Loading...
HomeMy WebLinkAbout11-08-12Weser 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 irl the appropriate form: Decedent's Information Name: Jesse R.. Clazk a/k/a: a/k/a: a/k/a: Date of Death: October 28, 2012 File No: ~~ - ~ ~ ~ ~ ~ 3 (Assigned by Register) Social Securiity No: 207-34-7370 Age at death: 68 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 926 Petersbure Road. Cazlisle PA 17015 South Middleton Twn. Cumberland Street address, Post Office and Zip Code City, Township or Borough Coanty Decedent died at 500 University Drive. Hershey PA 17033 Dem Township Dauohin PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death Ijdomiciled in Pennsy[vania ............................ All persona] proPet'tl' $ 5,000.00 /Jnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ /fnot domiciled in Pennsylvania ........................ Personal property in County $ Value ojreal estate in Pennsylvania ......................................................... $ loft ftft0 Oft TOTAL ESTIMATED VALUE.... $ 105.000 00 Real estate in Pennsylvania situated at 926 Petersbure Road, Cazlisle, PA 17015 South Middleton Two Cumberland (Attach additional sheets, iJ'rtecessary.) Street address, Post Office and Zip Code City, Towmahip or Borough County ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Exewtor(s) named in the last Will of the Decedent, dated eptember 19, 2012 and Codioil(s) thereto dated State relevant circumstances (eg. renancialion, death ojexecutor, etaJ "^' c~ Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorc ~ ro -~ T ~~~~ZZS5~, not a pa~to a ~~ divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. GS. § 3323(g), andt3i~Ot have.a5hild ~oin-rfD adopted; and Decedent was nei¢her [he victim of a killing nor ever adjudicated an incapacitated persons. ~ ~'-. ', i ~:.' ~_?, Q NO EXCEPTIONS ©EXCEPTIONS _ I ~ ~~ ~ ~ ', Q B. Petition for Grant of Letters of Administration (if applicable) c. t.a., d.b. n., d.b.n.c. t.a., pendente lite, If Administration, c.t.a. or db.n.c.Ga., enter date of Will in Section A above anll complete list of heir9.' Except as follows: Decedent was no[ a party to a pending divorce proceeding wherein the grounds fiu divorce had been established as defined in 23 Pa. C.S. § 3323(g) end was neidter the victim of a killing nor ever adjudicated an incapacitated person. © NO EXCEPTIONS ©EXCEPTIONS Petitioner(s), after a proper search hasMave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, efneeessary): Address Form HW-oz rev. loovzon Page 1 oft Oath of Personal Representative COMMONWF_ALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND 1 Othcial Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address Michele L. Brandt 109 Shirle Lane Boilin S rin s PA 1700'7 Dawn M. Clazk 997 Pinetown Road, Lewisbur , PA 17339 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tme 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 tmly administer the estate according to law. Sworn to or affirmed an subscri edbefore ' G~Qs {~1 w 2.,,..