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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (' ~b COUNTY, PENNSYLVANIA
Estate of
also known as
W l LA,..{ ~ .,..-: ~l7H
File Number
0:)/ - JLZJS - (j0017
, Deceased
Social Security Number ( ( 5'. I ~. o?~y Lf
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 Tr~amentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated ~ \~,';1.. ~ and codicil(s) dated ,'.::1.'1 l4~
~C~~
J 1/' c=t
I I
~ (~ (100
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
(Ifapplicable. 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 ari*:},.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.) '.'"'" '.'
~ .,,-~- ;
Name
Relationship
Residence
.~~
d
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. 0
Decedent was domiciled at death in rl )/Y\~r\c.)cf)~, ~ounty, Pennsylvania with his / her last principal residence at
- ~\~ ,,1. ;2Lf~ s;- c.ftfvP I ~ \ ,0 l/
(List street address. town/city. township. county, state. zip code)
Decedent, then
years of age, died on ~.
fL. 4. 07 at
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Persona~roperty in County
Value of real estate in Pennsylvania .:2{ ~ ~ L~~)
i~ (Cr ~. ~'1 ~~J C A--rv-p t-J, I':'L ~ ((0 J
$ ;).500
$
$
$ I 'tt',000 Lb.oo cu)J
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 fonn to
the undersigned:
T ed or rinted name and residence
. SMITH-
,V. ,;2 L()r, '::>,
~Jfz~~ 17DI
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
rU~l>
The Petitionet(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 beliefofPetitioner(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
1
',_.IJ ''I itt. day of
befo e me the ~
Signature :
LV
Signature of Personal Representative
Signature of Personal Representative
File Number:
J(/~()()?- 000' (
Estate of
W/LUItM
F S{Y\,~
, Deeeased
Social Security Number: /7 ':)., ;;l. ~ B 1/ Lf
Date of Death:
iJ. "I. D7
AND NOW,
having been presented
are hereby granted to
2>
-vv'fj ,.'.,
,c.::::AJ_ , in consideration of the foregoing Petition, satisfactory proof -
Tt:~~17tIl-{
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last! Will (a d CO,diCil(S)) ohDecedent., !,
'" ~~1 11 1/ A /) /\L1'1..1
FEES .. UU .- /l.fd.-/-!
/yo~ ~ ,~
Letters ............... $ ( y LY
. C bD
Short CertIficate(s) . . . . . . . . $ d )
Renunciation(s) .......... $
. fSeD
N: \\ ... $
r oct c< ~ . . . $ IS. 'tv
((",et/CA{ ...$/S,Q)
C'CJC1, C I ( . . . $ l s-.'-el
~ ...$ 10..'
.{ i D . . . $ G i..L.
. ?
in t~above'e'staie
Attorney Signature:
~J' ~/'h.l-
ro",5 3>)
3, tt N. 024/1, ~
Cj)-tY'P Mu.- ~ (7011
Attorney Name:
Supreme Court I.D. No.:
Address:
... $
... $
... $
TOT AL .............. $ 3.SS c:1j.G9
Telephone:
717 - '1 33- 5S5"lf
Form RW-02 rev. 10.13.06
Page 2 of2
H105.905MS REV. 6/06
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. 0 '?) _ [1..)0 '''"7
WARNING: It is illegal to duplicate this copy by photostat or photograph.
/2 J -4
C-4Q ~cY.Af)JL~ lf9MJfoL
No.
Frank Yeropoli
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
1273801
DEe 1 9 2007
Date
H105-143 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)
110014
STATE FILE NUMBER
IV
~/
86 YIS.
Bb. County of Death
Cumberland
Sd. Facility Name III oot institution. \tie street and numlJer)
319 North 24th Street
Irwin, PA
Sa. PIaca of Death (Check ooIy one)
Hospital:
o Inpatient 0 ER I Outpatient 0 DOA 0 Nursing Homo ~ Residence OOttlar " SIlecffY:
9. Was Decedent of Hispanic Onqm? [jj No 0 Yes 10. Race: American Indian, Black. White, ete
(If yes, specify Cuban. (SpeciIyl
Mexican, Puerto Rican, atc.) whi t e
4. Dete of Death (Month, day, year)
November 4, 2007
1. Name 01 Decedent (Firs!, middle, last, suffix)
William
F.
