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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 requests the grant of Letters in the appropriate form:
Max S. Wahl
Decedent's Information
Name: Richard W. Wahl File No: 21-12 - (.,' ~~~"~
a/k/a:
(Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 06/06!2012 Age at Death: 79
Decedent was domiciled at death in Cumberland County, pq (State) with his/her last
principal residence at 22 Rich's Drive, Shippensburg 17257 Hopewell Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Chambersburg Hospital, Chambersburg, 17201 Chambersburg Franklin Pq
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 $ 2 000.00
If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ................ Personal property in County $
Value of real estate in Pennsylvania ................................................................... $
TOTAL ESTIMATED VALUE $ 2,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets, if necessary )
Street address, Post Office and Zip Code City, Township or Borough County
® A. Petition for Probate and +ranf of I ot+ek Tec4~mon4~
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated 04/23/2009 and Codicil(s)
thereto dated
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 divorc not a pp'~r to a endsa
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and di ave a cht d~born
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
0 NO EXCEPTIONS ^ EXCEPTIONS ~~~- rte"'
^ B. Petition for Grant of L tters of Admini tration (If applicable) t`7 ~~~ t ~ _r? ~~
c. t. a., d.b.n., d. b. n. c. t. a., pedentelite, du s~ntia. d teminbpT&_`~
If Administration, c.t.a or d.b.n.c.t.a., enter date of Will in Section A above and comolet list of heirs. ~ -z _ ~.,:
Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had bee)~st blished a3~'define~ t't`r
in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Cl1
^ 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
Mark R. Wahl Son 42 Overview Lane
Lo sville PA 17047
Michael L. Wahl Son 24407 Galeano Way
Damascus MD 20872
Max S. Wahl Son P. O. Box 417
Mau ansville MD 21767
Form RW O2 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc.
Page 1 0~1~
1 ~
__ ,_, ___._ .._...,,,, ,,,,,,,,,~,,, ,,, a,,,,,,,t~~ ~„~ ,,,~C,,,Cnts rn 1ne roregoing reuuon are true and correct to the best of the knowledge and
belief of Petitioner(s) and that, as Personal Representative(s) of the Dece n//t~~,A~P titioner s) will wel and ul administer the estate accord' g to I w.
Sworn to or affirmed an su scribed before ~GV t ~ ~~ ~~ Date
me thi~,,~ day of . ~ ~ ~ C' ~ ` Date
By: '-(,
For the Register Date
Date
BOND Required? ~ YES ~ NO To the Register ofWi!!s:
FEES:
Letters ...................................... .... $ ~V . LC
( ~ )Short Certificate(s)...... ,. ~---
... . ~~( i
( )Renunciation(s) .......... ....
( )Codicil(s) ..................... ...
( )Affidavit(s) ................... ...
Bond ......................................... ....
Commission .............................. ....
Other
>> `~ J
Automation Fee ......................... ... ~. ~ . C~,~
JCS Fee .................................... ... r'~ _,~ ~T{--
TOTAL ...................................... ... $ I I~= ~"~~
Printed Name: Jerry A. Weigle Esquire
Supreme Court
ID Number: 01624
Firm Name: _ Weigle & Associates P.C.
Address: 126 East King Street
Shippensburg, PA 17257
Phone: 717/532-7388
Fax: 717/532-5289
E-mail:
DECREE OF THE REGISTER
Date of Death: 06!06!2012
Social Security No:
Estate of Richard W. Wahl File No: 21-12
a/k/a:
AND NOW, ~ ` ~- , in consideration of the foregoing Petition,
satisfactory proof having presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Max S. Wahl
in the above estate and (if applicable) that the instrument(s) dated 04!23/2009
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills ~ O
Copyright (c) 2011 form software only The Lackner roue, Inc. Page 2 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
LOCALRFI~1~~~'S CERTIFICATION OF DEATH
WARNIN~"~;plg"~a~i,~q~t~uplicate this copy by photostat or phatograph.
Fee for this certificate, $6.00 '~~~Z ~U~, 2~ P~ ~: ~ ~ This i~s to certify ti7at the inlfonnation here ~i~len is
P 18536873
Typ!/Print In
Permanent
Certification Number
Z~
3
K
'~
correctly copied 1mm cin original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will he f~Jr~~arded to she State Vital
Records ~Jffice foe p(°rnfanent filing.
