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HomeMy WebLinkAbout03-07-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Petitioner(s) named below, who isiare 1S years of age or older, apply(ies) for Letters as specified belo". and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: 47, SSA ~Gr F" ~,~2 e File No a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: ((9I -3Z- k~s'7 L Date of Death: ao 1~ Age at death: 7_ - :7z Decedent was domiciled at death in , -wn r(a~l C County, P (Scare) with his/her last principal residence at !aOS-EITr ~ACk PA . AA9alea.. PA noSS Tom. Ctw, f~v'(G~ Street address, Post Office and Zip Code City, Township or Borough % County Decedent died at (701 1-1rtr)es6,,n 9A- B76 rr-,!5b c5, Pte, 17i ld 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 $ 7t 3 2d 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.... S -i-S Real estate in Pennsylvania situated at: (Attach additional sheets, ffnecessary.) 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 _J4 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 parry to apending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~NOEXCEPTIONS ❑ EXCEPTIONS ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.ta., pendenx-&e, durante abs nt a, du=t"'noritute C= c C> rnC- If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above anreowlete list f he ff CD %AJ ~ Cn :;113 Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds dRiyic JBd been establisheM defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated RImo M C-7 C- ❑ NO EXCEPTIONS ❑ EXCEPTIONS U; 73 Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by tllg ll 'in`g~5pousETtBany) and hell (attach additional sheets, il-necessary): CD C C-3 C.) y t'.t Name Relationship ;~ddress CD Form liW-OZ my tnittnntt D.,,.o I ,.r,) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF ~~~~Yl~,l ~~~~ } Official Use Only Petitioner(s) rinted Name Petitioner(s) Printed Address P ~~ S : {S~'- Zb ~/Vo~ a In !`, e ` G~ The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) ofthe Dece ent, the Pet' 'o r(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date 317 20 t me tl 's day of „~( ~'~ Date By: ~ _ 1 ~ Date -o Far the Register Date BOND Required: Q YES C9 N FEES: Letters ..................... . (~~ )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ... , ... . ...... Automation Fee .............. . $ ~~C ~-L ~h C~' t JCS Fee ..................... TOTAL ..................... $ >•>• lb" To the Register of Wrlls: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court `~_. ` ' %~' ~ ~ ID Number: C '' yt t 70 rn - ~' Firm Name: ~ e7 Address: ~ T> r° t~~ t'~'Y D ~ 4. ~ ~ ~~ ~ -; y ~ Phone: ~ c: G; ~ Fax: ~ -I t.... Email: D ~-- 'r' DECREE OF THE REGISTER Estate of ~~~'~-~ ~~ ~Q~~(-~- }-~,~~,`~ File No: ~ l ~ ~. ~ - ~ ~~ a/k/a: AND NOW, ~~,~ t;,h ~ ,s~.~ ,inconsideration of the foregoi.n Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters _~,~,~ ~~. are hereby granted to U ~C:L ~~~ in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. G~ ~1- Register of Wills ,rte ~ ~ ~ +~ Y ~~ C~. (.~.Q.~i ~- ~ C~/-~ . Form RW-02 rev. loi/~izou Page 2 of 2 if 10,MlU RED I0iII) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED 0 ICE OF Fee for this certificate. S6.00 This is to ce(tify that the information hcre given is RE I E[~ OF r It~l S ~~IN QFF~ concctiy co ied from an orioa lal Certific ite of Death r`o~ VIA A duly filed with me as Local Registrar. The ori-lmal ?013 pp ~tlfl 7 Pit u 0ag~ ccltiflcatc ),kill he forwarded to the State Vital Rccords Office for permanent filing. CLERK O P 19180072 ORPHANS-COURT CUMBERLAND La, , PA Certification Number Local Reflistlar Date issued /Print In COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ck Ill, CERTIFICATE OF DEATH State File Number 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sev 3.5.1.1 Secunry Number 4. Dale.f Death (MO/DaY/Y,) ISpell M.) Judith S. Hulse le 161 - 32 - 4876 February 22, 2013 51. Age-last Birthday (Y11) 56. Under l Year 5c. Under l Da 6. Date of Birth (MO/DaYNear) (Spell Month) 7a BirthplaceJCiryand SUPtK Foreign Country) Months Days Hours Minutez Waynesburg, PA 72 July 20, 1940 7b Blrthplace(Counry) eels Ba. Residence =;.q,, Country) 8b. Residence (Sir.., and Number - Include Apt No) Bxc, Ditl Decedem Live in a Township] Pennsy E31es,decedentIn,Fdm Lower Allen Bd. Residence ICOUmY) 335 Wesley Drive Apt 420 Cumberland Be Residence (Zip Code) 17055 ❑No, decedent lived within limits of any/nom. 9. Ever in US ID Forces' 10 Marital Status at Time of Death ❑ Marled Walowed 11. Surviving Spouse's Name If wife, gWe name pn.r to first marriage) ❑Yes pJ NO ❑Unknown ❑Dlv.rced ❑hi-,Married ❑Unknown 12. Father's Name (First, Middle, Last. Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Homer Stewart Catharine Huffman Iasi. Informant's Name 141. Relationship 1, Decedent 14c. Informant's Mailing Address IStreet and Numher, Ciry, State, Zip Code) o David Hulse Son 120 Wabash Drive Lexington, Ky 40503 u ......................................~........ISa,Pace o, Death C. ec on Y.ne If Death Occurred in a Hospital: Inpatient :If Death Occurred Somewhere Other Than a Hospital Hospice Facility Decedent's Home ❑ Emergency Room/Outpatient ❑ Dead on Arrival ❑ Nursing Home/Long Term Care Facility Other (Specify) 1Sb Facility Name (If not institution, give street and number:SSc. City or Town, State, and Zip Code lSd. [ounry of Death (3mlyn CrcKbm Slane Diddle Harrisburg, PA 17110 Dauphin 76, . Method of Disposition ❑ Burial N Cremation 161, . Date of Disposition 16c. Place of Disposition (Name of cemetery, 4ri matorY, or other place) C] Femoral from Slate E] Donation ❑Other(Specify) 23 2013 Hollin er CreElato 2 16d. Location of Disposition (City or Town, State, and tlD 17. . 51 f F era) S or Person In Charge of Interment 176, Uc rise Number $ Mt. Holly Springs, PA 17065 - FD - 014889 lhtalme zzi,plate Funeralf HFuneral txnedC 18 Market P aza Wa Mec icsbur PA 17055 18. Decedent's Education- Check the box that best describes the 19. Decedent of Hispanic Origin Check the 20. Oeceden:',Race-Check ONE OR MORE races to indicate what m 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. ❑ 8thg,ade.,less is Spanish/Hispanic/Latino. Checkthe'NO" ® White ❑ Korean ❑ No dlploma, 9th 12th grade pyox if decedent is not Spanish/Hispanic/Latlno. ❑ Black or AlrlIm American ❑ Vietnamese High xhool graduate or GED completed L'.! No, not Spanish/Hlsp.rI,/Latm. ❑ American Indian or Alaska Native ❑ Other Asian ❑ Some college cretlit, but no degree ❑ Yes, Mexican, Mexican American, Chlcan. ❑ Asian Indian ❑ Native Hawaiian ❑ Associate degree (e.g. AA, AS) ❑ Yes, Puerto Rican ❑ Chinese ❑ Guamanian or Ch.-T. ❑ Bachelor's degree (e.g. BA, All, 651 ❑ Yes, Cuban ❑ Filipino ❑ Samoan ❑ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ❑ Yes, other Spanish/Hopanic/Lallno ❑ Japanese ❑ Doctorate le.g. PhD, EdD) or Professional degree ❑ Other Pacific Islander Specify) ❑ Other Ispearyl Is,.. MO 005, DVM, LLB 1D 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 Occupalbn - Indicate type of work White ❑Japanese ❑Samoan done during most of working life. DO NOT USE RETIRED. Black or African Amencan ❑ Korean ❑ Other Pacific Islander AdR1iI11Strdtive Assistant ❑ American Indian or Alaska Native ❑ Vietnamese ❑ Don't Knew/Not Sure ❑ Asian Indian ❑ Other Asian ❑ Refused 22b. Kind of Business/Industry ❑ Chinese ❑ Native Hawaiian ❑ Other (Specify) ❑ Filipino ❑ Guamanian or Chamono Insurance ITEMS 23a-23d MUST BE COMPLETED 23a. Date Pronounced Dead IMO DzYNr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23, License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d. Data Signed IMO/Day/Yr) 24. Time of Deat/1,I SL. 25. Was Medical Examine, or Coroner COntattedi ❑ Yes No CAUSE OF DEATH Approximate 26. Part 1. Enter thecham of events --diseases,injuries, or complications-that directly causedthade,th. DONOTentertermlnaleventssuchascardiac anent Interval: resplra[ory arrest, or ventricular fibrlllafign ho~t,^sholIw/i~ng~the eta,!! D,1O N/SOT ABBREVIATE, Enter only one cause on a line. Add addkion,l lines if necessary On. tI Death IMMEDIATE CAUSE L ~ % a. E IV IT 1~ ~rl F \ 1 Wr-S (Final disease or condition Due to (sir as a consequence of): resuitmg'm death) b. Sequentially list conditions, Due to (or as a consequence.fi: if any, leading to the cause listed online I. En-the UNDERLYING CAUSE Due to for ai a consequence.0 (disease w Injury that F mnated me eren11 re,u tm. d. In death) LAST. Doe to for as a consequence on 26. Part II. Enter other slA ]!)cant conditions contributing to ds ath but lot ,esulling In the underlying cause given In Part I 27. Was an autopsy performed? Cof)D h 6 9 u e P6A41A ❑Yes Np ze. were awopav Rnmri s aralahle to complete the cause of death/ ❑ Yes ❑ N. 29. N Female: 30. Did Tobacco Use Contribute to Death) 31. Manner of Death E )~F.Not pregnant within past Year ❑ Yes ❑ Probably ..,.,at ❑ Homicide 3 ❑ Pregnant at time of death ❑ No Unknown ❑ Accident ❑ Pending Investipt- ❑ Not pregnant, but pregnant within 42 days of death ❑ Suicide ❑ Could not be determined ❑ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Y,) (Spell Month) ❑ Unknownd pregnant within the past Year 33. Time of lnlury 34. Place of lnlury (e. g. home; construction site, farm; school) 35. Location of Injury IStreet and Number, City, State, Zlp 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): $Cenifymg