HomeMy WebLinkAbout11-05-12~_T- ;
PETITION FOR PROBATE AND GRANT OF LET~~S ;~~ ~'
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REGISTER OF WILLS OF CUMBERLAND
Estate of
ROSE Helen HERLIHY
also known as Rose H. Herlihy
Deceased
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COUNTY, PENNS ~~ANIA u.z
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Social Security Number
Petitioner(s), who is/are l 8 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.) ,t~~
A. Probate and Grant of Letters ~es,t:a~e~try-and aver that Petitioner(s) is /are the 'SEE BELOW named in the
last Will of the Decedent dated JULY 17, 1990 and codicil(s) dated
' NAMED EXECUTOR IN THE JULY 17, 1990 WILL IS DAVID F.HERLIHY, JR., HUSBAND OF THE DECEASED. DAVID F. HERLIHY, JR. IS DECEASED. NAMED ALTERNATE
EXECUTOR IS DAVID F. HERLIHY, III, SON OF THE DECEASED. DAVID F. HERLIHY, III RENOUNCES HIS RIGHT TO ADMINISTER THE ESTATE TO EILEEN SIMPSON.
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instrument(s) offered for probate,
was not the victim of a killing and was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding at the time of death
wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323(g): ;'~''' ~ X C f ~~G~fti`j -~~`~
^ B. Grant of Letters of Administration
(If applicable, enter: c. t. a.; d. b. n. c.t.a.; pendenle life; duranle absentia; durante minoritate)
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: (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.)
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at
CLAREMONT NURSING HOME, 1000 CLAREMONT ROAD, CARLISLE, PA 17013
(List street address, town/city, township, county, state, zip code)
Decedent, then 73 years of age, died on
05/29/2012 at CLAREMONT NURSING HOME
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) A11 personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$ _ '~~
$ ~5~ ~~C) ,,~
j~.
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name and residence
Eileen Simpson, 23 Kensington Drive, Camp Hill, PA 17011
Form RW-02 rev. 10.13.06
RW-02
Page 1 of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
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Tl~e 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 Decedent, the etitioner(s) will well and truly administer the estate according to law.
Sworn to o_r affirmed and ubscri d before , ~ ~ ~- d'~- ~~~~~~, Date ~ ~` -S ~~
me t i ~/7 y o ~ ~ Date
By' '~- Date
r e Register Date
BOND Required: ~ YES ~ NO
FEES:
Letters ..................... $
~ r.r ~ ~ ~,
( / )Short Certificate(s)..... .
( ,~ Renunciation(s)......... %j . L~G~
( )Codicil(s) ............. ~`~
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Oth .,_
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Automation Fee . .............. `
JCS Fee . ................... .
TOTAL ..................... $
To the Register of Wills:
Please enter my appearance b..y my signature below:
Attorney Sign
Printed Name: ~' (~ /~l~'`~ ~~'h:~LUt'I'~
Supreme Court /'
ID Number: ~ ~W~~
Firm Name: ~b'I'1 ~~t'~ L~ ~~L'~l~ ~~,
Address: ~' ~D/ rJ ~~~ / .1~%
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Phone: ~~ (7 Z ~ ~ ` `J Z5 d ~'~ /0 3
Fax: ~7/7 --~ ~~G ~
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DECREE OF THE REGISTER
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Estate of ~ ~ ~' ~~C'/) " ~~ ~ ;~~/'~ File No: ~~ ~ ~ ~ ,~- "`
a/k/a: ,~
AND NOW ~ ~~l~t'!'~,~~'/~ ~ ~~ ®~
in co ideration of the fore oing Petition,
satisfactory proof having been presented before me, IT IS DEC ED that tters ~ ~~ U/'~
~, % f~ are hereby granted to /~. /'~
in the abo e estate and (if applicable) that
the instrument(s) dated ~ /
described in the Petition be admitted ~6 probate ~i1d filed of record a~, the last Will,~nd Codicil(s)) of DeciZ¢ent
Register of Wills
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ROSE H . HERLIHY
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I,~SE H.
