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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF c.v~~i> COUNTY, PENNSYLVANIA
Estate of
also known as
cr Oc;~t1I..l~ ~T\4
File Number
~\ 0\ \\\\
, Deceased
Social Security Number I Y 4. I (p. ~o "'7<7
Petitiom:r(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
l51 A. Probate and Grant ofLettels Test1mcSntary and aver that Petitioner(s) i
last Will of the Decedent dated -1_ ~ ~ vC- and codicil(s) dated I
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 lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spouse (if~) 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.) c; i:,c.:,
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Name
Relationship
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
C W
Dec,edent was domiciled at death in t,.,J..fr't Co nty, Pennsylvania with his I her last principal residence at)l
l\\ LL- ,.. ~ CO"
(List street address. town/city, township, county, state, zip code)
IV
Decedent, then 5 5' years of age, died on B. t q. l) 7
at
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsy lvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania 'h. ~~t:r. H-oME
~ I or l-t. ~~ M S r {It'rlVf> t-! l.L. ~ I *( 01/
$ ~S:oD
$
$
$ 70 000 (~Oc)O)
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 undersi d:
T ed or rinted name and residence
(70 I ,
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
COUNTYOF rv~')
S8
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con-ect to the best of
the knowledge and belief of PetJtioner(s) and that, as personal rep}~ent;l.ttJ( ~ofthe Decedent, Petitioner(s) will well and truly
,dmini""",h",,,,, ",,'ding to l,w. .,/ ~
Sworn to or affirmed and subscrIbed
before me the ---1L day of
r~
Signl}(ure of PeriJ/wi Representative
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Signature of Personal Representative
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Signature of Personal Representative
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File Number: i::.\ t, \ \'"\\
Estate of Jc& pL . {h
Social Security Number: I tf tf /(,:, ~ 07 tt
AND NOW, ~ \4 , 'd.t<lo
having been presented before me, I IS DECREED that Letters
are hereby granted to 5J7-Jr4 J, ~/)).J.
, Deceased
Date of Death:
gt5-'0 "7
, in consideration of the foregoing Petition, satisfactory proof
~S~" hr:>
FEES
Letters .. .1.~.~... $
Short Certificate(s) . .l...o. . .. $
Renunciation(s) .......... $
~\, \ ... $
(~~\ ~2:> ... $
~L~ ...$
~-\u $
... $
.. . $
... $
.. . $
.. . $
TOTAL ............. . $
in the above estate
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Attomey Signature:
Supreme Court I.D. No.:
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I/Jiv-r> th L( a {( 0 I ,
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Attomey Name:
Address:
Telephone:
/17 - 7(.. ~ -It. c::;u
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Form RW.O] rev fO.13.06
Page 2 0[2
H105:-;05 REV IOI/()/1
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p
13771753
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 filing.
Fee for this certificate. $6.00
Certification Number
AUG 2 0 ~01 /
Date Issued
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REV 1112006
PRINT IN
AANENT
CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on raverse)
11. Decedent's Usual Occ lion Kind of wor1< done du' most of life. Do not state retir
Kind of Work Kind 01 Business I Industry
Homemaker Domestic
. 16. Decedent's Mailing Address (Street, city /town, state, zip code)
319 North 24th Street
Camp Hill, PA 17011
12. Was Decedent ever in the
U.S. Armed Forces?
DYes ~No
Decedent's
Actual ReSidence 17a. State
13. Decedent's Education {Specify only highest grade completed}
Elementaryl Secondary (0-12) College (1-4 or 5+)
12
14. Marital status: Married, Never Married.
Widowed. Divo<ced (Spec;!jl
Married
b\ \\
March 4, 1922
Lansford, PA
3, Social Securily Number
144 - 16
2079
1. Name of Decedenl (First, middl,e, last, suffix)
85 Yrs.
Smith
5. Age (Last Birthday)
6. Date at Birth {Month, de. , ear
7. Birt11p~ce(Ci
Ba. Place at Death (Check only one)
Hospital' Other'
o Inpat~nt 0 ER I Oulpet~1 0 DCA 0 Nursing Home
9. Was Decedent of Hispanic Origin?
(If yos. ,pedly Cubon.
Mexican, Puerto RIcan, ele,)
Bel. FacMity Name (II not institution, give street and number)
Cumberland.
Camp Hill
319 North 24th Street
William F. Smith
17b. County
Pennsylvania
Cumberland
Did Decedent
Uve ina
Township?
17c. 0 Yes, Decedent lived in
t7d. ~ No, Decedent Lived within
Actual Umits of
Twp.
