HomeMy WebLinkAbout04-02-13 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 requests the grant of Letters in the appropriate form:
Decedent's Information
Name: Kenneth E.McClain II File No: 21
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 184-38-2433
Date of Death: 03/25/2013 Age at Death: 66
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at 213 Ridge Hill Road,Mechanicsburg 17050 Silver Spring Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Forest Park Nursing Center Carlisle 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 $ 50,000.00
If not domiciled in Pennsylvania................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania................ Personal property in County $
Value of real estate in Pennsylvania................................................................... $ 90,000.00
® TOTAL ESTIMATED VALUE $ 140,000.00
Real estate in Pennsylvania situated at 213 Ridge Hill Road,Mechanicsburg 17050 Silver Spring Cumberland
(Attach additional sheets,if necessary.)
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)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 03/06/2013 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 mar 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)
at.a.,d.b.n.,d.b.n.at.a.,pedente lite,duran"sentia.d1Wte minoritate
ca 7 M
If Administration,c.t.a or d b.n.c.t.a.,enter date of Will in Section A above and comolete list of he C.; M C-)
Except as follows:Decedent was not a party to pending divorce proceeding herein the grounds for divolfee ho been estllisha0a0efned
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated perms.�y -
tTJ
®NO EXCEPTIONS ❑ EXCEPTIONS rn ryl rt
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by thg-fol"Iririppo sd'e;'(if an a d heirs(attach
additional sheets,if necessary):
C"> C:)
Name Relationship Address c.
t17 r c)
Form RW-02 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. 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
Penny E.Zimmerman 425 Steelstown Road
Newville,PA 17241
(717)773-2687
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 th Decedent,Petitioner(s)will well and truly administer the estate according to law.
Sworn r ffirmed a ubscri before Date Lt•2-� 13
me hi ay o g�� Date
By: Date
rllegir Date
BOND Required? ❑ YES I__I NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters.......................................... $ i w Atto�aig
( l )Short Certificate(s).........
( )Renunciation(s)..............
( )Codicil(s)........................
( )Affidavit(s)...................... Br I ey L Gr- y rrl
Bond............................................. Supreme Court M c 0 t✓s
Commission ....... .. ID Number: 34349 �]
Other G Yr '' fV rn r"l
ro :;7
Firm Name: Griffie&Associa e C.
( T Address: 200 �over Weet�
Carlisle,P 7013
PQ
Phone: 717-243-5551
Automation Fee............................ 1 Fax:
JCSFee.......................................
TOTAL......................................... $ ;2 E-mail: bgriffie @griffielaw.com
DECREE OF THE REGISTER
Date of Death: 03125/2013
Social Security No: 184-38-2433
Estate of Kenneth E.McClain II File No: 21
a/k/a: 41 �T
AND NOW, T,7 in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters Testamentary
are hereby granted to Penny E.Zimmerman
in the above estate and(if applicable)that the instrument(s)dated 03/06/2013
described in the Petition be admitted to probate and filed of record as the last Will(and odicil(s)) Decedent.
Re ' er of Wills
Form RW-02 rev.1o/11/2o11 Copyright(c)2011 form software only The Lackner Group,Inc. �,� ag 2 of
H105.805 REV(9/11).
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 RECORDED O F F I C E 1„'„' This is to certify that the information here given is
I ZH
REGISTER Of- Win ,'' OF Fiyy correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
,1013 APR 2 P o z3 certificate will be forwarded_ to the State Vital
a t-3 y ' a� _ Records Office for permanent filing.
P 19401710 CLERK a=°�,� = E�� 'II' �. 3
Certification Number D.R P N A N S I C OIMENT OE� ' .
1�1'
CUMBERLAND CO., P
j1 Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA.DEPARTMENT OF HEALTH•VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State File Number:
1.becadent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(MO/Day/Yr)(Spell Mo)
M Batt-38r a+-133 rc�oxc�n a5,
So.Age-Last Birthday(Ym) 15b.Under 1 Year Sc.Linda,1 Da 6.Data of Birth(MO/Day/Ye a r)(Spell Month) 7a. hplace,(CI tl State raljn Country)
65 Months Days Hours Minutes FebrU3ry 8 947arxls�t,T-g, �'`A
7b.Birthplace(County) Da n
Be.Res!fame(State or Foreign Country) eb.Residence(Street and Number-Include ADL No. Be.Did Decadent Live in a Township?
