HomeMy WebLinkAbout07-11-05
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,
Register of Wills of Cumberland County
PETITION FOR PROBATE and GRANT OF LETTERS
Estateof JAY 0 ;+ff.d(E-rr
also known as
No.
To:
2../- 05 -OLPI1
Register of Wills for the
County of Cumberland in the
Conunonwealth of Pennsylvania
, De!!led.
Social Security No. /7 </ - OS -0 /<f
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, and the execut_ named in the last will of the
above decedent, dated 0{ 0 'fK..<vi-~ , 20 0;;""
and codicil( s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in cZ..c:t /116 f::: -,:( /..I+-N.f)
Pennsylvania, with h_ last family or princiJ],al residen5J" a -r-
g. "'0. FJ.c (/ y'.tJ A I .b() fiJ
(list street, number and municipality)
())/I -rf, . I 0.''>-0 ..... '7r7 .
Decedent, then 11L years of age, died ,./ V( fIJ e- ,A,>, 20 .Q..L, at { . ~
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
County,
Ji.1 '((, FA I7cJ! /
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(Ifnot domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: 116 IV E
.$0 '1M
.~!",)~
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters
(testun
; administration c.t.a.; administration d.b.n.c.t.a.)
Residellc~s ~Of petitioner:)
~CVt~,\..... Vi \ J.2r,. rHoc...A( Pp,./76:;'j-
(}1 OCJ..f1.~'\ n lhe-uJ.Dr &f'{QA{ PI/-
- I~
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
SS:
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or 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 above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmedlj,d subscribed {~~' m
Before methl; /1 day of ~ _ ~
0i.&.<- ,20Q~ .
u
o&k1</~lt~~ Lfl-LJ (
Registe~~L ((iiJ./'.Ak
N:"'~ ULJ -05-0 (p/4
Estate of JA'-j o. Ii A-C K.E TT , Deceased
en
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DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW J u.L. " II 20 en , in consideration of the petition on the reverse side
here~:atisfactOry proof having been presented before me, IT IS DECREED that the instrument(s), dated
2.0 - 0 2. , descrIbed therem be admItted to probate filed of record as the last wIll of
JA c-;. HJ<\(l (fTI ; and Letters are hereby granted to IVkN J. a:sr nTSrOT
J'rn.J() Nft-I\JCY /(.OT:,TOT
FEES
Probate, Letters, Etc. .............
Will.................................
W.OD
15.00
Attorney (Sup. Ct. J.D. No.)
Short Certificates (l...) ............
JCP..................................
$
$
Renunciation........ ............... $
$ fl.OD
$ 10.00
Automation Fee................... $ ~~.O()
Bond................................. $
Total_ $ :J. (J()
Filed -TuL'-/ II 2005
Address
Phone
HI05H05 REV 1/115
This is to certify that the information here 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.
1156119G
No. Date
t2wn,. 71~'
Local Registrar
Fee for this certificate, $6.00
p
",UI'J ~ i 2005
,r
1105,143 Rov.2181 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
"
,
tu.ME Of DECEDENT (First, Mlddlo. l8st)
1.
AGE: (lul: BirthdaYl
Jay O. Hackett
SEX
Male
,.
&lAn,f'llEmlNBER
SOCIAL SECURllY NUMBER
,174 05_0514
TEOF~TH{~.Day. Y..)
.. 6/25/05
y~.
DAlE Of BrRTH
~7;'37I5)
..
CllY. BORO. TWP OF DEATH
BIRTHPlACE (CIty llOd
StaIlIorForeIgnCOUllby) 11
Reedsville, Pa 1..-0
T. h.
FACILITY NAME (II not InslitutiClrl.gMl ,trMt and number)
,
90
ERIOu~D
-0
~D ~JO
E-A.nwican1ndl8ln.8a.dc.White.
c_,
White
SURVIVING SPOUSE
\11-..........._)
... Cumber land
...
