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HomeMy WebLinkAbout02-08-13 (2) I Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUM 6 L(Z La N 7 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: H U 1:. sn y E iL S } 5 File No: a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 1 Z Z- S 7 4 L Date of Death: F E I~aZ u A 2y i , z 0 13 Age at death: Decedent was domiciled at death in C U VI ~ € L. -A N U County, ? E NN S y Lv q 14 1 A (state) with his/her last principal residence at 4115 V4f a.'rZ'4lLk E K0410 HA(nPQEr-) C Url'►6(2t-i,AtuO Street address, Post Office and Zip Code City, Township or Borough County Decedent died at >A0Lj 5VtfLCr HOSP►TA%- £f:kMe HILL 0J0)(JtXLANO Pi) 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 $ 2 0 & , C cO, 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.... $ Zoo, a vc- oc) (-gg 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 Z L , 2- 06 g and Codicil(s) thereto dated 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 0 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 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS EXCEPTIONS Ca Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the =lg6ng spouA.-fif an y %irs (attach additional sheets, if necessary): ;:0 _ C3 rn Name Relationship (bes frt M A (n ;i7 ;C C) C) C:) C C'7 ,.p "1 U 1 Cn O Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF L~1{Y~(SLf~i Ht✓i~ } Petitioner(s) Printed Name Petitioner(s) Printed Address Dt (L~ 01NCZ-7 tk) Y)AIIJ 'ST_ I PA 00 UANN ryiyE2-S 4155 t,.7-Ek--tz'41LLE F-OAp EMOLA PA i7oZs The Petitioner(s) above-named swear(s) or affirm(s) the stat ents 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) o the cedent, the Petition (s) w 11 wel and truly administer the estate according to law. Sworn to or affirmed and subscribed before "-1 ` .~~._!i,JC_J -Date J 1Y -j me his di day of J " LJ ,2' ~ 3 A 't Date B - i' - K_ V (s C L Date For the Register Date BOND Required: Q YES ® NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters $ Attorney Signature: ) Short Certificate(s)...... i C C C' ( ) Renunciation(s)........ . ( ) Codicil(s) ( ) Affidavit(s)........... . Bond Printed Name: Commission Supreme Court .U n w M Other ID Number: 03 (n P f Firm Name: M --r- n i r"I Address: ~D t' M M or- k-ki ;;v k-1 Tr ~G1 Cri (ZD _n =q -rl n [7 --i-y v Phone: C) C= n G9 F- 1-M Automation Fee ~ COY Fax: r- , JCS Fee iZ. SZ Email:„ CJ'1 -n TOTAL $~3. DECREE OF THE REGISTER 7 Estate of File No: a/k/a: AND NOW '>~1l1 l • bttm' L in consideration of the foregoing Petition, satisfactory proof having een presented before >1(,i , IT IS DECREED that Letters are hereby granted to -Dc 1 6 CAI 11 C:~ in the above estate and (if a lice ) that the instrument(s) dated described in the Petition be admitted to pro e and file o record as the last Will (and Codicil(s)) of Decedent. Register of Wills _ jyf Form RW-02 rev. 10/1112011 / Pag6-,2 of 2 H 105.AU~ REV 19/I I i LOCAL REGISTRAR'S CERTIFICATION OF DEATH RE69R6M:0FFsIGJEg®Fto duplicate this copy by photostat or photograph. REGISTER OF WILLS Fee for this certificate, $6.~This is to certifv that the information here given is LT 3 FEB U 8 AM 9 00 1` Ny~ correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original CLERK OF z, certificate will be forwarded to the State Vital ORPHANS COURT Records Office for permanent filing. MBERLAND CO., PA `a~fNT G'r,~~iy bl Certification Number Local Registrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Pei 11Inkt CERTIFICATE OF DEATH State File Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 1 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo) 6 2 Paul E. M.... Sr ale 31, - 2- 7 51. Age-Last Birthday (Y-) Sb. Under 1 Year Sc. Under 1 Da 6. Data of Birth (MO/Day/Year) (Spell Month) ]e. Birthplau (City and State or Forai Country) 83 Months Days Hours Minutes June 1 1 1929 Hi hs ire >a 7b. Birthplace (County) 8- Residence (State or Foreign Country) Bb. Residence (Street and Number - Include Apt No.) Sc. Did Decedent Live in a Township? S Rd_ EMY.., d dent lived In Hampden twp. d. Residence unty) 41 1 5 Wertzville Cumber 1 and Be. Residence (Zip Code) 1 7 QN,. decedent lived within limits of city/bor.. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married 29 Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) [2 Yes Q No QUnknown Q Divorced r3 Never Married QUnknown None 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Samuel Myers Mary Elizabeth Eckert 14a. Informant's Name 14b. Relatlonship to Decedent 1141, Informant's Mailing Address (Street and Number, City, State, Zip Code] g Dann T M ers Son 4155 Wertzville Rd., Enola, Pa17025 G --°''---"`.of Death kc heck only one z If Death Occurred In a Hos Ital: in S p paTlent :If Death Occurred Somewhere Other Than a Hospital: Hospice Fecllity Decedent's Home ergency Room/Outpatient Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Other (Specify) lSb. Fecllity Nam! (If not institution, give street and n mbar; 15c. City or Town, State, and Zip Coda SSd. C...t, of Death Hol S irit Hos ital Cam Hill Pa 17011 Cumberland 16a. Method of Disposition [RF Burial Cremation 16b. Date of Disposition 16c. Plsce of Disposition (Name of cemetery, crematory, or other place) Q Removal from State Q Donation Other (Specify) eb 5,.. 2.013 Highspire Cemetery Z 16d. Location of Disposition (City or Town, State, and Zip) 17a. S atur of Funer I Se a License or Person In Charge of Interment 17b. License Number Highspi.re, Pa 17034 FDO11897-L 17c. Name and Complete Address of Funeral Facility - Sullivan Funeral Home 51 N. ENOla Dr., Enola, Pa 17025 18. Decedent's Education - Check the box that best describes the 19. Decedent of Hispanic Origin - Check the 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 whether the decedent the decedent considered himself or herself to be. E] 8th grade or less is Spanish/Hispanic/Latino. Check the "No" White 0 Korean 0 No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American Q Vietnamese High school graduate or GED completed 5a No, not Spanish/Hispanic/Latin, Q American Indian or Alaska Native 0 Other Asian SOm< college credit, but no degree Q Ves, Mexican, Mexican American, Chicano Q Asian Indian 0 Netly! Hawaiian Q Assoclate degree (e. g. AA, AS) Q Yes, Puerto Rican Q Chinese 0 Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino E] Samoan 0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (specify) Q Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Race Self-Designation 6 Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Black or African American 0 Korean 0 Other Pacific Islander Sall es p Q American Indian or Alaska Native 0 Vietnamese Q Don't Know/Not Sure Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry 0 Chl nese 0 Native Hawailan 0 Other (Specify) Q Filipino Q Guamanian orCham.rr. Firestone Motors ITEMS 23a - 23 MUST BE COMPLETED 23a. D$$te Pronounced Dead Mo Day r) T3b,, Signature of Person Pron Ing Death (Only when app (cable 23c. Lic se Number BY PERSON WHO PRONOUNCES OR _S C CERTIFIES DEATH [ C V ~'L'~~R 2©/ 1 sCO (_3 23ds.~Q t//~~^-S5lgnetl (MO/~Dray/Yr 24. Time of Death ,t r y( r Ca/'681e~/TQ G~ ~3 1 S P tit as Me dical Examiner 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 terminal events such as cardiac arrest. Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE.. Enter only one cause on a line. Add additional lines if necessary _ Onset to Death IMMEDIATE CAU SE a. AS/11tH KJ1/JLt^( /f._'-C'L~lJ Li J ~EfLs (Final disease or condition 13ue to (or as a yy~sequence resulting I. death) ~a p f) b Sequentially list condi[lonz, Due to ors a on ~e of If any, leading to the cause listed on line a. Enter the \ e L; P.&- p / ( 5 '{7 UNDERLYING CAUSE Due to (or as a sequence of): .6.a (disease or injury that Initiated the events resulting d. ~r/ 1}JZ Qu.l t~// Q c Q i Pe'~ L~ &A-e ti in death) LAST. Due to (or as a consequence 26. Part 11. Enter other significant conditions contrib,tine to death but not resulting in the underlying cause given In Part I 27. Was an autopsy performed? 