HomeMy WebLinkAbout03-26-08
PETITION FORPROBATf= AND GRANT O:F LETTERS
REGISTER OF WILLS OF ~"'2'&ep-/an dJ
COUNT\:', PENNSYL V AN L\
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File Nurnber
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Peiiti\)\1t;r(c;\
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lji,-H r--t{.l(lO/lei\;))IS ;1fe [fie
and codicil(s) dated,~.
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last 'vVili of tht' Dcco::dent dated
(State relevaNt circumstances, e.g. rel1l..1ticialion, dealh of exeCUfOl', ele)
Except as folJ()\.\'s.. Decedent did not illarry, was n(Jt divorced, and did not have a chdd born or adopted afLet' i,:'::xecutli:H\ Qt' tbe ~n5irUn)ent\s) oiTered
for nrohatt 1.\ h Ihi! thl::" Vlclln, pf a kIilin2 and wdS ne\er adPHiloHeo an ml....al,'),lcliared rll':or"orr
n n I' "';n' r;f!._.d~,;_\{S ~_'.f .~dnl~ilL,trJt1'1n
(/fappiicable, enter: C.L..'?; db.!tc.ra,; pendente lite; durante absentia.; durante IninOf'/!afe)
h.:;Uli(ifi(i\~;j ~lllfA a P((OI\lC( st;\-li"..:il lld;;) f iU-ive a~(i:t(dlntl). tl.tAi D,~(.1;.:d~ih }"-;1\ W) ",;'\'.'iii ~Hld \Vd;:' ,')uf"i.'1Yt':d by tOt;: it);;Oi,VlIlg
Adlliiliulrlilioil c.1,a, or d.b,1!. c:.ra., emer dale of Will in Sectio/l A above and complete lis! 0'f heirs)
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(COMPLETE EN ,4LL CASES:) Attach IUlifitiollal sheets if!lecessary.
i~:ceden[ was dOrTuciied at neath In (~mjC:LL/...hL_ COllnt~ennsy!vanla ",{lth his I her last pnnclpal reSHlence at_.ti~_.____._
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Decedent, then_ll-,. years of age, died on J/iP,()a4-at jft/y .5j;"e,7 Jft5/'/l:,(, c:~ //1('/2
Decedent ,11 death ..wned propertv with es!ilT1~ted values 3.<; fl'!1nw<'
(l f don'iiciled in P A)
An P(Ts(JoaI prupcrt),:
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(If not domicrled Il1 P A)
Personal property in Pennsylvania
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(lfnot doniicilcd in PA)
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Value of recll estate in Pennsylvania
situated as follol,.vs:
\\!:;\,.~;,::(jj"<';, PdiLUnGr(6) rr:,Sl)(ctt\i::y ;'(:q\l-.:st(:..:;)
the undersigiieJ:
p\\)bate utH\c: last \\/;n ~lHd CfJdl(:il(s) plc~tnkd wi1h Ihis Pditio(t d(IJ the gIant tJfL.::ikiS jj-r lhf~ Jppropi'lrJ.u; fCf'Ii"'
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Typed or pr\med name :Jnd n:sidenc,~ ----1
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Page of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect 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 according to law.
SVv'orn to or affirmed and subscribed
?
"
before me the
~((] day of
__ dWfS
//)
t//
Signature of Personal Representative
Signature of Personal Representative
r'_~
C~'\
Signature of Personal Representative
C-'-
File Number:
~, ~~ trY-\\o
J-fe!en III lthi11S
Jq&J I gCl! 73
J.Lo , aI%
Date of Death:
, Deceased
~ ~)q/af
Estate of
Social Security Number:
AND NOW,
IVtpch
the foregoing Petition, satisfactory proof
having been presented before~, IT IS DEC~ that Letters
are hereby granted to \.) IASCJJ{ 11 1\ I
7
in the above estate
and that the instrument(s) dated f) TUJ {17
.
described in the Petition be admitted to probate and filed ofrecor
'~j?
FEES
U?33S'
Letters .... ./Y. . . . . . . . $
Short Certificate(s) . .~. . . . . $
Renunciation(s) .......... $
fJ,)!I! $
\CP $
~-/-u $
$
.. . $
$
$
$
$
TOTAL .............. $
qo
jltJ
Attorney Signature:
IS-
10
~
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
f3lJJ
Form RW.()2 rev. 10.13.06
Page 2 0[2
H105,Rn:1 kEV (011071
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Certification Number
This is to certify that the information here given i~
correctly copied from an original Certificate of Deatl
duly filed with me as Local Registrar. The origina
certificate will be forwarded to the State Vita
Records Office for permanent filing.
Fee for this certificate, $6.00
P 14123449
r:
.7~'l, ./?J ~~~ ~AR 1 :Y2008/
Local Registrar' Date Issued
(, -~:)
r'-.J
en
.."~
('-
REV 1112006
PRINT IN
4ANENT
:K INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
10. Race: American Indian, Black, While, ete
(Speci'l'l W I
11/ re
Twp
City/Bora
=}i~~~~~~)di1e=..
" ., ~ '
C~\1 f4 cI r1C'
Due 10 (or as a consequence 00:
~i.Q.l.tCf
Approximate inteNaJ: Part II: Enter other !lionificant conditions conlributino to death 28. Did Tobacco Use Contribute 10 Death?
Onset to Death but nol resulting in the underlying cause given in Part I 0 Yes 0 Probably
o No 0 Unknown
29. If Female:
o No\ pregMl'lt within pasl year
o Pregnant at time of death
o Not prepn!, but pregnanl within 42 days
01 death
o No1 pregnant, but pregnant 43 days 10 1 year
before death
o Unknovm \\ pregnant within the past year
32c. ~~~~ ~~> Slree!. Factory,
Due to {or as a consequence 00:
lr #..
j1flf NV1 W>
A L" 0 / {-trN
Sequentially lisl conditions, ~ any,
~~~o~ca:e~ed~~ a.
