HomeMy WebLinkAbout02-11-09PETITION FOR PROBA~nTE AND\GRANT OF LETTERS
REGISTER OF WILLS OF ~~.S~~L~I~ {~ COUNTY, PENNSYLVANIA
Estate of ~ `1P_~/n ~ctf!"! C/c:a ~tCL1QV2'1 Sbf~ File Number- I -~~ ~ 15~
also known as
Deceased Social Security Number !~U ~~- U~ ~7~~
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 Pt' Y'S'c~ i~ named in the
last Will of the Decedent dated 05~ ~ 7/~.Zb~ S and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.f
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.; 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.)
Name Relationshi Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
D
Decedent was domiciled at death in CiC,I MIB~Q-~-fl ~ County, Pennsylvania with his /her last principal residence at ~ Of Y1P~
l'ZO~ (V1grk~t-~y~t~~C_czvrn~.(-I-i'fl Ptt l~?b/! Curmb~t-i~nr) Ccc,,~fiy
(List street address, town/city, township, county, state, yip code) /~Dn
Decedent,then~yearsofage,diedon c.laNVlhu 1~~ DUI at /~arlcY' l~ai^r/ r''~~'crlfh CLtVsv Ser^Uf(t?S
Decedent at death owned property with estimated values as follows:
(lf domiciled in PA) All personal property $ ~, `~~/ . ~,/
(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
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 appropiW
the undersigned: O ~ ~ ~
Si afore T ed or rinted name and residence U ~ ~„ ~ ~:
Pam c u,r 1 D-~ w a x ;~ o
li~zc~ ~a .Lt~h~
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Form RW-02 rev. 10.13.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
--~/ ~~~,11~~ SS
COUNTY OF C~-U M~~/~11.J .
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 affirmeld and subscribed
bepre me the r_1 ~1 day of
r 2-~~~
For the gister ~~-
Signature of Personal Representative
w ~
Signature of Personal Representative Q a ~ ~ ~
Signature of Personal Representative w Lt. ~ Q ~ [~
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File Number: ~ ~ - Q`"1 ~ T1~7 ~ ~ `~~ W ~ c~°~ O
Estate of ~h ~./m cam. ~ r7 / C~ ~fr~Sb `) Deceased
Social Security Number: L~Q ~l - 4 / - 1 9 / ~ Date of Death:- / ~ - ~ D ~ `~
AND NOW, l ~ ~ ~ ,~ ~/`I ~, in consideration of the foregoing Petition, satisfactory proof
having been presented b ,~fe me, IT IS DECREES that Letters
are hereby granted to 1'a,rne ~ ~' ~ ~Jllr-~t nG7
_ in the above estate
and that the instrument(s) dated o~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Register ofiyills R?
Letters ............... $ i f ` y,-
,•'
Short Certificate(s) ........ $ Attorney Signature: ~ '`
~~
Renunciation(s) .......... $ -
~~ $ Attorney Name: ~" ? f?Q t'~ ~ [~ Q V'I S
.~
~ .. $
... $
...$
...$
...$
... $
... $
TOTAL .............. $~~ -9~0tT
Form RW-02 rev. 10.13.06
Supreme Court LD. No.: J~~ ~ ~- Z
Address: /' ~ /~CjX v~' ~ !j
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Telephone: ~~ ~ ~(~~
Page 2 of 2
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LOCAL RE(aISTRAR'S CERTIFICATION ~JF DEAT
WARNING: It is illegal to duplicate this copy by photostat or photograph.
