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HomeMy WebLinkAbout08-03-12PETITIOV FOR GR~tiT OF LETTERS REGISTER OF "ILLS OF ~~,x~, ~ ~ r- i ~ ~~ ~ COL~tiTY, PEti~SYLV_-~~'I.~ to ._~:~~ :a.r.u ~:. , ~:~ ~.o :~ <<:.. : ~ •, ~ ;r; of ;,~~-~ ~r o '~~~ _ ~` ', ; izs ~ ~- ~~F'.,:~; u~ ~^ ~~lo~,ti. any: u7 ~L,"rvOr: _.~~.','~~it ay~rij~ .::: .L.:O'~,b:. _ a:: ::.~"`....~'., I~ .' -~ tH- ~ ~r ~r'~ -~ n _ ~t, ~. ~:, ,, ~~.~ y; nt ~.: L :.~.~r_ ,, .:~` ap~r~~pr.ate for:r~: Decedent's informatio~i `ame• - i'Y1 i ~.. ~ 4 .~ ~ ~-- ~ ~'_ ~ c' ~ File ~o: a/k;'a: _ (Assigned by Register) a/k/a: ~ ~ 'f a/k/a: Social Security No: ~ ~[~ (~'•~ ~ ~ ~,~, `'`°~ ~~ Date of Death: fti't y,~~ ~ I ~ ~ ~ 1 ~. Age at death: ~ ~ Decedent was domiciled at death in [., y „~ b ~r 1 ~ ~• ~ County, P f} (State) with his/her last principal residence at ~~ 1 ~ ~ s~ (j ~ ~. C ;~ ~,~ " t~.-i ~~ Street address, Post Office and Zip Code City, ownship or Borou County Decedent died at ~ 1 ~ ~ ~ S~I !`~ ~ t7 n ~ ~~ `..~`~ L 7 a2S ~ ~ ~; a ~ c~/~ ~ ~ t.~ Pc~ ~.- i.; ~h6F't~ ~a~~ ~ ~ ~' 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 $ ~ ~ „ ~~' (,~: 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 ESTIivIATED VALliE.... $ [) ["~ _ (s Real estate in Pennsylvania situated at: (,4ttach 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 isiare the Executor(s) named in the last Will of the Decedent, dated ear - ~ c - E ~~ ~ls and Codicil(s) thereto dated State relevant circumstances (e.g. -•enunciation, 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. '~ NO EXCEPT IONS ^ EXCEPTIONS [] B. Petition far Grant of Letters of Administration (If applicable) c. t. u., d.i5.t~., d. b. n. c.t.u., pendente lite, datrunte absentia, dttrante mina•itctte If Administration, c.t.a. ord.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 i~123 Pa. C.S. § 3323(g) acid was neither the victim of a killing nor ever adjudicated an incapacitated person. [~ ~'O EXCEPTIONS ~ EXCEPTIONS ~ ,._ 7 P~ationer(s), after a proper search has/have ascertained that Decedent left no Will ana was survived by the followinouse (ifany) ~ heirs (attap4.'~ additional sheets, if necessary): ~ ~? ~ SJ x' a` ~ 1,.7 Name Retationshi Addressp~~'= -- _ ~' Ca.3 ~. ~: ~ ~_ -- .~ -__, .. ~ n 3> ..," Fnrm RW-0? ,•e~. ln~ll~ln!! Page 1 of 2 Oath of Personal Representative CO~~I~~iO~~WE:~LTH OF PEN~SYLVANI.-~ } ~ } SS: CO`~'VTY OF ~. ~ ~ Ia r!" ~ ~! r1 i~ '. ~~._ ~ ;cial Use Only;~ ~ C7 =~"~ ~ ~ i .' `~I Q ~. . .. C'~ _, , ~~~; r, .:icn~. ~:. r....,~ ~~~r:e + Petiricr:_„ ~; Prir._d .>.ccresa ~': N ~- i=ts i ~ ` ..p .. The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, t e Petitioner(s) will ~ ~~ tntly administer the estate according to law. Sworn tom affirmed a s bscribed be ore ~ ~ Date ~ ~ ~ ~-- .~ ~ ~' - ;~. ine is /'tL day of ~~~'~ Date By' Date or t e Re,;ister Date BOND Required: ~ YES ~ NO FEES: Lett ...................... $ ~~~c ( v) Short Certificate(s)...... 'mac ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( ) Aftidavit(s)........... . Bond ........................ Commission ................. . Other . , ..... . Automation Fee . .............. -~ ~) JCS Fee . .................... '- ~ TOTAL ..................... $ ~D To tl:e Register of Wi!!s: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of r C~ ~ f~ ~ -'~f' File No: ~ a/k/a: AND NOW, satisfactory proof having the instrument(s) dated ~~ described in the Petition be admi to probate and filed o Register ~~/ , in consideration of the foregoing Petition, ~~ presented before me, IT IS DECREED that Letters _ _ e hereby granted to / / ~/ Q ~y1 /~ , _ ~~ ^ ~ . a ~ , ~ ~ , ~ in the above estate and (if applicable) that as e last Will Wills Codici i; s)) of Decedent. C~ ~~~ ~~ Fnrm R 6i~-OZ rev. ~ nip ~i~n! ~ `~ `"t~"~a~ef2'bf 2 HI(!~.)tI)j R(,;V 1915 11 (jr~g~~~~~~ , ~ ~~ Fee for this certificate, ~C~.~(~ ~_8~~~~~~.. Certification N~an~a~~e Type/Print In Permanent ~,l w Q 5 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS !`COTI CI r'ATG ("1G rIG~TN _. _.. _. ,lack in k 9f .33-L 11 ----- Suffix) 2. Sex 3. Sociat Security Number 4. Date of Death (Mo/Day/Yr) (Spelt Mo) Middle Last al Name (First Le d t' , , , s g en 1. Dece Michael L Beidel Male 200-64-3533 March 13, 2012 Sa_ Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a.~irthp_ ~cP (C~eand S~aje or Foreign Country) LLJLC C d f.~ i ~ Months Days Hours Minutes 41 Februar 18 1971 7b. Birthplace (county) c,tm a.n 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Sc. Oid Decedent Live in a Township? pA P~ z ? S~-h e 2 1 ~ ~ b~ Oh Q Ves, decedent Ilved in twp• 8d. Residence (County) Cumb¢lreQn.d i2. i . . ng 1 8e. Residence (Zip Code) S'~- ~H.6 b(JCn No, decedent lived within limits of n~ g city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death [] Married Q Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes (,$~ No Q Vnknown Q Divorced }~ Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, last) G . GV.c.P~~i:.am B e~de~ Au.dne J . P1r.O~s.a eJr- Name 14b. Relationship to Decedent 14a. Inform n s 14c. Informant's Mailing Address (Street and Number, Gity, State, Zip Code) ~ G . 4tJ.~~c.am 81?~i..de.e Scr~thelc 7 5 ffa. y~ Gor.a v e Ra Izd, Newv.i.P~Ee PA 1 7 2 41 lSa. P ace o Death Chec on one --- --. _,-- -,_,,,,-, ..... ....... ....... ...... atient ,If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facili Decedent's Home ~ I l c ~ np : If Death Occurred in a Hospita Q Emergency Room/Outpatient Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Q Other (Specify) County of Death de 15d d Zi t C - . p o e, an lSc. City or Town, Sta 15 b. Facility Name (If not institution, give street and number; PA 17257 Cumberland ~ 210 East Orange Street Shippensbiirg, 16a. Method of Dlsposltion Q Burial Crernatlon 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) m ,~ Q Removal from State Q Donation Other (Specify) 3 -1 6 - 2 O 1 2 f{a.P~tin. eJc. Cfc.e.matofc.i.um c 16d. Location of Dlsposltion (city or Town, State, and Zip) 17a. Signature of Fun rv ce Licensee or Person In Charge of Interment 17b. License Num er ~ ~ M~_ ffa.2.ey Spfc.~.rrg.a, PA 17065 ~ 1="D-012984-L a E 7c. Namp~ a~nd Complete Address f Funeral Facility ~ p IYIC. 112 Rll2b~ K.f-n Skeet Sh.c- en.abu~c- PA 17257 Ln2JC a.e f~fame ~e eJc -8h e~z ( 7~bQ Y1 etc ~ ~° m . . . . _ . . . . . . o 1 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 18 i-° . 