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HomeMy WebLinkAbout11-08-12Reset 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 i Name: ROBERT H. BOWERSOX File No: 021 ~ ~~- ' ~ ~ (~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: SEPTEMBER 10, 2012 Age at death: 88 Decedent was domiciled at death in CUMBERLAND Cotmty, pENNSYLVANIA_. (stare) with his/her last principal residence at 83 SCHIMMEL WAY CARLISLE 17015 SOUTH MIDDLETON TOWNSHIP CUMBERLAND Street address, Post OfTice and Zip Code City, Township or Borough County Decedent died at HOLY SPIRIT HOSPITAL CAMP HILL 17011 CAMP HILL CUMBERLAND PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: t~ If domiciled in Pennsylvania .......................... .. All personal property $ 900,00.00 If not domiciled in Pennsylvania ...................... ..Personal property in Pennsylvania $ If not domiciled in Pennsylvania ...................... .. Personal property in County $ Value of real estate in Pennsylvania .................... ..................................... $ I.tl.~ TOTAL ESTIMATED VALUE.... $ 900.00.00 Real estate in Pennsylvania situated at: (Attach additionad sheets, if necessary.) Street address, Post Otfice 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 MARCH 5, 2010 and Codicil(s) thereto dated DDATT TATf`TATiIIAT FlIA !'T]ART FC A PACC TC ATTAf'T-iFTI i-iFRFTO State relevant circumstances (eg. renunciation, death of executor, etc.) 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. Q 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 lite, durante absentia, durante minoritate If Administration, c.t.a. or db.n.c.i: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 c.~~ Address n °~ O ~--' C7 ; ~ _ - ~ - ~ _. - :{ i fU -- --t ~- l~ ~ -'T'F Form RW-02 rev. l0/1 //20! I Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND ~r t~~~N ~''r ~~~ ~~~~~ ~~~ -8 Pik 2~ l 7 Petitioner(s) Printed Name Petitioner(s) Printed Address ROGER B. IRWIN 60 WEST POMFRET STREET CARLISLE P ~~'1~'v ~ '..'J~E~r ~M r 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 Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed an subscribed before "~ . c~^-L-s- Date `~ '~ / Z met day f , ~~ Date Dy' Date For the Register Date BOND Required: Q YES ~~O To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ..................... . ( 4) Short Certificate(s)..... . ( 1) Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other .,....., WILL . , ... . ~ 660.00 16.00 5.00 i a nn Automation Fee ............... 5.00 JCS Fee ..................... 23.50 TOTAL ..................... ~ 724.50 Attorney Signature: . ,~~ Printed Name: ROG .IRWIN, ESQUIRE Supreme Court ID Number: 6282 Firm Name: IRWIN & McKNIGHT, P.C. Address: _60 WEST POMFRF.T STRF.FT CART.TST.R, PA 1701'i 717 249-2353 717 249-6354 Phone: Fax: Email: DECREE OF THE REGISTER Estate of ROBERT H. BOWERSOX File No: ~, ~- ~ a.._ ~ ~ ~ I a/k/a: AND NOW, I~1~~Q G11 ~? Y' ~ U ~ `~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to ROGER B. IRWIN in the above estate and (if applicable) that the instrument(s) dated MARCH 5, 2010 described in the Petition be admitted to probate and filed of record as the last Will (arid Codicil(s)) of Decedent Register of Wills ~e t ~~~,~~.~ , Form RW-02 rev. 10//l/2011 ~ Page 2 of 2 u,n9.R^~ ??V ~9/"~ LOCAL ~, T , ~ CERTIFICATION OF DEATH WARNIN .~1 ~ Wi't' cate this copy by photostat or photograph. ~` ~~., ,L ~~~ ~('~.~ If L ~, I'~J Fee for this certificate, $6.00 P 18882262 Certification Number ~r Type/Print In Permanent 83 SChi ]Yr. ecadent Llve in a Township? Reslden a (cpunty) morel Way EB Yes, decedent lived In South Middleton twp d 8e. Residence (Zip Code) ~ No, decedent lived within limits of city/boro. er in US Armed Forces? 30. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If Wife, give name prior to first marriage) Ves Q No ~ Unkno Q Divorced _ Q Never Married ~ Unknown 2§ Donna Breraneman +'.°. nelationsnip to Decedent Niece 14c. Informant's Mallln Address (Street antl Number, frlty, state, 21p Code 75 Northv~ew ~ , M ec an>_cs urg, A 170 S If Death Occurred In a Mos Ital: .................°: ace o neat.., n one .... ._. _._ . _.....__ P ~ In Patient ............ ....L.'~...°....Y..... )If Death Occurr d s ~~ O ..•.---., e omewhere Other Than a Hospital: L.J Hos \ee Faclll ~~~"""""'""'"""""""" Emergency Room/Outpatient ~ Dead on Arrival Nursln Home/L P ty Decedent's Home T • ~ ong- erm Care Fecllity Other 5 lsb. Facility Name (It no[ institution, Ive street and number; 15c. City or Town, state, d 21p Code ( Peclfy) Hol S i i g y p r t Hosp i.tal Camp Hill , PA 17011 lsd. County of Death' Cumberland 16a. Method o/ Disposition Q Burial Cremation 16b. Dale of Dlsposlti 16 l c. P ace of Dls ~ Removal from State 0 Donation c^~~ a ~ ~ ~O~ Position (Name of cemetery, oratory, or other place) omer(spe°Ify) s7C Hoffman-Roth Elaneral H , ome & Crematory 16d Location of Di iti . spos on (City or Tpwn, State, and Zip) 17a. si of Funeral Service Llc or Parson In Charge of Interment 176 Carlisle, PA 17013 rc LI 5G . <ense Number /~ 013144E ~-C _ 17c:tJOarpe~ d com t ddr f caner Fa Ity E'3 L man-~ot~l ~unera'~ d .~ ome & Crematory, 219 North Hanover Street, Carlisle 18. Decedent's Education -Ch k th PA 17013 b , ec e ox that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Ch highest degree or level of school com let d t k h p ec e a t ONE OR MORE races to Indicate what e time of death. box that best describes whether the decedent the decadent consid Q Hth grade pr less d h ere imself or herself to be. Is Spanish/Hispanic/Latino. Check the ^No" Q No diploma, 9th - 12th grade ® White ~ Korean box If decedent Is not s I h Hls High school graduate or GED completed pan s / panic/La[Ino. ~ Black or African American 0 Vietnamese No not s l h/ , pan s Q Some college credit, but no de Hispanic/LaUnp Q American Intlian or Alaska Native ~ Other Asian gree Q Yes, Mexican, Mexion American Chican Q Associ t d , a e egree (e.g. AA, As) o 0 Asian Indian O ~ yes, Puerto Rican Native Hawaiian Q Bachelor's de h gree (e.g. BA, AB, Bs) ~ Yes, Cuban Q C inese 0 Guamanian or Chamorro ~ Master's de ree ( ~ Flli g plno ~ Samoan e.g. MA, Ms, MEng, MEd, M$W, MBA) ~ Ves, other spanlsh/HI spanic/Latino ~ Ja Doct r an t p o a e (e.g. PhD, EdD) or Professional de ese 0 Other Pacific Islander gree (S ecf p y) ~ Other (Specify) . MD DD5 DVM LLB lD 21. Decedent's single Rece Self-Designation -Check ONLY ONE to Indicate what the de<edeni considered himself or herself to be W Ite 22 ' a . a. Decedent s Usual Occupation -Indicate o ~ Japan ~ Samoan type of work Q BI ck r African American Q Korea done durin mo 5e t f g n s o working Ilfe. DO NOT USE RETIRED. Q Other Pacifl< Islander 0 American Indian or Alaska Native Q Vietnamese 0 Don't Know/Not s Supervl sOr ure ~ Asian Indian Q Other Asian 0 gefused 22b. Kind of Business/Industry Q Chinese ~ Native Hawaiian ~ Other (Specify) ~ Flliplno p Guamanian pr cnamprrp US Military Supply Depot ITEM S 23a - 2Bd M ST BE COMPLETED 23s. Date Pr no nc Dead Mo Day r 2 . signature o Person Pronouncing Death Only w en app Icab a 23c. Ucense Num er BY PERSON WHO PRONOVNGES OR CERTIFIES DEATH ~ ~ ~ O T zd ~ Z X 1- L -S~ ~~ ~ ~ ~~~ _ ~ ~~ ~; This is to certify thaC the information here given is correctly copied from an original Certificate of Death duly filed with me as Loca] Registrar. The original certificate