HomeMy WebLinkAbout06-02-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of ,7; A )J fJ
also known as
Wi' J/I~ JI1-5
.
File Number
'J-\ 02> ()S<116
, Deceased
Social Security Number /8-) -2(;; - 9/ Z 3
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 Testamenta~y and aver t~a: Petitioner(s) is / are the ;o/.l(J~'~- /" Ex~o 1c:>Y'
last Will of the Decedent dated /0/3;,/;:::/":) 0 f and codlcI1(s) dated
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 execution of the instmment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
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(If applzcable, enter- c t.a . d.b n.c t a., pendente IlIe, durante abseflllG, duttDiJt:!'Yllontate) CO ~_"
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PetitIOner(s) after a proper search has / have ascertamed that Decedent left no Will and was survived by the followin~anY)J!l helrf.(tC,3
AdmmistratlOll. c.t.a. or d.b n.c t a., enter date of Wi!llll Section A above and complete lzst of heirs.) e ~E:i I ,-i'~
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Re~ (-
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o B. Grant of Letters of Administration
Name
Relationshi
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent, then 7/
years of age, died onfY}a! i~ 2J){)8at
;& 1ih~,' I do/':t!.. EJJ44~/,_r_ JI;.;p
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
situated as fOllows:Ce.r'f,'~~\~4 /-p~ of D ejo..~ /f 'u.;/f? P IJ C
$ . ?.~ ocJO
$
$
$
Earl k
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:
Form RW-02 reV. 10.13.06
Page 1 of2
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 tme 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 tmly
administer the estate according to law.
A \ DC(j CJ591i)
JOhn IV wt! Il~
Social Security Number: /g-!:J- 10 C; /23
AND NOW, Q(.L.r1 C 2-
having been presented before me, IT IS DECREED that
are hereby granted to (C . . It) .
File Number:
Signature of Personal Representative
Sworn to or affirmed and subscribed
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Signature of Personal Representative
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Date of Death:
, Deceased
5 lId j;LCiY6
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Estate of
foregoing Petition, satisfactory proof
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in the above estate
FEES
Letters . t::2.0/W. . . . . $
Short Certificate(s) . . . /. . . . $
Renunciation(s) .......... $
tJtI( $
JcP $
Au .-0 $
$
.. . $
.. . $
. .. $
$
. .. $
TOTAL .............. $
06
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Attomey Signature:
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Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
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Forl/l RW-02 rev fO.13.06
Page 2 of2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6,()O
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P 14330724
Certification Number
J-\ 08 0598
This is to certify that the information here given i
correctly copied from an original Certificate of Deat
duly filed with me as Local Registrar. The originr
certificate will be forwarded to the State Vitr
Records Office for permanent filing.
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Local Registrar
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Date Issued
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
..
5. Age (last Birthday)
1. Name of Decedent (Rrst, middle, las\, suffix)
John
H.
Williams
6. Dale of Birth (Month, day, year)
May 29, 1936
71
Pine Twp., PA
v"
8b County of Dealh
ad. Facility Name (I! not institution, give street and number)
Cumberland
E. Pennsboro Twp.
Holy Spirit Hospital
11. Decederlfs Usual lion Kind of work done du mosl of world life. 00 not stale retired
Kind of Work Kind of Business f Industry
Asst. Mana er, Sales Electronics Mf .
16. Decedent's Mailing Address (Streel. city flown. state, zip code)
706 Cedar Ridge Lane
Mechanicsburg, PA 17055
12. Was Decedent eV€r in the
U.S. Armed Forces?
:KJves oNo
Decedent's
Actual Residence 17a. State
13. Decedent's Education (Specify only highest grade completed)
Elementary f Secondary (0-12) College (1-4 or 5+)
12
Pennsylvania
Cumberland
17b. County
18. Father's Name (First, middle, last. suffix)
~ Haden Williams
2(la. Informant's Name (Type f Print)
Shirley P. Williams
26 - 9123
Ottler
o Nursing Home 0 Residence DOther - Specify
9. Was Decedent of Hispanic Origin? KJ No 0 Yes 10. Race: American Indian. Black. White. elc
(lI yes, specify Cuban, (Specify)
Mexican, Puerto Rican, etc.) whi t e
14. Marital Slatus: Married, Never Married.
Widowed, Divorced (Specify)
Married
Shirley Mae Patrick
Upper A lIen Tw,
Did Decedent
Liveina
Township?
