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Home My WebLink About02-21-13 ESTATE OF : IN THE COURT OF COMMON PLEAS ANNA K. EVELHOCH : CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. rv n PETITION UNDER SECTION 3102 OF THE PROBATE, co _M ESTATES AND FIDUCIARIES CODE FOR M s w SETTLEMENT OF SMALL ESTATE r M CD c aA=- TO THE HONORABLE JUDGES OF SAID COURT: C= Cn Frank M. Evelhoch, II, your Petitioner, files this Petition for Settlement of a Small Estate under the provisions of Section 3102 of the Probate, Estates and Fiduciaries Code and in support thereof avers that: (1) Your Petitioner, Frank M. Evelhoch, II is a competent adult residing at 17 Pamela Drive, Mechanicsburg, Pennsylvania 17050, and is the son of the above decedent. (2) Anna K. Evelhoch died on January 13, 2013 at the age of 86 years, but prior thereto lived and was domiciled at 442 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania. A copy of decedent's Death Certificate is attached hereto as Exhibit "A." (3) Anna K. Evelhoch died with a Will. No Letters have been issued. A copy of Decedent's Last Will and Testament are attached hereto as Exhibit "B." (4) Anna K. Evelhoch had no probate estate when he died other than the following: Savings, Checking and Investment Savings Account with Members 1St Federal Credit Union with a combined balance of $4,008.33. A Date of Death Valuation is attached hereto as Exhibit "C." (5) The sole heirs and relationship to the decedent are as follows: Frank M. Evelhoch, Spouse Jeffrey L. Evelhoch, Son Frank M. Evelhoch, Il, Son (6) Your Petitioner avers that there are no creditors of the decedent and no claims unpaid known to your Petitioner. (7) Pursuant to the Last Will and Testament of Anna K. Evelhoch dated November 10, 1993, Frank M. Evelhoch is appointed to be the Executor of the Estate of Anna K. Evelhoch, with Jeffrey L. Evelhoch to act as Successor Executor. (8) Frank M. Evelhoch is unable to fulfill the necessary duties as Executor. (9) Letter issued by George P. Branscum, M.D. stating that Frank M. Evelhoch is unable to serve as Executor is attached hereto as Exhibit "D." (10) Renunciation signed by Frank M. Evelhoch in favor of Frank M. Evelhoch, 11 is attached hereto as Exhibit "E." (11) Renunciation signed by Jeffrey L. Evelhoch in favor of Frank M. Evelhoch, 11 is attached hereto as Exhibit "F." (12) Pursuant to Paragraph Three of the Last Will and Testament of Anna K. Evelhoch, Frank M. Evelhoch is the beneficiary of the estate. Therefore, no inheritance tax is due. WHEREFORE, your Petitioner respectfully requests that an Order be made authorizing Frank M. Evelhoch, 11 to act as Fiduciary for the Estate of Anna K. Evelhoch, and close the account with Members 1" Federal Credit Union with the proceeds made payable to The Estate of Anna K. Evelhoch, pursuant to Section 3102 of the Probate, Estates and Fiduciaries Code. By Roge - $ Irwin, Esquire Suprehi-d Court I.D. No. 06282 IRWIN & McKNIGHT, P.C. 60 West Pomfret Street Carlisle, PA 17013 (717) 249-2353 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Frank M. Evelhoch, 11 being duly sworn according to law, deposes and says that the facts contained in the foregoing Petition are true and correct to the best of her knowledge, information and belief. ,Z~v~c~~,✓ (SEAL) Frank M. Evelhoch, II Sworn and subscribed before me this , j ' day of February, 2013. COMMONWEALY ~O P NNSYLY84% seal Notary Public Karen S. Novi, Carlisle Bono, Z3mberland County Not ry Public , 11105805 RE%' (9/1 11 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 = This is to certify that the information here given is /if~A~~ PFiyy~ correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original y: certificate will be forwarded to the State Vital y a Records Office for permanent filing. Al i! 14 6 013 . MINT a4, , Certification Number Local Registrar Date Issued Type/Print In _ COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH State File Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. 