HomeMy WebLinkAbout03-10-05
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
MARY R. COULSON
Decea sed
No. ;( I-OS'dSi?
Social Security No. 162-26-5205
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioners are the Executrices named in the Last Will
of the Decedent, dated
Mav 15, 2002
and codicil(s) dated
State relevant circumstances, e.g. renunciation, death of Executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adop,ted after execution of
the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
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:
Name
Relationship
Residence
COMPLETE IN ALL CASES:) Attach additional sheets jf necessary.
Decedent was domiciled at death in
Cumberland
County, Pennsylvania, with her lasl family or principal residence at
402 Rickv Road. Upper Allen Township
(List street, number and municipality)
Decedent, then 89
years of age, died March 4. 2005
UtlPer Allen Township
at
605 East Winding Hill Road.
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property.....................................................................$
(If not domiciled in PAl Personal property in Pennsylvania................... ................$
(If not domiciled in PAl Personal property in County................................. .................$
Value of real estate in Pennsylvania ........................,............. ...................... m............................................ ....$
T olal......................................................................................................... $
105.000.00
11 0.000.00
215.000.00
Real Estate situated as follows:
402 Rickv Road. UDDer Allen TownshiD. Cumberland Countv. PA
Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
T ed or rinted name and residence
Arlene C. Oyler - 605 East Winding Hill Road
Mechanicsbur ,PA 17055
Mildred C. Rbodes -728 West Siddonsburg Road
Dillsburg, PA 17019
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that 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, Petitioner(s) will well and truly administer the tate accor' 0 law.
Sworn to and affirmed and subscribed
I r,-l:L
Before me this \.) day of
~C 'rI. . , 2005.
'~~~~~'-'
x
ARLENE C. OYL
y~(~
, MILDRED C. RHODES
(
No.
Estate of
MARY R. COULSON
, Deceased.
Social Security No: 162-26-5205
Date of Death:
MARCH 4. 2005
AND NOW, ~Ch J 0 ,2005, in consideration of the Petition on the reverse side
hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters Testamentary
d.b.nCLa.; pendente lite; durante absentia; duranteminoritate
are hereby granted to Arlene C. Ovler and Mildred C. Rhodes in the
above estate and that the instrument(s) dated Mav 15. 2002
described in the Petition be admitted to probate and filed of record as the last Will of the Decedent.
FEES
Letters........................... $ 3JD ,()O
Short Certificate(s) $_J (0, DO
Renunciation.............. $
Affidavit ()................. $
Extra rEl~O ()..u~ll $ l'Sob
Codicil............................ $
JCP Fee.................... $ It) .CD
Inventory........ $
Other~4~ $ 5 CO
TOTAL......... $ 35lv .00
3-10" 05
J4j prJo ~ilJU\ D~ llJ/1q.h~ir
Register of Wills ~
Attorney: Richard W. Stewart
I.D. No: 18039
Address: Johnson. Duffie. Stewart & Weidner.
301 Market Street. P.O. Box 109. Lemovne. PA 17043-
Telephone: 717-761-4540
G...~ &\0 (\o-\-o...?p.oC\..A.
"'<\'\';",':\
Thi, is to certify that the information herc given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~I?~?-'
Local Registrar
Fee for this certificate. $6.00
MAR 0 8 Z005
P 11335036
Date
. Aa~ 2/B7
~ 1-05 -;:td-.X-
COMMONWEALTH d(PENNSYLVANIA a OEPART~NT OF HEALTH a 'I\TAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (F".. MidOIe.l_1
."
$ll'<<iFII..Eli\.lIIAUPI
SOCIAl SEClJRITY NUtolBER
DATE OF,Ql'ATH .MOIW'l.n.~,~
'.Ma"ch 4 2 05
89
Coulson
I)NOefll'fEAfl
..... ....
