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HomeMy WebLinkAbout12-27-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WII.LS OF C4m6erl an d 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 Name: i h q q ~/ D Q W S a/k/a: a/k/a: a/k/a: Date of Death: pec a r-~ ~' f g~ dt o I a Decedent was domiciled at death in G tarsi 6 er I q ~ ~ principal residence at a y70 ~-Oba[~ O~i vgl /i~c%Q,,; Street address, Post Office sad Zip Code I, '' Cfty, Towusbip or Decedent died at ll l Se u ~~ ~r a n ~ ~ • l7 t ~~ ffLf/'I" ] S~ ti /'Q Street address, Poat Office and Zip Code City, Township or Bor gh File No• ~ ~ - ~ ~ ' ~ .~~ (Assigned by Register) Social Security No: 7 ~o~' J~a~ - to y ~~ Age at death• 6 7 County, pGnnS~~V4~t; 4 (Stare) with his/her last c~Lc,r~ ~7c sS UnDeT lie,. T~,,,P ~~i~er/qn~ Estimate of value of decedent's property at death: If domkiled in Pennsylvania ............................All personal property If not doneiciled in Pennsylvania ........................ Personal property in Pennsylvania If not domiciled in Pennsylvania ........................ Personal Property in County ValWe of real estate in Pennsylvania ........................................................ . TOTAL ESTIMATED VALUE... . Real estate in Pennsylvania situated at: oZy70 ~-Oi~QCI) Dr i y'e ~ 70 SS- Jd~4i?>~ (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Towusdip or Couuty State $_ 38 s o 0 0.00 $ _' $ X75. nnn. nv $ ln6Q.o00.00 ~Ura eu~r+~r~h~ Boroug Couuty 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 ~p~ i ~ ~ D~ a 0 d B and Codicil(s) thereto dated 111 D h2 State relevant circunrsbsuces (ag. rcn+~nciation, dtatk of execwtor, eta) Except as follows: after the execution of the instnunent(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(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS © B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, ~i:4. or db.n.~>: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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the followi~ spouse (if an~and heirs (attach additional sheets, if necessary): C ~~ ~ ~j c~ Pr- Name Relationshi Addr "~ ~~ ~ "~ - .~:: rn r~ ~ rat -. ~:~ ---' .~ t- '~- ~ ~ o Form Rw-oz rev. 10/11/1011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } ss: } Official Use Only REC~~i~E~ ~E~ l~E OF RE~~STE« t~F ~~~~LS Petitioner(s) Printed Name Petitioner(s) R2'~41J X D ~4>^/5 /10 ~,1~'NL~JV ~ 1~~"LL DfZ~E ~ 73~ 9 ~~ ~~ CUMBERl.AhD ~~. PA 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 Deced the Petition well and truly administer the estate according to law. Sworn to or affirmed d subscribed before ~ .~ Date 2 ~ / a. met day of '~ , ~.~~ Date By: ~ Date For the Register Date BOND Required: Q YES ~ NO To the Register of Wi!!s: FEES: Please enter my appearance by my signature below: Letters ...................... $ ~' lJ • (~~ (~ )Short Certificate(s)...... ~ Q~ , (~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond--•-• ................... Commission ................. . IO,, t11herlI 14~1~ Automation Fee ............... . JCS Fee ..................... TOTAL ..................... S Attorney Signature: Printed Name: Supreme Coart ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of L~ lCl.