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HomeMy WebLinkAbout11-20-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~U m b e~ %i~ o~ 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• may i_oots~ CR~S~ a/k/a: a/k/a: a/k/a: Date of Death: _ ) 1) t ~ ! Z Decedent was domiciled at death in ~r ~ r+~ t'Xc2 ~ ~ ,vaj principal residence at ~ ' f ~ /V a ~. 5 csco,t,~ S..i-R Street address, Post Office and Zip Code Decedent died at r4o ~y Sit RiT 1~6.~ , N o Street address, Post Office and Zip Code File No: ~~ - ~,~ -1~ (Assigned by Register) Social Security No: ~- Age at death• R~ County, _ Pr; N/vA , (Scare) with his/her last City, Township or Borougyyh~/ ? 1 Si STR~~% C~MI~ /Y'tG~ ~c~ City, Township or Borough Count Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property !f not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania If not domiciled in Pennsy!vania ........................ Personal property in County Value of real estate in Pennsylvania ......................................................... TOTAL ESTIMATED VALUE... . Real estate in Pennsylvania situated at: (Attach ndditional sheen, ijnecessary.) County State ~R , $ ZS, boo $_ Z.S~ 000 ~..«. xuarrss, cost vmee 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 Z Z ~ thereto dated l ~~ l ~ ~ and C6dicil(s) .~~ :~- n' r) - -_-~ N State relevant circumstances (eg. renunciation, death of execatoq etc.) r +t; =~ ~; Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not ma ~ r ~ T try, was not divorced not a party to~pendmp._ ,? ~ ' divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and diir~f.have a chih}~orn of - ; `-`' adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ _ ~ --~ ~,NO EXCEPTIONS ^EXCEPTIONS ~ -~-~ ~ -- t-> - ~' i'1"1 ~ ~ C~ ^ B. Petition for Grant of Letters of Administration (If applicable) cc+ ~'~' c.t.a., d. b. n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.xa. or d.b.n.c.l:a., enter date of Will in Section A above and tom lete list of heirs. Except as follows: Decedent was not a parry 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 I TU// Fonn RW-01 rev. 10/l!/1011 Page I of 2 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, iJ'necessary): Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } ss: COL; NTl' OF UWI~Q ~ ~ ~~ fr't[ fir}O~~FI' jYj-~jv~ ~~ ~ '~ i~ r Gsc. (anly', t ..~~1' ttillz ~~.'~I Z~ Pe~ 2• ~5 Petitioner(s) Printed Vame r}... ., Peutioner(si Printed : ~-~," .;" "; ` 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 Dec ent, the Petitioners dl well d truly administer the estate according to law. Sworn to or affirmed, at~d subscri]~ed before ~ ~~'`~`-~-~ Date / ~ ~ ~ Z me this ~Y-~~~+a., ~Jt ,lei, ~rlrll mot, _'ln ~ By: - For the Re ~-- BOND Required: Q YES ~NO FEES: Letters .............. ... . ( ~~ )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ~~lll ...... Jt~ -or ........ Automation Fee ............... :~ ]CS Fee . ................. . 7 TOTAL ..................... $l~~s~,:SL~ Date Date Date To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of I~u~ , I~ L"~ FileNo• ~~~ ~a-(~.~ a/k/a: AND NOW, ~ ,( ~~~',~D r ~_[~ , ~ 2 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters "~~c~ Q (~,Q n ~{~ ~ are hereby granted to ~_~~ -~~f in the above estate and (if applicable) that the instrument(s) dated 11YY'Q(`~ ,f'~~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent Register of Wills ~ ~ ~ ~ Form RW-n2 ,•~,,. rnirinni~ ~ ge 2 of 2 Hlnc ROS RPV lUn I I LOCAL REtBf~A1i~l~ l~ERT1FfCATfON OF' DEA~Tf-f WARNING: It is ~~~~ ~Q t;~ip4~~~~ this cagy by phatastat ;~~ phl~tograpl~. Fee for this certificate, ~ti.0() ti~~~ ~ay 2~ P~ 2% ~~ ,,,;, -1 t P 19064265 Certification Nwnber Type/Print In Permanent ~~ V -~~ ~~~ Qf~,~ r JJ ' , ( )(~= r. , ~ r Intormatu)n he 'c given IS I '- , II II II~~E.P. _ ~~h ~ c n ( ~ tl~ (~.tnc~~l III .:(:j <Ir iginal Ce rt;f(ea e of Death ;`'o% ~ `~~ (ul tlt:i{ ~ ~ith .u' I~ ~uu(i R~~ rsVar. I;~e original (~ (~~N~\ ~ /~`~ ~, ~,~ (:~JI h .(t( ~. il! I . ?Os~.,,rded to the Mate Vical 1 ~~~~~~~~~~ ~i v a?i I~ ~, ,cl:. t rt ~ icr 1 i ; ,~; nr,(nent filing. °~~ . , / ~~~ ~ NOV Z 0 01Z a "~ "'"' - _ gate .sr;ued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH _ VITAL RECORDS g ~.pK ~ ~F~eATE OF DEATH State File Number 1. Decedent's Legal Nama (First, Middle, Last, Suffix) .Sax 3. 5 1 I Nu 4. Date of Death (MO/Da /Yr) (Spell MO) Mary Louise Case emal 'P~~eC~tl-~b$r3'I Nov_ 1 6, 202 Sa. Aga-Last Birthday (Yn) 6b. Under 1 Year Sc. Under 1 Da 6. Date of BIKh (MO/Day/Year) (Spell Month) 7a. BlKhplace (City and State or Foreign Country) 89 Mpntna Daya H°"rs Mln"tea Jan_4,'1923 rrisbur PA 8a. Residence (State Or Forei Count 7b. BlKhplace (County) sup 7_ n Penns _ gn ry) e4b. Resldlnce (Street and Number -Include Apt No.J Bc. Did Decedent Llve In a Township? ( ) CamVi~~QrjiaP~i7a~7O~~ East Pt=_nnsboro Bd. R~I~e~,br~o~(,t~ and P , ea, de~leent used in twp He. Residence (21p Coda) Q No, decedent lived within limits of city/boro. 9. Ever In mad ForceaT 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Nsme (If wife, give name prior t° Rrst marriage) Q Ves ~NO Q Unkno Q Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, SufRx) 13 thlr's N for Ir a (Firrt, Middle, Last) Ira L_ Dunkle L~'ary ig4 '~rl~F{'3'~1ig 14a. Informant's Nam! 14b. Relatlonshi to Decedent 14c. Informant's Mailin Address (Street nd Number i [e, P nnie L_ Hoover daughter 42 Victor~a Way,~amp 0 , , H .......... If Death Occurred in a Hospital: ~~ Inpatient „eat... ec on y one .... .............................. ..... if D th~O ' ..... _ ... I ea CCUrred Somewhere Other Than a Hoapltal: """"""""""'" ........ '^---- ~ Hosp(ce Facillry CY~Declden'r's Home Q Emergenry Room/OUtpetient Oesd on Arrival ` Nursln Home/Long-Term Care Facilit r y Othe SSb. Facility Name (If not Institution, give street and number) lSC. CI ( PeciTy) ty or Town State d 21 _ , , an p Code lSd. Co ty of th t 1 East Pennsboro Twp Cum~er~and 16 a. Method of Dlspositlon Burial Cremation 16b. pate of Disposition 16c. Place of Disposition (Nama of cemet Q Removal from State e Q Donat on ry, crematory, or other place) och.r(speafy) Nov. 20, 20"1 Hollinger Crematory 16d. Location of Dlspositlon (City Town, State, and 21p) 1 1 nature of I S rvlce Licensee or Person In Charge of Interment 76. Llc Mt_ Holly Springs,PA'1 7065 ~t ~~~ ~'D-~'jf~'S'~`3L 17c. Nam! and Complete Address of Funeral Fa ility Musselman FH&CS 324 " ~ , Hummel Ave_ ,Lemoyne,PA I 7043 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Orlgln -Che k th h ' c e 20. Deodent s Race -Check ONE OR MORE races t° Indicate what ighest degree or level of school completed at the time of death. box that best describes whether the decedent th d 8 h e Q t ecedent considered himself or herself to be. grade or less is Spanlah/Hispanic/Latlno. Chick the ^NO" Wh N d l ite o ip Q Korean oma, 9th - 12th grade box If decedent Is not Spanish/Hispanic/Latino. Q Black or African A High school raduat i GED g mer e or can completed Q No, not Spanish/Hispanic/Latino Q Vietnamese Q Some college credit ree Q American Indian or Alaska NaNVe but no de e h , g t er Asian Q Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native H Q Associate degree (e.g. AA, AS) ii awa an Q yes, Puerto Rican Q Bachelor's degree (e.g. BA, AB, BS) Q Chinese ~ Guamanian or Ghamorro Q Yes Cuban , Q p no Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA FIII i ~ Samoan Q Yes, other Spanish/Hispanic/Lati no Q Doctorate (a.g. PhD, EdD) or Profeaslonal degree Q Ja Panese Q Other Pacific Islander . MD DDS OVM LLB 1D (Specify) Q Other (Specify) 21.