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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: Glenn Allen Glass File No: -!�� ' � `5 " �)�' ��
a/k/a: Glenn A.Glass (Assigned by Register)
a/k/a:
�a: Social Security No:
Date of Death: March 5 2013 Age at death: 76
Decedent was domiciled at death in Cumberland County� Pann�vania (Sraie)with his/her last
principal residence at 4 Annendale Drive Carlisle PA 17015 South Middleton Townshiv Cumberland Countv
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at 4 Annendale Drive Carlisle PA 17015 South Middleton Townshin Cumberland Countv
Street address,Post Office and Zip Code City,Townsh�p or Borough Cou�aty State
Estimate of value of decedenYs property at death: 10,000.00
If domiciled in Pennsy[vania...... ...................... All personal property $
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ..................... .. Personal property in County $
Value of real estate in Pennsylvania.............. .............. ............................ . $
TOTAL ESTIMATED VALUE. ... $ 10.000.00
Real estate in Pennsylvania situated at:
(Attach additional sheets,if necessary.) Street address,Post Otfice 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 March 1,2013 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.
Q• NO EXCEPTIONS Q 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.
Q NO EXCEPTIONS �EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse(if any)and heirs(attach
--.
additional sheets,if necessary): n 4;;; � �r�
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Name Relationshi A rg' �> -
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Forrn RW-02 rev. 10/11/2011
Page 1 of ?
Oath of Personal Representative o���ai use oniY
COMMONWEALTH OF PENNSYLVANIA }
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w i� t`r'i
COUNTY OF CUMBERLAND � C ,� �.,
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W �
Petitioner(s)Printed Name Petitioner(s)Printed Ad s� �? -..� t::
,
Juanita Glass 4 Annendale Drive Carlisle PA 17015 � � ..:.� � '"" �`�
a:�_ - .:..
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The Petitioner(s)above-named swear(s)or aftirm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s j and that,as Personal Representative(s)of Deceden,the Petiti r(s)will well and truly administer the estate according to w.
Sworn io or affirmed and subscribed before Dace ✓ /
->
me t ��day of �'� , �(�J�S Date
By:�-�.�`� ���',;,,_�'�T� �� Date
For ihe Register Date
BOND Required: Q YES �'�O To the Register of Wills:
FEES• Please eater my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( � )Short Certificate(s).. . . . . ( ()
( )Renunciation(s).. . . . . . . .
( )Codicil(s). . . . . . . . . . . . . �
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . rinted Name: R ald E.Johnson
Commission. . . . . . . . . . . . . . .. . . upreme Court
Other . . . . . . . . ID Number: 16453
��� �� . . . . . . ��
irV�Z�l�t%�Y`I . . . • . • • • �.� Firm Name: Andrews&Johnson
(Q{(�(�C1 . . . . . . . . i'j Address: 7R We�tPnmfret Street
. . . . . . . . Carlisle,PA 17013
. . . . . . Phone: 717-243-0123
Automation Fee. . . . . . . . . . . . . . . 'j Fax: 717-243-0061
JCS Fee. . . . . . . . . . . . . . . . . . . . . �. .� U Email: rP�nhncon�(p�na ne
TOTAL. . . . . . . . . . . . . . . . . . . . . $ � 0.00
DECREE OF THE REGISTER
Estate of Glenn Allen Glass File No: �;2� '� �� '�' �,�}l.�''�
a/k/a:Glenn A. Glass
AND NOW, �i , �U�..� ,in consideration of the foregoing Petition,
satisfactory proof having en presented before me,IT IS DECREED that Letters Testamentarv
are hereby granted to Juanita Glass
in the above estate and(if applicable)that
the instrument(s)dated March 1 2013
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent.
.�i,(IY TYG�1�t�C�'` �
Register of Wills � � '
���,�� ±,,�'�tl,'�� �lS��� 1 C.t.i ���f_�
Fo,m nw-oz rev. 10%11/2011 Page 2 of 2
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H105.;t(Ii KEV i'!�I I i
LOCA►L REGISTRAR'S CERTIFICATION OF DEAT'H
WaRINING: It is illegal to duplicate this copy by photostat or photograph.
