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HomeMy WebLinkAbout11-27-12 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 Name: Eugene M. Hession File No: 21 " Z)5 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 093-12-5525 Date of Death: 06/2412012 Age at Death: 89 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 Holy Spirit Hospital 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: If domiciled in Pennsylvania All personal property $ 5,000.00 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 $ 5,000.00 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. ❑X NO EXCEPTIONS F] 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. r-.s Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce haleen establi as in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adudicated an incapacitated person. ` C7 M A ❑ NO EXCEPTIONS ❑ EXCEPTIONS Co M c=a ro Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the foll=iWRease (Wy) aftd hF9s (attach additional sheets, if necessary): D Z rry -,3 rn "I ~ ~ CS C; , Name Relationship Address C-) C> `n r. rn > C r1 6:? k--+ 'r7 Form RW-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 N -j 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 Elkton, MD 21921 518-669-9950 © mm C11) 0 rn x c~ 0 ;0 Ar' N -~¢1=1 D rrt rrl .:1K The Petitioner(s) above-named swear(s) or affirm(s) the statemen in the foregoing Petition are true and correct to the best of the wledge nV r=- ry according t law. r- belief of Petitioner(s) and that, as Personal Representative(s) of a ecedent, Petiti (s) will vG$II and tru y administer the est , P c) Sworn to^^~~or affirmed and~subscribed {before Date me t ca' day of } ~ lu Q n'1 ~ Date By, Date For the Register Date BOND Required? ❑ YES [9//NO To the Register of Wills: FEES: t Please enter my appearance by my signature below: Letters $ ;/~~1,(✓l; Attorney Si nature: ( C; )Short Certificate(s)......... 'N" Lt ( )Renunciation(s) e,41 ( )Codicil(s) ( )Affidavit(s) Printed Name: Sean M. Shultz Bond Supreme Court Commission ID Number: 90946 Other IIII Firm Name: Saidis, Sullivan & Rogers Address: 26 W. High Street Carlisle, PA 17013 Phone: 717-243-6222 Automation Fee C- Fax: 717/243-6486 JCS Fee ? . ~ , TOTAL $ h C' E-mail: dhockenberry@ssr-attorneys.com DECREE OF THE REGISTER Date of Death: 06/24/2012 Social Security No: 093-12-5525 Estate of Eugene M. Hession File No: 21-- ( 2- 1 -2 Z~ a/k/a: AND NOW, - V 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 05/1312002 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s) of Decedent. i l 'lath Register of Wills Copyright (c) 2011 form software only The Lackl r Groupfilc. -i 1 -age 2 of 2 111111 4 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 .JV OF p REGISTER-OF WILLS ,,I'y~~a fyy Marina O'Reilly Matthew A, (111 •7 t7 tp C Z State Registrar GtL NOV I G 1 t JC :o V ~ 0~~ ~~ttttt A Gt ° ~9TMENt OF~~at( JU CUMBERLAWt CO., PA Date Type/Print in COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS Peiacklnkt CERTIFICATE OF DEATH State File Number. Lega) 1. Decedent's i Name (First, Midd/~le, Last, Suff z) 2. Se 3. Social Security Number 4. Data of Oes h (MO Day/Yr) (Spell Mo Ev e,ve. 4. essioJ i9 c- O - - aS 6 y \ Sa. Age-Last Birthd y (Y11) 5b. Under 1 year 5c. Under 1 Da 6. DaN of Birth (MO/Day/Vear) (Spell Month) 7a. Birthplace (City an Sta a or Forelg u t Months Days Hours Minutes N,v a p 0 S9 a3. b. Birthplace County) Sa. Re nce (State or Foreign untry) Hb. Residence (Street yyand,N bar -y Jude Apt No.) eOc. Did O etedant Live In • Township? t~ Sa. Realdente MA ) /00C? f eT NS CJ O Ate- v/ decedent lived In Ityp, A) C 16 f-J-1 Be. Residence (Zip Code) - Of.., decedent lived within limits of JCJ t%city/bro. .6-Wr-In US Armed Farces? 30. Marital Status at Tima of Death arr d Widows 11. Iving Spouse's Name If wife, given rt)e prior to tint marriage) (SYss 0 No 0 Unknown 0 Divorced 0 Nov., Married 0 Unknown 12. Father's Na a (First, Middle, Last, Suffix 13. Mother's Name Prior to FI t riag, ( rs1. Middle, Last) ASS/ 2 J, 14 14a. Informant's Name 14b. Relatlonsh(p t, DDeecedent 14c. Informant's Malling Address Street antl Number, C n State, 2Z COdef U C J -70,7_S- a: eta.