HomeMy WebLinkAbout07-01-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Thelma V. Cassidy File Number ~' ~ ~ ` ~~ ~ `~
also known as Thelma Vir. inia Cassidy
Deceased Social Security Number 199-03-6069
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW.)
Q A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXeCUtor named in the
last Will of the Decedent dated 10/22/1993 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: Renunciation by Marie Laybourn
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 / haver ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
d r]w.iv.ioirnFinn n f n nr ~ ~7 » r f A ON}OY /ll7tP of Will in .4ectinn A nhnvP and c~mnlete list ofheirs.) ~.1
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 101 North
Prince Street Shippensburq PA 17257 Shippensburg Borou Cumberland County
(List street address, towrx/city, township, county, state, zip code)
Decedent, then 88 years of age, died on 6/13/2009 at
Chambersburg Franklin Countv PA 17201
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 10,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 0.00
NONE
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
,, Arthur Shimkanon 408 Kara Way
hi ensbur PA 17257
Page 1 of 2
Form RW-02 rev. 10.13.06
(COMPLETE INALL CASES:) Attach additional sheets if necessary. ~~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ;
SS
COUNTY OF Cumberland
The Petitioner(s) above-named swear(s) or ai~irm(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 ~ day of
For the Register
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Signature of Personal Representative ~ t.-.. ` ~: ~ ,a
Signature of Personal Representative rT m Cif ;;.•,,
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Signature of Persona! Representative ~ C7~ ~ ° • + ~
File Number: ~~ ~ dG ~-~~ 1 ~'
Estate of Thelma V. Cassidy ,Deceased
Social Security Number:199-03-6069 Date of Death: 6/13/2009
AND NOW, ~ , 200_, in consideration of the foregoing Petition, satisfactory proof
having been presented fore me, IT IS DECREED that Letters Testamentary
are hereby granted to Arthur Shimkanon
in the above estate
and that the instrument(s) dated October 22 1993
described in the Petition'be admitted to probate and filed of record as the last ill (and Codicil(s)) of Decedent.
FEES
Letters .............................
Short Certificate(s) • •
Renunciation(s) ••••••••••••••••
....
C.f~ ....
$ ~S -C~
$ ~ In ~ ~..~
$ ~'~
$ ~~-~
$ .~
$ ~'~
$
....
....
$
....
$
....
.... $
.... $
TOTAL ............................. $ -
gister of Wills v V
Attorney Signature:
Attorney Name: H Anthon~Adams
Supreme Court I.D. No.: 25502
Address: 49 West Orange Street Suite
ShiQpensburg
PA 17257
Telephone: 717-532-3270
Form RW-02 rev. 10.13.06 Page 2 of 2
lOS.805 REV (01/07)
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 15663537
Certification Number
1105.113 REV 11/1008
TYPE /PRINT IN
PERMANENT
BLACK INK
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This ~ 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 fo e anent filing.
616.0
egistrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS ,,.~ CXJ
CERTIFICATE OF DEATH ,T~.-
(See instructions and examples on reverse) STATE FILE NUMBER t n
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1. Name d Decedero (Few, nridde, met, sul8z) 2. Sez 3. Sodsl Security Number 1. Dab d Death (Mmth, day, year)
Thelma Vir inia Cassid Female 199 - 03 - 6069 June 13 2009
5, /~ ((aq Bktlrdey) lJrtdet t Under 1 6. De1e d Binh .dry, 7. end tlwe or coed) Ss. Pence d DeMh (Cbedc arty one
warn
t>•ya
tldae
waaw
S0.tt]]a~GOrl Trap.
-~ Odrer.
88 Yn. Jul 26 , 19 20 Frtank7;n op. PA ®mpetmm ^ ER / outpelied ^ DOA ^ Nureirrp Floors ^ ttesiderce ^odrw • SPactiY:
8b. Couey a( DesM rk. Ctiy, Boro. Twp. d D»M 80. FedNry Nsme (ti nd krtiNlibn, plus tlrsM end nurtibw) 8. Was Decedent d Hispanic Orfpin? ~ No ^ Ye 10. Race: American mden. Bmdc, WNm, etc.
(ti yog. Wed1Y ~. ISPe~Y)
Franklin ~
Chambersbur
Chambersbur Hos ital - Mardcen. Pusno Rican, etc.)
Wh to
1t. 0eoeded'e lkud d work d one most d INe. Do rest omen M 12. Wao Deosdern war h the 19. Dsoedwdh Eduatbn (Spedly only hipMat grade comp mterl) U. MBnW : Monied. Never Married. 15. Survivkrp Spa
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' we (h wih, pNe maiden rrerrr)
Kind d Work Kkd d Buekre» / krdretry U.S. Amred Forces?
