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Home My WebLink About08-05-05 . Register of Wills of Cumberland County Estate o~ ~ren, e also knawn as PETITION FOR PROBATE and GRANT OF LETTERS ~Qa>bse" No. ~/-()5-IO~ To: t:f>eceased Social Security No. OS' , - '0- -10S" Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s , who isl.. 18 years of age or older, and the execut~named in the last will of the above decedent. dated r c . and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in (! V M ~ r \ 4." d County, Pennsylvania, with h~last family or princiJ>.a} residence at .D.a. ~&l$ ~. Sfor-t..n, H." CUI t\~rY\tde'\1'''''pJ M~t'~,\c$~~" (list street. number and unicipality) Decedent, then ~ years of age, died J ~ l t '1. f , 20~, at M"nllr lA r, 1lftJ"'" ~ttf" it(lS I 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: 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 (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ '3 ',tJoo $ $ $ 'l~/ODO WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant ofletters t~.s"tQ rn c!"","'(:I r'...y... . (tesb1fnentary; administration c.t.a.; adm~on d.b.ri.:ei.a.) .......] (~-) c.n S of Petitione s ~.". thereon. I ~.. '--j r.) , 1 ~... -' : '_-"J ," fT'I 'f'J , '~'l ~ N . Register of Wills of Cumberland County OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } SS: COUNlY 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. M(f- Sworn to or affirmed and subscribed Bef~ 5+'n c!"of ~ ,20 --- CIl <g' ~ ,2.. '" '-' { ~ CL0h U, ~~ner~ No.~' -() ~ - D 70). Estate of.~L."ReHCf 3'Aco !!SeW. Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW bt 5 20.Q5 in consideration of the petition on the reverse side hereof, satisfactory proo avmg been presented before me, IT IS DECREED that the mstrument(s), dated .3 - ~ (g '. OJ, described therein be admitted to pr~ate filed of record as the last will of C \()..rpnCe.. )~("hq> {"\ ; and Letters are hereby granted to A..\"\ AAoo.... C Ja c('-. b. <)Q 4,\ FEES Probate, Letters, Etc. ............. $ Will.................... ......... .... $ Renunciation... ........ ............ $ Short Certificates ( ) ............ $ JCP... ..... ............... ........... $ Automation Fee................... $ Bond...... ....... ...... ........ ...... $ Total $ 380. c.J1) Filed 8 ~ S - 20OS- 2>\o.dt) \~ . ()\.'"") Attorney (Sup. Ct. I.D. No.) Lio ,00 10.OD 5.1!1D Address -D : "I , (-) .: c::> ':. ::1') ',---:'-....1 ,.-1 ,~.:J ,-") ""1 ""'-1 ~ 'Tl ,-..1 Phone f'0 Thi" is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Lmtl Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. TYPEJPRINT IN PERMANENT BLACK INK ~\ iil '" => ~ :J <( ',' .I 'iv \11 s::\ \, -' \..,> --:> ... z UJ o UJ u UJ o u. o ~ z WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $6.00. l.":..c ~. ~~~~~ Local Registrar ",/lIII'Nn"",..""" \.....,'~~\.\" OF PEj:---___ ll#~~""- l~_~\ ~:JE ,-~, - ~~ ~ S ,fA:: }.i:~ l*~.,-~.. ,;*~ ""<::2 -~- /~~ \. ~ {,:;S "l "- ~P,. ~\.",,\ ---,_,'Tt MENl \)\" .", """"",U#J1JJlI1"ll p 1 1~:;' "". (I '~, '-"-'". "'-':1.... '\.~ '0,,;,.) ,) -' ;) JUL 2 9 2005 No. Date '} r-,.) c':::::> :;) c.rl ,,") I u; J } I j -,:] ;-',) H105.143 Rev. 2/87 ~l-OS-'/o~ COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH C0 " AGE (Last Birthday) Iwp. NAME OF DECEDENT (First, Middle, Last) Clarence Ja=bsen SEX 2,Male PLA E OF DEATH HOSPITAL: Inpll'lentD 88. SOCIAL SECURITY NUMBER 3.051 18 h "' BIRTHPLACE (City and Stale or Foreign Counlryt.J'y New York City 7, 90 v". ::~ID RACE - American Indian, Black. White. e (Specify) White SURVIVING SPOUSE (If wile, give maiden name) 5, COUNTY OF DEATH FAC!L1lY NAME (If not inslilulion, give street and number) Bb, Ctnnber land DECEDENTS USUAL OCCUPATION (Give kind of wor1l done duri~ molIl . . OfWOrlr;lnglll.:~notuse"'lIred) Dupllcate Brldge . 