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HomeMy WebLinkAbout04-18-13 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: Beistline Barbara S. File No: a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: `* Z,y 70 3 Date of Death: 43/22/2013 Age at death: b y Decedent was domiciled at death in Cumberland County, Pennsylvania (State)with his/her last principal residence at 55 East Main Street Mechanicsburg,PA 17055 Cumberland Street address,Post Office and"Zip Code City,Township or Borough County Decedent died at Holy Spirit Hospital, Camp Hill, PA 17011, Cumberland County 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 S 21,500.00 If not domiciled in Pennsv ivania. . . . . . . . .. . . . . . . . .. . . .. . Personal property in Pennsylvania S If not domiciled in Pennsylvania. . . . . . . . .. .. . . .. ..... ... Personal property in County S Value of real estate in Pennsylvania- .. .. ..... .... . .. . .. .... . .... . . . . . . . ... .. . . . . . . . S 0.00 TOTAL ESTIMATED VALUE. .. . S�-21,.500.00 Real estate in Pennsylvania situated at: Decedent owned no real estate at the time of her death (Attach additional sheets,ff necessaiyj Street address,Post Office and Zip Code City,Township or Borough County Q 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 19,2012 and Codicii(s) thereto dated None 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. E)NO EXCEPTIONS Q EXCEPTIONS © B. Petition for Grant of Letters of Administration (if applicable) c.t.a.,dAn.,d.b.n.c.t.a.,pendente lite,dctrante absentia,durante ntinoritau: If Administration,c.t.a. or d.b.n.e.t.a.,enter date of Will in Section A above and complete list of heirs. Except as fellows: 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.S 3323(8)and was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS 0 EXCEPTIONS Petitioner(s),aftera proper search has/have ascertained that Decedent left no Will and was survived by the @ owing spousLTany)and heirs(attach additional sheets, tf'necessarv): p xg X � CJ Name Relationship et y zz? to � Andrew Matter Son-in-law 104 East Sim son Street Mechanicsbur PA 1705;1: cl) -_0 00 ' � C c C)^ c? zz) PF C�o c":, co 'rl Form RW-t12 rev.. 1 f I V2011 Page j of 2 Oath of Personal Representative c� Official Use,Only $ ° m 'V m � C1.)COMMONWEALTH OF PENNSYLVANIA } 0 -ti (::> } rn SS: rte- ce) u COUNTY OF CUMBERLAND } Z: rri rrIf rn Petitioner(s)Printed Name Petitioner(s)PrintedA drlw Ss � =D x. ct� `n Cal The Petitioner(s)above-named swear(s)or affirm(s)the statements in the gg g Pet ition are true and correct to the best of the knowledge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,toner(s) I ell and truly administer the estate according to law. Sworn to or firmed subscribed before L, Date me this day o , 2013 Date gy; Date t e Register Date BOND Required: Q YES (F) NO To the Register of Wills: FEES: /1 Please enter my appearance by my signature below: /� Letters . . . . . . . . . . . . . . . . . . . . . . $ . VV Attorney Signature: ( 1 ) Short Certificate(s). . . . . . ;25. ( ) Renunciation(s).. . . . . . . . ( )Codicil(s). . . . . . . . . . . . . ( )Affidavit(s).. . . . . . . . . . . Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Richard C. Snelbaker,Esquire Commission. . . . . . . . . . . . . . . . . . Supreme Court Other . . . . . . . . ID Number: 6355 �p 15•QD .IPf 1 (r,DD Firm Name: Snelbaker&Brenneman,P.C. . . . . . . . . k5.1717 Address: 44 West Main Street . . . . . . . . Mechanicsburg, PA 17055 . . . . . . Phone: 717-697-8528 Automation Fee. . . . . . . . . . . . . . . �-t`� Fax: 717-697-7681 JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: TOTAL. . . . . . . . . . . . . . . . . . . . . $ 'O'M DECREE OF THE REGISTER ,1 Estate of Beistline,Barbara S. File No: oL fl " - V a/k/a: AND NOW, 201 q , in consideration of the foregoing Petition, satisfactory proof having been p e enteli before me,IT IS DECREED that Letters Testamentary are hereby granted to Andrew Motter in the above estate and(if applicable) that the instrument(s)dated July 19 2012 described in the Petition be admitted to probate and filed of r cord as the last Will (and Codicil(s))of Decedent. Register of Will Form RW-n2 rev. 1011112011 r4k DyPaggWe2 2 H 105.805 REV(9/11) 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, $6.00 REGISTER ffi/,,,fYYY/""'---- This is to certify that the information here given is L L$ f�E�,�TH OF p�iNy correctly copied from an original Certificate of Death X013 flPR pm duly filed with me as Local Registrar. The original j B iii I Z certificate will be forwarded to the State Vital Records Office for permanent filing. CLERK P 19475146 ORPHANS' C OF q9 - ��aI'll [��Q� z i 0 U R�` .jMENT OF,IFIfI Du > ✓ / , Certification Number CUMBERLAND C p,• PA -""""""""'jig Local Registrar Date Issued se/Print In COMMONWEQTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITA(RECORDS amem lack Ink CERTIFICATE OF DEATH State File Number: 1.Decedent's Legal Name(First,Middle,last,Suffix) 2.sea 3.Social Security Number 4.Date of Death(MO/Day/Y,)(Spell Mo) L stl�he -3,1-3'703 aol3 Sans Age-Last Blrthday lYn) Sb.UrMer 3 Year Sc.Under 1 Da 6.Dale of Bkth(Mo/DaY/Year)ISpe1I Month) ]a.Birthplace(City alb State or Foreign Country) 1 Months Days Hours Minutes �('h 1'1 Iq�i4 y J9, y / 7b.6mhplac<ICmmIVj a.Reside.e(Slate or Foreign Country) Bb.Residence(Street and Number,-Include Apt No.) Jk.Did Decedent flue Ina Tgwnship? B4.Residence IDOYnry) 5D3 N. ,11gr St. ❑Yes,decedent 1.In him. Y'f1 'e Be.Residence(21p Code) t M/NO,decedent(Wed within limits of 0.111 city oro 9.Ever m US Amnd Forces? 1D.Mann)Status at Time of Death [3 Iff Widowed 11.SunMng Spouse's Name(If wife,gore name prior to fint ma age) ❑Yes CK No ❑Unknewn ❑D-,c.d Cl Never Marred ❑Unknown W.Fatal s Name(First,Mitldk,last,SuNlxl e 13.Mother's Name-to Fist Marriage(FlnL Middle,""I Ir IN.Informant's Name C 1 14b.Relatlonshlp to Decedent 1<c.lnforman['I"ailing Address(Street and NU ,CIIy�State,zip Code) Qk 1706 G _ l _- a. ace o en r one ob" . nwtient---'---IU Deaih Occurred Om er Tin a Hospital ---d _--)]Deders Hom-i DAtn O ,H _ 3 ❑Emergi RooMOUtpatlent ❑Dead on A,..I I ❑Nursing Home/long-Term Care Facility ❑Other(Specify) ty) 15b.Facility Name(if not klHkutlpn,gone rtrcet and number) ISC.city or town,state,ant rep Code ISd.County of Death PAmp Odl PA 1,7011 16a.Met Oh Ion ❑eu I remaHon 16b.Date of Dlswsk n 16c.Place of Dispostlon(Name of cemetery,crematory,or other place) E ❑Removal boon State ❑Oona[bn ,(�/s {/ (` L2 ❑Other)Specify) 3 13 ,,1 .�-E7 Y1 1"1ATQ-YPF Igp l'Y•Q_ckA Q", Z16d.Incatlon of Disposition(City or Town,state,and Zip) 178.Signature d Funeral Service Licensee or P arge of Interment I 17b.Ike.•Number S1,1 Y1S10LL.1' PA 179,57 sew pl 1] Name and[ompkte Address of Funeral fadify �7a 18. edam's Educa on' eds the boa that belt d scilbes the 19.Decedent of a gin-Check the 20. dent's Race-Check ONE OR M ces to indicate what t°- highest bane or level of school rompkted at the three of death. box MM bert daudb s whether the decedent the decadem co.ltlered himself or herself to be. ❑glh{nde or less Is SpaNSh/H1sPanlc/Latmo.Check the'NO' J[Write ❑"man ❑No dlpkma,9th-12th grace box H decedent"not Spa°Ish/Hlipmk/lanno. ❑Black or African