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Home My WebLink About08-15-12Reset 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 Name: Helen C. Rhine a/k/a: a/lc/a: a/k/a: Date of Death: August 11, 2012 File No: ~ ~ ~ ` - ~~ ~ C/ (Assigned by Register) Social Security No: 200-24-0748 Age at death• 80 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 122 N. Fayette Street, Shippensburc PA 17257 Shippensburc Borough Cumberland County Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 121 Walnut Bottom Road Shippensburc PA 17257 Shippensburc Township Cumberland County 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 $ 35,000.00 If not domiciled in Pennsylvania ....................... . Personal property in Pennsylvania $ If not domiciled in Pennsylvania ....................... .Personal property in County $ Value of real estate in Pennsylvania ..................... .................................... $ ~_~~ TOTAL ESTIMATED VALUE.... $ 35,000.00 Real estate in Pennsylvania situated at: (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 May 28, 2002 and Codicil(s) thereto dated Shamn Hill and Rarhara R kn r r nrnm d h it ml s ~ c~ Px nt~ra in f v~r ~f T ~' Rhine ~x~hn ~x~ill act as sal Fa cn nr State relevant circumstances (e.g. 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. NO EXCEPTIONS ~ 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. 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): ~ (+y7 Name Relationshi Address ~ ~ ~" ~' TF ~ s~;~ -- _ ._... r-,. ~ r , .a. ": C~ ,~ r.. ~ ' ~ ~ e D C~ `= m _} ;_ ~-, ~ r~-~ 5~ ~. l `~ J ._,~7 .LL4 _' ``_ s-ri ~Q ..Y.i FormRW-02 rev. 10/1!/201/ Pagc 1 Of Z Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Petitioner(s) Printed Name Petitioners Jer Rhine 9944 Possum Hollow Road Shi ensbur PA 17257 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 or affirmed and subscribed be re ~ ~^ ` - Date ~ " ~~ ' 1 ~. me thi J ~~ay of ~~ l~ / Date BY~ Date r e Register ~ Date .~ BOND Required: ~ YES ~ NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Les ...... ( )Short Certificate(s)..... . ( ~) Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Olh r ....... Automation Fee .............. . JCS Fee . ................... . TOTAL ..................... $ ~,Gv ~ (,~ ~0G Attorney Signature: ~~~ ..-- ~ 6 ~~ ~~ $ -~--9-6'6"_' Firm Name: Address: (717) 532-6673 _t~mgleas~n ~mglea~enlaw_c~m DECREE OF THE REGISTER Estate of Helen C. Rhine File No: ~ ~ / ~ C~" ~, ~~ a/k/a: AND NOW, ~;~~' `' ~ ~ ~ ~ , in consideration of the fore oin Petition, g g satisfactory proof having b en presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Jerry Rhine in the above estate and (if applicable) that the instrument(s) dated May 28, 2002 described in the Petition be admitted to probate and filed of record,as the last Will (and Codicil(s)~of Decedenla \) ~ i ' ,~lri .'`Z~ Register of Wills Offia~Use Only .:.~.- . _; -^ - ~ r ' .~ .~ -. . ~ ? ~~-~. ...... L/ a '.~. t .. f '^ { ~-- tJ , - C7 ~ - ~T ~ Printed Address ~~ ~ = = r ._. ~ Ti -- " ` ~ c + Form RW-02 rev. 10/l1/20/1 Page 2 f RENUNCIATION REGISTER OF WILLS CUMBERLAND ~~ /-urn -r.- ~~ L, ~_~ ~^ ~ ~-- c~ c_.; ~:=, COUNTY, PENNSYLVANIA 2 i 1% c~ 94 Estate of Helen C. Rhine I, Sharon Hill Executrix/dau;;hter (Print Name) ...+ r'~ fe"! ~. c~ ~~ .,.T.-, -1-~ ~ ~ f . i . -_ 1~3 I... ~ / ' f 1... ;_y, . ~:., ~~ . - . ~,-~, ~- ~--~ O Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Jerry Rhine August 14, 2012 (Date) ~ ~~ ~~` (Signature) (Street Address) (City, State, gip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this 1 ~~~''~ day of ~~-~C(~.-S ~ 2.-~ ~ ~L ~"' ~, ~~Gd.,~.~~g l~ Notary Publi My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 Executed out of Register's Office NOTARIAL SEAL CIIRfSiY A ~tN~AUC'KAS NNM~ P1~IN~ '1~. CtMI~EALANO My COIAl11Igi~011 Mr ~. ~~ ~, n~t RENUNCIATION ~~ ~ - ~' `-~~. `- ~N REGISTER OF WILLS ~` ~=~ ~ ~ - " `~' '`= CUMBERLAND COUNTY, PENNSYLVANIA ~ _~; °Q ``n p ~.1- ~ ~. -~ ~~ 9~ ~ -~ --~, Estate of Helen C. Rhine I, Barbara Bakner Executrix/daughter (Print Name) Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Jerry Rhine August 14, 2012 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills ' ~ -~2~~:~tZ/~ ~~ (Signature) ' (Street Address) (City, State, Zip) ~ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this ~ t-~~ day ' ~ ~.