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HomeMy WebLinkAbout02-22-13 (2) PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF LC/~I nJ~ 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: ` File No: D .jj /-Y"./ Z~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 17 S~ q(, Date of Death: Age at death: 65- Decedent was domicile t death in County, (State) with his/ er last Jl principal residence at d A77 P r' Street address, Post offs and Zip Code City, Township or Borough / County Decedent died at 1Oe S, 61-4 rs~-l C f1- 1-9r.? / ~oSS ( C'UI►?~erIj~Rkq Street address, Post ice 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 $ / SO, p C:) 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.... $ d0 ~ Real estate in Pennsylvania situated at: (Attach additional sheets, ifnecessary) Street address, Post Office and Zip Code City, Township or Borough County NI-I[J] 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 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 ❑ EXCEPTIONS ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendentelite, duranteabs•entia, duranteminoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list ot"beirs. c-_n Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for d@rce had been e-alishMsfined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated persM -71 M C? ❑NO EXCEPTIONS ❑ EXCEPTIONS rn m CA 7m Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the f WIN sMse (i ) antCTibit ttach additional sheets, if necessary): C!3 Name Relationshi -n F :U N C"7 N t +9 'Tl CID Fora, RW-02 rev. 101112011 Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } SS: COUNTY OF ~lrz/~P/~L21?e } Petitioner(s) Printed Name Petitioner(s) Printed Address 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 De dent, the Petitioner(s ill well and truly administer the estate accor ng to la Sworn to or affirmed and subscribed before Date k me ~day of Date ,Z-7 / By Date For the Register Date BOND Required: Q YES PO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters $ 0'b Attorney Signature: ( ) Short Certificate(s)...... A5 ( ) Renunciation(s)......... C= aD ( ) Codicil(s) w %v M ( ) Affidavit(s)............ 3 'rt O O Bond Printed Name: 'L7 Qr-TI 7 Cn X Commission Supreme Court y r- N rn rn Other ID Number: ~ Z rn N :C7 q 1 - O O ►.t.... Firm Name: C7 C) V%ill (J. D Address: --rj r V Y'- rn ~i '0 Gti- Cn O Phone: Automation Fee Fax: JCS Fee Email: TOTAL $ 0.00 DECREE OF THE REGISTER Estate of File No:' a/k/a: AND NOW, in cons'deration of the foregoing Petition, 'MM satisfactory proof having been p e ented before me, I EREED that Letters .-MPSTOYIA are hereby granted to n (A ZY1 (I in the above estate and (if applicable) that 7) e the instrument(s) dated described in the Petition be a fitted to probate a 0d filed of r ord as the last Will (and Codicil of Decedent. ^ egister of Will A Fm-m R W-02 rev. 10/111201 / Pag 2 of 2 II Iil5 Sf)S RFA 19/1 I I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 RECORDEDICE OF Ih(, 1s to certifv that the information here given is I I ~:~41 OF p REGISTER O IL core ctly copied from an original Certificate of Death dnk filed with me as Local Registrar. The original 'b c L rtificate will he forwarded to the State Vital 1013 FEB 22 Pn 12- Q Records 01fice lor permanent filing. P 19179933 CLERK 0 ~~~t _ E~uTYYyYjjj, Certification Dumber PNANS COURT aE~~ Local [~etzi~strar Date issued /P~'v U M B E R L A N D C 0. ;DM Ii OAEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ` ck lnkt 111 IIIII CERTIFICATE OF DEATH State File Number: 1. Decedent's Legal Name (First, Middle, Usl, Sutflx) 2. Sex 3. SorIaI SecudH Number 4. Data of Death (MO/D,Y/Y,) (Spell Ma) Barbara Elizabeth Lumby fema1 175-40-9548 February 13, 2013 Sa. Age-ran Birthday (Yrs) Sb. Under 1 Year 5c. Under 1 Oa 6. Date of Birth (MO/Day/Year) (Spell Month) )a~@IrthpWce (CIcy and Soug~Q( Foreign Country( Months Days Hours Minutes WaynPSl7Dro, YA 65 November 18, 1947 7b.B1rthplace(000nry) Franklin ea. Mail.... (State or Foreign Country) Bb. Residents (Street and Number -Include Apt N..) k. I Id Decedent Llve In a Township] PA 908 S. York Street es, decedent awed in [iruwr Allan P. gd. Beside... (County) 1 k. Residence (EIp code) 1'] 0N0, decedent IWed within limits of ciry/bora. 9. Ever In US Armed Forrest 10. Marital Status at Tme of Death JaM,nied 0 W Idowed 11. S