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HomeMy WebLinkAbout12-14-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF Cw.,~..~„ COUNTY, PENNSYLVANIA Petitioner(,) named below. who is/arc 18 years of age or older,. apply(iesj for Letters as specified btaow. and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's In rmation L Name: .S uP File No: ~ ~ - ~02 - ~ `~)l.1`7 a/k/a: (Assigned by Register) a/k/a: ~~a' Social Security No• Date of Death: / 2~ Z / Z Age at dC~eath• - +~y Decedent was domiciled at death in .~,, ,~ Conn y, 1/ (stare) with hi ~e 1 principal residence at SZds ~ „a, ~ to Street address, Post Office and Code City, Towns ip or Boroogh Count Decedent died at 2 ~ ,jo ~ ~, ~ ~`~~ ~,¢ Y Street address, Post Office and Zip Code City, To ship or Borough County St/ate Estimate of value of decedent's property at death: If domiciled in Pennsy!vania ............................ All personal property $ .~~~ If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ 'r If not domiciled in Pennsylvania ................. . ..... .personal property in County $ Value of real estate in Pennsy!vania ....................... ........... $ 200 0~- ................... .. ~'"~~`` ~ T TAL ESTIMATED VALUE.... $ ~,Q,s"• t7~O Real estate in Pennsylvania situated at: s,.- e~lefLv ~ ,Q_~ (Attach additional sheen, if necessary.) Street address, Post Office and Zip Code City, To ship or Borough Count Y A Petition for Probate and Grant of Letters Testamentar ~• etitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated L/~e Z~ ZO/!7 thereto dated - ~ and Codicil(s) State relevant circumstances (eg. 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. ~O EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a.,pendentelite, durunteabeentia, duranteminoritate If Administration, c.t.a. or d.b.n.c.~a., enter date of Will in Section A above and com fete 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. ^NO EXCEPTIONS ^ EXCEPTIONS ~ ~,~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follow s~tse (ifany~d hei~'ctt~h additional sheets, if necessary): r-*~t `. O m ~ h ~ t%3 :'~'i Name ( Relationshi Fo,~,,,ltwnz ,~w. lniuizni~ Add s Z 1'tl `~ t"r't FY't o ~ ~ o 0 ~ o c ~'' - ~ n c> -o r m .,~ cn a Page 1 of 2 Oath of Personal Representative C(~~i~,(ON~•L'E.aLTFi OF Pc~+VS`i LV,~~;l,-~ } ~ ~ S~ RE R GlST~R OF~~~flLLS z Q~C ly Pal 1 `i5 ~ii~ /y3 Grl ~A^ .c ER AM Q ., ~p~ The Petitioners}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 Representatives} of the Decedent, the Petitioner(s) will well avid truly administer the estate according to law. Sworn to or aff rmed a subscribed before Date j~1 ~ /~' met '~ day of ~. By Date Date or the'Re,;ister Date ~.~.... BOND Required: Q YES NO To the Register ojWills: FEES: Please enter my appearance by my signature below: Letters ...................... S Attorney Signature: ( ~) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)............ n Bond ........................ Printed Name: ~ /' ~ ~,p,~b Commission ................. Supreme Court ~t~~~b Other .. , .. , ID Number: / • • • • Firm Name: • • • • • • Address: ••••••• Phone: Automation Fee ............... Fax: JCS Fee . .................... Email: TOTAL ..................... S DECREE OF THE REGISTER Estate of ~r~ ~, ~~l (,~-~- File No: ~` . I ~ - ~ ~9 a/k/a: AND NOW, ~`D rn~,(• ~ ~ 2~J (2 ,inconsideration of the foregoing Petition, satisfactory proof having been presented before tne, IT IS DECREED that Letters are hereby granted to • in above estate and (if applicable) that the instrument(s) dated Q ~ -- described in the Petition be _ fi~L' u R1V.t12 r.... lnttti~n i i pitted to probate and filed of record as the last Will (and Codicil(s)) of ]`decedent. Register of Wills LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.OOR E C 4 R D E D D F F 1 C E Q~ REGISTER OF ~~~'~~.l.S ~CI~ GEC 1`f Pfd 1 `f6 This is to certify that the information here given is co)1-ectly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. P 18 9 4 5 2 2„~ouAERK 4r ,(~~A,,.~` ~j d,~ ~ ~ p ~ 2p 12 NS COURT Perm Certification Numbe~,U.