HomeMy WebLinkAbout11-18-13 PETITION FOR GRANT UF LETTERS
REGISTER OF WILLS OF �I�l 5�f�)� 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 f
Name• F�tfKl� �i ����� File No• �r '�l�"� ���7
a/Wa: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ��� '�' �2-�6
Date of Death: � 3o i3 Age at death: �(o
Decedent was domiciled at death in �J tv�(?�v2L-��p County, Pf� (Srure)with his/her last
principal residence at eo u ivTnu M ���,,,c M f�NAt.rtcS(3 �2Er -�� 1lo s� Ct;r.1P���
Street address, ost OfTice and Zip Code City,Township or Borough County
Decedent died at (�I�ta�_�f'�t-Uc�S ��Gµq.�,ic.,5�✓I_.(�- �,4- I�c�� Cvr��.�i� Q�—
Street address,Post Office and Zip Code City,Township or Borough Caunty State
Estimate of value of decedenPs property at death:
If domiciled in Pennsylvania................ ... ..... . ... All personal properry $ a� V d d
Irnot domrciled in Pennsylvania. .................... ... Personal property in Pennsylvania $
If not domici[ed in Pennsylvania. ........... ............ Personal property in County $
Value of real estate in Pennsylvania... .................................... ......... ......... $
TOTAL ESTINIATED VALUE. ... $ ,�S—� �o J
Real estate in Pennsylvania situated at
(Altnch additionnl sheets,ijnecessary.) Street address,Post Oftice and Zip Code City,Towns or Borough ="' ;7E7 County
� � � �
Q �
� A. Petition for Probate and Grant of Letters Testamentarv � � `' �' �
�
Petitiouer(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated � � �� � ��ar�odicil(s)
thereto dated r�c� �7 �,. t-- 1--� �.r, t'ri
� 'w CX7 :a�
State relevant circumstances(e.g.renu�tciation,death of executor,etc� . ;,rG CS �-.�
V � � � �' �
Except as follows: after the execution of the instrument(s)offered for probate Decedeut did not marry,wascCi�t�dora�d,w�ot a pd'�`�rty a pending
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divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §3�,3�$3�,and did�t hav�-a r�d born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.',� —a � �
�NO EXCEPTIONS ❑EXCEPTIONS �-"' � �
❑ B. Petition for Grant of Letters of Administra.tion (If applicable)
c.[.a.,d.b.ri.,d.b.n.c.t.a.,pendente lite,clurunte absentiu,durmtte minoritute
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑NO EXCEPTIONS �EXCEPTIONS
i'�itioner(s),after a proper search has/have ascertained that Decedei�t left no��'i'::, �was survived by the fol(owing spouse(if any)and heirs(uttuch
uuu�tia�ul sheets, ifnecessury):
Name Relationshi Address
Fo,-��,�w-oz rev.!0/!1/10/1 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
��t u-- .I �'���s�i�'� 7 ?�� 5 �1�`'�-� �i Fv1�.�N�'��C���,� �',� -�7�:.s:�
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the fore ' Petition are true and correct to the best of the knowledge and belief
of Petitic�uer(s)and tliat,as Personal Representative(s)of the�ecedent,t e P titio er(s)will well and truly administer the estate according to law.
Sworn.to or firmed a. subscribed before Date 1� 1 U 13
me t � �$ y of ,02.�� Date
By: Date�:
�
For the Re�ister C'� Da� %� ('�'1
��T �
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m �' c� �= � �
BOND Required:�YES �O To the Register of Wil[s: � � r.— �,, �.� �
FEES: Please enter my appearance by�"s�g,�aF�i1�e b�v: '�3 '�
., � .
