HomeMy WebLinkAbout12-09-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cum ~ Q,l~a COUi~ITY, PENNSYLVANIA
Estate of ~A.V~ [.1 Ci. J a,m ~p~-
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COtLIPLETE A' or 'B' BELOW:)
FileNumber I -t~-'CX-~ 0
Social Security Number ~ ~' ~~
A. Probate and Grant of Lettner~ Test mentary and aver that Petitioner(s) is /are the G.JCC.(~V I Q ~ named in the
last Will of the Decedent dated !1 J r"~j zb0 and codicil(s) dated
(State relevant circumstances, e.g., renuncintioa, death ojexecuto,•, 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. Crant of Letters of Administra
((japplicabte, enter. c.t.n.,, d.b.n.c.t.n.; pendentelite; durante absentia; dura,:te mbTOritate) h.a
c:s
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sp?LCt~if any) at~eirs: elf
Administration
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.n.c.t.a., enter dale of Will in Section A above and complete list of heirs.) M
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Name Relationshi
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(CONlPLETE IN ALL CASES:) Attaclt additional s/:eels if/ tecessary. 4j ' `~
D~ec~edent,w~
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~ s~~om~' led d h in (Jm ~ ~Q.I~Gt C tat ,Penns vania wi h is /her last
a S~Uy principal residence at
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Decedent, then ll~ t/ years of age, died on ~ ~ ' ~ "t• ~~ at ~ ~ ~j~. GLYY1
Decedent at death owned property with estimated values as follows: "~Sp
(If domiciled in PA) All personal property $ ~p/ 1~-~Q , ~ ~
(lf not domiciled in PA) Personal property in Pennsylvania
$ _
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania e
situated as follows:
Where Fore, 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 T ed or rioted name and residence
,
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Forst RW-0? rev. 10.13.06 Pr3be 1 Of 2
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 14810363
Certification Number
REV 1112006
r PRIM IN
NANENT
,CK INK
1. Nero d Decedent (Rrsl, mitlde, leaf. au61x)
6. Age (Last BIrIMey) Under 1 r
kbeuw
6B Vra.
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
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
I~A V Id C ~u m Pcr 2. ~a a. sour.) Seamy Number r .. Data d Deem (Ma,m, day.
tAgx t day 6. Date of Birm (Month. day, r 7. BMlplece (C' and state a ~wumlry fie, Place d Dealm Check ony4orle) 2 5 November 24
PeYa lblxe kanulu .. .. .
&. Chy, Born, Twp. a
Cumberland ~Shippen
11. DecedenYa Usual Osd tlpn and a worx dale eah moat a wa
Kintl a Work Kmd of
Parts Mana¢er Machin
18.OarederlYa Meilvp Address (SUeeL dty /town, state, rip rnde)
121 Walnut Bottom Road
Shippensburg, PA 17257
16. Femer's Name (FrcsL nYdda, leaf, saex)
Inlomlenl'e Name RYPe /
Hay 15 , 1940 Neville , PA ^ rdpa6em ^ ER / oapatiem ^ DDA ~] Narsmg Home ^ Residarlu ^crolar - spedty:
Sd. Fedity Name (II not InsYDdbn, pve sheet entl rsvnbe~ B. Was Decedem d HLSpanic OnginT ®No ^ Yes 10. Rene: Arrericen Indian, Black, White, etc.
• (u ya^, apedy caban, (rl
Shi ensbur Health Care Center hbxican, Ppeno Rhin, etc.) White
b not aUte ~ 12. was Decedent aver in d1e 13. Deudenl's EduceYOn
/ Indus) U.S. Armed Forces? (spadN only highest grade COrllplaled) 14. Neural Selua; Marred, Never Meded, 15. SurvNi
ry Elementary /Secondary (0.12) College (1 A or 5+) Widowed, Divorced (Spwciy) n9 Spasa (II wife, gNe maiden name)
gn Yes ^NO 12
Divorced
Decedent s Did Decedent
Acdual Reaiderlce t7a. State Pennsvlvan_i a 7wov nstu ' 17c, ^ Yea, l3eudent LNed in 7w .
