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HomeMy WebLinkAbout11-05-12Reset 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: THELMA E. HENSHAW a/k/a: a/k/a: a/k/a: Date of Death: OCTOBER 11.2012 File No: ~ I - ~ c~ - I ~ l,Q D (Assigned by Register) Social Security No: Age at death: 92 Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA (crate) with his/her last principal residence at ~6 WILTSHIRE EAST STREET. CARLISLE. PA 17090 S. MIDDLETON TWP. CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at >L6 WILTSHIRE EAST STREET. CARLISLE. PA 17090 S. MIDDLETON TWP. CUMBERLAND PA Street address, Post Office and Zip Code City, Township or Borough County Stste Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 47,300.00 If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ n_no TOTAL ESTIMATED VALUE.... $ 47.300.00 Real estate in Pennsylvania situated at: N/A (Attach additional sheers, if necessary.) 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 JULY 11, 2001 thereto dated N/A State relevant circumstances (eg. renunciation, death of executor, etc.) County and Codicil(s) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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 born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.t.a. or db.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 Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationshi Address CO r.i ~ -~ r~u.~ ~ ~ ' - . -~ 1 .... f ~t~ .~ ~ .y _~ ~ D ~ ~ ` ~ ~ "~ 1.~ f ~'J Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath oC Personal Representative COMMONWEALTH OF PENNSYL.VAN]A } } SS: COUNTY OF ) r ©fFtcial~tf-sy~t~F r~.f t'(~f?L)t . '~ ~ ~ ~ ~ P,E:,_ .. .,~~I %~t;2 NO~I -5 FI9 I ~ 32 Petitioner(s) Printed Name Petitioner(s) Printed Address AMBERS. THIEMANN 5307 SPRING ROAD SHERMANS DALE P ~ Iv ~ i~''"~~'? The Petitioner(s) above-named swears) or affirm(s) the statements in the foregoing Petition are tme and correct to the best ofthe knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec ent, the PeN/bone will well and truly adminiatex the estate acco~rd~,in~g~t~o lpa~w~ Sworn to o-r affirmed an subscribed before ~~(/i Sd . ~ /,ixtL~t.K- Date __L'~_ me thi day of V ~ ~~ 02 Date By: ~ ~ i ~ Date For the Register Date BOND Required: Q YES ~ NO FEES: Letters ...................... (I (/ )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( }Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ (1,11 I\ $ ~V--In-L-- fhlh~i Automation Fee ............... SYi.ZL~ JCS Fee ..................... TOTAL ..................... $) ~3.fiO 0.00 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: William C. Dissinger Supreme Court ID Number: 27737 Firm Name: Dissinger &Dissinger Address: 400 South State Rnad Marv cvillr~A 17053 Phone: 717-957-3474 Fax: 717-957-2316 Email: mvl na net DECREE OF THE REGISTER Estate of Trl-P.~I.,IG ~~ ~eY1~~~) ~ File No: ~~~- ~,~- j~~Y a/k/a: AND NOW, N(}1/~ Y1.! ~ ` ~ c 7~ j ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Amber S. Thiemann in the above estate and (if applicable) that the instrument(s) dated July l 1, 2001 _ _ _ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent Form RW-01 rev 10/IIQ017 ~ C I C+` D C Register of Wills ~~I ~e t- (~y"[~Q~1~ ~l ~~ Pa 2of2 - n:4.C .~.t~ ~ ` LQl~r1~~rRAR'S CERTIFICATION OF DEATH ~~'~' t# i~iiill~~gal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.0~ ~ Z ~~~ -5 ~~ ~ ~ 32 ORPNA~V'~ ~~JJi=tT CUMBERLAND CO., PA P 18882871 Certification Number ~PC/Print In Permanent Black Ink a This is to certify that the information here given is correctly copied from 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. ~~~~ n x~ Ot~T 1 22012 Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA ~ OEPARTM ENT OF HEALTH ~ VITAL RECORDS CERTIFICATE OF DEATH _ mbar: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Dai< of Death (Mo/Day/Vr) (Spell Mo) THELMA HENSHAW