HomeMy WebLinkAbout09-04-12PETITION 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: 10 et ar File No: ~~-~~ - ~~~Jj
a/k/a: (Assigned by Register)
a/k/a:
a~c/a: Social Security No:
Date of Death: 8/31/2012 Age at death: 53
Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last
principal residence at 1491 Simpson Ferry Road 17070 Borough of New Cumberland Cumberland
Street address, Post Office and Zip Code City, Township or Borough
County
Decedent died at 503 N. 21st Street 17011 Cam Hill Cumberland PA
Street address, Post Office and Zip Code City, Township or Borou h
g County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ................................All personal property $ 50.000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
If not domiciled in Pennsylvania .............................Personal property in County $
I~alue of real estate in Pennsylvania .............................................................. $ _ 131.600.00
TOTAL ESTIMATED VALUE.... $ 181 600.00
Real estate in Pennsylvania situated at: 1491 Si111pSOr1 Ferry R08d 17070 Borough of New Cumberland Cumberland
(Attach additional sheets, ifnecersary.) Street address, Post Office and Zip Code Ctty, Township or Borough Coun
ty
® A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 5/18/1998
thereto dated and Codicil(s)
State relevant circumstances (e.g. renunciation, death ojexecutor, 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 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 com lete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been estab~is~ed as definedr •-?
in 23 Pa. C.S. § 3323(g) anti .vas neither the victim of a killing nor ever adjudicated an incapacitated person. C,.~
^ NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse ~
addttionalsheets, tfnecessar,~): ~~)'
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heirs (attach ' ~.
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l~brm RW-02 rev. l0///,2011
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Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF- ?ENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
Ga D. Wolfe 1491 Simpson Ferry Road
New Cumberland PA 17070
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 trul administer the estate according to law.
Sworn t pr affirtned an ubscribed before G[~ Date ~ ~ ~
me~thjs ~ O~ ` day of '~-~ Date
g !'1~ ~~ Z1~~~ Date
For the Register Date
BOND Required: ^ YES a' NO
FEES:
Letters ................. ..... $ V • l.' V
( ~ )Short Certificates(s) ...... l~ ' ' (-'
( )Renunciation(s) ......... .
( )Codicil(s) ....... ..... .
( )Affidavit(s) ............ .
Bond .........................
Commission ............. ..... .
Other
Automation Fee ................ .
JCS Fee .......................
TOTAL ............... ......$
-`~D
~S y
I ~ ~~-~
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney
Printed Name: Gerald J. Shekletski, Esquire
Supreme Court
ID Number: 40486
Farm Name: Stone LaFaver &Shekletski
Address: 414 Bridge Street
P.O. Box E
New Cumberland PA 17070
Phone: 717-774-7435 c ~.., ~
~
Fax: _
'
717-774-3869 ~ v~
Email: gshekletski@stonela~. r -o
~~
c
r ;c;
C-3 Y -[t
DECREE OF THE REGISTER O z; ca
Estate of VIOIet M. Wai"~ File No: ~•'~
a/k/a:
AND NOW "~ " ' ~~- ~1( ~ , °~L~ ~ ~ , in consideration of the foregoing Petition,
satisfactory proof having been presen ed before me, IT IS DECREED that Letters Testamentary _
are hereby granted to Gary D. Wofe _
in the above estate and (if applicable) that
the instrument(s) dated 5/18/1998 -_
described in the Petition be .dmitted to probate and filed of reco(rdras the last Will (and Codicil ) of Decedent.