i~~r fi)Y thi~~ ~ertificalc. ~;(~.l)i}
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'Chi, i~ tf} certtl~~ Ih 11 ~ ~ I i,rm t lu. h~) , ~~i~en )s
r<TlrLrt!ti <<)picd lir)m a I r.al C~IL!~i~ u° of lleath
duly fileLi with 111 <l•• ~ Y1 a I:crTr uel:~. I Lc Y}i-(ginal
cf,ltil~icur will I)e ,ll~ ~ ri'_t.l t.~ .Ile State Vital
IZei'f)I71~ ODIC It)C i)~'i'}::iilc(I IIII11~•~ ~ ~ 2009
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/PRINT IN
IMANENT
ACN INK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMRFR
1. Name of Decedent (Rrst, matlle, last, suXiz) 2. Sez 3. Social $ecurty Number 4. Date of Death (Month, day, year)
Thelma Patricia Richardson female 009 - O1''-•7912 January 19, 2009
5. Age (lass Birthday) Under 1 year Untler 1 day 6. Date of Binh (Month, day, year) 7, Birhplace (City and stale or foreign country] ea. Place of Death (Check only one)
Months Days Hours M.wlas Hospital; ether:
88 y,a. June 27, 1920 Canada
^ Inpatient ^ ER! Outpatient ^ DOA ®Nursing Home ^ Resitlence ^Other -Specify:
6h. Counry d Death &. City, Boro, Twp. of Death fio. FacilAy Name (H net inslqulion, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^ Yes 10. Race American Indian, Black, While, etc.
Cumberland Camp Hill pt yes, specify Cuban, (Specii~
Manor Care
MaxipanPpenpRican,etc.) white
71. Decedents Usual Occ tan Kind of work sate dunn most of workin Gle. Do rwl stale retired 12. Was Decedent ever in the 13. Decedent's Etlucation (Spedfy only highest gratle completed) 1d. Marlat Status: Marred, Never Martietl, 15. Surviving Spouse (II wife, give maiden name)
Kind of Work Kind of Business I Intluslry U. S. Armed Forces? Elementary /Secondary (0-12) College (f-4 or 5+) Widowed, Divorced (Speciyl
Homemaker Domestic ^rea ~]No 12 widowed
16. Decedents Mailing Address (Street, city /town, slate, zip cotle) Decedents Did Decadent
Pennsylvania
1700 Market Street Actual Residence 17a. slate.
Live ins 170. CI Yes, Decedent Lived in Twp,
Camp Hill
PA 17011 Township?
rib County Cumberland 17d~1
lw~~rn Camp Hill
~
Lim
t
, Aclua
I
its
o
city / Boro
IS. Famer's Name (First, madle, last, sulfx) 19. Mdher's Name (Rrsl, mkldla, maiden sumamej
William Victor Prinn Dorothy M. Cox
20a. Informant's Name (type I Print) 20b. Informant's Meiling Atltlress (Sheet, city I town, stale, zip case)
Pamela Sue Purrington 322 Valley Road, Etters, PA 17319
- 21 a. Method of Disposition ®Cremation ^ Dpnalbn 21 b. Date d Disposillon (Month, day, year) 21 c. Place d Disposkbn (Name d cemetery, crematory or other place) 21 d. Location (City /town, slate, zip code)
^ Burial ^ Removalhom5late j WasGemaNOnorponatlanAuthorizedrryy~~
^ Omer -Specify: i by Medical Examiner I Coroner? Ir7l Yes ^ No Januar 22 2009
y ~ Evans Crematory Schaefferstown PA 17088
,
22a. Signature of F rat Se ' ensee (or acting as such) 220. License Number 22c. Name antl Adtlress al Fadliry
- - FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Complete Items 3a-c only when cenirya 23a. o the best of my knowledge, death occunetl al the time, tlate and place stated (Signaure and tkle) 23b. License Number 23c. Dale Signed (Month, day, year)
physaran is not availade at Nme of tleam to
candy cause of tleam.
Items 24-26 must be cempleled by person
ho
on
tl
th 2d. Time of Death
~ 25. Date P owlcetl Dead (Monet, tley/,~year)
~l 26. Was Case Referred to Metlical Examiner /Coroner for a Reason Other than Cremation or Donalion7
w
pr
ounces
ea
. ~,e}
j AM. ~,z
~pnUQ iQ ZW, ^Yes ~Ne
CAUSE OF DEATH (See Inatruetlons antl examples) r Approximate imerval: Pen II: Enter other ajg~nl amdkions contributing t death, 28. Ditl Tobago Use ContnbWe to D
ealh?
