HomeMy WebLinkAbout04-04-08Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Geraldine F. McCormick
also known as
Deceased
No.
X21- ~K)~ - 03~~
Social Security No.178-16-5264
Sandra Lee Clemm and Marcia Ann McCormick
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 and aver that Petitioner(s) is/are the execut rlx named in the Last Will of the
Decedent, dated 7/31!1967 and codicil(s) dated
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 documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente life, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship
Residenm~e
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. f° w ~ ' . ~
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at Messiah Village, 222 Messiah Circle, Mechanicsburg, PA
(list street, number and municipality)
Decedent, then 86 years of age, died March 8 , 2008 , at Holy Spirit Hospital
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $ 9,000.00
(if not domiciled in PA)
(If not domiciled in PA)
Personal property in Pennsylvania ....................
Personal property in County ..............................
Value of real estate in Pennsylvania ........................................................................................
Total ..................................................................................................................... $ 9,000.00
Real Estate 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 undersigned:
Signature Typed or printed name and residence
S ~-~(,~ ~ Sandra Lee Clemm
141 N. 15th Street Cam Hill PA 17011
-~~ Marcia Ann McCormick
3422 Brisban Street Harrisburg, PA 17111
RW-7
Oath of Personal Representative {~
Commonwealth of Pennsylvania F,,, , _ ~, J y _':
COUnty Of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the forega~ ~~t~isi~ar~~.t~~ ~3
and correct 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. ~ ~ ^ ._- _ . ~~~Fj}{ G~
Sworn to and affirmed and subscribed ~~~ ~~~"'""'""' QR~~~';ts~i`,,; ~'~I, !~T
before rub this ~% `~ ~~ day of ~ _
~~~ ~n C..a~~i~U;~ ~-(2~ _ ~e2~--f/ ~ ~~,Z mac`,`..
DECREE OF REGISTER
Estate of Geraldine F. McCormick Deceased
also known as
No. ~~ ' ~GC~~ - G3~
Social Security No: 1.78-16-526, 4I Date of Death: 3/8/2008
AND NOW, ~~ `t r ~-~'~~ ~C~ , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~] Testamentary ^ of Administration
(c.t.a., d.b.n.c.t.; pendente liter durante absentia; durance minoritate)
are hereby granted to Sandra Lee Clemm and Marcia Ann McCormick
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
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Letters .................................... $
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Short Certificate(s) $
Ren Ion .................~:C%r.[~ $ ~~ ~X.J
Extr-a-Pages ( ) .............. $
Codicil-:- :.:.......................... $
JCP Fee ................................. $ ~ ~ - GO
Irtve~erq-i~fiax Forms.....~~:~$ ~«~
Other ......, ............................... $
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TOTAL .............................$
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Register o I t~~ /~~-
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Attorney
Attorney: Susan H. Confair
I.D. No: 70241
Address: 2331 Market Street
Camp Hill PA 17011
Telephone: (717) 763-1383
DATE FILED:
RW-7A
~ ~ ~ ~~~
OATH OF NON-SUBSCRIBING WITNESS(ES)
Cumberland
Estate of Geraldine F. McCormick
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Sandra L. Clemm and Marcia Ann McCormick
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they
acquainted with Geraldine F. McCormick
Deceased
was /were well-
and am/are familiar
with the handwriting and signature of the decedent, and that the signature of Geraldine F. McCormick
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
Geraldine F. McCormick is in his/her own proper handwriting.
(Signature) (Si ature)
141 North 15th Street
(Street Address)
Camp Hill, PA 17011
(Ci[y, state, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
1/~/~~ da
before me this 7" y
of ~ ~~~~
Deputy f r ste of ill
~'
Form RW-04 rev. 10.13.06
3422 Brisban Street
(Street Address)
Harrisburg, PA 17111
(Crty, State, Zip)
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ fee li>r this certificate, X6.00
P 1412~40(~
Certification Number
REV 1112006
PRINT IN
AANENT
CK INK
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 tiling.
,;~~ yrz.. ~ ~ ~ . MAI~ 1 27008
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
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RTATF FII F NI IMRFR
1. Name of Decedent (First, middle, laze, suffix) 2. Sex 3. Social Secunry Number 4. Date of Deatn (Monlp, day, year)
Geraldine F. McCormick emale 178 -16 -5264 !L•
Pie<~ f , y ~c>'3
5. Age (Last einhtlay) Under 1 year Untler t tlay 6. Date of Binh (Month, day, year) 7. Birthplace (City and stale a for eign country) 6a. Place of Death (Check only one)
86 Momre oam Mars MBWn
Mar. 12
1921
Selinsgrove,PA Hospital: Other:
Yre , ^ Inpatient ~ER / Ourpatienl ^ DOA ^ Nursing Home ^ Residence ^Other ~ Spedry~
8b. Counry of Death ac. City, Boro, Twp. of Death 6d. Facility Name Qf not in5111ution, give street and number) 9. Was Decedent of Hispanic Origin? No ^ Yes 10. Race:Ameriran Intlian, Black, White, etc.
