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Home My WebLink About06-18-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C «�-6e ,- ��.-.� 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 In�mation ��,� �r�� Name: �`� � G .C�Gc P� File No: t�, a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: c� (� '�j-�o� -S,$�G� Date of Death: �Aa. /� , ,��/,.3 Age at death: g � , Decedent was domiciled at death in Cu�--bE�/?,--„� County, /`�Pn�s�l✓��-' (Srare)with his/her last principal residence at a2Gs(, � �,..,�of �S�`i'«f , �'L,i,oC,�,,.�L�iil� l H�-d�'-�/-r.( Street address,Post Office and Zip Code ity,Township or Bo ough County Decedent died at ��i �. /�J�-�'� cS�f'�r� ��;G'�oa ns 6��—„- ��r� ��.f /�1' 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 $ 7S, 0 d (� If not domici[ed in Pennsylvania. ....................... Personal property in Pennsylvania $ � If not domiciled in Pennsy[vania. ....................... Personal property in County $ Value of real estate in Pennsylvania......................................................... $ ' TOTAL ESTIMATED VALUE. ... $ `'f S,� Real estate in Pennsylvania situated at: (Atrach additional sheets,i/'necessary.) Street address,Post Office and Zip Code City,Township or Barough County � A. Petition for Probate and Grant of Letters Testamentarv ��' Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated ��7��i 7/�7/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. `�NO EXCEPTIONS ❑EXCEPTIONS ,T ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.u.,d.b.n.,d.b.n.c.t.a.,pendente lite,durunte absentia,durante minoritute 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 f�livorce had b er�i estabj�h�as defined in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated p�o� � {-� � � � � ❑NO EXCEPTIONS �EXCEPTIONS � -t:t C , Petitioner(s),after a proper search has/have ascertained that Decedent left no W ill and was survived by th�IlAvi�pouke�'if an}�n�h3eirs(uttuch udditionul sheets,if'necessury): �. � , � �.% �==" w � � � � Name Relationshi e�s �� --�� f7 C � � .:) �. :7 � i"� a � G� � -�7 Fornt RW-Ol rev./0/!//20!/ Page 1 of 2 _ _ _ ��.,� Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF ��t�hC� �� } Petitioner(s)Printed Name Petitioner(s)Printed Address � /' �.�- 1 � � �.(,� ,n ? 3 � (2�f`� ��f L-'�lu✓l� / �JIS�' �"�� C ��.:r��,,��_ /y �� `1� The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are we and correct to the besrt of the knowledge and bqlief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,tl�e Petitioner(s will well an truly administer the estate accordin to law. ' Sworn to oz affirnzed and subscribed before Date " � ,�' me t is.