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HomeMy WebLinkAbout09-11-12Reset 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: Ronald L. Herr a/k/a: a/k/a: a/k/a: Date of Death: 08/17/2012 File No: ~ ~ - ~~ - ~'~~ (Assigned by Register) Social Security No: 170-32-3300 Age at death: 71 Decedent was domiciled at death in Cumberland County, pennsvlvania (State) with his/her last principal residence at 120 Mill Street Mt. Holly SprInQS 17065 Mt. Holly Snrinas Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Church of God Home 801 N. Hanover St. Carlisle 17013 North Middleton Twsn 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 $ 100.00 If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 120,200.00 TOTAL ESTIMATED VALUE.... $ 120.300.00 Real estate in Pennsylvania situated at: 120 Mill St. Mt. Holly Springs, 17065 Mt. Holly Springs Cumberland (Attach additional sheets, if necessary.) 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 May 29, 2012 and Codicil(s) thereto dated n/a 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 dive divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ©• NO EXCEPTIONS Q EXCEPTIONS ~._~ r:,~ ~i ~ _ ~ not a p~+ to a pendi4~ npt have a c hild {xorn~or, Lj ~ - t.., ' --~ ~~ ; 1 f_' L J L..." _. B. Petition for Grant of Letters of Administration (if applicable) - - ~ -- c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durant}~absentia, dur,~te mine 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 Q 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 Relationshi Address Form RW-Ol rev. 10/11/2011 page I Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address Kirb T. Herr 194 York Road Carlisle PA 17013-3151 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tote and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dece ent, e Petitioners w' ell and truly administer the estate acc ding o law. Sworn to or affirmed a~rl,~i subscribed before tt ~ ~ Date q ~~ t?` me thj,~ ~h~ day of ~~ ~~ ~ ~' ~~- Date By For the Register Date Date BOND Required: Q YES Q NO FEES: Letters .................... / ~ 7 ~L~ .. $ l( ( )Short Certificate(s)... ... ~ .~C ( )Renunciation(s)....... . . ( )Codicil(s) . .......... . . ( )Affidavit(s).......... . . Bond ...................... .. Commission ................ . . Other ...... .. Will ...... .. -S.CC~ ..... Automation Fee ............. .. .. ~ • C.'~' JCS Fee . .................. .. . ~C' TOTAL ................... .. $ 51 • S~ A<9A To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Adam R. Deluca, Esquire Supreme Court ID Number: 311738 Firm Name: Address: Allied Attorneys of Central Pennsylvania, LLC 61 West Louther Street Carlisle PA 17013 717-249-1177 717-249-4514 arrleh~caRSna~l.cnm Phone: Fax: Email: DECREE OF THE REGISTER Estate of Ronald L. Herr File No: ~ ~ ' ~~- ' ~~~~ a/k/a: AND NOW, ~ ~ ~~ ~~~1~e~ , ~~% / , in consideration of the foregoing Petition, satisfactory proof havin b_eenTpresentedbefnre me, IT IS DECREED that Letters Testamentary are hereby granted to Kirby T. Herr in the above estate and (if applicable) that the instrument(s) dated May 29, 2012 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. egister o Willsn ' Form RW-02 rev. 10/11/2011 ~ l~ Page 2 Of 2 LAST WILL AND TESTAMENT OF RONALD L. HERR I, RONALD L. HERR, of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, and administrative expenses shall be paid from my estate as soon as practicable after my death. It is my wish that upon my death my body shall be cremated and the ashes shall be placed beside my mother and father, at our plot in Mt. Holly Springs Cemetery. 2. I give, devise, and bequeath all of my real property and personal property that I own at the time of my death to my nephew Kirby T. Herr and my niece-in-law, Clairessa E. Herr, in equal shares, per capita. 3. I appoint my nephew, Kirby T. Herr, as Executor of this my Last Will and Testament. 4. The Executor of this Will shall have the power to distribute my estate in cash or in kind, or partly in either. 5. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. `~ 6. I recommend that my Personal Representative retain the law firm of Allied Attorneys of Central Pennsylvania, L.L.C., to probate my estate. ~~ IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of G, , 2012. ~~ `~ RONALD L. HERR n -:~~ ~ n ~ -~ ....; R'l~i "7i f ~7 r ~~ G i -- `- 7 CC ~". ""~ .. t_'i ~~._l ~ __ 'Tt ~ ~"7 ..