rv~>~erl and v. p
17b. Coon 17tl. Dfl No, Deuaent lived willvn
- aaamurmad Shippensburft c;ty/~
19. Moma's Name (Flrst, mkide, maiden surname)
21a. Matlgd d DieposNion i ~Cremalbn ^ Donation
^ Banal ^ Removal born Stele ~ Wp Crantetlon a Oomtion AuMOdxetl
Otlter - Spedty: ~ by 1Aedkal Eumkter / Coroner4 ~ vas
22a. ~igfi~re d iMer°l ~MCe Lkeneea (or person aakg es such) 22b. L
ZOD. InlcrmanYS Meiling Address (Street, city / bwn, ateN, z0 code)
328 Lake Heads Drive East Berlin PA 17316
Dais d DNpoeltlon (Mpdh, day, year) 21 c. Rau d Dlspoalbn (Name d cemetery, crematory a dMr plats) 21d. Loueon (CYy /town, state, zip code)
Nanber 22c.NameandAtldressdFadlhy Auer Cremation Services of Pennsylvania, Inc.
l 376-L 41 J e
wnpiwvlrems l3aq aYy Wien urYMn9
phyeiien is not avaikae at lime a Beam b
uddY uuae d d„Bi.
bans 24.26 must be arrpleted W pason
who prapuxws deeM. 23a. To mg6e9t of my death occurtetl al Jthe.tk,ne, date aM
l~/V/JI/r{Y^I Place sated. (SlgnaNre and tAle)
our Ir.-ALA
24. Tku d Death 26. Dale Pmloutcetl Deatl (Mash, day, ye^a~r) Mp
O9. Sd A• M. Novcmbcr ay g1Wg ~ 1
23D. Llurge Number
f~ // 23c. Date Signetl (Month, day, year)
R N 517 $ / b- IL I I I ay l o $
26. Was Case Relamed to Medkal Examiner /Coroner for a Reason Other Than Cremation or Donation?
^Yea
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CAUSE OF DEATH (See InatnwUOne erxf ezempbe)
Item 27. Par) I: Enter me rbein d awms - diseases, njudea, a campYCapona - that rorec0y ausetl IM death. DO N0T ante temYnal evade such as cerdac ertasl l Approximate Interval: Pan II: Enla other
r
26.Oitl Tobacco llse ContnDule to DeaM7
,
respirelory 8RB51, or VerIDIg11Br 6brYlai10r1 wldloUl Sfxnvllg the elpbgy. List Ot11y Orl@ cause art 9a0h ear. r Dn$et m Deets bN 1101 feaaYFlg m Ma a11dBlly{rlg CBU9e gwen in Pan I. ^ Vas ^ Pfpbably
IMIYEDIAiE CAUSE fFklal diueee w
mrxlYiarl reullkp M ) ~ a ~ ' r
r
t
^ No [] Unknown
Due b (a as a consequence oQ.
i 29. If Female:
^ Nd prepunt wadn past
ear
~ carldtlorr Y ~ ,
trues YeYd on Yr1e a. b'
D r y
^ Pregnant a1 ikne d tleam
ue to (or as a ansequax:e a):
6Ya L~Ya~C1AaUdSE~ c
suede reaullkq m death) LAST. r
r ^ Not Pregnattl, Da pregnant wilNn 42 tlays
d Due to (or ore a cIXlBequenu og.
; of deaM
^ Na pregnaN, Wt pregnant 43 days l0 1
ear
r
30e. Wee n Aa
WsY 30b. Were Mnopay Fkldrlga 31. Maurer d DeaM 32e. Dale d Injury (ManM, day, Year) 32b. Describe How Injury Occurred
PManNd? Avaeaae Pdor m Canpletlon y
balsa death
^ Unknown it pregnad wIMk1 me past year
d Cause of DeaM? .117 Natural ^ F{omicida 32c. Reu a Injury: Home, Ferm, Street, Faaory,
ORaxt Builtlkg, ac (Specityl
r~/~
^ Yes ty.+ro ^ Yea ~ ^ Acdderu ^ Perking Immd'gatbn 32d. Tnu d Iryay 82e. Injury M WorkT 321, Y TreIKpalalpn Iryury (SpedtyJ 32g. Location a Injury (Street, dY /tam, state)
^ Suidde ^ CouM Nd he Datermiled ^ Ves ^ No ^ Dmar / Cperela ^ Passenpar ^Pedeslnan
33a. Certl6ar (d1erA aYy one) M' 0111er - Spea/y:
CKtBYi^g pDysbhn (Phyaiaen urYlying terse d deem when another ' '
Physxaan has pralounced deem entl completed hem 23)
t
lM b 33b. SlgruMe one Tdb a CMYIx_
-'" ~ ~ /
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o
est a m
Y ,death occumd do to the nuee(s)end mennerr ehted_"-' ~
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• Prdqunang end certHying physklen (PhyNcien bah pralar~cing deaM aM urYtykq to tetra of deem) '-""""'-"" ;'
To tM beat d mY ktsowledlN, dseM occurred et dte time, dab, end ace, end due to tM tau
W se(e) entl manner ea eMled_
• MedkN Ezemll»rlCoroner
_ _ _ _ _ _ _ _ _ _ _ _ _' ^
"' ~ L' umber -
~l 33d. Signed (Monts, tley, year)
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On the bests a exeminedon entl I or I
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gedon, M my oplnbn, tleath occurred m the 0ma, date, end phu, end due to the uuss(a) end manna as eleted
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_ 34. Name end
A
ddress of Person WTo Carplet G d Death (Item 27
T
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36. Regis s
36
Date FI (M
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DisonsYbn ParmH Nn n'2nono7
H
LAST WILL AND TESTAMENT
OF
DAVID C. JUMPER
I, DAVID C. JUMPER, of 40 Colonial Court, Cumberland County, Shippensburg,
Peiulsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking all other wills
and codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral expenses, including my
grave marker, shall be paid from the assets of my estate as soon as practicable after my decease.
SECONTi: I give, devise and bequeath the residue of my estate, of every
nature and wherever situate, to my Daughter, Tracey S. Withjack, providing she shall survive me
by thirty (30) days.
THIRD: I direct that alI taxes that may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary
estate as a part of the expense of the administration of my estate.
FOURTH: I nominate, constitute and appoint my Daughter, Tracey S.
Withjack, Executrix of this my Last Will and Testament.
FIFTH: I direct my Executrix and her successors shall not be required to
give bond for the faithful performance of their duties in this or any other jurisdiction.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Tes~t{ament, consisting of tw~2) typewritten pages, each identified by my signature, this
~_ day of ,~,¢;2 , ~~?0~9 ~ .
(SEAL)
Davi C. Jumper
Signed, sealed, published and declared by the above-named Testator, David C. Jumper, as
and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
QJLQ.~
W' ness
Witness
Date:~'~-Q~
Date: 3-13' U4
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND
I, David C. Jumper, 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 instrument as my Last Will and Testament; 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 David C. Jumper, the Testator, this
_~3 -day of ,~A..-~_~~. , ~.
(SEAL)
Notary Pu is
tdoewhl eeof
Li~J.,l~ntper. NntAryt Punic
C~Ir111118~10,~ QrnbMrd ODtnly
M~/ ~orenYeeion E,c~nes J-iy 23.2006
Mener. ~ ~ea~w+a -uoww
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND
We, ~ f ~ ~ and S ,the
witnesses whose names are signe to e attached or foregoing instrument, being d ly qualified
according to law, do depose and say that we were present and saw Testator sign and execute the
instrument as his Last Will and Testament; that signed willingly and that he executed it as his
free and voluntary act for the purpose 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 that time 18 or more years of age, of sound mind and under no constraint or undue
influence. G~
Sworn or affirmed to and subscribed to before me by
and _~~~.~ ~ `/pc.,,/ ,witnesses, this / ,~-~C day of
2004. -~--
(SEAL)
_ ~ ,Witness
(SEAL)
Witness
'~
Not Pub '
O~r~ J ~~ ~Y PuOic
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