HomeMy WebLinkAbout07-13-07
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
NO..a~ - 07 - (Ju6Y
Estate of William F. Shuttlesworth
also known as
, Deceased
Petitioner(s), who is 18 years of age or older, applies for:
Social Security No. 206-03-9736
n A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of the
Decedent, dated and codicil(s) dated
State relevant circumstances, 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 documents offered for probate;
was not the victim of a killing and was never adjudicated incompetent
.............................................................................................
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B. Grant of Letters of Administration c.t.a. (Decedent's will desiqnates his brother, John J. Shuttlesworth, as
(c.t.a., d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
Executor and Decedent's sister, Doris Miller, as the alternate. John J. Shuttlesworth predeceased the Decedent and
Doris Miller renounced in favor of her husband. Charles Miller. Jeffrev M. Dows, the onlvsurvivinq intestate heir to
Decedent also renounced in favor of Charles Miller.
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if
an and heirs:
Name
Relationship
Residence
2830 Central Avenue
Camp Hill, Pennsylvania 17011
347 North Mountain Road
Newville, Pennsylvania 17240
Doris Miller
Sister
Jeffre M. Dows
Great Ne hew
f'...._")
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(COMPLETE IN ALL CASES:) Attach additional sheets if necesary.
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De~edent was domiciled at d~ath in Cur:nberland . County, Pennsylvania, with het:jpst fa~ or prfricf~~1
residence at 19 Poplar Drive, Mechanlcsburq, Pennsvlvanla 17050 ~ c] .-, ... ,', " ,
(list street, number and municipality) ,.> c....:>
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Decedent, then 87 years of age, died Julv 1. 20QL, at Carolvn Croxton Slane Hospice Residence, Susquehanna Twp.,
Dauphin County, Pennsvlvania
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property.........................................................................................___..........................$ 350,000.00
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania.............................. __............................ __................................................................................$ 95.000.00
Total............................................................ __............................ __.................................................................................$ 445,000.00
Real Estate situated as follows: 19 Poplar Drive, Mechanicsburq, Pennsvlvania 17050
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition andhe grant of letters in the
appropriate form to the undersigned:
William Miller
2830 Central Avenue
Camp Hill, Pennsylvania 17011
11 ;(1') ;';1\'1 pr'\ ,III
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
h:c for thi,; ccrtificate. "(-,.()l!
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P 13769495
Ccnification Numhe!
1TEM , 3
SHOULD READ AS RJLWWS:
J. 04 - 03 - 9"73 fa
~JY)~~
,EV 11/2006
PRINT IN
IANENT
:K INK
This is to certify that the illfolfl1ation here t'1\Cll i,s
correctly copied froIl1 an (,rigin,;l Certificate Oi Death
duly filed with me as Loe', I R\:gistrar. The (Tigin,:J
ccrtificate will he fOr\\lrJ,:d to the Still Vilal
Records Office for permancnt lilingJUL 0 7 2007
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
6. DOlle of Bir1h (Monlh, day, year)
Dauphin
'--f -~7-/9c..~o
8d. Facility Name (If no! instilution, give slreel nnd number)
Williams town , PA
Carolyn Croxton Slane Hospice Residenc
11, Decedr;ml's Usual Occu aUon Kind 01 work done durin most of worldn life_ Do 001 stale relired
Kind of Work Kind of Susiness f IndUSlry
Public Works Federal Governmen
16, Decedent's Mailing Address (Slreet. city !IOWIl, stale, zip code)
19 Poplar Drive
Mechanicsburg, PA 17050
18, Falher's Name (Fir~l, middle, lasl, suffix)
Frank B. Shuttlesworth
12. Was Decedenl ever in Ihe
US. Armed Forces?
~Ves DNa
13. Dececlenl's Education (Specify ollly highesl grade compleled)
Elemenlmy! Secondary (0-12) Collf!ge (1-4 or 5+)
8
Decedent's
AC!lJBI Residence 17a. Strite
Pennsylvania
Cumberland
17b. County
19. Mother's Nnme (First, middle, maiden sum<1me)
Sadie Fry
20a, !ntennant's Name (Type I Print)
Doris M.
