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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 request(s) the grant of Letters in the appropriate form:
Decedent's Information I
Name: MABEL R. BIXLER File No:
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 193-18-5343
Date of Death: NOVEMBER 23, 2012 Age at death: 89
Decedent was domiciled at death in CUMBERLAND County, PA (state) with his/her last
principal residence at 206 MC LAND DRIVE, MT. HOLLY SPGS, PA 17065 S. MIDDLETON TOWNSHIP CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at FOREST PARK NURSING HOME, 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 $ 30,000.00
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.... $ 30.000.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
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 10-17-2000 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.
WNO EXCEPTIONS Q EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c.l.a., d.b.n., d.b.n.c.t.a., pendente 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 cgmplete lister heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for c +oig had been establme"s defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated perW. 7-0 Cl>
-0 t*i -
0 NO EXCEPTIONS 0 EXCEPTIONS G-> c Cn 'a
r
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the I o g oust Fi any) }d emirs (attach
additional sheets, if necessary):
C r
Name Relationship "dlTss"
"I en Cno
f\J -n
Form Rw-02 rev. 1011112011 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
SANDRA K. IJEPFER 206 MC LAND RD., MT. HOLLY SPGS. PA 17065
JUDITH A. LUDT 6 WESLEY DR., CARLISLE, PA 17015
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 affirtned and subscribed before Date /1
m s day ' B , L~ C_ car e~ .t , Date
B 1 / Date
For the Register Date
BOND Required: 0 YES ®N To the Register of Wills:
FEES: r Please enter my appearance by my signature below:
Letters $ 1i. C Attorney Signature:
( ) Short Certificate(s)...... L
( ) Renunciation(s)........ .
( ) Codicil(s)
( ) Affidavit(s)........... .
Bond Printed Name: WILLIAM A. DUNCAN
Commission Supreme Court
Other ID Number: 22080
T Firm Name: 1 IRVINE ROW c'a
e- M
Address: CARLISLE =P2 r-i 17M
C7
Phone: 717-249-7780 ; U? ;K
Automation Fee ~j.(C Fax: 717-249-7800 C-~' C")
JCS Fee L Email: bill duncanhnrtrrtna,;;~ . ni' .
TOTAL $ a! 3. - '-0c9~~ ~ ~ r- r vi
Cn C'>
W `~7
DECREE OF THE REGISTER
~
Estate of MABEL R. BIXLER File No: -11-9/-
21
aWa:
AND NOW, (YCej1-), ( J/' in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to SANDRA K. HEPFER & JUDITH A. LUDT
in the above estate and (if applicable) that
the instrument(s) dated OCTOBER 17, 2000
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
`
Register of Wills -Z,j ;,I IL
Form Rw-oz reg. 1oiuizou Page 2 of 2
1110, M), kith ;911,
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
RECORDED OFFICE OF
Fee for this certificate, $6.00 Till" I,, to ccitl1v that th° information here given is
REGISTIER Or ti tLS nuo:lk copied from an original Certificate of Death
~JdLlk fi!Cd V ilh nie as Local Registrar. The original
^Ij'
C-10 10 An 10 3 ~ 1 ci.)II',~atc ti~ill he forwarded to the State Vital
?v PA ck11ck 0 "f'it~r flit per)uanent filim~.
P 18883863 CLERK OF
ORPHANS' COURT NOO 2 6 2012
Certification Number
CUMBERLAND CO., PA ! _o al Re, ,,tray Date ),sue(l
Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
Permanent
Black Ink CERTIFICATE OF DEATH State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social S¢curity Number 4. Data of Death (MO/Day/Yr) (spell me)
Mabel R_ Bixler Femal 193-18-5343 C)161-mhe!~ 23. 2012
Sa. Age-last Birthday (Yrs) 5b. Under 1 Year Sc. Under 1 Da 6. Dare of Birth (Mo/Day/Year) (Spell month) 7a. Birthplace (City and State or Forel Country)
a' 89 Months Days Hours Min t¢s October 1 O, 1923 York Springs, ~A
7b. Birthplace (County) Adams Cc>,urit_y
8a. Residence (State or Foreign Country) 8b. Residence (Street and Number - Include Apt No.) Sc. Did Decedent Live in a Township?