Camp Hi 11
City/Born
18. Father's Name (First. middle, last, suffix)
Rudolph Cebulewski
2Oa. Informant's Name (Type / Print)
Capt. William F. Smith
19, Mother's Name (First, micllte, maiden surname)
Magdalena Dylong
20b. lnlormanrs Mailing Address (Street. city I town, slate, zip code)
319 North 24th Street, Camp Hill, PA 17011
Evans Crematory
21 d. location (City! town, state. zip code)
Schaefferstown, PA 17088
i ~ Cremation 0 Donation 21b. Date of Disposition (Month, day, year)
i ~'~:rr=:.7~~~honzod lXJ Yes 0 No Augus t
ISOn acting as such) 22tl. ucense Numbef'
FD 013 340 L
21c. Place of Disposition (Name of cemetery, crematory or other place)
22c. Name and Address of Facility
Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
23b. License Number
23c. Dale Signed (Month, day, year)
24. Time 01 Death
C} : S1:l AM 25 Date Pronounced 0Ct1:Y' day:~ I c;- - D ?
26. Was Case Referred to Medical Examiner f Corooer for a Reason Other than Cremation or Dooation?
DYes IXlNo
CAUSE OF DEATH (see Instructions and examples)
Item 27, Part I: Enter the liIliin.~ - diseases, injuries, or complicalions -that d1red1y caused the death. 00 NOT enter lerminal events such as cardlac arrest,
respiratory arrest, or ventricular fibrillation without showing the etiology. Us! only one cause on each line. .
=~~~~~~\d"= . i 1 L -t~-h C- lSl.?..C(J'~f LC(., CJ4
o 10 (or as a consequence of):
Approximate interval:
Oosetto Death
Part II: Enter other sionlficant conditions contributina to death
but not resulting In the underlying cause given In Part!.
28. Did Tobacco Use Contribute 10 Death?
DYes OProlHlbly
.0 No 0 Unknown
29. II Female:
0"1f0t pregnanl within past year
o Pregnant at lime of death
o Not pregnant. but pregnanl within 42 days
ofdealh
o Nol pregnant, but pregnant 43 days 10 1 year
before death
o Unknown it pr99'lant within the past year
32c. Place of Injury: Home, Fa~ Street, Factory,
Office Building, etc. (Specify)
~~~~tKs~'~r~a.
~~\; UNDEALYlNG CAUSE
(disease or il)jul'{that inilialed~le
events restJltIng 10 death) LAST.
Due to (or as a consequence o~:
01.18 to (or as a consequence 00:
d.
DYes IiiJ No
DYes ONo
31. Manner 01 Death
IZI Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could Not be Determined
32d. Time of Injury
32g. location of Injury (Slreel, city Ilown, state)
308.. Was an Autopsy
Performed?
SOb. Were Autopsy Findings
'vaBBble Prior 10 Completion
ot Cause of Death?
M.
338.. Certifier (check only one)
~~u:':i~r:i~~=~:~~~~:::;;~ ~ thewhe=;~~h=:~: ::..~_ ~~ ~:d ~~~~ ~e: ~~ .. _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ 0 ...
Pronouncing and certttylng physlelan (Physician bOth pronouncing death and certifyil"lQ to C8l.je of deeth)
To the best of my knowledge, death occurred a1 the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ - - .. - - .. - - 0
~::~;:~sm~~~~;~o:'~ 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- 0
33<1. Dale ~ (Month, d'7'. year.) '.' 7
,5 - /b - (;
34. Name and Address of Person Who Completed Cause of Death (lIem 27) Type { Print
'Regisl"r"~~Dislri<tNUm.. . :z
.~IYl.., .' /
I 0<-1 II 0<1 / V
Di,posOion Permit No. DO 5 0'1:5)
STONE, SAJEIR
& STEWART
Attorneys at Law
414 Bridge Street
New Cumberland, Pa.
17070
t"
,..
LAST WILL AND TESTAMENT
OF
JOSEPHINE SMITH
I, JOSEPHINE SMITH, of the Borough of New Cumberland f) CQunt.}':., of .
Cumberland, and Commonwealth of Pennsylvania, declare this to..~ my ~~stwil1
and revoke any will previously made by me.
(....)
l'17
.'1
ITEM I: I devise and bequeath all of my estate, of every nature and
wherever situate, to my husband, WILLIAM F. SMITH, provided he shall survive
me by thirty days.
ITEM II: Should my husband, WILLIAM F. SMITH, predecease me or die
on or before the thirtieth 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 nature and wherever situate, to my son, TIMOTHY J. SMITH.