America ❑Vietnamese High school graduate or GED completed No,not Spanish/Hispank/LSNrw ❑American Indian or Alaska Nathq ❑Other Arian ❑Some college credit,but no degree ❑Yes,Mexkan,Mexkan American,Chicano ❑Asian Indian ❑Natme Hawaiian ❑Assadat,degree(e.g.AA,AS) ❑Yes,Puerto Rican ❑Chinese ❑GuamiNln or Camorm ❑Bache,degree le.g.BA,AB,BS) ❑Yes,Cuban ❑Filipino ❑Samoan ❑Master's degree le.e.MA,MS,MEng,MEd,MSW,MBA) [I Yes,other SpaNsh/Hupanic/Iatirlo ❑Japanese 11 Other Pad k Islander ❑Doctorate leg.PhD.EED)or Profsssknal degree (Specify)__ ❑Otar(SPecify) e..MO DDS DVM ll0 1D 21.Decedent's Single Raft SeN-OeslgnaNO,-Check ONLY ONE to indicate what the decedent considered himself or herself to be 22,.Decedent's Usual Occupation-Indicate type of woM1 WMte ❑Japanese ❑Samoan done during most of working lHe.DO NOT USE RETIRED. ❑Black.African Amennn ❑Korean ❑Other Pacific Islander n1D k'h'1 ❑American Indian or Alaska Natihe ❑Viemamese ❑Don'[Know/Nm Sure ❑Asian Indian ❑Other ASla, ❑Refused 22b.Kind of 11.0 ess/Industry ❑Chinese ❑NatNe Hawaiian 13 Other(Specify) ❑Filipino ❑Guamanian or Clumor. Do""e-5 iL ITEMS 23.-ad MUST BE COMPLETED Z3.Date Prorw need 9,o IMo DaY/Yr) 23b.Signature of Person P,mmundng Death(Only when appacabie) 23c.Ucenu Number By PERSON WHO MONOUNCES Olt CERnFJES DEATH U� .Date Sig d(M Day/Yrl 24.Time of D ath )2 25.Was Medical Examiner or Coroner COntected? Yes Np CAUSE OF DEATH Approximate 26.Part I.Enter the Chain of events-diseases,Injures,or complkatio"that directly caused the death.DO NOT enter terminal events such as cardiac arrest, Intenal. respintory amef4 or ventricular flbrllatl out showing eolio N TABBREVIATE.Enter only one cause tea line Add addttipnellmes if necessary. I Onset to Death ause o :MMEDIATECAUSE --------------s a. s ,Y Vt� Ch I (Final dlslafeorcoMillon Due to o a nslquence oi)'. rogrtmg m death) �. I b, Sequentially list common, D o( ,sequence oN: listed,te ft... the cewe I� °r9,'O�N < M/rnC Ir I listed on Nne a.Enter to c.� ��C ) •111.c UNDERLYING CAUSE Due to Ior as a conseque.e o0: (disease or Mlury tat initiated la evenH resulting d. In death)LAST. Due to(or as a consequence oo'. ' 1 S 26.Pont If.Enter other slanlfkant conditbns contributing to death but not resulting M the undensang cause time,In Part I. 27.Waf an autmey performed? 3 ❑Yes No f 2B.Were auropry findings avalbble to comptete the w u of death? ❑Yes No 29.If Femak: 30.Did Tobacco Use Contribute to Death? 33.Manner of Death E Not pregnant within past year ❑Yes ❑Probably p Natural ❑Homicide 9 Pregnant at lose of death �No ❑Unknown ❑Accident ❑Pending In-tigation ❑Not pregnant,but pregnant Rhin 42 days of death ❑Sukide ❑Could not be determined ❑Not pregnant but Pregnant 43 days to 1 Year afore death 32.Date of injury(Mo/Day/Yr)(Spell Month) ❑Unknown If pregnant within the part year 33.Time of Injury 34.Place of Injury(e.g.home;construction fa;farm;school) 35.Location of Injury(Street and Number,CItY,County,Slate,Up Code) 36.Inluryat Work 137.If Transportatbnlnjury,Spadry: 38.Describe HOw Injury Occurred: ❑Yes C]Dmn,r/Operator (j Redestran ❑No ❑Passenger ❑Other(Spedfy) 39a.Certder-phpMan,erffled mile practitioner,medical examiner/coroner(Check only pine): 11 CertHying onN Ta[be best pis my knowledge,death occurred due to to cauu(s)9,M manner stated. ❑Pronouncing&CertNying-Tq best of my kne e,death xcuned at to time,date,and place,and due to the causes)and manner stated. ❑Medical EomMer/COroner bases n and/or inueftigation,In my opinion,death occurred at to time.date,and place,ant due to the ouse(s)and manner stated. Signature of certgter. This of certifier: In 1/ titans