HomeMy WebLinkAbout05-08-13 (2) PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAN.D 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:
Victor E.Wertz
Decedent's Information (�
Name: Richard H.Wertz File No: 21 ��� ��-fV
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 201-18-8911
Date of Death: 04/27/2013 Age at Death: 86
Decedent was domiciled at death in Cumberland County, pq (State)with his/her last
principal residence at 870 Valley Street,Enola 17025 East Pennsboro Cumberland
Street address,Post Offics and Zip Code City,Township or Borough County
Decedent died at Emeritus at Creekview Mechanicsburg Cumberland PA
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedenYs property at death:
If domiciled in Pennsylvania...................... All personal property $ 3,000.00
If not domiciled in Pennsylvania................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania................ Personal property in County $
Value of rea/estate in Pennsylvania................................................................... $ 97,000.00
TOTAL ESTIMATED VALUE $ 100,000.00
Real estate in Pennsylvania situated al g70 Valley Street,Enola 17025 East Pennsboro 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 Testamentarv
Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 05/04/1977 and Codicil(s)
thereto dated
Inez M.Wertz.the named Executrix.nredeceased decedent on 11/9/2009. Petitioner is the names successor Executor.
State relevant circumstances(e.g.,renunciation,death o/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;n,ot have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.� �. -
��
�NO EXCEPTIONS � EXCEPTIONS C p �'`' � `''�
� `<• N-,
❑ B. Petition for Grant of Letters of Administration pf applicabie) rrt " r —r_ " �`
c.t.a.,d.b.n.,d.b.n.c.t.a., de?#e�durante abse��.,dulante minoritate
� r'�? C.7 -
If Administration,c.ta ord.b.n.c.t.a.,snter date of Will in Section A above and comolete list of h�l'rscn :'• -� -
Except as follows: Decedent was not a party to.pending divorce proceeding wherein the grounds for dietsrc �a��ee�tabli��d as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated p�rs,�n. �^ --
.� .`:�
�NO EXCEPTIONS � EXCEPTIONS ."'' �; µ�
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived bp�e°fiollowing spouse�,if'8nj!)and heirs(attach
additional sheets,if necessary): ,'�^..- F--' :�"a ,�y
-�7 •�
Name Relationship Address
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 OfficialUseOnly
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Victor E.Wertz 7594 Lakeside Ave.
Harrisburg,PA 17112
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 knowled e and
belief of Petitioner(s)and that,as Personal Representative(s)of the pe dent, Petitio r(s)will well and truly administer the estate accordi g law.
Swom to ��rmed and subscribed before �� � r - �� Date c�� /-
m e h' � �d a y o f ,�,� Da te
By ! Date
Fur fhe Register Date
BOND Required? � YES � NO To the Register of Wills:
Please enter my appearance by my signature�low:
FEES: -
C � i'�i �-j
Letters.......................................... $ 210.00 Attorney Signature: a .
� ,� t�
( 5 )Short Ce�tificate(s)......... 25.00 . � —, -- ,_,�,,
( )Renunciation(s).............. � �`.'; c�<
( )Codicil(s)........................ '.` -
r- A., i's-: � ,,�� �;_:
( )Affidavit(s)...................... Printed Name: Linda J.Olser�s� :�'w ,
.-�. _.. �. .,:.:
�x __,.� .�..
Bond............................................. Supreme Court c'' r .':b �
�:
Commission.................................. 92858 •. , ,.- •: _ .:
ID Number:
Other Will 15.00 �.,, ;.-::s c.,. _ '. .-F
Inheritance Tax 15.00 Firm Name: Hazen Elder Lau� 1 E�"'' " 4=y
Inventory 15.00 Address: 2000 Linglestown Road,Ste 202
Suite 202
Harrisburg,PA 17110
Phone: 717-540-4332
Automation Fee............................ 5.00 Fax: 717-540-4313
JCSFee....................................... 23.50
TOTAL......................................... $ 308.50 E-mail: lolsen@hazenelderlaw.com
DECREE OF THE REGISTER
Date of Death: 04/27/2013
Social Security No: 201-18-8911
Estate of Richard H.Wertz File No: 21 -� �� � ����
a/k/a:
AND NOW, �� �t"' �.1� , � ,in consideration of the foregoing Petition,
satisfactory proof having been presented bef ine,IT IS DECREED that Letters Testamentary
are hereby granted to Victor E.Wertz
in the above estate and(if applicable)that the instrument(s)dated 05/04/1977
described in the Petition be admitted to probate and filed of record as h ast Will(and Codicil(s))of Decedent
F�egister of Wills � �Q�/��
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H105.805 RHV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
�jACRNIyN�G: lt is illegal to rduplicate this copy by pho#ostat or photogra#�h.