Item 27. Pan t: Enter the chain of events -diseases, injuries, or complaatlons -that tlirectly causetl me tleam. DO NOT enter lemlinel evenh such as cardiac arrest, r Ousel to Death but not resuPong In me underlying cause given in Pan L _
^ Yes ^ Proba~r-
respimlory arrest, or ventricular fitxilla on wkheut showing the eddary Ust only one cause on each Gne. r
W MEDIATE CAUSE Final disease or t ^ No nknown
condition resulting a ~eam) _~ a ~ 29. flt~F]emaly; -~
o
'
Due to (or as sequ ce of): ,/ /
r t
f pregnant within past ear
y~
v
Sequentially Ik1 mrrtlilans, it any, l.,z,,. [.
le~dmg to the rouse &ned on Nne a. b~ ^ Pregnant at lime of tleath
Enter the UNDEgLYtNG CAUSE Due to (w as a consequence op: ~ ^ Nol pregnant, but pregnant within 42 days
c.
etlve~nis resulting mtdeem)reLAST.e of tleam
Due to for as a consequence o0:
^ Not pregnant, but pregnant a3 tlays to 1 year
d_ r before tleam
I
^ Dnknpwn it pregnant wrlhm the p8at year
30a. Was an Autopsy 30b. Were Autopsy Rraings 31. Manner of Death 32a. Dale of Injury (Monet, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home. Farm
Street
Factory
-
Pedom N?
Available Prior to Completion
^ NaWral ^ Homicitle ,
,
,
Oflae Builtlinq, etc. (SpecityJ
of Cause of Death?
^ Ves No ^ Yes No ^ Acndent ^ Pending Invesligaaon 32d. Time of Injury 32e. Injury al Work? 321. II Trensponalion Injury (SpecrtyJ 32g. Location of Injury (Street, city I sown, stale)
^ Sukide ^ DWW Nat be Delemkned ^Ves ^ No ^ Driver! Operator ^ Passenger ^Pedeslnai
M ^ Other - Speciry.
33a. Ce rer (check only oriel 336. Sig lure a of C r
• Certltying physician (Physican certifying cause el tleam when another physaian has pronouncetl tleath and compatetl Item 23)
To me best of my Knowledge, tleath occurred tlue to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Pronouncing and certifying physician (Physician both pronounang tleath and certifying to cause of death) - _
To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as atafed_ _ _ _ _ _ _ _ _ _ _ _ _ _ . m er /
~` i ~ 3 to Signetl (Month, day, year) d,
l~ ,~7^~~
• Medical Examiner! Coroner ~
l~ ~` W
On the basis of examination and I or investigation
in my opinion
tleath occurred al the time
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l
d tl
t
th
^
,
,
,
a
e, an
p
ate, an
ue
o
e Cause(s) and manner as etatetl_ 4. Name and Address of Person Who Co feted Cause ealh (Ite m j Type: Print a
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a - c
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35. Reg
strar
s Signatur a Distral Numb
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~ ~ °~'~ ~ I ~I / ~ ~ I 36. Date clad (Mon ,day, yea0 - / ~ I /
~ CHrn ~'~ /
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7CIt
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Disposition Permit No. O332I ~.
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I, 'phelma P. Richardson, of Claremont, in the County of Sullivan and State of New
Hampshire, do make this my last will, hereby revoking all earlier ones, and I dispose of my estate
in the following manner:
1. I direct the payment of all my just debts, funeral expenses and expenses of
administration of my estate.
2. I direct that any legacy and succession tax, inheritance, estate, transfer, or similar tax,
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whether state or federal or foreign, which shall be imposed on my taxable estate, whether or not
passing under this will, or upon any beneficiary or other recipient thereof as a result of my death,
shall be paid out of the residue of my estate as an expense of administration without proration.
