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HomeMy WebLinkAbout04-01-13 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 request(s)the grant of Letters in the appropriate form: Decedent's Information Z/-1$-034 7 Name: Martin F.Bretz File No: aWa: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 03/21/2013 Age at death: 89 Decedent was domiciled at death in County, PA (State)with his/her last principal residence at 20 North 12th Street,Apt. 125 17043-1449 Lemoyne Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at 11 l S.Front Street 17101 Harrisburg Dauphin 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 $ undetermined If not domiciled in Pennsylvania.............................Personal property in Pennsylvania $ n/a If not domiciled in Pennsylvania.............................Personal property in County $ n/a Valueof real estate in Pennsylvania.............................................................. $ 46 n/a O7" TOTAL ESTIMATED VALUE.... $ `'70 &D Real estate in Pennsylvania situated at: (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)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated 09/28/2006 and Codicil(s) thereto dated Renunciation of Beverly Ann Yaiko dated March ,2013 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 many,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.,pendente lite,durante absentia,durante minoritate If Administration,c,ta. or db.n.c.t m,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. ❑ NO EXCEPTIONS ❑EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following souse(if any)areirs( aa additional sheets,if necessary): �. ©> C7 Name Relationship Addre= = t3 r � rn 0 . a40 cz> ° JFP Form RW-02 rev.10/11/2011 Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: ` COUNTY OF CUMBERLAND a rn } Petitioner(s)Printed Name Petitioner(s)Printed Adltsa= C? -- 7 Pheasant View Drive Carrie Lee Clarke Dillsbur PA 4:50 -8843 c _ ZEs .. -- — — — > G 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 Decedent,the Petitioner(s)will well and truly administer the estate according to law. Sworn to or affirmed a bscribed before _ f JCt CA Ck"'..._ Date me thi day of - — _ , 2013_ _ _ Date By. –��'' __— _ Date �r�the Register — Date — BOND Required: O YES ® NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters. . . . . . . . .. . . .. . . . . . . . .. $ 20.00 Atto Signature: (3 )Short Certificates(s) .. . . . . 15.00 (I )Renunciation(s) . . .. . . . . . . 5.00 ( )Codicil(s) . . . . . . . . .. . . . . \ ,� ( )Affidavit(s). . . . . . . . . . .. . — Bond . . . . . . . .. . . . . . . . . . . . . . . . . Prin ame: John A.Lauer Commission . .. . . . . . . . . . ... . . . . . Supreme Court Other JCP Fee 23.50 ID Number: 78307 Inheritance 15.00 Inventory . . . . 15.00 Firm Name: MacDonald, Illig,Jones&Britton LLP .. . . . � �c Address: 100 State Street, Suite 700 — ' ' ' ' ' ' ' ' Erie PA 16507-1459 - • • . • • • • • • Phone: 814-870-7712 —. —• • .• • • . . . Fax: 814-454-4647 Automation Fee . .. . . . . . . . . . . . . . . _ 5.00 Email: 14upr@miib.com JCS Fee . . . . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . .$ f — -- — DECREE OF THE REGISTER Estate of Martin F. Bretz File No: � aWa: AND NOW, 2013 , in consideration of the foregoing Petition, satisfactory proof having b en presented before me,IT IS DECREED that Letters Testamentary are hereby granted to Carrie Lee Clarke in the above estate and(if applicable)that the instrument(s)dated September 28,2006 described in the Petition be admitted to probate and filed of record as the st Will(and odicil(s))of Dece ent. f � t Register of Wills `'r Form RW-02 rev.10'11.'2011 H105.805 REV(9/11)��._ ...0 Jr 7 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 ---E This is to certify that the information here given is REGISTER F 1 I»LS ,III''A`�H OF p correctly copied from an original Certificate of Death 1 `�,o` sG duly filed with me as Local Registrar. The original 1.013 APR 1 AM 11 QA;� 9; certificate will be forwarded to the State Vital °- z Records Office for permanent filing. P 19435058 �LERK °F a��'''��� 1 013 ORPHANS COURT 991�1ENT 0���''� Certification Number """1 CUMBERLAND CO.