~ Notary Publi My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 NOTARIAL REAL CHRIBSY A ~tIK~C~ MO~fy PYrYC TwP.. ~ ~ Ci0A1lIN~~011 ~ ~. ~` §i a .d ~ ~ ~ t a. } . _. fie t~ ~v,,y{~~~ v~/ ~(y ~~'jS.9~t~^µ~.. `5 f _i~~ Sv~~ F. a~ ~.l ... _ 'S: i 4' a i~l `. - ~~ .L.i~ r , ~~ s~ . .l } .~ .. }?~~ BUG { S A~~ 8~ 0 ~~~~~~ <<. i ~ ,'ll~ r'. ~i 0~,~'~i~~'~ u~~i~ t CU~~~ERtAND CO., PA 1. Decedent's Legal Name (First, Middle, Lest, Suffix) - - State Flle N 2. Sex 3. Soclai Security Number umber: 4. Date of Death (Mo/Day/Yr) (Spell Mo) Helen C Rhine Female 200-24-0748 August 11, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Days Hours Minutes South Newton Twp_, PA 80 April 17, 1932 7b. Birthplace (County) Cumberland 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number- Include Apt No.) Bc. Did Decedent Live In a Township? QYes, decedent lived In Fayette St A 122 N . . twp 8d. Residence (Counly Cumberland 8e. Residence (tip Code) 17257 ~[NO, decedent lived within limits of Shippensburg city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Marred Q Widowed 11. Surviving Spouse's Name (If wife give name prior to first marria e) , g Q Yes ~ No Q Unknown ~ Divorced [] Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle Last) , Wayne Comerer Laura Gettel 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State Zip Codej e= 0 , Jerry E. Rhine son 9944 Possum Hollow Rd. Shippensburg PA 17257 C 15a. P ace o Deat .......................................................... .........................................:...................................... Chec on y one if Death Occurred In a Hospiia l: `L{' Inpatient :If Death Occurred Somewhere Other Than a Hospital: ~~HOS ic F ilit ~` ~ ' ° s p e ac y Decedent s Home Q Emergency Room/Outpatient Q Dead on Arrival Nursing Home/Long-Term Care Facility Q Other (Specify) . 15b. Facility Name (If not institution, glue street and number) 15c. City or Town, State, and Zip Cocie 15d. County of Death Shippensburg Healthi;are Shippensburg, PA 17257 Cumberland m 16a. Method of Disposition )_] Burtai Cremation 16b. Date of Disposition 16c. Plai:e of Disposition (Name of cemetery, crematory or other place) u _~ , Q Removal from Slate Q Donation Other (Specify) August 13, 2012 Duga l Funeral Home 8a Crematory, Inc. d c 16d. Location of Disposition (City or Town, State, end Zip) 17a. Signature of Funeral Service Licensee or Person in Cha rge of Interment 17b. Cleanse Number Shippensburg, PA 17257 ~/~ n •--~ ~ ~ ~C.. FD-012884-L E 17c_ Name and Complete Address of Funeral Facility Dugan Funeral Home and Crematory inc. 51 Asper Drive, Shippensburg, PA 17257 ° 18. 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 wh t r - a 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/Wtino. Check the "No" j$[ White ~ Korean J$[ No diploma, 9th - 12th grade box If decedent is not Spanish/Hispanlc/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 Allan Q Some college credit, but no degree QYes, Mexican, Mexican American, Chicano Q Allan Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) BS QYes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's de a e. BA AB gre ( g• ) QYe C b , , s, u an Q Filipino Q Samoan Q Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) QYes, other Spanish/Hispanlc/Latino Q Japanese Q Other P ifi I l d ac c an s er Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q h Ot er (Specify) e. . MD DDS DVM LLB JD 21. Decedent's Single Race Self-D esignaiion -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 life. DO NOT VSE RETIRED. Q Black or African American Q K a ore n Q Other Pacific islander Q AmeNCan Indian or Alaska Native Q Vietnamese Q Don'i Know/Not Sure laborer Q Asian Indian Q Other Asian Q Refused 2<<^b. Kind of Business/Industry Q Chinese _ Q Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Ghamorro manufacturing ITEMS 23a - 23d MUST BE COMPLETED 23a_ Date Pronounced Dead (MO/Day/Yrj 23b_ Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR AUCJUSt 1 1 , 2O 12 CERTIFIES DEATH ' 23d. Date Signed (MO/Day/Yr) 24. Time of Death - . 