EMrrrwitsry / Secardery (0.12)
Copepe (1-1 a Sa) Wk
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rorca
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Seamstress U-Wanna-Wash Froc ^Y•a ®~ 9 Widowed
's•°.ce°w,raMe~npAed"ee(s~'a'rm'/bw"',m''zIV°°de)
Prince St. #5303
101 N °.ad°'>r' Penns lvania L°NemD°ad.nt
"`•^v»'°.o°ae'"L"ed" Twp.
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Shippensburg, PA 17257 TowneNp?
nb.ca,ntyCumberland 17d•®,~~dL"edwM1"' Shippensburg ~y/~
18. FetMr's Name (Firw, middle, met, suMb~ 1g. MoUrwk Name (Pint, niddo, rrrefden oumeme)
Arthur Elsworth Helm Pearl Elva Kelly
20e. kdorrnero'e Nwne (Type / Prkd) 20b. kdormeM'o Mdlkp Address (Stioel, dN !lam, amts. zip code)
'Arthur P. Shimkanon Sr. 408 Kara Wa Shi ensbur PA 17257
21 e. Madrod d Dmpatiim ^ Cremation ^ Darotim 21b. Dde d DmpoeNm (bbnfh. day, Yaw) 21c. Plea d Dmpoetibn (Nome d »mebry, aemdory a otirer pmts) 21d. Location (Ltiry /town, pate, code)
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^ other-~Hy.• tMa c~a~on o- Don.tion Awnat»a
MMedmNEzemlrrr/Corarw? ^Y»^No
June 18 2009
Cleversbur Cemete amp
on
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Sou
Cumberland Co. 17257
22a. Sipnetun d F tberreee a acYnp s orcfi) 22b. License Number 22c. Name end Addre» d FadBty M
14831-L Fo elsanger-Bricker F.H. Inc. PO Box 336 Shi pensburg, PA 17257
Compute ady aAren 23a. To ter bok d my mwwledpe, death acurnd M the ' , dwe pence amend. ( end tltie) 23b. Lk»nee Nurr~sr 23c. Dale Signed (Month. day. year)
ptryoicmrr m nd welebm r, time d d»tir b ~ ~
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21 21. Time d DeMh 25. Dom Deed Morrr, day. y»r) 28. W~ Ca» Retenad Medkrt Ezsminer l Corarrr tar Reoom Other ttwr Crwnotbn a oonstion?
Dronaria dab
w a ~1'~ p~.17 M. ~ ~ 3 0~ ^ Yes ~ No
CAUSE OF DEATH (See InstrueNono and axemplao) r ApproskrWe iraervel: Pad 8: ErMer otirw 28. Did Tdrtrxo Use Caerrbum b Death?
Imm 27. Pan k Edw the - dfeaetas, . a oonpticetiorre - thtl dkedly caused the deagr. DO NOT enter termmN suede ouch ea ardent wrest, r OrreM b Death bd not resutiinp in the urrderlyitrp auee given m Pwt 1. ^ Yes ^ Probably
npkabry enec6 a veddarmr tibrAltlbrr wMhaA olawMp the etblopy. Lent ody ar Woos m each Ikie. ~
r 8 No ^ Udoawrr
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Net corrdoions, tl r
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Due ( » ~ ^ Not pregrreM, but prapned witlrln 12 days
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Due b (a ae a coneequerra oQ: i prepgrd 13 des b 1 r
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^ Unknovm N pceprurd witMn the peal yew
3Da. Was en Aukyey 30b. Were Autopsy Fkaticgs 31. Merorer d Deattr 32a Date d k(rry (Modh, day. yew) 32b. Oeacrilre Now injury Ocaxred 32c. Place d kNceY: Flame, Fenn. 91ree1, Factory,
Once BuYdkrg
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Perlorrtred? Avatieble Prbr to ConpMBon
d Cause d Dsatfr7 r~ .
