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HomeMy WebLinkAbout07-24-12fi~CQf?I~'~n ;~~ICc ~ PETITION FOR GRANT OF LETTERS R~ G-. ! ... ~ ~ ~_,.~~ REGISTER OF WILLS OF CUMBERLAND COUNTY, ]?ENNSY~;2 JUL 24 AM 10~ 54 Petitioner(s) named below, who is/aze 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 fp~n; ,;:. OHPHl~y'~ GUURT Decedent's Information ~ I _ ~''~~~''`~" Name: T aya_n L Brnt ~=n File No: _ /~ a/k/a (Assigned by Register) a/k/a: a!k/a: Social Securit3~ No: Date of Death: ak Y /'~~~ Age at death: _ 64 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 1132 Mountain Road Upp er Mifflin Township, Newburg Cumberland Caus Street address, Post Office sod Zip Code sty, Townshry or 1Borough Decedent died at Holv Spirit Hospital Camp Hill PA 17011 Cumberland PA State Street address, Post Ottice sod Zip Code C,ty, Towneh~p or Borough County Estimate of value of decedent's property at death: $ 3 If domiciled in Pennsylvania ............................ All personal property Personal property in Pennsylvania $ Ijnot domiciled in PennsyWania ....................... . Personal property in County $ Ijnot domiciled in Pennsy/vania ....................... . `1 DD • OJ ........ $ I ~ Value of real estate in Pennsylvania .................. 1 ..................... ... LUI:.... $ ,2 ! 7 t `/ ©~ 00 YA L ESTIMATED TOT A rA IAI N { ~ ~ ~ 't'~ /j I .~ /J t' Ct.'D /~C N~yt(O-G C 1w uA°~~F(t-,~ (~KM ~G'Ql-A'AlP t -- o U Real estate in Pennsylvania situated at: - 1 (Attach additions! sheets, if necessary.) Street address, Poat Office and Zip Code 1'f ~~ City, Township or Borough Comfy ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named m the last Wtll of the Decedent, dated _ 10~06~2005 and Codicil(s) thereto dated Ektt,~ F 8 0 ~ 2 n7 d~ v na ~ Is ~ 'w!'t- Stste relevant dreumatmces (eg. renunnanon, death ojerecuror, ertc) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not aparty [o a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not gave a child bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated m incapacitated person. ® NO EXCEPTIONS ©EXCEPTTONS ^ B. Petition for Grant of Letters of Administration (Ieapphcable) c. t.a., d.b.n., d.b.n.c. t.a., pendente, lire, durarote absentia, durance minoritate If Administration, c.t.a or db.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 fbr 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. O NO EXCEPTIONS ~ EXCEPTTONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survivedby the following spouse (if any) andheirs (anach additional sheets, if'necessary): Name Relationshi Address u hter Tara Faulkner 2279 Benders Drive Bath, PA 18014 For.nxw-oz reu.loalizon Page 1 oft Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF coMB>;RRI'e~r1D Official Use Only 'tD42 JUL 2 Ali, I(!~ 54 Petitioner(s) Printed Name Petitioy s Pouted Address OH ~'S `' U h The Petitioner(s) above-named swear(s) or affirm(s) the state t[s in the fo~rj~ oing Petition aze true and corra:ot to the best of the knowledge and beuet of Petitioner(s) and that, as Personal Representative(s) of the ecedent, t~71 etitioner(s will well and tmly ruhninister the estate acoLOr inZg t~l j _ ~.