HomeMy WebLinkAbout11-01-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PEN SYLVANIA
Petitioner(s) named below, who islare 18 years of age or older, apply(ies) for Letters as specified below, and in support th reof aver(s) the
following and respectfully requests the grant of Letters in the appropriate form:
Decedent's Information
Name: Betty Mae Zook
a/kia: Betty M. Zook
a/kia:
a/k/a:
Date of Death: 10/09/2012
Decedent was domiciled at death in Cumberland County,
principal residence at Messiah Village, Mechanicsburg 17055
Decedent died at 100 Mt. Allen Drive 17055
File No: 21-12 .' ~
(Assigned by
Social Security No:
Age at Death: 91
PA
Allen '
mahio or
state
Estimate of value of decedent's property at death
If domiciled in Pennsylvania ...................... All personal property $
lfnot domiciled in Pennsylvania ................ Personal property in Pennsylvania $
Ifnot domiciled in Pennsylvania ................ Personal property in County $
(State) with his/her last
Cumberland
PA
Value ofrea/ estate in Pennsylvania ................................................................... $
TOTAL ESTIMATED VALUE S
Real estate in Pennsylvania situated at
(Attach additional sheets, i/necessary.)
37,000.00
Street address, Post Office and Zip Code
Ciry, Township or Borough
® A. Petition for Probats and Grant of Letters Testamentary
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated 1
thereto dated
County
and Codicil(s)
grace rerevanc cvcumstarrces te.g., renunaation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not mar 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 of 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., pedente life, durant absentia. durante minoritate
If Administration, c.ta or d.b.n.c.t.a., enter date of III in Section A above and complete li t of heirs,
Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been a tablished 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 spo se (if any) and heirs (attach
additional sheets, if necessary):
Name
Relationship
Address r*
~';' rr; c
~_~.,
_
_
G.. - t k
n`i '7-
-1 ~ ~ !. _ L_._
' •...~
r N =-
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Form RW-O2 rev. 10.11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative ,i"{~;;t ~, ;~~,f~'~
COMMONWEALTH OF PENNSYLVANIA } r'C~l ~ L_;? '"i.l C
} SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name Petitioner(s) Printed Address M
Norman F Zook 133 West Locust Street -Unit 201
Mechanicsburg, PA 17055 -
CO., PA
The Peiitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the be t of the knowledge and
belief of Petitioner(s) and that, as Personal Representative(s) of the D dent, Petitioner s) will well a truly administer th estate according to law.
Sworn to or affirmed a d ubscribe before Date /~' / -.f Z
me th' day of Data
By: Date
r the Register Dale
BOND Required? ~ YES ~ NO
FEES: iii
Letters ..................................... ..... $ 90.00
( 5 )Short Certificate(s)..... .... 20.00
( )Renunciation(s) .......... ....
( )Codicil(s) .................... ....
( )Affidavit(s) .................. ....
Bond ........................................ .....
Commission ............................. .....
Other Will 15.00
Automation Fee ........................ .... 5.00
JCS Fee ................................... .... 23.50
TOTAL ..................................... .... $ ~~
153.50
To the Register of Wills:
Please enter my auoearance by my sienature 6elew~
Attorney Signature:
Printed Name: Edmund G. Myers
Supreme Court
ID Number: 20558
Firm Name: JOHNSON DUFFIE
Address: 301 MARKET STREET
PO BOX 109
Lemoyne, PA 17043
Phone: (717)761-4540
Fax:
E-mail: egm~jdsw.com
DECREE OF THE REGISTER
Date of Death:
Social Security No:
Estate of Betty Mae Zook File No:
a!k/a: Be M. Zook
AND NOW, Zl~ l2 , in consider;
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Norman F Zook
in the above estate and (if applicable) that the instrument(s) dated 10/27/2005
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of
Register of Wills
Copyright (c) 2011 form software only The
2
of the foregoing Petition,
2 of 2
__ _ _
-- _
H1pg.RpS RFV ro/tn __. - ~ _
LOCAL REGISTRAR'S CERTIFICATION OF DE TH
WARNING: It is illegal to duplicate this copy by photostat or photogra h.
