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Home My WebLink About07-12-07 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA Estate of SHIRLEY E. STEPHENSON also known as SHIRLEY E. HACKER HIMES STEPHENSON , Deceased File Number ~/- 0 'l~ 0SS Social Security Number 168-26-4078 r-:> c-:=:) '.=:. Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW:) ~ I N 'J ;\\\i~ ~-~j _~-:t ;;; ,-";"\ ; . , ':"~) namedJ~;the . --c::l . '__~ r;. (, o ~:::"O -'-:0 :'fa ",-\- 00 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the CO-EXECUTRICES~~ S ".....~.) /....... last Will of the Decedent dated 1/12/2007 and codicil(s) dated; .~-J-) ";c~-n -tJ J- 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: NONE (State relevant circumstances, e.g., renunciation, death of executor. etc.) I'-'~ . ~::~ :;:2 ~ ~ ,-, /--; VJ v.:> o B. Grant of Letters of Administration (If applicable. 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:(.(f Administration. c.t.a. or d.b.n.c.t.a.. enter date of Will in Section A above and complete list of heirs.) I Name Relationshio Residence I (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his / her last principal residence at 411 MARKET STREET. NEW CUMBERLAND PA 17070 BOROUGH CUMBERLAND (List street address, townlcity, township, county. state, zip code) Decedent, then 74 years of age, died on 4/23/2007 1701 L1NGLESTOWN ROAD at CAROLYN CROXTON SLANE HOSPICE RESIDENCE HARRISBURG PA 17110 Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in P A) Personal property in County Value of real estate in Pennsylvania $ $ $ $ 1.000.00 0.00 0.00 0.00 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Lellers in the appropriate form to the undersigned: Typed or printed name and residence LAURIE E. BORDLEMA Y 535 7TH STREET NEW CUMBERLAND L YNDSA Y M. MOYER 114 FOURTH AVENUE NEW CUMBERLAND PA 17070 PA 17070 ForIllRW-O:! /"('\' IO,13_(){' Page 1 of2 Oath of Personal Representative COMMONWEAL TH OF PENNSYL VANIA ss 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. Signature of Personal Representative = <= -.. , I .; ~~~_~; " (. .) (~>.:) -.~f._J . <'.) ! ''''-1 - -~ j~._-) Signature of Personal Representative Signature of Personal Representative '- r- r N .C.'''''l c-; --0 , ,-~ -) ::K -T.1 File Number: ~/,.. 07 - (rJ3_~ =tJ .--1 '- . Estate of SHIRLEY E. STEPHENSON w w w 1-1 , Deceased Social Security Number: 168-26-4078 Date of Death: 4/23/2007 AND NO W, 't:. a J I ~ , OJ Co 7, in ,"n,ide"tinn of the f",egoing Petition, "ti,fuotory proof having been presented be e me, IS DECREED that Letters TESTAMENTARY are hereby granted to LAURIE E. BORDLEMAY and L YNDSAY M. MOYER and that the instrument(s) dated JANUARY 12. 2007 described in the Petition be admitted to probate and filed of record a in the above estate Letters ... .... ....... ... .... ..... ... Short Certificate(s) Renunciation(s) ................. [D,l{ ?.... ~.... IS. 60 IOcU S.~ FEES TOTAL $ 11.C{) $ ~. '0 $ $ $ $ $ $ $ $ $ $ $ Attorney Signature: Attorney Name: GERALD J. SHEKLETSKI. ESQUIRE Supreme Court J.D. No.: #40486 Address: 414 BRIDGE STREET NEW CUMBERLAND PA 17070 Telephone: 717-774-7435 Form R W.II: r,,\'. / Ii. /3.110 Page 2 of2 HIO:'\);:O:'\ REV 1105 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 filinb -7.. &<:;;5 WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~!Jl~- Fee for this certificate, $6.00 Local Registrar p 13353859 APR 1 ~ Z007 Date o CO .'-.:0 .~. .~f~, <;2 ~!-~~ r--:l c-? ~;::::. --' <- ,- r N .