HomeMy WebLinkAbout09-15-09 (2)PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Martha J. Haynes Shufflebarger
also known as Martha Josephine Shufflebarger
, Deceased
COUNTY, PENNSYLVANIA
File Number ~~ ~ ~ ~ ~ ~ " '~'
Social Security Number 226-26-9173
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 Executor
last Will of the Decedent dated April 3, 2001 and codicil(s) dated NA
named,in the
t..
.c
(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 exeG>~_ti~n')of the inst~ment(s~ off~r~d
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ ~ „ : ~ i
_v CI1
^ B. Grant of Letters of Administration cJ"1
(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 of heirs.)
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
23 RidQeway Drive South Middleton Township Carlisle Cumberland County, Pennsylvania 17015
(List street address, town/city, township, county, state, zip code)
Decedent, then 84 years of age, died on September 4, 2009 at her home
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ ~ ~ ~ oC °
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ J SDrCno
situated as follows: 23 Ridgeway Drive, Carlisle, PA 17015
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 afore T ed or rinted name and residence
William Minor Shufflebarger, 1311 Woodward Drive, Carlisle, PA 17013
Form RW-02 rev. 10.13.06 PagB 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.
x ~~
Sworn to or affirmed and subscribed
Signature of Personal Repres
IZefore me the ~ day of
~ ~ ~ ~,
For the Register J
Signature of Personal Representative
Signature of Personal Representative
r,a
C7 'a
File Number: (~ ~ CJ ~ - ~/ O ~..~ ~ ~ ~~'t ~ A ,
? t-C7 ~ c.~a ~~
~~rn _ _,
Estate of Martha J. Haynes ShufflebarRer , Desea``S CI1 r„~
? : r"`~ t
Social Security Numbe :226-26-9173 Date of Death: September 4, 2009 ~-% ~'~ -~ ~ `~'
~i
~:
--~
AND NOW, ~1~-~ ~ ~~ , in consideration of the foregoing Pe~tton, satisfary proof •;
having been presented before me, IT IS DECREED that Letters Testamentary v1
are hereby granted to William Minor ShufflebarQer
in the above estate
and that the instrument(s) dated Apri13, 2001
described in the Petition be admitted to probate and filed of recorc~as the last Will ~md Codicil(s)~,~f~eceden~: ~^
FEES ~~
Letters ............... $
Short Certificate(s) ........ $
Renunciation(s) .. ~ .. . .. $
... $
... $ f~~ U
... $ C
... $
... $
... $
... $
... $
~ ~ ct~
...
~- ~~~
TOTAL .............. $
~~/ ~ i
Reg' er of Wills ~
Attorney Signature: ~~
Attorney Name: Robert L. O'Brien, Esquire
Supreme Court LD. No.: 28351
Address: 19 West South Street
Carlisle, PA 17013
Telephone: 717 249-6873
Form RW-02 rev. 10.13.06 Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION C)F DEATIH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, ~fi.00
P 15729836
Certification Number
This is to ccrtity that the inl~Ln-malion I1CCC9 riven is
rL~rrcrtly ~~~o~ieli~~rum an nri~~inal Certificate 1~1 DeaU~
duly fill°~1 with nx a, L.ucal Re_is,U~ar. The ori~~inal
certific~:.te ~~ill br I~trwurtle~l to the State Vital
kccor~b. Office ILfr 1~1rru7ancnl filin~~.
~~-`raT~C° cF__ ~ _5 /1009
~~~. ~~~
Local R.e~~istrar Date Issurxi
r-a
C7 o a;
~.~ j7 ~~ 1 .._. ~
rn
~ - ~.., ,----~
:.
..
=
~ CJ7 t
v~ --
- .