(disease Of injury that initialed the
events resulting '" death) LAST.
b.
c.
Due to (01" as a cooseque.nce 1)f):
d.
Idl/l~1/1"
32d. Time of Injury
32g. location of Injury (Street. ctty I town. state\
DYes ~NO
DYes oNo
31. MaMor of Death
"g{Na""'1 0 _de
o _ 0 Pendng Investigation
o Suidde 0 COll~ No< be Detenninet!
M.
308. Was an Aulopsy
Pe<fooned"?
n. Were Aulopsy Flntings
Available POOr to Completion
of Cause of Death?
338. Certifier (check only one)
Certifying phy~lcian (Physician certifying cause of death when another phYSiCian has pronounced death and completed Item 23) 'rA
To the best of my knowledge, death oceurred due to the cause(s) and manner as !llIted........ _............ _................. -........ -..............~
~::u~m:,a: ~=~:=~~ ~l::::;::~~a:rt~~~~::~~~a: manner as stated.. _ .. _.. _.. _.... .... .... _ _.... 0
~::~:~m~;:~~:t: and f or investigation, In m'J OI'inioo., death oecurred at the time, data, and p~, and due to the cause(s} and manner a5 stated_ 0
r,(0.' .,.
( I!)
35. RegiStrarJ S'
~ t
UzIJ
CI
DispositiOn Permil No.
eX \ O?5 <b~lp
LAST WILL AND TESTAMENT
OF
HELEN M. ADAMS
c
i'.....,)
~-,. -,
I, Helen M. Adams, of Mechanicsburg, Cumberland County, Pennsy_~ania~~_'
being of sound and disposing mind, memory and understanding, do hereby':;;
make publish and declare this to be my Last Will and Testament and I
hereby revoke any and all wills and codicils previously made by me at any
time heretofore.
~.
FIRST: I hereby direct that my personal representative, hereinafter
named, to pay all of my just debts not barred by any statute of limitations, as
well as my funeral and testamentary expenses, including Pennsylvania
Inheritance taxes, as soon as my demise as may be practicable.
SECOND: All the rest, residue and remainder of my estate I hereby
give, devise and bequeath to my husband, Wilbur L. Adams, II, should he
survive me. In the event he predeceases me, or we die in a simultaneous
accident, I hereby give, devise and bequeath all the rest, residue and
remainder of my estate equally among my three children, Susan E. Weary,
Richard L. Adams and Wilbur L. Adams, III, equally and per capita. In the
event anyone of my children should predecease me and my husband, I
direct that his/her one-third share be divided equally between his/her
siblings.
THIRD: I hereby nominate, constitute and appoint my husband,
Wilbur L. Adams, II, as executor of my estate. In the event my husband
predeceases me, refuses to serve, or is incapable of serving, I hereby
nominate constitute and appoint my daughter, Susan E. Weary, to serve as
executrix of my estate. In the event Susan E. Weary predeceases me, refuses
to serve, or is incapable of serving, I hereby nominate constitute and appoint
my son, Wilbur L. Adams, III, to serve as executor of my estate. Said
persons shall not be required to post bond or surety in this or any other
jurisdiction to discharge the responsibility of acting as my personal
representative.
IN WITNESS WHEREOF, I hereby set my hand and seal on this
document which I declare to be my LAST WILL AND TESTAMENT,
consisting of this and one other typewritten page. The first page has my
signature along the side of the page to prevent fraud by replacement.
")? ~ /2 ~1-/\ G Q ~
Helen M. Adams, (Testatrix)
BE IT KNOWN that at the request of the testatrix, we the undersigned
witnesses, in the presence of the Testatrix and each other, have witnessed
her signing this document that she has declared to be her LAST WILL AND
TESTAMENT consisting of this and one other typewritten page, to which
she has also affixed her signature along the side of that first page.
-'} ,')/. -.- "Q?- 'J ~
/(f),:;t:t2/ C; . ,5;--; {cJl)~l. t:=
Printed name of witness
residing at ''132 S77hlS S. LCMD'INe- f?J. lA:.lti
/ilf cf ~/L
(Si~ature ofwitn 's)
reSiding~7;;Jrt,f61 o/~t
We, Ro},el::} E:' (~rC'}1.k/e ,and R~ 5 5e / /1/ ..<..kker7...7
being duly sworn, do here y declare to the ~ndersigned authority that we
witnessed the testatrix, Helen M. Adams, sign and execute this document
which she declared to be her LAST WILL AND TESTAMENT, and that she
did so willingly and voluntarily . We are both competent adults and in sound
mind.
I, Helen M. Adams, as testatrix, being duly sworn, do hereby declare
to the undersigned authority, that I willingly and voluntarily signed and
executed this document which I declare to be my LAST WILL AND
TESTAMENT in the presence of the above named witnesses.
I declare that I am a competent adult and under no duress, undue
influence or coercion in executing this document.
COMMONWEALTH OF PENNSYLVANIA}
COUNTY OF \)A-0~~\Y\ }
On this, the \ J.\~ of J'~('\r('\--J.O.Q5, before me, a Notary Public, the
undersigned officer, personally appeared \--\ ~ \e,^ ~c\aVY\.<; ,
known to me or satisfactorily proven to be the person whose name is signed
on this Last Will and Testament, and who acknowledged that he/she
executed the same for the purposes therein expressed.
In witness whereof, I hereunto set my han
My commission expires: \ a.-/ 9 f OJ ~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
April Fraker, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires Dec. 9, 2008
Member, Pennsylvania Association of Notaries