3. Mindful of any children and issue of deceased children of mine who may survive me
who are not named or referred to in this will, I make :.o specific provision for any one of them other
than as herein provided.
4. I may leave a memorandum stating my wishes with respect to the disposition of certain
articles of my tangible personal property, but such memorandum will be simply an expression of my
1
LEAHY d DENAULT, LLP • A-lTORNEYS AT LAW 778 BROAD STREET P.O. BOX 829 CLAREMC~NT, NH 03743-0829 (603) 543-3785
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wishes and shall not create any trust or obligation, nor shall it be offered for probate as a part of this
will.
5. All the rest, residue and remainder of my estate, whether real or personal and
wherever situate, I give, devise and bequeath to my husband, C. Ross Richardson.
In the event that my said husband should predecease me, or in the event that our deaths
should occur simultaneously, or approximately so, or in the same common accident or calamity, or
under any circumstances causing doubt as to which of us survived the other, then I give, devise and
~,~, J bequeath all the rest, residue and remainder of my estate, whether real or personal and wherever
. J ~ situate, to my children, Jeffrey Richardson, Pamela Purrington, and Gregory Richardson, all in
equal shares share and share alike. If any of my said children shall have predeceased me said
deceased child's share shall pass to his or her issue, per stirpes, and for lack of such issue to my
children then living.
6. An adopted child in any generation and his issue, including adopted issue, shall have
the same rights under this instrument as if born to the adopting parent and of the same blood.
7. I nominate and appoint my daughter, Pamela Purington, as Executrix of this my last
will and testament. If she shall not be living at the time of my decease, or if, for any reason, she
shall be unable or unwilling to accept this trust and act as Executrix of this my last will and testament,
I nominate and appoint my son, Gregory Richardson, as the Executor hereof. Except as otherwise
specifically herein limited, my Executrix and her successors shall have all of the powers conferred
on trustees by New Hampshire RSA 564-A, the Uniform Trustees Powers Act, as it exists at the date
of this execution of this Will, which Statute is hereby incorporated by reference.
2
LEAHY & DENAULT, LLP ~ ATTORNEYS AT LAW ~ 178 BROAD STREET ~ P.O. BOX 829 ~ CLAREMONT, NH 03743-0829 ~ (603) 543-3185
IN WITNESS WHEREOF I have hereunto set my hand and seal this 27`h day of May 2005.
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Thelma P. Richardson
Signed, sealed, published and declared by the above-named Thelma P. Richardson as her
last will and testament in our presence who at her request in her presence and in the presence of each
other have hereunto set our names as witnesses the year and date above written.
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3
LEAHY 5 RENAULT, LLP ATTORNEYS AT LAW t78 BROAD STREET P.O. BOx 8H9 CLAIREMCrNT, XJH 037x3-0829 (6031~433~185
.'~
STATE OF NEW HAMPSHIRE
COUNTY OF SULLIVAN
We, Thelma P. Richardson, Denise B. Saucier, and Debra Johnson-Melcher, the testatrix
and the witnesses, respectively, whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her last will and that she had signed willingly or directed another to sign
for her, and that she executed it as her free and voluntary act for the purposes therein expressed; and
that each of the witnesses, at the request of the testatrix, in her presence, and in the presence of each
other, signed the will as witness and that to the best of their knowledge, the testatrix was at that time
18 or more years of age, of sound mind and under no constraint or undue influence.
,~ ~
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Thelma P.. Richar son
Testatrix
~~
Wit ess
~1~, _
Witness
Subscribed, sworn to and acknowledged before me by Thelma P. Richardson, the testatrix
and subscribed and sworn to before me by Denise B. Saucier and Debra Johnson-Melcher, the
witnesses, this 27`h day of May 2005.
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EXPIRES
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Notary Public / Jtrs '
LEAHY @ DENAULT, LLP ATTORNEYS AT LAW 178 BROAD STREET P.O. BOX 8H9 CLAIREMONT, XIH 03 743-08 2 9 (6031~43~C7H5