HomeMy WebLinkAbout01-29-15 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)tht
following and respectfully requests the grant of Letters in the appropriate form:
Beverly A. Kreman
Decedent's Information
Name: Lillian M.Nissley File No: 21 -15 - (�
a/k/a: (Assigned by Register)
a/k/a:
alkla: Social Security No: 173-03-6682
Date of Death: 1212312014 Age at Death: 97
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at Manor Care Health Services,1700 Market St.,Camp Hill 17011 Camp Hill Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Manor Care Health Services,1700 Market St.,Camp Hill Camp Hill 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 Pennsylvania........................ All personal property $ 100,000.00
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$ 100,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post Office and Zip Code City,Township or Borough County
QX A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)that he/she/they islare the Executor(s)named in the Last Will of the Decedent,dated 0911 512 01 0 and Codicil(s)
thereto dated
(State relevant circumstances,e.g.,renunciation,death of executor,etc.)
Except as follows:after the execution of the instruments}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.
nX NO EXCEPTIONS Q EXCEPTIONS
❑B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.; . .n.; . .rr.c.t.a.;pe ante rte;durante absentia;ddrante mrnon a e
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 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.
ZX NO EXCEPTIONS Q EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decadent left no Will and was survived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
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Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
}
COUNTY OF Cumberland SS:
}
Petitioner(s)Printed Name Petitioner(s)Printed Address
Beverly A.Kreman 2008 Carlisle Road
Camp Hill,PA 17011
Name as listed in Will: Beverly A.Kreman
Wayne C.Nissley,Jr. 4196 Jasmine Place
Mount Joy,PA 17552 p rri.
Name as listed in Will: Wayne C.Nissley,Jr. ::u �
r' ^^r t'( co v 1 B t V
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correct to the be t of the k led
belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,Petitioner(s)will well and truly administer the estate �cordi/ tmvw.
Sworn to oraffirmed and subscribed before ° �J� Date /o���/�
met day Q-wDate
By'_ Date
For the Register U Date
BOND Required? 11 Yes a No To the Register of Wills:
FEES Please enter my appearance by my signature below:
Letters............................................ $ Attorney Signature:
( )Short Certificate(s).......... a _
( )Renunciation(s)...............
( )Codicil(s).........................
( )Affidavit(s)....................... Printed Narry Dennis J Ward
Bond.............................................. Supreme Court
Commission................................... ID Number: 15987
Other
jkM 1 1:� Firm Name: Dennis J.Ward,Attorney at Law
m/on )"5 Address: 114 East Main Street
Suite A
Ephrata,PA 17522
Phone: 717/733-8411
Automation Fee............................. Fax: 7171
JCS Fee.........................................
t5
TOTAL........................................... $ () tp— 0 E-mail: dward@dejazzd.com
DECREE OF THE REGISTER
Date of Death: 12/23/2014
Social Security No: 173-03-6682
Estate of Lillian M.Nissley File No: 21 -15 — ('
a/k/a:
AND NOW, C' �� ,in consideration of the foregoing Petition,
satisfactory proof having been presente fore me,IT IS DECREED that Letters Testamentary
are hereby granted to Beverly A.Kre,a�
and Wayne G.Nissley,Jr.
in the above estate and(if applicable)that the instrument(s)dated 09/15/2010
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s) of Decedent:
egister of Wills f�� •`(�Q)_ y�
copyright(c)2011 form software only The Lackner Group, c. 1L� - P ge 2 of 2
Vi 105.8.05 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
�^
OFF iCE OF "
Fee for this certg } HtY ,,,,frJr�j�� This is to certify that the information here given is
S-1 ' '` � �t n'°'I�p��H OF PfN` correct! copied from an original Certificate of Death
REG15' tt01, Y P g
duly filed with me as Local Registrar, The original
g certificate will be forwarded to the State Vital
C=
��� '��� � y x► Records Office for permanent filing.
P 23. 1097. � � -
�t't( DEC/2 14
Certification i.� L - Local Registrar
b r rani f--,/ffr"' Date Issued
Ap E R L►%a •"
Type/PYlnt 1n � .] COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH•VITAL RECORDS
Permanent -
Blackink CERTIFICATE OF DEATH N
1.O.C¢deni'S i gal lliala n M_ L�Tissla state Fit. amber•
Lil (First,Middle,Last,Suffix) Z.Sex S.Social Security Number ...Data of Death(Mo/Oay/Yr)(Spell Mo)
female 173-03-6682 December 23, 2014
Sa.AgQ-Last Birthday(Vrs) Sb.UntlCr 1 Y@ar Sc.Under 1 Da 6.pate Of Birth(Mo/Day/Year)(Spell Month) 7a.BlrthplaC@(City and Sta Le Or Foreign Country)
g MpnthS Daus Hpur. Minutes Lancaster, PA
January 27, 1917 7b.BlrthpI.-(County) onto. er
Be.Resldenc.(State or Foreign Country) Bb.KeSidenCe(Street and Number-InCjude Apt No.) 8C.Did Decedent Live In a TOwhship?
PA
8d.R-Idenn.(County) 1700 Market .St. 0 Yes,decedent lived In two
t1t CUmbe2C,1at2d Se.Residence(Zip Code) "' ERNC,d@Cedent Rved withtn timits of Camp HZ i l <rty/bora.
Ever in US Armed Farces? 30.Marital Status at Tim¢of Oesth (�Marrl.tl Widowed 11.Surviving Spouse's Name(If wlf.,glue na MQ prior t0 first marriage)
I
Yes
[ No 0 Unknown � DlyprCed Nay.,Married Q Unknown not a 13,.fLa1Jl
12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior t0 FIrSt Marriage(First,Middle.Last)
Albertus Bookman Lizzie Rhoads
148.informant's Name 14b.Reiatlon5hip to pec@dent 34 c.informant's Mailing Agdress(StrQat and Number,Ctty,Stat¢,2IR Code)
o Bever! Kreman dau hter 2008 Carlisle Rd. Cam [33L11 A
G 17011
If Death Occurred in a Hospital ❑inpatient _ _ _ _ iha_P aCm o Deat C ec Than
_
p Ilf Death OCturretl Somewhere Other a Hospital: (3 Hasp€e¢Facility OeeedQr�it's Home
Emerge»C
lSb.FaC)Hty NameRO{ipf mnofQL Iunts ¢ad Omn Arrival 1�Nuralhg Hm /Lan$-Term Cao Facm, Other Ic-1fy)ad er)aanotn,give ste0 On
15c.City or Town,State and Zip Cp de lStl.County of Death
a Ma r are al r Camp [3il] , PA 17011 Cj...Munit>arl
16a,Method of Disposition $J Burial {� Cr.mailon 16b.Date of Dis pesltlon Nome of cemete a place)0 R.-oval from State 0 OOnatlon Poslelon 16c,PI#ce of DIS ( ry,crematory,or other lace)
o oth@r(specify) 1/2/2015 Neffsville Lutharan Cemetery
163.Location of Dis po.'"..(City or Town,State,and Zip) 17a.Sign re of Funeral Se Mc¢U n see or Person in Charge of Interment 17b.UCente Number
Lancaster, PA 17601 FD 138864 L
` 17c.Nam.and Complete Address of Funeral Facility Kaarry A_ Snydar Fune al FIome
`g 141 E_ 6 e St_ Lancaster PR 17602
18.Decadent'.Education-Check the box that best da...bes the 19.D....ant of Hispanic Origin-Check the 20.OeCedent's Ra<e-Ch.ck ONE OR MORE races to Indicate what
�- highest degree or level of school completed at the time of death. box that best describes whether the decadent the decedent considered himself or herself to be.
O 8th grade or less Is Spa nish/H[Spa nlc/Latino,Check the"No" ($a White 0 to
M No diploma,9th-12th grade box if decedent is not Spanish/HspanIc/Latino, 0 Black or African American Vietnamese
(� High school graduate,ar GED completed jA Na,hot Spanish/Hispanic/LotinO 0 American Indian dr Alaska Native 0 Other..;an
SpMe College Credit,but no deg,e,! 0 Yes,Mexican,Mexican American,Chicano 0 Aston Indian 0 Native Hawaiian
O Assoc degree(e.g.AA,AS 0 Yes,Puerto Rican Ch1 e
O Bachelor's degree(a.g.BA,AB,BS) ci se E3 Gua manlan or Chamarro
O Yes,Cuban O Filipino 0 Samoan
I7 Master's degree(e.g.MA,MS,MEng,MEd,MSW.MBA) D Yes,Other SPanish/Hispanic/Latino 0 Japanese 0 Other Pacint,Islander
0 boctorate(.,a.PhD,CdO)or Professjonai deg-. (Specify) 0 Other(Specify)
e. MD DDS DVM LLB JD
21.Deb@dent's Single Race Self-Design#tion-Check ONLY ONE to indicate what the decadent Considered himself or herself to be. 22a.Decadent's Usual Occupation-Indicate type of work
to White 0 Japans. [] Samoan do nC during most of working life. 00 NOT USE RETIRED.