~....~!q...... wr.................................... If Death occurred in a Hospital: Inpatient (If Death Occurred Somewhere Other Than a Hospllal:....... L.I .Ifoapice Facility ~ Oaeedant's Homa 3 Emergency Room/Outpatient Dead on Arrival Nursing Home/Long-Term Care Facility Other (Specify) _ 15b. F till Name g not Institution, gl street and number; 15c. Clty Town, State, and Zip ode ISd Coun o! Death 16a. Method of Disp sitlon Burial 0 Cremation I6b. Date f OI Itlon 16c. Place of Disposition (Name of cemetery, crematory, or other place) 0 Removal from State 0 Donation d-{. Other (5petify) F ' S ~ "e 1 e- Z 16d. Location of Dlspositon (City or Town, State, and ZIP) 17a. Sign Of Funeral 5 ice Licen or Person in Charge of Interment 37b. License Number i-a +d Ie 1A e _ 9o_oi is-- t 17c. N m and Complete A~dresa of ral Facllit 46-tto 45;J -7 CI 0 Vi T JAI -y. AN wo I 18. Decedent's Educatlon - Check the box that beat describes the 19. Decedent of Hispanic Origin - Check 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~ecetlent considered himself nr herself to be. 8th grade or less bpanlsh/Hlspanic/Latino. Check the "No" hits 0 Korean No diploma, 91h - 12th grade bo 1! decedent la not Spanish/Hispanic/Latino. 0 Bieck or African American Viatnames e r High school graduate or GED completed No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Natlva 0 0 Other Asian Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano 0 Asian Indian 0 Native Hawaiian 0 Associate degree (e.g. AA, AS) 0 Yes, Puerto Rican 0 Chinese 0 Guamanian or Chamorro 0 Bachelor's degree (e.g. BA, AB, BS) 0 Yes, Cuban Filipino Q Samoan 0 Master's dogma (e.g. MA, MS, ME,& MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander 0 Doctorate (e.g. PhD, EdD) or Professional degree (Specify) 0 Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Race Self-Designation - Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work ®~Nrhite 0 Japanese 0 Samoan tlone during most of working IIle. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islander J~- /}-~dYQ Q n 7D/Pie q 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure V QICV! $ 1 F ~eU ~ 0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry 0 Chinese 0 Natiye Hawaiian 0 Other (Specify) 0 Fllipino 0 Guamanian or Chamorro UM 11 _VWel ~)c>e.- 131tLq. ITEMS 23. - 23d MUST BE COMPLETED 23a. Date Pronounced Dead Mo Day r 123b. Signature of Person Pronouncing Death (Only when applicable) 23c. O License U~INJumber BY PERSON WHO PRONOUNCES OR ~{V nD' S CERTIFIES DEATH ~1 ~r _1 23d. Data Signed (MO/Day/Yr) 24. Time of Death ~Tyy of a 3 + ka PAA 25. Was Medical Ex.min.r or Coron r Contacted? Yes 0 No CAUSE OF DEATH Approzlmate 26. Part 1. Enter the chain of events-diseases, Injuries, or compllcations-that directly caused the death. DO NOT enter terminal events such as cardiac arrest. 1 Interval: respiratory arrest, or ventricular fibrillation ~withoout showing Ithe etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary ~ Onset to Death IMMEDIATE CAUSE > ei ' _ `N ate( i A. I r -C Qr C.4- 15 1 19 ` 1 (-s (Final disease or condition a Due to (or as a consequence of): resulting in death) b. G V QCtA ' L _0 ~ I 3 ,1\ Sequentially Ilst condltions, cJ Due to (olrTSa- a consequence of): If any, leading to the cause I fisted on Iine a. Enter the 3 V NDERLYING CAUSE Due to (or as a consequence of): I (disease or I.Jury that Initiated the events resulting d. In death) LAST. Due to (or as a consequence of): 1 26. Part Ii. Enter other sianiflcan/tt conditions t Ib tl t d th but not res. king in the underlying cause given in Part 1 27. Was an aufopsy'peo md a? Coronary ltr~G~1$Cft$G~ Yes rf No 28. Were autopsy findings avallable V UKJC.