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Home My WebLink About06-08-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Martha P Savers also known as Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW.) File Number ~ ~ c~ 65r~,~ Social Security Number 202-36-5285 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXeCUtor last Will of the Decedent dated 7/11/2005 named in the 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 (/fapplrcable, 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.) (COMPLETE W ALL CASES:) Attach additional sheets if necessary. C7 `~` r-~ ~ ~~ "~, -~ ; ~ ~ ~,r -. _ ..,_; =`~ - t ca -~ ` ._ , _. ~C~= , c. ~ ..~. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal raT#'idence at ~~ 2106 Ma fred Lane -' `-~' Cam Hill PA 17011 Borou h of Cam Hill (List street address, town/ctry, township, county, state, =ip code) , Decedent, then ~ ~ years of age, died on 6/4/2009 940 Walnut Bottom Road at Manor Care Health Services Carlisle PA 17015 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA $ 200 000.00 ) Personal property in Pennsylvania $ (If not domiciled in PA) Personal ro e Value of real estate in Pennsylvania p p ~ m County $ 2106 Mayfred Lane, Camp Hill, PA 17011 $ 200 000.00 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: S' Typed or printed name and residence ~___, ~` William E. Sayers 3200 Street Miami US/~ FL 33133 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF Cumberland 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 ~----~~ (~ ~ ~. n~ before mrethe ~ day of the Register Stgnature of Personal Repre- se- ntat Signature of Personal Representative ---- ~ r- ~~ ~? r,i c -- era C.._ 1 07 ~~ Signature of Personal Representative ~> r- ~, ~ T _~~_, <. ~) `~ i File Number: ~ ~ ~~ b~~1,0 Estate of Martha P. Savers ,Deceased t.s~ Social Security Number:202-36-5285 Date of Death: 6/4/2009 AND NOW, _~~~ c~i~ny ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented befor'eJme IT IS DECREED Te that Letters stamentarv are hereby granted to William E. Savers in the above estate and that the instrument(s) dated described in the Petition be a dmitted to probate and fi led of record as the last Willa Codicil(s)) o ceden . 9 FEES ~ Letters ......~~ Od~~ // $ ;3(~(~ RegtsterofW'1ls ;`' Short Certificate(s) ••ti-J..~.. $ ~ 02 ~ Attorney Signature: Renunciation(s) ................ $ Gc~ I ~~ ,... $ /S Attorney Name: David H. Stone Esouire /1 ~ '~ y~. S Supreme Court I.D. No.: 39785 $ .... $ Address: 414 Bridoe Street .... $ $ New Cumberland $ PA 17070 .... $ $ Telephone: 717-774-7435 TOTAL ............................. $ S~/U Form RW-02 rev. 10.13.06 hag0 2 Of 2 IOi.805 RHV ((Il/07i 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 ~~~y: Certification Number This is to certify that the information here given correctly copied from an original Certificate of De;; duly filed with me as Load Registrar. The origir certificate will be forwarded to the State Vi~ Records Office f<,n- permanent filing. JUN 5 20 egi, car 'Date Issued n~ ~ ~ _, CM 7~':7 .~ , ,,,j T C27 r 7 cw ; ~,., '_.a-rt . ~" _~ l~! -;) -~ CJ: REV tlnoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 'PRINT IN dANENi CERTIFICATE OF DEATH a,l n~ t15,-11 n CK INK (See Instructions and exam les on reverse ` P ~ .STATE FII F NI IMRFF 1. Name of Decedent (First, middle, lash sunix) 2. Sex 3. Sodal Security Number 4. Date of Death Month, da , ear) ~ ~ Martha P. Sa ers Female 202 - 36 = 5285 June , 2 9 5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, year) 7. 