Fee for this certificate, $6.00
P 18861202
Certification Number
w/Pant m
rent
This is to certify t at the information here given is
correctly copied fro n an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
z
1a i ~~ !~l
Local Registrar Date Issued
COMMONWEALTH Of PENNSYLVANIA • OEPARTMEM OF HEALTH • VITAL REEAROS
('FRTIFI!•ATC AC EICATY
1. Decedent's laSal Name IFint, Mlddk, Last, Su/na) 1. Sea 3. Seckl Securky Number~w• w ^/. Date el DaaM (MO/Ory/Yr) (50!11 0)
Betty Mae Zook Female 177-16-0790 October 9, 2012
sa. Ne-IaN ekthtlry Irnl Sb. UMlr 1 Year k. Under 1 D B. pale el Blnh IMO/DaY/Yearl IspaX MonMl )a. BMhpbu IcRV>b Stab w Fonyn CeuMryl
91 Months on, Nekrs Mbmu A t 9
1921 Harri PfMS lvania
a
,
~ Ib. Bkthpllte Iceunryl
N. RINMrrce (StlVanla coontry)
'D`a'.f'n°n'.I. Bb. ResWlne ISNeet ant Numblr ~ Incbde Apt No.)
100 Mt
Allen Drive Bc. Ditl DecetleM live In a Townfhlp7
res
alne.mnY<em [I~ner Allen
w. RefberNe lceunryf . .
t p.
Q1EDberlallCl Be. Reslderoe 1110 rndel 1705tj ^ No, aecedent Ilved wtthin Mmtts of ary/b ro
9. Ever In US Amwtl forpsi 30 MaMN Sbew n Time of Death ~ MaMed WleowW SL SurvMry Spouu'f Name IN wih, Sh't name prbr b flnt mardaeel
^
~
Yes .
No ~ Unknown D Dlvwced ^ Never Martkd ^Unkrown
13. lathers Name IFxft, Middle, 4st. TuNd) 13. MotMff Name Prior m First Marrlya (flnU Middle, Las[)
Paul K. Kiner Ethel M.
lY.ln(ortwM's Name lab. RelatbnsMp to Decedent lac. Informant's MNllry Addrcu lStrcet and NUmber,Ory, Sbte, 2lp Codel 1'~QC,C,
NorEllan F. Zook Son 133 W, locust St., Unit 201, Mechanicsburg
c ---------'---' --------'a=te--•i non. ____ __ _ __ _
I/DeaM Otcuned tree HOSpnal: dlnwtknt IIf DlaMODUrted Semewherc Otherfiana lbsphal QHespke FacNiry ~ rJ Dercdent's Nome
^ EmerSencY Room/OutpatkM ^ Deaden ArrwN I NunklS Herww/LOM-Term Gre Facl4ly ^ Other (Specllyl
R
5 ISb. FecNity Nlme (1/ mt Intttutlon, tN<strtlt ant rwmber) 15c. EMY w Town, lute, and 210 Code 15d. EountY of Death
~
333 M rnbu'land
> I6a. hbMod d DkPefltiors Swkl ^ Cnmatbn SSb. DNe el DkpmNbn 16c. Pkn a kfan IName of ometery, crematory, or other pail
E
'€ D "`"'°"Nfr°"'ua" O °vnatlon
^ qN.r spetlM Oct. 16, 201 irdiantoram Gap Natirnal CeFletery
2 Idd.lxatbn o/DlspmttbnlGy wTOwn, Sbb, and vpl
Annville
PA
a
Ile. loner lSeMCe Plrsenb Charge a/Interment
e~a.t„ ]lb. UCenx Number
E , ~
~
~` Fp-138630
17c. Name ell CnnNdate Mdrea of FunerN FatNRY
8 Mal zi Funeral Elortle 8 Macke laze Wa c PA 17055
~
I- U. DecedeM'f Eduwtbn - C1weY tM bw Met heft dexNhef Mf 19, OecedlM W Nkpank Oryln -Check the ]O.OecedeM's Rate ~ C'heck ONE OR MORE races to Indbb what
Ayheft dlSree or keel of fchod tem
keM
[ th
[Y
f d
M
b
h
p
a
e
ne o
ea
.
