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HomeMy WebLinkAbout01-29-13PETITION FOR GRANT OF LETTERS REGISTER OF WII.,LS 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: Robert J. Gochenauer File No: ~ L~~ ~_~~~ a/k/a: Robert J. Gochenauer. Sr._ (Assigned by Register) a/k/a: a/k/a: Date of Death: 1/14/2013 _ Social Security No: Age at death: 9_1 _ _ Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 129 Walnut Bottom Road 17257_.. Shippensburg Townshl~-.Cumberland Street address, Post Office and Zip Code City, Township or Borough Couuty Decedent died at 129 Walnut_Bottom Road 17257 Ship~ensburg Township Cumberland PA Street address, Post Office and Zip Code City, Township or Borough Comty State Estimate of value of decedent's property at death: Ijdomiciled in Pennsylvania ................................All personal property $ 10.000.00 Ijnot domiciled in Pennsylvania .............................Personal property in Pennsylvania $ _- - Ijnot domiciled in Pennsylvania .............................Personal property in County $ Yalue ojreal estate in Pennsylvania .............................................................. $ -- TOTAL ESTIMATED VALUE.... $ -_ 10,000.00 Real estate in Pennsylvania situated at: IlOne (Attach additional sheets, if necessary.) Street addreav, Post Office and Zip Cade 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 7/14/2006_ __ and Codicil(s) thereto dated none __ none State relevant circumstances (eg. renunciation, death ojexecutor, de) 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(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 ^ 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 mtnort tale If Administration, c.~a. or d b.n.G>±t~, 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 ^ EXCEPTIONS `~_ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the~ellowing spouse{if any~tdriatirs (attach additional sheets, if necessary): ~ © C? _ ~ ~r~ C _ u~ r;:> z ,• -~~ > _ ,. PTame ~ tress ~~' r~r` -Y --r-- .,~` pus _ Ct> _..x ~.- ~ ~: -~.,~ „, __ ... ~,..; - --- . ~ .. E'~ l ~ 1..:`s ..;. _. .. -- ~~- - _ Form RW-Ol rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative ~ official use o,dy ~G - ~~ COMMONWEALTH OF PENNSYLVANIA } ~ ~ ~~ SS: COUNTY OF CUMBERLAND.... ~ R ~ ° ~ ~', - Petitione s Printed Name - ~) - - ° . ~ ` ' ' ~" PetitionB~( P,o ~ ~s;x ~ __~ ~. __ 309 Eisenhower Drive _ .. Shirle A. Smith Chambersbur _ ~ ~ `'/ ~~ i~' } ~._ ~ PA 17201 _ __ 1 fl The Petitioner(s). rbuve-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 Petitioner(s) will well and truly administer the estate according to law. ~ ~ , Sworn to r ffumed and subscribed before ~ ~Z~~ Date ~~~/~~ me tYiis ' ~ da f ~-~ Date ~~~ - By:i ~,~ Date - Fort a Register. - Date BOND Required: DYES ®NO FEES: Letters ....................... $ 45.00 (2 )Short Certificates(s) ...... 10.00 ( )Renunciation(s) ......... . ( )Codicil(s) .............. ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other will ......... _ _ 15.00 Inheritance Return _ , , , , . , ... 15.00 Inventory _ .... , , , . 15.00 Automation Fee ................ . JCS Fee ....................... TOTAL ......................$ To the Register of lolls: Please enter my appearance by my signature below: Attorney Signature: ( ~~~~ ~ i-- Prin d Name: Joe R Zullin er Supreme Court ID Number: 17516 FumName: ZUllinger-Davis. P.C. Address: 14 North Main Street, Suite 200 Chambersburc~ PA 17201 Phone: (717)264-6029 Fax: X717)264-1884 _ - 5.00 Email: jzullingerLzullinger-davis.com 23.50 128.50 - - - DECREE OF THE REGISTER Estate of .Robert J. Gochenauer a/k/a: .Robert J. Gochenauer, Sr. File No: _ ~_~_~__} ~ ~ AND NOW, ~.. ' ~ ~ , 2013 _ , in consideration of the foregoing Petition, satisfactory proof having been pres ed before me, IT IS DECREED that Letters Testamentar~_ are hereby granted to Shirley A. Smith -- - in the above estate and (if applicable) that the instrtunent(s) dated July 14. 