Carlisle
~laremont Nursing & Rehab
AS DECEDENT EVER IN DECEDENrs EDUCA nON MARlT At Sf" rus . M8lTIod,
U.S. AftMED FORCES? "'" COIl'IJIlel-<I) ~M.rrilId,~,
Iiil 0 '- "- _c_,
n.Yo. No u. (a.I2) U k (''''0<5<) 11!iaower 15-
11..SllI18Pennsvlvania Diet 11c.mYU,dKedonlllvedln East Pennsboro
_~l
Mveino o No,del;edllfllllved
11b. CotNJtv Cumhp:rl ;Inn town$hip1 11d. ....tdu8lllmllsolJ
MOTHER'S NAME (First, MIddI8.....Jd8JI SUITI8l1llIJ
11. Hatcl.e 7
INFOR~Nrs MAILING AOO.,ESS ($INet, CIlyfTO'WII..,.,Stale, {/II Code)
.... 108 Mtn V~ew Dr.. ..nOola, pa 17025
Pt.ACE OF DISPOSITION- twne ol~. ~ LOCA"TION. ClIylTown, Sl8le, Zip Cod.
.xOlhlll'PIlico
lWp
oeCEDENT'S USUAL OCCUPATION
(':r'~af~~~"'f
11t. Fork Lift 0 ere 11b. Warehouse
DECEDEMAllINGADDRESS(S\rlIlII.CilylTown.Stl.le. Zip CodlI) DECEDENT'S
ACTUAl.
RESIDENCE
(SlJIlnatroctioos
onoltllJfsldll)
KIND Of aUSINESS I INDUSTRY
108 Mtn View Dr
". Enola Pa 17025
F#lTHER'SI4AME (FnI, MJckUIt, lBst)
".
INFORMANT'S NAME (TypoIPrInt)
,0.
METHOD OF DISPOSmON
Dof1lIIIon 0 8uIW El Cromalion Gornolflllll'om S"1e [J
.21.. OU-(SpocICy)
SIC> FU S
".
cnVlboro
Reed A. Hackett
Ivan otstot
21c.Oak Lawn Mem Gardens 21d. Adams Co. I Pa
NAME AND ADDRESS Of FACILITY
22cSulliv n F
LICENSE: NUMBER TE D
,... '3;l?> I II - /.. ::fJ::':1S .><oS
WAS CASE REFERRED TO ~MEDlCAL EXAMINER JCORON~
21. Yes 0 No I!:::J
21.PARTI: E_............irl,IIonM...._plIullona..hl~c_,.._"'. Donal.n$II'....rncwl.",....Int,_h.._acor_pi...IorY.....et..J>ocI<Ol_t1......... :Appr0Un8Il1 PART.: OIhorsignilicont~contrIJutIngtoOulh,but
Uet.....,__......cIlllrw. 'in\erv8l'oo~ IKltre5u!tinglntheundlllfylngC8UlNgiven~PAftTI.
:onMl8ndd..lh
o ".. June 29 2005
UCE.NSE NUMBER
.... F. D. 011897-L
.
c.~6Z1'l{1v..$<-"'t."""""
OUE TO{OfI ASACOHSE Of):
Rr; /JAJS""p..(
DUET (QRASACOHSEQlJENCEOF):
P/)4CA-:;~
SequfIrIIlaIyllNcondlIiorI$ b
itany,lHdlnglolmllllldiale ['
CBUM. EnIer UNDERLYING
CAUSE (Diuan or Injury c.
"1tIlII1nililded1Mlnlt
re.l.IIIinllondllalh)L.AST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAIlABLE PRIOR "TO
COMPlETION OF CAUSE
OFQE,!.1"H1
,~
ACON C1UENCE
MANNER OF DEATH
-..
.........
Ii1
o
o
Homicide
Pendinglnvesllgaliorl
COuklnolblldelenninlld
DATE OF INJURY
{NonIh.D.oy.r_J
o
o
030.. ",Ob. M.
PlACE OF INJURY. AI hOIllll. filrm, streal, lilclol'y. ,,/f,co
buildlOil."'-(SPKi'11
,...
TIME OF INJURY
INJURY AT WORK? OESCRIBE HOW INJURY OCCURRED.
2... 21b.
CERTIFIER (Check onlv one)
.~~~~of~~~~~~~.=:I'~~r~~~~.~~.~.~~~.~~?~~..
...
YosD NoD
....