oa e
N art describes whetMr tM dettdmt aMae debdlnt conNMnd hlmaeN w Mnelf to be.
^ Mwade erlus kSP+NSh/11bpaMC/bikes. Clnek lM'Ne' Ip WhM ^ Ronan
NO dlpbma, 9M -13M pede bee H dsceelM b not SpankhMlspanlc/Latlno. ^ Black w Afrkan Amerkan ^ Vletwmex
^ Nyh sclad SndueU w GE0 <ompkted No, rut SpaNM/Hkpenle/btlro ^ Amerkan Intlbn or Alaska NttM ^ OMer Allan
^ Some eMkSe [redk, but ro dgrx ^ Yu, M<akan, Meainn Amerkan, Chkano ^ Asian IMkn ^ NaHVe Hawalkn
^ Assockta depot ley AA, ASI ^ Yes, PwRO Rkan ^ Glnese ^ Guamanian w CM
^ McMler'f tlaSree (•;. BA, AB, B51 ^ YH, Cuban ^ FWpino ^ Samwn
Q Mnbr'f hSne Ie.S. MA, M5, MEry, MEd, MSW, McAI ^ Yes, other lpanlsh/NlspaMe/ta[Na Q lawnex ^ qMr PacNk Isla
~Dxbnblt;. W10, Edo)or Profusbwl delve ISpecIN'I ^gMrlSpeclNl
!.. MO DDS DVM LLB 10
21. Decedent's SInEk Race SeE-0ldenatkm - CMck DNLY ONE to InMr [<wMt tM decedent comklerltl hlmfeN w MnNf to be. ]3a. Decedent's Uswl OCCUprtbn .IMkab type
1Cwhne
^ bwroft ^ samean
done dungy most o/werklry Me. tq NOT USER
^ Bktk or Afrkan Amerkan ^ Ronan
^ gMrPaNntld,nder ~,
Q Amlrlun IrNkn w Aks4 Native ^ VkiNmese ^ ppn't Erow/Not Sure
~ Alvan Indkn ^ OMer Alvan ^ Refused 32h. Rind of Wslness/IndwM
^ chbne ^ NatNe Hewalkn ^ aver IsPeciryl
^ FIIIpIrw ^ Gwmanknw[Mmwro DFRI 1'1411e
I1EMS 3A • MUSE BE COMPLETED L. Oab Prorwwc p! Mo ry r 33b. SlSnalun of Penan Prorounciry On when aPPlkabk) 33t
lkenu Numbr
.
BY P[RRON WND PROFIOU/N~S qt
E`~~~D~'~ R
4
33d. wb IMO av/Yrl Sa. nme or De•M
tv3
9G7d
]S. WasMMkal IMrer Der"Mr Canbcteei ^ Yes No
CAUSE OF DEATH I
Apwealmab
]k. Pail 1. EMer[M CMbofewnu--dkuus, InWries, or complkatbm~-that dkectly caused the deaM. 00 NOT enter terminaleynts suchascardNt arrest, In[erval~.
rcspfntory arrest, or yntrkularnbnNMbn wlthoutsMwiry Me etbbry.
