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Home My WebLink About08-01-12Reset 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 + 7 G Name: DALE O. HARTZELL File No: ~I - ~h- d0~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 174-OS-3179 Date of Death: NLY 19 2012 Age at death: 94 Decedent was domiciled at death in CUMBERLAND County, p~NNSYVANIA (ware) with his/her last principal residence at 128 PARKER STREET CARLISLE BOROUGH CUMBERLAND Street address, Post Oftice and Zip Code City, Township or Borough County Decedent died at 128 PARKER STREET CARLISLE BOROUGH 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 Pennsy[vania ............................ All personal property $ 100,000.00 If not domiciled in Pennsy[vania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ Value of real estate in Pennsy!vania ...................... .................. $ 154,00()_()0 TOTAL ESTIMATED VALUE.... $ 254.000.00 Real estate in Pennsylvania situated at: 128 PARKET STREET CARLISLE 17013 CARLISLE BOROUGH CUMBERLAND (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County 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 N/A 01/12/2012 and Codicit(s) State relevant circumstances (eg. renunciation, death of executor, 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; 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. Q 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 Relationshi Address rv ~' rn c . : } _' t - ~ ~ , r ,. ,. r y ~) - ~ -- tV y ~ C7 ~} ~,1 ~7 Form RW-02 rev. 10/I1/20I1 P1g8 1 Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Use h;: .~:a Petitioner(s) Printed Name Petitioner(s) Printed Address ' f r..;. --= •~ - ~ ~ J ~ r ~ ~ , ~ ~~' HARTZELL II DALE O 44 KINGS GAP ROAD CARLISLE PA 17015 ~ '' ~ , . ~ }~ ~ :, _ p C ~ - -i -'y ~ j.~ : 'lit ~~ The Petitioner(s) above-named swear(s) or affirm(s) the statement the fore ing Petition are true a correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the D ed t, th et tioner will ell dminister the estate according to law. Sworn to o~firmed bscribe before ~' ~ Date ~ ~ I Z met a /:Z. Date B Date Y~ Date or to Register BOND Required: ~ YES Q NO FEES: ~~~ ~O Let~rs ...................... $ ( )Short Certificate(s)...... , OD ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ••••••• ~~J,~ ....... - o~ Automation Fee ............... ~ b ....... - ,00 JCS Fee . ............. TOTAL ..................... $ !~ To the Register of Wi[!s: Please enter my appearance by my signature below: Attorney Signature: ~~a~,~ Printed Name: Supreme Court ID Number: THOMAS E. FLOWER 83993 Firm Name: FLOWER LAW, LLC Address: 10 W HIGH ST rear rcr ~ pA 17()1'i Phone: (717)243-5513 Fax: 57171241-4021 Email: 'rnr Fl nwFU_r AW C'()M DECREE OF THE REGISTER Estate of DALE O. HARTZELL a/k/a: AND NOW, ~~ ~ ~ J OJ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, I S DECREED that Letters TESTAMENTARY are hereby granted to DALE O. HARTZELL II in the above estate and (if applicable) that the instrument(s) dated 01/12/2012 described in the Petition be admitted to probate and filed of record as~he last Wil~(and Codicil(s)) o~Decedent. Register of Wills File No: ~~"~~- ~~~~f Porno RW-o2 rev. ioiiiiaoii G' P`age'2 of H105.805 REV f9/I U LOCAL REGI T„''__~~ ~~.' RTIFICATION OF DEATH WARNING: It is~~~lxe~tltl~t his copy by photostat or photograph. Fee for this certificate, $6.00 P 18627160 2U12 AtIG -1 This is to certify chat the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital 5 Records Office for permanent filing. L ~xx.~~a~--t~lae~x~ex' JUjI. 2 32012 Local Registrar ~ ~ Date Issued Certification Number Type/Print In Permanent Blaek Ink COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH State Flle Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Data of Death (MO/Day/Vr) (Spell Mo) Dale O_ Hartzell Male 174-05-3179 Jul 19 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Vnder 1 Da 6. Date of Blr[h (MO/Day/Year) (Spell Month) 7a. Birth lac ( Ry d State or Foreign Country) ~ ~ ~ i s e , PA Months Days Hours Minutes C r L March 2 2 , 1 91 8 7b Bl 9 4 yr s _ rcn ( p Sa. Residence (State or Foreign Country) 8b. J3eilderl£ea( =get~a nod N S L r I~ncl~ude Apt No.) IJ II ~t 33 YY CC LL L t~ 8c. Did Decedent Llve In a Township? PI' l PA 1 i QYes, decedent lived in twp. 8d. Residence (County) a r s e ~ C Cumber land Be. Residence (Zip Code) 1 7 O 1 3 No, decedent lived within limits of CAr l i s 1 e cl 9. Ever in US Armed Forces? 10. Mari[ai Status at Time of Death Q Married Widowed il. Surviving Spouse's Name (If wife, glue name prior to first marriage) $) Yes Q No Q Vnknown Q Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, last) Charles Hartzell Elsi wen 14a. Informant's Name 14b. Relationship Lo Decedent 14c. Informant's Mailing Address (5<ree< and Number, Clty, Stale, Zip Code) Dale O_ Hartzel! Jr Son 44 Kin s Ga Rd_ Carlisle 5 _ ......................................................... .......................................... 1( Death Occurred in a Hospital: ~ Inpatient ~ i a. P ace o _ _ _ ..............................eat...... °C..°^.Y. °..e ... ........ ... ...... ... ........ if Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~ ~•LJ -Decedent's Home Emergency Room/Outpatient Dead on Arrival Nursing Home/LOn -Term Care Facility Other (SpecMy) 15 b. Facility Name (if not institution, glue street and number, 15c. City or Town, State, and Zip Code 16d. County of Death 16a. Method of Disposition Burial Q Cremation 16b. Date of Disposition 16c. Place of DlsposlHOn (Name of cemetery, crematory, or other place) '€ Q Rempval from state Q Donation other(spe~lfy) 7 2 3 2 0 1 2 / / Mt • Ho11 S rin s Cemeter 16d. Location of Disposition (City or Town, State, and Zip) 17a. SlgnaLUrc of Funeral Service Licensee or Person In Charge of Interment 17 b. License Number i t Holl n ~'~'~ 7~ FD-01 1 5 - i re ve_ 17c. Name and Complete Address of Funeral Facility Ho11in er FH/Cremator Snc. Mt_ Ho11 S rin s 1 ~' 1H. 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 a[ the time of death. box that best describes whether the decedent ~C decedent considered himself or herself to be. Q gth grade or less Is Spanish/Hispanic/Latino. Check the "NO" (~ White Q Korean Q No diploma, 9th - 12th grade box if decedent Is not Spanish/Hispanic/Latino. Q Black or African Amerlean Q Vietnamese Q High school graduate or GED completed ~ No, not Spanlzh/Hispanic/Latine Q American Indian or Alaska NaHVe Q Other Asian Q[ Some college credit, but no degree QYes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) QYes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) QYes, Cuban Q Filipino Q Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Oottorate (e.g. PhD, Ed D) or Professional degree (Specify) Q Other (Specify) . MD DOS OVM LLB JD 23. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work White Q Japanese Q Samoan done during most of working INe. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q Don't Knaw/Not Sure Laborer Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q FIIlpino Q Guamanian or Chamorro ITEMS 2ga - 2 MUST BE COMPLETED 23a. Date Pronounce Dea (MO/Day r) 23b. Signature o Person Pronouncing Deat On y w en app Ica a 23c. License Num er BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d. Dale Signed (MO/Oay/Vr) 24. Time of Death 5 ~ 25. Was Medical Examiner or Coroner Contacted? Q Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complicatkans--chat directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: ithout showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add additional Ilnes If necessary _ Onset to Death respiratory arrest, or ventricular flbrillatlon w /' ~rpEl.pSA L_ ~ rt"~t-3~C" IMMEDIATE CAUSE ------------> a. (Final disease or condition Due [o (or as a consequence of): resulting In death) L p TZ ~ n J',r ~'./~ ~ ~~~ ~4s 5~~.~ b c ue to (o as a cons qu n e of): j Sequentially list conditions, if any, leading to the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): ' (disease or Injury that ~ G Initiated the events resulting d. .? In death) LAST. Due to (or as a consequence of): 26. Part 11. Enter other 1 n tI in [ d h but not resulting in the underlying cause given In Part t 27. Was an autopsy performed? _` - y ~r~ ` P ~~ Yes ~~ ~ 4f . -may ~- 26. Were autopsy findings available q t ~~_ i>fi~~~> fo complete [he cause of deaths Yes No { `' 29. If Female: 30. Dld Tobacco Use Contribute to DeathT 31 Ma n n~~er of Dea<h ~ Q No[ pregnant within past year Q Ves Q Probably ~ Q Unknown ~~ ~~ Ly~sa~ural Q Homldde Q Accident Q P ndin In ti ti ~' Q Pregnant a[ time of death Q Not pregnant, but pregnant within 42 days of death g ga e ves on Q Suicide Q Could not be determined Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr) (Spell 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, Glty, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 3g. Describe How Injury Occurred: Q Yes Q Driver/operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. Cart r (Check only one): ertifying phVSiclan - To the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronouncing 6 CertHying physician - To the best of my knowledge, death occurred at <he time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/Coroner On the basis of IniLiOn, nd/or Investigation, in my opinion, death occurred at the time, date, and place, and due [o the uuse(s) and p` Sated ~ O ` S ~ ~ s ~ ~ oS ~ li License Number: ~ ~'v' ~ y Title of ceKifler: '~~ - ` Signature of ce Klfler: 39b. Name, Address and 2Ip Code of Person Completing Gause of Death (Item 26) 39c. Data Signed (MO/Oay/Yr) 40. Registrar s Distrltt Num er 41. Registrar Lure ~.. 42. R istrar File Data Mo ay r - ~_ o ~~ ~ ao a 43. Amendments Disposition Permit No. V ~ /1 1.1~ REV 07/ 031 ~.. _. LAST WILL AND TESTAMENT ~~~ _~~~ ~'. o OF ~'~ . ~' __ . , ~c :.~- ;- DALE O. HARTZELL ~ ~, n, ~= ~„ $ ~ ~~ I DALE O. HARTZELL, of the Borough of Carlisle, Cumberla+a~l Coun~r, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me.. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or -. ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate in equal shares unto my children, Patricia Lee Hartzell and Dale O. Hartzell II, provided they survive me. THIRD In the event that my daughter, Patricia Lee Hartzell should fail to survive me, then I leave her share of my estate to her daughter, my granddaughter, Lauren. In the event that my son, Dale O. Hartzell It, should fail to survive me, then I leave his share of my estate to his wife, my daughter-in-law, Kimberl y Hartzell. FOURTH direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH I do hereby nominate, constitute and appoint my son, DALE O. HARTZELL II, to act as Executor of this my Last Will and Testament. Provided, however, that if he is unwilling or unable to act as Executor, I direct the duties of Executix to be performed by my daughter, Patricia Lee Hartzell. SIXTH I direct that no personal representative or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, DALE O. HARTZELL, have hereunto set my hand and seal to this my Last Will and Testament, consisting of two (2) typewritten pages, the first of which bears my signature in the margin for identification, this (•1'i' day of January, 2012. G~~c/ , DALE O. HARTZEL testator 2 Signed, sealed, published and declared by the above-named Dale O. Hartzell, Testator, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of said Testator and of each other. -~~-~~ ~• ~4?~~'~ ADDRESS 44 N. East Street ADDRESS Carlisle, PA 17013 404 W. South Street Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Dale O. Hartzell, Pamela F. Bowman and James D. Flower, Jr., the Testator and witnesses, respectively, whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of their knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. DALE O. HARTZELL, test r Pamela F. Bowman ,Witness ; D. Flower, Jr-, Witness Subscribed, sworn to and acknowledged before me by Dale O. Hartzell, the Testator, and subscribed to and sworn or affirmed to before me by Pamela F. Bowman and James D. Flower, Jr., witnesses, this ~~~day of January, 2012. Notary Public COMM ly •.. OP PENNSYLVANIA NOTARIAL SEAL TMQMAB E. F1,QIMER, No Public Ca(Ii3~ ~QrQ., CuR1b8i~8M~punty My Commission expires Ocbber 26, 2014 3