HomeMy WebLinkAbout04-24-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF [ fiber 1A'^ 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 �"-t-
Name: �_�At� f4o u i S File No: 2-13-
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ;�73 &' (-,�63
Date of Death: 3 31 i 3 Age at death: y
Decedent was domiciled at death in CAAP J4 County, og be-/ (State)with his/her last
principal residence at /3 '" d' Of epb .eft►
Street address,Post Office and'Lip Code City,Township A Borough County
Decedent died at �• n[? -A\ 041 e con #1 y i1 �!#16ci oq ,
,o-A..
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 $ �`C �
If not domiciled in Pennsylvania. ...... ......... ..... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ...... ....... ........ Personal property in County $,
Value of real estate in Pennsylvania...... ...................................... ......... $ �ZS'Xo
TOTAL ESTIMATED VALUE. ... $ �
Real estate in Pennsylvania situated at: )0)1-3 Sc � 1—)L— �h�t�1M►st 5 '`� i ��� C'(4,45-CI440
(Attach additional sheets,ffnecessary) Street address,Post Office anA Zip Code City,Tow ship or Borough County
I _
LiXA 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 3 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 Lot divorced,wplgot a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§g3(g),and diet hav"Mid born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. M C->
MYO EXCEPTIONS ❑EXCEPTIONS rn rn
B. Petition for Grant of Letters of Administration (If applicable) F:
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendenteWe, rtsrtte absentia,4�rante minoritate
F� <"7
If Administration,c.t.a.or d.b.n.c.t.a.,enter date of Will in Section A above ani glete liof 'rs ,
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for dl�5rce had beets estj is as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated Eason:
J.. _
5�NO EXCEPTIONS E]EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
Form RW-01 rev.10111{2011 Page I of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoi etition are true and correct to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of ecedent,the will well and truly administer the estate acc�ordJing to law.
Sworn to or affirmed an subscribed before 4
Date 4L._ '_'}.1
me this.qq ay of , �•� Date
$y: Date gig
For the Register Date
c M 6
BOND Required: M �
q Q YES NO To the Register of Wills: pp —_0
FEES: Please enter my appearance by my signatuFS b 'V�' ::-j Ct�
fi
Letters ... .... .. . . .. . . . . . .. . . S .00 Attorney Signature: ;Z)
( D )Short Certificate(s).. .. . . Cb
_ . , —r, a,
( 2 )Renunciation(s).. . . . . . . . 0,• D e,
( )Codicil(s). . . . . . . . . . . ..
( )Affidavit(s)... . .. . ... . .
Bond,. .... .. . . .. . . . .. .. .. .. Printed Name:
Commission. . . . .. . . . . .. .. .. . . Supreme Court
Other ID Number:
. . . . . . i Firm Name:
AA --... ... . . �20 D Address:
. . . .. . . Phone:
Automation Fee. .. . . . . . . . . .. . . Fax:
JCS Fee. .... . . ... . ... Email:
TOTAL. . ..... . .. . . . .. .. .. . . S
DECREE OF THE REGISTER j/
Estate of roo h e- bVis F ile No: t~' I �7&7
a/lda:
AND NOW, ' #C�lll ( , 2013 ,inconsideration of the foregoing Petition,
satisfactory proof having been presentk before me,IT IS�D�ECR�EE6'vis,at Letters ,Cn _t4
are hereby granted to. Jar � dr. _
to the above estate and(if applicable)that
the instrument(s)dated OUOe, 171, 2t)Dq
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s)) of Decedent
.&O.k 'fik,
Register of Wills TW04- "
Form RW-02 rev. 1011112011 Page 2 of 2
11705.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
I
RECORDED
Fee for this certificate, $6.00 ,,lil This is to certify that the information here given is
R E C I S T 1 "kl, ^,, �p�ZH OF p?y_ correctly copied from an original Certificate of Death
F
duly filed with me as Local Registrar. The original
1013 APR 29 P'f] j certificate will be forwarded to the State Vital
v _ _� a? R rds ffic for a anent filing.
