HomeMy WebLinkAbout08-24-07
PETITION FOR PROBATE AND GRANT OF LETTERS
,
REGISTEROFWILLSOF\.\ l\\,~\..u '\(CllJ\\'\'"
COUNTY, PENNSYL VANIA
Estate of \) \ C'---'l,-~ 1-- \ \ \CLLr
also known as
File Number
ZI- D1- OlqL/-
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COl'.IPLETE 'A' or 'B' BELOW:)
"-
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the-- V l)\ \\-;
last Will of the Decedent dated ()C,\ L '..1',^- \ C, "\2and codicil(s) dated
J.J b, \j \; c Ii
named in the
/
/,
(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 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
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lile; duralJle 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) aooheirs: (If
Admillistration, c.t.a. or d.b.n.c.t.a., enter date of Will ill Section A above and complete list ofheirs.) ':' <) ::.:-_~
. 0'1
Name
Relationship
Residence'
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
De,eedent wa,s dom,i.~iled at deatl1 in ('/ ~\ 6~ ,1"-- \.~.1J ,)~ County, Pennsylvania with his / her last principal residence at
~!\."- \1 'T'.;t c:' () ':, \--\-\ \)1) 2"-.: .> I~ \. ~ \.. ' ,4-. I -J .:r \" "J
(List slreel address, to WI/Icily, township, county, state, zip code) ,
C I . ~'J-
i 1.... { years of age, died on ,\-0 t I It f 7 at
r'-.~-"
............
tfi.,-e,
Decedent, then
I . tl '- y) i'''i
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 P A) Personal property in County
Value of real estate in Pennsylvania
, ~~
~
'-' -X)
...5.. -
$
$
$
$
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 Letters in the appropriate form to
the undersigned:
~ ~ 'l >::wkili,,- ~O d "
/iL.
1;);7
Forlll RW.(J2 rev 101306
Page Of 1.
Oath of Personal Representative
COM:-VfONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affim1(s) that the statements in the foregoing Petition are true and conect to the best of
administer the estate according to law.
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitjoner(s) will well and truly
(\ ')
X ,i v,' "'1V'Yli1 _ ~~Vl/',~J+-tJ-'--'
Si natt,re of Personal Representative \
()
Sworn to or affirmed and subscribed
'1 JeST
(f".l11e.the C)( day of
" ~~~il ,~O(
lh (b'~'ll ~ ~~ ~ OJ){;-J J\..~
ur ~ E<'or the Register ~~*j
Signature of Personal Representative
c-=.
~-~~.~
Signature of Personal Representative
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..... ...,
. .....
File Number: cll- Dl- 01 q ~
E"'teor M9- ''0 C'~. .1Vl ~ .
Social Security Number: I ~ I - 111 - Olv 3. 5 Date of Death: <t.
\.)
.--1
, Dece1(Sed
C~)
C)
en
AND NOW,
having been presented b
are hereby granted to
1- Ol
Ql.f
, I'] (Yi '7 , in consideration of the foregoing Petition, satisfactory proof
\ (' -:::, T ~ fv1r:: N.11\f2-J
in the above estate
and that the instrument(s) dated \ l) ~ - "\ 2.
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~
TOTAL
$ 3/:) . Q(")
$ 4,~
$
$ \ S- - 00
$ j(),()/:-,
$ 5.00
$
$
$
$
$
$
$ lD'-t.oU
FEES
Letters
Short Certificate(s) . . . . . . . ,
Renunciation(s) .",......
~~ 1\
~~-P
Cu.;....::tU'IY'0A.:\1 v",,",
Attomey Signature:
Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
,.... "," """
r'}l"In ;"'.:""~'/': r~v tfj..'_'.uu
Page 2 of2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
VVARNiNC' it IS illegal to duplicate this ('!->I by photostat or photograph.
p
13745D85
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H10S.143 REV 1112006
TYPE {PRINT IN
PERMANENT
BLACK INK
1, Name of Decedent (First middle, last, suflix)
Mary
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
o
C.J1
250 Smith Rd.
12 Was Decedenlever in the
U,S. Armed Forces?