~Ds/e~udent's Singl! Rac! Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself So be 22a D d ' W t . . ece ent s Vsual Occupation -Indicate !'~- SC ° Q Ja Pan esa Q Sam LVP. of work Q BI k r African Ameri done duri a ° a ng mast Of working life. DO NOT VSE RETIRED. can Q K e n Q Other Pacl9lc Islander Q Amenon Indian or Alaska Natlye Q Vletnameae hou S EW 1 f ' Q Don E9 t Know/Not Sure Q Asian Indian Q Other ASlan Ref"sad Q 226. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Otherf5peci/y) Q Filipino Q Guamanianor~hamorro OWn home ITEM 23a - 23 MUST BE COMPLETED 23a. Date Pronounced Deed Mo Day 23 b. Signature ° Person Pronouncin BY PERSON WNO PRONOV NOES OR Death O l h g ( n y w en a / PPlica le) 23c. Uonse Number CERTIFIES DEATH 23d. Date 51 ned ( a/Day/Vr) 24. Time o D atj~ ~y~ /t J j~~/]~/ r v -r -7 (t7 M 25. Was Medical miner or er Contacted7 Yes qn CAUSE OF DEATH 26. PCK 1. Enter the chQ in of ~v~ntg__dlseases, Injuries, or eompllcations--that directly caused the death. DO NOT enker terminal a'PProxima[e r spireto arrest t ry even s such as cardiac arrest , tricolor fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only on! cause on a Itn Add ° e. additional Ilnes If necessary Onset to Death IMMEDIATE CAVSE ______________> a.~ ~L! ~° ~~l h / •+ ~ ~yf d •~~J ~v ~ ~j Fi l d ~ r ~f ,C- ( na isease or condition D t (o resulting In death) ~ ~ f as a cpnalqulnc! qf). ~ b. Sequentially Ilst conditions, Due to (or sequence of): if any, leading to the cause as a con listed on Ilne a. Enter the UNDERLY NG CAUSE Of Due to (or as a consequence of): (disease InJurythaf F P.5 Initiated the events resulting d. In death) LAST. Due fo (or as a consequence of): - 26. Part II. Enter other zianlficant conditl S _ t Ib tl t d h but not resulting in the underlying cause given In part I ~ 27. Was an autopsy performedT ~ O Ves No 28. Wire autopsy Rndings available to complete the taus of death;' 29 If . Female: 30 Q Yes No Did Tobac U F a~ . co s. Contribute to DeathT Not pregnant within past year Q ~,GZ 31. Manner of Death O Probabl Pr ~ egnant st time of death y Natural 0 Homicide ~iNO Q Unknown ~ Q No[ pregnant but I- , pregnant within 42 days of death Accident Q Pending InvesHgaHon t Q N o pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) Q Suicide Q Could not be determ load Q Unknown if pregnant within the pas[ year 33. Time Of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Numb er, CI ry, State, 21p Code) 36. Injury at Work 37. If Transpo Kation Injury, Specify: 38. Describe Haw Injury Occurred: Yas Q rn Operator Q Pedestrian Q Pasae No Q gar Q Other (Specify) 3 ~i.seKifler (Check only one): ~~ Ce Kifying physiclsn - To the best of my knowledge, death o curved due t° the c e(s) and manner stated Q Pron i ounc ng aL Certifying physiclsn - To the b t of my knowlltlge, death occurred at the time, date, and place Q Medical Examiner/Coroner and due to the O h , - c n t a~asls of exg~inatlon, and/or investigation, In my opinion, death °c se(e) and manner stated a t the time date and lac /~ ~/ / 3 d , , p e, and due to the oase(s) and man rated 'K C GG- f Signature of ce Kiflar:_ sa~'G Title of certifier: N7 ~ License Number: /~i ~~j 9 .Name, Address and Zlp Code f Plrson C m leH C p ng ause of Death (Item 26) L 1p ~ 39c. Date Signed (Mo/pay/Yr) ~ '» `~- ~/ S ~ O-CP, 7~ ~~ C~i rM r~~ O. Registrar's Dlztrl/ct Nu bL/~ 41. Registrar s Slgnatu r / - ~/ / 42. Reglatre Flle D Da V r) 4 3. Amendminis // Z ~ Z ~~ Dlspositlon Permit No.