5ex 3. Social Security Number 4. Date of Death (M,/D-ay/Yr) (Spell Mo) Anna Kathryn Evolhoch Female 201-18-2593 January 13, 2013 .y Sa. Age-Last Birthday (Yrs) 5b. Linde, 1 Year 5c. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) °i~ 86 Mont n: Days Hours Minptes Sept 11, 1926 NawVille PA 7b. Birthplace (County) Cumberland 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number- Inclutle Apt No.) 8c. Did Decedent Live in a Township? 442 Walnut Sottom Rd. [:]Yes, decedent Ilved in twp 8d. Residence (County) Cumberland Be. Residence (Zip Code) 17013 Qy No, decedent lived within limits of Car11s1e city/boro. 17. Ever in US Armed Forces? I30. Marital Status at Time of Death M Married E3 Widowed It. Surviving Spouse's Name (If wife, give name prior to first marriage) p Yes EX No E3 Unknown [3 Divorced [3 Never Married E3 Unknown Frank M_ Evelhoeh 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) James Walters Ora Shenck 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code ) 0 9 Frank Evelhoch son 17 Pamela Dr_, Mechanicsburg, PA 17050 Ci . .........................................................~1--.++tt i5a. Place of Deat C e_c only one ~ If Death Occurred in a Hospital: u inpatient - i If Death Occurred Somewhe " - re Other Than a Hospital: ° Hos ice Facili P ty Decedent's Home Emergency Room/Outpatient Dead on Arrival Nursing Home/Long-Term Care Facility Other (Specify) 15b. Facility Name (If not institution, give street and number; 15c. City -17r; State, and Zip Code 15d. County of Death Tl-riornwald Home Carlisle, PA 17013 Cumberland 16a. Method of Disposition [g Burial E3 Cremation 16b. Date of Disposition 16c.Place of Disposition (Name of cemetery, re c matory, or other place) Removal from state E3 Donation Jan 17 , 201 Westminster Cametery Ocher (Specify) 16d. Location of Disposition (City or Town, Stat" and zip) 17 of ure of funeral Servi Lic or Person in Char Z ge of Interment 111. License Number Carlisle, PA 17013 013144r. S 17c. Name antl Complete Address of Funeral Facility al Ho & Cjr t__ 219 North Hanover Street, Carlisle, PA 17013 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. 8th grade or less is Spanish/Hasp a n(c/Latino. Check the "NO" Q9 White Korean [3 No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. [3 Black or African American p Vietnamese High school graduate or GED completed [X No, not Spanish/Hispanic/Latino E3 American Indian or Alaska Native E3 Other Asian 0 Some college credit, but no degree E3 Yes, Mexican, Mexican American, Chicano Asian Indian [3 Native Hawaiian E3 Associate degree (e.g. AA, AS) E3 Yes, Puerto Rican Chinese 's ) O Guamanian or Chamorro Bachelor degree ( g. . BA, A6, BS Yes, Cuban Filipino [3 Samoan Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) E3 Yes, other Spanish/Hispanic/Latino E3 Japanese [3 Other Pacific Islander [3 Doctorate (e.g. PhD, EdO)LBor Professional degree (Specify) E3 Other (Specify) . MD, DDS, DV M, L, JD 21. Decedent's Single Race Self-Designation - Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 221. Decedent's usual occupation - Indicate type of work While E3 Japanese E3 Samoan done during most of working life. DO NOT USE RETIRED. Black or African American [3 Korean E3 Other Pacific Islander Clerks 1st American Indian or Alaska Native M Vietnamese Don't Know/Not Sure `sY W E3 Asian Indian E3 Other Asian Refused 22b. Kind of Business/Industry E3 Chinese E3 Native Hawaiian Other (Specify) c E] Fillalno E3 Guamanian .,Ch.