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HomeMy WebLinkAbout09-10-12Reset 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: John T. Weidner a/k/a: a/k/a: a/k/a: Date of Death: August 26, 2012 File No: - ~`~ ~~`-J (Assigned by Register) Social Security No: 208-18-5427 Age at death: 86 Decedent was domiciled at death in Cumberland County, pennsylvania (state) with his/her last principal residence at 327 Zion Road, Mt. Holly Sprints, PA 17065 South Middleton Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Hershey Medical Center, Hershey Pennsylvania Derrv Township Dauphin 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 $ 25,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ _ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 25,~0~_00 TOTAL ESTIMATED VALUE.... $ 50,000.00 Real estate in Pennsylvania situated at: 327 Zion Road, Mt. Holly Springs, PA 17065 South Middleton Township Cumberland (Attach additional sheets, if necessaary.) 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 thereto dated n/a October 2, 1984 and Codicil(s) 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): Name Relationship Address ~ ,.~, ~ w~..., ~?- ~C,/ Q 1 ~._ ~. ., Form RW-02 rev. 10/11/2011 _,~~ _-, --•; =-:. 1 `{'-, L ~.~ ~., .. . j • C '- ~ ~ ~ _~ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } } SS: } Official Use Only r- .:r ~ --~ ~ ~1-t r-t-~ r . , Petitioner(s) Printed Name Petitioner(s) Printed Address ~ F , John T. Weidner II 323 Zion Road Mt. Holl S rin s PA 17065 :`' Tommy L. Weidner 329 Zion Road, Mt. Holly Springs, PA 17065 ---i c~ ~ -` ~~ ~~ 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 an subscribe be re "7 ) ~~. ` c ' Date ~ - ~ ~ ~" ~Z me th's Chdax.of ~" %/~. ~ `'.. ~''F - - - .__~_.. Date ~' /U /Z__ By: (, ~ ~~( -.~ - Date Register Date BOND Required: YES NO FEES: Letters ...................... $ 90.00 ( 10) Short Certificate(s)...... 40.00 ( 1) Renunciation(s)......... 5.00 ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ....... .~?t~ Automation Fee ............... 5.00 JCS Fee . .................... 23.50 TOTAL ..................... $ ----~~3~-- To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Nam~e;~Nathan C. Wolf, Esquire Supreme Court ID Number: 87380 Firm Name: Wolf & Wolf, Attorneys at Law Address: 10 West High Street .arlisle, PA 17013-2922 Phone: Fax: Email: 717-241-4436 717-241-4437 nathancw~l fn.emhar4mai 1. cam /7fs~ DECREE OF THE REGISTER Estate of John T. Weidner a/k/a: File No: AND NOW, , in consideration of the foregoing Petition, satisfactory proof havin been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to John T. Weidner, II and Tommy L. Weidner in the above estate and (if applicable) that the instrument(s) dated October 4, 1984 described in the Petition be admitted to probate and filed of record as the la t Will (and Codicil(s)) of Decedent. -~ ~ Register of Wills J~ ~~~ Form RW-02 rev. 10/11/2011 rake ~ o ~i -l ~.- `~X~' RENUNCIATION REGISTER OF WILLS Cumberland COUNTY, PENNSYLVANIA ~::: :~~ ~ ~ ' ---~-'~ ~-, . ,..k~ ~ . _, . ~,.. ~_~ t . . _ _ .. ~ , ~; _ --_ w_l r" -- ~. _ ... -~; -- ~,, ~ - ;-n ; .~ ~ -n ~ .. ... ~n C7 v ~ ~-r, Estate of John T. Weidner ,Deceased I, Wendy L. Price , in my capacity/relationship as (Print Name) daughter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to John T. Weidner, II and Tommy L. Weidner 08/31 /2012 (Date) ,~,. ~ ~ ~ (Signature) 350 Orchard Drive (Street Address) Catawissa, PA 17820 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills 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 ~ day otary Public My Commissi pires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Form RW-06 rev. 10.13.06 Notarial Seat Nathan C. Wolf, Notary Public Carlisle f3oro, Cumberland County My Commission Expires Apri119, 2016 MEMB€Ri PQNNSI'61-ANIA A'~S~EIATION OF NOTARIES REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA p ~/~~~'~~ No. 21- / a ,- ' Estate of Jv~~~ ~ ~~~ ~~~'~~ ,Deceased UNAVAILABLE WITNESS AFFIDAVIT / ~ )/ I, /,/~„c~~-, ~ ~~~/~ / ~ being duly sworn according to law, depose and say that I, the ~'~ Attorney ^ Personal Representative in the above referenced Estate, declare that ~Li/~L %/i~~ U ~r'lrE'~r.~ / and 4~',n~t ~"_t ,~' ,G/'~ -~ ~ lL~ l whose signature(s) appears as subscribing witness(es) to the Will or ^ Codicil of the above Testator is/are not readily available to prove the signature to the Testator by reason of Sworn to or affirmed and subscribed --~ ~ ~~-. ~.., _ ._~ Before me this , ~'-~~ da of Signature o ounse G ersonal Repre~~tive ~!? ~+ `~- - ~•A ,;a ~=_ o '? ~. ~' _ ~~ 11 j Y ..J L' ~.~r.~ / V Deputy Q'r egis `er of Wills ~~^'_; c ~ r-,:~ Sri (1VIust sign in Register's Office) ~ ~, ~-'' OATH OF NON-SUBSCRIBING WITNESS / / /~ ~,c%~ ~ ~~/~'/ ~ and r~~~~.~, tu. ~e~/,~~1` (each) a subscriber hereto; (each) being duly qualified according to law, depose(s) and say(s) that he is/she is/they are familiar with the signature of the above Testator of t~h~e/Q"~~ Will or ^ Codicil presented herewith and that he/she/they believe(s) the signature on the L7 Will or ^ Codicil is in the handwriting of the above Testator to the best of h/is/her/their knowle ge and beli ~` ~ r f`r 3~`' Sworn to or affirmed and subscribed '~' `~ ~ ~ ` Be~fgxe me~t~his ~ ~~-~~~ da of Sgna ' e of N -Subscribing W ~ ess `~ U'~t~~1, ~ 20 ~- - a ~,,/ ~ ... (~. ~ ~ ..