HomeMy WebLinkAbout11-14-13 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 requests the grant of Letters in the appropriate form:
Judith G.Gould
Decedent's Information
Name: Eleanor A.Ross File No: 21 —
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 047-14-2815
Date of Death: 10/25/2013 Age at Death: 89
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at 100 Mt.Allen Dr., Mechanicsburg 17055 Upper Allen Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Messiah Lifeways,17055 Mechanicsburg 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 lvania...................... All personal property $ 370 000.00
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 $ 370,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post Office and Zip Code City,Township or Borough County
❑X A. Petition for Probate and Grant of Letters Testamentary
Petitioners)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 03/09/2009 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=t vorced,*at not pra�to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323 ,Ad did not;hpve acl;$il orn or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ai c
❑NO EXCEPTIONS ❑ EXCEPTIONS M r C Cn
r— M
❑ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,ped(tMp le5 durante abSSntia.d{alrt&minoritate
If Administration,c.t.a or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heir s=> c-' � -��
Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorc ia -$een estwishedhas defined
in 23 Pa.C.S. §3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person. ....t f--
❑NO EXCEPTIONS ❑ EXCEPTIONS Cl 1
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
Form RW O2 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2 .!
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
}
COUNTY OF Cumberland } SS:
Petitioner(s)Printed Name Petitioner(s)Printed Address
Judith G.Gould 1048 Pebworth Rd.
Magnolia,DE 19962
Name as listed in Will: Judith G.Gould
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 knowledge and
belief of Petitioner(s)and that,as Personal Representative(s)of the D cedent,Petitioner(s) a.re well arp truly administer the estate according to law.
Sworn to or affirmed and subscribed before Date
me this 1r`"t day of Date
By. Date
For the Registe
Dale
BOND Required? E] YES n NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
i
Letters.......................................... $ 360.00 Attorney Signature: �,`; � t~r1
( )Short Certificate(s)......... x.00 G">
( )Renunciation(s).............. A-- c
Q
( )Codicil(s)........................ 1 rj
( )Affidavit(s)...................... Printed Name: Linda J.Olsen
Bond............................................. cfa v
Supreme Court
Commission.................................. ID Number: 92858
Other w j I 1 6 s c-
<D
Inheritance tax return 15.00 Firm Name: Hazen Elder Law f ; , ;
Inventory 15.00 Address: 2000 Linglestowtr*Road
Suite 202
Harrisburg,PA 17110
Automation Fee............................ 5.00 Phone: 717-540-4332
JCS Fee....................................... 23.50 Fax: 717-540-4313
TOTAL......................................... $ t E-mail: lolsen @hazenelderlaw.com
DECREE OF THE REGISTER
Date of Death: 0112 /2013
Social Security No: 047-14-2815
Estate of Eleanor A.Ross File No: 21 — 13-1a15
a/k/a:
AND NOW,_ r_AQ/e*_n bC4 -- 14 c=U 3 in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Judith G.Gould
in the above estate and(if applicable)that the instrument(s)dated 03/09/2009
described in the Petition be admitted to probate and filed of record jast I st Will(and Codic of Decedent
2011 f m Wills (�
Copyright(c)2011 form software only The Lackner Grou Page 2 of 2
11105.805 REV(9/11) - -
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal_to duplicate this.copy by photostat, orphotograph. . . '
PEG6Rbt `O:EFfCE Or
Fee for this certificate $6,.00 ,,,����"<� This is to certify that 'the'information here given is
REGIS TER.O5111LLS Ill[' p�tHQFpF°
,771E F rYy _ correctly'copied from an original Certificate of Death
`,`�o�' duly filed with me as'.Local'Registrar. The original
M NOV 1`f : (19M �� 55 � �� z --certificate will, be forwarded to the State Vital
Records Office for permanent filing.
