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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 request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: LEONCIA F. FAGEN File No:
a/k/a: LEONCIA F. FAGAN (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 181-42-8824
Date of Death: 02/04/2013 Age at death: 83
Decedent was domiciled at death in CUMBERLAND County, PA (State) with his/her last
principal residence at 620 GREASON ROAD, CARLISLE, PA 17015 WEST PENNSBORO TWSHP. CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 620 GREASON ROAD, CARLISLE, PA 17015 WEST PENNSBORO TWSHP. 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 $ 4,000.00
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.... $ 4.000.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
91 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 JULY 19, 2010 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.
0 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 ofAgirs. y
w ;IQ M
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for div' Jgd been es lish satefned
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ;7 r-h C)
'a CX3 C ~
NO EXCEPTIONS 0 EXCEPTIONS n7 = -t
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follov~ttg3jow (if,69y and:RirF?attach
additional sheets, ifnecessary): = . 7c C7 O
C7 ~ '41 -T'1
Name Relationship Addm sC
--t Cn O
Form RW-02 rev. 10/11/20/1 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND )
Petitioner(s) Printed Name Petitioner(s) Printed Address
CONSOLACION HUSLER 620 GREASON ROAD CARLISLE PA 17015
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 Dece nt, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before Date ~c l.T .tCli~
me day o ~r Date
By: Date
For the Register Date
BOND Required: Q YES P -N-10 To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters $ Attorney Signature:
( 1t[n~ ) Short Certificate(s)......
( )Renunciation(s).........
( ) Codicil(s) . .
( ) Affidavit(s)........... .
Bond Printed Name: WILLIAM A. DUNCAN
Commission Supreme Court
O hoer ID Number: 22080
Firm Name: DUNCAN & HARTMAN, PC
Address: 1 IRVINE ROW
CARLISLE C> PA a17,44 3~9
GCJ ~C7
:U f'* t q
Phone: 717-249-7780 M = C? t7U _
Automation Fee Fax: 717-249-7800 t' I- GR r'i m
JCS Fee . 93t' Email: bill(a7duncanhartr anTcvvsm
TOTAL $ ~J. X99"'. C7 c5 '►t -n
C'S G~ -try
3 C = C7
DECREE OF THE REGISTER M
C
Estate of LEONCIA F. FAGEN File No: co a/k/a: LEONCIA F. FAGAN j~
AND NOW, ~J✓, in consideration of the foregoing Petition,
satisfactory proof having been esented before m , IT IS DECREED that Letters TESTAMENTARY
are hereby granted to CONSOLACION HUSLER
in the above estate and (if applicable) that
the instrument(s) dated JULY 19, 2010
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decede t.
lJ
Register'of Wills Y
Form RW-02 rev. !0111/2011 Page 2 of 2
Mos ROS Rl''v (1'1 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, $6.00 REGISTER Or WILLS This is to certify that the information here given is
n" correctly copied from an original Certificate of Death
(.013 FEB 25 PM 1 58 duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
CLERK OF Records Office for permanent filing.
vl v e 3 r
* - >
T
y ORPHANS"CvR
f=c Vk! - F06 /2013
Certification Number BERLAND CO., PQ \INtUF~`II
Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH - VITAL RECORDS
Perment
;c:7. k - CERTIFICATE OF DEATH State Flle Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) ;:;'a 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo)
Leoncia F_ Fag --n le 181-42-8824 Februa 4 2013
Sa. Age-last Birthday (Yrs) 56. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. BlKh place (City and State or Foreign Country)
83 Months Days Hour, Mingtes March 15, 1929 Phili Ines
7b. Birthplace (County)
8a. Residence (Slate or Foreign Country) 86. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township?
PA - 620 treason Rd. yes, decedent lived in West Penns o
'g-d. Residence (County) twp. -1 E Cumberland 8e. Residence (Zip Code) 1715 No, decedent lived within limits of city/born.
