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HomeMy WebLinkAbout03-13-13 Reset 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: Mary Jane Blizzard File No: a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 173-18-8316 Date of Death: March 5. 2013 Age at death: 93 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at Bethany Village 325 Wesley Drive Apt 3223, Lower Allen Township Pennsylvania 17055 Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Holy Spirit Hospital 503 N 21st Street Camp Hill PA 17011 Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: Ifdomiciled in Pennsylvania All personal property $ 292,000.00 If not domiciled in Pennsylvania Personal property in Pennsylvania $ If not domiciled in Pennsylvania Personal property in County $ Value of real estate in Pennsylvania $ 0.00 TOTAL ESTIMATED VALUE.... $ 292.000.00 Real estate in Pennsylvania situated at: N/A (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ✓VJ A. Petition for Probate and Grant of Letters Testamentary n ; rrvl Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated Oabo 24, 200L1:_ aOCodicil(s) thereto dated Q7 rri C7 r s State relevant circumstances (e.g. renunciation, death ofexecutor, et Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was &t divorced, w dot a tyi a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § i3g, tlld did:!! t have,a elY ld born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated persons NO EXCEPTIONS Q EXCEPTIONS C7 t) © B. Petition for Grant of Letters of Administration (If applicable) tv 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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationship Address Earl W. Blizzard, III Son 1891 Limerick Road, Linwood, NY 14486 Thomas C. Blizzard Son 203 East Ridge Road, Dilisburg, PA 17019 Form nw-02 rev. !011112011 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 Thomas C. Blizzard 203 East Ridge Road Dillsbur PA 17019 The Petitioner(s) above-named swear(s) or affirm(s) the statement the foregoing Petition are t an orrect to e best f the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec nt, the Petitioner e a rely ad nister th estate according to law. Sworn to or affirmed and subscribed before V G~ Date c, met day of Date By Date r the Register Date BOND Required: ® YES (9) NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters S 0 -'97, Attorney Signature: ( ) Short Certificate(s)..... . 12P - 00 ( ) Renunciation(s)......... ( ) Codicil(s) ✓L~ ~7 ( ) Affidavit(s)............ Bond Printed Name: Suzanne S. Friday, Esquire Commission Supreme Court Other .~.ID Number: 201873 1 lS.TYG.. r .441 LA Firm Name: Nauman, Smith, Shissler & Hall, LLP Will I'5. DLL Address: 200 N. 3rd Street I Sth flr. m Harrisburg, PA 1 1 - =0 f P9 Phone: (717) 236-3010 e* 2 Automation Fee Fax: (717) 234-1925 P M W JCS Fee. Email: 4cfritlavnncsh cok c°, o TOTAL 4._7 -T' 403_ e-ee DECREE OF THE REGISTER r--, -t Estate of Marv Jane Blizzard File No: 2 t O ~ao a/k/a: AND NOW, in consideration of the foregoing Petition, satisfactory proof having ben resented before me, IT IS DECREED that Letters Testamentary are hereby granted to Thomas C. Blizzard in the above estate and (if applicable) that the instrument(s) dated October 24, 2000 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent 6 /1 A Register of Will of 2 Form RW-O2 rev. 1011112011 la, HIOS -SOS RLA (91( 1) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OEE3CE OF Fee for this certificate, $6.00 Thjs u, certify that the information here given is REGIS ; R OF LL I ~ p,~TN DF pF \ aY(recth copied front an original Certificate of Death (1111y filed ti~ith me as Local Registrar. The ori(Tinal '1113 MR 13 M 2 ce(tltTcatc ,viil be fur~\araed to the State Vital Records Office for permanent filing. P 1947480 CLERK ORPHANS COURT ..Mr!VTO~ 11111 ---K , Certification Number J)' ~N„D Local~Re~)strar Date Issued ype/P,m C U MR B E R L A sJ ~r.SSpnyDRATH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent CERTIFICATE OF DEATH State Flle Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Data of Death (M,/Day/Y,) (Spell Mo) Mary Jane Blizzard t~nale 173-18-8316 March 5, 2013 5a. Age-Last Birthday (Yrs) 56. Untler 1 year 5c. Under 1 Da 6. Date of Birth (M./Oay/Year) (Spell Month) ?a. Birthplace (City and State or Foreign Count ) 93 M°ntna Dan Hours Mmutea December 16, 1919 WilJvns , Penns I~vanis ?b. Birthplace (C.unty) Allectheny 8a. Residence (State or Foreign Country) Bb. Residence (Street and Number- Include Apt No.l 8c. Dld Decedent l"In a Township? Pennsylvania 325 Wesley Drive, Apt 3223 Pea, a«edem li edm Lower Allen wp. Ed. ReslrlaTld Be. Residence (Zip Code) 1 70511 ❑ No, decedent fixed within limits of city/boron 9. Ever In US Armed Forces? 