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HomeMy WebLinkAbout04-22-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C(/M/3,5R L A r,0 0 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: 7 AN 1 L C P, A 2�J4 1 (3 A L File No: — a/k/a: _X A 0 r<Gi. A k e AI R A C Go S i (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 4 z 173 Age at death: '7 Decedent was domiciled at death in Clint 6 t2 CANQ County, /;INNS y4 v&W/4 (Stare)with hi er 1 t principal residence at / p <o l y m 31 N AVE (fAm P M L L,,, /70)1 Can,t get L.A40 Street address,Post Office and Zip Code City,Township or Borough ®County Decedent died at /7 0 3 CoLvAAgrA /�( C4iP)V/`iL / )0/1 Cl,,n1�S�nU /®/9 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 $ /D d 000 406 If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County $ Value of real estate in Pennsyl vania......................................................... $ Id?,,T 0 O ,p 0 Q TOTAL ESTIMATED ATED VALUE. ... $ a�7�2D c7 r � Real estate in Pennsylvania situated at: /03 Co e.WK d t A t4 VI-'� N�/°fy/L d /0/? i ?D J) CPA B,91-t,ANO (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 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. ,VIO 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.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. NO EXCEPTIONS ❑EXCEPTIONS r�, Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the f&99 spouse("ny)?-R V*s(attach additional sheets,{f'necessary): 4"? n CZ Name Relationship $� mss --- --4 2�► CO ry m co Form RW-02 rev.10/11/2011 Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: C COUNTY OF 4fj,'M 6�A 44JJO } © Z n '� 7 Ci) ICJ Petitioner(s)Printed Name Petitioner(s)Printed ss" N Srrvkt-) b os3 47 /ylL✓ Sr AeLTM/ 7„-?'' -n - ,.. C-.> _. L-0 The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregomp,Petition are true and correct to the best of the knowledge and belief of Petitioner(s)and that,as Personal Representative(s)of the Deceden he Pe' ' ner(s)will well and truly administer the estate accord'ng to law. Sworn to gr of i ed subscri d before r Date ZZ met * a'. 17 day o [�-- Date By: Date o the Register Date BOND Required: 0 YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Lett rs . . . . . . . . . . . . . . . . . . . . . . $ 9/0- 00 Attorney Signature: ( �)Short Certificate(s). . . . . . 'Qp ( )Renunciation(s).. . . . . . . . ( )Codicil(s). . . . . . . . . . . . . ( )Affidavit(s).. . . . . . . . . . . Bond.. . . . . .. . . .. . . . . . . . . . . . . Printed Name: Commission. . . . .. . . . . . . . . . . . . Supreme Court O ID Number: _ Firm Name: N11 •a0 Address: . . . . . . . Phone: Automation Fee. . . . . . . . . . . .. . . Fax: JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: TOTAL. . . . . . . . . . . . . . . . . . . . . /I �— DECREE OF THE REGISTER Estate of / File No: �i aWa: /eo / C! AND NOW, , in consideration of the foregoing Petition, satisfactory proof havin been presented before me,IT IS CREED t t Le ers Yg are hereby ranted to ie Veh ij� 61 in the above estate and(if applicable)that the instrument(s)dated described in the Petition be admitted to prob e and filed of r c rd s the last Will(and Codicil(s))of Decedent. Register of Wills Form RW-02 rev. 10/11/2011 of 2 C5 �= X O M f'r'I M t'ti"i M M1 r C") 'L loot wt[I aub T C) C= I�-r4 y.,... M ��T Cn C� OF JANICE P. ARCHIBALD BE IT REMEMBERED, that I, JANICE P. ARCHIBALD, of 1903 Columbia Avenue,Camp Hill,Cumberland County,Pennsylvania,being of sound mind,memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: A. I direct that my Executor shall pay all my just debts as soon after my demise as may be convenient. B. I direct that my Executor arrange for the preparation of my body by the Relief Society President of my Mormon Church, and to further arrange for m, cremation. in my temple clothing, and for the least expensive container for my ashes, which shall be given to my next of kin for division and/or disbursement as they deem proper. I direct that no viewing of my remains be held except if deemed necessary and then so as to be limited to my Executor and immediate family members. I have pre-arranged the disposition of my remains and I prefer no memorial service,however if a minimum memorial service is held it shall not include a viewing and shall be conducted as a Mormon service. In order to stress to my family the importance of the above burial instructions I further direct that any beneficiary of this my Last Will and Testament who violates said instructions shall thereby absolutely forfeit any and all beneficial interests of whatsoever kind and nature which such beneficiary might otherwise have under this instrument and the interests of the other beneficiaries hereunder shall thereupon be appropriately and proportionally increased. C. Provided they survive me, I specifically bequeath to each of the following named individuals the amount of $1,000.00: Christina Kristofic; Steven D. Goss, Jr.; Robert S. Goss; Matthew C. Goss; and Jennifer Beck Miuney. Provided they survive me, 1 I specifically bequeath to each of the following named individuals the amount of$500.00: Rowan Page Minney; Gavin Lloyd Minney; Lillian Marie Goss; and Owen Steven Goss. D. I give and bequeath all tangible personal property as directed on a separate memorandum, if any, and any such property not so directed shall be divided as equally