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Home My WebLink About01-25-13Reset PETITION 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: Edward D. Barrick a/k/a: a/k/a: a/k/a: Date of Death: January 12, 2013 File No: ~~ ' / ~ - (J / (Assigned by Register) Social Security No: Age at death• 80 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 2017 West Trindle Road, Carlisle PA 17013 South Middleton Township, Cumberland County Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Transitions Healthcare, 595 Biclerville Road Gettvsbure PA 17325 Adams County Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania .................... . .......All personal property $ 170,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 170.000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough 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 June 12, 2003 thereto dated County 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 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. ord.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. NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by ~ following spp~x~e (if a~)'d heirs (attach additional sheets, i necessa ~1 _, ~,. Name Relationshi ~ ~~ "' ~,d ¢re S S K e ` ~..., ~. J ~ ' ~.+y .K' I .r ~ o .,. .Y ... Y.~~i 'r .. ~,, -. ; w ~ ~u' f_.__1 . r, ~. r ___ ?-~ ..:: ~..~ ~.M e:, ~ ~-~ ,~r°~ Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } } SS: } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address Pe L.V. Russell 2017 West Trindle Road Carlisle PA 17013 ..T..~r ~^~.,~ ~.._...~ '"~ d ..~7s ~-- ~~~~ _ -.,s t i ",~ - - ~ 3 i ~~.y The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and cor~ct,ti~ thebest~o the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly ~,dmini~ter the•e~tate a`e~ordi~g to law. {_ Sworn t r affirmed~ncLsubscribed before ! _:? - ~ 7}ate / ~ S - / ~ --. A me th' ~`t' 'day of ~t , ~ Dim ~ c.Date 5` o the Register `'late BOND Required: ~ YES Q NO FEES: ~•~~ Lett s ...................... $ ( )Short Certificate(s)...... - ` ~~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Ot er ...... ....... G~, ~~ ....... Automation Fee ............... • `'`~ JCS Fee . .................... ~~ C TOTAL ..................... $ ~9-99- ~~-3, ~-v To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Pr~nted Name: Rona d/E. Johnson, Esq Supreme Court ID Number: 16453 Firm Name: Andrews & Johnson Address: 7R West Pomfret tree ('arli ~ PA 17(113 Phone: 717-243-0123 Fax: 717-243-0061 Email: DECREE OF THE REGISTER Estate of Edward D. Barrick a/k/a: File No: ~ ~ " ~,~ " D ~ AND NOW, ~.,~ /7 G/~ 1' ~ ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Peggy L.V. Russell in the above estate and (if applicable) that the instrument(s) dated June 12, 2003 described in the Petition be admitted to probate and filed of record,~s the last W}ll (and Codicil(s) of Decedent. Register of Wills Form RW-OZ rev. 10/11/2011 Page ~t' tOl• C~~1S CCI•tltl4~itC'.. .`>f~.tff • ~~-~•/~, r -`- _ ? ?;a •. ~. ;4° _t ,`;; :' ,~?;:i? i~1~' !I~tNOI'itlcitll3tl ht.'-1'c; L'I~~t'Il !5 ,r - ,_ bt ~`'~~~t,~ ...~. 'fd~ ..~,~ ~~lya- l~~ t.r~ri_. ~`O r?; ( i) 1 elh C!I`tl,~1T?il~ ~~l'1"tiflCLlrt: l)r ~~l'~ith ,~~ ir'~. .j(I"4 i,ati:il 1\,!!i lil't' i'1'~ i.~C)C;l~ ~`).l'_'Iti2-ill. T~ii' t~'lt,iliil~ ~~ -. -:i~ I~,, / ;:. ~_; ~, `~~~ ~~ra °° !~ --(.mow t, t~ ..I l'~ ~?ki °)L 11 )1 ~~.~l, llt'~? `~() ill_. ~~alil: ~J ie~ii ,~1 j : t i .. r r '~ ~ "r'' ~' t~ ~~ i ~ t~. _)9 , ic:C' A~('?- ~)t'3lllai~ik-ill ~l~lil~; . ~ 'yam ~ ' l ~ f , , - ~ 4~ _. #~ •~"- J 1 ~ L~13 ~_ ~l-~lt,ca~!(I!l ~~~,i~ll7F~l_ ~ , GUI~~ERL.@,-~ _: ~~~~4 ~ _~~; .. - ~~ ~~ il~;~. r>~1~~ I~,~LIe(~ 0 .. . f ?