4:28 AM 25. Was Medical Examiner or Coroner Contacted? Q Yes Z8[ No CAUSE OF DEATH Approximate 26. Part t. Enter the chain of events-diseases, injuries, or complications-that directly caused the death. DO NOT enter terminal events such as cardiac arrest ' rote rvai: , respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary ~ Onset to Death IMMEDIATE CAUSE > a. Lung cancer (Final disease or condition ~ Due to (or as a consequence of): resulting In death) i b. Sequentially Ilst eondittons, _ ~ Due to (or as a consequence of): If any, leading to the cause listed on line a. Enter the c. - F1F W UNDERLYING CAUSE Due to (or as a consequence of): f (diseace.Dr injury that initiated the events resulting d. ~ u fn death) LAST. Due to (or as a consequence of): y' , _ 26. Part if. Enter other slRniflcant conditions contributinz to death but not resulting in the underlying cause given in Part 1 27 W w ~ . as an autopsy pe rformed7 Q Yes No m 28. were autopsy findings available to complete the cause of death? d Q Ves Q No 29. If Female: 30 Did T b c E ° Q Not pregnant within past year . o acco Use Contribute to Death? Q Ves Q Probably 31. Manner of Death ]$[ Natural Q Homicide r. .r °' Q Pregnant ai time of death ~ No Q Unknown Q Accident Q Pending Investl atlon ° Q Not pregnant, but pregnant within 42 days of dealt g Q suicide Q Could not be determined , Q Not pregnant, but pregnant 43 days to 1 year before death Q Unlmown if pregnant within th t 32. Date of Injury (MO/Day/Yr) (Spell Month) e pas year 33. Time of Injury 3a. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, Clty, State, 21p Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes Q DNvcr/Operator Q Pedestrian - Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): ]$Z Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronouncing g, Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/Co r oner - On t h e basis of ex aml natl On a nd/or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated ~A ff ~j J D ~ D c ~ ~f Signature of certifier: YY.~rr~.7fa.~/i .rl~ ~i~ ,V .CJ c~ Title of eerttfier: M.B_B_S. ucense Number MD063751 L 3 9b. Name, Address and Zip Code of Person Completing Cause of Death (item 26) 39 c. Date Signed (MO/Day/Yr) Amatul Khalid, M.B.B.S. 1988 Scot-and Avenue, Chambersburg, PA 17201 August 12, 2012 4 0. Registrar's DlstNCt Number 41. Reglstra is Signature 42. Registrar File ate (Mo/Day/Yr) V _ J J. 4 3. Amend menu 0739438 H1DS-ia3 Disposition Permit No. REV 07/2011 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, HELEN C. RHINE, of Pennsylvania being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all of my property, be it real, mixed or personal, to my children, Jerry Rhine, Sharon Hill and Barbara Bakner in equal shares, share and share alike, per stirpes. THIRD: I nominate and appoint my children, Jerry Rhine, Sharon Hill and Barbara Bakner Executors of this my Last Will and Testament. FOURTH: I direct that no bond be required of any Executors namned herein. IN WITNESS WHEREOF, I, HELEN C. RHINE to this my Last Will and Testament, set my hand and official seal, this ~;~' r~~' day of May 2002. ~ ~ '~~ ' `' ~ ~, .~ ~ ~ ' tom- ~ -~x r` • .~. EAL [ ~ Helen C Rhine =~ ~~`~ -~''~~ . __ .-~ ~~ ~ ~_~ ,J - ~ ..._ r-_ ~ - C1"1 ..a _t r ; ~ i -> -~~s Sworn to and subscribed, declared and Published by Helen C. Rhine, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of each other. .. __ ~~ ~. ..~. , ~' .~, t. =t __ ' f{~ ~` COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND I, Helen C. Rhine, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly and that I signed it as my free and voluntary act for the purpose therein expressed. Helen C. Rhine Sworn to and acknowledged, before me, By Helen C. Rhine, Testatrix This ~'~~'`~ day of May 2002. T ~ a ~~. { ~, ~.t. ~'.~ ~ ~ ,~ i~ .ti ~r 1, f I 3 Notary Public iVotariai Seal pub!'te ®awn Marie Shoop, Notary Shippen~burg ~3ora, Cumberland 20J4 My Ccm~sss~an i=xp~ces Feb. 5, COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~~ .fi~~ ,, 4 ~ •y ~ ~ <t .. ~, G~ ~~ jJi /p // / ~ Sworn to and subscribed before me by, H. Anthony Adams and Sharon Coleman Adams, The witnesses, this ,~.;~_ r~'~`~-`~~day of May 2002. i; Notary Public ~ 1`lateria8 deal l:i~~~~Ularie Shczap, l~atary P~biic ~11i~~~n~b~ jrg Borg, Cumber~snd Ca~r:fiy My ~c~~T`:c,+~:~sic~n Expires >=eb. 5, 204