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HomeMy WebLinkAbout12-13-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are I8 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: I lam Uy File No: ~ ~ ~~ t ~~~3 ai~/a. (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 10/20/2012 Age at death: 63 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 333 Evergreen Street 17070 Borough of New Cumberland Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 333 Evergreen Street 17070 Borough of New Cumberland Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: 775, 000.00 Ijdomiciled in Pennsylvania ................................All personal property $ If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ Ijnot domiciled in Pennsylvania .............................Personal property in County $ Value of real estate in Pennsylvania .............................................................. $ TOTAL ESTIMATED VALUE.... $ 775,000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough Couuty ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named in the last Will of the Decedent, dated 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 mazry, was not divorced, was not a party to a pending divorce proceeding wherein t'te grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ® NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grans of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.t.t+. 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 defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. r- ~, ^ NO EXCEPTIONS ^ EXCEPTIONS ~~~ ~~ _. Petitioner(s), after a proper seazch has/have ascertained that Decedent left no Will and was survived by the followin~Tpc~e (if any) a~`nd heil~t~h additional sheets, if necessary): T .~~ ~ ~ ~ - Name Relationship -.{ Ad f'- ~"'' rn m ~ ~ ~ 7C O C3 t~ O ~ ""r'S ~ ~ ~ 'v1 ~ ~-+ -- ~ t.._. y, cn U" c~ 4/4/2012 and codicil(s) Fort„ Rwoz rev. toittizott Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } RE Petitioner(s) Printe-1 Name Petitioner(s) Printed Address Patricia A. Gu 333 Evergreen Street ~ . 1 5 New Cumberland ~ 1 PaA 17070. CLERK 01= CUM~3ERLAND Cfl., PA The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition aze 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. /~ j,~ la ~3 a_ Sworn to or affirmed and subscribed before 2 1' ~j~,~~~~~'l~t ~k Date me t. ~ ~- day of ( ~ ~ ~ ~ ~~~-~ Date L~-s[sa.~~-(.~`~,~ • Date By: For the Register Date BOND Required: ^ YES ®NO FEES: Letters ....................... $ ( (,Q )Short Certificates(s) ...... a~ ' ( )Renunciation(s) ... ..... . ( )Codicil(s) ............. . ( )Affidavit(s) ....... .... . Bond ......................... Commission ................... . Other .....•••• i,11- ~ ......... ~ Automation Fee ................. ~~ ~~ JCS Fee ....................... 0~`3'~j0 TOTAL ................ .....$ ~ , ~ ~a Official Use Only To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name• David H. `Stone Esquire Supreme Court ID Number: 39785 Firm Name: Stone LaFaver & Shekletski Aaaress: 414 Bridge Street P.O. Box E New Cumberland PA 17070 Phone: 717-774-7435 Fax: 717-774-3869 Email: dstone a~stonelaw.net DECREE OF THE REGISTER Estate of Wllllam T. G aJk/a: AND NOW, ~~C-Q~~~~ ~ ~ 20~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Patricia A. Guy _ _ _ in the above estate and (if applicable) that the instrument(s) dated Aprll 4, 2012 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. egister of Will ~ ~~i 1 ~ n Form RW-O2 rev. ]0/11.201! ~'"C/1` ge 2 of 2 File No: ~ ~~ ~ a -, LOCAL REGISTRAR'S CERTIFICATIOIN OF DEAT1~ 1MARNING: It is illegal, to duplicate this copy ay photostat or photograph. E=ec for this certificate, S~i.Ot) RECO~RD~~D ~~~~~~ dF~ j1,~,,-,,, Th.