Loading...
HomeMy WebLinkAbout02-04-13 PETITION 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 requests the grant of Letters in the appropriate form: Clifford Allan Ward, Sr. Decedent's Information Name: Richard B. Ward File No: 21 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 204-03-3403 Date of Death: 12105/2012 Age at Death: 90 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 1844 Sheepford Rd., Mechanicsburg 17055 Lower Allen Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 1844 Sheepford Rd., Mechanicsburg 17055 Lower Allen 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 $ 5,000.00 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 $ 5,000.00 Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ❑X A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated 02/0112007 and Codicil(s) thereto dated State relevant circumstances (e.g., renunciation, death ofexecutor, 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 ❑ EXCEPTIONS ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pedente 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 pending divorce proceeding wherein the grounds for divorce had been e®blished ajdefned in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adudicated an incapacitated per4 . C m m F1 NO EXCEPTIONS E] EXCEPTIONS = © 'T1 G7 C-> Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by tr~fol ln/j~y spds~ (if zfi$ d heirs (attach additional sheets, if necessary): ;17).r ran1111 a=M "ms s Name Relationship Address "n O G) Cn C7 Form R'iV-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page t of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s) Printed Name Petitioner(s) Printed Address Clifford Allan Ward, Sr. 460 E Mount Airy Rd E7 PO Dillsburg, PA 17019 C Q M 4 Mt) r- =M m r1l ~ a c+ C.) o -n -n ~c) -n -o r-- rn W cn 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) ooff~e Dec dent, Pe tioner(s) will well and tt I minister the estate according to law. Sworn to or affirmed an'c~s, ubscribed before v1 4; 11 ~R ~1 T , Date - me I T r' day of Z t f Date B I-) J i Date For the Register Date i To the Register of Wills: BOND Required? ~ YES ~ NO FEES: Please enter my appearance by my signature below: Letters $ 20.00 Attorney Signature: ( 6 )Short Certificate(s)......... 24.00 ( )Renunciation(s) ( )Codicil(s) ( )Affidavit(s) Printed Name: Linda g Olsen, Esq. Bond Supreme Court Commission ID Number: 92858 Other Will 15.00 Firm Name: Hazen Elder Law Address: 2000 Linglestown Rd. Suite 202 Harrisburg, PA 17110 Phone: 717-540-4332 Automation Fee 5.00 Fax: 717-540-4313 JCS Fee 23.50 TOTAL $ 87.50 E-mail: lolsen@hazeneiderlaw.com DECREE OF THE REGISTER Date of Death: 12/05/2012 Social Security No: 204-03-3403 Estate of Richard B. Ward File No: 21 a/k/a: AND NOW tt Vic. r~-~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, I DECREED that Letters Testamentary are hereby granted to Clifford Allan Ward, Sr. in the above estate and (if applicable) that the instrument(s) dated 02/0112007 described in the Petition be admitted to probate and filed of record as th last Will (and Codicil(s)) of Decedent. Register of Wills I ti'L!'L~-t'1 1)'fi f~~ ~h Copyright (c) 2011 form software ly The c er Group, Inc. Page 2 of 2 11105.``0, Rf'\ 1W!I1 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OFFICE OF Fee for this certificate, S6.00 REGISTER OF WILLS qu ~ This is to certify that the information here (riven is ~11j ~~V `I s)f = c co,ltctly copied from an original Certificate of Death 1~~3 FEB u c ,,e ~~t _ duly filed with me as Local Registrar. The original Ut I rrq t 3S g ..imitate will be forwarded to the State Vital Records Office for permanent filing. CLERK OF P 1917 8 8 0 6 ORPHANS' COURT Certification Number CUMBERLAND Co.. PA ~.,-~=1f Local Registrar Date Issued 'riot In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS kIn;` CERTIFICATE OF DEATH State File Number: 1. Decedent's Legal Name (Flrlt, middle, Last, S.M.) Z. Sea 3. Social Security Number 4. Date of DeaM (Mo/Day/Yr) (Spell Mot t Eud WayA M 0.1 204- 340' bPr 5, . Age-Last Birthday (Yrs) Sb. Under 1 Year c. Under l Da 6. Data of Birth (MO/OayC/~year) (Soc sX. ]pell Month) ]a. Birth, ace (City and State or Foreign Country) 90 Months Day Hours Minutes I r 1 11 Birthplace ( ounty) ry e Ba. Resident Stale or Foreign Country) 8b. Residence (Street and Number - Include Apt No.) BcJD d Decedent the in a Township] 1 %L,111 C J7 G_ ~3 M * `L~Yes, decedent lw, d M efr- Al lfa~l1 -P, ed. R l ali e' ce ([aunty) 'f YI •IL]3"ci FF Be. Residence (Zip Code) b !35 ❑ No, decedent lived within limits of city/bolo. 9..