$TAl E FILE NUMBER
3. Social Securily Number ")
c9..Ck -0-5 JI't3~
Ba. Place of Death (Check only CIne)
Hospital'
o InpRlienl 0 ER IOlllpillienl 0 DOA
"0,1Ie 01 Death (Month, d<lY, ye<lr)
Jul
1, 2007
Other OSplCe
o NurslIlg Home 0 Residence e901l1er. Sper::ifl' House
5(] No 0 Yes 1 (1 Raco American Inelian, BlilCk. White, ele
(Specify)
14. Marital $latu.s: Married, Never fvli'lrripd,
Widowed, Oiv()[cEld (Sppcifl1
Never Married
white
Did Decedenl
Liveina
Township?
17C' e9 Yes. Oeceel"nl lived in
17d 0 No, Oecederll LIVE'd w~hlr
Acluallimils of
Silver Spring
Twp
Cilyl Boro
2Gb Informanl's Mailing Address (Strael, cily Ilown, statf', zip code)
2830 Central Avenue, Camp Hill, PA 17011
21d, Locali(ln (Cil\, Ilown, slate, zip code)
21c. Place of Disposition (Nilme of cemelery, cremalory or other plilce)
Rolling Green Memorial Park
Lower Allen Twp., PA 1701
23a To !he besl of my knowledge, dealh occurred allhe lime, dale <lnd place slaled (Sign<llure and lille)
22c. NAme and Address of FAcility
Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
23c Dale Signed (Morl!!l, day, year)
321, 11 TranspOl1alion Injury (SpflCify)
o Oliver I Opemlor 0 Pnssftogm DPlO'deslri;m
M 0 Olher . Specify'
33a CerMler (check only one) m3:'lb SlQnnl1lre and TIHA of CArllf!er
. ;:7~Z~:Sf~r~~1~~~~~~~I~~nd~~~~y~~~~~rl~~ ~~~~~I~:I~~~I~~~~~n~lh~~~~~rh~: ~~~n~:c~~ ~a~h~11:1~:m~l~e~ ~e~n~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
. Pronouncing and certllying phYSician (PhyslclfIn boll1 pronollnClllg dealh allel cellllyulg 10 Ciluse of death) 0 330 L""", 'I"mbo< -----J 3" D," 51900' 1M"''' .d,)V_ yellr)
To lhe best 01 my knowledge delllh occurred !lllhe limp oille and pl1lC~p, flnrl du~ 10 Ihr> (:I1Il!'lll{!'i) llnd mllnlH~r ;l!'l !'.!111[!{1_ - - - - - - - - - - - - - - - - - "t J '::) c.. J N _. 1:- _ j\ '7
MedIcal EXlImlmn I Coroner \J"" ~ l) l..a - I -.....:..) t./
0" \he b"" 01 mmm'"oo ,od I" lI"esllg,IIOO m my OP""O" ,,,", oce",,,,, 'I 1110 ,,'" dot"~ nod '''''', ,,,,I ,II" 10 '", """lsl end mnl1n" " ",,"'_ 0 134 ~'O ,,,' A"'"" 01 1''''0'' W ;O"~let"'d C ilISh D""111 IIlelllj{il ,.\ pe / Prrnl
