HomeMy WebLinkAbout07-12-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF 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: (_» ~ r~f-rt.t,d ~. ti.~ V1~e ~ ~ ~ r7 File No: ,~ ~ ,/ ~ -~~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: / .J ~ i L L Y 0 '1
Date of Death: J ,,. /~ e i 2 , z c.v , 2 Age at death: y ~;;
Decedent was domiciled at death in Cu.rn~~~t~~ ;t~~ County, ~a (Stare) with his/her last
principal residence at ,j y We51- F i elcl_ (J,^ -'tle •~tet tCSbi.e,r^~~ c:.kmberl ><i~
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at .3y ~VeS}'~~i elcls ~),^ ~1?N~l~ -,1tcs bc.:.~~r Ce.un~J~'/`~G:/lc~ Pal
Street address, Post Office and Zip Code City, Township or Bo ough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ........................... All personal property $ ~' Z~l ~, ~, ~( G c,
I/'trot domiciled in Penttsy!vania ........................ Personal property in Pennsylvania $
If trot domiciled in Pennsylvania ........................ Personal property in County $ / ~ y~ , ~ ~ „
Va/ue of real estate in Pennsylvania ......................................................... $-~~
TOTAL ESTIMATED VALUE.... $ .S 1 (1~ .~ L. ~/ o ~'
Real estate in Pennsylvania situated at:
(Attnch additional sheets, ijnecessary.)
Street address, Post Office and Zip Code City, Township or Borough County
dA. 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 b'l'1 ct r ~ h y z~,~,1 and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death of exectrtor, 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(g), and did not have a child born or
adopted; attd Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~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., pendente life, durante absentia, durmtte 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 trot a party to a pettdittg 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
Petitiotter(s),after aproper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, iJ necessary):
Name Relationshi Address ev
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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Official Use Only
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Petitioner(s) Printed Name Petitioner(s) Printed Address 't7 ' ~ : =i
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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 Decede t, the Petitio''ner('Js) will,~ell and truly administer the estate according to law.
Sworn to or affirmed and subscribed before ~ ~LCC~c ~"~1,~J L Date `t ~ t z -l ~
me t)~is-=-~ day of~_~(_ ~' ` ~ ;-~
By: i ,~ ~ 4 \~(.~~~`~ Z!~t ~(~ l ~ Date
For the Resister Date
BOND Required: ~ YES ~ NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters ......................
( /~1) Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ......
Atttotnation Fee .............. .
JCS Fee .....................
TOTAL .....................
$ ~GQ
SCI
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Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of _~~T(' /' ~ ( /CJ'C1~ File No:
a/k/a:
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AND NOW, ~,~ L ~ / ~ , .,~f C~ / , in consideration of the foregoing Petition,
satisfactory proof having been pr sented before me, IT IS DECREED tha etters Clr~cn f r''
are hereby granted to ~~ C /i ~~ f S~~/~
in the above estate and (if applicable) that
the instrument(s) dated _ /~ Cl ~/
described in the Petition be admitted to probate and filed of record as the last Will. (and Codicil(slYbf Decedent
FormR4V-0? rev. 10/il/2011
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CUM~ERi..AND CO., P~ R
COMMONWEALTH OF PENNSYLVANIA • DEPAPrMENT Of HEALTH • VITAL RECORDS
CFRTI FIfATF f1F IlF dT4E
1. Decedent's Legal Name (First, Mlddle, Last. Suffix) 1 S 3.5 - I S curlty Numbers ate .ire NG, Da[e o! Death IMO/Day/Yrl (Spell Mp( i
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6a. Age-last Birthday (Yrs) 56. Untler t Year Sc. Under t Da 6. Dale of Birth (MO/Day/Year) (Spell Month( ]a B hplace (City and St pr`F reign Co
n
Months Days Nours Minutes is
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ea. R idence (State or Foreign Country) 86. ~esidynce IS[rLegt andil 6~ Inclyde Apt No.(
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K/ Bc. Dld Decedent live in a To ship?
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decedent lived In V Q(
Bd.R Sidence lCD ty
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lM el',d.N Se. Resitlence (Zip Code) ^NO, decedent lived within limits p( city/born.
