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Home My WebLink About03-11-08 Estate of PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Cumberland County, Pennsylvania File No. ~ I - 0 X - 0;2/1 Social Security No. 521-42-1763 Deceased CHARLOTTE SMITH CHARLOTTE S. GOOD f/k/a CHARLOTTE M. ACKERT Petitioner, who is 18 years of age or older, applies for: (COMPLETE "A" OR "B" BELOW:) o A. Probate and Grant of Letters Testamentary and aver that Petitioner is the named in the Last Will of the Decedent, dated September 28. 1971 Executrix 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: D B. Grant of Letters of Administration (if applicable, enter: c.I.a.; d.b.n.c.t.a.; pendent elite; durante absentia; durante minoritate c; C~:" ~-~ Name Relationshiip Residence,: '~ . ::T-; " '-.'I~. ~l " 1 . --- ;:.:cD I I (COMPLETE IN ALL CASES): Attach additional sheets if necessary. :-=:-7/1 Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or pri~ipal resiGence at "'-"--, .. 70 Diane Circle. Camp Hill. Borouoh of Wormlevsburo. Cumberland County, PA (List street. address. town/city. county, state. zip code) (Jl N Decedent, then 79 years of age, died on February 12. 2008 at Hershey Medical Center, Hershey, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property.....................................................................$ (If not domiciled in PA) Personal property in Pennsylvania.....................................$ (If not domiciled in PA) Personal property in County....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ T otal......................................................................................................... $ 16,138.00 202.020.00 218.158.00 Real Estate situated as follows: 70 Diane Circle. Camp Hill. Cumberland County. PA with an assessed value of $159,720.00: and 2124 Derry Street, City of Harrisbura, Dauphin Countv. PA with an assessed value of $42.300.00 Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of Letters in the appropriate form to the undersigned: CHARLOTTE S. GOOD f/n/a Charlotte M. Ackert 219 North Second Street Wormleysburg, PA 17043 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. .--) Sworn to and affirmed and subscribed Before me this Ilt- ~ day of (~<-L:r- C \,--j , 2008. ~C.I' uL~) (j Od AJ1p'TI File No. ;;)1 - ('J?: - ()()./l Estate of CHARLOTTE SMITH Date of Death: February 12. 2008 Social Security No: 521-42-1763 ) . '- ~),;,. :-::-r..} -- _._.~ en ,,) , Deceased. AND NOW, ('{\(l..icL \ \ ,2008, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to CHARLOTTE S. GOOD f/n/a CHARLOTTE M. ACKERT in the above estate and that the instrument dated September 28. 1971 described in the Petition be admitted to probate and filed of record as the Last Will of the Decedent. FEES Letters........................... $ ~~\() . ()D $ dLl. tD $ $ $ IS IJ\J $ $ 1(;. ()O $ $ S. OD $ ~~. CO Short Certificate(s) Renunciation............. . Affidavit ( ).................. Extr51 Pages ( W.I \\ Codicil............................ JCP Fee....................... Inventory...................... Other.............................. TOT AL......... ,-J:!J.l nrG,,-,:;j ~ n1l1 ~ fJ/\ br. , J ,A~) Register of Wills ~ Attomey Signalure:4~ bur-- Attorney: EDMUND G. MYERS I.D. No: 20558 Address: Johnson. Duffie. Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemoyne. PA 17043- Telephone: 717-761-4540 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fce lor this certificate. $6.00 P 14122232 Certification Number This is to certify that the information here given is conectly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~ jyJ ~EB 20 Z008 /(! / / Local Registrar Date Issued (~ '".:......~'J .-........ :::-0 c,n N 14 REV l1l2OO6 :: {PAINT IN AMANENT .ACKINK 1. NamI oj Decedent (FinIl., mklIe, laS!, Slifix) COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on reverse) 2. Sex 3. Social Security NlI1'ber STATE FILE NUMBER S. !qo (last Birttday) 6. Dale oj Birth (Month. day, at) 7. Bint-olace{C' 79 January 14, 1929 Vienna, Yrs. ad. Facility Name (II not instilobon, gve street and number) Hershey Medical Center fI'IO$loI if.. Dona; stateretir KindrJ Business I Indllstry Healthcare '3. Oe<odent', Education (Speci~""y highest grade completed) EIemenIa'Y I S_'Y (0-12) College (1.4 or s+) 12 4 Pennsylvania Cumberland 12. Was Decedent ever in the U.S. Armed Forces? DYes 6aNo . 16. Decedenrs Maihng Address (Slreel, city I town. slate, zip code) 70 Diane Circle Camp Hill, PA 17011 Decedent's Actual Resldeoce 17a. Slate m. County 521 4. Date 0/ Death (Iotonth, dey, year) February 12,2008 .- 42 1763 Other: o R,.denee 001her. Sped~: RJ No 0 Yes 10. Race: American Indian. Black. WhIte, eIc (SpecifYI 14. Marital $talUS: Married, Never Married, Widowed, Divorced I SpecifYI divorced Twp white 11C.O Yes, Decedent lived in 17d. CiiI No, Decedent Livod with. Actual limits 01 Wormleysburg City f Boro 18 Falher's Namt (First midde, last, suffix) (unknown) Skalak 208. Inlonnanrs Name (Type I Print) Charlotte S. Good 19. Mother's Name (Ars!. mldcle, maiden surname) Ann~ Theresa (unknown) 2Ob. Inlormant's Ma~ng MdrBss (SlrMl, cily llown, stale, zip code) 219 North Second Street, 21c. Place 01 Disposition (Name 01 cemetery. crematory or other place) PA'17043 Evans Crematory Schaefferstown, PA 17088 FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Approximate interval: Pal1l1: Enter olher siCl'lificant cmditions conttb.dioo 10 dealh 28 Old Tobacro Use Contrbute 10 Death? Onset 10 Death but no! resulting in the undertyng cause given il Part I. 0 Yes 0 Probably DNa DUo'"""" 29. II Female: o Nol Jlfegnanl wiltln pasl year o Pregnanl allim& 01 death o Nol pregnant. bU: pregnanl within 42 days 01 death o Not pregnanl, but preg'lClnl 43 days 10 1 yea' beloredeath o Unknown il pregnanl within !he past year 32c. Place 01 Injury: Home, Farm, Street, Fac101'J. Ho~Bu...,g,eIC. ISpecilyI 32g. location 01 injl6y (Street, city I town, slale) 24. Time of Death 25. DaM Pronouoc.ed Dead (Month, day, year) 09:12 PM February 12, 2008 CAUSE OF DEATH (See Inatructlonl .00 ex.mplel) hem'l1. Pan I: Enter!he ~ - diseases. il1uries. or complications - that directly caused lhe dealh. 00 NOT enter terminal 9Y8nls such as carclac arrest respiratory arresl. or Vfll'IlrictW lbrilalion Mtholi $00Mng the etiology. Us! only one cause on each 11le. ~~Jt~:~~~~ .. Traumatic Brain Injury Due to (Of B6 a consequence 01)' b. Fall Due 10 (or as a consequence of): S~ialylistcondil:ions,~any, ~1~1: :OC:~I~~Z'J: i. =:J~~I~~1he Due 10 (or as a consequence ot). d. Y)a. Wu an Autopsy Pt<1olmed? D. Were ~ FilKings AvalatH Prior 10 Completion of Cause ot Dealh? 31. Manner of Death o Na",a! 0 Homidde I2Q A<tide<ll 0 Pend'.O tnv.stigalion o Slidde 0 Could Nol be De18rm_ 11:30 AM. o Yes IZI No o Yes 0 Na 32d. TIme of 1I1t.y 33a. Certifier (check on'Y one) Certifying physic*, (Physician cenilying cause ot d&a1t1 when another physician has pronounced death and cornpIeIe6 Uem 23) To lhe besl of my knowledge, dHlh occurred dutto lhI Cluse(I)lnd II18I"I'* lI.tlled......... _... _ _... _......... _...... _ _............................ __......... 0 ~~=n:, '= ~J.-:=~~ ~:;.~~~e:,~ anC:~olO::~~~~~ mlMlr a. lilted-.. ................ ............. _.. _.. 0 ::'''~~~= and I 01' Inv..tlgallon,ln my oplnAon, death occurred at the lime, dale, and pllce, and dUl to I'" cauH(l) and ,...nner u silled- ~ 23b. LIcense ~ber 23C. Dale Signed (Month, day, year) 26. Was Case Referred to Medical Examiner I Corooef for a Reason Olher than Cremation or Donation? IZIYes ONo 17011 1;2-1/1~1/1/1 34. Name and Adlhss 01 P8f'SOI1 'Nho ~leled Cause of Oealh (Item 27) Type I Prinl Lisa A. Potteiger 1271 South 281h Street Harrisbur PA 17111 DIsposition Permit No. OATH OF NON-SUBSCRIBING WITNESSES Register of Wills Dauphin County, Pennsylvania Estate of CHARLOTTE SMITH , Deceased RENEE M. MILLER and DONNA L. ETNOYER each being duly qualified according to law, deposes and says that they were well-acquainted with CHARLOTTE SMITH and are familiar with the handwriting and signature of the decedent, and that the signature of CHARLOTTE SMITH, to the foregoing instrument purporting to the Last Will and Testament of CHARLOTTE SMITH is in her own proper handwritin ~~'0A- en" M Mill" 2124 Derry Street Harrisburg, PA 17104 t/ll(~, /!~ Executed in the Register's Office '.,~ .';,&, I l ;;J ~. i Sworn to or affirmed and subscribed Before me this J.l-f It day of "; I J:;.,;., ~~- ,2008 (fl N II D.M.~'''<, C~ 1t'~ c Deputy for Regis,~er of Will ~ LAST WILL AND TESTAMENT OF CHARLOTTE SMITH BE IT REMEMBERED, that I, CHARLOTTE SMITH10f the Township of East Penns Boro, County of Cumberland, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments, Codicils or Writings in the nature thereof by me at any time heretofore made: 1. I direct that my Executrix, hereinafter named, shall pay my funeral expenses as shortly after my death as may be convenient. 2. All the rest, residue and remainder of my property and estate, of whatsoever nature and kind, whether real, personal or mixed, and wheresoever the same may be situate, of which I shall die seized or possessed or of which I shall be entitled to dispose at the time of my death, I give, devise and bequeath unto my daughter Charlotte M. Ackert, absolutely. 3. I do hereby nominate, constitute and appoint the said Charlotte M. Ackert to be the Executrix of this, my Last Will and Testament and direct that, any statute, Rule of Court or Decision of Court to the contrary not~tth- ,'" '. - standing, she shall not be required to post bond in any jurisdictlbh]in whtch it may be necessary that she act. ~o I,)! r~ -1- ; 1'"\ my Last Will and Testament this IN WITNESS WHEREOF, I have hereunto set my hand and seal to this Z!T4 day of September, 1971. A&/.J~ \~~ CHARLOTTE SMITH (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in the presence of each other, have hereunto set our hands and seals as subscribing witnesses. (SEAL) (SEAL) -2-