~~- Date JI - me t 's . ,N~ iday of eYl~ , ~ ~ ~~ ~n ~IV\ Date 11- R -) 2 By' Date For the Regisn=r BOND Required: Q YES !Q NO FEES: Letters ...................... ( ~ )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond .. ...................... Commi ssion ................. . $-SY)~ Ot^^her ~,'611II ...... ---- Automation Fee .............. . JCS Fee ..................... TOTAL ..................... St/~ ,~ 3. S(/ $ 0.00 To the Register of Wills: Date pease enter my appearance by qty signature belowe,: Attorney ignamre: LM- ~C? ~ ~ mzi, -- ' - S t: `1' ~'_ o ~ u ~~ =" ~,-n t7 }t ,_ . ~ ~- ~ Printed Name: Andrew H. Shaw rn,,~=' F _r. ~, Supreme Court < _ty w ~.:_ rn ID Number: 87371 D w ~~~ Firm Name: Law Office o1'Andrew H. Shaw, P.C. Address: 200200 S~Snrinn (',arden Street ~Illte 11 Carlisle, PA 17013 Phone: 717-243-7135 Fax: 717-243-7872 Email: andrew~ashawlaw e nm DECREE OF THE REGISTER Estate of Jesse R. Clark File No: Iv~~ - ~ ~ - ~~(~3 a/k/a: AND NOW, ~ ~ ~hUPn' 1 LN',I~ , 1 ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Michele L. Brandt and Dawn M. Clazk in the above estate and (if applicable) that the instrument(s) dated Seutember 19, 2012 described in the Petition be admitted to probate and filed of record as the last Will (and codicil(s)) of Becedent. Form RW-02 rev. 10/ll/2011 of Wills ~~~/~ 2 `\ r LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING If: is iU~Aal gyp.duplicate this copy by photostat or photograph. ~G~(1(~`~~, ,,~,.~~lc ~ ree jar mss cenulca~e, ao.(nj D12 ~0~ -8 P~ 3~ 36 I P 18883254 oaF'1:6I,~d„~ou~~ Certification nimnber -C~)PdBENLAND C~„ PE1 ~ a3 C c 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. ~`~~~ ~`~ odr ~ 1/zo~z Local Registrar Date Issued Tpyep: /P.I"t <° COMMONWETLTH OF pENNS VLVRNIA • DEPggTMENT OF HEALTH VITgL gECOgpS r•a..a e ~ yr ueATN <eaem z Le Name (Fb.e Mlaale. Laz<. suma) s<.<e Fna Numbs e e Jesse Ra Cla k s¢. °cul se<arl<y v,,,nee. m<. °r p¢. n(mn/p.Y/vr)(spen M°) e a. I Ha-Laz<glrtnaar (yrsl s<. u vae. > oe s. pat. nr Hlrtn (m°/Oav/veaq Rpeu M ml - q ° ° °n unto an mue H Tt}o ~!~~nla ana s<a<. relent rn ry 68 4 S r~ s PA 1 Bb. Reamena(s<ree<aaa Npmm.-In<Ipa. gp<Na g >b. Hlm,Place (caantrlCUm erland ea gPenns~<el vanian -) _. aD.<eeent u... Inan.wnanlP> ~ Ba. mena (c°,. 1 926 Pet urg Rd QCr<a, aaaaen<nyeam_SS R Vp ersb RC rl a . twp Umbe and e L e. Reamena alv coa¢ OvP, aemaent Ilr.a wgnln um1<s m m us Atmxa es <al st < ~ ) a uz at nm. ai De.m dty/baro. p m rvea p w we u. sarvlmn O v D wkn°wn <ea D N lee O u D ra 1tl B sPaa:e a Name mwlro, Hroe name mlar m ors<marm k v 1 l n n°wn ge ane, a N.me (Eo-ss, mmme. Laat, s re F 13. m°cne. s N.me Rrmr ca F e IHaa mlem¢. L ThEHOd ore Clar rs na.rl' sq S4a. I"mrmene. <r s a N.me g b. gel.nan,nlP t° Da<ea¢nt Sheltie l4<.mmrm.n amelnng gameaa!s<ree<.m Namb a G r ......_... _....._.. ...... ................._... . ¢r, ay ,seaee, I en e . ... .... a. .a ° ¢.< .< ° Hnaplc.I. .......................... ........ Ir oeam oaada Ina ... ........Y. on. ... ... I~'Inpauen< ei~6a:m DaaFea """""'...... ^ s ""'""""' "" y a HO am.wne..ome.4na,;a apiiSi: ry He36ibe s:~iiiti%...._....... ..... O Emar en<y gaom/oat Y']'oe<eaa:.'e":'de::;a""""'. patient peatl on q.clYal Nu.zln Home/Lao -Te.m Cere Fadll Ssb Fatalit N . y ty Otnec (SpaclEyl ama (li n°<Inztltutlnn, HI tree[ ana number; c CtY n<T°wn, state, ana 2Ip Coae M S H h . . ers e Medical Center Hershe Pa 17033 Ssa.c afi M n . a. e< aa m olap°agmn O a Pl l n remanan Sse. Date m olzpaa<lpn <. pma or Dlapamn°n (Nam o gema.,aL.am 6<ate ° E U ~~3 16 o a C l ., a peat a amecery, oemamrv < er °~sP°itil Nov. 2 20'1 ga HOllin .Late e.D apaa °n (cltvarTa ~n s tare C 1°^ remator ene ='w Mt - , , fre a. vFan¢ta xma u<enae. or paraez c vb. ucen.a N° HOlly Spri ¢gs 1 sg . mbar PA '17 3 • 06 ~•- a complete geareaa °r Ea oral F IucY t O l t 8 L >~ HOllin erFH&Cr mat r ~ e Decmenr. Ea.onan - cne<k ma b a Mat beat eeaenbea me s. Deaaen<ai Hlapam<Drlelo- cn«k me aee„t: ra° nlcneat a¢H.ee °. ~ierel ar.