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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 requests the grant of Letters in the appropriate form:
Deidra L. Randles
Decedent's Information a
Name: Dorothy A. Judge File No: 21-12 - I '22 )
a/k/a: Dorothy Judge (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 065-12-0900
Date of Death: 09/28/2012 Age at Death: 91
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at 1009 Jenkins Grove, Enola 17025 Enola Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Cumberland Crossing Retirement Community 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 $ 10,000.00
If not domiciled in Pennsylvania Personal property in Pennsylvania $
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania $
TOTAL ESTIMATED VALUE $ 10,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets, if necessary.)
Street address, Post Office and Zip Code City, Township or Borough County
❑X A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated 05/13/2002 and Codicil(s)
thereto dated
State relevant circumstances (e.g., 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 ❑ EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d. b. n., d. b. n. c. t. a., pedente lite, durante absentia. durante minoritate
If Administration, c.t.a or d.b.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 pending divorce proceeding wherein the grounds for divorc ad been estai~shed as 5 dined
in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated perst
O CCj
❑ NO EXCEPTIONS ❑ EXCEPTIONS ~-7 C> cS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the1f011a~rlrt"pouse-(if an al heirs (attach
additional sheets, if necessary): x• r' rv M M -4 ig
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19 sz)
Name Relationship Address v Ca -n -,t
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Form RW-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name Petitioner(s) Printed Address
Deidra L. Randles 73 Trent Road c^
Elkton, MD 21921 m
O
x_518-609.50
C C!s
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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 Decedent, Petiti n ) will II and tr y administer the estate accordin to law.
Sworn to or affirmed and subscribed be fore it, ~c Date
i t
me t fi1 da1. I I Date
By: y of DDate
~ ~
For the Register Dale
BOND Required? 0 YES ONO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters $ Attorney Signature:
)Short Certificate(s)......... ~.L
( )Renunciation(s) /v C
( )Codicil(s)
( )Affidavit(s) Printed Name: Sean M. Shultz
Bond Supreme Court
Commission ID Number: 90946
Othe
Firm Name: Saidis, Sullivan & Rogers
Address: 26 W. High Street
Carlisle, PA 17013
Phone: 717-243-6222
Automation Fee h .(~l
Fax: 7171243-6486
JCS Fee sa ~j.CjL
E-mail: dhockenberry@ssr-attorneys.com
TOTAL $ I y~ • S~/
DECREE OF THE REGISTER
Date of Death: 09/28/2012
Social Security No: 065-12-0900
Estate of Dorothy A. Judge File No: 21-12 2,:)- l
a/k/a: Dorothy Judge
AND NOW, R\ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Deidra L. Randles
in the above estate and (if applicable) that the instrument(s) dated 05/13/2002
described in the Petition be admitted to probate and filed of record as the I t Will ( nd Co icil(s)) of De ent.
yt
Register of Wills ~ t ~ ay-
Copyright (c) 2011 Corm software only The L, ckner Grou , nc.-t ` `/1 Page 2 of 2
H105.905 REV.(8/11)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Vital Statistics Law of 1953, as amended.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
RECORDED OFFICE OF ^f.{i+~oF P
REGISTER OF MILLS EyyMarina O'Reilly Matthew
l
9 State Registrar
LE-I2 NOU 27 Pfd 2 53 y
~~y9 1 2012
`-9jMENT OF~1~'
OWANSlCOUR_I /////f///1111
Date
CUMBERLAND CO., PA
Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH - VITAL RECORDS
PBlefack nk ck I,kt CERTIFICATE OF DEATH
State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Y,) (Spell Mo)
por-0-M v s-Iz. -0900 9 - 2S'/2
Sa. Age-Last Birthday (Yrs) Sb. Under 1 Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 71. Birt place (CI and State or Foreign Country)
Months Days Hours Minutes q p
1 I - I I Z I- --~-f-Z{j - - - - 7b. Bl thplace (County)
Ba, pa.1dence (State or Foreign Country) 8b. Residence (``Street and Number - Include Apt No.) 8c. Did Decedent Live in a Tess' llp? D I '~y
kl r` s - G`raV- es, decedent lived In l4 S I I 1 twp.
1 8d. Resitlen a Cou nty) OU q V 2- -Y
C-"(- (n G Be. Residence (Zip Code) I7 J ZS 0 No, decedent hued within limits of city/born.
