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HomeMy WebLinkAbout10-10-12Reset 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: Dean B. Drayer a/k/a: a/k/a: a/k/a: Date of Death: August 1, 2012 File No• ~~" ~ ~ - ~ ~ Q /~., (Assigned by Register) Social Security No: Age at death: 83 Decedent was domiciled at death in CUMBERLAND County, pA (State) with his/her last principal residence at 314 Old Fort Road, 17043, Leymone, Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Holy Spirit Hospital, 17011, 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 $ 0.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 0.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessarv.) Street address, Post Office and Zip Code City, Township or Borough 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 December, 28, 2000 County 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 Relationshi Address `-~ r..:y ; Sarah Dra er Survivin Souse 314 Old Fort Road Le mone PA 1 3~=- ' '~ please see attached ~" ` © r ~~~ ,.. - _ ~ W ~~ Form RW-02 rev. !0/l1!20/1 Page 1 Of Z David R. Drayer, 320 Jupiter Lane, Etters, PA 17319 Donald E. Drayer, HQ TF Falcon G2 Security APO AE 09340 Sandra D. Drayer, 314 Old Fort Road, Lemoyne, PA 17043 Linda L. Hughes, 736 Mumper Lane, Dillsburg, PA 17019 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } } SS: } Petitioner(s) Printed Name Petitioners Sarah Dra er 314 Old Fort Road Le mone PA 17043 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 D edent, the Petitioner(s) will well and truly administer the estate according to law. 7 Sworn too tf armed a s bscri d be o e <`'" ~ Date ~~ "~~ •~ ~~ . me this ~ day of ti~ C''I°i~. Date By: s ~ ~~~~ Date or t egister Date BOND Required: ~ YES Q NO FEES: 7. C~ ~f L e s ...................... O Short Certificate(s)...... . $ r _ . ©O ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Automation Fee . .............. ~ . JCS Fee . .................... . ©!J TOTAL ..................... $ ~.'6d'" ~~ To the Register of Wills: Please enter my appearance by my signature below: Attorney Si nature: ~, Printed Name: Amy H. Backenstose Supreme Court ID Number: 87008 Firm Name: Law Offices of Peter G. Angelos, P.C. Address: overnor's Plaza South, Building #3 Suite 330 ?OOl North Front Street Harrisburg, PA 17102 Phone: 717-232-1886 Fax: 717-232-4189 Email: ahhnl~_ga_com r_....:i Of I Use Only .~`~:r - -~ ~ ~j r..,~ -~-~ ; x T '^ :;., ..".. C ~~ O ... ~,3 t - ~?'~-' T _r Printed Address _ ~ti ~ --- , ,., C . ~.~3 , a Firm Rw-oz rev. ~o~ii~zoii Page 2 of 2 Oath of Personal Representative ~- oet~~;a~ ~:,~ o CO~t~tO~IVE.~LTH OF PF~'LSYLV,-~~;IA r z S~: T]Ie Petitioner(s) above-named swear(s) affirm(s) the statements in the foregoing P tion are taste and correct to the best of the luiowledge and belief of Petitioner(s) and that, as Personal Repres tative(s) of the Decedent, tl~e Petitio r(s) will well and truly administer the estate according to law. ( )Affidavit(s) Sworn to or affirmed and subscribed be re Date ine this day of By. Date Date For the Register Date ~"'`` - ~-r-- BOND Required• ~ YES ~ NO o the Register of Wills: ~ ~' • --~ - ; t: ',' FEES: P se enter m a earance b m si na Y PP Y Y g ''Blow: -"" _ ___ Letters ...................... $ ~. ,.., ,. , . Attorne ignature: ~., `--, "~ -~,. - r i ( )Short Certificate(s)...... ~~_:: '<:_ ~ ~~ ( )Renunciation(s)......... C~t.~; ? ~ ~~ ( )Codicil(s)........... ,..1 - ~ L.1r1 .. Qi Bottd ................. .... ... Printed Name: Commission .......... ....... Supreme Court Other ..... • .. ID Number: ••••••• Firm Name: • • • • • • • Address: •••••••• Phone: At tnation Fee ............... Fax: S Fee . .................... Email: TOTAL ..................... $ DECREE OF THE REGISTER ~ ~~ _..., t1~ ~w ~ ,r _. j-~_ '- .. i, --. ,. <_ .._ . . ~~ ~~~ ~~ Estate of P/~ File No: Z ~- ~ '~ -~ 1 / y a/k/a: AND NO ,~ , ~~~, in consideration of the foregoing Petition, safactory`~ having been presented before me, IT IS CREE that Letter ~ ~~~~ are hereby granted to ~r~~ ~~? ~ in the ab ve estate and (if aoolicahlel that tl}e-instrurn~t dated dribed tt~Petition ~.