R�VUr��,:.� r �. c' �t' _
Fee for this certificate. �6.00r �� ,,�,;,%,,,,,,::. "1'hi� is to certil'v tl� it thc� ini�ormation her� t����en is
{�EC�� i�i� �i" �:i,t�l--� ��,���' p,��H OFp " co�ie�:tly a�pieci fi��n� ��n ori�_inal Certificatc,��i`De�ath
<c, f�i�y=
o,'`�`�% ��'1'� c4udy lile� with m� <<ti t.ocal Registrar. Th� c����iginal
;�1Ji3 �T�fl� 17 ��� - � � �z� ceinfic�i�e �+ill h�• I��ru���rded to the St,ir�� Vital
;�; y�� �a; h�c��rd�; Otlice ii�� ��eiin�mcnt filing.
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P � 9 4 3 4 6 4 �__ o ft��A ra�s� c L�;J ii i,_oF�q'9 M �`��`,;P~��''' ��.��.�- �- M 7 �Zo ti3
- T ENT 4 --�--�-.�i
,,,,��� � � I�ate 1�;a� d
Certificalion Nu�nber . � �� ���"" Lr�cal k,e�*i�5lrair
:�- CUl�BERL�IE��� ��..
Type/Print In COMMONWEALTH OF PENNSYLVANIA��EPARTMENT OF HEAITH�VITAL RECOR�S
Pef'^a^e^T CERTIFICATE OF UEATH
Black Ink Stafe File Number:
N 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex - 3.Social 5¢curity N�mber 4.Date of Death(MO/Day/Vr (Spe�l Mc�j
Q7
_a male "1 64-28-0600 MarcY► 5, _
0 Sa.Age-Last Birthday(Vrs) Sb.Under 1 Vear Sc.Untler 1 Oa 6.Da[e of Birth(MO/�ay/Year)(Spell Month) 7a.BlrtM1place(Ci[y antl State or Forelgn Country)
v �� Monffis oa�� �o��� ti+����e� pctober 5,'1 9 3 6 ensbur PA =
7 6 7b.Birthplace�co�.,�,.�Cumber an
� 8a.Rasidence(State or Forelgn Country) Sb.Residence(Street and Number-Incl�de Apt No.) 8c.Did Dec¢de�i Live In a TownshlpT
� pennsylvania 4 Annendale Dr� �Yes,decedanclNedin South Middleton _�,�;P.
8d.Re�um�e"i'''land
8�.Residence(Zip Code) '1 7 O 1 5 �NO,deceden[Iived within Iimits of citi/�e��'o
9.Ever in US A�metl Forces? 10.Marifal 5[aeus at Time of O¢a[h Marrled � Widowed 11.Surviving Spouse's Name(If wife,give name prlor to first marrlage)
�Yes Q No �,Unknown �Divorced �NeverMarried �V�kno Juanita Grove _
12.Father's Name(Firsc,Middle,Last,SuKix) w13.Mother's Name Priorto Firs[Marrlage(First,Mltldle,last)
G1ass Mildred May Harris
14a.Informant's Name 14b.ftela[lonship to Oecedent 14c.Informant's Ma Ing ddres (Sfreet a Nu 1 5 e,2 de
s ' t G1ass wi£e 4 Annen�age �r_ �ar"'��`5``��; `�`�. �170'I .�
G isa. a�e o eac c .. ......... ........ ....... ... .. ......... ..... ....... ......~..