Ya 0 No [2:(
YosD
"'0
Suicide
.11b.
LICENSE NIIMBER DATE SIGNED tMon1h, o.y. 'tear)
..D'lc. /"1/J-d~.2-"f'''''''_ 31d. ?-.P-7."r
NAME AND ADDRESS OF PERSON WHO COMPlETED CAUSE Of DEATH
'MEDtCAl.. EXAMINER/CORONER (Item 21} Type or PIinl
On Ill. bull oI.X8mlnlltlon 8nd1Vf" Inv..ttpUon, k1lt1.y opIl1Ion.lk~th occwrH at UWllm.. d... and plac.. and dll. 10 1M .......(s).nd 81NL.~"- ^1. d~, ~
31.......nw.sS!.ated...............................................................-.,..........,..........,....................................................................0 32. /l'3o (;QCO ~ h.
RE TRAR'S SIGNATURE AND NUMSER DATE FILED (Month. Dav, Year)
w~l/vl
"PRONOUNCING AND CEItTlFYlNG PHYSICiAN (Physician bolh pron Jncing deBito lUld ce<1iI\'ing tQ ~ <If dull\j
To h bM.\of IIW knowlldll.. duth occurnd aI: th.llfIMI, d8t8. .".1 pl.",. 8IId du. 10 lh. cau'''l') .nd mlUl/lfl".' .1iIUd.
----
PA I?"~ s
cilr
LAST WILL AND TESTAMENT
OF
JAY O. HACKETT
I, Jay O. Hackett, 208 Senate Avenue, Apt. #506, Camp Hill, Pennsylvania 17011, being of
sound mind and memory, do hereby make, publish and declare this to be my Last Will and
Testament.
FIRST:
I hereby revoke all Wills and Codicils thereto by me at any time heretofore
made.
SECOND: I direct that all my legal debts, my funeral expenses and the costs of
administration of my estate be paid as soon as practicable after my death. I direct that my Executor
and Executrix payout of my estate, as a general charge thereon, all inheritance, estate, succession
and other taxes, together with any interest or penalty thereon assessed by reason of my death with
regard to all properties and assets subject to such taxes, whether or not such property and assets pass
under this Will.
THIRD:
I give, devise and bequeath my estate, real, personal or mixed, tangible or
intangible, of whatsoever kind and wheresoever situated, together with any property to which I may
have any power of disposition or appointment and whether acquired during or after my lifetime, to
my step-son, Ivan J. Otstot, provided he survive me for a period of thirty (30) days.
FOURTH: Should my step-son, Ivan J. Otstot, fail to survive me for a period of thirty
(30) days, then I give, devise and bequeath the rest of my estate, real, personal or mixed, tangible
or intangible, of whatsoever kind or wheresoever situated, together with any property to which I
may have any power of disposition or appointment and whether acquired during or after my
lifetime, to my step-daughter-in-law, Nancy K. Otstot.
FIFTH: In the event my step-son, IvanJ. Otsto1, and my step-daughter-in-law, Nancy
K. Otsto1, fail to survive me for a period of thirty (30) days, his or her interest in my estate shall be
distributed to Randall J. Otstot and Stacy M. Balaban, my step-grandchildren, share and share alike.
In the event Randall 1. Otstot and Stacy M. Balaban, my step-grandchildren, shall fail to survive me,
his or her interest in my estate shall be distributed to his or her then living children at the time of
my death in share and share alike. Should Randall J. Otstot or Stacy M. Balaban fail to survive me
and fail to have living children at the time of my death, such share shall then lapse and such interest
in my estate shall then be distributed in share and share alike to my step-grandchild, either Randall
1. Otstot or Stacy M. Balaban.
SIXTH:
My Executor and Executrix shall have the following powers in addition to
those vested in them by law and by other provisions of my Last Will and Testament, applicable to
all property, whether principal or income, including property held for minors, exercisable without
court approval, and effective until actual distribution of all property:
I. I direct that my Executor and Executrix and their successor( s), shall not be
required to give bond for the faithful performance of their duties in any
jurisdiction.
2. My Executor and Executrix shall not receIve compensation for the
performance of their functions hereunder during the period over which their
services are performed.