~:_ ~;~~" U E~ •,.. Fo~~~» Rcv-nz ,~w. ~nillizn~i tted to probate and filed of Register of Wills ~ ~ _ j ~, -11 D~.- ~. lr ('~ j ~ e«. ~ ~. ~ ~: ~ 3 4 7 cc~~e~R~~v~~ ~o',' P~ ~ - ` ~ ~? ~ ~~ . -- Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS Permanent Black Ink _ CER"!~'IFICATE OF DEATH State File Number: ~1 0 Q 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Vr) (Spell Mo) Dean B Dra er Sa. Age-Last Birthday (Yrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/D ay/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Monehs Days Hogs Minutes Los An ales California 83 January 31, 2012 7b. Birthplace (county) Sa. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Oid Decedent Live in a Township? Penns lVania 314 Old Fort Road QYes, decedent lived in twp. 8d. Residence (County) Cilmberland Se. Residence (Zip Code) 17043 ®No, decedent lived within limits of LemO~~te city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ®Married Q 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 Sarah Dra er 12. Father's Name (First, Middle, last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Kenneth Dra er Blanche Shedd 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Matting Address (Street and Number, City, State, Zip Code) o Sarah Dra er Wife 314 Old Fort Road Lemo to PA 17019 .. ................................................. . ............................................ 15a. P ace o Deat.. C ec on one ...................................... ................................... ... Y..................................... . ~~ z i~ , If Death Occurred in a Hospital: ly Inpatient e ,, ..uaa,~ Decedent's Home lf Death Occurred Somewhere Other Than a Hospital: t_J Hospice Facility ~ ~ Q Emergency Room/Outpatient Q Dead on Arrival . Q Nursing Home/Long-Term Care Facility Other (Specify) s iSb. Facilit Name If not institution, y ( give street and number; 15c. City or Town, State, and Zip Code lSd. County of Death ~ Hol S irit Hos ital Cam Hill PA 17011 Ctitnberland 16a. Method of Disposition Q Burial ~ Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) v Q Removal from State Q Donation other (specify) 8-3-2012 Cremation Societ of Penns 1Vania 16d. Location of Disposition (City or Town, State, and Zip) 17a. Sig at' r f Funera ice Licerisee or Pers Charge of Interment 17 b. License Number v Harrisbur PA 17109 FD-013376-L E 17c. Name and Complete Address of Funeral Facility u° Auer Cremation Services o£ Penns lvania n 4100 Jonestown oad Harrisbur PA 17109 m 18. Decedent's Education -Check the box that best describes the 1 cedent 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 Q Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese ® 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 0 Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese ~ Guamanian or Chamorro 0 Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino ~ 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. PhD, EdD) or Professional degree (Specify) Q Other (Specify) e. MD, DOS, 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. Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure Plumber Trade Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry ~ Chinese ~ Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Chamorro HVAC 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 BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 1 _ l~\ ~~ } L ~ 23d. Date Signed (Mo/Day/V r) 24. Time of Death y~~ ~~ ~j (1+ ~ r f 25. Was Medical Examiner or Coroner Contacted? Q Yes No CAUSE OF DEATH Approximate 26. Part I. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval: howing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death respiratory arrest, or ventricular fibrillation witho u t s l f ~ w IMMEDIATE CAUSE ---------------> a. ~ ~"V~ 7 ~.i t7~~~~ ~V\~ ~~ ~~...