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HomeMy WebLinkAbout10-09-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF cSL~~CIJ~~ ~ n(,~ COU`ivTY, PEVIVSYLVANL~ 1'etaior.er+s) named below. who is a 13 years of age or older, appiyliesi fcr Utters as spzcif:ed belo~c, at:d i„ support thereof aver!;s) the follo•-val_ and respectfi.tlly request(s) the grant of Letters in the appropriate form: Decedent's Information Name: $"u. s0.r+ K ~ ed e/`ei- a/kJ'a: a/k/a: a/k/a: Date of Death: !D - ~.~ 20 ~ L Decedent was domiciled at death in C K ~ `e.lt„ ~Q principal residence at ___ z ~ ~Ce $ w ~ ~~ ~ ~ iv ~ File No: ~ ~ - ~ a " ~ i (assigned by Register) Social Security No: zO6 " 16 - 8 ? S 7 Age at death: ~ $ County, `~~ (scare) withJxi~/her last /ryGL~RhiC~bt.r7 np~ IUD ~1J ey,IY1~L~~Cryo~ Street address, Post Office and Zip Code City, Towns ip or Borough County Decedent died at _(rolc~e.v L~~t~p /tf~-~.~s•~ L,~.~.~ 416 ~~~.,,~ ~t C~.,..,P ,~~lr G"4.~.`e; /1..~ /°.~ Street address, Post OfT a and Zip Code City, Township or Borough County State i 7d Il Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania If trot domiciled in Pennsylvania ........................ Personal property in County Value of real estate in Pennsylvania ........................................................ . TOTAL ESTIMATED VALUE... . Real estate in Pennsylvania situated at: (Attnch additional sheets, if necessary.) 12~: JCJO s Street address, Post Office and Zip Code City, Township or Borough County ~. Petition for Probate and Grant of Letters Testamentary a Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~-~.~"~9 9 / and Codicil(s) thereto dated State relevant circumstances (eg. 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(8), and did not have a child bom or adopte • and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. O EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (Ifapplicable) c.t.a., d. b. n., d. b. n.c.t.a., pendente life, durance 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(8) 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 W ill and was survived by the following spouse (ifany) and heirs (attach additional sheets, iJ'necessary): Name Relationshi Address c~ ~ 0 ~7 ~ - t r=F'- ~~ off. .~: _H N =~ tJ1 A? Form RW-01 rw. tnitlizntt Page 1 of 2 ~~- ~, i '~~~FiCE ~ REuI:~~~, Y,. .~-~ Oath of Personal Representative CO~I~[OVW'E:~LTH OF PE~NSY'LV,~VLa } } SS 2ti~2 QCT -9 PM 2~ 52 .~. , ~ G7/ D• bete fir- C~r!'SrC P~ f `70/ ~$ /~eOVe:-- '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 lmowledge and belief of Petitioner(s) and that, as Personal Representative(s) ofthe Deced it, the Petitione will well and truly administer the estate according to law. Sworn to ffirmed bsc~,t'be before ~~' ~ Date I~ - r -/ z met ' day o L„-l/i~.~ J ~Ai7 By: 1<, __ Register BOND Required: Q YES ~ NO FEES: Letters .... .... , , (~ )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other j~,l~;~ ...... s Automation Fee .............. . JCS Fee ..................... /, TOTAL ..................... S , Date Date Date To the Register of Wills: Please enter my~appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID .Number: Firm Name: Address: Phone: Fax: Email: DE(;REE OF THE REGISTER Estate of = ~~ h ~ , ~p~ Q re ~^ File No• 6~'~~ ~ (j~ a/k/a: AND NOW, _ ~ (` ~)f~X ~ , 2(J ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letter are hereby granted to in the a ove estate and (if appl ble) that the instrument(s) dated Q 15( [QQQ descrtbed to the Petttton be adtnttted to probate and filed of record as the last Will (and codicil(s)) of Decedent. egtster o i Is ~u~,~ c~~ t ' ~X- For,,, Rw_nz rev. ro~rt~znir Pag of 2 _.. _ _ v,~~ e~~ o>i~, ,~~,,, LOC~i~~~T~-R'S CERTIFICATION OF DEATH WARS` c~~s ') + ~ ~ duplicate this copy by photostat or photograph. _ rim: fRJ] 1 r[. AA• ree ror mis certmcate, ~b.UU [U1L