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 to be. Q 8th 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 American ~ Vietnamese Q High school graduate or GED completed No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree QYes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian h amorro Q Associate degree (e.g. AA, AS) QYes, Puerto Rican Q Chinese Q Guamanian or C Q~J Bachelor's degree (e.g. BA, AB, BS) QYes, Cuban Q Filipino Q Samoan P ifi I l d h er s an er ac c Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) QYes, other Spanish/Hispanic/Latino Q Japanese Q Ot Q Oocto rate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) e. MD DDS DVM LLB, JD 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 21 . White Q Japanese Q Samoan done during most of working life. DO NOT VSE RETIRED. n Q Korean [] Other Pacific Islander i i A mer ca can Black or Afr Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure ~ 22b. Kind of Business/Industry Q Asian Indian - Q Other Asian Q Refused Q Chinese Q Nat(ve Hawaiian Q Other (Specify) iv'~ T ycb ~~e~aYL( - Q Filipino Q Guamanian or Chamorro ITEMS 23a - 23d MUST SE COMPLETED 23a. Date Pronounced Dead (Mo/Day/Yr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH March 13 , 201 2 23d. Date Signed (Mo/Day/Yr) 24. Time of Death A rox _ 9:00 P . M. 25. Was Medical Examiner or Coroner Contacted? Yes Q No CAUSE OF DEATH Approximate Enter the chain of events-diseases, Injuries, or complications-that directly caused the death. DO NOT enter Terminal events such as ca rdlac arrest Inte rvai: Part 1 26 . . respiratory arrest, or ventricular fibrillation without showing the etiology. 00 NOT ABBREVIATE. Enter only one cause on a line. Add additional Tines If necessary Onset to Death Mixed SubSta-I1Ce Toxicity IMMEDIATE CAUSE --- -> a. (Final disease or condition Due to (or as a consequence vf): resulting In death) b. Sequentially list conditions, - Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c. VTIDERLYING GAVSE ' ~ Due to (or as a consequence vf): W (disease or Injury that ~ Initiated the evenu recd/[Ing d. W in death) LAST. . ~ Due to (or as a consequence of): J 0 26. Part I1. Enter other .ienifica nt conditions contributing to death but not resulting In the underlying cause given in Part 1 27. Was an autopsy performed? Yes Q No ~ ~ 28. Were autopsy findings available to com fete the cause of death? m v Yes No d If Female: 29 30. Did Tobacco Use Contribute to Death? 31. Manner of Death ' E . Q Not pregnant within past year Q Yes Q Probably Q Natural Q Homicide S m Q Pregnant at time of death but pregnant within 42 days of death re nant Not Q No Q Unknown Q Accident Q Pending Investigation ~Sulclde Q Could not be determined r°- , p g Q Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (Spelt Month) Q Unknown If pregnant within the past year Unknown 33. Time of in)ury Unknown 34. Place of in)ury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) Home 210 East Orange Street, Shippensburg, PA 17257 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: In~eS tad OVerdOSe quantities Of Q Yes Jg Nq Q DrivCr/Operator Q Pedestrian Q Passenger Q Other (specify) over the counter medications _ 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurr ue to the cause(s) and manner stated Q Pronouncing 8. Certifying physician - To the best of my kno _ ge, death occurred at the time, date, and place, and due to the cause(s) and manner stated t t d d manner s a e I$ Medical Examtner/Coroner - t sis of mina nd/or Investigation, In my opl nion, death occurred at the time, date, and place, and due to the cause(s) an Signature of certtfler: Title of certifler~h ief Deputy COrO'Re~icense Number: Address and Zip Co a of Person Completing Cause of Death (Item 26) 63 7 5 Bas chore Road , Spite 1 Name 39b 39c. Date Signed (MO/Day/V r) , . Matthew S_ Stoner, Chief Deputy ner Mecha~n.icsbur , PA 17050 May 3, 2012 ct Number 40,a Registrar's Distri 41. Re$IStra is 5 ature _ 42. Registrar Flle Date (Mo/Day/Yr) ~J 43. Amendments ~ " ~~~g2 ~-~~ -3 P~~ !