(1L.��tS�E.�a '��°;���r�, �f
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Fee for this certificate, $6.00 „����N""' This is to certify that the information here given is
;�;�3 ��t�`� 8 �'� � �.� ���'"�'`�H Uf pE'�`__
� � a����, _ iyy�_ correctly copied from an original Certificate of Death
`�.o = r; duly filed with me as Local Registrar. The original
}�� ?,� `� `_: Z� certificate will be' forwarded to the State Vital
�����;�t (.��` :°v ,, - a� ecords Office r permanent filing.
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F 19 6 2 H 3 6 o���Ar�s ccn�.�-r �o��,q _:� P��,,,'' 1� a�,� AP 3 0 013
�UMBERLAh�D �t� ��1 =--_9l ���;,��° I �
' --.,MENT 0 „ '
Certification Number """����"""' �� Local Registrar Date Issued
Type/P�Int In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEAITH•VITAL RECOROS
Pef'"a"e"` CERTIFICATE OF �EATH
Black Ink Statc Flle Number:
1.Dacedent's Legal Name(First,Middle,Last,Suffix) 2.Sez 3.Soclal Security Numb�r 4.Date of Death(MO/Day/Yr)(Spell Mo)
R i c 1-i a r d H. W e r t z Male 201 - 18 - 891 I April 27, 2013
Sa.Age-Last 61Rhday(Yrs) Sb.Under 1 Vear Sc Under 1 Da 6.Date of Birth(MO/Day/Year)(Speli Month) 7a.Blrthplace(Ciiy and State or Foreign Country)
�� Months �� ��Days Hou�s Minutes �� WeSt. F2.11V1�W���PA � �
� g6 Novesber ]O, 1926 �b.s��-cnPia�e(co��M Qmbex'land
Ha.Resltle�c@(StaYe p�FOrelgn Couniry) 8b.Residence(Street and Number-Include Api No.) . 8c Did D4. dent Livc in a Townshlp7
Pennsylvania � � � [�rea,.ae�ede.,n iwed o-, East Pennsboro� � . twP,
Sd.Rc9ide�ee�co�.,cY�.� � �870 Valley Street � � .
QIIT7berlaIld � � � 8e.Resltlence(Zip Code) �� � O No;decedent Iived wlfhin I(miis of �city/boro.
9.Eve�in US A�med Fo�ces7 10.Mariial Status at Tlme of D�atM1 � Married �Widowed 11.Surviving Spouse's Name(If wife,gtve name prior to flrst marrlage)
$}:Ves � No �Unknown 0 Divorced � Never Married �Unknow
12.FathePS Name(Firsf,Midtlle,Last,Suffix) 13.Mother's Name Prlor[o Flrst Marrtage(Firsi,Middle,Last)
Ea�e.ry Wertz Margaret Wagner
14a.InformanYs Name 146.Relatlonship to Decedent 14c.InformanYs Mailing Address(Street and Number,City,Sfafe,Zip Code)
o Victo�r E. �Wertz � � Son � � �� 7594�rLalce�ide Avexnie Harrisburg>�.PA�:171'.�12 .. .
G _ � _ _ � _ _ _ _ _ _ _ _ _ _15a P�cea D at �C.�e nYon¢ . .� . . ...
If Death Occu��Cd�in a HoSPital:. d Inp9tlent�� �If Death�OCCUYYed SOmewhe�e Other�TlYan a Hosp[tal: ❑Hospice FdCility Z]�Oecedent's Hovne�� �
� 0 Emergency Room/O t aNent � Dead on Arrival � � N ��sing Ho e/LOng-Tertn Care Facllity 0 Other(Specify) ���
15b.Facllity Name(If not Ins[Itutlon,glve sireet�and nUmber) i5c.Clfy r Town,State, tl Zip[otle ��� 15d.Coun t D ath
Faieritus��At Creetcview � ' � Dlechanicsburg, aPA 17050� � �er�anc��.� � ��
y, 16a.Method of Dlsposltion Burlal � Cremailon . 166.Date of Disposition 16c.Place of Dlsposition(Name of cemetery,crematory,Or oiher placa)
� � Remova�IfromSSate 0 Donetlon ... ���
� � � . ..O�ocner lsae��+y)�. � � � . May� 1�, 20]3 � Stone (�urch C��etery .. . �
2 16d.Location of�ispositlon(City or Town,Sta[e,and Zip) 17a;Signature•�ofi'Fu�neral�Service license¢or Person tn Ch�arge of Interment 17b.::License Number
1� � Enola, PA 17025 /Jtz� S6 • FD 012774-L
E�17c:Name and CompleSe Address of Funeral Faclilt � � � . � . �� � . .
