HomeMy WebLinkAbout08-20-12In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
IN RE: Estate of
NELLIE K. WOODS, .
Late of Carlisle,
Cumberland County, Pennsylvania
Deceased .
NO. ~ 1 - ~~, U / ~~
PETITION FOR SETTLEMENT OF SMALL ESTATE
Pursuant to Section 3102 of the Probate, Estates and Fiduciaries Code, the undersigned
Petitioner respectfully represents that:
1. The Name and Address of the Petitioner is:
Gregory E. Woods
122 Ashford Way
Camp Hill, PA 17011
2. The relationship of the Petitioner to the Decedent is: Son
3. The Decedent died on: June 24, 2012
4. The Decedent was domiciled at time of death in Cumberland County,
Pennsylvania, with a last family or principal residence at:
Sarah A. Todd Memorial Home
100 West South Street
Carlisle, PA 17013
5 ecedent's Social Security Number is: 172-01-9400
The D G~ ~' ~' ~ ~?
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6. The Death Certificate is attached hereto. ~~ - ., v c~:~,
7 The Decedent died: ~ =~ " y"
.
^ (a) intestate
Q (b) testate A copy of the Will is attached. ~~
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8. The name(s), relationship(s), and interest(s) of all parties beneficially interested
in the estate are: SUI JURIS
NAME RELATIONSHIP INTEREST es/no
Yes
Gregory A. Woods Son 100%
g. A Spouse's Elective Share
a (a) Has not been claimed
^ (b) Has been claimed (Give details]
10. If the Decedent died testate, the Decedent:
p (a) was not married or divorced after the execution of the Will
^ (b) was married or divorced after the date of execution of the Will
Give details]
11. If the Decedent died testate, the Decedent:
(a) did not have a child or children born or adopted after the date of execution of
the Will
(b) had a child or children born or adopted after the date of execution of the Will
Name Date of Birth of Adoption
NONE
12. The Decedent died owning property (exclusive of real property and property
payable under Section 3101 of the Probate, Estates and Fiduciary Code) of a
gross value not exceeding $5,000.00, which is itemized below.
Item Amount
Readers Digest Refund Check $ 58.00
Sarah A. Todd Memorial Home Refund $1,700.00
Estate Checking Account at BELCO Federal Credit Union $1,500.00
13. An itemized statement of all claims against the Estate is set forth below: NONE
(a) The following person(s), claims(s) the family exemption under Section 3121
of the Probate, Estates and Fiduciaries Code by virtue of being a member of
the same household as the Decedent:
Name Relat= Amount of Items Claimed
Total; 0.00
(b) The following persons claim reimburse) cable otheebhave paid with thei ~owen
claims (including inheritance tax, if app ) Y
funds: None
(c) There are no unpaid claims.
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14. There are no undisputed or disputed Claims.
15. The Petitioner has paid or will cause to be paid all Pennsylvania inheritance tax
due on all property to be awarded under this Petition.
16. All parties beneficially interested in the estate, other than the Petitioner, including
all holders of claims that are denied, or, in the case of an insolvent estate, all
holders of claims who will not be paid, NONE:
^ (a) signed the joinder in this Petition which is attached; or
^ (b) been mailed at least ten (10) days written notice of the date, time
and place of the Orphan's Court Audit session at which the Petition will be
ruled upon by the Court, a copy of which notice is attached hereto.
17. Your petitioner proposes:
(a) that the family exemption, if any, be paid or satisfied as follows: None
(b) that the following claims be paid: None
(c) the balance, if any, be distributed as follows:
~: Q2~RX Fa WOOU~, SOLE BENEF IARY OF THE ESTATE
Signature o eti oner "
Typed Na e: REGORY E. WOODS, Sole
Beneficiary, Join Owner of Account
Q ~
Signature of AttorKey for Petitioner
Typed Name: EDMUND G. MYERS, ESQ
Supreme Court ID: 20558
Office Address: Johnson, Duffle
PO Box 109, 301 Market Street
Lemoyne, Pa 17043
Telephone No. 717-761-4540
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VERIFICATION
The undersigned petitioner hereby verifies, subject to the penalties of 18 Pa. C.S.A.
