HomeMy WebLinkAbout01-22-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of MILDRED E. KEESEMAN File Number r~ ~ ~,~ Or,~`1
also known as
,Deceased Social Security Number 185010338
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW.)
^X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTORS named in the
last Will of the Decedent dated 6/13/1986 and codicil(s) dated
JAY E .SHUMAN, ELWOOD W. STOUFFER
(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: NONE
B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d. b. n. c.t.a.; pendente lire; durante absentia; durante minoritateJ
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 was domiciled at death in CUMBERLAND County, Pennsylvania, with his /her last principal residence at
210 BIG SPRING ROAD NEWVILLE PA 17241 WEST PENNSBORO CUMBERLAND
(List street address, town/city, township, county, state, zip code)
Decedent, then 95 years of age, died on 1/10/2009 at GREEN RIDGE VILLAGE
CUMBERLAND COUNTY NEWVILLE PA 17241
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 12.000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
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:
Signature Typed or printed name and residence
_
~ JAY E. SHUMAN 151 TURNPIKE ROAD
NEWBURG PA 17240
ELWOOD W. STOUFFER 7588 ROXBURY ROAD
SHIPPENBURG PA 17257
Page 1 of 2
Form RW-02 rev. 10.13.06
((,VMCLCIC l/V ALL C,AJCJ:J ,9nacn aaatnonat sneers y necessary. ~ -~
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 and subscribed
~ 3ignatul~ of Personal Representative JAY E. SHUMAN
befcre me theme. day of ~ -
`~ y ~ C f.Ct-crUY ~~5 r.,
1'1~~C t~ ~ -~ ~-'~ Signature of PersonalRepresenta e ELWOOD W. a7XOUFFER~,
~_ Q ,,~
~ w
For the Register Signature of Personal Representative _Ti ~ _
- ~
_,
..
.. ...,
- - - .~~ -
_-~ ~J
File Number: ~ ~ ~~ ~b~~ 1 ._.._ -
cn
Estate of MILDRED E. KEESEMAN ,Deceased
Social Security Number:185010338 Date of Death: 1 /10/2009
AND NOW, JANUARY ~~ , 2009 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters OF TESTAMENT
are hereby granted to JAY E. SHUMAN AND ELWOOD W. STOUFFER
in the above estate
and that the instrument(s) dated JUNE 13 1986 __-_
described in the Petition be admitted to probate and filed of
FEES
betters ........~.a.GC~~... $ ~oU
Short Certificate(s) •••••d••• $
Renunciation(s) •••••••••••••••• $
_~ c `~ .... $ ~ ~_
~~~L- .... $ ~
.... $
.... $
.. $
.. $
.... W ~
TOTAL ............................. $
as the last Wilh~and CodicilO of Decedeni.
Wrlls
Attorney Signature:
Attorney Name: H.ANTHONY ADAMS
Supreme Court I.D. No.: 25502
Address: 49 WEST ORANGE STREET, SUITE 3
SHIPPENSBURG
PA 17257
Telephone: 717-532-3270
Form RW-02 rev. 10.13.06 Page 2 of 2
OCA~, REGISTRAR'S CERTIFICATION OF' DEATH
WARNING: it is iliegal to duplicate this ropy by photostat or photograph,
}`L'C iC1I' )hC: C~1"1 '.fIL'i'c' S(;./li) ;irr "-~:~
Z
'
~~
~ ~ ~il:llS J~ !+- l:.•ilir i}la. tlh. Iif(lli.- <lil(/lf I?U'l' L',iA'Cil I
~
%'~:
~V
~ if ~'`~
3-e',~t' ~~
,.
r ITrTCC'il~ t iil,iCC::1-t 11 i1 ili7 n Ir'lildl ~~Cl'irllC:3IC. OI Ili:~41
-
>
til~ ;. ~ ~ ~y~
o ~., zat
r;
~
~ ~)
l4Ulti" )I;elj tili)l ile :.i~ 1.Otlil 'OL_
~e)t)flcat l~i' he !~l) -~:Ir~le 1
~
~~
(~rl-ltl-. ~ht (ii'I~'lll
<• thr Slate Vit
~
;
, 4a
, ~e~+.,,d, ~~rli«
1,1,~ + 11.111
!, ,;<'.
-
P ~49~6~iJ2 , r{
~~~
~
,~
- a ~~ e~~oy
1
- -
~ e11 i~,l .;ill V 1J 17li~lt
(_~ _---
yy
~~~r,1e 1V~Ut'll
,~
_L f
-1 ~
- .,.~
-
--j ~ -
_,
,. _.
. _.l ,
_ ._; any ~
1 ,,,.- a V
.. )
_
~
~
~
ir
-' '
_~
. ~..~ r
H1Q5-143 REV fl/2006
TYPE /PRINT IN COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~
PERMANENT
BLACK INK CERTIFICATE OF DEATH
(see instructions and examples on reverse)
_.. _ ....____ '1 \ R ~~
~, f~l ,.~~
0
_._._..__...,....,~,~ .~ - ... vim., a
1. Name of Decedem (First, middle, last, suffix) 2. Sex 3. Social Security Number 4. Det o1 Death (Momh, my, year)
Mildred S. Keeseman Female 185 - 01 - 0338 Q
5. Age (last Binhtlay) Under 1 year Untler 1 day 6. Dale of Binh (Momh, day, year) 7. Binhplace (C4y and state or foreign country) !)a. Place of Death (Check only one)
xamra Day: Howe ,4m^„ Hopewell Twp. , Hospital: Other:
95 vra. NOV. 16, 1913 umberland Co., PA ^Inpa9em ^ER/Outpatient ^DOA ®Nursing Home ^Resitlence ^Oth
i
S
er.
ty:
pec
8b. County of Death &. City, Soro, Twp. of Death 6tl. Fadltly Name (d ml insl9ulion, gNe street end number) 9. Was Decedent of H¢panic Origin? ®No ^Yes 10. Race: Amerkan Nd'en, BWCk
Where
etc
,
,
.
' III yes, speuy Cuban, (SceoiM
Cumberland W. Pennsboro TW r ~ Mexican,PUenoRicen
etc
)
,
.
White
11. Decetlenl'a Usual Occ atlon KiM W work done tlur moll of worlon tae. Do not state reliretl 12. Was Decedent ever in the 13. Decetlenl's Etl n (Specity Doty highest grade wrtpleted) 14. Mamal Status: Monied, Never Married, 15. Surviving Spouse QI wile
give maitlen name)
,
Kind of Work Kintl of Business /Industry U.S. Armed Forces? Elementary / Secontlary (012) College (td or 5+) Witlowed, Divorced (Speci/)'j
Seamstress Clothin Co. ^vea [ENO g Widowed
16. DeCetlent'6 Mailing Adtlress (Street, city /tam, slate, zip code) Decetlenl's Did Decedent
210 Big Spring Road Actual Reaitlence na. sate Pennsvlvania wee
17c. {E]Yes, Decedem Livetl in W. Pennsbo*-o T
Newville, PA 17241 wp.
?
17b. conmy Cumberland p 17d.^No, DecetleM lived rr4Mn
' Actual Limits of City I Born
18. Father
s Name (First, middle, lash sWlix) 18. Mother's Name (First, middle, maitlen surname)
Eber C. Shuman Bertie E. Kohr
20a. Informant's Neme (Type /Print) ~ 2W. Intortnam's Mailing Adtlresa (Street, city /town, state, zip cotle)
Jay E. Shuman 151 Turnpike Road, Newburg, PA 17240
21 e. Method of Disposition ^ Gemation ^ Donation 21 b. Date m Disposition (Momh, day, year) 21c. Place of DLslrosRion (Name of cemetery, crematory or other place) 21 d. Locelbn (City I town, state, zip cetle)
Burial ^ Removal from State ;
Was Cremetbn or Donation AUNOrized Franklin CO. ,
^ Other-specify by Mee IEzaminer/Coroner? ^Yes^No Jan. 13, 2009 Otterbein Cemetery
Lur an Tw PA
~ 22a. a of
rat 5 rv is a rsan a ' as such) 22b. Lcense Number 72c. Name entl Atltlress m FaciNly •
rf
- ~ FD-011776-L Fo elsan er-Bricker Funeral Home PO Box 336 Shi enbur PA 17257
Camplme Items 23ac omy when cerliying 23a. T be of knowledge, death accurtetl al time, tlale and place stated. (Signature and Idle) 23b. License Number 23c. D le Si nod y ye
physidan U na available al lime d deem to ~ g (Momh, der , err)
certify reuse of death. ~ 1
hems 24-26 must be cempleletl by person
• who pronances death 24. Time of Death 25. Data ro ncetl Deatl (Month, day, year) 26. Was Case Relerretl to edical Examiner /Coroner or a Reason Other n Cremation or Donation?
. M, / ^ Ves o
CAUSE OF DEATH (See instructions rid examples) ~ Approximate interval:
hem 27. Pen I: Enter the chain o1 events - diseases, injuries, or complicalbnb - that diredly causetl the death. DO NOT emer terminal events such as ceNiac anent
On
t t
D
th Pen IL Emer other 5 d nl coM I' oN b t na 1 tl 9th, 28. Ditl Tobaaw Use ComrPoule to Death?
,
se
o
ea
respiratory artesl, a vemncular libngalion wtlhom showing the elblogy. List only one reuse on each Noe. but not resuking in the untlertying cause given in Pan I. ^Yes ^ Probably
~ ^ No ^ Unknown
_
IMMEDIATE CAUSE ((Firwl disease or r
condition resuning in tlealh) ~ 'c.-.s
~ e. O~-~ '~ C% ~. ~ 1-~,CY~Q_. i
29. II Female:
Due to (01 es a Consequence ol): ~ ^ Nol pregnant within past year
Seq emialty IM contldklns, d any, b. ~
leatling 1o the cause listed on line a. t
^ Pregnant at time M tlealh
Enter Ne UNDERLYING CAUSE Due Io (a as a consequence ol):
r
^ Not pregnant, but Dregmnl wilmn 12 tlays
(tlisease or injury that inhialed the
evens resuamg m tlealh) LAST c. ~ of death
Due to (or as a consequence ot):
^ Not pregnant, but pregnan143 days to 1 year
d. ~ belore tlealh
^ Unknown it pregnant within the past year
30a. Wes an Autopsy
Penomretl? 3W. Were Autopsy Flagngs
Available Prior to CanDlelion 31. Manner m Death 32a. Date of Injury (Momh, tlay, year) 32b. Describe How Injury Occurretl 32c. Place of Injury: Herne, Farm, Siren, Factory,
Ogice Buildin
etc
(S
ecil
)
m Cause of Death? Nelural ^ Hambitle .
p
y
g,
^ Yes ~ ^Yes ^ No ^ AccMent ^ Pending Investigation 32tl. T o1 Injury 32e. Injury al Work? 321. II Trensporlalion Injury lSpecdyJ 32g. Location of Injury (Street, dly /town, slate)
^ Suicitle ^ Contl Nol be Delertnined ^Yes ^ No ^ Dover /Operator Passenger ^Pedestnan
M. ^ONer~Speaty~
33a. Candler (check Doty one)
• CenDying phyelclen (Physical certifying cause of death when another physkian has pronouMRtl tlealh and completed hem 23) 33b. Slg al T e of Cendier
- D -
To the best of my knowledge, death accurretl due to the cause(s) entl manner es statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• P -
ronouncing entl cerlitying physician (Physician both proiwuncing death and cenilying b cause of tlealh)
To the hest o1 my knowled
e
tlealh occurred M the time
date
erM
lace
and due to the
tl
^ 33c. ~ • ~ Nu 33tl. Date Sgnetl (Momh, day, year)
g
,
,
,
p
,
cause(s) en
mender es statetl-. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical Exemlrter/Coroner ~ V ~~' (~ '- ~ (~ / Z / Q
On Ina bests of exemiralion en eslignlon, In my n, tle h occurred M the lime, dale, end place, entl tlue to the cause(s) entl manner es statetl_ ^
~ Name entl Atltlress of Person Who Completed Cause of Death gte m 27) Type / Pnnl
%. Registrar's Sgnature and strict NUm
- l•ZI( I~I~ ISI
36. Dale Filetl (Month, day, year) D. Guistwite, D.O.
210 Big Spring Rd. , Newville
PA 17291
~ ,
Disposition Permit No. 0199379 ~ -
CS'~t s`~w ~~- p.a
~-? ;''
~ --
~ i _ ' ,~
~s r, N
LAST WILL AND TESTAP~NT ; '', ~ -;
I, MILDRED M~ KEESEMAN, of 8 Mountain Street, Borough~f~Newbuzg,
~_
c.rs
land County, Pennsylvania, being o-f sound mind, menory and understanding, do
3
;make and publish this my Last Will and Testament, hereby revoking and making
f~void any and all former wills and codicils by me at any time heretofore made.
'~ FIRST. I direct my hereinafter named Executors to
pay all my just debts
and funeral expenses as soon as conveniently may be after my decease; I further
i
direct that all inheritance and estate taxes that may be assessed in consequence
of my death, of whatever nature and by whatever jurisdiction imposed, shall be
~~paid from my estate as part of the
expense of the administration of my estate.
~~ SECOND. I give, devise and bequeath all my property, real, personal and
k
mixed, whatsoever and wheresoever situate, in five (5) equal shares, share and
share alike, as follows:
~s
a:
~ 1. I give, devise and bequeath one (1) equal share to my sister, VESTA
~~BUTTS, one (1) equal share to my brother, ERNEST SHUMAN, and one (1) equal spar
P
~to my sister, STELLA STOUFFER; provided, however, that in the event either my
brother or sisters should predecease me, then in that event, I give, devise and
~ bequeath the share of my deceased brother or sister, to the child or children
of my said deceased brother or sister, in equal shares, share and share alike,
then living at the time of my decease.
~~ 2. I give, devise and bequeath one (1) equal share to be divided equally
~~between the four (4) children of my deceased sister, rLADYS ARCHANTBEp,U, to wit,
i
'T'HOMAS ARCHANIBEAU, BERTIE *~ILLER, LEO ARCHAMBEAU and LISA LE1~M9II~, in equal
shares, share and share alike, or to the survivor or survivors of then then
living at the time of my decease, to wit, either THOMAS ARCHANIBEAU, BERTIE
MILLER, LEO ARCHAMBEAU or LISA LENY~'IING, absolutely.
'~ 3. I give, devise and
bequeath the remaining one (1) equal share to be
~~
;divided equally between the four (4) children of my deceased brothex, WIL!~R
SHUMAN, to wit, DIANE KOCH, JOYCE O'HANELY, NANCY FLYNN and STEVEN SHUMAN, in
equal shares, share and share alike, or to the survivor or survivors of then ~
~~then living at the time of my decease, to wit, either DIANE KOCH, JOYCE
i0'HANELY, NANCY FLYNN or STEVEN SHUMAN, absolutel .
~I y
~' ~... ": ~ 7YO ~^ . .~„ ti.-,-t-~_ (SEAL)
THIRD. I hereby nca~inate, constitute and appoint my nephew, JAY E.
=SHLIM~N, and my nephew, ELj•VOOD W. STOUFI~, or the survivor of them then living
at the time of my decease, as the Executors of this my Last Will and Testament,
i
Amy said Executors to have full power and authority to do any and all things
(necessary for the canplete administration of my estate, including the power
', to sell any and all real and personal property of which I may die seized, at
;public or private sale, in their discretion, and without any Order of any Court;
and I further direct that my said Executors not be required. to file any Bond
in connection with the settlement of my said Estate.
IN 6~TITNESS WHEREOF, I, MILDRID M. F~ESEMAN, have hereunto set my hand
sand seal to this my Last Will and Testament, written on three (3) sheets of
5
a'paper, this 13th day of June, 1986.
i
(~ v~ ~~ ~""'=.'~ ~ f 7~ -2..i /'2JLw..~t.~ CZ.n./'~~ (S'-"+'.~)
Signed, sealed, published and
declared by MILDRED M. T~SEMAN,
the Testatrix, as and for her
Last Will and Testament, written
on three (3) sheets of paper, in
the presence of us who have, at
her request, signed our names as
witnesses hereto in the presence
of the said Testatrix and of each
other.
s r.
f 1
;fi
,-
l
7i ~
1
2
COMNIONG~IEALTH OF PENNSYLVANIA
SS
~ COUNTY OF CL~IBERLAND
~f
I, MILDRID M. KEESEMAN, Testatrix, whose name is signed to the attached or
lforegoing instrtnnent, 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.
~n~.~-mot ~ `~"~..~..,,ti..a.u.
Mildred M.~Keesenan
Sworn or affirmed to and acknowledged before me by MILDRED M. KEESII~4AN,
the Testatrix, this 13th day of June, 1986.
~~.Q/ti .
Notary Public
COMMONWEALTH OF PENNSYLVANIA ~.Isa ~. Dobbs, FIOTARY PUBLIC
SS Shippensburg. PA CUfllb~fli(Id C~urtty
COUN'T'Y OF C[JMBERLAND 1Ay commission Expires August 15, 1lti8
We, ROBERT J.YOCUM and TERESA J. BURKHOLDER, the witnesses whose names
are signed to the attached or foregoing instnanent, being duly qualified
according to law, do depose and say that we were present and saw the Testa-
trix sign and execute the instrt~nent as her Last Will and Testament; that
~.he Testatrix signed willingly; and that the Testatrix executed it as her
free and voluntary act for the purposes therein expressed; that each of us,
in the hearing and sight of the Testatrix, signed the Will as witnesses;
and that to the best of our knowledge, the Testatrix was at that time 18
or more years of age, of sound mind, and under no constraint or undue influence,
.~
~:
i GGr ~ ~ ~ a°
Robert J . ' Yo~uYt
116 East King Stre~~, ~hippensburg, PA
''
r ~ 1986.
.l.~.t_~.r1 ~ ~• ~..~. ~ l ~ ~ rt--f'ir' ~ ,;
eresa J. Burkholder
Newburg, PA
Sworn or affirmed to and subscribed before me, this 13th day of June,
Notary Public
a.1s~ ~, D~Dbs, NOTARY PU6UC
>t?enspurc N~ Cum-sAanr Ginty
~y uxnrrnsswo EExpiry AuguN tS. t~
-3-