Dy" 5{No
Oecedenl's
ActLJaIResidence 17a. Slate
13. Decedent's Education (Speciry only highest grade completed)
Elementary I Secondary (0-12) Collega (1-4 or 5+)
12 3
STATE FILE NUMBER
C.
May
y~4
6. Date of 8irth (Month, day, year)
7. Birtt1plaoo(Ci
-14
0635
4, Date of Death (Month, day, year)
5,Age (Last Birthday)
8b, CounlyofDeath
Jan 3, 1913
Cumberland
, Md.
8a, Placeo/Death (CheckonIYOl1e)
Hospital Other:
Inpatient 0 EA I Outpatient 0 DOA 0 Nursing Home 0 Residence
9. (~~~~~=~~t ~~~~~~anjc Origin? fJ No 0 Yes
!Mexican, Puerto Rican, etc.)
Au
1, 2007
11, D~'edenl's Usual Occupation Kind of work done duri most ofwo/i!:in lile, Donal slate retired
Kind of Work Kind of Business I Industry
Nursing R.N.
. 16, Decedenl's Mailing Address (Slreel. city.l town, state. zip cOde)
Middleton t P
Carlisle Regional
o Other. Specify
10. Race: American Indian, Black, While, ate
(Specify)
white
\ .
Cumbo
8d. Facility Name (If not inSlitution, give street andnumberj
w
14, Marilal Status: Married, Never Married,
Widowed, Divorced (SpacifyJ
Pi'!
17C.O Yes, DecedentUvedin pon~
17d. 0 No, Decedent Lived within
ActuaJUmits01
TWp
17b.County
r.llmh
18.Father'5Name(Fi~t,middle,last,suffix)
Chauncy Claybaugh
2Oa, Informant's Name (Type I Print)
Judith M. Bennett
19, Mother's Name (First, middle, maiden surname)
Gertrude Ho
City/Boro
o
w
~
"
~
'"
't
200. Informant's Mailing Address (Street. city ftown, state, zip code)
248
Union Chur
igned (Month, day, year)
Items 24-26 must be completed by person
whopronoLJncesdealh
24. Timeo/Deeth
I:
25. Dale Pronounced Dead (Month, day, year)
CAUSE OF DEATH (See Instructions and examptes)
Ilem 27. Part I: Enter the ~ - diseases, injuries, or complications -Ihal direcUy caused the death, 00 NOT enter termiroal events such as cardiac arrest,
respiratory arrest, or ~entrictJlar fibrillation without showing lhe eliokJgy, List onfy one cause on each line
IM"';OIATE C~USE IFinal disease or . ?'Y]~ Pr
condition resuiting In death) --.. a I
Due to (or as a consequence on
Approximaleillterval
Or1Set to Death
Dyes No
3Ob, Were Autopsy Findings
Available Prior 10 Completion
of Cause of 0ea111? ./
DYes~
31, Man fDeath
Naturai DHomiclde
DAccident OPendinglnvesligation
D SUicide 0 Goold Not be Determined
2Q,lfFem
ot pl'egl8nt within past year
D Pregnantattimeotdesth
o Notpregnanl,butpregnantwithln42days
01 death
o Notpregnanl.butpregnant43daysto1year
before death
o UnknoWfl itpregnanl wilhm the past year
32c Place ot Irljllry: Home, Farm,Slreet, Factory,
Olfice8uilding, etc, (Specify)
:::,
'<t
~
Seqoentially list condttions, it any,
~l~~~ JNb~WlYt~~~~~Ee a
(disease or injury that initialed tt1e
events resulting In death) LAST,
b.
Due 10 (or as a coosequence ory'
Duato (or as a consequence olj
3Oa.WasanAutonsy
Performed?
")-..