8d.Residence(County) 1 3 Ridge Hill RC Yea,decedent lived in Silver Spring t-P
QIILI�373L C3 Se.Residence(Zip Code) 17050 Q No,decedent lived within limits of <Ity/boro.
9.Ever in VS Armed Forces? 10.Marital Status at Time of Death Q Married C3 Wdowed 31.Surviving Spouse's Name(If wife,give name prior to first marriage)Yes Q No Q Unknown Ja Divorced Q Never Married Q Unknow
12.F�jheYS Na¢It(Firg$,Mlctt(le,yt,$unx) �lar's�Natrla Pryor to First Marriage(First,Middle,Last)
14%. Yi�nMCC: 31 Rel_a_�o s(1 hip to Decedent 14c.I!gorrmla1,,V3 MOa1FlI'ng Addratsa(Straet and Number,CT,,State Zip Code
u 425 Steelstown Rd., Newville, �A 1'V241
G _ _ _ - _ _ _ __ __ _ _- _ - -- _ e. ace o eat e< on one _ _ _
S I7 Death Occurred In a Hospital: ❑Inpatient 1}Death Occurred Somewhere Other Than a Hospital: d Hospice Facility b Dlcede nt's Home
0 Emergency Room/Outpatient Q Dead cn Arrival 1 29 Nursing Nome/Lon -Term Care Facility 0 Other(Specify)
ISb.Facility Name(if not institution,give street and number) 15c.City or Town,State,and Zip Code 1Sd.County of Death
� Cumberland
�- 36a.Method of Olsposltlon Q Burial Cremation 16b.Date of Disposition 16<.Place of Disposition(Name of cemetery,crematory,or other plate)
Q Removal from SUte Q Donation
0 Other(Spa<Ity Mai-C_ 26,201 Bitner Crematory, T•T!'
2 16d.Location of Disposition(City or Town,State,antl Zip) 17a.Sig■ o FU I Ip LIC or Pa n In Charge of interment 17b.Llcense Number
Har :i0k vrg, PA 171 1 0 `(!,1 FD-1 38866
17c.Name and Complete Address of Funeral Facility
Jesse H. Get ie F-L.=R. 2100 Lin 1..t: ri.-Rd_ is PA 17110
d' 18.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the 20.Decedent's Rap-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 depdent the decedent,onside red himself or herself to be.
Q 8th grade or less is Spanish/Hlspanlc/Latino. Check the"NO" White 0 Korean
0 No diploma,9th-12th grade box If decedent Is not Spanish/Hispanic/Ladno. Black or African American Q Vietnamese
0 High school graduate or GED completed No,not Spanish/Hlspanlc/Latino Q American Indian or Alaska Native Q Other Asian
0 Some college credit,but no degree Yes,Mexican,Mexican American,Chicano Q Asian Indian Nativa Hawaiian
Q Associate degree(e.g.AA,AS) Q Yes,Puerto Rican Q Chinese Q Guamanian or Chamorro
Bachelor's degree(e.g.BA,AB,BS) Q Yes,Cuban Q Filipino Q Samoan
Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) Q Yes,other Spanish/Hispanlc/Latino Q Japanese Q Other Pacific Islander
Q Doctorate(e.g.PhD,EdD)or Professional degree (Specify) Q Other(Specify)
.MD DDS DVM LLB JD
21.Decedent's 5ingle 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 Q Samoan do during most of working life. DO NOT USE RETIRED.