~f1 °- (Final disease or condition Due to (or as a consequence of): resulting in death) `~~~ ~~ ~ ~ l~~'~~ J ~~' ,_ ``~ ~~ ~ b. ~r ` 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): (disease or injury that initiated the events resulting d. W V in death) LAST. Due to (or as a consequence of): _ 26. Part 11. Enter other sigtnifica nt conditions contributing[ to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy ormed7 o Q Ves No g 28. Were autopsy findings available to complete the cause of death? c Q Ves No _, 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death a ~ ~ Q Not pregnant within past year 1,a. Q Yes ~Proba bly k U Natural Q Homicide Q Accident ~ Pending Investigation m Q Pregnant at time of death Q Not pregnant, but pregnant within 42 days of death n nown Q No ~ Suicide ~ Could not be determined ~°. but pregnant 43 days to 1 year before death Q Not pregnant 32. Date of Injury (MO/Day/Yr) (Spell Month) , Q Unknown if pregnant within the past year 33. Time of Injury s 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 ~ Driver/Operator ~ Pedestrian Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner slated Q Pronouncing & Certifying physician - e best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/ ner - On is examinatio and/or investigation, in my opinion, death occurred at the ti~dat and place, and due to tyh~e/c~a use(s) and manner stated ~ ` 1jLicense Number: `' ,~ ~~~~ ` ~ Signature of certifier: Title of certifier: ~ 39b. Name, Address and Zip Code o erson Completing Cause of Death (Item 26) ~ .~~(,10 Q 39c. Da a Signed (MO/Day/Yr) ~ -~ ~rl~ S~ 1 S \~'C t~ ~~~ ~d 40. Reglstra is District Number 41. Registrar's Signatur . 42. Registrar F Date Mo/ ay/Yr) ~f K 43. Amendments ~~ ~ Q ~ ~ 3~ I~a~t ( ~~~f ~~ ~,~ H1O5-143 Disposition Permit No. lL~ REV 07/2011 m„ _ ~i -~ LAST WILL AND TESTAMENT c~ ~~ : ~ r~ ~- ~.: OF ~ ~ ~ ~ a~__ . ~ ;:,~ - o ~r _~ DEAN B. DRAPER ~ ~~: o ~=-.- _ _. : ca .. w I, Dean B. Drayer, a resident of and domiciled in the Commonwealt~i of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. The provisions of this Article FIRST shall not apply to the extent that contrary provisions concerning the payment or apportionment of any such taxes have been or shall be made in any inter vivos instrument executed by me relating to any insurance, trusts, gifts or other transfers, jointly owned property or accounts, or property subject to power of appointment. SECOND: I give all tangible personal property owned by me at the time of my death, including without limitation personal effects, clothing, jewelry, furniture, furnishings, household goods, automobiles and other vehicles, together with all insurance policies relating thereto, to my wife Sarah E. Drayer, if she survives me, or if she does not survive me, to those of my children (Linda L. Hughes, Donald E. Drayer, David R. Drayer and Sandra D. Drayer) who survive me, in substantially equal shares, to be divided among them as they shall agree, or if they cannot agree, as my Executor shall determine. THIRD: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), to the trustee under the following trust to be held and disposed of in accordance with the terms, covenants and conditions of such trust: Dean B. Drayer and Sarah E. Drayer Living Trust Dated: ~~e ~~~ ~ ~ , ZC~-~ ~; In connection with the preparation of any tax return for me or my estate, I authorize my Executor: to determine whether to elect to qualify any property as qualified terminable interest property for Federal and/or State estate tax purposes; to make any election available under Section 2652(a)(3) of the Internal Revenue Code with respect to qualified terminable interest property as my Executor may deem advisable; to make any election available with respect to Chapter 13 of the Internal Revenue Code and to allocate the same to =~-~ ;, -~ ~~~ _ ~~ =_ _:,._, .. ., . -_r ~,-_, ... ~ _ ~ ; ~_. - ~;t . ~ _~ ~..1 == ,~ ~_ ~~ p _.