§4904 (relating to unsworn falsification to authorities), that the facts set forth in the foregoing
petition which are within his knowledge are true, and, as to the facts based on information
received, after diligent inquiry, he believes them to be true.
Date:
Signature of eti oner
GREGORY E. WOODS, Sole Beneficiary,
Join Owner of Account
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ji05.805 REV r+/I I)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, `6.00
P 18b~.4865
Certification Number
This is to certiEv t}rat the inforn7ation here ~iVen is
co)Tectly copied fro(~~ an o)~i~ it~al C'ertific<ate ul Death
duly filed with ntc as Local Registrar. I'ht~ original
certificate ~~ill 1?e fl,)rwardcd to the State Vital
R~ Officr~,)en7ument filing.
1'11 JUN~2 8 2 12
Local Rei~is[rar [late Isued
Type/Print In
Permanent
Black Ink
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COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
CERTIFICATE OF DEATH
1- Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo)
Nellie K. Woods Female 172-O1-9400 June 24 2012
6a. Age-Last Birthday (Vrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/D ay/Year) (Spell Month) 7a. Birth lace (city and State or Forel Country)
Months Days Hours Minutes Cumberland Co. ~A
97 February 5 , 1915 76- Birthplace (cp~nty) Cumberland
8a. Residence (State or For¢ign Country) R
¢
idenc¢ (Stre¢t and
N
umber -Include Apt No.)
Sb.
s 8c. Did Decedent Live in a Township?
Penns lvania ~
V
-
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t
~ QYea, decedent lived in
twp.
Bd- Residence (County) 1000 W. SOUth St.
Cumberland
8e- Residence (Zip Code) o, decedent lived within limits of Carlisle 1
c ty/boro.
9- Ever in US Armed Forces? 30. Marital Status at Time of Death Q Married ~~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
Q yes ~NO Q Unknown Q Divorced Q Never Married Q Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Jacob W. Kutz Ruth Wa oner
14a. Informant's Name 146. R¢Iatlonship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
g Gre or K. Woods Son 122 s o Wa O
15a. P ace o Deat C ec
_ If Death Occurred In a Hospital: t~ Inpat(ent If Death Occurred Somewhere Other Than a Hospital: (~ Hospice Facility ~]` ~ Decedent's Home
Q Emergency Room/OUtpatlant Q Dead on Arrival
• Nursing Home/long-Term Care Facility Q Other (Specify)
o~ 15 b. Facility Name (if ndi ins[itutlOn, give street and n tuber;
u i5c. Ctt or Town, State, d Zi Code 15d. County of Death
y
1
Sarah Todd Memorial Home Car
l.isle PA
/013 G~imberland
S6a. Method of Disposition ~ Burlai Q Cremation 16 b. Date of Disposition 16c- Place of Disposition (Name of cemetery, crematory, or other place)
~° Q Removal from Stale Q Donation
Other (Specify) _
O
Z 16d tiort of ispositlon (r~y~ r Town, State, and Zlp)
~
`r
~ 1'la atu re of Funeral Service Licensee r Person rge of interment 1?b. Number
4
ris
urg~ YA:
I
a 01
819
E 17c. Nam¢ and Complete Address of Funeral Facility
8 ers-Harney Funeral Home 1903 Market St. C Hill PA 17011
IH. Decedent's Education -Check The box Shat best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE ra o indicate what
t
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 9th grade or less is Spa Wish/Hispa ni</Latino- Check the "NO" [`White Q Korean
0 No diploma, 9th - 12th grade box it decedent is not Spanish/Hispanic/Latino- Q Black or African American Q Vietnamese
High school graduate or GED completed not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian
Some college credit, but no degree s, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian
p Associate degree (e-g- AA, AS) Q Y¢s, Puerto Rican Q Chinese Q Guamanian or Cha morro
Q Bachelor's degree (e.g. BA, AB, B9) Q Ves, Cuban Q Filipino Q Samoan
Q Master's degree (¢.g. MA, M5, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese Q Other Pa<iflc Islander
Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) Q Other (Specify)
. MD ODS DVM LLB lD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to to dicat¢ 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 USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
0 American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure
0 Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry
Q Chinese Q Native Hawaiian Q Other (Specify)
Q Filipino Q Guamanian or Chamorro
ITEMS 23a - 23d MUST BE COMPLETED 2 to Pronounced Dead (MO/Day/Vr) 236. Signature of Person Pronouncing Death (Only when appllca ble) 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH ~ /
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23 a Signed (MO/Day/Vr
24. Time
ofDeath ~~
Q~`~. ~ e
~~ `~ 25. Was Medical Examiner or Coroner Contacted? Q Yes No
CAUSE OF DEATH Approximate
26. Part 1. Enter the chain of events--diseases, Injuries, Or complications--that directly caused the death. DO NOT enter terminal events such a ardiac arrest Interval:
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT
ABBREVIATE. Enter only one cause on a Tine. Add additional Tines if nec¢ssary Onset to Death
/
IMMEDIATE CAUSE > ~ ~~ A' ~l•Ti O YV /~{.LJI.JT'"[~~(
(Final disease o ondition Due to (or as a consequence of):
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
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or Injury Thaf
F Initiated th¢ events resulting d.