9. Ever In US Armed Forces? 10. Marital Status at Time of Death 0 Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
Yes No 0 Unknown
0 0 E3 Divorced 0 Never Married 0 Unknown
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name to to First Marriage (First, Middle, Last)
Tomas Rivera Theodora (Unknown)
141. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
Connie Huller
daughter
0 620 treason Rd., Carlisle, PA 17015
G ...r............ a. P ace o Deat C ec on Y one
s If Death Occurred '
In a Hospital: Inpatient ; If Death Occurred Somewhere Other Than
a Hospital: u Hospice Facility
_ Decedent's Home
0 Emergency Room/Outpatient ea Dead on Arrival _ 0 Nursing Home/Long-Term Care Facility Other (Specify)
15 b. Facility Name (if not institution, give street and ngtuber; lSC. City or Town, State, and Zip Code 15d. County of Death
Carlisle Re Tonal MedicalCenter Carlisle PA 17015
16a. Method of Disposition 0 Burial [ Cremation 16b. Date of Disposition 16c. Place Of Disposition (Name of cemetery, c matory, or other place)
Removal from state 0 Donation Feb 6 , 2013 ££man-Roth Funeral
Other (Specify) Home& Crematory
v 16d. Loca[Ion of Disposition (City or Town, State, and Zip) 17a. Simon re of Fune I S e U. erson in Charge of interment 17b. License Number
Carlisle, PA 17013
o 138504
17c. Name and Complete Address of Funeral Facility
m Ho££man-Roth Funeral Home & Cre o , 219 North Hanover Street Carlisle PA 17.13
18. D¢c¢denG'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
I- 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.
0 8th grade or less is Spanish/Hispanic/Latino. Check the "No" ® White 0 Korean
No diploma, 9th - 12th grade box If decedent Is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese
High school graduate or GED completed No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian
0 Some college credit, but n° degree 0 Yes, Mexican, Mexican American, Chicano 0 Asian Indian 0 Native Hawaiian
0 Associate degree (e.g. AA, AS) Yes, Puerto Rican
0 Bachelor's degree (e.g. BA, AB, BS) 0 Yes, Cuban 0 Chinese 0 Guamanian or Cha mono
0 Filipino Samoan
EJ Master's degree (e.g. MA, MS, MEng, MEd, MS W, MBA) 0 Yes, other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander
0 Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) 0 Other (Specify)
. MD DOS, DV M, LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself t° be. 22 a. Decedent's Usual Occupat(on -Indicate type of work
White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED.
0 Black or African American 0 Korean ~ Other Pacific Islander Homemaker
0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure
'W^ 0 Asian Indian 0 Other Asian 0 Refused 226. Kind f Business/Industry
0 Cht nese 0 Native Hawaiian 0 Other (Specify)
c 0 Filipino 0 Guamanian dr Chamorro ..2211 Own Home
ITEMS 23. - 23d MUST BE COMPLETED 23a. Date Pronou
PERSON WHO PRO RO NOUNCES OR nced Dead (MO/Day/Vr) 23b. 51 of s prop OUn ing Death (Only when applicable) 23c. License Number
CE C-°E 2 O \ /-1jT`
CERTIFIES DEATH
23d. Dale Signed (MO/Day/Vr) 24. Time o-f , th
eb l l ~YY~ 25. Was Medical Examiner or Coroner Contacted? 0 Yes No
CAUSE OF DEATH
26. Part 1. Enter the chain of events--diseases, injuries, or co Approxlmat¢
mpiications--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 CAUSE a. C~ c~~T-e_ ✓ C~ S tJ t Y GZ~ p ✓~A4 { p, U $
(Final disease or condition Due to (or as a consequence of):
resulting In death) C-Ce\N__`i C C✓'-_
Sequentially list conditions, Due to (or as a consequence of):
If any, leading to the cause
listed on I.— a r the
UNDERLYING CAUSE
Due to (or as a consequence of):
(di sea se or Injury that
F initiated the events resulting d.
I, death) LAST. Due to (or as a consequence of):
S 26. Part 11. Enter other significant conditions contributing t death but not resulting in the underlying cause given in Part I 2?. Was autopsy r~ Kormed?