ITEM III: Should any person entitled to a portion of this estate be,
in the opinion of the Executor, incapable of disbursing it because of age,
illness or other cause, and should it be impossible or inadvisable in the opi-
nion of the Executor for such share to be awarded to such person or distri-
buted to another for such person's benefit, the share of such person shall
be held, IN TRUST, and the Trustee, hereinafter named, shall accumulate the
income and shall apply from time to time such portions of income, accumulated
income and principal as it thinks proper for that person's support and educa-
STONE, SAJEIR
Be STEWART
A ttorneys at Law
414 Bridge Street
New Cumberland, Pa.
17070
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-
sibi1ity 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
during 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.
ITEM V: I appoint my Executor and his successors Trustee of any
trust created in this my last will.
ITEM VI: I appoint my husband, WIILLIAM F. SMITH, Executor of this,
my last will. Should my husband, WILLIAM F. SMITH, fail to qualify or cease
to act as Executor, 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 husband's nephew, ROBERT W. DeSANTIS of
Gaithersburg, Maryland, Executor of this my last will.
IN WITNESS WHEREOF, I, JOSEPHINE SMITH, have hereunto set my hand
and seal this )J. day of /f#;Jn~~J~ 1986.
7 1:. . +-,
(j,,"L~t-; L_X_/ .,)/hL-':'--.(~/
JOSEPHI E SMITH
(SEAL)
Page 2
STONE, SAJEIR
Be STEWART
Attorneys at Law
414 Bridge Street
New Cumberland. Pa.
17070
SIGNED, SEALED, PUBLISHED and DECLARED by JOSEPHINE SMITH the
Testator above named, as and for her Last Will and Testament, and in the pre-
sence of us, who at her request, in her presence and in the presence of each
other, have subscribed our names as witnesses.
LL.-Q..~ P-, (?,
Address ~ f
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Address /
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND
I, JOSEPHINE 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.
JO~~~ts~i~H' jF?r~2'2./
Sworn to or affirmed to and acknowledged before me by JOSEPHINE
SMITH, the Testator, this ~;)...
day of ,+-:t~0
, 1986.
Page 3
~;e, ~"kFf
Nota y Publi.
M'flIENEE LUCKEY. Notary Public
- . beMQd Cumberland Co.. Pa.
~C~~iatO\\,i~ires March 27.1989
STONE, SAJIER
& STEWART
Attorneys at L.aw
414 Bridge Stlreet
New Cumberland, Pa.
17070
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF C/~ :
we~9t<Jcb
the witnesses whose names are signed to
at3,.u~j)(J. /f~~,4.
the attached or foregoing instrument,
being duly qualified according to law, depose and say that we were present and
saw Testator sign and execute the instrument as her last will; that Testator
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 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 under no constraint or undue influence.
~R~
Witness
d~~/)C4~~
tness
~ Y/H~
this t:?:J. day of .fit t;,4'>l/~JJ
affirmed to and acknowledged before
and L)~a.~h~ "
Swor n to or
me by
witnesses,
, 1986.
~< 'Ii, ~/~
Not y Publi
MVE RENEE lUCKEY, Notary Public
New Cumberland, Cumberland Co., Pa.
I: i Commission Expires March 27, 1989
Page 4
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OATH OF NON-SUBSCRIBING WITNESS(ES)
/' REGISTER OF WILLS
L U/YYJI.::f2uW ,) COUNTY, PENNSYLVANIA
Estate of
--Jv ~'P{'f-tN b S~'/1")
, Deceased
Su~,] '~MI'h I and 77h~V ~ (/fa71-1..p.~'f-(,
(each) being duly qualified according to law, depose(s) and say(s) that she I he rYE;) was ~~ well-
acquainted with ~ ~~J"'-< ~ (~ and arr€9familiar
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with the handwriting and signature of the decedent, and that the signature of~lt1 Mb- YV\ ('/), I
to the foregoing instrument purporting to be the Last Will and Testament/CodiciPof -Jo ~{>t-h L( ~ ~ ()) /
is in his/~wn proper handwriting.
$~L~
(Sign r ..
(Str~~Zres(f?!t IOU /)1 .
(}1t -Q j,4~4' {'5ku-tj , ?fI i71Yf6
(City. State, Zip) {
(Sigllalltre)
319 tV. ~tf~ Sr
(Street Address)
?Chl. C'!krf f/, Lt- fA (7 () l I
Executed ill Register's Office
Sworn to or affinl1ed and subscribed
before me this \ ~ day
of ~~, :JDDi[)
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Form R W-04 rev. 10.13.06