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HomeMy WebLinkAbout07-31-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF __C~u M 6 e r' I q I-i cI COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 1 S 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: F_ n Nf~ y~/ _~~ 0 ~QS T a/k/a: a/k/a: a/k/a: Date of Death: Decedent was domiciled at death in principal residence at / t k -~V(,~ County, File No• _ ~ / ~ / d - ~t~ (Assigned by Register) Social Security No: /{/~ ~/E Age at death: `y9 ;lncxl^s cal c/ (crate) with his/her last Street address, Post Office and Zip Code City, Township or Borough yCount Y Decedent died at l/t ew ~v~ .S' ~,b,dt rrs a l7~ ; e Cur-t/~ P~ Street address, Post Office and Zi Code ~ r-s ~~ ~ 9y = ` P City, Township ar ough Count y State Estimate of value of decedent's property at death: If don:ici[ed in Pennsylvania ............................ All personal property $ T 6"D 00 If trot domiciled in Pennsylvania ........................ Personal property in Pem~sylvania $ If trot domiciled in Pennsyh~ania ........................ Personal property in County $ I~alue of real estate in Pennsylvania ................................ .............. $~~ O O D Ate TOTAL ESTIMATED VALUE.... $ ,S ~} ~~'~ ~j Real estate in Penns (vania situated at: i .> ~ y X` r-'1 + n , 1/, e w ir'l t% S' h~ry~~ b ~n i'o / 7aS 7 S' A/ ,~ I*+. y ~ h,. (Attach additional sheets, if necessary.) Street address, Post Office and Zrp Code City, Township or Borough Count Y ~] 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 dre Decedent, dated ~J n ~ c ,' ~ ~ ypp/and Codicil(s) thereto dated State relevant circmnstances (e.g. renunciation, dead of executor, etc.) Except as follows: afrer 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; and 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.u., pendente life, durante absentia, durante minoritcrte 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), afrer a proper search has/have ascertained that Decedent lefr no Will and was survived by the following spouse (if any) and heirs (attach udditiarul sheets, i~necessary): Name Relationshi Address n r ~, ~~ ~ b ~--. -~i ,` ~~ Z - - t..,,, r~y' ~~ >e _: r= ~~ r . r- (~ _T7 Form 2W-02 r-ev. l0/ll/10// -O =_ "'~ , w .~. `:...7.. ~-~ ~ ~~~Iof2 `~~ .~~ ~~ Use Onl ~ Oath of Personal Representative r' ' ~T, c; i 1 -~ , t--- ~ .~~ c~ . , ~ r, ~.- COMiVIONWEALTH OF PENNSYLVANIA - ~ ''' } SS: ~C. :- ~ - -- COUNTY OF } ~~_ ~ ~ -~-i Petitioner(s) Printed Name Petitioner(s) Printed Addre ~~ ~ O ~i'~Gc` Z. ~ G: ~f6' rt-t'ctrn w enSliu ? r t a ~ S/t3 C k o r 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 r affirmed and bscribed before .~~o-?Jtiyc.ec., ~ ~~~ Date tZ me this ~ d y of , ya~~.. ~.''!"~~c~,-_ "~j ~Y~ Date 'Z By: .c Date t, a Register Date BOND Required: Q YES ~ NO FEES: Letters ...................... $ 1 ~ ~7 ~ Ov ( )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . th ...... i•~ ........ •~n Automation Fee ............... d v 1CS Fee . ...................: +~ 7 ~ v TOTAL ..................... $~© To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Etnail: DECREE OF THE REGISTER Estate of ~G1 /`l (~L. ~"V /`J d r ,S7 File No: ~~ ~ , ~ ` ~ ~ ! a/k/a: AND NOW, ~ G(y ~;( t$ T / `S~ Z y t !L, in consideratito^n of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters S r fl /'h ~ ~1 Q are her by ranted to Ol"6 CCU Z• drS~ a. n prt A ,z. a~~ _ in the above estate and (if applicable) that the instrument(s) dated efr1, described in the Petition be admitted to and filed of record the last Wil (and Codicil(s)) of Register of Wills Fo,~,,, Rw-nz rev. lniltizntl ~/ Page 2 0`~``~'~~ ~~~~" ?' Y A~1 ~^ , L~~.