......""'...................... ...""'.........................""'..,........-................................ec__on,yo.,e. '
.........°°°---°-°. . --- .. .... ...
s If Death Occur�ed in a Hospltai: [� Inpatient - ;If Death Occurred Somewhere O(her Than a Hospital: �}Hospice Faclilty Decetlent's Home
° O Emergancy Room/OUtpatlent Q Dead on Arrival �Nu�sing Home/LOng-Te�m Gare Facllity Ofher(Specify) _
� 15b.Facllity Name(If not inst)tutlon,give street and number; .15c.City or Town,State,and 21 Co e 15d.Cou ty of D th-
n a1e Dr_ Carlisle, PI� �70'15 Cum�ber�andCo_ _
16a.Mechod of Disposiiion Burial Q G�emation 166.Dafe of�ISposition 16c.Place of Dlsposition(Name of cemetery,crematory,or other plac�)
�ftemoval from s�a<e O o��at�o� 3 J g�2 p� 3 Mt_ Hol ly Springs� PA Cem_
�' Other(Sprclfy)
� 16d.Location of Disposi[ion(City or Town,State,and Zip) 17a.Signature of F�neral Service Licensee or Person in Charge of Intermen[ l�b.Llcense Number
$ Mt_ Ho11y Springs� PA'I70 5 �� �. 01 '1589L
0 17c.Name and Compiefe Address of Fune�al Facili[
1in erFH&Crema�ory501N_ Baltimore Ave. Mt_ Ho11y Springs�PA'17065
°m' 19.Oecedent's Educatlon-Che<k the box that best de5cribes the 19.Decedent of Hispanl�Orlgi�-Check the 20.Decedent's Ra<e-Check ONE OR MORE races to indicate wh:iY
�-- highest degree or level of school compleied ac the time of deach. box fhat best tlescribes whether the tlecetlenf ihe decedenf co�sitleretl himseif or herself to be.
� 8th grad¢or less Is Spanish/Hlspanic/latino. Check the"NO" �Whlte � Korean
0 No diploma,9th-12th grade box if decedent is not Spanish/Hispanic/Lafino. 0 Black or African American � Vletnamese
g High school grad�aGe or GE�completed No,noi Spanish/Hispanic/Latino 0 American Indian or Alaska NaGive � Other Asian
� Some college credit,b�t no degree Ves,Mexlcan,Mexican Ame�ican,Chicano O Asian Indlan � Nafive Hawailan
� Assoclate degree(e.g.AA,AS) O Yes,Puerto Rican O Cl�inese 0 Guamanlan or Chamor��'�
Q BacM1elor's dag�ee(e.g.BA,AB,BS) ��'es,Cuban �FIIIP�^o 0 Samoan
� Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) O Yes,other SpanlsFi/Hispanic/Latino O�apan�se O Oih�r Paclflc Islander
� Ooctorate�e.g.Ph�,Ed�)or Professlonal degree (SpeciTy) �Other(Specify) _,._
.MD �DS OVM,LI.B JD
21.Decedent's Single Race Self-Designaiion-Check ONLY ONE to Indica[e what tFie tlecedent consitl¢red himseif or herself to be. 22a.Decetlent's Us�al Occ�pation-Indicace type ol"work
�J Whlt� 0 Japanese 0 Samoan done durYng most of worktng Ilfe. 00 NOT USE RETIRE(T.
�Black or African American �Korean 0 Other Pacific Islantler
�Ame�ican indian orAlaska Naxive �Vietnamese � Don't Know/Not Sure Dept_ Manager
�Asian Indian �O�her Asian Q Refused 22b.Kind of Business/Induscry
� p cni�ese O NaHVeHawailan p ocne.(sPe�irv> Plumbing Supply
Q Filipino �Guamanian or Chamorro
�TlM9 2!a-23d MUST S!COMPtL'fE0 23a. �ead(MO Day 23 .5(gnature ot Person Pronouncing Only w en applica �) 23c.License NumbC♦
BV PERSON WHO ORONOUNCES ON �u. JjQ
CERTIFIES DEATH UC.