Zaing Sp.use's Name (If wife, give name prior to first "Wage) 0Ves VINO OUnknuwn OD-rced ONeverMarried 0Unit,,- L31ke L 12. Father's Name (First, Middle, Last, Suf,) 13. Mother's Name Prsor to First Marriage (First, Middle, Last( Robert L. Condon Dorothy E. Knott 14a. Informant's Name 14b. Relatlonzhlp ro Detttlent 1dc. Informant's Mailing Address (Street and Number, CRY, State, Zip Coder or Luke Lumby husband 908 S. York St., MechanicsbL3rg, PA 17055 . Occurred o.mat If Death Occurred In a Hospkal: 17 Inpatient il( Death ath Occurted Somewhere Other Than a Hospital: Hospice Faclliry Decetlen['s Home a 0 Emergency Room/Outpatient ❑ Dead on ANwal 0 Nursing Home/Long-Term Care Facility Other (Specify) 2 15b. Facility Name (If not Ins[kuti m, give street and number; t15c City or Town, State, and Zip Code lsd. County of Death 908 S. York Street Mechanics PA 17055 Cumberland y ]6a. Method of Olspce,11 n Qq Burial 0 Cremation 16b. Date of D1,pcaiti,n ]k. Place of Dispmklon (Name of cemetery, crematory, or other piece) (JR, ",I from State 0 Donrtlon Other Specify) Feb.19 2013 Gate of Heaven Cemeterv 2 16d. Location of DlsposRi.n (City,, Town, Stale, and Zip) 17a. Signature of Funeral Service lic,nme or Person In Charge of Interment 11b. License Number s Mechanicsburg, PA 17055 FD 011667 L E 17c.Niml and COmplMe Address of Wnenl Faclllry 8 Mal 221 er 1 18. Decedent's Educatlon Check the box Mat best describes the 19. Decedent of Hispanic Origin - Check the 20.f dRs Rare - 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 decadent the decadent considered himself or herself to be. 0 81h grad<or less Is Spanish/H1up,nIcjUb- Check the-No' IN White 0 Korean 0 No diploma, 9th-12th grade box if decedent is not Spanish/Hlspardc/Latino. O Black or Ardcan Amerloan 0 Vietnamese 0High school graduateorGEDCOmpleted No. not Spanish/Hispanic/latino 0America, Indlanor Alaska Natwe ❑OtherAsian Some college credit, but no degree ❑ Yes, Mexican, Mexican American, Chicano 0 Azlan Indian ❑ Native Hawaiian As...late degree (e.g. AA, AS) ❑ Yes, Puerto Rlcan 0 Chinese ❑ Guamanian or Chamorro Bachel.rs degree (e.g. BA, All, BS) ❑Ves, Cuban 0 Filipino ❑ Samoan Masters degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ❑Ves, other Spanish/Hispanic/Latin. 0 Japanese ❑ Other Pacific Islander ❑ Doctoret, (e.g. PhD, EdD) or Professional degree ]Sped`') 0 Other (SPedfY) MD, DOS DVM L18, 1O 21. Decedent's Single Race Self-Designation - Check ONLY ONE to indicate what the decedent considered himself Or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RfTIREO. Blackor Allltan American 0Korean ❑ Other Pacific Islander sales 0 Amerkan Indian or Alaska Native 0 Vietnamese ❑ Don't Kn.w/Not Sure 0 Asian Indian 0 Other Asian 0 Refused 221. Kind of Buslness/Industry 0 Chi.... 0 Natwe Hawaiian ❑ Other (specify) manufacturing 0 Filipino 0 Guamani.nor Chamorro ITEMS23a-23d MUSTBECOMPl2TED 23a. DaJ{Pr pounced Dead lM. Day ) 23b. 5igFaturS /PerWWW~ Pronouncing Death Only when applicable) 23c. UCan. Number CEMM ON WHO PRONOUNCES OR , 11., ',1 { /11 L- CERTIFIE$ DEATH 1K..YJ iU yJ/`t,1Y>D11LAJ I~u •l l/l,V is I I 23dd{..-OO17 {{1^ Signed (MO/Da /M •N,l'` Z Tme of Death M 1`''m .l.3Jt121 s Medic,l Examiner or Coroner Contacted? ❑Ves No (A M. Wa CAUSE OF DEATH Appr.dm,te 26. Part I. Enter the chain of events- diseases, Injuries, or compli-1---that dire RN Caused the death. DO NOT enter terminal events such-ierdiacarrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology lDpO NOT ABBREVIATE. Enter only one cause on A line. Add additional lines if necessary ! Onset to Death IMMEDIATE CAUSE rU C-f?f+, 1/VOM/I 0G rtl-C Vblr r- ti (Final date.. or condition Due to (or as a Consequence op: resulting In death) b. Sequentially Ila conditions, Due to (or as a consequence of; H any, leading to the cause listed on Ilhe a. Enter the UNDERLYING CAUSE Due to (or as a mnsequenl<of): (disease or Injury that Inltlata i the events resulting d. . In M.) ?AST. Due to for as a consequence of): s 26. Part Il. Enter other agniflcant conditions contributing to death but not resulting in the underlying cause gluen in Part I R7,;; autopsy e ed? Yes No t.pH findings... liable ere the reuse of dath? Yet ❑ N. L 29. If fe ale: 30. Did Tobacco Use Contribute to Deathi 31. M r of Death Not pregnant within past year 0 Yes 0 Probably aural ❑ Homicide 0 Pregnant at time.