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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(ics) 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 Informatio ll�
Name: o ugY e*7,Ot, c File No: 0I - i y - Uy�
a/k/a: `� (Assigned by Register)
aWa:
a/k/a: Social Security No:
Date of Death: Age at death: 56
Decedent was domici ed at death in Cumberland County, Pennsylvania (state) with his/her last
principal residence at 210 West Locust Street 17025 Enola, Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at 210 West Locust Street 17025 Enola, Cumberland
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 $ 50,000.00
If not domiciled in Pennsy lvania. .... ................... Personal property in Pennsylvania $
If not domiciled in Pennsy lvania. ....................... Personal property in County $
Value of real estate in Pennsyl vania.......................................... ............... $ 10000000
TOTAL ESTIMATED VALUE. ... $ 150.000.00
Real estate in Pennsylvania situated at: 210 West Locust Street, 17025 Enola Cumberland
(Attach additional sheets.ifnecessary.) Street address,Post Office and Zip Code City,Township or Borough County
91 A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)avers)he/she/they is/arc the Executors)named in the last Will of the Decedent,dated May 15,2013 and Codicil(s)
thereto dated
State relevant circumstances(eg.renunciation,death of executor,etc)
Except as follows: after the execution of the instmment(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 bom or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
0 NO EXCEPTIONS ()EXCEPTIONS
0 B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.l.a.,pendent¢lite,durante absentia,durante 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 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.
Q NO EXCEPTIONS Q 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,ifnecessary):
_N
Name Relationship Addresy0
s .c
Form aw--02 rev.1011112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Edna Kelly Thomas 414 Woodland Road Canonsburg,PA 15317
The Petitioner(s)above-named swears)or affirm(s)the statemen in t foregoing Petit' are true and correct to the best of the knowledge and belief
of Petitioner(s)and that,a"Representative(s)of the Dec t,the Petition s)will we truly administer the estate accorr t laww.
Swom to or affirmed �me this day of Date
By: Date
For the Register Date
BOND Required: Q YES (F) NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . S 1 D Attorney Signature:
( 10 )Short Certificate(s).. . . . .
( )Renunciation(s).. . . . . . . .
( )Codicil(s). .. . .. . . . . . . .
( )Affidavit(s)... . . . . . . . . .
Bond... . . . .. . . . . . . . . . . . . .. . . Printed Name:
Commission. . . . . . . . . . . . . . .. . . Supreme Court
Other . . . . . . . . ID Number:
. . . . . . . . 1�j Firm Name: 27
('0411` ) ) lj Address: m .r Gy
i
. . . .. . C/'t'
. . nU .. -7
:X
. . . . . .. . Phone: CICe— �
Automation Fee. .. ... . . . . . .. . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . .. . • c6J� Email:
TOTAL. . . . . . . . . .. . . . . . . . . . . s,�X�•f� . C,?
DECREE OF THE REGISTER
Estate of- , )6h rl E- aQa 4 h o t r h)r File No: 02
a/k/a: r ,/
AND NOW,_ U1 C4 1 0( 1 , in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters :Zg,�:6Q klAf
are hereby granted to Cd0Q, kAjAq n a Q N
`Thahtta C
in the above estate and(if applicable)that
the instrument(s)dated �i� / � 20 I�
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s))of Decedent.
n
Register of Wills
Form RW-02 rev.1011112011 r r Page 2 of 2
laot Virr aub Teztament
llf
1
yobn (M (95 °, `' Q
A N) <�o
I, JOHN EDWIN GOUGHENOUR, of the County of Cumberland and Commonwealth of
Pennsylvania, being of sound mind and memory, do make,publish and declare this to be my Last Will and
Testament, hereby revoking and declaring null and void any and all Wills or Codicils by me at any:time
heretofore made.
FIRST: I direct my Executrix to pay the expenses of my last illness and funeral from
the residue of my Estate.
SECOND: I direct that all Estate,Inheritance and other death taxes that may be assessed
with respect to property or interest passing under my Will by whatever jurisdiction imposed, shall be paid
from my residuary Estate as a part of the expense of the administration of my Estate.
THIRD: I give all tangible personal property owned by me at my death and all
insurance policies on such property to my son, JOHN CHRISTOPHER GOUGHENOUR,provided that he
survives me by thirty(30)days.
FOURTH: I give the sum of Ten Thousand Dollars ($10,000.00)to the BETHANY E.
GOUGHENOUR, M.D. MEMORIAL FUND. If this institutional beneficiary ceases to exist, this gift to
the BETHANY E. GOUGHENOUR, M.D. MEMORIAL FUND in this Paragraph FOURTH shall lapse
and be distributed as part of the residue of my Estate as provided for herein.
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FIFTH: . I give the residue of my Estate as follows:
A. To 'my son, .JOHN CHRISTOPHER GOUGHENOUR, if JOHN survives
me by thirty(30)days;provided that if JOHN fails to so survive me,but is represented by descendants who
so survive me,then I give the residue to such descendants,per stirpes.
B. In the event there is no one living who is entitled to receive the residue of
my Estate under subparagraph A. of this Paragraph FIFTH, then I give the residue of my Estate in equal
shares to my sister,EDNA KELLY THOMAS, and my brother,EDWIN SCOTT GOUGHENOUR, ifthey
survive me by thirty (30)days,or to the survivor of EDNA and EDWIN who shall so survive me.
-SDCTH: All principal.and income shall be free from anticipation, assignment,pledge
or obligation of beneficiaries or remaindermen.and, while in the hands of my Executrix the same shall not
be liable to any levy,attachment or execution.
SEVENTH: I name and appoint my sister, EDNA KELLY THOMAS, to serve as
Executrix of this,my Last Will and Testament,to serve without bond in.any jurisdiction in which she may
act. In the event that EDNA is unable or unwilling to act as Executrix, then I name and appoint rriy son,
.JOHN CHRISTOPHER GOUGHENOUR to serve as Altemate Executor, also-to serve without bond in
any jurisdiction in which he may act.
EIGHTH: My Executrix and her successors shall have the following powers with
regard to the assets and liabilities of my Estate: to retain my investments, invest and reinvest in legal
investments, sell, grant options for sale or otherwise convert any real or personal property or interest therein
and to deliver good conveyances for the same,borrow money and secure its repayment by mortgage,pledge
or otherwise, compromise claims, make distributions in cash or kind or partly in each, lease real estate and
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other property,file any tax or gift tax returns that may be due on my behalf,retain such agents, accountants,
or other advisors and compensate the same from estate assets, associate with them a corporate fiduciary
with fiduciary powers in the Commonwealth of Pennsylvania, delegate to said corporate fiduciary the
exercise of any powers, exercise all other acts and things necessary or.appropriate in the management,
administration and distribution of my Estate and exercise any other powers granted to personal
representatives pursuant to the applicable laws of the Commonwealth of Pennsylvania, including but not
limited to those enumerated in Chapter 33 B and C of the Pennsylvania Probate, Estates.and Fiduciaries
Code,20 P.S. §§3311-3360.
NINTH: Words used in the singular-may be read to include the plural or the.plural
may be read as the singular. Similarly,the masculine form may be read to include the feminine and neuter;
the feminine may be read to include the masculine and neuter; and the neuter may be read to include the
masculine and feminine.
IN 'WITNESS WHEREOF, I have-hereunto set my hand and seal this "day" of
/CPU 20-/Z.
a (Signature)
HN ED GO&NOUR
Page 3 of 5
Signed, sealed and published and declared by-JOHN EDWIN GOUGHENOUR,the Testator above-named,
as and for his Will, in-the presence of us, who, at his request, in his presence and in the presence of each
other, have hereunto subscribed our names as witnesses hereto.
WITNESSES: �}
Signature: on Signature:
Print Name: i n C. Ut1 P/�1 Print Name:
Address: /78a Sumftyrpe& Address: 178oZ
Page 4 of 5
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
I, JOHN EDWIN GOUGHENOUR, the Testator, 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 acknowledged before me by JOHN EDWIN GOUGHENOUR, the
Testator,this day of 111sK of 20_g_.
OOMMONWEALTH OF PENNSYLVANIA CNWIN UG NOUR(Signature)
NOTARIAL SEAL \
GINA LIBALDI,Notary Public
Camp Hit Boro,Cumberland County f N
My Commission Expiroc February?2 2014 (Signature o o Public)
(Seal of Notary Public)
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF P,e�.4
We, ,C- e and lnet5,;VPr• the witnesses whose names are
signed to the attached or foregoin instrument, being duly qualified according to law, do depose and say
that we were present and saw the Testator sign and execute the instrument as his Last Will; that the
Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed;
-that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness;.and that
to the best of our knowledge the Testator was at that time 18 or more,years of age, of sound mind and under
no constraint or undue influence.
Swom to or affirmed and subscriW to before me by )E/a;ne. . MtcF '/s9O el- and
1 yl7e.s Pr,witnesses,this/?day of Pby .20j-
Witness (Sigwture)
r�,tyir�� 2 A
COMMONWEgLTM FP 1theSS (Signature)
ENNSYLVANIA
NOTARIAL SEAL
E INA UBALDI N I'hn Born,Cumb an rM b mission Expires February 12 X14 (Signature of otary Public)
(Seal of Notary Public)
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