Ut, I "`j ('p(J ~. ~j2 This is to certify that the information here given is correctly copied frojn an original Certificate of Death duly filed with me as Local Registrar. The original ~~ -' i'' certificate will be forwarded to the State Vital ~RPNA~V ~ I,CJIJ~T Records Office for permanent filing. P 18882749~~R~oco.,PA ~x~e. ~~~'asc~,~,c~rt.71e1C' OC~ 5 /Z 012 Certification Number ;,~a type/Print In Pvmanenc ~\ Q :J _-l U ~~ ~', ~_ >~ Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH _ VITAL RECORDS r'COTa Caf~ATC ~~ - - - - -~ ~ ' ~ ~ State Flle Number: 1. Decedent's Legal Name (First, Mltldle, Lsst, Suffix) 2 Sex 3 Soclel s i . . ecur ty Number 4. Oahe of Death (MO/Day/Yr) (spell Mo) Susan K_ Dederer F_ 206-16-8857 ctober 2 2012 Ss. Age-Last Birihtlay (Yrs) Sb. Under 1 Year Sc. Vntler 1 Da 6. Date of Birth (MO/Oay/Year) (Spell Month) 7a. Birthplace ity an Sta r F i ~' ~ p~ p i S o orG-e gAn Country) Months Days Hours Minutes ' 88 z s March 1 8 1 9 2 4 7b. Birthplace (eo~ney) ga. Residence (Stale or Foreign Country) Sb. Residence (Street and Number- Include Apt No.) Bc. Did Decedent Live In a Town hip? PA 20 Keswick Drive Si~ver S i ~ pr ng Ye:,d«eden[uyedlo 1 gd. Residence (cp~nty) Meehaniesbur PA p~ 1 Be. Residence (Zip Code) '~ '7 rj Q Q No, decedent I Wed w(thln Ilmit of r city/boro. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Nsme (If wife give name ri t fi , p or o rst marriage) Q Yes QNO Q Unknown Q Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First Middle Last) , , A11 14s. Informant's Name 14 Relati hi [ D d ' . ons p o ece ent 14c. Informant s Mailing Adtlrcss (Strc tan < City, State, 21p Code) oover Rd_ Carlisle, PA 17015 H Death Occurred In a HOSPital: atlent ..^° ..............................ssww .................................... ... .. ....... ..... t~ InP ~ ;If Death Occurred Somewhere Other Thsn s Hospital: i I~HOSpice Facility C]~Deeed t' ~H ~~~ ~~~ _ en s Ome Emergency Room/Outpatient Dead on Arrival ? Nursing Home/Long-Term Care Facility Other (Specity) 15b Facility Name (H not Instit [l i uuu . u on, g ve street and number; i5c. City or Town, State, and 21p Code 15d. County of Death n lBa. Method of Dlspositlon Burlel Cremation 16b. Date of Disposlflon 16c. Place of DlsposlHOn (Name of cemetery, crematory, or other place) Q Removal from Stat e Q Donation otner(sPeclty) 10/O5/201~ Hollin FH/Crematory,2nc 16d. Location of Dlspositlon (City or Town, State, and 21p) 17a. SI of Funeral Service Uce se r Pa in Cha of Int ment 17b. License Number rc ~ 011 S rin s PA 17065 FD-011932-L 17c. Name and Complete Address of Funeral Facility op gg Ora AVe M 1 a r ~ ~ t Hol1 in S PA 17065 S8. Decedent's Educallon -Check the b x that best describes the 19. Oec dent of Hispanic Origin -Cheek th 20. Decedent's Race -Check Oy,E OR MORE races to indicate what highest degree or level of school com l<ted t th i f d p a e t me o eath. box that best describes whether the decedent he ecetlent considered himself or herself to be. Q Bth grade or less is Spanish/Hispanie/LaTino. Check the "NO" White No di 1 Q Korean Q p oma, 9th - 12th Bratle b ox if decedent is not Spanish/Hispanic/Latino. Black or Afrlun American Q Vietnamese Q Hlgh school graduate or GED completetl o, not Spanish/Hlspanlc/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but na degree Q Yes Mexican M i , , ex can American, Chicano Q Asian Indian Q Native Hawallan Q Associate degree (e.g. AA, AS) Q Yes Pue RO Rican , Q chlneae Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino Q Guamanian or Chamorro - ~ ' Q Samoan aster s degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hlspanlc/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, ECO) or Professional degree (S if pec y) Q Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Race Self-Dealgnafion -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indlote type of