11., Owner/Dlrector 11b. Club DECEDENTS MAILING ADDRESS (Slreet, CIlyfTown. State, Zip Code) AS DECEDENT EVER IN U,S. ARMED FORCES? ve,K) NOD 12. MARITAL STATUS - Married. Never Married, Widowed, Divorced (Specify) ,.YlidaNed PA 17e. ~ Yes. decedent lived in Hamoden 17d. 0 ~~h~e~~~~~:: of D~ decedent lIve In a tDWnshlp? 355 S. Sporting Hill Rd. 16,Mechanicsburg, PA 17050 FATHER'S NAME (First, Middle. Last) 'B. Charles Ja=bsen INFORMANTS NAME (Type/Prinl) 2.., Andrea C. Ja=bsen METHOD OF DISPOSITION Burial ~ Cremation ~emoval from Stale 0 Olhel' (5o.dfy) ERAL SERVICE 17b. County Ctnnber land citylboro. PA 17013 LOCATION. CllyfTown, Stale. Zip Code Donallon 0 . 218. . SIGN Annville, PA PA Complete items 23a< only when certifying physldan Is not available lit time of deatl'1lo certify cause of death. Items 24-26 must be completed by pMSOn who pronounces death. IMMEDiATE CAUSE (Final disease or condition resulting in death)---+ . Approximate : interval between . onset and death Other significant conditions contributing to death. but not resulting In the underlying cause given in PART 1. Sequentialy list conditions { b. if any, leading to immediate _ cause. Enter UNDERLYING CAUSE (Disease or injury c. that Initiated events resulting on dealh ) LAST d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS PERFORMED? AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? DUE TO (OR AS A CONSEQUENCE OF)' MANNER OF DEATH ff o o DATE OF INJURY (Month. Day. Year) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Natural Homidde o o o :~CE OF INJURY buildi"'g,ete.(Spae~l 30e. Accident Pending Investigation Yes 0 No VesO NoD Suidde Could not be detennined 288. 28b. CERTIFIER (Check only one) .l~~~~~tGor~~~~~~3ghe~~;~ ~~~~~caduJ: loJ g,e:~.~:~(:I~~3rrC~x~~a~a h:t~Pe~~~~~.~ .~~~~.~~~ .:?~.~~~~.~.i.t~~ .~~)........ 29. .PRONOUNCING AND CERtiFYING PHYSICIAN (PhysiCian both pronoondng death and certifying 10 cause of death) To the best of my knowledge, death occurr.d at the tlm., date, and plac., and due 10 the causes(s) and manneres stat.d........... -MEDICAL EXAMINER/CORONER ~~~:rb::~::.~~~~~~I.I~~. ~~.~~ .l~~~~~~~~~~~: .I.~. ~~ .~~I.~~~~: .~~~.~ .~~~~~.~. ~.t. ~~~ .~.~~:. ~~~~:.~.~~ .~~~.~~'. ~~~ .~.~~. ~~ .t.~~ .~~~~.~~.~~~ .~~~.. 0 31a. REGISTRAR'SSIGNATUREANDNUMBE~ . ~. t\..I 33 ~ t\. ~~~ ~ 11d-ll 01 l.aSTW[J1.1. a:N'1> TEST&t:ME:NT 0;;: ."':> c".',. -~j CJ..&lXE:N CEJ &l CO 13S E:N ('J (j j"1 ~,' ) I (./~ ...'..... I, CLARENCE JACOBSEN, of Carlisle, Cumberland County, pennsyivanIa:, .. -! . declare this instrument to be my Last Will and Testament, in manner and formfollowing~"- c,] FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by me. SECOND: I hereby direct my Executrix to pay all my funeral expenses and taxes, as soon as practicable after my death. THIRD: I request a simple, inauspicious funeral in a manner I have made known to the Executrix. I direct that my remains be interred as closely as possible to those of my beloved wife. FOURTH: From time to time, I have provided a certain financial assistance to various beneficiaries of this my Last Will and Testament. None