(ti i, t(~ •rtit~, phut ;i~ j)rit)rmation here ~iveu is '' LZH_OF -EG~~~~~ Q~` ~~~,,,~,5 1,,1~'~~,P_ - PF~~;~_ c(~trc,~tly~ cO~,)ed i((7ju :r: Or.~~i)~a! Ce(tifi~aTe of T~eath ,~;tl'lp'~f "'~~ d(Jl~ t)led ~t~tF~i ~~J~ (~,. ~.(c•~1 Rc~isCr)r. The original `~ ~ I ~,< '!u~n (riled to th(° Mate Vital ~~~Z GEC 13 ~~ ~ ~,~~ ~~ 'A;~ k(~cOr,l, Ott(c, r(Ir ~~(:~rrt, in.~r,t I(ling. ,,~ * '< . ~ ..,~,~._-~ ~._ ~; *,: ~~~ ~ OCT 2 4 2012 _ q i ,'Q. II,, P ~.S~a15~C CLERK 0~ ~ °~,~~,~ ~~ ~~~''% ''C `~ ,9j - ~, , I ~ _ _- ------- ORPHANS COIfRT ~ MEN1t1~ ' ~eCT1IlCI111011 NU111~1C(" `~_'!~'!"-~'"~~~ II ~~S~RLAND C0.) Ply l.: a~ ~2~•«j.;l(:.r c>a!e Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH .VITAL RECORDS Permanent CERTIFICATE OF DEATH BI k I k State Flle Number: C 5 f nl . Decltllnt'z Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Secu^ty Numblr 4. Date of Death (MO/Day/Yr) (Spell Mo) William T. Gu Male 179-38-0981 October 20 2012 5 a. Age-Last Birthday (Yrs) 5b. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO Day/Vea r) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Deys Hpurs Minutes Mechanicsbur PA 63 June 20 , 1949 7b. Birthplace (co~ntY> Cu b r an ga. Residence (5[aN or Foreign Country) gb. Residence (Street and Number -Include Apt No.) BC. Dld Decedent LWe In a Township? Penns lvania O Ves, decedent Ilved In twp. Sd. Resident! (County) Cumberland 8e. Residence (Z1p Code) 17Q7Q [B NO, decedent lived within limits of NE!W Cumberland city/bprp. 9. Ever In US Arm<d Forces? 10. Marital Status at Tlme of Death ®Married O Wldowld 11. 6urviving Spouse's Name (If wife, glue name prior to first marriage) 0 Ves ~ No Q Unknown ~ Divorced ~ Nev r Married O Unknow 12. Father's Nam! (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marrtage (First, Middle, Last) William W. Gu Vir iT1ia Brinle 14a. Informant's Name 14b. R¢latlonshlp to Decedent 14c. Informant's Malting Address (Street and Number, City, Sate, Zip Code, ~ z a. ace o eat pn y pn! .... .... ........ ... _.. ..... ......... ........ .. ..._......_.. If Death Occurred in a Hospi[al: ~ InpaHenY -1f Death Occurred Somewhere Other Than a Hospital: ~ Hpspice Faculty Decedent's Home Emir !nc Room/Outpatient Dead on Arrival ~ Nursin Home/LOn -TerM Car! Facility Other (Specify) 15 b. Facility Name (If not Institution, give street and number; lSC. City or Town, Stat<, and zip Code 15d. County of Dea[h y 16a. Method of DlSposiHon ~( Burial Q Cremation 16b. Date Of Disposition 16c- Place of Disposition (Name of cemetery, crematory, or other p(ace) ~ Removal from State ~ Donation 2012 Other (specify) 0 16d. Location of D15positlon (City or Town, State, and Zip) ! 17a. Signature o Funera Ice LI or Person in Charge of Interment 17b. Ucense Number Cam Hill PA 17011 E'D 1 L E 17<. Name and Complete Address of Funeral Facility s ~' lg. Decedent'a Education -Check the box [hat best describes the 19. D<c<d<nt of Hlspa nit Origin -Check the 20. Oecedent'z Rac! -Check ONE OR MORE races to Indicate who[ I- highest degree or level of school comp)<t<d at the time of death. box [hat bast describes whether the decedent the decedent considered himself or herself to b<. ~ 8th grade or less is Spanish/Hispanic/Latino. Check ih< "N O" White Q Korean an American ~ Vietnamese Bl r Afri h/Hi i /L ti k d d S i pan span c a no. ac o c ec< ent Is not s No diploma, 9th - 12th gratle box If ~ High school graduate or GED completed ~ No, not Spanlzh/Hispanic/U[Ino Q American Indian Ur Alaska Native ~ Other Asian ~ Som! college credit, but no degree Q Yes, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hawaiian (~ Associate degree (e.g. AA, AS) Q Yes, Puerto Rican ~ Chinese Q Guamanian or Chamorro Q Bachelor'9 degree (e.g. BA, AB, BS) Q Yes, Cuban Q FIIl plno Q Samoan 0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino ~ Jape nese ~ Other Pacific Islander 0 Doctorate (e.g. PhD, ECD) or Professional degree (Specify) ~ Other (Specify) . MD DDS DVM LLB JO 21. Decedent's Single Rac<Self-Deslgnatian -Chock ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work White ~ Japanese Q Samoan done during most of working Ilfe. 00 NOT USE RETIRED. ~ Black or African American ~ Korean ~ Other Pacific Islander AmeACan Indlen Or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure e 0 Asian Indlen Q Other Asian Q Refused 22b. Kind o1 Business/Industry Q Chinese Q Native Hawaiian ~ Other (Specify) Q Filipino ~ Guamanian or Chsmorro ITEMS 23a - 23 MUST BECOMPLETED 23e. Date Pronounce Dea (Mo Oay Yr) 23 S gnature o erson Pronouncing Death (Only when applicable 2 c. Licens¢ Numb<r BY PERSON WNO PRONOUNCES OR CERTIFIES OEATN _ G' O ~ ~~~~ ~~t/ 23d. Date Signed (Mo/Day/Yr) 24. Time of Death __ G!^ - 25. Was Medl Examiner or Coroner Contacted? 0 Yes No CAUSE OF DEATH Approximate 26. Part L Enter the chain of a ants--diseases, Injuries, or complications--[hat directly caused the death. DO NOT enter terminal events such as cardiac acres[ Interval: cause on a Ilne. Add additional Tines if necessary Onset to Death l ol ogy. DO NOT ABBREVIATE. En[er only o respiratory arrest, OY ventricular flbrl11at1orTy/I thp UC sho wing the e[ / ( ~f ) ~ , ~ ~ IMMEDIATE CAVSE ___-____..____~ a, ~//~l (icJ _ ~ g J `. /a S i L/ J`~ I~ ~ <J (.. ) r ~~ (c /'~ /_ (Final disease or condition Due to (Or as a consequence of): resulting In dear^) b. Sequentially list conditions, Due to (or as a consequ<nce ot): If any, 1<ading to the cause listed on Tin! a. Enter the UNDERLYING CAVSE Due to (or es a consequence of): (~ (disease or lnJurythat F initlat<d the !vents resulting d. in death) LAST. Due to (or as a consequence of): 26. Part 11. Enter other sizenifleant conditions contributing to tleath but not resulting In the underlying caus¢ given in Part 1 27. Was a autopsy perfor d'T o O Yez ~ 28. Wire autopsy findings available m to complete the cause of tleath? ~ ~ Yes ~ No . 4 E 29. If Female: ithi r ~ N t t t 30. Did Tobacco Use Contribute to Death? Q y bl O Pr b 31~. Mai~ ^^¢r of Death R t l H id i eg o pregnan w n pas yea Q Pregnant at time of death y es o a ~ No ~Onknown ~ a ura ~ om c e ~ Accident Q Pending Investlgatfon .,~' ~ Not pregnant, but pregnant within 42 days of death 0 Suicide ~ Could not be determined ~ 0 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 Numblr, CIty, State, Zip Code) 36. Injury at Work 37. If TransportaTlon Injury, Specify: 38. Describe How Injury Occurred: ~ Yes 0 Driver/Operator 0 Pedestrian ~ No Q Passenger Q Other (Specify) 39a. Fier (Chock only on<): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated ~ Pronouncing Ji< Certifying physician - To the best of my knowledge, death occurred et the time, dace, and plat!, and due to the cause(s) and manner stated Q Medical