`5 Type/Print In ~ COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH ~ VITAL RECORDS / Permanent W Q >_ 0 O Z ~~•~ . •~ yr VGF\~f"1 1. Decedent's Legal Name (First, Middle, Last, Suffix) State File Number: 2. Sex 3. Social Secu ri[y Number 4. Date of Death (Mo/Day/Vr) (Spell Mo) ~ D' ~'~'~ i`/1 January 12, 2013 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc U d 1 D Ol . n er a 6. Date of Birth Mo Da ( / y/Near) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Days Hours Minutes 80 Newvi.l le, PA Jul 23 1 932 y , 76. Birthplace (county) 8a. Residence (State or Foreign Count Cl~nberland ^/) 8b. Residence (Street and Numb I l er - nc ude Apt No.) 8c. Did Decedent Live in a Township? PA YeS, decedent lived in South Middleton sd. Residence (County) 201 7 W _ Trindle Rd _ twp. G~-nnberland 8e. Residence (Zip Code) 1 701 3 Q No, decedent lived within limits of 9 E i . ver n US Armed Forces? city/boro. 10. Marital Status at Time of Death ~] Married Q Widowed 11. Surviving Spouse's Name (If wife Q Yes ~ No Q Vnknown Q Di give name i f , or to vorced pr irst marriage) Q Never Married Q Unknown Peggy Russell 12 F th ' . a er s Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Henry N_ Barrick Mildred P_ Bloser 14a Informant' N . s ame 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Ci Peggy Russell W' te, Zi co G P ~ 2017 W_ Trindle Rd_ Car1i 1e, 1 e 1 701 3 iz 15 PI f -••----,,,,--•-„ •: •.••• a. ace o Deat Check only one If Death Occurred in a Hos ital: - ....... ......................................................................••---...-- P Q Inpatient ~ If D ° ...---.....-....-..........-......... ; eath Occurred Somewhere Other Than a Hos ital: '••••'••••••••••••••••••••--•••--•••••- P Q Hospice Facility ~ Decedent's Home Q Emergency Room/Outpatient Q Dead on Arrival ~ Nur i H w s ng ome/Long-Term Care Facility Q Other (Specify) 156. Facility Name (If not institution, give street and number; • lSc Cit T Z LL . y or own, State, and Zip Code Transitions Healthcare lSd. County of Death Gettysburg PA -- `O , Ada1T)s 16a. Method of Disposition ~ Burial Q Cremation 16b Date of Di i i v . spos t on 16c. Place of Disposition (Name of cemete Removal from State Q Q Donation ry, crematory, or other place) »' p Other (Specify) 1/18/201 3 G~unberland Va11e M~ZOria1 Gard 16d Location of Dis iti . pos ens on (City or Town, State, and Zip) 17a. Signature of Fu eral Service Lic or~ ' ~n Charge of Interment 17 b. License Number Carlisle, PA 17013 ~ ~~ ~~~~ FD 012633 L 17c. Name and Complete Address of Funeral Facility Ewin Brothers Funeral Home, Inc_ 630 S_ Hanover St_ Car isle PA 1 ~ , 7013 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check th ' e 20. Decedent s Race -Check 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 th d ' e ~ ecedent considered himself or herself to be. 8th grade or less is Spanish/Hispanic/Latino. Check the "N o" ~CWhite Q No diploma, 9th - 12th grade Q Korean b ox if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed N o, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree 0 Yes M i M , ex can, exican American, Chicano Q Asian Indian Q Associate degree (e.g. AA, AS) Q Native Hawaiian Q Yes Puerto Rican , Q Bachelor's degree (e.g. BA, AB, BS) Q Yes Q Chinese Q Guamanian or Cha morro Cuban , Fili Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA Q P'nO Q Samoan Q Yes, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) (e. MD, DDS, DVM, LLB, JD) ~ Other (Specify) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be 22a ,White Dec d t' . . e en s Usual Occupation -Indicate type of work Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Crew Leader Q Asian Indian Q Other Asian Q Refused Q Chinese 22 b. Kind of Business/Industry Q Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Cha morro Ste SynteC CO _ ITEMS 23a - 23d MUST BE COMPLETED 23a Date P Cp r . ronounced Dead (Mo/Day/Yr) 23b. Signature of Person Pronouncin Death BY PERSON WHO PRONOUNCES OR g ( y p whe licabl J 23 p e c. License Number CERTIFIES DEATH 23d. Date Signed (MO/Day/Yr) 24. Time of Death ' 25. Was Medical Examiner or Coroner Contacted? Q Ves ~$ No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complicatior~s--that directly caused the death. DO NOT enter termin l i a resp events such as cardiac arrest ratory arrest, or ventricular fibrillation without showin the etiolo Interval: g gy. DO NOT ABBREVIATE. Enter only one cause on a lin Add dd e. a itional lines if necessary Onset to Death IMMEDIATE CAUSE ---------------> a. ~ ~/N-1, ~ C~~a rn Y~ ' _ (Final disease or condition Due to (or as a cons ~ -' ~r IT equence of): resulting in death) b. /4P~/+A.