HomeMy WebLinkAbout06-22-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21 - 07 - ~/6 IS
Estate of Pauline L. Shank
also known as
, Deceased
Social Security Number
192-14-6331
Christal A. Burns
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~ A. Probate and Grant of Letters Testamentaryand aver that Petitioner(s) is/are the
last Will of the Decedent dated 08/30/2002 and codicil(s) dated
Executor
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.) (. J
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executio~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: .~
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o B. Grant of Letters of Administration OC _ ;:::: ,-'n
app lea e, en er: c. .a.; . .n.c. .a.; pe en e I e; uran e a sen la; uran e mmofl a e -0 .c ,- . '..-
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following si'I'Use (if any) ~ heirs(Jf
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
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I Name
Relationship
Residence
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his I her last principal residence at
1 W. Penn St., Carlisle, PA 17013
(List street address, town/city, township, county, state, zip code)
Decedent, then 84 years of age, died on 06/10/2007
at Claremont Nursing Center, Carlisle, PA
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:
$
$
$
$
I~
5</.00")
!;o r oo~
Wherefore, 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:
Signature
Typed or printed name and residence
Christal A. Burns 16 Jason Ave.
Denver, PA 17517
Form
Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1 of 2
Oath of Personal Representative
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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.
Sworn to or affirmed and subscribed
me this ~ day of
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Si at r f erso al Representative Christal A. Burns
Signature of Personal Representative
Signature of Personal Representative
File Number:
21 - 07 -
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Estate of Pauline L. Shank
AND NOW,
having been presented b
192-14-6331
Date of Death: 06/10/2007
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, in consideration of the foregoing Petition, satisfactory proof
Testamentary
are hereby granted to Christal A. Burns
in the above estate
and that the instrument(s) dated 08/30/2002
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
Renunciation(s).........~........ $
ut~
d);J:
$
$
$
$
$
$
TOTAL.................................. $
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Attorney Signature:
FEES
Letters.... . ..... . ..... ............. . .. . . ... ..... $
90,0
g-, LV
Short Certificate(s)........................ $
Attorney Name: David R. Morrison
Supreme Court 1.0. No.: 17478
David R. Morrison & Associates
Address: 600-A Eden Road
Lancaster, PA 17601
Telephone:
717/560-1500
I d~ < CI
Form RW-02 Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 2 of 2
..
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r; =COR~JED OFfiCE \
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2001 JUN 22 PH I: 0 I
1liast llUill anb WtstattU\Ult
ORPHAN'S COURT
OF CUMBERLAND CO,. PA
PAULINE L. SHANK
I, PAULINE L. SHANK, of the County of Lancaster and
Commonwealth of Pennsylvania, being of sound mind and memory, do
hereby declare this to be my Last Will and Testament, hereby
revoking all wills and codicils heretofore made by me.
ARTICLE I
I devise and bequeath all my estate of every nature and
wherever situate to my children in equal shares. If any child
dies before I do, I devise and bequeath that child's share to my
grandchildren of that deceased child in equal shares. If a child
dies without children, I give that child's share to my surviving
child in equal shares. All of my children are living and they
are:
1) CHRISTAL A. BURNS, and
2) MICHAEL A. SHANK.
ARTICLE II
No fiduciary under this Will shall be required to give
bond or other security for the faithful performance of the
fiduciary's duties.
ARTICLE III
I hereby nominate and appoint CHRISTAL A. BURNS,
personal representative of this, my Last Will and Testament. In
the event that CHRISTAL A. BURNS predeceases me, or is unable to
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serve, or renounces the right to serve, I hereby appoint DAVID
BURNS, alternative personal representative. It is my preference
that David R. Morrison & Associates be retained as counsel for
the estate.
IN WITNESS WHEREOF, I, PAULINE L. SHANK, have hereunto
subscribed my name and affixed my seal this 30th day of August,
2002.
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(SEAL)
PAULINE L. SHANK
Signed, sealed, published and declared by PAULINE L. SHANK
as and for that person's Last Will and Testament in the presence
of us and each of us, who, at the request of PAULINE L. SHANK,
and in the presence of PAULINE L. SHANK, and in the presence of
each other, have hereunto subscribed our names as witnesses
day and year last above written.
residing at: 3091 Harrisburg Pike
t ~~, o/-~r
resldlng at:
Landisville, PA 17538
9 Wolf Circle
Ephrata, PA 17522
61.ftCS
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Pauline L. Shank
, Deceased
~
David R. Morrison ~
Cathy M. Montague (each) a subscrib ~ /ijtss ~
(Print Name/5) ~ _ :0 ~
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the 0 Will D Codicil(s) presented herewith, (each) being duly qualified according to law, dep@~rand ~
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say(s) that she / he / they was I were present and saw the above Testator I Testatrix s~~e sam~
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and that she I he / they signed the same and that she I he I they signed as a witness at the request of
the Testator I Testatrix in his I her presence and in the presence of each other.
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3091 Harrisburg Pike
(Street Address)
819 Hornig Road
(Street Address)
Landisville, PA 17538
(City, State, Zip)
Lancaster, PA 17601
(City, State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me thi~
of
day
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me thi~ /'1- +it day
of 9~ ~/)~1.
~ fJ-M. ~ -/.. d /lM(J tnJ
Notary Public
My Commission Expires:
Deputy for Register of Wills
(Signature and seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's commission.)
- ...... of
NOTARIAL SEAL
SANDRA L. HANSO\I, Notary Public
Manheim Twp., Cc,)nty of Lancaster
My Commission Expire:; July 28, 2009
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
Form RW-03 Rev. 10-13-2006
Copyright (el 2006 form software only The Lackner Group, Inc.
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
D1~~O 5
This is to certify that the information here given
correctly copied from an original Certificate of Dea
duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vit
Records Office for permanent filing.
,'ee for this certificate, $6.00
P 13550390
~ /J; ~~N 13 71J~7 /
Local RegIstrar Date Issued
Certification Number
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'REV 1112006
1 PRINT IN
MANENT
\CK INK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reve....)
12. Was 0ecedenI_ in the
U.S. Armed FOIteS?
Ov.. IlNo
=:"~ 17a.Slata Pennsvlvania
17b.CoooIy Cumberland
19. MoIher'1 Name (Flrsl"..mIddIe, 'lPl.flM.!Jame)
Bertha .1. .l\eJ.ly
. 16. Dececlanfa ~ Addrws (Sbeel, Cily ,_, SfIIl8, Zip cedi)
1 West Penn Street, Apt.
Carlisle Penns lvania 1
18. F...... NIme (FiIsl, niIldIe.lasl. UIIx)
Harry Clemens
20&. InIonnanI's Name (Type , Prinl)
Mrs. Christal A. Burns
21a. Malhad of 0i0p0sIti0n CramIIlIan 0 Don8lIon
o Burial 0 Removal 110m Slate WIa CnmIIlon or DonIiIIonAulllorizM
o 0Iher. Spdy: by ........ EIIIlIInIr' coron.r?
F....... S8Nlc;e ~(Ol ~ Idlng,. audl)
e. Mc.~" ,~
...... 23H 0AIy _ C8ltlIying 23a. To Iho boll 01 my knowIadga, death 0CCUIIIIl1t Iho tille, dele and place Ilal8d. (8q\aIIn and 1Ia)
phyaiclIIIlI not mIIIIle It tiIle 01 d8IlI1 to
Clll1lfy _ 01 death.
Ilems U-2ll nut be COll1lIaled by pe.-
who prllllOIf1l:8S daaIh.
17e. 0 VIS, lJocedent lNed in
17<110 No,Oec:edentl.Nedwithil CarIis Ie
ActuaIl.inMs of
2Ob. Informanl'. Mailing Addrws (SIreet, Cily 1 town, etaIe, zip cedi)
16 Jason Avenue, Denver,
21b. 0Ite 01 DIsposiIion (lotonIh, diy, yeat) 21c. Place 01 DiIpoaition (Name oI~, cremaIofy Of oIhar place)
13, 2007 remation Society of PA
Memorial Home &:
Pennsylvania 17517
21cl. Locelion (City 'town, sIIle, zip code)
arrisburg, PA 17109
Cremation Svcs, Inc.
CAUSE OF DEATH (9M InatruclIone and edlnpln)
ftam 27. Part J: Enter the ~ - dlseaaea, ...., Of ~ -lhal dncIIy aIllSlld lhlI dealh. 00 NOT entel temIilIaIlNlllIIJ SIlClI as cdac 8TT88I,
I8II*1IlOIy ....... Of vantJIcUar tbIa1Ion without Ihowlng Iho Illdogy. lilli only one cause on each Ine.
PaI1 n: EnIerolher __......... - '" Math
but not rasuIIing in the undertying cause gi\llIIlln Pin I.
alslCllllll:lons, u fl'/,
III CIUI8 IIsliId OIl lnB I.
EnIBr UNDERLYING CAUSE
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Due to (01 as a consequence 01):
I ApproxImaIll inl8Ml;
I Onset to DeatI
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Due to (01 as a conaequencB 01):
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Due to (or as a consequence 01);
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32g. location d Injury (SlIwel, city I town, slate)
:Ila. Was an Al*lpIy
l'9Ilomled?
Dl. Ware AutopSy Fincfngs
"vaiable Prior 10 Completion
01 C8uae d Death?
31. lolannet' 01 0eaIh
IE NeturaI 0 Hri:Id&
o Accident 0 Pending InvesIIgalIon
o Suicide 0 Could Not be Detenninod
M.
321. If TranIpOI\eIIon Injury (SpecI/y)
o DrIver I OperatOf 0 Paaengor Opllllastrtan
Other . Sped/y.
3311. Signature and TIlle 01 Cer1Ifter
Ov.. gJ No
OVIS ONo
32d. TIIll8 oflnjury
33e. C8flllier (Clleclt rn, one)
. ~...::'~-=:'~the~~and~~~~~~~~~':'~_________________ ~ ~
. =:~~OC:::=~and-:.~cer:t~~=_asatated..____u__ _ __.___u 0
. = .::::~ and I Of IIMIllQalIon, In my 0!IlnI0n, daaIII 0CCIImld allhe time, dale, and ,.., and due 10 the C8lII8(.) and _.. allied.. 0
34. Nerne and Addtaa 01 P8IIOl1 WIrO Completecl Cause 01 Death (1Iem 2n Type' Print
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Dispoailion Perm" No.
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10. Reca: Amllricar1India11, Blaclc, Whit., ale.
(Sp6cJI)<) Whi t e
Twp.
CIty , 80m
28. Did Tobecco Use ConhiluIe 10 Death?
o VIS 0 Probebly
o No 0 Unknown
29. If F9ma1e:
gj Not flIlIlPl8IIt within pas! yeer
o Pregnant at line 01 death
o Not flIlIlPl8IIl but pragnant within 42 days
of doaIh
o Not prognent, but pregnenl43 days 10 1 year
beIonl death
o Unknown K prognent within the past year
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