HomeMy WebLinkAbout03-31-06
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GR4NT OF LETTERS
I
I
, Jeceased
John T. Wertz I
Petitioner(s), who is/are 18 years of age or older, appl(ies) for: I
(COMPLETE 'A' or 'B' BELOW) I
[!) A. Probate and Grant of Letters Testamentary and aver that petilioner(s) is/are the
the Decedent, dated 06/29/1995 and codicils dated i
Estate of Dorothy A. Wertz
also known as
No.
21-06- D2..QO
Social Security No.
201-18-3386
named in the last Will of
State relevant circumstances, e.g., r :tnunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not ha e a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
D B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pe ~ent~ lite; durante absentIa; durante mmontate)
Petitioner(s) after a proper search has/have ascertained that Decedent left n :) Wi~1 and was survived by the following spouse (if any) and heirs:
I Name Relationship Residence 1
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
or principal residence at 46 South 39th Street, Hampden TOW~ShiP
(1st street, number, and municipality)
Decedent, then 80
years of age, died 03/11/2006
at
Decedent at death owned property with estimated values as follows: (Location)
(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:
50,000.00
130,000.00
Wherefore, Petitioner(s) respectfUlly request(s) the probate of the last Will alnd Codicil(s) presented with this Petition and the grant
of letters in the appropnate form to the underSIgned:
/ Signature Typed or printed name and residence
John T. Wertz 735 Ashurst Road
Havertown,PA 19083
"7
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group, Inc,
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
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 Decedent, Petitioner(s) will
well and truly administer the estate according to law. ~\ J n T. we~' _--
Sworn to or affirmed and subscribed - -
B I 51- day of
before me this
~
A. OO/P
,~~~
'/U^ ~ cl.Jptd:ljor ttle Register
No.
21-06- 0 z.'b
Estate of
also known as
Dorothy A. Wertz
, Deceased
Social Security No: 201-18-3386
Date of Death:
03/11/2006
AND NOW,
.~
319
200~ , in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 00 Testamentary 0 of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to John T. Wertz,
in the above estate and that the instrument(s) dated
6/29/1995
described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
FEES
Letters........................................$ :JJpO. 00
Short Certificate(S)......5............$ 7-0 I (;) 0
Will
ReftHl'leiati8R..............................$ /6.00
~ '-4t1A-/Le{ ~~
/'VI,J):Z PofWl"-flM ~I
Attorney: Michael L. Bangs
Affidavits ( )...........................$
I.D. No: 41263
Extra Pages ( )....................$
Address: 429 South 18th Street
Codicil.............................. u........$
JCP Fee.....................................$
10.00
Camp Hill, PA 17011
Telephone: 717/730-7310
Inventory............................. ....... $
E-Mail:
au.to
Other....... ........... ............ ........ ....$
5.00
TOT AL....................... ..... $
3J 0.00
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form FtVV-1(1991)
If
l' I', ;() certifv that the information here given is correctly copied from an original certificate of death duly filed with me as
'I l I'~ :!~iSlrar. 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.
Fee for this certificate. 56.00
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P 12409002
\,l, D 11" 5 2006
\'\,'\(\
No.
ITEM # S
SHOULD READ AS FOLLOW :
, ~'/' ".J.r
IVW~
~<-- /1'( ~
Date
3 Rev 01106
/PRINT IN
ItANENT
.CKINK
1 Name of Decedenl (FirSI, middle, last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FilE NUMBER
3, Social Securily Nurrber 4, Date of Death (Month. day, year)
Doroth
5. Age (Lasl birthday)
80
201 - 18
March 11 2006
7, Date of Birth Monlh. da , ear
Sept 11,2006
ea. Place of Death Check on one
~sin~:tienl 0 ERlOut tient 0 DOA ~h~~rsin Home 2& Residence 0 Other. S
9, ~~ec~en~~ ~~:~~~~~~~uban. 10, (~~:;erican Indwln. Black, WMe, elc,
Mexican, Puerto Rican, elc,)
Whi te
Cumberland
Harm:
11. Decedent's UsualOcc lion Kind of work done durin mosl 01 wor1<in me; do nol slale relired
S Kind of Work S Kind of BU~~ndustry
ecretary tate or ~a
16. Decedenl's Mailing Address (Slreel, cityllown, slate. zip code)
13, Decedent's Educalion eci
EJeme~lSecondary (0-12)
hi hest rade co leted
College (1-<1 or 5+)
14, Marffal Stalus: Married, Never married,
M~~~iD~~ed (Specnn
15. Surviving Spouse (11 wite. give maiden name)
46 South 39th Street
Camp Hill, Pa 17011
17a. Stale
Pa
p~e~~enl 17c, iK Yes. Decedenl Lived in
TOWl\sh~?