23d.D c i n� (MO/Da Yr) 24.TI of Oe th
25_ s Metlical Examiner r Coroner ConSatSedT Ves 0 No
CAUSE OF UEATH nPProw�,,:ai,��
26.Part 1. Enter the chaln of events--diseases,InJurles,or complicatlons--that tlirectly caused the death. DO NOT enter terminal events such as cardiac arrest Inferv3l
respiratory arrest,or ventricular fibriilatl IfhOUf shOwing the etlology.,�OO pNOT ABBREVIATE. Enter Only n a Iin Atltl additlonal lines if necessary Onset to I]i�a1h
e caus/e o �-,.��4 � c �/
IMMEDIATE CAUSE --"-"-"--"--> a. ��RO�I/��G ��S/ il G�G-�J C/��2 �✓/j/�Lj �lr'�-,f..•�.b__, ' �J (�.n^'D.Q�
L __"_
(Final disease or condition �ue to(or as a conseq�ence of):
resulting in death)
n_- -- -'--
Sequentially Iist conditlons, Due to(or as a consequence of):
If any,Ieading to the cause
listed on Iine a. Enter the c - _.__._
UNDERLYIIVG CAUSE �ue to(or as a consequence of):
(disease or inj�ry that
FInitfated[he events resulting d. _.,_._
in death)LAST. Due to(or as a consequence of):
S 26.Par[11. Enter other si¢niflcant conditlons contributina to dea[h b�t no[res�lting in the underlying�ause given in Part I 27.Was an autopsy p�rfo ed?
O Yes No
� 26.Were autopsy fintlings availat�le^
m co complete the cause o ath'r'
� Ves No � _
--9! 29.If Female: 30.Oid T co Use Contribute to�eathT 31.Man of�eath
oQ Not p�egnan[within past year Yes C Q Probabiy ural Q Homicide
� Pregnant at time of Ceath 0 No � Unknown 0 Accident Q Pentling Investiga[ion
V � Not pregnant,but pregnant within 42 days of deafh � Sulcide p Could not be determined
� � Not pregnant,b�i pregnanc 43 days to 1 year before dea(h 32.Date of Inj�ry(MO/Day/Yr)(Spell Mon(h) � _
0 Unknown If pregnant within the pasG year 33.Tlme of Injury
34.Place of Injury(e.g-home;construction sice;farm;school) 35.Location of Injury(Sfreet and Number,Clty,SGafe,21p Cotle)
36.I�J�ry at Work 37.If Transporta[lon InJury,Speclfy: 38.�escribe How Injury Occurred:
0 Ves ��rlver/Operator 0 Petlestrian
0 N - Q Passenger 0 Ofher(Specify)
39a. KIFler(Check only one)� !
Certifying physiclan-To tfie best of kn wletlge afh o red due t the c e(s)and m tated
-- 0 Pronouncing 8a Certifyin icia To<he bes wletlge,death occur ed at the tlme,datesand place,and d�e co the cause(s)and m ted
Q Medical Examinet/C n e basi stigatlon,In my opinlon,death occu�red at the time,tlate,and place,and duerTO th�e�c/d�use(5)9nd mdnne�s'Yi�tetl
Signature of certlfier'� Title of certifler: �� License Numbe�:^R���$���"'
396 Name,Addres d p Code of Person Completing Ca� aih(liem 26� 39c.�at ig d o/�ay/Yr)
.��� �.�'°�,r�.Q .,-r� ir .9 .��r��.s�N�-.� �-.J� .����s ��j ,�'
� 40.Registrar's DIS[ric[Number 41.Reglstrar'S Slgnature 42.Heqis[rar File Dafe(MO Day/Vr)
� - �in�.��a�.�c- e�r- - O �
° 43.Amendmen[s
�
- � Dlsposltion Permlt No. LJ��C� `� REV 07/201 �
. ra,�
LAST WII.,L AND TESTAMENT
OF
Glenn Allen Glass
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�V 'TY
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LAST WILL AND TESTAMENT
I, Glenn Allen Glass of Carlisle, Cumberland County,Pennsylvania,being of sound and
disposing mind, memory and understanding, do hereby make, publish and declare the
following as and for my Last Will and Testament, hereby revoking and all Wills
Heretofore made by me.
TTEM I: I direct my Executor or Alternate Executor hereinafter named,to
pay all my just debts, funeral expenses,transfer inheritance tax, Federal Estate tax, if any,
and other just charges against my estate out of my estate as soon after my death as is
convenient,this in order tt�at there may be no deductions of any kind from legacies and
benefits herein given.