Letters. . . . . . . . . . . . . . . . . . . . . . $ ���'. �'�� Attorney Signature: � �,� � `L' `"�'R ���
(,� ) Short Certificate(s). . .. . . L' • ; � r-�� � -r; � �� `-'
.�.� <:`r
( )Renunciation(s).. . . . . . . . '"� � f--• �'- �-r7
_ �._
( )Codicil(s). . . . . . . . . . . . . `� -�T�rn �
( )Affidavit(s).. . . . . . . . . . . ;� �
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . . . . . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . ID Number:
�� f . .;�. . . . I ,�L
i � t'X 1 [' .��1 . �� Firm Name:
��J�t'�a��Lf • • • • • • • • �! � Address:
. . . . . . . . Phone:
Automation Fee. . . . . . . . . . . . . . . � Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . �L`�� Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ '
DECREE OF THE REGISTER
Estate of � . ����� f�� File No: `��� '�� � %„2 �
a/k/a:
AND NOW, �(��� � ' ����Y�1 ', " ,��J � , in considerat1ion of the fo1re� going Petition,
satisfactory proof having be presented before me,IT IS DECREED t t Letters —�=��1 (� (Yl�/'�"1(} �'L.-/
are hereby granted to �j�i � ��. ���I��P� _
in the above estate and(if appli�uble)that
the instrument(s) dated �fl{"�� �try 2�'C'�{
described in the Petition be ad� mitted to probate and filed of record as the last Will (and Codicil(s)j of Decedent.
:-
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Register of Wills �, _
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Fo,„�nw-nz ,��v. ioi�tiznl� t Pa e 2 of 2
H105.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: it is illegal to duplicate this copy by photostat or photograph.
RE�OR�}E� "v��{C� ��
Ree for this certificate, $6.00 ,,,.� ,,,,.��"N"' --- This is to certify thaf the information here given is
�������� 4� ti�'``��-� ��,,n''��,P`jN QF PENy_ correctly copied from an original Certificate of Death
, ����`o`� =_ `fG,; duly filed with me as I,ocal Registrar. The original
���3 ����1� 1U �I t '�- 2 �o ` ,. ` a; , certificate will be forwarded to the State Vital
� ;� � a� Records Office for permanent filing.
.
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P 1985 �967 c��R� �� ==o�,�, - �?,,, -
4RPNANS� CGI;PT q'�TMENTOE��'P / �
,��''�
Gertification Number ����E��Q�,�� �� � ��� "'-��������""'"�� c eg t ar Date Issued
Typ�/V�int In COMMONWEALTH OF PENNSVLVANIA�DEPARTMENT OF HEALTH�VITAL RECORDS
Pen^'"°"` CERTIFICATE OF �EATH
BI <k Ink State Flle Numb�r.
1.D e eni's La{al Na (Flr lddle,Wst,Suffix) 2.Sex 3.Soclal Sewrlty Number 4.Date of Deafh(MO/Day/Vr)(Spwll Mo)
►cos-a -
Sa.A`e-tast Birt Gay(Yn) `Sb.Under 1 Year Sc.Under 1 Da 6.Da[e of Birth(MO/Day/Vear)(Spell MonSh) 7a:BlKhplace(GISy antl StaYe or rcisn Country)
�i 86 . . . � Months �ays Houn Mlnuies ��
Z- 7b.BIrtl�plac�(COUnty)
8a.Resld�tic�(St>Ca Or ForlFfrt CoUnSry).� �8b.Residence(Stroet and Numbw -Intlude Apt No.) 8c.Did Decedeni Llve in a Townahl T �
"sa.n..iae.,�. couocv) 4833 E� Z�'indle Road � re:,aa�eas�c iwea o-, -�en t.Np.
� Se.Resldenu(2ip Code) '�� 0 No,deCadent Ilved wlthln Ilmils of city/boro.