�day nf� � h e ,�3 /��r��—� _Date �C'',�,,,� BY�� .Date For the Re�is�er Date BOND Required:Q YES NO To the Register of Wi[ls: FEES: Please enter my appearance by my signature below: Letters . . . . . . . . . . . . . . . . . . . . . . $ f L�C' Attorney Signature: ( � )Short Certificate(s). . .. . . �C,'�.C� ( )Renunciation(s).. . . . . . . . ( 1 Codicil(s). . . . . .. . . ... . n ``; � aCs �..a Fq ( )Affidavit(s).. . . . . . . .. . . p 1�`I � ' � � � C� Q Boi�d.. . . . . . . . . . . . . . . . . . . .. . . Printed Name: pD � Commission. . . . . . . . . . . . . . . .. . Supreme Court � n � � Other . . ... . ID Number: � �' � �'�' �� _ r" - rn _�_� r� � I� tX. �'1 . . . . .. iS.CO � cn � c:� _ ~ C� • • • • • • • • f�,V�i Firm Name: C7 ,.,, .,., � -'- -n � . . . . . . �5�e b Address: t'y c'� "— .� "TT . . . . . . . ' � � . . . . . . . � --i i"_ . . .. . . y � � • • • • • • •• Phone: Automation Fee. . . . . . . . . . . . . . . �• (�� Fax: JCS Fee. . . . . . . . . . . . . . . . . .. . . -�-3•SL Email: TOTAL. . .. . . . . . . . . . . . .. . . . . $ �3�•,=ZT DECREE OF THE REGISTER Estate of �1��'� ( C, �,�(� File No: 02�. - � �j - �� a/k/a: AND NOW, ��'� �� ,.(,{''��- , : � � , in consideration of the fo egoing Petition„ satisfactory proof having been presented before me,IT IS DEC D that L ers �' ►�� are hereby granted to ` � f in the above estate and(if appl:c�ble? that the instrument(s)dated � ; � ;�� described in the Petition be admitted to pr bate and filed of record as the last Will(and Codicil(s))of'Decedent. o�' C�� ; o i � Register of Wil ��, C /�� `�� i %�'�,-�Jt�� !�k�: �� Form RW-02 ,-�v. �nit�iznl t , e 2 of:! O:�TH OF �Oti-SLBSCRIBI\G ti� IT�ESS(ES j REGISTER OF �VILLS ��'�4^/( COUI�;TY, PENNSYLVANI-� Estate of_ /�Q�� Gp�� , Deceased �-�o/ � �G�-�'L� and ��'�` ��`c%-�-�--� � (each) being duly qualified according to law, depose(s) and say(s)that she/he/they was/were well- acquainted with_ �� G�--� and am/are familiar with the handwriting and signature of the decedent, and that the signature of _ ��a S�l �� to the foregoing instrument purporting to be the Last Will and Testament/Codicil of d��i��c/ �� is in his/her own proper handwriting. ��eJ �-- l�� (5�gr�utui•e) Si na� ( 8 ) J °�-�o�� L� r��.n �s�/�� l,J�sf��-�.� << ��.,� (S�reer Addres�) • (Stree�AddressJ 1�� f� - �� /��--� � l �a v (City,State,Zi') (Ciry,Stnte,Zi'J Execcrted i►i Register's Office n � � Sworn to or affirmed and subscribed � �' w � �' �^� �j �J � ��7 p before me this�b''1 day � � � � �' � o f �',�'J� r r� '..._,, ,..;.; �,; n �, .:� � :�: r::� — � � �:> �' C° c � -�; -.~r I � � �s i� �:�� ' � ,-`""-- �s , _a Deputy ior Register of�' ls � � � � Form RW-04 rev. 10.13.0( O�TH OF '�O�-SL"�3SCRIBI:��G ti�IT:�E�S(ES) I:E,GISTER OF ��ILLS C�,.rn�r �u.n�.COUNTY, PEN"NSYLVANIA Estate of�c�.��'� � � a��' ,L}eceased ��,� ��a^�' and � ( t � �a-�. �� , (each) being duly qualified according to law, depose(s) and say(s)that she/he/they was/were well- acqi►ainted with �� 1., �� -{ and am/are familiar with the handwriting and signature of the decedent,and that the signatctre af ��,.�- �- q.��'_ to the foregoing instrurnent purporting to be ihe Last Will and Testament/Codicil of ,�� b �� ,� is in his/her own proper handwriting. � /'G� Sc�frutur•e} (Signature) �.�-i �[ _�� !