10. Mvltal Statusat Tlme of.-h 0Manned Widowed Il. Surviving Spouse's Nam.(Ifwlfe, glvename pri.rto fint marriage) ❑ Yes X N. 0 Unknown 0 DNOrced 0 Never Married 11 Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Francis''Patrick Kehoe Anna. Marie Siefers 14a. Informant's Name 10. Relati...hipto0ecedent 14c.I1form1nt's Malll", Address(StmetaM Number, City, State, Zip Code) Thomas C. Blizzard Son 203 East Ridge Road, Dillsburg, PA 17019 G 1sa.Paceo Dnth eg onl_2 If Death OccurredIna Mosphal: - Inpatient Ilf Death Occurred Somewhere Other Than, Hosplo_ _ _ _ 0H.spke FRC111ty _ _ _ j]Decedent's Home O 0 Emergenry Room/Outpatient Cl Deadon A-al ❑ Nursing Home/Long-Term Care Faclllry O Other (Specify) 4i 156.fa<Illry Name(Itn it lnsUtutl.n, glvestree[and number) 135c. City or sown, State, and Zip Code 1Sd. County of Death Hol Spirt Hos itz Camp Hill, PA 17011 Cumberland r 16a. Methpd of Disposition ❑ Burial Cremation 166. Date p/ Disposkion I6c. Place of Dlsposl[ion (Name of cemetery, crematory, or other place) 0 Ramo.1 from Star. 0 Donation March 71 2013 Hollinger Crematory ❑ aher lspe.iryl Z 160. location of Disposition (City or Town, State, and Zip) 17a. Slgnat f Funeral ServIc Llceniee or Person In Charge of Interment 3?b. license Number Mt. Holly Springs, PA 17065 FD-138630 E 17c. Name antl Complete Address of Funeral Facility Mal zzi Funeral Home 8 Market laza Way, Mechanicsbur PA 17055 18. Decedent's Education- Check the box that best descrlbes the 19. Decedent of Hispanic Origin - Check the 20.Decedent's Race- Check ONE OR MORE races to Indicate what 12 highest degree or level of,chcu.I completed .,,he timeof death. box that best describes whether the decedent the decedent considered himself or herself to be. ❑ 8th grade or less is Spanish/Hispanic/Latino. Check the "No' eA1 White 0 Korean ❑ N. diploma, 9th-12th grade box N decedent is not Spanish/Hispanic/Latino. ❑ Blackc,African American 0 Vietnamese "High school graduate., GED completed EN No, not Spa nish/Hispanic/Latin. O American Indian or Alaska Nature 0Other Asian 0 Some college credit, but no degree 0 Yes, Mexican, Mexican American, Dlcano 0 Asian Indian ❑ Hall. Hawaiian ❑ Associate degree(e.g. AA, AS) O Yes, Puerto Rican 0Cnintro ❑ Guamanian or Damorro 0 Bachelor's degree (e.g. BA, AB, BS) 0 Yes, Cuban ❑ Flilplno 0 Samoan 0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander ❑Doctorate(eg. PhE, EED) or Professional degree (Specify) 0 Other f5peclfy) e..MD,DDS DVM l1B ID 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 ~l White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. o Black or African American 0 Korean 0 Other Perth, Islander Bookkeeper 0 American Indian or Alaska NaUVe 0 Vletrorr- 0 Don't Know/Not Sure 0 Asian Indian 0 Other Asian 0 Refused 221b. Kind of Buslness/Industry 0 Chinese 0 Native Hawalta. 0 Other(Specdy) ❑ Filipino 0 Guamanian orChamorro Plumbing/Heating ITEMS 234- 23d MUST BE COMPLETED 123. Date Pronounced Dead (MO/Day/Y,) 23b. Signature of Person Pronouncing Death (Only when applicable 23c. License NUm r BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH rf G 24. Time of Death 1 J N,I C, 5 1 (p 23d. Dote Signed (MO/Day/Yr) 4Ib /Yl 25. Was Medic'SK4aminer or Co ner Conta d? 0 Yes No CAUSE OF DEATH Approximate 26. Part 1. Enter the chaln of ev s--dlsease;in)uries, or c-pli-Ions--that directly caused the death. 00 NOT enter terminal e...Issuch as cardiac in-, Interval: respiratory arrest, or ventricular fibrillation -wiitS1hout show/iinngthee tii,llo,p DO NOT ABBREVIATE. Enter roonly cause onnxa line. Add iddlu.n. lines if necessary. Onset to Death IMMEDIATE CAUSE ------------x a. / _j 0M/f'{~/floc 1kXi-I ILU/lF I (Flnal disease or contlitlon /T se ) I reawnng in death) n~~ D.4 b. Sequentially list a.ndsmm, Due to (°r as a consequence of) listed In linsg. 