* PA cal Registrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH State File Number: a 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Yr)(Spell Mal Martin Frederick Bretz Male 297-14-3399 lftlarc)h 91 S,0119 Sa.Age-Last Birthday(Yrs) Is b.Under 1 Year Sc.Under 1 Day 16.Date of Birth(Mo/Day/Year)(Spell Month) 7a.Birthplace(City and State or Foreign Country) 89 Months Days I Hours Minutes NOV 2, 1923 7b.Birthplace(County) Be.Residence(State or Foreign Country) 8b.Residence(Street and Number-Include Apt No.) 8c.Did Decedent Live to a Township? 3 PA 20 N 12th St:, Apt 125 QYes,decedent lived in twp, 8d.Residence(County) - Be.Residence(Zip Code) No,decedent lived within limits of Lemoyne city/boro. 9.Ever in US Armed Forces? 10.Marital Status at Time of Death E3 Mrried a Widowed ll.Surviving Spouse's Name(if wife,give name prior to first marriage) [Ryes U No Unknown 0 Divorced 0 Never Married �Unknown 12.Father's _Name(tFirst Middle,Last,Suffix) 13.Mother's Name Prior-to FI Marriage(First,Middle,Last) Martn H. tre Anna DrOtXe� 14a.Informant's Nam 14b. elatlonship to Decedent 14c. mant's Ma ling Addre (Street d Number City,St te,Z(p od Marta Fo�tz t `au hter Bern sise Bra ge tta- , 1 L g far sge, PA 17 .15 �-+ .......................................................... ...p.................................... 15a.P aee.o Deat.,C.ec only one).. ... .... ......... ... ... ... .......... .... ....... ....... ...... ac If Oea h Occurred in a Hospital: In anent :If Death Occurred Somewhere Other Than a Hospital: Hospice Facility u Decedent's Home Emergency Room/Outpatient Dead on Arrival Nursing Home/Long-Term Care Facility Other(Specify) a 15b.Facility Name(If not institution,give street and number; .SSc.Gity or Town,State,and Zip Code 15d.County of Death LL Harrisburg HOSpital Harrisburg, PA 17101 Dau hin 16a.Method of Disposition Burial Q0 Cremation 16b.Date of Disposition 16c.Place of Disposition(Name of cemetery,crematory,or other place) E3 Removal from State p Donation March 22, 20 3of'fman-Roth Funeral Hcxne & CraILlatOr�7 .� Other(Specify) ? 16d.Location of Disposition(CI ty or Town,State,and Zip) 17 afure of Funeral Service VFcenVe or Per n to Charge of Interment 17b.License Number Carlisle, PA 17013 013144E 17c.Name and Complete Address of Funeral Facility H -R al H & Cramato 219 North Hanover Street Carlisle PA 17013 m 18.Decedent'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 ro 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. J] 8th grade or less Is Spanish/Hispanic/Latino. Check the"No" White )3 Korean t (] No diploma,9th-12th grade box if decedent is not Spanish/Hispanic/Latino. [:]Black or African American E:3 Vietnamese Q High school graduate or GED completed t]No,not Spanish/Hispanic/Latino 1]American Indian or Alaska Native 0 Other Asian Some college credit,but no degree E3 Yes,Mexican,Mexican American,Chicano [:]Asian Indian 0 Native Hawaiian )3 Assoclate degree(e.g.AA,AS) Q Yes,Puerto Rican 1]Chinese 13 Guamanian or Chamorro )',2Q Bachelor's degree(e.g.BA,AB,BS) J]Yes,Cuban 0 Filipino [:3 Samoan j E3 Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) Q Yes,other Spanish/Hispanic/Latino )3 Japanese ED Other Pacific Islander C3 Doctorate(e.g.PhD;EdD)or Professional degree (Specify) E3 Other(Specify) e. MD DDS DVM LLB JD a 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 ['N White C3 Japanese 1]Samoan done during most of working life. DO NOT USE RETIRED. E3 Black or African American [:1 Korean 1]Other Pacific Islander Electrical Engineer 7 q E3 American Indian or Alaska Native Q Vietnamese C3 Don't Know/Not Sure 9 = 0 Asian Indian E3 Other Asian 1]Refused 22b.Kind of Business/Industry g M Chinese Q Native Hawaiian 1]Other(Specify) Q Filipino C3 Guamanian or Chamorro Electrical Company > ITEMS 23a-23d MUST BE COMPLETED 23a.Date P onounced Dead Mo Day r) 23b_Signature of Person Pronouncing Death my when applicable) 23c.License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH ♦, L _ /` 23d.Date SI ned(MO/Day/Yr) 