,
c
r
a-~ ~ ~
~
CJrI
_n'astea REV tvzaos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
aEafeA'"NE " CERTIFICATE OF DEATH
BLACK INK See instructions and exam les on reverse
P STATE FIL
E NUMBER
r 1. Name of Decetlent IFmL midde, IesL scam ~ 2. Sex 3. Sodas Secudy Number d. Oate of Death (Month, daY. year)
J. Haynes Shufflebarger F 226 - 26 - 9173 Sept. 4, 2009
5. Age (LIW Bidhtlay) l1Mer 1 year Under 1 eey 6. Date al Bidh (Month, day, year) 7. BiNplace CBy aM elate or forei country) Be. Piece d Death (Check only one)
'"""° °rys "°'" """'°° ChriPtiansburg, VA "°aP"°I ones
84 Ym. i%27/1925 ^mpetiem ^ER/OulpeBent ^DOA ^Nursing Home 1~'Aesidenca ^OIMr-Spedty:
Bb. Caunry d Deem &. Clry, Bore, Twp. of Deem Ba. Finally Nama (If not u~atild'bn, gIre coed mid mar6er) 9. Wes Decetlanl d Hkpenk OrlglnT ®No ^Yas 10. Roca: Amedcen In6en, BImA, WAite, ek.
Qunberland S . Middleton Grp. Pf rte. al~y cubes. lsP•dM
23 Ridgeway Drive Mexkan, Puerto Rlcen, ek.) White
11. DecedeMS UaW Bon KWd d work tlone mo91 d Ige. Do not stele rd1 12. Wee Dewdenl ever In me 13. DewtlaMa Education (Specify only higMSl grade completed) 14. Madld Status: Mamiad, Never Marred, 15. Surviving Spouse (II wile, gNe maiden name)
Divorced (SpecY/)7
Wxlowed
KIM d Work MM d Busirbss / IMuaby
Kindergarten teache Elementary Sc ,
U.B. Ambtl FanaT Elementary / Semndery (0.1 z) Cdlege (ti or 5r)
1 ^Yaa ®Np 4 Widaaed -
10. Decedents Mellkp AMress IsreeL dN /rows. ante. lip coda) Decedents Did Deredem S . Middleton
PA Llva Ina 17a~Yes
Decmlenl Lived n Twp.
23 Ridgeway Drive ,
Actual Residence 179. Slate
TownehipT nd. ^ Ne, Decetlent Lived wBhh
Cumberland
Carlisle PA 17015 tm.ca,ny
AdnlumBSa chy/Bom
18. Famefs Name (Flrsl, mkde, led, su04) 19. Mother's Name (Flrs1, mltlde, maiden wmeme)
James Minor Ha es Pearl J. Guthrie
20a. InfomumYS Name (Type / Pdnt) 20b. InlomvsM'a MaBing Address (Street, city / Wwn, smte, zip cMe)
William M. Shufflebarger 1311 Woodward Drive, Carlisle, PA 17013
21a Memotl d OkposiBon ~ remellon ^ Doralbn 21 b. Date d OieposlBOn (MOnm, day, year) 21c. Place d Disposltlon (Name of cenmlery, crematory m deer place) 21 d. LocaBan (cry / rowm, slate, zp code)
^ Burial ^ Remwd Irom SMIe ! Wn pemstlon «Damgon Aulhgrlred
^ OtMr-Spedy: I gMmAnl Exmnlnr/Coronas ^Yaa^Ng
9 8 2009
Evans Cremation Services
Leola, PA
22a. SipnaWre d F Lx:ensea 9
. ~-.~ n ~_ . _ ~ 22b. liceree Number
Fn n1 v~~~ i. 22c. Name end AMress d FedfBy
Ekvina Brothers Funeral Hcane, Inc. , Carlisle, PA 17013
Cargkte Ikms 23at ally when cMityig 23e. To best of my each occurred d the time, dale eM Piave slaletl. (Signature eM ' e) 23b. Licaree Number 23c. Date Signed (Month, day, year)
physiden k nd evadable el tare d deem to y~//~~/ ////(/, f~~f~~ ~a ~ ~,~-/7 /_ / J /, /!
