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HomeMy WebLinkAbout09-01-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Dorothy A. Sawyer also known as n/a Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) COUNTY, PENNSYLVANIA File Number ~/ ~ L'J Social Security Number 202-20-1974 ®/ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Executor last Will of the Decedent dated February 19, 2004 and codicil(s) dated n/a (State relevant circunsstances, e.g., renunciation, death of executor, etc.J 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 (If applicable, enter: c. t. a.; db.n.c.t.a.; pendentelite; duranteabsentra; duranteminoritateJ 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.) ,-~,~ 'c-~~,, __ c-.y ~ Name Relationship Resideri~e ?""" ~ __ "TJ r.. `e ~ r l (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~-a =-~ .~ v _ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at_ 's 312 Fourth Street. Summerdale. Cumberland County. Pennsvlvania 17093 (List street address, towrv/ciry, township, county, state, zip code) Decedent, then 80 years of age, died on March 29, 2009 at Sumterdale, Cumberland County, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 9,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ ([f not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 100,000.00 situated as follows: 312 Fourth Street, Summerdale, PA 17093 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 forrn to the undersigned: or printed name and residence `J: Michael L. Sawyer 405 High Mountain Road Shippensburg,PA 17257 named in the Form RW-02 rev. 10.13.06 Pa~Te 1 Of 2 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 -~ ~ day of ~1:~C~~Jt L ~ r ,, For the Register Signature of Personal epresentative - - ' .~ ~ ~ - ~~ ~~ _~ Signature of Personal Representative `~ ~~ ~ ;:~, _. ~,_ -~ -. ~,-~-'~ - Signature of Personal Representative -_ ~ ~ _._. `~ .. File Number: 2 i - t_.~'~ " Ci~S i ~ Estate of Dorothy A. Sawyer Deceased Social Security Number: 202-20-1974 Date of Death: March 29, 2009 AND NOW, ~ ~~`. I , ~, in consideration of the foregoing Petition, satisfactory proof having been presented be re me, IT IS DECREED that Letters Testamentary are hereby granted to Michael L. Sawyer in the above estate and that the instrument(s) dated February 19, 2004 described in the Petition be admitted to probate and filed of record as the last Wi (and Codicil(s)) of Decedent. FEES `' ` '~ L'l. ' ~ C Letters ............... $ ~~~ ~~~,.~ _ Register of Wills Short Certificate(s) ........ $ ~~ Ci~-% Attorney Signature: ~~ Renunciation(s) .......... $ Attorney Name: Mark W. Allshouse, Esquire ~~~~ • • • $ Ali ~L~ Supreme Court LD. No.: 78014 ~~""c` ~~`~ ~ ~` ~ ~ ~ ~ $ ~ ~~ 4833 S rin Road $ Address: P g ... $ Shermans Dale, PA 17090 ... $ ... $ $ Telephone: (717) 582-4006 ... $ TOTAL $ ~LL -4~~ ~0 Form RW-02 rev. 10.13.06 Page 2 Of 2 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: {t is illegal to t~upli~:ate #his copy by pi~otos#at or photoy~aph. • cC If.:~ fj11~ CCt.tllipl. "~Cr,l)1! '' t~~ZH ~1G ~A'.."'\ "~ ~ ~" 9 „ Z v'p~~'~'n NT Qt~~~~~tr, }llS Iti Ct) Ctf'11'.`. '1'.Ll? it?t~ Ililt?I~iilk.?IUiI 'ITC ~'11~1' C( 1lYCClI C(°I~1~'li'I -11 ti!1 (fl~lll.Ll ( '!~It?'Ct!fC ttl l>tat[1 cit(1~ (il~i1 ~~I[h ;;~, <~~ I 1~;' }2~ ~I.Irar. T,~r t~il~rtnaf :~.1tIfIC1U' h~ll~ IiNt 1:ICa h il].° .'+l~Uc° ViS;,l R>rrtlyds (ilt ~_ ~r)~t uiu~t illul REV 11/2006 PRINT IN AANEN7 CK INK L<irY( 1~~ ~i~trar 17~tti° I;suetl r...1 ~~ _ E_^~ - ~1 ~ ;_i _ti ~_ ~, _. ~ , ~,..,. r-' t Ji . - .