P 19480674 CLERK 01
ORPHANS' COUR "99TMfNT oE��P~ 0Q
It
Certification Number
CUMBERLAND C.O." 'P/ Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA.DEPARTMENT OF HEALTH VITAL RECORDS
PB. t
ckIrk CERTIFICATE OF DEATH
State File Number:
3.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Data of Death(MO/Day/V,)(Spell Mo)
Loraine V. Hovis Female 203-3. 6263 March 31, 2013
Sa.Age-Last Birthday(Yrs) 5b.Under 1 Year IS,.Under 1 Da 6.Date of Birth(MO/D.Y/Y..r)(Spell Month) 7a.Birthplace(City and State or Foreig1.C:1 unt
Months Days Hours Minutes Bethlehem Penns lea s
84 August 21, 1928 7b.Birthplace(county) Northam ton
8Residence 15tate or Foreign Country) 8b.Residence(Street and Number-Include Apt No.) 8c.Did Decedent Live In a Township?
1213 Scener Drive ®Yes,decedent lived in Silver SDrina 1tvo. twp.
Ed.Residence(County) y
Ctlmberland Be.Residence(Zip Code) 17055 ONo,decedent lived within limits of city/boro.
9.Ever in US Armed Forces? 30.Marital Status at Time of Death 0 Married ® Widowed 11.Surviving Spouse's Name(if wife,give name prior to first marriage)
0 Yes ®No 0 Unknown 0 Divorced 0 Never Married 0 Unknow
12.Fat Pa Name(First,Middle,Last,Suffix) 33.Mother's Name Prior to First Marriage(First,Middle,Last)
Paul H. Zellner I Bertha Schlegel
14a.Informant's Name 14b.Relationship[o Decedent 34c.Informant's Mailing Address(Street and Number,City,State,21p Code)
Jo ce V. Hovis Dau hter
g y g 165 Country Ridge Drive Red Lion, PA 17356
r' ................................................a. ace.°....aLt......eck only.one)..............................
......................................................... ...Pa _
"af It Death Oaurrctl in a Hospital: 1n Slant l if Death Somewhere Other Then a Hospital: �MOSpice Facility �,]Decedent's Home
Q Emergency Room/Outpatient Dead on Arrival ®Nursing Home/Long-Term Gre Facility Other(Specify)
SSb.Facility Name(If not Institution,gFva street and number; •15c.City or Town,State,end Zip Code 15d.County of Death
Manor Care Nur-stniz Home Ca.p Hill Pennsylvania 17011 Ctunberland
161.Method of Disposition 0 Burial ® Cremation 16b.Data of Disposition 16e.Place of Disposition(Name of cemetery,crematory,or other place)
0 Removal from State 0 Donatlon 1
other(Specify) t.�---L. -Q0� Cremation Society of Pennsylvania
Z 160.Location of Disposition(City or Town,State,and Zip) 17a.Slgna M pf Funeral Service L_ICensee or Person In Charge of Interment 17b.License Number
Harriaburg, Pennsylvania 17109 FD-013376-L
17c.Name and Complete Address of Funeral Facility
Auer Cremation Services of Pennsylvania, Inc. 4100 Jonestown Road Harriaburg, Pennsylvania 17109
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 Intlicate what
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.
E3 Sth grade or less is Spanlsh/Hispanic/Latino. Check the"No" ®White 0 Korean
0 No diploma,9th-12th grade box If Decedent is not Spanlsh/Hlspenic/Latino. 0 Black or African American Vietnamese
® High school graduate or GED completed ®No,not Spanish/Hispanic/Latino 0 American Indian or Alaska Native r Other Asian
0 Some college credit,but no degree Yez,Mexican,Mexican American,Chicano 0 Asian Indian 0 Native Hawaiian
0 Associate degree(e.g.AA,A Yes,Puerto Rican 0 Chinese 0 Guamanian or Chamorro
0 Bachelor's degree(e.g.BA,A8,BS) 0 Yes,Cuban 0 Filipino 0 Samoan
0 Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) Yes,other Spanish/Hlspanlc/Latino 0 Japanese
Other Pacific Islander
0 Doctorate(e.g.PhD,Edo)or Professional degree
(specify) O Other(Specify)
.MD DDS DVM LLB JD
21.Decedent's Single Race Self-Designation-Check ONLY ONE to Intlicate what the decedent considered himself or herself to be. 221.Decedent's Usual Occupation-Indicate type of work
00 White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED.
0 Black or African American 0 Korean O Other Pacific Islander
0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure Beautician
0 Asian Indian Other Asian 0 Refused 22b.Kind of Business/Industry
p chines. 0 Native Hawaiian O other(Specify) S if-Em oyyedl
0 Filipino 0 Guamanian or Chamorro �oBme tglOgy
ITEMS 23e-23d MUST BE COMP E 23a.Date Pronounced Dead(MO Day Yr 23b.signature of Person Pronouncing Death(Only when applicable) 231.License Number
BY PERSON WHO PRONOUNCES OR D 3-3 -�oJ3
CERTIFIES.DEATH {� n `_ ]
23d.Date Signed(MO/Day/Vr) 24.Time of Death �J. a!Ir7 .�tG+n.�N.6S/J /t &��/
3 :J D M 25.Was Medical Examiner or Coroner Contacted? 0 Yes No
CAUSE OF DEATH I Approximate
25.Part 1. Enter the chain of events--diseases,Injuries,or complications--that directly caused the death. DO NOT enter terminal eve�such as cardiac arrest Interval:
respiratory arrest,or ventricular fibrillation w_ Ithout show) he etiology. DON T BBREVIATE. ter only orJa{' us a 1116 Add a ortal line,If necessary Onset to Death
IMMEDIATE CAUSE --------------> a. L�,f--j•,,�a rr�y ' \
(Final disease or condition Due to(or as a consequence of):
resulting In death)
b.
Sequentially list conditions, Due to(or as a...sequence of):
if any leading to the Cause
listed on line a. Enter the
UNDERLYING CAUSE Due to(or as a consequence of):
(disease or Injury that
Initiated the events resulting d.
In death)LAST. Due to(or as a consequence of):
s_ 26.Part 11. Enter other slitnificant conditions contributing h but not resulting In the underlying cause given in Part 1 27.Was an autopsy pert.prme d?
Yes No
IWerc autopsy findings aVallable
n 1 to complete the s death?
V $ 0 Yes
29. f Fe 30.Did Tobacco Us Ccnt ute to Death? 33.Man ngY�f Death
Not pregnant within past year 0 Yes a Probably 1V .ra1 0 Homicide
0 regnant at time of death 0 No 0 known .-_Imo•-,C'_SE-<Ident 0 Pending Investigation
m 0 Not pregnant,but pregnant within 42 days of tleath 0 Suicide 0 Could not be determined
0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Vr)(Spell Month)
0 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)
36.Injury at Work 37.If Transportation injury,Specify: 38.Describe How Injury Occurred:
0 Yes 0 Driver/Operator 0 Pedestrian
_ 0 No 0 Passenger 0 Other(Specify)
iffier(Check only one):
Certifying physician-To the best of my knowledge,death occurred due to the causes)and manner stated
nc.ng a Certifying physlcl - the best of my knowledge,death occurred at the time,date,and place,and due to the-use(s)and manner stated
0 Medical Examl is of exam ,antl/or Investigation,In my opinion,death occurred time,date,and place,and due to the cau e�(s�)�a/nd�manner stated
Signature ler:
Title of certifler: License Number:
39b.Name,Address and Zip Code of Person Completing Cause of Death(hem 26) 39c.Date Signed(MO/Day/Yr)
:_Ac_ .r%a- 990 a r cl. C. R o Y 3
40.Regisira is District Number 41.Registrar's Signature 42.Reg rtrar File Dete Mo Day
oZ oZa- 0- - Oy-d
43.Amendments .
/OIDisposition Permit No. tJ REV 07/2011
LAST WILL AND TESTAMENT
OF
LORAINE V. HOVIS
I, LORAINE V. HOVIS, of Mechanicsburg, Cumberland Count6, Pennsyl nia4eing
C--
of sound and disposing mind, memory, and understanding, do hereby r k gubligg ar
declare this to be my Last Will and Testament and hereby revoke all oth;r"'`�V1s anti'Codicils
that I have made, including the Will dated March 19, 1993. .Y n:
FIRST: It is my wish, and I direct, that after my death m�'-body be qgmal6"d*d
that a suitable disposition of my ashes be made at the convenience of my Executor.
SECOND: I give and bequeath all of my personal jewelry, as equally as possible, to
my daughters: JANICE L. HOVIS, of New Castle, Pennsylvania; and JOYCE V. HOVIS, of
' Red Lion, Pennsylvania, or to whichever one shall survive me by thirty (30) days.
THIRD: I give, devise, and bequeath all the rest, residue, and remainder of my
Estate, of whatever nature and wherever situate, to my beloved husband, JACK G. HOVIS, so
long as he shall survive me by thirty (30) days.
FOURTH: Should my husband fail to survive me by thirty (30) days or should he
for any reason fail to take under this, my Last Will and Testament, then I give, devise, and
bequeath all the rest, residue, and remainder of my Estate, of whatever nature and wherever
situate, in three equal shares, to those of my children who shall survive me by thirty (30) days:
my daughter, JANICE L. HOVIS; my daughter, JOYCE V. HOVIS; and my son, JACK G.
HOVIS, JR., of Mt. Laurel, New Jersey. It is my wish to provide here for my children, not
spouse to indemnify my estate against liability for the tax attributable to my spouse's income,
and to consent to any gifts made by my spouse during my lifetime being treated as having been
made one-half by me for the purpose of federal laws relating to gift tax.
K. To distribute in cash or in kind or partly in each.
L. To employ agents, legal counsel, brokers, and assistants, and to pay their
fees and expenses as he may deem necessary or advisable to carry out the provisions of this
Will or any Trust.
The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time, until the actual distribution of all property. All powers, authorities
and discretion granted here shall be in addition to those granted by law and shall be exercisable
without leave of court. However, nothing herein shall be interpreted or construed to
encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a
manner contrary to or inconsistent with accepted standards of portfolio diversification and risk
management.
EIGHTH: I nominate, constitute, and appoint my husband, JACK G. HOVIS, as
Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of my husband to act for whatever reason in this capacity, then I
nominate, constitute, and appoint my daughter, JANICE L. HOVIS, as Executrix of this, my
Last Will and Testament. In the event of the renunciation, death, resignation, or inability of
my daughter to act for whatever reason in this capacity, then I nominate, constitute, and
appoint my son, JACK G. HOVIS, JR., as Executor of this, my Last Will and Testament. In
the event of the renunciation, death, resignation, or inability of my son to act for whatever
reason in this capacity, then I nominate, constitute, and appoint my other daughter, JOYCE V.
HOVIS, as Executrix of this, my Last Will and Testament.
I direct that no representative named above shall be required to post security for the
faithful performance of his/her duties in any jurisdiction insofar as I am able by law to relieve
him/her of such obligation. Any of my representatives shall be entitled to reasonable
compensation for the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 17 Ift day of
ZWdE. , 2009, on this, the fifth of five typewritten pages. I have also signed the
left-hand margin of the first four of these pages for purposes of identification only.
LORAINE V. HOVIS
SIGNED, PUBLISHED, and DECLARED by the Testatrix, LORAINE V. HOVIS, as
her Last Will and Testament, in the presence of us, who at her request, in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, LORAINE V. HOVIS, Testatrix, whose name is signed to the attached 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.
LORAINE V. HOVIS
Sworn or affirmed to and subscribed before me by LORAINE V. HOVIS, the
Testatrix, this i"7 ` day of Z rk-Q- 2009.
Notary Public
COMMONMALTH per, F PENNSYLVANIA
Notaiai SOW
Mary M.Loper,Notwy PuMc
ity
cownissw E Oct.27,2 n
Member,Pennsylvania Association of Notaries
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We, Debra K. Wallet and AY)n the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix, LORAINE V. HOVIS, sign and execute the
instrument as her Last Will and Testament; that she 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, the Testatrix was at that
time 18 years of age or older, of sound mind, and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me by and
Ann L. MCG It witnesses, this day of T.4r--e- 2009.
DI-1
Notary PublicO
OF PENNSYLVANIA
NotarMSed
Mary K Loper.Notary Pubic
QwV HN Boro,CW*&*W C-OU*
my Commission E)*w Oct.27,2D11
Member,Permsylvarda Association of NoUxies
RENUNCIATION n M
REGISTER OF WILLS ry
Cumberland COUNTY. PENNSYLVANTAW
Estate of Loraine Hovis Deceased
I, \ n N e- H O V 1 6 ,in my capacity/relationship as
(Print Name)
daughter of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Jack G Hovis Jr.
t -
(Date) igrwture)
d
g-2 ,"f'
(StreetAddress)
(City,State,zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed)W subscribed Before the undersigned personally appeared the
before e this day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes stated within on this day
of ,
4uty gist er of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev.10.13.06
RENUNCIATION C= `"' M
= :n =D 4-
M �
REGISTER OF WILLS r- �' r°- `' r`.
Cumberland
COUNTY,PENNSYLVANIA
C-
Estate of Loraine Hovis Deceased
in my capacity/relationship as
(Print Name)
daughter of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Jack G Hovis Jr.
(Date) (Signature
(StreetAddress)
(City, ate.
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before Vne this �day party executing this renunciation and certified
Of . that he or she executed the renunciation for the
purposes stated within on this day
r of
a
D Jty for Reg' t of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date ofexpiration of Notary's Commission.)
Form RW-06 rev.10.13.06