UNDER! DAY
Holn ! Wn.-
8IRTHPlACE(C""aNl
SW.orFor"'9"CQlJnlr~l
5 Adams Co.P
.female . 162 - 26 -5205
Pl..ACfOFDEMH(Checloonly"". ""',OSl,uCloOnlf)nall>8'l_J
HOSPrfAl.;
r~O e~lI.tIIO OOAO
-'1"'"
I. Mary R.
AGe\lallBlr1N:l.V\
DECEDENT'S U u..... occuP>V1ON
(~~~:o'::.::::'.'&~
u..sal.es l1k=lothing
DECEDENT'S MAILING AOORESS (Slr". Cilvf1O*n, Stalt, Zip Coo:ltl DeCEDENT'S
.,:;"....
RESIDENCE
17055 ~I~
w..SOECEDENTEVEAIN
U.S, AElMEOfOACES?
",0 "'fl
".
~o
'"
,.
FACILITY NAME (II r\Ol """'luhOr>, ll'.' slreel an<.i"""""'"
605 E. Winding Hill Rd.
COUNTY OF OEAl"H
Cumberland
."'.
""
...-
.....
Cumberland '-I/lip? 'T..o~~al
MOTHER'S NAME (First MId<k, ""'idefl SII"''1mal
MARlTA~SWUS.MlII'riBd
~r.Iart*G.~.
D~(Spacrlvl
divorced
ncXJ ......,dfCId/Io'ClMdll> tlppPT
SUFlVIVINGSPOUSE
lW,,",,-.gr..-...-tII{I1B!
402 Ricky Rd.
Mechanicsburg,
".
FArHER'SNAAlECFir5l.M""",LasI)
\h.sw. 'O1l.
,
l:I.llpn
....
PA
"'-
n.
27. ....,-1: EntII''''' lli__. inju......orcamp/lcalionll....;clleauudlllldlllllll Do rw)l.nl"ltMI mo"-ordlli"ll, 1IlH:Jl..CIIrcNC 01 "lIj)Iralory ",,'-.1IIlocIc Of n.lIlIlailur.
liIIt/lnlr_<;auuonUCllIint
".
INFORMANTS MAILING ADOFlESS(SU_. CiIy/'1brrm SIaIe, ZrpCodlll
05 E. Windin Hill Rd.Mechanicsbur PA
Pl..ACE OF DISPO$lTIOH.,....... Gtc.....II"'. er.m1llOly I.DCATIOH . CiIy/'TIlwrt. State, Zlll c.:m.
8!t1ng Green Mem. PA
".
INFCIAMAHT'SNAME(f'fPlll
Ms. Arlene C. 0 ler
"'OOSPOS<OON
eun.tXJ C_~O A."lOY.lI,omSl...D
OU>arcgp.:ifV\
E~SEA~ENSE
- ....;;~.
CompIatait-.23lKonlywlwnQllrtifying
phyaieiato.nDl........,1..imaofdaallllO
candy_of""
""",,U28_llB~by
~who~dHIII.
L
"'-''''E AND A!:lOAESS OF FACl\.lT'I'
.sselman FH&CS Inc.
2Wo*g~melAAve.
LICENSE: NtJt4fA ORE SIOHEO
""0 "!>....,(Z-c... ,......'"'~ .-'
2 IF. -0 ',J 230. '"3 -0..,)
wr.5CASEAEFERREOTOIolEOICALEXAMINEFlICOFIOHEFl1 ~
"".0 ~
n.
'AppIOlUrNoll PAFlTd, OdMrllignillcalll~ClWllrlbuIIlntllOdNUI.bu1
~lIll"""'~ lW.lftI.Illft;"'IM~_""",f",RTI.
I~anddllllllll
,
t
~TI!CAUSI!(FIRllI
"--(Jlcondilion
r.....-.gon_)_
eA.'l"~"""o
DUE1O\QA~"CONSEOUHlCEOI'):
(}A~~t"e......':::.