17c,:KJ Yes, Decedent Lived in
17d, 0 No, Decedent Lived within
AclualLimilsof
COy I 8oro
19. Mother's Name (First, middle, maiden surname)
Beulah Barbour
2Ob. lnfOl'mant's Mailing Address (Street, city f town. stale, zip code)
706 Cedar Ridge Lane, Mechanicsburg, PA 17055
21b. Date of Disposition (Month, day, year) 2fc. Place of Disposition (Name of cemelel)', crematory or other place)
Rolling Green Cemetery
21d. Location (City ftown. stafe, zip code)
Lower Allen Twp., PA 1701
22c. Name and Address 01 Facility
Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Approximate interval
Onset 10 Death
Sequenllal~ Iisf condibons, ~ any.
~~j~~O uJ:~~I~~~AM~ a
~~:~~I\~1nt~t;t~rtrsr
Due to (or as a consequence of):
d.
3Qa. Was an Al1Iopsy
Perfonned?
31. Manner 01 Death
30b Were Autopsy Findings
Available Prior to Compleliorl
01 Cause 01 Death?
o Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could Not be Determined
M
32f. H Transponation Injury (Specffy)
o Driver I Operator 0 Passenger
oO~er . 8p<ci~:
33b. Signature and Title of C
32g. Location of Injury (Street, city I town, slatel
oVes ~NO
oVes oNo
32d. TIme of Injury
33a. Certifier (check only one)
;~:'~r~r:~~~:~:nd:~~Iy:= ~~~~~::an=~~~h~:~rh:: ~=:..rw:_ed_ ~~ _a~ ~_m~I~~ ~e~ ~~ .. .. .. .. .... .. .. .... .. .... .. .. .... 0 ...
~::u=~a~~ :~:~J:a~~a~(:~~t~~ t~~i~~~~;n~::~~a:rt:1ot~:=~~a~~~ manner as stated.. .... .. .. .. .. .... .. .. .... .... .. .... 0
~:~;:;:n~~:~~f~:= and { or investigation, in my opinion, death occurred althe time, date, and place, and due 10 the cause(s) and manner as stated_ 0
I c:Z1 / I d I / I /' I 36. D." Filedjonlh. day. vaar)
. . . . . . .:5//..5: d tl (! f'
Ois,osrtion Permit No 01 q I ,\() 'I
23b. License Number
23c. Dale Signed (Month, day, year)
26. Was Case Referred 10 Medical Examiner f Corooar for a Reason Other than Cremation or Donation?
oVes ~No
Part 11: Enter other sianificanl cond~ioos conlribulino 10 death,
but nol resulting in the underlying cause given in Part I
28. Did Tobacco Use Contribute to Dealh?
o Yes 0 Probably
o No 0 Unknown
29. If Female:
o Not pregr\8nt within past year
o Pregnantaltimeoideath
o Not pregnant. but pregnant Within 42 days
of death
o Not pregnanl. bul pregnant 43 days to 1 year
before death
o Unknown if pfflgrlanl wilhin lhe past year
32c. Place 01 I,njury: Home, Faf!Tl' Street, Factory,
Office Bu~ding,etc. (Specify)
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1 \ 08osci5
Last Will And Testament
Of
JOHN H. WILLIAMS
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I, JOHN H. WILLIAMS, of Cumberland County, Pennsylvania, being of sound mind,
disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will
and Testament, hereby revoking all Wills and Codicils heretofore made by me.
PARAGRAPH 1. I direct my Executor or Executrix, as the case may be, to pay all of
my debts, funeral and administrative expenses as soon as convenient after my decease.
Furthermore, I direct that all state, inheritance, succession and other death taxes imposed
or payable by reason of my death and interest and penalties thereon with respect to all
property composing of my gross estate for death tax purposes, whether or not such
property passes under this will, shall be paid by the Executor or Executrix of my estate.
PARAGRAPH 2. My Executor or Executrix may, at his or her discretion, compromise
claims, borrow money, retain property for such length of time as he or she may deem
proper; lease and sell property for such prices, on such terms, at public or private sales, as
he or she may deem proper; and invest estate property and income without restriction to
legal investments unless otherwise provided hereunder. I authorize and empower my
Executor or Executrix to sell any realty and/or personally owned by me at my death and
not specifically devised or bequeathed herein, at public or private sale or sales and to give
good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living.
My Executor or Executrix is authorized and empowered to engage in any business in
which I may be engaged at my death, for such period of time after my death as seems
expedient to said Executor or Executrix.
Initials:
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PARAGRAPH 3. I gIve, devise and bequeath all of the balance of my estate of
whatever nature and wherever situate, including but not limited to all tangible personal
property owned by me at the time of my death, together with all insurance policies
thereon, unto my spouse SHIRLEY P. WILLIAMS, if she survives me by thirty (30) days.
