Loading...
HomeMy WebLinkAbout12-29-06 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CtJH.dE/lt.A,lJb COUNTY, PENNSYLVANIA Estate 0 f S}SAt.J c. aR.e~ e.P- File Number :J../-()0-11&3 also known as , Deceased Social Security Number lSI- 3Q .qo E!l6 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) ~. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the fExE Cu"f"D ~ last Will of the Decedent dated ~ "2.S and codicil(s) dated lJ&(' named in the (State relevant circulIlstances. e.g.. renunciation. death of executor. etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: o B. Grant of Letters of Administration (lfapplicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (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.) Name Relationshi Re' (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in '" (List street address. townlcity. township. coun 'J County, Pennsylvania with his / her last principal (ei~nce at ,,-4 5E ),~) 1 '"c, ., -T) : .-"- (-) iTl ...... .~--) Decedent, then !; I.t1 years of age, died on UO\l 1'3, "Z.Da.at nc\~ \<.otJ"s",~ Retob ....0 C) CO ['1 Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 2 ~(fl)O $ $ $ $ situated as follows: WheretGre, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the underSigned: Ty ed or rinted name and residence 74/7060 &cs+#;E. Bre~r I~ ~""Q.rt() Furm RW-02 rev. /0./3.06 Page 1 of2 Oath of Personal Representative COMMONWEALTH OF PENNSYL VANIA SS COUNTY OF The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con-ect to the best of the knowledge and belief ofPetitioner(s) and that, as personal representative(s) ofthe Decedent, Petitioner(s) will well and truly administer the estate according to law. s:;jj~:!!;:/i:JU-Uj~_A-- Signature of Personal Represemative Signature of Personal Represemative ~, ,=-,.~ -0 ' ::) ~-'O ~ "r-- '--"> c::::3 = en i":'~~:'; . ( -) ~) (,-=) o "',) OJ , ,; [~~j File Number: ~ \ - 0 lo - \ \ 1.o3 Estate of L ~ ~ J ~-LJo..-t""- /-';-1 q r'1 t""": rv I.D -,::', .~ ,.' ~ ) ,D~~ > o -T' I.D Social Security Number: I ~ 1- 3 ~ - q O~lp Date of Death: \\ - \3-()\Q::; =::j w AND NO W ~ c.... ~~ , d(X)\.o , in consideration of the foregoing Petition, sati:I;ctory proof having been presented before me, IT IS DECREED that Letters ~ 5 T ~ \"'lit" ('\1-0-...0 are hereby granted to SC:O~ (, ~2.~ in the above estate and that the instrument(s) dated ()C;:\ d..3 ;;) ()(')l., described in the Petition be admitted to probate and filed ofreco d as the last Will (and Codicil(s)) of Decedent. "', Letters ............... $ Loa, oa $ ~~, 00 $ $ \ ~_ 00 . . . $ \0. <.. ;D $ 5.0'0 .. . $ .. . $ .. . $ .. . $ .. . $ .. . $ TOTAL. .. .. .. .. .. ... $ \} 4 - <0 Attorney Name: ,J"K c.er( FEES Short Certificate(s) . . . . . . . . Renunciation(s) .......... W~\\ ..)CP ~-tlWo.-..a n- 0>."-.. Supreme Court J.D. No.: ogoo~" Address: 'Z.DD 0 L./fJ w.eST'oc.JJJ ~ tl zor-! l.\~ I f>P- \"1l10 Telephone: ~\I) (,'I-~~t)t.{ Form RW-02 rev. 10.13.06 Page 2 of2 Hilt:;:.;!)) RE\ 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 tiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 11/111111/11///"""" 111","~~\.i\\ OF PEl.--__. ".,..~~'1',,-.... ,"""" "..t::.... !i$~_. ~. ~."%. f:,ei. .~..' \?~ ~C); -:"f. I~~ ~ (,....)\.,..,d .,.)::..~ ~*~ '. ~" ~/*~ \<:::2~' ~'. .' /~/ ~~ . /.$S,I' - 7/1 ~I\.\."'" " .....---:!l"MENl ~~ """", "''''''''''/1//11/111/11/1 ~ ~ %;A~~~' Fee for this certificate. $6.00 LOl'al Registral P 12841220 ~lOV 1 5 2006 Dale' (") C;o ~~i -+r) ~':-: i~~; ::0 :::.:-:-.;; (~! -ri r---:l c::;:> = 0;;:,.-' Cl rrl ("") N I..D ( ~ ~ 1..0 0 143 Rev. 01,00 PEJPflINTIN ERMANENT lLACK INK 1 Name of Decedent (First. middle, last) COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS :-::; CERTIFICATE OF DEATH STATE FILE NUMaEFi co 14 Date of Death {Monlh,day, year) November 13, 2006 Susan 1<. Sex ) 3 Social Security Nuni>er C. Brewer female I . 