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HomeMy WebLinkAbout09-24-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of MILDRED C. SCHLUSSER also known as Deceased File Number ~ I'" ~~'- d ~ ~~ Social Security Number 194-28-8981 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 MAY 14, 2008 and codicil(s) dated (5'tate 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: 0 B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d. b.n.c.t.a.; pendentelite: duranteabsentia; duranteminoritate) 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 ofheirs.) ~ Name t~ ._ _~=' "C) _- ~ t-n _ . N r~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~ ~ - _ ,~~ ---~ Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal resi~nce at ~ ` 1475 LONGS GAP ROAD, CARLISLE, NORTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVAMA 17013 C,li (List street address. town/city, township, county, state, zip code) Decedent, then 95 years of age, died on 09/14!2009 at FOREST PARK HEALTH CENTER, CARLISLE, CUMBERLAND COUNTY. PENNSYLVANIA 17013 Decedent at death owned property with estimated values as follows: (lf domiciled in PA) All personal property $ 8,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 90,000.00 situated as follows: 1475 LONGS GAP ROAD, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA 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: Si nature T d or rioted name and residence PAULINE S. SHOEMAKER, 10 YORWICK ROAD, CARLISLE, PA 17013 named in the Form RW-02 rev. 10.73.06 Page; 1 of 2 - - `- - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for ihi~ certificate, $6.00 P 15729940 Certification Number r Ht05-143 REV 112006 TYPE! PRINT IN PERMANENT BLACK INK JI This i~ to certif} tl~ru the inforn(atiun hcn gi~~?n is correctly ro~iic~i Irnln an ;Tri,~inal Cel[ifi~~atr of Death duly tilc<1 ~~ith me as Loctll Ret~isllar. Tl~lc on-*inal ccrtilicate ~~ill hr f~rn~~~ar~le•~i to the S'_(te Vital Recurciz ~f)ffirr I~or rcrnumcnt tiling L~e. ~~ ~c~~~t~S~ 1 4 2009 Local Registrar r..~ mate I~suerl _ 4,^_^~ cn~_" O .°o C~ [-;~ - , -1 ~ ('7 -~ f?rn ~ r,- i - ;,=. ~ I ,'" „_ - - - ~ ~ ---1 ~ GT COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) ~T,r< <„ ~ ,,,,,,ego 1. Name d Decedera (Flrst, mitltlk, last, suffix) 2. Sex 3. Sodel Secunry Number 4. Date of Deelh (Monts, tlay, year) Mildred C. Schlusser Female 194 - 28 - 8981 Se tember 14, 2009 5. Age (last Binhtlay) Under 1 UIMer t day 6. Dale d Binh (Monts, de ,year) 7. &nhpleu9 (Cly and stele or foreign counay) ffi. Place of DeaM (Check ody one) 95 ~` p"` ~"° """'"` July 19, 1914 Carlisle, PA MwpiMl: o,ner: Yrs. ^In 6enl pe' ^ ER / Ouq>alianl ^ DOA ~] Nursing Hama ^ Residence ^Olher - Speciry: ffi. County of DeaM &. Boro, wp. of DeaM Bd. FaciNly Name Qf not mAbn, give street and number) 9. Was Decedent pf fe spenic Ongin7 ®No ^Ves 10. Race: American InOian, &ack, White, etc. N CcatG4~ (If Yes, spady Cuban (Spedly) / 't I~ ~ E1 ~ F Cumberland Carlisle , ar z5 ~ cr o M i R ex can, Puerro ican, etc.) White 71. Decedents Usual lion Nmd of work lane tlui moll d warki life. Do not stele reliretl 72. Was Decedent ever in the 13. Decetlent's Eduction (Sexily only hgheal grade completed) 14. Memel Sletus: Married, Never Mametl, 16. Survivkg Spouse (11 vole, give maiden name) Kind d Work Kits d Bwaless / Intlwlry U.S. Armed Forces? Elementary /Secondary (0-12) College (t-4 or Sr) Wltlowed, Divorced (Specify) Homemaker Own Home ^Ves C7~lo g Widowed • 16. Dxetlent'a Maigrp Address (Street, cnY /[own, slate, zip code) 1475 Longs Gap Road Decedents Ditl Decedent Amual ResNexe „a. 5181e PA Dve M a „p ~ yey l3ecedant L;ved M North Middleton gw Carlisle, PA 17013 . , y, Cumberland r mp? t7d.