128. Were aut.psy findings available TKO 1~ ,CQiLtn K~r- ~3 f~U n Yes B~No 4 to complete the cause of death? D Q Yes No 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death Q Not pregnant within past year Q Yes 0 Probably Natural 0 Homicide Q Pregnant at time of death 0 No fQ'CJ nknown Q Accident 0 Pending Investigation Not pregnant, but pregnant within 42 days of death Q Suicide Q Could not be determined Q Not pregnant, but pregnant 43 days to 1 year before death 32. Data of Injury (MO/Day/Yr) (Spell Month) Q Unknown ff 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, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: 'L'am 0 Yes 0 Driver/Operator 0 Pedestrian 0 No 0 Passenger 0 Other(Sp.Ofy) 39a. Certifier (Check only one): ®-tertlfying Physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated l-' 0 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 Q Medical Examiner/Coroner - On t aslz of examination, and/or Investigation, In my opinion, death occurred -the time, date, and place, and due to the caus/e~(s) and mann stated Signature of certifier: Title of certifler. rnn B License Number:~1 {J 4 4 39b. Name, Address and Zip Code of Person Complgting Cause of Death (Item 26) 391. Da a Signed (MO/Day/Yr) Yrtu - rJ a ( f 67im cl - 40. gistra is District Number 41. Registrar's Signature 42. Registrar File Date Mo Day ) 43. Amendments e LA 2, e> 1-5, 0 Disposition Permit No. O g ZI~X~a REV 07]/20 /2011 LAST WILL AND TESTAMENT OF PAUL E. MYERS, SR. BE IT KNOWN THIS DAY THAT, I, PAUL E. MYERS, SR., of Cumberland County, PENNSYLVANIA, being of legal age and of sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue influence of any person, do make, declare and publish this to be my Will and hereby revoke any Will or Codicil I may have made. C Cl> = rn C= C> rn Cl> ARTICLE ONE -U co Marriage and Children ;0 _(n :X3 M ca M s> r ~.,..y r►.s r- . rn oo ;;0 cr am single and have two living children. a C) C' ARTICLE TWO 00 ryl Debts and Expenses - c.> I direct my Personal Representative to pay all costs and expenses of my last illness and funeral expenses. I further direct my Personal Representative to pay all of my just debts that may be probated, registered and allowed against my estate. However, this provision shall not extend the statute of limitations for the payment of debts, or enlarge upon my legal obligation or any statutory duty of my Personal Representative to pay debts. ARTICLE THREE Tangible Personal Property I may leave a letter, memorandum, or other writing concerning some or all of my tangible personal property. If I do so, and the writing can be incorporated by reference as part of this Will or otherwise be legally binding (i.e., if said writing is signed and dated at the end thereof after the date of this Will), I direct that it be incorporated and/or that it be followed and prevail over the disposition below to the extent consistent with it. If it is not legally binding, I request (but not direct) that my wishes as expressed in it be followed. This provision shall apply whether the writing is executed before or after the date of this Will. ARTICLE FOUR Residuary of Estate I will, devise, bequeath and give all the rest and remainder of my property and estate of every kind and character, including, but not limited to, real and personal property in which I may have an interest at the date of my death and which is not otherwise effectively disposed of, to: DOREEN WINCHELL (daughter) 40.00% DANNY T. MYERS (son) 40.00% JACLYN E. WINCHELL (grand-daughter) 10.00% KENNETH D. MYERS (grand-son) 10.00% Signed by Testator/Testatrix: - 1 - If I name more than one person under this Article, such persons are to receive such property per stirpes. ARTICLE FIVE Appointment of Personal Representative, Executor or Executrix I hereby appoint DOREEN WINCHELL and DANNY MYERS, as Personal Representatives of my estate and this Will. The term "Personal Representative", as used in this Will, shall be deemed to mean and include "Personal Representative", "Executor" or "Executrix". ARTICLE SIX Waiver of Bond, Inventory, Accounting, Reporting and Approval My Personal Representative and successor Personal Representative shall serve without any bond, and I hereby waive the necessity of preparing