HERLIHY, of Camp Hill, Cumberland County, Penn-
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vania, being of sound and disposing mind, memory and under-
standing, do make, publish and declare this to be my Last Will and
Testament, hereby revoking and making void all Wills, Codicils or
writings heretofore made by me.
ITEM I. I direct that the payment of my debts and the ex-
penses of my last illness and funeral shall be paid from my estate
as an administrative expense as soon after my death as conveniently
may be done.
ITEM II. I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever juris-
diction imposed, shall be paid as part of the expenses of the ad-
ministration of my estate.
ITEM III. All the rest, residue and remainder of my estate,
real, personal or mixed, of whatever nature and wheresoever the
same may be situate, I give, devise and bequeath unto my husband,
DAVID F~. HERL'IHY, OR.; conditioned, however, that in the event of
his death in my lifetime, or in the event that my said husband and
I shall perish at the same time in a common disaster, or in the
event of my said husband's death within thirty (30) days after my
death, then the said devise and bequest of my residuary estate
shall lapse or be divested.
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Page 1 of 4 Pages ~'~ _ r ~'~~-~~-~~.~ ( SEAL )
RO E H. ERLIHY~
ITEM IV. Should my said husband predecease me, I give, de-
vise and bequeath my residuary estate to my children, per stirpes.
ITEM V. I appoint my Executor guardian of any minor bene-
ficiaries herein with power (1) to hold for minor all property pay-
able by law to a guardian appointed by my Will; (2) after con-
sidering the minor's wishes, to retain tangible personal property
or deliver it to the person standing in the place of a minor's
parent, without bond; (3) to invest the balance of the minor's
property and all accumulated income without the restriction to in-
vestments authorized for fiduciaries; and (4) to use income and
principal for the minor's maintenance and education, either
directly or by payment to any person selected to disburse it whose
receipt shall be a complete acquittance therefor. All unexpended
principal and income shall be paid to the minor at majority. For
purposes of this Will, majority shall be eighteen (18) years of age.
My guardian may, in discharge of all duties hereunder, pay
any minor's share deemed impractical of administration to the
person standing in place of the minor's parent or deposit it in an
interest-bearing account in the minor's name.
ITEM VI. No interest of any beneficiary under this Will or
any Codicil hereto shall be subject to anticipation or voluntary
or involuntary alienation.
ITEM VII. In addition to powers given them by law, my
> >r
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Page 2 of 4 Pages ~,,'~% `' ~°~'- ~ ;~,~ <~~ ~~_~~ -(SEAL)
ROSE' H . HERL' IHY f "~'
Executor or any successor acting hereunder shall have the following
powers, applicable to all property held by them, effective without
Court Order and until actual distribution:
A. To retain any property received by them (in-
cluding the stock of any corporate fiduciary
acting hereunder);
B. To sell real estate for any purpose, publicly or pri-
vately, for such prices and on such terms as they
deem proper, without liability on the purchasers
to see to application of the purchase moneys;
C. To compromise controversies;
D. To distribute in cash or kind or both at such valua-
tions as they may fix.
ITEM VIII. I hereby nominate, constitute and appoint my hus-
band, DAVID F. HERLIHY, ~7R., Executor of this my Last Will and Testa-
ment. In the event that David F. Herlihy, Jr. is unable or un-
willing to serve in that capacity, then I nominate, constitute and
appoint my son, DAVID F. HERLIHY, III, as alternate Executor of
this, my Last Will and Testament.
ITEM IX. I direct that my personal representative shall not
be required to give bond for the faithful performance of his duties,
any law of any state or jurisdiction to the contrary notwithstanding.
IN WITNESS WHEREOF, I have set my hand and seal to this my
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,.