Number: InD4JS./�� ' 39b.Name,Address and 21p rson Completing Ca of Death(Item 2SI 39<.Dan Signed IMp/Ory/Yr) v , o' 40.R<{bbafs OkMct Num 41. hi car's nature 42.Registrar 11 a Oate IMo Day r) � 3 dSY3 41.Amensimentf 4*g b S d�� is 0.1.N s4r,a LvQ i-S t n9 `,0'-143 nixnnfemn p,rmu tin n R nnn c> rn =Cca --Za c`nxr �i b- r --.d tZY Aq rri tt7 �t Z:\EP\WILL5,13 co eistline.Barbara.wpd (,7 Zn LAST WILL AND TESTAMENT OF BARBARA S. BEISTLINE I, BARBARA S . BEISTLINE, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I : I direct that my Fxecutorr hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II : I devise and bequeath the residue of my estate of every nature and wherever situate to my spouse, JAMES R. BEISTLINE, if he survives me. I^EM III : Should my spouse, JAMES R. BEISTLINE, fail to survive me, I devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to such of my children, MICHELLE MOTTER and JAMIE MITCHELL, as survive me . Should any of my children predecease me, I devise and bequeath the share of such child to her issue, per stirpes; and should any such child of mine leave no such issue living following my death, I devise and bequeath the share of such child to my issue, per stirpes . ITEM IV: I appoint my Executor and his successors guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a Page 1 of 3 guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor' s benefit . Such guardian shall have the power to use principal as well as income from time to time for the minor' s support and education (including college education, both graduate and undergraduate) without regard to his or her parent ' s ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor ' s parent or to any person taking care of the minor. ITEM V: I appoint my spouse, JAMES R. BEISTLINE, Executor of this my last will . Should my spouse, JAMES R. BEISTLINE, fail to qualify or cease to act as Executor, I appoint my son-in-law, ANDREW MOTTER, Executor of this my last will . ITEM VI : No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her .duties in any jurisdiction. IN WITNESS WHEREOF, I, BARBARA S . BEISTLINE, have hereunto set my hand and seal this i day of �-- 2012 . ,t t'' 1 4A BARBARA S . BEISTLINE Page 2 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by BARBARA S. BEISTLINE, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as w e ses . �. 414 Bridge St . , New Cumberland, PA Wit Address 414 Brid e St. , New Cumberland, PA Witness Address Page 3 of 3 <--) w M C l> CCs ::0 --n r=i C-a =O Cn ' rr '' rr€ r17 OD :Z rw OATH OF SUBSCRIBING WITNESS :. w� REGISTER OF WILLS Cumberland COUNTY, PENNSYLVANIA Estate of BARBARA S. BEISTLINE , Deceased David H. Stone and Tina M. Burkey , (each)a subscribing witness to (Print Namels) the R1 Will El Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and says) that she /Ise/they way/were present and saw the above ZeAwer/Testatrix sign the same and that sire/he 1 they signed the same and that -sloe/4+e/they signed as a witness at the request of the T-P,&wor-/T t ' in her l Ibis presence and in the presence of each other. (S1 lure) (Signature) t (Street Address) (Street,address) AvT / 7a 'fin (City,State.Zip) (City.State.Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed before me this day before me this 10� day Of of — V� J Deputy for Register of Wills otary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary'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. COMMONWEALTH OF PENNSYLVANIA Form Rw-03 rev. in.13.06 NOTARIAL SEAL JENNIFER A. MEARKLE, Notary Public New Cumberland Boro.Cumberiand Co. My Commission Expires July 7, 2016