-,E~v"er in US ArmN Forces? 10 Marital Status at Time of Death ❑Marrietl Widowed 13. Surviving Spouse's Name (I(wik, give name prior [o first marriage) Ly Tes ❑ No ❑Unknown ❑ Divorced ❑ Never Married ❑Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) J Gyn A'A 34a. In(.rmant's Name 146. Relationship to Decedent ldc. Informant's Mailing Address IStree and Number, City, State, Zip Code) 51,1 4bo CAw& , l ll P 1-7011 aeo eat p {Inpatient I( Oeath Occurred In a Hos Ital: curred Somewhere OthCer Than a Hospital: Hos Death ~c ,ice Facility t7 Decedent's Home ❑ Emergency Room/Outpatient ❑ Dead on Arrival rsing Home/LOngTerm are Pacify) Facility Other (S SSb. Facility Name (I( not Institution, give street and lumber; 15c Ci r Town, State, and Zip Code 15d. County of Death 'ca a L~cu-Ii-s ) 7D)3 , PA I6a. Method of Disposition n., ❑ Cremation 16b. Date of Disposition 11, Place of Disposition (Name of cemetery, crematory, or other place) Y, bgs4rM ❑ Removal from Stale Donation I~ 11i p(a R D I I I J other (spenhl / J L~~K=1'1 '11e YNFl✓I ~ YM'IC~ 16tl. Location of Disposition (C)ry or Town, State, and Zip) I]p_ SIAnFUnera ervice - on in Ch.-. o(In[erment 176 . Ucense Number Cam Wsll PA 17DIt V/ F Ola 74 L 1]c. Name and Com fete Address Funeral Facility ers - fVI R h sf. P.a I~ ass 18. D etlent's Education -C ck the boa that best describes the 19. Decedent of Mlspa is On Check the 20. Decedent's Race -Check O 00. MORE as to indicate what s highesfdegree or level of school completed at the time of death. boa that best describes whether the decedent theFaced ent considered himself or herself to be. I 8th grade or less Is Spanish/Hispanic/Latino. Check the "No' 21"ite ❑ Korean ❑ No dlploma, 9th - 12th grade boa if decedent is not Spanish/Hispanle/Latino ❑ Black or African American ❑ Vietnamese ❑ High school graduate or G10Completed p'14., not Spanish/Hispanic/Latin, ❑ American Indian or Alaska Native ❑ Other Au,n ❑ Some college credit, but no degree ❑ Yes, Meaican, Meaican 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, AS, BS) ❑ Yes, Cuban ❑ Filipino ❑ Samoan ❑ Masters degree (e g. MA, MS, MEng, MEd, MSW, MBA) ❑ Yes, other Spanish/Hispanic/Latin, ❑ Japanese ❑ Other Pacific Islander ❑ Doctorate (e.g. PhD, EdID) be Professi,nal degree 15pecify) ❑ Other (Specify) MD, DDS, DVM, LLB, 1D 21. Decedent's Single Race Self-Designation - Check ONLY ONE to indicate what the decedent considered himself or herself [o be. 22a. Decedent's Usual Occupation - Indicate type of work 211hi[e ❑lapanese ❑Samoan done during most of working life. DO NOT USE RETIRED. ❑ Black or African American ❑Korean ❑ Other Pacific Islander Foy _e. VVLUl ❑ American Indian or Alaska Native ❑ Vietnamese [3 Don't Know/Not Sure ❑ Asian Indian ❑ Other Asian ❑ Refused 22b. Kind of Business/Industry ❑ Chinese ❑ Native Hawaiian ❑ Other (Specify) ❑ Filipino ❑ Guamanian or Chamorro Fend Molt ITEMS 23a- 23d MUST BE COMPLETED 23a. Data Pronounced Dead (MO Day r) 231 . Sign of P non o Dea )Only when apPlicablel 23c. License Number BY PERSON WHO PRONOUNCES OR ] CERTIFIES DEATH 21 Time Qt') 1, 13 3U`6 23d. Dat 51 d IMO/Day/Yr) , -l o--sDeath J cis tT U 2 s Medical E miner o on,, Contacted] ❑ Yet (5L No CAUSE OF DEATH Approamate 26. Part 1. Enter the chain of everd -dlseases,mj,ries, or complication,-that directly caused the death, DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillatlon without sth,.m, the etiology. 00 NOT ABBREVIATE. Enter only one cause one line. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE a. y f~ i (Final disease or condition Due to for as a copse-nce IF). resulting m death) b Sequentially list conditions, Due to (or as a consequence off: (any, leading to the cause listed on line a. Enter the UNDERLYING CAUSE Due to Ior as a consequence of): (disease or injury that initiated the events resulting If In death) LAST. Due to (or as a consequence oO'. 