Page 3 of 4 Pages ~~~ ~ '~~~" ~~~- ~ ~ `~~ (SEAL)
~ROS H~: HERLIHY ~~
Last Will and Testament consisting of this and three (3) other pages
at the end of which I have also set my hand and affixed my seal for
greater security and better identification, this day of
_ , 1990.
~~
Page 4 of 4 Pages '~..-~." ~~' ~ ~`~ !f ~'~°~-~___(SEAL )
RASE H~HERLIHY
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published, and declared by the above-named Testatrix as and for her Last
Will and Testament, in the presence of us, who, at her request and in her presence,
and in the presence of each other, have hereunto set our hands and seals the day
an~"year above-written, and we certify that at the time of execution thereof,
said Testatrix was o sound and disposing mind and memory.
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COMMONWEAL' TH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS:
Rose H. Herlihy, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge
that I signed 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.
Sworn and acknowledged before me by Rose H. Herlihy, the within
Testatrix, this day of , 1990.
,, ,. //~~
ROSE H . HERL IH ~~ ;~'
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Notary Public
My Comm. Expires ~~:~~,.._wo., ,__, _~
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COMMONWEAL" TH OF PENNSYLVANIA ~+ ~ ~~~
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COUNTY OF DAUPHIN
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We ~ .~ _ _ _ _,._
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he
and
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witnesses whose names are signed to the attached instrument, being duly qualified
according to law, do depose and say that we were present and saw Rose H. Herlihy
sign and execute the instrument as her Last Will and Testament; that she signed
it as her free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testatrix signed the Will as witnesses and
that to the best of our knowledge, the Testatrix was at that time 1~ or more
years of age, of sound mind and under no constraint or undu~~in luence.
Vii; ~~; ~ =~ //(/ /,. ~, F /J//,l ~'~ ' /~~..',~////~j . ~ ! ,~~ . r
Sworn to and subscribed
before.. me this f ~ day
of , 1990.
.;
Notary Public
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H105905 REV.(8/11) -~ ~.. ~ ~ ~_ ~ /~%,,.,J~
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Vital Statistics Law of 1953, as amended.
~' t'~/.!(wry; ~f ~ ~( ; :i~~-}i~~.
WARNII-;-~It is ~ltegaly#Q~duplicate this copy by photostat or photograph.
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No.
Marina O'Reilly Matthew
State Registrar
~UL 0 9 2012
Date
Type/Print In COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State F"I N b
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I e um er.
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
Rose Helen Herlih emale 165 - 30 - 4628 N1a 29 2012
Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Birthplace (City and Sate or Foreign Country)
Months Days Hours Minutes PY11.Ladel tile, pA
73 July 27, 1 938 7b. Birthplace (County) 1 a e p 1a
8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Llve In a Townshi 7
Re
~ Ves, decedent lived in M1dd.leSeX
Sd.
sidence (Co
ty) 1 ~J~d C~_aremC?Tlt V1 iVe [w
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Cumberland 8e. Residence (Zip Code) 1 701 3 Q No, decedent lived within limits of city/boro.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married [~ Widowed li_ Surviving Spouse's Name (If wife, give name prior to first marriage)
Q Yes ® No Q Unknown Q Divorced Q Never Married Q Unknown
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Nam¢ Prior to First Marriage (First, Middle, Last)
John F~anchion Bridget Joyce
14a. Informant's Name 14b_ Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, Stat¢, Zip Code)
Eileen R_ Simpson Dau titer 236 Allendale Wa Hi11 PA 17011
. ......................................................... lSa. P ace o _Deat.._ C ec on one
............................................................ ------._......Y....... .
ac _
......_................... ._.................................. ............__.........._._........
