HomeMy WebLinkAbout09-11-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF��,��12QX I� 1 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 respectfiilly request(s) the grant of Letters in the appropriate form: !�
Decedent's Informati n �'
Name: D � L-' File No• �� ����(p�
a/k/a: � (Assigned by Register)
a/k/a:
a/k/a: Social Security No:o2<JS=O�—�%l lS—'"
Date of Death:�'��`,�/,3 Age at death: �,.!L
Decedent was domiciled at death in Cl��,��/2�.�i� Cou�}ty, �i4 (Srare)with his/her last
principal residence atS,��`�1,¢u/,gv //�, " �,lQ�rrs� .`6L.1�'/��7oii �.l�r��s r.342O ��ilr�G�G/-�i�
Street address,Post Office and Zip Code � City,Township or Borough County
Decedent died at.�l F.s�-�`�z..�A�//,��. �j��`LLr��-<�d�/ �,��,�f.302t/ �m.�3��/.,y�,,�� /�,¢
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of va(ue of decedent's property at death:
�
If domiciled in Pennsylvania............................ All personal property $ �,�7, �1���" 7
If not domici[ed in Pennsylvania. ....................... Personal property in Pemisylvania $
Ijnot domiciled in Pennsyh�ania. ....................... Personal property in County $
Value of rea[estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE.... $
Real estate in Pennsylvania situated ar.
(Atrnch additionn!sheets,i�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)he/she/they is/are the Executor(s)named in the last Will of tl�e Decedent,dated ��—/�—,�O /l and Codicil(s)
tl�ereto dated
State relevant circumstances(e.g.renuncintion,death of executor,etc.)
Except as follows: after tlie 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 chiid born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
� NO EXCEPTIONS ❑EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (Ifapplicable)
c.t.u.,d.b.n.,d.b.n.c.t.u.,pendente lite,durante ubsentiu,durunte 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 tlie 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�XCEPTIONS �EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the fo��spouse(itdiiy)and�eir"si(attuch
udcfitionul sheets,iJ�necessury): � ".^, `�
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Oath of Personal Representative ofs�,ai us�o�iy
COMMONWEALTH OF PENNSYLVANIA }
, // } SS: ,
COUNTY OF L'�h�/�L�ZL/��/!� } '
Petitioner(s)Printed Name Petitioner(s)Printed Address '�
�1��/2 � �� /`fd cc 2 L 12- ..��/ /C.4.`.r��r'il/� ��/z< dG-'
�'A�-rr� h�`LL �,� /70i� '
The Petitioner(s)above-named swear(s)or a�rm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s)and tliat,as Personal Representative(s)of the Dece ent,the Petitioner )will well and truly administer the estate according to law.
Sworn to or affirmed and su scri ed before - Dace �/C- /3
me this�day of�� �,�� Date
By�� Z �0�1-�"L'L Date
For the Reoister Date
BOND Required:Q YES 'O To the Register of Wills:
FEES: Please enter my appearance by my signature betow:
�-�
Letters . . . . . . . . . . . . . . . . . . .. . . $ 21 '��-'�-! Attorney Signature:
( �- ) Short Certificate(s). .. . . . '�L�("(, �
,_., ..;
( )Renunciation(s).. . . . . . . . n <;� ','��' i"�'a
� )Codicil(s). . . . . . . .. . . . . � '".:' =s
�' � '",:? -�r
� )Affidavit(s).. . . . . . . . . . . W =,�' �......; �
rti -, ,�:, ,
Bond.. . . . . . . . . . . .. . . . . . . . . . . Printed Name: -,��:_ r_ ,_._A ,
Commission. . . . . . . . . . .. . . . . . . Supreme Court r"' t�'� i� :--}
Other . . . . .. . ID Number: =- ��
� . . . .. . .. I�-t��> `�--� c� - ' "`.
