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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 request(s)the grant of Letters in the appropriate form:
Decedent's Information I [�J
Dj_
Name: Doris bersin File No:
a/k/a: Doris Louis Dersin (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: October 2,2013 Age at death:90
Decedent was domiciled at death in Cumberland County, Pennsylvania (state)with his/her last
principal residence at 801 N.Hanover Street,Carlisle,PA 17013 Carlisle Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Hershey Medical Center,501 University Drive,Hershey,PA 17033 Derry Township Dauphin 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 Pennsylvania..................... ....... All personal property $ 90,000.00
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsy lvania. ....................... Personal property in County $
Value of real estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE. ... $ 90.000.00
Real estate in Pennsylvania situated at: N/A
(Attach additional sheets,if necessary,) Street address,Post Office and Zip Code City,Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated May 24, 1999 and Codicil(s)
thereto dated N/A
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 0 EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.fa.,pendente lite,durante absentia,durante minoritate
If Administration,c.t.a. or db.nx l.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 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.
0 NO EXCEPTIONS 0 EXCEPTIONS
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,ifnecessaty):
Name Relationship Address
Form RW-02 rev.10/11/2011 Page 1 of 2
Oath of Personal Representative Official Use Only
STATE OF MARYbAND- PfNN S-/l,v A PJIA )
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Muryl E.Dersin II 2703 Loch Haven Drive I'amsville MD 21754
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 Decedent,the Petitioners will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before i�� Date ��f 2 2 zo13
me this day of Date
By: Date
For the Register Date
BOND Required: Q YES Q NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ 1 O od Attorney Signature:
( (0 )Short Certificate(s).. . . . . p°
( )Renunciation(s).. . . . . . . .
( )Codicil(s). . . . . . . . . .. . .
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Peter R.Henninger,Jr.
Commission. . . .. . . . . . . . . . . . . . Supreme Court
OtherwI . . . . . . . . ID Number: 44873
. . 1,5_p4 Firm Name: Jones&Henninger,P.C.
. . . . . Address: 339 W Governor Rd..Ste.201
. . . . . . Hershey,PA 17033
. . . . . Phone: 717-533-7113
Automation Fee. . . . . . . . . . . . . . . rj,(gyp Fax: 717-533-7233
ICS Fee. . . . . . . . . . . . . . . . . . . . . Email: z ete• hones-henninger_cnm
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 3i3 .1t37�16�
DECREE OF THE REGISTER
Estate of Doris Dersin File No:
a/k/a:
AND NOW, ,in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to
in the above estate and(if applicable)that
the instrument(s)dated
described in*the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills
Form RW-01 rev.10111/2011 Page 2 of 2
14105.805 REV(9111)
err
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LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, DORIS L. DERSIN, widow, of
RR1, Box 416, Houtzdale, Clearfield County, Pennsylvania 16651, being of
sound and disposing mind, memory and understanding, do hereby make, publish
and declare this as and for my Last Will and Testament, hereby revoking and
making null and void any and all former Wills and/or Codicils heretofore by
me made.
FIRST: I do direct my Executor hereinafter named to pay all my just debts
and funeral expenses as soon as may be found convenient after my decease.
SECOND: I do direct my Executor to pay all State and Federal transfer
inheritance and estate taxes on property passing by this, my Last Will and
Testament, from my residuary estate.
THIRD: I do give, devise and bequeath the rest, residue and remainder of
MY estate, real, personal, or mixed, and wheresoever situate to my
grandchildren, ERIC JOSEPH and LANCE JOSEPH, both currently residing in
Hummelstown, Pennsylvania, and to JESSICA DERSIN, currently residing in
Ijamsville, Maryland, in equal shares, share and share alike.
If any child named herein shall predecease me, their share shall
go to their parents, or parent, then living, at my death.
FOURTH: I give, confer and grant unto my Executor the authority to sell,
convey, exchange, partition or otherwise dispose of any real or personal
property of which I may die seized or possessed or which may at any time
form part of my estate, at public or private sale, for such purposes and
upon such terms, and in such manner, at such prices as he may determine.
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LASTLY: I nominate, constitute and appoint MURYL E. DERSIN, II, of
Ijamsville, Maryland, as Executor of this, my Last Will and Testament.
Should MURYL E. DERSIN, II, predecease me or be otherwise unable to serve in
this capacity, I nominate, constitute and appoint DENISE E. JOSEPH, of
Hummelstown, Pennsylvania, as Alternate Executrix.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this,
the 2nd page of my Last Will and Testament, the preceding page hereof being
identified by my initials contained in the margin thereof, all done the
O day of 1999.
(SEAL)
DORIS L. DERSIN
SIGNED, SEALED, PUBLISHED and DECLARED by the above named
Testatrix as and for her Last Will and Testament, in the presence of us,
who, at her request,. in her presence, and in the presence of each other,
have hereunto subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CLEARFIELD
I, DORIS L. DERSIN, Testatrix, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed it willingly, and, that I signed it as my
free and voluntary act for the purposes therein contained.
c z 2
DORIS L. -DERSIN
Sworn or affirmed to and acknowledged before me by DORIS L. DERSIN, the
Testatrix, this _a—letay of 1999.
Notary Public
My commission expires:
ERonald OTARIAL SEAL
Archer,Notary Pub lic
COMMONWEALTH OF PENNSYLVANIA: le f3om,CIEd Counn Expires March 23,2001
COUNTY OF CLEARFIELD
We, Peggy Swanson and Tamara S. Stodart, the witnesses 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 Testatrix,
DORIS L. DERSIN, sign and execute the .instrument as her Last Will; that
DORIS L. DERSIN signed willingly and that DORIS L. DERSIN 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;, and
that to the best of our knowledge, the Testatrix was at the time eighteen
(18) years or more of age, of sound mind and under no constraint or
influence.
ure
Signatures
Sworn or affirmed to and subscribed to before me by Peggy Swanson and Tamara
S. Stodart, witnesses, this - ay of .-I-YA— , 1999.
Notary Public
My commission expires:
NOTARIAL SEAL
Ronald E.Archer,Notary Public
Houttdale Dom,CIEd County
M ommission Expires March 23,2001