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HomeMy WebLinkAbout08-30-12Reset 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: Donna M. Feaster a/k/a: a/k/a: a/k/a: Date of Death: 08/15/2012 -~ File No: ~ ~ ~ ~•--~~ " ~ ~ ~~ ?~, (Assigned by Register) Social Security No: Age at death: 74 Decedent was domiciled at death in Cumberland County, Pennsylvania (Scare) with his/her last principal residence at 35 East Gate Drive #l05 Carlisle South Middleton Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Golden Livinc Center Camp Hill 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 $ 6,000.00 If not domiciled in Pe~ursylnania .................... a ...Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsylvanra ......................................................... $ TOTAL ESTIMATED VALUE.... $ 6,000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code Cih~, 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 August 29, 201 1 and Codicil(s) thereto dated 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 adulated; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS B. Petition for Grant of Letters of Administration (1f applicable) c. r. a., d.b.a., d.b.a.c.t.a., pendeate lite, dur•ante absentia, duraate minoritate If Administration, e.t.a. o~~ 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. s ~~ NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following .~(ifany) ati~'heirs to additional sheets, if necessary): t~'G ~ '~-'.~.1 ~~_~'- ~.. Name Relationshi Address ~ { ' ~ ; ~C- _ _ t`~ ~....'' ~ - . --~. ~..~ ~ , .~- Form RW-02 rev. 10/11;2011 Page 1 Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } SS: } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address Virginia Balo 4259 Nantucket Drive Mechanicsburg, PA 17050 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 tru}y administer the estate according to law. -~ Sworn t or affirmed a d subscribed before ~ ", ~~ ~: ~ ~~ ~= k~,c Date ~ ' _ { z_ s~ ,, , met ~ s ~"~ ay of ~ ~-` , ~5~~~ Date B ~ „~ - }': ' ~ ~ `~ ; ~ try Date For- the Register t Date /'~. BOND Required: Q YES ~'"NO To the Register of Wills: FEES: Please enter my appearance by my signature below: ~--_ ~ 1 Letters ...................... $ ( ~ )Short Certificate(s)... , .. ~ ~ ~ (~'(,:~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Otther ....... 1~ ~ ~ ... ..... L_~ 1~, Automation Fee ............... ~~ C` j'i JCS Fee . .................... -~3 ~> TOTAL ..................... $ r'~C' . ~~0:~0"U Attorney Signature: '~~ ~• ~ ~ i C`, f° f Printed Name: Stephen J. Hogg, quire Supreme Court ID Number: 36812 Firm Name: Law Offices of Stephen J. Hogg Address: 19 S. Hanover Street, Ste. 101 PA 1701 ~ n C'arliSle , ~' ~ r-.., ~. •~-~ tu~r~`t -7 "~ ; r~,,: Phone: 717-245-2698 =~'~ - ~ Fax: 717-245-0829 ~ t , , _ ~ ,~ , F__. Email: ~("- • ;~. ~"'~ ~ ti ~ . DECREE OF THE REGISTER ~'' -~" `'r' ~ Estate of Donna M. Feaster File No: ~ ~?~~;~ -~ ~ ~~--- ' ~ a/k/a: •~_ . AND NOW, ~""~~ ~ c' ~ ~ ~~ n'~ ~ ~~ :~}~~'l ~` , in considerat'on of the fore oing Petition, satisfactory proof having been presented fore me, IT IS DECREED that Letters. I -~'~ ~~ ~1'~~L~' ~ ~( • ~_ ~' ~ are hereby granted to ~ 1` Cl (~'1 " C~ -~'z lt. ~ C~ in th a ove estate and (if applicable) that the instrument(s) dated ~-t ~~ :~~ ~~''l described in the Petition be admitted o probate and sled of record as the last Will (and Codicil )) of Decedent. ~~ _ ~ ~ , Register of Wigs - : ~'~~ ~ ~~Z ~~ ~ C l ~~ ~2 /~~ ~ ~ i I Fore, Rw-oz Y~~~. ~ni~li~o» Page 2 of 2 [. . , ~ ~. . ` . `V .. _.~i~ F~ ~ .. }~~ ~ ~ BUG 30 P G~ 4 n - .