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HomeMy WebLinkAbout10-22-12Reset PETITION FOR GRAlNT OF LETTERS REGISTER OF WILLS OF t-` t.C /'~ ~ ~ C~~ 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: /ti'II~,L~%tJt~" $, /~~/~JS a/k/a: M A- , Lr~ GcJt~ .s?~~NS~i1J Ot~i~tJ.S a/k/a: a/k/a: Date of Death: Q C7T~ $; 7..G- ! Z File No: ~~ r I ~ + / l (Assigned by Register) Social Security No: ~ ~ ~"/ Z - ~ .~ f Age at death: q/ Decedent was domiciled at death in L ~ ly~,~ ~~L~<~vJ County, /©~ ~ (crate) with his/htr last principal residence at ~;,`~ Cif •1'~ /'1~L~Q.-~L~`~ JET` ~"l j=C/f-~¢,~~G~.l~('~,~G p,~r~7c~.~'.!" c~ ~f~x~ Street address, Post Office and Zip Code City, Township or Borough County Decedent died at t~OLY S'Pl~-fT I~SP~T1Q'L CAMP /ttiLC., Ph} LUMB, P~ 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 $ ~ ~t d UCH • ~ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ Q"© O''b'4 1 ~ TOTAL ESTIMATED VALUE.... $ ! S .000.00 Real estate in Pennsylvania situated at: ~ ~ G 5 • ~~~E 1 S ~ V ~f>~~ (,L[~/ '7'w~7. ~' {f~it,$• (Attach additio~zal 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 ~-PRi~ ~~ ~t'l and Codicil(s) thereto dated State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution ofthe 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__, r-.,a `~1 lU R ~: `~- ~ tV ~, ~._, k ~-"! Form RW-02 rev. 10/11/2011 "i :, -ti i:1 _i ~~ _~ 7'~ D N ~../~ Q Page 1 of 2 ~ ~ N ~~ Offic ~+Only ~ ~ , -~, C, J Oath of Personal Representative , r- -r , ---~ .- _ _ t _, COMMONWEALTH OF PENNSYLVANIA } .~._~-f~~_ - ~ ~ ..::' COUNTY O F CAM C~ C~: -=a --~-., } ~~ ~'_i w;-ry T r .._. Petitioner(s) Printed Name Petitioner(s) Printed Address ~'~% ' d~uA~-~' I.~ ~tr~~«~.r'' ~l ! S' G 6f l .vr.~T ~'i f'yl ..r r~~ GC~y ~Q-- j 7 ~%S3 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoi~~ Petition are true a correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the itioner(s) 'll wed a t , ly administer the estate accor 'ng to la Sworn to r of rmed a subscribed before J_~.~~~~ Date ~`~ 22- / Z me th's ,~~~~ay o , ~, ~ ~ ~ , ~, v~ ~~-~- Date % t' ~ .~ l/ ,~ By: ~-' ~f1.~-~~ Date o the Register Date BOND Required: ®YES ®NO FEES: Let rs ...................... $ ~~' Cc' ( )Short Certificate(s)...... ~ ~ ~~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . t~~ ::::::: - ~~ Automation Fee . .............. ~ ~` JCS Fee . ................... . TOTAL ..................... $ ~~"' To the Register of Wills: Please enter my appearance by my signature below: Attorney Sign e: Printed Name: ~~jIVN~S V ~ J ~l1 Supreme Court ^ ~ ~ ~~ ID Number: ~L. Firm Name: CC GC!`'~c~'" ~ ~ ~ ~~~ Address: G ' _~ DECREE OF THE REGISTER Estate of ~r ar' ~ ~' /j /' ~ File No: ~~ Jl ~ ~~ a/k/a: AND NOW, L ~ ~~t-'-/' ~ ~~ ~ ~ , in con ' ration of the foregoing Petition, satisfactory proof having been presented before me, IT DECREED that Letters ~StQ'~~n ~'d/' are hereby granted to / ,/ e/' , /~ mil? ~ja ~,~ ,~~~.j ~ ~ in the above estate and (if applicable) that the instrument(s) dated /'i L ~O / described in the Petition be adfnitted to probate and filed of record ~s the last Will,(and Codicil(s)) oft Decedent. ill Register of W s ~ ~ ~/ Q~" . Form RW-02 rev. 10/11/2011 ~~ Pale ~Of 2 ~~ ~ -li~~ t .! it `~'„-+'~ ~ ~'1~~.` 5 ~3flF~.a ~~i ~~,! ~ina~~d _ - +. $.q?£;~i. _ .. vJ . t'~.`r'1", 1..3 :'.~~.j ~1. ~ __ ' ;)t ,'~°;-(t ~~,?E,.,.Sw~Lj~4~ +~~ i ~i G.' ~V _ .., :~: ~+;,,~?ii+~k it.i-~" `'_',~:;1 1~ ) , U~FI,~~~~ L~)vfi ~, ,~ ~I~AND CQ., PA M z ~ ~nA ,~: :f~. _ ', "~i _ . '. i, ~' ~}'~ai iE' Ali: ".?~. ~a' lt~i '~~,~ ~~.~ ., _ .. ~..'. ~~i''ts~_ .. ~~ C ~ 3 . ~f ~ L''y.. ~ j ,,~. _ . _ -- -- -f.V_._ !_ _._ ~_. Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent CERTIFICATE AF 1']EATH ry aaa O_ 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Marlowe S_ Perkins Male ber 8, 2012 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/D ay/Vear) (Spell Month) 7a. Birthplace (City and State or Foreign Country) 91 Months Days Hours Minutes 0 un L11t Maine November 17 , 1920 7b. Birthplace (county) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? Pennsylvania 1206 SOUth Market St . F~Ves, decedent lived in Upper Allen cwp 8d. Residence (County) Dau h1n Se. Residence (Zip Code) 17055 QNO, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death 0 Married $] Widowed il. Surviving Spouse's Name (If wife, give name prior to first marriage) ® Ves ~ No ~ Unknown ~ Divorced Q Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior io First Marriage (First, Middle, Last) Grover S. erkins Esselyn Gilman 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) 0 Patty A_ Perkins Daughter 1206 South Market St_ Mechanicsburg, ~+ ......................................... ... ............... ..... 