~gERLAN© ~, ~~ Local Registrar Date Issued Type/Print In C ON LTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS f CQT~C~f ATC AG f1CATu ~_ ~[ata File Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sax 3. Social Security Number 4. Date of Death (MO/Dey/Yr) (SpNI Mo) S-~TM~ra D • Blust F~Inal l 70-36-2721 D~iJ~s 2 ~ 20l 2 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year 5c. Under 1 Da 6. Date of Birth (MO/Day/Year) (5pN1 Month) 7a. Birthpla Clty and State or Forelg untry) Months Days Hours Minutes r 8. ,' 94,7 7b. Birthplace (County) ~~• 8a. Resident Tate or Foreign Country) Sb. Resldenro (Street and Number -Include Apt Nb.) Bc. id Decedent LWe In a Township? "~ ~s es, decedent lived In ~/~ri a~ jD~/~/ gyp gd. Reside ce (County!)p • ~ Q ) (~ u m !3(A ~~N D g R d ~ J e. esi vnro (Zip Code) ~ NO, decedent Ilved wlthln Ilmita or chy/born. 9. Ever In s ed Forces? 1 M Ital Status at Timv of Death 0 Married WI owe 11. Surviving Spouse's Nama (If wife, give name prior [o first marriage) 0 Y es No Q Unknown ivoroed Q Never Married D Unknown 12. Fath s Na a (First, Middle, Last, u 13. Mother's Name Pri r o Fint Marty S, Middle, Last) ~~ ° ` 14a. Informant's Name 1 Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Clty, Sta , Zlp Code) ~L 5J ~ C L4NT~i2 ,~ /J + z 3 .......................................................:.. ......................................... If Death Occurred In a Hos Ital: p Inpatient 0 Emer en Room/O t ti t a. ace o eat a on n _ l .................................... ...............°..° .............................. ................. .. ................. ............................... .If Death Occurred Somewhere Other Than a Hospital: ~( Hospice Facility Lmacedent's Home J S ry u pa en Dead on Arrival 15 b. Facility Name (I t Instltutlon vv stre t d b r Q NunM Home/Long-Term Care Facility Other (Speciry) J ~ L S a , e an num er; c / 15c. CI or Town, State, and ZID Code /I~ O ~ 15d. unty of Death +NZtr 6~.?4 r ~ . 16a Method of Di iti ' 1 . ,,, ~, . spos on ~ Burial Cremation 0 Removal from State 0 Dona on th 16b. Date of Disposition lac. Place o Disposition (Name pf cvm ry, crematory, or other place) -- ~ o er (S eclty) ~~ ~l A ~O ~ . pC01 ~ ~R ` IT 1 cation of DisposNion (CI or Town, State, and Zip) 17a. Sfg ture o/ F r e r o in Ch terment 17b. License mbar e / f ~ ~ ~j /( C/ V ~ 17c. N me and Complet d sa of u al Facility ~ / cE / as ig ' . . Decedent s Education -Check the box that best de9cNbes the 19. rodent of bpaMc Origin -Check the dene's Raca -Check ONE R MORE races to Indicate what highest degree or level of school completed at the ti f d me o es that best describes whether the decedent erodent considered himself or herself to ba. Q Hth grade or less h " " s Spanis /Hlspanic/Latino. Check the NO hire Korean Q No diploma, 9th - 12th grade box If decedent Is not Spanish/Hlspanl4Latlno. Back or African Amercan 0 Vietnamese 0 High school graduate or GED completed No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native Q Other Asian S ~ ome collage credit, but no degree es, Mexican, Mexican American, Chicano 0 Asian Indian ~ Native Hawaiian ~ Assodate degree (e.g. AA, AS) Q Yvs Puerto Rlon , ~ achelor'a degree (e.g. BA, AB, BS) Vas, Cuban Q Chinese ~ Guamanian or Chamorro l Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, other Spanish/Hlspanic/Latlno Q Japa neae Q Other Pacific Islander ~ Doctorate (e. g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify) e. MD DDS DVM LLB JD 21. Dfcedent's Single Race self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual OCCU patlon -Indicate type of Work $Whlte 0 Japanese 0 Samoan done dur/ng most of working life. DO NOT USE REFIRED. O B aek or African American Q Korean 0 Other PeNflc Islander ~ ~i'~~i ~~ ~ American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure / /i ~ Asian Indian ~ Other Asian 0 Refused 22b. Kind of Business/Industry Q Chinese 0 Native Hawaiian Q Other (Specify) ~A Q Filipino Q Guamanian or Chamorro yE~` , . ~~r~ _/ ~,£~T C MS 23a - 23 MUST BE COMP D 23a. Date Pronounced Dea Mo Day 23b. Signature Person Pronouncing Deat y w en app Ica a 23c. Llcen9e Num er BY PERSON WNO PRONOUNCES OR CERTIFIES DEATH ,'3. ~ ~~~ 23d. Date Signed (Mo/DSy/Yr) 24. Time of Death 25. Wss Medkel sminer or Coroner Contacted? 