HamIXlen
Twp,
17b, County
(1 Imhpl"' 1 :mn
17d, 0 No. Decedent Lived within
Actual Umffs of
Cily/Boro
18, Father's Name (Firsl. middle, Iasl)
19. Mother's Name (Firs!. middle, maiden surname)
Edward A. Town
203. Informant's Name (Typelprinl)
Ann Bo Ie
20b, tnformant's Mailing Address (Slreet. CilyAown, state, zip code)
John Wertz
735 Ashurst Road Havertown Pa 19083
21b, Date of Disposffion (Month. day, year)
21c, Place of isposftion (Name of cemetery, crematory or otner place) 21d. Location (Cilyllown. slate. zip code)
011654-L
occurred at the time, dale and place slaled, (Signature and title)
Rolling Green Cemetery
22c. Name and Address 01 Facility
M ers-Harner'Funeral Home
Cam Hill Pa
1903 Market Street
IncCamp Hill, Pa 17011
23c. Dale Signed (Month, day, year)
23b, License Number
lIems 24-26 must be COmpleled by person
_ who pronounces death.
24, T1met~th: 12. f> M, 25, Mr~;;D~d(Mo;I~';Y2.eaOO'
CAUSE OF DEATH (See Instructions and examples)
lIem 27, Part I: Enter the ~ - diseases. injuries. or complications - that direcltf caused the death, 00 NOT enler leminal events such as cardiac arresl,
respiratory arrest. or ventricular fibrillation without showilg the eliology, DO NOT ab reviate, Enter nly one cause on a fine,
IMMEDIATE CAUSE (Final disease or
condffion resufting in dealh) ---7 a,
Approximale interval:
onse\ 10 death
26, Was Case Referred 10 a Medical Examiner/Coroner?
o Yes ~NO
Part II: Enter other sianificanl conditions contributina to dealh. 28, Did Tobacco Use Contribute 10 Death?
but not resulling in the underlying cause given in Part I. 'fit Yes 0 Probably
b' No 0 Unknown
Due to (or as a consequence oQ:
Uk~ .
I'V~~(i J~t7;
G-ER.I')
29, If Female:
\t Not pregnant within pasl year
D' Pregnanl allime of death
o Not pregnant but pregnant within 42 days
afdeath
o Not pregnant but pregnant 43 days 10 1 year
before dealh
o Unknown if pregnanl within the past year
32c, Place of Injury: Home. Farm, Slreet. Factory, Office
, Building, etc, (Specify)
Sequenlially list conditions, rl any,
leading to Ihe cause listed on Line a.
Enter the UNDERLYING CAUSE
. (disease or injury that inKiated Ihe
evenls resuning in dealh) LAST,
b,
Due to (or as a consequence oQ:
o Yes ~ No
d,
JOb, Were Autopsy Rndings
Available Prior to Completion
of Cause of Death?
o Yes 0 No
31 Manner of Death
~ Nalural 0 Homicide
o Accident 0 Pending Investigalion
o Suicide 0 Could Not Be Determ;ned
32a. Dale oflnjury (Month, day. year)
32b. Describe how Injury Occurred:
JOa, Was an Autopsy
Pertormed?
32d, T1l1le oflnjury
32e, Injury at Work?
o Yes 0 No
DC
33c. License Nurrber
D~-O{J 6 2 4J L Ctre h ,:S
34, NameandAddressofPersonWhoComplet5~~.:1.D~::p2&;~o \<c2..
I :)~rh",)~~~
(cr :- J r>.4 f /0 I
33<1. Date Signed (Month, day. year)
321.
32g, Location (Slreet. cilyAown, stale)
M.
33a Certifier (check only one)
. Certifying physician (Physician certifying cause o. death when another physician has pronounced death and compleled hem 23)
To the best of my knowledge, death occurred due 10 lhe.cause(s) and manner as staled ...........___............__.._........___................................._...............,..___..........0
. Pronouncing and certifying physician (Physician both pronouncing death and certifying to cause of death)
To the besl of my knowledge, death occurred at lhe time, date, and place, and due to the cause(s) and manner as s1ated_......._........................-............--.....-.....)t
. Medical examlnerlcoroner
On the basis of examination and/or investigation, in my opinion, death occurred at the lime, dale, and place, and due to the cause(s) and manner as staled .........0
35, Regislra(s Signature and Dislric1 Nurrber Date Flied (Month. day. year)
... __ I ~I / I ~ I /' I / I '/ tt1 ~
(See instructions and examples on reverse)
'200b
. .
La~ "1lV':U.l. 4k Te.tsD'1e:n.t
I, DOROTHY A. WERlZ , of Camp Hill, Pennsylvania, declare this to be my Last
Will and revoke any Will previously made by me.
FffiST: I declare that all my just debts and funeral expenses, including my grave
marker and all expenses of my last illness shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration of my estate.
SECOND: I bequeath my automobiles, household and personal effects and other
tangible personal property of like nature (not including cash or securities), together with any existing
insurance thereon to, JOHN T. WERTZ AND MARY ANN WERTZ-METCALF, per stirpes,
to be divided among them by my Executor with due regard for their preferences in as nearly equal
shares as practicable. Any such article allotted to a minor may, as my Executor thinks advisable,
either be delivered to the minor or any person to hold for the minor, or be sold and the proceeds paid
to the Guardian as provided in paragraph FOURTH hereof
THIRD: I devise and bequeath the rest and residue of my estate of every nature and
wherever situate to JOHN T. WERTZ AND MARY ANN WERTZ-METCALF, per stirpes.