9. Ever in US Armed Forces? 10. Marital Status a[ Time of Death Married El Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
E Y- ox.. 0 Unknown Divorced O Never ,,led 0 Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. M-t 's Name Priorto First Marriage (First, Middle, Last)
14a. ormant's Name n 14b. Relationship to Decedent ` 14c. Informant's Mallinggn~Address (Street and Numb r, City, State, Zip Code)
w+D
o Is r R 7 3 "7- r ~ i ISO ~ I k l o ) /1 ~ 19_
_ .1.. Place of Death Ch k I _
G
pital patient ...----....-...-............_?Sther on Th.. - a - H...osp.. ital:
If Death Occurred in a Hos: t] In If Death Occurred Somewhere Other C1 Hospice Facility ~ Decedent's Home
0 Emergency Room/Outpatient 0 Dead on Arrival _ __EEtN-J,,g Home/Long-Term Care Facility 0 Other (Specify)
or Town, State, and Zip Code 15d~.-Ctounty of Death
156. Facility Name (If not Instltution, glve gt and number, 1S, City
-cv .-<R. ~v-v551 K¢~4t..., GL r.wt... Ca,,-IfSte PA I70f~ W~... a sa.
16a. Method of Oisposition B rial 0 cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
m Removal from State 0 Donation
c 0 Other (Specify) /0 1 ZO f Z_ A l l F, . $ LPn7 C-~tr
16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature of ral Service Licensee or Person in Charge of Interment 17b- License Number
(rl1 ICz v(Ila t-113-77 o ne 170-0 0 1]S. is and Complete Address of Funeral Facility
.1, r., 1.4,x.. v3-o~ ca.. vn 5~.,.,. 1f ~1jay
18. Decedent's Education - Check the box that best descrlbes the 19. Decedent of Hi spank Origin - C eck the 20. Decedent's Race - Check ONE OR MORE races to Indicate what
highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be-
[3 8th grade or less is Spanish/Hispanic/Latino. Check the "NC" K White 0 Korean
0 No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American Vietnamese
High school graduate or GED completed No, not Spanish/Hispanic/Latino 0 American Intlian or Alaska Native 0 Other Asian
Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano 0 Asian Indian 0 Native Haalia
0 Associate degree (.g AA, AS) o Ves, Puerto Rican 0 Chinese 0 Guamanian or Chaorro
0 Bachelor's degree (e.g. BA, AB, BS) 0 Yes, Cuban 0 Filipino 0 Samoan
0 Master's degree (e.g. MA, M6, MEng, MEd, MS-, MBA) 0 Yes, other Spanish/Hispanic/Latino 01, P o 0 Other Pacific Islander
o Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) F1 Other (Specify)
(e. MD, DDS, DVM, LLB JD
l 21..Decedent's Single Race Self-Designation - Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22..D d.nt's Usual Occupation -Indicate type of work
White 0 Japanese Samoan done during most of working life. DO NOT USE RETIRED.
0 Black or African American O Korean o Other Paciflc Islander //11
American Indian or Alaska Native 0 Vietnamese Don'[ Know/Not Sure .SIB) 1-}.c(.~ 6 YA-X
0Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry
0 Chinese 0 Native Hawaiian 0 Other (Sp¢clty)
a O Filipino O Guamanfz~
ian or chamorro 'T n -1-Crn y r~P N 1 ck-I
ITEMS 23, - 23d MUST BE COMPLETED 23a. Date Pronounced lead (Mo/Day/Yr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR _ ~ _ 'J f a_ -6 L
CERTIFIES DEATH OW l'7 - V
23d. Da a Signed ( MO/Day/Yr) 24. Time of Deth~ c?
_ w
'l vv ` 25. Was Medical Examiner or Coroner Contacted? o Yes No -Er CAUSE OF DEATH Approximate
26. Part I. Enter the chain of events- tliseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval:
respiratory arrest, or ventricular fibrillation without showing the eti'o_logyn. DO NOT ABBREVIATE. Enter only one cause on a Iine. Add additional lines If necessary Onset to Death
(Final disease o ondltlon Due to (or as a consequence of):
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
if any, Ieading to the cause
listed on Iine a. Enter the
UNDERLYING CAUSE Due to (or ce of):
(disease or injury that
initiated the events resulting d.
