HomeMy WebLinkAbout01-07-13PETITION 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 _
Name: ~ imrnelberger File No: '~" ~ r ~ ~ ~ C !-~`
a/kla: Ralph Himm~IberC~er (Assigned by Register)
a/k/a:
a/k/a:
Date of Death: 12/23f~012
Social Security No: 172-01-4006
Age at death: g3
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at 32~ Wesley Dr., A_pt 311417055 Lower Allen Township Cumberland Connty
Street address, Post Office and Zip Code City, Township or Borough
Decedent died at 325 ilvesle~ Drive 17055 Lower Allen Townshi
Street adc•!ress, Post Office and Zip Code City, Township or Borough
Estimate of value of decedent's pr~~nerty at death:
If domiciled in Pennsylvani~~ ................................All personal property
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania
If not domiciled in Pennsylvania .............................Personal property in County
Cumberland PA
County State
$ 100,000.00
Value of real estate in Pennsylvanm ............................................................. $
TOTAL ESTIMATED VALUE.... $ 1 ~~~~~~'~~
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary;)
Street address, Post Office and Zip Code City, Township or Borough (:ounty
® A. Petition for Probate and Grant of Letters Testamentary g/19/2011
Petitioner(s) aver(s) he/she/th';,y is/are the Executor(s) named in the last Will of the Decedent, dated and Codicil(s)
thereto dated -
State relevant circumstances (e.g. renunciation, death of executor, etc.)
Except as follows: after the ~..•xecution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein t~-e 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.
® NO EXCEPTIONS; ^ 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, 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 l~l been establis as de,,~ e
in 23 Pa. C.S. § 3323(g) am was neither the victim of a killing nor ever adjudicated an incapacitated person. G ~ I'v"1 ~
^ NO EXCEPTIONS ^ EXCEPTIONS rn +r.
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the folio lnpd~s~e (if any and'heirs'~ittach
additional sheets, if necessarv): ~" C~~ _ ,
Name
Relationship e
~dt~ress• -° ~ ~„3
- 7 ~.~ ~~t~~~
~. ,,
Page 1 of 2
hbrm RW-02 rev. 10:'11,2011
Official Use Only
Oa~~~ of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } -=~-;
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COUNTY OF Cumber :.:~ ~-- ~:~.>
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Petitioner(s) Printed Name
Petitioner(s) Printe ddt~st`"'
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43 Oak KNoll Drive
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~~'~' ~~~' '~~ ~'' ~~~ ~~
Linda K. Himmelberger Berw n ~`
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- PP~~~~ 19312
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The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition~re 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)~wil~ well and truly administer the estate according to law.
1 J l~
Sworn to or a fi ed a suescrib d be-f re 4 . r ~'~ ~ ~-~: ~ ~~% - ~ ~~- ~ ~ ~-~ c G~ ~ ~. ~' ~ ~ ~ c ~~~ I Date ~ ~ ~ / ~/`
me thi ' ~-- ~ ay f ~ , ~~, '~ Date
t. p~~ ~~~~ Date
By: , ~ -
the Register °'~ Date
BOND Required: ^ YES ® NO
FEES:
Letters ....................... $
~.C';~
( ?)Short Certificates(s;~ ..... .
( )Renunciation(s) ... ..... .
( )Codicil(s) ...... ..... .
( )Affidavit(s) ......:..... .
Bond .................. ......
Commission ............. ..... .
Oth~r •••••••••
--- x ....
~ ~!~..... ~~ t'..
.. ...... - c L
Automation Fee .......... ...... ~~ _ ~
JCS Fee ....................... ~ U
TOTAL ............... .....$ '( ~~
,,
To the Register of Wills:
Please enter my appearance uy my s~gna~ure [~eiuw:
Attorney Signature: -. _.. ~
.,~ ~
- ~ ; /~ .
~~.
Printed Name: David H. Stake, Esquire
Supreme Court
><D Number: 39785
Stone LaFaver & Shekletski
Farm Name: 414 Bridge Street
Address: P.O. Box E
New Cumberland PA 17070
Phone; 717-774-7435
Fax: 717-774-3869
Email: dStOrle~StOnelaW.net
DECREE OF THE REGISTER
'~' .n ~ ~ ~
Estate of Ralph H. Himrrtelber~er File No: ~-- ~ ~ -~ ~ ~ ~`-` ~~
a/k/a: Ralph Himmelberger
r`1
AND NOW, ~ .~~-'~- ~ ~ ~~ , in consideration of the foregoing Petition,
satisfactory proof havin~ been presented of re me, IT IS DECREED that Letters TeStamentar~/
are hereby granted to Linda K Himmelberger _r.
in the above estate and (if applicable) that
the instrument(s) dated 91192011
described in the Petition be admitted to probate and filed of record
last Will (and Codicil(s)) of De
Register of Wills ~ ~j~'~,/~.~"/`~ ~'~._
Firm RW-OZ rev. l0~'11%2011 ~ /,r Page 2, Of 2~~
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Type/Print In COMMON WEA LSfHi O'~S~EN NSY LVANIA • DEPARTMENT OF HEALTH VITAL RECORDS
State File Number:
Permanent CERTIFICATE OF DEATH
rfl
Q
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g
a
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3ck Ink
Sex
2
Social Security Number
3
4. Date of Death (MO/Day/V r) (Spell Mo
1 .
.
. Decedent's Legal Name (First, Middle, Last, Suffix)
Ral h Himmelber er - -
n Country)
ei
F
S or
g
a. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/DaY/Year) (Spell Month) 7a. Birthplace (City and State or
Months Days Hours Minutes
93 October 5 1919 76. Birthplace (you nty)
8 a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township?
r Allen twp.
LOWE'
_
Penns lvania (Yes, decedent lived in
325 Wes le Dr . A t . 3114
Sd. Residence (c°unty)
Cumberland Se. Residence (Zip Code) 17055 ~ No, decedent lived within limits of city/born.
e)
t marria
fi
g
rs
US Armed Forces? 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (if wife, give name prior to
I
9
E
ver
n
.
[Yes ~ No ~ Unknown ~ Divorced ~ Never Married ~ Unknown
Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Last
Middle
t
Fi
'
,
,
rs
,
s Name (
12. Father
Bertha Mae Hetrick
b
er er
Abraham M. Himmel
14 b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code;
'
s Name
14a. Informant
Linda Himmelber er Dau titer
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+
a
' h ( ,
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) _ _ _
15 a. Place of Deat C ec on y one . .. ..... .... ......... .... .... ...... ........... ................. ......... .......
................................................. . ................................................ ... .. ther Than a H to ~ Hos c Fa crlity ecedent s Home
atient :If Death Occurred Somewhere O ospi I~ Pi e ~ Q D
~ In
I
~ p
f Death Occurred in a Hospital:
t ~ Dead on Arrival _ Nursing Home/Long-Term Care Facility 0 Other (Specify)
ti
en
Q Emergency Room/Outpa
treet and number; 15c. City or Town, State, and Zip Code 15d. County of Death
i
i
W ve s
on, g
15 b. Facility Name (If not institut
Mechanicsbur PA 17055 umb n
l
LL
a e
Bethan Vil
16a. Method of Disposition Q Burial ~~Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other p ace
O° ~ Removal from State Q Donation
12/27/2012 Hollin er Cremator
p Other (Specify)
and Zip) 17 rg to re of Funeral S rvice Li ee or P on in Charge ent 17 b. License Number
State
T
i
,
own,
ty or
16d. Location of Disposition (C
014819
Mt. Holly Springs, PA 17065
E 17c. Name and Complete Address of Funeral Facility
M ers-Hamer Funeral Home Inc_ 1903 Market St_ Cam Hill PA 1 O
h
t
m a
18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate w
elf to be.
dent the decedent considered himself or her
de
th
h
h
~ s
ce
er
e
et
highest degree or level of school completed at the time of death. box that best describes w
is Spanish/Hispanic/Latino. Check the "No" ~ White Korean
l
d
i
h
e or
ess
etnamese
gra
8t
box if decedent is not Spanish/Hispanic/Latino. Black or African American Q V
d
e
No diploma, 9th - 12th gra
leted ~ No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native Q Other Asian
om
GED
ii
d
p
c
uate or
an
~ High school gra
Q Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawa
an Q Chinese Q Guamanian or Chamorro
Ri
P
uerto
c
0 Associate degree (e.g. AA, AS) ~ Yes,
Cuban Q Filipino ~ Samoan
Q Yes
,
Bachelor's degree (e.g. BA, AB, BS)
other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific Islander
MBA) ~ Yes
MSW
MEd
,
,
,
~('~ Master's degree (e.g. MA, MS, MEng,
~ Other (Specify)
l
1
Doctorate (e_g. PhD, EdD) or Professional degree .(Specify)
~
(e. MD, DDS, DVM, LLB, JD)
-Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
ti
i
ED
'
on
gna
.
s Single Race Self-Des
21. Decedent
White ~ Japanese ~ Samoan done during most of working life. DO NOT USE RETIR
0 Black or African American ~ Korean ~ Other Pacific Islander C1vil ineer
'
t Know/Not Sure
0 American Indian or Alaska Native ~ Vietnamese ~ Don
Kind of Business/Industry
22b
.
Asian Indian Q Other Asian ~ Refused
Chinese ~ Native Hawaiian ~ Other (Specify)
EL1 ineeri CO
.
Filipino ~ Guamanian or Chamorro
pplic bie; 23c. License Number
Signature of Person Pronouncing Death (Only when
/Vr) 23b
d (Mo/Da
d D
ITEMS 23a - 23d MUST BE COMPLETED
BV PERSON WHO PRONOUNCES OR y
ea
23a. Dat Pronou e
~ ~ ~l ~ ~l l~l ~ rf .
~
~ ~y V ~~~ ~ ~~
CERTIFIES DEATH Q~ (~~J L.~~ I TTT
23d~ Date i ( ; Day/Yr) 24. T~ of Death
25. s Medical Examiner or Coroner Contacted? Q Yes No
CAUSE OF DEATH Approxirn ate
Part I. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest, Interval:
Add additional lines if necessary ~ Onset to Death
26
li
.
ne.
respiratory arrest, or ventricular fib~ation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a
IMMEDIATE CAUSE --------------> a.
Due to (or as a consequence of):
(Final disease or condition
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
If any, leading to the cause _
listed on Ilne a. Enter the c.
UNDERLYING CAUSE Due to (or as a consequence of):
z
. (disease or injury that
_ initiated the events resulting d.
e of):
Due to (or as a consequenc
In death) LAST.
a`,' i
in Part I 27. Was an autopsy performed?
i
S ven
26. Part 11. Enter other signlf'ca nt conditions contributing to death but not resulting in the underlying cause g Ves Nv
o ,D~~-(~~ZC~.S {~'\~~.~ T V-S 28. Were autopsy findings availa blc
~ ~~ y i~ re
~YZ~z ~~ S~ ~ /~ ~ de ath7
ts the cause Nf
ply
to com
. o
e
O
30. Did Tobacco Use Contribute to Death? 31. Manner of Death
29. If Female: 0 Yes ~ Probably j~Tl atu ral Q Homicide
~ ~ Not pregnant within past year ~ No known ~ Accident ~ Pending Investigation
i
d
v ~ Pregnant at time of death
S of deatF
ithin 42 da
t ne
~ Suicide ~ Could not be determ
m w
Y
~ Not pregnant, but pregnan
ear before death
1
t
43 d 32. Date of Injury (Mo/Day/Yr) (Spell Month)
I-° y
ays
o
Q Not pregnant, but pregnant
~ 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:
~ Yes ~ Driver/Operator ~ Pedestrian
~l~o ~ Passenger ~ Other (Specify)
39a. ertifier (Check only one):
~Certlfying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
death occurred at the time, date, and place, and due to the cause(s) and manner stated
e
knowled
f
g
,
my
) and manner stated
Pronouncing 8. Certifying physician - To the best o
death occurred at the time, date, and place, and due to the causes
in my opinion
n
ti
i
'
,
,
ga
o
of examination, and/or invest
/
~ Medical Examiner/COrO r - On the-bas
M ~ 4 ~~ ~ ~~
Title of certifier: /~~ ~ License Number:
ifi
er:
Slgnatu re of cert
39c. D to Sig d (MO/Day/Vr)
Deat~(It~ `\ C ~ ~ ~^ ' ~ ' T
son Completing Cause of
e r
39 b. Name, Address and Zip Co a •of P
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~~~~,1/ ~ ~S V ~ - •--- 1 ~Y~~~ ~~ _ _ ~
V
, /Day/Yr)
o
Date (M
42. R istrar ile
40. Registrar's District Number 41. Registrar's tore
43. Amendments
H 105-143
Disposition Permit No. ~ / / ~ '7 ~ ~` REV 07/2011
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Z:\EP\WIL~~S\Himmelberger.Falph 9-2011.wpd ~
LAST WILL AND TESTAMENT ~~ r__ ~ ~~~y
OF ~.. , ~ -
~.