Cumberland East Pennsboro / hf yes, speciry Cuban, (S p
No ( ` ~~ ~ ~ ~/_1, j / r / MBxican. Puano Rican, Blc) w Cl~ It e
11. Decedent's Usual Occu tbn Kind of work done dur' moll of wo ' Nfe. De not state retired 12. Was Decade 1 ever in th 13. Decedent's Educelbn (Speciry only highest grade compleletl) 14. Marital Status: Marred, Never Mametl, 15. Surviving Spouse Uf wife, give maiden name)
Kind of Work Klnd of Business /Industry U.S. Armed Farces? Elementary /Secondary (0-12) College (1 d or 5+) Wdowed, Divorced (Speciry9
' own home ^res ~olp 12 widowed
16. Decedent's Mailkg Address (Sgreel, dry /town, stale. zip code) Decedent's Did Decedent
slate Pennsylvania uve in a , 7p
Actual Residence ,7a
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d m Upper A 11 e n
DecedBm Lw
2 2 2 Messiah Circle
PA 17055
Mechanicsbur .
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Twp
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Township?
DeLedeSt
lUvedw;mm
nb.Counry Cumberland A7d.^ ~~
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clq Boro
16. Father's Name (First, middle, last, sugix)
Miles Kemberling 19. Mother's Name (First, middle, maiden surname)
Maude Moyer
20a. Inlormam's Name (Type / Pnnq Sandra C 1 e mm 20b. IntomunYs Mailing Address (Street clry /town, state, zip code)
141 N. 15th St., Camp Hi 11, PA 17011
21 a nod a Disposition ^ Crernatbn ^ paralgn 21 b. Date of Disposition (Month, day, year) 21c. Pace of D'sposPoOn (Name of cemetery, crematory a aher pace) 21tl. Location (City /town, state, zip code)
anal ^ Removal Irom State;' Was Cremetlon a Donation Authorized Mar . 13 , 2 0 0 8 R o 11 i n g Green Cemetery Camp H i 11 , P A 17 O 1 1
her ~ S i by Medical Examiner /Coroner? ^ Yes ^ No
-nature of Fu ' e Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Fadldy
FD-013163-L Musselman FH &CS,324 Hummel Ave.,Lemoyne,PA 17043
to Items 2 ~ only when cerhrying 23a. To the best of my knowledge, death scarred at ttre Hme, date and place stated. (SignaNre aM title) 23b. Lcense NaMer 23c. Date Signed (Month, day, year)
physican is not available al tulle 01 death 10
ceniry cause d death.
Items 24-26 must oe completed by parson 24. Tme of Death ~/ 26. Date Pronounced Deed (Monet, day, year)
~ 26. Was Case RBlerred to Medical Examiner /Coroner for a Reason Other roan Cremation or Donation?
rota pronounces death. G7 , I T ~ M~ ,1 /1/v s/
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CAUSE OF DEATH (See Instructions and examples)
r Approximate interval: Pan II: Enter other siani0cant corbitans conlnbutina la death, 26, Ditl Tobago Use Contnbule to Death?
Item 27. Part I. Enter the chain of events - eseases, injures, or canplkatkxxs -that erectly causetl the tlealh. DO NOT enter terminal events such as cardiac arrest I Onset to Death but not resulting in the underlying cause given in Pan L ^ Yes ^ Probably
respiratory arest w ventricular fbnllation without showing the etiology. List only one cause on each line.
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^ No Unknown
,
IMMEDIATE CAUSE (Final tlisease a i
mrlelkn razuPong m death) _~ a. ~ . G G / ~~~ `F••~'°~ z • ~ / ~~ /~/ ~~~+ -`^J ~ r Ci/-z ~~ 29. If Female:
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.. Due Io (or as a conseque oQ: ~
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~ 1 prBgmanl within past year
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SequenliaNy liar condriaxs, it any, b.
lee6r
to the cause Nsletl on line a
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//'' (.~ LJ Pregnant al lime of death
g
. Due to or as a con f)
Enter the UNDEREYING CAUSE ( sequence o I
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~ ^ Na pregnant, but pregnant within 12 days
f d
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sease or
njury t
atetl t
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evenLS rewlting In death) UST, t / 7~~ ~"uti /
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eat
Due to (or as a consequence OQ: ^ Not pregnant but pregnant 43 days to 1 year
d belae deem
^ Unknown it pregnant wimin the past year
30a. Was an Autopsy 30b, Ware Autopsy Fmtlilgs 31 Manrxx of Deam 32a. Dale of Inlury (Month, day, year) 326. Desenbe How Injury lkcurted 32c. Place of Injury: Home, Farm, Street. Factory,
Peromled? Available Pnor to Com0letion ~
aNral ^ Homkide Otlke Building, etc. (Specty)
of Cause of Daem?