9.Ever in US Armad ForcasT 30.Marital Status at Time of Deaih 0 Married � QtWldowad 31.Survlving Spouse's Name(If wife,give name prior to flrst marriaQa)
0 Yea � No �Unknown � Dlvorcetl �Never Marrled �Unknow �
12.FathaYS N�me(First,Middle,Last,Sufflx) 13.MothaYS Namw Prlor So Flrst Ma��lage(Fi�st,Middlc,Last)
=rvin H_ Niiller
14a.Info�manYS Name 14b.Relatlonship to�ecetlent 14c. nfo�mant's Mai InQ A d�ess Stroet and Num6er,City,State,21p CoGe)
� F�ik R�isser r- --- -- - - - .. _�e� _ e� a � - - - - - - - - � --
est n Yon
If Oaaih Occur'adin�a Mospial:� CI�Inpatlani� IIf D�ath�ecurred Somewhfre OtherThsn s Hoapital: d Mosplee Faclllty �C]DeCedBn['S HOT�
� � Ema ency RoorT/OUtpatlent� . . � Dead on Arrival � N rainQ Home�Wng-TSrm Gro Facllity� Q Other(Specify) � � � �
1 .Facility Nam.e Ii not tnsCRUtbn,QW�Streot and nu�l'�ber) 15c.Clty r Town,State,and 2tp Coda 15d.Co�anty of Death
� 16a.Method of DISp siHan �Burial � Cremation 16b.D�te of Dispositlon 1 c.Place of Dlspositlon(Name of cemeYery,cremafary,or other place)
$ O Ramovalfrom5ta[e O oo,,,c�o., 'IO/3/20'13 Ft� 2ndia�ltc.�t11 C'� National C�tery
� . ��. O o:na�tsa��iry1 P .
� i6d.LocaHOrl�o �ISpaSitioH(City orTOwn,State,and Zip) � 17e.SlgnituYe Of Funl�al Llcens�e o�Person in CharQe Ot InSw�ment 17G.llcenze�NUmba=
Anriv311e, PA 7 7003
ia�..Na..,.a.+a cert,a�ece ndare::of c��er.i F.�mcy
� 16.Decetlmf's EducaHOn- h�ck tha box th�t beat d�scribea the 19.Oeceda of Hispan c Oritin-Check the 20.Dece Yz Race-Check O E OR MORE races to Indicate what
hlghest degr�ea or 7evel of school completetl at the Ylme of death. box thai basi deseribes wheiher th�deeedent the decadent conzidered himself or herself to b�.
0 Hth grada o�lezs � is Spanish/Nlspanlc/LaYino. Check the"NO^ �White O Korean
� No diploma,9th-12th grade boz If decatlent is not Sp�nish/Hispanic/LaHno. � Black or Afrlcan Am�rican 0 Vlefnamese
{� Hlah sehaol araduate or GED compbted [�}NO,not Spanish/Hlzpanic/Latino �Am��ican Intlian ar Alaska Native � Othe�Atlan
O Some colle{e credit,but no deQr�e �Yes,Msxican,Maxlcan AmeNCan,Chicano �Asian Indian � � Nativ�Hawali�n
Q Associatw.de`ree(e.s.AA,AS) �Vez,PueRO Rican 0 Chlnese � Guamanian or Chamorro
O B�chelor's tleQre�(e.4.BA,A0,BS) O Yea,Cuban O Fllipino O Samoan
0 MasteYS d�grae(a.g.MA,M5,MEnQ,ME4,MSW,MBA) 0 Ves,othar SpaMSh/Hlfpanie/Latino �1aPanesa � Other Paciflc Islandar
0 DocmraM(e.`.PhD,EdD)or Professional d�gree (Spaelfy) 0 Othar(Specify)
.MD DDS DVM LLB JD
21.Dec¢denYS Single Race Self-DeslQnatlon-Check ONLY ONE to Indicaie what the tlecetlent consldered himsNf or herself to be. 22a.Decedeni's Usual Ocwpation-IndiCite type of wOfk
{�Whlie O Japanese � Simoan done d�ring most of workinQ Ilfe. DO NOT USE RETIRED.