will he farwarded to the State Vital O~IJ~r~.t`r J t,`ii~~tr Records Office for permanent filing. CUM~FRLAND CO., ~~„~Q~~~i~~~'r SEA 1 2hot2 Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CERTIFICATE OF DEATH 2. sex 3. social se rity Numberstate File N4u mDa[e of Death (MO/Day/Vr) (spell Mo Male 201-16-2746 September 10, 2012) _. Under 1 Da 6. Dale of Blr[h (MO/Day/Year) (Spell Month) 7a. Birthplace (City and state or Foreign Country) Hpprs MI^°t°, April 24, 1924 Hanover PA Idence (street and Number -Include Apt No) 8 Dld D 7b. Birthplace (County) Robert Harman Bawersox Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear 1 88 Months Days Ba. ResltleLce (state or Foreign Countrvl Rh. r - ner ° r Coroner ContaRed7 ~ Yes No 26 Part 1 E h CAUSE OF DEATH . . nter t e chain of t`_ tliseases, InJuries, or compli respiratory arrest or catlona-that directly caused the death DO NOT ent r t i Approximate , ventricular fibrillation withou t showing . e erm nal events such as the etiology. DO NOT ABBREVIATE. Enter onl on cardiac arrest ` IMMEDIATE CAUSE ---------------> a ~SO tf'~~~S y e cause on a Ilne. Add additi 0 ~\ ~ ~ onal Ilnes if necessary ~ Onset to Death . (Final tlisease or condlilon t ,~ ~ 1 OL-~ ~,` ~ ~ QV\ L~ D t resulting In death) b M t 1 4 p( zrquence of). .~ ~~ 1 ( . ~ segventlally list conditions, r ~O L 0.J \ /~ eiZ ~rY ~ C~ r~ if any, leading to the cause ~~ Due to (or as a consequence of): ~ __ listed on Ilne a. Enter the UNDERLYING CAUSE (disease or Injury that Oue to (or as a consequence af): initiated the events resultin8 d. ~ In death) LAST. O ' y 7 26 P t ue to (or a sequence of): c . ar 11. Enter other significant conditi t ib tl d but not resulting In the under) in caus y i ~ e g B ven In Part 1 n 27. Was autopsy performed? Ves ~ 28. Were autopsy Flndings available to com l t th y , 29. If Femaole- 0 N t pregnant wlthln past year p e e e cause of death? 30. pid Tobacco Use Contribute to Death? 0 Yes No 31. Manner of Death ~ Q Pregnant at time of death ~~OyY,es ~ Probe Dly Natural ~ i ~ Not pregnant, but pregnant within 42 days of death N ~t'o ~ Unknown Accident ~ Pendln g Investi ati .- Q ot pregnant, but pregnant 43 days to 1 Vear before death 32. Date of In ~ Suicide jur (M / g on ~ Could not be determined Q Unknpwn If pregnant wlthln the past year y O Day/Vr) (spell Monthj Yes Inlury occurred: ~ Q Driver/Operator ~ pedestrlen ~ No 0 Passenger 0 Other (specify) C rtHl (Ch k ly ) g[ C or[ifyl g phy i i T th b t y know ge, tl occurred due to the 'cause(s) and manner stated Q Pr pouncing g. Certifying phy -Tot est o knowledge, death occurred at the time, tlate, and place and due to the cause(s) and manner stated Q Medical Examiner/Coroner nd/or Investigation, in my opinion, tleath occurrctl at the time, date, and place, and due to the cause(s) and manner statetl signature of certifier: ex a a Title of certifier: b. Name, Address and 21 C f Person Completing Cause of Death ``Item 6) License Number: I~w~¢s ~ - ~ ~t , r`"~O ! o [ E/' F ~ ~ d R~ . SY1= /o / i C'n f+t H. ! l fl~ / 7o J! 39c- Date sl ned t /DaY/Yr) . Registrars District Number 41. Registrar s sl turc ~~ (~ rzV , 2~ 42. Registrar FI a ate Mo Day . Amendments `,\ ~Q later Disposition Permit No._ O - 1 -` S rte[) 1 H105-143 REV 07/2011 LAST WILL AND TESTAMENT I, ROBERT H. BOWERSOX, of South Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Co-Executors to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Co-Executors of my estate. 2. My Co-Executors may, at their discretion, compromise claims, borrow money, retain property for such length of time as they may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as they may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. I authorize and empower my Co-F.,xecutors to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Co-Executors are authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems exp~ient to said Co-Executors. ~ ~, . ~~ -~. ~ :~ rr"t ---~ ~ ... e ~ _,_. ,~. ~~J J ~ ~~ c G~ ~ CO ~~) ~ - ~-_ .. ' ~' 1 - ' ~~-.7 ~ cr~> ~ ~.~ ~ ~ ' ~7 ~_ i=n -~..t ~~ ~ 4. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: a. Ten Percent (10%) to HOSPICE OF CENTRAL PENNSYLVANIA; b. Ten Percent (10%) to FIRST EVANGELICAL LUTHERAN CHURCH of Carlisle, Pennsylvania; c. Ten Percent (10%) to CHARLES A. PASS in lieu of an Executor's fee; d. Ten Percent (10%) to ROGER B. IRWIN in lieu of an Executor's fee; e. Forty-Five Percent (45%) to DONNA BRENNEMAN; f. Five Percent (5%) to SUSAN BEAR; g. Five Percent (5%) to DWIGHT WILSON; and h. Five Percent (5%) to INDEPENDENT LIVING RESIDENTS ASSOCIATION FUND OF CUMBERLAND CROSSINGS. 5. I nominate and appoint ROGER B. IRWIN and CHARLES A. PASS to be the Co- Executors of this my Last Will and Testament. 6. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 2 7. No Co-Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 8. No beneficiary may assign, anticipate or pledge his, her or its interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. If any person entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person shall forfeit his or her entire interest inherited hereunder and all provisions in favor of such person shall be declared void and of no effect. The share of such person so forfeited shall be distributed as part of the residue pursuant to Paragraph No. 4 hereof, as the case may be, except that if such person is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary beneficiaries. 10. I hereby suggest that my personal representatives retain the services of Irwin & McKnight, P.C. as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5~' day of March 2010. (4 ~ t~J`~`~ ~/~C~~g~ Z~~(SEAL) ROBERT H. BOWERSOX 3 Signed, sealed, published and declared by ROBERT H. BOWERSOX, the above-named Testator, as and for his Last Will and Testament, in our presence, who, at his request, in his presence and in the presence of each other have hereunto set our names as subscribing witnesses. ,.- r 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, ROBERT H. BOWERSOX, KAREN S. NOEL and SHARON L. SCHWALM, the Testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~r~ ~ C~ ROBE~2T H. B WERS ;' N S. EL SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS: Subscribed, sworn to and acknowledged before me by ROBERT H. BOWERSOX, the Testator herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L. SCHWALM, witnesses, this 5th day of March 2010. ~- ~~ N to Public CgMM4NWEALTk1 OF PENNSYLVANIA Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro. Cumberland County 5 My Commission F~cpires Oct. 3, 2012 Member, Pennsylvania Association of Notaries RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA n `-= :a-, ~ ~- ~. (r-z ~-, . ,~ _r mac: _~ ~ ~ ~t_-_ .~.. .., '.~ ~ ...._ L,~ 1 ~ ~ ~ ._t1 O ~. __ ~ _: ; m "'~ J Estate of ROBERT H. BOWERSOX I, CHARLES A. PASS (Print Nome) EXECUTOR Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ROGER B. IRWIN OCTOBER 11, 2012 (Dare) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (Signature) 291 RIDG I L ROAD (Street Address) MECHANICSBURG, PA 17050 (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 ~ L' da Y Notafy Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission. ) OOMNIONWFALTH OF PEN ' YLVMQA Norerlal seal Karen S. Noel, Notary Pubdc CaANIe Bo% CutnOeAattd Comity My CAnrnbolon E~ DeC. 8.2015 MEMBER, P@INSYWANIA ASSOCUITION OF NOTARIES