[V~ `(LL to complete the cause /death? Yes No 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Mannar Death 0 Not pregnant within past year 0 yea 0 Probably dNaturaI 0 Homicide 0 Pregnant at time of death 0 No ~'lJnknown 0 Accident 0 Pending Investigation 0 Not pregnant, but pregnant within 42 days of death 0 Suicide 0 Could not be determined Q 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (Spell Month) 0 Unknown If pregnant within the past year (n 33. Time of Injury (/1 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) i 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: 0 Yes 0 Driver/Operator 0 Pedestrian 0 No 0 Passenger 0 Other (Specify) 39a. Certifier (Check only one): 0 Certifying Physician -To the best of my knowledge, death occurred due to the cause(s) and manner stated [jrPronouncing R Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated 0 Medical Examiner/Coroner - On the basis of axami anon, and/or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated 3 Signature of certifier. Title of certifier: 39b. Name, Address and Zip Code of Per n Com 1 ng Cause of Death Item 26) a°°nae Number; OS Olt't 3:15 39c. Oat Signed (MO Day/Yr) Rv ~n Modi DO. Ho rat Ho eta 5D3 *1, o?lsT 3~roet, CompM(IJP4 I~o)I SO141; P4 aota 40. Registrar s District Number 41 R Istrar s gnature 142. Registrar File Date Mo Day Yr 4.3s3 is Xut s t 070 5 3 S~{ HIOS-343 Disposition Permit No. REV 07/2011 LAST WILL AND TESTAMENT " RECORDTO O'+FiGE`Q'~ OF REGISTER OF 11 L5 EUGENE M. HESSION 27 P(, 2 52 (POUR-OVER WILL) CLERK GY I, EUGENE M. HESSION, of the State of Arkansao_Rp 'Sh revoke all Wills and Codicils heretofore made by me ~PA declare this to be my Last Will and Testament, in the mane form following: FIRST FAMILY STATUS I am single. There were no 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) Personal Representative: I appoint DOROTHY A. JUDGE to serve as my Personal Representative. In the event that she should be unable or unwilling to serve, I appoint the following, in the order named, to serve as my Personal Representative: 1. DEIDRA L. RANDLES 2. KEITH IAN BAITSELL 3. BRUCE B. RANDLES In the event that none of said nominees shall be able or willing to serve, then said nominees (or the survivors of them) shall be authorized to appoint an Alternate Personal Representative as they mutually agree. (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 EUGENE M. HESSION 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 EUGENE M. HESSION 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 Trustee, to be administered pursuant to the terms and conditions of Page 2 of the Last Will and Testament of EUGENE M. HESSION 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. EUGENE M. HESSION We, Sherrill Nicolosi and Diane L. Baker , do hereby certify that EUGENE M. HESSION, the Testator 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 his Last Will and Testament, and we at his request, and in his presence, and in the presence of each other, now sign our names hereto as attesting witnesses. L Address: 112 Desoto Center Dr. Address: 11 Desoto Center Dr. Hot Springs Village, AR Hot S ings Village, AR Page 3 and Final Page of the Last Will and Testament of EUGENE M. HESSION c:\clients\hession\wil l\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 Testator, 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 Testator declared to me and to the said witnesses in my presence that said instrument is his Last Will and Testament, and that he had willingly made and executed it as his 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 Testator, and in the presence of each other, that the said Testator had declared to them that said instrument is his Last Will and Testament, and that he 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 Testator and in the presence of each other at his request; that he 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. EUGE E M. HESSION, Testator C~ tness Witness Address: 112 DeSoto Center Dr. Address: 112 D )Soto Center Dr. Hot Springs Village, AR Hot Springs Village, AR Subscribed and acknowledged before me by the said EUGENE M. HESSION, Testator, and subscribed and sworn to before me by the said Sherrill Nicolosi and Diane L. Baker witnesses, this 13th day of May, 2002.% f My Commission Expires: ~ OTARY PUBLIC c:\clients\hession\afl his\SBN-dlb f °OENFELDT 4R"~ PUBLIC COUNTY My ~~r7m. Exp. Mar. 1, 2011