~~ f ~~ ~ ~r%2 f ~~ MEMBER, pENNMVANIA
L_7 ~ ~ ~ p~- S l2 7 COMMONVdEA1'ili flF ~VAN~
NpterlA! ~'
Pa1M N. pe1}'M ~ r,y~yt~ry AIbI1C
~~ rs
ISSQC(AT10f9 Jr err. .
fp4K'lrS~f %~~ l7vl~
7~71~yy.- z3r~~
-~ ~ ~ My Corranlsslon Bcpire~
/` ~ t~ ~ ~- .li ~ MEMBER, PENN5YLVANU ASSOi
Notary Public
Paul N. Detrick, NAY RibNc
North MkidkGon Twp., Cumberland t;ounty
April 29, 2015
Page 3