24.Time of De(at�h �/2 /- �G�G� Mb O-7 G-11-1-7L Jams -r: 125.Was Medical Examiner or Coroner Contacted? ET Yes E3 No CAUSE OF c)EATH 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 cardiac arrest. Interval: S respiratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary s Onset to Death IMMEDIATE CAUSE -----------> a. l GLC �1(C�_�.l ♦itI.J�Qir lam,_ �J'�� i (Final disease or condition Due to(or as a consequen of): s resulting In death) nn b. Sequentially list conditions, Due to(or as a consequence of): If any,leading to the cause - s listed on line a. Enter the C. �t�� UNDERLYING CAUSE Duet or as a conseq a ce of): (disease or injury that F Initiated the events resulting d. In death)LAST. Due to(or as a consequence of): j E 26.Part 11. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part I 27.Was an autopsy perf med? v E3 les- N 28.Were autopsy findings available - to complete the cauj-se­pf death? 3 O Yes L!ff-No 9�a1 29.if Female: 30.Did Tobacco Use Contribute to Death? 31. nner of Death ,t E E3 Not pregnant within past year 0 Yes JO Probably [•'Natural )] Homicide tg 0 Pregnant at time of death )] No ©Unknown )]Accident Q Pending Investigation )] Not pregnant,but pregnant within 42 days of death Suicide C3 Could not be determined �°- 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Yr)(Spelt Month) Q 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) a 36.Injury at Work 37.If Transportation Injury,Specify: 38.Describe How Injury Occurred: )l Yes )]Driver/Operator E3 Pedestrian 0 No 1]Passenger Other(Specify) 39a.Certifier(Check only one): ertifyin&physician:To the best of my knowledge,death occurred due to the cause(s)and manner stated � e pronouncing&Certifying physician-To the best of my knowledge,death occurred at the time,date,and place,and due to the cause(s)and manner stated E3 Medical Examiner/Coron O t sipr of examine ,and/or Investigation,in my opinion,death occurred at the time,date,and place,and due to the cause(s)and manner stated Signature of certifier: Title of certifier: \t t� License Number:1 r t S 6-7 6-7 W-1 L 39b.Name,-Address and Zip Code of Person Completing Cause of Death(Item 26) 39c.Dat Slgned(Mo/Day r) t .¢ _ v 3 01 I o'?v 40.Registrar's District Number 41.Regf ar's Signature 42.Registrar File Date Mo Day r) ' -� D /� A,4-.re a2a2 20 f3 43.Amendments W 5 H 105-143 � Disposition Permit No. ` - REV 07/2011 - C"> � rn c � mC � c.) OATH OF SUBSCRIBING WITNESS(ES) m , an r M rn Cn REGISTER OF WILLS C.; CUMBERLAND COUNTY,PENNSYLVANIA ` c' Estate of Martin 1:.Bretz ,Deceased Deborah M.StwWewicz James D.Cullen ,(each a subscribing witness to (Print Nimes) the 0 Will ❑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 r the Testator/Testatrix in her/his presence and in the presence of each other. La Pb. (Signature) (Sigrra t 100 State Street.Suite 700 100 State Street.Suite 700 (Street Address) (Street Address) Erie PA 16507-1459 Erie PA 16507-1459 (City,State,Zip) (City,State.Zip) Executed in Register's Off�rce Executed out of Register's Of ke Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed before me this day before me this day of of +V�� � ,201 . 3 1, I Deputy for Register of Wills Notary Publ My Commission Expires: g s" f -�2 :)()/4 (Signature and Seal of Notary or other 0 c ified to administer oaths.S o w d ate o f expiration uat ion of Notary's ry'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. Form RW-03 rev. 10.13.06 ` i NOTARIAL SEAL SNMYJ.McCRAY,NOTARY PU81.IC ERIE,ERIE COUNTY,PE NNA MY COMMISSION EXPIRES ON AUGUST 3,214 TNk0TNkYWRk0Tk0NDBjZnwwLjE= https://doc-Os-9g-docsviewer.googleusercontent.com/viewer/securedo... rn wti RENUNCIATION � M M M C") G"> C:p REGISTER OF WILLS r-' z M � = C1 LAND COUNTY,PENNSYLVA `t' C-> nC> a .�wwwwwwww� . w - Iwwrw r�r•. �_� r, M Q Estate of M4 -- - , Mau+F Bretz ,. Deceased L lky Iv Aim Yea �,. , ,..,., , in my capacity/relationship as (Print Name) RAMgd Fxecutrm and dsugUU of the above Decedent,hereby renounce the right to .wwww.wwwww�wn i i i .n i i i administer the Estate of the Decedent and respectfully request that Letters be issued to rgWk LAM Clarke # wwwww w■ w�w�.. / r.rrwrww� (la4te) (StB� ) 9437 Ream Road (Street Address) ,X 1472 , Pty.