-.,,. Insurance Company ITEMS 23, - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo Day/Y72-'. b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH "m 23d. Date Signed (MO/Day/Vr) Time of Death ~7- t Was lCledical Examiner or Coroner Contacted? O Yes No CAUSE OF DEATH 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 Approximate arrest Interval: respiratory arrest, or ventricular fibrillation without 117,)Ang the e,Eiology. O NOT ABB TE. En ly o e cause on a line. Add additional lines if necessary Onset to Death on n IMMEDIATE CAUSEn ho > a. (iJ p= msea:e or slI dluon .,sure of): eulting in death) Leo / u a rf~ ~ ~ Sequentially list conditions, Due to ( a consequ ce ofj` If any, leading to the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury that In itlated the events resulting d. in death) LAST. Due to (or as a consequence of): ij 26. Part 11. Enter other si ificant co itions tributin to death but not resulunderlYing cause nn in 27. Was an autopsy P rformed? the C3 Ves No m G?T ~iZr 28. ere autopsy findings available -n to co plete the cause of tleath? a' Q Yes E3 No ` 29. If Fe ale: 30. Did Tobacco Use Contribute to Death? 3 M f Death S Not pregnant within pass year Ves [3 Probablyatu ral Homicide E3 regnant at time of death NO 0 Unknown [3 Accident E3 Pending Investigation [3 Not pregnant, but pregnant within 42 days of death Suicide E3 Could not be determined F3 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of InJury (Mo/Day/Vr) (Spell Month) E3 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 Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. It Transportation Injury, Specify: 38. Describe How In W E3 Yes M Driver/O Jury Occurred: Aerator Pedestrian E3 No E3 Passenger E3 Other(Specify) 3Ka rtifier (Check only one ertifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated ronouncing 8' 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 Metlical Examiner/Coroner - t basis nation, and/or investigation, in my opinion, tleat/h[/~/lV /j~J at the time, date, and place, and due to the -se(s) and~mmanner stated Signature of certifier: Title of ce rtifler: [ - License Number , 0? 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Yr) Michael O. Daniels, 303 N_ Baltimore Ave., Mt_ Holly Springs, PA 7065 40. Registrars District Number 41. Registrar's 51 42. Registrar File Date Mo Day Yr) ° 43. Amendments ~ O 2 H105-143 Disposition Permit No. L`P REV 07/2011 LAST WILL AND TESTAMENT I, ANNA K. EVELHOCH, 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. ONE: I direct my Executor to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. TWO: I give, devise and bequeath all of my property of every nature and wherever situate to my husband, FRANK M. EVELHOCH, provided he has survived me by thirty (30) days or more. THREE: If my husband, FRANK M. EVELHOCH, has predeceased me, or failed to survive me by thirty (30) days or more, I give, devise and bequeath all of my estate of every nature and wherever situate to the following: a. To JEFFREY L. EVELHOCH .......................................................50%; b. To FRANK M. EVELHOCH, H .....................................................50% If either of the above has predeceased me, then the share of the predeceased will be distributed equally to the living issue of my aforementioned deceased son. FOUR: I appoint my husband, FRANK M. EVELHOCH, Executor of this my Last Will. If he has predeceased me, failed to qualify, or ceased to serve as Executor, I appoint my son, JEFFREY L. EVELHOCH, to be the Executor of this my Last Will. FIVE: My Executor may, at his discretion, compromise claims, borrow money, retain property for such length of time as he may deem proper, lease and sell property for such prices, on such terms, at public or private sales, as he may deem proper; and invest estate property and income without restriction to legal investments. SIX: No Executor acting hereunder shall be required to post bond or enter security in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 22nd day of August, 1995. SEAL) ANNA K. EVELHOCH Signed, sealed, published and declared by ANNA K. EVELHOCH, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other have subscribed our names as witnesses hereto. 