RALPH H . HIMMELBERGER ~ ( ~-~ `~~~~'
I, RALPH H. HIMMELBERGER, of the Lower Allen Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I: I direct that my Executrix hereinafter named shall pay all
my just debts and funeral expenses as soon as conveniently may be done
after my decease.
ITEM II: I devise and bequeath all the rest, residue and remainder
of my estate, of every nature and wherever situate, as follows:
A. One-half thereof to my daughter, LINDA K. HIMMELBERGER.
B. One-half thereof to my son, DOUGLAS R. HIMMELBERGER.
Should my son, DOUGLAS R. HIMMELBERGER, predecease me, I devise and
bequest his share to his wife, LYNETTE H. HIMMELBERGER, and in default
thereof, to the issue of my son, DOUGLAS R. HIMMELBERGER, per stirpes.
ITEM III: I appoint my Executrix and her successors guardian of
any property which passes, either under this w~_11 or otherwise, to a
minor and with respect to which I am authorized to appoint a guardian
and have not otherwise specifically done so, provided that this
appointment of a guardian shall not supersede the right of any fiduciary
in its discretion to distribute a share where possible to the minor or
to another for the minor's benefit. Such guardian shall have the power
to use principal as well as income from time to time for the minor's
support and education (including college education, both graduate and
undergraduate) without regard to his or her parent's ability to provide
Page 1 of 4
for such support and education, or to make payment for these purposes,
without further responsibility, to the minor or to the minor' s parent or
to any person taking care of the minor.
ITEM IV: I appoint my daughter, LINDA K. HIMMELBERGER, Executrix
of this my last will. Should my daughter, LINDA K. HIMMELBERGER, fail
to qualify or cease to act as Executrix, I appoint my son, DOUGLAS R.
HIMMELBERGER, Executor of this my last will.
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties in
any jurisdiction.
IN WITNESS WHEREOF, I, RALPH H. HIMMELBERGER, have hereunto set my
~~ day o f ,~ 2 011 .
hand and seal this --
E~
j'r ~ ~.,~
RALPH H. HIMMELBERGER
SIGNED, SEALED, PUBLISHED and DECLARED by RALPH H. HIMMELBERGER,
the Testator above named, as and for his Last Will and Testament, and in
~}- 1-~ i s r e rf i i e c t- i 1'1 }"1 i~ p r e c e Y?. C e a ~? ~ n ~- }~ e
the presence of us; .~:~ho a ~-,
presence of ea other, have subscribed our names as witnesses.
h
414 BRIDGE ST NEW CUMBERLAND, PA
Address
414 BRIDGE ST., NEW CUMBERLAND, PA
~~~;~- -
~- Address
Witness
Page 2 of 4
COMMONWEALTH OF PENNSYLVANIA:
. SS.
COUNTY OF CUMBERLAND
I, RALPH H. HIMMELBERGER, the Testator 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 this instrument
as my last will; that I signed it willingly and that I signed it as my
free and •~-o~_untary act for the purposes therei_r. contained.
RALPH H. HIMMELBERGER
Sworn to or affirmed to and acknowledged before me by RALPH H.
HIMMELBERGER, the Testator, this ~ day of ~~~~'~~~~~~~~ 2011.
" , ~ rci P
(y ~~ p~ Notary Public
$ c.b i ~~F ,.15 ~'..t i~ eL7 j` r
~88888~ ~~ > ~.i f ~7 1"'
Jutj ,.~,
Page 3 of 4
COMMONWEALTH OF PENNSYLVANIA
SS .
COUNTY OF CUMBERLAND
..-- \\
W e ,11~~~~ ~\ , ~''~`~-A-- and ~~~ ~~~~\ ,
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; ~~hat Testator signed. willingly and... that he executed i t 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.
Witness
Sworn to or affirmed to and acknowledged before me by
\ ~~ \ ~
~ ~
~-A-- and e~ ~_ ~`~...1~ l\ ,
. o
witnesses, this ~_ day of _. ~,~~i~~`~`[~~ ~ 2011 .
!~., : ~\``~'S~f~~,i1r~~,i ~i-~ ~~` ~'r~~i7U ~' °.,n~~~ Notary Public
,~_. ~, ? r ~~~r ~ g~ Y
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!- ca P,J ~~fJ,~B,s u'-!}y3 r~r3tt ~ Lr I.F,
Page 4 of 4