Female 022-22-8093 October 11, 2012 6a. Age-last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birth lace (CIty and State or Foreign Country) M th o ~ on s anaQa ay: Hoars Minaces December 6, 191.9 92 76. Birthplace (coancy) N A Ba. Residence (State gr Foreign Country) Bb. Residence (street and Number - Includ< Apt No.) 8c. Did Decedent Live In a Township? Penns lv n y a ia 6 Wiltshire E. ve: d«edentRYedln South Middleton , twp Hd. Residence (County) Cumber 1 and Be. Residence (21p Code) O No, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married ® Widowed il. Surviving Spouse's Name (If wife, give name prior to first marria e) g ~ Yes ®No ~ Unknown Q Divorced ~ Never Married Q Unknow N/A 12. Father's Name (First, Middle, last, Suffix) 13. Moth<r's Name Prior to First Marriage (First Middle last) ' , , James Hillier Ethel Cooke 14a. Informant's Name 346 Relationshi t D d ' . p o ece ent A b Thi 14c. Informant s Melling Address (Street and Numb<r, City, Stat<, Zlp Gode) ~ m er emann Dau titer 5307 Spring Road Stlet-m=*t=dale PA 17090 G •e`2 - .................................................~-----... .......................---........-------, If Death Occurred In a Hospital: t~~ 1 patient .....--------'-:...pee-o- oesc... __ <_< on y one _ _____ _ ___ ............... . _ _ ........ -If Death Occurred Some h -- ~~~~~~~~ ~~~ ~ ~~~~~-----""~~ -"""" y,s• w ere Other Than a Hos Ital: ~~ ~~~ P Hos Ice Facili P t 0 ' _ ~ ~ Emergency Room/Outpatient Q Dead on Arrival y 1y ettdent s Home Nursing Home/Long-Term Care Facility Other (Specfy) • iSb. Fa it f pot in ration, give street antl number; C.I"ial~es(ILZ re '~ lSC. Gity or Town, State, tl Zip Code lSd. County of Death _ . Carlisle, PA 17015 CLJmberland m 16a. Method of Disposition Q Burial ® Cremation Q Removal from State D S6b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q onation otner(sp afy) t 12, 2072 Rr.r, CCrentatory) *+ Funeral HCE1)e o 16d. Lo Lion f Dlsp sitlon (City or Town, State, and 21p) Carlisle, PA 17013 17a. Signet Funeral Se JFgU e r Person In Charge of Interment 17b. License Number / / _/C /'C FTr012909 I' 17e. Nar a amend co~er d,~r<~~~ar) r~LF rlllZ L a ~ k mad Carlisle, PA 17013 18. Decedent's Education -Check the box [hat best describes the 19. Decedent of Hlspanlc Origin -Check the 20. Decedent's Race -Check ONE OR MORE d ~ races to in icate what highest degree or level of school completed at the time of death. box that best describes whether the decedem the decedent considered himself or h lf b erse to e. Q Bth grade or less is Spanish/Hispanic/Latino. Check the "NO" White K Q orean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hlspanlc/Latino. ~ Black or African American ~ Vietnames e g--High school graduate or GED completed ~NO, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other A i s an Q Some college credit, but no degree ~ Ves, Mexican, Mexican American, Chlca no ~ Asian Indian Q N ti H a ve awallan Q Aasotla[< degree (e.g. AA, AS) Q Ves, Puerto Rtcan Q Chinese G Q ' uamanian or Chamorro Q Bachelor s degree (e.g. BA, AB, BS) 0 Yes, Cuban FIII 1 Q ^O p ~ Samoan ~ Master's degree g, (e.g. MA, MS. MEn MEd, MSW, MBA) Q Yes, other Spanish/Hlspanlc/Latino ~ lapanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (S if pec y) Q Other (Specify) . MD DOS DVM Ll6 JD 21. Decedent's Single Race Self-Deslgna[lon -Check ONLY ONE to indicate who[ the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate t e f k -Whit yp o wor e Q lapanese Q Samoan done during most of working Ilfe. DO NOT USE RETIRED. Q Black or African American Q Korean Q Ocher Pacific Islander BOOk 1<E!E! r Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sare pe Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Chinese Q Native Hawallan ~ Other (Specify) Q FIIIPino Q Guamanian or Chamorro M8CII1faC tU2-iZig ITEMS 23a - 3 MVST BE COMPL D 23a. Date Pronounced Oea Mo Day Vr 23 Signature o Person Pronouncing Deat (Only when appllcab e) 23c. License Num e BV PERSON WHO PRONOUNCES OR Q ~ ~ ~ ,R ~ ~ r CERTIFIES DEATH V 23d ate 1 ed (MO/Day/Yr) 24. Time of Death 1 0 ~. ~ ~ y - 25 W M di l . as e ca Examiner or Coroner Contacted? Q Yes No CAUSE OF DEATH Approximate 26. Par! 