FOURTH: I appoint JOHN T. WERTZ Guardian of any property which passes
either under this Will or otherwise to a minor and with respect to which I am authorized to appoint
a Guardian and have not specifically done so, provided that this appointment of a Guardian shall not
supersede the right of any fiduciary in his or her discretion to distribute a share where possible to the
minor or to another for the minor's benefit. Such Guardian shall have the power to use principal as
1
, ,
, .
well as income from time to time for the minor's support and education (including college education,
both graduate and undergraduate), without regard to his or her parents' ability to provide for such
support and education, or to make payment for these purposes, without further responsibility, to the
minor or to the minor's parents or to any person taking care of the minor. Should JOHN T.
WERlZ fail to qualify or cease to act as Guardian, I appoint MARY ANN WERTZ-METCALF
as Guardian.
FIFTH: The interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation.
SIXTH: My Executors and Guardians shall have the following powers in addition
to those vested in them by law and by other provisions of my Will 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:
1. To retain any property which I may own at the time of my death or which
may at any time be in their hands, or to exchange or otherwise dispose of any such property, at public
or private sale, without application to Court, on any terms, including the extension of credit, which
they deem advisable.
2. To acquire, by purchase or otherwise, any property, real or personal,
without being limited by any provision of law which restricts investments by fiduciaries and without
regard to any principles of diversification, including but not limited to common and preferred stocks,
bonds, mutual funds, common trust funds, secured and unsecured obligations, and mortgages.
3. To acquire and pay for, exercise, or sell any options or subscription rights
in connection with securities or any other property.
2
4 . To hold securities in the names of nominees or in bearer form.
5. To operate, repair, alter, improve, insure, grant options upon, mortgage,
partition, or lease for any period of time any real property or interest in real property which at any
time forms part of my estate or of any Trust herein created.
6. To retain and pay, as an expense of administration, accountants, attorneys,
bookkeepers, investment advisors, stenographers, and other assistants.
7. To borrow money from any source and for any purpose, including but not
limited to the payment of taxes, and to pledge or mortgage any assets of my estate as security for
money borrowed.
8. To pay any gift and to make distributions of my estate in cash or in kind,
or partly in each, and to allocate property to any gift other than ratably.
10. To determine whether to claim deductions available to me or to my estate
on estate tax or on income tax returns, and to determine whether to use date of death or alternate
valuation date values for estate tax purposes, in such manner as she considers advisable and with or
without making any adjustment between income or principal or among beneficiaries due to any such
determination, as they, in their discretion, decide.
SEVENTH: I appoint JOHN T. WERTZ, Executor of this my Last Will. Should
the said JOHN T. WERTZ fail to qualify or cease to act as Executor, I appoint MARY ANN
WERTZ-METCALF, Executrix of this my Last Will.
3
EIGHTH: I direct that my Executor and their successor shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this rJ C, day of
:='i~)~-- , 1995.
4
The preceding instrument consisting of this and four (4) other typewritten pages, each
identified by the signature of the Testator, DOROTHY A. WERTZ, was on the day and date thereof
signed, published and declared by DOROTHY A. WERTZ the Testator therein named, as and for
her Last Will, who, at her request, in her presence, and in the presence of each other have subscribed
our names as witnesses hereto.
~.-e;, aft~
-VJ~~~.
ADDRESS (
J:r1M)'~jib AfI ~^--
C ADDRESS
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D. I .-r. /I ,~)
d \,fJt>, f b I t"-- U'
ADDRESS
l')l'L~,2fhnll Il ~
NAME
5
. .
COfvlM:ONWEAL TH OF PENNSYLVANIA:
SS.
COUNTY OF CHESTER
WE, DOROTHY A. WERTZ, ~C. Ai\.GkS ,:Dill""" {. ~ft.YY1ltl~~r1
and 1('. -Su. . ,Jhe Testatrix and the witnesses, respectively, whose names are
signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument as her Last Will and Testament and
that she had signed willingly, and that she executed it as her free and voluntary act for the purposes
therein expressed, and.that each of the witnesses, in the presence and hearing of the Testatrix, signed
the Will as witnesses and that to the best of their knowledge the Testatrix was at that time eighteen
(18) years of age or older, of sound mind and under no constraint or undue influence.
j~LlLL~(n
6
.
Sworn, subscribed to and acknowledged before me by DOROTHY A. WERTZ and
subscribed and sworn to before me by the witnesses, tv"l'Lyi c, A-t~..~ c:;
S~5.,6Vl ,and~s~daYOf <;.}I..U,U
, 3)~Yl L,.~
, 1995.
~ .~~ ~
,/ '~1;A I. ~~
NOTARY PUBLI
f''\ot2(;';';! Seal
Melinda T i' ,~orCi'O''::3, Notctry Public
'Ne~;t Ch~st,Jr Garo, Ch?SlGi County
My CommiSSion Expire::> !'.Iime!l 1, 1999
____.-..--...z,___
M2rnber, Pei!r.~;yivani.::: f~~;:;;c<(';i8.tk:m of Notaries
7