( death 0 No Unknown 0 Accident ❑ Pending Imnalgation ONOt pregnant, but pregnant within 42 days of deat/ OSUidde O Could not be determined Not pregnant, but pregnant 43 days to I yea, before death 32. Date of Injury (MO/Day/Y,) (Spell Month) 0 Unknown lf pregnant within the past Veal 33. Time of Injury 34. Place of Injury (e.g. home; construction she; (arm; school) S. Location of Injury (Street and Number, Cis, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Yes ❑ Driver/Op-tor ❑ Pedeslrlan No ❑ Passenger ❑ other(spedfy)39a. rtlHer (Check o,N one): Certifyln8 Physldan To the best of my knowledge, death occurred due to the cause (s) and manner stated 0 Pronouncing 6 Certifying physician - To the best of my knowledge, death occurred at the time, data, and place, and due to the cause(s) and manner stated ❑ Medlc•1 E.amin mhsaNOn-ind/ Investigation, in mV opinion , death occurred at the time, date, and place. and due to tthe c]}a~ m(s) annd~~.m.~ainrnmer stated Signature of certifle ) Title of certifier'. License Nurrlm-m•-'O~t~I//G 396. Name, Address and ZIp Cale of Person C..,I.1 ng of Death (Item 26) NI; 1;7d-,[71j-S') 40.R<91strars District Number 41. Regl s Igna[urc 147gistrar File Date (MO ay r) l.~Yt~2 1F1.,,r 1, 1rt3 43. Amendments K X105 143 Cus-RI-Permit N.. 6O!7✓ •e_-__ - REV O]/2011 r.; C w M rn Cs7 p M C) = y. r- rv t*~ rrt r- Z m N c7 N T C> LAST WILL AND TESTAMENT ° c> C: C> OF BARBARA E. LUMBY KNOW ALL MEN BY THESE PRESENTS, that I, BARBARA E. LUMBY, residing in Cumberland County, Pennsylvania, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me at any time. PAYMENT OF EXPENSES L Payment of Expenses: I direct that my Co-Executors, hereinafter named, shall have the power, but not the duty, to pay all my just debts and expenses of my last illness from my estate as soon after my death as shall be found convenient. GIFTS II. A. Automobile: I bequeath my automobile to my husband, Luke Lumby. B. Personal and Household Effects: I bequeath my automobiles, household and personal effects and other tangible personalty of like nature (not including cash or securities) together with any existing insurance thereon, to such of my children, as are living on the thirty-first day after my death, to be divided between them in as nearly equal shares as practical. I may leave a memorandum setting forth suggestions as to the distribution of certain items and, while the memorandum is not legally binding. I hope the suggestions in it will be carried out. My personal possessions and household effects at my home at 908 South York Street, Mechanicsburg, Pennsylvania, are transferred to my children. III. Residue: I give the residue of my Estate, real, personal and mixed of whatever nature and wherever situated, in two parts, so that there will be one share for each child of mine who is then living or then dead. Should any child of mine predecease me, I give her share to her surviving children in equal shares, per stirpes, or if her children do not survive, then to my other child. FIDUCIARIES IV. Co-Executors: I hereby nominate, constitute and appoint my daughters, RICHELE A. DURBIN AND TOINETTE M. SHEARER, as Co-Executors. Shall either be unable or unwilling to act, the other shall act with full authority. V. Bond: No Executor appointed hereunder shall be required to give bond. VI. Resignation: Any individual Executor may resign at any time without court approval. ADMINISTRATIVE PROVISIONS VII. Protective Provisions: To the extent permitted by law, the interest of beneficiaries in principal or income shall not be subject to the claims of their creditors and others, nor to legal process, and shall not be voluntarily or involuntarily alienated or encumbered, except that nothing in this article shall preclude the assignment of all or any part of a beneficiary's interest to her descendants. VIII. Management Provisions: My Co-Executors shall have, in addition to the powers and authority conferred upon them by law, the following additional powers and authority: A. Sell/Lease: To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, at any time constituting a portion of trusts herein created, and upon such terms and conditions as they deem wise. B. Retain/Invest: To retain and to invest in all forms of real and personal property, including common trust funds, mutual funds and money market deposit accounts regardless of any limitations