8inhplace (City and state or for e n country) B a. Place of Death (Check only one) Monroe Days Havrs MinNes Hospital Other 89 Yrs. Se tember 21 1920 Blain PA ^ m tiara pa ^ ER /Outpatient ^ DOA ~ yQ Nursing Hpme ^Resitlence ^Other -Specify: Bb. County of DeaM &. City, Boro, 7wp. of Death 8d. FaciRry Name (If npt institution, give street aM number) 9. Was Decedent of Hispanic Origin? ~ No ^Ves 10. Race: American Indian, Black, White, etc. Cumberland Carlisle Boro of yea, apeclty Cuban, (speciryj Manor Care Health Services . Mexican,PuenpRicanetpa White 11. Decedent's Usual Ron Kind of work done dun most of workin rife. Do not state refired ~ 12. Was Decadent ever in the 13. DecetlenYS Education (Specity onry highest grade completed) 14. Marital Status: Married, Never Marred, 15. Surviving Spouse QI wife, give maiden name) Kind of Work Kind of Business /Industry U.S. Armed Faces? Elementary /Secondary (0.12) College (1 ~4 or 6a) Witlawed, Divorcee (specl/N Wid d Homemaker Own Home ^ Yea $7~1p owe 12 16. DecedenYS Meiling Address (Street, dry I town, stale, zry code) Oecedent's Did Decedent PA 2106 Mayf red Lri. Actual Resitlence 17a. Slate Llve in a 17c. ^Ves, Decedent Lived in Twp Townshipz 17b. County 17d. ®No, Decedent Lived wiMin /••,,.,,~ Hill Cumberland ~ "O1° Hill PA 17011 Actual Limits of I C;ry, Boro 18. Father's Name (Fl midde, IasL sunix) Charles ~obinson 19. Mother's Name (Firs) mitldle maiden s mane) Mary 5'hambaug~ 20a. Iniortnant'a Neme (Type /Print) 20b. Infonnanl's Mailing Address (Street, city /town, state, zip code) William E. Sayers 3200 Calusa St., Miami, FL 33133 21 a. Method of Dispositlon rematbn ^ Donalbn 21 b. Date of Disposition (MOnM, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 2t d. Loratien (City t town, stale, zip code) ^ Bunel ^ Removal from Slate i WaeCremetlonorponatlonAuthonzedl~y ^ June 5 2009 Holli er Cremation Services ~ Mt Holt S rings PA ^ Other ~ Specity: i b1' Medical Examiner rover? p(Yea No f . Y p g f 22a. ~ of Fune ~ as such) 220. License Number 22c. Name antl Atldress of Facility Myers- Harner Funeral Home 014819 L 1 3 Market St. Hill PA 17011 Complete Hams 23e~c amy when cennyirg i il bl t ti f d h t h i h t 23a. To the best o y edge, tleaM at tlta tlrtre, date aM place slated. (SignAt re antl title) ~ 23b. Li arise Number 23c. Date Signed (Month, day, year) no ava me o p ys c an a e a as o ceniry cause of death. ~~-i/ ~ / ~' yJ •.i ~ /6 ~y~~a ~j~ 'L`j~iL L / .~ ' ~U C) c Hems 24-26 must be completed by person 24. Time of Death 25. Date Pronounced Dead (MOnM, day, r) 26. Was Case Raferretl to Medical Examiner /Coroner Io eason Other Than Cremation or Donation? who pronancas death D~ A- M. /iV/W ~ ~r~ C ^ Yes ^ No CAUSE OP DEATH (See Inatructlon rid examples) r Approximate interval: Pen II: Enter other ~ qn lkant condlions co t bLtinq to aM, 28. Did Tobacco Use Comribute to Death Clem 27. Pan I: Enter ttw chain of events -diseases, injuries, or complications - that directry caused the aM. W NOT enter terminal even ts such as cardiac artesL r Onset to DeaM but rot resulting in the underlying cause given In Pan I. ^ Yes ^ Probamy respiratory artest, or venlncular fibnRation wnhouf showing the etiology 1 only one cause on each line. i IMMEDUITE CAUSE ((Fi l tli !~' t ~ , ^ Naknown na sease or cnrrdlion resulting m deaM) _' a " v( ~f ~~~ r~ y/ ~S (WL~(~ r ~ ~~t C~d~ LG~~(t 4 29. II Fert~ale. / Due to (or as a consequence oD: / ~ Not pregnant within pall year Lm`1 Sequenualry list condiROns, if any, b to nre cause listed on line a leadin 1 ^ Pregnant al time of tleath g . Due to (or as a con uence o ~ Enter the UNDERLYING CAUSE ~7 ff~ ' r Not ^ pregnant. but pregnant within 42 tlays (tliaeaae a k9ur1' Mal initialed Rre p evens resuning in deaM) LAST r of death Due to (or as a consequence olg r ~ Not pregnant, but pregnam 43 days to t year d before death ^ Unknown it pregnant wiMln the past year 30a. Was an Autopsy 30b. Were ANOpsy Findings 31. Manner of DeaM 32a. Date of Injury (Month, tlay, year) 32b. Describe How Injury Occurretl 32c. Place of Injury: Home, Farm, Street Factory, Pedonnee? Available Priw to Completion ,--,/ l=1 Natural ^ Homicide Office BuiMing, etc. (Specity) of Cause of Death? ^ Yes [~NO ^ Yes ^ No ^ Accident ^ Pending Investigation 32tl. Tme of Injury 32e. Injury at Work? 32t. If Transportation Injury /Spea/yJ 32g. Locatron of Injury (Street, city !town, stale) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Dmerl Operator ^ Passenger ^Pedestdan M. Other . Specify: 33a. CenlNer (check ony one) nil • C rti i h ki Ph id i f d M h M h i i h h l I tl d d 33b. Sign r rid Tltle of CerRfrer ~ //, .~ / ~ / ~ y w n ty rg p ye an ( ys an ce ng cause o ea en ano er p ys c an as prorwunce an eat wmp eted tem 23) '9 _) t / C i s / ! G/.,(~~ ~gt~r , l ~ / l.L +~l l "l W'1''l To the beat of my knowledge, death occurred due to Me cause(s) end manner as smted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ' , ` ! • Prorrouncing erW tendylrg phyakian (Physnian boM pronoundng death and cenitying to cause of death) To dre best of my knowledge, death oaurced at the time, date, and place, and due to the cease(s) end manner as atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c License Number 33tl. Dale dig (M ,day, year) 1 . /~/I/~, j~ ~ . •-- / c/ J ~ ~ ~ £ • Medical Examiner / Cororrer ~ r ~ • ~ `'V J ' ~' ~ `~ / / Dn dw bssia of examinaUon and / or investlgatlon, In my oplNOn, death occurred at tM 8me, dale, end place, and due to Me causNsl and manner as slated_ ^ 34 Name antl AtldreYs~l ~ yomp~uss yl~J (Item 27) Type I Print '' (l L 35. Registrar's Si re and Disl / I ~ I / I ~ I / I ~ I 36. Date Fi M day, year) ~~ ~ ~~ (( {, ~ ( ? ~ , ~ - , ~ d~~ 7 ~, 4 ~ ~ ls~' /' ~ f r...___..__ o_._...,_ 0332529 ep\wi11s\SAYERS,MARTHA C7 LAST WILL AND TESTAMENT ~::-: 7 , OF ,~:~;=,r; ~ MARTHA P. SAYERS "~ c-,: _., i .r ; r t _-; .~ ,. ) I, MARTHA P. SAYERS, of the Borough of Camp Hill, E~am~'berla~id County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I devise and bequeath all the rest, residue and remain- der of my estate of every nature and wherever situate to my son, WILLIAM E. SAYERS, if he survives me. ITEM III: I appoint my son, WILLIAM E. SAYERS, Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, MARTHA P. SAYERS, have hereunto set my hand and seal this ~_ day of _~ u~5, 2005. ~ a. ~t,.~ ~~' , MARTHA P . SAYE` S Page 1 of 3 SIGNED, SEALED, PUBLISHED and DECLARED by MARTHA P. SAYERS, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the prese of eac o her, have subscribed our names as witnesses. t`- r W i t ~ ~ G n~.~ ,(.~.~ rJc Address fitness Jam' ~ V. c~ ~ ~ ''~~~ Address ~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ~ SS: I, MARTHA P. SAYERS, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified accordin to law do hereby acknowledge that I signed and executed this inst g ru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. MARTHA P. SAvE S Sworn to or affirmed to and acknowledged before me by MARTHA P. SAYERS, the Testatrix, this -= day of ~~ 2005. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL J CAROL L. TROXELL, Ncstary public Notary Pub 1 i c New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, 2005 Page 2 of 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ SS: We, !?~, ~ ~ ~ s'~~.~ and ~ ~ ~. t ~~;~y~}~± 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 Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and --- -~ witnesses, this ~_ day of 2005. ~_ , COr'tAMONWEALTHOFPENNSYi.VAN1A Notary Publi NOTARIAL EiE:AL C~fiGL L. TROXELt_, Notary Public l+tew Cumberland Boro, Cumberland Co. My Gommisslon Expires Dec. 27, 2005 Page 3 of 3