HomeMy WebLinkAbout07-26-12PEtITION FOR GRANT OF LETTERS
REGISTER OF WILLS O CUMBERLAND 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 respecttully requests the grant of attars in the appropriate form:
Decedent's Information
Name: Lea Wayne Mentzer
a/k/a: Lea W. Mentzer
a/k/a:
a/k/a:
Date of Death: 0 711 2120 1 2
Decedent was domiciled at death in
principal residence at 1660 York R
Decedent died at
address, Post
Estimate of value of decedent's property at
If domlclled in Pennsylvania...........
if not domfclled in Pennsyltranla....
Hnot domiciled In Pennsylvania....
Value of real estate !n Pennsy/vanl
Real estate in Pennsylvania situated et 11 DD
(Attach additional sheets, it necessary.)
nand County,
Isle 17015
a zip c«fa
17015
Monroe
Code
File No: 21-12 - ~~
(Assigned by Reglater)
Social Security No: 164-30-4922
Age at Death: 83
pA (State) with his/her last
Monroe Cumberland
City, Township or Borough t;ounry
PA
state
All personal property $ 0.00
Personal property in Pennsylvania $
Personal property in County $
........................................................ $ 200,D00.00
TOTAL ESTIMATED VALUE $ 200,000.00
PA 17013
City, Township
t,vunry
® A.
Petitioner(s) aver(s) that he/she/they is/a a the Executor(s) named in the Last Will of the Decedent, dated 0712111999 and Codicil(s)
thereto dated
State relevant circumstances (e.g., renunciation, deem W execlROr, etc.)
Except as follows: after the execution oft instrument(s) offered for probate, Decedent did not mar was not divorced, was not a pa to a pending
divorce proceeding wherein the ggrounds f r 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 nekher the vi im of a killing nor ever adjudicated an incapacitated person.
®NO EXCEPTIONS ~ EXCEPTIONS
9 (If aDPlicable)
c.t.a., d.b.n., d.b.n.c.t.a., pedente life, durente absentia. du ~ minoritate
If Administration, c.ta or d.6.n.c.ta., ^~ +~
Except as follows: Decedent was not a pa to,pending divorce proceeding wherein the grounds for divorce had bee fished as~finedr~i C''~
in 23 Pa. C.S. § 3323 (g) and was neRher he victim of a killing nor ever a indicated an incapacitated person. C-, r ~
NO EXCEPTIONS ~ EXCEPTIONS '
Petitioner(s), after a proper search has/ha a ascertained that Decedent left no Will and was survived by the following ' (if any) and heirst.(a{t 1
additional sheets, if necessary): ~ ~ ' ' -`'
T ~,
Name Relationship Address ~ _ ~'~
Form RW-02 rev f0-11-2011 Copyright (c) 2011 form soRwaro only The Lackner Group, Inc. Page 1 of 2
Oath of Personal F~epresentative I
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COMMONWEALTH OF PENNSYLVANIA ) (,
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R~G~S~~~ ~ 1C ~ ~~~
SS:
COUNTY OF Cumberland
Petitioner(s) Printed Name Petitioner(s) Printed Address
Wanda L. Darr 1650 York Road
Carlisle, PA 17015
~:~; ~:
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The Petitioner(s) above-named swear(s) or a rm(s) the statements in the fo going Petition are true and correct to the best of the knowledge and
belief of Petitioner(s) and that, as Personal Re resentative(s) gltjie Q~cgde , PetRio
ne
wll and truly administer the estate accordin toy law.
Swom to r firmed a subscribed before (
, ~
/C.J /[ 1Lu/~ Date fD
^
me thi y o a ~
Dflta
Date
Register Data
t30ND Required? ~ YE3 ~ NO To the Register of Wills:
Please enter m appearance by my s1 nature below:
FEES:
Letters .......................................... $ 260.00 Attorney Signature:
( 2 )Short Certificate(s)........, 8.00 s -~
( )Renunciation(s) .............. t~~ G ~
^ L~ y(~+,~444+++ ' [
~~~:
( )Codicil(s) ........................ A
( )Affidavit(s) ...................... Printed Name: George F Douglas, III Esq.
Bond ............................................. Supreme Court
Commission .................................. ID Number: 61886
Other Will 15.00
JCP Fee 23.60 P
C.
Firm Name: Salzmann Hughes
Automation Fee 5.00 .
.
Suite 1
Address: 354 Alexander Spring Road
,
Carlisle, PA 17015
Phone: 717-249-6333
Automation Fee ............................
Fax:
JCS Fee .......................................
