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Home My WebLink About09-14-07 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA File Number 21-- Lll. O~'-/ D Estate of Herman L. Willis also known as , Deceased Rita M. Mackey, Thomas L. Willis, Lloyd J. Willis and Leonard P. Willis Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW) o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the last Will of the Decedent, dated and codicil(s) dated Social Security Number 171-28-2621 named in the State relevant circumstances, e.g., renunciation, death of executor, e~c. 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: Decedent was married to Betty J. Willis. She died on December 5, 2002. ~ B. Grant of Letters of Administration (It applJCable, enter. c.t.a.; d.b.n.c.t.a.; peaente lite; durante aosentla; aurante mmontate) Petitioner(s) after a proper seanch 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.) I Name Relationship Residence C 'j I ,- ." '-~, I ,"/j ,', " .. See attached schedule --..- , .. ~ (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at c: 67 Smithdale Road, Shippensburg, Southampton Township, Cumberland County, PA 17257 (List street address, town/city, township, county, state, zip code) Decedent, then 87 years of age, died on 06/30/2007 at Carlisle Regional Medical Center, Carlisle, PA 17013 Decedent at death owned property with estimated values as follows: (If domiciled in PAl 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 situated as follows: $ $ $ $ 50,000.00 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 Rita At. Mackey Typed or printed name and residence 59 Smith dale Road Shippensburg, PA 17257 717 -532-8224 Thomas L. Willis 273 Briar Lane Chambersburg, PA 17202 X. r /:z~~ ,~Sli?~L-~#/z 'z/[!~Lk; 717-264-3038 Lloyd J. Willis 59 Smith dale Road Shippensburg, PA 17257 717 -532-8224 LeOnard P. Willis- P.O. Box 457 Page 1 0,2 Shippensburg, PA 17257 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland County } 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 a=rding to law. Sworn to or affirmed and subscribed Signature of Personal Representative , I 1-+ i--- before me this I. day of (-'" :.~ (CQ II \ bl: '-- ,BOO 1 ;},,' C91 uL,cT~ Q{).ad ~)"t74 ,-- For the Register \J X Signature of Personal Re Lloyd J. Willis ~...e~/' ~~ ;--..,-, c; Signature of Personal Leonard P. Willis~ Re resentative ~..___t c..r) File Number: 21-- (:)"7- O,'f40 Estate of Herman L. Willis , Deceased Social Security Number: 171-28-2621 Date of Death: 06/30/2007 --J AND NOW, .~ r-u M.\,j.-lA l 4 having been presented before me, IT IS DECREED that Letters ,~ i....,. , /)(Oi ,-- , in consideration of the foregoing Petition, satisfactorY~proof of Administration are hereby granted to Rita M. Mackey, Thomas L. Willis, Lloyd J. Willis and Leonard P. Willis in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent. FEES Letters............................................ $ ~(), ()~ Short Certificate(s)........................ $ ,j (, Ll) Renunciation(s)............................. $ f' \, ,-, l~~ Attorney Signature: ,') h-'/(/ ~ '" ~(' J) C "--u::l,~""""cr-:u~ '-0-- Attorney Name: Richard L. Webber, Jr. Esquire Supreme Court I.D. No.: 49634 Weigle & Associates, P .C. Address: 126 East King Street Shippensburg, PA 17257 Telephone: 717-532-7388 TOTAL.................................... $ Form RW-02 Rev, 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 PETITION FOR PROBATE AND GRANT OF LETTERS (Continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Herman L. Willis also known as File Number , Deceased Social Security Number 178-28-2621 Naml Relationship Residence Rita . Mackey Daughter 59 Smithdale Road Shippensburg, PA 17257 Leonard P. Willis Son P.O. Box 457 Shippensburg, PA 17257 Lloyd J. Will is Son 59 Smithdale Road Shippensburg, PA (17,257 r./ :; Thomas L. Willis Son 273 Briar Lane Chambersburg, PA 17202 - . Li ~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ij ""' II ! <'1 ( ,~ H I "Ii/"-//o,;---... ,"',~~\ II OF p,:~i;";;" ; 'i.r' -", 1:"1,0_:" :,<'~~J,t-'\ ",~, "".~ \\ f~. ;i:~ ~~\ ,;c-,.I. . h~! \j;.....~ ',' ~~~5t C', ~Il" " ",\.V'- I" ~~"- / MEN\ \\' \',/ ' "'2'~'<:::"':::.!::'.:!I!:!-I}~!~-" p 'lr~77C;110 ...J.....J j '-'_ . !"1 j , /I, l~ Ii) >J I, I! '!l),'-." Ih1\ j, tl> ':l'IlIIy IIl:it till' 11li"l>rmatilln hell' gi\ l'll i~' ,'I)tll'C'lly ,'l>pH'd lru1l1 all l>ri!2i!lal CL'rtii"icatL' \11 DL'ath dLlh i"ikd With II1\: .\' Lllcal RL'gi,lral. rill' llriglll,!! "cTlltil.ak he' 1,1Iw:mkd 1<' thL' SLit", Vil,1i lur 1)L'r Iilin;.', (,?