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HomeMy WebLinkAbout01-29-13PETITION FOR GRA\1T OF LETTERS REGISTER OF WILLS OF _ ~~~/~'1~~~ . ~y ,~ COUNTY, PENNSYLVANIA Petitioner(s) named below, who isiare 18 years of age or older, appl(ies) for Letters as specified below. and in J support thereof aver(s) the following and respectfully requests j the grant of Letters in the appropriate form: Decedent's Information Name: -`` •~ a/k/a: a/k/a: Date of Death: ~"~~~t; ~,~.,~.~ i~~ / ~~~f',__~ - -y- ~• - ~ ~ Decedent was domiciled at death in C~~i~~/J 1.-~~ ~~~,,w ~~ principal residence at ' , ~_ ,,f ~j~`,J~,~;,~_- `~ f~ ~••~ Street address Post Offc'e~ d~p ~od Decedent died at ~l~ ~ ~~ 6 ~~ ..., . ~~, ,., Street address, lsos't Office'and Zip Code Estimate of value of decedent's property at death: If don:iciled in Pennsylvania ............................ All personal property $ If trot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ If trot domiciled in Pennsy!vania ........................ Personal property in County $ i~alue of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ " 13~ !~~ File No: ~ M (Assigned by Register) Social Security No: Z~~ - `~ - ~ ~ ;~ ~-- Age at death: _ ~', ~" County, f ~ir'~VS ~i~_l~i~ l~~u~ with~tis/her last •~ ~.~f ~ ~ wit l; ~c:_ City, Tawnshi or Borough County City, Township or Borough t o St to ~ ~. ~~ Real estate in Pennsylvania situated at: ~~`~/ /~~/~ (Act l dd ~~~~ ~~ hid ~ ~=~ nc z n rtronnl sheets, {f necessary.) Street address, Post Office and Zip Code City, Township or Borough County .' E ~ ~Y 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 ~ ~ ~~ ~4i~.. ; i ~j ~ and Codicil(s) thereto dated Jr'~',J ~ State relevant circumstances (e.g. renunciation, death ojexeartor, 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 ~',-_frs' d,t-,U r-~ ,:i.,,~~='~,,~,~, /~ . ,G'y~'/ ~ L`~= (';"'~ .~~,., . ~ ,~, f. ~ ~-- c-- C' ^ B. Petition for Grant of Letters of Administration (If applicable) /" - '~' ~ / ~ J. 7 c.t.u., d. b. n., d.b.rT.c.t.u., pendente lice, durance absentia, durur:te tninoritute 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. ^ NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(ifany) and heirs ~uttuch uclditiaTUl sheets, i f necessary): ~ ~ --- ~- A 'fi ~ ~~ Name Relationshi ~~~ss z-~ k',` =k ... ~ ~~w ..~~ ~~ f....., y r ~~ t.r,.~ r~,,~ , ~.,+~ ., _„ . ~:~ _, ~~' _.. a ~, . ., Fo~~n~ nw-nz rev. 10/II/Z~ll Page 1 of 2 Oath of Personal Representative C0~1~,(p~ ~,i; E,~LTH C~' PE~~S`r LV,~~iI.-~ } _7~,,~~~L c_.~" -~ /~-r C~~L-~ .~.~~ ; Orr;c~a; ~"sc Oniy ~~ ~.~. ~. ~r ~ _. ' 3.......-1. ., The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnle and correct to the best o~'ifie lu~owledgetand belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well alld truly administer the estate according to law. Sworn to or ffirmed an~ d subscribed before me thi ~hda ~ ~ Date ~ ~.~ ~ ~-;-~;~U(' . Y of ~ _.~~ ~ ' /~ ~ ~~ ~ Date By. ~-~ Date !-- ~~--.lUi~ F r he Resister ~ ~ , C~~ ; ,,~ , ~~ Date BOYD Required: ~ YES ~ NU FEES: Letters ...................... $ ~~ ~= c~ ( Z) Short Certificate(s)...... .t c` ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bolid ........................ Co1111111S51011 . ................. Othe .,..._, ....... i'I ! -vim i 7 .. ... l~ ~~n `ar/ .... ~~~b c~, Automation Fee ............... ~ t` JCS Fee . .................... ~ .5 C TOTAL ..................... ~ - ' ~~ To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: i f~ - ' ~ ~+~ -~ Printed Name:~?~j ~~!~~-7 ~, ~%~~/~'L!f1 Supreme Court _... ID Number: ~~~~ ~"~~ Firm Name: ~:~'- / r! ~ /~. ~'' ~~f -' Address: Gv'~ ~ - , Phone: "2 ~T=~ ~~ . --- ~ ~~ ~ Fax: j Email: DECREE OF THE REGISTER is Estate of ~ r`;~' File No: ,2 / ~ ~.~ - ~~,~ a/lc/a: AND NO~V ~ L~'/' v .,~ , to co; satisfactory proof having been pr sented before me, IT IS DECREED that Letters are hereby granted to ~ ' ~ ~ the instrument(s) dated described iti the Petition be a Fnr~n ntV_/l7 ,,,.. ~nia tnn ~ ~ of the foregoing Petition, (/~.- ~d ove estate and (if applicable) that fitted to probate and filed of recor as the last bVi 1(and Codicil(s)) o Decedent. Register of Wills ~ %~ ~,.I y i3 ~~ .. r I"«' It)I" l,~ll`, c'Z;I'tI~~lCait', `4{~.r)(? f . J ~_ll u~1~`~1C1 OI~i ~r''UI~i ~:''1' A~ Type/Print In Permanent W \[ t~ O V D 0 Z '~~.Lt~x, ~- _ «t-,~ ? {1 S', 1~ !~.p 91?(\' '.'tlu". 1~1C' ITl~[?I'l3lilll(?Ii tlc:1~? `?J~t:Ii I d'?~~ ~ .. i ~~ .f" 1~ '^ t ,)!~?"~i L~ ',:E)t i(':_f 1,`_)'?i iiil O1-1<~Illil~ ~tCtlil4'a?f'. (}f I~t~lIE1 ~( ~~~ `"`~~ `I ~' ~ tl~if ~Lilll ii i ;I~ ~ U~a~ ~~.~.ZI~l1'~iC. T~tE OII~Iil~i~ 7 p ~~ • r ' ` ~.. y~ ~ ~.~~ Fb '~ ~~ '"t I t`t.' 11:] r'9[ .( ! ~~ %lll~t.(j tl) tllt' ~?itlt(_' ~ti~11~cI~ ..r:~~ .!}+f,; ~~ j``i r dy:~ ~r~bi y^~,af~ ~ il.,~, ti11~~' ! }I 'yr~"J'Ii~~~I14'i31 ~IIITIL L ~ ?~ ~-~.,`. J A 1 4 a~+ a ~ ~`( e ~~• ) i.-s:~'~ v ~ __ _ , -.)~'a• '.'til!"<1l~ ~~ait ~,tiCll!wCj G L ~~ "~~ ~7t/~lSL7ii CiF 13ENN$1*LVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS --- - - -- - -~ _ ~ ~ ~ • `~ " ~ ~ State File Number- 1. Decedent's Legal Name (First, Middle, last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death Mo Da ( / y/Yr) (Spell Mo) Dol L ores . Wei 1e F Janua 12 20 3 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc Under 1 D 6 ~' . a . Date of Birth (MO/Day/Vear) (Spelt Month) 7a. Birth lace Ci p ( ty and State or Foreign Country) Months Days Hours Minutes C 1 ar 1S1e PA 85 May 1 7 , 1 927 7b. Birthplace (county) G~ti}-~r13nd 8a. Residence (State or Foreign Country) 86. Residence (Street and Number -I l d A nc u e pt No_) 8c. Did Decedent Live in a Township? PA ~S Yes, decedent lived in NOrth Middleton twP. 8d. Residence (County) 1 40 A11'l~ort Drive ~L~il~r1-aY1C~ 8e R id . es ence (Zip Code) 1 701 3 ~ No, decedent lived within limits of city/born. ver rn US Armed Forces? 10. Marital Status at Time of Death ~ Married }~ Widowed 11. Surviving Spouse's Name If ~ Y if $ ( w es e, give name prior to first marriage) 1 No ~ Unknown ~ Divorced ~ Never Married 0 Unknown _ 12. Father's Name (First, Middle, Last, Suffix) ' 13. Mother s Name Prior to First Marriage (First, Middle, Last) James Sowermaster Fannie Trostle 14a. Informant's Name 14b o . Relationship to Decedent Patricia A_ Adams D h 14c. Informant's Mailing Address (Street and Number, City State, Zip Code) ~i aug ter l40 Airport Dr_ Carlisle, PA 17013 s ....0 .....•...g .....Y ...-..... ...................... ............................................ r........ 15a : Place o Death C eck only one If Death Occurred in a Hos rtal: ............. ............... ................•.. ...............-...... P~ ~ Inpatient - if D th O em ~ ° / _ ...........