~"condiIiDnB
~~~lainWMdiala
_,E.....UNDIIIU'IMQ
e.wu:lOillaaMOf'"ll/l')l
......inIiIIIII<J_
'-.lIong"'~LAST
DUETO(CA ASACONSEOUENCE OF)'
DUE TO(CA ASACONSEOUENCE Of),
,
VIIl.SANAUlOPS'I' WEAEAUltlPS"IFtNOINGS
PERFORMED? N.lIJI..A8LE PfllOR TO
COMF1.E11ON OF CAUSE
"'.......,
",0
",0
MANNEFlOFO€"TH
,- ~ Hom;,:idII 0
AuidBnl P..-.dinlIln"'BllQlIlion 0
...... 0 Coluldnolbedal.rmiflBd 0
tlAJEQFINJURY
(Monlh,llBy.VtarI
TIME OF INJURY
INJURY AT WORK? DESCRIBE tIDN INJUftY OCCUflFlEO.
..... 0 HoD
".
"
I~ /".<, /; II
o
...
...0
2... HIt.
corTlI'lUlIOld oro., ""'"
.eEIfTlF'IINGPHYSlCl""(PhVk""C..llIyiilQcauSlloldealh""'llfIanoll\<jlpl\~'>Oal\~p<~0eil",ancc~Iod\\"",2:1\
To~hHCof"'y know\Bdge. ....... _II.......... '" """""101(.'''><1 """""118 '1"". .
n.
VlACEOF\t4JUI'IY.AI horn" him. Olrul.lac\Oly. 0",""
bUildlng."C,ISp&c.M
_.
.PftONOUNClHG AND C!RTIFYING PHYSlClAN (Ph}lSle"" bolt> P<or>olJI'I(;ln!l dealll an<.i clHlIly"'!llfJ ca"" 0/ dealhl
""'v..M.loI.....,Io.now'B6Q.. 6B.lhoccurrllCl.llhllllmB, d.I', _ pl"",'nd dlfBta 1111 ""l111(a).nd ....n""...........
'UEPICAL EXAMIHERICOAOHER
Onlh.buI.of.~andlOI'\I\".$tIg.'LOfI.\n"'Vop\nion,o....hQ(:cutr.d.llh.l\m..d.I.,.ndplae.,.ncldu.IOlheC:IUM{.).fld
lll....n....I.lod..................................................................................................
31..
REGISTRAA'S SIGN..,..-uRE ANO NUMBER
o
u.
012885-00001/5.14. 02/RWS/KL T /156302.3
Jragt Will anb \!regtament
OF
MARY R. COULSON
(:',
I, MARY R. COULSON, of the Township of Upper Allen, County of Cumberland,
Commonwealth of Pennsylvania, declare this to be my Last Will and Testament and revoke any
Will previously made by me.
ITEM I
I bequeath such of my tangible personal property to the persons designated in a separate
unsigned memorandum which I shall place with my Will.
ITEM II
I bequeath the residue of my household and personal effects and other tangible personalty
of like nature (together with any existing insurance thereon) in as nearly equal shares as practical
to such of my daughters, ARLENE C. OYLER and MILDRED C. RHODES, as survive me.
ITEM III
I devise and bequeath the residue of my Estate of every nature and wherever situate in
equal shares to such of my daughters, ARLENE C. OYLER and MILDRED C. RHODES, as
survive me. Should neither of my above-named daughters survive me, I devise and bequeath the
residue of my Estate of every nature and wherever situate as follows:
012885-00001/5.14.02/RWS/KL T/156302.3
A. Forty (40%) percent thereof to CHARLES H. RHODES, if he is then living. If
CHARLES H. RHODES fails to survive me, his share shall be added to the other
shares created in Paragraphs B and C below in the same proportions that those
shares now bear to each other.
B. Ten (10%) percent thereof to RACHEL HEISLER, if she survIves me. If
RACHEL HEISLER fails to survive me, her share shall be added to the other
shares created in under this Item III.