<nvul <omple<ea x m c-F«T u t45R~CS a e , a I me or aee<n. .mat b.a<aea<rmea wneme. Me aeaeem me a«.eem < nmaerea n n ma what O e araae a'e I Ir o, n vm e. 1 6 5e erse , en m/Hlapemm~am°. cne<k Me "N O" 8 W o N aplam., -12m reee a a l ` o k°' b IavHlap.nl</La ogl;~: a<b°°I gtaaaate °~GEp <amdle ~IU ar grN<an gmeN<an e so. I miw " O ea <"O Q t o l m/a s copegx c.etllt, but n° tleg<e< O gmerlcan Intllan x. glazka N O Om au..e ~ a e= ec gz an ¢ n ani mem .n gma O q e a¢mee te.g. qg, qs) a n, cm<an° O gzlm malan a e (e.B ° tan O emnee` O ~ualm q g .. ae O ~ a . c o m w ) r e , ., . n.marro mn E a Msw M EA • ° (e' ' ^^ 0H ~ p a^ ° ~ , ~ ) O rea, pmar sp.mab/Hl:pam4La<mx ee O amnan 0 D a e a <. te.6. v DHEaor a o o ++w^ roEe}aon. aa .: o ree~ s ome. Pa<Ina lalanaer o uD Dvm a (spe°") O ome, ¢paoryl e,D a M 1.~<e en<~ n "a o SmMe a<aea-Deals n-cbe<k orvLy oNEt°mma na me aeaa.n<<anaaerea nrm:ev °. mrseum b <e w wnlte o Kaaaneae e. a. De<ea.nre uaaalo«pp.<la o samaan n-mmoT US Pe °i w°rk 0 Back °c glrrcan gmerlcan 0 ne tluring mna<°( wo.ki qr I ng O 0<M1ec Paclflc Izlantler e. DO E RETIRED. namn o.maaka wn.,e Ovee amaae p er a pDa,a know/Nat sur. q n m Laborer opener al.m m` e: „ o gera,ea a o = . D we ee aweu.^ O D<ner lsweaM z2b. Etna ut guanmz/meustry of"'p'"° OG,..manlen pr cnamo.r° Army Distributio ' n cpmvLEreD Cent •Y Eg30N WNO ppONOVNCEH OR a' Dace P<on°unc¢ Oea Mo Day c g Deatn O . SIHna[ute o pe<son Pron°unc n M x O k appll<a CEtlTO IES OECT n y w e a c. License Num er tl a ° s16..¢ Dmu/Day/y.l T e or Deem m ` : AR a..'a zs. was meama E..mme. ar c°.nna. cpn<a<tea> p vea o CAUSE OF DEATH z6 P . .a L Ema. me tna n °r .-qla saes, mjanez, ar Pn< -oat m.ecth tosses tn. seam. Do NoT.nmr m ^ m xmn gppra.Imae reaplratorv amass °t„enm I b n m ew o . rm t., a. el erema aa<n a br m~on wmnap<an mg m¢.a mgy Do .<a.ar.<arteac ! i rval: NOT ABBREVIgTE. Enter °nly nn¢ caus l ci < ¢ nn a ine. qtly aetlltlanal Ilnez Ir necessary [ On o Oea<b IMMEDIgTE CgUSE .> a I }Y {7d b . < Fly i fpl m ala ae <omm~xn a . aeztM Dae cu Inr az a mnaega.n<e uq: eml Ina L u` l In6 ~ ~°~e ~a ~ze Duc to for ea a tun evuen<e nq: f r.m vn~m e .Enter me ~ c 1 VNOEgLYING CAYHE lal Injury Mat Due to 1°r ai a c°nsequence °f): 1 ~e ° i Inl te en<s cexul<InE a~ ~ ~ i m n a<) 1g5T y J Dae < az a <°n ° 1°r xequanro °i): 1 26 P 1 . art 1. Enter a n oerY nHCauseBwnin Pertl 2> Wa i- ' . sOy PsY Perf°rmea> Hya a~>rJ 0./l~vJ G(t lYwsp 1 11 No y, H•/t1E/J-Er5• >H. W utaP.Y nneings avail ble µ\ 8E tO a mple<e tn° Gauze °I eae ni Ir Fe a e ~ N t ex P Ola Tobacco Us¢ Cnn<rlbut¢ t° peam> N° O vnane wrtnl . <ye.r 3 Y O eB<n ~ .