work White Q Japanese Q S amoan tlone during most of working Ilfe. DO NOT VSE RETIRED. Q lack or African American Q Korean Q Other Pacific I l d s an er Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sur< Hou$ eW i f e Q Asian I tll n an Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawallan Q Other (Specify) Q FIIlpino Q Guamanian or Chamorro c~ Domestics U BE COMPLETED 23a. ~ teOPrp~unc<2~ I`ylo DaY r 23 , Signature o Person Pron Ing Bath On y w en app to a 23c. License Num er tY -ERBON WHO PRONOUNCES OR / / ~ L C[RTIF ES DFATN , ~~/,t ~ ~s ~ ~ /~~ ~ / --[ 23d. Dat Sign d (MO/Da /V ) ~~ -- - ~ ~'~~ ~~ ~ y r 24. Time of Death `~ / ~"~ (/ a- ~~1~ / ~ Z. ~} / Z, ~ S ..--. 25. Was Medical Examiner or Coroner Contacted? Q Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of~n~.__dlsesses, Inju Hes, or complicalfons-that directly caused the death. DO NOT enter Terminal events S h d uc as car iac arrest. Interval: rcspiralory arrest, or ventricular flbrillatlon without showln the etiology. 1DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset fo Death ~ IMMEDIATE CAUSE -------------> a. /~ ifi7 / T/fr71 (Final disease or condition Due to (or as a consequence of): resulting In death) ~ ~ - / Sequantlally list conditions, Due o (or as a conse uenc f q e o ): If any, leading to the cause listed on Ilne a. Enter the ~ UNDERLYING CAVSE ( r es a consequence (disease or Injury that Due to 0 of); initiated the events resulting d. In death) LAST. Y3 az a con Due to (or sequence of): 26. Part Ii. Enter other sla Ifl t dltl T Ib tl t d th but n t r lti I o esu ng n the underlying cause given In Part 1 27. Was an autopsyperfor ~ Q Yes o ~' 28. Were autoPry findings available _ to complete the cause of athi 29. If Fam~1e~ 30. Did Tobacco Use Contribute to Death? 33. M of Death Yes B~Not preBnent with ln Past Year ~ °~~ o ~~t ^~ gnant at [Ime f death Q Q Q a ~ d Q Unkn j own Accident No Pendin 0 pregnant, but pregnant within 42 days of death Q ~ g Ption Invest) Q Not pregnant, but pregnant 43 days fo 1 year before death 32. Date of In ury (MO/Da /Yr 5 Q Suicide Q Could not be determined 1 y ) ( pelt 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 a[ Work 37. If Transportation Injury, specify: 38. Describe How Injury Occurred: Q Vas Q Driver/Operator Q Pedestrian Q No Q Pass<nger Q Other (SPeclTy) 39a. C er (Check only one): , Certifying physician - To the best of my knowledge, death occurrctl due to the cause(s) end m r staled Q Pr i 6 onounc ng Gertifying physician - To the best of my knowledge, death occurred at The time, date, and place, and due to the cause(s) and manner stat Q Medical Exa d i /C e m ner oroner - On t sa le of examination, an /or f vestigation, in my opinion, dea t h curred et the Ti me, date, and place, and due to the a se(a) antl mann t d ~ ` ~~ ~~ ~~~~ er s ate / Signature o/ certifier: A~ea..~ Title of certifier: /fTJt_. ( ra ` . /IC t Ueense Number: ~/6 ]• p LG 70 a/L 39b. Name, Address and Zip ode of mpletln au of at (I 2B) ac ~~ a ~` 39c. Da1te StLpd (M /Day r) / J k ( ~' ~ - r ~A,1i r1c.~ I ~'~e-C.TC OIIOOYY S IOI O. R<giatrar's DlstrlR Number 41 - 1 555{{{a<e e istrar w ` - h [ O T-` . g r~~~TUre s ~. ~-1 ! 4 Registrar FI a Date Mo Day r 43. Am<ntlments _ ~ 6C~ H105-143 Dlspositlon Permit No. REV 07/2011 LAST WILL AND TESTAMENT I, SUSAN K. DEDERER, of the Township of Upper Allen, (Cumberland County, Pennsylvania, being of sound and disposing lmind, memory and understanding, do hereby make, publish-and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at tim~ ~~ her8tt:.fl7re IiiadC. ~,~!'