8 RicYiardson Ftrneral Home 29 S�outh Enola Drive Enola, PA 17025
�' 18.DecedenYs EducaHOn-Clieck the box thai best describes ihe 19.Dacedent of Hispanlc Origin-Check She 20.Oecetlenf's Race-Check ONE OR MORE races to Indicafe whaf
�- hlghast degree o�level of school compleietl at Yhe time of death. box that best describes whefher the decedent the decetlent considared hlmself or herself to be.
� Sth gradc or less I5 Spanish/Hispanit/Latino. Check the"NO" White � Ko�ean
[] No diploma,9th-12th grade box if decedent is not Spanish/Hispanft/Latino. � Black or AfNCan American � Vletnamese
C�1 High school graduaSe or GED completed � No,not Spanish/Hlspanlc/Latino �American intllan or Alaska Native � Other Asian
� Some college credit,but no degree �Ves,Mexican,Mexlcan American,Chicano O Aslan InClan � Native Hawallan
O Associate degree(e.g.AA,AS) �Ves,Puerto Rican O Chinese O Guamanian or Chamorro
Q Bachelor's deg�ee(e.g.BA,AB,BS) � Yes,Cuban � Fllipino � Samoan
0 Master's tlegree(e.g.MA,M5,MEng,MEd,MSW,MBA) O Ves,o[her Spanish/Hispanlc/Latino �lapanese O Oth�r Paclflc Islander
0 Doctorote(e.g.PND,EdD)or Professional degree (Specify) � Other(Specify)
.MD DDS DVM LLB JD
21.Decedenf's Single Race Self-Designation-Check ONLY ONE ro Indicate what She decedenf constdered himself or herself fo be. 22a.DecetlenYS Usual OccupaHOn-Indicate typ�of work
$j Whita �Japanese 0 Samoan done d�rtng most of working Ilfe. DO NOT USE RETIRED.
0 Black orAfACan American Q Korean � Other Pacific Islander
q O Amerlcan Indian orAlaska Na�ive �Vletnamese 0 Don't Know/NOt Sure I`1311 I?eparta�nt
1% 0 Aslan Indian � Other Asian � Refused 226.Kind of Business/Industry
� � Chlnese O NaSive Hawaiian � Other(Specify)
O.Fllipir�p � O GuamanianorChamorro Pennsylvania Railroad �
ITEMS I3a-23 MUST BE COMPLETED 2 a.Date c d Dead(MO Day Vr) 236.StgnaYUre of Parso��nouncing Death(�ap <9 e) 2 <.. ic����
BV PERSON WHO PRQNOVNCES OR . : /.�i I �� 1 2 ��j
CERTIFIES DEATH � � L/`Y � J .. �� �. � �
23d Da . i ned � Yr) � � 24.T�m`e�Qf/❑��i �',M . � . � �' . � . .
l,J`f-V� W� I , 2 s M.edfcal�xaminer or Coroner Contacted7 �� Yes No � � �
� CAUSE OF DEATH � � � �� .aPP.o.o„ate
26.Part 1. Enter the chaln of events--diseas¢s,InJuri¢s,or compllcatlons--Yhat direc[ly caused fhe death. DO NOT enter terminal events such as cardiac arrost, � Interval:
respiratory arrest,or ventAcular fibrlllatlon wlthout showing the eNOlogY� D/O� NOT ABBREVIATE. Enter oniy one cause on a Iine. Atld additional Ilnes if necessary. 1 Onset to Death
IMMEDIATE CAUSE ---------------> a. "t'��/ ��/�/i'C '
(Final tlisease or condl�lon pue to(or as a consequencc of):
resulting ln deaSh). . . Q``�� .
b.
5equentiaNy list contlttlons; � � � Due to(or as a�consequence of): � � � � � � � � � �.
if anv.Ieadine to ihe�cause � . .� . . � . � .. ..