~.. .. ~~ ~ ~5 r:° ~ Jg ~ y ~~ Ct~Mk~~P~~i~ CO., PA ~lU~ ~ 7 1..017 ~_ , Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE ~F ~EATI-1 _ __. -- _ 6~ 1v ^~ `) v W O 1. Decedent's legal Name < Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Yr) (Spell Mo) Donna Feaster Female August 15, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/D ay/Year) (Spell Month) 7a. Birthplac GiYy nd S ~ `y y to or Fq~e1'gn Country) Months Days Hours Minutes a r ~151e, Y'H - 74 May 12, 1948 76. Birthplace (County) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Sc. Did Decedent live in a Township? Penns lvania Yes, decedent lived in SOll trl. Middleton twp. Sd. Residence (County) 35 East Gate Dr . #105 Cumberland Se. Residence (Zip Code) ~ No, decedent lived within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death 0 Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) [] Yes ~ No Q Unknown Q Divorced Q Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior To First Marriage (First, Middle, Last) Albert Shover Marie Stuart 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) o Vir inia Balo Sister 4259 Nantucket Dr. Mechanicsbur PA1705 _~ If Death Occurred in a Hospital: Inpatient : SSa. Place of Deat C eck only onel If Death Occurred Somewhere Other Than a Hospital: CJ Hospice Facility ~ Decedent's Home ~ ~ Emergency Room/Outpatient Q Dead on Arrival _ Nursing Home/Long-Term Care Facility ~ Other (Specify) ~ 15 b. Facility Name (if not institution, give street and number; 15c. City or Town, State, and Zip Code lSd. County of Death Golden Livin Center Hill PA 17011 Cumberland 16a. Method of Disposition Q Burial ~ Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) d ~ Removal from State ~ Donation ~ Other (Specify) 08/17/2012 Hollln er Cremator ~ 16d. Location of Disposition (city or Town, State, and Zip) 17a. atu re of Funeral Service Licensee o rson i Cha a of Interment 17b. License Number d Mt. Holly Springs, PA 014819 E 17c. Name and Complete Address of Funeral Facility M ers-Harner Funeral Home lnc_ 1903 Market St_ Cam Hill PA 17011 m 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 what ,= 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/Latino. Check the "No" [~ White ~ Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American ~ Vietnamese High school graduate or GED completed [~'NO, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native Q Other Asian Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano 0 Asian Indian ~ Native Hawaiian ~ Associate degree (e.g. AA, AS) ~ Ves, Puerto Rican Q Chinese ~ Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, BS) ~ Yes, Cuban ~ Filipino ~ Samoan Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino Q Japanese ~ Other Pacific Islander ~ Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify) e. MD, DDS, DVM, LLB, JD) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work White 0 Japanese 0 Samoan done during most of working life- DO NOT USE RETIRED. Black or African American ~ Korean ~ Other Pacific Islander 0 American Indian or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure Nurses Aid Asian Indian ~ Other Asian ~ Refused 226. Kind of Business/Industry Chinese ~ Native Hawaiian ~ Other (Specify) Q Filipino ~ Guamanian or Chamorro Nurs a..n Home ITEMS 23a - 23d MUST BE COMPLETED 23 a. Date Pr pounced Dead (Mo/Day/Yr) 236. Sig a of Person Pronou ncin Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH t (, t" C/ l j~7~({]~~ /~ ~~~ 23d. at Signe (Mo/Day/Yr) 24. Tim pf pRgtFy~ ~ V ~ L ~ ~ ~LII\/.//l/f) 25. Was dical Examiner or Coroner Contacted? Yes 0 No CAUSE OF DEA H Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBR EVIATE. Enter only one cause on a line. Add additional lines if necessary Onset [o Death / IMMEDIATE CAUSE ---------------> a. / -s~~ ~~ r"7 ~~~ ` ~ ~ `` _~ (Final disease or condition Due to or as a consequence of): resulting in death) ~ - 1 , / ~ / ~ S sA~,.tl' G B'T"/Cis tiyt /hv/s T< s L G~J S~-~.k~ b. fyn S Sequentially list conditions, Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c. UNDERLYING CAUSE Due to (or as a consequence of): w (disease or injury that initiated the events resulting d. W u_ in death) LAST. Due to (or as a consequence of): 26. Part 11. Enier other significant conditions contributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy perfor _o Yes No ~ 28. Were autopsy findings available l h m to comp ete t e cause at ? D ves No _ a 29. If Fem 30. Did To o Use Contribute to Death? 