�, � � ,
. . . . .. . . �5.�� FirmName: °• ;
�►1,'U�X��-F�'1�Li . . . . . . . . � �.��� Address: •" ...� -- �
. . .. . . -'*'t u C✓7
. . . . . . �"' t__.a
. . . .. . . . Phone:
Automation Fee. . . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . .. . . . . . . . . . . . . . ` .�(� Email:
TOTAL. . . . . . . . . . . . . . . . . ... . $ . Ci
DECREE OF THE REGISTER
Estate of�.'�,O • � File No:_2-� `� I��j-- �i� (('�
a/k/a:
AND NOW, � �-� ,c���, in consider tion of the ore oing Petition,
satisfactory proof having been present d before me,IT I ECREED that Let rs �
are hereby granted to �����TI � . ��1L��n�'��
in the above estate and(if applicable)that
the instrument(s)dated
described in the Petition be ad itted o probate and filed record as the last�ill(and Codicil )),of�Dece ent.
� a �t C�S �. -
egister of Wills ����/'n�
1 " � � � �
Fo;�»,��v-n? �•�v. lnittiant� Page of 2
_ .�.
K�os.sas�v�gli i}
Lt3CAL REGISTRAR'S CERTIFICATICiN t�F DEATH
WARNING: It i� illegal.#o duplicate this copy by pho#astat p�photograph.
Fee'for this certi�cate> $6,f30 � .. ;,,,,f�,•,•�„„ � This is-to certify that the information hare given is
� ��, " 0�''`4:�j��F�'�`N - correctly copied from an original Certificate of Death
- . t . '.,� �._�• ' `•�3��'��'�_- __ yJ'�=, � daly filed with me as I;oea1 Registrar. The ariginal
� , ._` y ��_ .,. 2. ai certifieate will be 'forwarded .to the State Vital
�� Records Office for pe ent filing.
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LAST WILL AND TESTAMENT OF � ` : ' '
CLEO F. HENRY :' � ' ,.....� •
._ ,,,a - „{
� I, CLEO F. HENRY, of 521 Fairway Drive, Camp Hill, East Pennsboro Township,
Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament,
revoking any former Wills and Codicils made by me.
FIRST: I am not married. I have no children. I am naming my friend, CHERYL E.
HOERNER, as the beneficiary in my Last Will and Testament.
SECOND: I give my tangible personal property and all casualty insurance that I
am carrying on said tangible personal property to my friend, CHERYL E. HOERNER. In
the event my friend, Cheryl E. Hoerner fails to survive me, then I give said tangible
personal property to my , in equal shares or as near equal as possible,
to be divided between them as they might agree. If they are unable to reach agree-
ment, or, if they are unable to agree, then as determined by the President Judge of the
Court of Common Pleas of Cumberland County.
THIRD: I presently own, and have living with me, two cats. If one or both of my
cats survive me, my friend, CHERYL E. HOERNER, has agreed to maintain them in her
household with her own animals. If Cheryl E. Hoerner fails to survive me, at my death,
all of our animals shall be transferred to the care and facilities of Dr. Calvin Clements
and Palmyra Animal Clinic, Palmyra, Pennsylvania, for adoption and placement in a
home or homes of appropriate individuals, who will agree to such adoptions as deter-
mined by Dr. Clements or his designee veterinarian at the Palmyra Animal Clinic. Any
and all costs for the care and feeding of said animals by the Palmyra Animal Clinic, until
such adoptions, shall be borne by my estate.
FOURTH: I give the sum of Four Thousand Dollars ($4,000) to Daniel Burkett,
of 2 East Main Street, Walnut Bottom, PA 17266, to be deposited into and used for the
account of the Burkett Family Reunion held annually each June in Plainfield, Pennsyl-
vania, with withdrawals from said account to be determined by said Daniel Burkett and
with the amounts and uses of said funds to be used exclusively for the benefit of the
Burkett Family Reunion as determined by Daniel Burkett. In the event Daniel Burkett
Last Will and Testament of Page 1 of 4 �.�'`
CLEO F. HENRY CFH`\
fails to survive me, then his successor with the Burkett Family Reunion shall make the
determinations described herein.