±~z ~ ~~ ~ ~ •, ~ FIRST. I order and direct that all my debts an~~uner~l l~ expenses be paid by my Executor or Executrix as the case maybe, (hereinafter named, as soon as conveniently may be done after my (decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my husband, JOHN D. DEDERER, absolutely and in fee simple, if he survives me by as many as sixty (60) days. THIRD. If my husband, JOHN D. DEDERER, should not survive me by as many as sixty (60) days, then and in that event, I give, devise and bequeath three-fourths (3/4) of my Estate in equal shares unto my children, namely, STEPHEN D. DEDERER, PHILIP C. DEDERER and SUZANNE M. DEDERER, share and share alike, absolutely and in fee simple. Should any of my said children predecease me and leave lawful issue to survive them, I order and direct that the share or part of my Estate which such deceased child or children would have received hereunder had he, she or they survived me, be distributed unto the issue of such deceased child or children, per stirpes by representation and not per capita. FOURTH. If my husband, JOHN D. DEDERER, should not survive by as many as sixty (60) days, then, in that event, I give, LAW OFFICES SNELBAKER, devlse and bequeath one-fourth (1/4 ) of my Estate in equal BRENNEMAN & SPARE n shares unto my grandsons, ROSS WILLIAM DEDERER and GREGORY LEE DEDERER. In the event the surname of ROSS WILLIAM DEDERER or GREGORY LEE DEDERER is changed in any way (including the use of hyphenation) from the surname "Dederer", then his respective share shall lapse. In the event either ROSS WILLIAM DEDERER or GREGORY LEE DEDERER should predecease me, fail to survive me by as many as sixty (60) days or has a change in surname as explained hereinabove, then the share of said grandson shall pass to the survivor of the two. In the event both ROSS WILLIAM DEDERER and GREGORY LEE DEDERER predecease me, fail to survive me by as many as sixty (60) days, or have a change in surname as explained hereinabove, then the one-fourth (1/4) share of my Estate shall lapse and shall be distributed equally among my surviving children and their issue as set forth hereinabove. FIFTH. Should ROSS WILLIAM DEDERER or GREGORY LEE DEDERER be entitled to any portion of my estate prior to reaching thirty (30) years of age, then each of their respective shares shall be placed in a separate trust to be delivered unto STEPHEN D. DEDERER as my testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest and reinvest for the use of said beneficiary in a separate trust under the terms and conditions set forth Ibelow. A. To use, consume, expend and apply from time to time such amounts of income and principal as the Trustee in his sole discretion, shall determine to be appropriate for the medical and educational needs of the trust beneficiary; B. I designate any trust hereunder to be a spend- %i1L'ifi: i.rus~.. T•iie eneficiary siiaii have no right LAW OFFICES SNELBAKER. BRENNEMAN & SPARE to invade, pledge, assign or otherwise dispose of the assets (including income) of said trust nor shall any creditor of any beneficiary have any right to seize, levy or execute upon -2- said assets; and C. Upon said beneficiary attaining the age of thirty (30) years, I order and direct that the trust shall terminate and the net balance of principal and accumulated income shall be distributed to said beneficiary, absolutely. Srculd tl-,<e principal of the Trust herein be or become too small in the Trustee's discretion so as to make establishment or continuance of the Trust inadvisable, the Trustee may make immediate distribution of the remaining net principal and accumulated income outright to the beneficiary and if the beneficiary is a minor, distribution may be made to the appropriate Guardian, at which time the Trust shall terminate. In the event STEPHEN D. DEDERER should predecease me or LAW OFFICES SNELBAKER, BRENNEMAN & SPARE fail to act as Trustee, I nominate and appoint PHILIP C. DEDERER as alternate Trustee hereunder. In the event PHILIP C. DEDERER should predecease me or fail to act as Trustee, I nominate and appoint SUZANNE M. DEDERER as alternate Trustee hereunder. SIXTH. Should any