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HomeMy WebLinkAbout01-28-13PETITION 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 ~ ~ - ~ ~ ~ ~ ~ ~ .7 Name: HELEN E.__ALLE__MAN File No: - _ - (Assigned by Register alk/a• _ a1k/a: - --------- - -- - _ - _ - - - - a/k/a. Social Security No: ---__ - -- - - -- Date of Death. 1 /16/20.13_._ _- _- _ -- Age at death: _ _ _ -- -- _ Decedent was domiciled at death in Cumberland _ - _ County, PA _ - _ - (State) with his/her last principal residence at 1700_Mark_e__t Street ___ - _- 1.70.11 - Camp_HiII _ Cumberland--_ Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 1700_Market Street___ __ _ _ .1.70.11. -_ _Camp Hill - - Cumberland_ PA _ Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: 100,,000.00 All pe so I property If domiciled in Pennsylvania ................................ r na P $ - If not domiciled in Pennsylvania .............................Personal property in ennsylvania If not domiciled in Pennsylvania .............................Personal property in County $ - - Value of real estate in Pennsylvania .............................................................. $ - - -- TOTAL ESTIMATED VALUE.... $ - ~~~~~~~' Real estate in Pennsylvania situated at: _-_ - _- _ _ - - _ _ __ - - ____ ----- -__ __ Coun (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough tY ® 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 1/14/2013. - __ and Codicil(s) thereto dated _~/A -- _ _ _ - _- _ _ _ - - - - _ - - __ __ --_ _ - -- - _ ---- 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. 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. ..- . Aa7 _ ~ .~ ^ NO EXCEPTIONS ^ EXCEPTIONS ~ ~~~ and.he~t Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the fot~vispouse (~ ~ ,y) rs~:(attach `~, Ci.'~ ,' . additional sheets, if necessary): P"+~i ~.; k.:? t'~ 3 Name ' tY~ctdre~s ~ ~--' __. Relations ~ _ _ - _ _ __ h ~ ... - ---- -- .. .„ ... i ~` --... _._.__.._ ----. - _.--.__ ... ... .... .. .... .... i . ... i ~ r' ._ --i. ~ --- - -- 5 .`./ Page 1 of 2 /brm RW-02 rev. 10/11/2011 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF _C_UMBERLAND-- _ -_ __ } -- - _ - Official Use Only ,,,I _. - ~.~ -~. _. ~- -- - --- , Petitioner(s) Printed Name Petitioner(s) Printed Adds "= ~--w i ...,.. c~i7 - - --o- - - - - -- - - 57 WALSH ROAD '~ ° " ~_= - .. -_ -- HALIFAX - _ _- - u ~ - PA 1~932- ~AVID LIETMAN_------ ---_ - °,, i N 57 WALSH ROAD ~ ~ ' ._. ' - -- PA 1703 --- -- ~-~ , ~A-TRICIA LIETMAN__ ___-__- _ _- _- _- -- _-- HALIFAX..-. _-___ - - - _ - - - ,,., o _ ,;:°~ ~.. _ .. . ._. _ -- ..h... _ ti~-- 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 Decedent, th etitigner(s) will well and truly administer the estate according to law. Sworn to or afi ned and sub ~b~~ue~o e . ~~ ~_ - - Date ~ ~28~2013_ _- - ___ - j ~ E' /~ me th' --28 -_ day of ~ urn-- _ , __ ~-- '(,>'Gt-~-~-- - - - Date 1 /28/2013 _ ~~ ~ ~ - _ _ Date _ - - -_ _ - -_ - - - y,, - --- - -- Ff~° the Register Date -_ -- - - BOND Required: ^ YES ^ NO FEES: Letters ...... ................ $ _ -_ - - - - (5 )Short Certificates(s) ...... __ _ - _ ( )Renunciation(s) .......... _ - - - ( )Codicil(s) .............. -- - - - _ _ ( )Affidavit(s) ............. __ _ __ - _-- Bond ........ - - -- -- Commission ...... ............ - ---- -- Other ......... --- --_ - - Automation Fee ....... ......... _ ----- -- JCS Fee ......... ........ - _ __ -- TOTAL ......................$ -: - __- -- To the Register of Wills: Please enter my appearance by my signature below: - - - Attorney Signature: Printed Name: CHARLES-E. PETRIE - _____- _ Supreme Court ID Number: 29029- _ - -__ -_ Firm Name: CHARLES E. PETRIE - - Address: 3528 BRISBAN STREET - - it - - HARRISBURG _ PA 1.711_.1.._.. - - - - i Phone: 7.17__56.1-1.939- _. _- - -- _ _-- Fax: 717.561-4121_ _ _- _ - -- - - - - Email: I PetrieLaw@AOL.com -- __ - - DECREE OF THE REGISTER --- z- _~_l3_ -~l©~-_--- Estate of HELEN E. ALLEMAN _ _ _-----_ - -------___ - __ - _ _ -_ _ - -- File No: - alk/a: ----__-_- - _-_ - _ - - _ - - - - - - _ -- -_ AND NOW, ~ ~ ~ A r ~ - - ~ ~ ~ ~~-~ r ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS SCREE_~1 that Le ers - ~ ~~ b ranted to ~ ~- V ~ GL ~ n C~ ~ ~ ~l~ l G I. i~ _ L_~ ~ _~ are here y g in the above estate and (if applicable) t at -_ - _ -. -- -;- -- the instrument(s) dated _~~~ !') ~! Gt r' y-_ 1- ~ l - - - _ - described in the Petition be admitted to probate and filed. of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ' ~ ~ Form RW-02 rev. 10/ll/2011 ~ Pa'g~ . f . ~\ ~~ as '`~ ~ r i y*.. ae :J! i~lY ~i ! V ~j i~ ,~ COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH • VITAL RECORDS Type/Print In Permanent CERTIFICATE OF DEATH State Ffle Number: Black Ink - -+ ~_.. ~ cr,cial Security Nurtlber - , 4. Date of Death (Mo/Day/Yr) (Spell Mo) 1. Decedent's )_egal Name (First, ~iddl ay (Yrs7 moo. undo =a• --' --~--- - Months Days Hours Minutes :e or Foreign Country) 8b. Residence (Street and NumbC ~ inty) ~ • L 8e. Residence (Zip Code) M It 1 Status at Time eath ~ Marr iAO/Day/Year) (Spell Month) ~7a. BI hplace (City and ,~ ~ ` 7b. Birthplace (County) pt No.) Sc. Dld Decedent Live In a Township? QYes, decedent lived In o, decadent Ilved within limits of ~, ~ Widowed 11. Surviving Spouse's Name (If wife, r. I ~ city/boro. to first marriage) 9. Ever in US Ar d Forces? 10. ar a Q Yes No Q Unknown ~ Divorced Never Married Q Unknow ~~ n First M rlage (Fir lddle, Last) J o Mother's Name Prior t 13 / 12. Fa er's Name (First, Middle, Lasi, Suffl /~ ~ ~ 1 . ,~ ~ Zi /-e/ t 5 d L me N ' Decedent to R ationship 14b p ta e, rass re and Nu ber, City,~ 14c. Informant's Mailin ~ s a 14a nfo mant p ~ _ .. ... lSa. P ace o eat C ec on Y one ,,, ,,,,.... '• """""' t s Ho .. .. ....... ......... P .. .. Hos ice lit ~ D me .. ..................................................................... Fact eceden Ocher Than a Hos ital: ~ P y h G ~ ~ ....... ................................................. If Death Occurred In a Hospital: [~~ Inpatient ere :If Death Oc urred Somew Home/Long-Term Care Facility Q Other (Specify) i _ ~ Dead on Arrival ~ Emergency Room/Outpatient Q mber; d ng _ urs iSd. County of eath nd Z p de ~ Ci[y or Tow State, iS nu lSb_ Facility Name (If not institution, give street an ~ c O v~l ~ lace) h ~ ..~- Date of Disposition 16b er p 1 c. Place of Disposition (Name of cemetery, crematory, or ot ~ m iba. Method of Disposition urial Q Cremation Donation State Q l f . ~- - f3 '~'~~ ® ~ ~~/'~ S rom Q Remova Other (Specify) and t S ~ ~ / 1 gn re of uneral Se e Ice L ensee Pers Charge Interment 17b. License um er / a+ ~ ta e, 16d. Location of Disposition (City or Town, ' f.~ ~y ~ ~ 17c. Nam and C let~dresws o)f Funeral Fa ility ~ ~ f ~ Decedent's Race -Check E OR MORE races to indicate what 20 ~' dent's ducation -Check tthe box that best describes the D 19. ecedent of Hispanic Origin - eck the r the decedent th h . elf ent considered himself or hers the i°- ece 18. highest degree or level of school completed at the time of death. e e box that best describes w anic/Latino. Check the "NO" h/His i S Q KOrean hits mese i ~ 8th grade or less p s pan is box ecedent is not Spanish/Hispanic/Latino. etna V ~ Black or African American Q Other Asian t We ~ N l k Q No diploma, 9th - 12tH grade d No, not Spanish/Hispanic/Latino a as a Q American Indian or A Q Native Hawaiian 0 High school graduate or GED complete ~ Yes, Mexican, Mexican American, Chlca no Asian Indian ~ ~ Guamanian or Chamorro 0 Some college credi[, but no degree Q Ves, Puerto Rican ~ Chinese ~ Samoan soclate degree (e.g. AA, AS) helor's degree (e.g. BA, AB, BS) Ba Q Yes, Cuban /Latino i Q Filipino Q Other Pacific Islander Q Japanese c MS, MEng, MEd, MSW, MBA) MA g ree (e de ' c Yes, ocher Spanish/Hispan Q if ) S , . . g s Q Master Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) y pec Q Ocher ( e. MD DDS DVM LLB JD -Check ONLY ONE t i o in dicate what the decedent considered himself or herself to be. ne du ens mo t ofaworkingalfen DO NOT USE RETIRED. d2 on 21. Dece Ht's Single Race Self-Designat hire Q Japanese Q Samoan Other Pacific Islander Q o A / / S Q Black or African American Q Korean r Alaska Native Q Vietnamese di Don't Know/Not Sure Q / C - 22b. Kind of Business/Industry an o Q American In Q Other Asian d Refused Q ian ~ Asian In Chinese Q Native Hawaiian Q Other (Specify) Q Q Filipino ITEMS 23a - 23d MUST BE COMPLETED Q Guamanian or Chamorro (MO Oay/Yr) d De u`ced 23a. Date P 23b. Si n t e of Person Pronouncing Death (Only w~ apl~llcable) j\ 23c. License Number ' ~ ~ BY PERSON WHO PRONOUNCES OR ~ O g ~~ v` 3 /`~/ e ~ So 3 CERTIFIES DEATH 23d. Dat Signed (MO/Day/Yr) 24. Time of De~ h ~ Yes o 25. Was dical Examiner or Coroner Contacted? ~ ` ~ _ CAUSE OF DEATH Approximate Interval chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest, Onset to Death one c use on a line. Add additional Tines if necessary h l e 26. Part 1. Enter t ventricular fibrillation without show t y ing the etl logy. DO NOT ABBRE IATE. Enter on , or respiratory arres IMMEDIATE CAUSE ---------------~ a. -- Due to (or as a conuquence of): (Final disease or condition resulting in death) b. Due to (o onsequence of): Sequentially Ilst conditions, if any, leading to the cause listed on Ilne a. Enter the c~ Due to (or as a consequence of): UNDERLYING CAUSE ~c (disease or Injury that Initiated the events resulting d• Due to (or as a consequence of): c ~ In death) LAST. iven in Part 1 27. Was an autopsy perfor 26. Part 11. Enter other -- ^^-+"i'~ns contributin¢ to death but not resulting in the underlying cause g Q Yes o s avail ble di fi 0 ng n 28. Were autopsy to complete the cause eath7 ~ 'i