~.t ~-.s~ CiC3Q o's•_a R~ ~'9'~--."'~'L.oS I -E ~ a Sequentially list conditions, ~OT/~-S ' Yrf Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c. w UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury that initiated the events resulting d. in death) LAST. Due to (or as a consequence of): 0 26. Part 11. Enter other s~nificant conditions co ntributine to death but not resulting in the underlying cause given in Part I ~ 27. Was an autopsy performed? Q Ves ..tom No m 28. Were autopsy findings available to complete the cause of death? 29. If Female: Q Yes Q No 30 Did T b E . o acco Use Contribute to Death? 31. Manner of Death Q Not pregnant within past year u° Q Ves Q Probably atural Q Pregnant at time of death BT Q Homicide m Not re Want, but Q No -~n~known Q Accident Q P g pregnant within 42 days of death Q Pending Investigation r- Suicide Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) Q Q Could not be determined Q 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 In'u ~ ry (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. Ce (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronou i 8 C f nc ng . erti ying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Ex C oroner - On the basis of lion, and/or investigation, in my opinion, death occurred at the time, date, and place, and due to th e c use(s) and mann t d a er s ate ^^ Si a of certi Title of certifier: ~.~'~ License Number:W ~~ ~g.37L 39 - and Zip Cod of Person Completing Cause of Death (Item 26 - T~ 39c. Date Signed (MO/Day/Vr) 40. Registrar's District Number • 41 Re ist ' Si a t - a, t o . g rar s re ~ ~~~s 42. Registrar File Date (Mo/Day/Yr) 43. Amendments , \~ o t3 •~~~~ ( % H105-143 Disposition Permit No. ~ 7 ril!~ REV C17 /711 ~ n "`_~ ~. Gam.) ~. ~ f L ' t , 1 i ~~ .. . _.. ~ LAST WILL AND TESTAMENT ~ ~t ~~ ~ ~ - ~ ~ ~ ~ s .~~ ~ ~ _.._ ._.. ..., ;.r , c f , ,..~ w.. , EDWARD D. BARRICK ~ ,.. , - - - P :a I, EDWARD D. BARRICK, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my friend, PEGGY L.V. RUSSELL. Should my friend, PEGGY L.V. RUSSELL, predecease me, then in that event I give, devise and bequeath the residue of my estate of every nature and wherever situate to my daughter, KARLA A. NICKERSON. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint, PEGGY L.V. RUSSELL, Executrix of this my Last Will and Testament. Should PEGGY L.V. RUSSELL, fail to qualify or cease to act as Executrix, I appoint my daughter, KARLA A. NICKERSON, Executrix of this my Last Will and Testament. FIFTH: I direct my Executrix and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will an Testament, consistin of one 1 t ewritten a es each identified b m si nature this g ()Yp pg ~ Y Y g day of June 2003. (SEAL) Edward D. Barrick ` Signed, sealed, published and declared by the above-named Testator, Edward D. Barrick as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ,~ ~+ ~~ `. COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, EDWARD D. BARRICK, Testator, whose name is signed to the attached er foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Edward D. Barriek the Testator, this ~----~ day of June onn~z SEAL) AFFInAVIT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) ~--- d ~ ~ ~: • ~~ i.- ~~ ~-~ . r - 4. ~ ~ ~ the witnesses We, RONALD E. JOHNSON an whose names are signed to the attached or foregoin instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that Edward D. Barrick signed willingly and that he executed it as his free and. voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. S or ~: fi ed to and subscribed to before me by RONALD E. JOHNSON '= - ~ ; ,~:~ ° witnesses this ~ "~ da o Ju 2003. and ~-~ r y ~' ,~"`f/~j~l,G~ ~1-'"t-(SEAL) d !--(SEAL) ~. ,~ ~ ~ Witness 1 ~ / I Notary Public , NOTARIAL SEAL SHELLY SEXTON, Notary Pu~alic Carlisle Bara, Gumberiand County My Commission Expires April 26, 2007