� Biaek or Afrlun Amerlun 0 Korean 0 Other Paciflc Islander �xx��r
� O Am��ican InGlan or Alaska Native 0 Vlatnamosw � Don't Know/NOt Sure
0 Aslan Indian �Other Aslan O aer�sea 22b.Kind of Buslnesz/InGustry
� p cn�.,e,e O Native Hawalian O ocn���sP�ary) Braddoc]c Diesel (Ft� Mye.rs)
o F��,P��e O Guamanian or Gh�morro
ITEMS 13a-23� MUBT B6 COMPlETEO. �23i.Dai�Pronounced Daad Mo Dsy 23 .Slanature of PersOn ronouncing Death Only when appl{q le 3C.LlcenSe NuM6er �
9Y PERSON WHO pRQNDtJNCES OR . . . . . � .
CERTIFIES:OEATH���. � . �
23tl.Date Sige�ed�(MO/Day/Yr) . . � 24.Ti e of De th . � � �
25.Was Medlca�Examiner pr Coroner ConUCtetl7 � � Yes Na
� � CAUSE OF��EATH � � ,aPproxi�o.s�
26.Vart 1. Enter the chaln of events--tllseases,InjuMes,or complicatlons--that directly cauzeG She deaih. DO NOT�nter terminal evmts sueh as 4rdlac arrest, � Inferval:
rcspiratory arrest,or ventrlcular fibrillatlon withou�showing the etlaloay. 00 NOT ABBREVIATE. Enter only one cause on a Iine. ACd addifional Iines if neeessary. 1 Onaet to DeaTh
� 1
IMMEDIATE CAUSE -"""'-"""> a.rrc�s Ia� ��7 D C�rJr.�A C S�r A ZC'4'�e ti� 1
(Final disease or conCitlo� Due to(or as a consequence of): � �
rwculCin4 in dwath) �
b. �
S�quanGally Il�t ro�tlitlon�, � Cu�co(or as a coru�qu�nc�o�: � �
If any,IeadinQ�xo[ha.ca�ss �. � � � � � � � �
�IStetl on Ilna a: Enbr the . 1
UNDERLYINB-CAUSE Due to(Or as a wnsequlnce on: � 1 �
� (disease or InJury that � . � �
InitiaSaA the events resulti�g tl. �
� In daath)LAST. D�e to(or as a conseq�aenca ofl: ��
� 26.Pae!11..Entor other i1 buC nat resulting In tl�e underlying cause given In Part 1. 27.Wis an auiopsy parformed7
0 Yes No
� � � � . 2H.Were auiopsy finOlnas avallable
�' �. � �. . � to complete th�ca of d�ath?
� � � . � . .. . � � � O Yes c No
29.�1 ia 30.Did Tobaeco Use Contribute to Death7 31.Man f Dwath
�pregnant wl[hin past year O Ves p Pr�o aM� atural � Momicide
S Q PreQnant at Hme of Eeath 0 No �known O P.ceident � Pending InvestlQaSlon
�' � Not presnant,but pregnan!wlthln 42 days of dealh � Suicitle � Could not be defermined
� � Not prcgnant,6ut pregnan[43 daya to 1 yaar bafore daath 32.Date of InJury(MO/Day/Yr)(Spell Monfh)
� Vnknown If pregnant wilhin the past year 33.Time of Injury
34.Place of InJury,(e.Q.home;conztructlon slte;farm;school) 35.locaHOn of InJury(SVeet and Numbe�,qty,Couniy,Siate,21p Code)
36.Injury at Wo�k 37.If T�anspoKation InJury,SpeCify: 38.DaSC�ibe HOw InJury Occu�red:
� Ves � Drlver/Operator O Pedeatrian
� No � Passenaer � Othar(Spe<Ify)
39a.Ce -physl<fan,cartltied nurse practltloner medlcal ezaminer/coroner(Check only one):
ertifyina ony-To the best of my knowled death occurrod due to the cause(aJ antl manner stated.