26. Part 11, Enter other sleni scant conditions con lblUne to death but not resulting in the underlying cause 9,11n m Part 27. Was an autopsy performed] ❑ Yes [1~Na - 111. Were autopsy findings available to complete the cause of death] Z ❑ Yes ❑ No 29. If Female. 30. Dld Tobacco Use C-lbute to Death? 31anner of Death ❑ Not pregnant within past year ❑ Yes t_y U ❑.-/Probably (3y Nataral ❑ Homicide ❑ Pregnant at time of death ❑ Nonknown ❑ Accident ❑ Pending Investigation ❑ Not Pregnant, but pregnant within 42 days of death ❑ Suicide ❑ Could not be determined ❑ Not pregnant, but pregnant 43 days to I year before death 32. Date of Injury IMO/Day/vrl (Spell Monthl ❑ Unknown II pregnant within the past year 33. Time of Injury 34. Place of Injury I,. g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 3]. If Transportation Inlary. Specify: 38. Describe H,w Injury Occurred'. ❑ Yes ❑ DnVer/Operator ❑ Pedes ❑ No ❑ Passenger ❑ Other (Specify) 39a. Certifier (Check only one): ',Certifying physician -To the best of my knowledge, death occurred due to the cause(s) and manner stated ❑ Pronouncing & Certifying physician To the best of my knowledge, death ...urred at the time, date, and place, and due to the cause(s) and manner stated ❑ Medical Eaaminer/Coroner On the basis of enanumation, and/or Investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated Signature of certifier: Title of certifier License Number:!!P5) tllZt-(16 39b. Name, Address an Zip Code of Person Completing Cause of Death (Item 26) ray, ` 39c. Dat 51 d a/Oay/yr) 11 Nc Jvr ~fIVC C-;?-,r I-Pkus r L v~v j Z 40. P¢gis[rais Di strict NIumber 141. Re_ 's natu 42. Registrar File Date IMO DayIYr) 43. Amendment: •a I~ Ix Hl 5-143 O I /•31 tv O 1 7 01-1111m, Perini[ No. RFV nT]]ni tit 1 LAST WILL AND TESTAMENT OF RICHARD B. WARD I, RICHARD B. WARD, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and c2i&s that4;maAh6P-ve OI7 ~ rn G") O previously made. ° M~ a r-- a (n~ -C . p c~ n o Article I ° X c0 rnn w ° My just debts and expenses of my last illness, funeral, and administrationW my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath my tangible personal property in accordance with any memorandum I have handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Article IV hereof. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my son, CLIFFORD ALLAN WARD, SR, of York County, Pennsylvania. In the event that CLIFFORD ALLAN WARD, SR. predeceases me or fails to survive me by thirty (30) days, I give, devise, and bequeath the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate to my daughter-in-law, PATRICIA A. WARD, of York County, Pennsylvania, per stirpes. Article V I nominate, constitute and appoint my son, CLIFFORD ALLAN WARD, SR., as Executor of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my daughter- in-law, PATRICIA A. WARD, as successor Executrix of my Last Will and Testament. I direct that my Executor or successor Executrix be permitted to serve without bond. In addition to those 2 powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Executor or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executor and successor Executrix, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor or successor Executrix; and to pay from my estate reasonable compensation for all their services, 3 (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and 0) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, RICHARD B. WARD, hereby set my hand to this my Last Will and Testament, on re/~ (j , 2007, at Harrisburg, Pennsylvania. CHARD B. WARD In our presence, the above-named RICHARD B. WARD signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name Address • 2000 Linalestown Rd., Suite 202, Harrisburg PA 17110 (1ua 2000 Linglestown Rd., Suite 202, Harrisburg PA 17110 4 I, RICHARD B. WARD, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and Acknowledged before me by RICH RD B. WARD, the Testator on ra , 2007. Nota y Pu li ICHARD B. W RD COMMONWEALTH PENNSYLVANIA Notarial Seal Marielle F. Hazen, Nota7 Public Susquehanna Twp., Dauphin County My Commission Expires Sept. 23, 2010 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and Subscribed to before me 5 lei /V. and Lt ~lt Witness witne ses, on 2007. Wi ess Nota y Pu lic COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Hazen, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Sept. 23, 2010 5