HomeMy WebLinkAbout07-03-13 Oath of Personal Representative Official Use Only
COMMONWEALTHOFPENNSYLVANIA } 1 , S, 44 . �14 F4
} SS:
COUNTY OF C4.n-+.52-�' Ia-+��-- } � � �
Petitioner(s)Printed Name Petitioner(s)Printed Address
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The Petitioner(s)above-named swear(s)or affirm(s)the staremenu in the Poregoing Petition are we and correct to the best of the lmowledge aad belief
of Petitioner(s)and that,as Pe:sonal Representative(s)of the De ent,the Petitioner(s will � ell and tmly adminiscer the estate according ro law.
Swom to or affirmed an s bscribed before ��— Dace 7 -3 -ao�3
me t ' day of Date
By: Date
For the Register Dete
BONDRequired:�YES �NO TolheRegisterojWills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature: :-.,
( ) Sliort Certificate(s). ... . . p = � �
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( )Renunciation(s).. . . . . . . . � p � � �
( )Codicil(s). . . . . . . . . . . . . %Q c? —
( ) Affidavit(s).. . . . . . . . . . . ImT1 = c� ' �� ;.�
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Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: � �" m �.-.'.' �'�
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Commission. . . . . . . . . . . . . . . . . . Supreme Court � %�
Other . . . . . . . . ID Number. � � —L7 Ct �
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� . . . . . . . . Firm Name: O � � G�
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. . . . . . . . Address: ' —i �
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. .. . .. Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
1CS Fee. . . . . . .. . . . . . . . . ... . . Email:
TOTAL. . . . . . . . . . . .. . . ... . .. . $
DECREE OF THE REGISTER
Estateof �eqq(d, �n U(y� ���� Fi'.�No: r�v�J= �7y
a/k/a:
AND NOW, �L(,ll�/ �� ,�G/�3 •in cons�li n of the oregoing Petition,
satisfactory proof having been resented before me,IT IS���ED that Letters �
are hereby granted to ,�� �] . Z
in the above estate and(if applicable)that
the instrument(s)dated
described in the Petition be admitted t probate and filed of rd as e last W 1(and Co ' (s))of D edent.
gister o Wills �
Form RW-02 rev. 10/1120/l � Page 2 of 2
��
PETITION FOR GRANT OF LETTERS
REGISTER OF WII,LS OF ('u�a�'2-l�1� � COUNTY,PENNSYLVANIA
Petitioner(s) named below, who is/aze 18 yeazs 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 forrn:
Decedent's Information
Name: E G G 4 � V p A DElLSLi � File No:
a/k/a: T (Assigned by Register)
a/k/a:
a/k/a: SocialSecurityNo:
Date of Death: (a - d S= a1� �3 Age at death: 8 3
Decedent was domiciled at death in U m a6L l.A�� County, �A (Srare)with his/her last
principalresidenceat Bai4 L.sbLL�� oa. � G.m,ph, Il f 176�� �(yML3�R.l-11c7D
Street addrees,Poat./O�fifce and Zip Code City,Townahip or Boroogh County
Decedent died at �du LI Sb+�-� � I�o�� �ll,.�x,� � ��� � Pa !��� � �M ye r !�—OL
Strtet addrc�s,Poat OHice and Zip ode City,TownsAip or Borough County Smh
Estimate of value of decedenPs property at death:
ljdomiciled in Pennsylvanra............................ All personal property $
ljnat domicUed rn Pennsy[vania. .......... ............. Personal property in Pennsylvania $
Ijnot domiciled in Pennsylvania. ......... .............. Personal property in County S
Va(ue ojreal esta�e in Pennsylvania...................................... ................... $
TOTAL ESTIMATED VALOE. ... $ � �O • o a
Real estate in Pennsylvania siNated at �
(Attoch additionol sheets,iJneressary.J Stred addren,Poet Oflice and Zip Code City,Towmhip or Borough County
� A. PetiHon for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)he/she/they is/aze the Execuror(s)named in the last W ill of the Decedent,dated �J' �S�e�]0�,3 and Codicil(s)
thereto dated
Slate relewnt circumvnnca(eg.rmunciation,deaM ojexecuror,ete)
Except as follows: after the execution of the instrument(s)of£emd for probate Decedent did not marry,was not divorced,was not a partyto a pending
divorce proceeding wheroin the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),and did not have a child bom or �
. adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
�.piOEXCEPTIONS ❑EXCEPTIONS �
❑ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n., d.b.n.c.t.a.,pendentelite,durunteabsentia,duranteminaritute
If Administration,c.ta or db.n.c.ta.,enter date of Will in SecHon A above snd comolete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the growds for�orce had bee -�^eg�tablig�d�i defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated per e�n.0 `-^' m n
❑NO EXCEPTIONS �EXCEPTIONS � � c �'� �'
Petitioner(s),aftera proper search has/have ascertained that Decedent left no W ill and was survived by the fol�w��use(if any)a�h�(anuch
additiorca[sheets, i/becessary): � Z � � —u �;-t
Name Relationshi AWrEyc � �� �
Ci G -i. —
p ` '_ O
� r m
-a � �'` cn �
D
Form R W-02 rev.10/1//70!/ Page 1 of 2
.! . .._ .. . �
At1lIC AIJc 4c�'(9/��.i
RECt}R���i a, ;fG� 0�
RE�15"��:1t OF t''�L.f.S
LAST WILL AND TEST����, � �� � ��
oF � c�E�rc a�-
PEGGYJ.YAlYDERSLIGE'P�A�s ���RT
euMe�a�ar�a co., �a
I,PEGGY d.�'AN DERSLICE,a resident of the Commqnwealth of Pennsylvanis,malco,pu6lish
and declaze this to he my Last Wi11 and Testa�nt,revoking aIl wifls and codicils at any time heretofore made by
me.