0 Black or African American Q Korean Q Other Pacific Islander - - --
Q American Indian or Alaska Native Q Vietnamese 0 Don't Know/Not Sure
Q Asian Indian Q Other Asian Q Refused 22b.Kind of Buslnes d� t
Q Chinese Q Native Hawaiian 0 t9 ry Other(Specify) CCxI><Ilonweal OP PA
Q Filipino 0 Gua ma nlan or Chamorro
ITEMS Z o-23 MU B COMPLETED 23a.Date Prone.nced Dead Mo Dey r) 23 .Slgnatum o Person ronpuncing Death(Only when applicable) 23c.Ucenaa Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH 43 S-_7e 1-:3 7rJ
V J"_' -,v'/
24. � 3,Gyl/to�-t�/075fj,-C3>.v L
/
F.S.Was odlcal Examiner or Coroner Contacted? Q Yes No
CAUSE OF DEATH - Approximate
26.Part 1. Enter the chain of events--diseases,injuries,or complications-that directly caused the death. DO NOT enter terminal events such as card[,,arrest, I Interval:
respiratory arrest,or ventrieu ter fibrillation without showing the etiology DO/N%OT AB�BfREVIATE. Enter only one cause on a line. Add additional lines if necessary. I Onset to Death
IMMEDIATE CAUSE ---------------> a. -J iYL�6/YLt/l.�/� 1
(Final disease or wnditlon Du to(or as a consequence o � � ;
resulting I.death) 1
b. A_���.c:r C'.�n1'4 0 1
Sequentially list conditions, Due to(or as a consequence of): t
if any,leading to the cause
listed on line a. Enter the c. 1
1
UNDERLYING CAUSE Due to(or as a consequence of): 1
(disease or Injury that 1
F Initiated the events resulting d. 1
in death)LAST. Due to(or as a consequence of): ;
26.Part 11. Enter other but not resulting in the underlying cause given In Pan 1. 27.Was an autopsy p med?
ME WareQautopsyflndingslvallable
�+ to complete the cause of death?
� ner Q Yes O No
29.If Female: 30.Did Tobacco Use Contribute to Death? 31�.MJ of Death
0 Not pregnant within past year Q Ye (,-7j it7nknobly Natural Q Homlclde
Q Pregnant at time of death 0 Accident
0 Not pregnant,but pregnant within 42 days of death Q Suicide Q Could not be determined
r 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Yr)(Spell Month)
Q Unknown If pregnant within the past year 133.Time of Injury
1z 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of Injury(Street and Number,City,County,State,Zip Code)
C36.Injury at Work 37.If Transportation Injury,Specify: 38.Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Pedestrian
0 Q Passenger 0 Other(Specify)
39a. Rifler-physician,certified nurse practitioner,medical examiner/coroner(Check only one):
Certifying only-To the best of my knowledge,death occurred due to he cause($)and manner stated.
Q Pronouncing&Certifying-To the best of my knowledge,death occu ad K the time,date,and place,and due to the cause($)and manner stated.
Q Medical Examiner/Coroner-On the bast f examination and/or Inv si ion,In my opinion,death occurred at time,date,and place,and due to the cause(s)and manner
�ystated.
ySignature of certifier: ` Title of cartifler._�f � License Number: D 9
39b.Name,Address and Code Parson Co pleting Cause of D..lhh(I`ei;6) �� 39c.Data Sign/e�d(MO/D y/Yk
.71 !IU/ �j
40.Registrar's DiatriR Number 43.Regi 'a 51 lure - 42.Regis FI a bate(MO Day r
a--� 3 a2 aY�13
43.Amendment
0
Disposition Permit No. !] J -J`' REV EV S-143
07/20
LAST WILL AND TEST 1'V' ,
rn
rn � tr3 :a
r- M r
OF
c 4=1
- �
KENNETH E. MCCLAIN, II J �=
ra o-, C>
I, KENNETH E. MCCLAIN, II, of 213 Ridge Hill Road, Mechani&burg, *q
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my Last Will and Testament,
hereby revoking and making void all previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my Executor/Executrix hereinafter named to pay all of my just
vi
debts, funeral expenses and expenses involved or connected with the administration of
my estate as soon after my death as is reasonably possible. I direct my Executor/Executrix
to pay all inheritance, estate, succession and legacy taxes, to which my estate or the
transfer of any property hereunder may be subject, and to charge such taxes as part of the
expenses of the administration of my estate, being deducted and paid from the residue of
my estate and not to be deducted in any manner from any specific bequests made herein.