1. the Eno,U. _~L j i listed on line a. Eno, U. c. ~J7J`/l s.~ UNDERLYING CAUSE Due to (or as is consequence ofl: (disease or Injury that Initiated the events resulting d, in death) LAST. Due to (or as a consequence of): g 26. Part If. Enter other slenlficantcondition, contributing to death but not resulting In the underlying cause given in Pan 1. 27. Was an autopsy perf.rmed? ❑ Yes a-H. 121. Were-PA, find) ngs available to complete the cause of death? ❑ Yes 2-N. Y 29. If Female: 30. Did Tob- Use Contribute to Death? 31. Manner of Death 9 -O- Not pregnant wRhin pas, y... 0 as 0 Probably Q-Naturel ❑ H.xi ❑ PregnaM at Hms of path ❑ No Q-Unknown 0 Accident ❑ Pendinglnvestigation ❑ Notpregna"t, but pregnant within 42 days of death Suicide 0 Could-be determined ❑ Not pregnant, but pregnant 43 days to l year before death 32. Data of lnjury (M,/Day/Yr)(Spill Month) 0 Unknown if pregnant within the pastyear 33. Time of Injury U. Place of Injury (e.g. home; Construction site; farm; school) 35. Location of Injury (Street and Number, City, County, State, Zip Code) 36. Injury at Work 111, If Transportation Injury, Specify: 38. Describe H- Injury Occurred: 0 Yes ❑ Driver/Operator ❑ Pedestrian )DNO 0 Passenger 0 Other (Specify) 39a. Censer - physician, certified nurse Practitioner, medical examiner/coroner (Check only one): mortifying only - To the best of my knowledge, death occuned due to the cause(s) and manner stated. 0 Pmnouncing 8 Certifying To the best of my knowledge, tleathoccuned at the tlme, d,te, and place, and due to the cause(s) and manner stated. 0 Medlcal l!ominer/Coroner- n the balls of examIn 1t or Investlphon, in my Immon, death occurred at the time, date, and place, and due to the~ou(sse(s) and manner stated. Signature of certlFler'. Title of certifier. Y-'4^'~ License Number' a' `"31 q {i- 3 N me, Addren antl Zip `cde.f Person Cn77.cing Cause of Death (Item 2fi 39c. Date Slgne (M./D y/Yr) A .C tlC4ttr ~i ha CS O~ O6LO/3 40. Registrar's District Number 41 . Regi r naN(e j / 142. Registrar File Date (Nh DaYIY,) ~►4 as ulna fL~( o3 12t,3 43. Amendments 0819596 NiDSa43 Dlsoosltlon Permit Nq. fl 1143 c> rn c C> n~ c-> M :~a -=3 q s =IJ t rs %y LAST WILL AND TESTAMENT OF C-D rya s MARY JANE BLIZZARD I, MARY JANE BLIZZARD, of Carroll Township, York County, Pennsylvania, do hereby make, publish and declare the following to be my Last Will and Testament, hereby revoking all former Wills by me at any time heretofore made. FIRST: I direct my Executor hereinafter named to pay all my just debts and funeral expenses as soon after my decease as conveniently may be done. SECOND: I give and bequeath my share in Blizzards Plumbing, Heating and Air Conditioning, Inc., to my son, THOMAS C. BLIZZARD. THIRD: I give and devise my share of the real estate which I own with my son, THOMAS C. BLIZZARD, at 203 West York Street, Dillsburg, Pennsylvania, to my son, THOMAS C. BLIZZARD. FOURTH: All of my furniture, furnishings, books, silverware, jewelry, pictures, objects of art, automobiles and all other domestic and household effects and personal goods and chattels, of every nature and wheresoever situate, including all insurance policies thereon, I give and bequeath unto my sons, EARL W. BLIZZARD, III and THOMAS C. BLIZZARD, in equal shares. If THOMAS C. BLIZZARD has predeceased me, then his 1 Mary Jane Blizzard Last Will and Testament share to EARL W. BLIZZARD, III. If EARL W. BLIZZARD, III has predeceased me, then his share shall be divided between his children, JOSEPH I. BLIZZARD and JULIANNA C. BLIZZARD, in equal shares, and if either of them do not survive me, to the survivor of them. FIFTH: All the rest, residue and remainder of my estate of every nature, kind and description, whether real, personal, or mixed and whatever nature and wherever situate, I give, devise and bequeath unto my sons, EARL W. BLIZZARD, III and THOMAS C. BLIZZARD, in equal shares. If THOMAS C. BLIZZARD has predeceased me, then his share to EARL W. BLIZZARD, III. If EARL W. BLIZZARD, III has predeceased me, then his share shall be divided between