FIRST: 3 direet that the expenses of my ]ast iliness and funeral, the expenses of zhe
administration af my estata,and att estate, inheritance and siatilar taxes payable with respect to property included in
my astate, whether or nat passing under this will, and any interast or penalties thereon, shall be paid oat of my
residuazy estate,withoui apportionment and with no right of reimbursement from any reciprent of any such property.
SECOND: It is my desire that, upon my death, I be buried at Fort Indiantown Gsp National
Cemetery.
TFIIRD: I give ai1 the rest, residue and remainder of my propeny and estate, both real and
personal,of whatever kind and wherever Incated, that I awn or to which I shall be in any manner entitled at the time
of my death(collectively referred to as my"residuary estate"),as Follows:
A. I give one quazter(Itd)of my residaary estate as follows:
(a) Tf my daughter PATRICIA J. RZEPBLA svrvives me, to my daughter PATRICIA 7.
RZEPELA,
(b) If my daughter PATRICIA J. R2EPELA does not survive me,the aforesaid one quarter(1/4)
of my residuary estate shalt � paid and distributed to any then ]iviag issue o€ my daughter
PATRICIA 7.RZEPELA,Qer stimes.
B. I give one quarter(I/4)of my residuary estate as follows:
(a) If my daughter KARLA R.GLEIlvf survives me,to rny daughter KARLA K.GLEIM,
(b) If my daughier KARLA K.GLEIM does not survive me,the aforesaid oas quarter(2J4}of my
residuary estate shalP be paid and distributed to any then tiving issue of my daughter KARLA K,
GLEIM, er i s.
C. I give one quarter{1t4)af my residusry astate as follows:
(a) If my daughtcr ETHEL A. DAVIS survives me,to my daughtor HTHEL A.DAVIS.
(b} If my daughter ETHEL A.DAVIS dces not surviva mo, the afaresaid one quarter(IIA}of my
residuazy estate sha[1 be paid and diatributed to any then living issue of my daughter ETHEL A.
DAVTS,per stirg�s.
D. I give one quarter{]14}of my residuary estate as fotEows:
(a) If my grandson DERRICK SAMUEL VAN DERSLICE, my grandson JOSEPH WALT"ER
V AN DERSLICE and my gra�daughter LEAFI KELLY ar any of them sha12 survive me,to thosc
of my gtandson CIERRICR SAMUL'L VAN I7ERSLICE, my grandeon 70SEPH WALT"ER VAN
DERSLICE and my granddaughter LBAH KELLY who survive me in equal shares.
��,�.�-��.����,��
�
(b) If my grandson DERRICK SAMUEL VAN DERSLICE, rny grandson JOSEPH WALTBR
VAN DERSLICE and my granddaughter LEAH KELLY shalt not survive me,I give the aforesaid
one quarcer (1t4} of my msiduary estate to the ozher beneficiarios of my residuary estate, in
propoRion to their interests under this Article"1'HIRD and subjec[ta the provisions hereof.
