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HomeMy WebLinkAbout11-07-12Reset 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: Naomi R. Brehm a/k/a: a/k/a: a/k/a: Date of Death: October 26.2012 File No• .2 ~ ~ a ~) ~ ~ • (Assigned by Register) Social Security No: 1 Age at death: 85 Decedent was domiciled at death in Cumberland County, Pennsvlvania (state) with his/her last principal residence at 4405 Carlisle Road Dickinson Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 770 South Hanover Street Carlisle Cumberland PA 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 $ 36,544.00 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 ......................................................... $ 175 000.00 TOTAL ESTIMATED VALUE.... $ 211.544.00 Real estate in Pennsylvania situated at: 4405 Carlisle Road Dickinson Township, Gardners Cumberland (Attach additional 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 April 22, 1997 and Codicil(s) thereto dated n/a State relevant circumstances (eg. renunciation, death of executor, ere) 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(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 0 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, durance minoritate If Administration, c.t.a. or db.n.c.ta., 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. O 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 ~ c:a Zi =.~ 1 f` - ~'~ ~ -y Form RW-02 rev. ]0/!//2011 ~ "~ 0 -... 'T1 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Offieiai Use Only ~_ t Petitioner(s) Printed Name Petitioner(s) Printed Address Ricke L. Brehm 800 U land Street `~ ; t ~• r r ~ Mechanicsbur , PA 17055 ~{~EF3LJ~D CO.. PA 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 knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the/Petition~s)~wtil well and truly administer the estate according to law. Sworn to or affirmed and subscribed before lJ~~-~C ~~/y~t~-~-. Date I/- Z'~ z met ~s ~_ day of , ~~, Date By • s ~ ~ Date For the Register Date BOND Required: Q YES ~ NO To the Register of Wills: FEES' Please enter my appearance by my signature below: Letters ...................... $ ~ . d~ ( $) Short Certificate(s)...... ( 1) Renunciation(s)......... ( 0) Codicil(s) ............ . ( 0) Affidavit(s)........... . Bond ........................ Commission ................. . Other ~~ I~' ...... ~~7 Automation Fee ............... JCS Fee . .................... • ~? TOTAL ..................... $c~7,~•~7 $.bb Attorney Signature: Printe~/l~iame: Mark W. Al Supreme Court ID Number: 78014 Firm Name: Christian Lawyer Solutions, LLC Address: 4R't p~,lg Road 4hermanc DaIP PA 17090 Phone: (717) 582-4006 Fax: (717)582-7476 Email: marknchrictianlawTersnlutinnc.com DECREE OF THE REGISTER Estate of Naomi R. Brehm a/k/a: File No: ~ `- ~~ - ~ f 7 AND NOW, ~1VWc- t 11 ~ ~ ~ ~~ ~ 2 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentarv are hereby granted to Rickev L. Brehm in the above estate and (if applicable) that the instrument(s) dated April 22 1997 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ~e f ~~~-~ J Form RW-02 rev. 10/1 //20!! ~PU~'~~ Page 2 of 2 H]OfR05 REV (4h n LOCALr~~~;T~~'S CERTIFICATION OF DEATH WARNIN L~~ iti al~;)~~ Quplicate this copy by photostat or photograph. ~:. :, Fee for this certificate, $6.00 P 1888326 L ~x~- ~~~ew~~K~. ~ck'~'~ N 2 012 Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • OEPARTM ENT OF HEALTH VITAL RECORDS CERTIFICATE aF DEATH ~~ { Z ~}QY -7 ap} ~ f : (~ ~ 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 URPHt~f~ v v~~ l~ Records