imposed by law on investments by executors, or any principle of law concerning investment diversification. C. Title to Property: To cause any security or other property which may at any time constitute a portion of my estate to be issued, held or registered in their names, or in the name of a nominee, or in such form that title will pass by delivery. D. Capital Changes: To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate. and to take any action with reference to such securities which, in the opinion of the Co-Executors, is necessary to obtain the benefit of any such reorganization, consolidation., readjustment or sale; to exercise any conversion privilege or subscription right given to them as the owner of any securities constituting a portion of my estate; to accept and hold, as a portion of my estate, securities resulting from any reorganization, consolidation, readjustment, sale, conversion or subscription. E. Expense of Estate: To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including compensation to the Co-Executors. F. Allocate: To determine what is "Income" and what is "Principal" hereunder, and their decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Co- Executors may determine. y -2- G. Borrow: To borrow moneti, lron;7. any person, firm or corporation for the purpose of protecting and preserving or improving my estate or trust hereunder; to execute promissory notes or other obligations for amounts so borrowed. H. Hiring Professionals: To employ legal counsel, accountants, brokers, investment advisors, custodians, managers and other agents any employees and to pay reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. 1. Receipt of Monies: To receive, collect and recover the interest, rents, profits, proceeds, gains and other earnings and income of and from the property held by them hereunder. J. Partial Distributions: To makc., fror~n time to time, partial distributions, in varying amounts to the beneficiaries hereunder, prior to final settlement and distribution of my estate and in connection therewith to determine in their discretion, the time or times when such partial distributions may require recomputation of said beneficiaries' proportionate interests hereunder for the equitable cllocation of income or due to changing asset values pending final distribution. TAX PROVISIONS IX. Death Taxes: I direct that all transfer and inheritance taxes, state or Federal assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; that my Co-Executors pay, or prow ide for payment of all such taxes at such time, or times, and in such manner as my CO-Executors deem best. X. Tax Options: I authorize my Co-Executors to exercise any options available in determining and paying death taxes in my e ate. IN WITNESS WHEREOF, 1, BARBARA E. LUMBY, the Testatrix of this, my Last Will and Testament, typewritten on four (4) sheets of paper which I have identified at the bottom of each page by my signature, here?Into set my hand and seal the day of 2011 _(SEAL) BARBARA- K LUMEN ;ew . ' -3- The preceding instrument consisting of this and three (3) other typewritten pages, each identified by the signature of the Testatrix, BARBARA E. LUMBY, was on this day and date thereof signed, published and declared by BARBARA E. LUMBY, the Testatrix therein named, as and for her Last Will, 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. _ 4 COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND I, BARBARA E. LUMBY, Testatrix, whose n~ ,ie 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; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. a BARBARAL BY Sworn or affirm to and ac edged before me, by BARBARA E. LUMBY, the Testatrix, this ~a? day of `'ur►ua~~ 12013. Notar Pubic NOIAWRIM KM L COPPERSMIIN, WARY Tl1" CAMP HILL MORO, W MKRLM CW"" M11f COMMISSION EXPIRES JUNE 21.201S COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, -ro!©r✓ia5 4. 2af Q(' and iC u'a"Ol / corm e l / the witnesses whose names ned to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw BARBARA E. LUMBY, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Swo or affirmed to a 9d to before me by TAo1na6 1 . u ~e/' and onell , witnesses this dad- c. i~h~i~~ ~ - of 2013. Notary Publi rJ~1A0111ME1►LTf 10F'E NOTARIAL SEAL. GLORIA L MMRSMITH, NOTARY PUBLIC CAMP HILL BOR0. CUMBERLAND COUNTY MY COMMISSION EXPIRES TUNE 21, 2015