ease d seem. GL /(-
Gems 24-2fi imnt M wnpldetl q pemon 21. Time of Deem 25. Dek Prermuroed DeadU(MOn
m~aey~, yam) G,
'~'~
R
'
)~( 26. Wes Cese Retened too ediW Esmnmar / Comnar for a Reason oMer man cremates or DonaUOnT
^Yaa
wMpronom~ceaaeem. `
~~
L
'
7-~f ",XC:~
/
aem 27. Pan I: Enter pie Chen d evmas - dsaases, trtluMS, a canpkatbns -met damdly mused tl1e deem. Do NOT enter krminal eveMS such es m~ arrest, onset b Deem but not ruuNrg in the underkying cause even in Pen I. ^ Yes ^, -Pm,b,/ady.
respiretary aned, «vmadmdar IitrYleBn wimna showilq IM eBObgy. cad oNy one cause an ee~tire. ^ No LV^r"•"ON'^
IMMEDIATE CAUSE fFnd disease « ~~~ J y .? ~~ ~ ~A / L (i ~~ ' M L/ S
condiBon remilrg n N -~ a / 1 /„('~/ /r `/f'/C ~ r ~ Ou//r/(k (,7 29, rlf~Fem/ale:
ear
M wAhin
ast
t
Due ro la es a emruegnnce op: f,v U no
P
Y
DA
^ Pregiwll d lime d death
SegaemidNfy Est mndiliofd, d airy. b- ~~ ~~ j(C
lea~q to the cause daMtl pn kre e.
d)
D
W ^ Nd pre~am, but pregnant wnnin 4z deya
~
:
(« es e
uo
Enter Bn UNDERLYING CAUSE
~'
d deem
ldeeau a'~I'~rDpI'u Nat iNli~sd tM c
~
n deem) LAST.
events resumg
Due to (or es a wmequenm og:
~ 4k
~ ~ ^ Nd Dregrent, but pregnant d3 daYS to 1 yam
Mrore tlWm
tl. ^ Unknown If Pregnem wi1Mn tM past year
30a. Wes an Adapsy 300. Were Autopsy RMings 31. Manner of Death 32e. Date d Injury (MOnm, tleY• Yeerl 32b. Deacdbe How Injury Occurred
~ 32c. Place of In'ryry: Hone, Ferm, 9reeL Factory,
OBim BmltHry, etc /Spedty)
PedameT Available Pna to Compldim
d Cauca d Deadip rte(
pl Natural ^ HamkiOe
^ Aoitlent ^ Pew Invaali
alia~ 32tl. Time d Injury 32e. Injury at Work? 321.11 Trenspatatlan Injury /SDedM 32g. lzmelicn of Inlury (Strad, my f town, stale)
g
^Yas j~ylOo ^ Yes ^ No ~
~C ^ Sukitla ^ Caum Nd oa Dalmmined M ^Yas ^ No ^ D^Ym f Opsral« ^ Passenger ^PSdestdan
otnm - spedry:
33a Cenulm (check ony ale) 33b. Signature and rue d Cenif
-~
• CANlymg physklsn (Physoan nrldYln9 cause of death wrmn anomer phyarien Iles premrrcetl deem eM canpldetl Item 23l ~ w~~----__ _
Ta me beeldmy lolowledge,dam occumetl tln to Vin muN(e)and mnnm es slded_________________________________ .
• Pranauncing and wrlNying physklan (Physkien bdh prwwxirg deem eM cerlllyug b mire d tleem) _ _ -- _ 33c. license Number 33d. Dak Signed (! nth, tleY, M
~ To ma Ms1 d my knowledge, deem eeeurraa al1M tlme, deb, end piss, erM duo to the muea(e) erW manner u daled_ _ _ _ _ _ _ _ _ _ _ _ _ ^ /`
• McdIW ExsminmlC«wer ~ ( 7 L ~ v
on 1M weu d examinsnn ma / « mY«Bg.non, in my epidon, a.am «rrarred .t the nine, ae1e, erw plan, and am to me mwele) end menn.r.. at.tea_ ^ 3r. Name mw Amress of Person wM Cemplekd cause d Deem Plmn zn Typo / Pdm
0 3n. RegiaMY nawre aM Distdd a Riad (Mmm, my, rear) /~Au ~- (/.y2 ~hR-~ / '~ ~
~ r I ~, I f I C I I I ("~ I ~ 3 s /Z iN T d/~ svLT~ ~
DispasWOn Permit No.