If Death Occurred In a Hospital: ~] Inpatient 51f Death Occurred Somewhere Other Than a Hospital: ~ ~ Hospice Facility [~ Decedent's Home
° Emer en
Q g cy Room/Outpatient Q Dead on Arrival ~ Nursing Home/Long-Term Care Facility Other (Specify)
15 b. Facility Name (If not Institution, give street and number; lSC. City or TOWn, State, and Zip Code lSd. County of Death
Claremont Nursing & Rehab Center Carlisle PA 17013 Cumberland
my 16a. Method of Disposition Q Burial ~ Cremation 166. Date of Disposition
Q Removal from State Q Donation 16c_ Place of Disposition (Name of cemetery, crematory, or other place)
p Other (Specify) June 1 , 201 2 Cumberland Crematory, LLC
16d. location of Disposition (City or Town, State, and Zip) 17a. Sign e o un¢s erv L ens or Person in Charge of Interment 17b. Ucense Number
Carlisle, PA 17013 ~ F'D - 014889
E 17c. Name and Complete Address of Funeral Facility
Malpezzi Funeral Home 8 Market Plaza Wa Mee icsbur PA 17055
18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Rac¢ -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 bo
if d
d
t i
S
i
h
Hi
i
,
x
ece
en
s not
pan
s
/
span
c/Latino. 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
Some colle
e cr
dit
b
t
d
g
,
e
u
no
egree [] Ves, Mexican, M¢xiran American, Chicano Q Asian Indian ~ Native Hawaiian
Q Associate degrer_ (e. g. AA, AS) Q Yes, Puerto Rican Q Chinese 0 Guamanian or Chamorro
Q Bachelor's degree (e.g. BA, AB, 05) Q Ves, Cuban
~ Filipino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other 5 apish/His anic/Latino
P P Q Japanese Q Other Pacific Islander
Q Doctorate (e.g. PhD, EdO) or Professional degree (Specify) ~ Other (Specify)
e. MD, DDS, DVM LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considerod 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 BuS ~r1Ver
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure
0 Asian Indian Q Other Asian ~ Refused 22 b. Kind of Business/Industry
Q Chinese Q Native Hawaiian ~ Other (Specify)
0 Filipino - Q Guamanian or Chamorro Transportation
ITEMS 23a - 23d MUST BE COMPLETED 2
3
-a
. Date Pronounced Dead (MO Day/Yr) 23 b. 5 ature of Person P uncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH f
-
~
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O'~1..3
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23d_lDa~te Signed o/ y/Yr) j
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24. Time2of Death
~.1~ ~~ ~ ~ ~ l u ~~
Q 1 ~
C~ ~ ~y~
~J - 5 Q f • i 25_ Was Medical Examiner or r 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:
,
respiratory arrest, or ventricular fibrillation without showing the etiology. DO_N OT ABBREVIATE. Enter only one cause on a line_ Add additional Tines if necessary Onset to Death
IMMEDIATE CAUSE -------------> a. ~~~/~ r/1..L~ ~ ~L8(/~- +
'Final dis.a s¢ or condition Dale to for a~ a consequence ot):
resulting In death) ~
=
Q
Sequentially list condltlons, Due to (or as a consequence of):
if any, leading to the cause -
Iisted on line a. Enter the c.
UNDERLYING CAUSE Due to (or as a consequence of): '
W (disease or injury that
initiated the events resulting d.
~
u in death) LAST. Due to (or as a consequence of):
_
S 26. Part 11. Enter other significa nt condltlons contributlna to death but not resulting in the underlying cause given in Part I 27. Was an autopsy pcrf ed7
0
~
Q Yes No
r
28. Were autopsy findings available
m to complete the cause of death?
~ Q Yes No
d
E 29. If Fe fe: -
Nat pregnant within past year 30. Did Tobacco Use Contribute to Death?
