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Home My WebLink About09-16-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C u m b e r 1 a n d COLTNTY, 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 �� _ I�-aq�J Name: K a r e n L • M e 1 v i n File No: �a: (Assigned by Register) a/k/a: �a; Social Security No: Date of Death: 9/5/2 013 Age at death: 7 2 Decedent was domiciled at death in C u m b e r 1 a n d County, P e n n s y 1 v a n i a (State)with his/her last principalresidenceat 4 Oakwood Circle 17011 Hampden Township Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedentdiedat 4 Oakwood Circle 17011 Hampden Township Cumberland PA 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 Pennsy[vania................................AI I personal property $ 4 4 4�� • �0 Ijnot domiciled in Pennsylvania.............................Personal property in Pennsylvania $ If not domiciled in Pennsylvania.............................Personal property in County $ Value of rea[estate in Pennsylvania.............................................................. $ 4 21�5 0 0 •0 0 TOTAL ESTIMATED VALUE.... $ 8 6 5�5�� • �� RealestateinPennsylvaniasituatedat: 4 OdkW00d C1rCle 17011 Hampden Township Cumberland (Attach additiana!sheets,ifnecessary.) Street address,Post Otfice and Zip Code City,Township or Borough 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 2/7/19 9 6 and Codicil(s) thereto dated � State relevant circumstances(e.g.renuncia[ion,death oJexecutor,etc.) C p �'� .. � � �" Exce t as follows:after the execution of the instrument s offered for robate Decedent did not ma � . � p O p rry,was not di}u�-ce��as not a"}5arty to�a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),and�id�pt have a ghitd born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. � � � �=�= , :� � �c � NO EXCEPTIONS ❑EXCEPTIONS ---� - � <°.. ::...: ' __:3 a:�> C> .. . ❑ B. Petition for Grant of Letters of Administration(�fapplicab�e) '�.� 6--- F--'' `�:::': ;. c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,zfura' absenticF�eranf¢�mrno'ritate � �n J' �i If Administration,c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and comal�'e list of heia� 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. ❑ NO EXCEPTIONS ❑EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Decedent]eft no Will and was survived by the following spouse(if any)and heirs(attach additional sheets, if necessary): Name Relationship Address Form Rw oz rev. ioiuizo�t Page 1 of 2 Continuation of Petition for Grant of Letters Karen L • Melvin 209-30-2044 Decedent Name Page 1 Social Security Number Real Estate in PA 203 Apri 1 Drive 17011 Borough of Camp Hiii Cumberland Street address,Post OfSce and Zip Code City,Township or Boraugh County 835 Erford Road 17025East Pennsboro Cumberland Street address,Post Office and Zip Code City,Township or Borough County Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTYOF Cumberland } Petitioner(s)Printed Name Petitioner(s)Printed Address 2113 Orchard Road Laurie M • Gottdiner Cam Hill PA 17011 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 knowfedge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Petitioner(s)will well and truly administer the estate according to law. Sworn to or affirmed and subscribe befor„e�� t �f/l ' Date '-I(D�� me t ' c�y of , --�(1� 3 Date By: Dat�- ..� Far the Regrster � :=� ;-,-9 —r. � �, ,..i r.':,� m -� �.