of that financial assistance shall be considered an obligation by the donee to my estate or as an advance, but rather as a gift made during my lifetime, unless an obligation of payment has been evidenced by a Note or Mortgage. FIFTH: I hereby give and bequeath all my personal property to my children, CHARLES J. JACOBSEN of Walnut Creek, California, JOHN J. JACOBSEN of Saratoga Springs, New York; ANDREA C. JACOBSEN of Carlisle, Pennsylvania and ELISABETH JACOBSEN of New York City, New York, as they can agree or, if they . , ~) -, , I 'I ) ,1 cannot agree, as the Executrix shall determine. All items of personal property not taken by one of the beneficiaries herein shall become a part of my residuary estate. All the rest, residue and remainder of my estate I hereby give, bequeath and devise to the following beneficiaries and in the following proportions: CHARLES J. JACOBSEN of Walnut Creek, California, or, if he does not survive me to his spouse: twenty percent (20%) of my residuary estate; JOHN J. JACOBSEN of Saratoga Springs, New York, or, if he does not survive me to his spouse: twenty percent (20%) of my residuary estate; ANDREA C. JACOBSEN of Carlisle, Pennsylvania, or, if she does not survive me to her spouse: twenty percent (20%) of my residuary estate; ELISABETH JACOBSEN of New York City, New York, or, if she does not survive me to her partner: twenty percent (20%) of my residuary estate; My Executrix: five percent (5%) of my residuary estate; and My surviving grandchildren: fifteen percent (15%) of my residuary estate, in equal shares. I hereby direct that the gifts as set in this, the residuary clause of my Last Will and Testament, are unrestricted. Nevertheless, I have no objection to any of the beneficiaiies of this my Last Will and Testament donating any portion of his/her share which he/she may desire as a charitable gift in the memory of EMMA E. JACOBSEN. SIXTH: I hereby nominate, constitute and appoint ANDREA C. JACOBSEN to be the Executrix of this my Last Will and Testament. In the event ANDREA C. JACOBSEN cannot or will not act as Executrix for any reason, I then nominate, constitute 2 and appoint JOHN J. JACOBSEN as Executor. No personal representative shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal this 2--0 day of fh~ ,2002. Cf~ J~ Clar ce Jacobsen SIGNED, SEALED, PUBLISHED and DEC~~~ in th re,ce of: II" "" 3 COMMONWEALTH OF PENNSYLVANIA 55. COUNTY OF CUMBERLAND VVe, Carol J. Lindsay and Sharon Simpson 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, CLARNECE JACOBSEN, sign and execute the instrument as his Last VVill; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the VVill as witnesses; 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. Sworn or affirmed to and subscribed to before me by Carol J. Lindsay and Sharon Simpson witnesses this 26th day of March ,2002. -J1a~~~~ VVitness //) j / - -I/] / !LWL~ J (-~e. NOTARIAL. SEAL RE~Ee L, MURRAY, Notlry Publkl Carll~le ~oro. Cumberland Co.. PA My Commission Expires December 13. 2005 5 COMMONWEALTH OF PENNSYLVANIA 55. COUNTY OF CUMBERLAND I, CLARENCE JACOBSEN, 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 1 signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by CLARENCE JACOBSEN, Testator, this '2 6 day of 911-a% ,2002. " ", ! I '/ i "/(1 A'-f' -"~ 0 1.-( """ ~-'-'( Clarence &w NOTARIAL SEAL RENEE L. MURRAY, Notary Public Carlisle Bora, Cumberland Co., PA My Commission Expires December 13, 2005 4