DO NOT gBBREVIATf. Enter onN one cauu ova qne. Atld additbnal lines if neceuary. I Onxt to Deat
~J
IMMEDMTF GUSE ---------.._.> a. ~vt\1UK,~ 'FO 'T tA(.Cflf VY I
I
(final dluau w mMttbn Due to for nueuence off:
a aco
+
ruuklry mdeaMl
,1~
b. Lµ kSC EF': UV' YS
~GG~1.'~Gti LI N'1 uaN'~(
SeewntlalN Iht coneNbns, Dw eo for as a come4wrKe a
IF anY, keGry to the oux
OstM on Iles a. Eller Me
UNDERIYNaG GUSF Due b Iw as a conseeuence oft:
leklax w kdury tMt
F Inltlabdthl eVlMf rlwltlnE tl.
b tleuM LAST. Ow to for of a conuRwnce of):
$ 36. hn IL Eller oMer NlMRc M ,....um • trNa»w t de M but not rcsuMnS In tM wlderMry cawe SMn in Part I. 31. Was an Mapsy performedi
f
^ YH Na
~ ]B. Wan eubpW kIV rvaWbk
to complete tM caufe el deaMT
^ Yes ^ No
29. N femak:
(~ Not pnErunt wMdn
et
ear 30. Ob Tobacco Uu CPNnbkte b DeaMi 33. IMmer of Death
' y
w
^ PnpwM Ntlme of death ^ Yn ^ PreGbN
^ No iQ Unkrown BJ Natunl ^ Nomlcye
^ AukAeM ^ Ptndiry lmwxyetlon
~ ~ Not prepwM, but prlSnant wttRb 4] day al deaM ~ lukltle ~ CoWd rot M determirod
^ NM prgnaM, but preSnant A3 day to l yar Mbrc deaM
^ U
k
N 33. Date of Inlury IMONay/vrl IspeN ManMl
n
rown
praSMm wkMn tM put year 33. Time of IMury
31. VNace of IMury (e.E. home; carotroctbn she; brm; fchool) 35. LwaNOn of Iniury (Street ant Number, Cky, County, Stab, Zlp Cetle)
36. Infury at WOr! 37. I/TnuPwtatbnlMury, lpeUly: 30. Dlscrlbe MOw lnfury gcurted:
Q Yu ^ Dnver/Operator ^ Pedeftrlan
q! No ^ Pasxryx ^ ocher (Specdyl
39 CMNkr-phykbn,eertlfled rorse practltbntr, medkaleuminer/conror(Cheek onN owl'
CerWliry erdY-io tM hMt of mY knowledEe, deaM occurred des b tM uuulsl and manner shod.
Pnrounon(4 CRrtNyiry ~ To the hell of my Yrowkdde, dull occurred at the tlme, date, and place, and due to Me cwfN+I and mamxr slabd
,
^ Mtdkal Euminer/CO~On [h! Wsls of eaaminatbn aM/w Inwstyafbn, In my oplnbn, death
wcurrcd at the dme, dab, antl place, and tlw b the cauxltl and man
n
er ftatetl.
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Synaturc ofcMiner: I ~•JEyr Tide of certNkr: V). J ~ Ucenu Number: U,~JL'S/UIfY ~~
3%. Nerve, Address and Zip Cotle of Oenm Grripletky V x of DteM Ilbm 36) 39c. Oue Synod IMe/Day/vrl
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Dhposlnon vermn Ne. 0691777 REV of/3ou
i
`~.~c~t ~iYY ~~b ~e~t~.rrYe~t
OF
BETTY M. ZOOK
I, BETTY M. ZOOK, of Silver Spring Township, Cumberland County,
being of sound and disposing mind, memory and understanding, do hereby mak
declare this as and for my Last Will and Testament, hereby revoking and making v
Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts and the expenses of my last
from my Estate as soon after my death as conveniently maybe done.
ARTICLE II
TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicles(s), household and personal effects
personalty of like nature (not including cash or securities), together with any
thereon, unto my son NORMAN F. ZOOK, provided he survives me by thirty
event that my son, NORMAN F. ZOOK, is not living on the thirty-first (31st)
death, I direct that such tangible personalty and insurance thereon shall be distrib
residuary estate.