~ e i aeac ~ P nt a1: time ° 0. m ez ~U~y pby,~ b u r gnang O ^ P eH^ 0 cciaant ae ~ ~ tllry~nveRlgetl°n p N r t, b Bnan ut pregnant q3a t sm e ° r, /"' " e e p g a r d u e z. pa y bei eeee[n j ry (m°/D ~ sale no<be tle<erminea te n( In o o Unkn° .vhr) (spell m°nMl nln ene i a vea. pas ~ Time ai Inlury .Place °I Inlury Ix_H- n°me, c°nztructl° sRe, ra.m, xcn°°I) ~ ncaUan 35. L °r Injury (streee ana Number, e l<y, s<aee, Zlp C°ae) InO y °'k rv GIN'. n a O Dezvme Ha Inlurv Dccu.rad: m O D er/D O rv° O Passan er O o er (specrry) g 3 a 9 m~ ~ Y ) p rery pn~ e<m, . ~T° me eest °E h.y kn°wl¢age, ea.m u«wrea eae ome <aase(q and m tee ^er i<a P n°un • Bi CertllYing pnysicl n -~T h n ° t e ext °f my knawleege, aaatM1 retl a t ¢tlme, am¢. o o memca E.ammer/c° a m place, ene eae to Me cauae(sl ana manner sta<etl r - o., ~b~ x or examinanon, amronna :Nnno~. In l r Y Q I n aP on a< amen .<<n. <Im.. m<¢, ana pIa<e..na sae t° <ne a.a e aramHer ,~/ ac .mar ana menn.r stet. M~ e, gtlerezi >~i C~ s~~.( _ Llce a Numbet: HT1Q4 'j i I ~~~ F~RS'K~•, Medical C ng o ~ le nea (M°/D.vnt) enter, Hershey, Pa.17033 ~ Reg ss s D. to m e. ema<r. a& a i ~\O 4 ~~_~ HNtrar re D.<e aDav r qme^ m.m~C~~ ~ r6 c 6k~.~o ao a-- S ti zp°zltl°n Permit N°. ()' ( y `)(~ (~ Lt~' RE 1p5-143 t -., t~ LAST WILL AND TESTAMENT ~a "' Y"'~ ~„ c~ rn~~c -.. ~ =z OF ~ , r n -~ ~.~; m i ~~? ~-y JESSE R. CLARK c ~~~ -°- - '= ca `c=,„ r _n O w I, JESSE I2~. CLARK, residing at 926 Petersburg Road, Cazlisle, Pennsylvania, being of ~ a sound and disposing mind, over the age of eighteen (18) yeazs, and under no legal disability, do hereby make, publish and declaze this to be my Last Will and Testament, hereby revoking all other Wills and Cojiicils heretofore made by me at any other time. Article I: I direct that my Personal Representative(s), hereinafter named, pay all my just debts and funeral expenses as soon after my death as practicable, incauding all property, state and federal death talxes assessed against me, my estate, or my beneficiazies, without proration among my beneficiiiries. However, all property bequeathed or devised hereunder, either outright or in trust, is bequeathed or devised subject to existing mortgages, liens or encumbrances thereon. Article II: I confer on my Personal Representative(s) and/or any Trustee(s) appointed herein and their successors the right to sell or otherwise convert any real or personal property at public or private save, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my Personal Representative(s) shall determine, and to execute and deliver good and su)'ficient conveyances, assignments, and transfers of thf; property, without liability of any purchaser for the application of any consideration; to borrow money and to secure .Goa-e- ~ ~~ Jesse R. Clark its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability ort the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, as permittE;d under Act 28 of 1999, the "Prudent Investor Act"; to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shazes of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and all other powers given under the statutory and common law df Pennsylvania available at the time of my death and 'the power to do all acts and things necessaYy or appropriate in the management, administration and distribution of my estate.. Article IIIi At the time of execution of this Last Will and Testament I am single. Article IVJ, At the time of execution of