Q~ - ~O
LAST WILL AND TESTAMENT
OF
MARTHA JOSEPHINE SHUFFLEBARGER
I, MARTHA JOSEPHINE SHUFFLEBARGER, of Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my Last Will and Testament, hereby
revoking all other wills and codicils heretofore made by me.
FIRST
I direct the payment of my debts and the expenses of my last illness and
funeral from my estate as soon after my death as conveniently may be done.
SECOND
All the rest, residue and remainder of my estate, real, personal or mixed
wherever situate, I give, devise and bequeath unto my beloved children, Thomas Edwin
Shufflebarger, III, William Minor Shufflebarger and John Venoble Shufflebarger, should
they survive me by a period of thirty (30) days. Should a child predecease me or fail to
survive me by thirty (30) days, then I give, devise and bequeath that child'~s~are to
their wife, and if their wife has predeceased them or fails to survive them b~t~~ (3~ ~ L
rr art
1~ ~ Ut - _,
days to their child or children. ~~ ;t-; ~ -
--,
Q7
THIRD
I nominate, constitute and appoint William Minor Shufflebarger as
Executor of this my Last Will and Testament and in the event he is unable to serve I
appoint Thomas Edwin Shufflebarger as my alternate Executor. I relieve my personal
representative from the necessity of posting security in connection with his duties as
such in any jurisdiction in which he may be called upon to act insofar as I am able by
law t~ d~ sn
FOURTH
In addition to the powers conferred by law, I authorize my Executor in his
absolute discretion:
A. To retain in the form received, and to sell either at public or private
sale any real or personal property
B. To manage real estate.
C. To invest and reinvest in all forms of property without being confined
to legal investments, and without regard to the principal of diversification.
D. To exercise any option or rights arising from ownership of
investments.
E. To compromise claims without court approval, and without the consent
of any beneficiary.
FIFTH
This Will shall be interpreted pursuant to the laws of the Commonwealth
of Pennsylvania where it was prepared and executed.
_ _ _ __ _ _ _
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of three (3) typewritten pages, the first two pages of
which bear my signature in the margin for the purpose of identification, this the 3rd
day of April, 2001.
/~~ ~ (SEAL)
MART J EPHINE SH FLEBA GER
Signed, sealed, published and declared by the above named testatrix
MARTHA JOSEPHINE SHUFFLEBARGER, as and for her Last Will and Testament, in
the presence of us, who, at her request, in her sight and presence, and in the sight and
I
presence of each other, have hereunto subscribed our names as witnesses.
(1~-- AD D RE S S ~ ~ ~ ~ ~ ~ ~ n- ~-~" ~-~
C~.~l~lt~~~ - ~~'~~~i _ADDRESS ~i711i' L~lt.lP1%,tf ~'~. f'~t. l~ll~ _'~;~~c'~~. f~'.~ l ~C~~:~~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
(,
We, MARTHA JOSEPHINE SHUFFLEBARGER, `~~~.~/~~~i~/~~~
and ~ «' ~ ,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 of her Last Will, and that she signed willingly and that she executed as her
free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses,
~I and that to the best of their knowledge, the testatrix was at the time eighteen (18) years
of age or older, of sound mind and under no constraint or undue influence.
Sworn to and subscribed before me this 3rd day of April, 2001.
--~ (~) ~
NUtrlri r :~, ~~~,...~~ _ ...~ .
Jennifer S. Lindsay, r,~>:<r,y ,°~;p,~,:; i,
Carlisle Boro, Gumheriarci C;~ur~iy '~~~
My Commission Expires Nw. 29, ?u,3
McRlber,PennsylvaniaAssociati~nolNctaries