~ ~s~A~ Date ~ Swom to or affirmed and subscribed bef_ ore ~ Date me thi ~ d y f ~~~ Date HY Date Fo eglsler BOND Required: Q YES (J NO FEES: Letters ................. ..... $ (~ )Short Certificate(s). .... . ( )Renunciation(s).... .... . ( )Codicil(s) ........ .... . ( )Affidavit(s)....... .... . Bond ................... ..... Commission ............. Other GlJ1l1 ~~~ .... . ~~~~~ Automation Fee ............... JCS Fee ..................... TOTAL ..................... $ 10 ~ '~`~ To the Register of Wi!!s: orosao a..rae my aooearance br mY signature below: Attorney Signa ~l ~~~; Printed Name: David H.. Radcliff Supreme Court ID Number: 25483 Firm Name: Radcllf1` LdW Office. PC Address: 1 Ol 1 T firrrrtna Road Cni 1-a 2(11 T r~ .,c I a`c Phone: (717) 2 36-9318 Fax: (~ old 57R1 Email: Ara Ar•13 `°^- "," DECREE OF THE REGISTER Estate of Fatate of T^'^ r n''^~~n FileNo:~~ - ~°~ ~VO~ a/k/a: AND NOW, satisfactory proo ~'\ ~~cons~ideration of the foregoing Petition, presented before me, IT IS DECREED that Letters _ Testamentary aze hereby granted to Tara Eaullrner in the above estate and (if applicable) that the instrument(s) dated October 6 2005 described in the Petition be admitted to probate and filed Form RW-02 rev. !0/ll/2011 (and Page 2 of 2 nm?,aos kHtl 19/I I) LOCAL T AR'S CERTIFICATION CIF DEATH ~ it o duplicate this copy by photostat or iphotograph. W~~ Fee for this certificate, $6.00 ~a42 utL 2~ A~ ~Q; ~jl~ ~ s couRT P 18 6 2 7121~""~~~'"o ~" ~ Tvpe/Fein<In This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will he forwarded to the State Vital Records Office for permanent filing. L~R~M. ~!_~ ~ ~ JUG 2 0/2012 Local Fegistrar Date lesued COMMONWEALTX OL PENNSV LVANIA • DEPARTMENT of XEALTX VITAL REEORD9 Certification Number eck lnk t l.C fa x a~a+..a+ a `Z Sex 3 I securl Numberavavc ...c •-q. Drte of Oe+tM1 IMn/O+Y/Vt) (SPe11 Ma) 1 . oeaaent•xLe+.I N+melFlrss, Mlaale, Laa<welxl 170-3~-7732 18 2012 Ly emale Jean L. Hrotzman Anlryl oTelnn lMO/D.v/vmrl (spell MOnml 'BI t 6 D e{ $e s a . . P a.A a-last Blrtnmrlv.xl m. unaer scunaeriD. tona NOrtham MmPte. 1947 30 { r 64 Mnntbs oars Xnnrz July 9b. gimipl.n. tcnunM N r am t n cnumrv a laen.e tser..l .ne Nn ner- m=ine. Avt Nn.l eP. Dia oeceaant u.e In a mwnabmz tY. F a M1£Fl in 8 a nr { a. R.aiaene. [sta. o. 1132 Mountain Road .,,master urea In _UpP r l g s s )ree aecea.nt Mea wlmbr umrcs oT dN/born. a. Rexlamce Ieomev) ONU , Cumberland .. Rezla.na ulp cpael we a .m pnn[m. e w 11. g rvlving Spouse's N+me IIT wl/a, glue n e prlort rtlage) n M ln ve e n Vs Armrea Fnrceii +1 statue v[Tlme of DeaM O 1OO DI as ONever Marrl.a OVnknnwn vo l r yl NO ~unknnwn p vei 3. Mo[her's N Prlor to Firs<IN la[e (Nrat.N eels. Lest) sine 5uT11x) 1 Y 1 rase Mleel ~ta enay 1 , a, 3.Fetneis Name (FItxG He rn Warren ICreage b. ReLUnnablP to otae.n< 1 M nln Aeerea .ne rv~a ~rhty: s ~P.~IP `Ytb10 14 il8era I~sSei'<- ~~~~~+n~ + 1 +.. minrm.nrx N.me e Dau hter lkner g F 8 au Tara ............... i... aaen< li De.m oanrrca sPm.wnerc otn.rrnan Hpxprca: "'r~'iiozpic. rocniN ...YJ..o:~eaent•x Home ........ in l a Cl' .. a P t : D B o..rb ocae^rca I~ HnaP Ners n (spedM etlen[ e+a bn Arnwl 1 a Nome/Long-Term Cv.e Faculty O'[ner l /O M1 yyy T U p Emer e R m Fa IIIH Neme IIT not lnslituelnn. {IWe a<r+et antl nu b r, Ssc CIH or Tw+n, state, +na ZIp Case 1 a. CnunH oT~ eef 15 b PA 17011 Cumberland e v £ . 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CAUSE OF DEATH A ln[erva: orv 1 S6. p+reL Emu m.•ha nui events--eizeazea, Wueex,u. mmpnc.0ons-ma alreceN c+uzea eM1e stern. D i renter armnvl evanlz mcM1 ++c.rmau.r. zt gtle vaal<lonal Ilnas Il neceas+ry I Onset to Oeatn ruse on a Ilne - l[nout snnwlna Me e<lology. Do NOT ABBREVIATE. En[er on V nne c n w respiratory arrcxt, ar ventrlculvr nbrlilv<lo ^^ ~~ /'1~ I IMMEDIATE CAVSE ----- ~---> a. nlor oIl' 1 Oue t as a consequence 1 nvl elseaae or canel<lon ( raxul[In{ tluvlM1) ally llzt ntllt b Ove to (ar ass canae9uence on: ± .~.e I o a i~ v aaing t ne t a'rv. <.a on nne a. Ent., cne =. out rn for ax . =onseRUena bn: o NOgnLY1Na cause . ~ + itllx. a or Imu I ml.a'~a ma [x .+:wens a~ DPe m tp pence on, r ax a eonse9 ties.. m n ~ ~ + sea I ) z6. Pan n. Enter nine. r bet n ae n bar not rexwrm{ m m. unmriymfl a.,ze Owen In Pan T. ws tpPxv Perin. o Yea . a v.n.bl. vsv nnaln{a i to .me e.Wx. pia nz ~ _ Dla Tobacco VSe Can[nbute to 0e+tnZ 3U. roi each 31-M+ D 39. 1(Fe : of Pregnan[wi[nln Paxt Yaer ~ ~ Probably k +t 0 P all nl{elnvestl{atlbn ccltlent ~ A ' ath <wnnln az aevx oT ee.tn t { ~ Vn nown O sulcle+ O C cafe nn<be aeterminea o $ preen+nt. bu Prcman 0 Nat bu[ Preen+n«3 tl a 1 Year before tlev[M1 regnant No[ ate cal n 31. D Inlury fMO/Oay/Vr) (spell M ntFl f . p ~ ~ Unknown lT prcenan<wltnln the pas<Veer , Tlme o lnlury 3a. Pl.a n/ lar•rv t=.g. n.me; =nnurPnlnn xbe; i.rm; zcnnnn . Ln=annn nr lanrv (fiercer .na Nr.mbar, eiH, seat.. z p noel 36. Inlury a ark . li Tranxport+tlon lnlury, speclH: oexcrlbe How INury Occurretl. to l r O omar lsP mHl e t. ~_ O Pa se 9i niNInO PM1Vx only nTe): ebest v4nawleaae. cu aeu <a uxe<a<+nam nn <e a an seRl sna m mr tea eat ane vlac and ao me he < e a b + 3 " t + n , o urre r. u at+ niHln vzldan - of m wit t O P n { a c ) sna t a s I z a. .ea a M1 t a sae na Pia sna au e t opm n / 1i e s E m e e I cc I , O emm /, ~ s~Y r/tern kamin o Memo t- + L V ~~~I~Z r IS / I Lice • mbar nIC rtlne _~• Tl ~ C rtlflar o/ I{netl lMO/DeV/Yrl 39cuD+t g e . n m q C ai ers Comple eu of OeaM (lee 261 - nn p , aa sna ~ as e 398 PA /7 ~ ~ r' <// P P : 9 7 P. < s Da. n D.y yr e . R , M ea t... x DH<nct Num er .1. R. a +~ I~1 aota- dO aQC ~v¢c tic.). a . mt-aCO S gm.namen<z DixPnxlann PermR No. [ J7 ~ ~ ~ y_ REV BT/3D11 LAST WILL AND TESTAMENT ~' N ~° ~ n I, Jean L. Brotzman, presently residing at 1132 Mountiiin Road, Nag, U~er ~' ~~ Mifflin Township, Cumberland County, Pennsylvania 17240, being of sound min~~pe.kttory^~and : _*~ disposition, do hereby make, publish and declaze this my Last Will and Tesht, hereby revoking and making void all Wills by me at any time heretofore made. gG - ' a_ ` ~ o +== ; FIRST. I order and direct the payment of all my legally enforceable debt3~nd ` ! 