Loading...
HomeMy WebLinkAbout08-10-12 PETITION FOR GRANT OF LETTERS REGISTER OF WILL5 OF Cumberland County 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 ` U ~1 Name: Gregory A. Verner File No: ~, - ~ a a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 8/5/2012 Age at death: 60 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 39 College Hill Rd.. Enola PA 17025 Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 39 College Hill Rd.. Enola PA 17025 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 Pennsylvania ............................All personal property $ 80,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 200,000.00 TOTAL ESTIMATED VALUE.... $_ 280.000.00 Real estate in Pennsylvania situated at: 39 College Hill Rd., Enola PA 17025 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 January 11, 2011 and Codicil(s) thereto dated State relevant circumstances (eg. renunciation, death of executor, etc.J 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 bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS 0 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, 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. NO EXCEPTIONS Q 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 Addri~'C~ Ts ~ C` ~ - ;; r'L7 ~ 3 .7 ' F-i ; .: ~ ._.. Cs_ Ca ~ ~ <c} ~~ ~:~~ C"}'+ Form RW-O2 rev. ronlnoll Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } SS: } Petitioner(s) Printed Name Petitioner(s) Printed Address Jennica Marie Hea Hockle 111 E. Cohtmbia Ave. Enola PA 17025 ;;., ,: , , i v CUMBERI-~W© CO. ,PA 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 Petiticner(s) and that, as Personal Representative(s) of the Decedent, a Petitioner(s) will well and truly administer the estate according to law. Sworit to or affirmed anc~ subscribed before ~ Date 1 met ~ day of . (;' -~ '~}-- Date BY~'~ `1~~~ k ~ ~ .~ ~ Date Fur the Register Date BOND Required: Q YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ ( )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ Automation Fee .............. . JCS Fee . .................... TOTAL ..................... $ 0.00 Attorney Signature: c- Printed Name: Mary A. Etter Dissinger Supreme Court ID Number: 27736 Firm Name: Dissinger &Dissinger Address: 400 S. State Rd. Marysville, PA 1705'i Phone: (717)957-3474 Fax: (7171957-2316 Email: manr~gZna.net DECREE OF THE REGISTER Estate of Gre~orv A. Verner File No: ~ ~ - ~ a - 'U ~ ~C~ a/k/a: AND NOW, VC'~IJS..~-, ~~) , ,~d (~ , in consideration of the foregoing Petition, satisfactory proof having b n presented before me, IT IS DECREED that Letters TPr~+e~. YYl P Yl ~{1 h'? a are hereby granted to ~ - ~~ in the above` s to and (if appl' able) that the instrument(s) dated I- l 1- 2 O l l described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent Form RW-01 rev. !0/!1/201 / of Wills .,~~r k~~a~; ~r~ '~}}r .~ - '~~~ ~ C fly _ ~ .. uJ age 2 of 2 H 105.805 REV r9/III LOCAL~~~, ,~,_ ~~~¢~'S CERTIFICATION OF DEATH WARNINf~~,`#t~~g ~e~l,,~p~d~uplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ~~2 A~G ~ d Ph ~: ~ ~ ",'hip i5 to certil} ihal tlir information here t= - ~1Ven 1S correctly copied ~ir)r an original Certificate of Death duly tiled with me ~I~ Local( Registrar. The original ~~~,~ ~~~~~ artificatc. ~~il! he for~r,ardcd to the State Vital Kecurds Ofilet for pi~nn uient filing. Ct~uIBERLAND CO., PA Certification Number 2~ ~_ TVP!/Print In Permanent #33-310 Black Ink L(7cal Re~~isu~.u~ ----- Date [sued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS CERTIFICOTF AF nFATM 1. Decedent's Legal Name (First. Middle, Last, Suffix) 2. Sex 3. Social Sxurlty Number 4• Date d Dexh (MO/OSy/Yr) (Sp111 Mo) Gregory A Varner Male 181-38-9209 August 5, 2012 Sa. Age-last Birthday (Yrs) 5b. Under 1 Year Sc. Under 1 D! 6. Dste of Birth (MO/Day/Ye>r) (Sp<II Month) 7a. Blrthpixe (CIH and Stxe or Fae:gn Country) Mentn. Days Hears Ingtet Harrisbur PA 60 Ma 3, 1952 ]b. Birthplace (County) Ha. Residence (State or Foreign Country) Bb. Residence (Street e nd Number -Include Apt No_) Hc. Did Decedent Llve In a ToWnsAlp7 Penns lvania yea. detedlnt ny<d In East Pennsboro t Hd. Residence (County) 2 g wp. Cumberland ae.aeadlntt (zip cede) 1 7025 Prue. dettdint uy.a wehin umbt of lily/b«o. 9. Ever in US Armsd ForcesT 30. Marital Status at Time of Death Married Widowed 11. Surviving Spouse's Narttc (IT wife, give name prior to nrst marriage( Q Ves ~ Ne Q Unknown ~ Diverted Q Never Married Q Unknow 12. Father's Name (First, Midtlle, Last, Su//Ix) 13. Mother's Name Prior t0 First Mxrlage (First, Middle. Last) Anthon J. Verhovshek a 14a. Informant's Name 14 b. Rllatlonship t0 Decadent 14<. In/orman s Malling Address (Street and Number, Ci[y. State. Zip Coll; g Jennica M. Hockle St e dau ter 111 G ¢ .......................................................... ... ........................... .. . . 1f Death Occurred In a Hospital: ~ Inpatient a. .~! a ea __ _ _ _ _ ... ? ......... ....... ...K o^.Y. aria .... .... ... .... .. ............~ z.................. -- ~ If Death Occurred Somewhe < Ot1i<r TM1an a Hospital: ~ Hospice Faclht D d H yes Emar en RoomJOUtpa[lant Dlad on Arrival y en <tt ome Nursin Home/LO !Term Care Facility Other (Spec ) ~ a2 '~ 15b. Facility Name (If not Instl[utlon, gWe street antl number; ' 15c. City Or Town, State, and Zlp Code iSd. County of Death 39 Colla a Hill Road Enola PA. 17025 a r 16a. Method of DlsposltiOn Q Burial ® Cremation i6b. Oxe of Disposition 16c. Place of Olspozltbn (Name o/ cemetery, ematory, otfier plxi) o O Removal from state p Dpnanon other (sPetlfy) 201 2 ugust 7 Evans Cremator 2 16d. Location of Disposition (City or Town, State, and Zip) 17s. Signatur F 1 Se a licensee or Person In Charge of Interment Ilb. License Number Schea££e t PA 17088 rs own FS 012 849 L ITC. Name and Complete Address of Funeral Facility ~ 8 1H. Oecedent'a Education -Check the box that best describes the h h _ 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Chick ONE OA MORE r o irW (cote whx t ig est tlegre! or laver of school completed at the time of death, box that bast describes whether [he decedent he decedent considered hYmulf or herself to be. Q Hth grade or less is Spanish/Hlspanlc/Latino. Check [h< "N O" ~ WhKe Q Korean Q No diploma, 9th - 12th gratle box If decedent Is not Spanish/Hlspanlc/Latino. Q Blsck or African American Q Vietnamese Q High school graduate or GED completed ®No, not Spanish/Hispanic/La[in0 Q Ameticin Indlrm Or Alaska Naive Q Other Asian Q Some collsg< credit, but n° degree ~ Yas, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hswaiian I] ASSOCIate degree (e.g. AA, AS) Q Yes, Puerto Rican Chinese Q Q Guamanian or Chamorro Q Bacheloi s degree le.g. HA. AB, BS) ' Yes, Cuban Q O Filipino Q Samoan Master ® gr!! (e.g. MA, MS, MEn MEd, MSW, MBA) s de g. Q Yes, other Spanish/Hlspanlc/lA[In0 Q lapinlse [] Other Pacific ItlarWer ~ 17 Doctorate (e.g. Ph O, EdD) er Professional degree (Sped/VI I~ Other (Specify) . MD DDS OVM LLB ID -- 23.~Dyecedent's Singl< Race Self-D<slgnatlon -Check ONLY ONE to Indicate what the dacetlent consltlered himself or herseH to be. 22a. Oeudent'z UFUaI Occupa<lon - IndKae! type d woh Whit! J pr Q apanese Q Black or African American Q Korea ~ Samoan done during most of working IHe. DO NOT USE RETIRED. n O American lndlan or Alaska Native QVI![namise Q Other Pacinc Islander QpOn't Know/NOI Sure Human R0SOl1rCE'_8 Analyst Q Aflan lndlan Q Other Asisn Q Refusetl 22b. Kind of Bus{ness/Industry Q Chinese Q Netlye Hawaiian Q Ocher (Spe<Ny) Q FiIlPino Q Guamanian or Chamo rro t8te OVe rime t ITEMS 2 g - t MUST COMPLETED 23a. Date Pronouncid Dead (MO Day r) 2 Ignsture o Person Pronouneiry Deat Only when appgci , 3c. Ucenx Number gY PERSON WNO PRONOUNCES OR CERTIFIES DEATH AU USL 5, 2012 23d. Date Signed (MO/Day/Yr) 24. Time of Death A rx 10:00 AM 25. Was Medical Examiner or cpwner eontxteev m Y<s p No CAUSE OF DEATH Ap^roximxe 26. Part 1. Enter the chain o1 events-diseases, Injuries, Or compllca[ions--that directly caused the death. DO NOT enter terminal events such as cardiac arrest larval: respiratory arrest, or ventricular ff brilla[ion without showing the etiology. DO NOT ABBREVIATE. Enter only on! cause on a Tine. Adtl additional lints if necessary Onset to lkxh IMMEDIATE CAUSE ----------~--s a. Gunshot to Haad (Final disease or condKio^ Due to for >s a consequent of): -- e resulting In death) - b. Sequentially Ilst conditions, Due to Ipr as a consequence of): 1/ anY, leatling to the cause listed on line a. Enter the UNDERLYING UVSE (disease Or injury that Due to (or as a copse quanta Of): initiated the events resulting d. _ ~ ,n death) (.AST. Oue to (er as a consequence ofl: 26. Part II. Enter other 1 If( dill Ib I d f but n0[ resultin In the underl i i a g y ng cause g ven In Part I ZT. Was an autopsy plrformedi ~ res No zg- wir! atltoP:r n.wl..gs avai4tsle to complete the cause of dexhT 29. If Female: O Yes Ne Q Not pregnant within p st year a 30. Ditl Topacco Use Contribute to Deaths 31. Manner o1 Death ~ Pregnant at time o/ death Q Y<s Q probably 0 Natursl Homicide ~ ~ Pregnant, but Pregnant within 42 daVS of tleafr O 0 No ~ Unknown 0 Accident 0 Pending lnvez<Yatlon Not I7 pregnant, but pregnant 43 days to 1 year before death 32. Date of In u M°/Des /Yr S I~ Suicide I7 Could not rte dlcerminld j ry ( Y ) ( Pell Month) Q Unknown if Pre gnant within the past year 33. Time d Injury August 5, 2012 Aprx 10:00 AM 34. Place of Injury (e.g. home; construction site: farm; school) 35. Location of Injury (Streit and Number, CI[y, State. 21p Cod<) Home 39 College Hill Road, Enola, PA, 17025 36. Injury at Work 3J. If Transportation Injury, Specify: 38. Describe How Injury Occurretl: p y!s p Dreyer/operator p vede~trian Salf Infl (clad Gunshot -Hand can 9 121 No ~ Passenger d Other (Specify) 39s. Certiner (Check only one)- Q Certifying physician - To the best of my knowledge, death occu rr! tlue to the cause(s) and manner stated Q Pronouncing 6 Certifying physician - To the best of my kn m Midlcal E i death occurred at the time, date, and place, and due to the cause(s) and manner stated xam ner/Coroner - On the bacls pf ~ yyy ixa n / nvestigation, In my open ion, death occurred at the lima, dale, >nd place, and due t° [he cause(s) and manner stet<d __ r- SJgnawre of certHlen~ S nue d ~.rtm<r: Acting Coroner utln:e N.,mber: 39b. Name, Address antl Zip Cod! 01 Person Completing Cause of Death (Item 26j 39c. Da<i Signed (MO/Day/Vri Matthew S. Stoner, Actin Coroner 6375 Baeahore Road, Suites #1, Mechanicsburg PA 17050 , Au cast 6, 2012 40. Registrar's District Number 41. Registraf s •ture ~/ // d2. Registrx 1 a3. Amendments ~/1 ~n ~ Z '.[~. ~~ ~t-fit- HIOS-143 Disposition Permit NO. -7-T REV 07/2011 .. i~ - _ • i~ ~ . LAST WILL AND TESTAMENT OF GREGORY A. VERNER I, Gregory A. Verner, of 39 College Hill Rd., Enola, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM I. I direct that all my debts and funeral expenses '~ , including my cemetery lot and grave marker and all expenses of my last ill c ness, shall be paid from my residuary estate as s oon as practicable after my death as part of the expense of the administration of my estate. ITEM II. I make the following specific devises and bequeaths: a• my gun safe, all guns, ammunition, gun cleaning supplies, gun parts, and all gun related material and paraphernalia to Anthony Peter Verhovshek and his issue per stirpes. ITEM III. I devise and bequeath a~)._ of tho r t - _ e5.-, r~~:idLie afiCi remainder of my estate of every nature and wherever situate to Jennica Marie Hagy Hockley. For reason I care not to disclose, I leave nothing to Gregory John Verhovshek in my Will. ITEM IV. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passinci under my Will or otherwise, shall be paid out of the principal of res~ual estate . ~ ~.~ ~?~ -~ ~' F'. } t ~ f~ . ~ q7 ~r .c :. cr C1 ~ ' V ~ ~ -z. •• L~ _. I l a ITEM V. I appoint Jennica Marie Hagy Hockley, Executrix of this my Last Will and Testament. I relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament, which consists of 2. pages, to each of which I have affixed my signature this ~ day of ~_ v~r ~% , two thousand and eleven (2011). -~+.-~ Greg ry A. Verner, Testator Witness Witness Subscribed and sworn to and acknowledged before me by Gregory A. Verner, Testator and subscribed and sworn to and acknowledged before me by - and witness this ~~ day of 2011. NOTARIAL SEAL DANIELLE R VAN HORN Notary Public MARYSVILLE BOROUGH, PERRY COUNTY My Commission Expires Mar 31, 2013 COMMONWEALTH OF PENNSYLVANIA . ss ., COUNTY OF We, Gregory A. Verner, and ~~~, ~~ ~~~"~ {~(~ ~ ~ y~ a n d 1-~~ ~ the testator and the wi nesses respectively, whose names are signed to the attached or foregoing instrument, being firs duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it 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 that time eighteen years of age or older, of sound mind and under no constraint or undue influence. --~c..~..,..~ Grego A. Verner, Testator Wltne s 4 Witness Subscribed and sworn to and acknowledged before me by Gregory A. Verner, Testator and subscribed and sworn to and acknowledged before me by ,A and day of ~ witne ses this ~~IC1 2 011. w ~% +~ r Nota y ublic NOTARIAL SEAL DANIELLE R VAN HORN Notary Public MARYSVILLE BOROUGH, PERRY COUNTY My Commission Expires Mar 31, 2013