9. Ever In US Armed Farces? 10 Marital Status a[ Tlme p( Death ^ Married Widowed II. Surviving Spouse's Name Ilf wife, give name prior to first marriage)
^ve ~Np ^Unknown ^Divorced ^Never Married ^Unknow _
12. Father's Name (First, Mlddle, last, Suffix) 13. Mot er's Name PDOr to First Marriage (Firs[, Middle, Last)
u ti a.r <<s
14a.lnfprman['sN 14b. Rela[ionshlp to Decedent 14c.Informant's Malling Address(Stree[antl Number, Clty, State, Zip Code, r
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f Death C
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If Death Occurred in a Hospital: ~J In
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patient :It Death Occurretl 6pmewhere Other TM1an a Hospital'. ^ Hpsplce Facility Decedent's Hom
e
^ Emergency goom/Outpatient ^ Dead on Arrival ^ Nursing Home/Long-Term Care Facility ^ Other (Specify(
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lSb. Facil'r[y Name Ilf p - stitutio ,give street and number; 15 . Ci y or Town, State, antl Zip Code 1 .County of Deat
e k Nor aL_ J o5 uw~b¢.r~u-~
lfia. Method of Disposition ~ Burial ^ Cremation 16b. Date of Dispositlpn 16c. Place o Disposi[Ipn (Name of cemetery, crematory, or other place)
^ Rempyal rrpm State ^ Donation
^ Other lSpecllyl
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16d. Location of Dlsppsitipn (City or sown, Stale, and Zipl 1)a. Si of Funeral Se Ice License or Per on in Charge of Interme 1)b. license Number
vv w ~ ! OZO ( D 2! -1_
ln. Name and cp,~~PPiete Aeere:: or w r I Facility
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vl D a.r ~ -'~' ti t IZOI~
18. Decedent's Education ~ Check [he box that best describes the 19. pecedent pf Hispanic Origin -Check he 10. Decedent s Pace -Check ONE OR MORE races to Indicate what
higM1est degree or level of school completed at the time of death. box that best tlescribes whet M1er [he decetlem the decedent considered himself or herself to be.
^ 8th grade or less is Spanish/Hispanic/latino. Check the "NO' ~^Nhite ^ Korean
^ No tliploma, 9th - 12th grade box it tlecedent is not Spanish/Hispanic/Latlnp ^ Black or African American ~ Vietnamese
High scM1Dol graduate or GED completed No, not Spanish/Hispanic/Latino ^ American Indian or Alaska Native ^ Other Asian
^ Some college credit but no degree es. Mexican, Mexican American Chicano ^ Asian Intlian ^ rv ve Nawalian
i
^A Oate degreeee AA, AS) ^Ye toglcan ^Chinese ^GUa
manian or Cnamorro
^ BacM1elor i tlegree leg. BA, A8, BS( ^ Yes, Cuban ^ Filipino ^ Samoan
^ Master s tlegree leg. MA, MS. MEng, MEd, MSW, MBA( ^ Yes, other Spanish/Nrspani[/Latino ^ Japanese ^ Other PaCi/lc Islander
^Doctorale leg PhU, Edo or Professional degree (Specily7 _. _-. _._ - ^OtM1er (SpeciN7
e. MD, DDS, OVM, tLB, 1D) ~-
11 Decedent's Single pace Self-Designation Check ONIV ONE to indhate what [M1e decedent considered himsel(or Herself to be 12a. Decedent's Usual Occupation Indicate type pl work
F}p•~~White ^lapanese ^Samoan tlone during most of working life pO NOT USE RETIgEO
xLJ Black or African Amen<an ^ N ^ Other Pacllic Islander
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^ American Indian or Alaska Native ^ V e
tnamese ^ Don't Nnow/Not Sure a f
^ Asian Indian ^ Other Asian ^ Pelused 2Zb. Nind of Business/Ind try
^CM1ineze ^N ve Hawaiian ^Other l6pe<IIVI _-__
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^ Filipino ^ Gua
manian or Chamorro
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ITEM623a-23tl MUST BE COMPLETED 23a. Oa[e Pronounced Deatl lMp/Day/Yr( 136. Signature of Person Pro Dancing DeatM1 (Only when applicable] 23c. UCense Number
BV P
ERSON WHO PRONOUNCES OR --7T'' l /1
CERTIFIE60EATH JUT1G r.~ rX LO ,J. _/7"~
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Z3d. Dale Signed (MOIDayIYr( 24. iinre p! DeatM1 W J r /`
r ~- aura ~ 26 Was Medical Examiner or Coroner COn[actetl) ^ Ves ^ Np
CAUSE OF DEATH
Approximate
26. Par[ I. Enter the chain of ev ts-diseases, inlurles, orcomplications--that directly cauzetl the tleath. DO NOT enter terminal events such as cartllac arrest Interval.
c
respiratory arrest, or vents
ular fibrillation without showing [he etiology. DO
N
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T ABBREVIATE. E
rifer o
nly
one cause on a Ilse. Add additional lines if necessary Onset to Death
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IMMEDIATE CAUSE - >
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isease or colttlition Due to Ipr ai a consepuence ot(:
resulting In death) 1? ~y?
Sequentially 1151 cpndi[Ions, ~ Oue [o l0r az aconsequence pf-
if any. leading tp the cause ~ J
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b:tee on line a. Enter the
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UNDERLYING CAUSE Due tp Ipr azl3 conserluence all.