Examen<r/Coroner - On th is f examination, and/ar Investigation, In my opinion, death occurred at the [Im<, date, and place, antl due [o the cause(s) and manner stated Signature of certifier: Title of ee rtlfler: License Number: Z 39b. Hama, Ad Criss and Zip Code of Person Com piecing Cause of Death (Item 26) 39c. Dat< Signed (MO/Day/Yr) ur n e j 40. R¢gistrar's District Num r 41. Reglsirar s atura 42. egistrar Flle Dete O/ ay r) E ~~ 'e>~/~ ~~/01? ~p/1 S S 43. Amendments 0 w rl ,~/ it )/-7 Z:\EP\WILLS\Guy.William.wpd LAST WILL AND TESTAMENT OF c ~~~ ~ ~ m WILLIAM T. GUY ~ © ~ c~ ~ n rn~n ~ a ~~` ' ~ y' f" ~~ f-.a C.a ~ ~ m r•t ~~ A I, WILLIAM T. GUY, of the Borough of New Cue ~`end.~., C&2nl~rland ~ c < ~' -:3 'fit County, Pennsylvania, declare this to be my last N~i~l ---; ar}~1. rg~r4;~e any ~ will previously made by me. '~` ~ -, rn ~ ITEM I: All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, together with any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid from my residuary estate without apportionment or right of reimbursement. ITEM II: I devise and bequeath all of my estate of every nature and wherever situate to my spouse, PATRICIA A. GUY, if she survives me. ITEM III: Should my spouse, PATRICIA A. GUY, fail to survive me, I bequeath such of my tangible personal property which is set forth in a separate memcrandum which I shall place with this will to the persons therein designated. I bequest the balance of my tangible personal property to my son, DAVID T. GUY. ITEM IV: Should my spouse, PATRICIA A. GUY, fail to survive me, I devise and bequeath the residue my estate, of every nature and wherever situate, as follows: Page 1 of 4 A. Ninety-Two and one-half (92-1/2%) thereof to my son, DAVID T. GUY. B. Seven and one-half (7-1/2%) thereof to KIM TA, should she survive me. ITEM V: I appoint my spouse, PATRICIA A. GUY, Executrix of this my last will. Should my spouse, PATRICIA A. GUY, fail to qualify or cease to act as Executrix, I appoint my son, DAVID T. GUY, Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, WILLIAM T. GUY, have hereunto set my hand and seal this ~ day of ~ 2012. L~~7~~~ WILLIAM T. GUY SIGNED, SEALED, PUBLISHED and DECLARED by WILLIAM T. GUY, the Testator above named, as and for his Last Will and Testament, and in the presence of us, wh at his request, in his presence and in the presence of each otx-~`,71~av subscribed our names as witnesses. 414 Bridge St., New Cumberland, PA Witness Address /^ •~ r 414 Bridge St., New Cumberland, PA Witness Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND I, WILLIAM T. GUY, the Testator whose name is signed to the attached o:r foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes there iii contained. ~(/ '~.-- WILLIAM T. GUY ~ Sworn to or affirmed to and acknowledged before me by WILLIAM T. /~ ~h GUY, the Testator, this -I day of ~~{~ 2012. /" ;%'J~ ~ COMMONWEALTH OF PENNSYLVANIA f/'! ~~ JENNIFER A. MEARKLE, Notary Publlc Notary Pub 1 i c New Cumberland Soro. Cumberland Co. My Commission ices Ju 7, 2012 Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND . ~~--- We, ,~ ~~a`~c: and ~o~ o ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed to and acknowledged before me by r---_, ~ ~ ~ ~ ~ ~fM~ and ~~eL L- ~~-+~:-e~~ , witnesses, this ~~~ day of .~~;c~'~ 2012. ___..-, COMMONWEALTH OF PENNSYLVANIA ,,,----- S '~ ~.. . JENNIFER A. MEARia.E, Notary Public y ~- Notary Pub 1 i c New Cumberland Born. Cumberland Co. My Commission res J 7, 2012 Page 4 of 4 f Witness