HomeMy WebLinkAbout05-19-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
Estate of William O. Potts, Jr.
also lrnown as
. Deceased
COUNTY, PENNSYLVANIA
Social Security Number 202-12-2491
File Number 2~ --C7~1- y`{-l ~
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 5, 2002 and codicil(s) dated NA
(State relevant circumstances, e.g., renunctatton, 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
(Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendenteltte; duranteabsentta; duran{e.~tinorttate) i-=~
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Petitionen(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spotf any) an~eirs: (1f
Admintstration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) , -~_ ~ -~s
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(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
125 Stray4;r Drive, Carlisle. Cumberland Countv, South Middleton Township, Pennsvlvania 17013
(List streetaddress, town/clxy, township, county, state, zip code)
Decedent, then 77 years of age, died on November 24, 2005 at his home
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 500.00
(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: Cumberland County
named in the
Form RW-02 rev. 10.13.06 Page 1 of 2
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicils} presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
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
before me the ~"1 ' day of
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For the Register
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Signature of Personal Representative :
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Signature ojPersonal Representative :~ :~ , ,
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File Number: ~ ( - Uc'1 - U~-111
Estate of William O. Potts, 7r. ,Deceased
Social Security Number: 202-12-2491 Date of Death:November 24, 2005
AND NOW, \ ~ 1111. ~ UO~ inconsideration of the foregoing Petition, satisfactory proof
having been presented before , IT IS DECREED that Letters Testamentary
are hereby granted to Margaret C. Potts, 125 Strayer Drive, Carlisle, PA 17013
in the above estate
and that the instrument(s) dated November 5, 2002
described in the Petition be admitted to probate and filed of recQrd~gs the last V~'il~ (and Codic~(s)~ of Decedent
FEES
Letters ............... $ 2y •VU
Short Certificate(s) ........ $ ~, ~. ,c7cJ
Renunciation(s) .......... $
~A~ ... $ ~ s . ~
~Cf? ... $ Iv •o~
~v.~CV~o.~ t Or1 ... $ S - c~
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~2.4U ~e0
Attomey Signature:
Attomey Name: Robert L. O'Brien
Supreme Court I.D. No.: 28351
Address: 19 West South Street
Carlisle, PA 17013
Telephone: 717-24-6873
Form RW-02 rev. 10.13.06 Page 2 of 2
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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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 1~045a40
Local Registrar
Nov 2 6 2005
No.
}
Date
H,05.113 Rev. 2187
TYPEIPRINT
IN
PERMANEN
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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I NAME OF DECEDENT (Fln4 Middb, Last) SE% SOCIAL SECURITY NUMBER V..een GATE OF DEATH (Month, Dey, Year)
William O. Potts,Jr. zMale 3 202 _ 12 _ 2491 ~ Nov. 24, 2005
A E (Leal Bkmdey) Y DATE OF BIRTH BIRTHPLACE (Clry end P T n
MonMs Daya Hours Minutes Mdr . QeY. Year) State or Foreign Country) HoSPrtK: OTHER:
77 rrs. YS I",.esnt ^
s. e. 1928 ,.Ligonier, PA a EMDUIp•°•"' ^ DOA ^ ~ ^ nrw.na ® is .tlrr) ^
COUNTY Of DEATH CITY, BORO, TWP OF DEATH FACILITY NAME (H not InstlWtlm, gNa sheet and number) WAS DECEDENT OF HISPANIC ORIGIN? RACE -Artlerican Indian, Bhck WNh,
No® Vaso Nyea,epedfyCuben. (SPeC,fY) White
fl Cumt3erland x5. Middleton Twp. X125 Strayer Dr. , MezTcen, Puerb Rlren, ek.
,o.
DECF~EMB USUAL OCCUPATION KIND OF BUSINESS /INDUSTRY AS DECEDENT EVER IN DECEDENTS EDUCATION MARRAL STATUS - Marded, SURVIVING SPOUSE
(clw Nne awoa aww a moN U.S. ARMED FORCE39 ~ Nsver Mxrbd, Widowed, (awx., pM mmMn mmy
er.wnp w.: a• na u ~'~red) I.nwt+.rl6•amw cease' otvarad Isr»dty)
,,.. Dentist „b. Dentistry ,2.Y"°~ "°^ ,3. (e-+=I n.arX.) 4+ ,~ Marc'ied ,S,Margaret Cochrane
D CEDENTS MAILING ADDRESS (Sheet, CXy/TOwn, Stets, Zip Code) DECEDENTS ,Ta. Stab PA
125 Strayer Dr. ACTUAL Dld ,Ta ®Vss,dsoe0eM8vedin S. Middleton ,,,~.
RESIDENCE tlecedent
Carlisle, PA 17013 (saeinahuctlona Xveln. ND dereaenttved
,fl. on ether abe) ,Tb. County Ctnnberland townm+WT ,Td. ^ wNhin edam Iimxa of Dgy~,
FATHER'S NAME (Pint, Middb, Laat) W _ Owen Potts , $r. MOTHER'S NAME (FlrsL Middb, Maiden surname)
,fl. ,s. Atlyn Ramsey
I ORMANTS NAME (TypmPrtnt) INFORMANTS MAILING ADDRESS (Street City/TOwn, Shia, Zip Cade)
Margaret Potts
2th
.
2pb. 125 Stra er Dr., Carlisle, PA 17013
M HOD OF DISPOSITION ~~ DATE OF DISPOSITION PLACE OF DISPOSITION- Name M Cemetery, Cremetay LOCATION -City?own, Stan, Zip Code
^ Banal ^ Crematbn (J,emoval born Stab ^ (Nmw, vwl or Other Plere
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2, olher(s ) ^ rb ~lov. 28, 2005 :,D YorktOWfle Crematory
York:, PA 17404
21d
' SIC, R FUNE E C E OR P RSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY f f -
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--- 22b. 014819-L z2~. 219 N. H
h ms 23a-c Dory when Denying To the beet of my knowbtlge, tleaN oxured at tM tlme, date aM place soled. LICENSE NUMBER DATE SIGNED
physidan b not avaXsbb at tkne or deeM to (Signature and Tilt) ~
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onts, Dry, Veer)
cMxy ease a death. 1]a. 23D
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It 21-26 must M cornplated by TIME OF DEATH DATE PRONOUNCED DEAD ManM, Day, Veer) WAS CASE REFERRED TO A MEDICAL E%AMINER /CORONER?
perl•on who prorwunres tleath. ib/?/'1
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es No
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27; PART I: sett tlu ab.••.•, inlu.w «eanosnuon. w,leh c•e••a tl,• ewln. m na.nwr n. wee. ofayles, •w:n •. eudtae or w.prswry •rw•V •IwNt or a..rt rlw... ~ Approximate PART fl: OMx signiflrerlt condi8ona contdbutlng to death, W11
u•e ooh •n• uuw en xeh lbw.
~ Interval Mlween not reauhing in the untleHybp reuse gWen h PART I.
IMMEDIATE CAUSE (Final J
oneet and death
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dbyaae or wndroon e. ~ L'$ 1 A~~C CG~.NCEf
raabhhp in dsetlt) -~
DUE TO (OR AS A CON6EQUENCE OF)
Saouantlary Xst mrMitbna b.
fl ally, boding to Imnwtllab DUE TO (OR AS A CONSEQUENCE OF):
taupe. Fader UNDERLYING
CAUSE (Disease or b)wy c.
• IMt kdtbted evenb OUE TO (qr A8 A CONSEQUENCE 0~:
rewlXrq on deem) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
PERFORMED? AVAILABLE PRIOR TO
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COMPLETION OF CAUSE Natursl ~ Homicide
OF DEATH/
Acddent ^ Pendbg lnveatlgetbn ^ Yea ^ No ^
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Yee ^ No Vea ^ No ^ Sukroe ^ Couk not M determined ^
pIACE OF INJURY - At home, hmti street factory, ortbe
LOCATION (Stree4 Gryliawn, Shte)
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28 . 28b. 29. 70f
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C9271FIER (Chock only one)
IGNA D CERTIFIER
•~ERTIFYING PHYSICIAN (Ph re rg caws d death when another ph ides has orenounced death and completed item 23)
o tlw Mat of my knowlatl9e. daaRl oecOrtad dw to IM eawea(s) antl manner es abNtl. ...........................
• .................................... 31 b.
LICENSE NUMBER
/ DATE IGNED fflontlt, D
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'PRONOUWCING AND CERTIFYING PHYSICIAN (Phralcbn both pronowcing death and renflying [o reuse of death)
To tM Mat of m
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eath otourtad m • Bete, date, end place, and due to iha reusn(a) and manner as shtetl ...................... 3,e !
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'MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
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(Item 7) n7ype ~t ^^ LL ` ~ (
IDn the Mms of ueminWon and/or InveaOgmion, In my opinion, death «DUmd at 1M tlma, doh, and plow, and dw to fM cwaaa(a) and ~ ,'`
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REGISTRAR'S SIGNATURE AND NUMBER ~{nI~ - _ _ fF'~a~~ ~ ~~ I- ~' I ' nI
33. 6...~ ~• \ `.a.i..+at ~L DATE FILED (Month, Dey(p,~oar)``
C~L L.LV! T
31. 1 V~V
WILL
OF rte'
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WILLIAM O. POTTS, JR. ' ~ ca ~ -
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I, WILLIAM O. POTTS, JR., a/k/a WILLIAM O. POTTS, current o~ So~lth `-
Middleton Township, Cumberland County, Pennsylvania, declare this to be ~y Last V~11
and Testament, hereby revoking any and all prior Wills and Codicils made by me. ~'
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
Provided, however, in the event that my estate becomes liable for the debts of any
child of mine, said amounts shall be deducted from his or her share set forth in Paragraph
V(B) below. If said estate liability exceeds that child's share, the excess shall be considered
an asset to be claimed/collected by my estate.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath unto my wife, Margaret C. Potts, all tangible personal property which I
own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I devise and bequeath
unto my wife, Margaret.
V. In the event that my wife, Margaret, does not survive me, I devise and bequeath my
entire estate that would have otherwise passed under Paragraphs III and IV above as follows:
A. I intend to keep with this my Will a separate memorandum
concerning disposition of certain items of tangible personal property. I
bequeath the items on said memorandum to the persons desisted.
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B. All the rest, residue and remainder of my estate I devise and
bequeath equally unto my children. If any child predeceases me, twenty
percent (20%) of his or her share shall pass unto his or her spouse and the
remaining eighty percent (80%) (or the entire share if there is no surviving
spouse) shall pass unto his or her issue per stirpes. If said child leaves no
issue, that share shall be divided equally among the shares passing unto my
other children or their issue per stirpes.
VI. I appoint my wife, Margaret C. Potts, Executrix of this my Will. In the event that
she fails to qualify or ceases to act as Executrix, I appoint my daughter and son, Heather P.
Futato and William P. Potts, III, Co-Executors of this my Will. In the event that either
Heather or William fails to qualify or ceases to act as Executor, I appoint my son, Charles
Robert Ramsey Potts, as Co-Executor in his or her place.
VII. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I, WILLIAM O. POTTSo, JR., he with set my hand to
this my Last Will, typewritten on two (2) sheets of paper i uding the estation clause and
signatures of witnesses, this .S~h., day of Alo~.-.a: , 2
SEAL)
WILLIAM O. POTT/S, JR.
Signed by WILLIAM O. POTTS, JR., by him declared to be his Will in our presence,
who have hereunto subscribed our names as witnesses in his presence and at his request,
this S~h~. day of /-la~p,., L..,. , 2002.
residing at
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residing at
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
WE, WILLIAM O. POTTS, JR., GERALD J. BRINSER and ~i'R R` ~~~-? ~-. '~oT tl
,the testator and the witnesses, respectively, whose names are signed to the attached
or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will and that he
signed willingly (or willingly directed another to sign for him), and that he executed it as his
free and voluntary act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the testator, signed the Will as witnesses and that to the best of
our knowledge the testator was at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
Subscribed, sworn or affirmed and acknowledged before me by WILLIAM O. POTTS,
JR. he testat r, GERALD J. BRINSER and ~j.4~GA~ ec7 c, PoTt.S ,witnesses, this
`~ day of~i~~"Lrn~-~, 2002.
~'~C~',D (SEAL)
N ary Public
Dolores J. MetzlerSNotary Public
Upper AHen 'Rn~p,, Cumberland County
My Commission Expires May t0, 2ppq
nAamhP,r F'P.nnSylV3ntaA,gx~~ti~nntA~p~~~;~5
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