HomeMy WebLinkAbout11-03-05
Register of Wills of Cumberland County
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 is/are 18 years of age or older, and the execut~ named in the last will of the
above decedent, dated r-: e b. ( C , "2S j q ~ (j
and codicil( s) dated Iv r i\
P I
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in C ~, t'C\b€I- \(..v"t"J
Pennsylvania, with h.!5last family or principal residence at . I _lOA
.:lSC Cae /c'-S fh (I /20'{ {~~ (,'5.1(( r f \ 17.6/3
(list street, number and municipality)
Decedent, then ~ tC years of age, died 0 c.h- bet I L, 20 (\ 5, at CCt..--! i s I f !~ It i 6,"';.\.. r /11: f: d..i (.(; I
Except as follows, decedent did not marry, was not divorced and did not have a child bo~ or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
[;....1 I R Pre clC c <L.2..St. r:J Sa-no.. l-... u c '"c So ~ /f;r
,
County,
Cc"fc,.o.
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
(Unot domiciled in Pa.) Personal property in County
Value ofreal estate in Pennsylvania
situated as follows: IV / A
$ 5 c,['{.. . ,,1 t'
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the gra'.lt of letters
thereon.
Signature(s) ofPetitioner(s)
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testamentarr;;administration c.t.a.; administration d.b.n.c.t.a.)
Residence( s) of Petitioner( s)
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA
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SS:
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirrn(s) that the statements in the foregoing petition are true and
correct to the best of the knowledge and belief ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
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Sworn to or affirmed and subscribed
Before me this -~ f\l... <;::,
~~~~
{
day of
,20 ~S.
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R . \
eglster
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No. ~"-~S- '\~ \0
Estate of ~~~\..\~ ~. \:.l'\J\J~~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~~~ x':'\ ~~ \<... ~ 20~, in consideration of the petition on the reverse side
hereof, satisfactory proof having been pres~nted before me, IT IS DECREED that the instrument(s), dated
~~~ . '\ ~. " "" ~ ~ , described therein be admitted to probate filed of record as the last will of
"'~~~~ ~. ~1.~\J.:s~ ; and Letters are hereby granted to ~~~\\~~~ ~Ll~N V\~-9..."i'~ .
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation... . . . . . . . . . . . . . . . . . . . . $
Short Certificates (S) ............ $
J CP . .. . .. .. .. . . . . .. .. . .. . . .. .. . .. .. .. $
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Register of Wills '\
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Attorney (Sup. Ct. I.D. 0.)
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Automation Fee.. ... ... .. ... . .. ... 3>
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Address
$
$
20~S
Bond. . .. ... . .. . .. . .. ... . .. . . . . .. . ....
Total
Filed ",. ~
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Phone
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This is to certify that the information here given is correctly copied from an original certificate 0 delth dul:; I lied with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for p ~rm<lIlent filing.
WARNING: It is illegal to duplicate this copy by photostat or photog'aph.
Fee for this certificate. $6.00
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''''''''''''N,NIIJIJ"f
LL ~o~~~~
No.
OCT 1 4 2005
Date
v
r'-~
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H105.14J Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
TYPE/PRINT
IN
PERMANENT
BLACK INK
CERTIFICATE OF DEATH
STATE FilE NUMBER
NAME OF DECEDENT (First, Middle, Last)
o
~
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3454
DATE OF DEATH (Month. Day, Year)
4. October 12, 2005
SEX
5.
COUNlY OF DEATH
BIRTHPlACE (City and
L~~r or Mi~'lfrri)
PA
Re.ldence 0 ~~ft) 0
RACE - American Indian, Black, White, el .
(Specify)
White
10.
0:<\
8b.
AS DECEDENT EVER IN
U.S. ARMED FORCES?
Yeso Nol!!
12.
17a. State
PA
MARITAL STATUS. Married,
Never Married, Widowed,
Divorced (Specify)
14. Widowed
SURVIVING SPOUSE
(lfwif".giYflml;cjennlm,,)
17b. County
Did
decedent
Cumberland :~~~h~P? 17d. 0 ~~h~e~~~7~1~~~ of
MOTHER'S NAME (First. Middle, Mhiden Surname)
19. Sarah V. Cressler
~~:oRMA2:5bMA&~tf::E~iYr"~~dn; SI~~{rsie PA 17013
PLACE OF DISPOSITION. Name of Cemetery, Crematory LOCATION _ CltyfTown, Stale, Zip Code
or Other Place
17c. ~ Yes. decedent lived in
15.
N. Middleton
lwp.
citylboro
2005
LICENSE NUMBER
22b. 0l4819L
23b. 23c,
WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER?
26. Ye, 0 No 5t
To the best of my knowledge. death occurred al the time, date and place stated.
(Signature and Title)
23a.
TIME OF DEATH
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DATE PRONOUNCED DEAD (Month, Day, Ye,pr)
f' M. 25. a ~\ \:l. I :l-oC::l';:)
27. PART I: Entlr the dl......, lnJurl.. or compllc.tlon. which e,uHd the d..tl1. Do not .nterthe mode of dyIng, sueh., elrdlae or re.plr.tory 'rrllt, .hoek or h.,rt f.llurl,
Ult only on. elUle oneaeh Unl.
J
~
J
C>.J) ..--c.:
~r~
. Approximate
: interval between
: onset and death
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PART II: Other significant conditions conltibuting 10 death, but
not resulting in the undenying cause given in PART I.
DUE TO (OR AS A CONSEQUENCE OF):
c:.,->~
r.
:1
<i
E..
Sequentially list conditions { b.
If any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury c.
that initiated events
resulting on death) lAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DUE TO (OR AS A CONSEQUENCE OF)
DUE TO (OR AS A CONSEQUENCE OF):
MANNER OF DEATH
Natural
@
o
o
Homicide
DATE OF iNJURY
(Month, Day. Veer)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
Yes 0 No I5Ol.
Yes 0
NoD
Accident
Suicide
Pending tnvestigation
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o fuo~o
30.. 30b. M. 30e.
o PLACE OF INJURY - At home, farm, street, factory, office
tlulltllng, elc. (Specify)
30e.
30d.
LOCATION (Street, CityfTown, State)
30f.
SIGNAT~EAND6'~EO~E_RTIFIER ~ ~
....0 31b. ~ ~~ ~
LICENSE NUM~EIj. DATE StGNED (Month, Day, Year)
......[ii 31c. ~ <;\\.","Z.'-{\(, 31d. 0'-1. 1:2., '2.cI<:>S
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(lIem 27) Type or Print
~St> L...jl:.l.- r.......'l' ~~ 1T t-. 1'-'0
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34.
Could not be determined
28a. 28b,
CERTIFIER (Check only one)
.f~~~F:':~tGor::'~~;~~~~s~~:rhcg~~~~gaduJ: 1c:1 f:ea~ha~~:~(:)~~j~~x~~a~s h:~~~~~~~,~ .~.~~~, ~~ ,:?~~~~~~~. i.t~~.~~)..
29.
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.PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and c9rtifying to cause of death)
To the best of my knowledge, death occurred at the tIme, date, and place, and due to the Cause8(s) and manner as stated.,
*MEDICAL EXAMINER/CORONER
~~~~:rb:::t::e~~~~I.~~~I~. .~~~~~ .I~~~.t~~~~~~.~: .I.~ ,~~ .~~I.~~~.~: .~.~~.~ .~~.~~~~ .~I. ~~~. ~~~~:. ~~~~'. ~~~.~.I~~~" ~~~ ,~,~~..t~ .~~..~~.~~.~~.~~~ .~~~.. 0
3ta.
33. REGISTRAR'S SIGNATURE AND NUMBE~ ~. ~'eu..~~~
~lllaJllOI
"J.\-<:JS -~\'\\o
I, Marlin R. Clouse, of 1900 Douglas Drive, Carlisle, North
Middleton Township, Cumberland County, Pennsylvania, being of
sound and disposing mind, memory and understanding, do hereby
make, publish and declare this as and for my Last Will and
Testament, hereby revoking any and all other wills and codicils
heretofore made by me.