,n death) LAST. Due to (or as a consequence of):
S 26. Part 11. Enter 0th ienificant c nditions c n[ribu[ine to death but not resulting in the underlying cause given in Part I 27. Was ,psv P¢rtor ed?
O Yes No
28. Were autopsy findings available
to complete the cause of death?
0 Yes O No
29. If Female: - 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
o ~~Not pregnant within past year 0 Yes 0 Probably Natural 0 No midde
0 Pregnant at time of death 0 No 0 Unknown 0 Accident 0 Pending Investigation
0 Not pregnant, but pregnant within 42 days of death 0 Suicide 0 Could not be determined
m 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Y,) (Spell Month)
0 Unknown if pregnant within the past year 33. Time of Injury
'~`J ' 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 151- If Transportation Injury, Specify: 38. Describe How Injury Occurred:
0 Yes 0 Driver/Operator o Pedestrian
0 No 0 Passenger 0 Other (Specify)
C 39a. Certifier (Check only one):
t tying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
Pronouncing 8. C¢rtitying physician - To She best of my knowledge, death occurred at the time, date, and place and due to the c se(s) and man stated
o Medical Examiner/Coroner- a bass of a motion, and/or investigation, In my opinion, deathc rretl a[ fhe time, dace, and place, rid due to the cause(s) and tated
Signature of certifier: Title of certifier: C7 License Number:
39b. Name, Address and Zip Co n Completing Cause of Death (Item 26) 39c.~ate Signed o/DYr)
40. Registrar's District Number 41. Registrar's Sig 42. Registrar File Date (MO Day/Yr) OCT 1 201
° 43. Amendments`
p
H105-143
Disposition Permit No. U 7 REV EV 07/27/20
011
RECORDED OF ICI OF LAST WILL AND TESTAMENT
REGISTER OF 'LLS of
20112 CCU 27 PrI 2 53 DOROTHY A. JUDGE
C L E r;K fl (POUR-OVER WILL)
ORPHANS' COURT
CUMBERLAND gQ.,P%ROTHY A. JUDGE, of the State of Arkansas, do hereby
revoke all Wills and Codicils heretofore made by me and do make and
declare this to be my Last Will and Testament, in the manner and
form following:
FIRST
FAMILY STATUS
I am single. There was one (1) child born to me, namely DEIDRA
L. RANDLES. There were no other children born to me, nor adopted by
me, nor do I have any children who predeceased me, leaving issue
surviving.
SECOND
ADMINISTRATION OF MY ESTATE
(a) Appointment of Personal Representative: I appoint EUGENE
M. HESSION as Personal Representative of this, my Last Will and
Testament. In the event he should be unable or unwilling to serve,
I appoint the following, in the order named, to serve in his place
and stead:
1. DEIDRA L. RANDLES
2. KEITH IAN BAITSELL
(b) No Bond Required: I direct that no bond or other security
shall be required in any jurisdiction of my said Personal
Representative and Trustee for the faithful performance of their
duties hereunder.
(c) Waiver of Court Formalities and Authority of Personal
Representative to Act: Without restriction of the powers vested in
them by law, or elsewhere in this Will, and subject to all other
provisions of this will, my Personal Representative or Trustee,
without the necessity of procuring any Probate Court authorization
or approval, shall be authorized to exercise those fiduciary powers
which may be incorporated by reference in a Will or Trust and set
forth in Arkansas Code of 1987 Annotated §28-69-304, as amended.
Page 1 of the Last Will and Testament of DOROTHY A. JUDGE
THIRD
DEBTS, TAXES AND EXPENSES
(a) Trustee To Pay Debts, Taxes and Expenses: In my trust
referred to hereinafter, I have directed the trustee to provide for
payment of all (a) my legally enforceable debts, including debts
owed by me to a trustee individually, except debts which are an
encumbrance on real property, (b) the expenses of my last illness
and funeral, (c) the administration expenses payable by reason of
my death, (d) the estate and inheritance taxes (including interest
and penalties, if any) payable in any jurisdiction by reason of my
death (including those taxes and expenses payable with respect to
assets which do not pass under that trust).
(b) Personal Representative To Pay Debts, Taxes and Expenses
If Trust Has Insufficient Funds (To Be Paid From the Residuary of
the Estate, Without Apportionment): Despite the provisions of
paragraph (a) of this Article, my personal representative shall pay
the amount of those debts, expenses, and taxes referred to in
paragraph (a) of this Article directed to be paid by the trustee
but certified by the trustee as exceeding the principal out of
which the trustee is directed to provide for payment. Any such
amount payable by my personal representative because of any such
certification by the trustee shall be paid out of and charged
generally against the principal of my residuary estate, without
apportionment and without seeking reimbursement, recovery, or
contribution from any person.
FOURTH
GIFTS OF PERSONAL ARTICLES
AND MISCELLANEOUS INSTRUCTIONS
I reserve the right to enclose with this Will (or my
photostatic copy of this Will, or my Trust) a written statement
signed by me and dated, designating how certain items of my
tangible personal property shall be distributed and detailing my
funeral and burial instructions. This provision is made pursuant
to the authority granted under Arkansas Code of 1987 Annotated §28-
25-107, as amended.
FIFTH
GIFT OF BALANCE OF ESTATE TO TRUST
(POUR-OVER PROVISION)
All the rest, residue and remainder of my estate of every kind
and character, I give, devise and bequeath to the then constituted
Trustee of the DOROTHY A. JUDGE TRUST dated the 13th day of May,
2002, as amended, to be held subject to the terms and conditions
set forth therein (or if said Trust is not in existence, to my
Page 2 of the Last Will and Testament of DOROTHY A. JUDGE
Trustee, to be administered pursuant to the terms and conditions of
said Trust Agreement as it exists as of date of execution of this
Will, which terms and conditions are expressly incorporated by
reference).
IN TESTIMONY WHEREOF, I have hereunto set my hand and do
hereby declare this to be my Last Will and Testament, which I have
signed in the presence of Sherrill Nicolosi and Diane L. Baker , who,
at my request, attest the same in my presence on this 13th day of
May, 2002.
DOR HY JUD
We, Sherrill Nicolosi and Diane L. Baker , do hereby certify
that DOROTHY A. JUDGE, the Testatrix in the above and foregoing
Last Will and Testament, subscribed the same in our presence, at
the time declaring to us that said instrument was her Last Will and
Testament, and we at her request, and in her presence, and in the
presence of each other, now sign our names hereto as attesting
witnesses.
A dress: 112 Desoto Center Dr. Address: 112 eSoto Center Dr.
Hot Springs Village, AR Hot Spri gs Village, AR
Page 3 and Final Page of the Last Will and Testament of DOROTHY A.
JUDGE
c:\cIien[s\judge\NN iII\SBN-dlb
STATE OF ARKANSAS )
)SS
COUNTY OF GARLAND )
AFFIDAVIT IN PROOF OF WILL
BEFORE ME, the undersigned authority, on this day personally
appeared the witnesses named hereinbelow, and further, the
Testatrix, respectively, whose names are subscribed to the annexed
Will in their respective capacities, and all of the said persons
being by me duly sworn, the said Testatrix declared to me and to
the said witnesses in my presence that said instrument is her Last
Will and Testament, and that she had willingly made and executed it
as her free act and deed for the purposes therein expressed; and
the said witnesses, each on his or her oath stated to me, in the
presence and hearing of the said Testatrix, and in the presence of
each other, that the said Testatrix had declared to them that said
instrument is her Last Will and Testament, and that she executed
the same as such and wanted each of them to sign it as an attesting
witness; and upon their oaths each witness stated further that he
or she did sign the same as witnesses in the presence of the said
Testatrix and in the presence of each other at her request; that
she was at that time eighteen years of age or over, and was of
sound mind; and that each of said witnesses was then at least
eighteen years of age.
DOROTHY J E,i estatrix
c
fitness Witness
Address: 112 DeSoto Center Dr. Address: 112r'Desoto Center Dr.
Hot Springs Village, AR Hot Springs Village, AR
Subscribed and acknowledged before me by the said DOROTHY A.
JUDGE, Testatrix, and subscribed and sworn to before me by the said
Sherrill Nicolosi _ and Diane L. Bakery , witnesses, this
13th day of May, 2002.
NOTAR PUBLIC
My Commission Expires:
c:\clilents\judge\aff.her\SBN-dlb
t . rNOENFELDT
OF J"TARY PUBLIC
,-i~L-,.AD COUNTY
"AY torus. Exp. Mar. 1, 2011