�p.s � �'/��-� /� (i O-'"l Street A dress) ��'�� {Stree Rddr•ess) �--- �. �' � ? . �„ �-��-,��,� ,/� f �� (Ciry,Stnte,ZipJ (City.State,�p) ,.�.; Execxcted iri Register's t?ffice � � � � � � � c;:� �, Sworn to or affirmed and subseribed �, � � � �:, � � � � � �� before me this .�_,_,day � x> � �'�' p� '� r-- �.. � v� ;:w �,°� �f �.__ �1�� . � � � �, <� � - � c`7 c� � '� ;�i ;.� � : � � �, ._._ e`a , �Ut��'J' � � » %; (� i� ;�7 � � �� DepuCy for Register �' lis � �° Foriia RW-tl4 reu.10.13.t1t H105.805 REV(9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECO�t��U ��=F1�E 4�' Fee for this certificate, $6.00�E�i�-�'�� - �=t��.�_S ,,,u��""""�---- This is to certify that the information here given is �TH OF p ' • ,,�,o''��,P=_ fN?;f_- correctly copied from an original Certificate of Death p � �` � dul filed with me as Local Re istrar. The ori inai :'�)i3 JUN 18 �� l� �O r,� -� - z` certficate wiil be forwarded go the State Vital �v y - a� Recor Office for permanent f ' g. CLERK 0;=� �* - *; ,,. P 19 5 7 3 6 ��a�rs� cou��r -�`�� ~? ' ` _ �9lMENT OE;��'�' / ,� ,��'� Certification Numbet',U M B E R LA�'�� `•• �� °""""'�� Local gistrar Date Issued Type/Print In COMMONWEALTH OF PENNSVLVANIA�DEPARTMENT OF HEALTH�VITAL RECORDS Pefnan`"` CERTIFICATE OF DEATH Black Ink Sta[e File Number: 1.Oecedent's Legal Name(Flrsi,Middle,Last,Suffix) 2.Sex 3.Soclal Secu�lty Number 4.Date of Deaih(MO/Day/Yr)(Spell Mo) Mabel C.Baar Famata 209-'12-5565 May�4,20�3 Sa.Age-Last Birthtlay(Yrs) Sb.Undor 1 Vear Sc Under 1 Da 6.Da2e of Blrth(MO/Day/Vear)(Spell Month) 7a.Blrthplare(CI[y and State or Forelgn LounCry) Months Days Hours Minutes Roxbury 94 Saptembar�5,19'18 �p.strinPiace(councy) Franklin 8a.Residence(5[ate or Forelpn Couniry) Hb.Resitlence(Street and Number-IncluAe Apt No.) 8c Dtd Decedent Llve in a TownshlpT P'O' Episcopal Home 206 East Burd St. DYea,ae�eae�c�wed ir, cwP. 8d.Residcnce(COUnty) No,decadvnc IWed within Ilmits of ShippBflSbuf9 clty/boro. Cumbarland sa.rse:�aanca�ziP coae) �7257 �I 9.Ever In US Armed Forces? 30.Marital Stafus at Tlme of Death �Married Widowed 11.Survlving Spouse's Name(If wife,Qive name prlor to flrst marrlage) �Ves �No �Unknown �Divorced �Nevar Marrietl �Unknow 12.Father's Name(Flrsf,Middle,Lasf,Sufflx) 13.Mother's Name PNOr fo Flrst Marriage(First,Middle,Last) John Stamey Mery Catharina Maekey 14a.Informanc's Name 14b.RelaHonship to Decedent 14c.Informanf's Mafling Address(Street and Number,Qty,State,iip Gotle) ,� R.Kay Fauver Daughter '16887 Cumberland Highway Newburg PA�7240 .............. ISa.P ace """""'.'""........................ .......... eat ec on y o�e ••"'............... ................................. _....................................._ ............................ .... ....... ....... ..... ............................... If Death Occurretl in a Hospibl: � ��Inpatlent 'If Deach Occurred Somewhara Oiher Than a Hospital: Hosplce Facllity Decedeni's Homa a Emergancy Room/OUi aHent O Dead on Arrival Nursing Home/LOng-Term Care Facility Othar(Specify) ag 15b.Facility Name(If not Institutlon,give street and number] 35c.Cicy or Town,State,and Zip Code 15d.Gounty of Death 1 � 206 East Burd Straet Shippensburg Borough Cumberland � "my-, 16a.M¢ShoA of Disposiifon Burial 0 CremaHon 16b.Date ot D(sposltlon 16c.Place of Otsposltion(Name of cemetery,cremaiory,o�other place) � p nemo�ait�o..,sc�xe p oo�acio� May�7,20�3 P�easant Hall Cametery , OMer(Sp�cHy) � 16G.LocaHOn of DisposlUOn(Clty or Town,Siaie,and 2ip) 1]a.51 atur of Funeral 5 ice LI P n In Charga of Inierment 17b.Licanse Number � Pleaaant Hall,PA'17246 - n FD-O'1435�-L �')c.Name and Complete Atltlress of Funeral Facllity .9 Fogalsangar-Bricker Funeral Home 1�2 W King St.PO Box 336,Shippansburg,PA�7257 18.Decedent's Educatlon-Check tha box(hat bes[tlascribas fhe 19.�ecedent of Hispanlc Origin-Check ihe 20.Decetlen�'s Raca-Check ONE OR MORE races fo Indlcate what m highesc degree or level of school completetl at the Hme of death. box ihat best describez whether the decedent the tlacetlent considered himself or herself to be. �[Sth grade or less Is Spanish/Hispanic/Latlno. Check che"NO^ �Whita � 0 Korean � No diploma,9�h-12th grade box if tlecetleni Is not Spanish/Hlspanic/Latino. 0 Black or Af�ican Ame�ican 0 Vlwtnamase � Higli school gratluata or GED completeA �(No,not Spanish/Hlspanic/LaHno . Q Amerlcan Intlian or Alaska Nativa �Other Asian Q Som collape uedit,but no tlegree O res,Mexican,Mezican American,Chlcano Q Asian Indian � Native Hawallan �Assoclata degree(e.g.AA,AS) 0 Vas,P�erto Rican 0 Chlnese 0 6uamanian or Lhamorro p eeu,aior•s aea�e.�e.g.en,ne,es) O�'es,Cuban O Flllpino O�moan � MasSer's degree(e.g-MA,M5,MEng,MEd,MSW,MBA) O�'es,ofher Spanish/Hispanic/Latlno O�apanese 0 O[her Pacific Islander O Doctorate(e.g.PhD,EtlD)or Professional Aegrea (SpecHy) �Oth�r(SpecHy) .MD DDS DVM LLB JD 21.Dec�dent's Single Race Self-OeslgnaHOn-Check ONLY ONE io Indlcaie whai[he tlecetlen[consitlered himself o�h¢�self to be. 22a.Decedent's llsual Occupation-Intlicate type of work �White �lapanese �Samoan tlone tluring most of working Ilfe. DO NOT USE RETIRED. 0 Black or Afrlcan American O Ko.ea., �Oiher Pacific Islantler Homemakar Q 0 American Indian or Alaska Nafive 0 Vietnamese � Don't Know/NOt Sure � 0 Asian Intllan Q Oiher Aslan Q Refused 22b.Kind of Business/I�d�astry � 0 Chlneae Q Na[ive Hawailan Q Ottfer(Specify) OWII HOTB 0 Filipino O Guamanlan or Ghamorro ITEMS 3a-23A MUSf BE COMPLETEO 23a.Dafe Vronounced Deatl Mo Day 23b.51gna(ure o Person Pronouncing Deafh Only whan applica le 23c.Licanse Number BY PERSON WHO PRONOUNCES OR CERTIFIES�EATH � 23tl.Date Signed(MO/�ay/Vr) 24.Tima of Deaih 2:30 AM 25.Was Medical Eaam{ner or Coroner Contacied7 0 Yes �$[ No CAUSE OF UEATH App�oxlmate 26.Part 1. Enter the chaln of evants--diseases,Injuriez,or compllcations--thac direcily caused the daath. DO NOT mter tarminal events such as cardlac arrest, � Interval: respiratory arrast,or vent�icula�fibrillatlon wiihout showing the etiology. DO NOT AB6REVIATE. Enfer only one cause on a Iine. Atltl adtllfbnal Iines if necessary � O�seS to Death IMMEDIATE CAUSE -------------> a. �rebral vascular accident � 1 WO�K (Final disease or contlitlon Due to(o as a consequence of): � rosulHnQ In d�atfi) b_ cerebral vascular diaeese � 5 yrs xquanttauy us�convixions, oue m(or as a consequence of): � if any,leading co the cause Ilsted on lina a. EnSe�fha � UNDERLYING CAUSE Due to(or as a consequ�nce o�: (disaase or Injury that � �o�c�acea cne avants�e:wtb,e a. i � In tleath)LAST. Due to(or as a consequenca of): � 1 � 26.Part 11. Entar othar [ but not rosulting in[he untlarlying cause given in Part 1 27.Was an aufopsy pei'fo�med7 S O Yes No � recurrent urinary infadions;anxiety 28.Were autopsy flndings avallable � co�or�Pioce me w.;:e or ao.tnz 0 V05 NO � 29.If Femal¢: 30.Did Tobacco Use Contrtbute tn Death] 31.Manner of Deafh s Qot pregnani within pasf year �Y¢s O P�obably �[Natu�al � Homicltle Pregnant at tlme of daach �(No � Unknown 0 Accident 0 Pa^tling Investigatlon �' � Not pregnan2,but pragnanc within 42 days of deatt 0 Suicide 0 Could not be determined � Not preQnant,bu[pregnant 43 tlays to 1 yaar before dea�h 32.Oate of InJury(MO/Day/Yr)(Spell Month) 0 Unknown if preanant witM1in the past year 33.Tima of InJury 34.Place of Injury(e.g.home,constructlon siie;farm;school) 35.Lowiion of Injury(Sireet antl Number,City,Scaca,2ip Code) 36.InJury ai Work 37.If Transportation Injury,Specify: 38.Describe How Injury Occurretl: �Yes �Drivar/Operamr 0 Pedestrian � No O Pazsenper Q Other(SpacHy) 39a.Certlfier(Check only one): - j$[Certlfying phjrsiclan-To che best of my knowletlga,doath occurratl Gue to the cause(s)and manner stated �Pronouncing 8.Certifying physiGan-To th�besi of my knowledge,tleath ocwrratl at tha Hme,date,and place,and due ta the cause(s)and m statad �Metlical Examiner/COroner-On the basis of axamination,and/or InvesHgatlon,In my opinlon,tleath occurred ac She cime,date,antl place,and due to tha cause(s)and manner statetl - Signa[ure of ceKlfler:�. �-��-�r��- �7� Ticle of mrtlfler. M-�� Llcense Numbar: MD023572E 39b.Name,AdAress antl Zip Coda of Pe�son Completing Cause of Death(Item 26) 39c.Da�e Signed(MO/Day/Vt) � Dr.Michael C.Gaudiose,M.D.�757 Norland Ave,Suita�0�,Chambersburg,PA 1720't May'15,20�3 �j ao.ReQ scrar s oistricc Num aa.aegiscrar s a2. eg strar F e oace Mo av � ��- ��s Zb � � 43.Amendmen�s � - �- H105-143 � Disposition Perml[No.OH8Z0$3 REV O7/2011 � � � rnrn � � � �? o rn � � z � � _ �, � �" r �--' r�i rn LAST `J�ILL At1�� T�ST�P4�.�'idT � � � � -� a a . � ca c.� � t� � � -r; --�i I, i�Iabel C. Baer, of Letter'<cenny �l'ownsni�, Frank7_i��u�?ty,�e��yl�'ftania, � � � n bein� of sound mind, memory, and understandin�, do m�ke,b �}blish�rid�ec�lare � C!a 0 tnis to be my Last i�iiil anu Testament, hereby revokin� �d makirt�Ovoid �11 former a�ills by me at any time neretofore made. IT:�i�i l. I direct .ny yxecutor hereinafter r.ar�.ed to pay a7_l r.�y just debts ancl funeral expenses as soon after :�y c�ecease as may eonveniently oe done. IT�i�i 2. t�ll the rest, residue, and remainder of my yr�ropert;,�, �ti�hether real or personal and t�heresoever found, I aive absolutely to my husband, F-iarold r,. Baer, Sr., provided, however, that should she not survive me for at least thirty (30) days then I bive s��id resilue in equal shares to m� ci�i�dren, the share of any deceased child to �o to nis or ��Er issue per stirpes. IT:�:�I 3. i noMinate, canstitute, and appoint :ny nusbanc�, Harold �. Baer, Sr. , �:�ecutor of this my Last 'rii]_l and 'l�estarnent; and iiz tne event said :�xecutor shall not qualif5 or shall �or a:,J reason be unable or unwillin� to so serve, tiien I nomir.ate, constitute, and appoint 'riarold �. Baer, Jr. , �;xecutor. I1�P•1 4. In tne event that any child be under L'n� aoe of twent�r-011P. (21) years of a�;e at the tir�e an�r Uift hereunder vests in him or her, then I �ive said �ift to the person servin;� as executor in trust for said cililct unl;il he . or she attains the ak;e of twenty-o.ie (?1) y�ars, said trustee to have the power in his discretion out of said �iit to �rovicxe for the support, maintenance, education, arid ozYier needs of said child, to serve as �•uardian of the estate of said child during said cl^.ild's mir�orizy, and to turn the balunce over to said child wnen ne or she attains the a�e cf t�•renty-one (?1) years. I:�, ;JIT.d�;`;,� '��dHER�Cr I have hereunto set <<�J nanci ar�a seal this �� day oi � , in the year one thcusand nine hundred �nd sixt�-eioht (196�' , � MONW LTWOF�E SYLVAN�� Notarial Sea � l � Robin Lynn Burnhisel,Notary Public � �.,�e�,,� ��, , /p� �,,(,�� (Sr,AL� Shippensburg Boro,Cumberland County y� "Y`�� - . °� My Commission Expires May 8,2012 ��i C%�=Z/"E'� � /J ��J �'— � � "' � � Member.Pennsylvani�Assoc�ation of Notaries Signed, sealed, published, and declared by tne above named Testatrix as and ior h�r Last ;=iill and Testament, in our presence, wno in her ��reserice, at her reauest, and in the preser.ce of eacn other, have hereunto set our hunds as attestir.g witnesses. _- _ __-L` �---�-�1 f�=.�._--�--�_ _ �" �2- � � � � cr~..> %� F�'1 �{ � � �'i"> � C � _ � � � � •'Zr3 p ('r'i }� �V� •,i i,, z � � � z u: x c� _� � na � � �� a C�c�ab�r S, 20�i2 .•° � � � �`+� � ;— a A � � 'r'1 I, iVI�iBEL C. Br�ER, ��itig of 5our�d rnind wa�ild like ta have iriy c�aaglite�°, �i A I�r�Y (BAERj FAUVER,named as Executor of my es±ate upon my death, ir addition to my son, HAROLD E. BAER JR. , ` �. �J �yu/ _ . ��.% ��abel C. Baer Witr�ess C�trirnor�w�aith oi r�i�nsvlvania Count��of Fran��clin L�n t�is ��t; �ay c5f��to�e�', ?0�2, �efa�e m��, tl;e ubld�rsi�l�ed office�•, persanally appe�red�I�,BEL C. B�1�,R,known to me (Qr satisfactorilyj pro`�enj to �e the person w�e�se nar�le is subscribed to the above Agreernent and acknowledge�that sr.e executed tne same for the puz�oses therein cont�ined. 1N WITNESS WHEREOF, I iiereunto set my h�nd and official seal. � 1� � �Ylc�c�� _______ NOTARIAL SEAL DEBRA K.MORROW,NOTARY pt1BUC CHAMBERSBURG,FRANKLIN COUNTY,PA MY COMMISSION EXPIRES JIJNE 7,2003