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Home My WebLink About09-04-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Richard N. Davis also known as Deceased COUNTY, PENNSYLVANIA File Number ~ l ~ ~ 4~ ~~ Social Security Number 207-22-1884 Janice M. Davis 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 Testamentary and aver that Petitioner(s) is /are the Executrix last Will of the Decedent dated November 8, 2002 and codicil(s) dated Not Applicable 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 instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: Not Applicable B. Grant of Letters of Administration (/f applicable, enter: c. t. a.; d. b.n.c.t.a.; pendente life; durante absentia; durante minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or d. b. n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Decedent, then 84 years of age, died on August 18, 2008 at Chambersburg Hospital, Chambersburg, Chambersburg Borough Franklin County Pennsvlvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 4,500.00 (If not domiciled in PA) Personal property in Pennsylvania $ 0.00 (If not domiciled in PA) Personal property in County $ 0.00 Value of real estate in Pennsylvania $ 0.00 situated as fo 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 undlersigned: or orinted name and residence ~~~ 1 Janice M. Davis - 213 George Street, Hanover, Pennsylvania 17331 Form lew nz rev. ]0.13.06 Page I of t (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~- }~ -rz ~ ~ ~1' :.'" Sri Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal ~idehce at :'~ c 238 East Garfield Street ShipuensburQ Shinnensbur¢ Borough Cumberland County, Pennsvlvania 17257 3~ CJ t (List sheet address, town city, township, county, state, zip code) ~" Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true 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. Sworn to or affirmed a~njd subscribed be re me .,he " I day of ~~ ~~~~ ~;~, ~ r ~ L,.-~ cr the Register Signature of Personal Representative Signature of Personal Representative ~ Ca ~ C.7 - ;, :~ --o ~ r~ - -"~ Signature of Personal Representative C7 -n File Number: a ~ ~ 8 ~•~~ Estate of Richard N. Davis Deceased ~ ~=. ~? ' 7 ~" : ,..~ i ~ C~; z "r'l W "~ - _~ Social Secur'ty Number: 207-22-1884 Date of Death: August 18, 2008 AND NOW, , ~ , in consideration of the foregoing Petition, satisfactory proof having been presented be ore me, IT IS DECREED that Letters Testamentary ___ are hereby granted to Janice M. Davis itt the above estate and that the instrument(s) dated November 8, 2002 described in the Petition be admitted to probate and filed of record as the last Will (a~}d Codicil(s)) FEES Letters .... !i. `~~ ~ • • • • $ Short Certificate(s) .. ~ .... $ ~ CO Renunciation(s) .......... $ ~S;rl ...$ rs ,~,. t~ ... $ .~ ... $ ... $ ... $ ... $ ... $ ... $ W -.-~-~ TOTAL .............. $ YIC9 • R/egister of Wills l / `` J , Attorney Signature: 7.~[ n a (` ~ r \J Attorney Name: Elinor Albright Rebert Supreme Court I.D. No.: 83858 Address: 515 Carlisle Street Hanover, Pennsylvania 17331 Telephone: (717) 632-4300 Forn,Rw-oa rev. 10.13.06 Page 2 of 2 11 n, .a h H r~:v' r u von ) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, .x,6.00 P 144~1g~0 Certification Number This ii to certify that the information here given i correctly copied from an original Certificate of Deat duly filed with me as Local Registrar. The origins certificate will be forw• ed to the State Vita Rec Office f p nn ant filing. Local(~egistrar o Late Issued ~ :.: C ~ _ ~ i ~`t ~ ~ '"~ Cam'"{ .. _a,3 r~ ~ ,~ ,~I. ~ C- J ~ . C7O -n 3 _ --ice ~CI 7 i=rt . Htosus REV n/21x16 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~' TYPE / PRIM IN -Q ~ i ~ ,' k ('-'~ PERMANENT CERTIFICATE OF DEATH - BLACKINK ~ 1 (See Instructions and examples on reverse) ~~ 1 ~'~, ~~~ L~ STATE FILE NUMBER w 4 a 1. Name d Decedent (first, rtiidtlle, Mn, suMz) 2. Sex 3. Sodal SewMy Number 4. Date of Death (MOnM, day, year) Richard N. Davis Male 207 - 22 - 1884 August 18, 2008 5. Ape (feel Birthday) Under 1 r Under 1 day 6. Date of BiM (Month, day, year) 7. anhplace (Cky ell stele or loragn wumry) tle. Place of Death (Check ody one) Momry D'A ~~ mm's ranklin CO. Hospital: Other: 84 Yra. Ma 1 1924 argon Twp., PA plmatlem ^ER/OdpefleM ^DOa ^Narang HOme ^Resitlence ^Other-spepiy: 8b. County of Death 6c. City, Bwo, Twy. d Death 11d. Factlky Name (g not ireWution, gNe street ell number) 9. Was Decedent W Hispenk Origin? ~ No ^ Ves 10. Race: Amerkan Indian, Black, Wide, etc. (I1 yes, specify Cuban, (gpayly~ Franklin Chambersburg Boro Chambersburg Hospital Mexican,PuenpRipan,dp.) White 11. Decetlem'a Usual Oa lion Kkrtl d wok d one du ~ mon d ~ ile. Do not stale retired 12. Wee DecetleM ever m the 13. Decedent's Education (Specify oMy highest grade comp leted) 14. Merdal Status: Monied, Never Marred, 16. Survivirg Spo use (II wile, give maden name) Kirb d Wark Nbtl of Business / IrWuslry U.S. Armed Farces? Elementary /Secondary (0.12) College (1-4 or 5+) Witlaved, DNorced (Specily~ Machinist SICF Industries ^Yeb ®Np 12 Widowed 16. DBcedeM'b Mailing Atltlreas (Street dty /town, state, zip cede) DecetlenYa Did Decedent aam Pennsylvania live b a ITC Actual Residence na ^ yea Decedent Livetl b 238 E. Garfield Street . . , T Townsnip> "~ PA 17257 Shi ensbur 17b.Coanty Cumberland ne.C~~o~MweawnNn Shippensburg pp g, ~/Reno 18. Father's Name (First, mMde, lest, saga) 19. MoMer's Neme (First, midtlle, maiden surname) Robert F. Davis M rtle Williams 20a. Informant's Noma (Type / Pnm) lob. Imamam'b Melling Aderess (Saeet dry / bwn, state, zq code) Janice M. Davis 213 George Street, Hanover, PA 17331 21a. Melhotl d Disposition ^ CremMim ^ Dcnalion 216. Dale d Dsposkion (Monty, day, year) 21 c. Place d DispcePoOn (Name d cemetery, crematory or omen place) 21tl. Location (City /lows, slate, zq wtle) ~(] Burial ^ Removal horn Slate ^ Other- ' Was Cremation or Donation AuNOrhetl byMale.lExemmerlCororrer7 ^res^Ne August 21 , 2008 Spring Hill Cemetery Shippensburg, PA 17257 d urpwl Se ' such) 22b. Lirerse Number 71c. Name and Address d FadMy - ~~~^^ FD-011776-L Fo elsan er-Bricker Funeral Home, PO Box 336, Shi pensburg PA 17257 Carrplele perm 23ac anh' when canityup 23e. To the best d my knowledge, death occurred an tls fime, date end place Haled. (Sigreture and Lille) 23b. license Number 23c. Dafe Signed (MOnm, day, year) PhYBiuien a rot evadable et time d deaM b ceniry cause d tlleem. Iteme d-26 misl he completed by persm P 24. Time of Death ~ s (Q ^ // 26. Date ~ ~(~ , daY, year) ~j Case Rderred t 26. O o ~ I Ezamtner /Coroner for a Reason Other Than Cremation or Donafbn? p ce who ounces tleetn. M 1 / o V o CAUSE OF DFJ\TH (See Instrucllons entl examples) r Approzimete btenrel: Pad II: Eller dher sledfiram mrrdkbns contnhuf o t deaN, 26. Ditl Tdlaan Use Conbibde b Death? dam 27. Pen I. Enter 91e drein d evens - tlbeases, klunes, a rxmpkcelbrs-Ihal dirsclly caused me death. W N0T enter IerrMnel events such es cardiac ertem, f Onsd to Death bd not resulting b the untledyng cause gNen in Pan L ^ Yes ^ Probably resplretory err%1, of VamrkWaf 9br1118110n Wllllgll bhawirlg ttla BlldagY. L510r1y Orla CBaba ql aadl YnB. r i ^ No ^ Unkwwn ^ IMMEDIATE CAUSE 1Flrel disease or v~~ / cerMdlon rewdinpm death) ~ e. MyNl.f'l~a~p ~,~~ '(J ~~ ~ ; I S. ~kYY•+ 29. Il female: Due to la u a corsequerx:e oq: '" t ^ Not pregreM within peel year nlialry p61 conditions, N any, b, r ' a h ^ Pregnant al kme d death lea W t e cause gstetl on line a. qre to (or es a consequerae o1): r Eller UNDERLYING CAUSE r ^ NM pegnaM, bd pregnant wAhin 42 days (tllse~e a ."rry Thal biliaed the c r events resdl~ m death) LAST. r d death Due to (a as a consequence oQ: r ^ Pet pregnant, bd pregnant 43 days l0 1 year d. i bwore death ^ UMinown it pregrant wilMn the pass year 3Da. Was an Autopsy 30b. Were Aubpsy FkWings 31 of Demh 32a. Dale d Injury (Month, day, year) 32b. Descrbe lbw Injury Occuned 32c. Pence of Injury: Home, Farm, Street, Factory, Perbmwtl? Available Prior to Carnpletbn ~ Naturel ^ Flomcide S 1 8 !~ ~~ Odke BuiWirg, enc. (Specity) d Cause d Deets? kxs~ ^ Yes No ^ Ves ^ No ^ AaieeM ^ Pendng Invesegata»t 32d. Tine of Injury 32e. tiyury of Work? 321. If Transponatien Injury (Spedty) 32g. Location of Iryury (Street oily I lows, stale) ^ Suidde ^ Could Nd be Delennined ^ Yes ^ No ^ Otiver / Operebr ^ Passerger ^Petlesinan M ^Other-Specify 33a. Cendbr (~~eck only one) 33b. Signature end Title d Cendier • CenNying phyekien (Physklen certifying cause d death when another Dhyskdan has prpsunced death ell competed Kem 23) - M~ Ta the best of my knowledge. demh occurretl tluebthe wuee(s)end manner es slaterL________________________________ ^ • Pronaurrcing ell cenirying phyaklen (Physiden both pronourcing death entl cenilyk,g b cease of death) t d d th tl M th ti d d M M d t th d t k led d Q• 33c. License Number 33d. Date Signetl (Month, tlay, year) me, now ge, accume e a e, an p ce, ar ue o e cause(s) en manner as s ale To The best my ea _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner I Coroner ~ ~ G M D ~~ '7 40 ryyA~S~ (p C On the heals of ezem a vestigetion, fn mY oplnlo ~Mh - urred of the Ifine, date, and place, end due to the cause(s) entl manner as stated_ ^ f 34 Name and Address of Person Who Completed Cause of Oealh (hem 27) Type / Print 35. Pegslmr's Signature a 36. Gate F' (Month, y, Year I ZIP I ZI ~ ~I ~, ~'Rt~ (~-IAS I 1~ S j "{-y~~ 11.1 ~) On t s 1 re•-ez• t ~ f ~( ~-ttkrnrteRS'Bu~-cr ell P - - u o - ~ -(/ ~ DisposilionPermdNo. 007649 ~ L~4ST W I LL 74ND T~ST"~AM~N?" I, RICHARD N. DAVIS, presently residing at 238 East Garfield Street, Shippensburg, Cumberland County, Pennsylvazua 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved daughter, JANICE M. DAMS, presently residing at 843 Summit Avenue, Hagerstown, Maryland, on a per stirpes distribution basis, provided that she survive me by a period of sixty (60) days. THIRD. In the event that my said daughter, Janice M. Davis, should predecease me or is not living on the sixtieth (60~') day following my death and the said Janice M. Davis should die without issue who survive me, I then give, devise and bequeath my said estate to my brother, LEROY J. DAMS, presently residing at 599 Baltimore Road, Shippensburg, Pennsylvania 17257. FOURTH. In the further event that both my daughter, Janice M. Davis, and my brother, Leroy J. Davis, predecease me and my said daughter dies without issue who survive me, I then give, devise and bequeath one (1) share of my said estate to each of the following persons and entity: A. One (1) share to my niece, LEDONNA D. DARHOWER; and B. One (1) share to my niece, BEVERLY D. DANNER; and C. D. E. F. One (1) share to my nephew, JOHN W. DAVIS; and n ~ - ~;'~f~' ~ '' ~~ ~ ' ~ One (1) share to my niece, CATHY L. GRAHAM; and fi't~ ~ . ° 'F -~ ~ ~ ~ `~'T/ , ~' One (1) share to my niece, CAROL A. RUSSELL; and ~ ~; ~• - r,~ , ~ = . , . ,..,_, One (1) share to my niece, BETTY J. McCLANATHAN; and ~ ~ ~ ~ " ~~~'~ ~ `~ G. One (1) share to the MEMORIAL LUTHERAN CHURCH, of 34 East Orange Street, Shippensburg, Pennsylvania 17257, to be used as the church council deems to be in the best interest of the church. 'D ,__~..~ L~~-~ ~F ~'~F~ ' ' ~'~ ~~ (SEAL) WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 172 5 7-13 9 7 FIFTH. In the event that any of the above-mentioned beneficiaries should predecease me or are not living on the sixtieth (60th} day following my death, I then direct that the share of any such deceased beneficiary shall pass to the surviving beneficiary only. SIXTH. I nominate, constitute and appoint my daughter, JANICE M. DAMS, to be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint my brother, LEROY J. DAMS, to be the Executor of this my Last Will and Testament. SEVENTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. EIGHTH. 1 direct my Executor to retain the services of JERRY A. WEIGLE, ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, Richard N. Davis, have hereunto set my hand and seal to this my Last Will and Testament, written o two (2) pages, the first page signed for identification only, this ~ ~ day of %'YJr^~,,,..1z,.~.L , 2002. ~k.-~C"~T~ ,~~C~'~'--i'.~~ (SEAL) "~~ WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND and ~fPW p ~ia'~,~ ~_. ~ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Richard N. Davis, the Testator, sign and execute the instrument as his Last Will; that he signed willingly 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 of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. .. C7 7 ~k_ . D~ Sworn or affirmed to and subscribed before me by r~- , ~, -. /~ ,Q and ~o~ft'~1 1" d~ ~' ~~l ~ witnesses, this~~ ~'~~ day of ~'ut~~ii~ --, ` ~j (~' c' + /~/ i L/~ r ~ ~ ~,,~ - N ARIAt. SEAL JenyA 1Neigle, Notary Public 5hippensburg, PA Cumberland County My Commission Expires October 7, 2006 WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBU RG, PA 17257-1397 This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. }//~J ..fay C__. \ / 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, Richard N. Davis, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the 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. Sworn or affirmed to and acknowledged before me by Ric and N. Dav the T stator, ;. this ~~ ~~. day of ~;,~ ~~ , 02. ~"1 r II NOTARIAL SEAL Jerry A. Weigle, Notary Public Shippensburg, PA Cumberland County MY Commission Expires October 7, 2006 WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 726 EAST KING STREET - SHIPPENSBURG, PA 17257-1397