HomeMy WebLinkAbout01-30-13PETITION 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: BRIAN LEE ALEXANDER File No: 21-1~ 1
a/k/a: BRIAN L. ALEXANDER (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 12/26/2012 Age at death: 55
Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA (State) with his/her last
principal residence at 433 S YORK STREET, 17055 BOROUGH OF MECHANICSBURG CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at CLAREMONT NURSING HOME17015 MIDDLESEX TOWNSHIP CUMBERLAND PA
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 $ 1.500,000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
If not domiciled in Pennsylvania .............................Personal property in County $
Value of real estate in Pennsylvania .............................................................. $ 143,100.00
TOTAL ESTIMATED VALUE.... $ 1,643,100.00
Real estate in Pennsylvania situated at: 433 S YORK ST MECHANICSBURG 17055 BOROUGH OF MECH. CUMBERLAND
(Attach additional sheets, if'necessary.) Street address, Post Office and Zip Code City, Township or Borough County
® 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 9/28/2012 and Codicil(s)
thereto dated NON E
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 (1f applicable)
c. t. a., d.b.a., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate
If Administration, c.~a. or d.b.n.c.~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 the followinpouse (if any~a~d heitsw'~acitat=h
additional sheets, if necessary): _ ~ `--~° ~~._._ ,.. ~ ~„
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Name Relationship Adt~sg; -~-
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Forna RW-Ol rev. 10/11/2011 Page 1 of 2
Oath of Personal Representative ot~~~ai use only
COMMONWEALTH OF PENNSYLVANIA l ~ ~-~-' `~~~ ° `'`
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COUNTY OF CUMBERLAND ~~~ -- '~''
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Petitioner(s) Printed Name Petitioner(s) Printed ~dd~ss _ " ~,
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116 E. SIMPSON STREET "'~ ,~
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JANET L. YOST MECHANICSBURG M--- PA . 17055
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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 Representatives) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to ~ af~irmed a ubscri~ d before (~,~ ;: -2` --~ ~ ~~~ ~ ~~ -ti~ ~~ Date .' -- ~ p~' ~- - r ~ ~~ -
me this C day of , ZUl~ L Date
BY- ~ ~ Date
r the Register Date
BOND Required: ^ YES ® NO
FEES:
Letters . ..... $
( ~) Short Certificates(s) ..... .
( )Renunciation(s) ......... .
( )Codicil(s) ............. .
( )Affidavit(s) ............ .
Bond .........................
Commission ................... .
Other.. .........
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To the Register of Wills: I
Please enter my appearance by my "sig ` ~ure below:
1
Attorney Signature:
Printed Name: MURREL R. WALTERS, III
Supreme Court
ID Number: 24849
Firm Name: MURREL R. WALTERS, III
Address: ATTORNEY AT LAW
54 E. MAIN STREET
MECHANICSBURG PA 17055
Automation Fee ................ .
JCS Fee .......................
TOTAL ......................$
Phone: 717-697-4650
Fax: 717-697-9395
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Email: murrel(a~waltersgalloway.com
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DECREE OF THE REGISTER
Estate of BRIAN LEE ALEXANDER File No: 21-13- ~~
a/k/a: BRIAN L. ALEXANDER
AND NOW, !~ /-~- ~~ ~v , in consideration of the foregoing Petition,
satisfactory proof having been presen d before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to JANET L. YOST
in the above estate and (if applicable) that
the instrument(s) dated 9/28/2013
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills ~s~~j CC/~C/-u~c
Form RW-Ol rev. 10/11/2011
Page 2 of
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COMMONWEALTH OF PENNSYLdA~11Ai DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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1. edent's Legal Name ( first, Middle, Last, uffix) 2. Sex 3.
ocial Security Number 4 . Date of Death (MO/Day/Vr) (S ell Mo)
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Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Un er 1 Da 6 . Date of Birth (MO/O ay/Year) (Spell Month) 7 irthplace (City and St ate or Foreign ry)
~G Months Days Hours Minutes j f~`
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JY / 7b. Birthplace (County)
Ba. nee (State or Foreign Country) Bb. Residence (Street and Number - I elude t No.) Sc. Did Decedent Live in a Township?
^Yes, decedent lived in twp.
. Residence (Cou ty) ~~
8e. Residence (tip Code) ' ~ G ~/
~JNO, decedent lived within limits of ~ r- r ~ city/boro.
9. Ever in US A med Forces? 30. Marital Status at Tim
e
of Death ^ Married ^ Widowed 11. Surviving Spouse's Name (If wife, give name prior to Frst rriage)
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^ Yes ~Na ^ Unknown ^ Divorced Ls7 Never Married ^ Unknown
1 aI er's Na a (FI [, MI le, Las[, Suffix) 1 gther's Na a Prior to First rriage (First, Idle, Last)
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14a formant's N me
146, elations ip to Decedent
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f ma is Mailing Address (Street and Numbers Ciry, State, Zip Codel
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lSa. P ace o Deat C ec on y one!
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If Death Occurred in a Hospital: ~'tnpa[ient : W,
If Death Occurred Somewhere Other Than a Hospital: ^ Hospice Facility u Decedent's Home
^ Emergency Room/Outpatient ^ Dead on Arrival
~ ~fVUrsing Home/Long-Term Care Facility ^ Other (Specify)
. Facility Nam (Ii of institution, five st ee[ a d numbe ' 1 City r 7o
n, Stat , Zip Code. _
lyfl. Courtty of Death
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16a. Method of Disposition Burial ^ Cremation 166. Oate of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
^ Removal from State ^ Donation ~ r, /~ n rr
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^Other (Specify) ~~~ I
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lfid. Location of Disposition (City or Town, State, and Zip) 17a. Si re Funeral Servi a Licensee or Person in Ch of Interment 1 7 License Number
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7 a e and m lete Addr s of Funera F ility ,
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18. ecedent's ducation - eck the boz that best describes the 19. Decedent of H panic Origin -Check the 20. Decedent's Race -Check ONE MORE races to Indicate what
highest degree or level of school completed at the time of death. box that best describes whether the decedent the cJccedent considered himself or herself to be.
^ 8th grade or less is Spanish/Hispanic/Latino. Check the "No° hite ^ Korean
^ diploma, 9th - 12th grade
-ligh school graduate or GED completed box'f decedent is not Spanish/Hispanic/Latino.
(j~ No, not Spanish/Hispanic/Latino ^ Black or African American ^ Vietnamese
^ American Indian or Alaska Native ^ Other Asian
^ Some college credit, but no degree ^Yes, Mexican, Mexican American, Chicano ^ Asian Indian ^ Native Hawaiian
^ Associate degree (e.g. AA, AS) ^Yes, Puerto Rican ^ Chinese ^ Guamanian or Chamorro
^ Bachelor's degree (e.g. BA, A8, BS) ^Yes, Cuban ^ Filipino ^ Samoan
^ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ^Yes, other Spanish/Hispanic/Latino ^ Japanese ^ Other Pacific Islander
^ Doctorate (e.g. PhD, EdD) or Professional degree (Specify) _ ^ Other (Specify)
e.. MD, DDS, DVM, LLB, 1D
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
White ^ Japanese ^ Samoan don dun most of working life. DO NO7 USE RETIRED.
^ Black or African American ^ Korean ^ Other PaciOc Islander ~/t ~ y'~ ~ (f
^ American Indian or Alaska Native ^ Vietnamese ^ Don't Know/Not Sure L,~. ~ j (•,
^ Asian Indian ^ Other Asian ^ Refused 226. Kind of Business/Industry
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^ Chinese ^ Native Hawaiian ^ Other (Specify) /~ ~
^ Filipino ^ Guamanian or Chamorro ~~Unf d} t r, }'1
ITEMS 23a - 23d MUST 8E COMPLETED 23a. Date Pronounced Dead (Mo/Day/Vr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c Li rise Number
BY PERSON WHO PRONOUNCES OR ..+.~1 _ .~ !_-~ ~1 r.. -I
CERTIFIES DEATH 1 G Cl i•C/r yr), ~ () -1 ~~ 1. ~Y ~~.i s~`%Gs
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24. Time of Death ~C-1! - .s • ~W,1-1--.
23d
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Date Sig
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1 L - .G~ - I~I .1 ~~~ 25. Was Medical Examiner or Coroner Contacted? ^ Ves No
CAUSE OF DEATH Approximate
26. 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:
respiratory arrest, or ventrkular fl6rillation without showing the etiology. DO NOT BBREVIATE. Enter only one cause on a Ilne. Add additlonal Il
nes If necessary Onset to Death
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IMMEDIATE CAUSE ---------------
(Final disease or condition Due to (or as a consequence of):
resulting in death)
b
.
Sequentially list conditions, Due to (or as a consequence of)'.
if any, leading to the cause
listed on line a. Enter the c.
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or Injury [hat
initiated the events resulting d.
in death) LAST. Due to (or as a consequence of):
26. Pan II. Enter other significant conditions contribution to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed?
^ Ves No
28. Were autopsy Ondings available
to complete the cause of death?
^ Yes ^ No
29. If female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
^ No[ pregnant within past year ^ yes ^ Probably ~ Natural ^ Homicide
^ Pregnant at time of death ^ No ,Unknown ^ Accident ^ Pending Investigation
^ Not pregnant, but pregnant within d2 days of death ^ Suicide ^ Could not be determined
^ Not pregnant, but pregnant 43 days to 1 year before death 32. Oate of Injury IMo/Day/Yr) (Spell Month)
^ 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, Clty, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
^ Yes ^ Driver/Operator ^ Pedestrian
^ No ^ Passenger ^ Other (Specify)
39a. Certifier (Check only one):
Certifying physician - 7o the best of my knowledge, death occurred due to the causes) and manner slated
^ Pronouncing & Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated
^ Medical Examiner/Coroner - On th basis f xamination, a
d/or investigation, in my opinion, death occurred at the time, date, and place, and due to the
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cau
se(s) and manner s
rated
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Signature of Certifier:
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_ Title of certifier:
License Number: /
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396. Name, ddress and Zip Code of Pers Completing Cause of Death (Item 26) 39c. Date Signed (Mo/Day/Yr)
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40. Registrar's District Number
~ 41. Registr is Si n [tire
~ 42. Registrar File Date (Mo/Day r)
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43. Amendments
Disposition Permit NO.li~ ~~ I~ I REV 07/2011
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OATH OF SUBSCRIBING WITNESSO f- -~~ 4`~
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REGISTER OF WILLS ''~ ` ~~ ~-~~'
CUMBERLAND COUNTY, PENNSYLVANIA ~ ,.:~ ~ ,~
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Estate of BRIAN LEE ALEXANDER ,Deceased
CHARLES E. SHIELDS. III MICHELLE J. JURICK , (each a subscribing witness to
(Print Name/s)
the ^ Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his presence and in the presence of each other.
(Signature)
6 CLOUSER ROAD
(Street Address)
MECHANICSBURG PA 17055
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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(Signature)
6 CLOUSER ROAD
(Street Address)
MECHANICSBURG PA 17055
(City, State, Zip)
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Executed out of Register's Office 3 c~ N ~
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Sworn to or affirmed and subscribed ~ ~ ~
C' ~~} ~ `~
before me this ~ ~ day ~
of ~ ~'
~ ~ ~ ~ ~
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Deputy for Register of Wills Notary Public
My Commission Expires: I ~~ ~ ~-- ~~~f ~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
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Form RW-03 rev. 10.13.06 ~ (} ~ ~ ~~ ~ . ~~ ~
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LAST WILL AND TESTAMENT OF BRIAN L. ALE~I~ERY_~
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I, BRIAN L. ALEXANDER, single man, currently of Mechanicsburg; Cumberl~~d ~ ~ •"~
County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament, hereby revoking and making void any
and all prior wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
There are assorted family heirlooms in my home. I direct my Executrix named in
Paragraph 5 below to take possession and control of these and to distribute them between both
sides of my family. In order to avoid any arguments among my residuary beneficiaries as to
what constitutes an heirloom, my Executrix shall have full, final and absolute discretion in
making that decision. These heirlooms are to be distributed as fairly and reasonably as
practicable. In the event of disputes, my Executrix is to have the final and absolute say; I am
trusting her judgment in this matter completely.
These items are to be considered to be in the nature of specific bequests. All fees,
commissions, expenses and the like typically assessed and/or calculated against their values are
to be paid from the residue of my Estate and are not be assessed against the recipients.
Additionally, I direct that all death taxes are to be paid from the entire residue of my Estate
before any calculation of the final net distributable shares. I realize that this means the three (3)
charities named hereinbelow will share in the expense of the death taxes and this is my desire.
The balance of personalty not considered to be heirlooms by my Executrix shall fall into
the residue of my Estate and be administered in the customary manner.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situate, is to be divided and distributed as follows:
A. One-fourth (1/4) to my Aunt, JANET L. POST, per sti~pes.
B. One-fourth (1/4) to the BETHESDA MISSION, currently located at 2101 North
Front Street, Building 1, Suite 301, Harrisburg, PA 17110.
Page 1
C. One-fourth (1 /4) to the SALVATION ARMY HARRISBURG CAPITAL
CITY REGION, currently located at 1122 Green Street, Harrisburg, PA 17102,
to be used in the counties of Dauphin, Cumberland and/or Perry.
D. One-fourth (1/4) to the AMERICAN RED CROSS, currently located at 1804
North Sixth Street, Harrisburg, PA 17110, to be used in the counties of Dauphin,
Cumberland and/or Perry.
4.
It is my intention that beneficiaries named before or after the date of this Will on my life
insurance, annuities, individual retirement accounts (IRAs), in Trust for or j oint bank accounts
and any other assets for which I may designate beneficiaries will receive such investments and
that my Will provisions shall not control such investments.
5.
I nominate, constitute and appoint my Aunt, JANET L. POST, to be the Executrix of
this my Last Will and Testament. In the event that my said Aunt is unable or unwilling to serve
as Executor, I appoint my cousin, KATHY J. POST, in her place and stead. I further direct
that they shall not be required to file bond or other security in the Office of the Register of Wills
for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~r.~-day of
~~. , a.D. Zoi2.
/`~' `' ~ -~~~'.~ (SEAL)
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BRIAN L. ALEXANDER
Signed, sealed, published and declared by the above-named BRIAN L. ALEXANDER,
as and for his Last Will and Testament, in the presence of us, who at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
~S'o~
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