~., ~~ti~ property eligible for such allocation, whether or not such property is held hereunder, including property transferred by me during my life as to which I did not make an allocation prior to my death, in such amounts and proportions as my Executor may deem advisable; to determine whether to include or exclude any item of property; to determine within permitted limits the date of valuation of my estate; to determine whether certain deductions shall be taken as income tax deductions or estate tax deductions; and to determine whether to adjust between principal and income. FOURTH: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executor, at any time and without court authorization, may: distribute the whole or any part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole or any part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or persons with whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution is made shall be a full discharge of my Executor from any liability with respect thereto, even though my Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of twenty-one (21) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article SIXTH hereof. If the beneficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. FIFTH: I appoint my wife Sarah E. Drayer to be my Executor. If my wife does not survive me, or shall fail to qualify for any reason as my Executor, or having qualified shall die, resign or cease to act for any reason as my Executor, I appoint Linda L. Drayer as my Executor. If Linda L. Drayer shall fail to qualify for any reason as Executrix, or having qualified shall resign or cease to act for any reason as my Executrix, I appoint Donald E. Drayer as my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. SIXTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to pay any legacy or distribute, divide or partition property in cash or in kind, or partly in kind, and to allocate different kinds of property, disproportionate amounts of property and undivided interests in property among any parts, funds or shares, and to determine the fair valuation of the property so allocated, with or without regard to tax basis; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executor" z ~~~ wherever used herein shall mean the executors, executor, executrix or administrator in office from time to time. SEVENTH: If any beneficiary under this will and I die in a common accident or under circumstances in which it is difficult or impractical to determine who survived the other, such beneficiary shall be deemed to have predeceased me. IN WITNESS WHEREOF, I, Dean B. Drayer, sign, seal, publish and declare this instrument as my last will and testament this ~t'1..._ day of L>~~ k--vv~-~~~c~~. I also have affixed my initials on the bottom of each of the preceding pages hereof. ~l ~: .~ L.S. Dean B. Drayer " The foregoing instrument was signed, sealed, published and declared by Dean B. Drayer, the above-named Testator, to be his last will and testament in our presence, all being present at the same time, and we, at his request and in his presence and in the presence of each other, have subscribed our names as witnesses on the date above written. residing at ~C~~IC~" ~ ~IlC'~l~l~.~ ~~ residing at ~~9~-.~3 i ~~~/ 3 ~ g~ ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND COUNTY, ss. We, Dean B. Drayer _~t-~-7~`~_t~ W ~~~-. and --------------------- - ~4'~.f~-U ~ - _ ~~Z,~r'V(,~~, _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,the Testator 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 Testator, Dean B. Drayer, signed and executed said instrument as his last will and testament in the presence and hearing of the witnesses, and that he had signed willingly, and that he executed it as his free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testator, in the presence and hearing of the Testator and each other, signed the will as witness, and that to the best of his or her knowledge the Testator was at the time at least eighteen years of age, of sound mind and under no constraint, duress, fraud or undue influence. Dean B. Drayer estator Witness v',~ ,~'~ Wi ss Subscribed, sworn to and acknowledged before me by the said Dean B. Drayer, Testator, and subscribed and sworn to before me by the above-named witnesses, this 8 `~ day of ~ .~ ~,~,~~ ~.~,'~.~a2.F-~~ ~= ~ ~. No ublic y commission expires on Notarial Seal Kimberly J. Gardner, Notary Public Middlesex Twp., CumeS p~ 3,2001 My Commis,,ion E~4i Member Pennsylvania Association of Notaries