HomeMy WebLinkAbout08-29-12~ rcesei
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: Conrad E Headley File No:
a/k/a. (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 150-09-8048
Date of Death: August 5 2012 Age at death: 96
Cozen , pP,,,,~~,wania _ (Stare) with hislher last
Decedent was domiciled at death in Cumberland tY
principal residence at 28 Elm Tree Circle, Newville, West Pennsboro Townshiy. Ctunberland County _ County
Street address, Post Office and Zip Code City, Township or Borough
Decedent died at Green Rid e Villa e Newville Cumberland Cozen Penns lvania
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death: $ 5,000.00
If domiciled in Pennsylvania ............................ All personal property
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ x_(1(1
If not domiciled in Pennsylvania ........................Personal property in County $ 0_~0
Value of real estate in Pennsylvania ............................................ .
TOTAL ESTIMATED VALUE.... $ 5.000.00_
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.)
Street address, Post Office and Zip Code City, Township or Borough
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last Will of the Decedent, dated June 5, 2008
thereto dated n/a
State relevant circumstances (e.g. renunciation, death of executor, etc.)
~,ouniy
and Codicil(s)
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 life, d~nte absentiurante mi~ritate
C --.
~~c.
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and co ~ list ot~[eirs.r--,.~ ~--;
fT7 ~' i. G"1 r X7
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divo#~ 3~~ been e~ lished ~s ~efined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ~Lr~; (_
NO EXCEPTIONS ~ EXCEPTIONS
ni"} - ~ ...~..~
Petitioner(s), after a proper search has/have ascertained that Decedent left no will and was survived by the
„,t,t,r~.,n~t cheetc. ifnecessarv):
~g~ouse (if ~) and;tt~r
~ ~~ ~n 0
D W -~
Page l of 2
Fonn RW-02 rev. 10/11/2011
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
}
} SS:
}
Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
Caroline G. Headle 28 Elm Tree Circle Newville PA 17241
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, th Pe~itioner )will well and truly administer the estate accordi to la
~~s
Sworn to r,,~~firmed a ubscribed bef re ~ Date, - C
me tl~~ ~~ of ,~ %~ Date
// l1 ~ , n f i ,~ _ ~ v'1 /Y1)I /~ Date
By.
For the Register
Date
BOND Required: Q YES Q NO
FEES:
Letters ...................... $ ~V.
(~ )Short Certificate(s)...... `~,~~
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
t„~-r ....... _
Automation Fee ...............
JCS Fee ..................... ,
TOTAL ..................... $
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printe ame: Taylor P. Andrews, Esq
Supreme Court
ID Number: 15641
Firm Name: Andrews & Johnson ~':
Address: ~+ Pnmfr .t S rP ~-. r--~ -r3 ;-r-s
C'arlisle~PA 17013 ,.~~~ ~ ~'?i
tV ~'
'~a ~ . _; ~ ~. a t ..~
Phone: 717-243-0123 Z G' ~ . -_
Fax: 717-243-0061 -- ~° J- --n
Email: tI andrewsnna net 0~~- l,,,a t= rr2
...,i
DECREE OF THE REGISTER
Estate of Conrad E Headley File No:
a/k/a:
AND NOW, ~ ~ ~~--, in consideration of the foregoing Petition,
satisfactory proof having been pr ted bef e, IT IS DECREED that Letters Testamentary
are hereby granted to Caroline E. Headley
in the above estate and (if applicable) that
the instrument(s) dated June 5 2008
described in the Petition be admitted to probate and filed of
Form RW-01 rev. 10/11/2011
as the last Will (and Codicil(s~ of Decedent.
gister f Will /~ ~~
~~,_, i~ ~ " ~~~.
2 of 2
HIO~_h05 REb' 19/I I i
L. -~RAR'S CERTIFICATION OF DEATH
><t,-+s~l~~l~gal to duplicate this copy by photostat or photograph.
Fee fur this certificate, $6.00~~~ f 4 A~~S 29 P~ 2. 3~J
d~1'1`1~' ~ 'vt:~~
P 18 ~ 2 7 5 ~~e~s~o co., ~A
Certification Number
nt
aesYf'nk
1. Decedent's Legal Name (First,
Sa. Age-Last Birthday (Yrs) 56.
~x 9 6 M
Ea. Residence (State or ForeiEa. Rasidence_ (sta:a or Foreign I
8d. Residence (County)
hor l -
9. Ever in US Armed Fo ces7
4.Yes Q No Q Unknown
tot-
.Y. 'i:
e~ ]
1
1
1
s
~ 1
n
m
4
E
s
~'
O_
CERTIFICATE OF DEATH
Phis )s to ccrt~t~ !Itat the in,ormati(>n here given
correct-y copse.,( t~rom an (uiginai C`c~rtii~icate of De.
duly filed u~iti~ use as Local Re~~iStrar. The ori~i~
certificate ~~~ii' be furu~ard(°c.i t~(> the State Vi
Records l~ffi' <, fOr permanent Fihn~.