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter termin l a events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without s'h~ oA~swing the et logy. O NOT ABBREVIATE. Enter only one cause on a line. Add eddltlonal Ilnes if necessary Onset to Death IMMEDIATE CAVSE ---------------> a. _ K ~ d tf t ~~ ~~ `V V•'C (Final dlseax or condition pue to a co e a nsequ nee of): - / \ resulting in death) ~ ~~~ ~ ~ ( b. v__'w [//J~ts~M~ f~ / Sequentially Ilst conditions, Due [o (or as a consequence of): If any, leading to the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): - ~ (disease or injurythat F initiated the events resulting d. ~ In tleaih) LAST. Due to (or as a consequence of): S 26. Part 11. Enter other s~ ifl t dirt t Ib tl t d th but not resulting In the underl in y g cause given in Part 1 27. Was an autopsy p rfor d7 g Ves 28. Were autopsy findings available ~& to co plate the came ~desth? C O Y 29 f - j es ~1 . I Fem le: 30. Dld TYo bacco Vse Contribute to Death? 3 M er of Death t pregnant within past year Q Probabl 'S ~ yNatural Q Homicide Pregnant at time of death Q Unknown Q Attldent 0 P N di t b m ~ o en pregnant, ng Investigation ut pregnant within 42 tlays of death Q / ~ Q Not pregnant, but pregnant 43 days to 1 year before death 32. Dale of In Q Suicide Q Could not be determined Jury (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 Transppr[atlon InJury, Specify: 36. Describe How Injury Occuretl: )~ Ves Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): Q C<rtifying physician - To the best of my knowledge, death occurred due to the cause(s) and m r stated Q Pronouncing ffi Certifying physician - To t~] best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q M d l e ica Examiner/Coroner__ On the. lag saif exa mina on and or i/nv~eztlgatlon, In my opinion, death occurred at tM1e tlm<, date, and place, and due to the cause(s ) a nd mann r t tl t / r ' • ~, 7 - e _e ~s J~ L/ Signature of certifier: E ! 1_( / r-~'e l / A Q ~ L~ /f -Title of certifier: ~l1-A1r Li M D m ~~ N cense Number: t/ l ( 39b. Name, Address and Zip Code of Person Completing Cease of Death (Item 26) ALD J. KO ACg MD . 39 . O a goad (MO Day/Yr) ;Mow Braadles Family Preclip Lamar t ` ~ L/ Rtl. to s PA l?OO7- 40. Registrars Dis rict Number 41 Re istrar' ~]gR t = . g S ure ~ ^ a ( 42. Registrar FI at< Mo y a3. Amenemen : ~_r ~~ ~-~~ • do 1 a pizposition Permit NO. ~'1 '1~~~'/ H105-143 - RF_V D7/7fll l F~~'''~'~ ,4.4t]h ! ~ ~~ i? ~~iY -5 ~~ f ~ 32 ,,, , OR€~-itW'S CUI~PF CUMBEPLAT~D CO., PA- LAST WILL AND TESTAMENT OF THELMA E. HENSHAW Dated: July ~~ 2001 McClure & Miller Attorneys At Law 717 State Street, Suite 701 Erie, Pennsylvania 16501 LAST WILL OF THELMA E. HENSHAW I, THELMA E. HENSHAW, of the County of Erie and Commonwealth of Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. ARTICLE FIRST All estate and inheritance taxes (including interest and penalties, if any), together with all administration expenses, payable in any jurisdiction by reason of my death (including those taxes and expenses payable with respect to assets which do not pass under this Will) shall be paid out of and charged generally against the principal of my residuary estate, without apportionment. I waive any right of reimbursement for, recovery of, or contribution toward the payment of those taxes and administration expenses, except my executor shall, to the maximum extent permitted by law, seek reimbursement for, recovery of, or contribution toward the payment of Federal or state estate tax attributable to property in which I have a qualifying income interest