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Home My WebLink About03-10-08 PETITION FOR PROBATE AND GRANT OF LETTERS (' I.H"\ b {,~ I 't ~ cO COUNTY, PENNSYL VANIA REGISTER OF WILLS OF Estate of also known as Sh. iA}ei G, SAkffe", File Number ;< / - Og- - 0;2 (0. ~ , Deceased Social Security Number ~.3;( -}J) ,- 9686 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) ~. Probate and Grant of Letters Testamentary and aver that Petitioner(jf is /-afe'the last Will of the Decedent dated ..:Tv,( t :3 J ;lDl>2- and clldie;I(,) ddkd 2,><€.c- LxtV"1 )( 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 executio~()fthe instrum~s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ;--: ~ :::n; , i -n :P' i .-;-:. ~~~.2 ::.u o B. Grant of Letters of Administration .<'.,\", - (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; duraflfe;iRliIdritatej CJ I .-' ~.. Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following sRti)ls.e (ifany)itr.d 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.) ')::0 - --I Name Relationship Residence ~:2 sA'f) Decedent, then g/ years of age, died on 7JJ 1<.1" Co A 7 JMfat , )II) / y 51); f'J t /I()fj .ddd , Ir~ $ .l{ f)-t ('Iik ^Jl/1: 1 c.JI $ $ $ 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 ofreal estate in Pennsylvania situated as follows: ..j-/~ (0/ t h '1 ,f J, (}un f) ;11 / I fJA- , I f-o J. " ;f!- .,Jf"{{ If! rt:'Y'fIl/l1.eCl /70 II J.OOO Wherefore, Petitioner0 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: I1t- /. 7) L 'L FormRW-02 rev. /0.13.06 Page 1 of2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. t;,'l~ I'm thi, certificate. $6.00 dI~ii;;; ;I;,'(~\}IiQ~ p?i:---~ I'#:/ ~4trFJ.____ ~~_/ ~ - \~\. ~~/ ,. \-p~ ~c:J[. :-~. :!~~ ~e,..)\ _ ...,d . '~~ L,-, -~ ;*1 ,~~ //~~l ~-!!MENt \)\ ~~",'l ......,,""""noIlIJJ/JII'1 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. P l' 4. f)Q8)QQ'" c...u ..... '...ib Certification Number ;ffe i11.J1.2/) tL- 5ilDU12d rf.-Pi :-ft.;; 6iev -Ie. 3/7/oi I .' - -- (::::) - -p , ,j "-.::J C> "7'"":1 Hl05144 REV 1112006 ...:' TYPE I PRINT IN PERMANENT BlACK'NK #31-232 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on raversa) C) C STATE FilE NUMBER f,j ~ ~ <I. 1. Name of Deced&nl (First, mkkIe. last, suffix) Shirley 5."'" Ilut BOo1Ma,) 81 B Shaffer 80. County 01 Ooalh ,tI.4W1f'At<>'v T'"l> CCyIIloro Items 24.16 must be complelid by person who prOOOUOC&S dealh '. 25. Dale Pronounced Dead (Month, day, yearl 12:40 A. .. March 7, 2008 26. Was Case Relerred 10 Medical Examiner I Coronel' lor a Reason Other It\atl Crtmalion Of 00nIIi0n? m:I v.s 0 Na CAUSE OF DEATH (Setllnatructlona nd ..emp"') Item 27 Part l: Enter the ~mnli - diseases. InJUOElS. Of complicalloos - that directly caused !he dealt!. DO NOT enlel' terminal events such as car<Iac arrest, respilalory arrest, Of Vilfllricular fibrillalion wilhoul showing !he etiology List only ooe cause on each line !o ~ ~ :3 ! 321."Transportaliont~(SpecifyJ o Driver I Operalof 0 Pa&Ser'lQ8l' DPedestrian O!he<.Spsafy, 33a CerIifier (c:hsck only one) 33b. Signature and Ti =::rJ:~'::~C:;:'~~~7':=~::"~_~~_~~~~~___'_-~____________ 0 ~ Pronoww:lng II\d certifying physician (Ptlysaan boIh pronouncing death and certifying to cause of death) 331:. license Number 33d. Date Sqi8d jMonlh, day, yeatJ T....bNtofm, kMwIedge.deelll...."....... ...., ...... end piece, end due to'" cauH(.)... m.nne........d.____ -- -- -- - - ---- -- 0 Marc h 7, 2008 Medical E.wninet I Corontt VI On... bNt. of ............. end I" .w...,....... In m, ..Inlon. dulll................., ...... end ......... due..... ceuoe(.)........... u........ A J4 "!In.~1!'1' ~ "'N~!l',:" ~I'WIWype """ :"'AogisJllsSigne"'.""'''''"''' 