� _ _:� BOND Required: ❑ YES � NO To the Register of Wills: � � ! �---� ; . _._, FEES: Please enter my appearance by m ��ry+tvre be�o�v: ��_.. . c� Letters. . . . . . . . . . . . . . . . . . . . . . . $ �• O Attorney Signature: � � . � � ( (� )Short Certificates(s) . . . . . . � ;�� ^� � r � ( )Renunciation s " �� `- '� O. . . . . . . . . . �%� � I , ( )Codicil(s) . . . . . . . . . . . . . . � F;' `"' -,� ( )Affidavit(s). . . .. . . . .. . . . Bond . . . . . . . . . . . . . . .. . . . . . . . . . Printed Name: D a v i d H • S t o n e, E s q u i r e Commission . . . . . . . . . . . .. . . . . . . . Supreme Court Othe . . , .. . , . . ID Number: 3 9 7 8 5 � — �� FirmName: StOC1E LaFaver & Shekletski . �` ��n �� Address: 414 B r i d g e S t r e e t . . . . . . . . . P • 0 . Box E � � � � � � � � � New Cumberland PA 17070 . . . . . . . . . Phone: 717-774-7435 � � • � • � � • • Fax: 717-774-3869 AutomationFee . . . . . . . . . . . . . . . . . �� Emai�: dstoneblstonelaw• net JCS Fee . . . . . . . . . . . . . . . . . . . . . . . �,� TOTAL . . . . . . . . . . . . . . . . . . . . . .$ j DECREE OF THE REGISTER Estate of K a r e n L • M e 1 v i n File No: �� w' ��-7 / a/k/a: AND NOW, � , , � , in consideration of the foregoing Petition, satisfactory proof having been presented be ore me,IT IS DECREED that Letters T e s t a m e n t a r y are hereby granted to L a u r i e M • G o t t d i n e r in the above estate and(if applicable)that the instrument(s)dated 2/7/19 9 6 described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent. � Register o Wills ,�� ;� Form RW-02 rev.!0/1Ii20!! � e Of•2 J H105.805 RBV(9/LI) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ,�r�, �.. _ _ _ ,_ Fee for this certificate $f'00 - "' ,,,��""' � This is to certify that the information here given is _�� ; J �� . �• � ,,��p�'�H OF pF�;- _ correctly copied from an original Certificate of Death `,��o�"� y L; duly filed with me as Loca1 Registrar. The original t, �� 1 5 2 ` '� = 9' certificate will be forwarded to the State Vital ''!i� �'f_.; �l� �� J ;o- � , `. za x,� � a� Records Offic�permanent filing. ,` �� . � f� "l � 6 � 14 0 4�L=�s:�c �; =°�,,991�_- _�E�,��,,, y� �z� �P 0 � 1013 ,,, N S C 4 U�i7 .,MENT OE Certification Number '��"""'"��' Local Registrar Date Issued l _ __ GllMBERLA�D Ct?., PA __ _ __ /'-�Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENTOF HEALTH�VITAL RECORDS P°""'"°"` CERTIFICATE OF DEATH Black Ink � State Flle Number: 1.Decedent's legal Name(FIrsY,Middle,Last,Sufflx) 2.Sex 3.Soclal Sacurlty N�mbcr 4.Oate of�ea�h(MO/Day/Vr)(Spell Mo) Karen L. Melvin F. e t 1 Sa.Age-Lasf Birthtlay(Vrs) Sb.Under 1 Year Sc.Under 1 Oa 6.Date of Blrth(MO/oay/Year)(Spell Manth) 7a.Birthplace(City and State or F reign Country) ' � . Monihs� Days Hours Minutes .. � � . Z.BtrOb2. .P'd. 72 Januar �LS 1941 �b.Birthplace(Coutity) n r 8a.Residerlce(Sta[e or FoYeisn Country) 86.Rasidence(Street and Number-Include ApY No.). Bc:Did D� dent Liv��n a Townsh�p? �.�. � � �. � �� . J-� ¢�tv�s:ae�ea�.+c u..�a�., Hami�den c.,�,a. 8d.Residenpe(COUnty) . 4 Oalcwood Circle � � � � �� 8e.Residence(Zip Code) � � . �No,.decedent Iived wlthln IlmiCS of ��Nty/boro. 9.Ever in US A ed F rcesT 10.Marital Status at Tlme of Death Q Married [�Widowed 11.Surviving Spouse's Name(If wife,glve na e.prior to flrst marriage) �Yes �JO �V nknown 0 Divorced �Never Married 0 Unk 12.Father's Name(Flrst,Middle,last,Suffix) 13.Mother'S Name Prlor m First Marriage(Flrst,Middle,lasf) Paul W. Cribbs 14a.InformanYS Name � 14b.Relatlonship to Deredent 14c.InformanYs Ma11Ing Address(Street and Number,Gity,State,Zip Cadd 7 . 0 Larr J. Melvin son 'i� . � . . . .. . . , Ci .... � ......� � � .............................""•"......15 P o. � S .C'g P Y.o . �........ .��.. . ..._. ...... . . ........ ... W'"" ..... ............ ........... ...'".... .. ... ... � If Death OccVrrld In a Hos ital. �Irl 2tient =1f Death Occurred Somc hcr0 Other TF�an a Hos ital� Hospice Facili �� _ p P P � ty: �Decetlen[s H me ° 0 Emergalrycy�Room/OUCpatle(�f Deod bn Arrival O Nursing Home/long-Term Care Facllity . Other(Specify) �� °e�' 15b.Facility Neme(If not InStlTUt�on,:give street antl number; 15c.City orTOwn,State,and ZIp.COde � �� i5tl.Cou�nty of OCach � � � 4 Oaicwood Circle Cam Hi11 PA 17011 ' Cumberland y 16a.M�thod of Dispositlon [�Burial 0 Cremailon 16b.Oate of�ISposltion 16c.Place of Dispositlon(Name of ceme[ery,c matory,.or otM1er place) . �� .Q�.Remrn/al from Sfate �Donation � � � . re .� o�he.tsPa�ir�.� O 2013 Rolli Green' ri 1 P 2 16d.�LoCacWn of U�sposition�(Gity or Town,State,antl Z{p) 3Ta.Signat� bf Fu see or Person tt�Charge o4lnYerment 17b.�Licenst Nvmber �'� �:�..BL[1 �.��111.. F8 1.70�.1 � 17c.Name arW Complete Adtl�ess of Funeral Facllity � - 8 I�1 ers-Harner Funeral Home Inc. 1903 Market Street Cam Hill Pa 17011 °� S6.Decadc�nYs EducaYlon-Ch�ck the box thet besi describes the 39.Decedent of Hlspenic Origin-Check ihe 20.�ecadenYs Racc-Check ONE OR MORE races to Indicat�what t- highesc degrae or level of school compleYed at ihe time of death. box thaf best descMbes wh�ther ihe decedeM ihe decedent mnsideretl himself or herself io be. 0 Sth g�ede o�less Is Spanlsh/HlspanlC/Latlno. Check the"NO" �WhtCe 0 Ko��an 0 No diploma,9th-12th grade box If decedent is not Spanish/Hispanic/latino. �Black or African American 0 Vietnamese �High school graduata or GED completed � $]No,not Spanlsh/Hlspanic/Latina �Amerlcan Intlian or Alaska NaHVe � Other Aslan 0 Some college credlt,but no degrea �Ves,Mexican,Mexican America�,Chicano �Aslan Indian 0 Native Hawailan . � Associate dag��e(e.g.AA,AS) �Ves,PueKO Rlcan 0 Chinese ' Q Gu nian or Chamorro Q Bachclor's degrea(¢.g.BA,AB,BS) �Ves,Cuban 0 Filipino � Samo� � MasteYs degree(e.p.MA,M5,MEng,MEd,MSW,MBA) 0 Yes,other Spanish/Hispanlc/lail�o �Japanese � Ofher PaciFc Isla�der 0-DOCiorate(e.g.PhD,EdD)or Professional degree (Specify) �Other(Specify) .MD DDS DVM LLB JD 21.DecedenYs Single Race Self-Designation-Check ONLY ONE to i�dicata what tha decedenf considared himself or hersalf to be. 22a.Decedent's Vsual Occ�pation-Indicate type of work �White 0 Japanese 0 Samoan done tluring most of working life. DO NOT USE RETIRED. Black o�African Amerlcan 0 Korean 0 OCher Paclflc Islander _ q 0 American InCian or Alaska NaHVe �Vi�tnamcse 0 Don't Know/NOt Sure BOO�.CZCEE EL' nS �Asian Indlan �OFher Asian 0 Refused 22b.Kind of Business/Intlustry � 0 Chlnese �Native Hawailan 0 Other(Spacify) �Flllpino O Guamanian or Chamorro ITEM5��23a- tl M T 9E COMPLETED 23a.Date Pro unc Dead(MO Day Yr�) 23b.SignaYUre of Perso'1 Pronouncing Death(Only wHCn app Ca le.� 2 �c.Lic�ense Number" BYP4RSON:WHO�PROryOUNCES�OR � 5 � . CERTIFIES DEATN � . . � . � � � . . 23d.DaYe�Sign d(M /DaY/�'Y) � 24.Time of�eath . �. ... �.�. .: � � S� Vl 25.Was Medical Examilier or Coroner Contacted7 Yes. �� No � � � � � � CAIJSE OF�DEATW � � � �� = iapproximace 26.Part I. Enter ttie chaln of e ents--diseases,injuries,o mpllcatlons--that directly c sed the d�ath. DO NOT enter t�rminal e ents such a ardiac arres[ Interval: respiratory arresi,or ventrlcular flbrlllation without showing the etiolagy. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add add(fional Iines if necessary Onset to DeatM1 IMMEOIATECAUSE ----------> a. ('��ln1l LV�/�J� 3 (Flnal tlis�ase or condliion oue to(or as a o en o�: resulting in d�ath) . b. C'�EtYt/rGt�.c�I cir�-�f �aLl.