O Ves No
12-- Were autopsy findings available
to complete the cause of death?
29. If Female: 0 Yes O No
30. Did Tobacco Use Contribute to Death? 31. Manner of Death
E Not pregnant within past year Yes
0 0 Probably Natural 0 Homicide
0 Pregnant at time of death NO 0 Unknown Accident Pending Investl
m 0 Not pregnant, but pregnant within 42 days of death 0
t- 0 Not pregnant, but pregnant 43 days to 1 before death 32. Date of In Nlo/Da 0 Suicide 0 Could of be deterimined .
0 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 137. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
0 Yes 0 Driver/Operator 0 Pedestrian
0 No 0 Passenger 0 Other (Specify)
39a. Ce Kifier (Check only One):
0 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 occurred at the time, date, and place, and due to the cause(,) and manner stated
0 Medical Examiner/Cor Se; -h of exa minatlon, and/or Investigation, in my opinion-, td~eath occurred at the time, date, and place, and due to the cause(s) and manner stated
Signature of certifier: C Title of certifier: 1/ License Number.
391?. Name, Addre d Zlp Code of Person Completing Cause of Death (Item 26) DatSigned (MO/Day/Yr)
- 0 0 eRt"1 1 Fc* b A 0",-'s
40Registrar's District Number rs Signature . Registrar File Date (MO Day r)
43. Amendments
_O
H10S-143
Disposition Permit No. REV 07/2011
C= M
LAST WILL M
~ n
& rn - C> C=
11
TESTAMENT r- a rT v
_
C>
°Ya
I, LEONCIA F. FAGAN, of 620 Greason Road, Carlisle, West Igia'bRo, Umbprlaiid
County, Pennsylvania, being of sound and disposing mind, memory and w2e tanding,-,do Eer~`~i'y
make, publish and declare this as and for my Last Will and Testament, here rdvokin A y ind~l
other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot in accord
with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real,
personal or mixed, and wherever situate unto my children, ABRAM N. LEHMAN, CURTIS G.
LEHMAN and CONSOLACION HUSLER, in equal shares, per stirpes.
FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint my daughter, CONSOLACION
HUSLER, as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from
the necessity of posting security in connection with her duties, as such, in any jurisdiction in
which she may be called upon to act insofar as I am able by law to do so. In addition to the
powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the
form received, and to sell either at public or private sale any real or personal property owned by
me at the time of my death.
IN WITNESS WHEREOF, I have hereunto set my hand and se o this, Last Will and
Testament, consisting of one typewritten page this day of ,
2010.
LEONCIA F. FAGAN
Signed, sealed published and declared by the above named Testatrix LEONCIA F. FAGAN as
and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
COMMONWEALTH OF PENNSYL VANIA
. SS.
COUNTY OF CUMBERLAND
1, LEONCIA F. FAGAN, 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; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
LEONCIA F. FAGAN
Sworn or affirmed to and
acknowledged before me, by G
LEONCIA F. FAGAN this I / day
of 2010.
1~/ t
Notary Public
NOTARIAL SEAL
JOAN D. ADAM"S. Notary Public
Carlisle Boro- Cumberland County
pAy CommissiCn FxPjres (NarC 91.2011
COMMONWEALTH OF PENNSYL VANIA
:SS.
COUNTY OF CUMBERLAND
We, W I"AAM A 1 0 IhV(,A I~ and A4 OW IL4V~~
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 LEONCIA F.
FAGAN sign and execute the instrument as her Last Will; that she signed willingly and that she
executed 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 (18) or more years of age, of sound mind and
under no constraint or undue influence.
Sworn or affirmed to and
subscribed before me by
V ~ N
em A /V1 A . LTA,) G and
) 1 !u
witnesses,
this I g441 day of 2010.
~
Notary Public
~
C0mm0~8VVE ,r.I_Ti t OF PENNSYLVANIA
N0 T AF ir.L S AL '
JOAN D. ta.DM . rotary Public,
Carlisle 5oro., Cun"berland County
My Commission Expires March 7, 2011