^NO, Decedent LNed wtlhin n6. ceanly actual umiLaw ayyBOro 18. Fadwfs Name (First, mitlde, last, sufix) 19. MoMer's Name IFlrsl, mkHe, maiden sumeme) Milton Sh hart Mamie Brown 20e. Intompnl's Noma (Type / Pnm) 20b. Inlormants Meiling Adtlres6 (Street, City / town, aMle, zip catle) Pauline Shoemaker 10 Yorwick Road, Carlisle, PA 17013 21a McMOd d Disposibon i ^ Cremation ^ Donation 21 b. Date d Disposition (MmM, day, year) 21c. Place d Diepwilion (Name of urnelery, tremetay or nMer place) 21 tl. Laution (C)ry /town, slate, zip code) ~ Bwial ^ RemovalhomSlale jwaacr.mwonerDaribnAUllwnzetl Sept 17, 2009 waggoners united Methodist ^ OMer - Speciy: by Medlin Euminer /Coroner? ^ Yea ^ Np Carlisle , PA 17013 22a. BgnaNre of FUn (or person xhng as sudp -- 22b UUrae Number 22c. Name and Addressd Fatilily Hoffman-Rot Funeral Home & Crematory, Inc . - ~~ - 138425 Complete Ileiw 23ec only when rortltying 23a. Ta best of my MnaMedge, tleaM occurtetl al Me tlme, dal9 antl place staled. (Signature antl title) 23D. Liunse Number ~ 23c. Dale Signed (Monts, day, year) physician a rat evadable at aura d death to pertilywaaeaeeaM. ~'Yl `~ C„ 4r` " ~Ll1J:sZV.i L ~ 3i ~ pte,x btt 1~, Jod y hems 21-26 ,null be canpkletl M parson - w"ppmnp,mpaadeaM 24. Time of Dee 5~o 25. Dale Pronounced Deetl (Month, day, year) r ~{ X00 9 t b 26. Was Case Referred to Metlipl Examiner / Comner for a Reason OMer Man Cremation or Donation? . 0 p M. , 1 e cvtit ~cp C.~a ^ p e N CAUSE OF DEATH (See Inatructlons and examples) r Approximate interval: Item 27. Part I: Enter the drein d evens - dnaesw, Injunes, or oomPtiCadora -Mal tlrecly cawed Me tleaM. DO NOT emer temanal evens such as rardec arteN, Onset 1o DeaM rwgratay artasl, or vmldculer AMtiation wiMoul showing die elldogy. List mly are cause on each line. Pen II: Enter other sani6wnt mrxedons con(nbulka ro dxM, but not resulting M Me undertying cause given in Pan L 26. Ditl Tobacco Use Con(dhula to DeaM? ^ Yes - PrdMfAy MMEDIATE CA E ((Fmel Qseese ar 1 ~ ^ Unknown ~ ~ ~ ~J~ ~ /j ,~y ~ ~ ~) / ~ '/ ~ J mrdNOn tleaM) / G'~ ~L- ~ ~ c i~y ~ ~' 29. H Female: :,,1.+ i a. 1{ IMiG/~-G~ C-~,. ~`7/ / ` ,~ C..)-('O~ / ~ D (r as,a segue (f'. ~ ~ ~ ~ -T- ^ Npl pregnant w4hin pwl year Sequent eY Asi corltldions, it any, b_ +..... ~~, ,. ~~,~yr Ia9dmg Io the uuee tisla0 m line a. ^ Pregnant al lime of death Emw the UNDERLYING CAUSE Due to (or as a consequence off: r ^ Not pre nanl, bN 9 pegiant within 42 days (tluease or mryry Mal inPoetetl the r aven5 resuting m tleaM) LAST o' I of tleath Due to (or as a towepwnu off: Na nanl, Dul ^ preg pregnant 63 tlays l0 7 year d txdme tleaM . ^ Unkrawn if pregnant w4Nn the past year 30a. Wes an Autopsy P n tl? 30b. Were Aulapsy Rndkx35 g d d P i 31. Maurer d DeaM 32a. Date of IrQury (Mmlh, day, year) 32b. Describe How Injury OcarteO 32c. Place d Injury: Fdonre, Falm, SIreaL Feclory, e orme va e e r or W Completion ,/ L'J Natural ^ Homititle Oaica Sullding, eta (Specify) of Cave of DeaM? ^ Yes ^^No ~ ^ Yes ©.IYO ^ ~~nt ^ Pending Invesligetion 32d. Time d Inlury 32e. Inlury et Work? 32f. II Trenspanetlan Inlury (SP~fYI 32g. Locetgn of Injury (areal, cdY! lawn, stele) ^ Suidtle ^ Coultl Nd he DNermiried ^ Yes ^ No ^ Dover /Operator ^ Passenger ^Pedeslllen ~' CRmfier ( onN ~) 336. Signature and a of fiker • Cartltylrg plyeldal (Physcian cerMying cause of duM whm ar,oNer physcian has pronounced tleath