~1 / ~ (,(~ File No: ~ 1 - ~ ~-- ~ ~j~ a/k/a: AND NOW, '~-e ('Q. rYl h D (~~ 7 ~~ 12 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED at Letters ~~ c5 rYl.l' I'~ ~-CQ I(l.~ are hereby granted to _ ~ (i~.t n k ~ (~cS . in the above estate and (if applicable) that the instrtunent(s) dated - ~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicils}) of Decedent Form RW-02 rev. 10/11/2011 Wills ~ c ~i~~~- 2 of 2 „Yr„~i..+r+la AC X11__ ~jE)~E~,~~F~ i~a~STRAR'S CERTIFICATION OF DEATH liVi>,l?~`I~:,~tQ~ihlegal to duplicate this copy by photostat or photograph. 13~{?.~AfV;;' C~L~nT ,^ F Fee for this certificate, $6.OI>v~~~"~BERL~;~',~ ~~'~'"' ~ This is to certify that the information here given is P 1917 8 ~~_~5 3 Certification Number e/Print In rrrsanent correctly copied fmm an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vita( Records Office for permanent filing. ~~ ~- }~rn~.n.. /~ / ~~/ ~ Local Registrar Date Issued COMMONWFALTN OF PENNSYLVANIA • DEIARTMENT OE NFALTN • VRAL RECORDS v s .-a a . • State Flle Number: 1. Decedents lyl Name Ifh4 Mlddk, las4 $ttNiK) 2. Su 3. Soc1N SeNrlty Number {. Dek o(DeaM IMO(Day/vrl IspeR Mel Linda KaY ~WS a 482 - 52 - 6408 aCt .r ~ Sa. Aee-un ekthaay nRI Sb. Udder 1 Yar sc ureter I b. Date of Birth IAKe/DeY/YwI IsaeB Month) 7a. BMhpIw llDtk'a Stake,~!Foreyn [auMry) M Mh M D Si i a s ourn MMUbf RYS otix C , lA 67 July 10, 1945 m. etrthplac.ltountyi L. Resklena (Arta « FarelBn CotaMM W. RniderNe (StreM all Number -Indude Apt lro.l k. qe OecNlenl Lke In a TewnMlpl lvania 2970 I otDaeh Drive Yes, eeaeeent lhed M jlpper Alll~1 ~ r ea.i (C9umy) ee. RefMenn (nP Cedal ^No, eeceeent Bwe wMhM NmM of cpy/yprp. 9. Ewr M US Armed f«m7 10. MadtM Stew at Time of Death MaMed ~ 11. SuMWrN SDOUp'a Name (If edfe, BYae name prier ro first mardaBel pyu QO No ^Unknown $I almrvd ^ Never Married ^Unknown 12. FeIMYS Wme IFks4 Mlddk, las4 Sufflsl Arth v 13. M«Mrs Name Prbr to Flit MarRye (FIn4 Mlddk, tart) i ur .+ar2sorl Dorothy Muth 14a. Infomant's Name 1{b. RNatlpnhlp ro DKedMt ik Informant's MMlirlg Address (Street and Number, Oly, Stall, Op Codel Brian K D 8 . aws Son 160 Winding Hill Drive Effete, PA 17319 ' ..................... ' .........._ :...................... ~! .............................. f , a I Meth OccumW M • NespMal: MOetknt ill Death DecvrrM Semewhen Othn TMn a Napttal: Nasplu FariMly [y DecetlentY Nome E Rodn/putpaNent Oasd on ARNaI N«sln flpme ilrm Grc hclNty Other ISpedryl r ~ 15b. FadIM, Wme III not Mwtkutlon, Blve street ell numMr; l5e CRY «Town. Sbte, all 21p fade lSd. County M OeaM LL Harri ital Harris , PA 17112 Dauphin lbs. MMhad a OYlatltbn ~ Btrrkl 0 Cremation Ibb. Oue of Dlsposllbn 1&. Pkte of DM paRlon IName of cemetery, crcmuory ««Mr plaal 0 Removal from Sbte ~ ~~ , aMr(sp.d I D 22 201 Gate of Heaven CeE1ie llid. l.ootkm M dspoehbn (Ory «Torun, Stab, and 21p1 ]7a. F w Peron In ONrry of IntermMl 17b. LkerNe Number Mechanicsburg, PA 17055 _ FD - 014889 17c. Name end C«npNb AddreN of FunerN FanNty 8 Mal zi EUr3eral Hone 8 Market P za Wa Mechanics PA 17055 ~ ~ U. Decedent4 Educetbn - Owck tM ba MH best deuRbea tM 19. Oae[Eent d Nlspenk OrIBM -Check Me 20. Decedent's Rea - [heck ONE OR MORE races tO lMkate