`: 11 .., ~t~ s~~(. znJ~ ~~, ~ ~ ( ~ ~CE12 JUL 31 ~~ 3' c~s~~~R~..w~~ ca. ~ 18537430 . ~ _..~- ~~~~~(~(t IO,; .~ Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS PermanenT C'FRTI FIC'ATF f7C 1-1FAT1-J ,~l a 1. Dace de nt'z legal Name (First, Mitldle, Last, Suffix) 2. Sex 3. Social Security Number" Y4. Date of Death (MO/Day/Yr) (Spell Mo) Edna W_ No>rc.e~ ~ema.ee None Ju.Q.y T 3, 20T 2 Sa. Age-last Birthtlay (Yrs) Sb. Untler 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Near) (Spell Month) ?a. BI hplace (Gift' antl State or Foreign CounTry) Mpnths Days Hpurs Minptes Deeember 27 1932 ~ ~fa~a Pa. 79 c , 7b. Birthplace (County) Ba. Residence (State or Fore lgn Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Oecetlent Live in a Township? Penn.a .eV aJa.i_a 1 T 8 MOU.re~a.i.J2 V-i.ew Road Qves, decedem llYed In CnrJ 1-h Nor.)f nw T..rn_ twp. Sd. Residence (County) Cumbelf,2.and 8e. Residence (Zip Code) ~ No, decedent lived within limits of city/boro. 9. Ever In US Armed Forces? 30. Marital Status at Time of Death 0 Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marrlage7 ~ Yes [~ No ~ Unknown ~ Divorced ~ Never Married Q Vnknow 12. Father's Name (First, Mlddie, last, Suffix) 13. Mother's Name Prior to First Marriage (Firs[, Mitltlle, Last) T,~tt.(.d W _ Z-immelunarL Kale S . W eau elz 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, Slate, Zlp Code) s 0 P.Zan.enee Z_ Non.eZ Dau. 6iteh. 745 Mo(,LJ~a.ivL V,i..ew Rd. SGu ervbcUC Pa17257 W .......................................................... ......................................... ` ' ......... 16a: P ace o Death Check only one .. e - If Death Occurred in a Hospital: [-,] Inpatient ............................ .... ... _ _ If Death Occurred Somewhere Other Than a Hos Ital: ~ ~ ~ ~ ~~~~ ~~~ ~~ ~~~~~ ~~~ ~ ~ ~ "'"' "" """"""""""'-----""""' p ~ Hospice Facility g] Decedent's Home Q Emergency Room/Outpatient ~ Dead on Arrival . ~ Nursing Hom¢/Long-Term Care Facility 0 Other (Specify) i5b. Facility Name (If not institution, give streeT and number; 16c. Litt' or Town, State, d Zip Cotle 15tl. County of Death T T 8 MauJ~a.i..n V.i.2ttJ Road Slupperv.,bwcg, Pa_ T 7257 Cumb¢rJC.Ccznd m 16a. Method of Disposition ® Burial 0 Cremation 16b. Date of Disposition 16c. Place of pisposition (Name of cemetery, crematory, or other place) $ Q Removal from State Q Donation 7-T7-2012 Meadow View U Q d On d ~ M i ~ o<h<r(Speclfy) . . . r. e ¢.vevrow , te. Ceme~e~cy Z 16d. Location of Disposition (City or Town, State, and Zip) 1?a. gna[pre of F n rat Service LI Or Person In Char ge Of Interment 17b. License Number Newv.c.e.ee, Pa_ T724T 1=D-074357-L 0 12c. Name and Complete Addresz of Funeral Facility 7=a eX.6an elc-Bn~efzefc 1=ccrtelca.e i-lame 112 W28~ K.i.n SX-ice¢~ Sh.i_ en.abwc Pa_ 77257 m 18. Decedent's Education -Check She box that best describes the 19. Decetlent of Hlspa nic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what ti highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself [o be . ® 8Th grade or Tess is Spanish/Hispanic/Latino. Check the "N O" ~ 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 c0 mpletetl [~ No, not Spanish/Hispanic/Latino ~~ American Indian or Alaska Native 0 Other Asian ~ Some coil¢ge credit, but no degree ~ Yes, Mexican, Me%ICan American, Chicano ~ Asian Indian ~ Native Hawallan Q Associate degree (e.g. AA, AS) 0 Ves, Puerto Rican ~ Chinese ~ Guamanian or Cha morro Bachelor's degree (e. BA, AB, BS 6~ ) 0 Yes, Cuban ~ Filipino ~ Samoan ~ Master's degree (e.g. MA, M5, MEng, MEd, MS W, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific Islander 0 Doctorate (e.g. PhD, EdD) or Professional tlegree (Specify) ~ Other (Specify) . MD, DDS DVM LLB, JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what xhe decedent considered himself or herself to be. 22a. Decedent's Usual Occupa<io -Indicate type of work ® White ~ Japanese Q Samoan done during ost of working Ilfen00 NOT USE RETIRED. m ~ Black or African American ~ Korean 0 Other Pacific Islander ~ -l f omemaFte/c. ~ American Indian or Alaska Native ~ Vietnamese ~ pon't Know/N Oi Sure Q Asian Intlien - Q Other Asian 0 Refpsed 22b. Klntl Of Business/Intl UStry ~ Chinese Q Native Hawallan ~ Other (Specify) Q Filipino Q Guamanian or Chamorro OwK f-(ome ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronop ncetl Dead (MO/Day/Yr) 23 b. 5 nature of Pe rs Pr uncing Death (Only when applicable) 23c. License Number O BY PERSON WHO PRONOV NOES OR __ CERTIFIES DEATH V~ ~ E~ _ 23tl. Date Signed (MO/Day/V r) f D«[h T'~ NS Z 44^ 4- /~ • . +"3 Z Z V ~ ` S~ f-t T"~ 2 85 Me cal E%aminer or Coroner COntact<d? 0 Yes CAUSE OF DEATH Approximate 26. Pert 1. Enter She chain of events-diseases, Injuries, o mplicatlons--that directly caused the death. DO NOT enter terminal eve n[s such as cardiac arrest Interval: e respiratory arrest, or ventricular fibrillation without showing the etlolog DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE ---------------a a. ~~~ ~ `, Z~ (Final disease or condition Due to (or as a consequence of): resulting In death) - b. Seq uen[lally list con dltlons, - Ova to (Or as a consequence of): - If any, leading to the cause ' listed on line a. Enter the -ENDER LYING GAVSE ~ Due to (or as a consequence of): w (disease or Injury that 11 Initiated the ev n[s reNlting d. I e ~ in death) LAST. ~ Due to (o as a consequence of): • S 26 Part 11. [Hier other sianifi<a nt contllClons conTribuking to death but not resulting In th¢ un derl Yin6 cause given In Part' I 27. Was an autopsy pert red? ~ Yes a- 28. Were autopsy fl ngs avalla ble to complete ih of death? « ~+ ~ Yes ~ No 29. If Female: 30. Oid l"obacco Use Contribute fo Death? 31. Manner of Death c ~ Not pregnant within pasT year Pregnant at time of death ~ Ves ~ Probably /§~'NO ~ Unk Natural 0 13omicide ~ m ~ Not pregnant, but pregnant within 42 days of death nown ./~ Accident ~ Pending Invesfigatlon ~ Suicide ~ Could not be determined ~ ~ Not pregnant, but pregna nt 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr) (Spell Month) ~ Vnknown If pregnant within the past year 33. l-Imc of Injury 34. Place of injury (e.g. home; construction site; farm; school) 35. Location oT Injury (Stre¢t and Number, Clty, State, Zip Code) 36. Injury at Work 37. If Tra nsportatlon Injury, Specify: 38. Descrlb¢ How Injury Occurred: Q Ves Q Driver/Operator Q Pedestrian NO Q Passenger Q Other (Specify) Certifier (Check only one): Ce. rtlfying physician - To the best of my edge, death occurred due [o the cause(s) and manner slated a ncing 8 Certifying physician - T of my knowledge, death occurred at the time, date, end place, and due to the cause(s) and manner stated ~ Medical Examiner/Coroner - On the of a Jp~{jNJO and/or investigation, In my opinion, deat7~q<cvrretl at the time, date, antl place, end due to t~~ se(s~a .Jala p r slated ( ~~, ~ ~ s Signature of certifier: YJ TiTle of certifl¢r: X y License Number: v j ~~ ~- 39b.~ ,Address and Zp Cptle P n Comp Cause of peplF~ (hem 26) I/7 ,Lt 39c. Dat< gned (M .Day/Yr) _ ` 40. Registrar's District Numbe. 41. R¢ ra gnature 42. istra le Dat¢ (MO/Day/Vr) °~ ~ ~ ~ //~- Z.E. i ~ 43. Amendments Disposit ion Permit Nn. 0 7 3 9^ 7 5 H105-143 Rev n?/2nt I s C r..~? ^ z Q "~~ rJ • C~. -x -; ~ ~ i ' 7 Q7 --J LAST WILL AND TESTAMENT :?`-- , ..... ~~_,~'cf ' .; ., C'~C.; - -~. _ -~; ~ EDNA W. HORST ry ~„~ r- _ ; ; ; ~._ D ~ ~~~ ~ ~ C,.~ -n I, EDNA W. HORST of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, revoking all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. ~~ \ SECOND ~~ I give, devise and bequeath all of my estate of "~ whatever nature or wherever situate to my children, per stirpes. I direct that any real property owned by me at my death shall be appraised. After appraisal the property shall be offered by an ~ auction among my children with the property to be sold to the ~'`,( ~~, highest bidder. Provided further gnat in the event that the ~ highest bid shall be less than ninety (900) per cent of the appraised value I direct that the property be sold publicly and the net proceeds divided among my children per stirpes. All personal property shall be divided equally by my children per stirpes. If my said children are unable to all agree on the distribution of any or all of such personalty I direct that such personalty be sold and the net proceeds divided by my children, per stirpes. THIRD '4 I direct that no trustee, personal representative, guardian or other fiduciary named, nominated, or appointed by this my Last Will and Testament shall be required to post any bond or give any security of any type for my purpose whatsoever, any law or rule of court notwithstanding. FORTH Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable hereunder shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. SIXTH I appoint MY DAUGHTERS Florence Z. Horst and Marian Z. Nolt, Co-Executrixes of this my Last Will and Testament. IN WITNESS WHEREOF, I nave hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typewritten pages, the first of which bear my signature in the margin for the purpose of identification, this 26th day of January, 2001. ~j~~~, ~~ ~ / V`~`"~~ ( sea 1) Edna W. Horst Signed, sealed, published and declared by the above named testatrix, EDNA W. HORST, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. .~` c ~, '-~~~Y~~~`~-~ ADDRESS 95 Alexander Sprinq Rd, Carlisle, PA ~'Z~ ~e- >JJti.'fG-'~ ADDRESS 95 Alexander Spring Rd, Carlisle, PA COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS. We, EDNA W. HORST, Steven J. Fishman and Roger M. Morgenthal, the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument of her Last Will and Testament, and that she signed willingly and that she executed 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 witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Affirmed and subscribed before me his 26th day of January, 2001. ~~ -- t~GTA~A3. SEAL TRtCfA L i3A1f.EY, P~datory Public SouMsamptQn Twp., Cumb+srsand Ca., PA My Commissions Expirata Aug, 1~, x"a(Yt