36. _1""""....'....'1 6375 Basehore Roadr Suite #1 ~l . I....?I / 1..2J / Id I 7. Mechanicsburg, PA 7050 jtl3;;L'l..'~ Dves DNa 31, Manner 01 Death ~NaILJlaI 0 Homicide o Accident 0 Peoding Investigation o SUICide 0 Could Not be Delennined AppfO.Ilimate inl8rVaI: ParI II: Enter oCher ~ condiIians contl'tlulnllll dIattI, 28. Did Tabacco Use CoooitUe to DNIl7 Onsel10 OtIaIh bulnotr9$Ullingin Ihe underlying cause given in Part I 0 Yes DProbabIy DNa 0........ 29. n Fema6u: o NoI.._."""...._ 0"'_.....01..... o NoIpregl8ntbUpregnantMlhin42di1p ........ o NoI.._......-.....,....yeer -- 0-'..-............,.. 32c. Place of Injury Home, Farm, SltNt, FackIry, 0lIice Buting. "" 1_) ~J~~~~&;~~~dlS9~ Pulmonary Emboli Due 10 (or as a c:onseqoence of) , Atraumatic Pelvic Due 10 (Of as a consequence of): Fracture ="'t:t~';~a Enter Ile UNDERLYING CAUSE ~=~e~~ -::a~It.1r Due to (()j' as a cOIlS&quence of): 301. Was an Autopsy p- 30b Were Autopsy FinOOgs Available Prior to Complelioo of Cause of Death 1 M Coroner Dves .J:l..No 32d. Tlffi8otlojury Disposition Parmil No. , . LAST WILL AND TESTAMENT OF :~) SHIRLEY B. SHAFFER l! I. Shirley B. Shaffer, a resident of the Commonwealth of PelUlsylvania, lnake;.:publisb and declare this to be my Last Will and Testament. revoking all wills and codicils at any time heretofore ma,de by lUp. FIRST: I direct that the expenses of my last illness and funeral. the expenses 'Qr the I..: administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will. and any interest or penalties thereon. shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: I give all tangible personal property owned by me at the time of my death, including without limitation personal effects, clothing. jewelry. furniture. furnishings. household goods. automobiles and other vehicles. together with all insurance policies relating thereto. to those of my children Blake Kelmeth Shaffer and Trei Lynn Essey who survive me, in substantially equal shares. to be divided between them as they shall agree. or if they cannot agree, as my Executor shall detennine. THIRD: I give all the rest. residue and remainder of my property and estate, both real and personal. of whatever kind and wherever located. that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"). as follows: (a) To tllOse of my children who survive me and to the issue who survive me of those of my children who shall not survive me. per stirpes. (b) If no issue of mine survives me. I give my residuary estate to those who would take from me as if I were tllen to die without a will. unmarried and the absolute owner of my residuary estate, and a resident of the Commonwealth of Pennsylvania. FOURTH: If any property of my estate vests in absolute ownership in a minor or incompetent. my Executor. at any time and without court authorization. may: distribute the whole or any part of such property to tile beneficiary; or use the whole or any part for the health. education. maintenance and support ofthe beneficiary; or distribute the whole or any part to a guardian. committee or other legal representative of the beneficiary. or to a custodian for the beneficiary under any gins to minors or transfers to minors act. or to the person or persons with whom tile beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom tile distribution is made shall be a full discharge of my Executor from any liability with respect tllereto. even though my Executor may be such person. If such beneficiary is a minor. my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article SIXTH hereof. If the benefi- ciary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. ~~ C6 f~ r;? .zf~~ FIFTH: I appoint Blake Kenneth Shaffer to be my Executor. If Blake Kenneth Shaffer shall fail to qualify for any reason as my Executor, or having qualified shall die. resign or cease to act for any reason as my Executor, I appoint Teri LYlUl Essey as my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. SIXTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended. or any successor thereto. and all powers conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain. sell at public or private sale. exchange. grant options on. invest and reinvest. and otherwise deal with any kind of property, real or personal. for cash or on credit to borrow money and encumber or pledge any property to secure loans; to divide and distribute property in cash or in kind; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys. accountants and other persons for services or advice. The term "Executor" wherever used herein shall mean the executors. executor. executrix or administrator in office from time to time. SEVENTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. IN WITNESS WHEREOF. L Shirley B. Shaffer. sign my name and publish and declare this instrument as my last will and testament tIllS 3rd day of June. 2002. ~Sl~; r!~~ The foregoing instrument was signed. published and declared by Shirley B. Shaffer, the above- named Testatrix, to be her last will and testament in our presence. all being present at tIle same time, and we. at her request and in her presence and in the presence of each other. have subscribed our names as witnesses on the date 1. wrilleIl. MA ~ Q.o./1l_ ~~IJ ~~//} having an a~ess at ;~(OJd J PA 2 " ACKNOWLEDGMENT AND AFFIDAVIT n, . COMMONWEALTH OF PENNSYL VANIA. COUNTY OF /u!..a~ . ss. We, the Testatrix and the witnesses whose names are signed to the attached or foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the Testatrix, Shirley B. Shaffer, signed and executed said instrument as her last will and testament in the presence and hearing of the witnesses, and that she had signed willingly, and that she executed it as her free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testatrix, in the presence and hearing of the Testatrix and each other. signed the will as witness. and that to the best of his or her knowledge the Testatrix was at the time at least eighteen years of age. of sound mind and under no constrain1, duress, fraud or undue influence. ~~c!'~ If,='n~ U/l1 Witness ~j17 ~.~ Witness Subscribed, sworn to and acknowledged before me by the said Shirley B. Shaffer, Testatrix, and subscribed and sworn to before me by the above-named witnesses. this 3rd day of June, 2002. ~.K.~ Notary Public My commission expires on . NOTARIAL SEAL Roxanne K. Weller, Notary Public Township of Susquehanna, Dauphin County My Commission Expires May 9, 2005 Member, Pennsylvania Association of Notaries RENUNCIATION ;~-, ,) o -::n \, C':J _.~ ~C"'-il REGISTER OF WILLS ( vtvlber }o..l\. J COUNTY, PENNSYLVANIA ~.; a .1 ','I ~.-.~ ." ...._J .. I c., c. Estate of ~ h Irle'1 8 - S'~a..ffer , Deceased I, 13 J It- ke. ke hytQi " q (Print Name) C l( e,- vt-OV- ~Aa. ff'ev~ , in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to } ~r i t...'1h~ Zs.':;e'f r.1!ID 109 '7./ );(. d. .~ k:o~-ffc, ~ (Signature) - /3,j-8Lf SaY/itA. IsaJov" Sf. (Street Address) .. I--;O'.:Itl-I.... Va J/ey, G../Ift~iD.. 921C8 (City, State, Zip) (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this / d ~ day of .-ttJo!t c;~ ,,-, ;ZOJ/ , Deputy for Register of Wills (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 GLOR.iA J. Camp Hm ~r,i Ccmml[;:~,Jl ttOT/\:-;.;:;;:t S~::;~iL r.:Js!'y Pubnc c~ ._C:~'t;:~?1 ymJ ,::1, ,.<J11