L~ixve_ ~~~~„~.c. _ AU~ 7 201
Local Registra) Date Issued
_, ... y ~umxf 2. Sex 3. Social Security Number5tate File Number:
4. Date of Death (MO/Day/Vr) (Spell Mo)
1 Year Sc. Vnder 1 Da 6. Date of Birth (MO/Day/Ve 1 (Spell 0 5 0- O 91rth8 0 4 8 ~ Aug 5, 2 0 1 2
Days Hours Minutes n ) P ty and State or Foreign Country)
April 17,1916
~) eb. Residence (Street antl Number -Include Apt No.; Bc. Dltl Decedent Livebin a Topya a County
nship7
28 Eim Tree Circle QYes,deeedentliyedlpJ oe ~y~ _
8e. Residence (Zip Code) Q No, decedent lived within Ilmlss of >, M'P
Marital Status at Time of Death ~Marrled Gi Widowed 11. Survivln 5 city/boro
Q Divorced ~ Never Married Q Unknown g Pouse's Name (If wife, give name prior to first marNage)
ufflx) Caroline Gaunt
13. Mother's Name Prior to First Marriage (First, Middle, Last)
._~ _ .. .. Jessie Zawi t,__-,_-
Q Emera.urr;a m a ~ spltai: Q Inpatle
ge nc Room Outpatient Q ~
b. Facility Neme (If not Institution, give street a
a. Method of Dispos Sion .Q Bur(a
~ Remo 'al from State Q Donati
_ ~ ither (Specify)
d. Location of Disposition (City or Town, State,
St. Ho11y SprincTS P
_. Name and Complete Address of F....°.~l te..u
Tree Circle Newville,~epa
a Hospital: /'Y. ........... ........................... ...
~.....+a Le or lsposrcion I16c. Place of Disposition (Name of cemetery, crematory, or o
Aug 7,2012 Hollinger Crematory
]S S1~t F F I S 1 ELI Person 1., r•i.°.e. ..r ._.___ _ t _ _.
FD 9963
"' ~ "~°" ' - •-n x that best describesthe
Ighest degr ~e or level of school com
leted
t
h 19. Decedent of Hispanic Origin -Check the
p
a
t
e time of death.
Q 8th grade or less box that best describes whether the decedent
Q No diploma, 9th - 12th grade is Spanish/Hispanic/Latino. Check the "No"
~ High school graduate or GED completed box f decedent Is not S
panish/Hispanic/Latino.
8' Some College credit, but no de
Bree No, not Spanish/Hispanic/Latino
Q Associate de
gree (e.g. AA, AS) Q Yes, Mexican, Mexican American, Chicano
Q Bachelor's degree (e.g. BA, AB
BS) Q Yes, Puerto Rican
,
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, Cuban
Q Yes
other S
anish/Hl
Q Doctor.,te (e.g. PhD, EdD) or Professional degree ,
p
spa nic/Latino
e. MD DDS DVM LLB JD (Specify)
1. Decedent's Single Rac¢ Self-Designation -Check ONLY ONE to i
White ndicate what the decedent conside
d h
Q Japanese
Q Black or African Ameri re
imself or
Q Samoan
can Q Korean
Q American Indian or Alaska Natlye Q Vietnamese Q Other Pacific Islander
'
Q Asian I.,dlan Q Other ASian Q Don
t Know/Not Sure
~ Chinese ~ Natlye Hawallan
Q Filipino Q Refused
Q Other (Specify)
~ Guamanian or Chamorro
EMS 23a - 23tl MUST BE COMPLETED 23a
Printing
Date Pron
/PERSON WHO PRONOUNCES OR
RT .
o nced De d (MO Day Vr)
Q
^ ~ ature of Person Pronouncing Death
O
l
:
IFIES DEATH
Itl
Date Si
-~
d ~ Q ~ ~
(
n
y when applicable) 23c. license Number
L f.
.
g
g
~ /~~D ;
~• $
2q. Time of Death ~/`~~ ~~,CS-T Ii
/~
•,.~ ~ .~
-
t
~
L
l
, 1 v
l I ~'I
25
~ `~ 5
W
3 tF ! Cr L
~ 5z
.
-
as Medical Examiner or Coro
n
e r
C
ontacted7
Q Y" O
26. Part I. Enter the chain of event°-di
res
irat Np
CAUSE OF DEATH
seases, injuries, or compliFations--tFlat directly caused th
d
p
ory arrest, or yentrlcular fib e
Approximate
eath. DO NOT enter terminal eyenss such as cardiac arr
rillation without showing the etiology
DO NOT
IMMEDIATE CAUSE ----___~ .
est.