IJ::
<:t:::
~
32d. Time oi InJury
I
o
~
~
33e. Certiliar (check only one)
Certifying physlcllm (Physician certifying celJSe 01 death when another physician has pronounced death and completed Item 23)
To the best of my knoWledge, death Occurred due to Ihe cause(s) and mannerss stated.. _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _ _ _ _ _ _ 0
Pronouncing and certifying physicilln (Physician both pronOUncing death and certifying 10 cause 01 death)
To the besl of my knOwledge, death Occurred at the time, date, and place, and due 10 the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
~lt1~a~::~~~:~~;~:t~: and lor investIgation, in my opinion, death occurred at the time, date, and place, and due to lhe causers) and manner as slate<L 0
35, Reglstr '
.
"'"""'dD~.N~~~
I~ II I N.II 10 I
Disposition Permit No.
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LAST WIT.....L AND TESTAMENT
I, 11ary C. Va.!. of Clearville, County of Bedford,
and Com.'1lOnwealth of Pennsylvania, hereby revoke any and all
former vTills executed by me and declare this instrument to
be my last will c~d testament.
E1illIT.: I direct that all my just debts and funeral expenses
be paid as soon as may be convenient after my decease.
SECOND: All property \-1hich I shall own at my death and all
property over which I shall then have any power of appoint-
ment, I give and appoint to my beloved hUSband, Theodore R.
-'--
Nay, if he shall survive me. If my said husband shall pre-
decease me, then all property i-lhich I shall then own at my
death and all property over which I shall then have an,? pOl{er
of appointment, I give and appoint per stirpes to each of
these my children if they survive me: V.l8.rI~~ R. May, Gordon
Kent V.l8.l, and Judith ~~y Bennett.
THIlD: If any of my above named children shall be deceased
at the time of my decease and leave living issue, then his
share shall pass to his then living issue l..rho shall take per
stirpes of the same share that the deceased child or children
would have taken of my estate if living.
.. , , .
FOURTH: If any of my three above named children shall be
deceased at the time of my decease and leave no living issue,
then his share shall be divided equally 8JllOng my then surviv-
ing issue.
E1EIli: I appoint my daughter, Judith l.fu.y Bennett executrix
of this, my last tvill and testament, ,dth the pO"\ver to appoint
in her discretion a banking institution to act as Co-Executor.
SIXTH: I direct that my above named executrix, Judith 11a~
Bennett,be not required to give any bond, and that if, not-
wi t hstanding t his request, any bond is required by law,
statute or rule of court, no sureties be required thereon.
"
Signed und sealed this :?, (~ day of (( rL 1972
in the presence of the undersic~ed witnesses.
The foregoing instrument consisting of two (2) typewritten
pages was signed, published ~illd declared by the testatrix to
be her last will and testament in t.he presence of us, who,
at her request, in her presence, ffild in the presence of each
ocher have hereunto subscribed our names as witnesses.
f'
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(2)
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
C.l1.ffi~Au.ncA COUNTY, PENNSYLVANIA
Estate of
M~~~
t.
\~~\I
J
, Deceased
b ~~'\) ~~'{\"~-\\) -:ry,
and yt;141\h2:.vJ (:- -g[ Nrv ~ \ \
(each) being duly qualified according to law, depose( s) and say( s) that she / he / they was / were well-
acquainted with M ~ '4"\\ ~.. M 1\ ~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of M i) \t\} t,,,~ c-r-
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~~ ~ "l ~ ,
1''\ ~ "J
~~~
1~ S~ ~~~(~
(Street Addres'J
~:.~~~;"\~'bv,~J I ~ 11 , fll~J
is in his/her own proper handwriting.
~4~L--.
('to Va11((S-HlrLE~lV(~
(Street Address) I
C~ L L CS LE:: P 1\ l --=> 6 \ "3
(City, State. Zip)
_'hJ
Executed in Register's Office
Sworn to or affirmed and subscribed
',,;
r'~ :
before me this
of _~ ~jklSt
Q.~ day
, ri.GD1 .
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C)
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Form RW-04 rev.IO.J3.06