35 ReglS'""SI9"atuI n DlSlllclNumbffl ~ -~ /, Q..., / / 136 DOle. Fi7'!':!9t: "'y yoml-I ~W-t ld R ~~[("h I'\d.
~ / '< /~ ~~-~ 'l~aOo 7 --_ ~~ ~LJ ~__L~ID!J ________
Oi5j10silion Permil No, (J I \ 1 7.. q q
24, Time of Oealh
25, Dale Pronounced De(ld (Month. day, year)
!I', oS AM .JL,I'i I, 2007
CAUSE OF DEATH (See Instructions and examples)
Item 27. P1l111: Enter Ihe ~ - diseases, Illjuries, or complications -Ihlll direclly cilllsed [he death. DO NOT enter (erminal ovenls slIch <IS cardiac arresl,
respiratory arresl, or venlriculnrfibrillilliol"withoul showing Iheeliology, Listolllyolle cause on each line
IMMEDIATE CAUSE IFi"l disease 0' ,i I~ IV', \/ r.J .It ~ 'A
condlllonreslIlllngllldealh) ---.. a Q~ (.:::.L.! t:::. '-tlt'll _
0", Ii I '}+1 , 1"'I"'i'\'" 01)'
Sequefllially list conditions. if a.ny (! { ) }.-J -J )
~~1~1~~~0 J~eO~~tyiN&~AU~nEe a Due 10 (or as a consequence of)
(disease or il~iury Ihat iniliated Il1e
events resulllng In dealh) LAST.
Apl)rmilll~le inlelval
Ollsello Dllalh
Due to (or as a consequence 01)
JOb_ Were Au!opsy Findings
Available Prior 10 Completion
of Cause of Oealh?
31. MaonerofOeath
~alurnl 0 Homicide
DYes ON,
o Accidflnl DPelldillglnvesligalion
o E;uicide 0 Could Nol be DelerminAd
32rt. Time of Intllry
23b, License Numbel
26. Was Case Referred to Medical EXClminer ! Coroner lor a Ae8son Other than Crem,lIion 01 DOl1alion?
o Yes IZI No
D(\r1II: Enter otl1er ~ignifu:.1\l)tMdlliQjTh_c..Qn1l!!Mm~ffib,
bu!nol reslIlling in 1I1e lIndeill/ingc811se given InPMi
28 Did TobacCD Use Contrihllle to Deatl-?
DYes o Probably
o No 0 Unknown
I<~JJA! PAduR.c;
.lJiJ)
28 If Fem~le
o NOlpregl1anlwilhll1paslyear
o Pregnanlalllmeoln8i\lll
o Notpregnanl.hulpr'3gl1ill1twllhin42days
olcleillh
o NOlpregnanl,bulpregnanl 43 days 10 1 year
llelNedealh
o UnkMwnilpregl1ilnlwilhintl1epilslvear
32c. Plilceollnjury: Home, Fnrm,Streel, FadolY
OfJic:eBtliltting. etc. (SpflCify)
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"PaUll Oo-ell" LAsTCWILL..JWb T2ST.AM2%
of
William F. Shuttlesworth
I, William F. Shuttlesworth, a resident of Mechanicsburg, Pennsylvania, being of sound and
disposing mind and memory and over the age of eighteen years, do hereby declare this to be my Last Will
and Testament, and I expressly revoke all Wills, including codicils, heretofore made by me.
ARTICLE I
1.1 I hereby declare that at the time of making this Last Will and Testament that I am single.
1.2 I declare that I have the below listed children at this time: none
ARTICLE II
2.1 I declare the entire residue of my estate to the Trustee(s) then in office under that trust
designated as "The William F. Shuttlesworth Revocable Living Trust" established ) ~
~, 191...'7 of which I am the grantor. I direct that the residue of my estate shall be added to,
administered, and distribukd as part of that trust, according to the terms of the trust and any amendment
made to it before my death. To the extent permitted by law, it is not my intent to create a separate trust
by this will or to subject the trust or the property added to it by this will to the jurisdiction of the probate
court.
2.2 I hereby direct that my Executor or my Trustee(s) may elect to: (1) use administrative expenses
as deductions either for estate tax purposes or income tax purposes; and (2) to use either date of death
values or optional values for estate tax purposes, regardless of the effect thereof on any of the interests
under this Will.
2.3 I further direct that my Executor or Trustee(s) shall not be required to pay any debt in advance
of the due date thereof, including installment obligations, but instead may pay the same in installments
as each installment comes due. However if the Trustee(s) deem it to the advantage of the estate any or
all debts may be paid in advance of their required installments.