2 ACKNOWLEDGMENT AND AFFIDA VIT WE, ANNA K. EVELHOCH, TERESA M. HENRY and CHERYL L. CLELAND, the testatrix and witnesses respectively, whose names 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 as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the 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. ANNA K. EVELH CH T RESA . HE HERYL L. CLELAN COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by, the testatrix herein and subscribed and sworn to before me by ANNA K. EVELHOCH, TERESA M. HENRY and CHERYL L. CLELAND, this 22ND day of August, 1995. Notary blic LNotaed seal Betzi A Morrison, Notary Pubk Caide Born, Cumbertand County My Comrnisslon Expires Dec. 15,1998 tuber, nsyNanii-A-w elation of Notaries A MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 408628-00 D-ate Account Established 01/31/2011 Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $5.00 Total Interest Accrued 01/01/2012-12/31/2012 $8.32 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 408628-11 D-ate Account Established 01/31/2011 Principal Balance at Date of Death $3,974.65 Accrued Interest to Date of Death $0.06 Total Principal and Accrued Interest $3,974.71 Total Interest Accrued 01/01/2012-12/31/2012 $5.26 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 408628-05 D-ate Account Established 01/31/2011 Principal Balance at Date of Death $0.00 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $0.00 Total Interest Accrued 01/01/2012-12/31/2012 $25.30 Name of Joint Owner None MEMBERS 1ST FEDERAL CREDIT UNION Tessa L ~Ki~ Lending Insurance Support Specialist January 25, 2013 Estate of: ANNA K EVELHOCH Date of Death: 01/13/2013 Social Security Number: 201-18-2593 5000 Louise Drive • P.O. Box 40 • Mechanicsburg, Pennsylvania 17055 • (800) 283-2328 • www.memberslst.org THORNWALD HOME 442 Walnut Bottom Road, Carlisle, PA 17013 (717) 249-4118 • (717) 249-8906 FAX www.ucc-homes.org 23 January 2013 Re: Frank M Evelhoch DOB : 04/27/1924 SSN: 201-16-6168 To Whom It May Concern, The above-captioned resident, whom I have followed as attending physician since his admission to Thornwald Home on June 8th, 2010, is listed as the Executor for his wife, Anna, in her Last Will & Testament. This letter serves to inform those interested legal parties that Mr. Evelhoch is unable to fulfill the necessary duties as the Executor due to moderate cognitive impairment relating to the diagnosis of dementia CVA. If I can be of further assistance or you require further information, please contact me at the facility. Thank you. Sincerely, e3 M- 1~ George P. Branscum, M.D. Attending Physician ' A program of service for the older person sponsored by United Church of Christ Homes RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of ANNA KATHRYN EVELHOCH , Deceased I, FRANK M. EVELHOCH , in my capacity/relationship as (Print Name) EXECUTOR of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to FRANK M. EVELHOCH, II -64~b oi- V-`-, (Date) (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciation for the purpstat d ithin on this day of 'J Q/~ Deputy for Register of Wills No ary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Karen S. Noel, Notary Public Form RW-06 rev. 10. 13.06 Carlisle Boro, Cumberland County My Commisslon Expires Dec. 8 2015 RMalk F@NN5YLVANL4 A550CUTION OF NOTARIES RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of ANNA KATHRYN EVELHOCH , Deceased I, JEFFREY L. EVELHOCH , in my capacity/relationship as (Print Name) SUBSTITUTE EXECUTOR of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to FRANK M. EVELHOCH, II I (Date) (Sign bufnr~jcl - E (Street Address) (City, State', Zip)' Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and -subscribed Before the undersigned personally appeared the before me this Z Y day party executing this renunciation and certified of 1 c, i1 2- v i that he or she executed the renunciation for the purposes stated within on this Z, 'i day of Jct.-vim- Zo 132 S} A~Llaj~l Deputy for Register of Wills otary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENN. ILVANIA Notarial Seal Gabrielle A. Gordon, Notary Public Form RW-06 rev. 10. 13.06 Upper Gwynedd Twp., Montgomery County My Commission Expires Nov. 26, 2013 Member, Pennsviv; sglation of Notaries