for life, over which I have a power of appointment, or which is included in my gross estate by reason of Section 2036 (c) of the Internal Revenue Code of 1986, as from time to time amended ("Code"), and which tax is not otherwise paid or payable. ARTICLE SECOND A. I give all the tangible personal property that I own at my death, including any household furniture and furnishings, automobiles, books, pictures, jewelry, art objects, hobby equipment and collections, wearing apparel, and other articles of household or personal use or ornament, to my husband, RICHARD C. HENSHAW, if he is living on the thirtieth day after the date of my death or, if my husband is not then living, then unto such of my children who are living at the time of my death, namely, AMBER SUSAN THIEMANN and JAMES C. LUND, as they shall agree. ARTICLE THIRD I give, devise and bequeath all the rest, residue and remainder of my estate, real and personal, unto my husband, RICHARD C. HENSHAW, if he is living and if he is not living, then as follows: A. Fifty (50$) per cent thereof unto my daughter, AMBER SUSAN THIEMANN, if she is living, and if she is not living, then unto her issue, per stirpes, and if she leaves no issue surviving, then unto my issue, per stirpes. B. Fifty (50~) per cent thereof unto my son, JAMES C. LUND, if he is living, and if he is not living, then unto his issue, per stirpes, and if he leaves no issue surviving, then unto my issue, per stirpes. 2 ARTICLE FOURTH In addition to the powers given them by law and by the other provisions of this my Last Will, my personal representative shall have the following powers, applicable to all property held by them, effective without court order and until actual distribution: A. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales, leases or exchanges for such prices and upon such terms and conditions that they deem proper, without liability on the purchasers to see to the application of the purchase moneys. B. To compromise controversies. C. To distribute in cash or kind or partly in each. ARTICLE FIFTH I nominate and appoint my husband, RICHARD C. HENSHAW, to be the Executor of this my Last Will and Testament. In the event my husband, either at the time of my death or thereafter, shall be unable or unwilling to act for any reason, I nominate and appoint my daughter, AMBER SUSAN THIEMANN, as Executrix of this my Last Will and Testament. No personal representative acting hereunder shall be required to post bond or enter security in any jurisdiction. 3 1 IN WITNESS WHEREOF, I, THELMA E. HENSHAW, have hereunto h.~ set my hand and seal on this the C~ day of July, 2001. Thelma E. Renshaw Signed, sealed, published and declared by the above named Testatrix, THELMA E. HENSHAW, as and for her Last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. r' ''~^~ 4 ACKNOWLEDGMENT TO SELF-PROVE WILL We, the witnesses and Testatrix, whose signatures appear below and whose names are signed to the attached or foregoing instrument, being duly sworn, do hereby declare and acknowledge to the undersigned authority: (1) that the said Testatrix signed and executed said instrument as her Last Will and Testament; (2) that she signed willingly; (3) that she executed it as her free and voluntary act for the purposes therein expressed; (4) that each of the said witnesses in the presence and hearing of the Testatrix and of each other signed as witnesses; and (5) that the Testatrix was at the time she signed said Will, eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Testa 'x r fitness 717 State Street, Erie, PA 16501 Address Witness 717 State Street. Erie. PA 16501 Address Sworn to and subscribed before me by the above signed Testatrix and the above signed witnesses this ~~day of July 2001. G~~. ~ . _ Notary Public ~~~~ idU'TARIAL BEAL. MINA IM. B!!8>3C1(, NOTARY M~LC ERE, ®E COI>RIY, ~l~A. y IAY COMMi8810N E>O~IES OCT.19, ESOS