HomeMy WebLinkAbout02-08-13PETITION 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: ETHEL M. RICHWINE File No: ~~ - ~..~j - ~~:~
~Wa' (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: JANUARY 13, 2013 Age at death: 93
Decedent was domiciled at death in CUMBERLAND County, pENNSYi.VANIA (Sta_le; with his/her last
principal residence at 801 N. HANOVER ST. CARLISLE 17013 NORTH MIDDLETON TOWNSHIP CUMBERLAN_ D
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at CARLISLE REGIONAL MEDICAL CENTER CARLISLE 17013 CARLISLE CUMBERLAN_ D 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 $ 275 000 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.... $ 275,000 00
Real estate in Pennsylvania situated at:
(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 JANUARY 25, 1989 and Codicil(s)
thereto dated
RFNi JNC'iATInN FC-R NAN('Y M 4HANK ATTAC'HFI~ hTFRFTn
State relevant circumstances (eg. 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.
O NO EXCEPTIONS O 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 db.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.
Q NO EXCEPTIONS O EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (r~f~as-y) and heirs (attach
additional sheets, ifnecessarv): n
er- :' a ~
ca ••~
Name Relationshi A rt~6 r'r"+ -- Q
~ A t^'
t~ rY'i
r' z rn
z -x
~,~ ~ acs
`~~ .
~
c
~~
-~ rw-
Form RW-o2 re.., roirli~oli Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
se Only
~Eea~a~a
CAtnTr., -
Petitioner(s) Printed Name dress ;
Printed Ad
Petitioner(s)
GERALD L. RICHWINE pp
)
2118 WALNUT BOTTOM ROAD CAR~LihB tiA 1 15
o '
GUMBERLAN
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 Dec ent, t e Petitioner(s) w' well and truly administer the estate according to law.
Sworn to or affirmed d subscribed before ~l ~ ) y Date ~ ~~ • Z~13
r
met 's _ day of r; Date
,~. Date
sy:
For the Register Date
BOND Required: Q YES Q NO
FEES:
Letters ...................... $ 310.00
( 2) Short Certificate(s)...... 10.00
( 1) Renunciation(s)......... 5.00
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........
WILL ........ 15.00
INVENTORY ........ 15.00
INH TAX RETURN ........ 15.00
........
Automation Fee ...............
5.00
JCS Fee . .................... 23.50
TOTAL ..................... $ 398.50
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
"? /~ 9
tr " /„
Printed Name: ROGE . IRWIN, ESQUIRE
Supreme Court
ID Number: 6282
Firm Name: IRWIN & McKNIGHT, P.C.
Address: ~fl WFCT P(1MFRFT RTRF,F.T
rnRt rcr F„ PA 17013
Phone: (717)249-2353
Fax: (717)249-6354
Email:
DECREE OF THE REGISTER
Estate of ETHEL M. RICHWINE File No: - ~ ~ - ~ ~~ ~ I f~
a/k/a:
AND NOW, , in consideration of the foregoing Petition,
satisfactory proof having been prese t d before me, IT IS DECREED that Letters TESTAMENTARY
are ereby granted to GERALD L. RICHWINE
in the above estate and (if applicable) that
the instrument(s) dated JANUARY 25 1989 -
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
r1 - ~ ~ ~,
Register of Wills ,.
~ ,~ ~~`~,~2C~t.~t.~~. _ , ~ ~.,e. pi-
Fo~ Rw-oz ,-ev. ~oi~~i~nii Page 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
1NARNING: It is illegal to, duplicate this copy by photostat or photograph.,
~~OR~~~ ~~~~~'~ 4~
Fee for this certificate
~
,
REG~~~~~ ~~ ~~~~~ 1
his is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
p pp
~~~3 FEU 8 (t~ ~ ~~ certificate ~~iil he forwarded to the State Vital
Records Office for permanent filing.
~,~ ~~ / f~ ~ ~(~-y~ L E R K O F 7 ~
~ ~~~RT ~~ "~'
- ~~.~1~1N 2 5~1(l13
Cerhhcation Nu
~ ~BER~-A(~d CQ,~ ~A Locai Regi~~trar Date Issuod
Type/Print in
Permanent COMMONWEALT H OF PENNSYLVANIA -DEPARTMENT OF HEALTH -VITAL RECOR OS
Black ink
1
' CERTIFICATE OF DEATH
. Decedent
s Legal Name (First, Middle, Last, Suffix) State Flle Number:
~ thGl R 1 c.h w ~ YlC 2. Sex 3. social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
~
~
sa. Age-Last Birthday (Vrs)
'
Gtr. Vnder 1 Year
Months Da
s
Sc. Under 1 Da
H
6. Date of Birth (MO/D 174
ay/Near) (Spell Month) -05-3605
7a. Birthplace Cf U ~ )3 ~fl13
( ty and Sta S
F
93 y ours Minut es
Nov 1r 1919 e r
ore lgn Country)
Carlisle P
Ba. Reside nce (State or Fore
PA i
gn Country)
86. R
8
esidence (Street and N
01
umber- Include Apt No.)
