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HomeMy WebLinkAbout11-28-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF +'~~(// t,~~L~,~~.~~ ,~ COUNTY, PENNSYLVANIA Petitioner(s) named below. who isi~re 18 years of age or older, apply(ies) for Letters as specified below. and in support thereof aver(s) the following and respectfully requests j the grant of Letters in the appropriate form: Decedent'.. formation i / ,^~~ Name• V a/lc/a: a/k/a: a/k/a: Date of Death: ~if~~e~1~ ~ ,~ r Decedent was domiciled at death in '' `" ? i principal residence at ___ __~ f{~Qn r? / ;l~rl UP. ;~ i Street address, Post Office and Zip Code , ~ ~, Decedent died at ~~ ~ /f / G'. rr ~r~ Street ad ress, P st Office and Zip de File No: ,~.~ ' ~ ~, (Assigned by Register) Social Security No: 1~ ;~ - ,;~,,~ - .J~.~ n ~, Age at death: ;~~ City,/Township or Borough ~ ~ ~,~-~ ~ 7~ ~~ t ity, Township or Borough Estimate of value of decedent's property at death: (Stare) with his/her last County ;'1 County State If domiciled in Pennsylvania ............................ All personal property $ :,~~~) , ~ L' C If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $~ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ / lj ~~ ~! L~ ,~ _ TOTAL ESTIMATED VALUE.... $ ~ .3 ~~ ~~ (' } ` ,. Real estate in Pennsylvania situated at: f ! ~~.- ~". i ~il',~' ~ ~' (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 thereto dated and Codicil(s) 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 deftned 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. [~Z] NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.u., d.b.n., d.b.n.c.t.u., pendente lite, durunte absentia, dururlte minor•itute 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 a pending divorce proceeding wherein the grounds for divorce had been established as deftned iii 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): r..5 Name Relationshi .~. AdcS~sQ -~- ~ ~ ~'= `~7 C. C!) ;X7 m~c~ ~ r" ~ rn oo ... 4.,~ ~.,.r? .,,.W..t m~~t a'""1 ~~ ~~ w Fo,~n, nw-nZ rev. In/ll ~Zn/t Page 1 of 2 Oath of Personal Representative COivIMONWEALTH OF PENNSYLVANIA COL`~~ i `I~ OF } SS: c~ ,~ rn rn icial list C~"tTr y ~ ~.~ -" ;~ rn ~ ~ ~ G"~ ~ -.~ °'i:onerf s j ?rin.Zi; ~anze ~ ?~ ~[ionerl s ~ Pr;n:~a .~ddrwsS --~~ ~ ~ ~, . ~"~~ /7 .~~ ;J. -~0~ 1 ~ i `~ ~1.~lC ~ ~ ~u17 1 ~? Ord fL'/~ ~~~ ~ ~'' 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 Decedei~p, the Petitioners) will w~tl and truly administer the estate according to law. Sworn to firmed an bscribed before ~~~ rl-I~ ~~ ~.~/..~,~ ,~ Date - me thi ~ dray of 2c~ ~ /~ _~ v Date $y. ~f'`~'~-- ~ Date F the Register J _ Date BOND Required: ~ YES ~ NO FEES: ( ~) Short Certificate(s)...... ~ '='t' ( j )Renunciation(s)......... ~ ~`~~- ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other Automation Fee . .............. r 4~r JCS Fee . .................... ' • .~ d TOTAL ..................... $ `~Ll~ S To tlae 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 Q'u f f /I~ ~ ~UC c' n File No: ~l ~ I ,~ ~- ~ ~:~ ~, a/k/a: AND NOW, ~ {~~' /n ~P.~ ~~ ~ 0 I ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS CREED that Lett s - ~ ~~/Iae f - ~ r are hereby granted to ~ 0 Q the above estate and (if applicable) that the instalment(s) dated ~~ described in the Petition be admitted to probate and fi ed of r~c~rc~ as the last W`11(and Codicil(s))t~f Deceden>a Register of Wills '' Lf For»~ R6I~-o? rev. In~ll~2nll "'~~Of 2 a C L ~ ~'~ K G ~ . ~ ~~ ~. ~- : ~, ~ n~ l ~, ~, i ~ ~~ ~ ~ ~ }y~1 ~'i"-C1~!