(1t.t~ - Signature n-Subscribing Witness Deput ~ for ister of Wills (Must sign in egister's Office) r ~~ 'n-ti xA . ~_ l • _.>W.~J ~} i _.) ,. ! L V `~J ~J t,~~ I-~ i c ~. ..~ .~ 3 ~~.~~ ~ ~ AU;~ 2 7 ° 2 01 ~~.x~ ~ . ~ ~i~s~~ 2 ~~ ~ Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent CERTIFICATE OF DEATH Black Ink 0 Q r~ y -~ a 3 a 0 O_ a 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Numbers 4. Date of Death (Mo/Day/Vr) (Spell Mo) John T_ Weidner Pda1e 208-18-5427 Au ust 26 2012 Sa. Age-Last Birthday (Vrs) 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) 86 Months Days Hours Minutes August 21 1 926 West Readin PA 7b. Birthplace (County) BeY-]CS 8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? PA 327 Zion Rd_ QYes,decedentliyedin SOUth Middleton tw 8d. Residence (County) p. Cumber 1 and Se. Residence (Zip Code) 1 7 O 6 5 Q No, decedent lived within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Yes Q 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) Francis Weidner Bessie Miller 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) o Son 329 Zion Rd_ Mt_ Ho11 S rin s PA C z ............................................... ....P...... If Death O d i H it l ~ I i - 15a. Place o Deat (Check only one ~ 1 6 5 ..........................................................p. - ........_ _ ° d ccurre n a osp a : n at ent : Emer enc Room Out atient Q g y / p Q Dead on Arrival . If Death Occurred Somewhere Other Than a Hospital: ~] Hospice Facility [] Decedent's Home Nursin Home Lon Q g / g-Term Care Facility Q Other (Specify} o c 15 b. Facilit Name If not institution, y ( give street and number; 15c. City or Town, State, and Zip Code lSd. County of Death M.S. Hershe Medical Center Hershe Pa. 17033 Dau hin m 16a. Method of Disposition Burial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from State Q Donation 08/30/201 Cumberland Valley Memorial Gardens - Q Other (Specify) 2 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature of Funeral Service Licens or P sgn in Charge of Interment 176. License Number Carlisle PA 1 701 3 FD - 1 3881 2 E 17c. Name and Complete Address of Funeral FacilityH0111nger Funeral Home & Crematory Inc , _ 501 N_ Baltimore Ave_ Mt Ho11 °' 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 ~ hi hest 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. 8th grade or less is Spanish/Hispanic/Latino. Check the "No" White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed ~No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino Q Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q 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 Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Black or African American Q Korean Q Other Pacific Islander Si l M i t Q American Indian or Alaska Native QVietnamese QDon't Know/Not Sure gna n a enance Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Railroad Q Filipino Q Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~ ~ n t ~ ©1 23d. Date Signed (MO/Day/Yr) 24. Ti a of Death 25. Was Medical Examiner or Coroner Contacted? Q Yes Q 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 as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without s h o w ing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death c C y ~ ~ IMMEDIATE CAUSE ------ > a. WY ~t / (Final disease or condition Due to (or as a conseouence nf): resulting in death) ^ M ~ ~ /. /~ ` / ~`~ ~ ~ j~ ,, rte] ~t y - 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_ ~ v in death) LAST. Due to (or as a consequence of): ~ 2 6. PaK I1. Enter other si nifican conditions contributin to death but not cesulting in the underlying cause given in Part 1 27. Was an autopsy pe ormed? ° p t'~ $ Q Yes No ~ m . / ~~ ~ ~ J.~ i' 11 r~ ~~ 28. Were autopsy findings available to complete the cause of death? ~ ~ t L~ C~-C ~ Q Yes Q No 29. If Female: - 30. Did T bacco Use Contribute to Death? 31. Manner of Death o Q Noi pregnant within past year Yes Q Probably ~ Natural Q Homicide v Q Pregnant at time of death Q No Q Unknown Q Accident Q Pending Investigation m Q Not pregnant, but pregnant within 42 days of death Q Suicide Q Could not be determined ~ Q 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; construction 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: Q Yes Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Pronouncing 8~ Certifyin 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/Cor - On the asis of examination, and/or investigation, in my opinion, de at h occurred at the time, date, and place, and due to the c a use(s) and man n er s ta te d (~ / ( ~ ~ J ~ / ~ / ~ - ~ T 2 ~~ " Signature of certifier: Title of certifier: I t License Number: JV~ -- I~ K ~v 39b. Name, Address and Zip Cod _ er on Completing Ca o e 6 Hershe Pa 17033 ~ ~~~~'~ Medical Center ~ 39c. Date igned ( o/Oay/V r) , y, . - ~}N-t~1T-R ~~~ U~ 40. Registrar's District Number 41. Registrar's nature 42. Regis rar File ate (MO/Day/Yr) 43. Amendments Disposition Permit No. ~ 1~ \ ~ ~ ~~ REV 07% O1] ~ (Z r1 7" C.'+ (: 1 ? r n }n -i ~ ! 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