HomeMy WebLinkAbout05-14-08
PETITION FOR PROBATE AND G
NT OF LETTERS
REGISTER OF WILLS OF
_ ~ka./( ___! .._
A/k
COlTNTY, PENNSYL V A:\[A
EstJt~ 1Jt"
s: 17 ~oI
File Number
~ \ 0<6 ():)3~
, Deceased
Social Security Number /(3;2/ 2;;2 , ~BI
also know n a,
Petitioner(s). \\ 1\0 is!:\rI~ I ~ years of age or older, apply(ies) for:
(COMPLETE '.-1' or '8' BEl. 0 IV:)
~. Probak ;llld Clant of Letters T sta
last \'':ill ,)t"lhe Dcc,d~llt dated /:& ~O
ntary and aver that Petitioner(s) is / are the
q and codicil(s) dated ';If-
~SP4tf ( relrese~-J,TfIC? named in the
I /
(State relevant circulIlstances, e.g.. renunciation. death of executor. etc)
Except as follows, Decedent did not marry, was not divorced, and did not ha./e a child born or adopted after execution of the instnlDlent(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
(lfapplicable, e/lter: c.t.a.. d.b.lI-c.t.a.; pe/ldente lite; dura/lte absenlw: dura/lle mi/loriiale)
() ~
Petitioner(s) after a pl'Oper search has / have ascertained that Decedent left no Will and was survived by the followin~~e (if any)~ heirs:
Admitlistration. c.t.a. or d.bll.c.l.a. ellter date of Will in Section A above and complete list of heirs.) -,~] 2g :lit
i., :l:J,.
Name
Relationshi)
-
..
.- -. ;""
(CO,"IPLETE IN ALL CASES:) Attach additional sheets if/lecessary.
Decede.pt was do . iled ~~death in i/nt)erklt-;! County, Pennsylvani' with his / he~ prij1cipal residence a';"
/O~> erSl~cPh Yo 'Ie" p/i 2-- J/1C:-f</4S0"l UJ.
(U" ,,,.,,, ,,"',"'. ", 8;;,"'1>;'. """". "",. ,j, ''''''jl?>f 2<<)8 ~ r!, sle
Decedent, then years of age, died on 7/ at Cc..
R:J tD~~/
!ferlrdtt / (ft/~r
Decedent at death owned property with estimated v3illCS as follnws:
(lfdomiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
/2fJ, 600 ~
/
$
$
$
$
situated 3S follows:
Wherefore, Petitioner(s) re$pectfully reque$t(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form (<1
the undersigned:
Forlll RW.02 rev 10 1306
Pagelof2
Oath of Personal Representative
COMMONWEAI,1f! Ur PE0il'iSYLVANIA
SS
COU0iTY OF
The Pdi:,I';I\CP,J "h"\"'<!_~::lcd ;;''.,':11(;;) c1r a'fiul1(S) ,hat the statements in the foregoing Petition are tllJe and COlTect to the best of
I iJ,: k .1-.1;', kd~:c Jl!d bel Ie f () f F'clitioncr( 3; :lmI th~lt, as personal representative(s) 0 f the Decedent, Petitioner(s) will well and truly
administer the estate according to law,
Sworn to or affIrmed and subscribed
J(j
0~v-0
SigUt/turf:: 0/ Persond Representative
o
So
'- .-U
]--0
T~~
; ~:; ~::
) CJ(j
O-Ti
C
:0
~-l
'"
<::::;)
<::::)
<=
...J!j;;
:x:-
-<
,~~
...,. -'-;
+-)
, )
::;Li
i,', =:1
~{; (-9
(-J
,,')
,')
,_C)
nl
.
S,gllolllre oj Pasoll"{ RepreSe/1lalive
-0
::::J:
: .)
File Number: ~ \ ()~ ~ lQ"b0;>
Estate of ( ka /I A OClI1J;r1
I~. 22. 12/'lQq.
Social Security Number: I V C?JV L
en
i'-j
in the above estate
record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ... .l;).Q,.C>QQ. '
, S-
Short Certlficate(s) . . . . . . , .