FIRST. I direct that all my just debts and funeral
expenses be paid from my estate as soon after my death as
practically and conveniently may be done.
SECOND. I direct that my remains be interred within my
family's burial plot located at vJestminister Cemetery, beside my
beloved deceased wife, Marian Clouse.
THIRD. I authorize my personal representative to expend
funds from my estate, in such amounts as my personal
representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my
grave.
FOURTH. I give, devise and bequeath my interest in a
condominium in Fairfield, Williamsburg, Virginia to Barbara E.
Martin and R. Scott Martin, subject to any outstanding balance
owed on said condominium.
FIFTH. I give, devise and bequeath any and all tangible
personal property owned by me at the time of my death unto my
longtime friend, June M. Martin, provided she survives me by
thirty (30) days. In the event she fails to survive me by
thirty (30) days, I give, devise and bequeath all said tangible
personal property unto her children, Barbara E. Martin and R.
Scott Martin in equal shares per stirpes.
SIXTH. I give, devise and bequeath any and all real estate
owned by me at the time of my death, unto my longtime friend,
June M. Martin, provided she survives me by thirty (30) days.
In the event she fails to survive me by thirty (30) days, I
give, devise and bequeath all said tangible personal property
unto her children, Barbara E. Martin and R. Scott Martin in
equal shares per stirpes.
SEVENTH. I give, devise and bequeath all the rest, residue
and remainder of my estate unto my longtime friend, June M.
Martin, provided she survives me by thirty (30) days. 'jIn the
event she fails to survive me by thirty (30) days,r-give,
devise and bequeath all said tangible personal property,u~to her
children, Barbara E. Martin and R. Scott MiiI\tin 'in'" equal-~hares
per stirpes. c,,-'" .'
-~..'
EIGHTH. I direct that any and all Inheritance, Estate and
Transfer taxes imposed upon my estate passing under my will or
otherwise, shall be paid out of the principal of my residuary
estate.
NINTH. I hereby nominate, constitute and appoint Barbara
E. Martin as Executrix of this my Last Will and Testament. In
the event that June M. Martin predeceases me then I direct that
my Executrix serve without compensation. I hereby relieve my
Executrix from the necessity of posting security in connection
with her duties, as such, in any jurisdiction in which she may
be called upon to act insofar as I am able by law to do so. In
addition to the powers confeLred by law, I authorize my
Executrix, in her absolute discretion, to retain in the form
received, and to sell either at public or private sale any real
or personal property owned by me at the time of my death.
IN WITNESS WHEREOF, I have hereunto set
this, my Last Will and Testament, consisting
pages this ' day of -:I" i',-;:,{ ac <'I,.
,,I
my hand and seal to
of two typewritten
1989.
,
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Marlin R. Clouse
Signed, sealed, published and declared by the above named
Testator Marlin R. Clouse as and for his Last Will and
Testament, in the presence of us, who, at his request, in his
sight and presence and in the sight and presence of each other,
have hereunto subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ss.
I, Marlin R. Clouse, 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.
"'"'-. ,''',I ;-., '''s, ,.; ,.,,,~..J ,f'~ (.i ""',..,J....,.}".L..
fvla:Clin R. Clouse
Sworn or affirmed to and
acknowledged before me, by
Marlin R. Clouse this~~day
of ,...;1." , 1989.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ss.
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We, /[ .',t, /-". ! )':-tA..( (. "...~<.." and
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 Marlin R. Clouse
sign and execute the instrument as his Last Will; that Marlin R.
Clouse signed willingly and that Marlin R. Clouse executed 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 will as witnesses; and that to the best of our knowledge,
the Testator was at that time eighteen (18) or more years of
age, of sound mind and under no con~traint/Rr ~~due influence.
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Sworn or affirmed to and
subscribed before me by
-~-k1 4;;'./ ~,1..-)l ~ i" (' (;<_;( ( and
, witnesses,
this"[, day of '::/,: //.(l < '>__'-j.," , 1989.
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Notary Pup-fie /( ~-'9IEAL) /./"
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