___ Hi05-143 -- - REV 07/2011 LAST WILL AND TESTAMF.NT.OF MARY L. CASE I, Mary L. Case, of Cumberland County, Pennsylvania heing of sound mind and memory, iIo make, publish and declare this my Last Will and Testament, hereby revoking any and al[ Wills Icy me heretofore made. F'IRST': 1 direct that my funeral be conducted in a manner corresponding with my estate and situation in life, and that all my just debts and funeral expenses be paid and s~aisfied by my Executrix hereinafter named, as soon as conveniently may be after my decease. ~ISCn1~1D: 1 ~>ive, devise and bequeath all the rest, residue and remainder of my estate, real, F;er~onal and mixed, ~~f whatsoever kind and wheresoever situate, which I may own c;r have the right to dispose of at the time of my death, in equal shares to I3orrni~; L,. Hoover, Judy A. Reynolds, }Ierbert M. Case, Terry J. Case, Barry L. Case and Janice L. keys or their issue, per stirpes. ..y_=":,!fti-~I~H: l l:~reby nominate cc~nstitu'e and t d appom my aughter, Bonnie L.. Hoover, Ex~;~~utrix ;Sf tha my Last Will and Testament. If Bonnie L. Hoover is unable or i~:m~~illing to serve as such, I then appoint Barry L. Case to so serve. I direct that rry personal representative be excused from entering and/or ftling any bond, to insure the proper performance of her duties, in any jurisdiction where such bond ` would be required in the absence of this sentence u.. ~ '~ ' C . w ~. ~.:, C ~ - CV L ~ -- r~ , _._. ' ~ _. ;_ ,.. ~ CL. r_.} C -: ~-+~~ ~: `^< <° - ' ~ Page 1 of 3 ~_ - _ ~° 1ti~~.i,.C. ,~~». ~h, FIFTH: I direct that any and all inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid out of the principal of my estate before any distributions are made to any Beneficiaries set forth herein. I, Mary L. Case, the Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ,. ~,,~ . ~ (Seal) Mary L. Case COMMONWEALTH OF PENNSYLVANIA §§ COUNTY OF CUMBERLAND Sworn to or affirmed and acknowledged before me by Mary L. Case, the Testatrix, this 24th day of February, 2011. l COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marisa Seeger, Notary Public East Pennsboro Twp., Cumberland County My Commission Expires Dec. 15, 2013 Member, Pennsylvania Association of Notaries NOT RY P BLI My Commission Expires: We, Jeffrey N. Yoffe and Yvonne Dobson, the witnesses, whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were Page 2 of 3 ~~ ~_ ~i M.L.C. present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 years or more of age, of sound mind and under no constraint or undue influence. ~. effrey N. Yoffe 214 Senate Avenue, Suite 404, Camp Hill, PA 17011 ~yv Y nne Dobson 127 South 18~' Street, Camp Hill, PA 17011 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND • §§ Sworn to or affirmed and subscribed to before me by Jeffrey N. Yoffie and Yvonne Dobson, witnesses this 24th day of February, 2011. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marisa Seeger, Notary Public East Pennsboro Twp., Cumberland County My Commission Expires Dec. 15, 2013 Member, Pennsylvania Association of Notaries ~i / il/ NOTA Y PU IC My Commission Expires: Page 3 of 3 ~ ~ ~ M.L.C.