Renult:);itS)
.Je-P
~fo
Supreme Court T.D, No.:
c1wD
.;<0
AttOll1ey Signature:
$
:5
:5
$ IS-
$~---
$~--
$
.$
:5
$
$
$
$ GIOot
Attomey Name:
Address:
Telephone:
1i j'$'l [! / )
TOTAL.
e"._... aUf n' "0\1 In } ~ n(i
Page 2 0[2
H105.805 REV (01107)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14528414
Ul
Q)
'M
0.
o
tl
l!')
~~
~
;t
Certification Number
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.
~. ~~~ MAY 1/2D08
Local Registrar ~~ Date Issued
Q
~;;O
,. ::0
.2-0
'TO
. :)>r-
..~~~~
_ >--~ C)
"; \.--' fl
.~)\=
::0
-o-f
);>
,....",
c:::>
c:::>
t:::X:)
::Jt
::t1oo
-<
.::-
-0
:::JC:
-
..
U1
( ~')
"i'Of
H105-143R€V1112006
TYPE I PRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
d-. \ () ~ tf:i~ 3
6. Date of BIr1h (Momh. day, year)
7._1
~l.f
October 10, /q2. 3
Bb. County of Death
C'tLVV'\n~y I a.. ..-. d
11. Dec9dent's Usual lion Kind 01 WOI'k dorle d' most 01 worki life. Do not slate retired
'~rui~.W...... Kind~_I'_
D1SaS~ec-~o-Ord. Amerie~8s~ed
. 16. Decedeofs MaiWlgAddre&s (Street, city I town, state, zip code)
lOCoS M~ersThlN'" R.:l
GO'....cl ne r- C\. 11 ?>2.
18.Father'sNarne(FtrSl,middle,IasI,suffO:)
Gwyn
208. Intormanl's Name (Type J Print)
Michelle
AI.
12. Was Decedent eVer In the
U.S. Armed Forcos?
Dy., KlNo
:e:;~ 17a.Slale Pr-r\V"-S'4/VllV\';t"l
170. County CU-"Y\ ber\ a. "'C\
4. Dale 01 Death (Month, day, year)
Apn \ 30,2.008
Olher.
DOthef. Specify,
10. Race: American Indian, Black, White,ele
ISpecifYI
White
14. Marilal $tatus: Married, Never Married,
Widowed, DiIIOl'Ced (Spec/f).1
Divorced
Did Decedent
Uve~a 17c.EXv..,_Uved~ DickinRon Twp_
Township? 17d. 0 No, Decedent Lived within
AclualUmilsof
~
City/Born
M.
Witherow
19. Mothers Name (First. middle, maiden surname)
Bett Armenta
2Ob. Inlormanfs MlHlng AddI'tSS (Street, city I tu.vn, stale, zip COCIe)
1065 M erstown Road
21c. Place 01 Disposition (Name of cemet9IY, crematory or other place)
s.
Davis
white
Gardners, Pa. 17324
21d. L.ocatlon (City I town, stale, zip code)
Shoops Cemetery Harrisburg, Pa. 17109
Inc.50~t~'H~!t~i~Bf~n~~;.pa. 1706
'-'4-26mustbecompleledbypeBOll
who pronounces cl8a1h.
24. Time of Death
I Approxinate interval:
: Onset 10 Death
,
,
i :2Jtr.~
,
,
1
,
,
,
,
,
.
:::i.,.~~,~
C ilV.::;:;::",f-,'Ve. h~,^...1- -P",-:[u.~
Due to (OI'asa 00: .
S<"vcyp i"Ue",.'<. c:~J"c~y"P4-{-t.v
Due 10 (or as a consequence of): I I
~8s(~~~a
= UNDERLYING CAUSE
~re:.,~m~~~
b.
Due to (or as a consequence 00;
3Oa.WasanA~
-
d.
OOb......AuIopsyF_
Available Prior to CompletIon
of Cause of Death?