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^ Yea [~NO ^ Yes [~Ffo ^ Acdderrl ^ Perrdirq Irwsdfpetion 32d. Time d Injury 32e. mMsy al Work? 321. M Tnrwponetiorr Injury (Spedly) 32p. Locrion d 1MaY (Street, dry I k„wr, slam)
^ Suidde ^ Cor/d Nd be Demnnkrd ^ Yes ^ No ^ Driver I Operator ^ Possergw ^Pedeafrmn
M Otirw • Spedly:
33e. Cw1Niw (dradc any one) 3~. Sipnelutg and TiBe d ier
• cermyk,p phyeiderr (Phyeiden anNykg cause d deadr when arrodrer ptrysYden has prarocercred deatir and comported tiem 23)
To Me best of my krrowledP, deedr occurred due b Hre ceuee(s) and rnenrrer » netad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _' _ _ .. _ ^
• Pronounckrp orrd annylnp phyeblwr (Physkdwr bah prorarurdrtg death and artitymp to aces d death)
To the beat of my knowledge, deNh occurred al the time, deN, end place, end due b the eeuoe(s) end mwrner ee s1Ned_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Medkal Eswdrrw / coroner 33c. Number
~~ U J 3 a d ~ " ~ 33d. Date .day, year)
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lM the bum of eaemirntfon and / a Inveellgetbn, in my Mon, h occurred at the time, dsle, and pmrx, end due to the awe(s) end manner» sMed_ ^
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3/, Nerve and Address d P rem Who Compl//et~red Causo d Item 27) Type /
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35. Registrar's SignaWre and r 38. Filed (Mmth, day. year) ~~ ~jv~
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Dispostibn Permit No. `Lei`' ~ S i] 9
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RENUNCIATION
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
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Estate of Thelma V. Cassidy ,Deceased
I, Marie A. Laybourn , in my capacity/relationship as
(Print Name)
testatrix and daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Arthur P. Shimkanon
~7 0
(Date)
(Signat e)
17577 Lake Park Road,
(Street Address)
Boca Raton, FL 33487
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciatio for the
purpo stated within on this 7 ~ day
of ,
..
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oath COSNho~~~~~~~~~t~o~i+fsion.)
Notsnsl Seed Pubes
H. Anthony Adams Notary
Shippensburg Boron Cumberland My
My Commission Expires May 31 ~ 2010
s~
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LAST HILL AND TESTAMENT
I, THELMA V. CASSIDY, being of sound mind, memory and
understanding, do make, publish and declare this my Last Will and
Testament, hereby revoking all prior wills and codicils made at any
time before by me.
FIRST: I direct that all my funeral expenses and just debts
be paid as soon as practical after my death.
SECOND : I give and bequeath my car and any and a 11 j ewe lr. ~~ of
any nature or kind, to my daughter, Marie Laybourn.
THIRD: The rest and residue of my estate, be it real, mixed
or personal whatsoever and wheresoever situate is to be sold and
divided equally between my son, Arthur Shimkanon and my daughter,
Marie Laybourn, per stirpes.
FOURTH: I nominate, constitute and appoint, my children,
Arthur Shimkanon and Marie Laybourn, to be the Executors of this,
my Last Will and Testament.
IN WITNESS WHEREOF, I, Thelma V. Cassidy, to this my Last Will
' ~da of October
and Testament, set my hand and seal, this ~ y ,
~~,~
c~ ,~.
is 199. --~-
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r' , . -~ --- („r' - _, .~-~~ ~`' FAT,
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T ie a V. Cassidy
t F , ~ ,y ..,...J (...~ . ~, 3 ~s
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Swof~ to and subscribed, declared and
published by Thelma V. Cassidy, as
her Last Will and Testament, and so 3 _
done in the presence of we the ,n
witnesses, who sign at her request, -~
and in her presence, and in the ~ ~,
presence of each other . ~.-
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COMMONWEALTH OF PENNSYLVANIA:
•SS
COUNTY OF CUMBERLAND •
I, Thelma V. Cassidy, whose name is signed to the 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; and that I signed it willingly; and that I
signed it as my free and voluntary act f the purpose therein
expressed. //, •
G~;
T e a V. Cassidy
Sworn to and acknowledged, before me,
by Thelma V. Cassidy, the Testatrix,
' s ~~ day oiF Octok~Pr ; 19 9 3 .
.. ~~TA~~A~ SEAL
AA~dN MAR1E SHOOP, Notary Public
Notar b is ghipp~nsburg, Cumberland Co~nty, PA
y My ,~~,~-~;~i;sio~`t E~p3~as Feb. ,.~, 1996
,,,.~,w..._..,
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
We, H. Anthony Adams and Sharon Coleman Adams, the witnesses
whose names are signed to the foregoing instrument, being duly
qual.if ied according to law, do depose and say that we saw the
Testatrix sign and execute the instrument as her Last Will and
Testament; that she 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, and that to the best of our knowledge and the
Testatrix was at the time at least eighteen (18) or more years of
age and of sound mind and under no c~-~nstraint or undue influence.
~. ~n
~` ~G~i~ ~..c~./ , ,,~~~.~ti.~./
. u..-,c.. ~~Yv
aron Coleman Adams
Sworn to and subscribed before me by,
H. Anthony Adams and Sharon Coleman Adams,
t'tle witnesses, this~~--~~lay of October, 1993.
y.
Notary Pu d is
l~10 A Ad" ~No~tary Public
DAWN MARIECu gland County, SPA
Sh~ppensburg : ~ , 9