as possible among my surviving children. All "Mormon" items that are not chosen by my children shall be donated to the Camp Hill Ward Library of the Church of Jesus Christ of Latter Day Saints (LDS). ITEM 2: All the rest,residue and remainder of my estate,ofwhatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my children as follows: A. One third (1/3) share to my son, Steven D. Goss. In the event that Steven D. Goss does not survive me,then his share shall be distributed to his issue in equal shares per stirpes; B. One third (1/3) share to my son, Lorane C. Goss, III. In the event that Lorane C. Goss, III does not survive me, then his share shall be distributed to my other surviving children, in equal shares per capita; C. One third(1/3)share to my daughter,Ellen K. Goss. In the event that Ellen K. Goss does not survive me, then her share shall be distributed to my other surviving children, in equal shares per capita. ITEM 3: A. The share of my son, Steven D. Goss, shall be distributed outright and free from any restraints of Trust. B. The share of my son, Lorane C. Goss, III, shall be distributed as follows: 1) My Executor shall distribute as soon as reasonably practical the amount of$5,000.00 to said beneficiary, the executor's judgment as to the timing of such distribution to be final and not subject to 2 review. 2) The balance of said share to be used as the premium or deposit into a commercially available non-assignable immediate fixed 10-year certain annuity to be purchased by the executor on the life of said beneficiary and to be ultimately arranged so that said beneficiary is the owner, annuitant, and payee of said annuity contract. C. The share of my daughter,Ellen K. Goss,shall be delivered to and shall be held by my Trustees,hereinafter named, IN TRUST, for the following uses and purposes: 1) The Trustee shall pay to or apply for the benefit of the beneficiary for his or her lifetime, such amounts from the principal or income, up to the whole thereof,as the Trustee, in his or her sole discretion, may from time to time deem necessary or advisable for the satisfaction of the beneficiary's special needs, and any income not distributed shall be accumulated and added to principal. As used in this Trust, "special needs" refers to the requisites for maintaining the beneficiary's good health, safety and welfare when, in the discretion of the Trustee, such requisites are not being provided by any public agent,office or department of the State of Pennsylvania, or of any other state, or of the United States. "Special needs" shall include, but not be limited to, medical and dental expenses, insurance therefor, clothing and equipment, travel, entertainment, programs of training,education and treatment and essential dietary needs. 2) This Trust is created expressly for the beneficiary's extra and supplemental care,maintenance, support and education in addition to and over and above the benefits she or he otherwise receives or may receive as a result of his or her handicap or disability from any local, state or federal government, or from any other private agencies, any of which provide services or benefits to supplement other benefits received by him or her. 3) The Trustee shall take into consideration the applicable resource and income limitations of any public assistance programs for resource and income limitations of any public assistance programs for which the beneficiary is eligible when determining whether or not to make any discretionary distributions. In carrying out the provisions of this Article, the Trustee shall be mindful of the probable future needs of the remaindermen of this Trust, and it shall. No decision of the Trustee may be questioned or challenged for the reason that the Trustee may also a remainderman under the terms of such trust, in that it is my express desire that my appointed trustee serve in that capacity, and that he is best suited to make observations and evaluate evolving circumstances so as to determine the course of action which will best carry out my intentions with respect to both the lifetime and remainder beneficiaries. 3 4) It is my further intent that no part of the corpus of the Trust created herein shall be used to supplant or replace public assistance benefits of any county, state, federal or governmental agency which serves persons with disabilities which are the same or similar to the impairments of the beneficiary. For purposes of determining the beneficiary's eligibility for such benefits,no part of the principal or income of the Trust estate shall be considered available to him or her. In the event the Trustee is requested by any department or agency to release principal or income of the Trust to or on behalf of him or her to pay for equipment,medication or services which other organizations or agencies are authorized to provide,or in the event the Trustee is requested by any department of agency administering such benefits to petition the Court or any other administrative agency for the release of Trust principal or income for this purpose, the Trustee shall deny such request and is directed to defend, at the expense of the Trust estate,any contest or other attack or any nature of this Item. In addition, the Trustee may apply to a Court of competent jurisdiction for authority to amend the Trust to carry out my intent. I specifically recognize and request that any such Court modify this Trust Agreement as necessary to insure that my directions for the care of the beneficiary are followed and that this Trust is not considered an asset so as to disqualify the beneficiary from federal and state assistance. 5) No interest in the principal or income of this Trust shall be anticipated, assigned or encumbered, or shall be subject to any creditor's claim or to legal process,prior to its actual receipt by the beneficiary. Furthermore,I declare that it is my intent as expressed herein, that because this Trust is to be conserved and maintained primarily for the special needs of the beneficiary, no part of the corpus thereof, nor principal nor undistributed income, shall be subject to the claims of voluntary or involuntary creditors for the provision of care and services, including residential care, by any public entity, office, department or agency of the State of Pennsylvania or of any other state, or of the United States, or any other governmental agency. 6) Upon the death of the beneficiary,the Trustee may pay the expenses of' the last illness and funeral, and all administrative expenses relating to this Trust and the beneficiary's estate, including reasonable attorney's and accountant's fees, if, in the Trustee's sole discretion,other satisfactory provisions have not been made for the payment of such expenses. 7) This Trust shall cease and terminate on the death of the beneficiary and thereupon the Trustee shall distribute the balance of the trust estate, after expenses, in equal shares to my other surviving children. 4 ITEM 4: I direct my hereinafter named 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 demise, 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 or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my son, STEVEN D. GOSS, as Executor of this my Last Will and Testament. Should my son predecease me, fail to qualify, cease to act or renounce probate,I then appoint DAVID J.LENOX,ESQUIRE,as Contingent Executor of this my Last Will and Testament. ITEM 6: I appoint STEVEN D. GOSS, as Trustee of the Trust established hereby for the benefit of Ellen K. Goss. Should STEVEN D. GOSS,fail to qualify,cease to act, or renounce this appointment as Trustee, I then appoint, CHRISTINA KRISTOFIC as Contingent-Trustee of said Trust. If any income or principal shall be payable hereunder or pursuant to a beneficiary designation in any insurance contract, annuity contract or qualified retirement plan,or any like third party contract,to any person who shall be incompetent to receive the same by reason of age or incapacity, I appoint I appoint my herein named Trustee as custodian over such property for the benefit of said beneficiary and hereby direct my executor or any insurer, or plan administrator to deliver such property to said custodian. I further nominate said Trustee as the representative payee for Ellen K. Goss, if such a role needs to be filled after my death, for the benefit of Ellen K. Goss. ITEM 7: I direct that my Executor, Trustee or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 5 ITEM 8: My Personal Representatives shall have the following powers in addition to those vested in them by Law and by other provisions of this, my Last Will and Testament, exercisable without court approval, and effective until distribution of all property: A. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. B. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. C. To sell at public or private sale, to exchange, or to lease for any period of time,any real or personal property and to give options for sales,exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. E. To borrow money from persons or institutions, themselves included, and to mortgage or pledge any or all real or personal property as they in their sole discretion shall choose,without regard to the dispositive provisions of this instrument. F. To compromise any claim or controversy asserted by or against my estate or Trust estate. G. To make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. ITEM 9: Finally, I wish to advise my Executor that the health insurance coverage currently maintained for the benefit of my daughter, Ellen K. Goss, through and under my Highmark benefit plan will continue to be available to provide health insurance for her after my death conditioned on the company receiving notice within 30 days of the date of my death, and the payment of continued premium. Please review my personal papers for literature regarding Highmark benefits and contact phone numbers and addresses. 6 IN WITNESS WHEREOF, I have hereunto set my hand and seal this 4" day of June, 2012. ' `ES -4-L l e P AA (SEAL) ANICE P. ARCHIBALD LIMAt 7 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We,JANICE P.ARCHIBALD,DAVID J.LENOX,ESQUIRE and M.SUSAN McMICHAEL, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly(or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eighteen (18)years of age or older, of sound mind and under no constraint or undue influence. J E P. ARCHI ALD WITNE q '/�j -A,# . C V/.-Jim , Jim WITNESS Sworn to and subscribed before me this 4th day of June, 2012. NOTARY PUBLIC MY COMMISSION EXPIRES: COMMONWEALTH.OF PENNSYLygN Noteriai S", S.Dawn Gla"49r,Notary Public My C Dommburg Bono,York county salon r"May 17,2013 Member,Pennaylvanla AaBOC�aHon of Notaries 8