CLERK O.l=
P 198 $ 9.722 _.. .
wRPHANS COURT
Certification Number C U M S E R L A N p .0 0.a Pk "" afte1 R glstrar 701**Date Issued_
Type/Print In COMMONWEALTH OF PENNSYLVANIA-DEPARTMENT OF HEALTH-VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State File Number:
1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex I%;*;*I Security Number 4,Date of Death(MO Day/Yr)(Spell Mal
iEIL IOR �- ROSS F iF7- /5/-12SlS �GTOBE/e .Z1Si rWla
Ss.Age-Last Birthday(Yrs) Sb.Under l Year Se.Under 1 Da 6,Data of Birth(MO/Day/Year)(Spell Month) 71.Birthplace(City and State or Foreign Country)
Months Days Hours Minutes ��QSr Nq�� &T
V/ar' o 'DFGGeMaCe a/ �9'�3 7b.Blnhplaee(CO.ntvl WEST NAVEA/
Ba Residence(SUte or Fonlgn Country) orb.Resid-Ce(Street and Number-Include Apt No.) ac.oil Decedent Live In a Township?
NS ya�dANlf} ${Yes,decadent loved In 4pJPl�i� J4LArAJ _P.
Bd.Residence(COU,ey) -
/oo - tt E.✓ DaeidE
C aly7d6Ka�wa Be.Residence(Zip Code) 17OSS JC3hio,decedent lived within limits of cltv/bore.
9,Ever In US Armed Forces? 10.Marital Status at Time of Death Q Married WI owe 11.S.-Mng Spouse's Name(If wife,give name prior to first marriage)
Q Yes No Q Unknown Q Divorced Q Never Married Q Unknown
12.Father's Name(First,Middle,last,Su1Ylx) 13.Mother's Name Prior to Flnt M.Mage(First,Middle.Uet)
Doht�tilc MIT Z,;= -D6 C co MAitTw E'r W11aJrbJeS.S
14a.Informant's Namc 14b.Rel.tlenship to Decedent 14C.Informant's Mailing Add rose(Street and Number,Clty,State,Zlp Code)
SrL/EitJZ Ts{orsPSOJti uGNra.� /27 Fie aQ lw.�o.'ore Pw. /4o Js
..................... see o eat ..,ore on.,one.............................. ...... ... ............. .....
If Death Occurred In a Hospital: I��Inpetlent If Death OtCUrretl Somewhere Other Than a Hospital: �Hospice Facility �Decedem's Mome
Emerge, Room/Out .tlent Q Dead on Arrival Nuning Mome/long-Term Gr!Fa<ill _ Other(Specify) -
1Sb,F ;ty Name(It not Inatlt.d.n,give street and number; 1S.,City or Town Sbte, nd 21p Coda 15yy.Ceunty Of Death
HES /A /r6s✓A S MEC#4~4/CS.4 KJQG fQ tZo�S CKMQFR
16a.Method of Dlsposl[lon Q Burlal rem.tlon 16b.Date of Disposition 16e.Place of Disposition(Name Of cemetery,crematory,or other place)
Q Re 3.Ot from state Q Denatlq, /O �q �?C13 ✓ANS CRFI�?ATia/J SE le�/���
Other(Spec) )'..
16d.Location of Olspo.ltlen(City or Town,State,and Zip) 17a.51gn. a O1 Fu nerel ServlCe Licensee or P rson in Charge of Interment 17b.-Licensor Number
SeHA>ErtgSTb&3A. I-70£t8 �/' G>,2l 2 2-9-
1.1c Name nd Complete Br)presa of Funeral Fa Iity
1-62>f
a 1g.Decedent's Educe len-Check the box that beat describes the 9.Decadent of Hispanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE races to Indicate what
highest tlegn.or level of school completed at the time at death. box that bait describes whether the decedent the decadent considered himself or herself to be.