Register of Wills~~ ~ ~/~~~ ~~'~"(~
Form RW-02 rev. f 0/l l/201 / ]Jage Of 2
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P 1880078
.~Iri ,
Type/Print In
Permanent
Black Ink
1. Decedent's Legal Name (First, Middle
Violet M_ Ward
Sa. Age-Last Birthday (Vrs) Sb. Under ;
5 3 Months
2 Ba. Residence (State or Forelan Gm,nt...
~ Yes ~ No ~ Unknown
L2. Father's N~vame (First, M( die,
Vaugrin Wa rfi
~~';I2 Sc~' -4 P~9 3~ 4~,. „
ry.~. ,,,
4~ ,:
((~~ ~ p ~ ~, .~~ .°.l i;i
c~~~B~~~~~ co.. ~_ ~~. A
s, ~~~~ _ SEPi ~(}
. - _
i :, _ . ___
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
CERTIFICATE OF DEATH
ast, Suffix) State Flie Number:
2. Sex 3. Social Security Number
Fema 1 "~ 9 2 - 4. Date of Death (MO/Day/Yr) (Spell Mo)
sc. underl Da 6. Date of Birth -'`2-3546 August 31 207 2
Days Hours Minutes (Mo/Day/Yea r) (Spell Month) 7a. Birthplace (City and Slate or Forei
September 1 8, 1 958 B"c°^"try>~
Sb. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Livebin al TowinshlpT untY) r h
1491 Sim m n
pson Ferry Rd pyes,decedentuyedln
Se. Residence (21p Code) '~ '7 ~ 7 0 twp.
arital Status at Time of Death ENO, decedent Ilved within Ilmics pf New Cumberland
Divorced L2S Never Marrie ~ Married ~ Widowed 11. Surv(ving Spouse's Name (If wife, give name nrl..~... city/boro.
~ Unknown n___ __ _
p
oryant_s Name, _Ol £ 14
r
J.7 . W a E=LLy
Relat(onshi
Co Decedent
y
1 ~n r an
p
O
~~ ~]
c
-
~ If Death Occurred In a Hospital: •• •~ wr •""'"""""^--'••-~••~-•
1 a. P ace o Deat C
m .............
LJ Inpatient ........
e
Q E
If D
h
c
_
u~' mergency Room/Outpatient
on Arrival
15 b ;
eat
Occurred Somewhere
OtheYTha n•:
. Facility Name (If not institution, give strOt and n
Holy Spirit Hospital umber; ~ Nursing Home/Long-Term Care Far
•15 c. City orTOwn,State
and2l
C
d
~
16a. Method o9 Disposition
® Burial ,
p
O
e
Camp Hi 11 , pA ~ ~
~i 0 Cremation
Q Removal from State
~ Donation 166. Date of Ois
Position 16c. Place of DI
othar(spe°Ify) Sept_ 6, 20'1 2 Rolli)
16d. Location of Disposition (City or Town, State, and Zlp)
Cam
17 natur
f F
~
E p H i 11
. P A 1 7 0 1 1
17c. Name and C
l e °
yaf;al seryici%%/4nsee~
G~.r~t
.-
J~
8 omp
ete Address of Funeral Facility
Stone & Mur ~
r
'm' ray Funeral Hom 408
1B. Decedent's Education -Check the box that best d
3rd _ Street
t- escribes the
highest degree or level of school completed at the time of death.
Q Bth grade or l ,
19. Decedent of
boz that be
t d
i
ess
~ No diploma, 9th - 12th grade s
escribes
wh ther the de edent
is Spanish/Hispanic/Latino. Check the "N
"
High school graduate or GED completed
Q Some college cr
di O
box.lf decedent is not 5
Panish/Hispanic/Latino.