~_ -
~ ~~~~~
L Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF HEALTH ~ VITAL RECORDS
- ~ - "" ' ' ' State Flle Number:
1. Decedent's Legal Nam! (First, Meddle, L•rt, SuHlx)
2. Sez 3. Social SecuNty Number 4. Date of Death (MO Day/Yr) (Spell Mo)
RICHARD W. WAHL
Male '182-30-34'16 June 6
2012
,
Ss. Age-tart Birthday (Yrs) Sb. Under 3 Veer Sc. Vnder 1 Da 6. Date of Birth (MO/Day/Vlar) (Spell Month) 7a. Birthplace (City and State or Forei
n C
t
g
oun
ry)
Months Days Hours Minutes State C011ege
79
December 5, •1932 7b. Birthplace (County) Centro
Ba. Resldence (SbLe or Foreign Covn[ry) 8b. Residence (Stru[ and Number- Include Apt Nv.) gc pid Decadent Llv
In
T
h
e
a
owns
ip?
PA 22 Rteh•a Drive )B[ves, decedent IIYeI In Hopewell ewe
ad.Reaalnte(ceDnty)
Cumberland 8e. Resldence (21p Code) '17257 ONO, decedent lived within limits of
city/born.
9. Ever In US Armed Fortis? 30. MariUl 54tus a[ Time of Death Marrlel Q Widowed 11. Surveyin
S
ous
N
'
If
if
g
p
e
s
ame (
w
e, glue name prior to firrt marriage)
Q Yea ~ No Q Unknown Q Divorced Q Never Married ~ Vnknown
Coleta Ann Wyatt
12. Father's Name (Ffrrt, Middle, Last, Suffix) 13. MoMer's Name PNOr [o Flrrt Marriage (First, Middle, Last)
Herbert Wahl
Ethel Shaeffer
14a. Informant's Name 14b. RelatlOnshlp to Decedent 14c. InfOnnant's Melling Address (Street and Number, City, Strte
Zip Code)
Max S
Wahl
,
.
Son P.O. Box
4 e7
Maunganaville MD 21767
~
.
If Duth Occurred In a Hospital: ~[~ InPlHent :If
~
~ ~~ ~
•
Death Occurred Somewhere Other Than a Hos
IUI:
"""" "' ""••••••:s-••
Emir anL:y Room/OUtwdent P t,,.J Hospice Facility ~~~-•~
Decedent H "--'
Dine ~~ ~~
Q D
eal on Arrival Nuraln Hem!/LOn -Term Care Facility OMer (Specs )
15b
Facili
N
If
I
.
ty
ame (
not
nstitvtlon, give sMe[ and number, lSc. City Or Town, Slate, and 21p Code 14d
Count
f D
[h
.
y o
ea
Chamberaburg Hospital Chambersburg, PA 17201 F
ranklin
36a. Method of Dlapositlon ~ Burial Cremrtion S6b. Date of Dlspesitfon I6c. Place of Disposl[lon (Name of cemetery, crematory
or other place)
O Remowl from State O D
i
,
onat
on Rollin
Other (Specfy) June 11, 2012 gar Crematorium
16d. LODUOn of Dlsposl[lon (City or Town, Slate, and 21p) 17a. gnatura O Fun al Se ! ice a or Person 1 Int
r
7
e
ment 1
b. License Number
Mt. Holly Springs, PA 17065
FD-014351-L
17e. Name and Complete Address of Funeral Facility
' Fogalsangar-Bricker Funeral Homo 112 W King St. PO Box 336, Shippensburg
PA 17257
.~ ,
SB. Deudent'f Edvu[IOn - Check the box that best describes Me 19. Decadent of Hbpanle ONgln -Check the 20. DeudenL's Race -Cheek ONE OR MORE razes t
hlghert degree er level of school com
l
I
di
t
d
p
o
n
e
e
cate what
at Me [line of death, box that best describes whether the decedent the louden[ eonsilared himself or herself to be
~ Bth grade or lase
.
Is Spanish/Hispanic/LKlno. Chock the "NO" ~,[ White Q Keraan
~ No diploma, 9th - 12th grade
box If lecadlnt Ie not Spanish/Hlspanic/LatlnO. Q Black er African American 0 Vietnamese
~ High school graduate or GED completed ~( No
no[ S
anish/Hi
l
,
p
sPan
c/4tlno Q American Intllan or Alaska Nstlve Q Other Asian
0 Some collage credit, but no degree Q Yaa, Maxlun
Mexlun American
Chi
,
,
cano 0 Aflan Indian 0 Native Hawaiian
Q Associate degree (e.g. AA, AS) O Yes
Puerto Rlun
,
~ Bachelor's degree (e.g. BA, AB, BS) ~ Ves. Cuban ~ Chinese ~ Guamanian or Chamorro
Martv's d! 0 FIIiPino ~ Samoan
~ gree (e.B. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, ether Spanish/Hispanic/Latino
)~ lapanefe ~ Other Pacific islander
~[ Doctorate (a.g. PhO, EdD) or Professional degree
(Specify) Q Other (Spec)
. MD DDS DVM LLB JD fy)
21. Decedent's Single Race Self-pesigna[lon -Check ONLY ONE to intlicat! what The decaden[ wnsldered himself or herself to be
22a
Deced
nt'
]$[ Whit
U
l
.
.
e
s
sua
Occupation -Indicate type of work
e Q Japanese 0 Samoan tl
one during moss of working Ilfe. pp NOT USE RETIRED.
Black or Afrlun American ~ Korean Q OMar Pacific Islander
Q American Indian or Alaska Na[Iye ~ Viatna mere Q Don't Know/Not Sure PfOfB860r
~ Asian Indian _ _[] ether Asian ~ Refused
22b. Klntl d Business/Industry
~ Chinese ~ Natlve'Hawallan ~ Other (Specify)
~ Filipino O Guamanian or chamorro Shlppensburg university
ITE S 23a - MUST BE COMPLETED 23a. Dale Proneuncad Deal (MO Day/Vr) 23 b. Signature of Person Pronouncing Death (Onl
BY PERSON WHO PRONOUNCES OR
wh
l
y
en app
icable) 23c. Vicense Number
June 6, 2012
CERTIFIES DEATH
23d. Date Signed (MO/Day/Yr) 24. Time o/ Death ,
7:35 PM 25. Was Medical Examiner or Coroner Con[acted? Q Yea ]$ No
CAUSE OF DEATH
26. PeS I. Enter Lhe chain Of !vents-diseases, Injuries, or complica[lons--Mat directly caused the death
ApprOZimate
DO NOT
.
enter terminal event such as urdlac arrest, Interval:
r piratory arrest, or ventricular fibrillation wlthoui showing the etiology. 00 NOT ABBREVIATE
En[er onl
on
.
y
e cause on a Ilne. Add addlLivnal Ilnaz ff neussary ) Onset to peach
IMMEDIATE CAVSE ----> • Respiratory failure
(Penal disuse or condition Due to (or sequence oT):
es • con
resulting In lea[h)
' _ b Sepsis
-Sequendally Ilst conlitlons, Due to (or as • consequence oT)~
H any, hading to ih! cause -
Ilsted on Ilne a. Enter the
UNDERLYING CAVSE '
Due to (or as a consequence of): i
(disease or Injury shat
•^
~
c Initiated the events resulting d. _ ~
In death) LAST.
\
iii
%
" as a con
--
Due io (or sequence °f):
26. Part 11. Enter other sienlflunt cronditl
vns ib tl d h but not resulting In the underlying cause given In Pert 1
7
2
. Was an autopsy pertormed?
Lymphoma
Yes No
28. o c re aveopsy findings available
t plate the csuse of death?
29. If Female:
e
ta Vea No
30. Dll Tobacco Vfe Contribute to Death?
Q Not pregnant wlthln part year 31. Manner of Death
S ~ Preg^ant ai time of death ~ Yea O Probably ~ Natural ~ Homicide
~ ~ Not pregnant, but pregnant wlthln 42 days of desth ~ NO )~ Vnknown 0 Accident ~ Pending Investigation
J~ Not pregnant, but pregnant 43 days to 1 year before deatF 32
~ Suicide ~ Could not be determined
Dat
f I
.
e o
njury (MO/DSV/Vr) (Spell Month)
Q Unknown If pregnant within the past war -
33. Time of Injury
34. Place of Injury (e.g. hum.; censtruc[lon else; farm; school) 33. Location of Injury (Scree[ and N
b
um
er, CI
ty, 5[atc, Zlp Cvde)
36. Injury of Work 37. If Transpolta[lon Injury, Specfy:
36. Dese4lbe How Injury Occurred:
)~ Ves ~ pNVer/Operator 0 Pedestrlen
~ No ~ Passenger 0 Other_ISPecIH)
99a. Certifier (Check only one):
~$( Certifying physician - To the beat of my knowledge
death occurred due [
th
,
o
e cause(s) and manner sfe<ed
~ Pronouncing 6 Certllying physician - To [he bee[ of my knowledge
leach occurred
[ th
,
a
e Hma, data, and place, and due to <he cause(s) and msnner stated
Q Medical Examiner/COrpner - On the teals of exsmina[lon, and/or Investlgatlon
In m
o
ini
l
h
,
y
p
on,
eec
occurred at the time, date, and place, end due to the cause(s) end m r stied
Signature of certlfler:.~ .~ ~c%~ ~~ ~~ TJ ~
e
Title of ceKlfler: D.O. License Number: O$007729L
39b. Nsme, Adlress and Zlp Code of Person Comple[In
bus
f D
h
g
t O
est
(1[em 26) 39c. Os[e SI
Dr David A. Hoffmann, D.O. 112 N 7th St, Chambersburg, PA 17201 gnea (MO/Day/Yr)
40. Registrar's Dis[rlc[ u bar 41. Regla nature Jung 6, 2012
a /~-~ ~ tr ~ 42. trar FI a Date (MO DaV/Yr)
43. Amendmen[f ®~ ~Q~ L
DlsposlHOn vermin No. 0739456 H305-143
REV 07/2031
__ _ _ ~-
LAST SILL AND TESTAMENT
v:
~.~
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I, RICHARD W. WAHL, presently residing at 22 Richs Drive, Shippensburg,
Cumberland County, 17257, zip being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void all Wills
by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as maybe convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to our children namely, MAX S. WAHL, MICHAEL L.
WAHL, and MARK R. WAHL on a per stirpes distribution basis.
THIRD. I nominate, constitute and appoint my son, MAX S. WAHL, presently
residing at 13638 Village Mill Drive, Maugansville, MD 21767 to be the Executor of this my Last
Will and Testament. In the event that MAX S. WAHL be unable to fulfill the duties of Executor,
I then nominate, constitute and appoint MICHAEL L. WAHL, presently residing at 24407
Galeano Way, Damascus, MD 20872 and MARK R. WAHL, presently residing at 42 Overview
Lane, Loysville, PA 17047 or the survivor thereof as Co-Executors of this my Last Will and
Testament.
FOURTH. I direct that my personal representatives shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, RICHARD W. WAHL, have hereunto set my hand and seal
to this my Last Will and Testament, written on one (1) page. this _ ~~ day of
~ , 2009.
. ~
_ `~ Q
c>r : ~ Ca ~ a-'t ~ LL/ ~-t/~r~-~-- (SEAL)
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~ ~~~
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A~
t~.s
WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
This instrument was by the Testator, on the date hereof, signed, published and declared by him to
be his Last Will and Testament, in our presence, who at his request and in the presence of each
other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed
our names as witnesses. ,~
~._ .
~:~'~ccu ' .r.~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, RICHARD W. WAHL, 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; that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
RICHARD w. wAHL
Sworn or affirmed to and acknowledged before
me by RI HARD W. W HL- e Testator,
this ~ ;? day of , 200 .
C0~ yyEAL1M Of P~ ~ ~lr ~w
NOTARIAL SEAL
Jerry A We~yle, NOt~ry Public
City o' Sh~nre"sburp, Curf-berlend County
My ;- :~ ^ ;s ~n Expir~tt October 07, 2010
WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 1z6 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
I-INAVtYsMN3'+ ::;1~;;+C: alu,~OJ
--,......~...w.
.~ .~~ r"h t:.;.R
>.f 1+~lr
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
_ ~~ ,~
1
and -~~-Q. S,.~ I C h1 C2 - ~ .~ ~T~ ~~., ,the witnesses whose names are signed to the
foregoing instrument, being duly qualified according to law, do depose and say that we were
present and saw-RICHARD W. WAHL, the Testator, sign and execute the instrument as his Last
Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as
witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more
years of age and of sound mind and under no constraint or undue influence.
~~ ~ _ j
~~ _,
-~
;' ~;
,~.,
~, ~ L._.
~ '
,. -
Sworn or affirmed to and subscribed before me
by _~ C~ `~ r ~ c. i c. _j ~ ,~'-Q \l ---'
.~ -
and ~~~..SS I C~-`~ ,~Z. I..~ ~-J-c~
this % 5,i,~ay of CX-~~/~/ /, 2009.
Notary (f. "
CQMMON WEA~TN.O~ -ENNSylVAN1A
NOTARIAL SEAI
Jerry A. tNei0le, Notary Public
City of St-iMeeaburp, Cumberland County
My Comnli•Np- Expires October 07, 2010
WEIGLE be ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURC,, PA 17257-1397
A~N~1~.1ttNN~~1 i0 NIiAJJ* ,;"~..a:
A .~2 1A111AY0~+
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