ABBREVIATE. Enter Onl Interval:
Y ane a line. Add additional lines if necessary ! Onset to Death
~~yc-C~_~-- t-~ [~y,_" ~ (~.
(Final disease or condlYion i C . ~ _
~~~y
resulting in death) D t (
q f)
b.
Seq uenTla lly list conditions,
if any, leading to the cause Due to 0
( r as a consequence of):
listed on I(ne a. Enter the
UNDERLYING CAUSE
(disc e ~ Injury that Due to (or as a consequence of):
Initiated the events resulting d,
In death) LAST.
Due to (or as a consequence pf):
26. Pert 11. Enter other slgnifi t ditl [ ib t__ ~ t d
~h but not re
lti
,
su
ng In the under) I aus
Y ng c ¢ given in Part 1 27. Was an autpnev ..e.r......_~~
' Female: to complete the cause of deaths
Q Not pregnant within 30. Old Tobacco Use Contributor toDeath] 31. Manner of Death Q Ves Q No
pest year
Q Pregnant at time of death Q Ves Q Probably Natural
Q Not pregnant, but pregnant within 42 days of death Q N° Q Vnknown Q gccldent Q Homicide
Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Q Suicide O Cou d not be d eerlmined
Q Unkrown if pregnant within the past year Jury (MC,'Day/Yr) (Spell Month) ~
S. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
Q Yes ~ Driver/Operator Q Pedestrian
Q No Q passenger 0 Other (Specify)
)a. Ce er (Check only one):
Q Certifying physician - To the best of my knowledge, death occurred due tp the cause(s) and manner stated
Pronou ncxam~ Certifying physician -To the best of my knowledge, death o red at the time, date, and place, and due to the c
Q Medical E Iner/COrone the basis of examination, and/or Inyestigationr In my opln;on, death se(s) and manner stated
red at the time, date, and place, and due to the c se(s) and r stated
Signature of eertlfler:~~ ~ ccu~ au nne
Title of certifier: _ Licornse Numb¢r:~ ~ ~ ~ - L
lb. Name, Address and Zip Co .. ..,. n,.°. a ause or ueath (Item 26) ~ S
` 39c. Dilate Signled (MO/Day/Yr)
~. Registrar's DI t i t N b 41 R gl t s~.Sa~^.. t o l p ~~ Z.
,~ ` a`(~ / " f~` y~ ~~(~^ ( or 42 R gi [ FII O t Mo Day Yr)
LLL-Jt1J~~R1lNNV Li _ rTTraafees aaa l'~\~= V~~ ~....~ _ _
Disposition Permit No._~ ~ ~ ~ [ ~~'~ H1o5-143
REV 07/2011
NE OR MORE races to Intllcate what
the~ eceden[ considered himself or herself to be
$whlte .
Q Korean
Q Black or African American Q Vietnamese
Q American Indian or Alaska Native Q Other Asian
Q Asian Indian -
Q Chinese Q Natlye Hawallan
Q Filipino ~ Guamanian or Chamorro.
Q Japanese 0 Samoan
Q Other Paclflc Isla nd¢r
Q Other (Specify)
self to be. 22a. Decedent's Usual Occupation -Indicate type of wort
done tluring mos[ of working life. DO NOT USE RETIRED.
i ~_~ , { ` ^
` ~. ,e.~li S 1
LAST WILL AND TESTAMENT
OF
CONRAD E. HEADLEY
,5 .
CU~~~~~F,~J~ND CC., PA
I, CONRAD E. HEADLEY, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any and all wills and
codicils heretofore made by me.
ITEM I: My personal representative shall pay from the residue of my estate the
expenses of my last illness, funeral and burial debts duly allowed against my estate, and all death
taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death and incurred with
respect to all property taxed to my estate regardless of whether such property passes by this Will or
passes outside of this Will.
ITEM II: I bequeath those my automobiles, personal effects, household goods,
and other tangible personal property of like nature (not including cash or securities), together with
any existing insurance thereon, if any, as may be my individual property and not the property of my
Wife, CAROLINE G. HEADLEY, or owned jointly by me with her, as set forth in a separate
memorandum which I shall place with my Will to the persons therein designated. If I shall leave no
separate memorandum, or with regard to my automobiles, personal effects, household goods, and
other tangible personal property of like nature (not including cash or securities) not referenced by
such memorandum, I bequeath such property to my Wife, CAROLINE G. HEADLEY, if she
survives me by thirty (30) days. Should my Wife, CAROLINE G. HEADLEY, not be living on the
thirty-first day after my death, I bequeath such tangible personal property and insurance thereon to
my son, CONRAD RICHARD HEADLEY. I ask, but do not require, that my son, Conrad, shall
~p~ transfer to my son, RALPH W. HEADLEY, items that Conrad believes RALPH would appreciate
~.
• having. As the sole recipient of this tangible personal properly, my son, Conrad, shall have absolute
discretion as to what items should be preserved, what should be discarded, what should be donated,
and what should be sold.
ITEM III: I devise and bequeath the residue of my estate, of every nature and
wherever situate, to my Wife, CAROLINE G. HEADLEY, providing she shall survive me by thirty
(30) days.
ITEM IV: Should my Wife, CAROLINE G. HEADLEY, predecease me or die
on or before the thirtieth day following my death, I devise and bequeath the residue of my estate, of
every nature and wherever situate, as follows:
A. I give and bequeath one half (1 /2) of the balance of my estate to Delaware CarePlan,
Inc., TRUSTEE, IN TRUST, for my son, RALPH W. HEADLEY administered pursuant to the
terms and conditions of the supplemental needs trust [not to be confused with any self-settled trust
created by my son, Ralph or by his guardian with his assets] executed by me and known as the
"Ralph William Headley CarePlan Trust".
B. I give and bequeath the balance of my estate to my son, CONRAD RICHARD
~~
~~
HEADLEY. If he shall not survive me, I give and bequeath his share to his issue, per stirpes. If he
shall not survive me and he shall have no issue, I give and bequeath his share to the TRUSTEE
referenced above with the share to be added to the Trust defined above for my son, RALPH
WILLIAM HEADLEY.
ITEM V: No interest of any beneficiary under this Will, any codicil hereto, or
any Trust created herein, shall be subject to anticipation or voluntary or involuntary alienation.
ITEM VI: My Executor and Trustee, and their successors, shall have the
following powers in addition to those vested in them by law, and by other provisions of my Will,
applicable to all property, whether income or principal, including property held for minors,
exercisable without court approval, and effective until actual distribution of all property:
A. To borrow money from any person or institution, including my Executor or
Trustee, and to mortgage or pledge any or all real or personal property as my Executor or
Trustee ir. its sc±le disc.~~±ion shall chocse.
B. To compromise any claim or controversy.
C. To invest in all forms of property (including stock, common trust funds and
mortgage investment funds, whether maintained by my corporate fiduciary or others) without
restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper,
without regard to any principal of diversification or risk.
D. To retain any or all of the assets of my estate, real or personal, without regard to
any principal of diversification or risk.
E. To sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such
prices and upon such terms or conditions as they deem proper.
F. To employ agents, brokers, legal counsel, realtors, and other assistants and
~~
advisors, investment advisors, and specifically including an experienced and qualified case
manager to advise Trustee as to the most appropriate care and services to be provided to
Beneficiary as well as the consequence on government benefits of proposed distributions
from the trust, as shall be deemed by the Trustee needed for the proper administration of the
Trust, and to do so without liability for any neglect, omission, misconduct or default of any
such agent or representative, provided he, she or they were selected and retained with
reasonable care.
ITEM VII: I appoint my Wife, CAROLINE G. HEADLEY, Executrix of this my
Last Will and Testament. Should my Wife fail to qualify or cease to act as Executrix, I appoint my
son, CONRAD RICHARD HEADLEY of Castle Rock, Colorado, as Executor of my estate. If
neither my Wife nor my son qualify or act as Executor, I appoint F&M Trust, Shippensburg, PA, as
Executor of my estate.
ITEM VIII: I direct that my Executrix and her successors shall not be required
to give bond for the faithful performance of her duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I, CONRAD E. HEADLEY, have hereunto set my hand and
seal to this my Last Will and Testament, consisting of six (6) printed pages, each of which bears my
signature, this 5th day of June 2008.
SEAL
~ )
CONRAD E. H ADLEY, estator
Signed, sealed, published and declared by the above-named Testator, CONRAD E.
HEADLEY, as and for his Last Will and Testament, in the presence of us, who, at his request, in his
sight and presence, and in the sight and presence of each other, have hereunto subscribed our names
as witnesses.
,,~ H~~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ~ SS.
WE, CONRAD E. HEADLEY, TAYLOR P. ANDREWS, and ~/QdLINEG ~~~ly
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 and for his Last Will and Testament and that he signed
willingly-and that he executed as his free: and volur~ta.*°y ac+, for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses
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.
1
CONRAD .HEADLEY, estator
T
J
,Wit ss
Subscribed, sworn to and acknowledged before me by CONRAD E. HEADLEY, the Testator, and
subscribed to and sworn or affirmed to before me by TAYLOR P_ A1~TDRE ~'~'S and
6' ,witnesses, this 5`~' day of June 2008_
~mmvNWtgLTH OF PrNNSY~VAhI,~
NOTARIAL SEAL Notary Public
SHELLY SEXTON, Notary public /
Carlisle Born, Cumberland County (,
~ ~~~~ Expires 'I 26, 2011