-,-~\ {-'j (2':-~-\ '''J :::--\ -0 :1': AEV 1112006 I PAINT IN 'IlANENT CK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) Y? v.) v.) Dauphin ed. Facility Name (If not instituUon. give streel and number) STATE FILE NUMBER 1. Name 01 Decedent (First, middle, last, suffix) Shirley E. Hacker Himes Stephenson 6. Date of Birth (Month, day, year) 7. Birthplace (City and etale or 'oreign country) 3, Social Security Number 168 - 26 - 4078 4, Date 01 Death (Month, day, year) April 23, 2007 74 v" September 28,1932 Harrisburg, PA Sa. Place of Death (Check only one) Hospital: Other: Hospice o Inpatienl 0 EA / Outpatient 0 DOA 0 Nursing Home 0 Residence Q90ther _ SpeCify:HO US e 9. Was Decedent of Hispanic Origin? I1Q No 0 Yes 10. Race: American Indian, Black, White, elc (II yes, specify Cuban, (Specify) Mexican, Puerto Rican, elc.) whi t e 5. Age (last Birthday) 8b. County 01 Death Twp. Carolyn Croxton Slane Hospice Residenc 11. Decedent's Usual Occu tion Kind of work done durin most 01 worki Ine. Do nol state retired Kind 01 Work Kind of Business I Industry Su ervisor Communications . 16. Decedent's Mailing Address (Street. city ftown. stale, zip code) divorced Twp 411 Market Street 12. Was Decedent ever in tile U.S. Armed Forces? Dves 5lINo Decedent's Actual Residence 17a, State 13. Decedent's Education (Specify only highest grade compleled) Elementary I Secondary (0-12) College (1-4 or 5+) 12 14. Marltal Stalus: Married, Never Married. Widowed, Divore&d (SpeciM 17b. County Pennsvlvania Cumberland Did Decedent live in a Township? 17c.D Yes, Decedent Uved in 17d.lS:1 ~~:"i:::;~'~UvedW;lh;n New Cumberland City/Bora 19, Mother's Name (First, middle, maiden surname) Florence Clemmer 2Ob. Informanl's Maning Address (Street, city ftown, state, zip code) 114 Fourth Avenue, New Cumberland, PA17070 21c. Place of Dispos;oon (Name 01 cemetery, crematory or other place) 21d. location (City I town, state, zip code) ~ Evans Crematory Schaefferstown, PA 17088 Complete 1I8ms 23a-c only wilen certtlying physician is not available at tlme 01 death to ""' certify cause of death. 23a. To the best 01 my knowledge, death occurred at the lime, date and place stated. (Signature and title) 22c. Name and Address 01 Facility Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 . ~ 2:3b. license Number .AM 25. Date Pronounced Dead (Month, day, year) A ri /23. 2.601 G2BG1ttE 23c, Date Signed (Month, day, year) Fl 1<..\\ 2.<1: 2607 "" lIems 24-26 must be completed by person who pronounces death. 24. Time or Death :0,10 26. Was Case Aeferred 10 Medical Examiner I Coroner for a Ae on Other than Cremation or Donation? Dves 121 No CAUSE OF DEATH (See Instructions and examples) lIem 27 Part l: Enter the ~ - diseases, injuries, or complications - that directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest, or ventricular fibrillation without showing the etiology. list only one causa on each tine. Dv" ON' lZ1 Natural 0 Homicide o Accident 0 Pending Invesligalion D Suicide D Goold Not be Determined I Approximate interval Part H: Enter other sianificant conditions contributina 10 death, 28, Did Tobacco Use Contribute to Death? Onset to Death bul not resulting in lhe underlying cause given in Pan I 0 Yes 0 Probably o No 0 Unknown 29. " Female' o NoI pregnant within pas! year o Pregnant at time 01 death o Not pregnant, bul pregnanl within 42 days of death o Not pregnanl. but pregnant 43 days to 1 year before death o Unknown if pregnant within the past year 32c, Place of Injury: Home, Farm, Street, Factory, Office Buiiding, etc, (Specify) =~~A~Sttn~'~ J~~~ ~se:; Sequentially list conditions, if any, leading to the cause listed on line a Enter !he UNDERLYING CAUSE (disease orinfury that inijiated the evenls resulllng In death) LAST. b. \ ~t\'<.c\~\(Nlj-\ dt" L.l\l , DUf:I [0 (or as a consequence ory: Due to (or as a consequence 01) d. 30a. Was an Autopsy Performed? JOb Were Autopsy Findings Ava~able Prior 10 Completion of Cause o/Death? 31. Manner of Death DYes 00 No :32d. Time 01 Injury M 321. II Transportalion Injury (Specify) o Driver / Operator 0 Passenger DPedestrian DOthe,._Iy: 33b. Signatura and Tille of (; 33c.license Number 02 '8<;;' 7 32g. Location 0' Injury (Streel,dty I town, stale) o-l :3:3a. Certifier (check only one) ~~~g:::~~~=:n=~~~:~e :~~t~~~Canu~o~~~rn~~~:r~: ~~;:.~ ~~Ih _a:d_c:"~~~ ~~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ~ ~~o::~~fa~~ ~~:~~::.::~a~:=:~ t:~~~:~~:nin~e;::c~~~:~:~ot~~a:~~~~~ manner as stated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 Medical Examiner I Coroner On the basis of examinalfon and I or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ D Ij ~ / It' 34. Neme and Address 01 Person Who Compieted Causa of Death (Item 27) Type I 111 M.\ChCle.i E 1(16(\YID 5/.' N. 11.t11 0t1r'eet-, LJ::XY'iO'lfk"-., PA 17uf.3 Disposition Permit No Cl> \ "") I ~ (,1 7 _ .. " ep\wills\STE?HENSON,SHIRLEY LAST WILL AND TESTAMENT OF SHIRLEY E. STEPHENSON r~.....,") (":::) ~ C) r---'- IT] -:.:tl ,- ~ "'-...._- r-- N ~ '""' :i: C0 I, SHIRLEY E. STEPHENSON, of the Borough of New Cumberland~ w Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate, in equal shares, to my children, LAURIE E. BORDLEMAY, LYNDSAY M. MOYER, and PAUL L. HIMES, JR., who survive me. ITEM II: I appoint my daughters, LAURIE E. BORDLEMAY and LYNDSAY M. MOYER, Co-Executrices of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I, SHIRLEY E. STEPHENSON, have hereunto set my hand and seal this leA. day of S2CltUJ&~J- , 2007. .) ~ ,;1 , ~<li.er7s f ~4".y7L~ SHIRLEY E ( STEPHENSON Page 1 of 3 .. SIGNED, SEALED, PUBLISHED and DECLARED by SHIRLEY E. STEPHENSON, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presen~~~ each other, have subscribed our names -~~ Wl tnessl.~ /~ I ! L--- .. WiEness/ . .- as witnesses. 414 Bridqe St., New Cumberland, PA Address 414 Bridqe St., New Cumberland, PA Address COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, SHIRLEY E. STEPHENSON, the Testatrix 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 this 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 con- tained. . ii' ^ A/UI.!t]E {". .j};(~...~ SHIRLE E. STEPHENSON Sworn to or affirmed to and acknowledged before me by SHIRLEY E. I~~fgu~_ Notary Public ~ , 2007. STEPHENSON, the Testatrix, this COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CAROL L. TROXELL, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, 2009 Page 2 of 3 . COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, ~~,_~-S~kLJ-rsk~ and ~J.1l~.fVI \0~i~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~.c-- - - : .~ -,..... , Witness L-/ -~.".... C_~ -. Witnes Sworn to or affirmed r~rtAQcC J, S~~k~ witnesses, thi~~ day COMMONWEALn-1 OF PENt":0'_:~:~\ NOTARIAL SEAL . '_ CAROL L. TROXELL. Notary Pub\!,; d B Cumberland C0 New Cumberlan or,o. 0 27 20CC; My Commission Expires ec. . _~:_: to and acknowledged before me by ~W\~IV1 ~-\f\-.- cl ~~y,,~\-.~ , 2007. ~~ ~. -, " A~ ...~ ~.~ ~ Notary Public and Page 3 of 3