C. Ten (10%) percent thereof to ANDREW HEISLER, if he survIVes me. If
ANDREW HEISLER is not then living, his share shall be distributed to the other
shares created under this Item III in the same proportion that those shares now bear
to each other.
D. Ten (10%) percent thereof to educational and/or charitable organizations that qualifY
for exemption under Section 50 I (c )(3) of the Internal Revenue Code for the
purposes of research of macular degeneration, the organizations and the amounts to
be determined by Thomas R. Pheasant, M.D., or if he is unable to make such
determination, then a physician who is a member of the practice with which he was
last associated shall make such determination.
E. Ten (10%) percent thereof to educational and/or charitable organizations that qualifY
for exemption under Section 501(c)(3) of the Internal Revenue Code for the
purposes of research of orthopedic diseases, the organizations and the amounts to 'be
determined by Thomas R. Pheasant, M.D., or if he is unable to make such
determination, then a physician who is a member of the practice with which he was
last associated shall make such determination.
2
012885-00001/5.14.02/RWS/KL T/156302.3
F. Ten (10%) percent thereof to Robert D. Oyler Memorial Organ Fund of St. Mark's
Evangelical Lutheran Church, West Fair, Pennsylvania.
G. Ten (10%) percent thereof to the Alliance Medical Education Scholarship Fund of
the Foundation of the Pennsylvania Medical Society.
ITEM V
I direct that all inheritance estate taxes that may be assessed in consequence of my death,
. shall be paid from my residuary estate as a part of the expense of the administration of my Estate.
ITEM VI
I appoint my daughters, ARLENE C. OYLER and MILDRED C. RHODES, Executrices
of this my Last Will and Testament. Should either of my daughters fail to qualifY or cease to so act
as Executrices, I appoint my attorney, RICHARD W. STEW ART, Executor of this my Last Will.
Should my attorney also fail to qualifY or cease to so act as Executor, I appoint any member of the
law firm with which he was last associated as Executor of this my Last Will. I direct that my
Executrices or their successor shall not be required to post bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this In., day of M( r ,2002.
W:~:llf'c1~"'1-(SEAL)
MARY R OULSON
3
012885-00001/5.14.02/RWS/KL T/156302.3
SIGNED, SEALED, PUBLISHED AND DECLARED, by MARY R. COULSON, 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 presence of each other, have subscribed our names as
witnesses.
~ (~""'\"3"'-- rL-
Address
Lemoy nl PA
Address
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
:SS:
COUNTY OF CUMBERLAND
I, MARY R. COULSON, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
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.
~a:;{!~J;ft~ ~
Sworn to or affirmed and
Testatrix, this I S ~day of
acknowledged before me,
""r<'\ ~
by MARY R. COULSON, the
,2002
~~
Notary Public
~
"'
\--'--N'OTARIAL SEAL
DIANNE LENIG. Notary Public
I Lemoyl\\l BOlOugll Cumberland Co.
My CommissIon Expires Dec. 21. 2005
1,__.____
4
012885-00001/5.14.02/RWS/KL T/156302.3
AFFIDAVIT
COMMONWEALTH OF PENNSYL VANIA
:SS:
COUNTY OF CUMBERLAND
We, ~rr'D 1\ DOfl"'..... and _LO( I A .lZ.,d\ard , the witnesses
whose names are signed to the foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testatrix sign and execute the foregoing
instrument as her Last Will and Testament; that she 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; and that to the best of our knowledge, the Testatrix was
at that time at least 18 years of age, of sound mind and under no constraint or undue influence.
~
~ () L/Jdif1llt7L
and
~ -(~~...\".,"~
-...." ~ ,2002.
witnesses,
'&"~. ..c<...~\.l.:d
~ -~
this 1,5 ~ day of
Sworn to or affirmed and subscribed to before me by
. ~'-I'<,-^->"
Notary Public
~
NOTARIAL SEAL
DIANNE LENIG. Notary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21, 2005
5