2.4 I stipulate that any asset under litigation, lien, or claim that might cause the
assets of the aforementioned Trust to be compromised in any fashion, be held separate from the said Tw.$t
until it is free of any claim or threat to the integrity of the Trust. (::;: '-::) ~-.J
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ARTICLE III
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3.1 If the disposition in Article II, above, is inoperative or is invalid for any reason; or if the twst
referred to in Article II above, fails or is revoked, I incorporate the terms of that trust herein by reference,
as if executed on this date, without giving effect to any amendments made subsequently, and I bequeath
and devise the residue of my estate to the Trustee(s) named in the trust as Trustee(s), to be held,
administered, and distributed as provided in that instrument.
C/O) (--
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Signed:Pt~ f. ~
Page J
.
LAST WILL AND TESTAMENT
WITNESS PAGE:
We, the undersigned, do hereby certify that William F. Shuttlesworth on this ~ day of
f)~~_~ , 19~, declared the above and foregoing instrument, consisting of four (4) pages,
each of which is signed by William F. Shuttlesworth, to be his/her Last Will and Testament, and that
thereupon he/she asked us to act as witnesses to such Will, and did in our presence of each of us sign
his/her name to such Will; that, thereupon, we and each of us, in the presence of William F.
Sh lesworth and in the presence of each other, do sign our names as witnesses to such Will.
(Witness Signature) //2.-//-97 Date
Vv\. ~ I4-l~ (Print Name)
ILl p~ f' I c.-I 'O-c--{ ve. (Address)
M-c:.t...~~~\ f..... J 7\~C; (City, State, Zip Code)
I&~ j. )f{ ~/ ~ (Witness Signature) 12.-/1--9'? Date
De.~t J. 'P. ~ L-h.1< Sr--. (Print Name)
)
I t..J P6f' a..r 'Or-0A (Address)
. '{V\.~~c:....\....,,., I A... '7oSS (City, State, Zip Code)
.
Signed~~^,#~ f.~
Page 4
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ARTICLE IV
4.1 I do hereby nominate the following individual(s) as the Executor(s) of this Will, to serve in the
order listed: John J. Shuttlesworth, Doris Miller.
4.2 The Executor shall have full power and authority to carry out the provisions of the Will,
including the power to manage and operate during the probate of my estate any property and any business
belonging to my estate. However, the Executor should not compromise the referenced trust in any fashion
by premature transfer of assets that may carry any claim or litigation into the Trust.
4.3 The Executor or Trustee(s) shall serve without bond. However, in the event that one (1) or more
bonds are required for one (1) or more such individuals, in their capacities as Executors hereunder, then
I request that such bonds be nominal bonds, and, my Executor shall pay any such bond premiums, as
bonds premiums are due, as administration expenses of my estate, until the administration of my estate
is completed.
IN WITNESS WHEREOF, I have hereunto subscribed my name to this document, my last Will and
Testament, which consists of two (2) typewritten pages, and for the purpose of identification, I have
initialed or signed each page, all in the presence of the persons who are witnessing, at my request, the
execution of this, my last Will and Testament on this II day of f)..:.....-. b~ , 19 qo ")
at V\iI.~~-.J(.~\,.....y7' fi. .
.u~4t, f ~DJ1ll/"ttfl~
William F. huttlesworth
Signed)f~...~/h1 f ~
Page 2
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Certificate of Acknowledgement of Notary Public
State of Pennsylvania)
:ss.
County of Cumberland)
On this I \ day of 'O~...o-\o..cr , A.D. 19n, appeared before me William F. Shuttlesworth
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose
name is subscribed in this instrument, and acknowledged that he/she executed it.