0 Black or African American 0 Korean 0 Other Pacific Islander
Ci 0 American Indian or Alaska Native 0 Vietnamese 0 Oon't Know/Not Sur@ Lah>ocer
.7C 0 Aston Indian 0 OthO,Aslan 0 Refused 22b.Kind of Business/ihdu.try .
0 Native Howalian 0 Other(Specify) "
0 Filipino 0 Guamanian or Chamorro Manufacturing
ITEMS 23a-23d MVS?BE CO; PL[TED 23a,O to PfahaU»C tl Dead(Ma/Day/Y r) 23b.Slg to of person Pronoun g De th{Only when appiicabia} 23c.License Numbar
C'PERSON WHO PRONOUN(
I�j)�(
CERTIFIES DEATH
23d.'a�t¢" Ig�n@�d r( ./D.y r) 24.Time oT 'y+'It
L` V t r,_` 25.Was Medical Exa I Y Coroner Contact'ed7 0 YesNp
CAUSE OF DEATH I Approximate
26.Part 1. Enter the�'rjn, f�tg--diseases,injuries,or compiicmtions--that dirCctiy caused the death. 00 NOT Cnt¢r tarmtna€avant.such as cardiac arrest, t interval;
respiratory arrest,or va111I..i.r fibrillation without showing theoology. DO NOT ABBREVIATE. Enter only one cause 4n a line. Add additi...l lines if necessary. 1 Onset to Death
e
IMMEDIATE CAUSE -- - �.Tu � •1 fes, 1
(Fln suiting€n death)disease Or condition
suitOu.to(or as consequence of):
i» I
,. ^I'-
b. - .�'+- to `,= f
,•gyp�. l �Sequchtially list conditions, .p
Due to(or on.quannt.oIf any,leading to the cause
led ,II
on Tina a. Enter the I
UNDERLYING CAUSE @ to(or as a co sequence of): C t
(of.....ar injury that /
G Initiated the events r...1,1ng d.
In death)LAST. Due to(or as a eons@quenee of):
PQK Ii. E»XQY other 5tt HI t �i i sOntNbutin}[ig, ,gt,(-j but not resulting in the underly{ng cause given In Pont i. E28..
as an autopsy P mad?
"" C1S'�iJ��inr .E3t0 nntlin YesNo
pay gs available
")?, Complete the<aa @ Of death?
YQS
29.1 FC male: 30.Did Tobacco Use Contribute to Death? 31yyy.Manner of Oeeth
Pre pregnant w#thin past year 0 Yes 0 Probably _ Natural 0 Homicide
Pregnant at time pf death No 0 Unknown AeNdant €� Pending Investlg.tlon
°od 0 Not pregnant,but pr.gnani within 42 pays of death
D Not pregnant,but pregnant 43 days to 1 year before death 32.Data of Injury(Mo/Da /Yr 5 0 S.IcId. C] Could not be,d.termin.d
0 Unknown If 1 Y )( p¢II Month)
pregn#nt within the past year 33.Time of Injury
34.Piece of Injury(S,9.home;eenstruetlpn sit.;farm;school) S.Location of injury(Street and Number,City,County,State,ZIP Code)
36.Injury at Work 1.31.If Transportation Injury,SIP Ify; 38.Describe How Injury Occurred:
C7 Yes 0 Drover/Operator 0 Pedestrian
0 No 0 Passenger 0 Othar(Spectfy)
392 Certifier-physician,certlfled nurse practitioner,medlcal examloar/coroner(Check only one):
Certifying only-To the best of my knowledge,death occurred due to the cause(.)end mann.r stated"
Pronouncing&Certifying-To the bast Of my know dgc,death occurred at the timl,date,and Piece,and due to the cause(s)and manner stated.
