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HomeMy WebLinkAbout07-09-12Reset 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: VIOLA B. AUGHENBAUGH a/k/a: a/k/a: a/k/a: Date of Death: 07/01/2012 File No: ~~ ~ / ~~ ~ ~ O (Assigned by Register) Social Security No: 174-20-2670 Age at death: 92 Decedent was domiciled at death in CUMBERLAND County, p ,NNSYLVANIA (State) with his/her last principal residence at 1000 CLAREMOND ROAD. CARLISLE 17013 MIDDLESEX TOWNSHIP _ _CUMBERLAND Street address, Post Otfice and Zip Code City, Township or Borough County Decedent died at 1000 CLAREMONT ROAD, CARLISLE 17013 MIDDLESEX 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 $ 4,900.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvateia ......................................................... $ TOTAL ESTIMATED VALUE.... $ 4.900.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough ® 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 thereto dated 02/27/ 1998 County and Codicil(s) State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution ofthe 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(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. Q NO EXCEPTIONS Q EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (if applicable) c. t. a., d. b. n., d. b. n. c. t. a., pendente lite, durante absentia, durante minoritate 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 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. O NO EXCEPTIONS ©EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address r.a c°:a ~ ~r ' ~ f_... l .._ ~_~ r°-- ~_.... ~ _ ~ FonnRW-02 rev. 1Oi11,'30i1 ~ L~ Q 4'7 '1~~11 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } ort~~;dt ~s~ o~,iy t ` DTI ° - N_. c_ r ~ r-,-; !v'.) fV { ti r~ ' c ~ Petitioner(s) Printed Name Petitioner(s) Printed Address '"~ "~J ~_ ~~ '=i-i CORRIN L. AUGHENBAUGH t_ °' ._ = t 1778 SUMMERFIELD DRIVE MECHANICSBURG ~'A~7055 I'V _ r-r't ~ o ~n .~ The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing 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 Petitioner(s) will well and truly administer the estate according to law. Sworn to ffirmed and subs ribed be ore ~r,~,~w.~-. ` L;.a,,~,~.ct Date ~ - ~i -i y me thi t~hday,.of ~ ~ ~ Date By: ~ ~, / ~ ~ Date BOND Required: Q YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ 30.00 ( 2) Short Certificate(s)...... 8.00 ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ WILL ........ 15.00 Attorney Signature: Printed Name: ROG B. IRWIN, ESQUIRE Supreme Court ID Number: 6282 Firm Name: IRWIN & McKNIGHT, P.C. Address: 60 WEST POMFRF.T STRF,ET CARLISLE,pA ]7013 Automation Fee ............... 5.00 JCS Fee . .................... 23.50 TOTAL ..................... $ 81.50 Phone: 717 249-2353 Fax: 717 249-6354 Emait: DECREE OF THE REGISTER Estate of VIOLA B. AUGHENBAUGH File No: ~ ~ `J ~~ ~~Li a, k/a: AND NOW, ~ , in consideration of the foregoing Petition, satisfactory proof having be presented before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to CORRIN L. AUGHENBAUGH in the above estaie and (if applicable) that the instrument(s) dated 02/27/1998 described in the Petition be admitted to probate and filed of Form RW-01 rev. l0/l l/?011 ~y(S. I ,~~ r(>, (!j;} ~i~)-~~r,~~(,~. ~;f,.o," Z~i2 JUL -9 P~ 2= 05 - Ot~'~'S Gt~i~Rj _ ~ ~(~}MOIEf~ANO CO. ~ ~ mac. ~-JUL 2 2012. Type/Print In COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent Rlark ink CERTIFICATE AF IlFAT1-1 O State File Number: 1. Decedent's Legal Name (First, Middle, last, Suffix) 2. Sex 3. Social Security Number 4 D t f D h . a e o eat (MO/Day/Vr) (Spell Mo) Viola B_ Aughe~lil~augh F 174 20 2670 July 1 2012 Sa. Age-Last Birthday (Vrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a Birthplace (Cit and State F i C ~ . y or ore gn ountry) Months Days Hours Minutes S D PA 92 ~ February 2 , 1 920 ,b Birthplace (cgt,n ) err . ty y 8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? PA es, decedent uYed in Middlesex t,,,,p, Sd. Residence (cq~nty) 1 000 Claremont Rd_ Cumberland Be. Resld ence (21p Code) Q No, decedent lived within limits of city/boro. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death 0 Married ~~] Widowed 11. Surviving Spouse's Name (If wife ive name i t fi , g pr or o rst marriage) ~ Yes ® No ~ Unknown ~ Divorced Q Never Married ~ Unknow _ 12. Father's Name (Firs[, Middle, Last, Suffix) 13. Mother s Name Prior to First Marriage (First, Middle, Last) John Calvin Smith Viola Bertha Adams 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Codej 0 C Cowin L. Au henbau h Son 1775 Summarfiald Dr_ Mechanicsbur , PA 170 i c ........................................................... ....Pat....................-............ - If Death Occurred in a Hos _ pital: In l t ..--.. 1Sa. P ace o Deat Chec on y one ..... . .............. .. .. ....................... ............... ......... ..... ..... e _ ° en ~ E a 1 ........... ..... lf Death Occurred Somewhere Other Than Hospital: Q Hosp"ce Facility ~ Decedent's Home 4 mergency Room/Outpatient Q Dead on Arrival Nursing Home/Long-Term Care Facility Q Other (Specify) - c 15 b. Facility Name (If not instil ution, give street and number; SSC. City or Town, State, and Zip Code 16d. County of Death C1ar~Ttont Nursin & Rehab_ Center Carlisle, PA 17013 Cumberland 16a. Method of Disposition ~BUrial ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory or other place) ~ Removal from Stare ~ Donation pother (specify) , 7/5/201 2 Mt _ Gilead United Methodist Church C~rtete v 16d. Location of Disposition (City or Town, State, and Zip) 12a. Signature of F Service lice p Cher r rs ge of Interment 17b. license Number a SherlTlans Dale, PA 17090 Cl FD 012633 L 0 12c. Name and Complete Address of Funeral Facility Elvin Brothers Funeral Homo, Snc_ 630 S_ Hanover St. Carlisle, PA 17013 m 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what ~ highest degree or level of school completed at the time of death- box that best describes whether the decedent th e d ecedent considered himself or herself to be . ~ . ~ ~ 8th grade qr less is Spanish/Hispanic/Latino. Check the "NO" L~ white 0 Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese ~ High school graduate or GED completed ~~ ,not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian _J~SOme college credit, but no degree 0 Ves, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Ves, Puerto Rican ~ Chinese Q Guamanian or Chamorro ' O ~ Bachelor s degree (e.g. BA, AB, BS) Yes, Cuban ~ Q Filipino 0 Samoan ' Master s de ~ gree (e.g. MA, M5, MEng, MEd, MSW, MBA) 0 Ves, other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific islander 0 Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (S if pec y) . MD, DDS, DVM, LLB, JD 21.~Decledent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual OccupaUOn -Indicate type of work white ~ ~ Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American ~ Korean ~ Other Pa ifi I l d c c s an er Q American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure L . P _ N _ ~ Asian Indian 0 Other Asian ~ Refused 22 b. Kind of Business/Indust ry Q Chinese ~ Native Hawaiian ~ Other (Specify) Q Filipino Q Guamanian or Chamorro Car]_15J_.e HOS 1ta1 ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH . 23d. Date Signed (MO/Day/Vr) 24. Time o De th , ~ ~2 {~? ~7J (9 J~5 Q~ (_ Z Q /Z L ~ (o T ~ 25. Was Medical Examiner or Cor er Contacted? ~ Ves on 0 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: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary Onset to Death IMMEDIATE CAUSE > I ~-f A ^~ (Tl o.J (Final disease or condition pue to (or as a consequence of): esulting in death) b. D E r-, ~.~,-n a Sequentia liy Ilst conditions, Due to (or as a consequence of): if any, leading fo the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a ~onse quence of): (disease or Injury that initiated the events resulting d. In death) LAST. Due to (or as a consequence of): S 26. Part Ii. Enter other sienifica ni conditions co ntr'butine to death but not resulting in the underlying cause given in Part I 27 Was an autopsy perfor ed? . O Yes +Q Np 2S. Were autopsy findings available (o complete the cause of death? Ves ~ No o 29. If Ferpaie: Not re a t ithi 30. Did Tobacco Use Contribute to DeathT 31 . M~anner of Death p gn n w n past year Q Pregna nT at time of death ~ ~Y 0 Probably 0' N U k ^ L~ 'V ato ral ~ Homicide ~ Not pregnant, but pregnant within 42 days of deatf o ~ n nown ~ Accident ~ Pending Investigation Q Suicide ~ Could not be determined ~ 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Mo Da /Yr S jury ( / y ) ( pelt 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, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 3g. Describe How Injury Occurred: Q Ves ~ Driver/Operator O Pedestrian Q No ~ Passenger Q Other (Specify) 39a. f.Ertifier (Check only one): ~i Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and m r sated Q Pronouncing ffi Certifying physician - To the best of my knowledge ath occurred of the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/Coroner - On the basis of a nett vestigatio n, in mY opinion, death o cu rred at the time, date, and place, and due to the cause(s) and manner stated Signature of certifier: Title of certifier: ~ ~ License Number: ~~ - O YZ` 4Y-~ 396. Name, Address and Zip Code of Perso p etin Death (Item 26) 39c. Dale Signed (Mo/Day/Vr) 40. Registrar's District Number Registrar s Si~pa4 re ~~ L/' \^~L._1_t~_ 42. Registrar Efle Date (MO/Day r) 43.Amendments Disposition Permit No. ~ P1 ?} (~ Cry H105-143 ~~ REV 07/2011 va ~~~ :%_ . ~--_ ..:> ~.,e t.~.,, a_.s~ r`~ r-- ;~.' ~-j r ,-, ~.~ O N L3,. 01 "') ~.Q~ '~ ~J _'' J ~~ :~..,~ LAST WILL AND TESTAMENT d ~I VIOLA AUGHENBAUGH of th B r h f rli 1 e o oug o Ca s e, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my personal representative or representatives, hereinafter named, as soon as conveniently may be done after my decease. I further authorize my personal representative to expend funds from my Estate in such amounts as my personal representative shall consider appropriate, for the disposition and memorial of my remains. SECOND. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my children, CORRIN L. AUGHENBAUGH, JAMES R. AUGHENBAUGH and J. ROGER HENBAUGH, in equal shares. If any of them should fail to survive me, I give, devise and bequeath the said residue of my Estate unto such of my issue who shall survive me, in equal shares, by representation and not per capita. THIRD. For the purposes of this my Last Will and Testament, a person shall not be deemed to have survived me unless he or she shall have survived me by more than WAYNE F. SHADE ninety (90) days. Attorney at Law 53 West Pomfret Street Cazlisle, Pennsylvania 17013 FOURTH. I order and direct that any estate, inheritance or similar tax due as a result of my death with respect to any property passing as a result of my death, shall be paid from the residue of my Estate before its division into shares and prior to distribution as an expense of administration and that no part of the taxes should be prorated or apportioned among the persons or beneficiaries receiving the taxable property. It is my express intention that all inheritance taxes imposed as a result of my death be paid from the residue of my Estate whether or not the property passes under my Last Will and Testament. My personal representative shall have full power and authority to pay, compromise or settle any such taxes at anytime whether with respect to present or future interests. FIFTH. Any and all decisions, determinations or actions made or taken by a personal representative or Trustee hereunder, if made in good faith, shall be final and conclusive on all persons who are or may become interested in my Estate. No fiduciary acting under this my Last Will and Testament shall be liable for any error in judgment or for any depreciation or reduction in value of any Estate or Trust assets at anytime, in the absence of willful default. LASTLY. I nominate, constitute and appoint my son, CORRIN L. WAYrrE F. SHADE Attorney at Law 53 West Pomfret Street Cazlisle, Pennsylvania 17013 AUGHENBAUGH, to be the Executor of this my Last Will and Testament, but if, for any reason, he should fail to qualify as such Executor or decline or cease so to serve, I nominate, constitute and appoint my sons, J. ROGER AUGHENBAUGH and JAMES R. -2- AUGHENBAUGH, to be the successive alternate Executors hereof, all to serve without bond. IN WITNESS WHEREOF, I, VIOLA AUGHENBAUGH, have hereunto set my hand and seal to this my Last Will and Testament which consists of five (5) typewritten pages to each of which I have affixed my signature, this 2 7th day of February , A.D. One Thousand Nine Hundred Ninety-Eight (1998). SEAL) Viola Aughenba g The preceding instrument, consisting of this and four (4) other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by VIOLA AUGHENBAUGH, the Testatrix therein named, as 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. ,, WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Cazlisle, Pennsylvania 17013 -3- Acknowledgment COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, VIOLA AUGHENBAUGH, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament 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 VIOLA AUGHENBAUGH, this 27th day of February , 1998. YL Viola Aughenb gh ~.,-`..,..~ c ~ Notary Pub is Notarial Seal Connie ,1. Tritt, Notary Public Carlisle, Culnberiand County My Commission Expires Oct. 5, 2400 Affidavit WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) We, Wayne F . Shade and Karen F . Byers ,the witnesses whose names are signed hereto, 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 and Testament; 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 eighteen or more years of age, of sound mind and under no constraint or undue influence. -4- Sworn to or affirmed and subscribed to before me by Wavne F . Shade and Karen F. Byers ,witnesses, this 27th day of February , 1998. ~~ ~~~ Notary Publi Notarial Seal Connie J. Tritt, Notary Public Carlisle, Cumberland County My Commission Expires Oct. 5, 2000 WAYNE F. SHADE Attorney at Law 53 West Pomfret Street Carlisle, Pennsylvania 17013 -5-