31. M r of Death E of pregnant within past year es ~ Probably Natural ~ Homicide uo ~ Pregnant at time of death ~ No 0 Unknown ~ Accident Q Pending Investigation m 0 Not pregnant, but pregnant within 42 days of deatF 0 Suicide ~ Gould not be determined ,°- 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; co nstruct(on site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: 0 Yes ~ Driver/Operator ~ Pedestrian No ~ Passenger ~ Other (Specify) 39a. C rer (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Pronouncing 8a 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 Medical Examiner/Coron On the basis of examin ion and/or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated / Signature of certifier: - ~"~J Title of certifier: ..dirt ~~T lG/ license Number: /~7.~ d L Li 3O ~.{ C 39b. N me, Address and Zip ode of Person Completing Caus of Death (Item 26) 39c. Date Signed (Mo/Day/Yr) ~4 is.~ ~ ii! _ s~'f' ~+~ ~~ l6a cs~s ~ ~ T~ •,. „ /~- ~ ~~.~c use u >r t 2 0 / Z 40. Registrar's District Number 41. Registrar's Sign re 42. R istrar File Date (M ay/Vr) % - oZ/~ /G 4/ Z 43. Amendments a ~ ~~y'~, ~y~g ~ o~ D Disposition Permit No. 0740623 REV 07/2011 ~- Q WILL OF ~,~, DORNA M. FEASTER ~ ~k-, `~ _. ` ~+ ° " .~ ~.-' :> I, Donna M. Feaster, of Cumberland County, Carlisle-,-~c~-~: Pennsylvania, declare this to be my last Will and hereby red all prior Wills and Codicils. =-~~`~ ~---- i `) ~ `: © '_ __. f ' ~ =~ ~.: _ - r~a •_ c~-~~ ?, I direct th?t all !","'l,~l ,„sa d,~~,`~ f:.6n?ra! yYpe::sv,~, gravemarker and adr~inist~ative e~:;~-nses shall be paid from my residuar;~ estate as s:ion as prac~;;able aftr~r my death. 2. I direct that all inheritance, ~st?te transfer, successi~~n and death taxes of a~'y k~~~d w~`~atr-,ever wr~ich may be payable by reason of ~ny dea;.h sn~~ll be pa~c~ out of my res~dua~ ~ es~ate. 3. I direct that my entire estate be distributed as follows: A. I direct that my entire estate go to Virginia Balog. B. Should Virginia B~„'vr predecF~ase rnt~ I direct that my entire esta~e go to Jeffrey i=caster. ~. I appoint Virginia Ba!oy, Executrix of this my lass Wii;. Should Virginia Balog, p~ edecease me or pease to .pct in such capacity, ;appoint Jeff; ey Feaster as alternate. 5. The Executrix of thi ~ V'~lill shall rave tine power to distribute my estate ~n kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of ___ , 20.1. ~'h -~ Donna M. Feaster ~ ~ s ~ The preceding instrument consisting of this and one other gage was on the day and date hereof signed.; published and declared by Donna M. Feaster as and for her last Will 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 hereto. ~° ~ r ,~ + ~ ,~, 1 ITNESS WI NESS LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ArKNOWLEDCMENT State of Pennsylvania County of Cumberland ss I, Donna M. Feaster, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that 14igned and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ^^„ /~ ~ 17 r 1 V!'~~ ~~. ea4: i,yf Sworn to or affirmed and ckn~wledg ~ before ~ nna M. e a s ~ t~~i~= day oi~ - - - .--, 20 n J. ~~ag~~ Rir~ Pub1~ wNy Co~nf~ ~ ' 3w ~~13 ~ - s _ ~~~.-__~ ~~~v,~~..~~.~.~,:.~.~.~~...2, ~ - Nc}cary Public/Attorney State of Pennsylvania County of Cumberland ss ,~-... We,~ ~~i ,~` ~... --~~.#~,~~~~ and ~ ~ ~~-,`the LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 witnesses whose names are signed to the attached or f~~regoing instrument, being duly qualified according to la~v, Diu depose an~~l :~~y that we were present and saw the Testatrix sign and exzcu*e tf~:e instrument as her last Will; that the Testatrix signed willing,;r and executed it as her free and voluntary act for the purposes therein :expressed; that eacl~~ subscribing ~n~it,~ess ~ the hearin'-! Inc sight n. the 'testatrix signed the Will as a witness: ar~d that to the best of our knowledge the Testatrix was at that time ~ 8 or more years of age, of sou mind a-nd'~nder na constraint r ~~~~due influence. ,. ~S orn to or affir ed and sutras ri d to before me by witnesses, this _~da of , 2011. Y NOTARIAL ~--~ n J. H®g~, ry Pu CarN~t~ ~3crq Curnl~~,~ C®. eta ~ O^'~~~ >° gar 3, 2t~13 AFFID~.VI~° Public/Atto