wMt hIBMR dMrce «kwl M srlwW oNnpeted at Me tim f d th b h b e o ea . oa t at ut describes wMMer tM decedent tM deadem consMwed hlmsell or herseM b 6e. ^ BM Bnde«kM Is SpenMh/Nbpenk/Ladno. Check the'NO' While ~ Kaaan ^ No dipbma, 9M - 12th Breda bet N decedent k net SpanishMkpank/Latlno, ^ Nack «A/rlcan AmeRCen ~ Vktnamese ^HlBhfchool padueee«GEDamplead ~NO, not Spankh/Nhpanlc/laUne ^Amercan Indian er Alaska NrtWe Other ASkn ^ Some cogege r+e014 but no degree ~ Yes, Mealan, McKkan American, Chicarro ~ ANan Indian ~ Nathre Nawalkn baodate dyne le{. AA ASI ~ Yn, PueRO Rkan ~ Chinese ~ Gwmanlan «[hamomo ^ Bachelor's degree Ie.B. BA. AB, B51 ^ Yu, Cuban ~ Flllpirm ~ Simpan ^ MasbYS darn le.e MA, M5, MErµ MEd, MSW, MBA) ^ Yes, rrther $panish/MMpankJbdno ~ Japanese ^ Other Patlflc Islantler ^ Dpct«ate (a.B. PhD, EEO) a Pre/essbnai dare! ISwcBVI ~ OtMr ISpeufyl e . MD DOS DVM LIB 1D 21. Decedent's Sire pea SeN-OeslBnatlon -Chet! ONLY ONE to Mdkate wMt tM decedent comldeM hhnseN «herselr to be. 22a. Decetknt'a Uwal Ocwpatbn - Indipte type o/work Whtte ~ ApeMaf ~ Samar done duriry moat e/ worldry IKe. DO NOi USE RETIRED. ^ Black «AMan AnNrksn ~ Koran 0 OMm PacNk Isbnder ^ American IMlen w Alaska Native ^ Vklnemoe ^ Don't Know/Ilot Sure Ia~ ^ Askn kMbn Q Other bkn ^ Mfusad 22b. KIM olBwlness/Indurtry ^ [hMese ^ Nrthre XawaWn ^ abet (SpNIM ^ Fipplno ^ GuamaMen «l:ham«ro ~•5. { rv. '`''7 REfAS 2L - lad MI16r BE COMPIFIfD 23a. Dora Prpnpunad Deed ( eY rI x3b. SlBneturc o Person PronounclrlB DeaM IDnM when ap e 23<. LkMw Number BY OEllSON YYND PRONOUNCiS OII CfR]Nl[S OBATN 23d. Date SIB (MO/D+Y/Yr) x{. Tlrne er Death S' 1 25. WN McEWIEKNnMer«Caroner [ontaptea7 ^ Yef Ne CAUSE OF DEATH Appmalmm 26. Part L EntN the cfigln of awash-Elseases, InWrks, d wmpNceNOns-that dlrKdy ousel IM EeaM. DO NOT enter terminN ewntt such as aMlx arrest Interval: respinbry smart, a wntncWar flbRRaUOn wtt ho u l shoa+kr{ tM etblgy. DO NOT ABBREVIA T E. En te r only one cruse on a Ilne. Add addltbnal Ilnas I/ necessary j Onset to DeaM ? ~ 7 ~ J ' ' g IMMEDIATE UUSE '-"---"'------> a. ~~ 1 /"H C ~'~~'N I /8 L ~C re! J s"/~~'~ (Final dlMase er CoMitbn Due to tar as a ransequence ell rewltlnB In dull) b. p/J ~1~1a2 orl ~q Saquantlapy Ike coMkbns, Due to ter as a canugwnce ofl: n .m, leadNy ro the au.e Ilrted on Nne e. Eller Me UNDBIILYING CAUSE Due to for u a sanuque«e oft: (tlbease «InWry Ulet F Irdtlrted tM event rewMng d. In daathl LAST. Due to rot as a consegwnee oft: s~ 26. hrt 11. Enter other NNIflaM aMBtbns arrWblrtku b deaM but not rewRMB In the underlylry cruse BNen in Part I 2T. was an autapry parl«medt I Yes No ~ 2B. Wen autopsy Mdkyf awllabk pp rocompkb the ou. aeaen7 Yu W 29 M Fe k: B NOt n t khl 30. Did Toba¢o use Contribute to DeaMP 31. of Death an w n put war PR ^ Yes ~ IrooablY Wtunl ~ NomlUde ~ ^ Prgnant at Hme of death ^ No Unknown ^ Accident ~ PMdInB Inwstly[bn ~ Met pngnan4 but pnBrlant wltMn 12 days a/deaM ~ Sukke ~ Could rat be dHennlnetl ^ Not prgrNM, but pregnant {3 day to 1 war Mfore death k 32. Date of InWry (MO/DSY/Yr) (Spell Menthl ^ Un nown I/ pngrwnt wphM tM part yar 33. Tlma o11nWry 3{. Plea o/ Inlury Ie.B. home; conrtrrMbn Me; brm; scroll 35. Locatbn o/ InWry IStleet and