- ~ ^ ~t 1 y ~~' ~ ~n Q N ~ Page 1 of 4 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, RONALD L. HERR, the TESTATOR, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ~~ u-~-~- ~ ' ~ ~~~ ./~ ~t RONALD L. HERB COMMONWEALTH OF PENNSYLVANIA S.S. COUNTY OF CUMBERLAND q~ On this ~ (, day of , 2012, before me personally appeared RONALD L. HERB, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and he acknowledged that he was the declarant who executed the same for the purposes therein contained. IN WITNESS WHEREOF I hereto set my hand and official seal. of Pu lic ,_...sr.~_.e.~ ~~~'~Rl~t. SEAL fit t"~: , =.`'.~~~ ::~~~e'~ ~ ~vac~st;h 24, 2fYI5 Page 3 of 4 The preceding instrument consisting of this and three other pages was on the day and date hereof signed, published and declared by RONALD L. HERB, as and for his Last Will and Testament in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~~~~ Witness Wi ne s Page 2 of 4 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS WE, G~,vv-. ~ ~ ~.Q~,I~C~ and ~C,l,ll.`~~ ~~ - ~~n~ the witnesses whose names are attached to the foregoing document, being duly qualifie according to law, do depose and say that we were present and saw testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. .~ Sworn or affirmed and subscribed before me by /~ ''~) ~(~,~j ,I- lC. ,~1VCd1~ and viLCcvr,~x.-~ • ~7~,n.lc~ this ~ day of , 2012. of Public/Attorney NOl'API.~. SEAL JJ 59~~'~~~4ie-~ ay .,"y~."~.~„,'!fix*t"'~;(~'>.;., i~'~.~q"Jp~~a67Ty^~U„b~C 9 t ', t . ~ ~ b' n Yt '.day Y?M'e 3~ ~41~i (~ 5555 ,Y Sx~ ~ .A6 ~. '+.s 4~"551 tiei ~„ ,~ "~: - ;sj~[t~=5 6~~c1~eh ~~1, 2015 G__o~..._ ~~..~_o~_m.~ Page 4 of 4 HIOSBOS REV !9/I7) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARIQ~CE~!'~GIt~~i~t~~i~~t~uplicate this copy by photostat or photograph. ~il.i?`v''_. I,?ill ! C Fee for this certificate, $6.00 ~ ~, ~ ~ ~~~ ~ ~ P~ Ct1MBE ~,{'' ;~J~ P 18627807 R~-EW~CO.,PA Certification Number Type/Print In Permanent Black Ink ~_ This )s to cerlifp_hai the inti)rn)jtirlu hc.)e ~tven f; con-ectly e,opied t~ irh an ori~tinal C~e(tifi,a~e o1~L)eath duly filed l~~ith (r(r as Local Re~~i,t~-ar. The ari~_inal certificate will h,~~ for~~~arded to the= State Vital 55 Records C)ffice #ilr }~ero~anent f11in~~. C~~ ~~ _ ____ ___AI~G_ 2 0 2012 Local Registrar (~~(te 3ssucd COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, SufRx) 2. Sex 3. Social Security Number~•a 4,•,y to of Death (MO/Day/Yr) (Spell Mo) "170-32-3300 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Ycar) (Spell Month) 7a. Birthplace (City and Stale or a gn oun[ry) /t ~ Months Days Hours Minutes 7b. Birthplace (County) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Bc. Did Decedent Live in a Township? 1 2 O M111 S t . QY d d es, ece ent lived in twp 8d. Residence (county) Mt Ho11 S s PA ~y~~ Se. Residence (Zip Code) Ip,~O, decedent Ilved within limits of L$bo 9. Ever In VS Armed Forces? 10. Marital Status at Tlme of Death Q Married Q Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes [ENO Q Unknown Q Divorced [Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) 14a. Informant's Name 14b. Relationship to Decadent 14c. Informant's Mailing Atldress (Street and Number, City, State, Zip Code) ~ )1 G ¢ .................°--°°-°-°--------°------........... ........°°°---------°°.-......°°°---------~sa:P.as~.°--.se5... ac onygne _ _ _ _ If Death Occurred in a Hos ital: .................................................. ...... ... ......... ..... ...... ..-.... .... - ~ ~- ..'.. I ti t f D h ~ - ° . p npa en ~ I eat Occurred Somewhere Other Than a Hos Ital- P Hospice Facility LI Decedent's Home Q Emergency Room/OUipaYlent Q Dead on Arrival ~N rsing Home/Long-Term Care Facility Other (Specify) • lSb. Facility Name (If not Institution, gNe street and number) 15c. ify orT wn, State, and Zip 16d. unty of Death ~ ~, 16s. Method of Disposition Q Burial ® Cremation 16b. ate of Dispos ion 16 Pla a of Disp on (Name of cemetery, crematory, or of er p ace ) Q Removal from State Q Donation ouer(speolry) ~ Ho11in ar FH/Crematory, Sne ? 