~ No
not S
ani
h
H
e
t, but no degree
Q Associate degree (e.g. AA, q5) ,
p
s
/
ispanic/Latino
O Yes, Mexican, Mexican American
Chfca n
Bachelor's degree (e.g. BA, qg, BS) ,
o
~ Yes, Puerto Rican
Q Master's tlegree (e.g. MA, MS, MEng
MEd
MS 0 Yes, Cuban
,
,
W, MBA)
~ Doctorate (e.g. PhD, Ed D) or Professional de
gree 0 Yes, other Spanish/Hispanic/Latino
e. MD DOS DVM LLB JD (Specify)
Zl. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the dec
® White
d
~ Japanese
Q Black or African American Q Korean e
ent consideretl himself or
0 Samoan
Qy O American Indian or Alaska Native 0 Vietnamese
Q Asian Indian ~ Other Pacific Islander
~ Don't Know/Not S
Q Chinese ~ Other ASlan
0 Native Hawaiian
~ F
l ure
Q Refused
i
ipino
Q Guamanian or Ch Q Other (Specify)
amo
ITEMS 23a - 23d MUST BE OMPLETED 2 rro
ate Pron
BY PERSON WHO PRONOUNCES OR ou ced Dead Mo Day/Yr) 23b. Signature of Person Prc
CERTIFIES DEATH n
~ `
to Signed (MO/Day/Yr) 24. Time of t^~
_ 3~ ~,~,~ c _ _ r~ O` A + w
K f``V// \
F
s
s
D
O
_~
26. Part I. Enter the chain o{~~_diseases, injuries, or eo ~ ~'AUSE OF OEAT~
r mplications--that directly caused the dea
espiratory arrest, or ventricular flbrillai o witho t showing the etiology. DO NOT ABBREVIATE. Er
IMMEDIATE CAUSE ------________~ a ~ ~ 1" `~ /
(Final disease or condition (~~(~(~ --/-(~~
resulting in death) ,,,,rr•~t~ D e to (o as a consequence of);
b. ~-'s
Sequentially list conditions,
If any, leading to the cause Du to (or as a consequence of):
Iisked on line a. Enter the
UNDERLYING CAUSE
(disease or InJu nthate Due to (o as a consequence of):
Initiated the eve is r suiting d,
in death) LAST.
Due to (or as a consequence ofl:
ispita l: __.._.... .......... __ ___
Hospice Facility ~ ~~""'
Decedent's Home
Other (Specify)
' -' lSd. Co f Death
Cumberland
itl (N f t ory, o other place)
' Green Cemetery r
rson in Ch ge nterment 17b. License Number
`°~ FO Ol 2342-L
aW Cumberland, PA 'I '7070
20. Decedent's Race -Check ONE OR MOgE races to indicate what
the decedent considered himself or herself to be.
~] White ~ Korean
~ Black or African American 0 Vietnamese
Q American Indian or Alaska Native Q Other Asian
Q Asian Indian ~ Native Hawaiian
Q Chinese ~ Guamanian or Cha mono
FIIIPino
~ Japanese ~ Samoan
0 Other 5 0 Other Pacific Islander
( pecify)
self to be.- 22a, Deced$e-.n^t~s tUSUaI Occ~ug
d~~~1`y+S~raIL1 VeO NiOTU EPRETIRED'
U.S_ Government
repranercon:actec7 p Yes I
1ldOT entea uterminal events such a ardiac arrest
my one c qn a line. Add adtlitional Imes If necessary
/lA n ~/'.ie / _
~_~
+'-~~-.
Approximate
Interval:
Onset to Death
to complete the c of death?