Q Bth grade or less Is Spanish/Hlspsonic/Latino. Cheek the"NO" Jim White Q Korean
Q No doplema,9th-12th grade box If decedent Is not Spanish/Hlsps ni./Latine. Q Black or African American Q Vietnamese
High school graduate or 6ED completed No,not Spanish/Hl.panlC/Latino Q American Indian or Alaska NKlve Q Other Asian
Same eellege credit.but no d.gree Q Yes,Mexican,Mexican American,Chicano Q Asian Indian Q Native Hawaiian
Q Associate tlegna(e.g.AA,AS) Q Yas,Puerto Rican Q Chinese Q Guamanian or Chamorro
Q Bachelor'°ree(e.g.BA,AB,BS) Q Yes,Cuban Q Filipino Q Samoan
Q Master's degree(a.g.MA,MS,MEng,MEd,MSW,MBA) Q Yes,other ipanlsh/Hlspanlc/Litlno Q Japanese Q Other Pacific Islander
Q Doctorate(e.g.PhD,EdD)or Professional degree (Specify) Q Other(Specify)
.MD,DDS,DVM LLB JD
T Decedent's Single Raca Self-Design.tlon-Chack ONLY ONE to Indicate whet the decedent considered himself or herself to be. 22s.Decedent's Usual Occupation-Indicate type of work
1g White Q J.Pan... Q Samoan done during most of working life. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure
Q Asian Indian Q Other Asian Q Refused 22b.Kind of Business/Industry
OChin... Q Native H=.fisn Q Other(Spsclfy) ��
Filipino Q G limenian or Chsmofro
ITEMS Z..-2 -1.15T WE COMPLETED 23 a.Data Pronounce Dead (-./Day 211 .5 gnature o Parson Pronouncing Daat Only when applicable) 23c.License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES OEAT
2Ha.Date signed(Me Day/Yrj .. 24,Time _:TM 20 125.Was Medical Examiner or Ceronar Con[actatl7 )j�Ves Q Ne
CAUSE OF DEATH Approximate
26.Pan I. Enter the Chain of events-diseasea,Injuries,or COmplicetlons-that directly caused the death. 00 NOT enter terminal events such as cardiac arrest, ? i-roxim
respiratory arrest,or ventricular fibrillation without showing the gy. DO NOT AAS.REEV/I�(�TE. ET*,only an,,cause on a llna. Add Iddlllonal lines If necessary } Onset to Death
IMMEDIATE CAUSE LA
(...I dose...or condition Due to for as a consequence of):
resulting in death) NI-F--^A`n/t
b. Du I))�]g )
Sequa leads Ilse conditions, Due (or 1s s egos quenee on:
li and,leading to the r the T -
Ilrted on Ilne a. Enter the <. '
VNDERLYINtl GVSH .. Due to(or as a Consequence of):
(tll&et theta
F
Initiated the events resulting d.
qG in death)LAST. - - Due to(or.9 a consequence of):
26.Pan It.Enter other but not resulting In the undertong cause given In Part I - _ _. 27.Was an autopsy pe��r/o�� ed7
Q Yes �No
Were findings available
2B to complete the cause f death7
. ... - Q.Yea No
29.If F �Xa!7: HO.Old Tobacco Use Contribute to Death? 31.Mannar of Death
Q'NOt pngnsnt Alhln Part Y.ar Q Va. Q Probably Em-f4 tural Q Homicide
Q Pregnant at time of death Q No gCJnknown Q Accident Q Pending Investlg.tlon
Q Not Pregnant,but preg,a nt.wlthin 42 days of death Q Suicide Q Could not be determined
V+ Q Not pngn.nt,but pnana nt 43 days to 1 year before death 32.Data of Injury(MO Osy/Yr)(Spell Month)
Q Unknown If pregnant with[,the past year 133.Time of Injury
34.Place of Injury(e.g.home;construction site;farm;school) 3S.Location of Injury(Street and Number,City,State,Zip Code)
96.Injury at Work 37.If Transportation Injury,Specify: HH.Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Petlestrian
Q No Q Passenger Q Other(Specify)
39a.Certifier(Check only one):
l�Grtl/ylrig phyalcoan-To the beat of my know) death occurred due to the cause(s)and manner stated
b_Pronouncing A Certifying physician-TO the art of knowledge,death occurred at the time,date,and place,and due to the cause(s)and manner stated
JQ M-01cal Examiner/Coro On the b mina d/or investigation,In my opinion,death o;K,-d at the time,date,and place,and due to/Tthem-�e caus(e(s))� d meenner stated
Signature O6CSrtlflert TI le of certifier: License Numbel`1 3 17 99 3 U
39b.Nam ,Adtln&s I Person Ca�altting use of Do a (Item 6) •.t 39c.Data Signed Mo/Day/Yr)
ID 0
40.Rag star a O strict Num 41.Re ar's Signature JL`- 42.Registrar Fit ate(3M0 Dey Yr
siog
.