PA 70 O Walnut
B Bottom Rd _ Ayes, decedent lived In tl. Residence (county) twp
Cumberland Be. Residence (Zip Code) 1701-4 ONO, decedent lived within limits of Car 11 s 1 e clt
9. Ever ih US Armed Forces? 10. Marital Status at Time of Death 0 Married ® Widowed tl. Surviving Spouse's Name (If wife, give name prior to first marriage)
0 Yes CR No 0 Unknown Divorced 0 Never Married 0 Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
J_ Raymond Phillips Maude Eve1 n Myers
141. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Adtlress (Street and Number, City, State, Zip Codel
o Sandra K H f 206 McLand Rd_, Mt_ Ho11y Springs, P
G isa. Place o Deac... c ec
if Death Occurred in a Hos to l: _ ,,,,,,,__on y one
.
.
pI ;If Death Occurred Somewhere Other Than a Hospital: Faclli .w
_ pica ty ..may
Hos ant's Ho
mw* ced-
~ 0 Emergency Room/Outpatient 0 Dead on Arrlvai Nursing Home/Long-Term Care Facility E3 Other (Specify)
1Sb. Facility Name (If not institution, give street and number', •isc. City or Town, State, and Zip Code i5tl. County of Death
o Carlisle PA 17013 umberland
16a. Method of Disposition CR Burial 0 Cremation 16b. Date of Disposl Tion 16c. Place of Disposition (Name of cemetery, crematory, or other place)
Removal from State Donation
D )ther(Specify) 11/29/201 2 Westminster Memorial Gardens
v 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signatur ofFuneral Serv ~ ensee or. Person in Charge of Interment 17b. License Number
i s
Carlle, PA 17013 FD - 138812
0 1-77. and Complete Address ofIUneraiFacility HQ1linger Funeral HQ 1~te & remator
501 N_ Baltimore Ave_ Mt_ Ho11 s tin s P1706~
18. Decedent's Education - Check the box that best tlescribes the 19. Decedent of Hispanic Origin - Check the 20. Decedent's Race - Check ONE OR MORE races to Indicate what
t- 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.
0 Sth grade or less is Spanish/Hispanic/Latino. Check the "NO" (a White 0 Korean
0 No diploma, 9th - 12th g-d, box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese
High school graduate or GED completed (g No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native Other Asian
0 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 C) Filipino 0 Samoan
0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacifc Islander
0 Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) 0 Other (Specify)
. MD, DDS, DVM LLB JD
21. Decedent's Single Race SeIF-Designation - Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work
3 White 0 Japanese 0 Samoan
0 do ne during most of working life. DO NOT USE RETIRED.
Black orAfrican American 0 Korean 0 Other Pacific Islander e r
v America
0 n Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure C 1 le
0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry
0 Chinese 0 Native Hawaiian 0 Other (Specs fv)
O Filipino O Guamanian or Chamorro Federal Govt _
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronoun ce~dd Dead (MO/Day/Yr) 23 b. signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR / _c 3 2Q
CERTIFIES DEATH ovr-ft C+
23d. Date Signed (MO/Day/Yr) 24. Time of Death 0 A a ~ y' a
OV CM bz~ Z 3 ZOj Z. / S 25. Was Medical Examiner or Coroner Contacted? 0 Yes p~lao
CAUSE OF DEATH
26. Part 1. Enter the chain of events--diseases, injuries, or complications--that direct) - Approximate
y caused the death. DO NOT enter terminal
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line_ Add additional lines if necessary Onset to Death
IMMEDIATE CAUSE a.
(Final disease or condition Due to (or as sega+enc of):
re salting in death)
Sequentially list conditions, Due [o (or as a consequence of):
if any, leading to the cause
listed on line a. Enter the
UN DERLVING CAUSE Due to (or as a con
sequence of):
ff; (disease or Injury that
I.