~t pregnant within past year 30. Dld Tobacco Use Contribute to Death? C• Yes a Q No
~ Pregnant at time of death ~ Yes ~ Probably 31. Manner of Death
0 Not pregnant, but pre ~fTo' Unknpwn ~rM3tufal O Homicide
Q Not Bnant within 42 days of death ~ Pending Invests
pregnant, but pregnant 43 days to 1 year before death O Su tide t ~ Batton
~ Unknown If pregnant within the past year 32. Date of Injury (MO/Day/Yr) (Spell Month) ~ ~ Could not be determined
a. mJUry at Work 37. If Transportation InJury, Specify:
Ves 0 Driver/Operator ~ Pedestrian 3B. Describe How Injury Occurretl:
Q No ~ Passenger 0 Other (Spec)
fY)
)a. Certifier (Check only one):
O PCertrifying physician - To the best y knowledge, death occurred due to the eau
ncing JL Certifying p To the bass of my knowledge, death o se(s) and ma started
~ Medical Examiner/COro r O a e basis of examination, and/or investigations indmt the Nme, date, a d place and due to the c
Y opinion, tleat se(s) andam stated
Signature of certifier: red at the time, date, and place, nd due to the
arna,Address an r Cod of Pers se rr~T Gr Title of cer[Ifier: ur~ _ /y~
~~N A _ R_ 9"/C~T!Pietir)~'Eau of Da h 1 License Numn,..J / j
-~S /~
Disposition Permit Nn. ~ 7'-"s>rf•/ J! ~TL~
eP\wille\ward.y~\5_98
n
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LAST WILL, AND TESTAMENT ~~ ``~ ----'j
OF -,
VIOLET
~ w ~-= r,.
M. y~~D ~- c~ ~
-
cam; r,
I, VIOLET M. WARD, of the Borough of New Cum
County, Pennsylvania erland, Cumberland
declare this to be my last will and revoke a
will previously made by me. ny
ITS I~ I devise
and bequeath all of my estate, of every nature
and wheresoever situate, to GARY D. WOLFS, if
ITEM II: he survives me.
-~ Should GARY D. WOLFS fail to survive me
bequeath all of m I devise and
y estate, of ever
brother Y nature and wherever situate, to my
, DATE C' WARD. Should m
y brother, DALE C. WARD, fail to
survive me, I devise and be
queath all of my estate, of every nature
and wherever situate, to the FIRST CHURCH OF GO
ry Streets D, Fourth and Strawber-
Harrisburg, Dauphin County, Pennsylvania.
ITS--=1-II' I appoint GARY D, WOLFS Executor o
Should GARY D. WOLFS fail to f this my last will.
qualify or cease to act as Executor, I
appoint my brother, DALE C. W
ARD. Executor of this my last will.
Should my brother, DALE C. WARD
fail to qualify or cease to act as
Executor, I appoint my Pastor, PAUL ANDERSON, Executor
will. of this my last
IT-E-M IV~ No fiduciary acting hereunder shall be re ui
bond or enter security for the faithful performance of q red to post
any jurisdiction. his duties in
Page 1 of 3
IN WITNESS WHEREOF, I, VIOLET M. WARD, have hereunto set my hand
and seal this '~"
~~ day of Gt.~.-, , 1998.
VIOLET M. WARD
SIGNED, SEALED, PUBLISHED and DECLARED by VIOLET M. WARD, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses.
_ v i~ ~ ~ ~_
Witness '~-~ ~-e`-~G
Address "
~~-----
Witness
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND ~ SS:
Address ~~
I, VIOLET M. WARD, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified accordin
to law do hereby acknowledge that I signed and executed this instrug
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
VIOLET M. WARD
Sworn to or affirmed to and acknowledged before me by VIOLET M.
WARD, the Testatrix, this (~~
__ day of ~~ 1998.
--__,
~ ~ ~
Notary Public
Page 2 of 3
NC)TR~IAL ~~'A~
~fp~~q~G~rp~i (~; -f~) ep,.Yq,9 ~ .)Ji', (I
"'J ~4,~9k916F:DJI Vl1 L/~ ~ ~lY ~~''' II J.
~° ~~J ~~rtl 13, X999
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
~_
We , ~ and ~~-~-~ ~ ~ ,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix 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; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
7
Witnes
.~.s
.~`~
Witness
Sworn to or affirmed to and acknowledged before me by
~~ and
witnesses, this ~ day of , 1998.
Notary Public
t~i~'3~'A~IAL SEAL
~"""~s'."~ t:, ~a ~;;~ '~ 'Ts~ ~i~3±1(~ CO.
My ~~~nEnyis~~c~i ~rpi~es aril 13,1999
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