in death) LAST- Due to (or as a consequence of):
ag 26- Part 11. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy performed?
G . r ~y ~ )1
~~~Q
~
`
S Q Ves
~ ~"r`t
` _
'
~ t' •/~/ 28. Were utopsy findings available
to mplete the cause of death?
co
~ Q Ves Q NO
29. If Female: 30. Dld Tobacco Use Contribute to Death? 31. Manner of Death
t} ~Rpt pregnant within past year Q YY$~-. Q Probably Q Natural Q Homicide
Q Pregnant at time of death B~NO Q Unknown Q Accident Q Pending Investigation
~' Q Not pregnant, but pregnant within 42 days of death Q Suicide Q Could not be determined
~ Q Not pregnant, but pregnant 43 days So 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month)
Q Unknown if pregnant within the pas[ yeae 33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, Cliy, State, Zlp Code)
36. Injury at Work 37- If Transportation Injury, Specify: 38. Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (Specify)
39a. Certifier (Check only one):
[-3-G'Efifying physician - To the best of my knowledge, death o red due to The cause(s) and m r stated
Q Pronouncing Sa Certifying physician -TO the best of my knowledge, death occurred at The time, date, and place, and due to the cause(s) and m stated
r
et(It baste o~¢xa=inatlon, and/or investigation, in my opt nlon, death occurred at the time, date, and place, and due
to the cause(s) an
d
Sated
Q Medical Examiner/COrorKr - C~
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Title of ce rtifler:
License Number:
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Signature of certifier:
`
39b. Name, Address antl Zip Code of Person Completing Cause of Death (Item 26)
` 39c. Date Signed (MO/Day/Yr)
3
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40. Registrar s District Num er 41. Registrar's Signal 42. Registrar File Date (MO/Day/Vr)
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43. Amendments
Disposition Permit No. ~ ~ ~i'~ ~ f~ 7 R V O?/2011
Last Will and Testament
OF
NELLIE K. WOODS
I, NELLIE K. WOODS, of the Borough of Camp Hill, County of Cumberland,
Commonwealth of Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking and making void any and all former Wills made by me.
ITEM 1. I direct that all my legal debts and funeral expenses, which my estate is
obligated to pay, be paid and satisfied by my Executor, as soon after my death as may be found
convenient.
ITEM 2. I give, devise and bequeath all the rest, residue and remainder of my estate of
every nature and wherever situate to my son, GREGORY E. WOODS, and his then living
issue, per stirpes.
ITEM 3. I appoint my son, GREGORY E. WOODS, Executor of this my Last Will.
ITEM 4. I direct that my Executor shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal this ~ day of
~ , 2007.
(SEAL)
NELLIE K. WOODS
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in the presence
of each other have hereunto subscribed our names as witnesses.
f ~• ~~
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AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA SS
COUNTY OF CUMBERLAND
and
We, NELLIE K. WOODS,
the Testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument as her
Last Will and that she had signed willingly and that she executed it as her free and voluntary act for
the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
NELLIE K. WOODS
Witness
Witness
Subscribed, sworn to and acknowledged before me by NELLIE K. WOODS, Testatrix,
and
and subscribed and sworn to before me by
,witnesses, this day of , 2007.
Notary Public
310349
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