O Pronoun<ing 8.Certifyin[-To the best o knowledge,death occurred ae the time,dace,and placw,and due to the cause(s)anE manner statad.
0 Medical Examiner/COroner-On tha b f examination and/or investigation,in my op{nion,Aeath oeeurred at The tlme,date,and place,and Cue eo ehe�eau�syay(s)end manne�siated.
Signature af eertifier: Title of certifler: �� License Number:�"� G'?���
39y N�me,Atltl�esa and Zip Code of Parion Complailn`Cause o4 Daath(It�m 26J 39c.Data Slsn d /D�y(1'�)
(l-.�G'�Ee�t�.c���Az�zL�4,�...., �2 0o QFfr /'.Pe..^-a eEt..a�1 rt.m �f..,o H..t n•a .-,oi� � 10�° fN}��t3 .
� 40.Re ar S DiaflNyt Num er 41.Reg r s SIS . 42.ReQlsfrar FHe Dat� Mo�ay
� 43.Amendn�ents .� �� O ' .
�
09lv D�+SG� �=os_=<3
DlzposlHOn Perm�t No. REV 07/2012
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I , MARY ELLEN REINERS, of Harrisburg, Pennsylvania, �� �reby c�eelar�, rii
this to be my Last Will and Testament, and hereby revoke any Will oryEodicil pr�ously`� �
made by me. ;
ITEM FIRST:
1.1. I bequeath any and all motor vehicles and their accessories and equipment, all
personal effects and belongings, all clothing and other articles of household use or
ornament and all other tangible personalty of like nature owned�y me at the time of my
death, to my son, RICHARD W. REISSER, provided he survives me by sixty days.
1.2. Should my son, RICHARD W. REISSER, predecease me or die before the sixty-
first day after my death, I bequeath such tangible personalty in equal shares to my
grandchildren, ERIK JON REISSER and ANDREW WAYNE REISSER, or the survivor
of them.
ITEM SECOND:
2.1. I devise and bequeath the rest, residue and remainder of my estate of every nature
and wherever situate, of which I may die seized or possessed or to which I may be
entitled at the time of my death, including any property over which I may have the power
of disposition by appointment or otherwise,to my son; RICHARD W. REISSER,
provided he survives me by sixty days.
2.2. Should my son, RICHARD W. REISSER, predecease me ar die before the sixty-
first day after my death, I bequeath such residue in equal shares to my grandchildren,
ERIK JON REISSER and ANDREW WAYNE REISSER, or the survivor of them.
ITEM THIRD:
3.1. My Personal Representatives, Trustees and Guardians of Estate, or such of them
as are appointed in this Will, shall have the following powers in addition to those vested
in them by law and by other provisions of my Will, applicable to all property, whether
� .�,2�a
principal or income, exercisable without court approval, and effective until actual
distribution of all property. Such list of powers is not exclusive and it is not meant or
intended for the powers hereinafter set forth to be exclusionary and in derogation of any
remaining statutory powers:
3.1.A. To accept and retain any or all of the assets, real or personal, including
investment securities, and real estate which may at the time of my death comprise my
estate, if they shall consider it expedient and�to the advantage of my estate to do so,
without being liable for any diminution in the value hereof;
3.1.B. To invest such estate property in securities other than those designated as
legal investments under all applicable laws of the Commonwealth of Pennsylvania;
3.1.C. To sell at public or private sale, to exchange or to lease, for any period of
time, any property of any nature whatsoever and to give options for sales, exchanges or
leases, for such price or prices and on such terms as they may see fit, and to make,
execute and deliver to the purchaser or purchasers thereof good and sufficient deeds of
conveyance therefor, and all assignments, transfers and other legal instruments necessary
for passing of title and ownership thereto absolutely and in fee simple, free and
discharges of all trust, without liability on the part of the purchaser to set to the
application of the purchase money;
3.1.D. To allot any share as undivided interest in any property, real or personal,
constituting a portion of such share and to make joint investments therefor;
3.1.E. To make distribution in kind, or partly in kind and partly in money, as they
may deem proper and at such valuations as they may establish therefor;
3.1.F. To execute and deliver any and all instruments in writing which they may
deem advisable to carry out any of the foregoing powers. No party to any such
instrument in writing signed by them shall be obliged to inquire into its validity or be
bound to see to the application by them of any money or other property paid or delivered
to them by such party pursuant to the terms �f any such instrument.