_21JJ2.jh 2 DatL' 1"l!,',1 ,- .,') Li"! ~' Hl05.143 REV 1112006 TYPE I PRINT IN PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER 1. Name of Decedenl (First, middle, lasl, suflix) Herman L. Willis 5. Age (Last Bir1hday) 6. Date 01 Birth (Month, day, year) 4, Date 01 Death (Month, day, year) 2621 June 30, 2007 4/10/20 Shippensburg, PA Jgi,pa'.,' OERIOutpalo" ODOA ONo""9Hom, OR"ide'"'' OOlh",Specily Bd. Facility Name (" not inslitution, give street and number) 9. Was Decedent of Hispanic Origin? gg No DYes 10. Race: American Indian, Black, White, etc (If yes, specify Cuban, (Specify) Twp. Carlisle Regional Medical Center M"ican, poenoRk,", 'Ie.) White 87 12. Was Decedenl ever in the U.S. Armed Forces? OVes DlNo 13. Decedent's Educatioo {Specify only highest grade compleled) Elementary I Secondary ((}'12) College (1-4 or 5+) 8 v" Bb. County 01 Death Cumberland ~ 11, Decerlenl's Usual Occ atien Kind 01 work done durin most 01 worki Iile. 00 not slale relired KindofWorII Kind 01 Business f Industry Farmer Self Employed . 16 Decedent's Mailing Address (Street, city I town, state, zip code) 67 Smithdale Road Shippensburg, PA 17257 ~:a~~~idence 17a,Stale pennsylvania 17b,Coun~ Cumberland Other. 14. Marital Status: Married, Ne~er Married, Widowed, Divorced (Specify) Widowed P:e~~nt He. ~Yes,DecedentLivedin Southampton Township? 17d,D No, Oecedellt Lived within AcIualUmilsol Twp City/Boro 18. Father's Name (First, middle, Iasl, suffix) Robert M. Willis 19. Mother's Name (First, middle, maiden surname) Elizabeth Ocker 2{)b. Inlormanl's Mai~ng Address (Slrest, city flown, slale, zip code) 65 Smithdale Road, Shippensburg, PA 17257 21c. Place of Disposition (Name of cemetery, crematOf)' or other place) 21d.location (City ftown, stale, zip code) Shippensburg, Spring Hill Cemetery Cumberland Ct., PA 17257 22c.NameandAddressoIFacilityFogelsanger-Bricker Funeral Home J Inc. P.O. Box 336, Shippensburg, PA 17257 Approximate interval Part II: Enler other sianilicant conditions contribUlina 10 death, 28, Did Tobacco Use Conlribute 10 Death? Onsel to Death bul not resulling in the underlying cause given in Part I. D Yes D Probably D No D Unknown 29. If Female D Nol pregnantwilhin past year o Pregnantaltimeoldealh D Nc1plegnanl,biJlpregnantwithin42days c1dealh o Nol pregnanl,but pregnanl 43 days to 1 year betoredeath o Unknownilprt>gnanlwi1hinlhepaslyear 32c. Place of Injury: Home, Farm, Sl:reel. Factory, Ollie!! Buildmg, etc. (Specify) 20a, Intormant's Name (Type I Prinl) Leonard P. Willias CompIe1e Items 23H only when certifying physician is nol a~ailable at time of death 10 certilycause 01 death. I jJ1 j) Jlems 24-26 musl be completed by person who pronoonces dealh 24. TIme 01 Death 2. GO 7 CAUSE OF DEATH (See instructions and examples) l1em 27. Part I: Enter the ~ - diseases, injuries, or complicalions -thaI directly caused the dealh. 00 NOT enler lermirlal events sudl as cardiac arrest, respiralory arrest, or venlricular hbrillalion withoul showing the etic1ogy.lisl only one calISe on eadlline. ~':d~~~~ij~~~ a~~~\ dise.:;. (.... E V K Ef111T- lJ/TH ,-I-Sc..ITtS F#/LVI2E a CHI2fJ/V'IC i-E"t.-KoC-yn c Due 10 (or as a consequence 01): b t../VEJL FA-/LUrU.; Due to (or as a consequence 01) ft(.{/ TE. /2.EIJAL Due 10 (or as a consequence 01) 2- ~ ~ ;:.t. '-l :::t' Sequentially list condilKllls, if any, ~~l~~~o 8NhERLYiNh~AU~; a (disease or injury Ihal miliated the events resulting m dealh) LAST. d. 30b. Were Aulopsy Findings Available Prior to Comple1ioo of Cause 01 Death? 31.Ma rolDeath Nalural D HomicJde o Accidenl D Pending Investigation o Suicide 0 Could Not be Oelermined M 321. 11 Transportalion InjUlY (Specify) DDriver/Operator o Passenger DPedeslrian DOlher - Specify 33b. SignalulC and Title 01 Certiller t.....e:,.t-, ~ 2... 3Oa. Was an Aulopsy Performed? OV" ~ o V" 0 No 32d, Time 01 InjtJry \I) :jl " 3 33a_ Certifier (check OfIly one) Certifying physician (Physician certifying cause 01 death when another physician has prOflounced death and compleled l1em 23) lothe besl of my knowledge, death occurred due to lhecause(s) and manner as slatecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ 0 Pronouncing and certifying physician (Physician both pronouncing death and certifying 10 cause 01 dealtl) To Ihe best of my knowledge, death occurred allhe lime, date, and place, and due to the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ Medical Examiner I Coroner On the basis of examination and I or ln~esllgation, in my opinIon 23b. License Number HD 07 ~ ">22..L 26. Was Case Relyrred ~edical E)(3miner f COfOner lor a Reason Other than Cremation or Donation? DYes ~o 32g. localionol InjUlY (Sl:reel,cityltown, slate) /0 l-ecL ' /-tD i o W 0> ~ 3~ Registrar's Signalure and District N ~ I Lj (I '2-J / V I Disposition Permit No,