Dy" ~
3211 TmeotlrVury
31. Manner ~
[31<IiW", 0 H_
0- DPeodlng__
o """"" 0 Cou~ Not be De!em;nod
Dyes
M.
~
z
w
c
w
"
w
c
i5
!
33a. Certifie< 1d1eck only one)
Certffy(ng phyticflll (Physician ce~ cause of dealh **' anolherphysiciBn has pm1IOtIIC8d death IIIld compI9fsd Jlem 23)
Tothe bett of my knowIedge,deIth occurred due to Ihe ClUM(I) and IfIII'lI*lIs1Ited.._ _.. __ _ __ _ ____ _... _ _ ___ ...__ _.. __ _ ___ _ 0
Pronouncing and cortiIyIl1lI phys'_ (P_ bolh ~ dea~ andcerm,;ng to cause Of dea~J
To the best of my knowledge, death occuned 8l: the time, dale, and pIace,and due to the cauSe(s) and manner as stated., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
~~~~c: and/Of' Inwst/gation,/n myopinlon, dMfh occtHlI!d at !he lime, dBte, BIld pJacto, and due to the eause{s) and mannet 81 stated.. 0
1.7\ I r I d.. I \ I C) 1
DIsposition Permll No.
23b. Ucense Number
23c. Dale Signed (Month, day, year)
26. Was Casa R4lofell9d to Medical Examiner I Coroner lor a Reason Other than Cremation or Donation?
Dy., ~
Part II: EnterolhersilJ'1ifican:corrifionsaJnfrltJllt~n1odeBtfl
butnotl1SUllilVilln\tleunclertyingtaUS8~"P!l.rtl.
28. Old TObacco Use Contrflxtte 10 Death?
DYes DProbobly
~D-
b.,"h<'~s /11.<" 1/..J......5
b.?tYle..,f,'...
29.IfFemaIlI:
o Not P'9l1'OnI-pootyur
o Pregnantalllmeoldealh
o Notp<egnanl,butpregnarlwlth.42days
Ofdea~
o Not pregnant, but pregnanl43 days to 1 year
beIoledea~
DU"""",,'_wlthinlhepootyeer
32c. P\ace 01 Injury. Home, Farm, &rael., Factory,
OlllceBuIkIng.11I1:.(SpocI/yI
"g. LocaIIon ~ loj",! Ismt, dIy 1_,_'
Last Will of Jean A. Sanford
I, Jean A. Sanford, domiciled and residing in the County of AdaQlS,
State of Pennsylvania, declare this my will and revoke a~and ill
former wills and codicils. ':: ~~ 0 ~
'':;:,- -<
- ,'",PI
ARTICLE I-FAMILY :-~~~ +"
I was married to Emery J. Sanford, now deceased, and I have no H:ViP~ ~
children.-o ~
):.'-
DEFINITIONS:
a. children Whenever it is necessary to determine who is a child or
descendant of any person, those persons shall qualify who at the time the
determination is made had been born in lawful wedlock, born to and
acknowledged by the person, or adopted prior to attaining the age of 18
years (regardless whether such birth or adoption occurred prior to or after
the date of my death). A child conceived but not yet born at the time such
determination is made shall be considered as then born, if such child is later
born and survives for ninety days.
b. survival. Whenever a beneficiary's interest in my estate is
conditioned upon surviving me, the beneficiary shall be deemed to have
survived only if alive on the ninety-first day following the date of my death.
c. gender. As the context requires, the gender of words shall be
interchangeable.
ARTICLE II - APPOINTMENT OF FIDUCIARIES
a. Personal Representatives: I nominate my good friend, Michelle
Witherow of Gardner, Pennsylvania, to serve as Personal Representative for
this will. If for any reason Michelle Witherow fails to become or ceases to
act as Personal Representative, I nominate my sister, Dorothy Dunkleberger,
to serve as Personal Representative of this will.
b. Guardian. I have no minor children at this time.
c. Bonds.. No Personal Representative or guardian wherever acting
shall be required to give bond, or surety.