Iisted on Ilr�e e�. Ente�.the . � � � . ��
UNOERLYING CAUSE Due to(or s a consequence o1): � � � 1 . � � �
(disease or in)ury ihat � �� � � �� � �� . .� 1 � �
� Initiaced the events resultlng d. �
�.in death)�lAST. � �. . Due(o(or as a consequence of): � � �� � �� �
's .�26.Part 11. Enter oH�er�}gnlficant contlltlons conSrlbuiin¢to dea 1 bui noi resulting in Yha underiying cause given in Part I.. � � � �27.Was an a�topsy pe�rto�r�*.ed�
. ° �� � � � . . .. . . � . . � Yes Q�No
.� . . � �� � . . . . .
. � . . . . . 28.Wa�e auYOpsy flndings available
y � � . . ���.to complete the c f deathi
yy � .. . .0 Y�s a B��
3� 29.If Female: 30.Ditl Tobacco Use Contrib�te io Death? 31.Ma�°r of Death
o � Notpregnantwi�hinpastyea� 0 Ves O Probably Q�Natural � Homicide
p Pregnant at time of deaih [3 No � Unknown � Accitlent � Pending Investigatlon
$' � Not pregnant,but pregnant within 42 days of death Q Sulcltle 0 Could not be determltied
�- � Nat pregnant,b�t pregnant 43 days to 1 year before death 32.Date of InJury(MO/Day/Vr)(Spell Month)
� Unknown If prc�gnant within the pasC yea� 33.Time of InJury
34.Place of InJury(e.g.home;conSY�ucflon site;fa�m;schooi) 35.Location of InJury(St�eet antl Number,CITy,County,Sta[e,2ip Code)
36.Injury at Work 37.If TransportaHOn InJ�ry,Spectfy: 38.�escrlbe Now Injury Occurred:
0 Yes � Drlver/Operetor � Pedesirlan
0 No � Passenger � Oiher(Specify)
39a.Cer[Ifier-phys(cian,certifled nurse proctitloner,medical examiner/wroner(Gheck only one): '
0 j',efEtfying only-To She best of my knowledge,death occurred dua to the cause(s)and mann r statetl.
�Pronouncing 8i Certifying-TO the best of my knowledge,death occurred ai She time,date,and place,and due to[he cause(s)ar,a�„a.,.,er scatea.
O M�dlcal Examiner/CO�one�-On ihe si��minaiion / Investlgatlon.In mY oPinlon,death occurretl at the tlme,date,aritl Place,and due to the Cau5els)and manner stated.
Slgnature.ofceltlfler; �`� �TitleOfcertifier.�� ��O Llc�nseNumber:� ���7����Z"'77�
396,NaYne,Atltlress e�n Ip C�r f Person Com$leiing Cause of Death(Item 26) � � �� 39c.Date.5lgnetl(y�O(D�y/Yr) '�.
�1 c�•-d� L- J.r u� -rs/J H�t7 o J�;/ /1./ �-s>f, �/� !'7fl z r �fl>l/.�
� 40.Regisira�'s D�strlct Number � � � 41.Registrar's Slg fe �42 Registrar Fi e Date(MO ay r
,�, " /- e� /� ��.3o d/ 3
� 43.Amentlments �
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�rsSm WII�L 1sND TESTAMENT OF hICHX�Fi,U H« V�ERTZ.
I, Richard H. Wertz, of Ea�t Pennsboro Township, Cumberland Count ,
Pennsylvania, hereby declare this to be my last Will and revoke all T�ills which
I have previouel� made.
l. I direct my Executor to pay the expenses of my funeral and las
illness ag soon ae convenient after my death.
2. l�ll of the rest, residue and remainder of my eetate I give, de
vise and bequeath to m�y wife, Inez �I. Vrertz� a.bsolutely.
3. If mq wife, Inez M. �ertz, should predecee,se me, or ahould we
both die in a common accident, then I order and direct my �xecutor hereinafter
named to eell all the rest, residue and remainder of my real and pereonal prop-
erty at either public or private sale and con�ert the same into caah; the net
proceeds derived therefrom to be divided into three equal psrts or sh�res:_
(A). One part or share thereof I give and bec�ueath to my eon,
Victor E. Wertz,
(B). One part or share thereof I give and bequeatla to �y son,
Richard R. Wertz,
(C). And the remaining part or share thereof, I give and be-
queath to CC1GB, ATew Cumberl�.nd, Pa., and its successora, in trust
nevertheless, to invest and keep the seme invested and to pay over
the net income deriveii theref rom to the person or persona incharge
of �y eon, Thomas P. Wertz, in monthly payment�; said income to be
used exclusively for ti�e aupport, maintenance and education of my
said son; and if in the opinion of CCNB eaid income is insufficient
to adequately pa,� for the support, ma.inten�nce and education of �
said son, the said CCbTB is hereby authorized and directed to pay to
said pereon or persona in chgrge of my said aon, as much of the pri
cipal as it deeme necessary for the proper eupport, maintenancd �.nd
education of my said son without obtaining an order of Court there-
f ore. 6nd when � eon reaches hia ma�ority� I direct my said Truste
to pay over to him the corpua or principal.