--.. : ea - ccurred Somewhere Other Than a Hos rtal: FF .. '""""""•••••••••••--••--••••-••- P LI Hospice Facility [~ Decedent's Home Emer enc Room Outpatient Q Dead on Arrival ~[$ Nursi H w . ng ome/Long-Term Care Facility ~ Other (Specify) 15b. Facility Name (If not institution, give street and number; 15c Cit T Z LL . y or own, State, and Zip Code lSd. County of Death Church of God Home C ~; arlisle, PA 17013 C~~nberland 16a. Method of Dis osition B i l - v p ~ ur a Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from State ~ Donation Other (Specify) 1/15/2013 Evalzs Crynation Services 1 d ~ 6 . Location of Disposition (City or Town, State, and Zip) 17a. Signature of F neral Service Licensee rso~ harge of Interment 17b. License Number Leo1a, PA ~ ~ FD 012633 L 17c. Name and Complete Address of Funeral Facility E<,vin Brothers Funeral Homo, Inc-, 630 S_ Hanover St. Carlisle PA 1 m , 7013 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Ori in -Ch k th ' r= g ec 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 wh th h e er t e decedent the decedent considered himself or herself to be. 0 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" hite 0 Korean ~, - No diploma, 9th - 12th grade b,_.oy~x if decedent is not Spanish/Hispanic/Latino. ~ Black or African American 0 Vietnamese ~ High school graduate or GED completed No not S i h/Hi ~y , pan s spanic/Latino ~ American Indian or Alaska Native )] Other Asian Q Some college credit, but no degree ~ Yes Mexican Mexi A i , , can mer can, Chicano Asian Indian Native Hawaiian Associate degree (e.g. AA, AS) ~ Yes Puerto Rican , ~ Chinese ~ Guamanian or Chamorro Bachelor's degree (e.g. BA, AB, BS) ~ Yes Cuban , ~ Filipino 0 Samoan Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Ja an p ese ~ Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (S if pec y) ~ Other (Specify) e. MD, DDS, DVM, LLB, JD 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 Occu [~fCa/hite ti I d pa on - n icate type of work 0 Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American ~ Korean Q Other Pacifi I l d c s an er ~ American Indian or Alaska Native 0 Vietnamese ~ Don't Know/Not Sure Produce Manager A i ~ s an Indian ~ Other Asian 0 Refused 22b . Kind of Business/Industry ~ Chinese ~ Native Hawaiian ~ Other (Specify) Q Filipino Q Guamanian or Chamorro Grocery Stores ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo/Oay/Yr) 23b_ Signature of Person Pronouncing Death (Only when applicable) 23 BV PERSON WHO PRONOUNCES OR Li c. cense Number ~(~a /~ / ~ ^,~ CERTIFIES DEATH O~~! n w ~ ~~c~~~ 23d. Date Signed (Mo/Day/V r) 24. Time of Death /L-~~ J ,f ~~ r ~ - J`O ~-~f~ 25. W Medical Exa rner or Coroner Contacted? Q Yes No CAUSE OF DEATH Approximate 26. Part 1- Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter ter i l m na events such as cardiac arrest. Interval: respiratory arrest, or ventricular fibrillation with t showing the et i ology. D O NOT ABBREVIATE. Enter only one cause on a line Add dditi l l . a ona ines if necessary ~ t to Death J ~ ~ f IMMEDIATE CAUSE ---------------> a. ~ ~ / .y~.L/f~Q~ (Final disease or condition Due to (or as a consequence of): resulting in death) _ b. Seq uentiaily list condiiio ns, 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 conse uence f) q o : (disease or injury that Initiated the events resulting d. v in death) LAST. Due to (or as a consequence of): S 26. Part 11. Enter other s~nifica nt conditions contributive to death but not resulting in the underlying cause given in Part I ~ 27. Was an autopsy performed? ~ Yes No ~~~ ~~ m 28. Were autopsy findings available to complete the cause of death? a Ves ~ No 29. If Female: 30 Did o . Tobacco Use Contribute to Death? 