$c. Did Decedent Ll 7b. Birthplace (County)
ye in a Township?
Bd. Residenc (County) N _ Hanover Street ~I Yes, decedent Ilyed in North Middleton
Cumberland twp
9. Ever In u5 Armed Fo rtes? 10. Mari 8e. Residence (Zip Code)
tal Status at Time of Dea ]-']013
th O M
l
d O No, decedent Ilyed within limits of
city/born
.
au
e
Widowed
Q Yes Q[NO Q Vnknown Q Divorced ~ Never Married ~ Unknown 11. Su rvlying Spouse's Name (If wife, g(ye name prior to first marriage)
12. F-ath~~Jf 1I~y (Ffr tt,, MldQrJle, Last, Suffix)
W 11~1am ~
13
10tClour . M Lh Nam Pr t0 Firs[ Marriage (First, Middle, Last)
r$i5clrec~ 1~eitch
G 14a. Informs t' Name 14b. Relationship to Decedent
Gera]P.d¢ L. Richwine son 14 f a t'S ailin Address (Street and 11~~~~mbe Clty sate ZIp Code)
~~~~3' Wa~nu~ Bottom Ra
~a
rlisl
P
_
° ___
If Death Occurred In a Hospital ® In Beni - _ - -
O Emer Pa
gency Room/OUtpakient Q Dead On Arrival ,
e,
A 17015
-_15a. P ace o cat ec on Lr one
I if Death Occurred Somewhere Other Than a Hos Ital - _ - - - - - - -
p
~ Hospice Facility ~ Dec
1
d
'
~
156. Facility Name (If not Institution, give street sod number)
Carlisle R T
l e
ent
s Home
Q Nursing Home/Long-Term Care Facility
Q Oche
15 c. City or Town, State, and Zip Code ( Pacify)
lsd
ona
Medical
Center
16a. Method of Disposition Burial Q Cremation .000ntyofDeath
Carlisle, PA 17015 CLlinberland
Q Removal from State Q Donation
p ocher (s
if 166. Date of Disposition
Jan 19
201 16c. Place of Dis
Position (Name of cemefe ry, crematory, or other place)
W
po c
y)_
16d
Locati
f , estminster Cemetery
.
o
Dis sltion (City or Town, State, and Zip)
Carl is~e r PA 17013 a. Sig ature of Funeral se rv ce L tenses or Person In Char
ge of Interm
t
~ en 17b. License Number
013144E
~
3 ' 17c. Name and Complete Address of Funeral Facility
Hoff
-
man
Roth Funeral Home & Crema o , 219 North Hanover Street, Carlisle, PA 17013
'~ 18. Recede nT's Ed ucaHan -Check the box that best describes the 19
D
~ .
<cedent of Hispanic Origin -check the
highest degree or level of school tom p)eted at the time of death. box that best describes whether the decedent
s to indicate what
Q 8th grade or l
h
d
O
O
R
t
e
ecedent considered h m
Self or hers
e
lf to ba
ess is Spanish/Hispanic/Latino. Check the "No"
O No diploma, 9th - 12th grade
White
~
box If decedent Is not Spanls h/Hispanic/Latino. O Korean
~) High schopl graduate or GED completed Black or African American Q Vietnamese
~ No, not Spanish/Hlspa nit/L
ti
Q S
a
ome college credit, but no de
no Q American Indian Or Alaska Native Q Other Asian
gree ~ Yes, Mexican, Mexican American
~ Associ
Chi
t
d
,
a
e
cano Q Asian Indian
egree (e.g. Aq, q5) Q Ves, P4ert0 Rican )~ Chinese Q Native Hawaiian
D Bachelor's degre
(e.g_ BA, AB
BS)
C
,
Q Yes, Cuban Q Guamanian or Cha mono
D Master's degree ( .g. MA: M5, MEng, MEd, MSW, MBA) ~ Yes, other 5 Q Filipino Q Samoan
panlsh/Hispanic/Latino
<] D
octorate PhD, EdD
(e~g~ ) or Prefesslonal degree
Q Ja panes< ~ Other Pacific Islander
S
(
pecify) 0 Other (Specify)
. MD DDS DVM LLB JD
_
21. Decedent's single Race SeIf~~Design aTlon -Check ONLY ONE to indicate what the decedent considered himself or herself t
~Whlte
b
'
o
e. 22a. Decedent
s Usual Occu
Q Japanese Q Samoan pation-Indicate type of worl
O Black or African Ameri
a
d
q
•~i c
one during most of working life. DO NOT USE RETIRED.