However, my Executor/Executrix need not accelerate and pay those unmatured
obligations which, in his, her or its opinion, it might be proper and more advantageous to
retain or renew and pay as they become due and payable. If I do not own a burial plot or a
grave marker at the time of my death, I authorize my Executor/Executrix, in his, her or its
GRIME&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East,Suite D
Carlisle,PA 17013 Page 1 of 7 Chambersburg,PA 17201
sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave,
and to expend sums from my estate for this purpose.
SECOND
I give, devise and bequeath the rest, residue and remainder of my estate of
whatsoever nature and wheresoever situate, together with all insurance proceeds thereon,
to my dear and close friend, PENNY E. ZIMMERMAN, whom I have raised as my own
child,providing that she survives me by sixty(60) days).
THIRD
I grant my Executor/Executrix the following powers in addition to and not in
limitation of such powers as my Executor/Executrix shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
LJ (b) To join in any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect thereto;
to deposit investments under agreements and pay assessments; and generally
to exercise all rights of investors, including but not limited to, the voting of
shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East, Suite D
Carlisle,PA 17013 Page 2 of 7 Chambersburg,PA 17201
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my Executor/Executrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
(h) To compromise claims without court approval including, but not limited to,
any controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
(j) To access, use and control any digital device that I may own or have license to
use (such as computers, cell phones, etc.) for purposes of accessing,
controlling, deleting, transferring and distributing any digital asset and digital
account that I may own or have license to use, to the extent then authorized by
law. My Executor/Executrix has authority to obtain any username, login,
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East,Suite D
Carlisle,PA 17013 Page 3 of 7 Chambersburg,PA 17201
password or other electronic credential associated with any of my digital
devices, digital assets and digital accounts.
(k) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management of
the settlement of my estate.
(1) To disclaim any benefits to which I may have been entitled posthumously,
whether said benefits result from distribution from an estate, trust or any other
such account.
(m) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
FOURTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall
any beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary.
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East, Suite D
Carlisle,PA 17013 Page 4 of 7 Chambersburg,PA 17201
FIFTH
I nominate, constitute and appoint my dear friend, PENNY E. ZIMMERMAN,
as Executrix of this my Last Will and Testament. In the event Penny E. Zimmerman is
deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever,
then I nominate, constitute and appoint my brother, CHARLES A. MUMMA, JR., as
Executor of this my Last Will and Testament. I direct that my Executor/Executrix shall
not be required to give or post bond for the faithful performance of his, her or its duties in
this or any other jurisdiction.
SIXTH
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of seven (7) typewritten pages, the first four (4) of which
bear my signature on the side margin, for purpose of identification, this 4 h
day of MAa"(-Lrl , 2013.
WITNESS•
n4v\"
KENNETH E. MCCLAIN, II
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East,Suite D
Carlisle,PA 17013 Page 5 of 7 Chambersburg,PA 17201
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND
I, KENNETH E. MCCLAIN, II, the Testator 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 and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
e�z'- F -qc- "
KENNETH E. MCCLAIN,II
Sworn or affirmed and acknowledged before me by the Testator this Vk
day of lfi,r , 2013.
Corrnnonweaft of
NOTARIAL SEAL
KELLY L PEREZ
Notary Public
CadIsle Borough,Cumberland Caunty
My Commission Expires JanM 25 2018
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East, Suite D
Carlisle,PA 17013 Page 6 of 7 Chambersburg,PA 17201
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
. SS.
COUNTY OF CUMBERLAND
WE, L�,ad I c4 L- 1..�r% 1 and s,A-
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will and Testament; that he signed willingly and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testator signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testator was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by Ora d 1
and I Lbin J. &L<55 P 4 l this�day of ILIA �� , 2013.
Commor�realth of pen nla N& Pub i
NOTARIAL SEAL
KELLY L PEREZ
Notary PubIIO
Carlisle Borough,Cumberland Cotmly
My Commission Expires January 25,2016
GRIFFIE&ASSOCIATES
Attorneys At Law
200 N. Hanover Street 100 Lincoln Way East, Suite D
Carlisle,PA 17013 Page 7 of 7 Chambersburg,PA 17201