2
3. To allocate receipts and expenses to principal or income or partly to each as
they from time to time thinks proper in their discretion.
4. To borrow money from any person or institution and to mortgage or pledge
any or all real or personal property as my Executor and Executrix in their
discretion shall choose, without regard for the dispositive provisions of this
instrument.
S. To compromise any claim or controversy.
6. To make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as they may determine, and at valuations finally to be
fixed by them.
7. To invest in all forms of property (including stock or other securities and
common trust funds and mortgage investment funds), without restriction to
investments authorized for fiduciaries, as they deem proper, without regard
to any principle of diversification or risk.
8. To retain any or all of the assets of my estate, real or personal, including any
shares of stock or other securities I may own, without restriction to
investments authorized for fiduciaries, as they deem proper, without regard
to any principle of diversification or risk.
9. To sell at public or private sale, to exchange, or to lease for any period of
time, any real or personal property and to give options for sales, exchanges
or leases, for such prices and upon such terms or conditions as they deem
proper.
3
10. To exercise any law-given option to treat administrative expenses either as
income tax or as estate tax deductions, without regard to whether the
expenses were paid from principal or income.
11. All shares of principal and income hereby gIven shall be free from
anticipation, assignment, pledge or obligation of the beneficiaries and any of
them, and shall not be subject to any execution, attachment, levy or
sequestration or other claims of the creditors of said beneficiaries or any of
them.
SEVENTH: I do hereby make, constitute and appoint my step-son, Ivan J. 018tot, and my
step-daughter-in-Iaw, Nancy K. Otstot, the Executor and Executrix of this my Last Will and
Testament. Should either one or both fail to qualify or cease to act, I appoint my step-
grandchildren, Randall J. 018tot and Stacy M. Balaban, to fill the remaining vacancy or should both
fail to qualify or cease to act, Executor and Executrix of this, my Last Will.
EIGHTH: I direct that my Executor and Executrix, in their discretion, to engage any law
firm to represent my estate and to handle any and all matters related to the administration, probate,
etc. of this my Last Will and Testament.
4
IN WITNESS WHEREOF, I, Jay O. Hackett, Testator above named, have hereunto
subscribed my name and affixed my seal this ,1Z9 day of ~~ ,2002.
(SEAL)
~ 0' -tW-,~
&fay . Hackett f
Signed, sealed, published and declared by the above-named ,Testator, Jay O. Hackett, as and
for his Last Will, in the presence of us and each of us, who, at his request and in his presence and
in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and
year last written above.
Name
.~
Address
/o~~~~
C;j~Jcf~/7~)
~~a- 4d4
WITNESS
:235 7l f>'1LtJ~ Ref?--
Sn~~rft 1762~
5
STATE OF PENNSYL V ANlA:
SS
We, NMcl K or:sTGI
and
S tJNf)/I!
/YJ ILKe
.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 Testator sign and execute the
instrument 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 the time 18 or more years of age, of sound mind and under no
constraint or undue influence.
~<~
.^
~,. ~
~c'4/ ---;?/1~
"-WITNESS
Sworn or affirmed to and subscribed to before me by d ANt- <.( K.. (jTS1?> /
and -..S IfNDiVJ- fr1 I L-. t{E' , witnesses, this :;1 'j /lcday of Morel,
2002.
NO&U#
7
NOlIIrial Seal
~_~ F. Switzler. Jr.. Nooary Public
_I """"sboro 1\vp.. Cumberland eooU,h'
My ComIIIissiOll Expiles Aug. 13. zoOS'
MlmJer,PennaylvaniaAasoc_,ofNolaJtes
ST ATE OF PENNSYLVANIA:
SS
I, Jay O. Hackett, 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; that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
~~e~
Sworn or affirmed to and acknowledged before me, by Jay O. Hackett, the Testator, this
:J9...Jt. dayof f1qrc4
.2002.
No~f~
Notarial Seal
EaDonaJd F. Switzler, lr., Notary PbbIic:
st PenDJboro Twp., Cumborland eou:D_l)
My Commission Expirea Aug. 13, 2()Oj
Member, Pennsytvania ASsociaIIonofl\lo1mtes
6