0 Ves ~ NO CAUSE OF DEATH Appr°xlmata 26. Part 1. Enter the chain of events-diseases, Injutivs, or complications-that directly caused the death. DO NOT enter terminal events such as cardiac arrest ~ Interval: res irato arre t t i l . p ry s , or ven r cu ar flbrlllatlon without showing the etiology. DO NOT ABBREVIATE. Enter only one rouse on a Ilne. Add addl[lonal lines If necessary Onset to Death i IMMEDIATE CAUSE --------------r _ ~Jrl -(..I.YK O h ~ - .3 ,- S~ (Fi l di na sease or condition Due to (or as a Consequence of): resulting In death) Sequentially Ilst conditions, D ue to (or as a eonxquence of): If any, leading to the cause 9 1 , ~I ^~ listed on Ilne a. Enter the ~._ N ~-Lf 5 ~ -Fi VC Tc.~ ~ t~,a Qyl a s ~ ~j ~ f ~ ~ S I ! UNDERLYING CAUSE pf). t (disease or Injury that Due to (or as a consequence Inltlated the events resulting d. S L ~ G C a ~ c ! („-, C„` t~rkr-ot,>'it In death) LAST. Due to (or a9 a consequence of): B 26. Part 11. Enter other signiflc t ditl t ibuU t d ath but not resulting In the underlying cause given In Part 1 27. Was an autopsy pertormed7 (, S O / G /~ ' S 5 "~ R f r.+1.st_ a. ~ Yes No , ~ ~J / 28. Were autopsy findings avalleble Jam 1~ µ-~ ~'L ~t'`~ ~ p-c-~/ Tura 5 i O Y~ to complete the cause of death? 29. If Female: ~ Yea No Eg 30. Old Tobacco Usa Contribute to Death? 31. Manner of Death ® Not pregnant wlthln past year ~ ~ Q Pregnant at time of death ~ Yes 0 Probably ~ Natural ~ Homicide ® No 0 Unknown . i-° ~ Accident ~ Pending Investigation 0 Not pregnant, but pregnant wlthln 42 da ys of death 0 Not pregnant, but pregnant 43 days to i year before death 32. Data of In u Q Sulclde 0 Could not be determined 1 ry (MO/Day/Yr) (Spell Month) Unknown If Q pregnant wlthln the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; schoo 35. Loeanon or Injury (street end Number, Clty, star., zip eoa~) 36. Injury at Work 37. If Transportatl°n Injury, Specify: 36. Describe How Injury Oeeurrod: Yes Q Driver/Operator 0 Pedestrian 0 No ~ Passenger 0 Other (Specify) 39a. Certifier (Check only one): ® Certifying physician - To the bast of my knowledge death occurred due t° [h d , e cause(s) an manner stated ~ Pronouncing 8a Certifying physician - To the best of my knowledge, death occurred at ehe time date and place and d h , , , ue to t e cause(s) and manner stated Q Medical Examiner/Coroner - On the basis of axe Ina and/or investlgatlon, In my opinion, death occurred at the time dale d l , , an p ace, and due to the cause(s) and manner stated Signature of certifier. Tltla of certifier: ~ D License Number: J/>~ Dv-Fa'~ o~ / 39b. Nama, Address and Zip Coda of Person Completing Gause of Death (Item 26) 39c. Date Signed (MO/Day/Yr) M4~i airy kK:a-==r PO /3 vx gSa F/-yylG Nc.I~S ~ /70 . 40. Registrar s D s rlc[ Number 41 R i t ' S ~ 6 . eg s rar s 5ignatur 42. lt~ g lstrar FI a Da[a Mo Day 43. Amandmenta ~ ~~~ ~ J ~ ` -O ~ - -~~ Z ye /". a .s ..vim u'R _ : .o~v Disposition Permit No. `-' C7 ~J O_~ ~ ~ H105-143 RF\/ n7 /Jnt 1 LAST WILL AND TESTAMENT OF SANDRA D. BLUST K I, SANDRA D. BLUST, having my legal residence at 5265 Joshua Road, Mechanicsburg, Cumberland County, Pennsylvania, hereby declare this to be my Last Will and Testament, revoking all other wills and codicils heretofore made by me. ARTICLE ONE I declare that I am not married. ARTICLE TWO I have one child whose name and birth date are as follows Name ALLISON ZANG ~, ~"" O ~ M ~ ~~ ~' ~ 4?0 rnx~ %~ y r r, , t» ~a ~a ~~~ f_. -~ ~.,~ r,y a~~ ~ - ac v c~ ~ --v O a -~, ~-n c> ca ~ ~ .