(dice pr lnlury [hat
i fed me a em: respmng d. -
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m aeaml LAST. Dpe tp for as a consegpenee oft:
16. Part tl. Enter other significant cpndltlons cpntrlbutne to death but not resulting in the underlying cause given In Part I 1). Was an autopsy pertormed]
^ Yes No
18. Were autopsy /lntlings available
to omplete the cause o(tleath?
t
^Y ^ No
es
19. f F
emale: 30. Oitl Tobacco Use Contribute [o Death? 31 Manner DF Death
f
Ip. NOt pregna twithln past year
n ^ Yes ^ Probably Natural ^ Homicide
Oregnant at
time of death ^No FErE Unknown
/' ~ACCitlent ^Pending Investigation
^ Not pregnant, but pregnant within 41 tlaVS of death ^ Suicide ^ Could not be determined
^ Not pregnant, but pregnant 43 days [o l year before death 32. Date of lnlury IMO/Day/Yrl )Spell Month)
^ Unknown iF pregnant within the past year 33. Time p(Injury
34 vIa<e of lnlury leg. home; construction site; farm; school) 35. location of lnlury (Street and Number. City, State. Zlp Code)
3fi. lnlury at Work 3) Il transportation lnlury, SpeciN. 38. Describe How lnjurv OCCUrred.
^ Yes ^ Driver/Operator ^ Pedestrian
^ No ^ Passenger ^ OtM1er iSpecity)
39a. Certifier I<heck only oneJ.
^ Certifying physician - To the best of my knowledge. tleath occurred due to [M1e cauzels and manner stated
^ Pronouncing 8 CertiNing physician ip the best pt my knowledge, death occurred at the ti e, tlate, antl place, and due [D the causeli) and manner statetl
^ Medical Examiner/Coroner - On [he basis of eaa ination, and/or inves[igat on in my opinion, death o
cc
urred aI the time, tlate, and place, and due [o the causelsl and marine
atee
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Ttle of Certlfler
~ License Number
39b e, Addrezz antl Lip Cptlep[ rso Completing Cause o! DeatM1 Iltem 261
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40. Registrar's District Number 41 gi 'gnature
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~ 42. Reg ar File Date IMO/Day/Vr
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43. Amendments
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Disposition Permit Np. V 'YJ qFV ri]I]Dlt
LAST WILL AND TESTAMENT
I, GERTRUDE W. WELDON, of the Township of Silver Spring, County of
Cumberland, and 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 Executrix, hereinafter named, as soon as conveniently may be done after my
decease.
SECOND. I give, devise and bequeath all the rest, residue and remainder of
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my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto
my three (3) children, namely, JUDITH A. SPESSLER, DELORES J. WIEDMAN
and DONALD L. WELDON, share and share alike, absolutely and in fee simple.
If any of my said children should predecease me and leave lawful issue
to survive me, I order and direct that the foregoing share attributable to such
deceased child shall be distributed unto his or her lawful issue per stirpes by
representation and not per capita.
LASTLY. I nominate, constitute and appoint my daughter, namely, JUDITH
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LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
A. SPESSLER, to be the Executrix of this, my Last Will and Testament, but if for
any reason she should fail to qualify as such Executrix or cease so to serve, then and
in that event, I nominate, constitute and appoint my daughter, namely, DELORES
J. WIEDMAN, to be the Executrix hereof.
It is my will and intention that the person or persons otherwise
qualifying as my personal representative or representatives hereunder shall not be
required to post bond or other security as a condition of such qualification and
appointment.
IN WITNESS WHEREOF, I, GERTRUDE W. WELDON, have hereunto set
my hand and seal to this my Last Will and Testament, which consists of two (2)
typewritten pages to each of which I have affixed my signature this 9th day of
March, A.D., Two Thousand One (2001).
_.~..~.:~~;~-r*C, _ '-~' .;~~ ~ ^r,, ; (SEAL
GERTRUDE W. WELDON
The preceding instrument, consisting of this and one (1) other typewritten
page each identified by the signature of the Testatrix, was on the date thereof
signed, sealed, published and declared by GERTRUDE W. WELDON, the Testatrix
therein named, as and for her Last Will and Testament, in the presence of us, who,
at her request, in her presence and in
our names as witnesses hereto.
the preen e of each other, have subscribed
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COMMONWEALTH OF PENNSYLVANIA)
SS.
Subscribed, sworn to and acknowledged before me by GERTRUDE W.
COUNTY OF CUMBERLAND
We, GERTRUDE W. WELDON, RICHARD C. SNELBAKER and JANE J.
GOONEY, the Testatrix and the witnesses, respectively, whose names are signed to
the attached or foregoing instrument, being first duly sworn, do hereby declare to
the undersigned authority that the Testatrix signed and executed the instrument as
her Last Will and Testament and that she had signed willingly, and that she
executed it as her free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the Testatrix, signed the
Will as a witness and that to the best of his or her knowledge, the Testatrix was at
that time eighteen years of age or older, of sound mind and under no constraint or
undue influence.
WELDON, the Testatrix, and subscribed and sworn to before me by RICHARD C.
SNELBAKER and JANE J. GOONEY, the witnesses, this 9th day of March, 2001.
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Notary Pudic
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
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