or filing any inventory, accounting, appraisal, reporting, approvals or final appraisement of my estate. ARTICLE SEVEN Powers of Personal Representative, Executor and Executrix I direct that my Personal Representative shall have broad discretion in the administration of my Estate, without the necessity of Court approval. I grant unto my Personal Representative, all powers that are allowed to be exercised by Personal Representatives by the laws of the State of PENNSYLVANIA and to the extent not prohibited by the laws of PENNSYLVANIA, the following additional powers: 1. To exercise all of the powers, rights and discretions granted by virtue of any "Uniform Trustees' Powers Law," and/or "Probate Code" adopted by the State of PENNSYLVANIA. 2. To compromise claims and to abandon property which, in my Executor's opinion is of little or no value. 3. To purchase or otherwise acquire and to retain any and all stocks, bonds, notes or other securities, or shares or interests in investment trusts and common trust funds, or in any other property, real, personal or mixed, as my Personal Representative may deem advisable, whether or not such investments or property be of the character permissible by fiduciaries, without being liable to any person for such retention or investment. 4. To settle, adjust, dissolve, windup or continue any partnership or other entity in which I may own a partnership or equity interest at the time of my death, subject, however, to the terms of any partnership or other agreement to which I am a party at the time of my death. I authorize my Personal Representative to continue in any partnership or other entity for such periods and upon such terms as they shall determine. My Personal Representative shall not be Signed by Testator/Testatrix: - 2 _ disqualified by reason of being a partner, equity owner or title holder in such firm from participating on behalf of my estate in any dealings herein authorized to be carried on between my Personal Representative and the partners or equity owners of any such partnership or other entity. 5. To lease, sale, or offer on a lease purchase, any real or personal property for such time and upon such terms and conditions in such manner as may be deemed advisable by my Personal Representative, all without court approval. 6. To sell, exchange, assign, transfer and convey any security or property, real or personal, held in my estate, or in any trust, at public or private sale, at such time and price and upon such terms and conditions (including credit) as my Personal Representative may deem advisable and for the best interest of my estate, or any trust. I hereby waive any requirement of issuing summons, giving notice of any hearing, conducting or holding any such hearing, filing bond or other security, or in any way obtaining court authority or approval for any such sale, exchange, assignment, transfer or conveyance of any real or personal property. 7. To pay all necessary expenses of administering the estate and any trust including taxes, trustees' fees, fees for the services of accountants, agents and attorneys, and to reimburse said parties for expenses incurred on behalf of the estate or any trust hereunder. 8. Unless otherwise specifically provided, to make distributions (including the satisfaction of any pecuniary bequest) in cash or in specific property, real or personal, or in an undivided interest therein, or partly in cash and partly in other property, and to do so with or without regard to the income tax basis of specific property allocated to any beneficiary and without making pro rata distributions of specific assets. 9. To determine what is principal and what is income with respect to all receipts and disbursements; to establish and maintain reserves for depreciation, depletion, obsolescence, taxes, insurance premiums, and any other purpose deemed necessary and proper by them and to partite and to distribute property of the estate or trust in kind or in undivided interests, and to determine the value of such property. 