Pennsylvania,
publish and
~id any and all
and funeral
~ other tangible
i ting insurance
~ )days. In the
i following my
e as~art of m~V
cp n
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~~
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ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate
nature and wheresoever situate, as follows:
A. 80% thereof unto my son, NORMAN F. ZOOK. If my son,
ZOOK, is not living on the thirty-first (31st) day following my death, I giv
his share to his wife, DOROTHY E. ZOOK, and if his wife, DOROTHY
not living on the thirty-first (31st) day following my death, I give and beque;
my son, NORMAN F. ZOOK, to his son, ZACHARY T. ZOOK.
B. 20% thereof unto my son, LARRY E. PATRICK. If my so
PATRICK, is not living on the thirty-first (31st) day following my dea
bequeath his share to his wife, DORIS J. PATRICK, and if his wii
PATRICK, is not living on the thirty-first (31st) day following my dea
bequeath the share of my son, LARRY E. PATRICK, in equal shares, t
ROBERT PATRICK, JAY PATRICK, RAY PATRICK, and
MITCHELL.
ARTICLE IV
EXCLUSION
I have made no provision in this my last will and testament for my
Patrick, as I do not intend for him to receive any share of my estate.
whatsoever I
vORMAN F.
and bequeath
E. ZOOK, is
h the share of
n, LARRY E.
:h, I give and
e, DORIS J.
rh, I give and
~ his children,
PATRICIA
Thomas A.
2
ARTICLE V
UNIFORM TRANSFERS TO MINORS
In the event any beneficiary of my Will has not reached the age of twenty-fi e (25) years at
the time for distribution of his or her share, distribution of said share maybe made i the discretion
of my Personal Representative after considering the age and needs of the beneficiary either directly
to the beneficiary or to a Custodian for such beneficiary until age twenty-five 25) under the
Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable
Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of re idence of such
beneficiary as the case may be. My Personal Representative may designate as such Custodian any
institution or person, including my Personal Representative, qualified to act as a Cus odian for such
beneficiary under such Act in effect at the time such distribution is made. A eceipt for any
payment or distribution so made shall be a full discharge therefor to my Personal
who shall not be responsible to see to, or be liable for, the application of such procee~
ARTICLE V
TAXES
I direct that all taxes that maybe assessed in consequence of my death, of v
or by whatever jurisdiction imposed, shall be paid out of my residuary estate a
expense of the administration of my estate.
ARTICLE VI
PERSONAL REPRESENTATIVE
I name, constitute and appoint my son, NORMAN F. ZOOK, Executor ~
Will and Testament. Should my son, NORMAN F. ZOOK, fail to qualify or ce
name, constitute and appoint my son, LARRY E. PATRICK, alternate Executor ~
thereafter.
nature
a part of the
this my Last
e to so act, I
complete the
3
administration of my estate. I direct that no fiduciary appointed herein shall be
bond for the faithful administration required in any jurisdiction.
Iuired to post ~
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, m Last Will and
Testament, this ~ 7TXday of ~,~„~-~~ 2005.
(SEAL)
BETTY M. OK
Signed, sealed, published and declared by the above-named Testatrix, as d for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in he presence of
each other, have hereunto subscribed our names as witnesses.
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
VVe, BETTY M. ZOOK, and ~ /i, ~/ ,and
the estatrix and the witnesses, resp ctively, 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 her Last Will
and that she had signed willingly and that she executed it as her free and volun ary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
4
Testatrix, signed the Will as witness and that to the best of his knowledge the Test
time eighteen years of age or older, of sound mind and under no constraint or undue
BETTY
Wi
Subscribed, sworn to and acknowledged before me by BETTY M.
subscribed and sworn to before me by
~ ,witnesses, this day of
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
CARLEEN S. JENSEN, Notary Public
Lemoyne Boro., Cumberland County
My Commission Expires Dec. 17, 2007
Notary
:261771.
5
was at that I
Testatrix, and
and
2005.