ITEM II: By way of explanation,the bulk of our personal property and real
estate is in the joint name of myself and my dear spouse,Juanita Glass, and we understand
in the event of the death of either of us,the said jointly held property which has been
accumulated by both of us will vest in the surviving spouse and that is my will.
ITEM III: All the rest, residue and remainder of my estate, I give,devise and
bequeath absolutely unto my dear spouse, Juanita Glass, conditioned upon her surviving
me.
TTEM IV: In the event my spouse should predecease me, I do than and in that
event give, devise and bequeath all the rest, residue and remainder of my estate,to Diana
Martin,Brenda McGowan, Jeffrey Glass and Jessica Crowley
ITEM VII: I do hereby nominate, constitute and appoint my spouse,
Juanita Glass,Executor of this my Last Will and Testament, In the event should my spouse
predecease me or for my other reason be unable or unwilling to assume the responsibility
of Executor of this my Last Will and Testament, I then constitute and appoint Nellie Hilton
as Alternate Executor. I authorize my Executor and Alternate Executor to sell any real
estate or interest in real estate I may own at the time of my death at public or private sale as
they see fit and to give to the purchaser or purchases thereof good and sufficient deeds or
acquaintances for the same. I further authorize that no bond of any kind be required of my
personal representative for the faithful performance of their duties by reason of the fact that
they may be living outside the Commonwealth of Pennsylvania, all in accordance with the
Probate,Estate and Fiduciaries Code.
�� 7
IN WITNESS WHEREOF, I, Glenn Allen Glass, above name Testatrix, of set my hand
and seal to this my Last Will and Testament which consists of three(3)typewritten pages
to each o ;which I have affixed my signature this �_day of
� � , 2013.
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA))
:SS
COUNTY OF CUMBERLAND ))
I, �!����t111 J�I 1 e.n \� I��S� ,the Testatrix whose name is signed to the
attached or foregoing instrument, have been dully qualified according to law, do
Hereby acknowledge that I signed and execute the instrument as my Last Will and
Testament; and that I signed it willingly and as my free and voluntary act for the purpose
therein expressed.
Sworn to or affirmed and acknowledged before me by
�n � � S , the Testa.trix,this ! day of
� � , 2013
� �
es tnx
CC1�tiMONWFAL�Fi OF PENNSYLVANIA
Notaria�Seal
Susan J.Pzrson,Notary Public
Sa��th Midcil,:t�n Twp.;Cumberland County a.!`�- Q��(.'�
P�y Corr�missien iacp+res Nov.10,2013 NO pUbI1C
Marnh�r,nerns�ivani�Asseciakion of Notaries
_
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AFFIDAVIT
CONiMONWEALTH OF PENNSYLVA1vIA))
:SS
COUNTY OF CUMBERLAND ))
r_-----, �\1
We, ��,�� � , �L �c��'[)��d ��' L-��� ��r �
The witnesses whose names are signed to the attached or foregoi g instrument, being duiy
qualified according to law, do depose and say that we were present and saw the Testatrix
sign and execute the instrument as `Y �i Last Will and Testament; and that the Testatrix
signed willingly and executed it as ` free and voluntary act for the purposes therein
Expressed; that each subscribing witnes in the hearing and sight of the Testatrix signed
The WiII as a witness; and that to the best of our knowledge the Testatrix was at that time
18 or more years of age, of sound mind, and under no constraint or undue influence.
Sworn to or a�irmed and ubscribed to before me by � oc�q�r � t c� rc,d � ,
and S A�� e/�n e �«� , witnesses,this f day of
, 2013
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itnes �'���� ,
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o Public
CQMMON�(VFALT9-i�F P�NNSYLV�1NlA
Notana!5eat
Susan 7.Parson,NoC�r�Putriic
Sa+rth Midcfletor�Twp.,Curr��ertand County
R1y Cornmissio�a�c>iires Nov.S0,2013
Memhar,per�ns•i'�a�+!r?.ssr,n�is3Cion of Nctaries