2006 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/Il/2011 ~Q ~ ~(~~\"_ „_ f ' ,.I n ,,, age 2 of 2 _ _ __ _ _ _ (, ;~ ; f-, ~lijf ~{~~l ~o~,R. lz is illegal t~s d~~li~~~«. ~~~~ , :~~~~ i~, ~'sr11.. ~(. t..+~~ :-~ s.:r z- ,'( -,:. i ~ :- I ~- _-- I :Y -- ,ti ~. •- ~ ~ ). ~. .,. ( el. t o the ,~°rt)ilLa,e, tiff ,, !~ - ~ _- _ ,.;; ~ } rr 1 (1Li:7r1 ~ i ~t~ y ~~ 42~ 1,- ~ 'i It ~ s. , _:. ~. n ': f` ~ - .. 'r ''j ,. j,.~ r ~. ;¢ -;~. ~,,,~,,..~~,(,), ..~,~,i~~, ~~ .,.; . __ ~ur~~~R~~~l _ ~ . , Type/Print In Permanent COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALT rCf7Tart~ w H ~ VITAL RECOR D$ E }o~ e 2 1. Decedent's Legal Name (First, Middle, Last, Sufflk) ~ ~ ... .--. s r State File Number: 2. Sex 3. Social Security Number 4. Date o7 Death (Me/Day/Yr) (Spell Mo) Robert J. Gochenauer Sr - Male 183-12-4025 January 14, 2013 Ss. Age-Last Birthday (Yrs) 5b. Under 1 Year Sc Vnder 1 Da . 6. Date of Birth (MO/Day/Vear) (Spell Month) 7a. Birthplace CI ( ty and StaCe or Fprelgn CounCry) Months Days Hours Min t u es 91 Shippensburg A il 1 pr , 1921 7b. Birthplace (County) ga. Residence (State or Fprelgn Coun[ p ) Franklin ry) Bb. Residence (Street and Number - IndUde A t No. 8c. Did Decedent Live In a Township? PA ~~y Sd. Residence (County) 129 Walnut Bottom Road ~ptYls, decedent lived In Shippensburg tvxp CV mberle nd ee. Residence (Zip Code) 1725'7 QNO, decedent INed within limits Of Clty/boro_ 9. Ever In US Armed Forces? 30. Marital Status at Time of Death Q Married ~ Widowed 11. Surviving Spouse's N m If if Y s e ( w e, glue name prior fo first marriage) es Q Np Q Vnknown Q Divorced Q NeyK Married ~ Vnknown 12- Father's Name (First, Middle, Last, Suffix)' ' 13. Mother s Name PHpr to First Marriage (First, Middle, Last) Bruce W. Gochenauer Laura Mae Duke eta. Informant's Name I4b g . RelstlOnzhip to Decetlm[ Shirley A. Smith ~ D 14c. Informant's Melling Addrezs (Street and Number, City, sroi<, Zip Code) G ~ aughter 309 Eisenhower Drive Chambersburg PA 17201 .......................................................... ........---......-..-...-...-........,........3..~:.,lace.°... eat... _ _ •• - ec only one If Death Occurred In a Hos Pital:~ In anent •""'••'-•••• ••--••-••••-•••••-•••••.... frr .. .. ........ .......-.- ... .......... P ~ ilf Death OtCUrrld Somewhere Other Than a Hos Ital: ••- -•~•-----•--"" P LJ HosPlce Facility --••••••• ••••-• - Q Emergency Room/O t M D d ' H U pa ece ent s ome en[ Dead on Arrival N lSb. Faclll ( urfln Home/Long-Term Care Facility Other (specify) ty Name If not InztittHion, give street and nUm bar) -ls i ~ c C ty Or Town, State ^nd Zlp Cod! 15d. County of Death Elmcroft of Shippensburg Shi ~, ppensburg,.PA 17257 Cumberland 16a. Meth Od of Dispasitlon ~ Bunal Q Cromatlon S6b D f . ate o Dlspos)tion 16e. Place of Dispvsltlon (Noma of umetery, crematory, or other plan) Q Removal from Sbt! ~ Donation other (Specify) January 18, 2013 Paliclawns Memorial Gardens 16d. Locstlon Of DlfpOSitlon (City or Town, slate, and Zlp) 17a. Signs neral Service Liunz<e or Perapn In Charge pf In[ermeni 17 b Lic N ~ . ense umber Chamberaburg, PA 17201 • FD-014831-L 17c. Name and Complete Ad tlress of Funeral Facility F l oge sa Weer-Bricker Funeral Home 112 W King St. PO Box 338, Shippensburg, PA 17257 m T- 18. Decedent's Education -Check the box that best describes the 19. Decedent Of Hispanic Orlgln -Cheek the 20. De~edenYS Race -Cheek ONE OR MORE rotes Lo Intliut highest degree Or level of school completed K the tim h f d h e w e o at eat . box that best describes whether [he decedent - the decedent Considered himself or herself to be Q 8th grade or less . IS Spanish/Hlapanic/LStlno. Check the "NO' White ~ Korean NO diploma, 9th - 12th grade b If d ~ ox ecedent is not 5 Q High school gratluste or GED completed Panlsh/Hizpanit/Latlno. Q Black or African AmerlCan Q Vietnamese ]$( No not Spanish/Hispsnic/Latino , [~ American Indian or Alaska Native Q Other Aslen ~ some College credit, but no degree Q Yes. Mexican, Mexican AmerlCan Chicano A i , ~ s Q Assoelate degree (e.g. AA, AS) an Indian ~ Native Hawaiian O Yes, Puerto Rlean ' Chlnes< Bachelor s degree (e.g. BA, AB, BS) O Yes, Cuban Q Q Guamanian or Chemorro ' Master s de (e.g. g, Q Filipino ~ Samoan Q gree MA, M5, MEn MEd, MS W, MBA) ~ yes, other Spanish/Hispanic/Latino J Q apanese ~ Other pacific Isla ndcr Doctorate (e.g- PhD, EdO) or Professional dlgrle (S if pec y) Q Other 5 !. MO DDS DVM LLB JD ( Pedal) 21. Decedent's Single Rlce Self-Deslgnstlen -Check ONLY ONE tO lnd(cste what the deeetlent consitlered himself or herself [p be. 22a Detect ant' ~[ White U l . s sua Occupation - Indicate type of work ~ Japanese Samoan [] Black or African American [~ Korean Q done during moat of working life. DO NOT USE RETIRED. ~ Other PaclHC Islander American Indian Or Alaska Native Q VIlLnsmese Q Don'[ Know/Not Sure ~ Mechanic Q Arlan Indian _ [] Other Asian Q Refused Q Chinese 22b. Klntl o1 Business/Industry awallan Q Other (SPetify) Q N l ua man ~ Flliplno O G lan or cha motto Borough of Shippensburg ITEMS 23a - 23d MVST BE COMPLETED 23a. Oate Pronounced Dead (MO/Dal/Yr) 23b. Signetu re o1 Person Pronouncing Death (Onl BY PERSON WHO pRONOV NOES OR h y w en a pplicable) 23c. License Number CERTIFIES DEATH 23d. Date signed (MO/Day/Vr) 24. Time W Death 7:30 PM 25. was Medical Exw miner pr cpronpr epnta¢ced? Q Yes ~ No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--desewses, Injuries, Or complicwtlons--that directly caused the tleaLh DO NOT t . en er terminal events such as cardiac arrest, j Interval: rospiratvry arrest, or ventricular fibHllaCion without skewing the etlolpgy. DO NOT ABBREVIATE. Enter only one cause en li d a ne. A d additional lines If necessary i Onset fo Death IMMEDIATE CAUSE ------> a respiratory T9ilUre (Final disease or condition Du! to (or as a conseq uenCe pf): resulting In death )~ - - b. Congestive heart failure Sequentially list condiilons, Du¢ to (or as a conseq uence of): If any, leading To the cause - - IlsLed on Ilne a. Enter the ,~ V NDERLYING CAUSE (d iseese yr Injury that Due to (or as a consequence of): •. ~ ~ Initiated the events resulH ng d. ~- In death) LAST. Du¢ tp (o as a consequence Of): y~ Z6. Pwrt 11. Enter other sl¢nificant contlitions ntrlbutina to d th but not resulting In the underlying cause given In Part I ) ~ 27. Was an autopsy pe HOrmed? Yes No ~ 26. Were autopsy findings available °..' x' tv complete the cause of death? 29. If Female: ~ Y c es YJo 30. Did Tobacco Vse Contribute to Deafh7 Q Not pregnant within past year 31. Manner Of Death Q Pregnant at [Im¢ Of death Q Yes Q Probably Natural ~ Homicide 0 No Q Unk m nown Q Not pregnant, but pregnant within 42 days of deatt Q Accident Q Pending InvesNgatlOn r- Q Not pregnant, but pregnant 43 days t0 1 year before deaYF 3J. Date of InJury (MO/Day/vr Q Suicide ~ COUId not be determined Q Unknown If pregnant wilhln the past ) (spell Month) year 33. Time oT Injury 34. Place of InJury (e.g. home; consiructlon site; farm; school) 35. Locstlon oT In $tre<C end Number, CI )i'r1' ( ty, State, Zip Code) 3 6. Injury si Work 37. If Traniportativn InJury, Specify: 3B. Describe Haw InJury Occurred: Q V¢a Q privet/Operator p Pedeatrlan - Q Nv Q Passenger Q Other (Specify) 3 9a. Certifier (Check only one): ~[ C¢rtlTying physician - TO the bas[ of my knowledge, tlesCh o red due Co the cause(s) and m stated Q Pr nouncing 8. CertRying ph sicia T h e y n - v t e best oT my knowledge, death occurred at the time, date, wnd place, and due t0 Che c e(s) end m Q M dicsl Examiner/Coroner - On Che bases of examinati on, and/or Investlgatlen, In my oplnlan, death occ rred wf the time, date, and place, antl due to the cause(s) wnd m nn r stated signature of certifier: >7 .¢y /'~ ~~ ~ ;/ ~f~ z~ u < 3 . Title pi certleer. M.B.B.S. MD063751 L Ucehse Number: - 9b. Nerve, Address and ]_Ip Code of Person Completing Cause of Death (Item 26 ) Amatui Khelltl, M.B. B.S. 1988 Scotland Avenue, ChamberBburg PA 17201 39c. Date Signed (MO/Day/Vr) 4 , 0. Registrw is District Number January 15, 2013 41. Reel Signature yy 4 Reglstrer FII< Date (MO/Day Yr) / _- a7't-- /~ ~ 4 / 3. Amendments /~J ~~ Dlsposltion Permit No. 0818898 H105-143 REV 07/2011 JRZ = 5.1 gochenaur.lw July 6,' 2006 LAST WILL AND TESTAMENT I, ROBERT J. GOCHENAIIR, of 201 East Burd Street, Shippensburg, Pennsylvania, being of sound and disposing ~ nd, me-mory ..,end understanding, do hereby declare this to be ~h •~;, wile k~e~by revoking any and all former wills and codici~ r-~tr~ ~yKime cc~ heretofore made . ~ . c~> ..~ :. ;~ r R.. ~ ~.... ~h . ., y,~ I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. II. I give, devise and bequeath the residue of my estate of every nature and wherever situate to my children, namely Barbara L. Shoop, Janetta A. Guyer, Robert J. Gochenaur, Jr. and Shirley A. Smith, in equal shares, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death, and in default of any such then-living issue to my other then-living children, equally. The term "issue" shall not be defined to include step-child. III. Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including property held for minors, exercisable without Court approval, and effective until actual distribution of all property: A. To retain any and all of the assets of my estate, real or personal, without regard to any principle of diversification of risk. B. To invest in all forms of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. C. 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 deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. E. To compromise any claim or controversy. F. To distribute in cash or in kind or partly in each. Page 2 G. To hold property in their names without designation of any fiduciary capacity or in the name of a nominee or unregistered. IV. 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. v. The interest of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation; and the principal and income shall be paid by the trustee or guardian directly to or for the use of the beneficiary entitled thereto, without regard to any assignment, order, attachment or claim whatever. VI. I appoint my daughter, Shirley A. Smith as executrix of this my will. Should my daughter, Shirley A. Smith, predecease me, fail to qualify or cease to act, I appoint my daughter, Janetta A. Guyer, as executrix of this my will. Page 3 vII. No bond shall be required of any fiduciary hereunder in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of five typewritten pages, the first three of which bear my signature in the margin for the purpose of identification this _ l~`~~`"day of 21ZQ[2 . ` C~~~t~ (SEAL) Signed, sealed, published and declared by the above-named testator as and for his last will and testament in our presence, who in his presence, at his request and in the presence of each other have hereunto set our hands as attesting witnesses. ~ ~G4 , r ~ ~ We , ROBERT J . GOCHENAUR, ~Q ~-G ~ ~,~ ~ ~ ~ (d ~~ and ~l~"GN ~ ~t~S the testator 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 testator signed and executed the instrument as his last will and testament and that he executed it as his free and Page 4 voluntary act for the purposes therein expressed and that each of the witnesses, in the presence and hearing of the said testator signed the will as witnesses and to the best of their knowledge said signer was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testator Witne Witness Subscribed, sworn to and acknowledged before me by the above-named signer and subscribed and sworn to before me by the above-named witnesses this ./yam day of 2 ~,~ . -`"~ Nota Publ ' COMMONWEALTH OF PENNSYLVANIA Notarial Seal Teresa J. Burkholder, Notary Public Shippensbur~ Boro, Cumberland County My Commission Expires Aug. 6, 2008 tUSmber, Pennsylvania Association of Notaries Page 5