n O Korean O Ocher Pacific Islander
Q American Indian or Alaska Native )~ VI¢tnam<s< 0 Don't Kno
E'XeCUtlve Administrati
/N
w
O[ Sure
ve
Q Asian Intlian Q Other Asian Q Refused
Q Chinese
22b
. Kind of Business/Industry
Q Native Hawaiian Q Other (Specify)
Q Flllpino Q
Guamanian or Chamorro Carlisle Barracks
ITEMS 23a - 23d MVST BE COMPLETED 23a. Date Pro npunced Dead (MO Day r) 236. Signature of Person Pr
BY PERSON WHO PRONOV NCES OR
on ouncin Death Onl
y I I 3 8 ( y when applicab <) 23c. License Num e
CERTIFIES DEATH ~4^un-r- 13 201 r
23d. Date Signed (MO/Day/Vr) 24. Time of Death MDL( c.t -i 1'-t5-
"~ I3 ~~~ t3 1 O ~ 20 .ecP^
25. Was Medical Examiner or Coroner Conta cted7
~ Yes No
GA
F
s
T
y~
S
s
USE OF DEATH
26. Part I. Enter the chain of events--diseases, Injuries, er complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
respiratory arrest, or yem:rlcular fibrilletlon without showing the etiology. DO NOT ABBREVIATE. Enter onl n
/^~ y one cause o aline. Add addltianal Ilnes if necessary.
IMMEDIATE CAUSE ---------.--___> a. /'~C~~~L ~Q$ A I~rZ'L~ -~~n (
(Final disease Or condition D t
resulting In death) may' ( ~M4 c¢ or).
b. ) vl n ~.~
sequentla lly Ilst conditions, Due to (or as a consequence of):
if any, leading to the cause
fisted on Ilne a. Enter the
UNDERLYING CAVSE
(d15ea5e or Injury that Due To (or as a consequence Of):
Initiated the events resulting d.
rn death) LAST.
Due to (or as a consequence of):
26. Part 11. Enter other scant diti n5 t Ib ti but not resulting In the under) in
y g caus¢ given in Part I. ~~ ..._ _
Appr0%Imate
Interval:
Onset to Death
utopsy flnding3`ayallable
To c mplete the c of death?
pregnant within pal:t year o Use Contribute to Death?
Q V
c 31. Manner of Death u No
Q Pregnant at time of tleath
)~ Not pregnant
but pre
nant
i
hi es
~ probably
Q No ~`nknown
Q Homicid¢
,
g
w
t
n 42 days Of death
D Not pregnant, but pregnant 43 days to 1
e
b
f Q ccideni
0 Pending Investigation
~ s
i
id
y
ar
e
ore death
~ Unknown If pregnant within the past year 32. Date of In
Jury (MO/Day/Yr) (Spell Month) u
c
e Q Could not be determined
lace of Injury (e
g
home
cnn
t 33. Time of Injury
.
.
;
s
ru coon site; farm; school) 35. Location of In
Jury (Street and Number,
City, County, State, Zip Cotle)
Inlury at Work 37. If Transportation Injury, Specify: 36. peseribe How In
~ Yes 0 prayer/Operator ~ Pedestrian Jury Occurred:
O No Q Passenger ~ Other 5
( pacify)
39a. Certifier- physicla n, certtfletl nurse praetitlone r, medical eza mine r/coren¢r (Check onl
~ Ceortifying only - To the best of my knowledge, death occurred due to the cause ~' one):
pouncing 8. Certifying - To the best of my knowletl (s) and manner slated.
D Medical Examiner/Coroner - On the balls of examinat on and/o roinyestld at the Yime, date, and place, and due to the cause(s) and manner stated.
gallon, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated.