Q Yes No - m v 0. Did Tobacco Use Contribute to Death? l 3er of Deat Homicide Natural a € 29. If Fe e: Not pregnant within past year y Yes ~ Pr Q No nknown Q Accident Q Pending Investigation Suicide Q Could not be determined c~ ~' 0 Pregnant at time of death Q Not pregnant, but pregnant within 42 days of death Date of Injury (Mo/Day/Yr) (Spell Month) 32 Q ~°- Q Not pregnant, but pregnant 43 days to 1 year before d eath . ~ ~i ~7S ~ 33. Time of Injury L, ~ Unknown if pregnant within the pass year Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 5 eci 38. Describe How Injury Occurred: Injury at Work 37. If Transportation in}ury, p >Y: y Q Driver/Operator Q Pedestrian No Q Passenger Q Other (Specify) ^. ar (Check only one): Certifyln6 Physician - To the best of my knowle ath occurred a to the cause(s) and manner stated ~ Pronouncing g. Certifying physician - To the st of m knowle ,death occurred at the time, date, and place, and due to the cause(s) and manner stated ~ Medical Examiner/Coroner - On the ba xam tion, /or investigation, In my opinion, death o c red at the time, date, and place, and due to the c seA) Title of certifier. License Number: VV Signature of certifier: 39c. Date SI d ( /'~ b. Name, Address and Zip Code of Perso om ng Cause of Death rem ;6) f~ Q E l~.i '~~ _ 4 (~ 1V ~ 'f!i ~ / - 42. Registrar FI a Date . Registrar's District Number 41. R/~T/@~r's Sig re 2~/ /J~ 1 ~, H105-143 (~~( C-/j.~~ REV 07/2011 Disposition Permit No. twp_ ._ d, ... C r..~ ~.,...~ ~,_~ ~,..r.s u :~ r LAST WILL AND TESTAMENT -~ q _ - ~ .~ - . I HELEN E. ALLEMAN, of 1700 Market Street, Camp Hill, Co~rity of ~~ erland Penns lvania, do hereby make, publish, and declare this to be my Cumb Y LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death, I give, devise, and bequeath all of my property, real, personal, and mixed to DAVID and PATRICIA LIFTMAN, or to the survivor of them. THIRD, that I hereby appoint DAVID and PATRICIA LIFTMAN, as the Co- Executors of my Estate. If either is unable or unwilling to perform in this capacity, then I hereby appoint the other as the Executor of my Estate. I direct that my personal representative shall not be required to post bond in this or in an other jurisdiction. Y ~~ ve hereunto se m~~~~ e }this IN WITNESS WHEREOF, I ha ~.. ,~~ ,f,~ rn ua 2013. <'`~ ! _ ;r ~_,`; , / ; 14 day of Jan ry, ,~ ~____, ~, HELEN E. ALLEMAN ~~~ WITNESS ~. ~., wM~.~ ._.> WITNESS ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, HELEN E. ALLEMAN, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have 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 HELEN E. ALLEMAN, the testatrix, this 14~ day of January~1 013. .~ ~-~~ -~ HELEN E. ALLEMAN -~-, TARY BLIC .~v_~ ~. r"~~ -r~i~~yl?v t~ i 3 _ ~y ~~ e~FTiIAVTT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and PATRICIA LIFTMAN, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT; that HELEN E. ALLEMAN signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE and PATRICIA LIFTMAN, witnesses, this 14~ day of January, 2013. G"~~..G.~~°~ WITNESS -~ ,. `~-- w. ~---.. WITNESS TARY~UBLIC CC?MMON`NEALTH OF PENNSYLVANIA ~lOTARIAL SEAL ~CE~ LY ~.'~~EreTS, Nei: ~i' i/'~:~~gc ~,.~_ Pv?y ~;ommiss~on Exr~~s January 27, 2013