Disposition Permit No 7 REV 07/2011
j !
5
RECORDED OFFICE OF
REGISTER OF 1"!ILLS
Q13 'OU 19 9I�I?AS��WILL AND TESTAMENT
CLERK OF OF
ORPHANS' COURT
CUMBERLAND CO., PA ELEANOR A. ROSS
I, ELEANOR A. ROSS, now domiciled in Dauphin County, Pennsylvania, declare this
to be my Last Will and Testament. I revoke all other wills and codicils that I may have
previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executor from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executor has to claim
reimbursement for any such taxes which become payable as the result of any property over
which I have the power of appointment.
Article III
I give, devise and bequeath my tangible personal property in accordance with any
memorandum I have handwritten or signed, located with my will or with my valuable papers and
T
found within 30 days of the probate of my will. Gifts may only be to persons who survive me or
to organizations which exist at my death, and if there is a conflict, the memorandum having the
latest date shall govern. To the extent no such memorandum is found, or all of my tangible
personal property is not disposed of pursuant thereto, my tangible personal property shall be
added to my residuary estate and pass under Article IV hereof.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my children, JUDITH G. GOULD,
of Magnolia, Delaware, SHERRY L. THOMPSON, of Carlisle, Pennsylvania and KIM D.
GEORGE, of Harrisburg, Pennsylvania, per stirpes. If a beneficiary fails to survive me by
thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants
shall receive,per stirpes, the share the beneficiary would have received had he or she survived
me by thirty (30) days. The share of any deceased child who does not have living issue shall be
divided and distributed to my remaining children,per stirpes.
Article V
I nominate, constitute and appoint my daughter, JUDITH G. GOULD, as Executrix of
my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any
reason whatsoever of my Executrix, I nominate, constitute and appoint my daughter, SHERRY
L. THOMPSON, as successor Executrix of my Last Will and Testament. I direct that my
Executrix or successor Executrix be permitted to serve without bond. In addition to those powers
granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and
to file any qualified disclaimer I could have filed if living. My Executrix or successor Executrix
shall receive reasonable compensation for services rendered to my estate.
2
S
Article VI
In addition to the powers conferred by law, I authorize my Executrix or successor
Executrix, in her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executrix or successor Executrix; and to pay from my estate reasonable compensation for all
their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death, and
3
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, ELEANOR A. ROSS, hereby set my hand to this my Last
Will and Testament, on G 2009, at Harrisburg, Pennsylvania.
ELEAN R A. ROSS
In our presence, the above-named ELEANOR A. ROSS signed this and declared this to
be her Last Will and Testament and now at her request, in her presence, and in the presence of
each other, we sign as witnesses.
Name Address
2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110
2000 Linglestown Rd., Suite 202, Harrisburg, PA 17110
1, ELEANOR A. ROSS, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
Acknowledged before me by
ELEANOR A. ROSS,the Testatrix
on lnl�R c A _' 2009.
Notary Public ELEANOR A. ROSS
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Melissa M.Kain,Notary public
Susquehanna Twp.,Dauphin County
My Commission Expires Aug.11,2010
4
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute
this instrument as her Will; that she signed and executed it willingly as her free and voluntary act
for the purposes therein expressed; that each of us in her sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or
more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
Subscribed to before me
by M�&I S. p'►II.L
and M :►, R ID: / fitness
witnesse , on N144.ceq , 2009.
Q
Witn
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Melissa M.Kain,Notary Public
Susquehanna Up.,Dauphin County
My Commission Expires Aug.11,2010
5