31. M nner of Death No[ pregnant within past year )] Ves ~ Probably `~N t l ~ °1 a u ra ~ Homicide Pregnant at time of death ~~,~// 9~+1 NO ~ Unknown ~ Accident N 0 r- ~ ~ Pending Investigation ot pregnant, but pregnant within 42 days of deatF ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In u ~ Suicide ~ Could not be determined j ry (Mo/Day/Yr) (Spell Month) 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 J ry (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 No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): Certifying physician - To the b t f k l es o my now edge, death occurred due to the causes} and manner stated Q Pronouncing g~ Certifying physic n - To the best of my knowledge, death occurred at the time date and place and d t th , , , ue o e cause(s) and manner stated ~ Medical Examiner/Coroner - O the basis o xamination, and/or investigation, in my opinion, death occurred at the time date and lace and d t h , , p , ue o t e cause(s) and mar-n7ner stated Signature of certifier. - Title of certifier: ~7~ Li - m ~ ~ 3S S /~ E cense Number 39b. Name, Ad ress and Zip Code of P rson Completing Cause of Death I m 26) 39c. Date Si ed (M Day/Vr) rYl H 7> ~~; ~ ~~ ~ BOG s ~ a-.., s. e n/, ,n n rr, [ r ~ ~ b f ~ ~ a-v ~3 40. Registrar's District Number 41 Re istrar' Si . g s r = ~~ C-a t6 42. Registr File Date (Mo/Day/Vr) , 43. Amendments ~ oi3 (~Q- /l (~ ~ H 105-143 Disposition Permit No. CC..77 ll lJ V.~ REV 07/2011 ~i- 13- jl O_~T~ 0~ SLTB~C~BItiG ~~-I.~_,~ES~(ESj ~ ~- :~~ - ~ r~~ >~GISTER OF ti~'ILLS ~e ~ ~ ~~ C.._ ~~~~ y ~ COLNTY, PE~~ SYLVANL~ ~ ~ :o ~,, ~~' r ... . ,, ~. ,. ,: d ~. ~~ ~- _..,., . +~... 9 , ... ... _. '. ~q u ML ~_~ ._.L..._ .~... } .-a n 4,.~ , Estate of ,~ >'~''.-~--~' G~ `- (/~ ~_.. --j ~ ~ ~ ~ G ,`TTcccascd (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 (Signature) presence and in the presence of each other. (Signature) T (Sweet Address) (City, Stale, Zip) Execccted in Register's Office Sworn to or affirmed and subscribed before me this ~ ~~' day of _, ~~/~ ~~ putt. , o" Register or`,~'.'s (Street Address) (City, State, Zip) Execccted otct of Register's Office Sworn to or affirmed and subscribed before me this day of '_~ Ot~_ ~' P~~~~ic ?~1}~ Car:::~ issior Expi-es: (Senature 2nd Jeai of Notary or ot:`;zr e't":,:i~~ c~~aii' ;.: to administe: oaths. sho« date o`e~piration c`votar;'~ 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. Fonts RW-03 rev. /0.!3.06 OATH OF NON-SI.TBSCRIBI~TG WITNESS(ES) R~GISTER OF WILLS ~C~ - ~ COUNTY, PENNSYLVANIA r Estate of .~--~~ - ~i^-e-f' ~i G~~`~~ ~ ~~~ Deceased r~ l ~ ~ ~~~ and , (each) being duly qualified according to law, depose(s) and say(s) tha she / he /they was /were well- acquamted with r -` ~ x c~ ~ ~" and am/are familiar with the handwritin and si nature of the decedent and that the i nature of .c?lc°•~- _- ~ ~~ ~-~--~- ~ - ~ g g ~ sg ~ to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~, ~ ~~r..