�Ca-c�C 6 Sequentia4ly Ilst co�dltiona, oue to(ar as a.c � sequenee ofl: �� . � � � . �� if any,leading So the cause � � � � �� Iisted on Iine a. Enter the . � �� UNOERLYING GAUSE � Oue Co(or as a consequence o�: � � � � � � � (diseasa or lelj�ry that . � . � . . .. . . . . . . � . . . � InitiaTed the av�nts resulting d. . . � it�death)LAST. . . Due to(or as a consequence of): � . p �26.Part 11. Entcr other { ifl ant dition ributi�n to d t bu^t,no6t resulting in th uri_'� e Blve�� . ��27�.W �an�autoPSY Pert�o�r ed? a. � � � res �wo g . '�L(L w��.� .. i . � 28,W autopsy flntlings avallable . � � � e pleie the cause f deathi � ...�. .. �:io c.om�Yes �o ^� 29.If�FeJ� : 30.Did Tobacco Use Contribufe to Death7 33.M ner of�eath E H Not pregnant within past year 0�R � Probably B Natural 0 Homidde t4 � Pregnant at tlme of death B�NO p Unknown �Accident 0 Pending InvestlgaHon °ci � Not pregnant,but pregnant withln 42 tlays of tleath 0 Sulcide � Could not be tleiermined � � Not pregnan[,but pregnant 43 days to 1 year betore deatl� 32.Date of Injury(MO/Day/Vr)(Spell Month) Q Unknown If pregnant within the past year 33.Time of Inj�ry 34.Place of Injury(a.g.home;construcUon site;farm;school) 35.Location of Injury(Street and Number,City,State,Zip Gode) 36.Injury af Work 37.If Transportation Injury,Specify: � 38.Describe How InJury Occurred: 0 J� 0�river/Operafor 0 Pedesirlan ��NO 0 Passenger � Othar(Speclfy) 39a.Certlfier(Check only onc): �Certifying physician-To the best of my knowledge,tleath occurred tlue tollie causa(s)and mann�r stated .�J Pronouncing 8 Certifying physicisn-TO the best of my knowledge,death occurred at the time,date,and place,and due to tha cause(s)and mannar stated 0 Medical Examiner/COro -1On the basis of examination,and/or Invesfigation,In my opinion,deaih d t the Hme,date,antl place,and due[o the causa(s)and manner stated Sigl�ature of certifle�: uJ•-� Tiile of certifler: oc�c..t� �,�s„�e N,,.mb«: .•�f.O o�.Cf3 G��/�1� 39b.Name,A dress a.n Zip Cbdc of Parson Compleiing Ca�se of D�aih(Item 26) � � � � 39c.Date Slgne �(MO� ay/Yr.) . � r •.,.c ,�► � ��3 C� ,3 40.Regi t ar's Dlst�ic[NuTbBr 41.Registrar's tur� �4y. egistra�F�e at � .. ... �/ (Mo aY r) �� - .s� � i 9 /�o�o�3 � 43.Amendments - � �� ' � s�ovin��u p�o�'a��✓�iti'� � C�E2r�yi.✓G �i�ysici��✓ Q D(spo5iiion Permit No.�/ ��/ �� H105-143 G REV O7/2011 ep\wills\melvin.kl\1-96 • . � , °.aY � ��; '..� ;'4 O ' > r � � � �,�1 .. . .. rY-� �'� — _. c � . .. �� ._,� .. �7 �, j..... k.___� �`• �;: _;'J . . t,� G_ , . '� ._. . , � i: LAST WILL AND TESTAMENT �� C.� , "'? `' -_,,,a OF r� c.; , — . . �.. � , KAREN L. MELVIN : �_ ., ' � __:� ,,"a r,n, , ' �-- ,U -;� I , KAREN L. MELVIN, of Hampden Township, Cumberland County, Penn- sylvania, declare this to be my last will and revoke any will previ- ously made by me . ITEM I : I bequeath all of my tangible per.sonalty (no� including cash or securities) and insurance thereon to such of my children, LAURIE M. GOTTDINER, LARRY J. MELVIN, JR. , and LISA L. MELVIN, as are living at the time of my death which shall be divided among them by my Executrix with due regard for their personal preferences in as nearly equal shares as practical . ITEM II : I devise and bequeath the residue of my estate of every nature and wherever situate as follows : A. One-quarter thereof to my daughter, LAURIE M. GOTTDINER, or to her issue, per stirpes . B. One-quarter thereof to my son, LARRY J. MELVIN, JR. , or to his issue, per stirpes . C. One-quarter thereto to my daughter, LISA L. MELVIN, or to her issue, per stirpes . D. One-quarter thereto to be divided between my then living grandchildren. ITEM III : Should any person entitled to a share of my estate not have attained the age of twenty-five (25) years at the time for Page 1 of 5 distribution to him or her, I devise and bequeath