FOtTRTfi: If any property of my estate vests in absotuta awnership in a minor or inoampetent,
my Execumr,at any time and without court authorizatipn, may; distribute the whote or any part of such praperty tu
the beneficiary;or use tha whole or any part for the heslth,educatiqn, maintenance and support of the beneficiary; or
distribute the whole or any part to a guardian, committee or other legai representative of the beneficiary, or to a
custodian far the 6eneficiary undar any gifts to minors or transfers to minors act, oc to the persan ar persons with
wham the beneficiary resides. Evidence of any such disVibution or the raceipt therefpr executed by the person ro
whom the distribution is rnade shall be a full dischazgo af my Execuror from any liability with respect thereto,even
though my Executor may be such person. If snch�neficiary is a minor, my Ezecutor may defer the distributian of
the whole or any part of such property until the beneficiary attains the age of eighteen{I$)yeazs, and may hold the
same as a separate fund for the beneficiary with all of khe powers described in Article SIXTH hereo£ If the beneti-
ciazy dies before attaining said age,any balanae shall be paid and distributed to the estate of the beneficiazy.
FIFTH: I appoint my daugh[er PA11tICIA J. RZEPELA to be rny Executax. If my daughter
PATRICIA J. RZEPELA shall fa'rl to qualify for any reason as my Executoq or having qualified shall die, resign or
cease ro act for any reason as my Executor,I appoint my daughtex KARLA K.GLEIM as my Executar. I direct that
na Executor shalt be reqaired to fite or furnish any bond,surety or other security in any jurisdiction.
SIXTH: I grant ro my Executor all powers wnferred on executors under the Pennsylvania
Probate, Estates and Fiducisries Codo„ as ame�ed, or any successor thereto, and aiT powers conferred upon
axecutors wherever my Executor may act. F also grant tp my Executor power to retain,seli at pubtic or private sale,
exohange, grant options on, invest and reinvest, and otherwise deel with any kind of property, real or personal, for
cash o�on credih, to borrow money and encnrnber or pledge any property to secure Ioans; to divide and distribute
property in cash or in kind; ta exercise a11 powers of an absoiute owner of praperty; ta compromise and ratease
c(aims with or without consideradon;and ro employ attorneys, accountants and other persons for services or advice.
The term "Exacutor" wherever used herein shall mean the executors, executor, executrix or administraror in office
from Gme ta time.
SEVENTH: I direct that for purposes of this will a benefioiary shall be deemed to predecease ma
unless such beneficiary survives me by more than thirty days.
This document was prepared under the authority of IO U.S.C.§ 1044 and implementing militazy
regulations and insuuctions, by Captain Robart E. Samuelsen II, U.S. Army, who is licensed to practice law in the
Stata of Minnesota.
IN WITNESS K'HEREOF, I, PEC3GY J. VAN D S E, sign my name and publish and
declare this instrument as my last will am3 testa�nt this,��ay of 2�3. I also have affixed my
signature on the bottom of each of Xhe preceding pages hereof.
��18�3���
P 7.VAN DERSLICE ,
The faregoing instrument was signed,published and declared by PEGGY J.VA,N I}ERSLICE,the
above-named Testa[rix, to be her last wiil and testament in our presence,alt being present at the same time, and we,
2
at her reques[and in her presence and in the presence of each other, have subscribed our names as witnesses on the
date above written.
IWf, /•
having an address at
CwGJG , �A
i 70/3
�
having an address at
Q�c.�t�. �.A-
1 7 o i�
3
� ��
ACKNOWLEDGMENT AND AFFIDAVIT
CC?MMdNWEALTH t7F PENNSYLVANIA,COUNI'Y OF Ct7MBERLAND,ss.
We,PEGGY J. VAN DERSLICE and_pA UZ�p�"�/QN�'__ fj N.p ____ ____
—�=S—!��'--�—?'�—���'�-------
_________, �e Testatrix azsd the witnesses respectiveiy, whose
namos aze sigaed to the attached or foregoi�g instrument, being first duly swarn, do hersby dectare to the
undersigned authority that the Testatrix, PECiGY J. VAN DERSLICE, signed and executed said instrument as her
last wil! and testsment in the presence and heazing of the witnesses, and that she had signcd willingly, and thak she
executed it as her free and voluntary act and deed for the purposes therein expressed,and that each of the witnesses
at tha request pf the Testauix, in the presence and hearing of the Testatrix and each other, signed the will as witness,
and that to the best of his or her knowledge the Testatrix was at the [ime at least eighteen years of age, of sound
mind and under no consuaint,duress,fraad at undna influence.
-�4kk�{�'N�,aaJ�
P�CJC C 7AJ1rA
steVix
P_�K�
w�tness
�#�?�� CJ
Subscribed, sworn to and acknowledged befpre me by the said P$GG J. VA >E�SLICH,
Testatrix, and subscri6ed and sworn fa befare me by the above-named wifiesses, this ��ay af���r �n ,
2003. y
N4 PttjJ�iC
My oommission expites on �� J� ,LrJo,$"
Nararial Seal
Betry S. Kis[ler, Notary Public
Cartisle Boro. CUmbsiland County
My Commission fizpires May t4, 2005
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