Smith
6. Data of Birth (Month, day, yoar)
5. Ago (Last Birthday)
17b. County
Pennsylvania
Cumberland
17e. 0 Yes, Decedent Lived In
17d.1la No, Decedent Lived with<n
Actual Limits of
Twp
. 16. Decsdenrs Mailing Addlllss (Slraet. city ftown, state, Zip code)
319 North 24th Street
Camp Hill, PA 17011
fEl Falher's Name (Firsl. middle, fast, suffix)
Jacob Smith
12. Was Decedent eYer in the
U.S. Anned Forces?
!JgY8$ ONo
Decsdenrs
~ Residence 17a Slate
13. Decedenrs Educatioo (Specify only highest grade compIeledl
Elementary I S<lcondo.ry (o-t2) CoIlogo (1"" or 5+)
12
14. Marital Slatus: Mamod. Nevor Morried,
WIdowo<J, Divortod ISpecify)
Widowed
Camp Hill
City I Bora
208. Informant's Name (Type f Print)
Susan J. Smith
21a. Method of Disposrtioo I' rn Cremation 0 DonatIon
. 0 Bunal 0 Removal from Slate I W.. Cremation or Donation Authorized
o 0lIl0r" Specify: I by MedicII examiner I Coroner?
228. see (or person acting as such)
19. Mother's Name (Firsl, middle.ll1OI<len sumemo)
Margaret Troutman Riley
2Oll. Inlonnarn's Mailing Ac*lI&ss (Slreel, city 11oWn, Slate, zip code)
319 North 24th Street, Camp
21e. Place of Disposition (Name of oemotery, cnmatory Of _ place)
Evans Crematory
Hill, PA 17011
21d. Location (City f town, state, zip code)
Schaefferstown, PA 17088
o
w
en
:J
en
~
. .
Inc., P.O. Box 431, New Cumberland, PA 17070
231>. license Number
230. Date Signed IMonth, day, year)
It8ms 24-26 must be completed by person
wno pru<lOIJOOlS deatf1
24. TITTlll 01 Oeatf1 l..J.. (/
/ t) 7p'lM
25. Dele Pronounced Dead (Month, day, year)
/J-~- 0-7
26. Was Case Raferred to Medical Examiner I Coroner lor a Reason Other than Cremation Of Donation?
DYes ~No
CAUSE OF DEATH (See Instructions and examples)
Item 2J. Part I: Enter the ~ - diseases, injuries, or compiications -that dir8ctIy caused the death. DO NOT ent8f terminal 0Y8fl1s soch as canIac anest,
rospIr8fOI)' anosl, Of ventricular fibrillatioo Without showing the atioIogy. Lisl only one cause on each Hoe
Approximate interval:
Onselto DeafIl
Part II: Enter other RiMmnt condition..~ contributina to d&ath,
but not I1ISUIIng in !he underlying cause given in Part I.
~=~~~'W!)~
(~f)N6-t571/1r II~~ FAIL~,4F
b DuetO(r~/v.?tf)?#~
Due to (or as a consequence of):
M0fJ67U>7Y ~5tr'
28. Did TobacCo Use Contribute to Death?
o Yes 0 Probably
J2(No 0 Unknown
29. " Female:
o Not pregnant within pest yaer
o Pregnant at time 01 daath
o Not pregnant, but pregnant wflt1in 42 days
of death
o N01 pregnant, but pnIgOOnt 43 deys to 1 year
before d~<::frh
o UnknoWf1 n pregnant within the pas! year
32e. Place of Injury Home, Farm, areet, Factory,
Ollice Building etc. (Specify)
Sequ~~:'~~a
= UNDERLYING ClllSE
~"'~,,~~mr
Due to (or a, a consequence of):
d.
o Yas .Ja1io
3<Xl. Were AUlopsy Findings
Available Pnor te Completion
of Cause of Deatf1?
DY.s~
31. Manner of Daath
.ar:tunlI 0 Homiljde
o AI;cidant 0 PanOOg Investigation
o S\lIcide 0 Could No( be Dolermined
32d. T1lTlt oIlnjuJy
329. location of Injury (Slreet. city 11oWn, state)
308. Was an Autopsy
Parformad?