TOTAL ......................................... $ 311.50 E-mail: gdougtas~satzmannhughea.eom
Estate of Lee Wayne Mern
a/k/a: Lee W. Mentzer
AND NOW,
satisfactory proof having been
are hereby granted to Wanc
in the above estate and (if applicable) that th Instrument(s) dated _
described in the Pettion be admitted to prob to and filed of record as
l)7/Y111898
Will (and CodiciKs)1 of
6Tegister of Wills
Copyright (c) 2011 form software only The
DECREE OF THE REGISTER
Date of Death: 07/1212012
Social Security No: 164-30822
File No: 21-12
C~~O ~ , in consideration of the foregoing Petition,
me, IT IS DECREED that Letters Testamentary
Page 2 of 2
H IOS.ROS RLV (9/11)
LOCAL RE RTIFICATION OF DEATH ~~ " 8~l~
WARNING: It i - '„~~~IG~i s copy by photostat or photograph.
tt..j-~
Fee for this certificate, $6.00
P 18626936
)m~"°" ~ This is to certify that the information here given is
1 JUL 2b At 1~ F PfNy~ correctly copied from an original Certificate of Death
o~ `_ _ r~_ - duly tiled with me as Local Registrar. The original
l„ - ~ ~ 9= certificate will be forwarded to the State Vital
1~ 'O y a Records Office for permanent filing.
~,ava ,~ ~- ' *'
1~tttr
99lMENTOE~~~ ~~~}t°u~ `,°~._.^-,~,r' ~l~l 12/2012
'~""' "'" Local Registrar Date Issued
NMONWEALTH OF PENN3VLVANIA. OEPAgTMENT OF HEALTH. VITAL REC00.D3
GERTI FIGOTE OF ~EOTH _ __
Certification Number
TyP!/Prlnf In
~ verman.nx
1. Oscsdsnt's Ls{al Nam! (First, Middl<, Las[, SufflK) 2. 3sz 3. Srxiv Security Num ! q. Da[v of DvgtM1 (Me Day r) (30e11 Mo)
r
Lae W. Me-ntzer M 164 30 4922
Jul 12
Ss. Age-last BlRhdw IYn) b Un ar V gr 6c Under De 6. Date Of BIRh IMO/Ogy/Yegrj (Spell MOntM1) Ts. Birthpllcs~(Clty and Sll or FOrolgn Country)
ry Momha Osya cars Mlnu[va C.aZ'11Ei1e P
`mil 83 Au 30 r 1 928 Tb- BlrehPl+ce (coYrtq.)
Bg.RlHdvnca (State or Forel{n Country) Bb. Real voce (3troat god Number - Inelutla Apt NO.) Bc. Did Decedent Liw In ! TownshlpT
PA Va, a.<.d.m uy.d n. M1ddleseac ttyp,
y
~
l1O
Btl. R<fl lnce (Ceuntyj ~~~
,~ Pike
Harris
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G1mnY2erland se. Real snca (21p Code) Q No, decedent qwd wRM1In limits eT city/born.
9. EYSr In U3 Arm! ForcesT 10. Mgrl[g 3[stu ![ Time o D!rt Married I owe 11. Surveying 3pou[e's Ngme (H wIN. {Iw name pNOr [o first mgmiggaj
R VIf Q Ne QUnknewn Q Olvprced O Nwer Married QVnknoWn
12. FK !YS Nsma (Flrrt, Middl<, last, Sufflz) 13. MefM1Vr•s Name Prior [o Flrat Marriage First, MI d s, UFV
Charles W_ Mentzer Ve1va Sriu ri?T-1-
14v. In ant's Nam!
rrr, 1qb. RelatlonaM1ip to Decedent 14c. Informant's Malling Address (3trsK end Numbgr, CIN. Scats, 21p Codaj
Franda L. Darr Dau
ter 650 York Rd.
Carlisle BA
1 701
........................................... .... ................
YY
I/ Death Oc<urrod in a Hoapil(, ~ y-Inpatient .•.'
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.,.. ...
e u ^c on on! _ _ _
...................
....... .... j4... .. .... ... .... ... ... ... .........
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:If OaatM1~OCCUrrad 3o,naw Other Then a Hoapill: ~ Hofpice FgcRILy ~ Decaesnt'a~Hgme
Ems nc Room/OU[ sHlM Dsad I
on Ardyal Nunl Hems/LOn -TVrm Cvrv FscI1Ry Other (Spec )
,
13b. Facility Nsmf (1/not Ins[ tut on, {Ne street and tuber;
13<. CIN or n, 9U1, sn Zip Coda 13d. ounN e1 Dea[M1
li
3 1650 York Rd. Car
sle( PA 17013 L~,mtbarland
16a. Mv<hod o1 Dlaposl<lon eYrlll Cromatlon 16b. Dv<e eI Dlapoal<lOn 16c. Place of DlapesltlOn (Name M cgmg[!ry, cromstery, Pr otM1Sr place)
Q 0.lmoval from Stall Q Dpna[Ipn
axhlr (sPltlN)
7/16 2012
LefSort CE3nete
16d. LeclNOn O/ DlapeflHen (CItY or Town, 3[lxe, and Ip) 17s. 51{nalurc of F r I Swrvlc! Ucenss srge Interment 1Tb. License Number
Carlisler PA It'D 012633 L
ITC. Ngms god Complete Adtlross W Funergl Fae111N
Fxvin Brat rs Ftilneral Hsz)'je Znc. S S
~ 1{. Detgdent's Education - C ack fM1e box that bee[ d erlbea tM1e 19. DecadMt of Nlspinlc Ongln -Check the 20. Dlcadsn[Y Race - Check O E OR MORE rocas tp Indical whet
r hl{hart dsgroe or Iswi rN school completed et the tl a of death. box that bast describes whvtM1Vr [hv dgtedent the decedent <onsidercd himsah or M1enelf to bs.