10. To participate in any plan of reorganization, consolidation, dissolution, redemption, or similar proceedings involving assets comprising my estate or any trust created hereunder, and to deposit or withdraw securities under any such proceedings. 11. To perform such acts, to participate in such proceedings and to exercise such other rights and privileges in respect to any property, as if she or he were the absolute owner thereof, and in connection therewith to enter into and execute any and all agreements binding my estate and any trust created hereunder. 12. To compromise, settle or adjust any claim or demand by or against my estate, or any trust, to litigate any such claims, including, without limitation, any claims relating to estate or income taxes, or agree to rescind or modify any contract or agreement. 13. To borrow money from such source or sources and upon such terms and conditions as my Personal Representative shall determine, and to give such security therefore as my Personal Representative may determine. All authorities and powers hereinabove granted unto my Personal Representative shall Signed by Testator/Testatrix: -3 - be exercised from time to time in her or his sole and absolute discretion and without prior authority or approval of any Court, and I intend that such powers be construed in the broadest possible extent. ARTICLE EIGHT Construction Intentions It is my intent that this Will be interpreted according to the following provisions: 1. The masculine gender shall be deemed to include the feminine as well as the neuter, and vice versa, as to each of them; the singular shall be deemed to include the plural, and vice versa. 2. The term "testator" as used herein is deemed to include me as Testator or Testatrix. 3. This Will is not a result of a contract between myself and any beneficiary, fiduciary or third party and I may revoke this Will at any time. 4. If any part of this Will shall be declared invalid, illegal, or inoperative for any reason, it is my expressed intent that the remaining parts shall be effective and fully operative and it is my intent that any Court so interpreting same construct this Will and any provision in favor of survival. ARTICLE NINE Misc. Provisions I direct that this Will and the construction thereof shall be governed by the Laws of the State of PENNSYLVANIA. I, PAUL E. MYERS, SR., haying signed this Will in the presence of b1r.Pl~,lfl lY)a,e1 and likA who attested it at my request on this the 9,t day of 2008, declare this to be my Last Will and Testament. PAUL E. MYER , Testator The above and foregoing Will of PAUL E. MYERS, SR. was declared by PAUL E. MYERS, SR. in our view and presence to be his/her Will and was signed and subscribed by the said PAUL E. MYERS, SR. in our view and presence and at her request and in the view and presence of PAUL E. MYERS, SR. and in the view and presence of each other, we, the undersigned, nessed and attested the due execution of the Will of PAUL E. MYERS, SR. on this the day 2008. Witness Signature Witnes Sif nature J Signed by Testator/Testatrix: -4- Print Name:Print Name: , L r \~oc~t Address: - - 2a..> Address: ~-7 City, State, Zip: Cf, 't, City, State, Zip: - 2 -r c v Signed by Testator/Testatrix: 5 PENNSYLVANIA SELF AUTHENTICATING AFFIDAVIT Commonwealth of Pennsylvania County of I, PAUL E. MYERS, SR. the testator/testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by PAUL E. MYERS, SR. , the testator/testatrix, this _-~U day of E'g8,Quo2 y 2008. v Testator/Testatrix PAUL E. MYER R. Signature Notary Public -DJ/ Seal and official capacity 'OMM0r4wtAL1 H OF PENN i NOTARIAL SEAL ~ Notary Public DIANE J. UGLE, Net East Pemsboro Twp., Currlb, My Commission Expires 'F Commonwealth of Pennsylvania County of Cum.b-~r1 n d We, AA Ze.JUA ~ U-.Pj J' and PAL;-A ~ ValI C 'h1 the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. L Sworn to or affirmed and subscribed before me by 'AA and ,tJ /A~ (rifi'l witne this o?(y day of 2008 Witne Witness,- QC) Signature Notary Public / Seal and official capacity of COMMONWEALTH OF PENN`': Notary Public NOTARIAL SEAL DIANE J. NAUGLE, No' East Pemsboro Twp., CuaA., 1 My Comrr4ssion Exerts I