and cpmpleted Item 23) To the best of mylawwkdge, death occurred dw to dre uuagal antl manrer as atade4-------------------------------- - ~,/7/ ? ~~_ ,~+ • Pronoundng end cergtyilg phYaickn (Physiden bdh pronoundng tleaM aM urtilyMp to cause of tleaM) 33c. License Nu r 33tl. Dale Signed (Monts, tlay, year) To the beat of my IrtawMdge, tleaM xturted at the Ilme, sate, BM place, and due to Ure pau8BI9) and manner as ststetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • MetlMSI Faamirlx /Coroner ~ ~ ~ ~ .. On Me beats d examinatbn antl! a Inveatlgalion, in my opinion, death occurred al the Ilme, date, and place, and due to the causels) antl manner ae etated_ ^ 34 Name antl Mdress d Person WM CgmpleteE Caus~of DaeM (lle m 277,AType /Print ' 36. Regis) lure and 1 r Imo I ~ I I ~ I ~1 I ~ - ~ ~ ~ ~ 3$:.D,ale (Mm ,tlay, year) _ ~ ( ~) ~' t ~ /- Fl l - c /`~ ~ c. ~ / / (~ " /./ / G , . e~.~.c i -~ ~ c G . ~ ~ _ /~ ~ ~ ) L Disposabn Permit No. `,~~Il.~ `'Fry r n -., ~ ~ r c~ - '-° - , ~ _ ~ c,n ~ (T1 ~.- _i ~~ ~ ,_ -_ {11 ''. ~`l7 LAST WILL AND TESTAMENT ' 'r"'.R - `~ .. _Y .._.~ ~ '.S I, MILDRED C. SCHLUSSER, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My personal representative shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath all of my estate, whether real, personal or mixed property, whether tangible or intangible, and wherever situated, unto my daughter, PAULINE S. SHOEMAKER, absolutely. 3. I nominate, constitute and appoint the said PAULINE S. SHOEMAKER as Executrix of my estate. 4. I direct that my personal representative shall not be required to file a bond to secure the faithful performance of her duties in any jurisdiction. 5. I authorize and empower my personal representative, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments or any property of any nature which I own at my death; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard Page 1 of 3 Pages l~~ i M.C.S. R~7 to any or all property of any kind forming a part of my estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this 14`" day of May, 2008. ~iU~~%!/~ % L ~ AL) Mildred C. Schlosser SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. `~ ~' , Page 2 of 3 Pages r COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND I, MILDRED C. SCHLUSSER, 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 I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Mildred C. Schlusser Sworn or affirmed to and acknowledged before me by MILDRED C. SCHLUSSER, the Testatrix, this 14"' day of May, 2008. '? Not Public - COMMO ALTH OF PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA N°tanal sal Martha L. Noel, Notary Public SS. Carlisle Boro, Cumberland County COUNTY OF CUMBERLAND ~ My Commission E>~ires Sept 18, 2011 Member, Pennsylv2r!ia Association of Notarfes r We, S ~ ~ L . ~ 1 ~;~ ~~_ and ~/~ rI `~`~ h ~W ~G ~~htl1~K.~. the witnesses whos 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 MILDRED C. SCHLUSSER, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix 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 the Testatrix was at that time 18 or more years of a e, of so mind and under no constraint or undue influence. `--- A ress (mil 1.~. ~?,~,..-~-c;,-r-~1- Address ~r> ~ ' ,,.., Sworn or affirmed to and subscribed before G:\SBloom\Office -Estate Planning\Schlusser, Mildred C\will.doc Public day of May, 2008. -Noharial Seal Martha L. Noel, Notary Public Carlisle Boro, Cumberland County My r.,ommissfon hires Sept 18, 2011 Member, Pennayli-:~n1a ,Aaanc;t±tion of Notaries Page 3 of 3 Pages