Physician - To the best of my Meiji death occurred due to the cause(s) and manner staled tine S Certi ying phYsicia -T e be my knowledge, death occurred at the time, date, and place, and due to the cause(s) anal marine, staled ❑ Msdicsl Examiner/coroner- ation,and/o,mw:igafion, in my opinion, death occurred at the time, date, and place, and due to the c...e^(s) and malnnerstated_ Signature of certifier: Till. of certifier D License Number: 1~,fts ~ddressand Of son Completing Cau of Dertth,(item 2y ~A / 39c. Da signed MojCNYNr) 8 (6~+a I OOOV ♦(N/-k✓t 2 'Y2 2Dl'3 40. Registrar's Distrkt Number dl Re Sis gnatu 42. Re tray File te(MO Day r) 43. Amenamevl4 l 4d !'P r b 0819577 Hlos-143 Disposition Permit No. qEV 07/2011 LAST WILL AND TESTAMENT Cl) C: r OF © ril c~ a =3 ci e , =_0 E- as ::`,:m JUDITH S. HULSE C1 I, JUDITH S. HULSE, of Mechanicsburg, m`b~x'la s C) c County, Pennsylvania, make, publish and declare this as endpf( _0:r V.1. my Last Will and Testament, hereby revoking all Ether WiP S X114 Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, DAVID S. HULSE, GEORGE F. HULSE, III and KATHY L. JOHNSON. SECOND: Should my son, DAVID S. HULSE, predecease me, I direct that his share under this, my Last Will and Testament, pass, in equal shares, to his daughter, ELAINE M. HULSE and any other children that he might have. THIRD: Should my son, GEORGE F. HULSE, III, predecease me, I direct that his share under this, my Last Will and Testa- ment, pass, in equal shares, to his daughter, BRITTANY D. HULSE, his daughter, JILLIAN L. HULSE, and his step-daughter, TIFFANY R. ARNER, and any other children that he might have. FOURTH: Should my daughter, KATHY L. JOHNSON, prede- cease me, I direct that her share under this, my Last Will and t'. Testament, pass, in equal shares, to my surviving children, DAVID S. HULSE and GEORGE F. HULSE, III. ' FIFTH: In addition to all powers granted to them by ' law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. t (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified I' retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the t extent the plan or the law permits them to do so, and to exercise 'any other rights which they may have under the plan, in whatever manner they consider advisable. SIXTH: I direct that all inheritance, estate, trans- 2 fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SEVENTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. EIGHTH: I nominate and appoint my son, DAVID S. HULSE, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said DAVID S. HULSE, I nominate and appoint my son, GEORGE F. HULSE, III and my daughter, KATHY L. JOHNSON, Co- Executors of this, my Last Will and Testament. I direct that my Executor or Executrix, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 1_i-t day of 1999. /r (SEAL) JUDJ'T'H S. HULSE Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. W Address { Address OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of Judith S. Hulse , Deceased David S. Hulse and (each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were well- acquainted with Judith S. Hulse and am/are familiar with the handwriting and signature of the decedent, and that the signature of Judith S. Hulse to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Judith S. Hulse is in his/her own proper handwriting. ~1' (Signal W) (Signature) 1 zG 11\1,a 6ash Pc (Street Address) (Street Address) /_e,t ,-u 1v vi, ~ D SO3 (City, State, Zi) (City, State, Zip) C> 3 Executed in Register's Office C= ® rn C) Sworn to or affirmed and subscribed m ~ i Ci before me this day Cn of u f l nagiii.z; 2oauauu o rn CDO eputy for Register of Wills cn _n Form RW-04 rev. 10.13.06 V5a ,a OF OATH OF SUBSCRIBING WITNESS( C S C ° S 3 FIB 7 P l 3 05 REGISTER OF WILLS _ CUMBERLAND COUNTY, PENNSYLVANIt RAC,, G i CUMBERLAND CO., PA Estate of Judith S. Hulse , Deceased James D. Bogar , (each) a subscribing witness to (Print Name/s) the ® Will El 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 presence and in the presence of each other. (Signature) (Signal re) One West Main Street (Street Address) (Street Address) Shiremanstown. PA 17011 (City, State, Zip) (City, State, Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed `l day before me this day before me this r / of of 1j)[a1rh. Deputy for Register of Wills Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's 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. CQMMORVQH OF PEN N Form RW-03 rev. 10.13.06 NOTARIAL SEAL BETH B. LENGEL, NOTARY PUBLIC SHIREMANSTOWN BORO, CUMBERLAND COUNTY MY COMMISSION EXPIRES DECEMBER 12, 2015 L l<<~~~av5~ no 10VLSGv- Lv6,-Vs 9:,,- Ja "es 60 M C-> ;K G5 ;Yr r'7$ CD -q C= C j C.J @: FVi M