Q Yes Q Probably 31. M per of Death
Natural ~ Homicide
v Pregnant at time of death No Unknown
Q Q Q Accident Q Pending Investigation
m Q Not pregnant, bu[ pregnant within 42 days of death ~ Suicide ~ Gould not be determined
1°- Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell 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, Clty, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
Q Ves L7 UriverjOperator (_i Pedestrian
0 No ~ Passenger ~ Other (Specify)
39a. ertifter (Check only one):
Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
Q Pronouncing g. Certifying physician - To the best of my knowledge, death occurred at the [ime, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/C
oroner - On the basis of examination, and/or Invest
ig
ati
on, in my opinion, eath occurred at the time, date, and place, and due to the
ca
u
se(s) and mann
e
r stated
A
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Signature of certifier: 1l~ ~~L,(~ ~~ ~ ~ A ~~t.- Yti Title of certifier. License Number: l J7 Od~~O~
39 .Name, y4d ress nd _ ip Code of Person r~,^~^'eting-c~a-.as~o#s¢ath (K m 26} ~ - i,~ ~2
e
t 39c. Dale Signed Mo/Da /Yr
)
J
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40. Registrar's District Number 1 41. R~e~ist ra is Signature _ 42. Registrar Fil Date MD Da
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5 ~ ~ ~l ._ ~ T
43. Amendments
-... i
0729430 H105-143
Disposition Permit No. REV 07/2011
a=
R.ENUNCIA.TION
REGISTEI2.OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of ROSE H. HERLIHY
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Deceased
I, DIANE SHORT , in my capacity/relationship as
DAUGHT ER tlvame)
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
EILEEN_SIMPSON
I~ y- Iz
(Date)
(Signature) '
(S//treet~~Address)
(City, State, Zip)
Executed iu Register's Office
Sworn to or affirmed and subscribed
before me this
day
of ,
Deputy for Register of Wills
Executed out of .Kegister's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renuncia 'on for the
purposes stat F ithin on this `~ day
of ~..~ I 'l.._ _
~-/.~ .~
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Notary Public
~~ ~ ~ ~ ~
IVIy Commission Expires;,, f tc ~ ~,
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.Ob
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Merri C. Kramer, Notary Public
RW-06 Dillsburg Boro, York County
My Commission Expires June 24, 2014
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RENUNCIA-.T~ON ~ t , ~ ~'~_ , : ! -:R
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REGISTER OF WILLS ~ -_-~ ~ co ; ~ ~ ~- ~=
CUMBERLAND COUNTY
PENNSYLVANIA ~" ~ ~? `~`' ~?
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Estate of _ROSE H. HERLIHY
Deceased
I, CHRISTOPHER HERLIHY , in my capacity/relationship as
(Print Name)
SON
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
EILEEN SIMPSON
(Date}
Executed in Register's Office
Sworn to or aff rmed and subscribed
before me this day
of ,
Deputy fox Register of Wills
Form RYY-06 rev. 10.13.06
(Signature) '
3 ~-il~~ Ic L, Y.
(Street Address)
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~ r da
v,
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Notary Public
My Commission Expires:
(Signature and Sea! of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Rw-os TINA M. BURKEY, Notary Public
New Cumberland Boro, Cumberland Co.
My Commission Expires April 15, 2013
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RENUNCIATION ~
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REGISTER OF WILLS .f
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CUMBERLAND COUNTY, PENNSYLVANIA .:
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Estate of ROSE H. HERLIHY ,Deceased
I, DAVID F. HERLIHY, III , in my capacity/relationship as
(Pant Name)
EXECUTOR/SON of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
EILEEN SIMPSON
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(27ate}
(SigrYature) ~ J
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(street ~4dclress) 11
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(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
Form RYY-pb rev. 10.13.06
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this „_,,,,,~ ~ `~ day
Notary Publi
My Commission Expires: ~ -- I ~ - - ~ ~1 c,~
(Signature and Seal of Notary or other official qualified to _
administer oaths. Shvw date of expiration of Notary's Commission.)
RW-06 NOTARIAL SEAL
GINA UBALDI, Notary Pul;ii;
Camp Hill Boro, Cumberland County
nny Commission Expires February 12, 2014