4. I appoint my wife, Inez M. Wertz, Eaeeutria of thia Will. Shoul
he, for any reason, fail to gualify or cease to act as such� I appoint my son,
Victor E. W ertz� Eaecutor of this Will,
IN WITAIESS W�EI�EOF', I haee herewnto eet my hand and eeal thia �%
day of A�ay, 197?.
� , -�� �� � SFAL).
SIGNED, SEAI�D, PUBLISHED L�iTD DECI.,�ItEL by the above name 8ichard
I
H. Wertz� as and for his last Will and Te�tament, in the presence of ue, who, a
.his request� in his presence and in the presence of each other l�ve hareunto
subecribed our na,mes as witnesses.
'1 � , - �.�.� � ���., ,��
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OATH OF NON-SUBSCRlBING WlTNE�S(ES)
REGISTER QF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
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Estate af Richard H.Wertz r�rs -� c-���S��`' F��y�
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Cynthia Wertz and Moily Wertz .=�`� �:' `-` ;_-: t``
Pnnt Name -' }—�' �'' �� �
(PrintName) f ) :�g � � -y�«
{each} being duly qualified according #o law, depase(s} and say{s) that she 1 he !they was/were well-
acquainted with Richard H.Wertz and am 1 are familiar
with the handwriting and signature of the decedent, and that the signature of Richard H.wertz
to the faregoing ins#rument purparting to be the Last Wiil and Testament/Cadicil of
Richard H.Wertz is in his/ her own proper handwriting.
�
r��9� `�} Gynthia Wertz� rs;9�at°`e} Holiy
7594 Lakeside Ave.
(Street Address) (Street Address
Harrisburg, PA 17112
(City,Sfafe,Zip) (City,Sfate,Zip)
Execu#ed in Register's Office Executed out of Register's Office
Sworn ta or affirmed and subscribed Sworn to or affirmed and subscribed
befare me this—�--day befare me thi l�s--�y—day
� t ' s�� .
ofi { � , ��-1- . of ��`� ,
� .� L, �-��:�—
Qeputy for Register of Wilis t ry Public�
My Cammissian Expires: �i �1 t�
(Signature and seal of Notary or other officia!quali�d to
admirrister oaths. Show date af expiration qf Notary's commission.}
�OMMONW�ALTH OF PENNSYL.VANIA
NQTARIAL S�AL
MACKEiVZiE CLAAK,Natary Pubiic
$usquehanna 111nrrp.,Dauphln County
My Commtssion E�Ires JBnuary t 1,2U17
Form�W-D4 Rev.10-13-2008 Cppyright(c}2006#orm software only 7he Lackner Group,Inc.
OATH OF'�NON-SUBSCRIBING WITNES►S(ES�
REGISTER OF WILLS OF CUMBERLAND GC?UNTY, PENNSYLVANIA
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Estate af Richard H.Wertz • � �'?�eeased '_;� ;;,
,�„ �. �T'= c� ,
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°:.:� c-,, �,.., ,.,
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Cynthia Wertz and Holly Wertz �, ;_ , . ,
(Pnnt Name) (P�nt Name) �y��
.�.�
(each) being duly qualified according to iaw, depose(s) and say(s) that she / he I they was I were weii-
acquainted with Richard H.Wertz and am i are famiiiar
with the handwriting and signature of the decedent, and tha#the sigrtature of Richard M.Wertz
to the foregoing instrument purporking to be the Last Wilf and TestamentlCodicil of
Richard H.Wertz is in his! her own praper handwriting.
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/Srgnature) �ynthia Wertz �Si9nature) Holly @rtZ
7594 Lakeside Ave. __/�7� ,r7cruh�lr'in /i c�J �r
{Streef Address} {Streef Address}
Harrisburg, PA 171 �',��f� �f4 ,j�'d,�5
(City,State,Zipj (Ciry,State,Zip)
Executed i egisfer's 4ffice Executed out of Register's t3ffice
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COMMONWEA�TH 4F PE�IN�SY�VANIA
NOTARIAL SEAL
ELIZABETH M.MACGEE,N4TAfiY PUBI.IC
CAMP HiLL BORO,CUMBERLAND COUNTY
MY COMMISSION EXPIRES APR:9,2016
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