PARAGRAPH 4. In the event that my wife predeceases me or fails to survive me by
thirty (30) days, I then give, devise and bequeath all of the balance of my estate of
whatever nature and wherever situate to my sisters and brothers, JOAN GELORMINO, of
Patton, Pennsylvania, BRENDA WILLIAMS-DENZER, of Belsano, Pennsylvania and
TIMOTHY H. WILLIAMS, of Strongstown, Pennsylvania, in as nearly equal shares as is
practicable, not per stirpes.
PARAGRAPH 6. I direct that any and all Inheritance, Estate, and Transfer Taxes
imposed upon my estate passing under this will, or otherwise, shall be paid out of the:
principal of my residuary estate.
PARAGRAPH 7. I nominate and appoint my brother-in-law, RICKY PATRICK, of
Mechanicsburg, Pennsylvania, to be the Executor of this my Last Will and Testament. If
he predeceases me, fails to qualify or is not able or does not serve for whatever reason,
then in his place I appoint my spouse, SHIRLEY P. WILLIAMS, to be the Executrix of
my estate.
PARAGRAPH 8. In addition to the powers conferred by law, I authorize my Executor,
in his absolute discretion:
(a) To retain in the form received, and to sell either at public or private sale any
real or personal property.
Initials: "",,t/ A/
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(b) To manage real estate.
(c) To invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principle of diversification.
(d) To exercise any option or rights arising from ownership of investments.
(e) To compromise claims without court approval, and without the consent of any
beneficiary .
PARAGRAPH 9. No person(s) shall benefit hereunder unless such beneficiary shall
survive me by thirty (30) days.
PARAGRAPH 10. No Executrix, Executor or Trustee acting hereunder shall be
required to post bond or enter security in this or any other jurisdiction.
PARAGRAPH 11. No beneficiary may assign or anticipate his or her interest in any
income or principal held or distributable hereunder; and no beneficiary's creditors may
attach or otherwise reach any such interest.
PARAGRAPH 12. (OPTIONAL PARAGRAPH) I direct and otherwise recommend
that my Executor and any successor Executor utilize the services of the Law Offices of
Peter J. Russo, P.C., of 3800 Market Street, Camp Hill, Pennsylvania 17011 to probate my
estate as they have become familiar with my wishes and desires.
Initials: Jilt:?(
IN WITNESS WHEREOF, I have hereunto set my hand and seal this.3 day of
F'~a./, 2007.
H. WILLIAMS
Initials: .J II k/
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The preceding instrument, consisting of this and 4 other typewritten pages, was on the date
thereof signed, by the above-named Testator as his Last Will, in the presence of us, who at his
request, in his presence and in presence of each other, have subscribed our names as witnesses
hereto.
~~e_~
Ashley Ripe '-
3800 Mar et Street
Camp Hill, P A
D~ u.cN.~.~
Dorothy D. ~berle
3800 Market Street
Camp Hill, P A
Initials: ../1/ vi
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, JOHN H. WILLIAMS, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
this instrument as my Last Will; that I signed it willingly, and that I signed it as my free and
voluntary act for the purposes therein expressed.
~7/W~
Ja!'iN H. WILLIAMS
Sworn to and subs~ed
before me this '3 day of
~ ~2007
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Notary Public
COMM EAL tti OF PENN YLVANIA
Notarial seat
Cesar L. Buono. Notary Public:
Camp HiD Bora. Cumbeftand County
My Commission ExpireS Jan. 15.2008
Member. Pennsylvania Assoc;aUon Of Notaries
Initials: ---iJ/ul
AFFIDAVIT
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
We, Ashley R. Sipe and Dorothy D Haeberle, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that
we were present and saw JOHN H. WILLIAMS, Testator, sign and execute the instrument as his
Last Will; and that he executed it as his free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight ofthe Testator signed the Will as witnesses; and that to the
best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
CWx~ (2 - ~~
Ashley R. i e
3800 Mark Street
Camp Hill, P A 17011
i". ~ 7\~
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Do~othy D. H berle -
3800 Market Street
Camp Hill, P A 17011
Sworn to and subsc~d
befor~s ~ day of
. trl! It.- , 2007.
~~
Notary Public
COMMON' EAL1H OF PENN YLVANIA
Notarial Seal
Cesar L Buooo, Notary PubIie
Camp HiD Bom, Cumbertand County
My Commission Expires Jan. 15, 2008
Member. PQftn~vlvar>ia Afs~ia11on Of Notaries
-4L-
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