~~MtM1 {red! er less is 3panlsM1/Hispanic/Latino. Check <hs "NO" g4VM1il Q Korsgn
Q No diplomg, 9Ch - 12th grade bOk If tle<edent Is not Spanish/Hlspgnlt/Lgtlno. 17 Black er AMCan American Q Vle[ngmsu
Q High school graduate or GED completed not Spanish/Nispanic/La[In0 0 American Indian Or Alaska Nv[Iw Q DIM1<r Asian
Q 6emg tolls{! trgtlit. bYt no degree Q Yea, M<xlcgn, McKlcan Amerl[an, Chicano Q Asian Indian Q NaCiw Ngwglign
Q Associate degree (a.g. AA, A3) Q Yla, PVerto Rican Q Chlnlse Q Guaminlan or Chamorro
Q BlchlleYa tlegree (e.g. BA, AB, BS) Q Vas, Cuban Q Filipino Q Sgmggn
Q Mgrtvr'a dvgroa (v.g. MA, M3, MEng, MEd, M3 , MBA7 Q Yes. Other Spansh/Hispvnic/LaVne Q aapansa< Q Other Paclflc Islander
Q Doctoral (a.g. PM1D, Edo) or Pr0(esslonsl degrc (Specify) Q other (SPeciN)
VM lD
21. Osc9~ant s 31n6 a Race 3NRDasignetlon - Check O
dAlVl Q J LY ONE to Indicate whrt <ha tlgtvdln< consleercd himself or M1en<If to be. 22g. Oetgdenx's Usual IXcupatlOn - Indicate Npv o wo
3
!P!n!
Q Black or Alrican American Q Koravn e Q
amwn duns during most 01 working Ilh. DO NOT USE RETIRED.
~ Other Pgciflc lalentler
Q American Intllan ar Alasks Na[Iw Q VINn! Q Don't Know/Not 3urc A11 t ~ vEj LYjeC`)'tAttlc
Q AsIM Indigo Q Other Igo Q Refused 226. Kin Dualnaas/Indurtry
Q Chinese Q Natlya wailan Q ocher (SpaclN)
Q Filipino (~ Guama lan or Chamorro ~•]. Men zer t 8 Autp CJ@r V1
• - D 23a. at! ronounca Daa Mo gy r 23 . 6lgnalro Pgnon re,teunc ng D<s On y w s app G . L canes m yr
W P{R;ON w«o PRONOVNC[f OR
CERTIFItl DEATH
~.R a oia , p „ yN /> _ s /?nra-> 3Sg3~
23 .Dal Ignad (Me/D.Y/Yr~
24. Tlms a
lafl~ ^ l w FJ"
~~ a( ~"s'Y i-, 23. Wsa Msdlcal Eaaminvr or Coroner Contact T i Ne
CAUSE OF DEATH AppreKlmgxe
26. Pert 1. Enlr tM1a chvln of wants--diseases, In1u lee, Or complications-that directly ClYSetl the death. 00 NOT enlr terminal events such as cardiac arrest Inlrval:
respiratory srrcsf, qr ventricular flbrlllrtlon wit out s
l,
owi th! f[I logy. DO NOT ABBR[VIATE. Enlr only one caYie on s line. Mltl atltlKlOnal lines N n<clasary t onset to o.atn
IMMEDIATE CAUSE -------------~ a. ~ r
~
tI
(Flnll dlf!!ae er cendltlon Due <o (or as a ronsequence of):
resulting In death)
b. i
Slquantlally list condltlona, Du! t0 (ter ei a tenalqulne! Of):
I} any, llatlln{ !O ih< cause
Ilrted on Ilne a. Enter the c.
UNDERLYING C.AU9E DYe to (or va a concaqulnce of):
(dlssgfe or Inlury Mat
Initlgtsd the syanu resulCing d.
In dsakh) lAST.
Due Cu (qr sequence en: )
ai a con
16. Pgrt 11. Enter other t bY[ not r<sYlting In TI,! underlying ceua< given In Part I 2 as an aYlpay pvrMrmadT
Yai
g. Waro autepiY flnOln{s wslNbls
Co romplste Ms cause W deathT
Yva NO
29. I F<mala: 90. Did Tobacco Use Contribute <o DsatfiT 31. Msnnsr of Osat
Q NOC pro{nant within pest year D Yei Q Probably tural j7 Homlcltle
Q Pro{nant at time o/ darth 1
^~.,~g~~ Q Vnknown ~
ACPIdeM Q Pentlln{ Inysztl{atlon
,g Q Net Pro{nant. but Prstnant within 42 dvys o death J Q Suicide Q Could not b! da[srmined
Q Not pregnant, but pregnant q9 days t0 1 we babr! death 32. Drta ref Injury (MO/Dry/Vr) (Spell MOrRh)
Q Unknown H prcgnan<wlthln tM1e part year 33. Tina of In)ury
34. Place Of Injury (l.g. home; cons[ructlon site; farm; school) 33. Lo<a[lon of Injury 3troat and Number, CIN. Sl[!, Zlp COtle)
36. Injury vt Work 3T. If TranspertvtlOn Injury, 3p CIN: 3B. D<acrlbe NOW In)Yry Occurrctl:
Q Yaa Q Driwr/Operator Q P<tle teen
Q No Q Passenger Q Othe fSpeclN)
3 Ftlflar (Chock only one):
~CgrtNying pM1yflclln - To th! blax of mY knewlltl a, da!!M1 eccurtld due to th! cause(s) and manner atltld
Q Pronouncing A CartlNing pl,ysiclan - To th! b!a of my knowledge, tlvatM1 occurrltl at the time, tlgtg, gntl Plata, antl dw tq [M1V cause(s) sntl manner slbtl
O Medlcll Exeminer/Ctsroner - On tM1e Is M eaa In teen, gntl/Or Invaafigatlon, In my opinion, deat
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cVrr.d !t [h! [Imo, dal, gntl plgcg, gntl doe <O <h
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51{nltYro oT Certifier: ~' y
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TKIa oT certifier: r I D Llwnag NVmblr: ,~ r O ~tq T ~ )i G
39b. N!m dr fa nd Zlp Ctsd! of Plraen Cemplltl g Cause of DIaM (Item 6j 39c. a e Signed (MO/Day r)
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40. R!{Irt
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Disposition Psrmlt Np. REV OT/z011
/~- ~/~
LIAST WILL AND TESTAMENT
I, Lee Wayn Mentzer, of Carlisle, Cumberland County, Pennsylvania,
being of sound an, disposing mind, memory and understanding, declare the
following to be m last will and testament, hereby revoking any and all wills
heretofore made b me. ,
Item I. I dir ct my executrix hereinafter named- to pay all my debts and
funeral expenses.
Item II. I gi e, devise and bequeath all my property, both real and
personal to my da ghter, Wanda L. Darr, providing she survives me .
Item IV. I n urinate, constitute and appoint my daughter, Wanda L.
Darr, as my execu 'x, and direct that she shall serve without bond.
IN WITNES WHEREOF, I have hereunto set my hand and seal this
~-~ ~ dayo 7" ,1A9~"1`1`19
~..
Lee ayne Mentzer
Signed, sealed, pu lished and declared by the above named testator
as and for his last ill and testament, who at his request, in his
presence, in our p esence, and in the presence of each-other have
hereunto subscrib d our names as attesting witnesses:
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COMMONWEALT~i OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, Lee Wayn Mentzer, whose name is signed to the attached or
foregoing instrume t; 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;' d that I signed it as my free and voluntary act for the
purposes therein a pressed.
~~~~ 4
Lee Wayne Mentzer
Sworn to and sub:
before me this the
A~ M. 4i
C~AiMe BMw~
'd ! 99~'
sT ay o -~99~-
Notary
3eM
Wry t~Elit
COMMONWEALTI-~ OF PENNSYLVANIA
COUNTY OF
We,~- and whose names are
signed to e attach d or foregoing ins ment, being dul qualified according
to law, do depose a d say that we were present and saw testator sign and
execute the instrum nt as his last will, and that he signed willingly and that
he executed it as hi free and voluntary act for the purposes therein
contained, that eac of us in the hearing and sight of the testator signed the
will as witnesses; d that to the best of our knowledge, the testator was at
that time 18 or mor years of age, of sound mind and under no constraint or
undue influence. A _ .!
_'Y4 pRC~R ~ ~a~u~ ~M
~.lt4.'a`, `ail , dl
Sworn to and subs "bed before
Me this 21st day of j
. ly, 19
r
C,
Anne M. Cox, ry Public
ddisle Boro~-, nd CouMp
Mp eommisswn ex July 14, 2001