16d. Location of Disposition (City or Town, State, and Zlp) 17a. tore of Funeral Service n in arge f Interment o 17b. License Number Mt.HO11 S s_PA X7065 FD-0'1'1932-L 37c. Name and Complete Address of Funeral Facility rj 0 1 N $a 1 t 1 ra AV e 8 Ho11in er FH Cram for nc °~' 18. Decedent's Education -Check [he box that best describes the 19. Decedent of Hispanic Origin - Chec the 20. Decedent's Race -Check ONE OR MORE races to indicate h t F- w a highest degree or level of school completed at the time of death. box that best describes whether the decedent the cadent considered himself or herself to be. Q Bth grade or less Is Spanish/Nispanic/Latino. Check the "NO" hits Q Korean n _NO diploma, 9th - 12th grade bo If decedent is not Spanish/Hispanlc/Latino. Q Black or African American Q Vietnamese Tr C High school graduate or GEO completed o not S ani h/Hi i /L ti ~v w , p s span c a no Q American Indian or Alaska Native Q OLFIer Asian Q Some college credit, but no degree Q Ves, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) QYes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Ves, Cuban Q F{Iipino Q Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. Ph O, Ed D) or Professional degree (Specify) Q Other 5 1 ( pee ry) . 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 t f k ype o wor se Q Samoan done during most of working Ilfe. DO NOT USE RETIRED ~ Q . ack or African AmeHCan Korean Q Q Q Other Pacific Islander Q American Indian or Alaska NatNC Q Vietnamese Q Don't Know/Not Sure Nur s i n Assistant Q Asian Indian Q Other ASian Q Refusal 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q Filipino QGUamanian or Chamorro Nursing HOmas ITEMS 23a - 23d MUST BE COMPLETED 23a. Date P onou need Dead (MO Day 23b. Signature of Person Pronouncing Death Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR _ CERTIFIES DEATH 23d. Datga SI ned (MO/Day/Vr) 24. Time of Deat Rn/r,~~p t~gZ~/ O 25. Was edical Examiner or Coroner ntatted7 Q Yes No CAUSE OF DEATH Approximate 26. PaK 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 Rbr111ation withou/t showing the etiology. DO NOT ABBREVIATE. Enter(oJ_~ly one cause on a Ilne. Add adtlitlonal Tines If necessary Onset to Death ~ , ~ / ~//~YIO~ /- IMMEDIATE CAUSE --------------> a. / Q (Final disease or condition Due t ° (or aence ps ~ / i resulting In death) / ' ~ ~ `, ~ ~ AA b ~ -/ / //'. '- _ •'r/C' Sequentially list conditions, Due to (or as a consequence o If any, leading to the cause listed on Tine a. Enter the UNDERLYING GUSE Due to (or as a consequence of): (disease or Injury that F Initiated the events resulting d. in death) LAST. Due to (o as a consegv nee of): 26. Part 11. Enter other sl nifl nt n i I n ntrl tin to h but no[ resulting in She underlying cause given in Part 1 27. Was an autopsy pert rmed7 g Q Yes No 26. Werc autopsy findings available to complete the cause of death? Q Yes No 29. If Female: 30. Did Tobacco Use Contribute So Death? 31. Manner of Death E aj Q Not pregnant within past year Q Pre nant at time of death Yes Q Probably ~ ~ Natural Q Homicide .~' g Q Not pregnant, but pregnant within 42 days of death No Unknown ///~~_ Q Q Suicide t ~ Cou dlnno[ be dl~erimined Q Not pregnant, but pregnant 43 days to 1 year before dealt 32. Date of Injury (MO/Day/Vr) (Spell Month) Q Unknown if pregnant within the past yeas 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 Ves Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39 Certifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the c se(s) and manner stated Pronouncing 8 Certifying ph sician - To the best of my knowledge, death occurred at the time, dale, and place, and due to the c se(s) and manner stated Q Medical Examiner/Corona f Op thebaa/sFSpf_~~ Inat~ n,y~j d/ r Investigation, in mV opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated J _ A A ! o ~ _ /,_f/ !_ Signature of certifier: L~( // _ !~ M Title of certifier: M J7 License Number K~ ~3~$ ~~~ 396. Name, Address and 21p Code of Parson Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Vr) l~ 1 [_~nb~\ 4~X~ 1 cis /1,4a fl3 FJ - '`Sz\'l-l vYt -4- L1 r n t'2 O bS O 1 (d- 40. Registrar s Olsirttt Number 41. Registrar' turn L~~' i~~1 42. Registrar Flle Date Mo Day r . F~~ . ao ~o~~ 43. Amendments !t (7 ~Gt f7 (- H105-143 Disposition Permit No. \7 I n l ,1 ~P REV 07/2011