this share of each such person to my trustee hereinafter named, IN SEPARATE TRUST, to hold, manage, invest and reinvest the share so received, and the accumulation of income thereon, and to use and apply the income or principal, or so much thereof as, in trustee' s discretion, may be necessary or appropriate for the beneficiary' s support and education, (including college education, trade school and graduate school) without regard to his or her parent' s ability to provide for such support or education, or to make payment for these purposes, without further responsibility, to such beneficiary or to such beneficiary' s parents or to any person taking care of such beneficiary. Any princi- pal or income not so applied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years . If the said beneficiary dies before attaining the age of twenty-five (25) , the trust shall terminate and such share shall be distributed to his or her issue, per stirpes, and in default thereof shall be dis- tributed to my issue, per stirpes . ITEM IV: The interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM V: With respect to any trust created for a grandchild of mine under Item III herein, I appoint the parent of such child who is my child the Trustee thereunder; and in default thereof, I appoint my Executrix and her successors Trustee of such trust . ITEM VI : I appoint my Executrix and her successors guardian of any property which passes, either under this will or otherwise, to a Page 2 of 5 minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this ap- pointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor' s benefit . Such guardian shall have the power to use principal as well as income from time to time for the minor' s support and education (including college education, both graduate and undergraduate) without regard to his or her parent' s ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor' s parent or to any person taking care of the minor. ITEM VII : I appoint my daughter, LAURIE M. GOTTDINER, Executrix of this my last will . Should my daughter, LAURIE M. GOTTDINER, fail to qualify or cease to act as Executrix, I appoint my son, LARRY J. MELVIN, JR. , and my daughter, LISA L. MELVIN, as Co-Executors of this my last will . ITEM VIII : No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, KAREN L. MELVIN, have hereunto set my hand and seal this rl � day of �,��G��,,�,�.t�-�,-ck , 1996 . �]�L�'�-�-�,... �!. d �(.�.��n.-..,._ KAREN L. MELVIN Page 3 of 5 SIGNED, SEALED, PUBLISHED and DECLARED by KAREN L. MELVIN, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the ese ce of e c, other, have subscribed our names as witnesses . c� � ess Address �,�,IYy'vi2a-� • r�-�D7"�f-C..uao- 7�,u.v �2-�..��c.�w�z.�C i� Witness Address COMMONWEALTH OF PENNSYLVANIA: .SS . COUNTY OF CUMBERLAND . I, KAREN L. MELVIN, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. / � ? , '�:�.L�.:� �.�:� ��_�C,�,.�,,� KAREN L. MELVIN Sworn to or affirmed to and acknowledged before me by KAREN L. MELVIN, the Testatrix, this �� day of , 1996 . ,� ,��,� c��'��. L�� R.: 4 i � 1 �',�5;�^, F � � , , ' �, Notary Publ c ��z� _._`• _..._. j d 4,i i,��:o��'{�� ....��.... k t m^u9',..7 Page 4 of 5 COMMONWEALTH OF PENNSYLVANIA : :SS . COUNTY OF CUMBERLAND . 1 Y We, - u�� I-� . S�� and , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence . ness �6,.��12f� �}'`� � �-�Y'-2.-�v2 a.�V Witness Sworn to or affirmed to and acknowledged before me by �, 3 /w ` and ��• � , witnesses, this � day of ��a , 1996 . C.; R :,_ ' ` �'a° ;;��,q Notary Publi .. � . .. � � R'� ;.sPn 4 �°.___°-_-�-�-�—_._...e._._.,.., ._.�.n. � d��. -..� Page 5 of 5