Office for permanent filing. Cl1MBERLAND CEJ.. PA --~ Certification Number '~ ryPe/Pnnt In Permanent Black InK 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Soclsl Sacunty Number 4. Date of Death (MOJOW/Yr) (Spell Mo) Naomi R_ Brehm F_ 162-22-0993 October 26, 2012 Sa. Age-L<s< Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 pa 6. Date of Birth (MO/D ay/Vear) (Spell Month) 7s. Bin:hpiace (City and S[ste or Foreign Country) /), Months Days Hours Minutes Gardners PA -"1 $5 July 1 ~ 1 9 2 7 7b. Birth Place (County) 8a. Residence (State or Farelgn Country) - 8b RF ip < ce (Street d Nu bar -Include Agt No.) ~ d ~ 8c. Did DecedaM LWe in a Township? 4lJ Car i s E3 ROaCl Q,Syes, decedent Ilved in p, Hd. Residence (County) Gardners PA Sa. Residence (Zip Code) 1 7 3 2 4 [] No, decadent Ilwd within limits of city/boro. 9. Ever In US Armed Fomes7 10. Marital Status at Time of Oeaih Q Msrrled Wldowe 11. Sunaving Spouse's Name (If wife, give name prior to first marnage) Q Yes ~ No Q Unknown Q Divorced Q Never Married Q Unknow 12. Father's Nsme (First, Middle, Last, Suffix) 13. Mother's Name Prior [O First Marnage (First, Mlddl<, last) Nellie Ruth 14a. informant's Nam< 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, Siate, Zlp Cod<) ~ Dau ht 4405 Carlisle Rd_ Gardners, PA '17324 .............................•---...........-•--•-•--.... ....--.....-......---.................---. Wufr If Death Occurred in a Hospital: tJ Inpatient ~ ....-......-~:...s<e.°....a.e... on y one ar _ ... °~ ............................................P .-........................ ...........-........................ If D th Occurred Somewhere Other Than a Hospital: LJ ~HOSpice Facility LJ Decedent's Hom< 3 Emergency Room/Outpatient Dead on Arrival Nursln Home/ion -Term Csre Facility Other (5 aci P fV) lSb. Facility Name (If not institution, glue street and number; 15c. City or Town, State, and Zip Coda lSd. County of Death ~ Chapel Pointe At Carlisle Carlisle PA 17013 Cumberland ~, 16a. Method of Disposition Bur1al Q Cremation 16b. Date of Disposition 16c. Place of Dlspositlon (Name of cemetery, crematory, or other place) 0 Removal from SLaM 0 Donation o:her (S eafv) 1 1 -1 -201 2 Goodyear Cemeter Gardners , ~ 16tl. Location of Dlspositlon (City or Town, State, and Zip) 17s. 5 Lure of Funeral SC 1 Llc r Pen In Charge of Interment 17b. Ucensa Number Gardners PA 17324 ~ ~ FD-011932T. 17c. Name and Complete Addrev of Funeral Facility 5 ~ 1 N $a i m~re Av 1 pfS I;o 1 ;> r n ~ 16. Decedent's Edueatlon - Check t e box [hat best describes t e 19. edent o ispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what 1= highest degree or level of school comp)e[ed at the time of death, box that bast describes whether the decedent the decedent considered himself or herself to be. ~ 8th grade or less Is Spanish/Hlspanle/Latino. CMck the "No" White Q Korean _,. Q No diploma, 9th - 12th grade box if decedent Is not Spanish/Hlspanie/Latino. Q Hlack or African American 0 Vietnamese v `High school graduate or GED completed not Spanish/Hispan{c/Utlno 0 Amarlean Indian or Alaska Native (] Other Asian ~ Soma college credit, but no degree [] yes, Mexlca n, Mexican American, Chicano Q Aalan Indian 0 Native Hawaiian ~ Associate degree (e.g. AA, AS) [~ Yes, Puerto Rican ~ Chinese ~ GuamsMan or Chamorro ~ Bachelor's tlegrea (e.g. BA, AB, BS) ~ Yes, Guban ~ Filipino Q Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) [] Yes, ocher Spanish/Hispanic/Latlno Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Raca Self-Designation -Check ONLY ONE to indicate what the decadent