&M.,Z40 Executed in Regbter's Office Executed out of ReghterIs Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciation for the purposes stated within on this day Deputy for Register of Wills Not Public My Commission Expires: {Signarisra and Seld of Notary or o0wr official quali$cd to tuimi�ustor oa hs.Show date of expiration of Notary's Commiulon.) LYDIA A CAREY NOTARY Pt10l.I6, State of New York No.01CA6046425 Form RW-06 re Conimission txc,lres Auyusl 14, 20-d v l0.13.Ob 1 of 1 3/22/2013 5:32 PM � M w6 M wW C .� C" I► M M n M � '-K vca LAST WILL AND TESTAMENT C> a OF -- r co MARTIN F. BRETZ I, MARTIN F. BRETZ, of Erie County, Pennsylvania, being of sound mind and memory, declare this to be my Last Will and Testament. FIRST: I direct that my legal debts and expenses of my last illness and funeral be paid out of my estate as soon as may be convenient after my death. SECOND: I direct my Executrix to distribute my tangible personal property in accordance with a writing signed by me, which writing may be made and changed from time to time by me after the execution of this Will. I give all such property not effectively disposed of by me by the terms of such writing to such of my daughters, BEVERLY ANN YAIKO, MARTA J. FOLTZ, and CARRIE LEE CLARKE, who are living at the time of my death, to be distributed among them as they shall mutually agree and in the absence of such agreement as my Executrix alone shall determine making such distribution in as nearly equal shares as possible. Any personal property distributable to a minor may be delivered to the person with whom the minor resides or such other person who may have custody of the person of the minor, without the intervention of a Guardian. The receipt of any such person shall be a full acquittance of my Executrix as to such distribution. All expenses, including storage and insurance, incurred for the delivery and distribution of my tangible personal property to the persons or parties entitled thereto shall be administrative expenses of my estate. THIRD: I give and devise the residue of my estate to my daughters, BEVERLY ANN YAIKO, MARTA J. FOLTZ, and CARRIE LEE CLARKE, or to the then living issue per stirpes of any daughter of mine who does not survive me. FOURTH: I authorize my Executrix to sell any and all real estate which I may own at the time of my death, at public or private sale, for such prices and upon such terms as my Executrix believes advisable. My Executrix is authorized to make, execute, and deliver any deed or deeds therefor, conveying title thereto in fee simple absolute or for any lesser estate to any purchaser or purchasers. FIFTH: I authorize my Executrix to make distribution of my estate in kind or in cash, or partly in kind and partly in cash, as my Executrix shall believe advisable. SIXTH: All death taxes payable because of my death, whether on property passing under this Will or otherwise, shall be paid from my residuary estate, without apportionment or right of reimbursement. SEVENTH: I appoint my daughter, BEVERLY ANN YAIKO, Executrix of this, my Last Will and Testament. Should BEVERLY decline or for any reason be unable to so serve or continue to serve, then I appoint my daughter, CARRIE LEE CLARKE, Executrix. If CARRIE should likewise decline or for any reason be unable to so serve or continue to serve, then I appoint my daughter, MARTA J. FOLTZ, Executrix. EIGHTH: No fiduciary appointed in this Will shall be required to post bond or any security in any jurisdiction in which such fiduciary shall be required to serve. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of September 2006. Ut,r. SEAL Martin F. Bretz Signed, sealed, published, and declared by the above-named Testator, MARTIN F. BRETZ, to be his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have signed our names as witnesses. 100 State Street, Suite 700 `Witness Erie, Pennsylvania 16507-1459 100 State Street, Suite 700 Witness Erie, Pennsylvania 16507-1459 976998 -2-