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 my beloved husband, Earl F. Brotzman, provided that he survive me by a period of sixty (60) days. THIRD. In the event that the said Eazl F. Brotzman sho~.dd predecease me or is not living on the 60`s day following my death, I then give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate as follows: A. I give and bequeath the full sum of Two Thousand ($2,000.00) Dollazs to Tammy Bower; and B. I give, devise and bequeath all of the rest, residue, acid remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, Tara Faulkner, absolutely. In the further event that Taza Faulkner should predecease me or is not living on the 60s' day following my death, I then give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate to Timothy Galloway. FOURTH. I nominate, constitute and appoint my husband', Earl F. Brotzman, to be the Executor of this my Last Will and Testament. In the event that he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint Tara Faulkner to be the Executrix of this my Last Will and Testament. FIFTH. I direct that my personal representative(s) shall not be required to give bond for the faithful petformance of their duties in any jurisdiction. ~ (SEAL) WEIGLE 6 ASSOCIATES, P. C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSRURG, PA 1]25]-139] SIXTH. I hereby direct that all federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of administration of my estate and that such be paid out of the rest and residue of my estate. IN WITNESS WHEREOF, I, Jean L. Brotzman, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for identification only, this _~~ _ day of DC~a~E ti , 2005. ~ ~ ~~ x4~~- (SEAL) WEIGLE 6 ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET' - SHIPPEN SBURG. PA 1925"!-1397 This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and ::~emory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ____~~~ i c SS I, Jean L. Brotzman, 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. Sworn or affirmed to and acknowledged before me by ~J~ea~n L. Brotzm the Testatrix, this -g> day of T~ ~ r , 2005. ~h~if/nc.l~. II IAGBEAL SHARD 4. ~'EE5€'~ JfI , N07ARY PUBLIO YHIPPEN{1UR~ a,'j,^~(v, C,t<IMBERUND CAUNT! MYOtlMMISS!~~'r' ~'r$'i~t+~ JULY 18 2008 WEIGLE 6 ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-139] COMMONWEALTH OF PENNSYLVANIA SS COUNTY O'F~CUMBERLAND We, 1'cz `~ r~ c.~ c. /n9 1_('F .~ `~KI C I R L • ~QIYI_~__ -, and ~~(S'L~ ~ l ~.~P ,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 Jean L. Brotzman, the Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our Imowledge the Testator was at t:he time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me r.'-,~.,. d3~.7 --- i by ~ c rl c ~ a ~r ~~ --~ C witnesses, this ~ f day of ~~ ~ ~~ '~ , 2005. l~~ NATARIALaEAL RICHARDL Na~Pc>'~ Iq NOTARYPUBLIO 6HIPPEN86~~"` ~ ,~~ r.,'/®ERLANDCOUIRY MYCAMn§;S~~; ~:+~ ~=XP'`,c: JULY 162006 WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING sTREEiT - SHIPPENSBURG. PA 1]25]-139]