_2J~~
Notary Public
My Commission Expires
Residing in
NOTARY SEAL:
Notarial Seal
Glenn W. Hebert, Notary Public
North Newton Twp., Cumberland County
My Commission Expires May 8, 2000
Signed.Jt~ r.~
Page 3
OATH OF SUBSCRIBING WITNESS(ES)
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REGISTER OF WILLS
r.llmn/?,...l and COUNTY, PENNSYLVANIA
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Estate of Willi::lm F C;:nlltt1esworth
, Deceased
Donald P. McHale, Sr. and Jane McHale , (each) a subscribing witness to
(Print Namels)
theXl Will 0 Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that ~~ / they ~ were present and saw the above Testator /~~ sign the same
and that ~i he / ~ signed the same and that x~lk5~/ they signed as a witness at the request of
the Testator / jf~:&MR~ in x~ / his presence and in the presence of each other.
a~_ /7!elld~
~nature)
14 Poplar Drive
(Street Addres'J
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(Signature)
Mechanicsburg, PA 17055
14 Poplar Drive
(Street Address)
Mechanicsburg, PA 17055
(City. State. Zip)
(City. State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
day
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this IcftI'lJ day
of ~ ' /..bo'l.
N~~ ir/ X(f-
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
before me this
of
Deputy for Register of Wills
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
CmAMONWEALTH OF PENNSYLVANIA
Notarial Seal
Form RW-03 rev. 10.1306 Rhonda L. Lang. Notary Public
City of Harrisburg. Dauphin County
My Commission Expires /\ug. 9. 2008
Register of Wills of Cumberland County, Pennsylvania
RENUNCIATION
Estate of William F. Shuttlesworth
No. Al - 01 - OfJiiSLf
also known as
, Deceased
---------------------------------------------------
---------------------------------------------------
The undersigned, Doris Miller, sister and designated Executor, and Jeffrey M. Dows,
nephew and only other intestate heir of the above Decedent, hereby renounce(s) the right to administer the
estate and respectfully request(s) that
Letters of Administration, c.t.a. be issued to Charles Miller, Doris Miller's husband and Decedent's
brother-in-law.
Witness
hand this
July
,20~.
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28311.~amp Hill, Pennsylvania 17011
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Je ey M. Dows (Signature)
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347 North Mountain Road, Newville, Pennsylvania 17240
(Address)
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(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this , \ day of
'J uJ.. j ,20-.0].
N~~ ~~
My Commission Expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Cathy M. Sheriff, Notary Public
Silver Spring Twp., Cumberland County
My Commission Expires Oct. 26, 2010
Member, Pennsylvania Association 01 Notaries
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
NOTE: Renunciations executed outside the Office of Register of Wills
are required in some counties to be notarized.
Form RW-4 (Dauphin County, Rev. 9/92)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct
to the best of the knowledg6 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 and affirmed and subscribed
a?rub f<~ ~/fL~
before me this --.l2...__ day of
()B\~ __~20ili
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.............................................................................................
DECREE OF REGISTER
Estate of William F. Shuttlesworth
Deceased
No. ~ \ - U7 - (See 5L{
also known as
Social Security No:
AND NOW, J3th L
proof having been presented be
Date of Death: July 1. 2007
L, 20fl, in consideration of the Petition on the reverse side hereon, satisfactory
, T IS DECREED that Letters 0 Testamentary [RJ of Administration c.t.a.
are hereby granted to William Miller
in the above estate and
that the instrument(s), if any, dated December 11. 1997
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
TOTAL............... .
$
$
$
$
$
$ I t),Q7)
$
$
If)
$ Lf-r oS .
:J0?O
.5.tD
Letters........................ ..
$ 4\D.LD
Short Certificate(s)..(5).....
Renunciation................. .
Affidavit ( ).................
Extra Pages ( ).... .... ....
Codicil..........................
JCP Fee(&u.~f7.~\...
Inventory... . . . . . . . . . . . . . .. . . . . .
Other........................... .
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Attorney: Shaun E. O'Toole
1.0. No: 44797
Address: 2813 North Second Street
Harrisburq, Pennsvlvania 17110
Telephone: (717) 213-6653
DA TE FILED:
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Form RW-1 Page 2 of 2lDauphin Count) _ Rev. 9/92