M.
338. Call1Iler (ct>ed< Ol"tf one)
=;:.~ ~~=~:~~~W::":=~~_~~_~~~~e:':S~__ _______ _ __ _ _ __ _ 0
. ==: =~~ 0::; ~~I~ ~~':~ta~U::"~~~~ manner u Ilatad.. _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ 0
~~"=.::':',,=...., I or ~n. In my optnlon, dMth oc:c;urred at \hO lImt, dill, and pIac:o, Ind due to \hO _ae(I} and mannar.. a1atod.. 0
!
~
~
0"7
:~r's~~~
-4 II ~ /1 /1 36~.i~~6'7)
Olsposttlon Permit No t:O'l O.~ '7 Lj..
/7 {J-v:J
OATH OF NON-SUBSCRIBING WITNESS(ES)
? ,REGISTER OF WILLS
( Jfl.tMc;r)~R COUNTY, PENNSYLVANIA
02/ - c:JOO~/ ()O() 7
Estate of
0jlic.~ F ~l~
, Deceased
~ 7. >rrll /7-J and '7Ji~,/ IY) (W-;"1.cPc.Lr-t"t (~ ,
(each) being duly qualified according to law, depose(s) and say(s) that she / he / ~ was /~ well-
acquainted with W /,iA NY'> (=- SY)/;-~-) and an@familiar
with the handwriting and signature of the decedent, and that the signature of tJtUl /lWt. r ~,n +
to the foregoing instrument purporting to be the Last Will and Testament/CodiciYof eJ, 1)7 /h1'\ F ~ ,'n t
is ir@/her own proper handwriting.
ISig"a,LliJl
f :
3 ) 1/ il. d 11 /h :)'1
(Street Address)
(lAtvp H,k t (10 I (
(City, State, Zip)
I JfJp /Ii fIn- tf"
(S~~ U
'802 1k1111 0 if) ~n v.i.
(Street A dress)
fJ7'41;111({') bUAIj fA /70S'O
(City, tate, ip) f
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ....2 rz{_ day
/~'yt:f
, Q..(L/~ .
",J
Form R W-04 reI! 10.13. 06
STONE, SAJER
8< STEWART
Attorneys at Law
414 Bridge Street
New Cumberland, Pa.
17070
,....,,'\ <;.',-
c./J '.)
+--;
II
I-
I
LAST WILL l~D TESTAHENT
OF
ciJ
"l-.
-to
,rr
-d'
:q::
. .....~
HILLIAM F. SMITH
------.-.------.-
I, WILL IAH F. SMITH, of the Borough of New Cumberland, County of
Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will
and (tev()ke any wIll previously made by me.
ITEM I: I devise and bequeath all of my estate, of every nature and
wherever situate, to my wife, JOSEPHINE SMITH, provided she shall survive me
by thirty days.
ITEM II: Should my wife, JOSEPHINE SMITH, predecease me or die on or
before the t.hirtieth day following my death, I devise and bequeath all of my
estate, of every nature and wherever situate, to my daughter, SUSAN J. SMITH,
of Charleston, South Carolina provided she survives me by thirty days. Should
my daughter, SUSAN J. SMITH, predecease me or die on or before the thirtieth
day following my death, I devise and bequeath all of my estate, of every
na t u re i!nd wherever si tuate, to my son, TIMOTHY J. SMITH.
ITEM III:
Should any person ent 1 t led to a port. Lon of thi s es tate be,
in the opinion of the Executrix, incapable of disbursing it because of age,
illness or other cause, and should .it be impossible or inadvisable in t.he opi-
nion of the Executrix for such share to be awarded to such person or distri-
buted to another for such person's benef.i t, the share of such person shall
he held, [N TRUST, and the Trustee, hereInafter named, shall accnmulate the
income and shall apply from time to time such portions of income, accumulated
.i ncome and principal as it thinks proper for that person's support and (~duca-
II
STONE,SAJER
& STEWART
Attorneys at Law
414 Bridge Street
New Cumberland, Pa.
