HomeMy WebLinkAbout04-05-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of NINA L. SHEAFFER
also known as
Deceased
_ COUNTY, PENNSY.~,VANIAo __ ,
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File Number ~ ~ ~~~ -~ ~~ ~ ~ Y ~ :~E7
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Social Security Number 171-2&p~~h'
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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 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(sl offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(!f applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter 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 Relationship Residence ~
(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
35 EASTGATE DRIVE, APT 306, CARLISLE, SOUTH MIDDLETON TOWNSHIP. CUMBERLAND COUNTY, PENNSYLVANIA 1 7 ~ 1 5
(List street address, town/city, township, county, state, zip code)
Decedent, then 74 years of age, died on FEBRUARY 5, 2010 at CARLISLE REGIONAL MEDICAL CENTER,
CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows
Personal property in Pennsylvania
Personal property in County
$ 500.00
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:
or printed name and residence
ROGER B. IRWIN, 60 WEST POMFRET STREET, CARLISLE, PA 17013
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named in the
Form RW-02 rev. 10.13.06 Page 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
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~'or egister
Signature of
Signature of Personal Representative
Signature of Personal Representative
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File Number: ~ ~ -' l1 ~ V~J J
Estate of NINA L. SHEAFFER ,Deceased
Social /S,ecuri/(ty'~~j,Number: 171-28-0449 Date of Death: 02/05/2010
AND NOW, ~~{~ l,U~~~.L~ ,~ ~~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to ROGER B. IRWIN
in the above estate
and that the instrument(s) dated ~ " J " ~ 9
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
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Letters ............... $ 20.00 Register of Wilh ~. ~?~
h (_~ ~ x"11 bt .~:~i..1.:~ J
$ 4.00
Short Certificate(s) Att
Si
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........ orney
gnature:
Renunciation(s) .......... $
JCP $ 23.50 ROGER . I IN, ES
Attorney Name: QUIRE
AUTOMATION FEE $ 5.00 Supreme Court I.D. No.: 6282
WILL $ 15.00
... $
Address: 60 WEST POMFRET STREET
• • . $ CARLISLE, PA 17013
... $
... $
' ' ' $ Telephone: (717) 249-2353
... $
TOTAL .............. $ 67.50
Form Rw-oz rev. ro.13.06 Page 2 of 2
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LAST WILL AND TESTAMENT ' ~ ~ .~ ~~~
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I, NINA L. SHEAFFER, of Mechanicsburg, Cumberland County, Pennsylvania,
declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my executor to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executor to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate as
follows:
(a) My jewelry to Patricia Neiles.
(b) $500.00 to The Humane Society of Harrisburg Area, Inc., Eppley Road,
Mechanicsburg, Pennsylvania, and
(c) All the rest, residue and remainder to Betty Christakos, of Mechanicsburg,
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P_ __1b~54113
('i'rtli~i'-.IIIUi] ~t1171~er ---
This is to cer;if~~ that the infortl~ation here given
correctl~~ capird from an ori_inal Certificate of Dea
duly filed ~~/ith .7l c' as local Registrar. The origin
certificate Neill he forwarded to the State Vit
Kecords Office t</r permanent f?ling.
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Local Registrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
o.m,, ast e,ilM1x) 2. Sez 3. Sodal Seconry Nanher 4. Date of DeathlMOnts, my, year)
Nina L. Sheaffer F 171 28 _ 0449 2/5/1010
5. Age (Last Bidlmyl Under 1 Under 1 8. Date of Binh Monts, m , 7. Bi end state or farel coo M. Pkm d beam Check one
klonma Days liaus Afiaaes Hospital: Other
74 yB_ 5/11/1935 Carlisle, PA ~,npelieM ^ER/Outpetienl ^DDA ^Nursing HOna ^Reeirlenm ^gher. SpeM/:
Bo. Caunry d Deem &. CRy, Born, Twp. of Death /b. Faallry Name pf not instiNtim, giv street aM number) g. Was Decedent of Hispenk Odgin7 ®No ^Ves - L8. Rem: Amerk bldian, Black, While, eb.
- Cumberland South Middleton .Carlisle Regional Medical Center (Mexpn~PuerynR ~,mc.l White
• 11. DeadaMS Usual Oav tron Kits d wale tlone a most d woe Be. Do not stele retl 12. Was Decedent ever m the 73. Dammnt's Etlumllan (Spedly only highest green canpleted) 14. Mwtial Setae: Mardeq Never Marred, 78. Survivklg Spouse QI wtta, give maiden name)
KirM d Wale Kintld Buskass/Indatry U.S. Amletl Farces? Elements I Secmdery (012) College (1d w 5t) Widowed, Divorced (Spedyy)
Boo r Ha isbur Health Ca ^ res K] No 1 ~ Divorced -
- 1s. Deceeenrs MaFirg Address (street dry /farm, stare, sip ~) Decetlanra pA Dld Decemnt
35 Eastgate Drive, Apt. 306 nP. ®ves, DePedent aced m South Middleton
ActuM Resimnce 17a. state Tnwmshlp?
Twp.
_ Decedenf
Lived within
+>b. Coady C<miberland 17d.^NO
Carlisle PA 17015 o
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Ciy/Boro
1B. Famers Name (Firer middle, lest, sutra) 19. Momer's Name (FM, middle, meidm wmarel
C1 de - Sheaffer Cleo R. Berry
20a. Informant's Name (Type I Print) 20b. Idomant's Marling Atltlress (Sheet, dry / Mvn, state, zlp coda)
er B. Irwin 60 W. Panfret St., Carlisle, PA 17013
_ 21 e. McMotl of D'eposilan ®Cremeaon ^ CmeOOn 21b. Dale d Dlspmitlm (Mmm, my, year) 21c. Pkca al Dispositlm (Name d cemetery, aemalory a omar place) 21tl. Lwatbn (Clry/fawn, slate, z'q cotle)
^ Bwal ^ Renbval tree Slate i Was CmraNOn a Donatlon Autlrodad
^ anar. IbYMeMpelEZamkar/CaonerT Ares^Np
-
2/9/2010
Evans Cremation Services
Leola, PA
22a Sgneture d F L'caaee (a as 22h. License Number 22c. Name end Atltlress of Faclllry
- - FD 012633 L Ewing Brothers Funeral Hcane, Inc., Carlisle, PA 17013
Complem Rena 23ec mty when mniryulg 23a. To the hest d my krwwledge, th axunetl at the uma, rote and place sratetl. ISgnaNre and amJ 23b. License Number 23c. Dale Sigred (Madh, day, year)
physiden N nd avaMhle at tlme of roam to
celery caws d male. ~'
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- Rena 2428 mint M canplated by perm 21. Time of Dmm 2h. Date Prawurlmd Dead (Masco, my, year) 26. Was Case Relanetl to 'cal Ezamirer /Coroner for a Reason Omer Nan Cremetron a Daatim?
who prawunces deem. ~ ..I. y+ M. Z I S~~ i ^ vas
CAUSE OF DFATH (See Inatructbna arts exampbs) I Appoldmate interval: Pan II: Enter timer e!^dfimnt andiL . cmtrtlxainn t_g depth 28. DM Tobacco Use ContriWte w Death?
Item 27. Pen I: Error the chdn of events -diseases, njurks, a almplimaaa -mat dlrxmy calmed the deem. DO NOT enter IamFnal events sots as mrl5ac arrest, Onwt to Death but nd resWtkg ro tta unmmymg cause gNen m Part I. ^ Yes ^ PloMdy
reaprerory aaesl, or ventricular fibilletim wittna sMwirg me etiology. fist mty one cause m each Ilse.
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^ No ^ Ur~krgwn
IMMEINATE CAUSE 1F I tlisease a `
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cantlilbn resulting m meet)
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29. tt Femek:
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Duero (w as a crosaquerce on: ,
beW list cmdEda, it aM. b. ~f ~'. 2. c~ l_o~rr-~ I ~~'7, f i
ro tla use Rstetl m Fee a Nd pregnant wilNn past year
^ Preglenl at titre d roam
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Enter UNDERLYING CADSE Due b for es a crosequerxe ~:
^ Nd pregnenl, but pregneM wimin 42 mys
ldseese a injury met NRiatetl the i
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evems resulting in deem) LAST. I of math
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Due ro for m a cansegualm oF/: t Nd pregrent bd Pregmnt d3 aYS to 1 year
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^ Unkrewn II pregmnl wimin me past year
30e. Was an Adapsy 30h. Were Autopsy Fn6ngs 31. Manner m 32a. Date of Injury (MOnm, my, year) 32b. DBSCnM Now Injury Oaurred 32c. Place of Inlury: tMme, Farm, Street Fadory,
Pedomatl? Available PMr b CanPlemn t
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itlm ~ OtRm BWldrg, att. (SpecityJ
d Cause d Deem? ure
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^ Yes LrNO ^Ves ^ No ^ ~~nt ^ ~~g 1~~~ mod. Tkre of Injury 32e. Injury at Woa7 321. It Traneponalbn Ilqury (Spealy) 32g. Lacatlon d Injury (Street, city /lows, slate)
^ Suidm ^ Caultl Nd M DeUnnkwd M ^Ves ^ No ^ Dlarer/Operetor ^ Passenger ^ Petlestdan
Omer ~ Specity:
3m. Certifier (aleck
~ cost
aw. signaure ens rm d caper
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cease d roam wean amnar
~tMn9 Physk4rl (Physiaen wrlAying pflyaidan has promalmtl deem end completed Rem 23)
To tea Maidmylalawl.age,drelomurrsd due to sM e•aa•(al and manner aseMM_________________________________ ^ /
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• Pronourleing artl pmlylrg phyalelen (Physil.~n bom praalmoing roam aM wntiybg b muse d roam) 33c. License Number 33d. Mre Skvad (Mmm, mY. yeert
TotMMetmmYwnowl.ag..eaaloaumdatthanme.eau. andWam.sndaemtheenaets)andmanllera,aurae-----------------.
• ANdlalEnminsr/Coroner tnD'~ ~.)(G' .? .f/.~~i0
Dn the Mafia d aaminetlan and / or mvaaBgmbrl, in mY oldnlan, deem oaurted m the time, dale, and place, antl due to the nux(e) arts manner u staled. ^ 34. Name antl Address d Parsm Who
Completed Cause of Omm (Item 27) Type
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Pant
35. Ragiahe/s re aM Dis ' re Ftled (MOmh, mY, Yearl d
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Ouposmon Perms No.