~s-` r r ~ SZ-~ `~ is in his/her own proper handwriting. (S~gnature) (Street Address) (City. Stare, Zip) Executed in Register's Office Sworn to or affirmed an~Jd subscribed before me this ~7~~ day of ~ z r .~.4 ~.~ . ~~ ~~ lty for Register of Wills (Signature) (Street Address) ~' ~ ~ ,.~ (City, Slate, Zip) ~ _ ._. ~...~...7 d .~n"~ P o i y y p ~ /. ~y !r ~ .M ~ ` ' g~ :.f ~ ~ a y ~,~ a ~' ._. i ~;: _~v _._~ t : , ~~ ...~.:: °~b-~ Form RW-04 rev. 10.!3.06 a. t'__ ~_ ~ ~- C~,"~ ~V ' ' C.rJ ,.1 r ..~ C ., --_. ;. i .e f __ _ I, DELOR.ES L. WEIGLE,, of North Middlton~w:~~'ownshiF.p~,, ~ ; R:,y ..~ "~'i Cumberland County, Pennsylvania. declare this to be my last will anal revoke any will previously made by me. I. I devise and bequeath alI of my estate of every nature and wherever situate to rr-y husband, BRUCE R. WEIGLE, providing he shall survive me by thirty days. II. Should my husband, Bruce R. Weigle, predecease me or die an or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature ar~d wherever situate in equal shares to such of my children, DOUGLAS A. WEIGLE and PATRICIA A. ADAMS, as survive me by thirty days. III, Should my son; Douglas A. Weigle, or my daughter; Patricia A. Adams. predecease me or die on or before the thirtieth day following my death, I devise and bequeath th.e share of such child to his or her issue per stirpes Living on the thirty-first day following my death; and should any of my said adult chi 1 dren 1 cave no suc.:h issue i wing on tl~e thirty-first day following my death, i devise and bequeath th.e share of such child to my other child, or to their issue per stirpes living on the thirty-first day following my death. :.;~ r .~ ~• n IV. Until distributed, no gift or' beneficial interest shall be subject to anticipation or to voluntary or involuntary alienation. V. I appoint FINANCIAL TRUST SERVICES CCIMPANY of Carlisle, Pennsylvania or its successor in business, guardian of any property which passes either under this will or otherwise to a minor and with respect to whom I am authorized to appoint a guardian and have not otherwise specifically dome sa, provided that this appointment of a guardian shall not supersede the rigrit of any fiduciary ir- its discretion to distribute a share where passible to the minor ar 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 far such support and education, ar to make payment for these purposes, without further. responsibility,, to the minor or to the minor's parent or to any persoiz taking care of the mirtar . ~' UT. I direct traat all taxes that may be assessed in ` consequence of my death, of whatever nature and by whatever , ~ jurisdiction imposed, shall be paid from my ~~esi.duary estate as a cart of the expense of the admini.stratian of my estate . ` r~, .~ VII . I appoint my son, D~UGI,AS A. WEIGI,E, and my daughter. , PATRICIA A. ADAMS, co-executors, or the survivor of them. executor of this my Last will. Should both of them fail to qualify ar cease to act as exe~°utors, i appoint FINANCIAL TRUST SERVICES CC}MPANY of Carlisle, Pennsylvania or its successor in ~ I business, executor of t?:;i.s my ~ ast w:i. i 1 . I i ~ ~ ~ .~ C ]_ 1~ E~ { ' ~, t: ~A <~ ~ ~{ i ~ e ~ ~ ~" ?...~ ~ (1 1° ~i :~ ;i'! e~ t~ i ~ ;7 I' c:~ ] . c3 ! i ~ l~l ~ ~. it U ~. b =~ r e ~ i:. i :: N ~ r ~~ c . .v. ~ ~ , ~-, ~ i c~ ~ ct r ~;. ~~. 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