~: t ~ I ~.. ~-~~ ~ . ~~ ,~. ~~ ~'- ~~~ ..,~.s ~1~8E~t.~D ~~~~. ~~ ~.~~ U., Pq ,. ~. are Disposition Permit No. G' L J ` ~ C/~ REV 07/ZO11 LAST WILL AND TESTAMENT OF MICHAEL L. BEIDEL I, MICHAEL L. BEIDEL, of the Borough of Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made: FIRST: PAYMENT OF EXPENSES - I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. SECOND: SPECIFIC DEVISE OF REAL ESTATE - I hereby devise my real estate, together with improvements thereon, located at L10 East Urange Street, Shippensburg Borough, Cumberland County, Pennsylvania, to my brother, WILLIAM A. BEIDEL. If he predeceases my, I then devise said real estate to my father, G. WILLIAM BEIDEL. THIRD: RESIDUE OF ESTATE - I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal, or mixed, of whatsoever kind and wheresoever situate, unto my brother, WILLIAM A. BEIDEL. In the event my brother fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest, residue and .~ remainder of my estate, be it real, personal, or mixed, of whatsoever kind and wheresoever situate, unto my t°ather, G. WILLIAM BEIDEL. .FOURTH: EXECUTOR - I appoint my brother, WILLIAM A. BEIDEL, Executor of my Will. In the event that WILLIAM A. BEIDEL predeceases me or is unwilling or unable to serve as Executor, I then appoint G. WILLIAM BEIDEL Executor of my Will. Neither my Executor nor any successor shall be required to give bond. FIFTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual payment to a beneficiary or to his or her account, no interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary. IN WITNESS WHEREOF, I hereunto have signed my name to this, my Last Will and Testament, consisting of two (2) typewritten pages, this _~_ day of ~~ f~~ ~ ~~' , 1995 . ,/? MICHAEL L. BEIDEL, Testator In our presence, the above-named Testator signed this and declared it to be his Will, and now, at his request and in his presence and in the presence of each other, we sign as witnesses: PAGE 2 +. ,, r ~.. J ' i ~- r { 1 {._ STATE OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, MICHAEL L. BEIDEL, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will and that I signed it as my free and voluntary act for the purposes therein expressed. -' ~°` .- ,, ~~ ,- MICHAEL L. BEIDEL, Testator We, having been duly qualified according to law, depose and say that we were present and saw MICHAEL L. BEIDEL sign the foregoing instrument as his Will; that he signed it as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing and at his request signed the Will as witnesses; and that to the best of our knowledge he was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ;, ;~ N _, ~ {, , ,. /~, t ,~ ~ o '~ - ..1. PAGE 3 Y ~ ~ Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testator and by the witnesses whose names appear opposite on this ~ ~;~F ~~ day of '°~~ a j Notary Public NOTA~,IAL SEAL Rlcl+ard L. Webber, Jr., Notary Public Newville Boro, Cumberland +Coun~y My Commission Expires April 20, 1998 PAGE 4