beneficiary other than ROSS WILLIAM DEDERER or GREGORY LEE DEDERER share in my estate when less then thirty (30) years of age, I order and direct that the distributive portion of my Estate attributable to said individual beneficiary shall be paid over and delivered unto STEPHEN D. DEDERER, as my testamentary Trustee, and placed in a separate Trust, IN TRUST, NEVERTHELESS, to hold, manage, invest and reinvest for the use and benefit of said beneficiary upon the following terms and conditions: A. I authorize my said Trustee to pay so much of the income arising thereon together with so much of the principal thereof as in the opinion of said Trustee is necessary or -3- desirable to be expended for the support, maintenance, health and education of said beneficiary to the proper payee, including any Guardian of said beneficiary, for such purposes. B. During the existence of the said Trust, I order and direct that the beneficiary thereof shall be prohibited from pledging or assigning any assets in said Trust or from otherwise anticipating any distribution hereunder and that no creditor of said beneficiary shall have the right to levy upon, attach or otherwise obtain any assets in said Trust. C. When said beneficiary attains the age thirty (30) years, I order and shall terminate and the balance of principal an. shall be distributed to absolutely. Should the principal of direct that the Trust then remaining net ~ accumulated income said beneficiary, the Trust herein be or become too small in the Trustee's discretion so as to make establishment or continuance of the Trust inadvisable, the Trustee may make immediate distribution of the remaining net principal and accumulated income outright to the beneficiary and if the beneficiary is a minor, distribution may be made to the appropriate Guardian, at which time the Trust shall terminate. SEVENTH. I nominate, constitute and appoint my husband, LAW OFFICES SNELBAKER. BRENNEMAN & SPARE JOHN D. DEDERER, to be the Executor of this my Last Will and Testament, but if for any reason he should fail to qualify as such Executrix, or cease so to serve, then and in that event; T nominate, constitute STEPHEN D. DEDERER to be the Executor hereof but should he predecease me or fail to qualify, then, in -4- such event, I nominate, constitute and appoint my son, PHILIP C. DEDERER, as Executor of this my Last Will and Testament. In the event he should predecease me or fail to qualify, then, in such event, I nominate, constitute and appoint my daughter, SUZANNE M. DEDERER, as Executrix of this my Last Will and Testament. I further direct that no person serving as Executor, Executrix or Trustee hereunder be required to post bond to secure the faithful performance of his or her duties in the Commonwealth of lPennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to (this my Last Will and Testament written on five (5) pages this 28th day of September, 1999. SEAL ) Susan K. Dederer Signed, sealed, published and declared by SUSAN K. DEDERER, the Testatrix above named, as and for her Last Will and Testament, in cur presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. (SEAL) --~~ (SEAL) LAW OFFICES SNELBAKER, BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) We, SUSAN K. DEDERER, PHILIP H. SPARE, ESQUIRE and SUSAN L. ZYCH, the Testatrix 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 Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. t Testatrix tness Witne Subscribed, sworn to and acknowledged before me by SUSAN K. DEDERER, Testatrix, and subscribed and sworn to before me_by PHILIP H. SPARE, ESQUIRE and SUSAN L. ZYCH, witnesses, this 28th day of September, 1999. ~. Nota y Pu lic Law oFFices NOtenBi Seal SNELBAKER, (`.rhnStlne M. White, No Public BRENNEMAN Mechanrestwrg Boro, Cumbnd minty & SPARE My Commission Expires Sept. 1 ] 20p'1 ~ ~ Member. Pennsylvania Association of Notaries