15a: Pace o Deat... C ec on ). one _ ac If Death Occurred In a Hospital: Inpatient : If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~~ Decedent's Home ~ Emergency Room/Outpatient ~ Dead on Arrival . 0 Nursing Home/Long-Term Care Facility ~ Other (Specify) og 15b. Facility Name (If not institution, give street and number; lSC. City or Town, State, and Zip Code 15d. County of Death Hot S irit Hos ~ta1 E. ennsboro 'I~ Cumberland m 16a. Method of Disposition $] Burial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) p Removal from State ~ Donation ]-0~]-22012 Indlantown Gap National Cemetery Other (Specify) a+ 1 d. Locat( f Dispo i n (City or Town, State, and Zip) ~nnvz°f ~e '~~ 17a. Signature of Funeral Se ice Licensee or Person in Charge of Interment 17b. License Number , --~ -~~ FD-013592-L E 17c. Name and Complete Address of Funeral Facility 8 Hetrick-Bitner Funeral Home 3125 Walnut St_ Harrisbur PA 17109 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 t°- 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. ~ 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. 0 Black or African American 0 Vietnamese ~ High school graduate or GED completed No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native ~ Other Asian Q Some college credit, but no degree ~ Ves, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawaiian Associate degree (e.g. AA, AS) Q Yes, Puerto Rican ~ 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) Q Yes, ocher Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) e. MD DOS DVM LLB JD 21. D edent'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 ~ Japanese ~ Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American 0 Korean Q Other Pacific Islander Credit Manager Q American Indian or Alaska Native ~ Vietnamese Q Don't Know/Not Sure Q Asian Indian Q Other Asian ~ Refused ~ Chinese 0 Native Hawaiian Q Other (Specify) 22b. Kind of Business/Industry Q Filipino ~ Guamanian or Chamorro Seasrs Roebuck & CO ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~ ~ aS ~~ / n ~ J 2~_ r ~~~~~'~~~ ~~ /~ JV ~ ~7 ~~ 7 23d. Date Sig ned (Mo/Day/Yr) 24. Time of Death ~' - l~ o Qp / ~. L/ u/I^I 25. Was Medical Examiner or Coroner Contacted? ~ Yes J~ 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 showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Tines if necessary Onset to Death IMMEDIATE CAUSE ---------------> a. !~ S P 1 RAT t o 11 Q h1 )= U M o N- 4~ E (Flnai disease or condition Due to (or as a consequence of). resulting in death) b. SE.J~'r-Z~ T~~/SPI-iA Gl~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. ~ in death) LAST. Due to (or as a consequence of): S 26. PaK 11. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed? O ~ i--i >/ P4 RT ~r Pt 1 ~JJ fZ *L J S (o r-1 i-~ 7' P ~ RT £ ~ S-C" I ~J ~ C N r 0 Yes ® N o ~ .c - _O c 28. Were autopsy findings available v to complete the cause of death? Q Yes ~ No 3 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death E Q Not pregnant within past year 0 Yes ~ Probably ® Natural ~ Homicide S 0 Pregnant at time of death ® No 0 Unknown ~ Accident Q Pending Investigation ~' 0 Not pregnant, but pregnant within 42 days of death ~ Suicide ~ Could not be determined i-° ~ Noi pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (Spell Month) ~ 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: ~ Yes 0 Driver/Operator ~ Pedestrian ~ No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): ~ Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronouncing 8• 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 Q Medical Examiner/Coroner - On the basis of examination, and/or investigation, in my opinion, death occurred at the time, date, and place, and due to th e c a use(s) and manner stated ~ n r ~ Signature of certifier: Title of certifler.