^ Ves ~ No ^Ves ^ No ^ Acatlenl ^ Pending Investlgalion 32tl. Time of Injury 32e. Injury at Work? 321. II Transportation Injury (Specity) 32g. Locelion of Injury (Street, city I town, slate)
^ Suicide ^ Could Nol he Delertnined ^ Yes ^ No ^ Dover / OpBreta ^ Passenger ^Petlestnan
M ^Other - Speaty:
33a. Cenilier (check only one)
• Cenirying physlcWn (Physkien cenirying cause of death when amther physician has prorwuncetl deem arM completed Item 23) 33b. S tore and Ttle of ' rat,
~ ''77
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To the beet of my krawledge, death occurred due to the cause(s) and manner ea eteted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^, ~
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• Pronouncing ere ceneying physlden (Physidan troth pronouncing tleam and cenirying to rouse of death)
To the lost of my krlowkdge, death occurred at the Ilme, date, and place, and due to the cause(s) one manner as statee_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~^. . Lcense Number 33tl. Date Sigrrel (Month, tlay, year)
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• Meelcal Examiner/Coroner ~~
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On the baste of exeminaeen end I or Investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) one manner es stated_ ^
34 Nam~//4 and Adtlress of P Who Compkl se of pp~~a~~ (Item 27) Type / Pnnl
35. Registrar's a aM Distn ~~
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~ ~G~m 38. Date Filed (Monet, day, year)
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Disposition Permit No. O ~ F
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~.,_~-~~ LAST WILL AND TESTAMENT
C} L.:~,:. OF
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u - GERALDINE F. McCORMICK
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~ ~, GERALDINE F. McCORMICK, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament,
hereby revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses from my estate as soon as may be convenient
after my death.
II - All the rest, residue and remainder of my estate
of whatever nature and wheresoever situate, I devise and bequeath
unto my husband, Robert F. McCormick, Jr., providing he survives
me by thirty (30) days.
III - Should my said husband fail to be living on the
thirty-first (31st) day following my death, then I devise and
bequeath all the rest, residue and remainder of my estate of
whatever nature and wheresoever situate unto my issue living on
the thirty-first (31st) day following my death per stirpes.
IV - I appoint my daughter, Sandra Lee Clemm, guardian
ARNOLD & SLIKE
ATTORNEYS AT LAW
2109 NARKET STREET
CAMP HILL, PENNSYLVANIA
of any property which passes either under this will or otherwise
to a minor and with respect to which I am authorized to appoint
a guardian and have not otherwise specifically done so. It is
my intention to appoint my said guardian, Sandra Lee Clemm, as
guardian in all of the instances listed in Section 18 (b) of the
Wills Act of 1947, as amended, as well as in other instances
where I am authorized by law or permitted to do so. Such guard-
ian shall have the power to use principal as well as income from
time to time for the minor's education, support and welfare
without further responsibility to the minor or minors or to any
person taking care of the minor or minors. It is my intention
~~~i _~~, ~ ~r~r,-~~ Page 1
that the foregoing powers may be exercised by the guardian with-
' out further court approval. The said guardianship shall termi-
nate as to each beneficiary when he or she reaches the age of 21
'years, at which time his or her share of the principal and any
accumulated income shall be distributed to him or her absolutely.
The interest of the beneficiary or beneficiaries hereunder shall
not be subject to anticipation or to voluntary or involuntary
alienation. Should my said daughter fail to qualify or cease to
act, I appoint Dauphin Deposit Trust Company of Harrisburg,
Dauphin County, Pennsylvania, substitute guardian of the estate
of any minor beneficiary.
V - All taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed
shall be considered a part of the expense of the administration
of my estate, and my personal representative or representatives
shall have the absolute power in his or her discretion to pay the
same at once whether or not the law under which they are imposed
permits the postponement of all or part of them to a later time.
VI - I nominate, constitute and appoint my husband,
ARNOLp ~ SLIKE
ATTORNEYS AT LAW
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA
Robert F. McCormick, Jr., Executor of this, my Last Will and
Testament. Should my said husband fail to qualify or cease to
act as such, then I appoint my daughters, Sandra Lee Clemm and
Marcia Ann McCormick, Coexecutrices of this, my Last Will and
Testament. Should both of my said daughters fail to qualify or
cease to act as such, then I appoint the said Dauphin Deposit
Trust Company, Executor of this, my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
on this, the day of ~l>~,~ 1967.
/;'! ~.r,..~. -~'~ ~?~ ~ ~ ~y ( SEAL )
Ger Aldine F. McCormick
Page 2
Signed, sealed, published and declared by GERALDINE F. McCORMICK,
Testatrix therein named, on this and two (2) other sheets of
i
~ paper as and for her Last Will and Testament in our presence,
who, in her presence, at her request and in the presence of each
other, have hereunto subscribed our names as attesting witnesses.
~ ~~ ~ ~
Name Add ss
r. .
Name Ad ress
ARNOLD 3 SLIKE
ATTORNEYS AT LAW Page 3
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA