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HomeMy WebLinkAbout10-26-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Mary B. McClintock also known as COUNTY, PENNSYLVANIA File Number LI ~ Zao I ~ /~ Deceased Social Security Number 201-16-6557 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 August 30, 2000 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: 0 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.) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at Sarah A. Todd Memorial Home, 1000 West Orange Street, Carlisle, Cumberland County, Pennsvlvania 17013 (List street address, town city, township, county, state, zip code) Decedent, then 83 years of age, died on September 30, 2009 at Sarah A. Todd Memorial Home 1000 West Orange Street, Carlisle, Cumberland County, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 6,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: rv Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of ~~pters in the app~riate form to-~ `~ ~. the undersigned: ~- r~~? ..~ : ~ .... si a ure T d or Tinted name and residence ~='- ,-~. ` ' ~ ~~~ Diane K. Herman 430 Capitol Hill Road, Dillsburg, PA 17019 ~_ ;. rt _ ~w ~~r ~~.gi1.~~ y ~w~~ 1 ~ ~ wr~tY, 1 J . ',~~ JJ l~ ~.. . .. _~~ Form RW-02 rev. 10.13.06 Page 1 of 2 named in the 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 affirmeld_and subscribed befo . ~me the ~ ~ ~ day of ~~~~ ~~ For the Register Signature of. Signature of Personal Representative Signature of Personal Representative C~~ N ~' ~~w~' W :~'7 ....Y._ _~~i File Number: ~ , -~ {.-~ ..~ ~_,~ ~ ~' { r r ' N , ;..* . Ma B. McClintock Estate of rY ,Deceased- ~~ ~ ~` T,+! ~~ ;°-, Social Security Number: 201-16-6557 Date of Death: ~ ~ ~ ~ ~ ~ ~` ~ - _ ~_ AND NOW ~ ZOD~ , in consideration of the foregoing Petition, satisfacto~proof ~ ~. ~ having been presented before me, I I DECREED that Letters Testamentary are hereby granted to Diane K. Herman in the above estate and that the instrument(s) dated August 30, 2000 described in the Petition be admitted to probate and fi led of record as the last Will (and Codicil(s)) of De edent. i FEES ~, O't7 $ Letters ............... ~ Register of Wills '' , ~ Short Certificate(s) ........ $ c7v Attorney Signature: -' Renunciation(s) .......... $ ~-- ... $~~T~ Attorney Name: Dale F. Shughart, Jr. `^ ... $ ~ ' ~ Supreme Court I.D. No.: 19373 ~~ ... $ b ~ ... $ Address: 10 West High Street • • • $ Carlisle, PA 17013 ... $ ... $ ' ' ' $ Telephone: 717-241-4311 ... $ TOTAL .............. $ 3 au •9.A9- Form RW-02 rev. 10.13.06 Page 2 of 2 _ - _ _ N1~c Rnc R°~~ mt/m~ -_ -- _ --~ ~~ 2t- LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15730228 Certification Number H105.143 REV 11/2008 TYPE! PRINT IN PERMANENT BLACK INK ir. ~ • U This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~~ d~ 1 2009 Local Registrar Date Issued na. C~ ° `^_• ._ ,: ~ ~ • ~ ~:~ , ..-r~ C~ _ r_.t ~: ~ ,. ~-~ IvJ -•-i ~ , _ - .. :;y CdD COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) CTATF FII F NIIMRFR 1. Name d Decedere (Rust, mills, lad, wmx) 2. Sex 3. Sadel Securwy Number 4. Date d Death (Monet, day, year) Mary Beatrice McClintock Female 201 -- 16 - 6557 Se t. 30, 2009 8. Age (Last Birthday) ((rider 1 year lMder 1 6. Date d BiM , ley, er) 7. ( and state a - Ba. Place d Dean (Check one) '""""' °"` "°'"' "`""° Jan . 4 , 1926 Carlisle , PA "°'~'~ °"~` 83 ^ Irtpetlent ^ ER / OutpetkM ^ DOA ®Nurairg Home ^ Reafderrce ^Otlrer - Speciy: Yre. 8b. County d Deem Bc. City, Bono, Twp. d Denth Bd. Facwk, Name (If na irotwWm, give streeq and rxxnber) 9. Wee Decedent d Hispank Origin? [~ No ^ Yea 10. Face: American Inden, Black, Whore, etc. Cumberland Carlisle Sarah Todd Memorial Home ('~''e8''P~i~°ibao' ( White Mexican, Puerb Rican. etc.) 11. DacederlCa Uwd Khd d wok D ons moat d Ne. Do nd ebte 12 Was Decedent ever in Bic 13. Darsdent'a EdurxBorl (Seedy orwy higlteet grade completed) 14. Medial Sbtus: Marled, Never Martbd, 15. Survivkg Spouse (8 wore, ghre maiden name) oti°r°°d (S er Wa°iead 4h9 Kind d Wok Kind d Bladrtesa / kldustry U.S. Amred Forces? Elerttentary / Sp~rrdary (0.12) j1 Copege (1-4 a 5+) . O ~ p . Laborer Shoe Co. ^Yr ~]No ,B.DeoaderlCaMewltgAddress(slreaL /race, cede> ~ ~ ~ '$ PA °idD~°`~"t W. Pennsboro nc °e~e°ar" L"°d k. T""• ~J Y« R l IilY . 19A Burgners PA 17015 l li C . . Adtal Resfderlce na ebb tap Cumberland ~ 1?d.^ ~~^ 1?b c a e, ar s ~ ~,,~„~ Ala . y 18. Father's Nerne (FlraL middle. IeA, eu8br) George Barrick 19. Homer's Name (FkaL mkide, meklerl sumerrb) Esther Killinger 2oa. Idorranra Nerve (Type r Prklt) Donald McClintock lob. InaxmanTa MeiNrp Address 13beeL dh / ~~ ~~ ~ ~) 19A Burgners Mill Rd., Carlisle, PA 17015 21a Mswgd d Olepoaabn [] Crsmaeon ^ oorxstlon 21b. Deb d DiepoNlWn (MOMh, day, Year) 21c. Pleoe d DapoaPoon (Name d cemetery, cremetary a other pkce) 21d. LocaBon (Cory !tam, date. UP code) ®~ ^ 11°n'~"e ""a ~"`i0na A?"10fbsd 9 Westminster Memorial Gardens Carlisle, PA 17013 ^ other - spdry: cemn.r ^Yr^No w Oct. 2 200 dF erelsarvicet.farbee ) 22e. z2b o 22c.IwarberMAddressdFadwly Hoffman-Roth Funeral Home & Crematory, Inc. ~~ - ol 219 N. Hanover St., Carlisle, PA 17013 CanplaM fblla 23as sly when prtwykq 7c Heat d my kraaAedpa, death gp~med at the tlme, dale and place shied. (Sigrakxe and Tor(e) 23b. Lk:eroe Number 23c. Date Signed (MorNh, dey~ yeer phydcWl M nal eveweble at lets d daatll b / ~ cerwly twee d deed. ,/ hams 24.28 mud be mrlpbWl by person 24. Tfrtw d Oaath „Z _-L /. ~~ . Daq DeW ( .day. yeah 28. Wes Case Referred tgJ~Ndcal ExamNer / Carabr fa a Reaecn Other tlten Cremalbn a Daxatlon? r , / who pralolalcw doom. ~' M, ~ ~ ^ Yee L 7 n o CAUSE OF DEATH (Sae Irtetructlons and examples) r Approxinbte Interval: dec st h OT i i t Pad II: Enter o81er ause iven m Pad L i t i th d d b d wk 28. Did Tatlecco (ices ContrWute b Death? ^ Yes ^ Probedy arre rta even s suc as cer enbr temt , i Oraet b Deem wem 27. PeA 1: Fnbr the gb~p118p1g - dbrar, Yihxies, a mripwcariorre -that dMx11y cawed me deem. DO N reegretory erred, a verMrlaYer IDdwedon wtlbut showing db etblogy. List only one calxre an each Wte. r r e un y rlg c g n n e u resu q ~„Nv ^ Urlkrlowtl MIk1EDIATE CAUSE dleear a r ! ~ ~ N P T 1 b r/ ~ tA~ ~.~5 toala8orl rea4tktg In 1 _~ a 29. H Female: d wwhkt eer ~t d . Due to (a as a arreequance d): l , , ~ ; A t_ `~ H-~ (Ad ¢~-`> ~ ~ tit E~ T ' wet eondwora, w arty, b pregrbr Pa P ^ re9na , d i b w ~ ~ E ~ ^ Na pregnarlL but pregnant wi1Nn a2 days Des a (a as a conasyumrlra 1= ~Yr c A l ~ E u N O d deem ~~~ i ~ d e d ~ e I ~ Iay T c e elswg 7n deem) LAS . ~ bversa r Due to (a r a consequence af): , ^ Not PrepanL but pregnera 43 days kt 1 year blare dealt d. I ^ Unknown w pregnant wimp tlla pad year 30a. Was an Aubpsy 30b. Were Autopsy FkxlYge 31. Hamer d Drm 32a. Date d ~Y (Monet, day, Yeerl 32b. Describe How ~+Y Ocaared . 32c. 01~ Bduw rry~. ~SP~M Seed, Faday, Perkxmed7 Avewade Prbr t0 Compldbn d terse a Dim? ,.~/w ^ ~~ L~ ~ ^ Aoddent ^ Pendrp Inveawgetlon 32d. Time d Injtxy 32e. ktJury at Wok? 321. If Trenspaatlon Irytry (Spedty/ 32g. Locatbn d Injury (Street, city / born, state) ^ Yes ~'I~o ^ Yee ^ No ^ Sutdde ^ Coukl Nd be Determined ^ ~ ^ Ddver /Operator ^ Passenger ^Pedestrian ^ Yea M Omer - Sb•dfY 33s. CertlBer (check only one) 93b. SlgnaNre and de d br • c.rBtying physician (Phyaicien csAwykg cause d deem when amlMr phyafderl hoe prorwlax;ed deem ens oompbted Kam 23) drthoccurredduetotheaur(s)andmennaratabd_-----^-------------------------- totMbeatdmyknowbdge , • Pronounckrg and nAKying phyakWl (Physicierl both prorlolaroing deem and certllykrg to sues d deem) ^ 33c. Liceree Number 33d. Date Signed (Math, day, year) To the beat d my krwwlWgs, deNtl oaurred et the Bale, deb, and plan. arul due to the cause(s) and manner r stabd- - - - - - - - - - - - - - - - - - M /C ~ ~ •` C1 ` ,S ~,.y _ ~-~ 't 4 J ~ q 1 3 ~ ~ O t l oroner • kledkal Exam er On die brie d examination aM / a imrtlgatlon, M my opinion, death oxurred al the tMe, dale, and place, and due w Uw cause(s) and manner r stNecL ^ ~. Ivartle erd Address d Person Wtto C°nlplebd Cause d Deem (Kam 27) Type / Pdm ~fl d L+ t ~ S F C'vN t1'~V Ki4L1 ~ 35. R ~ and ~ I ( I h I 1ra~' ~~ I I 12 -~`DQ ac~c ~e . Dab, Fllea 1M~, day, Year) , / _ ` w l ~ q2i S P-zl~~ i~ ~ CA~K..~. ~~ tG ~t~ 11 ~ 13 , , - > - r .. Diepoei8on Permit No. \ 1 X111© t~~~ LAST WILL AND TESTAMENT OF MARY B. MCCLINTOCK ,.~ ..... s ) ~.f ' \ ~ ~ ' ~. ~,,,'_J I , Mary B . McClintock, of West Pennsboro . Township, ~ -- ~_ ~~-~~ , -- ~-a ~ ,, -~ -~~ Cumberland County, Pennsylvania, declare this to be my last'~Willr~ _~ _ ~. , .;. .: and Testament and revoke all Wills and Codicils previously made ~'"' ~ ~ by me. ITEM I: I direct that my legally enforceable debts and funeral expenses, together with the expenses of the administration of my estate, including any state, federal or other death taxes payable because of my death, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II: I bequeath all of my clothing, personal effects, furniture, furnishings, household goods, and other tangible personal property of like nature (excluding cash on hand, any motor vehicles I may own at my death and tangible evidences of intangible property), together with any policies of insurance applicable thereto, including any prepaid premiums, unto my son, Douglas A. McClintock, provided he shall survive me by thirty (30) days. ITEM III: I devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate in equal shares unto my four (4) children, Donald L. McClintock, Duane E. McClintock, Douglas A. McClintock and Diane K. Herman, provided, however, that the share of any of my said children who shall predecease me or die on or before the thirtieth day following my death shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death and in default of such then living issue, such share shall be added to the shares for my then living children and the issue, per stirpes, of my then deceased children. ITEM IV: I appoint my daughter, Diane K. Herman, Executrix of this my last Will and Testament. Should my said daughter fail to qualify or cease to act as Executrix, I appoint my son, Donald L. McClintock, Executor of this my last Will and Testament. ITEM V: I direct that my personal representative, as well as her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~~ day of August, 2000. [SEAL ] Mar cClintock The preceding instrument, consisting of two (2) typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Mary B. McClintock, the Testatrix therein named, 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. ~ ~~~~ .,.. ~ f ' . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Mary B. McClintock, Dale F. Shughart, Jr. and John J. Baranski, Jr., the Testatrix and the witnesses, respectively, whose names are signed to the 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, and that she executed it 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 witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of. age or older, of sound mind and under no constraint or undue influence. Testatrix r~ ~ D 1> ~ ~' ~Wi s~ ' W' ne s Subscribed, sworn to and acknowledged before me by Mary B. McClintock, the Testatrix, and subscribed and sworn to before me by Dale F. Shughart, Jr., and John J. Baranski, Jr., witnesses, this ~ day of August, 2000. ~~ Notary Pu is NOTi1111AL slJIL sOp0O0~'R~-~wuC _ ~~ ~1QS OCTOSEw t~7~~