considered himself or herself to be. 22a. Oecedant's Usual Occupation -Indicate type of work White Q Japanese Q Samoan done during most of working Ilfe. DO NOT USE RETIRED. Black or African American [] Korean Q Other Pacific Islander American Indian or Alaska Native 0 Vietnamese Q Oon't Know/Not Sura Packer Q Asian Indian 0 Other Asian ~ Refused 22b. KMd of Business/Industry (] Chinese Q Native Hawaiian Q Other (Specify) ~ FIIlpino 0 Guamanian or Chsmorro Rice Food Corp _ ITEMS 23a - M ST BE COMPL ED 23a. Date Pronounce Dea (MO Day 23 . Signature o Parson rono Ing Death On y when app Ica a 3c. License Num er BY PERSON WHO PRONOVNCES OR /~ ! ~~ CERTIFIES DEATH V ~ ~" / 23d. Data 51 nod {M DaV/Vr) 24. Tlm< of Oesth - - ^i /~~ j ' - S ~ 25. Was MMleal Examiner or Cor r CoMaRad? Q yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter The chain of events-diseases, Injuries, or compllwtlons--[hat directly caused the death. DO NOT enter term{nal agents such as cardiac arrest In[a rval: respiratory arrest, or veMrlwlar fibrillation without sho Ong [ etiology. NOT ABBREVIATE. Enter only o /, • Ilne. Add edtli[lonal Ilnes If necessary S Onset to Death %"-use IMMEDIATE GUSE -----------> ~ •/L•` ~y/ (Final disease or condition Due to (or as a consequence f): ~ resulting In death) b Sequentially Ilst conditions, Oue to (o as a consequence of): 3 if any, leading to the cause listed on Iina a. Enter the UNDERLYING GUSE Due Co (or as a consequenea of): ; (mseaae or injvrythat Inma<ed ehe eventa rcsul[lne a. r as a con na € -' in tleath) LAST. Due to (o saque vf): i 26. Part 11. Enter other t 1 1 tl but not resulting in the underlying cause given In Part I 27. Was en autopsy pert ed7 ~ yes No 2B. Were autopsy findings available to complete the cause of death2 O Vas No 29. If Fa ale: ~NOt prognant within past year 30. Dld Tobacco Vse Contribute to Death? Q Vas Q Probably 31. Manner of Death Natural Q H i id Q Pregnant at time of death ~. ENO Q Unknown om e c Q Accident 0 Pending InvestlgaUon ~' (~ Not pregnant, but pregnant within 42 days o1 dean Q Suicide Q Could not be determined r- ~ Not pregnant, but prognant 43 days to 1 year before dea<F 32. Date of Injury (MO/Day/Yr) (Spell Month) Unknown If pregnant within the past yea. 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zlp Cod<) 36. Injury it Work 37. If Transportation Injury, Specify: 3H. Descnb< How Injury Occurred: [~ Yas 0 Driver/Operator 0 Pedestrian Q No 0 Passenger Q Other (Specify) 39a.J.artlfler (Check only one): R] C i rtif i h i - T th t f k l b d d h e y ng p ys c an o e es my now o e ge, eat v red due to the use(s) antl m stated ~ Pronouncing 8. "Certifying physician - To the bast of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated ~ Medical Examiner/coroner - a ba f a minaHOn, a tl/o/r InvestigsHOn, In my opinion, death occurred at the Hme, tlata, antl place, and due to the cause(s) and manner stet<d xa _ Signature of certifbr: A A i(~ Title of certifier: ~"~ ~ License Number: K~ X358 rl .~~ 39b. Noma, Addrass antl Zip Code of Peraon Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Yr) H ~s 'SOa ~ k rc. t l S rtv~ Ph tZOla ' O 1 D l O. Registrar s District Number 41. Reg serer s Lure ~` 42. Registrar Ile ate Mo ay - O ~ 8'crt. ~b a 43. Amendments Disposition Perml[ No. d- 1 ~ ~~ OJ H305-143 REV 07/2011 LAST WILL AND TESTAMENT I, NAOMI R. BREHM, of Dickinson Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executor to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executor to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my husband, Donald E. Brehm, providing he shall survive me by sixty days. 4. Should the gift in Paragraph No. 3 not take effect, I devise and bequeath all of my estate of every nature and wherever situate as follows: (a) I direct that Lori Ann Brehm shall be able to live in my house at 4405 Carlisle Road, Gardners, as long as she is single and as long as she desires to and actually does live. in my house. She is to pay the taxes, insurance, utilities and upkeep as long as she lives in the house. (b) All my furniture, dishes and other personal property is to stay in my house as long as Lori Ann lives there and when she leaves the house permanently, the personal property is to be divided between my daughter, Lori Ann Brehm and my son, Rickey L. Brehm, share and share alike, ~ -- r-., r. ;> l ~- Q N ~7 TJ ~: 1 ~ f c U ~ ~~ri ~ 4 .i C7r _ _. _ °y_w i °'T't ," '-ra (c) If and when Lori Ann leaves my house permanently, the property shall be sold and the balance of the money shall be divided between my two children, share and share alike, and (d) All the rest, residue and remainder of my estate, I give to my two children, share and share alike. 5. I nominate and appoint Donald E. Brehm to be the executor of this my Last Will and Testament; he is to serve as such without bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, Inominate and appoint Rickey L. Brehm and Lori Ann Brehm, as substitute executors, also to serve as such without bond, with the same powers as are given herein to my executor. 6. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this u"' day of April, 1997. ~rr.~~u ~ g ,~ ,~~ (SEAL) NAOMI R. BREHM Signed, sealed, published and declared by NAOMI R. BREHM, the above named testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, NAOMI R. BREHM, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the 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 that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. /, N OMI R. BREHM ERYL L. CLELAND RTHA L. NOEL COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by, NAOMI R. BREHM, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this :~ ~' day of April, 1997. ~~ ~.~ ~..~yettary Public Notarial Seal Ro er B. Irvvin, Notary Public Carlis~e Boro, Cumberland County My Commission Expires Oct. 3, 2000 Member. penn~ylvanie As®ociAtion of Notaries _ _ _ ____ 11!05/20].2 12:51 7].75827476 MARF4 W ALl_SHOLISE ESQ It~NUNCIATION REGISTER OF WILLS CUMBEIKJ...A,NA COUNTY, PENNSYLVANIA, PAGE 07./0], e _ 4..' J ~`~l2~oY-7 A~~~~ 4I ORt F?,~1''; vl1~ it Ct1MB~R~ANp CO.. PA Estate of Naorni- R. Ezeltm • Aeeeased I, Lozi ,A,wa Brcban _ _ , iu~ zny capaeityrretstlartship as (rriwrNanrs) dauylxter of the about Doeedent, hereby renounce the right to adminisoer the Estate of the Uocodent and respectfully roquest that Letters be issued to hickey L. Brehm . '~ fQore) ^~) F.xtrcrrerd iK Register's QjJics Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wllls Forte RW-06 rev. 10.13,06 4405 Carlisle Road r5tnerAddnes) C+ardners, I',A 17324 (City, Soars. Z+PJ Eaeeerded owt ojRegisYCr's O~ic~e Before the undersigned personally appeared the party executing this renunciation snd certified that he m she executed the renunciation for the purposes stated within on this 51'^ day of -Sov ~rbe~ ~O- ~ 1Votary f'u lit My Gomtnission Expires: ~ -~ 3' ~ b (Sianewre u+d sed of Noasty or other olr~ quatitwd to administer oaths. Show dens of expiration oFNoNry's Ganmission.} CON1TrI0NWFALi'H OF PENNSYLVANIA NOTARIAL SEAL Evelynn F Miller, Notary Public Carlisle Boro, Cumberland County M commission ez fires Janu 13,1016