~O~" p (TA ~1 ST License Number-_i! 1_LJ Q- 4-0 47 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) ~ o / / .S'PJ ~' JT o5~0 i *ct / / "7r0 / / 39c. Date Signed (Mo/Day/Yr) , A 1V RA.S i~l-i A ~ T~ 1 n1 A S A fLA P V ~ O~ /1/ aZ / s'T i- . , /1 P I a S 1 2. 4~' ~ar's D tract Nu er 41. R i is Signature 42. Registrar File Date (Mo Day Vrj ~ ~~ ~ ~d I 43. Amendments Disposition Permit No. O CJ ~ ~~~I J ,~ H105-143 REV 07/2011 r .~ C?~ ;; `T) LAST WILL AND TESTAMENT -~ -~-~- , --. OF c<~ =' t~v ~~-. MARLOWE S . PERKINS ~~y ~' ~- -~' t.J ~_.. ... ~._.. ~ ~1 ~~ ~~ /Y• 1..I~~ I, MARLOWE S. PERKINS, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills and Codicils by me at any time heretofore made. ITEM I: I give, devise and bequeath all of my estate, of every nature and wherever situate, together with all insurance thereon, to my wife, MARY R. PERKINS, if she shall survive me by sixty (60) days. If my said wife predeceases me or fails to survive me by sixty (60) days, I give, devise and bequeath all of my estate, of every nature and wherever situate, together with all insurance thereon, as follows: A. I devise all that certain parcel of real estate and improvements thereon located in Upper Allen Township, !"1 ~ Cum erl_and COl1nt~.7 PQnnc~ l TTani~, ~'~i~osJ;i ~'S ~ 20~ .70titi , 1'~ u Market Street, Mechanicsburg, Pennsylvania, to my daughter, PATRICIA A. PERKINS, and my son, THOMAS V. PERKINS, in equal one-half shares as tenants in common subject, however, to the right of my daughter, PATRICIA A. PERKINS, to occupy said parcel so long as she is living, under the following terms and conditions: ~.;~t ~- - ~~. _:~=, c ~-- T' ~ -'7.- 'i' 1 -'~` r, `~ 1. My said daughter shall be responsible for the payment of all utilities, insurance, taxes, maintenance and ordinary repairs. For purposes of this paragraph, "ordinary repairs" shall mean repairs not exceeding the cost of $1, 000 for each separate item. The cost of repairs exceeding $1,000 for each separate item shall be shared equally by my daughter and son. 2. My daughter shall not be responsible to pay rent or any other fee or charge for occupancy of the said parcel. 3. My daughter's right to occupy shall be terminated upon her failure to reside there for a period in excess of 180 consecutive days, or upon her voluntary termination of said right by written instrument. ITEM II: I give, devise and bequeath all of the remainder of my estate in equal shares, to my daughter, PATRICIA A. PERKINS, and my sore, THOi~iAS V. PERKINS. The share of any child who predeceases me shall be divided equally among his or her issue. ITEM III: I appoint my daughter, PATRICIA A. PERKINS, and my son, THOMAS V. PERKINS, Co-Executors of this, my Last Will and Testament. ITEM III: I direct that no personal representative shall be required to provide security, surety or bond in any jurisdiction for the faithful performance of any duty under this Will. - 2 - IN WITNESS WHEREOF, I, MARLOWE S . PERKINS, have set my hand and seal to this, my Last Will and Testament, this ~~J~ day of 2011. ~, . ,~ ~'~`~.~'~t,1,~'~C,: ~~ .~ - ,._, ~ -....,, c..Tz- ( SEAL ) MARLdWE S. PERKINS Signed, s algid, publssried and declared by i%iARLC~vE S . PF~RKIivS, the Testator, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of each other, we believing him to be of sound mind, memory and understanding have hereunto subscribed our names as witnesses. o f ~~1~~~~ ~ ~- ~A - 3 - COMMONWEALTH OF PENNSYLVANIA COUNTY O F ~~~~1 f ~u r~ ~ ~:.~ ~ r ~~~,~-~.._ : We, MARLOWE S. PERKINS, //~ t SS: f,~ /,~~~~~t r'°~..~ `~ ~' and the Testator and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authorit1~ that the T~stat;:r signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge, the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ,~ ~ ~ MARLOWE S. PERKINS i" ,~ / ;~ Subscribed, sworn to and acknowledged before me by MARLOWE S. PERKINS, the Testator, and subscribed and sworn to before me by :,~ ,~'rr~ ~~ S ,~ ~' ~ and /,~! ~ ?i7/ ~ ~,~.s ~~~ ~~ witnesses, this ~~ ~ day of ; /~~f 2011 . ~! / /• F~ Notary Public ~ MMfaNWEALTH QF P~hlfN$lf ~ _ 4 _ NQTARIAL SEAL JENNY A. TOBlAS, Notary Public City of Harrisburg, Dauphin County IN Commission Expires February 15, 2013