~'19tll~i] ~'llii.l,~.'1~ ~ j~~j}r'( [`}(~j~3jr~j r~f~ ~' T• f i/ ~ ~ ~ 7'! t 7 iJ V Sf , ~ ~./ ,t; ~ - [R ) - _ , ~ _ _ ' ~ _ i 1, i ~ 1 (.~ d ti .~l 1) L C Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH State File Number: `~ i~ O_ ¢~ Z 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Yr) (Spell Mo) Pauline V. Baten Female 182-22-3306 Nov ~, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Oa 6. Date of Birth (Mo/D ay/Year) (Spell Month) 7a. Birthplace (City and Stale or Foreign Country) 83 Months Days Hours Minutes Harrisbur Pa ,tune 15, 1929 7b. Birthplace (County) DaU l7in 8a. Residence (State y Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township? F'A 8 Randall Dr. East Pennsboro i~9 Ves, decedent lived in twp. Sd. Residence_( `~y~ um rland CC~~ Se. Residence (Zip Gode) (] No, decedent lived within limits of city/boro. 9. Ever in U~4rmed Forces? 10. Marital Status at Time of Death ~ Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to firs[ marriage) Q Yes ® No ~ Unknown Q Divorced ~ Neve r Married ~ Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) James Halbleib Florence Cooper 14a. Informant's Na a 14b. S Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) s 0 usan Brennan DAUGHTER 400 Stratford Circle Locust Grove, VA 22508 .......................................................... .................................. lSa. P ace o Death Chec on one .... . ... ..... _ .......... ..........................................Y..................................... ... ...-... ....... ...... ~ oc If Death Occurred in a Hospital: Inpatient Hosplce Facility LJ Decedent's Home If Death Occurred Somewhere Other Than a Hospital: IJ ~ Q Emergency Room/Outpatient Q Dead on Arrival _ ~ Nursin Home/Long-Term Care Facllit g y Q Other (Specify) 15b. Facility Name (If n i sti ti 1 e str at and number; ~or~f ~' ~r~t~ gt l 15c. City or Town, State and Zip Code i5d. County of Death ° Z p oap a G amp Hill, PA 17011 Cumberland 16a. Method of Disposition Burial 0 Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) p Removal from state p Donation Nov 7, 2012 Rolling Green Memorial Park Other (Specify) ~ 16d. Location of Disposition (City or Town, State, and Zip) . Si nature of Funeral Service Licensee or Person in Charge of Interment 17b. License Number d Camp Hill, PA 17011 Mario A. Billow FD-13845-L ~ u° 17c. Name and Complete Address of Funeral Facility Sullivan Funeral Home 51 N- EnOla Dr. EnOla, PA 17025 m 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race - Gheck 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. ~ 8th grade or less Is Spanish/Hispanic/Latino. Check the "NO" ~] While ~ Korean No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American (] Vietnamese High school graduateor GED completed ~] No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian ~ Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian ~ Associate degree (e.g. AA, AS) Q Yes, Puerto Rican ~ Chinese ~ Guamanian or Ghamorro ~ Bachelor's degree (e.g. BA, AB, BS) ~ Yes, Cuban ~ Filipino ~ Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese (] Other Pacific Islander Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify) e. MD DDS DVM, LLB, JD) 21 ecedent's Single Race Self-Designation -Check ONLY ONE to in dicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work ~ White ~ Japanese ~ Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American ~ Korean (] Other Pacific Islander Secr@t8 r)f Q American Indian or Alaska Native ~ Vietnamese ~ Don't Know/NOi Sure ~ Asian Indian ~ Other Asian ~ Refused 22b. Kind of Business/Industry Chinese 0 Native Hawaiian ~ Other (Specify) Q Filipino ~ Guamanian or Ghamo rro Federal Government ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23b. Signature of Person Pr a Death (Only when applicable) 23c. License Number By PERSON WHO PRONOUNCES OR cERT1FtE5 DEATH R ~ ~a~~ 23d. Date Signed (Mo/Day/Yr) 24. Time of Deat h ~ L ~~ ww~~--.