~'_ ~i - ,`~ :',9 I - al -_-1 -' ; COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBER 1. Name of Decedent (First, middle, last, sulliz) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) g2 202 -20 L1974 March 29,2009 5. Age (Last Birthday) Under 1 year Under 1 day fi. Date of Birth (Month, day, year) 7. BiMpace (City and state or loreign country) 8a. Place of Death (Check only one) Months Deys Hours MNNee Hospital: Other 80 Feb. 17, 1929 Harrisburg,PA Vrs. ^ Inpabent ^ ER /Outpatient ^ DOA ^ Nursing Home Residence ^Other ~ Sped ~. N Bb. County of Death ec Ciry, Boro, Twp. of Death Bd. FacBiry Name (If not inslitufion, give street end number) 9. Was Decedent of Hispanic Origin? No ^Yes 10. Race. American Indian. Black. While, etc. Cumberland Summerdale 312 Fourth S t . Of yes, spacity Cuban, 1S~eyiryp e W[11G Mexican, Pueno Rican, etc.) 11. DecedenYS Usual Occu tan Kintl of work tl one dunn most of worki INe. De not stale retiretl 12. Was Decedent ever in the 13. Decedent's Education (Specify only higMSt grade compl eted) 14. Marital Status: Married, Never Married, 15. Surviving Spo use (If wife. give maiden name) Kind of Work Kind of Business / Intlustry U.S. Armed Forces? Elementary /Secondary (0-12) College (t-0 or 5a) Widowed, Divorced (Speci/y) qualit control packaging ^Yes No 9. widowed 16. Decetlent's Mailing Adtlress (Str9el, city /town, state, zip cotle) Decedent's Did Decedent Pennsylvania 312 Fourth S t . Adual Residence 17a. Slate Live in a 17c. ^ vas, Decedent Lived in trop. mwnamp? PA 17093 d l 17bceanty Cumberland 17d~AOi °~mis'p~°edw""ingummerdale a e, Summer a c;,y,Bn,n 18. Father's Name (First, middle, last, suaix) 19. Mother's Neme (First, mitltlle, maiden surname) Richard Reichert Marion Arnold 20a. Informant's Name (Type I Print) 20b. Informant's Mailing Address (Street, dry I town, 5181e, zip cotle) Edward J. Sawyer 312 Fourth St.,Summerdale,PA 17093 21 a. e(hod of Disposition ^ Cremation ^ Donation 21b. Date of Disposdion (MOnM, day, year) 21c. Place of Disposition (Name of cemetery, crematory or oNer place) 21 d. Location (Ciry /town, state, zip toilet Burial ^Removaltrom5late ba o~uthodzed ~ a l e t April 1,2009 Rolling Green Cemetery Camp Hi11,PA17011 / ^Yes^Nd dica Examrer o M C nature of Funer a Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Faaliry FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemo ne P.A 17043 pate Hems 23ac ony rotten cedihying 23a. To the best o n7 ledge, a occurred at the time, date and place stated. (Signature and Nle) 236. License Number 23c. Date Signetl (Month, day, year) physician is not availaNe at time of death to Q „ / ~ . / r a J ~/ comfy cause of death. /G/l/ ~ / /~f J a J o aeme 24-26 must ce competed by person 24. Time of Death 25. Date Prorarxxed Deed (Month day, year) 2fi. Was Case Relerred to Medical Ezaminer /Coroner for a Reason Other than Cremation or Oona(ion? who pronounces deaM. ~ M. ^Yes o CAUSE OF DEATH ( e Instruetlons and examples) r Approximate interval: Pan II: Einar odrer significant contlitlons contributing to tleam, 28. Did Tobacco Use Contribute to Death Item 27. Pan I: Enter the chain of events - diseases, injudes, or cgnpfications -that directly caused the death. DO NOT enter terminal events such as caNiac arrest, r Onset ro Death but trot resufiing in the untledying rouse gNen in Pan 1. ^Yes ^ Probably respretory anent, a ventricular fibnllatbn wAtwN showing the etiology. List ooh/ one cause on each Ilse. ~ ^ No ^ Unknown IMMEGIATE CAUSE Final disease or ~ n • A ,- \ ,, ~y~~~ condRlon resrAdng m ~ath) ~ a. ~ (~t.~/V W ~- V~/I V t D ~~- ~ n I~ n ~ e.r ~ Q ~ ~ r r "•'Jr ~ 29. II Femole. ^ bT r Due to (or s a IZrosequence oft: Not pregnant wilh~n pass year L \ Sequential list condiliars, if any, b. d ~' y~ ` ~'~l7 ~~-,S' 1/J -- - - _ ~ ^ Pregnant at lime of death leading ro the cause listed on lire a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): ^ Not pregnant. but pregnant within a2 days (disease or ifryury Inat initialetl d1e c i r m d ath) LAST t fi of tle91h . even s resu ing e Due to (or as a consequence oq: r ^ Nat pregnant, but pregnant a3 days to I year d i bebre death ^ Unkrwwn if pregnam within me past year 30a. Was an ANOpsy 30h. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Manlh, day, year) 32b. Describe How Injury Occurretl 32c. Place of Injury. Home, Farm, Street Factory. Pedametl? Available Prior to Completion ^ Natural ^ Homicide OXice Building, etc. (Speciy) of Cause of Death? ^ Yes ^ No ^Yes ^ No ^ Acddenl ^ Pending Investigation 32d. Tine of Injury 32e. Injury al Work? 32f. II Transportalbn Injury (Speak) 32g. Location of Injury (S1reeL city /town, state) ^ Suicide ^ Could Not be ~Detennirred ^ vas ^ No ^ Driver I Operator ^ Passenger ^Pedestnan M ^Other~ Specfy: 33a. Certifier lcheck only One) 33b. Signature and Ti le of Ce ter • Codifying physician (Physician cenilymg cause of death when another physician has pronounced death and mmpleletl Item 23) - ~ / , 1 To the hest d my knowledge, death occuned due Io the cause(s) and manner as ataled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ' • Pronoundng and cenifying physician (Physician both pronouncing death and certifying to cause of death) To the best of my krrowledge, death occurred at the tune, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number 33tl. Date Signed (Month, day, year; rn e oS3 'Z Z ~ (- 3 ~ 3 , ~yG / • Medical Examiner/Coroner On the basis of ezeminalion and 1 or inuestigatlon, in my opinion, tleelh occurred at the time, date, and plain, and due to the cause(s) and manner as stated_ ^ L~ 39 ryame Address of Person Wt w Comple te d C a us e of Death (Item 27) Type /Porn an tl nature aM r 7 Si Re 35 38. ale led (M th, tlay, year p l ,i ( ~, n ~ ~ , ~ ~ " D -1 ~ r ~ ~'"-k ~ lrV w• ~~ ~ / ~ f l g g . L I I I I I j! ~~ /UD~ ~' ~~ll COY ~l ~ - . . ., ~ l l - 11 w Diaroaitfnm Pernll Nr. ~ 33 a `~` v 8 WILL OF DOROTHY A. SAWYER I, Dorothy A. Sawyer, of Summerdale, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after mys~._., ~~., death. ~-' u ~~~ . -~ ~,;. _ ,;~ ,y~ 2. I direct that all inheritance, estate, transfer, succ~~n `~' - lr.'3 and death taxes of any kind whatsoever which may:-:fie ---~ payable by reason of my death shall be paid out p~=Li~,y residuary estate. - _~ ~'" t~ . , 3. I direct that my entire estate be distributed as follows: A. I leave everything to be distributed equally to my sons, Edward Jay Sawyer, Tom J. Sawyer and Michael L. Sawyer. Should Edward Jay Sawyer, Tom J. Sawyer or Michael L. Sawyer, predecease me, their share shall lapse and go the surviving sons. 4. I appoint Michael L. Sawyer as Executor of this my last Will. Should Michael L. Sawyer predecease me or cease to act in such capacity, I appoint Edward Jay Sawyer as my alternate. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 IN WITN SS HEREOF, I have hereunto set my hand this day of ~ : -~~ , 2004. ., ,.. c.-t '~~. Dorothy A. S yer The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Dorothy A. Sawyer, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. r NESS ITNESS LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania County of Cumberland ss I, Dorothy A. Sawyer, the testatrix, 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; that 1 signed it willingly and as my free and voluntary act for the purposes therein expressed. , r F~ DOROTHY r .SAWYER ~j f Sworn to or affirmed and acknowledged before m~by DOF~,QTH A. SAWYER, the testatrix, this f ~ ~` day of ~~""" /~ . ~, , 2004. ,rG ~~ ~~ a NorAI~IAL~AL N tary Public/A rn STEPHEN J. HQC~C~, ;~"t?TARY F~17Si.tC cARLISL>reo>~~ `~a:'~cR~"N°C°"Pa FFIDAVIT COMMIS IbtdEM%~t~~'" '~PTEMBER&Z005 ~yl~~ ss County of Cumberland We, ~_L~c^~...~r7~C~~'~~~'"and ~~+~~ v ~y~~3'bL~~the LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of so ~ d mind and undeppr no constraint or undue nfl nce. Swor or affirmed anti subscribed to before me by witnesses, this ' ~' ay of -,,~,,~~''.-~~~?~!~~, ~ ,,~, ,. ~'f,~'' Notary Public/Atto -- NOTARIAL SEAL STEPHEN J. HOGG. NOTARY Plf9ttd:. CARLISLE BpRO, C~JMgERLANO CO. ~ K MY COMMISSIQN El(F'IRW BiP'TEMHET3 ~, QCs+.