Number, Ctty, SUte, xIP Code) 36. Inury a Work 3]. If Tnnsportatlon Inlury, Specify: - 3s. DeserMe lbw Inlury Occurred: Yn 0 Drwer/Operator 0 Petleaeden ^ W ^ hwnpr ^ OMer ISpatiNl 3 9a. CertMkr lCheck ally oral: Q 4rdhua PhYdtlan -TO tM best of my Frlovrkdp, deaM accreted dw to ell uuselsl all manner sla1M ~ PronouMlry B GRNyey physklan - To the best O• , dNM o¢urrcd at tM dme. deb, ill place, all tlu! to tM Uwe(sl and manner stand ^ Medkal EKaminer [M el ea , a «IMUfyatlen, M my oplMon, deaM occurred at ell time, date, all place, and dw eo the awelsl all m anner stated /~ ~ Synrturc of artMk1: TRk o/ certlAer: llanu Numher:~ y 3~ -1 ,)~ 3 b. Nerve. Address all OP o/ Panon Cam Cause of DeaM IMm 261 39c. Dale SIgnM IMOMaY/vrl ~ ~Co lJ ~ 31. ~R ti71 ~ ,- as 4 0. R ~ ~ ~ 1 ,~ {l. Regktra s tun 3. Regk[ar D~ r ,a ~o a ~, 4 3. Amendmerlb 0819489 Nlos-la3 dspesklon Permtt Na, qEV 07/x013 ~~~~ ~~~ ~~~ V~~~~~~~ ~~ r__ c~ ~, ~ ~ m ~p ~~ c~ OF Q'' -~ ~`~-, cia LINDA K. DAWS ~; u~ ~ ~ a BE IT REMEMBERED, that I, LINDA K. DAWS, of 2470 Loc Di~ive~;,, ~° a:~ . ~ __ Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, '' mory an ~y understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof made by me at any time heretofore. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my two children, BRIAN DAWS and BRICE DAWS, in equal shares per stirpes. ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 4: I appoint my son, BRIAN DAWS, as Executor or of this my Last Will and Testament. Should my son, BRIAN DAWS, predecease me, fail to qualify, cease to act, or renounce probate, I then appoint my son, BRICE DAWS, as contingent Executor of this my Last Will and Testament. ITEM 5: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 1 _~ ITEM 6: My Personal Representative shall have the following powers in addition to those vested in them by Law and by other provisions of this, my Last Will and Testament, exercisable without court approval, and effective until distribution of all property: 1. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 2. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 3. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. 4. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. 5. To borrow money from persons or institutions, themselves included, and to mortgage or pledge any or all real or personal property as they in their sole discretion shall choose, without regard to the dispositive provisions of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7. To make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 10th day of April, 2008. WITNESS: ~~ ,~..f~t ~ ~~ l~>>~ (SEAL) LINDA K. DAWS 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS We, LINDA K. DAWS, DAVID J. LENOX, ESQUIRE and APRIL L. GASPER, the Testatrix and the witnesses respectively, whose names are signed to the attached or 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 Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this 1 b~day of ri ~ , 2008. NOTARY PUBLIC MY COMMISSION EXPIRES: COM"c".^;,;lf,/E~?L?LI E ;~s r ~V YLV IA Nc:arial Seal S. Dawn Gladfefter, Notary Public Dillsburg Boro, York Counly MY Commission F~Iree May 17, 2009 Member, Pennsylvania Association of Notaries 3 WI ESS m