11070
tion (including) education in college, trade school or graduate school)
after taking Into consideration his or her other available assets and sources
of income, and shall make payment for these purposes without further respon-
sibility to the beneficiary or to the beneficary's parent or to any person
taking care of the beneficiary. Any principal or income not so applied shall
be distributed to the beneficiary when he or she becomes of age or competent,
or to the personal representative of the beneficiary's estate in case of death
durL1.g minority or before becoming competent.
ITEM IV:
I direct that all taxes that may be asessed in consequence
of my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from my residuary estate as a part of the expense of the administration
of my estate.
IT EH V:
I appoint my Executrix and her successors Trustee of any
trust created in this my last will.
ITEM VI:
I appoint my wife, JOSEPHINE SMITH, Executrix of this, my
last will. Should my wife, JOSEPHINE SMITH, fail to qualify or cease to act
as Executr.ix, I appoint my daughter, SUSAN J. SMITH, Executrix of this my last
will. Should my daughter, SUSAN J. SMITH, fail to qualify or cease to act as
Executrix, I appoint my nephew, ROBERT W. DeSANTIS of Gaithersburg, Maryland,
Executor of this my last will.
and seal
IN WITNESS WHEREOF, I, WILLIAM F. SMITH, have hereunto set my hand
//' /1 ~/ 1- -
this ,~;i~.9day of l -;i::~/:/c/"~? /~;86. _--' fl';/;
~// '//'.// / / I
- ~1t/~~-~~ ~ ~ ?'~~~-j SEAL)
Page 2
STONE, SAJER
& STEWART
Attorneys at Law
414 B ridge Street
New Cumberland, Pa.
17070
II
, .
SIGNED, SEALED, PUBLISHED and DECLARED by WILLIAM F. SMITH the
Testator above named, as and for his Last Will and Testament, and .in the pre-
sence of us, who at his request, in his presence and in the presence of each
other, have subscribed our names as witnesses.
)
-/
// , ",
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.. i " ,.-",\ {' I~'" :, '/"",,-,
c- 'i, ~ /, 1/, ( .' ~-'C) ---.......
"-'~~(?'r~' "/' f~ 'I
-~"\..f' ,~_~~___,_,___
Witness
i I
,I /"
[/(J?.JJ,..,/'-
Address
//,
(--<,J..M.I'.~."Q J\ )-!:J1 /
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-''W i t n e s s
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' ._._~_._.
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Address /
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND
I, WILLIAM F. SMITH, the Testator whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law
do hereby acknowledge that I signed and exected 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 contained.
>,,,?
/// ~
"'-, /, . ./;;Z; /j I'
, /-.-=Y'". // /'
~ L:>' . / ' ':.:.z::::::: / / /
\vILLIAM F ~"""'SMI'FR" ,"--':.---------
Sworn to or affirmed to and acknowledged before me by WILLIAM F.
SMITH, the Testator, this ~ ~ day of ~5'zi:'<e,v
, 1986.
'4/ /t ~i J
) rJ!f~ .. ';;~'VL.,{L,,~
I Notary/Public ~
Page 3
rAVE RENEE lUCkEV, Notary Pub/Ie
New Cumberland, CUlJlb,rl,nd'(o p
My CommiS$;on Expires MIlch 27; ':~9
.
.
STONE. SAJER
& STEWART
Attorneys at La\N
41 4 Bridge Street
>le\N Cumberland. Pa.
17070
"
COMMONWEALTH OF PENNSYLVANIA
:SS:
COUNTY OF CUM~LAND :
/' 17:\ / /1
weW~IJ~)
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 a
saw Testator sign and execute the instrument as his last will; that Testator
signed willingly and that he executed it as his free and voluntary act for t
purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the will as witnesses; that to the best of our knowledge, the
Testator was at that time eighteen or more years of age, of sound mind and u er
no constraint or undue influence.
~CXJ~
Witness
,/~a"~XJ.~.L.~ /~
',--, tnes s
Sworn to or affirmed to and acknowledged before me by
I
I
I
(I/;'L2j,'/~AV :tl. /f/~
this j J. day of/vfr/'l'n,At'A)
, 1986.
C). _VLfI.J
and .I.lI2./,IrdJ t2. /) CL~~~;
, witnesses,
KA YE RENEE LUCKEY, Notary Public
New Cumberland, Cumberland Co., Pa.
My Commission Expires March 27, 1989
Page 4
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