FIFTH: I give the rest and remainder of my estate, real and personal, to my
friend CHERYL E. HOERNER. In the event my friend, Cheryl E. Hoerner, fails to
survive me, I give, devise and bequeath the rest and remainder of my estate, real and
personal, to or the survivor of them, or, if they fail to survive me, to
their issue per stipes.
SIXTH: I name my friend, CHERYL E. HOERNER, as my Executrix. In the
event, my friend is unable or unwilling to serve, I name as my
Executor. I direct that my Executrix or Executor, and their successors, regardless of
number or gender, serve without bond in any jurisdiction in which called upon to act.
SEVENTH: I give to any Executor named in this Will or any Codicil hereto all of
the powers now applicable by law to fiduciaries in the Commonwealth of Pennsylvania
and, in particular, through the Probate, Estates and Fiduciaries Code, as effective and
as in effect on the date hereof, during the administration and until the completion of the
distribution of my estate, and until the termination of all trusts created hereunder and
until the completion of the distribution of the assets of such trusts.
EIGHTH: No interest of any beneficiary under this Will or any Codicil hereto or
any Trust created herein shall be subject to anticipation or to voluntary or involuntary
alienation.
IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and
Testament this 18th day of November, 2011.
� � �- �'�c�.J�.t.
��� (SEAL)
CLEO �. HENRY, Testatrix
Last Will and Testament of Page 2 of 4 `'!
CLEO F. HENRY CFH
SELF-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND .
I, CLEO F. HENRY, Testatrix, whose name is signed to the attached or forego-
ing instrument, having been duly sworn according to law, do hereby acknowledge that I
signed and executed the attached instrument as my Last Will and Testament; that I
signed it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed, on this the 18th day of November, 2011.
�'Q�.. 1
CLEO F. HENRY, Testatrix
SUBSCRIBED, sworn to, and acknowledged before me by CLEO F. HENRY, the
Testatrix, this 18th day of November, 2011.
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I., C�,�t. �.��. �.�C' \.I�.taa.-`V�.
Notary Public
COMMONWEALTti OF PENNSYLVANIA
NOTARIAL SEAL
MARJORIE L.JOHNSON,Notary Public
Camp Hill Boro.,Cumbe�iand County
�.�t:,�'�,�nmis�ion iret 15,2015
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Last Will and Testament of Page 3 of �"f
CLEO F. HENRY
_ _ _ _ _
SELF-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND .
WE, the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw CLEO F. HENRY sign and execute the instrument as her Last
Will and Testament; that she signed willingly (or willingly directed another to sign for
her), and that she executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, at the request of and in the presence and
hearing of CLEO F. HENRY, and in the presence of each other, signed the Last Will
and Testament as witnesses; and that, to the best of our knowledge CLEO F. HENRY
was at that time eighteen (18) years of age or older, of sound mind, and under no
constraint or undue influence.
,
_ -� � �. t.
Witness
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y' � r�f _4 �
Witnes
�;
Witness
SUBSCRIBED, sworn to, and acknowledged before me, a notary public,
by'l,�`� ��l�if�"1(;� , �l ���L, �, and
������C�C�...� T. ''(�"l�� ��Qlt,�, witnesses, this 18t" day of November, 2011.
COMMONW�L7H OF PENNSYLVANIA
NOTARIAL SEAL ��j - ` `� 1, �q.,�--,�....�
MARJORIE L.JOHNSON,Notary Public ; ;�'�''� _J��Y�I
Gam�?Nill Boro.,Cumbe�iand County Notary Public
�Ay Cu;�nmission E�ires ril 15,20i5
Last Will and Testament of Page 4 of 4
CLEO F. HENRY