Ittatetl the events resulting d.
In death) LAST. Due to (or as a consequence
of):
S 26. Part II. Enter other siRn"f'cant conditi t ib ti t -car h but not resulting in the underlying cause given in Part 1 2as an autopsy Pe or ed?
G D Yes No
ere autopsy findings available
$ complete the cause of death?
w 29. If Female: E ,/Not preg
nant within past year 30. Did Tobacco Use Contribute to Death? 31. Manner of Death 0 No
as ~a 0 Yes ~_Probably a
Natural Homicide
0 Pregnant at time of death 0 No 0 Unknown 'Accident Pending Investigation
m 0 Not pregnant, but pregnant within 42 day, of death 0 ( 2 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) 0 Suicide 0 Could not be determined
0 Unknown if pregnant within the past year 33. Time of Injury
M 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 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
0 Yes 0 Driver/Operator E3 Pedestrian
0 No 0 Passenger 0 Other (Specify)
39a. Certifier (Check,
nly one): aline
~~Certifying physician - T he best of my knowledge, death occurred due to the cause(,) and m r stated
0 Pronouncing 8 Certifyi g by I an -Tobest of y knowledge, death occurred at the time, date, and place, and due to the c e(s) and manner stated
J 0 Medical Examiner/C - tit e/basis1o* artlinatian, and/or Investigation, in my opinion, death occurred at the time, date, and place, and due to the ca-(s) a,dr manner stated
i• Signature of f7 Title of certifier: License Number: M J O~"~ 6~d E
39j1. Nam, ddress and Zip Cpd¢ Person Co~ pietinR Ca usp op f q¢ath 6) 39c. Date "goad ( /Day, _3
~•/\DwlN't T/l1 `LT•+C~~~//l/ _T/ ~A f, 4KJ^•,C/LPL` A_UE. M.-(. -k L r S, r ?Qf✓ / a-!o ~a -
40. Registrar's District Number 41. RegisTra is s 42. Re_g``strar Flle Date (MO Day r)
13k =CAI 0
43. Amendments
O
Q
HID -143
Disposition Permit No. Q L~ UD~ REV 07/2011
REG0R w. b D ri Y4
bb .9 a y
CU t~ FLC i 0 i v 4
CLERK LAST WILL AND TESTAMENT
CUMBERLA4
I, MABEL R. BIXLER, of South Middleton Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executrices to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. 1 authorize and empower my executrices to sell any realty owned by me at my death,
at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I
could do if living.
3. 1 give, devise and bequeath all of my estate of every nature and wherever situate as
follows:
(1) My property at 206 McLand Drive, Mount Holly Springs, to my daughter,
Sandra K. Hepfer,
(2) My property at 16300 Pine Ridge Palms (Lot S-8), Ft. Myers, Florida, to
my daughter, Judith A. Ludt, and
(3) All the rest, residue and remainder to my two daughters, share and share
alike, the child or children of any deceased child taking the share their parent would have taken if
living.
4. I nominate and appoint Sandra K. Hepfer and Judith A. Ludt, to be the executrices of
this my Last Will and Testament, they are to serve as such without bond.
5. I hereby suggest that my personal representatives retain the services of Irwin,
McKnight & Hughes as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 17TH day of
October, 2000.
(SEAL)
MABEL R. BIXLER
Signed, sealed, published and declared by MAABEL R. BIXLER, the Testatrix above
named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, MABEL R. BIXLER, SHARON L. SCHWALM and MARTHA L. NOEL, the
testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will, and that she had signed willingly, and that she executed
it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses,
in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of
their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
MABEL R. BIXLER
SHARON L CHWALM
M THA L. NOEL
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by, MABEL R. BIXLER, the
testatrix herein and subscribed and sworn to before me by SHARON L. SCHWALM and
MARTHA L. NOEL, witnesses, this 17TH day of October, 2000.
Notary Pu tic
No anal Seal
Rot- Irwin, Notary Public
Boro , Cumberland County
[vly Commission Expires Oct. 3, 2004
ivlW"r, Pennsylvania Association of Notaries