181 - 38 - 9086 Under 1 da 7. Dale of Birth Month, da~, year 8 Birtholace and slale Of foreign country) ea. Place 01 Death Check on one Hours I Minules I I I Hospital: I Other: Oc t 0 b e r 11 1 950 Ha r r i s bur 2 PAl 0 lnoalienl 0 ERiOJlDal~nl 0 DOA 0 Nursing Home IIIi Res"enee 0 OIher. s".ci~. Be. City. 8oro, Twp 01 Death 8cI Facil~y Name (If nOl inst~ul\on, give slreet and nuntler) 9 Was Oecedent of Hispanc Origin? 10. Race: Amen:::an Indian, Black. Whrte. elc ~ No Q Yes (lryes, specify CUban, (Sped""" Mexican, Puerto Rican,elc./ white Lower Allen Township 1195 Kingsley Road 5/1J;le(LaSlbirthday) 6 Under 1 year I Months Days ';/1 Y" _ 8b. County 01 Dealh Cumberland 11 Decedenl's Usual Occupation Kind of work done durin most of WlJrkino lile; do not state retired Kind of Work 'Kind of Businessllndustry Section Chief State Government _ 16. Decedenl's Ma~ing Address (Stree!, cilyltown, slate, zip COde) 1195 Kingsley Road Camp Hill, PA 17011 12. Was Decedent ever in the US Armed Forces? DYes mr No Decedenl's Actual Residence 17a. Slale 13 Decedent's Educallon {Spe<:ily only hi hesl rade co feled I ElementaryfSecondary (0-12) I eonege (1-4 or 5+) 12 2 14 Marital Slatus: Married, Never married, Widowed, Divorced {Specif)1 divorced 15 Survivinq Spouse (1Iwfte, give maiden name) Pf'nnRy1RniR Did Decedent Uveina Township? 17c. ~ Yes, DecEldenllived in 17d. 0 No, Decadenl Lived w~hin .A.::tual limits 01 l.mJPr All pn Twp 17b. County Cumberland Cityl13:Jro 18. Falher's Name (Firs!, middle, last) Ralph A. Craver ":t 19. Mother's Name (First, middle, maiden surname) Dorothee Barry <08. Intormant's Name (T)'J)eIprinl) 2Ob. Informant's Mailing Address (Street, cltyltown, slate, zip code) Scott E. Brewer '13 Briarwood Court, Mechanicsburg, FA 17050 21a. Method 01 Disposijion .r! Burial 0 Cremalion 0 Aemovallrom State 0 Donation o Olher'Specl~: November 16, 2006 : 11a. ~eo1:l~en:~ r:::m~u~ 122~~<e~~~_r340 L Complete "ems 23a-c only when certifying 23a. To lhe best of my knowledge, death occoosd a' the lime, dale and place staled< (Signa lure and litle) physcian is not available at lime of death to certify cause 01 death. . ~ems 24-261Tllsl be CO"llleted by person Who pronounces dealh 21 b. Dale of OisposKion (Month, day, year! 2fc. P1aceorDisposif~(Na~ofc8melery.cremaforyorolh8tpl.ace) I 21d. locafion(Cify.1own, slale, zip code} Prospect Hill Cemetery IHarrisbur2 PA I 11c> Name 'nd Address 01 FacNiy Thrthemore FH & CS, Inc. P.O.'~ox 431, New Cumberland, PA 17070-0431 ..<,,31:>. lic.ense Nurrber 23c. Date Signed (Monltl, day, year) 125. Date Pronounced Dead (Month, day, year) AM NO\le.rnbe.r 13 2.001.o CAUSE OF DEATH (See instructions and examples) "em 27. Part l: Enler the ~ - diseases, injuries, or to~licalions -thaI directly caused the death. 00 NOT enter terminal 8venls such as cardiac arrest, respiratory arrest, or ventreular flbrination without showing the etiology. DO NOT abbreviate. Enter only one cause on a Une. IMMEDIATE CAUSE IFinaldiseaseor lJU&/-a-h'L ~f (AACA'f;1.~ condi\1on resuKlng III death) -7 a. _ _ ___ Due to (01 as a consequence oQ: 24. TimeolOeath 26. Was Case Referred 10 a Medical ExaminerlCoroner? 10:/0 DYes tIl No : Approximale interval: : onsetlodeatn Parlll: En'er olher sionificanl cond~ions conlri:lLJ~no in death, but nol resulting in Ihe und4'o/ingcause given in Par1I. 28. Did Tobacco Use Contrbute 10 Dealh? o Yes 0 Probably o No 0 Unknown 29 1fFemale: o Nol pregnant within past year o Pregnant at lime of death o Nol pregnant. but pregnant within 42 clays oldealh o Not pregnant, but pregnant 43 days 10 1 year beloredealh o Unknown il pregnant within the past year 32c. Place 01 Injury: Home, Farm, Slreet, Factory. Office Building, e{c. (SpecJiy1 Sequentially tisl condijions, if any, le8dinglo the cause lisled on linea. - En'er the UNDEI=Il YING CAUSE . (diseaseolinjurythatinniatedthe evenls resulting in death) LAST. b. DUll 10 (Of as a coftSequence oQ: Due 10 (O! as a consequence o/): o Yes ~ No d JOb. Were Aulopsy Findings Available Prior 10 Coft1)lelion of CaU!;e 01 Death? OVesONo 31 Manne' 01 Deall'! b( Natural 0 Homicide a Accident 0 Pending InvesliQation tl Suicide 0 Could Not Be Determined 32a.Dateollnjury(Monlh,day,year) 32b. DescrtJe how Injury Occurred: 3Oa. Wasan Autopsy Performed? 32d. Time 01 Injury M I 32e.lnjuryalWofk? CJ Yes 0 No 321 II Transportation Injury {Specif}1 tl DriverlOperalor 0 Passenger tI Pedestrian 0 Other - Specify: '-1gnalu"andTl.2L/~ Q 33c. License N~7/~r lYIhD 1 %()07 C 34. Name and PJjdress of Person WhOXO~leled Cause of Dealh ~1\em 27) TY~,o/P~nt /11 ClYL( A. ~UI..tJ'rl.f);.(tt ~ /) U). YiJ ~ 7Ct.~~L(p~'ht), i I V I 32g. Loc;.ation (Street. cityllown, state} 338. Certifier (check onty one) Certifying physician (Physician certifying cause 01 dealh when another physician has pronounced death and corT'4Jleled lIem 23) To the best 01'"'1 knowledge, death occurred due to the cause(s) and manner as stated "_"_"___'_ ..............."'...., .........". ........,..........................__ .................""... ..._0 Pronouncing and certifyIng physician (Physician bolh pronouncing death and certifying 10 cause 01 death) To the best of my knowledflt, death occurred at the time, date, and place, and due 10 the cause(s) and manner as slatoo....._..... ..........._.._._ ""m ..................... .._...0 Medical examiner/COl'Qner On the basis 01 examination and/or investigation,!n my opinion, death occurred at the lime, date, and place. and due to the cause(s) and manner as stated ...."...0 1~5~~~'r~ ~:l0''':': '''':>1/ I...?I/ V , I;/;?~~L~::;;;rt V 33<1. Dale Signed (Mottl", day, Year) (See instructIons and examples on reverse) LAST WILL AND TESTAMENT OF SUSAN C. BREWER understanding, do hereby make, publish and declare this as and for my Last Wjl,f,a:~d 0'1 ~ i"""-...) C) g I, Susan C. Brewer, of 1195 Kingsley Road, Camp Hill, PA 170n~113, ~ Pl C) N \.D _~TJ :.." CO) C:.J .:T7 .0 r-i~ .' . C-:J ) :1 Cumberland County, Pennsylvania, being of sound and disposing mind, memorY;:~d '-: "' I Testament, hereby revoking any and all prior Wills and Codicils made by mea;t:.~ny ti~ ~ 0 heretofore. CX) ITEM I: I direct that the expenses of my last illness and my death, including all costs and expenses of administration of my estate, my funeral, and all taxes arising by reason of my death be paid from the residue of my estate as soon as practicable after my death. ITEM II: I give, devise and bequeath all of the rest, residue and remainder of my estate of whatsoever nature, whether real or personal, to my children, in equal shares, to be distributed as follows: A. One-third (1/3) unto my son, SCOTT E. BREWER, or his issue per stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue, per stirpes. B. One-third (1/3) unto my daughter, SARA E. BREWER, or her issue per stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue, per stirpes. C. One-third (1/3) unto my daughter, SHEILA SHARADIN, or her issue per stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue, per stirpes. INITIALS: M ITEM III: In addition to all powers conferred herein upon my Executor or personal representative, or vested in them by law, my said Executor or personal representative shall have the following powers applicable to all property, real, personal and mixed, wheresoever situate, exercisable without Court approval and effective with respect to each item of said property until actual distribution thereof: (a) To pay all taxes, charges and expenses of maintenance, upkeep, improvement, development, protection and reservation of any obtained or acquired real or personal property. Such payments may be made either from principal or income as my said Executor shall determine; (b) To retain or invest any and all funds, whether principal or income, and any real or personal property without restriction to legal investment; (c) To purchase investments at premium; (d) To exercise all rights of a security holder or shareholder in any corporation; (e) To lease, mortgage, pledge, give options upon or sell at public or private sale and without approval of any court and without any responsibility to the buyer or buyers to see to the application of the purchase price, any real or personal property or portions thereof, irrespective of the manner or means by which the same was acquired by my said Executor; (f) To make any payment or distribution herein provided for in cash, in kind or partly in cash and partly in kind, except as herein otherwise specifically provided at valuations fixed by my Executor at the time of distribution. -2- INITIALS: ~ ITEM IV: I direct that no interest of any beneficiary in the income or principal of any Trust created by this Will or in any property distributable to a beneficiary hereunder may be anticipated, assigned or encumbered or be subject to any creditor's claims or legal process prior to its actual distribution to the beneficiary. ITEM V: I hereby nominate, constitute and appoint SCOTT E. BREWER to be the Executor of this, my Last Will and Testament. In the event that SCOTT E. BREWER has predeceased me or cannot qualify or, having qualified, cannot or does not continue to serve as my Executor then, in that event, I appoint SHEILA SHARADIN as substitute Executor of this, My Last Will and Testament. It is my specific intent that my Executor be provided with reasonable compensation for services provided to my estate. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction, but if bond is nevertheless required it shall be without surety. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, this lhth /-d"-I day of d &c,~-l/JAi..t.tJtJ , 2006. ( xLAU/lG ~,uJ Name -3- INITIALS: ,JI/J This instrument, consisting of a total of five (5) typewritten ages, initialed at the bottom of each page for security purposes, was on the date thereof signed published and declared by SUSAN I:. BREWER, Testatrix herein named as and for her Last Will and Testament, in our presence, who, at her request, in here presence and in the presence of each other, has subscribed our names as witnesses whereof. -4- INITIALS: #-6 , COMMONWEALTH OF PENNSYLVANIA COUNTY OF \:)Avo'n', .-..... 55. We, the Testatrix and Witnesses, whose names are signed to the foregoing instrument, being first duly sworn do hereby declare to the undersigned that the Testatrix signed and executed the instrument as her Last Will, that she signed willingly, and executed it as her free and voluntary act for the purposes therein contained, and that each of the witnesses, in the presence and hearing of the Testatrix, was at the time eighteen (18) years of age or older, of sound and disposing mind and under no constraint to undue influence. ~[~ SUSAN &~EWER ~~~ Witness Sworn and subscribed to before me this ;. 3r<;1 day of Oc\'OfxO'(~ , 2006. v(y/7 . i/, ~4e;v1h. }{~ Notary Public My commission expires: COMMONWEALTH OF PENNSYLVANIA NolariaI Seal Melissa M. Kain, Notary Public Susquehanna Twp., DauphIn County My CommIssIon Elcplres Aug. ii, 2010 -5- INITIALS: WJ