Slgnatu re of certifier: TI[Ie of certifier M - ~
39b. Name, Address e d Zlp Code of Person Completing Cause Of Death (Item 26) License Numb<r: /VT ~ t-t L# Z. t N S
S>0.-ha~~ Alodtl~«~L4 MO . , ~3 (0 1 Ad~xLi..dxr ~j n' g ~Gir 39c. Dat¢ Signed (MO/Day/Yr)
40. Reglstra is District Number 41. Registrar's 51
- ~' ~ < l1 42. R¢ istrar FileyDate (MO Day
43. Amendments - ~~~ ` IS
-~"(w~~~#~ 3 1
I I 5hc~~~\c\ r-e h' ~n~!- -~>l ~IS~ t-~-l3~i`R (= ''``
DtspoSitiOn Permit NO. ~ ~~~ V t ~ H105-143
- -. - _. _ _ REV 07/2012
tt~~ t11 ~z~ C e~~~nt~~E
I, ETHEL M. RICHWINE, of the Borough of Carlisle, Cumberland
County, Pennsylvania, declare this instrument to be my last will
and testament, hereby expressly revoking all wills and codicils
heretofore made by me.
1. I direct my executors to pay all of my debts, funeral
and administrative expenses as soon as may be done conveniently
after my decease.
2. I authorize and empower my executors to sell any realty
owned by me at my death and not specifically devised herein, at
either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every
nature and wherever situate as follows:
(a) My furniture and appliances to Marshall L.
Prosser, and
(b) All the rest, residue and remainder to my son,
Gerald L. Richwine, and my daughter, Nancy M. Shank,
_~
share and share alike, the child or childrer~ ~ any ~ ~
deceased child taking the share their parent ~u~icbav~ ~ ~
~x+r --~
taken if living. A z ~ coo ~a ~
x
~ ~ ~ ~ ~
~~. I nominate and appoint Gerald L. Richwine an,~' I~n y Mcx~ ~: ~
.~ ~... m
Shank,, to be the executors of this my last will and ~"estamenti ~ ~
they are to serve as such without bond.
5. I hereby suggest that my personal representative retain
the services of Irwin, Irwin & McKnight as attorneys in the
settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this Z5" day of January, 1989.
_y.~~1c.c..r~' ~' /.' ~~'~..c,~''-_.~.,~,_.:~ (SEAL)
ETHEL M. RICHWINE
Signed, sealed, published and declared by Ethel M. Richwine,
the testatrix above named, as and for her last will and
testament, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our
names as witnesses hereto.
2
ACKNOWLEDGEMENT AND AFFIDAVIT
WE, ETHEL M. RICHWINE, BETZI A. MORRISON and SHARON L.
SCHWALM, the testatrix and witnesses respectively, whose
name<_~ are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her Last
Will and that she had signed willingly, and that she executed
it a.s her free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in their presence and
hearing of the testatrix, signed the Will as a witness and
that to the best of their knowledge the testatrix was, at that
time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
_,._ , ,
ETHEL M. RICHWINE
B ZI A..M RRI N
SHARON L. S HWALM
COMMONWEALTH OF PENNSYLVANIA:
ss.
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by
ETHEL M. RICHWINE, the testatrix, and subscribed and sworn to
before me by BETZI A. MORRISON and SHARON L. SCHWALM, witnesses,
this t.5` day of January, 1989.
,~~
-- ~~
R cp . iR;~;,'~, Pif,7TARY PUBLIG
ARLi„ F 70 ~0:!GH, ~:;~1<~E9i„A~;p CGUNT
A4Y CCP , iS~lC?N Ex?IP,"cS ~T. 3, 13<?2
Fu,emh:,r, Ae~ns;~;;nia rs~~,~~iH:;or ~i 1V~fi~re~
RECORI3ED OFFICE OF
REG(STFR OF ; ILLS
1013 FEB 8 A(~ 8 `~?0
RENUNCIATION
CLEF; (C 4~= REGISTER OF WILLS
ORPHANS' COU~~MBERLAND COUNTY, PENNSYLVANIA
CUMBERLAND CO.r 1'A
E §- 'r= ~ i i ^ ~.
,r,
Estate of ETHEL M. RICHWINE
I, NANO' M. SHANK
(Print Name)
CO-EXECUTOR
Deceased
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
GERALD L. RICHWINE
l 3D /~ x
(Date) (Signature)
374 ALEXANDRIA COURT
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this _ day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Street Address)
MARIETTA, PA 17547
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
pu~pyaes stated within on this ~~ day
of , O~
N tary P blic
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
cor+r~oNVV~~+ aF ~NNS~rwnNrA
N~aAal Saad
Karen 5. Noml, NoWY C~ou~
~~~ ~' Cum pec. 8 2015
My Comm _
w+~