~~ W 25. Was edical Ex Iner or Coroner Contacted? Ves ~ No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or compli cations--that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. 00 NOT ABBREVIATE. Enter only one cause on a Ifne. Add additional lines if necessary Onset to Death ~ ~ ~ ~ ~ ~ `~ ~ ~ / ~ IMMEDIATE CAUSE ~ f'J --------------~ a. f1 J~ C ~rv1 = ~ ~'1 ~ r' <- (!~!c rl< ~ ~ ~~ (Final disease or condition Due to (or as a consequence of): resulting in death) Sequentially list conditions, Due to (or as a consequence of): if any, leading to the cause listed on Ifne a. Enter the c. UNDERLYING CAUSE Due to (or as a consequence of): z (d lsease or Injury that s Initiated the events resulting d. V_ in death) LAST. Due to (or as a consequence of): S 26. Part 11. Enter other si¢nlfica nt conditions contribuiin¢ to death but not resulting in the underlying cause given in Part I 27. Was an autopsy perfor ed? v Yes No ~ 28. Were autopsy findings available m to complete the cause of death? v Yes o o. E 29. if Fe ale: N t e a t ithi t 30. Did Tobacco Use Contribute to Death? P bl Y b 31. M nner of Death Natural ~ Homicide cs pr gn n w n pas year o ~ Pregnant at lime of death ~ y es Q ro a ~ No (~Jnknown ~ Accident ~ Pending Investigation m ~ Not pregnant, but pregnant within 42 days of death ~ Suicide ~ Could not be determ{ned ~°. ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) ~ Unknown if pregnant within the past year 33. Time of Injury 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: ~ Ves ~ Driver/Operator ~ Pedestrian ~ No Q Passenger Q Other (Specify) 39a. rtifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated ~ Pronouncing 8. 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 ~ Medical Examiner/Co basis of examination, and ron~aL ~- O n~ ~j t ated /or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner s ~ J ~ / ~ - ~~ ~ f ~ '~ ~ ~ $ ~ ~ / ~1 Signature of certifier: / f~~ / License Number: Title of certifier: 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Sig d (MO Day/Vr) ~ ~ P Q t> K J= 6 ~1 ,qwJ » ~ /C I'J I/ i..t f~ f- y7 ~/ 1 '7~ dq/,IS-.~T re yr ~C ~R ...• C 7 d ~ ! l i ~-~~-. ~...~ ~ m © ~n ~ ~'° ~ ~ o ca m RENUNCIATION ~ ~ ~~ -~ ~v ~ ~~~ rr~m ~ ;~ ~~~ ~ ~~ -~ ~°n REGISTER OF WILLS ~° ~ ~? ,:~ {~: ~~ r~ =-~~~~'~~~--ter - r COUNTY PENNSYLVANIA ~ ` '~'" =~ ° r i , ~~ ~ r~ _ __ Estate of `_-~~~-~ ~-t_~t < _ u~ ; , ~ . -~- ~ ~ , ~ ~ -' ,Deceased _~-~ ,~ I, ~ ~ C.. 5 ~~ ~v ~ /i.~r'~~vi~~~--.~ , in my capacity/relationship as (Print Name) ~c: ~ ~~ i ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~~ ~'i~~/~ e~ ~' S l ~ e l L / -~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (Signature) (Street AC~reSS) (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this $ ~ day Notary Public My Commission Expires: v ~ ~ ~ y 1-~-- ~ ~ ~ (Signature and Sea( of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) BARNABAS M. ADDAI Notary Public Commonwealth of Virginia 7009870 My Commission Fxoires Sep 30, 2014 ~.~y:..;#~. THE LAW OFFICE of: JAMES M. BACH Attorney-At-Law LAST WILL AND TESTAMENT FOR PAULINE V. BATEN !~ ~ • ~.,ast Will And Testament Of ,~ r--~ ~ u AULINE V. BATEN ~~~ =-~ ~ ~ ~ULINE V. BATEN of the TOWNSHIP of EAST PENNSBORO ~ ~ ~,,COL~ of CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, ``Jbeing in good bodily health and of sound and dis osin mind and memor and not P g y~ acting under duress, menace, fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing my worldly goods while I have the strength and capacity so to do, I do make, publish and declare this my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my Executors hereinafter named, pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that be buried in a lot which I own situate at the Rolling Green Cemetery, Camp Hill, Pennsylvania ITEM 3. I give, devise, and bequeath, the sum of Ten Thousand Dollars ($10,000.00), free from tax, to JEFFREY BATEN, per stirpes. ITEM 4. All the rest, residue and remainder of my entire estate, wheresoever situate, and whatsoever it may consist of, I give, devise and bequeath, absolutely, and in fee, to the following named individuals in the percentage amounts set forth next to their names: SUSAN J. BRENNAN 33 1 /3% of my net residuary Estate MICHAEL D. BATEN 33 1 /3% of my net residuary Estate DONNA J. GOSIK 33 1/3% of my net residuary Estate ITEM 5. I nominate and appoint SUSAN T. BRENNAN as Executrix of this my LAST WILL and TESTAMENT. Should the Executrix herein named fail to qualify or cease to act as Executrix, then I appoint DONNA T. GOSIK as Executrix in her stead. .. ~~ /~J ~.~~ LrgA L l L" ~< PAULINE V. BATEN Page 2 of 4 ITEM 6. I hereby direct that all my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 7. I order and direct that my Personal Representative(s) named herein use the legal services of JAMES M. BACH, as Attorney for my Estate. ITEM 8. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executor out of my residuary estate. ITEM 9. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. PA ULINE V. BATEN `mss-~~ ~ _~ ~~,,.-, WITNESS~~`~.~...~ l,_,~'~ ~ ~€ ~ , ~" WITN S ~ .~'~- ASOI~I,~MA DIAI~IA L. WEBER Page 3 of 4 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss I, PAULINE V. BATEN, the TESTATRIX, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn to or affirmed and acknowledged before me, by: PAULINE V. BATEN, the TESTATRIX this 19`h day of October, 1999. na l~r.nvF v Ra r~N --- ~+~ t' ° ~~ ~"~~~~~ ~ ter s .., w.., -.T Y'y d r Mechanicsburg, PA 17055 My Commission Expires: 05/13/03 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We, JASON J. MAZZEI and DIANA L. WEBER, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the TESTATRIX sign and execute the instrument as her LAST WILL; that the TESTATRIX signed it willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each witness in the hearing and sight of the TESTATRIX signed the WILL as witnesses; and that, to the best of our knowledge, the TESTATRIX was, at the time, 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and acknowledged before me, by: JASON J. MAZZEI and DIANA L. WEBER, witnesses, this 19`h day of October, 1999. . --~ f -~ i ~° , !II ! ,~ ! WITNESS ~.~~.~~r _.,d :,=~ .~'~',~~- WITNES ~ ,~' ~. ,~ ~°' JASO J. ZED ' DIANA ~. ER >~f :~ ~~ ~ ~ ~~" ~ ~°" NOTARY PUBLIC He~sreQd~; Y+,, ~-att~i~+~xr~A°a ~'~ '~"''~`~~ ~ Fi Y =~~ ~ ~~ ~r ~`~"r ~ Mechanicsburg, PA 17055 ~~~~~ ~~ ~ ` ~ ~~~ My Commission Expires: 05 / 13 /03 '"!~I'1 _ -~- J M. BACH, ESQUIRE NOTARY PUBLIC ~ 3 J, MES M. BACH, ESQUIRE Page 4 of 4