0 Mmdlcat Examiner(Corone a ba of tiers and/or investigation,{n my opjni.h,drat occur et she time,date,and place,and due to the s}and manner stated.
Signature of ce rtifle r._,.,, s Title of certifier:Z- 11C7 M U....e Number;, �_
39b. ddre,s and 21 of P.son Com Icong Ce se f Death t 2 39 .Data Signed(M«p../Da1/Y�1s))..,,..ss
40tstra n_Number f •� G4-.t t
41.Heg€strar's Signature 42.Registrar Flje Date{M /Day/Yr)
43.Amendments 4 , R " -•�-4s" -�
1 D j H105-143
Disposition Permit NO. / REV 07/2012
r
LAST WILL AND TESTAMENT
OF
LILLIAN M. NISSLEY
I, Lillian M. Nissley,of Camp Hill, Cumberland County, and Commonwealth of
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,publish and
declare this to be my Last Will and Testament. Any and all Wills and Codicils made by me at any
time prior to this Will are hereby revoked and void.
n
c- ^ M
I. DEBTS AND DEDUCTIONS:
I direct my Executor hereinafter named to pay all of my just debts an&e�p7ensWof my rn
last illness and funeral expenses out of my estate as soon as may be convenient after 11%y4eceme. `.
IL TAXES: ,
I direct that all estate, inheritance and other taxes in the nature thereof, togethei5with
any interest and penalties'thereon, becoming payable because of my death with respect to the property
constituting my gross estate for death tax purposes, whether or not such property passes under this
Will shall be paid from the principal of my residuary estate, and no person receiving or having a
beneficial interest in any such property, whether under this Will or otherwise, shall at any time be
required to contribute to or refund any part thereof.
III. DISTRIBUTION:
A. I give and bequeath the sum of five hundred dollars ($500.00) unto my friend,
Susan Snyder,presently of 35 Kreicier Ave., Lancaster, PA i 70501; and
B. I give and bequeath the sum of one hundred dollars ($100.00) unto my friend,
Doris Lownsbery,presently of 53 Kreider Ave., Lancaster, PA 17001; and
C. I give and bequeath my diamond ring, wedding band and all of.my jewelry
unto my daughter,Beverly A. Kreman, presently of 2008 Carlisle Road,
Camp Hill,PA 17011; and
E. RESIDUE:
I direct my Executor hereinafter named to convert all the rest,residue and
remainder of my estate, both real and personal, of whatsoever nature and wheresoever
situate, into cash, by private sale or public sale, or both, if, as, and when my Executor
deems appropriate under the circumstances then and there existing and I give, devise,
and bequeath all such rest, residue and remainder of my estate so converted into cash.
or otherwise, after payment of all debts and obligations, liabilities, expenses, taxes,
and costs of administration unto my issue in equal shares per stirpes.
IV. EXECUTOR:
I nominate, constitute, and appoint my children, Beverly A. Kreman and Wayne C.
Nissley,Jr., or the survivor of them, as Co-Executors of this my Last Will and Testament. I direct that
my Executors shall not be required to file a bond for any purpose whatsoever in connection with the
settlement of my estate.
IN WITNESS WHEREOF,I have signed this my Last Will and Testament on-ljg� , 2010.
Lillian M. Nissley
Signed, published and declared by the above named Testatrix,Lillian M. Nissley, 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 subscribed our names as witnesses hereto.
Name —� Address
js
Name Address
2
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
70
m rn
� �_
rn �' n
Estate of Lillian M. Nissley De �lsec
►-► F r t
Beverly A. Kreman
.. cn
Howard Kreman (each) a subscribing witness to
(Print Names)
the ❑x Will ❑ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s)that she/he/they was/were present and saw the above Testator/Testatrix sign the same
and that she/he/they signed the same and that she/he/they signed as a witness at the request of
the Testator/Testatrix in his/her presence and in the presence of each other.
(Signature) Bd4ldrly A. Kreman (Signature) Howard Kreman
2008 Carlisle Rd. 2008 Carlisle Road
(Street Address) (Street Address)
Camp Hill, PA 17011 Camp Hill, PA 17011
(City,State,Zip) (City,State,Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed nd subscribed Sworn to or affirmed and subscribed
before me this �q day before me this day
ofbRIJURz of ,
Deputy for Register of Wills Notary Public
My Commission Expires:
(Signature and seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s)at time of notarization.
Form RW-03 Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc.