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HomeMy WebLinkAbout09-15-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Paul M. Simmons also known as Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLI3TE 'A' or 'B' BELOW.•) COUNTY, PENNSYLVANIA File Number ~ ~ ©~ ~~~ U Social Security Number 195-16-4704 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Co-Executors last Will of the Decedent dated November 27, 2006 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 instrument(s) offered for probate. was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate) :-.~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the follod~g spouse (i~ty) and ~teirs: (If Administration, c. t. a. or d. b. n. c. t. a., enter date of Wilt in Section A above and complete list of heirs.) -, CC..~~ [!~ ' '~=. ' -, -- _. ._ Name Relationshi R e -- r > ~__t .~ . , , ~~ ...r .. y -j/ (COMPLE'TE INALL CASES:) Attach additional sheets ijnecessary. N Decedent was domiciled at death in Cumberland County, Pennsylvania with his f her last principal residence at 346 Old Stonehouse Road Boiling Sarin ~ PA 17004 (List street address, town city, township, county, state, zip code) Decedent, then 83 years of age, died on September 9, 2008 at Manor Care ~ , 1~( L17~>,.T L 6 ~ 7-~ P Decedent at death owned property with estimated values as follows: (If domiciled in PA} All personal property $ 35,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 200,000.00 situated as follows: 346 Old Stone House Road, Boiling Springs, PA 17007, 1251 Boiling Springs Road, Mechanicsburg, PA 17055 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: Si nature T ed or rinted name and residence Rocco E. Simmons 56 Ashburn Drive, Mechanicsburg, PA 17050 Marie L. Zeigler 1251 Boiling Springs Road, Mechanicsburg, PA 17055 Tammy L. Karns 191 Birch Lane, Carlisle, PA 17015 named in the Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COLJNT'~ 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 affrmedd and subscribed before nYi. the I ~ day o ,~~~'~ ~ ~~ For the Register ~ki+iiG 2 Signature of Personal Representati e ignaq re of Personal Rep •esent ive ,• Signature of Perd~onal Representative File Number: Estate of Paul M. Simmons Social Se unity Number: 195-16-4704 AND NOW, v~ u~, in having been presented offf jjre me, IT IS DECREED that Letters are hereby granted to 1~0~ L~ f ~ l I~1~Uns ~~y/ e ~~ ~~Cr~ - s } e Y .__~ ~~ t v~ % F "1 --I~ j '-1 f _ , ~. _.~ Deceas~l N tTt "~O V ~ .C'" W Date of Death: September 9, 2008 ~~ S_, F <_3 L ~ J \. the foregoing Petition, satisfactory proof ~ in the above estate and that the instrument(sl dated y t]e s'~ /' c~ ~ ~~~ described in the Petition be admitted to probate and filed of record as the last Will (end Codicil(s)) o~Decedent. FEES Letters ..~.~'~,.~~... $ ~~Ib Short Centificate(s) ..V`~.... $ a~ Renunciat:ion(s) .......... $ (,~~tl ... $ ~s ~~-...$ S ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ 3 ~D ~' Register of Wills w`-"'` "T }', Attorney Signature: ~'' -~~L~~_ Attorney Name: John M. Eakin Supreme Court LD. No.: 6351 Address: Market Square Building Mechanicsurg, PA 17055 Telephone: 717-766-3172 Form RW-02 rev. 10.13.06 Page 2 of 2 I05BU5 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION ®F DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14752661 Certification Number Hwsu3 FEV n~zcos TYPE, PRINT IN PEFMANENT BLOCK INK S l ( ~1 0 z 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. Local Registrar Date Issued r..a _._ ___ ~ c _ - -- _~ ~-- c=a ,~ ~ `, ~..1 .? -' ~ -',~ 3 _~ ~ ~~- :y -~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS W CERTIFICATE OF DEATH (See instructions and examples on reverse) ~,,,r< <„ ~ ,,,,,woo ~ ~ /5 ~ ~ Cj 7 ~ 1Name aDecedent IFlrst. nadNe. Wsl, sulGx) 2. Sex 3. Saral Secwgy Naater 9. Date of Deam IModh, day, year) PaUI M. SimmOpS Male 195 - 16 - 4704 September 9, 2008 5 Age (last Blnnday) Under 1 year lMder 1 day 6. Dale a Birth (Norm, day, year) 7. &nhplaw {City aria sure a fa country) ea. Place d Death (Check only one) pw~sw Days rags Mriubs MosDital: O me r: 83 ,,,~ February 6, 1925 , ~ / Mechanicsburg, Pa. ^mpalaa ^ER/aapatwm ^DOA ~NursepYkvne []ReaiJence goner spenirv. Bb. County d Deam &. CNy, Boro. Twp of Death Bd. Factliry Name pf trot irwtiNtion, ry ve greet and nixroer) 9. Was Oecedea d Wspenic Origin? ~No ^ Yes 10. Race. Amercan N!0an, &xk, YYhNe, ek. Cumberland S. Middleton (n yes, specify ca,an, jsp°°iM Manor Care Afexkan,PuerwRican,ekl White 11. Decedent's Usual Occu ~ lion Kind d work done a mast a world kle. Oo nor stale rear 72. Was Decedent ever NI tlra 73. DecederN's Education (Specify oNy highest grade comgeled) 16. Martial Saws- Marr1e0. Never Mazried, 15. Surviving Spouse (If wire, pve maMan name) KaW d Wok KM of Business / 4Musuy U.S. Artred Forces? Elementary /Secondary (0.72) College (1-A a 5a) W~~• DKarcetl ISPeaM School Bus Driver Trans ortation Yae ^N° Widowed • t8. Decetlmts MaYe!g Addess ISne«, cpy /town, state, zip coda) Decedaa's Did Decedent Monroe PA 346 Old Storehouse Road MdudResiOerce 17a Sale o~~p? ,TC.~IWea,Decedenttive0n Twp. ili ti PA 17007 B S s ,m. carnrv Cumberland t2d.^NO. DeceOea Lyved wNNn o n , n , Adualtiralsd cNy,ear° 78. Fatnei s Name (Post, middle. Vast. suN'u) 18. Mother's Name (First, mitlde, maiden wmprle) Penrose Simmons Edith Reynolds 20a Inlamanl's Name IType / Prmll 20b. mfomanl's Maiing Address ISNe«, cry /town, slate, zip coda) Marie L. Zeigler 1251 Boiling Springs Road Mechanicsburg, PA 17055 21 a. Memotl d DisposNan ^ Crematpn ^ Donator 21b. Date d DsposNgn IMonm, daK Year) 2tc. Place a Disposition (Name a cemetery, crematory «adwc place) 21 d. Location {CNy 1 awn, state, :p code) ~Bunp ^ fiertavaf hom State •_ ^ her~specdy: Was Crsmatlon a DorWbn Authorizad alEa.mm.ryc«en«a ^Yea^r~ September 12, 2008 Trindle Spring Mechanicsburg, Pa. 17055 22a. d Funeral Licen as such) 22h. License NaMer 22c. Name and AOGess a Facwly • - Y FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055 enema ~ any when carlnying 23a. ball a my .Beam scared el me time. mle and place stelae. (sipa wre am mle) z3e. License N°moer z3~. Data syred (MaNh, tlay, ye«) pnypcian is ml avaNaole al wne a Deam m rs auva a loam. rd'y ~~~iJ L /L/) ! ~ ~ S i 7 - L eP ~eMSer a~v`Ja w pemc 2o~T8 mop «canpbwe °Y person 2 d Dean 25. DaN Prmwncetl Dead (Noah, day, year) 26. Was Case Kalahari b Me0aa1 Examiner / C«orar fa a Fleason Omer ran CrAma1 a Donation? ~ wtA Dranur«;es Beam. I ~. ~ ,~ O (~ . M. , P -Fe M (~ v ! ~.,~.~j 9 0) w.tD Q Ves No CAUSE OF DEATH (Sea 10a4uctbna eAM ssamples) , Approxunpe upenp: Pad II: Emer aner ~ 2B. Did Tabaao use Carmtuk ro Deam7 hem 27. Pan L Eaa me cBalBd events -diseases. injuries. a canlNical'wns -mat Directly caused me dean. W NDT enter terrtunal even ts such az cardiac arrest, 1 Onwt 1° Deem Dul rat resutlkg p me undenyiig cause given n Pan L ^Yas ^ Prebady respiratory anep, a Yeanculer fbdllatlm wahod stgwirg the etiology. List agy one cause on each tire. i i o ^ Unkrgvm ~~~~~a Rtsb,~~ art -~ a ~ p(, ,~ ~NF.~. ^ b (a as uary~~~op: Sevwnla4yy Iat cor!tiaon>. a any. D. _~/V'b G -1 Y I ~1 ! U (il.~ ~ ~ ~A1 tW/Y ~A ~'}) fY`~i ~ Nd pegaM wNhn past year ^ Preg~ara ar m~e m seam le m the rouse listed on tine a. Due to a as con ) Enter 6~e U1mEalY1NG CAUSE ( ~°a~ °I ~ r ^ Na pregnant. but pregrwnt withn 72 Gays (0~5e:rse a injury mat initialed tl1e every rewWng m Beam) UST °' a a seam . Due to (a as a Consequence op: i ^ Nor pregnant, but pregraril43 days to t year d. z Oelae Beam Unkrown p prep ant wi1Nn me pap yw 30a. Was an Aacpsy 30b. W«e AWOpsY Findxgs 31 Maruar cl Deam 32a. Dew a Injury (Monet, day, year) 32b. Describe How Injury Occurred 32c. Waco d Nquy. Marta, Farm, Stre«, faaay, Penortnetl7 Avatlade Prior to Completion of Cause of Deam? ~ Natural ^ Hanicitle Onice B~Kf. ~ (Spa°ryYl ^Yas ~ ^Yas ^ No ^ Aaidenl ^ Pend!q Invesllgp~ 32d. Tare d mN°Y 32e. g4aY at Wok? 32f. N rcansp«ution Nryury (Spec;M 32g. L«aeon d gWtY ISlrep. aY I bwn, pale) ^ Suk~tle ^ Could Not u Delermirre0 ^ Yes ^ No ^ Driver / Operala ^ Passenger ^Ppkstrien M Ome(- Specify: 73a Candor (ate Day onej 33b Slgnatae erW Tpe a Ce wr • Cenirvinp gryaician IPnysarau canNyinq rouse or tleam wlW:n aMlher physican has pro!wunced Beam and complele4 Nem 23) J Y/ To tM butannY knowMdga, aam ocartu dw to Nw causels)and martyruslaleL____________..__ _________________ • Pronouncing rW anBying pnyskWr jPnys!cian Uom prorouncmg dean aM ceNNmg b cause of deem) To tM uY of rnY Mowtedge, esaM occurred N tlw 8me, OaM, uM place, ue ew b 1M cause(s) antl manrNr as staced_ • Neekal Enmbrr I C«oner _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Nanbec s, xt ~ D I 1 fq/ ~ I'z' i ./ a ` 33tl. Data Sgned IMonm. Day. year) ~ n n ~~ y w'' L •7 On IM baps Of uemiNNOn and / « mYCellgallen, m my Oplnian, deem eecaced M lne lNnl, dale, aiW puce. and due 10 1he ClUaelf) one maaMr V aWerL ^ 34 Name and Address of Parson Who Com,Neletl Cause d Daam jllem 27) Type PnN 3;. Feg~ r s Sipawia aM DisuKr Nu ! 36 Dale FNed (Noah, day, reap i%1NALD J. KGVaCS, k1D a<*ur ac m - l.>~ II I aa'ZI I I ~I ~? ~~ ,,,,g PA 17W1 t358lranown Fd~ \ ~ ` l.i C.I Disposition Parrot No. O ~ S ~ `•' `s~ l0 ~G~je '~a~t ~iit anb ~Ge~tament of PAUL M. SIMMONS I, PAUL M. SIMMONS, of Monroe Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby snake, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my F^,~ decease as the same can conveniently be done. ~ ~ __, ; -1. ~n ' j , ~ ~ ....- ~ i ~ ~:.-._C._, ~ I direct that there shall be paid out of my residuary estate all estate, mhe~ice aid T~ ?~; .. ~ ~ like taxes together with any interest or penalty thereon imposed by the Goverment of tl~ `` United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. I give, devise and bequeath my entire estate, real, personal and mixed to my wife, GLADYS M. SIMMONS, absolutely and in fee simple. -1- 4. In the event my wife predeceases me I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate to my three children, ROCCO E. SIMMONS, MARIE L. ZEIGLER and TAMMY L. KARNS, in equal shares. 5. Lastly, I nominate, constitute and appoint my wife, GLADYS M. SIMMONS, to be Executrix of this my Last Will and Testament and in the event that my said wife should predecease me, or should she be unable or unwilling to serve in such capacity, then in such event, I nominate, constitute and appoint my three children, ROCCO E. SIMMONS, MARIE L. ZEIGLER and TAMMY L. KARNS, Co- Executors of this my Last Will and Testament in her place and stead, and in either event, I direct that my said personal representative be excused from posting bond or othcr security for the faithful performance of their duties, in any jurisdiction. I direct my Executors to sell my real estate as soon as may conveniently be done at public or private sale and for such consideration as it, in its sole discretion, considers fair and equitable. IN WITNESS WHEREOF, I have hereunto set my hand and seal this,~~ day of rlovember, 2006. au M. immons -2- COMMONWEALTH OF PENNSYLVANIA ) : SS COUNTY OF CUMBERLAND ) I, PAUL M. SIMMONS, the testator, 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 the same instrument as my Last Will and 'Testament; that I signed it willingly, and that I signed it as my free and voluntary act and .deed, for the purposes therein expressed. 7 ~ .. Gfi..c~L ~ .L~ ~~, ~n-~rvt ~..~.y (SEAL) 7 a~u Vim. Simmons Sworn and su scribed to before me his ~{ 7 day of November, 2006. ~„~~ _ NCL~~CiAI SEAL ,, Y~ h~LI~I h!. f~ELSf~N, Notary Public ~ Notary u is M~~~~a?~i~t~u~g fro, Cu~nberian+~ Ca, ~,= ; ~. ~ ~_•,: , ;fission L~pires 3une 27, X007 COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND We, the undersigned, MARIE L. ZEIGLER and JOHN M. EAKIN, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator, :PAUL M. SIMMONS, sign and execute the instrument as his Last Will and Testament; ithat the said testator 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, of sound mind, and under no constraint, duress or undue :influence. ~ t~I?Tl~r4aAL SEAL EiEIDI M. idlELSOt~, Notary Public i~~~l~a~i~burg Coro, Cumberland Co. Car,~snai~ion fires June 27, 2007 -3-