-
..
c.n
~
~
~~
1
ARTICLE III - EXPENSES AND TAXES
1. Payment. My Personal Representative shall pay from the principal
of my estate (excluding specific gifts):
a. The expense of my last illness, my funeral and the
administration of my estate, wherever situated, including the cost of
safeguarding and delivering bequests; and
b. All estate, inheritance and succession taxes (but not generation-
skipping taxes) assessed by reason of my death. However, if such taxes are
increased because of the inclusion in my taxable estate of property over
which I have a power of appointment, such increase shall be paid by the
person holding or receiving that property. Interest and penalties concerning
any tax shall be charged in the same manner as the tax.
2. Reimbursement. I waive for my estate all rights of reimbursement
for my payments made pursuant to this Article.
ARTICLE IV - SPECIFIC GIFTS
1. Real Estate. At this time I own no real estate. Any real estate
that I may own at the time of my death shall be distributed per the
disposition of the residue.
2. Tangible Personal property All personal property will be
distributed per the disposition of residue.
Definitions:
a.
b.
Unless otherwise specifically provided:
i. Specific gifts shall include policies of insurance
thereon and proceeds of policies of insurance,
condemnation awards or other proceeds of
involuntary conversion which are unpaid at the time
of my death.
Specific gifts shall be subject to any mortgage
indebtedness, security interest, taxes or assessment
thereon which are unpaid at the time of my death.
As used in this Article, "tangible personal property"
includes all personal and household effects such as
jewelry, clothing, automobiles, furniture, furnishings,
silverware, books, pictures, and collections. It does not
11.
~~
~
~
2
include property such as money, precious metals held for
investment, bank accounts, stocks or securities.
c. Any pecuniary gift under this Article shall carry with it a
proportionate part of the income earned by the estate
from the date of my death to the date or dates of
paYment.
ARTICLE V - DISPOSITION OF RESIDUE
I, GIVE all of the rest, residue, and remainder of my estate, real, personal,
and mixed, whatsoever and wheresoever situated, of which I may have the
power to dispose of at my death (but not property over which I may have a
power of appointment), as follows:
1. My good friend, Michelle Witherow: If my friend survives me she
shall receive the residue of my estate.
2. Ifmy friend, Michelle Witherow does not survive me, then the residue
of my estate shall go to my sister, Dorothy Dunkleberger.
3. Contingent takers. If neither Michelle Witherow nor Dorothy
Dunkleberger survive me, then per stirpes to my mother's descendants who
SUTVlve me
~
~
~
I have signed this will on this 20th day of December, 2007. ~ ~
fhvn.~~ /~Z- \0
Jean A. Sanfort! I
We saw Jean A. Sanford, in our presence, sign this instrument at its end.
She then declared it to be her will and requested us to act as witnesses to it.
We believe her to be of sound mind and memory and not under duress or
constraint of any kind. We then, in her presence and in the presence of each
other, signed our names as attesting witnesses. All of this was done on the
date of this instrument.
~:ZN/
..~ .~~
residing at
~o .;V~U 'd .
3~ )/;1 17/ c!h~
residing at
3
SELF - PROVING AFFIDAVIT
STATE OF PENNSYLVANIA ]
COUNTY OF ADAMS ]
We, the attesting witnesses to the will of Jean A. Sanford, state under
oath that each of us was present and saw the testator sign and declare as her
will the instrument of which this affidavit is a part.
Each of us believed her to be of sound mind and memory and not under
duress or constraint of any kind; and that each of us then attested the will at
the testator's request and in the presence of the testator and of each other.
~ ~ ...
" .,,/~ -~A /
Subscribed and sworn to before me this 14th day of May, 2007, by Lucas A.
Nell, who is personally known to me or produced as identification:
; and by Thomas R. Nell, who is personally known to me or
~=tiy
Notary Public's ature
;%rc/~ !. /lIel/
Notary Public's name printed
My commission Expires:
Notarial Seal
Marcia L. Nell. Notary Public
Reading Twp.. AdaJUs County
My Commission Expires Sept. 12. 20 I 0
Member, Pennsylvania Association of Notaries
~
~
~
~~
4