my Last Will and Testament I have the following children; A. MICHELLE L. BRANDY; B. DERON R. CLARK; C. DAWN M. CLARK. Article V: I hereby nominate and appoint my daughter, MICHELLE L. BRANDY, and my daughter, DAWN M. CLARK, as Co-Personal Representatives of this my Last Will and Testament. My individual Co-Personal Representatives shall not be required to furnish bond or surety. Article VL' I give, devise and bequeath my RESIDENCE to either MICHELLE L. ~~,~° C~, Jesse R. Clazk BRANDY or DAWN M. CLARK, absolutely and in fee simple, with Forty-Five Thousand and 00/100 ($45,000.00) Dollazs in value of said residence to the daughter not taking ownership of said residence and Twenty Thousand and 00/100 ($20,000.00) Dollazs iri value of said residence to DERON R CLAARK. If, for any reason, neither of my daughters choose to take ownership of said residence, I direct my Personal Representative(s) to sell said residence at public or private sale, and to distribute the net proceeds therefrom to my children as follows: A. 40% to MICHELLE L. BRANDY; B. '' 40% to DAWN M. CLARK; C. ', 20% to DERON R. CLARK. Article VIIk I give, devise and bequeath all the rest and residue of my estate of whatever kind and description wherever situate, to my children in equal s,hazes, per stirpes. [Remainder of page intentionally left blank] ~ .Pl« Jesse R. Clazk IN WITNZESS WHEREOF, I have hereunto set my hand and seal this ~~'day of Se ~ , zolz. ~' d(SEAL) Jesse R. Clark Signed, sealed, pu by the foregoing 7 for his Last Will a consisting of four presence of us, wl and in his presenc presence of each c set our hands as w fished and declared stator as and l Testament, pages, in the at his request, and in the er, have hereunto COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, JESSE I$. CLARK, Testator, whose name is signed to the attached or foregoing instrument, being duly qualified according to law, do hereby acknowledge that I signed and executed 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. Sw to o~ affirmed and acknowledged before me by JESSE R. CLARK, the Testator, this ~~nday bf app f 2vyt Y1P/- , 2012. CSd.GdQe. ~~--~ ~-(lc~/C rbMMONWEALTI OF PENNSYLVANIA JeSSe R. Clazk No • Aal Seal Sarah D. Diedr nan, Notary Public GAlsle eoro, umberland County ~ MY Commission res Nov. 5, 2013 ~ Member. PennsvNan a ASSOdadon d Notaries ptary PUbI1C My Commission expires: COMMONWEA~.TH OF PENNSYLVANIA COUNTY OF CiJCMBERLAND We> uJ Y-t ` ~~uJ and fPA ~-- S~ICtI..J , the witnesses who a names aze signed to the attached or foregoing instrument, being duly qualified accordin to law, do depose and say that we were present and saw Testator sign and execute the inst ent as his free and voluntary act for the purposes therein expressed; that each of us in the heazin~ and sight of the Testator was at the time 18 or more years of age, of sound mind and under nol constraint or undue influence. Swom to o affirmed and subscribed before me by ~~r~ - ~ crJ and ~~CPr>` ~ • ~~>uW ,witnesses, this /Q~ day of ~o f , 2012. ~~ 1 ~ ~~ ~ ~~ otI~ary Public My COmml$slon EXpireS: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Sarah D. bieckman, Notary Public GAlsle &xo, Cumberland County ~. 5 My Commksbn Fi~ires Nov. 5, 2013 Member. PennsvNanla AssocWdon d NoteAa