ITEM FOURTH:
4.1. All of my insurance policies which provide indemnity for the loss of any of my
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2
personal or real property by fire, windstorm or other similar casualty (including any claim
for the loss of any such property which I might have at the time of my death against any
insurance company), I give and bequeath, respectively,to those persons or corporations,
as the case may be, who shall become the owners of such properties by reason of my
death, whether such ownership be acquired under provisions of this Will, by survivorship
or by other means.
ITEM FIFTH:
5.1. I direct that my Personal Representatives are appointed in this Will, as well as
their successors, shall not be required to give bond for the faithful performance of their
duties in any jurisdiction in which they may act.
ITEM SIXTH:
6.1. All federal, state and other death taxes payable because of my death, with respect
to the property forming my gross estate for tax purposes, whether such property passes
under this Will or any Codicil hereto, or whether such property is owned by myself and
others jointly or by the entireties or is proceeds from insurance on my life, including any
interest or penalty imposed in connection with such tax, shall be paid out of the property
devolving under this Will, or any codicil hereto, or any person owning or receiving any of
said property not passing under this Will, or any Codicil hereto.
ITEM SEVENTH:
7.1. The term"child", "children", or"issue"herein used shall specifically include
after-born children and adopted children.
ITEM EIGHTH:
8.1. I appoint my son, RICHARD W. REISSER, Executor of this iny Last Will.
8.2. Should my son, RICHARD W. REISSER,predecease me, fail to qualify or cease
to act as Executor, I appoint my grandson, ERIK JON REISSER, Executor of this my
Last Will.
8.3. Should my grandson, ERIK JON REISSER, predecease me, fail to qualify or
cease to act as Executor, I appoint my grandson, ANDREW WAYNE REISSER,
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3
Executors of this my Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this ��``' day of
r� , 2004.
, ,..
WITNESS: �7 L���n-', ��-�Z-�'—a4
MARY EL REINERS, Testatrix
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ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Dauphin
I, MARY ELLEN REINERS, the Testatrix whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowled before me.by MARY ELLEN REINERS,
the Testatrix, this�day of ►-i ( , 2004.
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MARY N REINERS, Testatrix
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= �' / I ___ �
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Kathy M. hughart, Esq.
Supreme Court I.D. No. 39779
4
AFFIDAVIT �
Commonwealth of Pennsylvania
County of Dauphin
We, �� � ��iY���,�.� and ���/�c�y�y� �--�t.� �s~i//O ,
the Witnesses w ose 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 the Testatrix
sign and execute the instrument as her Last Will; that the Testatrix signed it willingly
and executed it as her free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and signing of the Testatrix signed the Will as a
Witness; and that to the best of our knowledge the Testatrix was at that time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and cknowledged before me by the forenamed Witnesses, this
� day of - r>� , 200 .
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�" athy M. hughart, Esq.
Supreme Court I.D. No. 39779
Commonwealth of Pennsylvania
County of Dauphin
On this, the ��' day of ��r���� , 2004,
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before me,the undersigned officer,personally appeared Kathy M. Shughart, known to
me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania
(or the state in which execution of the will took place), and certified that she was
personally present when the foregoing acknowledgment and affidavit were signed by the
Testatrix and witnesses.
In witness whereof, I hereunto set my hand and official seal.
�� � � , ,� ��� ��
, �r,
Notary Public
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1�11�311 A.PO NOTARY PUiUC
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