his children, JOSEPH I. BLIZZARD and JULIANNA C. BLIZZARD, in equal shares, and if either of them do not survive me, to the survivor of them. SIXTH: Should the assets of my Estate be payable to a person or persons under the age of twenty-one (21), my Executor shall hold said assets in trust until he or she attains the age of twenty-one (21), paying over to them or for their use and benefit, the proportionate share of the net income of said assets until the time of distribution at the age of twenty-one. SEVENTH: My Executor is hereby authorized and empowered to sell securities or other property, real or personal or both, and my Executor is further authorized to borrow money for any purpose necessary in connection with the payment of taxes or other matters 2 Mary Jane Blizzard Last Will and Testament incidental to the settlement of my Estate, either secured or unsecured, at such rate of interest as may be necessary and to pledge the assets of my Estate as security therefor. My Executor shall have the power to make distribution in kind or partly in kind and partly in cash, to retain all or any part of my property, real or personal, including non-income producing assets, constituting my Estate for such time as he may deem best or to invest or reinvest the same without being restricted to "Legal" investments, including common trust funds and mutual and money market deposit accounts of banks. I further authorize and empower my Executor to borrow money from such persons as he may desire, including the power to borrow money from herself, as fiduciary, under any Trust Agreement and to execute and renew promissory notes and to pledge the assets of my Estate as security therefor. EIGHTH: I direct my Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my death, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate under the provisions of any state or federal law now in force and effect or hereafter enacted shall be prorated among the persons interested in the Estate to whom such property is or may be transferred to or to whom any benefit accrues. 3 Mary Jane Blizzard Last Will and Testament NINTH: I nominate, constitute and appoint my son, THOMAS C. BLIZZARD, Executor, under this my Last Will and Testament. If he is unable or unwilling to serve, I nominate, constitute and appoint my son, EARL W. BLIZZARD, III, Executor, under this my Last Will and Testament. No bond shall be required in this or any other jurisdiction. TENTH: I request my Executor to employ SPENCER G. NAUMAN, JR., as Counsel for my estate. IN WITNESS WHEREOF, 1, MARY JANE BLIZZARD, the Testatrix of this my Last Will and Testament, typewritten on six (6) sheets of paper have hereunto set my hand and seal this Lt day of 2000. JANE BLIZ Signed, sealed, published and declared by the said MARY JANE BLIZZARD as and for her Last Will and Testament, in our presence, who, in her presence at her request and in the presence of each other, have hereunto set our hands as attesting witnesses. N M ADDRESS ' i N AN4 E ADDRESS NAME ADDRESS 4 Mary Jane Blizzard Last Will and Testament COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF DAUPHIN I, MARY JANE BLIZZARD, 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 as my free and voluntary act for the purposes therein expressed. c vyct~ MARY OAAE BLIZZARWI'l Sworn or affirmed to and acknowledged before me by MARY JANE BLIZZARD, the Testatrix, this 4 day of ©aAo Lie r- , 2000. ub lic jytar4yP~ Commission Expires: NOTARIAL SEAL JEANNETTE CHELGREN, Notary Public City of Harrisburg, Dauphin County Commission Expires Feb. 15, 2001 5 Mary Jane Blizzard Last Will and Testament COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN We, \,j Ut, j and TEf!e / G /,9- _,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 Testatrix sign and execute the instrument as her Last Will; that Testatrix signed willingly and that Testatrix 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 that Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. f r. 4 ! a` Sworn or affirmed to and acknowledged before me this day of e eY , 2000. tary Public y Commission Expires: NOTARIAL A SEE",; EayJ9ANNETTE CHELGREN, N, srY PubAc of Hivrislrxp, Osu~h bi. 5 C'Ounty 1 s "ion Expires 6