~~ °~ ~ ~ --~ ---~ ~w rn r-- y, -~ cn trs , Birth Date November 4, 1982 Any references in this Will to my descendants are to my child and her descendants and to any other children subsequently born to or adopted by me. ARTICLE THREE I direct the payment from my estate of the expenses of my last illness and funeral as soon after my death as conveniently may be done. ARTICLE FOUR I intend to leave a memorandum which will direct the distribution of certain items of tangible personal property, and I request that my wishes as set forth in said memorandum be followed. To the extent that my tangible personal property is not disposed of by memorandum, all of the tangible personal property that I own at my death, including any household furniture and furnishings, automobiles, books, pictures, jewelry, art objects, hobby equipment and collections, wearing apparel, and other articles of personal and household use, equipment and ornament, and all insurance thereon shall be distributed with the residue of my estate. ARTICLE FIVE I give the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, to my child, ALLISON ZANG, provided she survives me by thirty (30) days. If she fails to survive me by thirty (30) days, her shaze shall be distributed to her descendants, per stirpes. ARTICLE SIX If at any time there is no beneficiary entitled to receive all or any part of my estate, my estate shall be distributed to my nephew, MATTHEW KERCH, or his descendants, per stirpes. ARTICLE SEVEN If any portion of my estate is distributable to a beneficiary who is then under the age of 25 years, my Executor may distribute that beneficiary's share, without further responsibility, either directly to that beneficiary, to a qualified individual (including himself or herself) or trust company designated by my Executor as custodian for that beneficiary under an applicable Uniform Transfers to Minors Act or similaz law, or to the individual having personal custody of that beneficiary (whether or not court-appointed), and the receipt of the distributee shall discharge my Executor. ARTICLE EIGHT No beneficiary or remainderman under this Will or any codicil hereto or any trust created hereunder shall have any right to alienate, encumber or hypothecate his or her interest in this Will or any codicil hereto or any trust created hereunder in any manner, nor shall any interest of any 2 beneficiary or remaindennan be subject to claims of his or her creditors or liable to attachment, execution or other process of law. ARTICLE NINE Should the payment of expenses, claims and taxes from any Qualified Retirement Plan or Individual Retirement Account ("IRA") assets which comprise my estate cause my estate to be disqualified as a "Qualified Beneficiary," it is my intent, and I hereby direct that, to the extent practicable, no expenses, claims and taxes shall be paid from such Qualified Retirement Plan or IRA assets. ARTICLE TEN I appoint my daughter, ALLISON ZANG, as Executor of my Will. If she is unable or unwilling to serve, I appoint my nephew, MATTHEW KERCH, as Executor of my Will. If he is unable or unwilling to serve, I appoint my brother, FRANK KERCH, as Executor of my Will. I give to my Executor, in addition to and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to settlement of my estate to be exercised from time to time in the discretion of my Executor, without further order or license of the Register of Wills or of any court: 1. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to distribute property in kind, to compromise claims, and to sell any property at public or private sale; 2. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 3. To engage in litigation and compromise, arbitrate or abandon claims; 3 ~ ~ r 4. To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-prorata basis, and for such purposes to make reasonable determinations of current values; 5. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; 6. To invest and reinvest in every kind of property and investment which persons of prudence, discretion and intelligence acquire for their own accounts; 7. To manage, control, repair and improve all real property; 8. To procure and carry at the expense of the estate insurance of the kinds, forms and amounts deemed advisable by the Executor to protect the Executor and the estate against any hazard; 9. To pay all taxes, assessments, fees of the Executor and all other expenses incurred in the collection, care, administration and protection of the estate; 10. To exercise such powers, herein conferred, after the termination of the trust estate until final distribution of the estate assets; and 11. To do all the acts, to take all the proceedings, and to exercise all the rights, powers and privileges which an absolute owner of the property would have, subject always to the discharge of their fiduciary obligations; the enumeration of certain powers in this Will shall not limit the general or implied powers of the Executor; the Executor shall have all additional powers that may now or hereafter be conferred on them by law or that may be necessary to enable the Executor to 4 Y administer the estate in accordance with .the provisions of this Will, subject to any limitations specified in this Will. No bond shall be required of any fiduciary hereunder in any jurisdiction. No fiduciary hereunder shall have any liability for any mistake or error of judgment made in good faith. My Executor shall receive reasonable compensation for services performed as determined by the court in which this Will is admitted to probate. ARTICLE ELEVEN I realize that Executors are given discretion by law to make various elections which affect the income and estate taxes payable by estates and beneficiaries, as well as the relative shares of beneficiaries, such as taking administration expenses as deductions for either estate or income tax purposes, selecting options for the payment of employee death benefits, electing to take a qualified terminable interest as part of the marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing joint income tax or gift tax returns and redeeming corporate stock. The decisions made by my fiduciaries in any of these matters shall be binding upon, and not subject to question by, any affected persons. I rely upon my fiduciaries to take into consideration the total income and estate taxes payable by reason of their decisions including those payable by my survivors, and they are authorized in their discretion, but not required, to make adjustments between income and principal as a result thereof. 5 . , ARTICLE TWELVE I direct that all estate, inheritance and other taxes in the nature thereof, together with any interest and penalties thereon, becoming payable because of my death with respect to the property constituting my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid from the principal of my residuary estate, and no person receiving or having a beneficial interest in any such property, whether under this Will or otherwise, shall at any time be required to contribute to or refund any part thereof; provided, however, that this direction shall not apply to the taxes on any property included in my estate solely because of a power of appointment thereover which I possess but have not exercised or on any qualified terminable interest or to any generation-skipping transfer taxes. IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this ~Q day of 2010, set my hand and seal to this my Last Will and Testament, consisting of six (6) pages. ~~ SANDRA D. BLUST SIGNED, SEALED, PUBLISHED and DECLARED by SANDRA D. BLUST, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses Residence ~~ Residence ~,~I 6 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN We, SANDRA D. BLUST, ~ > and ~G~1t,1 C /~'~ w ~ ~ ,Testatrix and witnesses, respectively, whose names are signed to the attached and foregoing instrument, being first duly sworn, do hereby declaze 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 therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~,• ~~'~~ TESTATRIX I ESS WI SS Subscribed and sworn to and acknowledged before me by SANDRA D. BLUST, the T statrix, and subscribed and sworn to before me by /~Q/' s and ~ ~ E Lo •-k; witnesses, on this J U 2 9 2010 otary Public nv~ v r~l~ i i_~}~~fha 3 v ~ 1~ ° ! ..`1I 3 ..... ..... .... ...........s.~ • ~ ~ i ,~fi)(, U~ Pl Of8f165